HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 4ANorthwoods #2 Lot 4A Block 1 #051-741-39 2FvISf'Zo Municipality of Anchorage Page 1 of 3 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. SW000023 PID Number. 051-741-39 Nome: PETER &KATE HAEUSSLER Wastewater System: ❑ New ■ Upgrade Address: 23019 NORTHWOODS DR. EAGLE RIVER, AK 99567 ABSORPTION FIELD Phone: (907) 345-2071 No. of Bedrooms: 3 ODesp Trench ❑Shallow Trench ■Bed aMound OONer LEGAL DESCRIPTION Sol not-¢ 0.4 cPana R Total MVA, Bern w4hol Wade: 2.12 - 5.04R Lot: Block: Subdivision: ara yedc Nina m P" boom owngln 0wwl d.pth tw.Mh pip. 0.72 4A 1 NORTHWOODS #2 1.40 — 4.32 R R Township: Range: — Section:0— ro 00.0100.01ee«e orwral Brads: araw WHIM 64 — — 2.2 R R ore,.l .Ian: Nwnk.r of Imes: Distsno. s.r...n so.s: WELL: ❑ New ❑ Upgrade 18 FLI 4 4 R Clw.ircaAarl Prk te. A C :Tool CoW Tw Total yp,a,ptlo,t „n,rr 1152 PIPs natenot ASTM D -3034/F-810 R R so,R oru4r: .` Data orsrd: stella watt Laval, inat r. GREEN CONTRACTING Dots Mmol: 3/9-15/2000 "" ° sa AL I"e " c'ght Alae &-old: TANK WY R R SEPARATION DISTANCES ■Septic 0Holding 0S.T.E.P. To Sana AbFl ktion Holding ubk � Idw.ea< CHORALE TANK � � 1000 From Stuotft. Well 200'+ 200'+ — — 25'+ uw. of STEEL "wne. 2 Surface 100'+ 100'+ - - - LIFT STATION Water Lot— 5'+ 10'+ — — Size H Val Ywwfoat.r. P Una M W'* at "IGn eaW alarm el: Foundation 5'+ 10'+ — — — Curtain PwnP dar. owbW ew� Www W. Drain NONE KNOW BENCH MARK Remarks: SEPTIC TANK WAS INSULATED. Looauan end Dea 1pMn: BOTTOM OF T1-11 SIDING ® POINT A A«anw a..a"a 100.00 R 110000.2" ecAL 00 od �4p� cP �.• AWWC, INC. Dates: 3/9/2000 Inspections performed by0 o°O* 'y?.. 2nd 3/10/2000 3rd 3/15/2000 QO If e A. am ss;' 79 epartment of th and Human Services approval Revewed and approved by-it/ Date: �z0fl dprofessio�°ao 4 040000 —013 Ca.. 9/91) 4M 25 PERMrr NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW000023 051-741-39 PNH. pUDE - 99311 NS1 AfM 5il 5f2 fOP Oi fMK TOP OP f" Af N Ef - 9687— Af OU1LEf - 9688 I I NSW 1000 6UON I I AfWf-orm 9Nwcf6n S�t'11CTANK Afo�im.eff> 69 -9920 (AVG.) ,r• 3 en+ --r ++ran s!� 1' • � ` , '.. DRAT ALASKA NATER & AVASTKNVATKR CONSULTANTS, INC. 6901 DF9ARR ROAD. W" T9 • ANCHORAGE. " GV304 • PHONE 007)337.6179 • F" 07)33&3246 REPARED FOR: PHONE NUMBER: PACS PETER do KATE HAEUSSLER (907) 688-6585 EGL DESCRIP710N: NORTHWOODS SUBDIVISION #2; LOT 4A, BLOCK 1 YPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE '17/200 I BY: J.L.M. N.T.S. NUMBER: 3OF3 —7953 •`pO jp�a vIsr�q VERMtT NUMBER: AS DRAWING PARCEL NUMBER: 051-741-39 SW000023 EXISTING BED TO BE USED AS A RESERVE S'. NEW 1000 GALLON SEPTIC TANK— 0�" NEW DRAINFIELD TN/i INSTALLED FLOW DMDER (FD) -DBL2 -DBL1 A B \ 17.8 22, [STFf 19.3 18, M. ALASKA. R'ATIJR & WASTEWATER� ' ' — — CONSULTANTS.INC 1" = 30' 6901 DEBARK ROAD. SURE 2B •ANCHORAGE. AK 99504 • PHONE 901 ]1!179 • FAx 907U36a7t6 PAGE NUMBER: REPARED FOR: PHONE NUMBER: PETER do KATE HAEUSSLER (907) 688-6585 2 OF 3 EGAL DESCRIPRON: NORTHWOODS SUBDIVISION $2: LOT 4A, BLOCK 1 YPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade �XC ( A�1-4� 3—,o -co 2:3oP, Date Issued: Mar 02, 2000 Expiration Date: Mar 02, 2001 Permit Number: SW000023 Parcel ID: 051-741-39 Legal Description: NORTH WOODS PHASE II BLK 1 LT 4A Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 023019 NORTHWOODS DR Owner Name: Peter & Kate Haeussler Lot Size: 60430 SQ. FT. Owner Address: 23019 Northwoods Dr. Total Bedrooms: 3 Permit Bedrooms: 3 Chugiak , AK 99567-5463 This permit is for the construction of: Disposal Field ZSeptic Tank 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 ( 1BAAC80 ). 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. Received By: Issued By: Date: 3'%` 0(�) Date: 3-2 —00 ALASKA WATER & WASTEWATER CONSULTANTS. INC. .� February 16, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Design of Septic System Upgrade for Lot 4A, Block 1, Northwoods Subdivision #2 To whom it may concern: The existing 3 bedroom house is served by a community water system and a private septic system. The existing septic system consists of a 1000 gallon septic tank and bed type drainfield. The existing drainfield is in a state of failure and need to be upgraded prior to the sale of the house. A test hole was excavated east of the existing septic system. We arc proposing that a 1000 gallon septic tank and a bed type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layer is a GM/ML material to a depth of 3 to 4 feet and then transitions to a SM/ML material to a depth of 14 feet (bottom of test hole). No groundwater was encountered during the excavation of the test holes; but after 8 days, the monitoring tube was checked and groundwater was found to be at 11.25 feet. A percolation test was performed between the depth of 5.0 feet to 6.0 feet which had a percolation rate of 17.1 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 17.1 minutes/inch b. Allowable Application Rate: 0.4 gallons/day/R2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 1125R2 f. Total Depth: 5 feet (max.) g. Effective Depth: 0.5 feet h. Width: 18 feet i. Reduction Factor: N/A j. Minimum Length: 63 feet long ft2 k. Effective absorption area= 1134 6901 Debars Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 3. SURFACE RATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached design, the average topography in the area of the proposed upgrade is a 3 to 5 percent running from approximately southeast to northwest; in short, there are no slope concerns. The bed is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, _ soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 NOTE: ALL PROPERTIES SHOWN ARE SERVED BY A COMMUNITY WATER SYSTEM AND PRIVATE SEPTIC SYSTEMS. LOT 3A BLOCK 1 NORTHWOODS S/D J2 LOT 2 BLOCK 7 NORTHWOODS S/D 12 LOT 1 BLOCK 1 NORTHWOODS S/D 02 EXISTING BEDROOM LOT 7 BLOCK 1 NORTHWOODS S/D #2 LOT 8 BLOCK 1 \ _ / NORTHWOODS S/D 12 / / THII PRO ED SEPTIC UPGRADE (SEE DESIGN. PAGE 2 OF 2) r i LOT 5 BLOCK 1 ' L5 I V NORTHWOODS S/D /2 � I 2EE I wi USE lail - / s /�—LF---- i LOT 2 BLOCK NO/D 12LOT I y 8 BLOCK a / NORTHWDODS S/D 02 / ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE 28. ANCHORAGE. AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 NORTHWOODS SUBDIVISION 12; LOT 4A, BLOCK 1 (TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE y(� PETER AND KATE HAEUSSLER 2/16/2000 1 J.L.M 688-6585 1 = 100' 1 1 OF 2 J f e A. ess: I" E-7953 �•4po- PROPOSED DRAINFIELD UPGRADE. EXCAVATE A BED THAT IS 5 FEET DEEP MAXIMUM BY 18 FEET WIDE BY 83 FEET LONG. ADD 0.5 FEET OF CLEAN. WASHED DRAINROCK. O WALL PARALELL TO SLOPE. ISTING 36� 32- BED TLOCATION IS USED AS A%R(SERVE SITL-% T /1 TANK TO LL FLOW DIVERTER LL DBL CO SED 1000 GALLON SEPTIC TANK FOUNDATION CLEANOUT / NORj�0p0 ORNE ALASKA WATER AND WASTEWATER CONSULTANTS, INC. oo�oo 8901 DEBARR ROAD. SURE 28. ANCHORAGE. AK. 99504O... e PHONE: (907) 337-8179/FAX: (907) 338-3248 0��� A LL DESCRIPTION: t '.'y NORTHWOODS SUBDIVISION: LOT 4A. BLOCK 1 OF WORK: O DESIGN OF SEPTIC SYSTEM UPGRADE Op ••• •': ' e re ss; PARED FOR: PHONE NUMBER: Q o 7953 :i SHARON MINSCH (907) 688-6585 d��, ''• E: DRAWN BY: SCALE:PAGE: 44pedPro feas\oe°o�P 2/16/2000 J.L.M. 1 = 40, 2 OF 2 OppO000�a ALASKA WATER & WASTEWATER CONSULTANTS, INC. 69 PHONEE(0 )33758 9 . FAX (90 )ANCHO' 338 2469504 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: NORTHWOODS SUBDIVISION #2: LOT 4A. BLOCK 1 PERFORMED FOR: PETER AND KATE HAEUSSLER DATE PERFORMED: 2/3/2000 DEPT�HI TEST HOLE #1 (feet ORGANICS 1 7 DATE DRY e SOIL CLASSIFICATIONS SOME 11.25' 2/11/2000 W/ PRESOAKED 4+ HOURS PRIOR TO TESTING GRAVEL 9 •- 10 — 6' 11 lidGPI�IIIilllML 2 12- 30 4-1/4' 13— (VERY HARD 3:15 — AT BOTTOM) 14 rte%GMCIL N/NN • 3:45 ' 4-1/4' 15- 5161718 I!SWIIIIIiIIIMH 5 16- — 6- 17— ' %//%CH 6 ' 8 30 4-1/4' 19 • 20 r3l141lI. Sc114111111 7 DATE DRY e 11.25' SOME 11.25' 2/11/2000 W/ PRESOAKED 4+ HOURS PRIOR TO TESTING GRAVEL 9 W/D DEPTH) 10 — 6' 11 2 12- 30 4-1/4' 13— (VERY HARD 3:15 — AT BOTTOM) 14 4 3:45 B.O.N. 4-1/4' 15- 5161718 5 16- — 6- 17— 6 ' 8 30 4-1/4' 19 20 COMMENTS: DEPTH TO GROUNDWATER DATE DRY 2/3/2000 11.25' 2/8/2000 11.25' 2/11/2000 — PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING SITE PMN I' - 100' EXISTING THREE • BEDROOM HOUSE .TH/1 DATE READING CLOCK TIME PERC. HOLE DIA. 6 (INCHES) I NET TIME (MINUTES) I WATER LEVEL READING NET DROP (INCHES) 2/8/2000 — PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 2:45 — 6' — 2 3:15 30 4-1/4' 1-3/4' 3 3:15 — 6- 4 3:45 30 4-1/4' 1-3/4- 5 3:45 — 6- 6 4:15 30 4-1/4' 1 -3/4 - PERCOLATION RATE 17.1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RLN BETWEEN 5.0 FT. AND 6.0 FT. PERFORMED BY ALASKA WATER & WASTEWATER. 1. JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PERFQRMD IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE - 22 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/ PHONEI kNEW ❑ UPGRADE MAILING ADDR S LEGA DE`SSCCR,IPTION Jr dr_ P LOCATION NO. O),�tEDROOMS V DISTANCE TO: Well Absorption read �� Dwelling / PERMIa6� 3 ( /JpK Y i zQ Lu Manufacturer /�1 v Ma n No, of cd partments Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth G Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. 2 F Manufacturer Material Liquid capacity in gallons Lu = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO, J Lu Z H Z W No. of lines Length of each line Total length of lines Trench width inches Distance between lines FTop p of tile to finish grade Material beneath tile inches Total effective absorption area Lu t7Length I/ Width Depth ` PERMIT NO. /Q a Lu Type of crib Crib diameter_ Crib depth eae Total effective absorption arLu DISTANCE TO: Well �� 1-2 Building f undatiop ! Nearest lot line/n 1..� J Class Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIP ATERIALS SOIL TEST RATI G INSTACL�B., cS REMARKS L L LL RIF APPROVED DATE LEGAL Q 72-013(80.4/78) V `J -r V 0 F= F4 W�FZ 1=4 0 FE rwl L-1 r -j 1 1::: 1 ma I I t-EPARTMENT L HEALTH AND ENVIRONMENTAL ..,OTECTION 825 `L' STREET, ANCHORAGE, AK. 99501 264-4720 J'a - SF=W PERMIT N6.' , 021023 .'IND APPLICANT LIFESTYLE IND SRA 1452-T 99502 la-b_�lq 345-3891 LOCATION j b LEGAL L4BI NORTHWOODS PHASE II LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: 00109000k@ R Ed b MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S 3 Cir Fj *%o�'F= t 0's Er F= -F E--- 1-•1 W-1 -Z-1 p/pe THE LENGTH DIMENSION 15 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). /3 a ' , F"F= -f- Ft E= " IZ:- " W I E> -r" IK_-_ -- ­-` FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F,lE=lDUlFZE=> _rn"K 9_51Z-ZF== :IL X01 C3"' 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. ___ _rwlo < � > 1_zff;;zf= FZFE-QUIFZFECG 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=FEEFRMI-T F=XFmlF,*E=:S ENEEC::FEME�F=K! :3::L.- JL SA:B;2 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:________________________________________ APPLICANT IGNED:---------------------------------------- APPLICANT LIFESTYLE IND ISSUED BY_, --- --- ATE_ V4. 0 X, i U & E ENG AEERING & DEVELOr HENT 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: %E �E�� �'C Q S &VAI -S7 -Tel. No. 6'9? - 2(3 3 Mailing Address: ,, // eau �'4 fes' Ate` � 9,56 7 Legal Description: Z,' %` `¢ ,, B z -o C/< i� /I ogy-y V oo 6 5o8. Depth (feet) 0 1 Soil Characteristics ==2 3�N 4 5 P � l «� Y ��.41 !/�LL�f ..J/4mil" 7 9 10 11 12 �r 13 14 15 16 PLOT PLAN A10--5eALE PERC.TEST L4sT KGs --xi /A/ %� AV OF e�4C®e Ground Water Encountered: Yes No If yes, what depth- :49 / �m........wm w..,..uaww.ine e a Proposed Installation: Seepage Pit Drain Field ° Se ®•%=o• S e Earl P. Ellis ®oc °e NO. 1745•E Performed by: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST ❑ SOI LS LOG PERCOLATION TEST PERFORMED FOR: h+ wr 6—Ar l d DATE PERFORMED: Z LEGAL DESCRIPTION: 16r y dlk 9 Noxny-4)oo q 5 PRA5�i SLOPE SITE PLAN P F E EITI©rc�aotC. 1 V 2 3- �X� 4 i 5ArVoy SILT JJCL,A`( 5 33o4)9 6 R / 7 i 8 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 Date Gross Time Net Time 14 Net Drop 9 f 2y/gz 15 - it 16 3 A� OF A e 4 Z� 17 i b1011 in a 3 'eo aammeeme 0m �. A �o r.�, 18 311(, tY . /0.,/o to m; 'N r o n a . aq•e 's� y 19 r+ g. Robert A. Shafer 20 O No. 1457-E �^ COMMENTS PERFORMED BY: �aA;, Inas P. 6SKA 2�7 72-008 (6/79) Reading Date Gross Time Net Time Depth to Water Net Drop 9 f 2y/gz �._ Io - it 3 1 r 9! SO i b1011 in a 3 �o r.�, '�,, 'ot`i /1!0 311(, /0.,/o to m; 'N 311 t/8 PERCOLATION RATE 1 (minutes/inch) TEST RUN BETWEEN 0q FT AND FT CERTIFIED BY' DATE: r • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 s Certificate of On -Site Systems Approval r Parcel I.D. 051-741-39 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods Phase 2, Block 1, Lot 4A Location (site address) 23019 North Woods Dr. Current Property owner(s) Christopher & Wendy Emond Day phone Mailing address PO Box 771415 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. - COSA Fee $ 15� Date of Payment 0111115- d:`,= Receipt Number 51;3ba� COSA# 05C45t`{7- Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone - 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 5/26/2015 Conditional approval for bedrooms, with the following stipulations: By: — LL� Original Certificate Date: The uni fieL chorage Development Services Division (DSD) issues Certificates of -On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet t -- ., If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -:Site Systems Approval Checklist Legal Description: North Woods Phase 2, Block 1, Lot 4A A. WELL DATA Well type Public Date completed _ Total depth ft. Date of test Static water level Well production If A, 3, or C provide PWSID # AWWU Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Parcel ID: 051-741-39 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in, AT INSPECTION ft. ft. g.p.m. g.p.m. Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Collected by: Date installed 3/9/2000 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 05/28/15 Pumper C. ABSORPTION FIELD DATA Date installed 3/15/2000 Soil rating 2 z 0.4 GPD/SF Bed g (g.p.d./ft or ft /bdrm) System type Length 64 ft. Width 18 ft.. Gravel below pipe 0'7 ft. Total depth 4 ft. Eff. absorption area 1,152ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/21/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0/2 in. Water added 495 gal. New depth 2/4 in. Elapsed Time: 140 min. Final fluid depth 0/2 in. Absorption rate , 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. 'Pump off" level at E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Cycles tested Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS As Built on file 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. Engineer's Printed Name Steven R. Pannone Date 5/26/2015 COSA canary sheet_2-6-15.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage1 0+ in. $U • Municipality of Anchorage =� y "i1 t On -Site Water and Wastewater Program s (907) 343-7904 E > r Certificate of On -Site Systems Approval Parcel I.D. 051-741-39 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods Phase 2, Block 1, Lot 4A Location (site address) 23019 North Woods Dr. Current Property owner(s) Christopher & Wendy Emond Day phone Mailing address PO Box 771415 Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fxj Single Family (w/wo ADL) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: ReceivedbyDate: COSA to be released t gineer, unless otherwise requested by the engineer. - - COSA Fee $ Date of Payment Receipt Number i513409� COSA# 05C 51g2 -q Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone - 6. DSD SIGNATURE fie/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 5/26/2015 Conditional approval for bedrooms, with the following stipulations: —)• V1 IIJ❑IaI VCI LIIIUOtC vaic. C 1 I - % F f.) The uni fl o chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAhluesheet E ., c If more than I septic system is on the lot: COSA Checklist # t of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: North Woods Phase 2, -Block 1, Lot -4A Parcel ID: 051-741-39 A. WELL DATA Well type Public If A, B, or.0 provide PWSID # AWWU Well Log (YIN) Date completed_ Total depth ft. Date of test Static water level Well production Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. U Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L. Date of sample: B. SEPTIC/HOLDING TANK DATA Wires properly protected (Y/N) . Casing Height (above ground) - in, AT INSPECTION Collected by: ft. Tank Type/Material Septic/Steel bate installed /9/2000 Tank size 1,000 gal Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 05/28/15 Pumper C. ABSORPTION FIELD DATA Date installed 3/15/2000 Soil rating (g.p.d./fe or ft2/bdrm) 0.4 GPD/SF. system type Bed Length 64 ft. Width 18. ft. Gravel below pipe 0'7 ft. Total'depth 4 ft. Eff. absorption area 1,152 ft Monitoring tube Y_ Depression over field N' Date of adequacy test 5/21/2015 Results (Pass/Fail) Pass For 3. bedrooms Fluid depth in absorption field before test 0/2 , in. Water added 495 gal. New depth 2/4 in. Elapsed Time: 140 min. Final fluid depth 0/2 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at - in. Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line. Animal containment areas SEPTIC/HOLDING TANK ON LOTTO: Manhole/Access-(Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service'line 10+ Surface water 100+ Driveway, parking/vehicle_ storage 1-0+ Curtain drain 50+ Wells on adjacent lots 100+ in. G. ENGINEER'S CERTIFICATION 1 certify that i have determined through field inspections and rbView of Municipal records that the above systems --are in conformance with MOA COSA guidelines in effect on this date,- Engineers ate:Engineer's Printed Name Steven R. Pannone Date 5/26/2015 COSA canary sheet 2-6-15.doc -- 1 Municipality of Anchoragee 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. 051-741-39 COSA #Oq _0035 Expiration Date: 0 1. GENERAL INFORMATION Complete legal description North Woods Subdivision #2 Block 1 Lot 4A Location (site address) Chuaiak. Alaska 99567.23019 Northwoods Drive Current Property owner(s) Joseph G Kelly Day phone (907)748-2808 Mailing address Chuaiak, Alaska 99567.23019 Northwoods Drive Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 2-17-2009 Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with h10A 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 or the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail anc satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc 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 Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: v Original Certificate Date: tact., 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 #2 81 L4A Parcel ID: 051.741.39 A. WELL DATA Well type A If A. B, or C provide PWSID # 21M Date completed NA Sanitary seal (Y/N)ISA Total depth _NA A ft. Cased to -NA ft. FROM WELL LOG Date o ssL Static water level Well production WATER SAMPLE RESULTS.- Coliform ESULTS:Coliform ,e Hies/100 mL ft. Well Log (Y/N) N Wires properly protected (WN) N Casing height (above ATI Nitrate mg/L Other bacteria Ga g.p.m. Ar c: ugA Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ANCHORAGE TANKISTEEL Date installed 3.15.00 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) NA 00 mL Date of pumping 2.12.09 Pumper SANITARTY PUMPERS C. ABSORPTION FIELD DATA Date installed 3.15.00 Soil rating (g.pAA12 or ftz bdrm) 0.4 System type BED Length 64 ft. Width 18 ft. Gravel below pipe 0_72 ft. Total depth 2.12.5.04ft. Eff. absorption area11 52 ft2 Monitoring tube Y Depression over field N Date of adequacy test -12 6.09 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test Q In. Water added 450 gal. New depth Din. Elapsed Time: L min. Final fluid depth Q in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date LIFT STATION Date in in "Pump on" level at _ in. -"Pump off' IeveLat� Datum Cycles tested 1 'SEPARATION DISTANCES SEPARATION NCE: Septic tankAift station on lot Absorption field on lot FROM WELL ON LOT TO: level Meets alarm & circuit requirements? On adjacent lots Public sewer main Publics anhole/cleanout Sewer /septic sene Holding tank containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 10+ Absorption field 5+ Water main 100+ Water service line 25+ Surface water 10+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 100+ Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 20+ Curtain drain 50+ Wells on adjacent lots 00+ F. COMMENTS in. G. ENGINEER'S CERTIFICATION.•��t :'L 'Q .•... I certify that I have determined through field Inspections and 49 L. review of Municipal records that the above systems are in ; �, ............. -10 conformance with MOA COSA guidelines in effect on this date. i Engineer's Printed Name Steven R. Pannone. P.E. �......... . j �i ste a 0#0* .t _ ........"..• nei �i i� • S>4 Date 2119/2009 ei. �;M"�••• COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number, ven R. f''Cnno N. CE 8�n9 1 1 f r I I I 1 1 ASBUILT SE14ARD h I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE, , FOLLOWING DESCRIBED PROPERTY, -I : y40• j "t/4.PT.C/L'071 f B.f%/' AND THAT NO ENCROACHMENTS UIST EXCEPT AS DATE, i INDICATED. IT. IS THE RESPONSIBILITY OF THE yllrcell� OWNER TO DETERMINE THE EXISTENCE OF ANY GRID, EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- FB, VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION tB OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN, ARY LINES. �� f �'. Na. M..k U�.'4 . �¢,•. LS -6915 •� MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of EnWronmental Services On -Sits Services Section 50 chorage,Alaska 99519-6650 . , ... (907)3434744;' v Agent _SHARON I MINSCH w/ REMAX OF EAGLE RIVER Day phone'' (307) 694=4'L00 . -_ - ` CERTIFICATE OF HEALTH AUTHORITY Unless otherwise requested, HAA will behold for ' APPROVAL FOR A SINGLE FAMILLY DWELLING:` pickup.: 2: NUMBER OF BEDROOMS 3 3. TYP E OF WATER SUPPLY.; ParceILD.# 051-741-39:HAA# rf'A DwO /Dj Individual well ,Communitywell' Public wafer xxx ! 1. GENERAL INFORMATION + + Complete legal description NORTHWOODS SUBDMSION2 LOT 4A BLOCK 1I. $ Ing to the Iega%; and status of system `1 ., , • r ix " 4. TYPE OF WASTEWATER DISPOSAL.' Location (Site address Or directions) ' 23019 NORTHWOODS DRIVE . = ' I" ' Holding Tank , CHUGIAK.-ALASKA 99567 Cornmiinityon--site Property owner ` PETER °k` KATE HAFUSSLFR Day phon0.(907) 345-7071 NOTE: ffcorh' munity,wastewatersystem, provide written confirmation from State ADEC ,r...,. Halling address, 23019 NORTHWOODS 'DRIVE CHUGIAK: AK 99567 Ing to the legality and status of system: Lending agency ` I ' , Day phone - Mailing address Agent _SHARON I MINSCH w/ REMAX OF EAGLE RIVER Day phone'' (307) 694=4'L00 Ad( reSS 16600 CENTERFIRD DRIVE. SUITE 01 EAGLE RVER, AK 99577 Unless otherwise requested, HAA will behold for ' pickup.: 2: NUMBER OF BEDROOMS 3 3. TYP E OF WATER SUPPLY.; Individual well ,Communitywell' Public wafer xxx ! + �} NOTE If communky well system, provide written confirmatron front State ADEC attest Ing to the Iega%; and status of system `1 ` ix 4. TYPE OF WASTEWATER DISPOSAL.' • on-site xxx individual Holding Tank , Cornmiinityon--site I •; Public sewer. NOTE: ffcorh' munity,wastewatersystem, provide written confirmation from State ADEC Ing to the legality and status of system: 72-025 (Rev. 1191) Front MOA A21 Computer Version ' Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $750.00 at, or prior to, closing for the engineering services provided. 5.' STATEMENT OF INSPECTION BY.ENGINEER: As certified by my seal affixed hereto and as of the validation date shown below, l verify that my Investigation of this Health Authority Approval application shows that the on -she 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,veriy that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and inspection,'the on-slte water ;supply and/or wastewater disposal system Is In compliance with all Municipal a State codes; ordinances, and regulations In effect on the date of this Inspection Name of Firm LAS O y Phone -(907j 337-6179 Address •69011 DE oi Engineer's Signature ?` Date 3 s w In conducting thisrevaluation, AWWC l ted to e a thorough, conscientious engineering anaysis of the system !n accordance with ADEC and D S G61cfellnes& negulations 7774 reported results described the rlormance of the system under the condit/ons encountered at the time of the test and separatiori distances ._, _. measured to ieadiyldenLfiabfefeatur&s The operatfortel itis of el! wells soil septic;systems'depend ' ,on the local Smay u ge o tam( belrid senw! by em thaThese oon9 ones are oouutsside control o(water 0000aoopp' the evaluator of the system. Sans1e test results do of the riot uarantee future rrranc9 system, nor do theyguarantee that there are no hidden defects or encroachments p AMW, inc can therefore not provide any warranty for future estimate of how long the41 system will continue to meet the operational requir9ments of the ADEC or MOA DHHS s 0 ° S 7779 content of this report la for the sole benefit of the owner listed aborre. Any, rvQn6ii upon or use of this report by airy other person or party Isnot authorized 0 . .. ... nor will Iteonferanylegal right whatsoewr i Q a e r A Gayness: F DHHS SIGNATURE r 0� +' 7953 V Approved for bedrooms • l t 4�edr're ressi0007 Disapproved ; , i t �DD00000 j Conditional approval for bedrooms; with the following stipulations Additioh Comments By: i LfJ_' / ..bate The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements: Employees of DHHS do not conduct Inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible for errors or omisslons in the professional engineers work. 72-025 P". 1191) Back MOA 021 Computer Version i\Lt.EI V LV Municipality of Anchorage MAR 20 2000 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division muCv RL11Y OI AW;nu 825 OV Street, Rm 502 Anchorage, Alaska 99501 (907) �4�+p4j'TAL SERVICE° CI1 Health Authority Approval Checklist Legal Description: NORTHWOODS S/D #2: LOT 4A, BLOCK 1 Parcel I.D.: 051-741-39 A. WELL DATA Well Type PUBLIC If A. B. or C. attach ADEC letter. ADEC water system Log present (Y/N) Date ComDieted Total depth FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Collform Date of B. SEPTIC/HOLDING TANK DATA Nitrate height (above ground) Wires properly protected (YIN) AT lklOnff^f^kl by: 9— p.m- Date installed 3/9-15/2000 Tank size 1000 Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression (YIN) NO High water alarm (YM) N/A Date of Pumping NEW Pumper C. ABSORPTION FIELD DATA Date Installed 3/9-15/2000 Soil rating (g.p.dJft2 orft2/bdrm) 0.4 System type BED Length 64' Width 18' Gravel thickness below pipe 0.72' Total depth 4.3' Effective absorption area 1152 S0. FT. Monitoring Tube present (Y/N) YES Depression over field (YM) NO Date of adequacy test NEW Results (Pass/Fail) — For 3 Bedrooms Fluid depth in absorption field before test (in.): — Immediately after= Fluid depth — (ins) Minutes later. — Absorption rate =_ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date 72-026 (Rev. =er Computer Verson gal. water added (in.): — D. LIFT STATION Date installed Size Manhole/Access (YIN) High water alarm level at* *Datum 'Pump ofr level at* E. SEPARATION DISTANCES PUBLIC WATER SYSTEM SEPARATION DISTANCES FROM WELL ON LOTTO: Septic(holding tank on lot On ad' Absorption field on lot On adjacent lots Public sewer main Public sewer manhoWdeanout Sewc service line Lift station SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water maWservice line 10'+ Surface water 1 oo'+ Driveway, parking/vehicle storage area 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. ENGINEER'S CERTIF TI I certify that I ve e i field Inspections and review of Municipal systems are In conformance with MOA gul s on this date. Signature Engineer's HAA Fee $ 00. Date of Payment Receipt Number 72-026 (Rev. w9er computer Venbn Waiver Fee $ Date of Payment Receipt Number eooaoop00 [A. Gafness; x7953 }' k ........:••'�oPc o f seat°�°ate MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services M On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # LLQ - --o \ HAA # "L\M � (moi LM 1. GENERAL INFORMATION Complete legal description Lot 4A; Block 1; Northwoods Subdivision 42 Location (site address or directions) 23019 Northwoods Drive Property owner Thomas M. McAssey (Deceased) Day phone Mailing address Executor/Allen Lyle 338-4552 (hm) 384-3220 or 2122 or 2123 (wk) Lending agency CITY MORTGAGE Day phone 563-0700 Mailing address ATTENTION: Lynn Pope Agent Glen Carlson/2001 REALTY Day phone 276-2001 Address 2600 Denali Shite 4 Anchorage Alaska 99504 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE'OF WATER SUPPLY: Individual well Community well Public water 3 y NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 S. STATEMENT OF INSPECTION BY ENGINEER 6. 0 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 Phone S & S ENGINEERING AddressELOOP Read Ncqaule verEagle River, Alaska 99577 Engineer's signature Date All � Z �'IY •• 00 u. $ 9 •• *Y :° �° O ° yp ° j�OTI° p v IA•� �� �•• R009613HA�ER,P.E. ; �� Gj °• E'&215 DHHS SIGNATURE Approved for '� bedrooms. I Disapproved. Conditional approval for bedrooms,with the following stipulations: Additional Comments auTlc The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -,tAo arr o L5 Parcel LD 5a Z A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 11°200k Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION g.p.m. Etpf8 1991 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot s t k ; On adjacent lots �h Absorption field on lot On adjacent lots Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Nitrate RECEIVED Public sewer manhole/cleanout Petroleum tank Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size t Compartments Z Cleanoutso/N) T— Foundation cleanouto/N), —Depression (Y� High water alarm (YA ri Alarm tested (Y/N) til/4� Date of pumping l l — \ <�;, -`� k Pumper L_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '��� On adjacent lots To property line o Absorption field Surface water/drainage t C>0 k k Foundation Water main/service line 1� 72-026 (Rev. 7/91) Front ` 'CONTINUED ON RACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y, — Manufacturer Manhole/Access (Y/N) 'Pump off' level at Cycles tested SEPARATION1,13 S"TANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA Date installed j 1- � 0 ` $ Z On adjacent lots Soil rating 2 3� Length -22L.0,Width 7_-77- ' Surface water System type T��D Gravel thickness 0.5 Total depth 9-1 Total absorption area 1) S2 Cleanouts present6lyIN) Depression over field (Y& Date of adequacy test I l-1 t Results /fail) PSS for / bedrooms Peroxide treatment (past 12 months) (Y,P A.O146 Jt* -'o 1 --'/kJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots A Property line 1C) ( To building foundation 4s, To existing or abandoned system on lot '"J On adjacent lots 5e:, t 1Cutbank '-1)(1- Water main/service line lr---)t k � }- Surface water ) g)n Driveway, parking/vehicle storage area Sbt k Curtain drain /- E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe4lgQ�theeaiflQf this inspection. ®F A1,4 %%1, S & S ENGINEERING Signature 17034 Eagle Renner Loon Road No 204 Eagle River, Alaska 99577 Engineer's Name Date i�x 4 v HAA Fee $ Date of Payment -- Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ( �F�pAOFESS�flNP.® �ff ll � c r.. i l til h _1 �lit)r DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 995Q3 FOR: S & S Engineering November 8, 1991 PWSID # 213001 WALTER J. NICKEL, GOVERNOR 563.6775 My review of the records on file in this office reveals that the Northwoods Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf Time APPLI(-"`NT FILLS OUT UPPER HACK ONLY Property Ownert7"(t/ I�lj`ti Time Phone Mailing Address Date Zip Code.!✓ �� ? Date ) Buyer Address Inspector Zip Code Lending Institution Inspector � Phone Address J.n PK Zip Code ENVIR(-Mj', 1 ,A.: _o-,-1-TION Realty Co. & Agent 1982 - % Phone Address.; 'CONDITIONS OF APPROVAL Zip Code Legal Description .� G, 1s;ogD04A Se— ir Street Location. I 6) P729 'S /- Type of Residence Soils Rating Single Family Well To Absorption Area Well Log Received ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual - ATTACH WELL LOG. A well log Isrequired for all wells drilled since June 1975. `F Community. - - - -For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Disposal j__r_ "Individual Year Individual Installed: _, ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date _ Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DFPT. C= I,1,17a X ENVIR(-Mj', 1 ,A.: _o-,-1-TION 1982 RECEIVED (�) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' 3" 48 r DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size p� Well to Tank