HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 2 LT 4North Woods #2 Block 2 Lot 4 #051-741-29 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw SC P.O. Box 196650 Anchorage. AK 99519-6650 Pagel of 3 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW101039 PID Number: 051-741.29 Ran"ankins. Tim Wastewater System: ❑ New ® Upgrade Md,eae: 22335 Whispering Birch, Chugiak 99567 ABSORPTION FIELD Phorle: Hunts of Bedreenr: 0 o..p rMrml D sn.now rwtm D e.d o Moww ®ower: LEGAL DESCRIPTION Sol R." Tota D" *= original grade. cpo�Ftt Ft. sw*, Lor auOdM : Depth to ppe kodan kern wig" "rale G,.vel depot beneam ppe: 2 4 North Woods Ft. FI Toe,ump: R.nY•: li t : Fu added akoke ongl" grade: Gravel Length: Ft. Ft. Well: ❑New El Upgrade Gravel eedth: Numoar or IMea: I Dolame Ostveen It" I FL Ft. Claes al,wt (Pm *. A S. CI- Total Depot: Cased b: Tota Nmrpoan area. Pp. Mate" Class A Ft. Ft Fj onur Doe Need: Sul. w.w Level'. Natelw: Date Metaled: FL Flintstone Const 5125/2010 Yw Pvnp $at at. Cum" H"M.00ke Gro TANK GPM F,. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. O Other. To Septic Absorption Lit Holding lubliuPrIvaie 'r"'I"°"" '+'' From Tank Field Station Tank Sewer Unit Anchorage Tank 1000 Gal, was 200+ 200+ 200+ • 200+ Macaw: Steel Numoer of cw,"nmenu: 1 2 ev/htew.lm 100+ LIFT STATION 15+ :e. anu ara�re,. W1.11111 Gel. Foundelbn 5.71 P+ro on M N0 -Pu wr leveltl Mph mate, alum at. N. N N. 100+ Pump Make a Model Elecotw Mapemou penormed by: Curtan Dram Remarlo: Septic Tank replacement only BENCH MARK lneatan and D.P.: Door Jam M.,rnnd lovalgn: ( rA ` -e ( C_0 100.0 Ft. Lf� Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 512512010 aaa♦a 2nd 512612010 ��..Or 1•♦ . ................ : �?,°' ♦i Development Services Department Approval 49TH Conditional Approval Date: ° ;y % r ... ..................... • . r Steven R. Pannone: r ♦ No. CC 8149 ' '♦1�'et�2b,.'All, Reviewed and approved by: Date: ♦♦ , q�,,� / / `BSEP REA (E)� / 4F % / y�r MT NOTES: / /AREA / 5 `SEPTIC AREA (E) / AWWU WATER MAIN (E) Y / KEY BOX (E) 5.0i WATER SERVICE 13 LINE (E) 10008 SEPTIC TANK (P) 1000g SEPTIC FC TANK (E) DC ABANDON PER CODE 3 BR HOUSE (E) 25x42 BED (E) SEPTIC AREA (E) 3 / AREA SERVED BY COMMINTY WATER / NO WELLS W/IN 200' / / / / / / IRECORD DRAWNG I PLAN FA / / / / / WIN / CO FC / T1 / T2 / DC / M� PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTHWOODS S/D PHASE II Blk 2 TLT Tim Hankins 22335 Whispering Birch Or Chugiak, AK 99577 i / / / / / / / / / TIES / A / 11 1 .1 8.4 / 1 8.7 / 24.2 9.8 / 32.1 19.3 / ' 1 / / / / I 5/26/10 49 .. .. ....... I P.I.D. NO 51-741 i even Pannone ] PERMIT N( CE 81491y. o/ swxxxxxx • • • L Sheet k1k�`6" 1 of 2 / / / / NOTES: / /AREA / 5 `SEPTIC AREA (E) / AWWU WATER MAIN (E) Y / KEY BOX (E) 5.0i WATER SERVICE 13 LINE (E) 10008 SEPTIC TANK (P) 1000g SEPTIC FC TANK (E) DC ABANDON PER CODE 3 BR HOUSE (E) 25x42 BED (E) SEPTIC AREA (E) 3 / AREA SERVED BY COMMINTY WATER / NO WELLS W/IN 200' / / / / / / IRECORD DRAWNG I PLAN FA / / / / / WIN / CO FC / T1 / T2 / DC / M� PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTHWOODS S/D PHASE II Blk 2 TLT Tim Hankins 22335 Whispering Birch Or Chugiak, AK 99577 i / / / / / / / / / TIES / A / 11 1 .1 8.4 / 1 8.7 / 24.2 9.8 / 32.1 19.3 / ' 1 / / / / I 5/26/10 49 .. .. ....... I P.I.D. NO 51-741 i even Pannone ] PERMIT N( CE 81491y. o/ swxxxxxx • • • L Sheet k1k�`6" 1 of 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 3—BEDROOM HOUSE UPGRADE, NEW 1000g STEP TANK, ABANDON EXISTING TANK PER CODE, FILL WITH GRAVEL. CONNECT TO EXISTING FIELD. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 10 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12 FEET BELOW EXISTING GRADE, STOP WORK & NOTIFY THE ENGINEER IMMEDIATELY. S k 0 0 0 a ui 1i to 0 , oU W g t� z 0 U � Q 97.3 93.7 NEW 1000 g 93.5 SEPTIC TANK CONNECT PROFILE TO EXIST'G ABBREVIATIONS BED CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE DESIGN PARAMETERS LEGEND FC FOUNDATION CLEAN OUT UPGRADE SEPTIC SYSTEM —w—,v WATER LINE/ TQ TANK CLEAN OUT NO. NO. BEDROOM: (3 gpd) WELL RADIUS C# CLEAN OUT NO. TANK SIZE: 1,000 gallon STEP M# MONITOR TUBE NO. — es — ea — EXIST'G SEPTIC R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT as NEW SEPTIC DV OIVERTER VALVE FS FLOW SPLITTER —0--- CHAINLINK FENCE (E) EXISTING (P) PROPOSED (N) NEW NOTES: ♦7�T�� 7�T� �t PANNONE ENG SVC, LL.0 P.O. BOX 100217 ANCHORAGE, AK 99510 pF A ��1 L � '��•"' '4 � ig�Q S�q() Dole 5/26/10 Scole PHONE (907) 272-8218 FAX (907) 272-8211 o *; Q9 TFi '•,* �� /•••• 1 NTS RECORD DRAWING NORTHWOODS S/D PHASE II Blk 2 TLT 4 P.I.D. NO 51-741-2 Tim Hankins eleven Ponnor+e / PERMIT NO. 22335 Birch DF CE 8149 ' (I,'l` swxxx xx Sh2e0Fx2 DESIGN NOTES ChuW0klpering 9� AK 99577 \.�� On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP101039 Tax Code Number: 05174129000 Work Type: Septic Upgrade Permit Effective Dates: May 24, 2010 to May 24, 2011 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: NORTH WOODS PHASE 2 Site Legal Address: NORTH WOODS PHASE 2 BLK 2 LT 4 G:1559 Owner/Address: HANKINS TIMOTHY W & BARBARA C 22335 WHISPERING BIRCH DRIVE CHUGIAK AK 995675450 Site Mailing Address: 22335 WHISPERING BIRCH DR, Chugiak Lot Size In Sq Ft: 29184 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either. A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: /u Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 051.741.29 Property owner(s) Tim Hankins Day phone Mailing address22335 Whispering Birch Drive Zip Code 99567 Site address 22335 Whispering Birch Drive Zip Code 99567 Z Legal description (Sub'd., Block & Lot) North Woods SID Phase II, Block3�Lot 4 Legal description (Township, Range & Section) Lot Size 29.184 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Pannone (Signature of property owner or authorized agent) Permit/Rush Fees: 313 Waiver Fees: Date of Payment:/2`i Date of Payment: Receipt Number: CK (i Set Z Receipt Number: (Rev. 11/05) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevermoanenaak.com May 23, 2010 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: North Woods S/D Phase 11, Block 3 Lot 4 RUSK Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The existing tank is within 0.5 feet of a newly constructed arctic entry and the house is scheduled to sell on May 31. The existing tank will be filled with clean gravel and abandoned per code. The surrounding lots are served by public water systems and there are no wells within 200 feet of the proposed septic tank. This lot is served by public as well. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 2 of 2 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 4 slopes to the northwest at approximately 3 to 5 percent in the area of the septic system and house. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 615 East 82n° Ave, Cuite 86, Anchorage, AK 99503 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, /!%sKs Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 615 East 82nd Ave, Cuite 86, Anchorage, AK 99503 Telephone: (907) 272.8218 FAX: (907) 272-8211 ~- SE / / / a'roTl, XAREA (E) NOTES: / AR/(7/�—SEPTIC AREA (E) / AWWU WATER MAIN (E) / KEYBOX (E) S.0/ WATER SERVICE / LINE (E) 11. 1000g SEPTIC TANK (P) 1000g SEPTIC\ TANK (E) ABANDON PER CODE 3 BR HOUSE (E) 25x42 BED (E) \SEPTIC AREA (E) 3 AREA SERVED BY COMMINTY WATER NO WELLS W/IN 200' / , / / / / (ISSUED FOR CONSTRUCTION I PLAN / / / / / / / / / PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 / / / / / / / / NORTHWOODS S/D PHASE II Blk 2 TLT 43 Tim Hankins��r�(—k LP -f %**' 2233Chugiak eAKg99S577e Or /'+ I FA / / / / / i , / / / / / , / / / / / 1 , Date 5/23/10 :*"k1'=50' ••••• P.I.D. NO i • / 51-741- """""` / PERMIT NO. CE 8149 �/ swxxxxxx 1 OF 2 / / / NOTES: / AR/(7/�—SEPTIC AREA (E) / AWWU WATER MAIN (E) / KEYBOX (E) S.0/ WATER SERVICE / LINE (E) 11. 1000g SEPTIC TANK (P) 1000g SEPTIC\ TANK (E) ABANDON PER CODE 3 BR HOUSE (E) 25x42 BED (E) \SEPTIC AREA (E) 3 AREA SERVED BY COMMINTY WATER NO WELLS W/IN 200' / , / / / / (ISSUED FOR CONSTRUCTION I PLAN / / / / / / / / / PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 / / / / / / / / NORTHWOODS S/D PHASE II Blk 2 TLT 43 Tim Hankins��r�(—k LP -f %**' 2233Chugiak eAKg99S577e Or /'+ I FA / / / / / i , / / / / / , / / / / / 1 , Date 5/23/10 :*"k1'=50' ••••• P.I.D. NO i • / 51-741- """""` / PERMIT NO. CE 8149 �/ swxxxxxx 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. LIRI)' Selpf.c_ 3. SCOPE OF WORK: 3—BEDROOM HOUSE UPGRADE. NEW 1000g STEP TANK, ABANDON EXISTING TANK PER CODE. FILL WITH GRAVEL. CONNECT TO EXISTING FIELD. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 10 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12 FEET BELOW EXISTING GRADE, STOP WORK & NOTIFY THE ENGINEER IMMEDIATELY. 5 O Z Z ts O ¢ O O w 5 P_W m oL) o c o S z� Z 0 U � Q NEW 1000 g SEPTIC TANK CONNECT PROFILE TTODEXIST'G ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE DESIGN PARAMETERS LEGEND FC FOUNDATION CLEAN OUT UPGRADE SEPTIC SYSTEM —w—w— WATER LINE/ T# TANK CLEAN OUT NO. NO. BEDROOM: (3 gpd) WELL RADIUS C# CLEAN OUT NO. TANK SIZE: 1,000 gallon STEP MN MONITOR TUBE NO. —as — es — EXIST'G SEPTIC R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT — ss — as — NEW SEPTIC DV DIVERTER VALVE FS FLOW SPLITTER 0 CHAINLINK FENCE (E) EXISTING (P) PROPOSED (N) NEW NOTES: A7�11�� �� �N g B�XO10102 J ANCHORAGE, CK 99ISI0 PHONE (907) 272-8218 FAX (907) 272-8211 ,� CL OF A/gS�k� tP' � ig•• 9 1 j *: TFi '. * �� Date 5/23/10 ISSUED FOR CONSTRUCTION Scale NTS �•• ••• .•:••I P.I.D. NO NORTHWOODS S/D PHASE II BIk 2 TILT Tim Hankins 1c,` L�j� 22335 Whispering Spwee Dr ;iteven Ft. Pannone•/ / i �I(4s CE 8149 . tR� =e� +1� 51-741-2S PERMIT NO. 5wzxxxzr SheetOF DESIGN NOTES Chugiak, AK 99577 � pjES90+a� 2 72-013 (Rev. 3/78) 0 /-1— !^ MUNICIPALITY OF,ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 625 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPH��ONNjjE I EDINEW S" 'i�lem C7Z ! C ❑ UPGRADE MAI LING ADDRESS - .02 &Z bu S LEGAL DESCRIPTION D Ur[ v 10415�0'_ LOCATION NO. OF BEDROOMS j TO: J)Vell Absorption area Dwelling PERMIT NO. 72- L)DISTANCE U Y EZ Manufacturer Material No. of compartments wF ` £� Z Liq. capacity in gallons Inside length Width Liquid depth ./ ) ,,. IF HOMEMADE: �. .-- ."--� J a Z DI TO: Well Dwelling PERMIT NO. Z < Manufacturer Material Liquid capacity in gallons 2 O Well Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: J LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines Z w inches cc CC Top of tile to finish grade Material beneath tile Total effective absorption area p inches LJ'-42.5^ Length Width Depth. is S PERMIT. NO. A) 72L Qa Type•e crib - CritrdierReter Crtb- e h Total effective absorption area LU ti DISTANCETO: Building foundation Nearest lot line CIts ep Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER d-- PIPE MATERIALS ,b .3a3 c( N SOIL TEST RATING + INSTALLER SK REMARKS V m 2 bJi;. /( (j / .-TG per-)o CSC+ .a 5 � l J_arcU , PIiAbq90 w� d s bL, 3 `. r APPROO�VEtD5 DATE LEGAL . 4E - / / `7 42_ 72-013 (Rev. 3/78) 0 /-1— TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 230 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L's FE F=lm -r " = -I---* I F= " 0i -r " :0::L la F? FA V ED C-' F="F=* Ir " = :E_: THE LENGTH DIMENSION IS THE LENGTH IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). r " FE -T- FR E= r4 C " L4 101_x" 11 :S !ffa. 174 10 10 F= _r THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). E' U I F:;Po F= L --.o :F. E* F=10 -r I #Z� _r F4 " K , I = F= -1 ID 04 10 1:3 n L- t- C -J N!E3 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. ":F. F:" F= F;.'! E' FZE"Q U I � E01 — — — RACKFILLING 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. PlINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE Is 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. DIAGRAMS ARE OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION AVAILABLE TO INSURE PROPER INSTALLATION. lFlmF=FRM I -r F=XF=o I F;,F::7:E3 E>F=C_:F=ME.F=FR :3-11_ --=' .41 C,=: L::a 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 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:-. ?11 ---------------- 11 MA STEV GS jll'a ISSUED By c -' I i I e\ V4. 0 ---- DATE_ DEPARTMENT HEALTH AND ENVIRONMENTAL ROTECTION 825 iL' STREET., ANCHORAGE., AK. 99501 c -,q 264-4720 Ael 'mt TE !E; FE L-4 FE FR F:I* E: FZ r-1 I _r Cf PERMIT NO. 820972 ) APPLICANT STEVEN L SKAGGS Po BOX D CHUG IAK 99567 688-2831 LOCATION LEGAL L4 82 NORTHWOOD PHASE II LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 230 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L's FE F=lm -r " = -I---* I F= " 0i -r " :0::L la F? FA V ED C-' F="F=* Ir " = :E_: THE LENGTH DIMENSION IS THE LENGTH IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). r " FE -T- FR E= r4 C " L4 101_x" 11 :S !ffa. 174 10 10 F= _r THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). E' U I F:;Po F= L --.o :F. E* F=10 -r I #Z� _r F4 " K , I = F= -1 ID 04 10 1:3 n L- t- C -J N!E3 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. ":F. F:" F= F;.'! E' FZE"Q U I � E01 — — — RACKFILLING 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. PlINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE Is 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. DIAGRAMS ARE OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION AVAILABLE TO INSURE PROPER INSTALLATION. lFlmF=FRM I -r F=XF=o I F;,F::7:E3 E>F=C_:F=ME.F=FR :3-11_ --=' .41 C,=: L::a 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 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:-. ?11 ---------------- 11 MA STEV GS jll'a ISSUED By c -' I i I e\ V4. 0 ---- DATE_ • -0 & E ENC NEERING & DEVELG, �MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: 57-'E 1/,F- /1 L ' �/�f� ix �' S C,10 A13 7-% Tel. No. AU - Mailing Address: P' 69, 8 d)< > (:�6hl() gr//q/� , 41 /,)eX5 7 Legal Description: L'07- 4/ /j L0 c/< 2, IVO/LT/fr.y oo/Q JI'U1-3 , , P,VASC 2T" Depth (feet) Soil Characteristics 0 1 All �5 11- S� /L 2 3 4�5 Pe/LG -7—,FsT y 6 7 8. 9. 10 11 12 13 14 15 16 510 S,Q �t1 A CCs Esq lL�/�f/� �23 o Oleg. 5 PLOT PLAN Ajo !jcc q[.c PERC.TEST / /4-'/ L 4s r 3® 44 /A✓ aq W/ti/Iti Ground Water Encountered: Yes r No If yes, what depth AV OF A`a ®•���°°eeeeeeeeeee� �� s :49T� m ®�► ow•4eeyeMgees+•••ee•e•"eei°^ 41 Proposed Installation: Seepage Pit Drain Field 0 ..• we e • ••e•. •ee Earl P. Ellis Perform OAF ed by: 1WAN .�� 0 PLOT PLAN Ajo !jcc q[.c PERC.TEST / /4-'/ L 4s r 3® 44 /A✓ aq W/ti/Iti Ground Water Encountered: Yes r No If yes, what depth AV OF A`a ®•���°°eeeeeeeeeee� �� s :49T� m ®�► ow•4eeyeMgees+•••ee•e•"eei°^ 41 Proposed Installation: Seepage Pit Drain Field 0 ..• we e • ••e•. •ee Earl P. Ellis Perform OAF ed by: 1WAN .�� PA6 f yiwR+..i.� �w'er..a Crvc �v 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 OSC251200 Parcel ID 051 -741-29 Expiration Date: 5/19/2026 Legal description NORTH WOODS PHASE 2 BLK 2 LT 4 Site address 22335 WHISPERING BIRCH DR Current property owner(s) SEEMAN JOSEPH J & DIANA A X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments 0 Original Certificate Date: 5/29/2025 This ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 1. GENERAL INFORMATION Parcel I.D. 051-741-29 Complete legal description NORTH WOODS PHASE 2 BLOCK 2 LOT 4 Location (site address) 22335 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 SEE Current property owner(s) iOS EPH & D I h/*% NAA Q Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 7 Private Well serving # dwelling units ❑ Other Non-public well as regulated by MOA n Water Storage X Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: 10 Private Septic ❑ Private Septic serving 2 dwelling units M Holding Tank El Community Septic or Public Sewer 5. SEPTIC TANK: F-01 Steel E] Plastic 0 Concrete F-1 Fiberglass Age 15 -See advisory if steel or fiberglass older than 20 years tl 6. ABSORPTION FIELD: n AWWTS nN Bed n Deep Trench n Wide Trench n Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: 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 Date of Payment COSA # 1 -S C- Waiver # COSA Appiicafiori_ A^P(20205.010C COSA Checklist.docx COSA Checklist Legal Description: NORTH WOODS PHASE 2 BLOCK 2 LOT 4 Parcel ID: 051-741-29 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA 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 49” Date of pumping 5/19/2025 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 10/29/1982 ALL standpipes present per record drawing Total measured depth from grade 3.6 ft (max) Measured depth to pipe invert from grade NA 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 5/20/25 Results Pass Fluid depth prior to test 0 in Water added 500 gal New fluid depth 1 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 450 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 remaining 6 in Comments/Deficiencies: 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) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No 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 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MET CODE AT TIME OF INSTALL. 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 05/23/2025 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 & 05/23/25 q�LCl'�6 !/`J��5618y�1ti71 z c-0 amu- - H 14• '-° Municipality of Anchor SEP 15 2ols ° On -Site Water and Wastewater Progra (907)343-7904 �6 C' sae Er. r`<<01 fi-8 L9yA Certificate of On=Site Systems Approva Parcel I.D. 051-741-29 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods Phase 2 Block 2 Lot 4 Location (site address) 22335 Whispering Birch Dr. Current Property owner(s) Kleine, Zenith Day p hone Mailing address 165 Cleveland Ave. Grand Terks, ND 58201 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 Fx] Individual Water Storage ❑ Holding Tank ❑ Community Class A Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNadance request for:, COSA to be released to the engineer, unless otherwise requested by the engineer. - COSA Fee $ 152(0 — Waiver Fee $ _ Date of Payment q / I lo11(. IDate of Payment Receipt Number O�8�2(,, Receipt Number, COSA# 05Qe N - Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto Ind as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of O4 Site SystarrApproval 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: 1 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 tha`fthere 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 pate 09/15/2016 6. DSD SIGNATURE ,' System #1 Approved for bedrooms t SIeven W. *0 a' SSystem #2 Approved for bedrooms CE -8149 Y Pp �1.y's'�;.•. ••s Disapproved �\�Z%K_ Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSP) 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 COSAbluesheet f :.. c If more than 1 septic system is on the lot: COSA Checklist # 1 of -1 Structure served by this system Certificate of On -Site Systems Approval Check#ast Legal Description: North Woods Phase 2 Block 2 Lot 4 A. WELL DATA Parcel ID: 051--741-29 Well type Class A If A, B, or C provide PWSID # 213001 Well log (Y/N) Date completed . Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water levet ft. ft. Well production g.p.m. 9.p -m. . WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/25/2010 Tank size 1000gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping o9/1*16 Pumper JR's Septic A Li C. ABSORPTION FIELD"DATA Date installed 10/29/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 230 Sf/br System -type Bea Length 42 ft. Width 25 ft.:: Gravel below pipe 0.5 ft. Total depth 3'6` ft. Eff. absorption area 1050 - Monitoring tube �. Depression over field N Date of adequacy t 09/13/16- est Results (Pass/Pail) PASS For 3_bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: 75 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. T Any rejuvenation treatment (past 12 mo.) (Y/N & type) N� If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot NIA On adjacent lots NSA Public sewer main NSA Public sewer manhole/cleanout NIA Sewer /septic service line NIA Holding tank N[A Animal containment areas NSA Manure/animal excrete storage areas N/A- SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 10+ Absorption field 5+ Water map. 25+ Water service line 25+ Surface water 100+ Wells on adjacent lots 200+ ABSORPTION FIELD -ON LOT TO: Property line 10+ Building foundation 10+ Water main 25+ . Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 18 Curtain drain 50+ Wells on adjacent lots. 200+ - F. COMMENTS - Drain field presoaked in accordance with engineers bulletin., Survey on MO. 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 Pannone Date 09/15/2016 COSA canary sheet 2-6-15.doc 2s 7 E)OSMO HOUSE 5 UNDER NO CIRCUMSTANCES SHWLD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR LSTAOLISIUNO BoLT10ARY OR FENCE UNE& THE SIRVEYOR TAKES RESPONSIBILITY FOR ]HE 94TIAL TRANSACRON ONLY AND ASSUMES FINANCIAL umtm ONLY FOR TFIE COST OF THE SURVEY. US= DISTANCES PREVAIL OVER SCALNM REPROOVCLON WAY CAUSE ERRORS IN SCALE. Lot MNKT SURVEY TYPE SYMBOLS FUMAT01 AS WLT • SET REBARDRAINAGE -.. ;`::':•`; ASPHALT pulp. FWAL EIRtICTAIL At -MAT a FWND ROAR WA -FENCEi•�... CONCRETE RAFOAM Al.LT... iVRKY ... TOORN�^%ASSUMED EEY. Wr*—F MrTAL FENCE W000 DECK PLAT PLANS k LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OP THE BUILLER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE CROUNO AND VISIBLE PALL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS, TO FINISHEO GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW ...e rY *e Pr nr ANY IAASUFNTC- rMCNANTS OR RESTRICTIONS MAY PREVENT SOME PAPRONEMENTS FROM BEING SEEM AND LOCATED. nwK w •..r rw.r ..M w. rnrA Y. R 7ATO1 AS-BIRT �CAw►I�...'..IAA'MI �M iw 1 r wrM r r , II �M...rr.r..-..-. do �1 aTAvcttAee As—eulT A Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 842 G 12 AVE ANCHORAGE. ALASKA 990M Vr : 1" = 40' w. �.. ..,.,..,..... Dat. SRV.TCA'S/26/10 O.o.T Or.CheG+1CkAi er. Det. Oro"i 57/10 1 ww:1559 W'0' 1149 Laq.I DK+aotFeA: • LOT 4 BLOCK 2 NORTH WOODS #2 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 S �' Anchorage, AK 99519-6650 U www.muni.org/onsite A(907) 343-7904 /1 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. o5i-742-2g 1. GENERAL INFORMATION COSA#-05Cto /055 Expiration Date: S .2 -7- / j Complete legal description Northwoods Phase II Block 2 Lot 4 Location (site address) 22335 Whispering Birch, Chugiak, AK g9S67 Current Property owner(s) Tim and Barbara Hankins Day phone 72o-6jS-g125 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2211s Whispering Birch, Chugiak, AK ggs62 Day phone Marrianne Grant Day phone ;2g-6602 Unless otherwise requested, COSA will be held by DSD for pickup. -- -2. NUMBER OF BEDROOMS: -- - - 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, t 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 fr the Municipality of Anchorage files and from my investigation and Inspection, fhe ofd site water sugpI a / astewater disposal system is(are) in compliance with all applicable Municipal �rYd State codes, ae� a regulations in effect at the time of installation. L' '• ` ` 1 Name of Firm Pannone Engineering Services, LLC Phone 272.8218 Address P.O. BOX1002i7. Anchorage, AK 995io / Engineer's Printed Name Steven R. Pannone. P.E. Date 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 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 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: Original Certificate Date: 7-10 (Rev 11 \ 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: Northwoods Phase II Block 2 Lot 4 Parcel ID: 052.74144 A. WELL DATA Well type A If A. B, or C provide PWSID # 213oos Well Log (Y/N) DM completed— Sanitaryseal (Y/N)_ Wires properly prof (Y/N) Total depth ft. Cased to ft. Casin ght (above ground) in. OM WELL LO AT INSPECTION Date of test Static water level ft. ft, Well production g.p.m. g.p.m. WATER SAMPLE LTS: Coliform colonies/100 mL Nitrate mg/L Othe acteria colonies/100 mL nic: ugA Date of sample: _ Collected by. B. SEPTIC/HOLDING TANK DATA Tank Type/Material _Anchorage Tank Steel Date Installed z zoio Tank size 2000 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout 1(Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) NIA Date of pumping _ /V as J Pumper C. ABSORPTION FIELD DATA Date installed 1ol2gLg82 Soil rating (g.p.dJft? or ft'/bdrm) iao System type Bed I i Length 1.2 ft. Width 2s ft. Gravel below pipe o.c ft. Total depth i5 ft. Eff. absorption area 1050 it2 Monitoring tube Y Depression over field N Date of adequacy test s/17/2o10 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test )Try In. 1 Water addedr o gal. New depthDry in. Elapsed Time: o min. Final fluid depth Pa In. Absorption rate >=,kto+ 9-p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date D. LIFT STATION Date ins `Pump on" level Datum Size In gallons 'Pump off" level qt —in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM Septic tankAift station on lot Absorption field on lot Public sewer Sewer /sept i4service line adess (Y/N) _ alarm level at Meets alarm & circuit requirements? lots On adja t lots Public sewer ma Holding tank AqkKa'['containment areas Manure/animal excrete storage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation _ S. Property line ao+ Absorption field S+ Water main 2s+ Water service line 2c+ Surface water Zoo+ Wells on adjacent lots Zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine zo+ Building foundation so+ Water main 2c+ Water Service line 2S+ Surface water Zoo+ Driveway, parking/vehicle storage _2o+ Curtain drain _None Known Wells on adjacent lots _too+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in V. conformance with MOA COSA guidelines in effect on this date. 0 e ;;� Engineer's Printed Name Steven R. Pannone. P.E Date COSA Fee $ Date of Payment Receipt Number, (Rev. tiros) s/,21&/l6 Waiver Fee $ Date of Payment Receipt Number '�: `ICvcn P. Pannone; No. CE 2149 IN Kam or q alellaCT KRlrR tn.a / `C / C) / C. EXISTING HOUSE 3 B UNOER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED ►OR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE ONES. THE SURVEYOR TAKES RESPONSIBILITY ►OR ]HE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL, UASTUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG REPRODUCTION MAY CAUSE ERRORS N SCALE. Lo 9.R%ty SURVEY TYPESYM60LS P'gJNIATKfI AS -ML?• SET REBAR ORANACE ASPHALT ........... Ma SIRLCTM AS^RALT �O� FOUND OMAR 4 -g. -e. WOOD FENCE �•.... CONCRETE ROT Pow ... AS.eNLT... �9AvCr... idPIIPIAP/lY _._ �,. v 400 l ASSUMED ELEv. .R—{t-IF METAL FENCE ® WOOD DECK r Cr THE n• PROPC UTLTTY C :ASEMENT! ON THE IsuRyEY CERTIFICATION PLAT FLAN w.:.w wain.•+ � ia•`r.�. n + i POUNOAIICN AS-VALT r..gawMwar errr FNA. STRUCTURE AS -OMT .w r....rwr TO I ONLY THOSE IMPROVEMI VE SHOWN. FENCES. WEDS. NE HTO.. ARE SHOWN IN TH NS MAY PREVENT SOME LUPI AND Prepared by Robert E. Johns, Jr. & Assoc. Professional Lend Surveyors ' Seale: n r Ree. Let S.F. Ree. Plat fie = 40 ....; Date Se, e,ae! 5/26/10 D. by. REJ jw.d by. R'•' RT ..... •• JR. ••f ♦ °ala °fgwRt 4127 +,: 5/27/10 —:1559 W'0' 1149 %• ........0 'i 'w LRgol Da,dgt,aq: ... LOT 4 BLOCK 2 ti,''eP.,ai,.a ����' NORTH WOODS #2 CES ,. 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 !'E7dGGAS -7, Phone(9or) 7-xG --io r.� Address 99&� D E, Engineer's signature 6. DHHS SIGNATURE 0 �iC/Ucr /�ALtiJG—it�j . 1G .9S,�/� /96`1 •S� Z Approved for 7-1/ R FE bedrooms. Disapproved. Conditional approval for Additional Comments auTlc Date �-t9,CDco bedrooms, with the following stipulations: Date 7_/G_ q9 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. 1191) Back MOA M21 02 • Anchora� A. WELL DATA Well type If;A; B, or attach ADEC le Anchorage SF Alaska 99501 • (934-' `la' lif �' Log present (Y/N) Date completed `-.... .Cased to. " Casing height (above ground properly protec Y/N) Date_ L J 5877 94-1—No. ATI CTION Received Of r , Addrass ®c tr V �� g.p.m. ©®© ALANCE DISE JRJ §bptic Pum 16718 Mercy Drl. Other bacteria 1820 cerhorNese By I B. SEPTIC/HOLDING TANK DATA Date installed %Zg' R Tank size" Number of Compartments z Cleanouts (Y/N) Y Foundation cleanout (Y/N) N Depression (Y/N) 'y High water alarm (Y/N) Date of Pumping 143197 Pumper C. ABSORPTION FIELD DATA { Date installed ���� Soil rating (g.p.d./ft2 o ft2/bdr -Z�o system type Aga Length yz Width .2.4' Gravel thickness below pipe- Total depth .a9 Effective absorption area /�✓`�� Monitoring Tube present (Y/N) Y Depression over field (Y/N) c Date of adequacy test Results (Pass/Fail) For -� bedrooms Fluid"depth in absorption field before test (in.); Immediately after ���gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate f- g.p.d. Peroxide treatment (past 12 months) (Y/N) 1f yes, give datef'' 72-026 (Rev. 3/96)" i D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON Septic/holding tank on lot Absorption field on lot On adjacent lots On adjacent lots "Pump off" level at* Public sewer-m�n Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 0/ Property line SZ Absorption field i Water main/service line 2- � Surface water/drainage io c 4-1 Wells on adjacent lots °O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /,9 Building foundation /B Water main/service line 2S tz;K Surface water /D ° �Fd Driveway, parking/vehicle storage area 9 i Curtain drain A%-'-� Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name pm�ct�s T �tiG�Y Date HAA Fee $ 3 d ®-Q O Waiver Fee $ _ Date of Payment C�/� V?dr_` Date of Payment Receipt Number 0 g0S_7 l X23 /q J Receipt Number 72-026 (Rev. 3/96)* ico!s in t tpe a� vvk. stems are ..•` w Y r ••• ••��� ";. DOU k KENLEY: �' CE 8176 I % MUNICIPALITY OF ANCHORAGE =° • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services "--`On=Site Services Section -^ W .., Boz 196650 Anchorage; Alaska ' 99519-6650 �;;:, :10i,343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL'FOR A SINGLE FAMILY DWELLING Parcel I.D. #HAA# 1. GENERAL INFORMATION - - Complete legal description Nori hWoocQ 5 !Si�tic: 'Q(nc�� z Location (site address or directions) Z 2335 W h is per irg 6 v c k S. 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. _ KND Engineering Phone Name of Firmwirnigan Blvd. Eagle River, AK 99577-8736 Address Engineer's signature Date is OF Ak K ' a' P1Vk. s® , 9' Kenneth A DuW W;4 CE 7116 � 6. DHHS SIGNATURE . _Approved for bedrooms. additional Comments _ 1.8, i V. CAUTION kThe Municipality,nchorage Department of Health and Human Services (DHHS) issues Health Authority '11,!Ai6proval Cel \ i viswbased only upon the representations given in paragraph 5 above by an independent profe6hal 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 DHHSo not al - 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.M(Rm.1191) Beck MOAB21 G Municipality of Anchorage ENVIRQNICIPALITYOFANCHOBAGE DEPARTMENT OF HEALTH & HUMAN SERVII.t5 rAISERVICESD1VISIo Environmental Services Division nn 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343T474 1995 RECEIVED Health Authority Approval Checklist Legal Description: Alordu)dngS /7lldse 0,Z dlt R L/vt `7` Parcel I.D.: 651- 7511 -22 A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number Zi 301 Log present (Y/1) Date completed Total depth Cased to Casing height (above ground) Sanitary seal ) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /0 2 2 Tank size 1 D_ 0 Number of Compartments z Cleanouts (Y/N)� Foundation cleanout (Y/1) N Depression (Y/N) N High water alarm (Y/N) ISI A Date of Pumping 10 /Z 5 Pumper 1 Ws P A- None _-.hDwvi ovi Dry ;naJ 0.s-6,,.44- C. ABSORPTION FIELD DXTA Date installed to Z Soil rating (g{ -Ff�2 ft2/bd ) 230 System type 8r_J Length NZ Width 251 Gravel thickness below pipe 0,5' Total depth_:3 11 cd Effective absorption area 10-500 Monitoring Tube present(Y/I)Y Depression over field (Y/N) AJ Date of adequacy test j D / Results (Pass/Fail) Pa -S S For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after_y7L gal. water added (in.): _ Fluid depth _ Minutes later: (in.) Absorption rate = x/50 f g.p.d. Peroxide treatment (past 12 months) (Y/M N If yes, give date &A D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent l On adjacent I Public sewer mantic Lift station "Pump off' level at* SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation (a Property line /0,+ Absorption field (o 1 Water main/service line 1 D 4 Surface water/drainage 100 I -l- Wells on adjacent lots 2UDt `I" SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation _ / D, + Water main/service line l h 1 -l- Surface water I DC7 -t Driveway, parking/vehicle storage area 10 1 + Curtain drain I Dy -t Wells on adjacent lots 2(3() ' f F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal r� in conformance with MOA HAA guidelines in effect on this date. fir* w Signature P ® �+� Engineer's Name S ® m Date 1QS" HAA Fee $ dt/t/ Date of Payment (� r/ // 51 — Receipt Number /, 3 QR (�f�--se Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number ��;V�'%V% 'F OF 41 Kenneth M. Duff k•• CE 71 6 �e per 0\� �OFESSIO�tP� are 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 SINGLE FAMILY DWELLING Parcell.D.# HAA# 1. GENERAL INFORMATION Complete legal description Lot 4; Btock 2; No4th Woada Subd i.vi,6ion Phaae II Location (site address or directions) 22335 Wh,iapen.i.ng &Ach Dni.ve Property owner Thomas E 9 Eileen C. Buzek Day phone 274-3385 Mailing address Lending agency City Moxtgage Day phone Mailing address Anchorage, A2a,6ka Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:- 3 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water Day phone 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 XX 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 Address S & S ENGINEERING Phone 17034 Eagle River Loop Road No 204 Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for 5 Disapproved. By Conditional approval for Additional Comments bedrooms. Date IZ-^ . ve iv •T l� �ro �y /r� 1 loroey'tl� IM1T+ bedrooms, with the following stipulations: 11ITIr 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 #21 l� �ro �y /r� 1 loroey'tl� IM1T+ bedrooms, with the following stipulations: 11ITIr 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L"4 wz Parcel I.D. SID P�4ac c_ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 213 oC�l Log present (Y/N) Date completed , Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2_0 Absorption field on lot 2.00 Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate AT INSPECTION 3 /DC7 z Z M 9 r so. - 9 -P.M. g'� Oi to Q a co to < Z y V O ^' z On adjacent'lots On adjacent lots — Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed (�' 2`� ' �Z Tank size \ "710'�' bnArt- Compartments Z Cleanouts ON) Foundation cleanout (Y&) ', Depression (Yo ^� High water alarm (Y& Alarm tested (Y/N) O�%t Date of pumping' ?7 � 3 0 Pumper GESS Poo l - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Z" �'t Y On adjacent lots Foundation LO To property line t Q� Absorption field ivy Water main/service line 10 k Surface water/drainage 1 as 72-026 (Rev. 7/91) Front CONTINUED ON BACK 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/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots off" level at tested Surface water Date installed - la -2011 HA2 Soil rating + System type 6>✓> Length 42- Width 25 Gravel thickness o,S Total depth s r Total absorption area / aSb 0 Cleanouts present t9N) Depression over field (Y& Date of adequacy test �- / ` 2 - Results �/fail) PSS for TSR-�. r"3) bedrooms ,Peroxide treatment (Past 12 months) (Y& r`,DAk jz_tlb �., bj If yes, give date j IlAo J ,.� a rr eK r. l Ly TU R_,rx. 13F�O R-fi biz- Ak'F"efer- �tGSr SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '2,0 a t ✓ On adjacent lots a) /�- e Property line 110 t 4- '� To building foundation I To existing or abandoned system on lot A IA, On adjacent lots -> C) Cutbank /'` Water main/service line J IL - 1 p` ,x.5.5 owtp,a Surface water 100, Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING Signature 17034 Eagle River Loop Road Ne 204 Eagle River, Alaska 99577 Engineer's Name Date HAA Fee $ —/ 7©, c' Waiver Fee: $ Date of Payment G—,72- Date of Payment Receipt Number -y1 ��S�S'8 / %�%� Receipt Number 72-026 (Rev. 3/91) Back MOA 21 •�fl�`1`� M9, A V� 0 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering February 19, 1992 PWSID # 2131001 WALTER J. HICKS -L, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Northwood Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. BR/cf Sincerely, 4ZA09— �O Byron Roys Environmental Engineer MUNICIPALITY OF ANCHORAGE g DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 p Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot L N B z n7 block, subdivision, sectipy�, township, range) a 2rrNt.�a a��.s Z Location (address or directions) G�+ (b) Applicant Name 5"Z A° hf" C � '— Telephone: Home Business 1uy_ V / 9 •. 1 A_ 1 I D Applicant Address ` I' (c) Applicant is (check one)I. Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); (d) Lending Institution _y7/(%Pr A T rh' ;2 elephone Address --- (e) Real Estate Company and Agent��� Address lC' 13 Telephone ele honegow (f) IV1* the HAA to the following address: S & S Engineering Eagle giver, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. 3. WATER SUPPLY Individual Well ❑ Community - Puxv Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite o Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hea, Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequatL 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 S & S Engineering Telephone Address SRB 196x Date 066, yyq w1 [�4 fyW MH u A fY.+. nee ,uT\b J n Sea O b�R\M ♦II ♦I.A A\IW: O\ � b J 6. DHEP APPROVA, ) Approved for bedrooms ,S R Date Approved Disapp o ed Cond ti nal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. Gti MUNICIPALITY OF ANCHORAGE (MOA) PNCk� &RA HEALTH AUTHORITY APPROVAL (HAA) P��(t DNEP��p EGj\DXA CHECKLIST - FEBRUARY 1984 �VN�CD�etONjH QR�Q� 264-4720 ` Legal Description: L L/ ,5Z p� 1 `t WELL DATA Well Classification t,�3�-t If A, B, C, D.E.C. Approved Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Dqp of Grouting Static Water Level 6 Pump Set At Casing Height Above Ground VS nitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot 'L.0 fl t ; On Adjoining Lots — To Nearest Edge of Absorption Field on LotJ-QZ>(� ;On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Clean out/ To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments p Oki S y® -1 B. SEPTIC/HOLDING TANK DATA Date Installed 1 0'Z `- 5' Size 1L_A-;=P" No. of Compartments Standpipes-O/-0dJ - Air -tight Caps &.Nj_ Foundation Cleanout (Y Depression over Tank kY6 Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Date Last Pumped S-ZI -Z5S ;for ``--- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply WeC> t ~ a w To Building Foundation To Property Line lot To Disposal Field — bt 0 To Water Main/Service Line t o To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z�gZ 3d ` I52 Type of System Design 3 Date Installed b"C1 �' Z- Length of Field -( Z' Width of Field zs Depth of Field S r Gravel Bed Thickness lf� Square Feet of Absorption Area Standpipes Present Qpw Depression over Field (-Y& Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well o1 } To Property Line To Building Foundation , Z l Lot FIN On Adjoining Lots l& To Existing or Abandoned System on 30 1 +- To Water Main/Service Line t1:p To Cutbank (if presggt) ) To Stream/Pond/Lake/or Major Drainage Course ��yy1V4 To Driveway, Parking Area, or Vehicle Storage Area ) �� ( Comments 64.417'/ X 6S 14J -r le X,001C7-A,=6 7D d,40' G✓l �4fsa1-� Zf 0J D. LIFT STATION Date Installed .T D 2 C/ A T TlG/ rrF /9i' iN S Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at L "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date JIM 15 SRB 196x Company "SffMOA No. �.�-G� 3 a`,►► Receipt No. �.r ���o ;;L Date of Payment �' �_� ��,•• ~•BJP /� tt Amount: $ � 7 �'. ... w � ..•, Page 2 of 2 72-026 (11/84) S "tr E nA id 4. " "') N I', DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE_ 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: 0- fl -a PWS I.D.# BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the System is in compliance with the State Drinking Water Regulations Sincerely, MUNICIPALITY OF ANCHORAGE DEPARTMEN If OF HEALTH AND ENVIRONMENTAL PRIU i ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL E . OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) J (addressLocation or directions)�2OTelephone: (b) Applicant Nam ..., _ ' . • r af: may, ar/ vy_�.. , (c) Applicant is (check one):,Lqnding Institution ®; Owner/builder ❑ ; Buyer ®; Other (explain); f (d) Lending Institution Telephone ----- Address — _(e) Real Estate Company and Agent - Address 4 Telephone _ (f) Mail the HAA to the following address: rs TYPE OF RESIDENCE Single-FamilyX Multi -Family Number of Bedrooms 1_? Other 3. WATER SUPPLY Individual Well 0 Community O Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public O Community D Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/64) Page 1 of 2 ■ MUNICIPALITY OF ANCHORAGE (MO HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L_ZZ:rr `+ T-3L'K • Z TLs `tet Ln� Z A. WELL DATA Well Classification If A, B, C, D.E.C. ApprovedON) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: f To Septic/Hefdirng Tank on Lot On Adjoining Lots 1 To Nearest Edge of Absorption Field on Lot ° `F ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results / CommentsiZ-rth��r�s B. SEPTIC/HGI DIN TANK DATA Y Date Installed Size I No. of Compartments Z_ Standpipes ON) Air -tight Caps 07N) Foundation Cleanout (Y 6D Depression over Tank (Y40 Date Last Pumped $ 74 -'e6' Pumping/Maintenance Contract on File (Y/N) A ; for Holding Tank High -Water Alarm (Y/N) t�S Temporary Holding Tank Permit (Y/N) A Separation Distances from Septic/t+efdirrgTank: To Water -Supply Well To Building Foundation To Property Line L L> (" To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 23a ' A Type of System Design Date Installed Z_,1 — Length of Field 4'Z Width of Field ?.s Depth of Field 5� a Gravel Bed Thickness Square Feet of Absorption Area l C:' Standpipes Present ON) Depression over Field (Y6P Date of Last Adequacy Test Results of Last Adequacy Test &a Separation Distance from Absorption Field To Water -Supply Well ��� -( To Property Line To Building Foundation Z t To Existing or Abandoned System on Lot IQ : On Adjoining Lots :fl _�- To Cutbank (if present) o To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed _ Size in Gallons J Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guid/elines in effect on the date of this inspection. Signed Date mpany PSRB 196X CoMOA No. ���`� 3 .,."��•r1O��r\ „,XLE RIVER, ALASKA S95U PH. 694-2979 Receipt No. lnJ`— w*+► ••••.,• S l �. I �•,�9�b � 9c Date of Payment "J6- 22- S5 Amount: $ 45 . bb i e ' S be Page 2 of 2 72-026 (11/84) sebwt A. Shafer No. 1487-E •• .•' ��s '••... ..•• Q�, E 2MOFESS10`AW U tj'F L(]S BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ! Telephone: (907) Address: A ANCHORAGEIWESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 _- DATE: / 7 /l7 ,P5 PWS I.D.# 136 O1 To Whom it May Concern: Accordin to records on file in this office the Water System is in compliance with the State Drinking Water Regulations Sincerely, Time Time APPLIC'NT FILLS OUT UPPER HAk ONLY Property Owner A r lAo Phone Mailing Address Zip Code Date Buyer (0�15fJrl s 2� t44 ertl�6 6ftg4ts Address Inspector j Zip Code Lending Institution �; �/� �j l� /'rMQ/iC Phone Address Zip Code 562 Realty Co. & Agent P j� Mk� 6A t jJ.p{' Phone Address Date Sewer Installed Zip Code Well Log Received Legal Description LO Street Location o Type of Residence - - Single Family - ❑ Multiple Family No. of Bedrooms..._ ❑ Other Water Supply ❑ individual ATTACH- WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sew Disposal Individual ltai 1Q-;�,ej-kms Year Individual Installed: ❑ ublic Utility When Connected to Public Utility. LA — ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( 7,} -APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL AP OVAL DATE 11-3 BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size O�c7 ti— �� Well to Tank