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Home My WebLink AboutNORTH WOODS BLK 4 LT 20No th Wood Block 4 Lot 2:0 #05! -74! -03 Municipality of AnchoragePage / of ~ 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: '5'JX/q~°O~ ~ ~ PIDNumber: 0,¢'/-~"/ Name: 7~/.~- ~'//0/~ ~ Ce. Wastewater System: E~,New [] Upgrade Address: jO. ~. ~0)(' ~A ~ ~ ~/~c~ ~ ~ ~ ~- ? ? ABSORPTION FIELD Phone: Nc. of BeSoms: ~ DeepTrench ~ Shallow Trench ~Bed ~Mound ~ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: ~. o ~,sq.~. /' D'~ ,~'~) Subdiv~ion: Depth to pipe bosom from original grads: Gravel depth beneath pipe Township: ~ Range: ~ Section:~ Fill added above~,original~ grade: Ft. Gravel length: ~ ~ Ft. WELL: ~ New ~ Upgrade Gravel width: . Number of lines: Distance between lines: /0 Ft. q ~.~ Ft. Classification (Private, A,B,C): ~ Total Depth:/ ~ Total absorption area: Pipe material: Driller: ~ / Date Drilled: Static Water Level: Installer: Date installed: ~ GPM Pump Set at: Ft.II Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~Septic U Holding ~ S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: ..o~ ~.~ .i.,. ~,.t,on ~..~ ~w~r,,n. ~ '~ Z~ Sudace Water /0~ ~ /O0 '~ ' /00'+ LIFT STATION Lot ~ ~ ~ ~ Size in,lions: ~ Manufacturer: "Pump on" level at: "Pump off" level at: High water alarm .ou.~.t~on ~'' /~ /~ ' ~ ~,, ~,, Ou~ain Pump Make & Model ~ Electrical Inspections pedormed by: Drain ~ ~0~ ~ ~ ~0~1 ~. ~~ L,~?~ ~, Remarks: ~E¢~~E .~ ~/L~ BENCH MARK Assumed Elevation: E 17034 Eagle River Loop~ad, No. 204 Inspections pedormed by: ,~~~ ~gie Eiver, Aiaska ~;5,, Dates: 1st //- ~- ~ " 2nd /~- ?-~ '~ ~ ~ ,O",,T C. COW~N '~;~.., CE-880] /~ Department of Healffian~ ~uman ~rvices approval .~.., ......... ~,,, ~~~ ~~ %~, Reviewed and approved by: Date: Z -/¢- ¢¢ 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW980396 PAGE 2 o~ 3 MuniclpaLit o? Amchoracm DEPARTMENT OF HEA~THAND HUIVTAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 eAnchor~lge, Atask~ 99519-6650eTetephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 20, BLOCK 4, NORTH WOODS P.i.o. NO, 051-741-03 / / ---... .,/ / ~ ~ NEW DRAINFIELD / WITH ORENCO /~ / / ~.~..~ ~T~./~ , /TO SAND FILTER .~o~ ~ ~ / / ~'"~.~T. SITE~/ 715 / N ~'~ Z / I __APPROX. / N ~ -~ ,,7 ~w~.s~.v,c.~L,.~ / / 19 PERMrr NO. SW980596 PACE ,5 OF 5 Municip. o, Li-t,,/ oF Anchor'aQe DEPARTMENT OF HEALTH AND HUb'TAN SERVICES ENVIRONMENTAL SERVICES DIVISION . P.D. Box 196650 e..Anchor~ge, A[~sR~ 99519-6650 ·Te[ephone, 343-4744 ON-SITE WASTEWATER L)ISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOT 20, BLOCK 4, NORTH WOODS P.LD. NO. 051--741--05 ~-FINAL GRADE 98.0' ~INSULATION 93.9' ~ 93.6' N.T.S. MT1 =103.3' L ~TTI MT2 MT2=103.8' MT4=108.6, l X ~--FINAL GRADE~MT~/MT3=103'7' ,~ ~ ~.__~ ' z-ORIGINAL GRADE 7 ~,_ INSULA~ ~,~"mu.~ j~~'-__- _-- __ - r~.u~ ~-~o N.T.S. GROUNDWATER AT 95.6' ff~'a.o.u. A B C ~'CO - 12.0' 18.5' ST1 - 11.5' 25.5' .~T2 - 12.0' 26.5' _S - 12.5' 51.0' VlT1 56.5' 59.0' - VlT2 58.0' 74.0' - ~T5 65.5' 74.0' - MT4 44.5' 39.0' - WED 15:28 HEAVENLY LIGHTS ELECT CO $?~ $894 491 Willow Street · Wasilla, Alask~ 99654 Phone# (907) 373-3893 · Fax# 373-3894 P.02 C! D ~x C~£ I'~, /"? ~,t v~-tL'~-w':a'' ( 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 (9O7) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 05, 1998 Expiration Date: Oct 05, 1999 Permit Number: SW980396 Legal Description: NORTH WOODS BLK 4 LT 20 Design Engineer: 0003 S & S Engineering Owner Name: Robert Shafer Owner Address: PO Box 773303 Eagle River, AK 99577- Parcel ID: 051-741-03 Site Address: Lot Size: 23098 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. 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. 5. The following special provisions. This permit is for a bottomless intermittant dosing sand filter system. Received By: Issued By: ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS September 9, 1998 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN 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 SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 20, Block 4, North Woods Subdivision Request you issue a permit to install an innovative (Bottomless Sand Filter)septic system to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and a percolation test was performed for each hole. The approximate location of the test holes are indicated on the attached site plan. At the time of excavation, groundwater was encountered in test hole #3 at 5.5 ft. After seven day groundwater monitoring, the monitoring tube was checked and groundwater was at 3.0 ft. During the excavation of test hole #4, groundwater was encottntered at 5.0 ft. After seven day groundwater monitoring, the monitoring tube was checked and groundwater was at 4.5 ft. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius that can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, Robert C. RCC/srj Enclosure 17034 NORTH EAGLE RIVER Loop · SUITE 204 ° EAGLE RIVER, ALASKA 99577 ._l's-- 60' SITE PLAN DESIGN ~0 ~m /~ ~ I / r~ ~ ~ ' / k / I ~ ~ / ~ o~ ~mo ~ . ~~ - ' ~ '5%'~ ~, I; I ' N.T.S. PROFILE DETAIL S, CALE _~ ~ ~ o ~ ~ ' ~ > z ~ ~ Field cut 4 PVC to Fit ~ ~ ~ ~ ~ (sc. 40) · , , N.T.S. DESIGN DETAIL SCALE N.T.S. PROFILE DETAIL SCALE,,,.%,'~',-. LEGAL DESORIPTION:~O ~ ~/h( ~F~/~wnship, Range, Section: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9- SLOPE SITE PLAN 10- 11 12 13- 14- 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? [oring? - ! ~ "" Dale: Gross Net Depth to Net Reading Date Time Time Water Drop z/3/. - I/ Io; ~ b" IO ?~~' , COMMENTS PERFORMED BY:~034 Ea9le ~iver [~p g~a N~, ~ ~ _ CERTIFY THA~ TH~ TEST WAS PERFORMED IN Eagl~ ~iv~r, Alaska ~,[~ ........ EFFECT ACCORDANCE WITH ALL STATE AND MUNICiPaL ~u ~.INES IN ON THIS DATE. DATE: ~ ~ ~ ~ 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCR,PTION: 8/~' ~ ,/~,~'~hip, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN / / ~_ E P~a Gross Net Depth to Net ding Date Time Time Water Drop ~ ~.'~ ~# i~,' ~,, PERCOE'ATION RATE (-~inutes/inch) PERC HOLE DIAMETER COMMENTS / ~/ S&SENGINEERING , ~ ! ')., ~agle ~lYer~ AlaSKa ~V3// ' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM OESIGN August 4, 1998 (907) 694-2979 FAX (907) 694-1211 BOTTOMLESS INTERMITTENT SAND FILTER SPECIFICATIONS Lot 20, Block 4, North Woods Subdivision GENERAL STATEMENT OF WORK The work covered by these specifications and the plans consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an intermittent sand filter system as described herein and on the attached drawings. All work under this project shall comply with the latest edition and addendum to all applicable codes, ordinances and standards including Municipality of Anchorage-Dept. of Health and Human Services (MOA)-(DHHS) septic installation guidelines and On-Site Waste Water Disposal Systems permits. 4 Bedroom Single-Family Dwelling = 600 GPD Use 2.0 GPD/SF for polished effluent 300 sq. ft. required 360 sq. ft. sand filter and absorption area Sand filter to be constructed on accepting soil SITE INVESTIGATION The Contractor who proposes to complete this project must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of surface and subsurface materials or obstacles to be encountered insofar as this information is reasonably ascertainable from an inspection of the site, including all prior exploratory work, as well as from information presented by the plans and specifications made a part of this project. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility for performing the work as stated in these specifications and drawings. 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 ° EAGLE RIVER, ALASKA 99577 Page 2 Lot 20, Block 4 North Woods Subdivision August 4, 1998 Location of utilities will be the contractor's responsibility. At least forty-eight (48) hours prior to commencing work, the Contractor shall contract all local utility companies to obtain underground utility locates. The Contractor shall exert due care to prevent damage to utilities. Should a utility be damaged, the Contractor shall notify the utility company and shall have repaired at his own expense any damage resulting from failure of the Contractor to request an underground utility locate or to exert due care. If any utility company determines that a utility has to be temporarily raised, lowered, moved, guyed, shored, braced or otherwise protected during construction, it shall be done at the expense of the Contractor to the satisfaction of the utility company. INSPECTIONS Typically, there will be a minimum of four (4) inspections required during the installation of the waste water disposal system. These inspections will occur as follow: Inspection of work in progress may be made by the Engineer and MOA-DHHS at any time. The following schedule of required inspections is to be adhered to. Twenty-four (24) hours notice is required prior to each inspection. Inspections can only be arranged during weekdays and during normal working hours. The following inspection schedule is to be strictly adhered to: Septic tank/lift station is in place, but not backfilled. Sewer piping from building to tank is complete and properly bedded. Sand filter location is excavated and prepared for filter construction. Engineer to be notified with Contractor's schedule during actual construction of the sand filter to allow spot inspection during construction. Any deviation from reported schedule is to be reported to the Engineer. Final inspection of the sand filter with all pressure piping in place, but prior to placement of cover material. Test pressure piping to ensure adequate flow and pressure, (requires completion of lift station wiring and piping prior to this inspection). 4. Inspection of final grading and adequate cover. The Owner shall contract with the Contractor to perform the work outlined in these specifications, plans and in accordance with the attached MOA permit. There will be no contractual arrangement existing between the Contractor and S&S Engineering. S&S Engineering shall be the Owners' representative and will inspect the work as stated above to document the Contractor's activities. Final acceptance of the Contractor's work rests with the Owner and the MOA. 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 Page 3 Lot 20, Block 4 North Woods Subdivision August 4, 1998 responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. All landscaping, fences, sidewalks, paving, driveways, utility markers and other improvements, removed to facilitate the Contractor's operations shall be fully restored to their original condition and location by the Contractor unless otherwise directed by the Engineer. Items damaged by the Contractor during removal, storage, or restoration, shall be repaired or replaced in kind by the Contractor. This work shall be considered incidental to the project. MINIMUM MATERIAL SPECIFICATIONS 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T_vpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes ASTM D2241 Yes Yes ASTM D2239-74 Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting Engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with water tight couplings (Caulder, Femco, or equal). SEPTIC TANK/LIFT STATION General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station and piping to the sand filter. Page 4 Lot 20, Block 4 North Woods Subdivision August 4, 1998 B. Materials 1. Tank for Lift Systems a. Septic tank shall be a 1300 gallon two compartment tank for use with Orenco Systems, Inc. patented lift station assembly or approved equal. The tanks shall be designed for adequate burial depth as required by MOA and State regulations. The design or analysis shall be in accordance with accepted engineering practice and local regulatory agencies. c. In areas with high ground water, the tank shall be adequately weighted or anchored to prevent flotation if the tank is pumped. 2. Risers a. First compartment shall have a separate 4" pump out riser. The second compartment shall have a separate 4" pump out riser. An additional second compartment manhole riser shall extend above surface grade, shall have a minimum nominal diameter of 24", and shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the riser. 2. UL listed electrical cord grips, installed in the J-box. c. A lid - shall be furnished with the riser. It shall be constructed to meet H-10 loading requirements and have a latching mechanism. d. Riser installation - each riser shall be sealed or welded to the top of the tank in such a manner as to prevent infiltration of ground water. e. Lid insulation - 4" rigid extruded polystyrene shall be placed inside and attached to the lid. f. Riser insulation - 2" sprayed shop applied urethane on circumference of riser with 46465 Tnemec coating. Page 5 Lot 20, Block 4 North Woods Subdivision August 4, 1998 3. Effluent Pumping Assembly a. Effluent pumping assembly shall be Orenco systems (TM) Model 20- OSI-05-HHF series, or approved equal consisting of the following: 1. 1/2 H.P. 110/120 volt or equal U.L. Listed effluent pump. Screened pump vault (U.S. patent No. 4439323) 59" deep, 3/16" thick high-density PVC cylinder houses the pump, level controls and screen and serves as a baffle to prevent the screen from clogging. o Fifteen 1 1/2" diameter holes are drilled in the vault at a level that places them at about the midway point of the depth in the septic tank. Flap check: Allows the vault to drain when removing the tank. Screen: 15" diameter cylinder of high-density polyethylene 1/8" mesh. 5. All piping shall be PVC or other non-corroding material. b. Pump controls and alarm system shall be Orenco systems SICTETMRO 110 volt with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30°C to 65°C, continuous sound to be located inside the home. 6. Oil-tight visual alarm with push-to-silence feature. Automatic audio-alarm reset. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). Page 6 Lot 20, Block 4 North Woods Subdivision August 4, 1998 8. Nema 4x-rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight of septic tank/lift station. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded and sloped to drain back to the septic tank. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. CONSTRUCTION SEQUENCE In order to ensure proper installation, the system is to be installed in the following order: 1. Sewer line from house to tank 2. Septic tank/lift station 3. Sand filter 4. Final grading CONSTRUCTION 1. Pipe Grade and Alignment Variance of individual pipe sections from established line and grade shall not be greater than 0.05 feet, providing that such variance does not result in a level or reverse sloping invert. During the progress of the work, the Contractor shall provide instruments such as transits, or levels, for transferring grades from offset hubs or other construction guides from the control points and bench marks provided to the Contractor by the Engineer. The Contractor shall provide qualified personnel to use such instruments and who shall have the duty and responsibility for placing and maintaining such construction guides. 2. Pipe Laying All pipe shall be laid with Class C bedding, free of large stones and organic matter. Page 7 Lot' 20, Block 4 North Woods Subdivision August 4, 1998 Each section of pipe shall be handled carefully and placed accurately, the spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Each section of pipe shall be properly supported to ensure tree alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be securely and satisfactorily closed so that no undesirable substance will enter the end of the pipe or fittings. Bedding of Pipe for Sewer Lines The pipe should be bedded with Class C bedding materials, compacted to 95%. Native materials may be used as back fill material above the pipe, provided it is free of large stones and organic matter to a point one (1) foot above the top of the pipe. All pumping services shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be to code by a licensed electrical contractor, with Municipality inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. Tank Installation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.1 foot, end to end, on undisturbed or compacted to 95% classified sand fill material. Line excavated tank pit walls with 2" +35 PSI burial foam full depth of tank. Back fill between tank and foam and compact in a manner to prevent damage to tank surface coating. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank location to a depth of 2' above finished grade to allow positive drainage away from tank and counteract buoyancy. Connections All connections to be as per MOA-DHHS and UPS requirements PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. Page 8 Lof 20, Block 4 North Woods Subdivision August 4, 1998 SAND FILTER The work under this section consists of materials and construction/installation of the sand filter. A. Materials The Contractor shall provide a washed sand to meet ASTM CM33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. A sample may be taken from the sand bed during construction for purposes of quality control. If the sample does not meet specifications, all sand will be removed and replaced. The Contractor shall provide pea gravel that shall be a washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. 3. The Contractor shall provide round rock that shall be washed gravel with rounded edges, well graded with maximum diameter of 1/2". ° The Contractor shall provide the manifold assembly. The manifold assembly shall be the Orenco Model SFM 1036 or equivalent with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior to assembly. Flushing valve to include riser to +12" above finish grade with extension handle provided to operate globe valve from the ground surface. 5. Side walls and top of the filter box to be insulated with 2" direct burial polystyrene insulation and be inside the plywood box. 6. The Contractor shall provide the filter fabric. o The linear air diffuser line and compressor are available from Orenco, no model number available. The feed line from the house to the filter is HDPE arctic insulated pipe 3/4"-2" SDR-11 Maskell-Robbins or equivalent. The compressor will have a gauge (0-10 psi) and be installed in a heated area, crawl space, or garage. B. Construction of Sand Filter The sand filter construction is to follow procedures as outlined in the Orenco Installation Manual as applicable to this design. Rock, pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or rock layers. This would include any soil material picked up by excavation machinery buckets Page 9 Loi 20, Block 4 North Woods Subdivision August 4, 1998 while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. Work on the sand filter may be suspended at the Engineer's discretion due to inclement weather conditions, such as rainfall. The sand filter and material stockpiles will be completely covered by a tarp over night during construction until finished. Filter internal construction should be accomplished in one (1) day's time. The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water run off. Side slopes shall not exceed 3:1. Six inches of top soil and seed are required over the entire sand filter when the side slopes approach 3:1, or at the discretion of the M.O.A. The Engineer will reject any sand, round rock or pea gravel that does not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR/INSTALLER 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. 051-741-03-000 Expiration Date: Legal description NORTH WOODS BLK 4 LT 20 Site address 22747 MC MANUS DR Chugiak AK 99567 Current property owner(s) SLATER JASON M & ADRIENNE D 10/15/2025 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 10/18/2024 his Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approvd_June 2022 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-741-03 Complete legal description NORTH WOODS BLOCK 4 LOT 20 Location (site address) 22747 MCMANUS DRIVE, CHUGIAK, AK 99567 Current property owner(s) JASON & ADRIENNE SLATER Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 25 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ® AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment > 2 ° =7' Date of Payment COSA # 0S C - Z y/ Co Waiver # COSA Applicalion.doc COSA Checklist.docx COSA Checklist Legal Description: NORTH WOODS BLOCK 4 LOT 20 Parcel ID: 051-740-03 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - COMMUNITY WELL 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. 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 _____ Comments B. TANK DATA Measured operating fluid level in septic tank NA* Date of pumping 6/19/24 Required maintenance completed, if AWWTS Comments: *FLOATS C. LIFT STATION Required maintenance completed Age of lift station 25 years Lift station material PLASTIC Comments: IDSF & LS WAS MAINT BY L&S SERVICES D. ABSORPTION FIELD DATA Which system tested (date installed) 1/19/1999 ALL standpipes present per record drawing Total measured depth from grade 3.8 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 6/19/24 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 1 in Elapsed time <20 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA 0.5’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 6 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per visual observations, measurements and MOA record documents. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No **5 ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5+ ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATII/III SEPARATION DISTANCE REQUIREMENTS. **PER CODE AT INSTALLATION. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/12/2024 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 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/12/24 iVIMC[PAUN OF A11CRoRAon • Comrauni;zy Aevelopmeot Depar=cnt • On,Sitc Wator & Wastewater PrQgMnl P: 907-3439904 ^ F: 907-343-7997 • P.O. RoX 196650 ADQJ,orage, AK 99519-6650 a http://wvi�rv.muni.4rg/bvild�a� Intermittent Dosing Sand Filter Maintenance Log Owner _ Street Address X1722 Mc, I—Vk(n �% S Phone Legal Dese. PID _._ §eatic `tare -Sludge level „inches -Pumping: required s o -Pumping completed$ /bsorotron dead: ., -Liquid level inches -Flushing valves per approved design4-P-0 -All flushing valves opened, distribution lines flushed, and flushing valves closed no i.,ift station: ,,Pump basket cleaned es o •Biotube effluent filter cleaned es no / -Timer float setting inches -High level float setting inches -Reference point. D a -Pump on__( _0 seconds Pump off ®M minutes -cumulative lifetime cycles �0 b ��, -Cumulative run time 6 9 ,curs 6 -Operation satisfactory 9 —0 Air System: 1 -Air pump filter cleaned es o -Air pressure •-,�.--psi 1� -Date of latest install or rebuiid -,-Air system operation safiisfacto o satin ticto Y Alert SKatrn -Dedicated electrical circuit es no •Audible and visual alarm inside dwelling no .f;�cto -Float setting inches ,Alarm system operation attafacten not satiM„._M� Comments: ........................................ ........... ....... .......................... ............ I ......... .,........ ....................................... ............................................................................................. .... ..........................................................................................I..................... ................................................................................................................................................ ti Maintenance Provider: Technioian cc W 3 J Date of maintenance__ �I Company Signature ID- Maintenance Log_040313,00 Deas..._ AN IDSF - INTERMITTENT DOSING SAND FILTER NORTH WOODS B4, L20 OWNER: By'` C_ y� l/Gy ' u` (signature) Date: (`yank C' ij(print name) STATE OF A -L— �, Gfi'. iG' C 10167 (YA ) 55. lv/15/-)I The foregoing instrument was acknowledged before me tills /� day of 1%i?/; &C", 204, by S hglzor, Lee (114w16, CcmTc^wea::^ Fr.— • � s.._.� �'�6TARY PUBLIC FOR A -L— �� P� ShARON s! °alar - Nota: f sea. ARK - No[ary Pubic My Commission expires: 1/- �D-1(p-ycoming County My:o•r^fission ExpiresAprif 20, 2026 Ccm,^issien Nu,7ber 1255437 /1 ;signature)Date: IT/ �U / print name) Title: (rev. 05/18/2018) Page 3 of 3 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. osx-7zF~-o3 GENERAL INFORMATION Complete legal description North Woods, Block 4, Lot 2o Location (site address) 22767McManus Drive COSA # O%C/.L ~/Iq Expiration Date: Current Property owner(s) Brenton Alesander & Teresa O'Connor Mailing address Day phone Lending agency Mailing address Day phone = Real Estate Agent Tim Kelly/Dan Wolf Team Mailing Addres,~, ~ "L~, Unless O~hetwise requostod,',¢~A will bo NUMBER OF BEDRQOMS~ ~:;: .. Day phone 632-62o5 TYPE OF w/~E~ s. UCpL~: Individdal Well ..... .-' Individual Water St0~'ge Community Class ~Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer D D 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box ~.oo217, Anchorage, AK 995zo Engineer's Printed Name Steven R. Pannone, P.E. Date 11/28/201~. Engineers Comments: In conducting an adequacy test,' I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE t,"" Approved for '~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: · ,,:, .'"";:*0:z ON-SITE ; WASTEWATER L~))) i 11:~~' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) / Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal DesCription: North Woods, Block 4, Lot 2o ~ A. WELL DATA Parcel ID: o~.-7,..~.o3 Well type Public Date completed ,. Total depth Date of test Static water level Well production J WATER SAM PL~~TS: A~enic'~~'- ug/I '- ' SEPTIC/HOLDING TANK DATA If A, B, or C provide PWSID # Well Log~~ Sanitary seal (Y/N) W~ly~protected (Y/N) Cased to ft.~ ~'~sing height (above ground) FROM WELL LOG ' J~AT INSPECTION ~ ft. ft. in. g.p.m, g.p.m. Nitrate mg/L Date of sa~nple: COllected by: Tank TYpe/Material .... Premier, Polyethylene Tank size- z=loo ga!.. Number of Compartments Date installed a21,-lagq8 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Date of pumping' Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper ~,~t-'~f~'~~,-~ ~~ C. ABSORPTION FIELD DATA Date installed ~.~,1~h.~98 Soil rating (g.p.d./~ or ~/bdrm) 2.0 g_~d/sf Length .36 ft. Width =o ft. Total depth 2.; - _~.F ft.. Eft. absorption area 960 ~ Monitoring tube Y System type Bed I Mound Gravel below pipe 0.5 Depression over field N Date of adequacy test aal:tni',o~.., ResultS (Pass/Fail) PASS For .~ bedrooms Fluid depth in absorption field before test _o in. Elapsed Time: ~.8o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added6~.2 gal. New depth3 in. Absorption rate >= 600+ g.p.d. If yes, give date D. LIFT STATION Date installed "Pumpon" level at Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons "Pump oH' level at 3~ in. Cycles tested 3 Manhole/Access (Y/N) Y High water alarm level at z~4 Meets alarm & circuit requirements? Y in. SEPARATION DISTANCES FROM WELL ON LOT TO: on lot Absorption field o~ Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Manure/animal excrete~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line ~.o+ Absorption field. Water main ~.o+ Water service line Surface water ~.oo+ Wells on adjacent lots ~.oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: F= Gw Property line ~o+ Water Service line ~.o+ Curtain drain ,;o+ COMMENTS l, ENGINEER'S CERTIFICATION Building foundation ~.o+ Surface water Wells on adjacent lots ~.oo+ I certify that I have determined through fi~ld inspections and · review of Municipal records that the abo~e systems are in conformance with MOA C0S~4 guidelines in ~ffect on this date. Steven R. Pannomej P.E. Engineer's Printed Name Date COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Water main ~.o+ Driveway, parking/vehicle storage ~o+ OF 4/ Waiver Fee $ Oate of Payment Receipt Number ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETW~EEN MUNICIPALITY OF ANCHORAGE THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this 30 Day of Mo,~,~nlo,~r of 20..i\ , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Trealment System (AWWTS), described as I- ~). ~. ~. at ZZTq7 Definitions. located , Anchorage, Alaska. A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any pans, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On-Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systeras given at the time of property sale and title transfer in accordance with AMC 15.65. 3. Fee. Owner shall pay to Municipality an annual fee of ($ t~ .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. These approvals certify that the systems are adequate for the homes that they support and meet the c. odes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Coastraetior,) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 Thc term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On-Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and...R, emoval of Additional Eauit~ment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Conslruction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, roles and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the t~mns and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWAVTS Operating Permit is: ~:~]- ~4}/l/t}rt}~ £ y C. Owner acknowledges that the fmc schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by lhe Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of ti(lc of the property will not occur without a new Certificate of On-Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any' way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: A&~;~,,,_ ~o. ~l~_~r Anchorage: Purch.asing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall bc brought in thc Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of thc parties under this Memorandum of Undemanding. I0. Severabilitv. Any provisions of this Memorandum of Undemanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: Title: Date: ll-~O - ~[. Date: STATE OF ALASKA ) THIRD JUDICIAL DISTRICT ) MUNICIPALITY: The fomgoinginstmment was acknowledged before me this 30 day of l~/t2~ , ~ My Commission expires: BONNIE COAST L Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-741-03 GENERAL INFORMATION Corn plete legal description r,o t Location (site address or directions) Current Property owner('~) Mailing add~:es$1, ~:~ Expiration Date: / 20; Block 4; Nort~oods 22747 McManus Dr, Ron Thomas PO Box 670108 Chugiak, Subdivision Dayphone 688-9213 AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 i~vestigation, based on procedures outlined in the Health Authority 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 fudher 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. NameofFirm S & S Engineering Address 17034 N. Eagle River Loop Ste. Engineer's Printed Name Robert DSD SIGNATURE V'~ Approved for J-~ Disapproved. Conditional approval for bedrooms. Phone 694-2979 204 Eagle ,River, AK 99577 Date ~/$¥4~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 01102) X Maintenance Agreements : , Supplemental Engineer's Report Other Original Certificate Date: ~ - ,,~-..~ ~ ~:) /-~ Deyelopment S ~.~.!~e~s..~D~e p a r t men'"'~' ~'f- ;~ ~iroand) !n. · g.p.m. ..... g.p.m Date of sample; Collected by: Clea ft. ft. :~I~O ft~ Mo,n. it~r, ipg tube __ Depression gver,..fi~!,d F?? ~ bedrooms- . Water added ~(~ gal New depth 6' n in. Absorption rate >= Size in gallons ~ I '~O Manhole/Access (~N) "Pump off" level at ~ in. High water alarm ~evela[ Z/z~'" in Cycles tested ,~. Meets alarm & circuit requirements? ',/~;_'~ c sewer main line On adjacent lots acent lots Public sewer manhole/cleanout Holding tank __ aln .i0 ~- adjacent lots _ Water service line /0 Absorption field Surface water Building foundation Ilo Water main [~ ~4- Surface water /~'+ ~ Driveway, parking/vehicle storage Wells on adjacent lots 200 ~ ;'i'.:: ~;' :i,: through field inSPections'and that the above systems are in with MOA HAA guidelines in effect on this date. CE -8801 Waiver Fee $. Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 051-741-03 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 20, Block 4, Northwoods S/D Location (site address or directions) NHN McManus Drive Pro perty owner Mailing address Lending agency Mailing address Ron & Shelly Thomas Day phoneTarget 694-2388 Day phone Agent Tarqet Realty/Dick Brown Addressp~ Rn~ 774627, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: Day phone 694-2388 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE oF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank Community on-site Pub lic sewer NOTE:;;:,~If com~ity 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 INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further 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 Engineer's signature $ & S ENGINEERING Eagle River, Alaska 995?7 Phone Date DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025{R~v:1/91) Back VlOA~21 !'" CEIYED ' Municipality of Anchorage dAN 2_ - DEPARTMENT oF HEALTH & HUMAN SERVICES ., EnVir,o.nmental services DiviSion. 825 L Street, Room 502 Anchorage; Alaska 99501 , (907) 343- Legal Description: A. WELL DATA Well type Log present (Y/N) Total dePth Health Authority ApProval Checklist St, K. ~' /v0£r~ k~o~a$ Parcel I.D.: O ,¢'-1 - 7¥/-o If A, B, or C, attach ADEC letter. ADEC water system number Date completed; CaCed to Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMP~ Coliform ~ D o~[~ample: FROM WELL LOG ~'" g.p;m. Casing h~ Wires.~o~perly protected (Y/N) AT INSPECTION B. SEPTIC/HOLDING TANK DATA Nitrate Other bacteria Collected by: g.p.m. C. ABSORPTION FIELD DATA Date installed 1 ~/ ~ / ~ ~ Soil:rating ~or ff~/bdrm) Length 3 6" Width Effective absorption area 3G 0 Date of adequacy test H ( ~ - ~ Results (Pas Fluid depth in absorption field before tes~ (in.); Immediately after gal. water added (in.): bedrooms .. Fluisdepth (ins) Absorption rate = g.p.d. ~ast 12 months) (Y/N) If yes, give date 72-026 (Re~/. 3/96)* Foundation cleanOut ~)'N). ¥¢~ -'( : Depression (Y/~j) h~ ~ Date of;~Pumping ~/~ '-'~ ¢ ~' Pumper -- Date installed I~1¢'t~'~ Tank size' 13o 0 Number of Compartments ~ Cleanouts {~/N). High water alarm ~N) ~'' ~- "~- LIFT STATION Date installed 13~/ ~( °l ~ Manhole/Access ~/N) ¥ ~ .,,r High water alarm level at* z.f ¢ Size in gallons "Pump on" level at* *Datum "Pump off" level at* '7 ~, Cycles tested SEPARATION DISTANCES SEPARATION I~ISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot On adja~ ~ent lots Public sewer manhole/cleanout Public sewer main Sew~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~" ~ ~rproperty line ,3 5- Absorption field Water main/service line / 0 ~ Surface water/drainage / o ~) ~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ~ Building foundation ) ~ Water main/service line ? ~ '~ Surface water ! O ~) -)- Driveway, parking/vehicle storage area /o Curtain drain ~0,,~ /,~',v~-~ ,,~ Wells on adjacent tots ~ ~0 I certify that I have determined thru field inspections and review of Municipal rec~l~..8/pfffe al) ~s are in conformance w~h ~OA H~ guidelines in effect on this date. Signature En-ineer's Name /~'~/ ~ ' ":'", HAAFee $ ~ ~ ' ~ Date of Payment ~/' /~'~-} ~ ~ Receipt Number /---//-/~4'--,~ (~//7/-~ ~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*