The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS PHASE 2 BLK 2 LT 12North Wood Pha, lock 2: Lot 12 051,-821 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 211480 PID Number: 051 821 12 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name JIMERSON ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22238 SHADOWY SPRUCE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 -- GPD/SF JTotal -- Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade -- Ft. Gravel depth beneath pipe -- Ft. Subdivision Block Lot NORTHWOODS PH2 B2 L12 Fill added above original grade Ft. Gravel length -- Ft. Township Range Section Gravel width -- Ft. Beds: Number of Lines -- Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line -- Ft2 -- - Ft. Well _ - - - +25 TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR Capacity 1000 Gal. Surface Water +100 _ _ _ Material Number of compartments Lot Line +10 - - - NA PLASTIC 2 Foundation +1 LIFT STATION Manufacturer Capacity Remarks old tank disposed of per moa code - _ Gal. Tank Replacement Only Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield ARM SERVICES Drainfield unk Co/MT3034 Inspector Charles Balzarini BENCH MARK (Assumed elevation) 100 ft Inspection ection 151 1/12/22 1/13/22 Location and description 2nd aro 4`h GARAGE DOOR THRESHOLD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp -`"®®� kk Conditional Approval: Date 'STM.. •:�� ,/ �� •CHARLES Septic System D� Approved ��flZ�t� Date .21346.-12 � G BALZARINI �+� ��`�� . • CE -13854 .. �`��,�' Note: this does include • ��1� PROFESSION approval not well permit requirements. `� kKEv UOIULI 10) CHARLES G BALZARINI CE-13854 2/2/22 Lot 3 00 Lot 4 WOODEN FENCE / / Lot 12 28,811 S.F. / MANHOLE 75' ELECTRIC / EASEMENT 4.2•x4.3• FENCE Lot 11 NK / S �33es� e'8f•os•� 111 � � 26 g• GRID __NW 1560—_ Project U M a6 GRAVEL DRIVEWAY' N o 99515-3049 (U n oQ000p00 A X04 Lot ken®langsurvey.com N PORCH J jonathan®langsurvey.com O} 61.6' 1111 2 / / 4.2•x4.3• FENCE Lot 11 NK / S �33es� e'8f•os•� 111 � � 26 g• GRID __NW 1560—_ Project U M a6 GRAVEL DRIVEWAY' N o 99515-3049 (U n oQ000p00 A X04 Professional Land Surveyors ken®langsurvey.com N PORCH J jonathan®langsurvey.com O} 61.6' 1111 6.p• 48'22"W 258.90' 1" 1 25.0' Lot 13 15' T&E EASEMENT I NOTES: 1) DUE TO SNOW & ICE COVER, THE GRAVEL DRIVEWAY IS APPROXIMATE. 2) THE LOT IS SERVED BY A COMMUNITY WATER SYSTEM. 0 V) PLOT PLAN ___ AS BUILT _x_ SCALE —11 — 50__ GRID __NW 1560—_ Project No. Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska (907) 522-6476 Phone 99515-3049 (907) 522-4625 FaxF oQ000p00 A X04 Professional Land Surveyors ken®langsurvey.com o jonathan®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 12, BLOCK 2, NORTH WOODS SUBDIVISION — PHASE 11 (PLAT No. 82-204) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the __` -- Day of �ard�4i} ______, �-�'•L �' at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH*I L — 202. •' 0?peSSIONAX- � _ AECC963 MUNICIPALITY OF ANCHORAGE mens On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 -� http://www.muni.org/onsite ' v r. Department Permit Number: OSP211480 Work Type: SepticTank Upgrade Tax Code Number: 05182112000 Site Legal Address: NORTH WOODS PHASE 2 BLK 2 LT 12 G:1560 Site Mailing Address: 22238 SHADOWY SPRUCE DR, Chugiak Owner: JIMERSON MATTHEW D & JESSICA A Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: 11/24/2021 Expiration Date: 11/24/2022 Lot Size in Sq Ft: 28811 Total Bedrooms: 3 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: _46J Date: Date: r Z .202 MUNICIPALITY OF ANCHORAGE Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343=7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051 821 12 Property owner(s) JIMERSON Mailing address Site address 22238 SHADOWY SPRUCE Day phone Legal description (Sub'd., Block & Lot) NORTHWOODS PHASE 2 BLOCK 2 LOT 12 Legal description (Township, Range & Section) Lot Size 28,811 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El Septic Tank El Upgrade (w/wo ADU) (D) El Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: 0.2 2 5 Waiver Fees: Date of Payment: It 2 Date of Payment: Receipt Number: O 3 3 $ Receipt Number: Permit No. O S /0,21 t t/(fV Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for NORTHWOODS PHASE 2 BLOCK 2 LOT 12 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced. The owner wishes to replace the tank at once. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 11/13/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211480, Rebecca Carroll, 11/24/21 CHARLES G BALZARINI CE-13854R EGISTEREDPROFE S S IO N ALENGINEER11/20/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211480, Rebecca Carroll, 11/24/21 ~'~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME C~'~ IPHONE ~NEW LOCATION I NO.~EDROOMS ~, DISTANCE TO: W~ ~ ~. AbsorptioT~, Dwelling ~ ~ ~ Manufacturer ~ No. of compartments ~ Liq. c~'~alJon, IF HOMEMADE= Inside length Width Liqui th ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~ ~ DISTANCE TO: ~ No. of lines Length of each line Total length of lines Trench width Distance between lines inches ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area Q inches ~ Length q q ~ Width ~ ¢ t Oepth .~ ( PERMIT N~ ~ ~ Type of cri~ ~ Crib diameter ~ Crib depth~ Total effective absorption area ~ Class ~epth Driller Distanco to lot line Pfi~MIT ~O. ~ DISTA~Cfi TO: BuHdinO foundation Se~er line Septic tank ABsorption area{s) OTHER PIPE MATERIALS ~ ~ ~ ~ REMARKS U~ ~ ,,,, 72-01: F'ERr~I T NO. APPLICANT STEVENS SKAGGS CONST. P, O. BOX P CHUGIAK AK. LOCATION LEGAL LOT '12 BLK .~ NORTHWOOD SUB PH# LOT SIZE TYF'E OF ~nlL ABSORF'TION _,,.~TEM IS MR',;z, IMUM NUMBER OF E:EDROOMS = 44444 SQJARE FEET SOIL RATING (S..] FT,,"BR)=~,~'-"-.~ THE REQUIRED SIZE UF THE ~C~L HEE~OE~'TI~OI-~i~_TEM I_. C, EF'TH= 7 LE~UTH---- --~8~'~] (~RR'~ "~ EL DEPTH-- 5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE GROUND RND THE 80TTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT APPLICANT HAS THE RE:,FJN_,IBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION IN_,FEL. TION_, OF ANY WELLS ADJACENT TO THIS PROPERTY AN[) THE II ' * '- ) N_MBER OF RE_-.IEENUE=. THAT THE WELL WILL SERVE. TI.-~C~ ,:'. ~-'-:'- ) I ~'-,~SPE~]T I ~]N_- ~ RF~2E I~.'EQLi I RE[:, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEF'RRTMENT WILL BE =,LIBJEL. T TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS · 100 FEET FOR A PRIVATE WELL OR '150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERi~I I T E;:-~F' I RES [:~ECE~'IBER I CERTIFY THAT -I' i: I AM FAMILIAR WITH THE REC..!UIREMENTS FLR ON-SITE SEWERS AN[:, WELLS AS SET FORTH BY THE blLINICIPALITY OF ANCHORAGE. 2: I WILL INSTBL~THE SYSTEM IN ~CCORD~NCE WITH THE CODES. 3~: I LtNDERSTRND ~T TH~N-SITE SEWER SYSTEM MAY REQUIRE ENLBR~EMENT IF THE Russell Oyster 694-2774 Performed for: O & E EN~,'NEERING & DEVELG,~MENT CO. Legal Description: ,L- Depth (feet) 0 9__ 10__ 11 Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Soil Characteristics Earl Ellis 688-2280 Tel. No PLOT PLAN 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Yes ~ No__ Proposed Installation: Seepage Pit Comments: Performed by: If yes, what depth Drain Field. ~ PERC. TEST APPLICANT FILLS OUT uPPER HAl ONLY Prop~[ty ~)wner J~ ~'A/ ~ g'~'~ ~-'- Phone .: Mailing Addre~ ~C]?/ ~ ~ .~.~ ~?~--~ ~ r ZiP Code Buyer Address ,~__ Zip Code Le'~ing Institution Phone Address Zip Code Phone Realty Co. & A~nt Address~ Zip Code Legal Descript~n ~ /~ ~ Street Locati~ ~) ? ~ ~. ~ ~ Type of Resi~nce ~e Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply al A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975. nity For wells drilled prior to that date, give well depth (attach log if available); ~ Public Utility Se~e~sal ~lndividual Year Indiv~ual Installed: ~ ~ ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date (~ Inspector Inspector Inspector Inspector Field Notes: /&/O ,/~3 ~t J'~ MUNICIPALI~ OF ANCHORAGE DFPT O~ ','~'LT',~ ~ ENVIRONM;:h M,. ~ .O,ECTION X<C 1 1982 RECEIVED ( ~) APPROVED BEDROOM8 *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVA~ DATE J ~ -~ ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3/82) MUNICIPALITY OF ANCHORAGE CAS H Development Services Department p p z� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051 821 12 1. GENERAL INFORMATION Expiration Date: D e- C- I � , ), 0 )- J Complete legal description NORTHWOODS PHASE 2 BLOCK 2 LOT 12 Location (site address) 22238 SHADOWY SPRUCE Current property owner(s) JIMERSON Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver request for: N O N E Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee,13 Waiver Fee $ Date of Payment Date of Payment Receipt Number �3� �`� Receipt Number COSA # 0 S C a a 1 0 3 2 Waiver # Distan 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 2/2/22 6. DSD SIGNATURE -41 System #1 Approved for System #2 Approved for Disapproved Conditional approval for 3 bedrooms bedrooms *: 49 TH •. iCHARLES G BALZARINI �FG.; • CE -13854 • �`�� /sTFq•••.....••'0 ��F�PROfE5S10�P -� bedrooms, with the following stipulations: WATER A tv n By: �?��` �� Original Certificate Date: a 3 o2�2-Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: B. TANK DATA Age of tank(s) years Tank type/material3ODVWLF Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) NORTHWOODS PHASE 2 BLOCK 2 LOT 12 051 821 12 11 1 ON PUBLIC WATER 0 Septic NA NEW TANK bed 1982 12/16/21 3 4.5 0 na 450 0 0 0 450 NA NA No cleanouts in bed per record drawings. ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ 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 From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ 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 septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft 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 If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft F. ENGINEER’S 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 conformance with MOA COSA guidelines in effect on this date.2/22/22 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Parcel I.D. 051-821-12 1. GENE~L INFORMATION Complete legal desCription cos^# o ~ Expiration Date: NORTH WOODS: BLOCK 2, LOT 12 Location (site address) 22238 SHADOWY SPRUCE, CHUGIAK, AK 99567 Current Property owner(s) JOHN & JANET SIMPSON Day phone Mailing address Lending agency ~'' POBOX 671563, CHUGIAK, AK 99567 ':~ Day phone Mailing address Real Estate Agent LES BAILEY & ASSOC. - KW Day phone 694-1234 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE.'O~ WA,~'~'R,~UPPLY: ,~i,vid'ual Weli'~ "::; , ;i, jndividu~i .Water Sto~,ge ~Com~Unity~ClaS~ A_~ Well Public water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site ~] [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality Of A~ch°rage 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 ^ or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and aS of the validation date shown below, I verity 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 verity that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 12/15/2011 Engineer's Comments: This inveStigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested, The flow cand absorption rates may change due to subsurface conditions that may not be observed froth the surface, hanges inland use, Ioc~i soil characteristics, groundwater levels that maY fluctuate during the .year and the water usage of the family being sewed by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics a nd are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. bedrooms. DSD SIGNATURE J~// Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X ~ ,~.,~v-.. WATER Arsenic Adviso~ Maintenance Agreements Supplemental Engineers Report Other Original Certificate Date: / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Parcel I.D. 051-821-12 1. GENERAL INFORMATION Complete legal description COSA# ~:~} ,~ ~'-~ \~\ % Expiration Date: (~- ~_ ff" / L~ NORTH WOODS ~ BLOCK 2, LOT 12 Location (site address) 22238 SHADOWY SPRUCE, CHUGIAK, AK 99567 Current Property owner(s) IOHN & IANET SIMPSON Day phone Mailing address PO BOX 671563, CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent LES BAILEY & ASSOC. - KW Day phone 694-1234 Mailing Address Un/ess otherwise requested, COSA will be held by DSD for pickup. OF.~DROOMS: 3 ,TYPE O?~WA TE~;'~UPP LY: I nd!ivid6a[ ~11 ' ¢ ?.: ,""i'~id6~['~ter~Storage ' c°'m~bn'itY'Class A We, Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 06/01/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function.satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE [//'"' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: E · ON.SITE : WASTEWATER Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NORTH WOODS #2 BLOCK 2, LOT 12 A. WELL DATA Well type COMMUNITY - A Date completed Total depth f. If A, B, or C provide PWSID # 213001 Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Date of test 'Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100mL Nitrate Arsenic: mg/I Date of sample: B. SEPTIC/HOLDING TANK DATA mg/L Other bacteria Collected by: Parcel ID: 051-821-12 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION g.p.m. colonies/100 mL Fluid depth in absorption field before test [ in. Water added 450 gal. New depth < 0.5 Elapsed Time: 1__ min. Final fluid depth ~ in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date __ Gravel below pipe 0.5 ft. Total depth 43 ff. Monitoring tube Y Depression over field N__ Results (Pass/Fail) Pass For 3__ bedrooms in. Length ~zt ft. Width 36 ff. Eft. absorption area 158~ ft2 Date of adequacy test 5/31/11 Tank Type/Material Septic/Steel Date installed 12]1982 Tank size 1000 gal. Number of Compartments _2 Cleanouts (Y/N) __Y Foundation cleanout (Y/N) _Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/31/11 Pumper IRs C. ABSORPTION FIELD DATA Date installed 12/1982 Soil rating (g.p.d./ft~ or ft2/bdrm) 265 System type Bed LIFT STATION Date installed Size in gallons "Pump on" level at in. ~Pump off' level at Datum Cycles tested SEPARATION DISTANCES 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 containment areas in. Manhole/Access (Y/N) High water alarm level at __.in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ ~Water Se. rvice line 10'+ Surface water 100'+ Curtain drain SlY+ (Nene Knewn) COMMENTS Absorption field 5'+ Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage · Wells on adjacent lots 200'+ 10'+ G. ENGINEER'S CERTIFICATION ..~~ ., i certify that I have determined through #eld inspections and .~ ~,~.'.. ~. ...;, .~ ..;..: · review of Municipal records that the above systems are in .'..~~~:; ~"~&' conformance with MOA COSA guidelines in effect on ~his date. !.~ . . '~:.~..... ,:,,.:.:~...~"~ ~ ~ ~.. .~ .. Engineer's Printed Name KENNETH M, DtTFFUS COSA Fee $490.00 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number / L,:,: _. , Block LOT SURVEY CERTIFICATION f*E~"~:~I,OP~O t~ fRS ~mpcovements sit,J¢l~ there~ ore ~ffhin t~ prop- er~.v nes ar,d ~o ~t over~p 0¢ encroocf ~ ~joce~ property and thor no tmpr,:,.¢emer~s ot~ OdjOOa~f property overlap 0¢ encr~chon the premises LEGEND.. 0¢-0.~ 0 = lr~ pipe an~ rear r~,~emd e = ~8"x ~" rear ~1 rms survey Dote Prepared by: ,9. £, BUTTON '!~ (~07)279-~200 .5/~ ~:' E;'~/;'/b Ave. >~ncho~-oge, ~i~'sk'c~ ~,950/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~/ /~'~ NAA# 1. GENERAL INFORMATION Complete legal description Lot 12; Block 2; North AUG 2 G Woods Subdivision ~2 Location (site address or directions) 22238 Shadowy Spruce Chuqiak, AK Ken Best '24850 Hammond Court Dayphone 694-9301 Eagle River, AK 99577 :~ Rroperty owner -, Mail!n~ address` ',,..Lending agency t. Mailing address Day phone Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3\, NOTE: Individual well Community well xx× Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer 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 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. $ & $ ENGINEERING Nameof Firm l?13:~41~..lel~;ve, L,~epl~,~..i ~,, ~_n4_ Phone ~ c/cf . -~,~ -7 ~ Eagle Ri~ver, Alaska 99577 Address Engineer's signature ~'~/~-- ?/~'¢~-- Date ~/'~' c. /~'7 DHHS SIGNATURE X Approved for b Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Sen/ices (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 DH HS 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. 724)25 (Rev. 1/91) Back MOA ~21 · Municipality of* Anchorage DEPARTMENT OF HE~,LTH & HUM/~N SERVICES EnvirOnmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501 · (907) ~ Health Authority Approval Checklist LegalDescription: ~'~" ~'~' ~t~ ~i.~OOD~ ~>l~arceilDi OJ'! ~"~.! Well type l~k I! A, B, or C, attacbADEC letter. ADECwater system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to Casing height (ab =-. Wires FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATEF g.p.m. g.p.m. Nitrate Other bacteria ~le: B, SEPTIC/HOLDING TANK DATA Date installed Foundation clean¢ Date of ~ Collected by: Tank size: ~,C~o c:) Number of Compartments ~ .Cleanouts (~,) y Depression (Y(~D ~ High water alarm('YAN')~ Effective absorption area Date of adequacy test '2.0 ~ System type ?;;~::) ~ Gravel thickness below pipe ~, ~ ' Total depth ~, ~ ~ Monitoring Tube present~q)~ Depression over field (Y~I~ /~ Results~Fail) }~"~ For ..~ bedrooms Fluid depth in absorption field before test*(in.); ~) ~ Immediately after~__~ gal,watb~' added (in.i Fluid depth (ins) Minutes ater ~/D Absorption rate -- Peroxicle treatment (past 12 months)(Y~ Da ~ /~"~J~)If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date inStalled Size in gallons Manhole/Access (Y/N) "P u m ~ o.~.[~-~'-~ High water alarm level *~-~'-'""'~ *Datum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Spw~ On adjacent lots Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: FoundatiOn ~- ~Jr Property line lcp ~ ~' Absorption field Water main/service line ~ O t-l- ~ ~c Surface water/drainage [o z:) Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I;3 ~ Building foundation ~ ~ t ~ Water main/service line \ o ~' ¥ Surface water \ O ~ ~,~L. Driveway, parking/vehicle storage area ~'-~ ~ '~ Curtain drain I,.~/,~.~ I/--~c~/~ Wells on adjacent lots ~'~O ! '{-' ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of MUnicipal recor~j~ ~-~-.~'~ms are SignatureinC°nf°rmance withMOA ~~~ ~lAAg~idelineslneffectonthisdate. Engineer's Name Date ~/~ HAA Fee $ ~ - ~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number