HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 11Northwoods #2 Block 1 Lot 11 #051 -801 - 04 Municipality of Anchorage Page —1 of Z" 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: -ii4tiIf Ji41PID Number D 1 P .Ol 6+ Name: '1614 NI I. STT I Wastewater System: iii New ❑ Upgrade Address: C 1CAIac4- 22-1-(o k1E1.1 17gAziLvi St20-44-1;e.., cia4/.4- ABSORPTION FIELD Phone: No. of Bedrooms: 4 0 Deep Trench 0 Shallow Trench '14 -lied 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: D' GPD/Sq. Ft. Total Depth from original grade: 41 Lot: 1 I Block: .( N,,,r�Syjndivjsipry; „ .r, , , 1 K� ii Y� S CXR �'ND�1E7L pepth,to pipe bottom from original grade: Ft. Gravel depth beneath pipe 0. S Ft. S1•4Range: Township:11 S4. l• (UJ Section: Fill added above original grade: — 1,. O Ft. Gravel length: � a Ft. WELL: ❑New ❑Upgrad Upgrade GraveldepW: I.,I.1C,7l1.2o Ft. Number of6;s: nes: Distance between� lines: Ft. Classification (Private, A,B,C): 1‘111A14 l G 1 ►-I�t _.. Total Depth: Ft. Cased To: Ft. Total absorption area: �% IN�1 eQSQ. Ft. PipePmaterial:'Pjjo --iG K'Zi3c - Driller: Date Drilled: Static Water Level: Ft. Installer: ,� � JU1.t 1 K L (JA��3i-. Date installed: I I /� -i -' L Yield: GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES -Septic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines M`�an�uff�a�c•t'�u�rerr,�-�A� � ..�( %^"t."�%*'R/IGJ+`fs .11.40( Capacity in gallons: ' 1 LY,JO Well -. ` �J�� /c'4- Material: `' •- " Number of Compartments: —7i- Wai re (C (GSD`+LIFT STATION Lot Line Id fig l C�t'i- �— l' Size in gallons: Manufacturer: Foundation 15'4- ' 0$+ _ ,� �- "Pump on" level at: "Pu • • ' level at: High water alarm at: Curtain Drain �. Pump Make & M.. - Elec rical Inspections performed by: W Li Remarks: BENCH MARK /f/n_m Location Description: and cow.... 'Lf/4-6C. ✓1 /®/ Assumed Elevation: C ll 1468eo oe® /�). o • , 49 T gt ' ., ,� ;•. •.,.0000 i9 � �li * Inspections performed by: 94» ' lti t pates: 1st I Ho -1 1.. •o••• •• ..,s• .�` .. R Al * AMR,P.E. •• 44 fit 9F:p 5 `oNP�,�.��,. , ®� ��>e'�--41. - 2nd l (- (0 -1 I Department of Healt uma r = ices approval Reviewed and approved by: � ' ;► ��' f 'Date' /%/�4�` 72-013 (1/91) MOA 25 Permit No /lkiC11 I1,74 Page !� of Municipality of Anchorage 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 i'le,Rn� I�Icac�nsND�Sz 1t 7L . LD1 It PID No •'°611°4 Legal Description: "rINISIA G�O3?E COA q GO- Mt !J !0.0I7 a- 7 S4 t '-/ 11.6.c11 Chi tA2 o� Wk Mf1 Mit Salt' 04 2") G\/. coi ,1t',,., 1.50 0!pa . . Tl.4 ••• • e #. • • • • . • ••0 •• • • ROG - - J.8 FERC P.E. • S°ea A 02 • C?�� 01 e 141�®pROFESS\ON' 00000 72-013 A (2/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910334 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:ETTEN JOHN L OWNER ADDRESS:22436 WHISPERING BIRCH DR CHUGIAK, AK 99567 PARCEL ID:05180104 LEGAL DESCRIPTION: NORTH WOODS PHASE II B 1 L 11 SEC 4, T15N, R1W, SM LOT SIZE: 32848 (SQ. FT.) NUMBER OF BEDROOMS: y,3' THIS PERMIT: #.21(/,/a-/�� THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: Ot11313 I,s4 ] CY' AJ Col I DATE ISSUED:10/18/91 EXPIRATION DATE:10/18/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: uJ, 0,6r-z/z1-c COkiir ekc G<%ayv� b1. /4- Yi) /moi r4TiA' . , 4 DATE: DATE: (p/zi ( /04 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 ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN November 5, 1991 Mun cepa . ty o$ Anchorage DEPARTMENI OF HEALTH AND HUMAN SERVICES 825 L St'ceet P.D. sox 196650 Anchorage, A.Lasha 99519-6650 REFERENCE: Lot 11; Stock 1; month Woods #2 Request you -issue appnovat ob the design changes to permit #SW910334. The exti-ting Septic tank was excavated November 1, 1991 to ue.4-L$y .integn.ity. The .tank was j ound to be ag poor .integn.ity and in need ob nepxacement. At this point the owner wishes to upgrade the system to a 4 bedroom capacity. A second test hate was pergonmed and the system redesigned with an a,?,tennate site designated. We do not anticipate any adverse e66eets on ne.ighban.ing properties by this design change. Since the con.ilcacton £4 on-site, expedition o6 your review w -L -U be appreciated. I4 you have any quest -tons an regw.ine add.i,tLonae tnpnmation ban yawn nev.iew, p.eease contact us. s OSP G 011V??%1 43 I6'61 c ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 S-Lneenek y, ROGER J. SHAFER, Y.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 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 ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. Uctoben 14, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Murricipa.P.L.ty os Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Ataska. 99519-6650 REFERENCE: Lot 11; Btacfz 1; Nanth Wood4 #2 SubdLviAion; Request you .issue a penm.it .to-.n4-tatt a septic upgrade an .the reseneneed pnapen.ty pen can attached design. An adequacy .test was pensonmed on the existing system between .the dates os Sep.temben 13, 1991 and September 20, 1991. We sound .the absonp.t on capacity os .the existing system .to be .less than adequate sor a 3 bedroom house. A .test hate was excavated and a pencotatian .test persanmed. We do not anticipate any adverse esse.e 6 on neighboring properties by .the -i.ns.tattati.on os the pnaposed upgrade. Is you have any questions on require add.itLonat .insanmation, ptease contact us. S.ineenety, ROGER J. SHAFER, P.E. RJS/gm MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION OCT 1 4 1991 RECEIVE© 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 la - SCALE r milLr t4Tc-Q,e,c i7i9C Pi?E5 — .namiama — • XO'r6 1.7 Got -It -kit) t-ry u1 air*P. r15el . —r;.,, -22. Jerry �x �tirr rM s�PTt c -rvr-W im 0 A • • 0 Si en •:•� • Li�6 ,5,! ' \ t2.6 -E7 coat . C rte( 1-16 t;' F1/2 .r7 To c� GIAI.• T r'5E 041,.c2cm--tEv Cpm 41-e4terty) c=f-...G.7 7I - n•3 4eny�z eye' c) :(7.3-20c17 ' Acr-c)-‘ 1369 t • r 9.94 8: 1-7 e • • • • • A 0 v r r r • J • l9t• Ms •0 if4 • 0.4 el • .iA • /y • � •• ••.4 �✓ 0$44 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .'� V"'LEGAL DESCRIPTION: " 1--1\ lL 1 l I _ \ t.l __Township, Flange, [1....\:.....i'r-. -1+, lt.J� SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 cLEPT (Fe#T7 %* . 494 liAili; e o • ?; �l: no • RE'D DATEPERFORMED�1I 111 '.17 • . Yt. o 04. 0 .., . •cr • v .•� :off • NNP .o• RAFE"h, P. . ,8215 colz- 11,•1 Q^ ` SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? t, S L 0 P E Depth to Water ADe Monitoring? Date: T N Reading Date Gross Time Net Time Depth to Water Net Drop f: 4=-A 1,L' �-C coil 1 (1 -4. e 1 l'. E'c..9 -- -451 /o. ..._- I- 2:Gbt Ic>Y�VI t, /L 7,5`.3 .15 2.,0 1t 4YA ` 4 2:2v u of tlal )5" q -7.-.4.5.0a\ 4,\ice' 3 e. � b °C.1 eta a 4 Vs ` 3 /a ` PERCOLATION RATE ,i ,{ TEST RUN BETWEEN COMMENTS 3-1''14.1# 1 r 12-1 l 1- it ENGINEERING (minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY .0 Eagle River Loop Road No. I..., , Alaska 99577' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 0 THIS DATE. DATE' CERTIFY THAT THIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: (►I 51,0- IIA o ;He ..6.4 n /"� rt,'• DATE PERFOR FE$ P.E. 082,5 e,��'Ns� Township, Range, Section: a,apS SL - '- . SLOPE 10.c1„rry1 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? r -to ''1, Depth to Water After Monitoring? ►o Date: w�`1-r►\ S L O P E SITE PLAN N 41 tk A-' Reading Date Gross Time Net Time Depth to Water Net Drop 179- g.- CPAr1G- t Lj "{ e -e-1 b s \ Vo- ex' l . — '-,iii-6 -- Z 130 : $0 3 `Vvt..• ► '%u" 3 ',A r.7 :10 q" Nit,` 4 :' ;tO '5T/$4 45Wle4 ,fob ',10 "ti11.0.. Vitt,. (0 V ;1 e7 . 1 I7 "31I '5-11t.." PERCOLATION RATE 3'2"' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 6» FT AND (.o FT COMMENTS S & S ENGINEERING 17034 Eagle River Loop Road No. 2 PERFORMED BY Eagle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN I HIS DATE. DATE' k7'» i -C1 MUNICIPALITY OF ANCHORAGE • 7-r - ( 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 ��'''''"�'� }� �`��-�� (� L. � r�� ®i'l�.C� - f) ,.6 L PHONE�c7 �(�c, ,2 3 / ®'NEW ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION // / Nole7Xcoddcis 77 - LOCATION NO. OF BEDROOMS SEPTIC TANK DISTANCE TO: 1p�II��� / 1d � /7`,Z Absorption area / 3 / Dwelling /6 / Mate�G PERMIT NO. R_ !OS'S- No. of compartments Manufacturerf� Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth / Uri 0 - ,�,_ 6 JTZ 0 Z a DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each line • Total length of lines Trench width inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area SEEPAGE Length Width Depth 6 PERMIT NO. Typc of crib Crib diameter Crepth Total effective absorption area DISTANCE TO: Well je4,. ,.yt /_/",0 Building foundation .,.. (3 r Nearest lot line 4- (63 / w Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS b 303,E I SOIL TEST RATING .2r0 It �� / % INSTALLER SKS S (A) -- / REMARKS 01CA FE/A +0 los_ e12duidd civ. tc DIVA 9re4c.( -&U iAce•G ( tae_ikotz_ Su_ft 7 b PRd()t ck_J a _I 00_,S, 351 I G,' a pd, .Z�I J i apt APPROVED ��/,/,/���,,7 -7�('�, ,�AAPPPPRR DATE LEGAL ze-t4/ ex 72-01'3 (Rev. 3/78) NUNINAIL...I1".1A OF IF41ICIF:IF91OFE DEPARTMENT DEPARTMENT HEALTH AND ENVIRONMENTAL 10TECTION 825 'L' STREET, ANCHORAGEAK 99501 ON—Isx-rIE :.F.F.EE-wa.R! IF.F.zmIlr- c--) PERMIT Na ( 8210.55 ) rhutsicp--)-qa APPLICANT STEVEN L SKAGSS CONST PO BOX D CHUGIAK 9956? f7.88 -24J31 LOCATION LEGAL L11 81 NORTHWOODS II LOT SIZE 99999g SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (SQ FT/BR)= 2/0 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ENIaRTh= t_farniOM= 17.31-F:Rov. pomp -INA THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIEM THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). s77..x..== 131.1FIL_L_orAs-, 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. --- MO <2> FIFZEZ 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. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2: BEDROOMS. SIGNED. APPLICANT TEVEN L SKAGSc• cIiNST ISSUED BY DATE__LC.). ,Ne r O & E ENC.NEERING & DEVELOP IiVIENT 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' 5EVE cl CoAig7-• Tel. No 6H-283/ Mailing Address. P, c), &dX ©/ CAUL/44/4, A44• 994'6 7 Legal Description: Lot- 1/, 6‘ OCK /, ' "O -77iVeloe2 508 D.) P44A-SE 1E Depth (feet) Soil Characteristics 0 1 ML. SILT— 7t740 SC/L. 2 -3 4 5 6 7 8 1=c- . �E�T P G/zp'1%aLC.1 SAaB kgeE of S/LTi NED DEA C/7 io .2/Q 4/0, .t?. 11 12 13 8O7-7e.4f ®JG- 7'- 14 14 15 16 PLOT PLAN de, 'C4 LE PERC. TEST /576 `/ 44 -ST Hca ,4//,t( /272�"%t, ` -2/0 0A/4. Ground Water Encountered: Yes No ✓ If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments' ° sw Oaacogao ••aa ••a e. ••'•.a. i • •ads••? ®® a Earl P. Ellis ; w a #4 2, "_ NO 174•F •. 4.4141.4. "�4.70 'JC- ®o.:\!n •�s�� ®Y�A0� d A eeoe0a eoe�•�_S ott�. EV I * �I Performed by: GV" �La/�CJ Date: 6/27/ f 3 ( TO-- 1 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.orgtonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 051-80-104 G(�GG Parcel I.D. COSA# Expiration Date: 3 - & - 0 7 3167 1. GENERAL INFORMATION Complete legal description T,nt 11, R1nrk 1, W*nrrhnnnAn SID p2 Location (site address) 92416 Whiaprrinl+ Rirch Dr. Pet-e-r'o Creek, Ak. 49567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent .irffrry Churchill Day phone 41.0.7a304—.2444— Day phone Joe/Crentlanri Polity Day phone 317 _ r, g 30 Mailing Address 114" n'a Clonn--thy• Eagle River, Ak 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well 0 TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site Individual Holding Tank Community On-site 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 and required pendent fprrofessr the tional civil engineer registered In the State of Alaska. Certificates of On -Site Systems App f 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. By: 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 Address 17034 Eagle River LPhone 97f' -y n7'— P• Rd. -Eagle River, Ak. 99957577 Engineer's Printed Name Rnhprr r r� Date 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for -C'-- i. r A, % ROBERT C. COWAN tie 4,4 •ti •, CE -8001 �?� It \ A C‘ I': �i��^�1 css1�',�^:,..� bedrooms, with the following stipulations: tt War.rriprt • N -SITE ; Gas �$: WATER WASTEWATER PROGRAM �o ibia111)))111‘g Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (R.w.11)05) Original Certificate Date: '3 - 6 -0 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.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: l -or II f T3couc I ? Nocn-ItLtebs ti- Z Parcel ID: 05 I -80-ray A. WELL DATA 1.1\ Well type2!51-K- If B, or C provide PWSID # — Well Log (Y/N) -- Date completed = Sanitary seal (Y/N) = Wires properly protected (Y/N) — Total depth — ft. Cased to — ft. Casing height (above ground) — in. FROM WELL LOG Date of test Static water level ft. ft. Well production g.p. g.p.m. WATER SAMPLE RESULTS: AT INSPECTION Coliform colo i' - -. r' mL Nitrate mg/L Other bacteria colonies/100 mL Arsen' _ mg/ Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5r I=/7c / Srre c_ Date installed I1 i` / 9 1 Tank size 1 zso gal. Number of Compartments ?- Cleanouts ON) 'IES Foundation cieanout�l) *5 Depression over tank (YYIQ) 1J0 High water alarm (Y 5) 00 Date of pumping 7 (z3/O 10 Pumper 73-2IC ?Doi Prrt,C, C. ABSORPTION FIELD DATA Date installed I I 14,111 Soil rating (g.p.d./ft= or ft2/bdrm) O. 3 System type Br Length I ft. Width 3 te r ft. Gravel below pipe O.5 ft. Total depth L±ft. Eff. absorption area 201kt? Monitoring tube YES Depression over field'Uo Date of adequacy test 2lzl,A G Resu . : ail) 7455 For q bedrooms Fluid depth in absorption field before test Oa in. Water added 682 gal. New depth 6" in. Elapsed Time: I060 min. Final fluid depthI n in. Absorption rate >= &CO+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) 100 If yes, give date -- D. LIFT STATION Date installed Size in gallons 'Pump on level at _ in. 'Pump offs leve - _ in. Datum Cycles tested E. SEPARATION DISTANCES UBLI L 0141 612._ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal . • . ent areas High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adja Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas in. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 1-1-- Property line 54 - Absorption field 5 4 - Water main 10 ri Water service line 10 "} Surface water /DO Lb Wells on adjacent lots rn)r"/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 14 Building foundation /0 s1 Water main /0 y Water Service line /0 r -f Surface water /(?) / Driveway, parking/vehicle storage /0 II Curtain drain IJO,JF. P./teat) Wells on adjacent Tots r -- F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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 eo4tA i C- COW4r✓ Date .,,,.s�v\Zl ,..........sc.„.......... .1.1:47.OF /: r:�21 ... .. 0::.tt 44-c) f ••i7', ' t id Id '1,�•ROBERT CC"COWA `" "•" CE-Bt401 .:%,e t�l ~•• .................0 c.- ,..-r ow 11 t` 11!:744-eclt\'�' ' COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) 4% .vD Waiver Fee $ Date of Payment Receipt Number 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 051-801-04 HAA # O ff(00 CO Expiration Date• i /, 0 /o5 1. GENERAL INFORMATION Complete legal description North Woods Phase 2, Block 1, Lot 11 Location (site address or directions) 22436 Whispering Birch Dr., Chugiak, AK 99567 .. Currerit Property.owner(s)• Rick & Grace Brumfield Day phone 688-6600 Mailing address Lending agency Mailing address Day phone Real Estate Agent reat_LancLRE Day phone 694-91 25 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank O 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. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700; South Bragaw St. P.O. Box '196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ' (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST=, Legal ,Description: NORTH WOODS PH.2, BLOCK 1 LOT 11 A. WELL' DATA Well type' Public Date completed If A, B, or C provide PWSID # Well Log (Y/N)' I;r ' Sanitary "seal (Y/N) ' Wires properly; protected (Y/N) Total depth ' ft: - Cased to ' ' ft. Casing height (above ground) FROM WELL -,LOG I AT INSPECTION Ii Parcel ID: 051 -801 -04 Date of i test ' Static' water level Well production WATER ,SAMPLE RESULTS: Coliform; j - colonies/100 rill.' Arsenic i ' '' , mg./I. i 11 HI, ' B. SEPTIC/HOLDING TANK DATA i'i Bili i Tank Type/Material - Septic/Steel! (Asch: Tank) Date installed 1 1 /0 7/1 9 91 1. , i lal ; . ; . ;. Tank size 3 i'' 1250 gal.'•Number of Compartments_2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm`'(Y/N) .N Date ofpumping 01/21/0 4 ' ; !Pumper. ' JR' s 'Nitrate °f' mg./I. 1' ',Date'of,`sample: ft. g.p.m. Other bacteria colonies/100 ml Collected by: C. ABSORPTION FIELD DATA ., Date installed 11/07191:-. 'Soil rating " 6.p:d./ft2 or ft2/bdrm) System,:type BED' Length 56 ft. Width ; 36 . i .. ft. Gravel below pipe 0.5' Total depth 4 ft. Eff. absorption area 2016 ft2i Monitoring tube Y • Depression over field N • I �ii ' -1 j e ' �llr i , , l. E For 4 bedrooms ,,'i w Date of ;adequacy test 01/21/04 1 • ° Results (Pass/Fail) Pass Fluid depth,in absorption field before test:._ in. I Water added 606 gala,;: New depth 5.5 in. Elapsed Time: -1440 min: Final fluid I!depth 2. in.: I, Absorption rate >= 600 ' g.p.d. Any; tejuven'ation treatment (past:12 mo.) (Y/.11& type) Yi (Jetted & Acid) Ilf yes, give date 11/11/03 m N 0 r z 0 to C) r m 0 NOIldWbOS34 1V931 5 to o ro n D 0v-oz -tid Fr, N C 1 0 0 0 G .<Oi O ro N O' C <, -• 3 n G'O N fD 0 fD • -, f0 G d ro n N o N- t0 -Ai Cr O C O Q r n N O y •C O N CD O. N • CD O O ro -.." N 3 9,. 0 0 = 0 - 0 • O •7 __ __�_ f� N fD N ro I'DO -• 7 0 Q y c N O al O N N N O C d ..f 3 -w C • S c V IZI O.o. 0. 4, O''-• ro CD O O In O , N . S fS -p ::. f<1) NA NCN X ro< N •OONv ro ▪ US n 0 o m g- o - 0 - DN a =Om N fD ID o :N (DO 0' • ro X ID • • uoisinipgns tD ••rn 0 w rn 0 u) r m C7 MZ 0 --I-I m x - 0 v co N C m to 0 O c 0 0 N011dlJOS34 6L6Z-1,69(L06) 5m o o n v o V V Z ii mo V N g E" O o 0 c e O 9 o o aO N ;0 m..�n0eo a O N = N• • = `1 O' = O v a U m -40 m a CD m tiO 0 0 t0 O N N N Ntri G O 0 0 a m v m mo. a N o 0 • N' o 0 n 70> mv N N o= 0 x 0"_ 0 0 0 SCD o -w _..4. 00 O N ( C V ▪ O o o. n 0 a. O- 0 ID u 0g. O .. "' V , C_ me, =06- 0 0fDo N a t. ... OW 0 m v T0, rn Cn 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description HAA# 4-1dollt7 r) Lot 11; &od. 1; Norah Wood6 Subdiv.i.6Lon; 'r2 Location (site address or directions) 22436 ft/Gaspe/Ling Bitch Property owner John g Candy Eden Day phone Mailing address 22436 Wha6peninq Bitch ChugLafa, Aaaska 99567 Lending agency Day phone Mailing address Agent RAE HALL GREATLAND REALTY Day phone 694-9125 Address 11411 02d Glenn Highway Eagle Rivet, Ala. 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: �✓ 3. TYPE OF WATER SUPPLY: Individual well ✓ Community well XX Public water 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 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 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 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 Address t 7oaa Fr.# River Loop Road14, Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By' 7y� Date !_�/. CAUTION 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 (Nov. 1/91) Back MOA 021 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:lAI I2'' II ' A. WELL DATA Well type Pr If A, B, or C, attach ADEC letter. ADEC water system number 2-1.7245C) I Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Parcel I D Date of test Static water level NOV 1 2 1991 Well flow g p m RECEIVED I 1/ C D Pump level 1� C 1. L V L FROM WELL LOG AT INSPECTION. OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION SEPARATION DISTANCES FROM WELL TO: � M1 Septic/holding tank on lot C ; On adjacent lots Absorption field on lot i•t4 r k ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by B. SEPTIC/HOLDINGU-1-67t1 TANK DATA U Date installed 1 "67t, CleanoutscN) Y High water alarm (Y/N) I Date of pumping ' -.1". Tank size Compartments Foundation cleanout(VN) f Depression (Y yj> Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: A��� Well(s) on lot AIDI V On adjacent lots 14- Foundation 1(14- To property line (nl'Ir Absorption field ✓ Water main/service line \ l Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Dat: installed Manufacturer Size in g • s Manhole/Access (Y/N) Vent (Y/N) on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed l- I -� kO 1J Z Soil rating 6f12 I System type .165.7 Length � Width e -271e, I Gravel thickness cc'', ✓" Total depth 4 Total absorption area Depression over field (Y(t Cleanouts present4ftl) / Date of adequacy test Results (pass/fail) t for bedrooms Peroxide treatment (past 12 months) (Yg N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot NG On adjacent lots '2-v(7 -1 Property line To building foundation t;:.•t On adjacent lots 1X Cutbank To existing or abandoned system on lot I,► -1- Surface water k 4E � Driveway, parking/vehicle storage area Curtain drain Water main/service line IL7 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect oar ate of this inspection. ,�••PQ e 4041. 3 & 5 ENGINEERING f.y'.••• ll Signature 17034 Eagle River Logs Roud.No.1 4 �/* 4 WF, °.,' "•, >r9 Eagle River, Alaska 99577 . ; • • .. • • • • • ••••00 Engineer's Name 00 .® Date 1"'"9.91 �• • ROG. 5 PER, P. • • 462)''''• a2 .•.� •°.<(. .410 1i 19Fo�'ROFESStCt• P�' HAA Fee $ 7° Date of Payment //-/aZ - 7/ Receipt Number 02.37 /0)7 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee' $ Date of Payment Receipt Number s1C' /\ c--,Ci."i L c--,[iii..: L_ DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 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 APPLIr NT FILLS UPPER HA �` ONLY Pro„:'+rty O `ner Mailing Address \ j,. -.^1/ S e06 IV/ i, -7/ l /OUT i'7iei~/n� - ^�� "�`" Com- Zip Code 99 Vl. Zip Code Phone( `, (� 3 / 3.`j 0 Buyer Address - Lending Institution Address / -6 Zip Code Phone Realty Co. & Agent Address 5 R� I/l l 0 //I / / `V ti)(5/- .� Y2 - L) Zip Code (eta y )4-0- a eel ,Y2}1 Phone Legal Description Street Location }. ) } 7/) 'OC7 � Z Type of Residence M. -Single Family ❑ Multiple Family El Other No. of Bedrooms Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Water Supply ❑ Individual [1:1.BVmmunity ❑ Public Utility - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log If available). Sewer Disposal 171/ Individual ❑ Public Utility ❑ Holding Tank - Year Individual Installed: / e. ,, % 2 When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time a t ',L .4-1? Date Date Date Date ,c - )a.-9sa , 09 Inspector Inspector Inspector Inspector rtGk Y Field Notes: MUNICIPALITY OF ANCHORAGE DEPT OF t'[ALT)1 & ENVIROIJM'ctJ(AL EO,ECTION OCT 61982 RECEIVED ( ^ ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE J' h 'CONDITIONS OF APPROVAL V BY. Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72.023 (3(82)