HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 13 LT 2North Woods #3 Block 13 Lot 2 #051-732-23 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program, 4700 Bragaw St.; P.O. Box 196650 Anchorage, AK 99519.6650' www.d.anehorage.ak.us(907)343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number: SWO90148 PID Number: 051-732-23 Name:NORHTW00DS #3, LOT 2, BLOCK 13 Wastewater System: ❑ New ■ Upgrade Address: 23120 GREEN GARDEN DRIVE • CHUGIAK, AK ABSORPTION FIELD Phone: No. of Bedrooms: (907) 250-5480 3 O Deep Trench ■ Shallow Trench a Bed 0Mound 0Other LEGAL DESCRIPTION Soa Ro" 0.6 Total Depth from wigirol grade: 3.5 MAX GPD/sn. FL n. Block: Lot: Subdnieion: Depth to ppe kotta,n /ram ".1 grade: Or" depth bawlh pipe: "I' 13 2 NORTHWOODS #3 SEE DWG. In. SEE DWG. In. Township: Range: Section: Madded ako.e wlgkal grog: Gro.N knvh: — — — SEE DWG. FL 132 (3 ® 44) n WELL: ❑ New ❑ Upgrade Waal .�eU 5 Nwnaw a krwe: 3 Getenw bt.een Yaee: 15 R n. Cbealco (Pnwte. A.B.Q: Toto) oro Caned To.(scatc c) Total ae.wptfan ww: P" lnatwiat 758 D 3034/ F-810/SCH 40 n. n So. Fl. DNNr Dad Dnlra; Static wolw Le : kWollw: GREEN GENERAL Dote metalled: 9/3-4/09 n rwtl Pulnp SO At: Camp Neighl AOoee Gr : TANK GPN n In. SEPARATION DISTANCES aseptic OHolding ■S.T.E.P. 0Others To Septic Absorption Lift Holding NK/PrHele YO'"'I«tw..: ANCHORAGE TANK C dy a gobw: 1250 :ram Tank Feld Station Tank Se.w unfe Well zoo'+ 200'+ zoo'+ — 25'+ wtvial STEEL Nama. at awnpwtm.nt. 2 Surface water 100'+ 100'+ 100'+ — — LIFT STATION Lot Line 5'+ t0'+ 5'+ — — SH F gallam: 1250 Nonuf«tw . ANCHORAGE TANK Foundation 5'+ 10'+ 5'+ — — en Vwl el ump Of ler.1 aL Hpn .alw alwmW: 41 41 45 Pump Y ,. a YoaO: ORENCO ENatnral kleyect wnwmea br. Curtain Drain NONE KNOWN P20 OSI 05 HHF-5 STAGE WALKER ELECTRIC Remarks: ABANDONED OLD SEPTIC TANK PER UPC BENCH MARK L«aka„ and Deewipt.: BOTTOM OF SIDING AT CORNER OF HOUSE CLOSEST TO TANK Aewned Ete.atian: 100.00 n Inspections performed by: GEG, Ltd. Dates: 1st 9/3/09 ENGINEE? SEAL 4p� 09 00OF LgsO�o 3rd 9/3%09 ooP.OF... Development Services Department ApprovalQ'?. 4 T _ .to Conditional approval:: Date: .. .. . 'r' .A. . G•..... •.:. . CE -79P3 t p �o�•�cgoo 4Op�"Proresslof, /�� Reviewed and approved by: ee� f ate: l�-O� R e OO000��o PERMIT NUMBER: SW090148 ASBUILT DRAWING PARCEL ID NUMBER: - 051-732-23 GARNESS ENGINEERING B p,'?' H GREEN GARDEN DRIVE A �-••••••• .• •• .••• ST1 46.31 36.97 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ST2 51.09 42.23 2 OF 3 - - - - - - ess.: MH 52.46 43.76 •' `�oL �OPr TYPE OF WORK: DATE: QO4p 4 INCH UNE IS CAPPED AT AS—BUILT DRAWING MT1 59.79 17.89 TANK AND NOT HOOKED UP TO S.T.E.P. TANK MT2 95.43 50.75 MT3 58.02 29.87 — — — — — — — — — — _ — — — MT4 93.32 54.59 1' NEW 1250 GALLON' MTS 63.54 45.37 ,�„'F = S.T.E.P. TANK MT6 ham. OLD TO BE USED AS RESERVE MTS ST1 . NEEDS T SITE. NEEDS TO BE CONNECTED TO THE S.T.E.P. TANK PRIOR TO USING. H NEW NORTHWOODS 03, LOT 3, BLOCK 13 NORTHWOODS /3, LOT 5, BLOCK 13 I'4 EXISTING 3 BE HOUSE NOTE TEST HOLE LOCATION ON DESIGN WAS INCORRECT, ACCURATE LOCATION IS AS SHOWN ON THIS DRAWING NORT14WOODS /3. LOT B. BLOCK 13 (Rev. DINS) L GARNESS ENGINEERING GROUP, Ltd. p,'?' H _ CONSULTANTS B GENERAL CONTRACTORS �-••••••• .• •• .••• ........ 3101 L TIDJ11 colo. LAlO 101 . MKMYUOL W e 7 /n01S (e01f3T- IN • W (WMM-M" Ownrpr�yern PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •• •••• QQ ';J Gar .•••••• STEVEN BIXEL 250-5480 2 OF 3 y y ess.: LEGAL DESCRIPTION: NORTHWOODS /j3. LOT 21 BLOCK 13 DRAwN BY: K.D.b1.•�.�9 QO s ' , 3 �Eo� •' `�oL �OPr TYPE OF WORK: DATE: QO4p ' AS—BUILT DRAWING 9/8/09 fss"of% (Rev. DINS) L FROM :GGC INC FAX 140. :9076961815 Sep. 08 2009 12:53PM P2 WALKER ELECTRIC CLINT WALKER 10319 Colville SL EAGLE RIVER AK, 99577 Llctme 0 1710 Phone 6968964 Cel N 223.6304 Email Clinwan&ol.00m To: Green General Contracting Date :9-5-09 Ref :Northwoods #3 Lot 2, Block 13 Permit : This is to certify that on site sewer lift station at above mentioned property has been wired in accordance with the standards of the National Electrical Code and manufactures specification. Systems were checked and performed as specified in the systems manual. Clint Walker Y-60 `19YA`I/ A A O O N MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW090148 Legal Description: NORTH WOODS UNIT 3 BLK 13 LT 2 Design Engineer: 0855 GARNESS ENGINEERING GROW Owner Name: STEVEN BIXEL Owner Address: 23120 GREEN GARDEN DRIVE CHUGIAK , AK 99567-5436 Date Issued: Aug 13, 2009 Expiration Date: Aug 13, 2010 Parcel ID: 051-732-23 Site Address: 023120 GREEN GARDEN DR Lot Size: 0 SO. FT. Total Bedrooms: 0 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By Issued B — Date: 3 v 5 Y Date: epI h' Municipality of Anchorage Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05, 1— ;':� — o? _� Property owner(s) STEVEN BIXEL Day phone 250-54RO Mailing address 23120 GREEN GARDEN DRIVE ► CHUGIAK AK Site address Zip Code 99567 Legal description (Sub'd, Block & Lot ) NORTHWOODS 03, LOT 2. BLOCK 13 Legal description (Township, Section & Range) Lot Size Sq.Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 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. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees;: o Y Date of Payment: i' % O Receipt Number. .Z A (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS z---- August 3, 2009, Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Northwoods #3; Lot 2, Block 13, To whom it may concern: The existing 3 bedroom house is served by public water and a private septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to install a 1500 gallon S.T.E.P tank and a 5 -wide trench type drainfield consisting of 3 pressurized trenches. One test hole was excavated on the property. The drainfield is designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the vicinity of the drainfield is a 1-5 percent slope, running approximately south to north. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. M.S. NOTE! Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact C.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamcssengincering.com ALL SURROUNDING PROPERTIES I I NORTHWOODS 1}. I NORTHWOODS 13. ARE SERVED BY PUBLIC WATER LOT 14, BLOCK 1z LDT 13, IONSK 121 li w II IIr— NORTHWOODS /3. NORTHWOODS 13. LOT S, BLOCK 13 LOT S. BLOCK 13 J I I Of 1 I >I II , II NORTHWOODS LOT 7, BLOCK 13 I I I II II II LIVE ALDER AVE____________ NORTHWOODS 13. I NORTHWOODS 13, I NORTHWOODS /3, I NORTHWOODS 13, LOT 4, BLOCK 14 LOT 3, BLOCK 13 LOT 2, BLOCK 13 LOT 1. BLOCK 13 GARNESS ENGINTEERING GROUP, Ltd. •---•+-•• CONSULTANTS 3 GENERAL CONTRACTORS 1 C Tp011 IIOb. /1/R 101 � AMDICIULi. //( N]Or � r10L (ypTinylw � ry M,fav_�,u , rw•m rKLrMLV rUK: PHONE NUMBER: STEVEN BIXEL 250-5480 LECAL DESCRIPTION: NORTHWOODS #3, BLOCK 13, LOT 2 TYPE OF WORK: SITE PLAN 1 OFy 2 '• f yY -- ne . DRAWN BY: QO p� CE -7 53 a`G KDM 7/23/2009 LLJ�= ' I NORTHWOODS /3. NORTHWOODS /3, NORTHWOOOS 13. 1 I } LOT 10, BLOCK 12 LOT 11. BLOCK 12 LOT 12. BLOCK 12 I I O >1 NORTHWOODS 13. 1 I v LOT 9, BLOCK 12 11 11 I I i 0 II NORTHWOODS /3, LOT S. BLOCK 12 GREEN GARDEN DRIVE /� / Ru—3 y. EXISTING 1 I I 3 BEDROOM 1 1 HOUSE �� NORTHWOODS /3. 1 1 LOT 1, BLOCK 13 I J I NORTHWOODS 13. / PROPOSED I 1 1 m I of LOT 3, BLOCK 13 SEPTIC SYSTEM =s w NORTHWOODS /3. NORTHWOODS 13. LOT S, BLOCK 13 LOT S. BLOCK 13 J I I Of 1 I >I II , II NORTHWOODS LOT 7, BLOCK 13 I I I II II II LIVE ALDER AVE____________ NORTHWOODS 13. I NORTHWOODS 13, I NORTHWOODS /3, I NORTHWOODS 13, LOT 4, BLOCK 14 LOT 3, BLOCK 13 LOT 2, BLOCK 13 LOT 1. BLOCK 13 GARNESS ENGINTEERING GROUP, Ltd. •---•+-•• CONSULTANTS 3 GENERAL CONTRACTORS 1 C Tp011 IIOb. /1/R 101 � AMDICIULi. //( N]Or � r10L (ypTinylw � ry M,fav_�,u , rw•m rKLrMLV rUK: PHONE NUMBER: STEVEN BIXEL 250-5480 LECAL DESCRIPTION: NORTHWOODS #3, BLOCK 13, LOT 2 TYPE OF WORK: SITE PLAN 1 OFy 2 '• f yY -- ne . DRAWN BY: QO p� CE -7 53 a`G KDM 7/23/2009 NUMBER OF BEDROOMS: 3 GALLONS PER DAY (CPD): 450 CC PERCOLATION RATES: 24 MIN./INCH W PROPOSED APPLICATION RATE: 0.6 MINIMUM DRAINFIELD SO.FT.: 750 H DRAINFIELD DFSIGL MAXIMUM DEPTH: 3.50 FEET WIDTH: S FEET LENGTH: 132 (3 O 44) FEET M.OA APPROVED SAND FILTER: N/A EFFECTIVE: 1.00 FEET REDUCTION FACTOR: 0.87 ACTUAL SO.FT.: 758 PROPOSED ORAINF)ELDS ARE PRESSURIZED. DRILL (10) 1/4' HOLES (SPACED EVENLY) PER I ES TOTAL OLD DRAINFIELD m— BE USED AS A RESERVE SITE NORTHWOODS /3, LOT 3, BLOCK 13 NORTHWOODS /3, LOT 5, BLOCK 13 R PERTAINS TO THIS DESIGN. IMLL JUKKULI NUING I-KUrtHnts JN A COPY OF THE LETTERARE SERVED* BY PUBLIC WATER EG. BY PROCEEDING FORWARD INSTALLATION, THE ENGINEER, CONTRACTOR AND NOTE: THE CONTRACTOR SHALL r OWN, Y OWNER AGREE THAT THEY HAVE THE WEST LOT LINE FLAGGED ) THESE SPECIFICATIONS AND BY A REGISTERED LAND SURVEYOR 0 ACCEPT THE TERMS AND PRIOR TO CONSTRUCTION. )NDITIONS OUTLINED. GREEN GARDEN DRIVE 4 PROPOSED 1500 .:.�i•• GALLON STEP TANK t; .;L:". EXISTING 1000 GALLON SEPTIC TANK TO BE COMPLETELY ABANDONED PER UPC reto T — — — EXISTING 3 BEDROOM HOUSE SED DRAINFIELD �- IPu,, NORTHWOODS /3, LOT 6, BLOCK 13 GARNESS ENGINEERING GROUP, Ltd. -• • --. CONSULTANTS d GENERAL CONTRACTORS .ml L n fvo, fort fo, • M CMM/LS. AK ffe0l . n (W?).=1 ,j„ • 1" (907) a PREPARED FOR: PHONE NUMBER: PAGE NUMBER: STEVEN BIXEL 250-5480 2 OF 2 LEGAL DESCRIPTION: DRAWN BY: NORTHWOODS 03, LOT 2, BLOCK 13 KDM TYPE OF WORK: DATE: PROPOSED SEPTIC SYSTEM DESIGN 8/3/2009 F o°O`''.' 4 v p......... . ............. I f e A. Gar ss: c 'Prof essl0a, O��DO�DOo ��Opp (MINUTES) READING o��pF 7/29 2009 1 3:40 GARNLSS 6• o NGINLLRING GROUP,'Ltd. y�00 2 SULTANTS a GENERAL CONT CTORS 9 S 0. Su 3701 CnO 101• A SW]• SO 141 •FAIL W N• ML851fp p,r,.wp.rbq.mm-•••••• •••• •••••• ••:•*O 3 SOIL LOG - PERCOLATION TEST 0 LEGAL DESCRIPTION: NORTHWOODS J3. LOT 2, BLOCK 13 ••.Jeff a ess, PERFORMED 4 3 :per e� p f/5ptf.•' SFO FOR: STEVEN BIxEL DATE: -7/28/2009 ��. ' E— 9DEP (f et7 =- - ORGANICS44�o'paslon0% ro/a 5 TEST HOLE 1 p0000 Slot, 1 6• _ 6 SOIL CLASSIFICATIONS 2 4 3 4` 1 1 4• _ _ ORG ------- ------------------ ----- 3 ? Iai`.! GP MIL i GREEN GARDEN DRIVE HIM GM CL '-------- 4 GC OL ,. °° SW MH -------- ---------------- SM i i OH SM TO GM % e; 6 SC THI1+ Q 7 DEPTH TO DATE GROUNDWATER 615` NORTHWOODS /3, �. 7/28/2009 LOT 3, BLOCK 13 3 BEDROOM z SO 9.5' 8/4/09 HOUSE 9 SCALE: 10 1 1 1• ' 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP 12 13 ML 14 15 B. .11. 16 17 18 19 PERCOLATION RATE 24 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: KYLE MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS COMMENTS: GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE PERFORMED BY WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 09 TIME (MINUTES) READING (INCHES) 7/29 2009 1 3:40 - 6• _ 2 4:10 30 4 1 2` 1 1 2` 3 4:10 - g• _ 4 4:40 30 4 3/4` 1 1 4• 5 4:40 - 6• _ 6 5:10 30 4 3 4` 1 1 4• 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 RFPnRT NAME / LL S7CNE s'i� P/HONE ANEW �+ s V —ZS ❑ UPGRADE MAILING ADDRESS //® -0 (fdu ,-, k LEGAL DESCRIPTION Z !3 LOCATION �A /V[2f S�rl� NO. OF BEDROOMS 3 OY DISTANCE TO: Well ;o'LIZ AC Absorption area Dwelling PERMIT NO. A0 A"& -A4 4v— CL I– z NF Manufacturer tr eCf G._ Material No. of compartgtents Liq. capacity in gallons 100o IF HOMEMADE: Inside length Width Liquid depth z DISTANCE TO: Well Dwelling PERMIT NO. 02f Manufacturer Material Liquid capacity in gallons w = DISTANCE TO: Well Pu k /i�" Foundation Nearest lot line PE I N Lu LL z Z W ~ No. of lines Length of each line Total length of lines Trench width inches Distance betu�(eep lines ¢ Fes- Top of tale to finish grade i Material beneath the Gpa Total effective absorption area � / C^, inches LU Length Width Depth PERMIT NO. a I_ CL wa WBuilding Type of crib Crib diameter Crib depth Total effective absorption area Ch DISTANCE TO: Well foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS �d SOIL TEST RATING ZZ INSTALLER 5 rhe w",. SEe s lonj REMARKS V Iry N ' �. o 0 LLL APPROVED DATE LEGAL 13 A/M, #wo o ds %— 79_M2 lo.,.. Z/mol 1v1UIN 1l.1 rAL.1 I T Ur ANUMUKAOC Department of Health and Environmental Protection 825 Street, Anchorage, AK. -`9501 264-4720 U Permit # HANDWRITTEN PERMIT # # W.FLL AND/OR ON-SITE SEWER PERMIT Applicant: Mailing Address: f'� / ', �.• (1 iu c �_ii Location: Phone Number: Legal Description: L�� / %( �:. li �,r•��,�--,�� /�/ Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed:_ Holding Tank: Maximum Number of Bedrooms: Soil Rating (sq. ft/br) ��/ aJce 5 7�l� The Required Size of the Soil Absorption System Is:' ZY DEPTH YL r LENGTH _ _3� GRAVEL DEPTH 6 WIDTH 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). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number Df residences that the well will serve. #, TWO M INSPECTIONS ARE REQUIRED # # 3ackfilling of any system without final inspection.and approval by this department gill be subject to prosecution. 4inimum distance between a well and any on-site sewage disposal system is 100 feet Eor a private well or 150 to 200 feet from a public well depending upon the type :)f public well. Minimum distance from a private well to a private sewer line Ls 25 feet and to a community sewer line is 75 feet. well logs are required ind must be returned to this department within 30 days of the well completion. ether requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 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 remodeled to include more hat 3 bedrooms. Signed: -dtiC3 Issued by: f'�C '✓�- �.Lc! _ ' 7f Applica Date: SWP/024(1/81) ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • is DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 5TC11Z--1,/ S/C'46• S COiVST.e• DATE PERFORMED: 61/a' // 'T3 �p / //' T/.�l//���. R / w, --5'/)y" - LEGAL DESCRIPTION: Z07-'�i 7>G.GC/L /� 1,X047*V JcJ,0 -5'6Je - / %,gs'E 3 DEPTH SLOPE SITE PLAN (-/V0 5C LE 1 1 (FEET) 10L 51,-,- 2 3 4 �1% :51L,7-1- G2LJl1�c,7) h;/.E S. mn 5 v 7 9 IN 5 10- 11 0 11 WAS GROUND WATER �JJ S ENCOUNTERED? i -S L O 12 P _ IF YES, AT WHAT 8 : �/ / E 13 DEPTH? / IV Nf. It kill 15 ® cogo's * 'm° g 11 16 � •.°° .......,.. s..., .. ...° ..... .o. if 17 R` S Earl P. Ellis W ®�Q NO. 1745•E 18 C� ��� ° • �e ��pROFESSI�NP�®~� 19 4�Oes®aoa�°` Reading Date Gross Time Net Time Depth to Water Net Drop //: 0 Z S it !r 7 /Z;oz f -5- 20 20 7 PERCOLATION RATE �y // /l' (minutes/inch) 3 Z i TEST RUN BETWEEN FT AND � FT COMMENTS .SLOPE 47— P/T N �} /y ° /Vtl ��"D.2yG/L �ICOUx/T,E�.€L> e CXC�IG�4T-rx d S J PERFORMED BY: EBq,-L E:'LG/S CERTIFIED BY:j_[�Gr /" ' 1�� DATE: 6 $ C- E/vc>/A/xn--.2/.V6 72.008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-732-23 Certificate of On -Site Systems Approval Expiration Date:.Z `7 Legal description NORTH WOODS UNIT 3 BILK 13 LT 2 Site address 23120 GREEN GARDEN DR Chugiak AK 99567 Current property owner(s) ADAM & JESSICA BRUSCHER X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: By: bedrooms, with the following stipulations: Original Certificate Date: Z -3 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 MUMUPAUTY OF U HCHO QGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcell.D. 051-732-23 Complete legal description North Woods #3 Block 13 Lot 2 Location (site address) 23120 Green Garden Dr. Chugiak, AK, 99567 Current property owner(s) Adam & Jessica Bruscher 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ® Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: V Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 14 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench © 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 $ 2590 Date of Payment Z i CD2 "3 COSA # oSc23 r� Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: COSA Checklist North Woods 93 Block 13 Lot 2 Parcel ID: 051-732-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ELL DATA ❑ Well lag d with Onsite (or attached) Date drilled a} 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. Comments _ B. TANK DATA Measured operating fluid level in septic tank 41 Date of pumping 3/13/23 ❑ Required maintenance completed, if AWWTS Comments D. ABSORPTION FIELD DATA Which system tested (date installed) 9/3/09 0 ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade ft (min) 0 N/A — pressurized field. ✓❑ Per record drawings, field is insulated. F/1 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 Comments/Deficiencies (trench 1/2/3) 3 trenches, 450 COSA Checklist June 2022 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative trate; mg/L ❑Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date C. LIFT STATION Z Required maintenance completed Age of lift station 14 years Lift station material Steel Comments: Adequacy test date 4/18/23 Results 0 Pass Fluid depth prior to test 0/0/8 in Water added 450 gal New fluid depth 0/8/8 in Elapsed time 180 min Final fluid depth 0/0/8 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY ] 2.8/13.6/12.7 Effective depth (per record drawings) in Effective depth used 0/0/8 in Effective depth remaining in 12.8/13.6/4.7 added to center trench. 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 5+* Community Sealer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank - 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ 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 Surface Water > 100'✓❑ Yes if No ft Tank to Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' © Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' 21 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *Meet 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 Arcterra Consul Engineer's Printed Name Kenneth Duffus Phone (947)-596-6111 Date —As .2.5 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 4i 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 u 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 l/a 6 KF NNETH M 4 FUS f i F c - 49M � .A* COSA Checklist -June 2022 a Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 051-732-23 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods Unit 3 Block 13 Lot 2 Location (site address) 23120 Green Garden Drive Chugiak, AK Current Property owner(s) Hartman Day phone 727-5555 Mailing address same Real Estate Agent Viki Kaas, Homes Unlimited Day phone 727-5555 2. TYPE OF DWELLING: �Iv N Single Family (w/wo ADU) ❑ Duplex ,\ ; ❑ Multiple Dwellings (Single Family and/or Duplex)\`4, � 'A �" 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual N Individual. Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System N Public Sewer ❑ Received by:� Date: COSA to be released to the engineer, unless otherwise iquested by the engineer. COSA Fee $ SLG•ao f' 7/.% ( D = S Sy�6 Date: Date of Payment !I — � _ /(0 Receipt Number d GS yg-l) COSA# 0SZ—'/4r5'2- 9 Date of Payment Receipt Num Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 11/4/2016 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: The Municipality of Anchorage Devlopmenl Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12. ooc If more than 1 septic system is on the lot COSA Checklist # of i I Structure served by this system i) 4.J' e.i A 7 r. I a . Pe.rtificete of ®n -Site Systeims Appr®vaa.Checklast Legal Description: /Vortii LAA.Jm tj" 3 6/3 /.z Parcel ID: 0 -s/ -%?Z- 23 A. WELL DATA PVC34tG r„� 47'Er2 Well type Date completed Total depth ft. Date of test. Static water level If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to ft. FROM. WELL LOG Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL ft. c. Nitrate mg/L Arsenic ug/L . Date of. sample: B. SEPTIC/HOLDING _TANK DATA, `- TankType/Material 5-rA °/ Tr Tank size /Z Sr9 gal. Number of Compartments. Z Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. 9 -P.M. Collected by: Date installed Cleanouts (Y/N)! y Foundation cleanout (Y/N) Depression over tank (Y/N) Al High water alarm (Y/N) Date of pumping 3 Pumper `�f}At ti � 1 !J)441f�ZS C. ABSORPTION FIELD DATA Date installed Soil rating g.p.d./ft2 r ftZ/bdrm) d. 6 System type T -M Length 13z ft. Width0p S ft. Gravel below pipe s ft. Total depth S3 ft. Eff. absorption area Wf12 Monitoring tube� Depression over field,Q,_ Date of adequacy test / S Results (Pass/Fail) _�. For 3 bedrooms Fluid depth in absorption field before test _�}_ in. Water added d O gal.-.New,depth .2 in. Elapsed Time: min. Final fluid depth d in.. / Absorption rate >'= • S� g.p.d. Any rejuvenation treatment.N (past 12 mo.) (Y/N & type) D If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum /3 eras E. SEPARATION DISTANCES WELL ON LOT TO: IVA Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Size in gallons /2 SO Manhole/Access (Y/N) "Pump off' level at in. High water alarm level at ys in. Cycles tested Lf Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: r Building foundation S r� Property line /d zr Absorption field ] f r Water main / o r 1 Water service line Surface water /OG rI,- Wells on adjacent lots /aa `h ABSORPTION FIELD ON LOT TO: Property line /G r r Building foundation l0 z'f Water main 16'1 - Water 6.fiWater Service line-•; /6 Surface water IQO fi= Driveway parking/vehiclestorage Z0''I'" Curtain drain //it/K Wells on adjacent.lots _&aL4 F. COMMENTS _ G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspectionsand review of Municipal records ;that the above systems are, in conformance with MOA COSA guidelines in effect on this date. t Engineer's Printed Name l E✓C t /�i (y Date Z COSA yellow sheet_2-6-15.doc 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 091— 721-.17 COSA# D Ct O 3 / 5� 1. GENERAL INFORMATION Expiration Date: 9-/0 Complete legal description NORTHWOODS N3. LOT 2. BLOCK 13 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 23120 GREEN GARDEN DRNE • CHUGIAK, AK 99567 STEVEN SIXEL Day phone 250-5480 23120 GREEN GARDEN DRIVE • CHUGIAK. AK 99567 Day phone AMERENA KIMMEL w/GREATLAND REALTY Day phone 354=4834 11411 OLD GLENN HWY • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 hdmeowners. 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 samples. (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 mx seeljjffixed hereto and as of the validation date shown below, I verify that my investigation,,based li�i- (Srocedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that fhe.�n site water supply and/or wastewater disposal system is (are) safe, functional and adequate for fAq nurVbei of bedrooms and type of structure indicated herein. I further verify that based on the infornNion 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 S and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG. LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or 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. S. DSD SIGNATURE _ L Approved for —3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: / COSA Checklist C/ Septic System Advisory Arsenic Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory By: Original Certificate Date: -t 0 i (Rev 11N5( Municipality of Anchorage ° Development Services Department Building Safety Division On -Site Water 8 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 $3, LOT 2, BLOCK 13 ParcellD: 05I-733.-:0 A. WELL DATA Well type Date completed PUBLIC WATER If A. B, or C provide PWSID# Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Tank size 1250 gal. Number of Compartments E Foundation cleanout (YIN) YES Depression over tank (Y/N) NO Date of pumping NEW Pumper ft. g.p.m. colonies/100 ml. Date installed 9/4/09 Cleanouts (Y/N) YES High water alarm (Y/N) YES C. ABSORPTION FIELD DATA ee�ow FlrvnL cwwe Date installed 9/3-4/09 Soil rating 6Q>r ft'/bdrm) 0_6 System type TRENCH Length 132 (3 ® 44 ft. Width 5 ft. Gravel below pipe 1.06-1.13 ft. *3.31— Total depth 5.33 ft. Eff. absorption area 758 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS 'For E bedrooms Fluid depth in absorption field before test= In. Water added=gal. New depth=in. Elapsed Time: — min. Final fluid depth= in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 9/4/09 Size In gallons 1250 Manhole/Access (Y/N) YES "Pump on" level at 41 in. "Pump off' level at 41 In. High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATER Septic tank/lift station on lot On adjacent lots Absorption field on tot On Public sewer main Sewer /septic Public sewer manhole/cleanout Holding tank Am containment areas Manure/animal excrete storage areas _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ' Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ 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 conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSAFee $�)sc)+ e,0 2US� Date of Payment 9� U Receipt Number 5 3 0 y (Rev. 11/05) : Waiver Fee $ I Date of Payment Receipt Number GREEN GARDEN DRIVE N R=125.00 96 EAST 133.06 15' UTILITY EASEEMENT LOT 3 . SEPTIC VENT 4P o.A �e N LOT 2 SEPTIC TANK Q SEPTIC VENTS co- Ell o- N ° F,d OLC�j N° deck �_2.00H' w ro 112 StNodsmg a o a 0 42 0 deck 5 OH EAST 143.00 LOT 5 I LOT 6 �OFA� A, Oro -'49TH* c FredvJalatka No. 3255-S r EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Recert CEA BE In N 81181 LOT 1 9 r its IY z SCALE: 1"=30' LOT 7 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's Inspection of the following described property: LOT 2. BLOCK NORTH WOODS SUBDIVISION. UNIT III Anchorage Recording Precinct. Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto. that no Improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways. transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage. Alaska this 8th day of September .2009 FRED WALATKA & ASSOCIATES Engineers and Surveyors MUNICIPALITY OF ANCHORAGE • i DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # �',� \ --) i. i- a '�_) HAA # 'A1�c1�L��� 1. GENERAL INFORMATION Complete legal description Lot 21 Block 13, Northwoods #3 Location (site address or directions) _23120 araan Aarrltmn Property owner Margaret Murphy Day phone Brook/Remax Mailing address Lending agency Day phone Mailing address Agent 'Brook St -i l tnkar/RPmax of Fggl a Ri var _ Day phone fiqd-,d2f1D Address 16600 Centerfield Dr., Suite 201, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: - Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72.025 (Rev. 1/91) Front MOA #21 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. s & s ENGINEERING Name of Firm i 7G$,;, Eagle River Loop Road No. Z~ Eagle River, Alaska 99577 Engineer's signature , - Phone Date DHHS SIGNATURE Approved for -/" ~/~ -~ ~' bedrooms. Disapproved. Conditional approval for 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 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. 72-025(Rev. 1/91) Back MOAit21 4 RECEIVED Municipality of Anchorage SEP 10 1998 DEPARTMENT OF HEALTH & HUMAN SERVICES 00* Environmental Services Division MUNICIPALITY of ANCHoaA 825 L Street, Room 502 + Anchorage, Alaska 99501 • (9drVN146s44VICES DIVE HealthAuthority Approval Checklist Legal Description: L-Clf Z G" _3 N J �COD_5�Parcel I.D.: A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 213 00 i Log present (Y/N) Date completed Total depth Cased to Casing height (ab round) Sanitary seal (Y/N) Wires erly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE ULTS: Colifor Nitrate Other bacteria ate of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed -7 Tank size 1,_�c� Number of Compartments 2 CleanoutslTs"") = Foundation cleanout QN) Depression (Y& -r3 High water alarm (Y/N) Date of Pu MjpngjA,1 .`gam Pumper d% �U � F� c ^5t, C. ABSORPTION EI9LD DATA bate nstalfeii""' `' ....' Soil rating (g.p.d./ft2 orft?/bdrm) "' A + System type Length `` '3�Widtl J� Gravel thickness below pipe C1rL1� Total depth b Effective�absorption area 6&f Monitoring Tube present 6N) over field (Y4 Date of adequacy test 7b' Results&1�/Fail) For bedrooms u Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): Fluid depth /� (ins) Minutes later: �® Absorption rate = d g.p.d. Peroxide treatment (past 12 months) (Y6) /J d^J if 6ed-1''� If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N). Size in gallons "Pump off" level at" High water alarm level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELLON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots PubJic sewe~ S_~eewer/septi~.se~li~~'--~~ Lift station' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' ~ J~ Property line I ~ ~ Water mai n/service line t<~ Sudace water/drainage ~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Prope~y line ~ ~ Building foundation [ ~ ~ Sudace water ~ ~ ~ Absorption field I Wells on adjacent lots Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review in c°nf°rmance With~A,~uid~e~ i'n e~ff~ct °n this date', · Signature --~/'~ ~ ~ Engineer's Name Date ~ / ~ / ¢'/' ~/' HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/96)* "x MUNICIPALITY OF ANCHORAGE • i` DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 9951976650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # Cc 1—'112- 03 HAA # 1. GENERAL INFORMATION Complete legal description Lot 2; Btockz 13•; .No,%th Woodz :Phase 3 Location (site address or directions) 23120 Gaean Qatden nh,iv Chucliah AK Property owner to eph BoswP.P.P 8 LPAP.iP UPnmae^ Day phone 699_3223 Mailing address 23120 Gneen Ganden Dative Chupiah AK 99567 Lending agency Day phone Mailing address Agent Baook Stittnea CENTURY 21 COLONIALDay phone 696-8600 Address 11901 Bus nest B vdSuite-103 aq?P Kwon, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V 3. TYPE OF WATER SUPPLY: Individual well Community well. XXX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91). Front. MOA x21 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 Aut. hority Approval application shows that the on-site water supply ancVor wastewater disposal system is safe, fud'~ti0nal 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 fr°m rny inVestigation and inspection, the on-site water supply and/or wastewater disposal systemis in ,comp~nce~with all Municipal and State codes, ordinances, and regulations in, effect on the date ~.~t~hls ~J:)ection. Name of Firm . .~ .'~., i,.".."_.£Ri~C ~ ///'~ .// Phone Engmeeffs signatur~~ Date Eagle River, Alaska 995~ DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms· bedrooms, with the following stipulations: Additional Comments The ~!~umc~pahty of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority "Ap~r'~/ai:~Certific~eS ~e~ed only Upon the representations given in paragraph 5 above by an independent Profe~i~'~aiengineer'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. Em ployees 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 IRev. 1/91~ Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L_,�:T 2 5v.,4- 13 r OVTA \kOdo13 Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number 213oa-A Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/ c FROM WELL LOG Date of test Static water level Well flow SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot _ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform B. SEPTIC/HOLDING TANK DATA ; On adjacent lots On adjacent lots _ Public sewer manhole/ Collected by: d'7'1 • A g.p.m. Other bacteria Date installed -1—S-5 Tank size X (=>o C> Compartments 2 Cleanouts 50N) 4 Foundation cleanout/N) Depression (Y� High water alarm (Yf r� Alarm tested (Y/N) '� Date of pumping `tQ Pumper Sfr. (sst'aau SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J_ On adjacent lots r,�A< Foundation To property line io Absorption field 10 k Water main/service line Surface water/drainage l o o 4- e5tk tl- 72-026 (3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Lev~.J~~ High water alarm level Cycl~l~t~eE~ Meets MOA electrical codes (Y/N) .~ SEPAR~ON TO: Welh3n'q~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ ~ ~ -5 Length '"'2 G, ~ Width t~ Total absorption area (-.'~"~ ~' ~-~c..c. Date of adequacy test ?.-~ '['] -~ ~ Water level in absorption field before test Soil rating (GPD/FF) Gravel thickness Cleanout present ~'N) Results~/fail) Peroxide treatment (past 12 months) (Y~I'I~ //.-~-- [ ~/~/¢---. System type ~ O, 5" Total depth /-/, o Depression over field (Y/~ for After test / If yes, give date ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-~c~ To building foundation On adjacent lots Surface water Curtain drain ~l On adjacent lots '~/> Property line ! c> ~ ~ To existing or abandoned system on lot Cutbank ~/~ 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 Signature $ & s ENGINEEEI ~ngineers Na~ _,_., .... ~,..,.~ h:. ?: HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number of this inspection. 72-026 (3/93)* Back APPLI(.0AT FILLS OUT, UPPER HAS` ONLY Property Owner 3(-,kcy)o , ` YA 'i `,f is Mailing Address i'. i�. t Ly -1 �t� O� lA(� _� K Zip Code Date Buyer Address Zip Code Lending Institution -'"`'` " "'` `{' "'. '' - Phone Address Zip Code Field Notes: Realty Co. & Agent. Phone Address Code ++ Legal Description LV CZip ` Street Location �Y\�� ( { –'—,: APPROVED BEDROOMS Type of Residence -4?T'Single Family (` ) DISAPPROVED •❑ Multiple Family No. of Bedrooms ( ) COND TIONA APPROVAL' ❑ Other DATE_711vo III Water Supply BY: L ❑ 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 Septic Tank Size Sewer Disposal ._., g L- f`ndividual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date 0!/ Inspector Inspector Inspector Inspector Field Notes: Lim to El H 2 JUL 1519@3 "Munir„pality of Anch+rtW " De t. Of Health & APPROVED BEDROOMS 'CONDITIONS OF APPR(E"'Onnlentat Proteafia11°' (` ) DISAPPROVED ( ) COND TIONA APPROVAL' DATE_711vo III BY: L Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 (3182)