Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 13 LT 3North Woods
Unit 3
B 1ock 13
Lot 3
#051-732-24
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: 05P 1110'7 1 PID Number: C)51 --73Z— 2'1
Name. I)Al£ Fo&AL
Wastewater System: ❑ New XUpgrade
Address:
PO goK 6 1ft Clnu r A k A K V50
ABSORPTION FIELD
19
Phone: Number of Bedrooms:
J7
❑ Deep Trench X Shallow Trench ❑ Bed ❑ Mound ❑ Other:
LEGAL DESCRIPTION
Soil Rating:
�•(O
Total Depth from original grade:
GPD/Ft'
Ft.
Block: Lot: Subdivision:
13 3 N #3
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
rfA woo�y
D. (o Ft.
3. y Ft.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
2 Ft.
X S Ft.
Well: �u�liL ❑ New ❑ Upgrade
Gravel width:
5
Number of lines:
Distance between lines:
Ft.
Z
10 Ft.
Classification (Private, A, B, C):
Total Depth:
Cased to:
Total absorption area: pp
�p
Pipe
L� Material:
SG� 0
Ft.
Ft.
Fe
{' SID
Driller:
Date Drilled:
Static Water Level:
Installer: /1 1
ll
Date Installed:
Ft.
%1ke lAr��rAciln
— � /% 2011
Yield:
Pump Set at: I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
❑ Septic ❑ Holding 'V(S.T.E.P. ❑ Other:
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ublic/Private
Sewer Line
Manufacturer:
AnChOr
Capacity:
1250
e Ah
Gal.
Well
I
200 +
ZAot +
I
Zoo •4
/ /
(
25 4
Material: l I
Sfee
Number of Compartments:
Z
Surface Water
Ippt +
loot
IcI +
/VIA
LIFT STATION
Lot Line}
t
5
I
I�
t
5+
p
N A
Size:Manufacturer:
125D Gal.
/)
/`Ih QRa (, TA✓I
Foundation
rj 'i-
`O
5 �-
A/ e
/,
I A
Pump on" level at:
-Zin.
Pump off' level at:
Z'0 in.
High water alarm at:
23 in.
Curtain Drain
�jDt+
5� I+
5D t�
N A
V�r2ENCa
Pump Make & Model
Electrical Inspections performed by:
AA Li' f
/ - `
Remarks: `
L i5 in �atnk A 64nAon•ed p
BENCH MARK
ryIy,, nn n }} 11
140hY RQ u�f[.rytQ✓1T$, EX+ jin Gaud@
Location and Description: 1I1 1 (►
S` 64 Cort)en
o$o"1 i .SO(A
IQVIL Abov, J I _ �,o�� &V)v,-
Assumed Elevation:
�O Ft.
�cE. A/Df `661 c:k60(1- A -
Inspections performed by: � q Dates: 1St 6 9 �l
LARS S� �� n1
Engine tamp
2nd
QF
Development Services Department Approval
CO.
4,
Conditional Approval Date:
� . 49 . r
LAR
11 � �o MD°_
C,
(��.•
Reviewed and approved by: Zill --e' Date:
(Rev. 04/06)
A CONNECTED EXISTING DRAIN I
VIA DIVERTER VALVE
P
C Da
• /ITTM 111111
Lot 3 E Q
/ G
INSTALLED 3-8EDROOM SEPTIC SYSTEM
1250 GALLON STEP TANK
Lot 4 LENGTH 2 x 48 FEET
WIDTH 5.0 FEET
TOTAL DEPTH 4 FEET P k3
ROCK DEPTH 3.4 FEET
INSULATION 2 INCHES
COVER 2.0 FEET
NLOT 5
NOTE. NORTHWOODS SUBDIVISION IS SERVED BY A
CLASS A PUBLIC WATER SYSTEM.
NOTE.• THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE, I' = 50 FT, BENCH MARK 0 'A"
Lot 2
SWING TIES
OF
I � 49-th n'-
- �g� SPURKLAND
(� NO. CE -11500
SNUKKLANU t NLiINt t h'IN(i NORTHH'OODS 13 BU 13 LOT 3 SEPTIC SYSTEM ASBUIL T
203 W 15TH. AVENUE DATE: JULY 19, 2011
ANCH. AK. 99501 DALE FOGAL SHEET: 1 3 GRID:NW1459
907 279-3916 23044 GREEN GARDEN DR., CHUGIAK, AK 99567
PERMIT #CSP111071 PID # 051-732-24 Nor thwood#3B13L3Dl,dwg
To Existing Trench
0 0 0
° Trench #1 °
z
5' Wide
1250 GAL STEP TANK
48' L ong
4' Deep
Q
3.4' Sewer Rock
o
2' Insulation
'
a
2' Cover
�
3
PR/MARY TRENCH
N. TS
y
U
NO SCALE o Trench #2
5' Wide
48' Long
4' Deep
a 3,4' Sewer Rock
2' Insulation
M 2' Cover
o
°
M ni for
Trench #1 2' CoverELEV=foo'
TEST HOLE
, G , ti iOZ.is ELEV.=104.5' 2' Insula tion
E.G. ELEV.=101'
ELEV.=95.3' ELEV.=95.3'
ELEV.=1020'
SIl t Barrer
ELEV.=98.5'
3.4 Ft of Septic Rock
1250 GAL STEP TANK
Effective
.Wlgs"%��11,
. OF..,q/ ��...
B.O.H. ELEV=87.0' M nitor
NO SCALE
2' Cover
Trench #2 ELEV.=1025'
•.4W.*,
: C'
% . •.... 49, h .... �%
2" Insulation i ,,... .... . r
' •R
ELEV.=100.0'
SPURKLAND
I�Gf AV
• �AV
Silt Barrier
No c -11500 •ti
�1`��F'••. /i 2 •��':
,,� p •. ��....•.•P� :��
ssio �.
ELEV.=96.5'�1�
3.4 Ft o f Septic Rock
�����.►�����
Effective Bench
Mark Bottom Siding S House Corner
Assumed
Elevation of 100 feet
SPURKLAND ENGINEERING
NORTH WOODS #3 BLK 13 LOT
3
SEPTIC SYSTEM ASRUILT
203 W15th Ave
Anchorage A k
99501
DALE FOGAL
DATE: JULY 19, 2011
23044 GREEN GARDEN DR., CHUGIAK, AK 99567
SHEET: 3/3 GRID: NW 1459
PERMIT # OSP 111071 PID 1 051-732-24
NW#3B13L3D3.DWG
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111071
Tax Code Number: 05173224000
Work Type: Septic Upgrade
Permit Effective Dates: May 24, 2011 to May 23, 2012
Design Engineer: SPURKLAND ENGINEERING
Subdivision: NORTH WOODS UNIT 3
Site Legal Address: NORTH WOODS UNIT 3 BLK 13 LT 3 G:1459
Owner/Address: FOGEL DALE R & KAROL A
PO BOX 672190 CHUGIAK AK 995672190
Site Mailing Address: 23044 GREEN GARDEN DR, Chugiak Lot Size in Sq Ft: 26723
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: f
Q
h plll
TrE4tG�2 v�
Site Mailing Address: 23044 GREEN GARDEN DR, Chugiak Lot Size in Sq Ft: 26723
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: f
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C)_51- 732 - Z V
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) J,al',�- F4< Day phoneC1A3 -- 3V ?I
Mailing address Fl; BoX G-1700. Chyelt: ,k, Ak-4
Site address .230 9q Gree., Prue
Legal description (Sub'd., Block & Lot) Ao,19 W',Js �3 l�jK 1� Lol 3
Legal description (Township, Range & Section)
Lot Size
Sq. Ft.
Number of Bedrooms :
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
(M all that apply)
Initial ❑
Absorption Field 151
Septic Tank 15 Upgrade )
Holding Tank ❑
Renewal ❑
Privy ❑
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for ,� Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or authorized agent)
fe'/Rush Fees:
Date of Payment:
Receipt Number:
Permit No. c k
GABuilding\On Site\Forms\Client Forms\Permit App_010411.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
(Rev. 1/11)
v a lW:+J
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
North Woods #3 Block 13 Lot 3
Municipality of Anchorage May 17, 2011
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
23044 Green Gardens Drive
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property. The
proposed system will serve a 3 -bedroom single-family residence. The existing system was installed in
1983 and did not meet COSA operational requirements. A soils log, design calculations, a site plan,
design drawings and construction specifications are enclosed for your review.
Design Calcs: No Groundwater observed to a depth of 14 feet below ground surface (May 18, 2011)
Soil Rating. From Testhole (5/5/2011)
16 min/in = 0.6 gal per sq.ft/day
No. of Bedrooms 3
Required Area per Bedroom: 15010.6 =250 sq.ft.
Total area required: 250 x 3 = 750 sgft
System: The proposed system consists of a 1250 gallon STEP tank and a shallow trench absorption
field. The absorption field will be 96 feet long and 5 feet wide and contain 2.5 feet (750 sq.ft. effective)
of sewer rock.
Soils: A test hole was excavated on May 5, 2011. See the attached soil logs. Ground water was
monitored for through May 17, 2011. Ground water was not observed.
Surface Water: No surface waters were observed within one hundred feet of the proposed septic system
upgrade.
Topography: The lot slopes to the north at approximately 5-10%.
Waivers: None
The installation of this septic system will not prevent wells and septic systems from being installed on the
adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
lWlAll �iwu
Environmental Consulting and Design
concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely
4
L rs Spur land, P.E.
Spurkland Engineering
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Tract 1B / Lot 10
Lot 10
Lot 9 Lot 10
I I I
Lot 8
Lot 7
\
40, I I I to
GP�p6 /J/��i C5 Lot 1
Lot 6Lot 3 TH Lot 2
/ 1
/ /
I
// Lot 4 1 LOT 5 I Lot 6 I Lot 7 I I
/
I
- -- ------ ------
— — 15UTIL ESMT — — — —
NOTE. • NORTHWOODS SUBDIVISION IS SERVED BY A
CLASS A PUBLIC WATER SYSTEM
NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
50 0 50 100 150 200 250 300
SCALE, 1' = 100 FT,
5I'URKLANU LNUINUMING NORTHUODS�3 BU 13 LOT 3 SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DA TE.- MAY 16, 2011
NCH AK. 99501 DALE FOGAL
907 279-3916 1 23044 GREEN GARDEN DR., CHUGIAK, AK 99567 SHEET. 1/3 GRID: NW 1459
PERMIT #0SP110XXX PID # 051-732-24 Nor thwood#3B13L3Dl.dwg
Lot
lY
�i
25
JYUKKLANU LNUMtK/NG NORTHWOODS 13 BU 13 LOT 3 SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE DA TE., MAY 16, 2011
ANCH. AK. 99501 DALE FOGAL SHEET.- 1/3 GRID.NW1459
907 279-3916 23044 GREEN GARDEN DR., CHUGIAK, AK 99567
PERMIT #17SP110XXX PID # 051-732-24 Northwood#3B13L3Dl,dwg
TEST HOLE
E.G. ELEV.=
H2O ELEV.=
B.O.H. ELEV.=
To Existing Trench
° Trench #1 °
5' Wide
48' Long
4' Deep
2,5' Sewer Rock
2' Insula tion
2' Co ver
PRIMARY TRENCH
N, TS
TrE
ELE
S/l t
ELEV.
1250 GAL STEP TANK C)
0
r
a,
ILK
.o
a
I
L
2, 5 Ft o F Septic Rock
Effective
NO SCALE
Trench
ELEV.=
Sit t Ba rrie
ELEV.=
1250 GAL STEP TANK
OF
•P,.•,••' ...
%,
✓J, °. No.
0
2,5 Ft of Septic Rock
Effective Bench Mark
Assumed Elevation of 100 feet
SPURKLAND ENGINEERING NORTH WOODS #3 BU 13 LOT 3 SEPTIC SYSTEM DESIGN
203 W15th Ave DALE FOGAL DATE; MAY 16, 2011
Anchorage A k 99501 23044 GREEN GARDEN DR., CHUGIAK, AK 99567 SHEET: 3/3 GRID; NW 1459
PERMIT # OSPXXXXX PID # 051-732-24 NW#3B13L3D3.DWG
y
V
a
NO SCALE
o
Trench #2
5' Wide
48' Long
4' Deep
2,5' Sewer Rock
2' Insula tion
M
2' Cover
o
°
TrE
ELE
S/l t
ELEV.
1250 GAL STEP TANK C)
0
r
a,
ILK
.o
a
I
L
2, 5 Ft o F Septic Rock
Effective
NO SCALE
Trench
ELEV.=
Sit t Ba rrie
ELEV.=
1250 GAL STEP TANK
OF
•P,.•,••' ...
%,
✓J, °. No.
0
2,5 Ft of Septic Rock
Effective Bench Mark
Assumed Elevation of 100 feet
SPURKLAND ENGINEERING NORTH WOODS #3 BU 13 LOT 3 SEPTIC SYSTEM DESIGN
203 W15th Ave DALE FOGAL DATE; MAY 16, 2011
Anchorage A k 99501 23044 GREEN GARDEN DR., CHUGIAK, AK 99567 SHEET: 3/3 GRID; NW 1459
PERMIT # OSPXXXXX PID # 051-732-24 NW#3B13L3D3.DWG
01
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorage.ak.us
(907)343-7904
Soils Log - Percolation Test
Performed For: 941C[0y"l Date Performed:
Legal Description: &Pi gwc�75 #.3 $IK 13 Lc,t 3 Township, Range, Section:
Depth
�/ �11.: �JRfrAN itm5
3-
L)
7
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
S li It W/
�JGiyk',JE1'�1�
W'
M
FW
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
Date:
Z5
L
0
P
E
Site Plan
SPURKLAN'D r
L_
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
4;00)
C
s TAit
3
1
1 ' , p�
30
3/_/ '/
Vq
00
17/6
m
`1�n;:�
i
3'
PERCOLATION RATE (W (minutes/inch) PERC HOLE DIAMETER (�
TEST RUN BETWEEN FT AND _ FT
COMMENTS PfZ �OtkZ�
PERFORMED BY: Logs `, C ;'2 n& I ���6M � ' CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCIt WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5
f : • - 4 SPUTMand E [nee N , I 1_I O
Environmental Consulting and Design
Single Family On-site Wastewater Disposal System
Construction and Material Specifications
Subject Property: North Woods #3 Block 13 Lot 3
Date: May 17, 2011
General:
1. The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall
be the owner's representative and will inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
2. The scope of the project includes the procurement and installation of a 3 -bedroom on-
site wastewater disposal system at the location depicted on the attached site plan
drawings. The scope of the work includes the installation of a 1250 gallon STEP tank
tank, a drain field comprised of 2 trenches, 5 -feet wide x 48 feet long, with a maximum
depth of 4 feet, with2 .5 feet of septic rock below the distribution piping. All components
of the proposed septic system must be constructed a minimum of 100 feet from any
surface water or water wells in the area. A minimum of 4 feet of earthen cover is
required over the septic tank and a minimum of two feet of cover is required over the
drain field. In addition to the required earthen cover, 2 -inch thick, 40 psi, direct bury
board foam shall be installed directly over all installed piping.
3. Construction shall be in accordance with the approved site plan and design drawings and
any special provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality
of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
policies.
4. The contractor is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
S. The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also responsible for vegetation of
all areas disturbed by septic system installation activities.
6. Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Property owners installing their own systems
must receive advanced approval from MOA DSD prior to system installation activities.
7. The contractor shall ensure that ALL materials being used are in compliance with the
most current guidelines established by the Municipality of Anchorage. Refer to
"Standards and Specifications for Component Parts and Materials Used in the
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
a g g
Environmental Consulting and Design
Construction of On-site Wastewater Disposal Systems", Dated December 2000, as
provided by MOA DSD, On-site Water and Wastewater Program.
Septic Tank Installation:
1. A new septic tank, of the size specified in the design drawings, shall be procured from a
qualified manufacture/supplier if the existing septic tank is found to be defective.
Construction shall include two 4" diameter cleanouts for pumping access.
2. The burial rating of the tank shall be adequate for the actual burial depth encountered.
3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank.
4. All standpipes on the tank shall extend a minimum of 12inches above the final grade.
S. Tanks installed with less than 4 feet of cover shall be insulated.
6. The sewer service line from the house to the tank shall have a minimum slope of 2%
unless prior approval is obtained from the engineer.
7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be
sufficiently compacted to prevent future settlement of the soil.
8. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings.
9. A cleanout shall be installed 1 to 4 feet from the foundation.
10. Post tank cleanouts shall be installed per MOA requirements. Does not apply to
pressurized lines.
11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist
buoyancy forces when there is not adequate soil cover to resist uplift force. The
contractor shall refer to the engineer for direction regarding this matter.
12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the
tank.
13. All holding tank and lift stations shall have an audible and visible alarm inside the
residence being served.
14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform
Electrical Code. A municipal electrical permit and inspections must be obtained where
required by the MOA.
15. The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from
any residential water well, 150' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
16. The contractor shall remove or abandon the existing tank in compliance with the Uniform
Plumbing Code.
Drain field Construction:
1. The drain field shall be excavated to the dimensions outlined in the design drawings. If
any discrepancies are noted, contact the engineer immediately for clarification.
2. The drain field shall be installed parallel to slope contours.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
v� ll..atJJ LLII UU L.1W:1
Environmental Consulting and Design
3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the
excavation become smeared, they must be raked or scarified prior to the placement of
filter sand or drain rock.
4. The drain field must be a minimum of 5 feet from the test hole excavation.
S. Distribution pipe is to be installed level with perforations facing downward, atop a level
bed of drain field rock. Septic rock shall then be placed atop the distribution piping to
provide a minimum of 2" of cover, level across the entire width and length of the trench,
above the piping.
6. A silt barrier must be installed at between the final drain rock and the native soil backfill.
The silt barrier shall cover the entire drain rock surface.
7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design
drawings, and extend a minimum of 12" above final grade. The portion of the
monitoring tube below the septic rock must be perforated and the portion above the
drain rock shall be solid.
B. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be
installed when the backfill depth is less than 3 feet.
9. Drain field back fill shall be mounded to prevent depressions from forming due to
subsequent settlement of backfill material.
10. The contractor shall verify that the drain field is a minimum of 100 feet from any
residential water well, 150' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
Inspections:
1. A minimum of two inspections are required by the Municipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
2. The first inspection must be conducted after the excavation of the drain field and before
the placement of any gravel. The septic tank may be set in place, but may not be
backfilled.
3. The second inspection must be conducted after the placement of the silt barrier, gravel,
distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any
backfill.
4. The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
S. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours
notice is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
72.013 (Rev. 3!78)
MUNICIPALITY OF ANCHORAGE
J
DEPARTr' \' T OF HEALTH & ENVIRONMENTAL PR07-�, TION
IL
VIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE
SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
I JKNEW
❑ UPGRADE
MAI LIP ADDR
LEGAL DESCRIPTION
Walk)1
LOCATN
NO. OF BEDROOMS
J
Well
Absorptiaq?A /
Dwe ling
P IT
U
DISTANCE TO:
rn n'a
Y
Manufacturer
Mater
No. of compartme,7
E2
Q
N ~
Liq. a acit allons
IF HOMEMADE:
Inside length
Width
Liquid depth
C Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JQ2
S?FQ-
Manufacturer
Material
Liquid capacity in gallons
O
W.2
DISTANCE TO:
II
n��
F u ion -
—
Nearest I t inQ
1-
P R IT 0 Y,
� LL Z
No. of lines
length of each line
T9taI le gt liges
Trench width
Distance betwee 'nes
�?W
y '//'�/O',`
O
^" inches
Top of tile to finish grade
Material beneath file
Total effectiv abs r 'on
yea
inches
!'J
Length
TVidth
Depth
PERMIT NO.
W
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
aF
Wa
NWell
Building foundation
Nearest lot line
DISTANCE TO:
Class
Depth
Driller
Distance to lot line
PERMIT N0.
J
J
.
W
3
Building foundation
Sewer line
Septic tank
Absorption area (s)
DISTANCE TO:
OTHER
\
PIPE MATERIALS
v
/
�.�
SOIL TEST RATING
1
1l
INSTALLER
REMARKS
lh
b
el,
ELL
APPROVED
DATE LEGAL
%%Yh,
13
L&3
72.013 (Rev. 3!78)
72-013 (Rev. 3/78)
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
•
PHONE
NEW
l
UPGRADE
MAI LI ADDR
--
M Ick
107
LEGAL DESCRIPTION
LOCAT N
NO. OF BEDROOMS
Well
Absorption r /
Dwelling
P ITN
U Y
DISTANCE TO:
m n
F- zQ
Manufacturer r
Mater' _ .
No. of compartmez
wF
rn
Liq. a acit al1ons
IF HOMEMADE:
Inside length
Width
Liquid depth �—
6Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Jaz
_ F
Manufacturer
Material
Liquid capacity in gallons
w=
DISTANCE TO:
F u eijon °
Nearest I
W Z z
No. of lines
Lengtrh of each line
T9taI le gt iges
Trench width
Distance between 'n9s
F. ? cc
e 'y q'f1 *
D
inches
-�—
Top finish
Material beneath the
Total 'on
F
of tile to grade
'
effectiv absrlr
fa
I�
p
s L
inches
Length
TVidth
Depth
PERMIT NO.
Lu
0
Qa F
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Lu
WWell
Building foundation
Nearest lot line
DISTANCE TO:
_j
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
G- VV
PIPE MATERIALS
P.\j
SOI L TEST RATINGmoon
+,—1
/
✓
P
INSTALLER
REMARKS
I
a
3
W W0_4 61X3
it^n^ I X 40*
APPROVED
DATE LEGAL
/rrr
1
72-013 (Rev. 3/78)
ity
of
Anchorage
PCH 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLFS,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
November 22, 1983
Alaska Environmental Control Services
1200 W. 33rd Avenue, Suite B
Anchorage, Alaska 99503
Subject: On-site As-builts
Dear Dr. Reid:
This department needs the discrepancies cleared up on the
following as-builts before they can be accepted:
Lot 11 Block 5, Alpine Woods
(Bolin Const.)
The total depth of the system is listed as 14.5 feet.
The soils test was done 8-2-83 with a total depth of 14
feet; so a new log is needed to show the new con-
ditions, also the total effective absorption area
appears to be wrong.
Lot 16, Block F, Knik Heights
(Jay's Exc.)
The soils test was done to 9 feet and the permit called
for 5 feet of trench depth; however, the total depth on
the as -built is 6 feet.
Lot 3, Block 13, Northwoods #3
(Skaggs)
The bed should have been insulated in the areas where
the top cover was 3 feet or less. Was this done?
Lot 4, Block 2, Seaturn
(ATC Ent.)
The as -built shows 40 feet of gravel being installed
and a total depth of 44 to 45 feet; this may have been
a transposed figure.
MUNICIPALITY OF ANCHORAGE
Department,/' Health and Environmental^lrotection
325 L Street, Anchorage, AK _.j501
264-4720
Permit # # # # HANDWRITTEN PERMIT # # #
"-'_-�/OR ON-SITE SEWER PERMIT
Applicant: JA4t5z G c - Mailing Address:
Location: //Pho e Number:
Legal Description: A4%%�`i�'[��/ud1Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: _ Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: 7Z;L— Soil Rating (sq. ft/br) 130
The Required Size of the Soil Absorption System Is:'
DEPTH �1 LENGTH _ GRAVEL DEPTH . Sujd& WIDTHJY
S
The length dimension is the length(in feet) of 46t- rh '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(H&f:DM) TANK SIZE _ /000 GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # # TWO M 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 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 that L3.beZdrs.
Signed: Issued by:
Applicant
Date: fS=/.S =�'3
SWP/024(1/81)
r SOILS LOG
. ` MUNICIPALITY OF ANCHORAGE
gc DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Steve S K-11 5 DATE PERFORMED: A " 9 1 1193
LEGAL DESCRIPTION: Nae+ ood--jr 510cv 13 C.t3 MDA ST$3 oaf
SLOPE SITE PLAN
i
MMOMENNEEM
Date
Gross
Net
Depth to
2
f,•
1 • 49
/
0[7"1) (:glt( 9
WAS GROUND WATER
ENCOUNTERED?
S
ie s LO
■/,■.®N®®®®
stlys.�ly J"""'I
.. .....
a -i
P
12
♦
f" "
' "'•"•••' Q�
IF YES, AT WHAT
e
,
a
13 .
0. Wray
ie
.Reid, J►. � W �
2251•E
DEPTH?
`
933
—
r J
MEMEMMMMON
yy
20
2. i0
yo
9r`1
_
MMOMENNEEM
Date
Gross
Net
Depth to
i 1
f,•
1 • 49
e's9%
*
WAS GROUND WATER
ENCOUNTERED?
S
ie s LO
■/,■.®N®®®®
�. :.
.. .....
a -i
P
12
♦
f" "
' "'•"•••' Q�
IF YES, AT WHAT
e
,
a
13 .
0. Wray
ie
.Reid, J►. � W �
2251•E
DEPTH?
MMOMENNEEM
Date
Gross
Net
Depth to
Net
Time
Time
■/,■.®N®®®®
Drop
a -i
923
-
3,00
NNEENEENNE
io
a.*]
.zq
933
—
3.00
MEMEMMMMON
153
20
2. i0
yo
9r`1
_
.I■®■®®®®®®
_
100 y _
l0
216/
`9
■I■■■■■■■■■
3.03
i0Z3
11
1 �a.
3!
91MMMMe®■E®
\
'■■■■■■.■■
MEMEMMM
.IIM--E.E...
■,.®®R'®■®■®
■ENNNI®®®e®
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
a -i
923
-
3,00
133
io
a.*]
.zq
933
—
3.00
153
20
2. i0
yo
9r`1
_
3.00
_
100 y _
l0
216/
`9
Ip06
3.03
i0Z3
11
1 �a.
3!
20
'PERCOLATION RATE (minutes/inch)
A TEST RUN BETWEEN FT AND z FT
COMMENTS. 5.; I 'AteI & 131 17A B•
PERFORMED BY: Darr CERTIFIED BY: DATE:
72-008 (6/79)
PERFORMED
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
625 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: N•,}^„,,,:,a
SEPT
(FEET
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
(pm) 1:.+
SLOPE
DATE PERFORMED:
•OF'A`.q%1 1
�:� •••F,� WAS GROUND WATER S
,4 �[ �/ ENCOUNTERED? Ye `- L
000,00” see
✓_ P
•' •• '•'• •"•:•'•� IF YES, AT WHAT , E
Leroy C. Reid, r. �� DEPTH?
%••• 225I..E •' �y�'/ 6 of . pE,< hie
Fy •.•. ....• AV
SITE PLAN
i
O
20 PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND 2 FT
COMMENTS 5
F
f3
PERFORMED BY: D4,c'j CERTIFIED BY: DATE:
72-008 (6/79)
Gross
Net
Depth to
Net
Reading
Date
Time
Time
Water
Drop
29
7o
2' bo
YO
/oe-.
l0
2-81
,If
20 PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND 2 FT
COMMENTS 5
F
f3
PERFORMED BY: D4,c'j CERTIFIED BY: DATE:
72-008 (6/79)
Municipality of Anchorage
Development Services Department
Building Safety Division tt J
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I. D. 051-732-24 COSA#
Expiration Date: (r. P l lc 1 1
1. GENERAL INFORMATION
Complete legal description Lot 3, Block 13, North Woods Unit 3
Location (site address) 23044 Green Garden Drive Chugiak, AK 99567
Current Property owner(s) Jason and Francesca Longlet
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
23044 Green Garden Drive Chugiak, AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑✓
Day phone
Day phone
Day phone
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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
!.�' Approved for 3 bedrooms.
Disapproved.
Phone 522-7773
Date 711 712 01 2
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineers Report
Nitrate Advisory Other
By. 0 I—C/( Original Certificate Date:'7 — �
(Rev. VMS)
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: Lot 3, Block 13, North Woods Subdivision Unit No. 3
A. WELL DATA
Parcel ID: 051-732-24
Well type _ If A, B. or C provide PWSID # _ Well Log (YIN)
Date completed _ Sanitary seal (YIN) _ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: _ mg/I Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/STEP Date installed 6/9/2011
Tank size 1,250 gal. Number of Compartments Three Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) Y
Date of pumping 4/25/2012 Pumper Royal Flush
C. ABSORPTION FIELD DATA
Date installed 6/9-16/2011 Soil rating (g.p.d./ft2 or ft2lbdrm).6 GPo/SF System type 5' wide Trench
Length ss ft. Width 5 ft. Gravel below pipe 3NA# ft.
Total depth 6 ft. Eff. absorption area 673 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/11/12 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 1 in. Water added gal. New depth "' n.
Elapsed Time: "" min. Final fluid depth ""' in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION
Date installed 6/9/2012
"Pump on" level at 28 in.
r)atnm Vault Rim
Size in gallons 250
"Pump off" level at 28 in.
Cycles tested "`
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Manhole/Access (Y/N) Y
High water alarm level at 23
Meets alarm & circuit requirements? Y
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal 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 >19 Water main >10'
Water Service line >to- Surface water >100' Driveway, parking/vehicle storage >25'
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS: Lot is Served by AW WU Water System. `"` Septic System Constructed Less Than 1 Year Ago. Absorption
Trenches have 1" of Standinq Water. Adequacy Test Unnecessary to Verify System is Functioning as Originally Designed.
G. ENGINEER'S CERTIFICATION
"
Cleo "'
o,; 49m
l certify that l 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.
0MICOAR g
Engineer's Printed Name Michael E. Anderson, P.E.
,��Jcir •� ty
♦ �F� •� -1
f�r_PROrt
Date 7117/2012 _
COSA Fee $ qqo Waiver Fee $ _
Date of Payment 71/u;a Date of Payment
Receipt Number G S 2 6C� Receipt Number
(Rev. 11/05)
in.
X6,1
Municipality of Anchorage
' *AE
Development Services DepartmentBuilding Safety Division
On -Site Water and Wastewater Program
4700 Elmore 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. 0151,73Z- 24 COSA#
Expiration Date: r %--
1. GENERAL INFORMATION
Complete legal description A&R—, "woops 43 r6iock x3 Lok 3
Location (site address) 2.3o Wy GaeeN -GTAR.0Eh Dr.. 044gi 4 k A k/ 99561
2.
Current Property owner(s) _ DALE Fo4A.l Day phone 689-3V77
Mailing address
Lending agency
Mailing address
PO got, 6-421901 Chu IAk , A K li5C7
Real Estbte Agent
Mailing Address
Unless otherivise.:rq.quesr"ed, COSA will be held by DSD for pickup.
NUMBERQP BEDROOMS:
Day phone
Day phone
3. TYPE OF WATER.SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ -Individual On-site
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class _A Well ❑ Community On-site ❑
Public Water System V9 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 SP�Wi[XVID Snoin C-CU/V&
Address 2o& W, 15tti A✓e., Te. Ze2, Ax4eeag /41< 9YS0/
Engineer's Printed Name L,42S
PV 414 h ci
5. DSD SIGNATURE
. _-Z Approved for bedrooms.
Disapproved.
Phone 271-391/6,
Date S12-10
.��. �' A C.QS 1
�''
Ek :l....
/ ...f
�� �n'• LARURKLAND. e
�r 11500
Conditional approval for bedrooms, with the following stipulations:
�tttit��r(rrrr�'
i-tV OF Aarff
5 ON-SITE
WATER AND
• WASTEWATER
JJJ
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: ZV r Original Certificate Date:
(Rev. 11/05)
Mutticipklity of Anchorage v�
p U
• "° Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: /V01AW00d "3 BIK 13 L-1 3 Parcel ID: Of 732-2y
A. 111ELL DATA Pu 61 c
Well type Pu bl; L
Date completed —
Total depth -- ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID # Z 1300 t Well Log (Y/N)
Sanitary seal (Y/N)=
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform — colonies/100 mL Nitrate — mg/L
Arsenic: — ug/L date of sample: _
Wires properly protected (Y/N)
Casing height (above ground) '— in.
AT INSPECTION
9—
p.m-Collected by:
B. SEPTIC/HOLDINGTANKDATA-�- 1
Tank Type/Material Anc6orG 14„ k sled
Tank size 1250 ' gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N) IV
Date of pumping I'V2w Pumper
C. ABSORPTION FIELD DATA
Date installed I Soil rating (g.p.d./fe or if/bdrm) 0./O System type Stiatlow T64rL�
Length 2 X qg . ft. Width S ft. Gravel below pipe 3.1 ft.
Total depth (o ft. Eff. absorption area _IN ft2 Monitoring tube �` _ Depression over field
Date of adequacy test Aty Results (Pass/Fail) — For — bedrooms
Date installed 49/11
I
Cleanouts (Y/N) Y
High water alarm (Y/N) v
Fluid depth in absorption field before test — in. Water added — gal. New depth — in.
Elapsed Time: — min. Final fluid depth in. Absorption rate >= — g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date —
D. LIFT STATIM
Date installed to g I Size in gallons 1250
"Pump on" level at 28 in. "Pump off' level at _2 in.
Datum Cycles tested Mew
VRtiL7 RvA
E. SEPARATION OISTANICES
SEPARATION INSTANCES FRMA WELL ON LOT TO: Public.
Septic tank/lift station on'lot
Absorption field on lot
Public sewer main
Sewer /septic service Nine
Animal containment areas
Manhole/Access (Y/N) Y
High water alarm level at Z3 in.
Meets alarm & c ifuuit'requirernents? _ X
Ware .
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:
I
Building foundation .5+ Property line 5 + Absorption field 5 +
Water main 10 (+ Water service line 10 •t' Surface water 1001+
Wells on adjacent lots Zoa +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I Building foundation 101 Water main lo'+
Water Service line 1014- Surface water I Oo'+ Driveway, parking/vehicle storage
Curtain drain 50 + Wells on adjacent lots ZOO �+
F. COMMENTS
G.. �s CER CATIKKIMI A Cqs 1 t f
I certify that 1 have determined #vough field inspections and 49 T
review of Municipal,, records #hat the above systems are in :0 .
conformance with, MOA COSA guidelines in effect on this date. / - .. ..
LL I� PURKIAND;
Engineer's Printed Name AILS SD4r' ►fin rr,".. y 5 ,i
Date 8 121 l 1! �'FO' • • • p�,.'•"
COSA Fee $_Z: 50
Date of Payment... , 1 11
Receipt Number 7 22 --
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
Fm
samw SEW=
lzz�5-.
/ 1= 77.31.
C.A.vrs
�� ExlsTi�v
a1 2y
Z-3 Jl
Ib°
2,5-,5- . 93
.I
L-
UNDER NO CIRCUMSTANCES SHOULD AN AS-SUILT BE USED FOR CONSTRUCTION OR FOR ESTABU9i1NG BOUNDARY 012 FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UAMUTY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE S
LOT SUIMY -tun YL 1 1 I r F—
FU MAIM AS-BIALT
FlML SiRUC1URE AS -BMT
PLOT PLAN ... AS.-BIRLT ... Ln�RWr • .. TOPDa"I'My
IT 15 THE RESPONSIBILITY OF THE BUILOM OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE COYMANTS OR RESTRICTIONS
WHICH IDO NOT APPEAR O F ANY RECORDER SUBDIvI PLAT -
SURVEY CERMFICAMN r, �
P -LOT PLAN
Ngo+. en Ur�� to M Old of� �� �•pa ��l
Uod.dp. mA .1d
FOUNDATION AS -BUILT 1
L ftb t 1: tonna o-_ em -by +Ub VAt I
Aw. 11b,rE m AT-eull of m.
- ..s M.m.u.n w Ws.s nlnw� � T _ Q• •
Qo ,.na„d.n.nu o� QAF
021
MAL STRUCTURE AS-BUILT\�
•eu.ty. m ra we s.n w �� e..en � pr=fssate++d V��ad�
dYnnJ�+ond trdoin+atlan _
SYMBOL
SET ROM DRAINS ASPHAL'
o FOUND REBAR $"-•g-8- WOOD FENCE--° CONCRE
ASSUMED ELEM *-4--* METAL FENCE ® SNOOD 0
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL
SHOWN. pENCEM WELL% SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWA-
ETC.. ARE SHOWN IN THEIR APPROMMATE LOCATION. ONLY. SN(
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATI
ALL DISTANCES ARE RECORD UNLESS OTHERIMSE NOTE
Prepared by
Robert E. Johns, Jr. & Asso4
Professional Land Surveyors
842 E 12 AVE.
ANCHORAGE. ALASKA "501
Rea Lot S F Rec. Plot File I
t„ = 401
� hy.4am-]feddby.7-07-11 Drum 7-07-11 �'�`Nw 1099/ I1 -
LOT 3, BLOCK 1.3i. NORTH.J60ODS SUBD .
UNIT # 111
r MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services
` DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # C6N - --I sa''Q'l HAA # UA 03 \ L -L)9
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 3; B2ockz 13; North Wood3 Subd.iv.i.6ion Phaze III
Location (address or directions)
23044 Green Gan.den D)Live
(b) Property owner Wayne 9 Tells Moane Telephone: (home) Business
Mailing Address
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent GREATLANa REALTY ATTN: Rae Hatt
Address 11411 02d G.2enn Highway, Eag.2e R.iveA, A.2aska 99577
Telephone
694-9125
(e) Mail the HAA to the following address: (or check hereXX if hold for pick up.)
List contact person and day phone number below:
s & 5 ENGINEERING
17034 Eagle River Loop Road No. 204
I
2. TYPE OF RESIDENCE
Single -Family CXX Number of bedrooms 3
3. WATER SUPPLY
Individual Well ❑ Community CQX Public ❑
Note !f community; well system, must have written confirmation from the State; Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site}( Public ❑ Community ❑ Holding Tank 0,
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval 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 Firm5& 5 c Telephoner
� ,
Address 17034 Eagle,River Loop Road No. 204
_I_- seep
Date
lti,yyjj
'�L A�• i3' �9,,v'��iY. �9
cr;<
in erx§ Seal
r:
tors ,t �rsfi$w , jw,
6. DHHS APPROVAL
Approved for bedrooms b Date
Approved Disapproved /h // Conditional
Terms of Conditional Approval Xt4uU�
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 orderto 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. 7/58) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
• Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744 46
Legal Description: ,., wr.; > y�,«y3
A. WELL DATA
Well Classification
Well Log Present (Y/N) Date Completed
Total Depth Cased to Depth of Grouting
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
If A, B, C, D.E.C. Approved Q/N) N_
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot Zoo ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot "Loo "- ; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected by ; Date
Water Sample Test Results ,
Comments 4'blD'k"'L17bcol►.�o2,rNvlan���� DEF�4nR.a1 i�atz tG S,�r� S?'//'.kA0&J
B. SEPTIC/HOLDING TANK DATA
Date Installed 11-J9 -93 Size 100 0 No. of Compartments 7.
StandpipesO/N) 4_Air-tight Caps (p/N) \1 Foundation Cleanout O/N) \
Depression over Tank (YO kJ Date Last Pumped
Pumping/Maintenance Contact on File (Y/N) A- ; for
Holding Tank High -Water Alarm (Y/N) 4/1— Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well Z� o 1 � To Building Foundation S �}
To Property Line l0' `" To Disposal Field 50
To Water Main/Service Line tD�
To Stream, Pond, Lake or Major Drainage Course 10c)
Comments �� `��SP�L
72-026 (Rev. 7/88) Front Page.1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in AbsorptionStrata 4-A, p�ga— Type of System Design UE.D
Date Installed 11-14-93 Length of Field 'FD 1
Width of Field 1 L9 Depth of Field 2 - ar
Gravel Bed Thickness taS
Square Feet of Absortion Area Comet off' Statndpipes Present (.fir/N)
Depression over Field (Yo Date of Last Adequacy Test '2-3-c� 1
Results of Last Adequacy Test SPe_r G��..r-\ Fr-d;P -
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well Zo o %k- To Property Line 4D 1
To Building Foundation la " To Existing or Abandoned System on
Lot }'L]Dr; On Adjoining Lots `�
To Water Main/Service Line 10 To Cutback (if present) ''���•
To Stream, Pond, Lake, or Major Drainage Course 1077 "r
To Driveway, Parking Area, or Vehicle Storage Areay>1,1--
Comments
D. LIFT STATION
Date Installed
"Pump On" Level at
High Water Alarm Level at -
Tested for
Meets MOA Electrical Codes
Comments
Dimensions
Manhole/Access (Y/N) .
— "Pump Off" Level at
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed s ug FNGIN EERINIG
Company 17034 Eagle River Loop Road No. 204
wage 'ver,
Date
MOA No.
Receipt No.
Date of Payment
Amount: $ (__�o .—
Receipt No. _
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
date of this
o a,.
a -"a WALTER J. NICKEL, GOVERNOR
Ll"',� «.` ill. C✓ a l., Lf is
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
March 11, 1991
FOR: Roger
S & S Engineering
PWSID #213001 Northwoods--Deerhorn Park S/D--ER/Chu
My review of the records on file in this office reveals that the
Northwoods--Deerhorn Park S/D Class A Public Water System is in
compliance with the provisions of 18 AAC 80.060, State of Alaska
Drinking Water Regulations. e
Sincerely,
Timoth A. Karnowski
Environmental Engineer
Time
APPLIC^-1-1MT FILLS OUT UPPER HALp NLY
Property Owner
jameSHarkey OD11Stuctl.Otls inc... Phone
"
Mailing Address
P. 0. BOX 410, Chugiak, Ak. Zip Code 99567 688-9603
Buyer
Address
Zip Code
Lending Institution
Inspector
Phone
Address
Zip Code
Field Notes:
Realty Co. & Agent
Gallery Of �r `.10 Marcia outealt
Phone
Address
603 W. Tudor W -y AnahO Ak. Zip Code 99503
563-3655
Legal Description
Lot 3j, Blo k 131 NOithwoods #3
Street Location
GreM Garden Dr.
Type of Residence..
_
❑kSingle Family
F
❑ Multiple Family
No. of Bedrooms—3
❑ Other
Water Supply
❑ Individual
f
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
k Community.
For wells drilled prior to that date, give well depth (attach log if available).
- ❑ Public Utility
Sewer Disposal
1983"
Individual
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
Inspector
Inspector
Inspector
Inspector
Field Notes:
( APPROVED BEDROOMS
(- ) DISAPPROVED
( ) CONDITIONAL A' PROVAL'
DATEI
BY:
'CONDITIONS OF APPROVAL -
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank -
Well Log Received -
Septic Tank Size .
72 023
Time
APPLICANT FILLS OUT UPPER HAI! '\ ONLY
Property Owner
y - jj = S-f-yq-J�;�" �/ C.04 -,S - ��.Vtit;..�
Address
=PlonoMaiNng
�` ZipCode ��' __
Buyer
Address
Zip Code
Lending Institution
Phone
Address
- Zip Code
Date
Realty Co. & Agents{f
%��/�% L.. %- Phone
Y1'"
l' b
ddress-�^
r )� Zip Code
Legal Description
1 t) % K 1-3.
Street Location
Type of Residence
nn nncc
0'-�) l
E�SIngle Family
❑ Multiple Family
No. of Bedrooms :z
❑ Other
Water Supply
❑ Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer Disposal
[]-Individual
Year Individual Installed:
El Public Utility
When Connected to Public Utility:
❑ Holding Tank
MUN
"PION
VP
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
nn nncc
0'-�) l
Field Notes:1/
/' , C)
MUNICIPAL
DEPT. OF f;`A! Ti { <:
L^.Nt,^` n NTAL PROTECTION
CH RAGE.
IP LI
MUN
"PION
VP
ENVIKOM-'v
APPROVED BEDROOMS
`CONDITIONS OF APPROVAL
( )DISAPPROVED
p-
I V � D
( ) CONDITIONAL APPRO L'
� � E
DATE G 2-M
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area_
© vim
Well Log Received A/ /S
i..E
Z �1 ^ c��
Well to Tank
C/
Septic Tank Size ¢ G�CD
MAR -29,91 FRI 13,12
GREAT LAND REALTY
FAX N0. 9076943093 P,01
WW
to be
Tax
%TION
❑ Urban
T UP
© Over 7556
WTH RATE
❑ Rapid
PERTY VALUES
❑ increasing
AND(SUPPLY
Shortage
Ile Family yU Not Likely
Family Likely
;!-family In process
tmarciai To;
istrial �0
ant
e: Race or the racial composition of ih
AMENTS: The subject Sul
ell-inainr�ned sin=gle
3� i crn 'i riinrovem-e—n— s ,
045-�1
PORT t ire rto.'111•-Q5G235t
LENDER DISCRETIONARYI �J$- ,,, I,.I '; '• ?
Salo Price
Date
32='2 Mortgage Amount $
APPRAISED Mortgage Type
C W18
ib e er paw—
Fee Simple
+halls
Discount Points and Other oncossr
HOA SIMO.
n a
Leasehold
Size
Paid by Seller
S_
GUY Ftp
���•
Srregti ar
❑Condominium (HUD/VA)
Shape
Drainage
appears equa e
;e, ,
® Suburban
De M!nimis PUD Source
[] Rural NEIGHBORHOOD ANALYSIS
Good Avg. fair . Poor
F1E] 11
2i 75%
ED
Under 25%
Slow
Employment Stability
convenience to Employment
❑
: ®❑
1 (—j
FEMA Flood Hazard
Yos`r• N x
® Stable
Stobie
[�
Declining
Convcnionoe to Shopping
Schools
El©
17`
Livia
L�
❑
❑
ID
® in Balance
❑
Over Supply
Over 6 Mos.
Convenience to
Adequacy of Public Transportation
❑
(
❑
0
3-6 Mos.
PREDOMINANT
SINGLE FAMILY HOUSING E
Recreation Facilities
OCCUPANCY
$PRICE (000) (yrs)
Adequacy of Utilities
Property Compatibility
a
�.
[j
Q
owner
Tenant
p
❑
$0 Low 4
-- -Ggh
Protection from Detrimental Cond.
t;R1
t❑�t
tr❑�11
Vacant (0-5%)
[�
I
Police & Fire Protection
General Appearance at Properties
LJ
❑
L..�
.
;tom
u
:❑
Vacant (over 5%)
❑
Predominant
110 _ 7
Appeal to Market
, ,
god are not considered reliable appraisal factors.
on is located 3/4 mile west of
Peters Creclt exit.
It is 'a large,
zany
eleveConcnTiie bu0 up i averst;e qu'cilz Y, coitveiri
�•_-�=--�— yrs
rcnsionsx • x '
i Area s Corner
ting Classifications szn—rest en a Zoning
clricity
s
Mr
nitary $ewer
rrm Sewer
MMEENTS (Al
nd owne
lim I
orics
pa (Det./Att) d
(sign (Style)
risting ?'
oposed _
idcr Construction l
p (Yrs.)
area
asphalt
Curb/Gutter
Sidewalk
Street Lights
none
No
r�i7
9verss easements, encroachments, special assessments, Slide areas, MO.):"-
is above—greet gr a w�.tii a gees oT pe—
Chugiak 63 ilities. Subject slightly
verse 'Sans ao a apnrasser.
+halls
o .lax
EXTERIOR DESCRIPTION
Topography
s 1? y, a ve ;. r
Foundation CC bloClt
Size
ypzca : A
- 'lrl�*
Exterior Walla
Crawl Space
���•
Srregti ar
s
Shape
Drainage
appears equa e
o Privato
View
ypioa7
ysAr-TJsnow coyer
Is window Type w000�'csm
Landscaping
_ I—
gravT�
Storm Sash no
Driveway
Apparent Easements
no Verse riO�eC�
1 (—j
FEMA Flood Hazard
Yos`r• N x
No
r�i7
9verss easements, encroachments, special assessments, Slide areas, MO.):"-
is above—greet gr a w�.tii a gees oT pe—
Chugiak 63 ilities. Subject slightly
verse 'Sans ao a apnrasser.
+halls
o .lax
EXTERIOR DESCRIPTION
FOUNDATION BASEMENT
INSULATION
640 Root ❑
Foundation CC bloClt
Slab _ _ Arca Sq. Ft.
% Finished
704�� Cci!ing�
- 'lrl�*
Exterior Walla
Crawl Space
TryiaulZ— walls �S tci
:� a Root Surface asp h shin
Basement Yes Ceiling
none Wa!Is�
Floor
iis�— Gutters & Dwnspts,
Sump Pump
none z� Floor
carp viny None
Is window Type w000�'csm
Dampness
none n Outside Entry
yes Adequacy.
Storm Sash no
Settlement
nonenEd-
Energy Efficient =tams:
Screens n0
Infestation
-- stgandard
I'8 Manufactured House no
Snsula Lon
— _— *cedar accen s
Dining Kitchen Den FamilyRm. Ree. Rm. Bedrooms #Baths
Laundry Other Are _
Livia
loors
opt/vinyl
+halls
-r�a1=
'rim/finish
Worm- Sn
ath Floor
v1�
lath Wainscot
ceroAl c
loots
House Entry
Typo FA
Fuel g:x
Condition av;
Adequacy s�,
COOLING
Central NA
Other
Condition
,AR STORAGE: Garage x Attached
Vo. Cars 2 Carport ❑ Detached
condition ave None Built•in
MdRionai features: a tall, arge
BI shelves, ecver entry;
a.
7
rt
General market conditions
n_�1w O:aroan IM.
Rangcloven
Disposal
Dishwasher
None
Stairs
Drop Stair
Scuttle
Floor
Heated
Finished
,airs n0otlod, modsrnizatio— n, uto-0
floor covering in �F
IMPROVEMENT ANALYSIS Good Avg, Fair Poor
Quality of Construction
Candifion of Improvements
Room Sizes/Layout )
Closets and Storage
Energy ENicieirey
Plumbing -Adequacy & Condition it
Electrical -Adequacy & Condition
Kitchen Cabinets. Adequacy & Con
Compatibility to Neighborhood
Appeal & Markelability
Estimated Remaining Econcmic Li._ YrS.
Estimated Remaining Ph Sical Life
39, w© oVe, ac agana win aw,
�_•:t..--� ��"�.'v r•or�flnnM! tJ'd'8�a� i i
and impact in subject/market area regarding 10an discounts, interest ouyeowns aIt cu �ca�lu
meet has improved with property values stable eif of
Microwave
_J
Intercom
]
Adequate
X
House Entry
]
Inadequate
❑
Outside Entry
Electric Door
Basement EnI
spo 1
, Scissor
,airs n0otlod, modsrnizatio— n, uto-0
floor covering in �F
IMPROVEMENT ANALYSIS Good Avg, Fair Poor
Quality of Construction
Candifion of Improvements
Room Sizes/Layout )
Closets and Storage
Energy ENicieirey
Plumbing -Adequacy & Condition it
Electrical -Adequacy & Condition
Kitchen Cabinets. Adequacy & Con
Compatibility to Neighborhood
Appeal & Markelability
Estimated Remaining Econcmic Li._ YrS.
Estimated Remaining Ph Sical Life
39, w© oVe, ac agana win aw,
�_•:t..--� ��"�.'v r•or�flnnM! tJ'd'8�a� i i
and impact in subject/market area regarding 10an discounts, interest ouyeowns aIt cu �ca�lu
meet has improved with property values stable eif of
MAR -29-91 FRI 13:14 GREAT LAND REALTY FAX N0, 9076943093
,,,,y,;,,„ �•a„*:,,� UtillllR'lt,J1iM KC..`JrILiCPi i IAII. /�Mi•KAl�lif.. lt'iRt'VK 1
IuILOING SKfcfCH ($HOW GROSS UVING AREA ABOVE GRADE)
$114.Z.0_RS
amender
for Freddie Mac or Fannfe Mae, show,on�y square !trot eaiculaaoml and coat approaO commonls in this Space.
' 28.'00 'X" 38.00 'X °', °1.00 •'.= ° 411064.00
11V/1''
` 2:00 'X " "7:00 °X'• -1:00 `:. ° '-•14:00
'LIV/1
'
' 26:00 'X` 26.00 "X" 1:00 '=' °676V'00
*BSM"
`BSM
" 6.00 'X' '6:00 °X' =1:00 -. '-36:00
Sales or Financing
20.00 X 26-00 'X'41.00 = "520.00
CAR
6.00 'X " 6.00 X • °1.00 '= 36.00
GA1Z
Total Gross Living Area:•1050
I
comments 'on Obsolescence:
-10790-
4a functional or economic obsolescence
Data of Salo/Time
aas noted by the 'appraiser:
jarlte•C •adjustment: $13/sf for '90%f in basement.
See attached drawing'for floorplan
.
.
. ,.
Layout. w
s milar i
O L sup
4ite value "includes sieptie.'
_
Not Required by Freddie Mac and Fannie Mae)
loes property conform to applicable HUO/VA property standards? Yes Q No
I No, explain:
P. 02
File NO 11-0562351
ESTIMATED REP,•...iUCTION COST -NEW -OF IMPtiOUF((Vlj:jJ,TS;;,,Ct,
s . Ft. ®�
48600 ;,":�i �, , il' So, 440,
1,0504
Dwellinr�
640 �i7smt5q. Fl. _ '
Extras fpl; wo(xls't:v, etc.
see p, I_ -- --
Speclal Energy Ellicient Items
Porches, Patios, etc. cov er, dealt- _ _
7 37
Garage/Carport —Sq. _ . =� = 1r1r=
Total Estimated Cost New m$
'
Physical Functional External
Less 71500 m � 0
'Depreciation
50
Depreciated Value of Improvements .............. _
Site frtp. °•as is" (driveway, landscaping, etc.) _ $$__--__•_
J5_t 000—
ESTIMATED SITE VALUE ................ . ..... . . _
(It leasehold, show only leasehold value.)
--......... w,.,•w .nnnnnntl o A 122,672
IBUIGRICV VALLA[ 9, V.11I n.,••�•••+••
Construction warranty Yes [ No
Name of Warranty Program
Warranty Coverage Expires
The Undersigned has rocltad three MCant sales of properties most similar and proximate to subject and ties Considered these In the market analysis. Trle aescrpuon nnuwuuo u vw a
Adjustment, rallaetino market rOUCI)on t0 1h030 IlOtns of slgnlfioant verlation between the sublect and cornparablo properties. If a significant Item In the comparable property is $00riOr
to, or mord lavorablo than, the aubjadt'property, a minus (-) adjustment is made, thus reducing the indicated velu0 of subi001; if a-Igni[ioant item In the comparable is Inferior to,
or less favorable than, the subject property, a plus (+) adjustment is made, thus increasing the indicated value of the subject. CDMPARAnLE NO. 3
ITEM SUOJECT COMPARABLE NO. i COMPARAOLE N0.2
-�� igen en now ower p �`$91"� { '• -
ampson D"r u °
Adaress 3/13 Northwotxis #3 16/3 5ampsan Est 18/16 Northwoods -1/5 ParXvper;,�'eFx•.
r r-
5-rC11-e nor seas samesuw1visiors ml As o a e•,
eraximity to Subject r $---'Y20-OdsS ; $-_=-51 000 II gM
f
Sales Price $ _ 4 , $ .89 C� 1 $
5rice/Gross Liv, Area
$114.Z.0_RS
amender
$ !
AM1)
AMDS
xnspe Ifion
)ata Source
VALUE ADJUSTMENTS
DESCRIPTION
DESCRIPTION • t•) S adiuslmeat
, ,
DESCRIP, ION + !-!s Auiu,lnwnt
'lam%A11TC I
� (-t s aajuatmanl
bESCRIPTION,�
7LT3%F'T; ,
Sales or Financing
I
;
'
Concessions
I
---
-10790-
'� T'--
-'�I90='T0%90 ,
Data of Salo/Time
/
su erior
Location
average
2 /ave
s milar i
O L sup
227iZar
-2275'0/sem
-`5904"l.Inf +21 0D-
Site/View
f
Sltnl sr ����
stmt ar
Design and Appeal
Quality cl Construction
v
8 erage
average
s m air
similar I
---_'I
'similar ;.-X00-$�a6--
8T1� .�._ _;
""'-4'•
—�---•- =' 0017'
,
Age
1983
, _JOU
lnferlo]• +5; 000
Sim ar
"similar '
Condition
Above Grade
go
Total , edrms i Baths
Total , edrrns Baths r
Tatal , tdrnts 1 ealhs J -11000
Telal . BdrmS , Baths i
Room Count
-1
2 ' 3
0�0
4 2 -2,000
1 19 Sq. F_ -31400
, • _a,_
r q. Pt ; -21100
, 0$4 +300
`fin
Gross Living Area
_ 1, Sq, PL
5qu fin
93 O�rPin -2,
-
ln
_ :
7Z0
Basement & Finished
Rooms Below Grade
2-1•-1
3-2-0 +2,000
:
_1•-1-1 —� --�"
2-1-1 ---
slml ar �_ -�-
Functional Utility
average
sim laic
GFA
simx.lsx• ---
_"OiiW9 1CA
7 I"--
- -
_Healing/Cooling
GaragelCarport
GFA _
G2 -BI —
±
Cr -2 -BI _ —
t��IY
i-
- 'clack ;�
Parches, Patio,
•--,—I
qov entry
cov entry
cov entry
deck I
coo entry I
Pools, etc.
deck
mrd
deck
—0.iar
�siniflar
slniiTrir ;
Special Energy
Ellicient items
insulation
Cpl +6,000
t
"fpra- - 2 r
p ; +2 s OT)�S
Fireplace s)
kitchen
fp1 & woods
TV—DG�� 19 bb
RVQ'' l
RVl?G, upgrad I�
500
5.�.
' •-200
ve ext gls
Other (e.g,
equip„ remodeling)
scs truss
v.c I h500
hdwd fir : -1,
2
1
,wu
+, r
.,_. AA! r,w..u,
1
n + tai-'$
: Lj * f -'s -
.n, Irl$
Indicated Value 1llllllllll�il1881111818111''llh I�� illll 8111 ii'l +1ill'I(', I 132. �o� �i�►���� i�i�i��ii�+�►�ii+i!��$ 125:404
of Subject I I i$ 119, 300 I , S
Comments on Sales Comparison: #2 to th �n the su Oect su Lvision appe:zrs to �e a --u 1n a gator
relative to the other data. I is indicative of sin improving tnar'ket.
River Pro r . I' j a...0 --
condition. •#3 is located on a small site in �as1e 1�
INDICATED VALUE BY SALE$ COMPARISON APPROACH ...................... • .. 1, 000 con 'etion cr lano/alid$ deifies ?' EI�"�
1111
INDICATED VALUE BY INCOME APPROACH (if Applicable) Estimated Market Rent $ 000 /Mo. x Gross Sent Mulli Per A .1 S na o
This appraisal is made [] '°as Es° Q subject to the repairs, alterations, inspections or conditions listed below A A----• t
Commonts and Conditions of Appraisal:_ #3 was utilized because of lack of other data in the immediate
ntark_et area. See_vc sheet £or repairs. _
Final Reconciliation: rl'k>e SzLles Comparison Analysis is relies uPoT^aaci senatnaevest— Opduetacf`
—
is cross supported by the _ Cost Ap roach. Me Income App'___ i _ - ---7 ,;, , rte" 771;1
investor oriented �--tinge-- - -
This appraisal is based upon the above requirements, the ccriitication, connt and limiting ecndiiiort5, and Market Value dclinilion That are stated ip
Qx FmfJA, HUD &/or VA instructions.
,. � 18
Froddie Mac Form 439 (Rev. 7/86)/Fannie Mae Form 10040 (Rev. 7186] lO0d with cS O February 8 10-91- to be•$. 1 0;1400
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE SUBJECT PROPERTY AS OF---
I (We) certify: that to the best of my (our) knowledge and belief the lads And data used herein are true and t:arrect; that I (wo) personally Inspected the subjecl proRy
Inside and out, and have made an exterior inspection of all comparable sales cited in this report; and that I (we) have no undisclosed Interest, present or prospe0'iVe�
/';� ��/ REVIEW APPRAISER Did
APPRAISERS) Q Did,Not
(if applicable g�nprure DrnhPrr°ii