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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 4 LT 6 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231308 PID Number: 05182103 Dwelling: ❑Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name SULLIVAN ABSORPTION FIELD ❑ Deep Trench N Wide Trench ❑ Bed ❑ Mound Site Address 23234 NORTHWOODS ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 4 0.45 GPD/SF 6/6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3/3 Ft. Gravel depth beneath pipe 3 Ft. Subdivision Block Lot NORTHWOODS PHASE 2 BLOCK 4 LOT 6 Fill added above original grade 0.7/0.5 Ft. Gravel length 78/78 Ft. Township Range Section Gravel width 5/5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1333 Ft z 2 8 Ft. Well - _ _ _ _ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water +100 +100 — _ Material Number of compartments Lot Line +10 +10 - - NA POLY 2 Foundation +10 +10 _ _ LIFT STATION Manufacturer Capacity Remarks dimensions are "north/south" Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank EXIST Tankto 3034 GUARANTEED SVCS Drainfield 3034 CO/MT3034 Inspector C&M ENGINEERING BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 9/25/23 2nd 9/27/23 Location and description 3`d 9/28/23 4`h 9/29/23 TOP OF DECK ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF A1,q k Conditional Approval: Date •' .cS�,� j �� Q�. �. •:9 ;0e49 TH • • • r� Septic Syste t;HARLES G BALZARINI j ApprovedDate zo z ��J� , CE -13854. ..�� Note: this approval d snot include well permit requirements. • • PROFESSIOO 3/10//i k.- UJIuL IU) CHARLES G BALZARINI CE-13854R E G I S TEREDPROFE S S I O N A L E N GINEER 3/10/24 Lot 6, Block 4 North Woods Subdivision Phase II 42,049 Sq. Ft. +/- 23234 Northwoods Drive 2 Story Wood Frame House With Attached 2 Car Garage S SSS S SS SS SS SS T T T EE M.H. SC 2 6 . 3 19.0 2.7 2. 7 3.9 42.5 2 6 . 3 25.7 2.8 5.6 2.7 34.1 24.1 3 0 . 3 10.8 2' O V E R H A N G 35.8 38 . 0 47.5 9.7 94 . 1 15' UTILITY EASEMENT N0 ° 0 0 ' 0 0 " E 2 7 1 . 1 8 ' S0 ° 0 0 ' 0 0 " E 2 7 1 . 3 8 ' N89° 55' 23"W 155.00' N90° 00' 00"E 155.00' LOT 5 LOT 7 T E ℄ NORTHWOODS DRIVE 30 ' R. O . W . EDGE OF PAVEMENT SHEDS 10.3 1 5 . 6 7.9 6 . 1 PA V E D DR I V E W A Y PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. October 18th, 2023. Legend: Scale 1" = 40' Gas Meter Electric Meter/Outside Power Deck Septic Fence Mailbox S G E Lot 6, Block 4 North Woods Subdivision Phase II General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Joan Sullivan 23-431 10/19/2023 82-204 1559 E T Elec. Pedestal Water Valve Tel. Pedestal x S T A T E O F ALA S K A 49 TH ROYEVRUSDNALLANOISSEFORP DER E T S I G E R Pierre M. Stragier NO. LS-9812 10/19/2023 M.H.DrainConcrete MUNICIPALITY OF ANCHORAGE 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 On -Site Wastewater Disposal System Permit hent S 00 � L Q , Department Permit Number: OSP231308 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 05182103000 Site Legal Address: NORTH WOODS PHASE 2 BLK 4 LT 6 G:1560 Site Mailing Address: 23234 NORTHWOODS DR, Chugiak Owner: SULLIVAN JO -ANNE M Lot Size in Sq Ft Design Engineer: C&M ENGINEERING SERVICES Total Bedrooms: This permit is for the construction of: 9/18/2023 9/17/2024 42049 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: S Date: Issued By: �-� Date: o/.70 Z 3 CI MUMURAUTY OF AHCHORA GEE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section -- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05182103000 Property owner(s) SULLIVAN JO -ANNE M Mailing address Site address 23234 NORTHWOODS DR Day phone Legal description (Sub'd., Block & Lot) NORTH WOODS PHASE 2 BLK 4 LT 6 Legal description (Township, Range & Section) Lot Size 42,049 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx] Initial ❑ Single Family (SF) ❑ ADU) Septic Tank ElUpgrade ED(w/wo (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: NA 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: G% 5 Z Waiver Fees: Date of Payment: X2.3 Date of Payment: Receipt Number: co i�Z Receipt Number: Permit No. 05 3 I S I] Z 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 P2 B4 L5 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. We are requesting an expedited review of this application. 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 will be of MOA approved construction. 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. There are steep slopes below the field, less than 10’ in height. The steep slopes are near 25% (4:1) and can be easily filled/graded to 4:1 to remove steep slope concerns. The repair must be performed by a moa certified installer in accordance with MOA requirements. 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 8/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231308, Curtis Townsend, 09/18/23 CHARLES G BALZARINI CE-13854REGISTEREDPROFESSION A L E N GINEER 8/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231308, Curtis Townsend, 09/18/23 Residence: NORTHWOODS P2 B4 L6 number of bedrooms 4 br Water usage/bedroom 150 gpd/br Water Usage 600 gpd system type: Conventional type: Shallow Trench Application Rate 0.45 gpd/sqft required absorption area 1333 sqft trench width (W) 5 ft MIN gravel depth (D) 3 ft Shallow trench factor 0.58333333 (W+2)/(W+1 Min Required Length: 156 ft Calc By: CGB Date: 8/19/2023 C&M ENGINEERING SERVICES 907-854-5558 Septic Design Calculations RESIDENCE/LOT INFO DRAINFIELD REFER TO PLANS FOR DETAILS OF CONSTRUCTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231308, Curtis Townsend, 09/18/23 Municipality of Anchorage Development Services Department On -Site water and Wastewater Section 4700 Elmore St. p O Box 196650 Anchorage , AK_99519 -6650 ··www .muni.org/ons1te (907) 343 -7904 Soils Log Percolation Test ,('?:!}_ ,1.,~U,~Vfr!.l=:._ ___ -;---;-------~Date Performed :7/)J(/:;:, Performed For: _ 7V' 1 '::".':t+t Ph BL/: L,b Township , Range , Section : --:-:----------- Legal Description:}_~~:;t_f:t_~~~1D$.1..b......!L.L-=-=-S~'lo:::;:p:e--Site Plan 0 1 2 Depth ::U 5- (6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- ~t,11'.. -;p--;;.r.1t uM~tJt:.~) ,1-1/T 'I 4'/1"') °P,eH I WAS GROUND WATER ENCOUNTERED?flO I I s Sti fl , ~/'-" IF YES . AT WHAT DEPTH?.,V(~ L-_J_--1-4-~--l--+-+---+- +----1 Depth to Water After Monitoring?f-/ort' P --- E l---4-~--+--+-~-+-+--t--+--l Date ~f&'.i$ Reading Date Gross Tim e Net Time Depth to Water Net Drop -J/JC/)Tj 5,' 5~ 0 L[ ..,O/lb 0r~-\J7 )0 4 -'?llb 1,¥6 I 4 it'Xt n 4 -0/{f:J (J "'- q: ?l/ ?-;n Q,- lrlf6 IJ/(6 )4 ! ~5 f)t,[-o/fb (? I s ,<95 10 4.-t?/(b Ii).fi£ I PERCOLATION RATE 4(2 (minu les/lnch) PERC HOLE DIAMETER h .TEST RUN BETWEEN :2 1 s FT AND 1 f) FT COMMENTS (;;fl{),._µ11'0e,,v,tr&L NOT Ez.;T.l'.5 t<ft~,./ TO crcuR_ -;e,,v~. PERFORMEDBY: UvVl £/,.,{:u."'IV£e-lZ..Jtv6 1 --c::::::::::::CE RTIFYTHATTHISTESTWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUN ICIPA ~LJFFEC T ON THIS DATE . DATE : lf/(/0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231308, Curtis Townsend, 09/18/23 AS BUILT SURVEY W 8y" S.3' 1-3"W, ,/ar .no Zrc- f , Richard P. Hankins, hereby certify that I have surveyed the following described property: Z07' 6, &oCK 4-.1 N047-11 W000-5 Stf6G. • OfJgSE - Anchorage Recording District, Alaska, and that no encroachments exist except as indicated hereon. �•.�-OF At sfi�It is the responsibility of the owner to determine the: existence of any easements,.covenants, or restrictions which do not appear on t ; 49Itr " the recorded subdivision plot. Under no circumstances should any data hereon be used for construction or for establishing r��--* -••--�• boundary or fence lines. � � bC1 i 1 SLS .ja,�'•,,,r 00 i r Data ; Drawn by: Prepared by RICHARD P. HANKINS REGISTERED QRQFESSlONA�. SAND SURVEYOR P 0. BOX 1105 - EAGLE RIVER ALASKA Scale: Piot f if ing no, t i 8z _ zoo- PH. 694.2371 99577 t B1 .f yx N p GT Z I..sKr,�r 4 O N �j } t W 8y" S.3' 1-3"W, ,/ar .no Zrc- f , Richard P. Hankins, hereby certify that I have surveyed the following described property: Z07' 6, &oCK 4-.1 N047-11 W000-5 Stf6G. • OfJgSE - Anchorage Recording District, Alaska, and that no encroachments exist except as indicated hereon. �•.�-OF At sfi�It is the responsibility of the owner to determine the: existence of any easements,.covenants, or restrictions which do not appear on t ; 49Itr " the recorded subdivision plot. Under no circumstances should any data hereon be used for construction or for establishing r��--* -••--�• boundary or fence lines. � � bC1 i 1 SLS .ja,�'•,,,r 00 i r Data ; Drawn by: Prepared by RICHARD P. HANKINS REGISTERED QRQFESSlONA�. SAND SURVEYOR P 0. BOX 1105 - EAGLE RIVER ALASKA Scale: Piot f if ing no, 3o • 8z _ zoo- PH. 694.2371 99577 � t3 /-~ MUNICIPALITY OF ANCHORAGE ' , ~/~ S'1' 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 PHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOM8 Well [ Absorption area Dwelling PERMIT ~ ~Z Manufacturer ~e~ Material~_e [ N°' of c~mpartments Liq. capacity in gallons IF HOME.DE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~_~O Z ~ Manufacturer Material Liquid capacity in gallons D~STANCE TO: CO~., ~ F°""d~ti°" 2_ ~ =.5 ~.~ Well Nearestlotline PERMITNO. No. of lines Length of each line Total length of lines Trench width Distance between lines ~ ~ ~ Top of tile to finish grade ~ { Material beneath tile Tota~ effective absorptio~ area Length Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Buildin~ foundation 8ewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER I~ R EMAR KS ~'~ APPROVED DATE LEGAL 72-013 (Rev. 3/78) ,i I I ,,'"~T MUNICIPALITY OF ANCHORAGE DEPAR ~ MENT 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 PHONE Z&31 ~NEW MAiLING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well ~ ~ DISTANCE TO: ~- ~ Absorption area Dwelling PERMIT NO. , Liq, capacity in gallons Inside length Width Liquid depth ~ ~ OO IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. · --~O Z ~ Manufacturer Material Liquid capacity Jn gallons ~ Well Nearest lot line PERMIT NO, ~ DISTANCE TO: ~m~~ ~ Foundation ~ ~ _~ Z No. of lines ~ ~Length of each ~) ~ l~line Total le~of lines/o~ Trench ~width inches Dista~e between~l ~) ~li~es ~ ~ ~ Top of tile to finish grade ~ Material beneath tile Total effective absorption ~ea ~m Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation 8ewer line Septic tank Absorption area(s) OTHER pVC , SOl L TEST RATING ~ ~" INSTALLER ~ APPROVED DATE LEGAL 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Departmen~-~f Health and Environment~,Protection 825/~ Street, Anchorage, AK. 29501 264-4720 p . ''~,~ /~ ~/~'~* * * HANDWRITTEN PERMIT * * * ermlt ~3~(~' ~2~-~-L--~ND/OR~ -- ON-SITE SEWER PERMIT Applicant: ~ ~~ Mailing Address: Location: Phone Number: Legal Description: Z~, ~ ~/~ /~/~ LOt Size: -' Type of Soil Absorption System Is: Trench:. _~ Drainfield: Seepage Bed: Holding Tank: Maximum Number/' of Bedrooms: __ Soil Rating(sq.ft/br) ~ The Required Size of the Soil ~sorption System Is: ~/;~ DEPTH ~ LENGTH 77 . GRAVEL DEPTH ~ WIDTH ~/~ The length d~ension 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). There is no set width for trenches. The gravel depth is the m~im~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~ ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = /OOO GALLONS ~ ~ 'Permit applicant has the responsibility to inform this department during the inst~ll~tion inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of.the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 51, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is include more drooms< remodeled to thaw 3 be / /~ Date: ,~_--t'~_ -- '~' / ~U SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMED FOR: LEGAL DESC,RIPTtON: .SOILS LOG J~'"'PERCOLATION TEST DATE PERFORMED:, 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15- 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? SLOPE IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop (.~,',PS % - ~ z~ ~ ._ ,7 Z. ~ - PERCOLATION RATE TEST RUN BETWEEN COMMENTS ~ CERTIFIED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-821-03 Certificate of On -Site Systems Approval Expiration Date: 9/25/2024 Legal description NORTH WOODS PHASE 2 BLK 4 LT 6 Site address 23234 NORTHWOODS DR Current property owner(s) SULLIVAN JO -ANNE M XThe On-site system(s) is/are approved for bedrooms Conditional approval for 4 bedrooms, with the following stipulations: Comments or advisories: By Original Certificate Date: 3/20/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department P P Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 s Certificate of On-Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051 821 03 Complete legal description NORTH WOODS PHASE 2 BLK 4 LT 6 Location (site address) 23234 NorthWoods Current property owners) Sullivan 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY:,U�j Private Well E] Private Well serving 2 dwelling units �❑Private Well serving 3+ dwelling units 0 Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench X Wide Trench ❑ 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 $ z 0 Waiver Fee $ Date of Payment Z 1 2 I q -'O Date of Payment COSA # 0 S C 2 0 3 0 Waiver # COSA Application—June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. 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 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping 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) 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. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No 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 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 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 Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 3/10/24 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 GENERAL INFORMATION Complete legal description Northwoods #2, Lot 6, Block 4 T15N R1W Section 3 Location (site address ordirections) 23234 Northwoods Drive, Chugiak Property owner s¢_o~-~- A. & ,~oAnne ~4. Sullivan Day phone 688-3814 Mailing address HC 80 Box 116, Northwoods Drive, Chugiak, AK 99567 Lending agency N/A Day phone Mailing address Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: 3 "-4 x Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY AP PROVAL CHECKLIST Legal Description: /¢0£7'/¢~ooz~$ ¢¢Z /.07- ~ 8/,/d ~ A. WELL DATA Well type ,/¢ If A, B, or C, attach ADEC letter· Parcel I.D. ADEC water system number ,~/~01 Log present (Y/N) Date corn pleted Driller. Total depth Sanitary seal (Y/N) Date of test Cased to FROM WELL LOG Static water level Well flow Pump level SEPARATION DISTANCES FROM W/EL~L TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service lin/o/ WATER~k'~IPLE RESULTS: Germ Nitrate. D~te of sample: Casing height/,.--"'" Wires property protected (Y/N)/.. / MUNICIPALITY OF ANCHORAGE AT I~,~'PECTIOJ~NviP.,ONMENTAL SERVICES DIVISION .,..- .".:. I ,t /- D ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC~NG TANK DATA Date installed 0~;/?.~ Tank size /~O~ Cleanouts (Y/N) ~V£~ Foundation cleanout (Y/N) Compartments ~ Depression (Y/N) /J High water alarm (Y/N) pumping /~/0~//?/ Date of Alarm tested (Y/N) /A,//~Z~ Pumper -~,~/~ SEPARATION DISTANCES FROM SEPTIC/H ...... ~-TANK TO. Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field /./OD ' ~V'/x~ Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 February 4, 1992 FOR: Eagle River Engineering PWSID # 213001 My review of the records on file in this office reveals that the Chugiak Utilities (Northwoods 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. Sincerely, Byron Roys Environmental Engineer BR/cf ~_~ printed orr recycled paper b y O.D. APPLI~,NT FILLS OUT UPPER HA. ONLY Froperty. Owner ~p~. /~0 ~'~/~m8 Phone Addres~ Buyer Address Zip Code Phone Lending Institution Address Zip Code Phone Realty Co. & Agent Address Zip Code Ty~e~fl'esidence ~Single Family [] Multiple Family No. of Bedrooms [] Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Gom ividual munity For wells drilled prior to that date, give well depth {attach log il aYailable). [] Public Utility Sew_er~sposal: ~Jndividual Year Individual Instatled: [] Publi~ Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182) 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 051-821-03 NAA# )l~ ~q ~ GENERAL INFORMATION Complete legal description Northwoods #2, Lot 6, Block 4 T15N R1W Section 3 Location (site address ordirections) 23234 Northwoods Drive, Chugiak Property owner ~nt~ A. & JoAnne M. Sullivan Day phone 688-3814 Mailing address HC 80 Box 116, Northwoods Drive, Chugiak, AK 99567 Lending agency N/A Day phone Mailing address Agent N/A Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 3 '.4 NOTE: Individual well Community well x 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: x Individual on-site Holding tank Community on-site Public sewer If community wastewater sysfem, 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 Eagle River Engineering Services Phone694-5195 Address P.o. Box 773294, Eaqle River, AK 99577 Engineer's signature ~'"'~ Date. 6. DHHS SIGNATURE .~ Approved for ,--.~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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: A~O£7'/'//,uoOZ)$ '/" I S ,,V A. WELL DATA Well type ,'~ Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. FROM WELL LOG Date of test Static water level Well flow . ,/,,g~.m. .um.,eve, SEPARATION DISTANCES FRO~.EI_L TO: Septic/holding tank on lot Absorption field on lot Public sewer main If A, B, or C, attach ADEC letter. ADEC water system number ~0~)/ Date completed Driller Cased to Casing height . ~.--'"~' Wires properly protected (Y/N) / ~ MUNICIPALITY OF ANCHORAGE /~J~JJECTIOI~NvII~oNMENTAL SERV CES DIVISION Sewer servi~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank EIVED Nitrate. Other bacteria Collected by: / Date installed DS/? Cleanouts (Y/N) YE.~ High water alarm (Y/N) Date of pumping B. SEPTIC/HQL-I;)tNG TANK DATA Tank size /¢ (¢00 Compartments Foundation cleanout (Y/N) y~_,4 Depression (Y/N) /A//D Alarm tested (Y/N) /"//,,~ 0~//--)¢(~ / Pu m per SEPARATION DISTANCES FROM SEPTIC/H ...... ~TANK TO. Well(s) on lot ~ On adjacent lots ~ ~/J To propertyline ¢¢/ ~ ~ ~ Surface water/drainage Absorption field Y-/OD ' Foundation Water main/service line 72-026 (Rev. 7/91) Front ' CONTINUED ON BACK PAGE C. LIFT STATION Date installed - , - - ~ ~Y/N) Size in gallons Vent (Y/N) __ _ 'Pump on" level at _,---'" "Pump off" level at High water alarm level .~ ....._.-~"'~Ir' Cycles tested Meets MOA electrical code.,s~-~) __ SEPARATION~J~t'S~ANCE FROM LIFT STATION TO: W~t On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ Length ~ 5- / Width Total absorption area Depression over field (Y/N) Results (pass/fail) Manufacturer . ~ Peroxide treatment (past 12 months) (Y/N) Soil rating ,~/~ /~/,~ ~/~/- System type Gravel thickness ?.~/~ Total depth Cleanouts present (Y/N) ~ Date of adequacy test ~'////~ for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /Y//~ To building foundation Onadjacentlots "~¢~ Surface water Curtain drain Onadjacentlots '~.~¢* Propertyline .2~, / ~¢~,~.~ To existing or abandoned system on lot Cutbank ~v/,~ Water main/service line Driveway, parking/vehicle storage area 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. Signature Engineer's Name Date HAAFee$ ./~ Date of Payment Receipt Number 72-026 ~Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt NUmber