HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 14 LT 5Northwoods #3 Block 14 Lot 5 #051-732-33 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231007 PID Number: 051-732-33 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ®Upgrade Name JORDAN FALCON & ALEXA HAYES ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 23006 LIVE ALDER AVENUE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 LEGAL DESCRIPTION GPD/SF Ft. Depth to pipe invert from original grade Gravel depth beneath pipe Ft. Ft. Subdivision Block Lot NORTH WOODS UNIT 3 14 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft' Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Holding Sewer Lift Station Total absorption area Number of trenches Ft. Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 200'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ -- GREER 1000 Gal. Material Number of compartments Lot Line 10'+ -- NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Remarks Septic tank insulated, deck recently rearranged, tank Gal. is 5'+ to deck supports & 2'+ to stairs landing with no point Alarm location Electrical installed by load & supported by deck. MOA notified & discussed Installer J(�g PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 1st 2/2/23 2Id 2/2/23 Location and description 3rd 4 t BOTTOM OF SIDING Near Gas Meter ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: '' • •' Date • } • ® •:'� 00 • 7H , vim... •• •• ••••••••••••••. Septic Syste Approved - -- -'" '• Curtis Huffman ��•. Date . ��?02 CE 128991 �w�®'�/ �sf '. 3/6/2023 .� • C��,i Note: this approval does not include well . F,p '••....• �. a• F©�°ROFESSIONA ..� permit requirements. 1RPv nsmgil R) S SSS G E S S PID:051-732-33 PERMIT:OSP231007 FIRST WATER CONSULTING NORTH WOODS UNIT 3 BLK 14 LT 5 XXXXXXXXXXX X X X X X X X X X X XXXXXXXXXX X X ℄/,9($/'(5$9(  ('*(2)3$9(0(17 3$9(''5,9(:$<6+(' 6+(' /27/27 /27/27 */(119,(:(67$7(6:(673+ 3/$7 L=72.24R=175.00 N90° 00' 00"E 62.92 S00° 00' 00"E 178.05S89° 59' 03"W 150.00N05° 00' 00"E 193.53SG E   /RW%ORFN 1RUWK:RRGV6XEGLYLVLRQ8QLW,,, 6T)W /LYH$OGHU$YHQXH 6WRU\:RRG)UDPH+RXVH :LWK$WWDFKHG&DU*DUDJH SC SS SSSS S S S SSS PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. March 3rd, 2023. Legend: Scale 1" = 30' Gas Meter Electric Meter/Outside Power Deck Septic Fence Lot 5, Block 14 North Woods Subdivision Unit III General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Kelsea Doucakis 23-055 03/03/2023 83-68 1459 G E S x 0DU R E GISTEREDPROFESSIO N A L LA NDSURVEYORPierre M. Stragier No. L.S. - 9812 SC Septic M.H. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231007 Work Type: SepticTank Upgrade Tax Code Number: 05173233000 Site Legal Address: NORTH WOODS UNIT 3 BLK 14 LT 5 G:1459 Site Mailing Address: 23006 LIVE ALDER AVE, Chugiak Owner: FALCON JORDAN & HAYES ALEXA Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: Department 2/6/2023 2/6/2024 25670 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: I S 5 137 M ()A Date: Issued By: Date: Z /2-,,, Z 3 MUNICIPALITY OF ANCHORAGE Development Services Department V-01 Phone: 907-343-7904 On -Site Water & Wastewater SectionFax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-732-33 Property owner(s) JORDAN FALCON & ALEXA HAYES Day phone Mailing address 23006 LIVE ALDER AVENUE, CHUGIAK, AK 99567 Site address 23006 LIVE ALDER AVENUE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 3, BLOCK 14, LOT 5 Legal description (Township, Range & Section) Lot Size 25,670 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank Q Upgrade 0 Duplex (D) F-1Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: .29 Date of Payment:on�� �aU.23 Receipt Number: RU 3�l3 Permit No. 25P;'_b100'� Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! February 3, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: NORTH WOODS UNIT 3, BLOCK 14, LOT 5 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank may be required. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231007, Curtis Townsend, 02/06/23 FIRST WATER CONSULTING NORTH WOODS UNIT 3 BLK 14 LT 5 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231007, Curtis Townsend, 02/06/23 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION " P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5W 9200/!n PID Number: o,51- 7.37,- ,33 Name: Prkrl. Wastewater System: El New [� Upgrade Address: 23097 i Goc Nv��iA ABSORPTION FIELD Phone: No. of Bedrooms: ❑Deep Trench ❑Shallow Trench y$;Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: A 5 Total Depth from original grade: Z 5 GPD/Sq. Ft. ' Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ll ' 1V0,97WWQ0PS 4' 2, O Ft. O• S Ft. Township: Range: W Section: + Fill added above original grade: Gravel length: 0 Ft. Ft. • WELL: 015'f*4❑ New ❑ Upgrade Gravel depth: f.)/prq Numberoflines: Distance bgtweenlines: / d Ft. Cd_ ICt Ft. Classification (Private, A,B,C): Total D Cased To: Total absorption area: Pipe material: Ft. Ft. UO SQ. Ft. �1 30,a4 �7 5 TM Driller: Date Drilled: Static Water Level: Installer: Date installe : Ft. GeEr�/� �N, ov, as za 9z Yield: Pump Set at: Casing Height Above Ground: - /')< (� TANK GPM Ft. Ft. r/ F�`o'^� l2ec.'4 SEPARATION DISTANCES (septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Wrbiie/Private Manufacturer: - Capacity in gallons: From Tank Field Station Tank Sewer Lines �AA le d J Well ZQ� ;f �QD /�/7J N /A / �t/lA Mate =trial: ( Number of2mpartments: Surface Water � �llA MIA /\1/A N% LIFT STATION Lot�� Line / /0 / /V/A N A� / /0 / Size in gallons: Manufacturer: Foundation / q 7 G / 1\j1A 1\11,4 1q,4 "Pump on" level at: off' level at: High water alarm at: CurtainN/� Al�A /��/,� n�/� �,//� Pump Make del Electrical Inspections performed by: Drain / j Remarks: x s � se,o � r.jAr BENCH MARK Location and Description: 5 /'S/ /NSULiIr/ow OV FIELD, ', & X /5 -r W6 rlILO 4 e, l/ ,I12 Assumed Elevation: 'On t7)/V 07 -IL / ACL91 4) Ft - ENGINEER'S SEAL V OF At I1 tis dr �����••••.•.s••��� Inspections performed by: t1/6/1VEEK Dates: 1st �' W9 * r�S y 2nd 0 za 9 ,...:.. ..•....4, , A Department of Health d uman Services approval �a<,.e tcu!sera ^: Ao OW Reviewed and approved b Date: 72-013 (1/e1) MOA 25 . •.;.., ,Permit'No. SW 920016 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Northwoods #3, Lot 5, Block 14 Legal Description: T15N R1W Section 4 PID No.: 051-732-33 M LOT 6 NO WELL W 0 O O O. SEPTIC N SYSTEM � +50' z 40 M40 ®L TH# I -� LIVE ALDER h w ry N WATER LINE IN APPROX. LINEER 42.0- 0 4 HOUSECIa B 42,0. N A II I I TH#2 '�• �•. a I I I p SHED 111 S 89'59'03" W 50.00' �V E R.O.W. LOT 4 NO WELL ..._ __. SE.PT.I% _.——..._.. __.. + 40' 0 O 00 n SWING TIES O z A - C = 30.8' B'- C = 29.1' A - D = 61.0' B:- D = 30.8' A - E = 89.4' B. -_E __ 71.8' 0 — TEST HOLE i • — MONITOR TUBE 0 — SEWER CLEANOUT + — WELL 4+31+VRVH - LEACHFIELD ... . .. EASEMENT SCALE 1" = 50' ELEVATIONS n REAR GARAGE DOOR THRESHOLD (NOT TO SCALES V ASSUMED ELEV = 100.00"; y 0 ORIGINAL m GROUND - -- -- : --- .LEVEL R_96Y +18" N❑ GROUND WATER 2' 35 PSI ENCOUNTERED TANKTING 942' 94.2' INSULATION ss.r FIELD PAGE 1 OF 1 K MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 101-9 a ANCHORAGE, ALASKA 99519-6650 &u_4f�_r� ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920016 DATE ISSUED: 2/20/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE: 2/20/93 OWNER NAME:COLEMAN DARRYL R & OWNER ADDRESS:23047 LIVE ALDER AV 2)ipfn CHUGIAK,AK 99567 nnoJ�o'�D OU PARCEL ID: 05173233 LEGAL DESCRIPTION: NORTH WOODS UNIT III BLK 14 L T 5 LOT SIZE: 25670 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: Y: `* < DATE: O L/ZC ,9 DATE: 20 Louis Butera, P.E. Registered Civil Engineer February 12, 1992 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods #3, Lot 5, Block 14 Narrative Dear Mr. Smith, MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION rEb 12 1992 RECEIVED The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and community well. 4. Drainage will not be effected and is not a major consideration in our design. We are requesting a 5' lot line waiver to better facilitate installation of the system. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 • Eagle River, Alaska 99577 • Telephone (907) 694-5195 • Fax (907) 694-3297 VACANT LAND NO WELL ® — TEST HOLE • — MONITOR TUBE O — SEWER CLEANOUT + — WELL NO KNOWN CURTAIN DRAINS ++t+HH+I+ PROPOSED LEACHFIELD NO SURFACE WATER COURSE +100' ---— EASEMENT SEPTIC IC SITE PLAN LEGAL: LOT 5 BLK 14 NORTH WOODS UNIT III OWNER: COLEMAN CONTRACTOR: HASMIER JOB # 92-005 1 DATE: 02/19/921 SCALE 1" = 40' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 b. 1� xF in F . oP r4�°h �q n n ALDER AVE (y N WATER LINE IN R.O.W. tQ APPROX. I WATER LOT 6 U1 LINE 1 LOT 4 0) I 42.0• NO WELL W N HOUSEa 0 0 42.p, N r 0 0 0 0 SEPTIC TANK 2 SEPTIC �S+SOEM Z sa _—DIVERSION VALVEy�l ° O NO WELL In ✓ Z 4�1° ° 1 1 1 TH#Z ® <a• EXISTING SEPTI j� ✓. r 'O• 'i °'1 o SEPTIC +40' ^•1� n SHED FIELD o m 1 1 1 40 TH#t J/ S 8✓9'59'03" W 150.00' 0 VACANT LAND NO WELL ® — TEST HOLE • — MONITOR TUBE O — SEWER CLEANOUT + — WELL NO KNOWN CURTAIN DRAINS ++t+HH+I+ PROPOSED LEACHFIELD NO SURFACE WATER COURSE +100' ---— EASEMENT SEPTIC IC SITE PLAN LEGAL: LOT 5 BLK 14 NORTH WOODS UNIT III OWNER: COLEMAN CONTRACTOR: HASMIER JOB # 92-005 1 DATE: 02/19/921 SCALE 1" = 40' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 b. 1� xF in F . oP r4�°h �q n n SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 5, BLOCK 14, NORTHWOODS #3 A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. BED 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. The bottom of the bed shall be level, plus or minus 1.5". 3. The total depth of the bed excavation is not to exceed 2.5' at any point. 4. The sewer line is to be tied into the existing sewer line that leads to the existing bed to allow effluent switching to the upgrade leachfield by means of a diversion valve (Bull Run or equivalent). 5. The bed gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the bed is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 2.5' GRAVEL DEPTH = 6" BED LENGTH = 50' BED WIDTH = 18' SOIL RATING = 0.5 GPD/ftz BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,000 (existing) Twenty-four (24) hours notice required for all inspections. (ENGINEER'S SEAL) ?. s?v Municipality of Anchorage s DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 <u SOILS LOG - PERCOLATION TEST o� �1n ©eoao &voa®a V��A OFESS� .ao. PERFORMED FOR: 494/�y� �di'e ..,q ,� DATE PERFORMED: � X k LEGAL DESCRIPTION: 477<-_s e/K 3TOWnship, Range, Section: 7-1,$-r, fe / w rC� y SLOPE SITE PLAN Al I 1 %upSni/ � Ul'Sa...ic n , 2 vim^ ,- N 3 l O 4- 5 5 6 ( i Si �i�b �Gi✓e�,./ I,-r4aC� C �i✓G K<r tea(.' �GNiI f� 8-//I 7 O 8 �• 9- 10 10 — O WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT 12 DEPTH? 13 Depth to Water Aller Monitoring? f" i' " i' Date: 14 15 16 17 18 19 IEmommomom ■■.■..■.M■ ■■■■.■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop SOA PE 2 /1'.11- a..,.N -2.'//,9 '. Iy�i6 .. 1 f- �• a7:o? 3o r....:r 3ta•• 6 •• 20 t__] PERCOLATION RATE r (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND ? FT COMMENTS - 1419�; NJ Y ra /oerc , 2 �, h...� r /p 71D p r G.on/ty_ 3- ✓.moo( �a I PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) (ENGINEER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ' SOILS LOG — PERCOLATION TEST d""%,°�.,"'''4�� � '� Euw� �a„ �, ate• PERFORMED FOR: O1 A"Ct ,,, DATE PERFORMED: -30 / q LEGAL DESCRIPTION: 1Township, Range, Section: 7—, j— /e /w sty y SLOPE SITE PLAN ;r// A' 1 2 O o / N o• 3- 4- 5 45 .4 6 /41.0014-rQ UC/ 1 �e �_ SNL Kcr mel �CNli% d��// 7 O 8 9 �. t0 — _ WAS GROUND WATER G ENCOUNTERED? NO 11 - S IF YES, AT WHAT L DEPTH? P L r 12 E 13 Depth to Water After Monitoring?' // Date: "T Reading Date Gross Time Net Time Depth to Water Not Drop 5'04K //74/s: e Ste. 1'6„ 6" 20 t__j PERCOLATION RATE S (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS .-�U c r4 r—r PERFORMED BY: L ' /�?'' iq I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Rev. 4/85) PROW 291 Inc, OMon, M. 01411 MUNICIPALITY OF ANCHORAGE M E M O R A N D U M Date: February 21, 1992 TO: Accounting & Budget Fourth Floor, DHHS FROM: On-site Services, ESD Fifth Floor SUBJECT: Request for Refund - Account # 2570-9426 Please make the necessary arrangements for the following refund. During the review process of the permit it was re -designed and a Lot Line Waiver is not required for this property. Eagle River Engineering Services Lou Butera, P.E. PO Box 773294 Eagle River, Alaska 99577 Lot 5 Block 14 Northwoods Subdivision #3 Sewer permit with lot line waiver Permit #SW920016 Account # 2570-9426 Amount: $70.00 Receipt # 23444/728 dated February 12, 1992 Thank you. Laur\ ntgomery On-site Services cc: File MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On -Site Sewer/Well Permit Application 05/ X32 - 33 NOTE: Application must be filled out completely. SINGLE FAMILY DWELLING Parcel Identification Number Property Owner Name IDA/2Ryl- COLEMAN Day Phone 2 07' Mailing Address 2 304 1 L1Vj5 A101 gyp, 0HUb//).K Xle Zip Code 995/77 Legal Description y rw000 5 *3 Lot 7"l5N /:3 W Section Township MUNICIPALITY OF Lot Size 2 5i (y / 0 .Ae.e&4q. Ft. Inspections will be conducted by: ENVIRONMENTAL SERVICES DIVISION Number of Bedrooms Approved Engineering Firm ri L } 1992 `ot�3 -6 S Municipality (permit fee included) Does your house contain any of the following: Hot Tub, Swimmiin Pool, Therapy Pool, Jacuzz E C E I ED or Water Softener Unit? If yes, which one? � t. This application is for: Sewer Only I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and in accordance with applicable Municipal codes. _�j--- - 40 l/ Fees: n � _] n t o Receipt # a 3 `� Perm t # 72-012 (Rev. 10/86) Sewer and Well Sewer Upgrade L Well Only Municipality of Anchorage A DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 ---------. .... - ON-SITE SERVICES FEE DOCUMENTATION Date Paid: Name of P yer: (N eon ecl Mailing Ad ress: Off of the ) 73a - Legal Description(s): �S � -:�)_ Type of Payment: (Indicate Amount Paid) Health Authority: — $ewer & Well Permit: I - Excavator Permit: Engineer Permit: 0 Well Permit: Pumper Permit: Sewer Permit: 90 Well Driller Permit: Copy Request: 72-034 (Rev. 10/87) Tank Manufacturer: (Waste Treatment) DISTRIBUTION: Permit Number: #: 748 OS -23444 WAIVERS: d o Lot Line: �U Well to Tank: Well to Field Field to Surface Water Tank to Surface Water WHITE—MASTER FILE CANARY—PROGRAM FILE M.....�.....� APR -09-192 09:55 1 b s WESTERN UTILITIES TEL NQ c 206-722-9477 049 poi i02 x 11t0i1il•1114AL VIR MEATIER VALVA NOW AVAILABLE IN P.V.A. INDS 676 NDS 676P For, septio tank leach fields, Irrigation and other applications Here's the simplest, strongest, most economical divorter valve ever invented for septic tank leach fields and other applications In drainage and Irriga- tion systems. Made of tough AN molded plastic that will not shatter, bend, rust or corrode, Lighter In weight, t=asler to handle and out. Lose expensive to ship. With dlverter valva stem, you can control the Inde viduals and up to three outlets, in any combination. With a three-way valve stem, you divert flow to any two outlets. To permit flow through all outlets, Just lift the valve stem out of the assembly. To install, connect standard 4" plaetic sewer and draln coupllnps or regular reducer fittings to inlet and outlets on the four-way distributor box. (Unwanted outlets may be sealed by Installing outlet cap.) Out dlverter shield to desired depths and Install In top elseve of distributor box. Insert dlverter valve stem, Cover with diverfor shield cap. 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IIElO M`NICIIINiI{ 4187 P03 SPECIFICATION GUIDE,, N1'1111e119YALT ,DIVERTER.VA CLONED05 i1 C TANK Ng ' Ns O�%C `ti✓ ,4 ITJ 0 TANKIN S TANK NO NNER ITEM M8 BUILT IN STOP INDICATES CLOSER P0SITI0N on TURN TO N4 011 04 WARRANTY All Nblt produlNs no 111 uenteed 491111181111111140916 te1uI11RI from foully *orkrhpnshlpof tnelodds, oldmr In fiber Mis and slhpr eNpsnea requltod to repfi0e'defO011Te p16010111 or replb 01 eny dettupe 1141olling from the use 11IR001 *111 qql bt'sllewod by Nog. our 114WIlty Is limllod to fepltefe+lent Of products 00newladod by NGl 10 be detective. pOSlilvt C6NTRgW To dived flow, fuel pteeo /* hoodlo end turn roles tum. Affows ehdw (low pllldln, To just ro 110w V10 NI00A from just lertlere YelYe eIOM Item enembly. TURN TO N4 011 04 WARRANTY All Nblt produlNs no 111 uenteed 491111181111111140916 te1uI11RI from foully *orkrhpnshlpof tnelodds, oldmr In fiber Mis and slhpr eNpsnea requltod to repfi0e'defO011Te p16010111 or replb 01 eny dettupe 1141olling from the use 11IR001 *111 qql bt'sllewod by Nog. our 114WIlty Is limllod to fepltefe+lent Of products 00newladod by NGl 10 be detective. 3 Length ofac�� Top of tile to finish grade . . - Meametwee MUNICIPALITY OF ANCHORAGE r �— DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION LC* ENVIRONMENTAL ENGINEERING DIVISION Type of crib 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME DISTANCE •DISTANCE .. , PHONE NEW IN •Building ev 31 ❑UPGRADE MAILIN DDRESS foundation• V' O , CKA1'T LEGAL D SCRIPTION .N■.■■■E■■■I■■■■■ ■■■■■■■■■■■M■■■. ■■■■R■■■■■■■■■■■ LOCATI N NO. OF BEDROOMS DISTANCE TO: W Absorption area Dwelling PE T NOA Oy [— Z a � Manufacturer Mat i 1221 No. of com artments y Liq. c' allons IFHOMEMA E: Inside length �,_,� Width L Liquid depth �+�.. Y JaZ DISTANCE TO: Well Dwelling PERMIT NO. = Z Manufacturer Material Liquid capacity in gallons = DISTANCE TO: Wel,yI.-.�� Foundation Nearest lot line RR %, . /� P �MITIVD. 3 Length ofac�� Top of tile to finish grade . . - Meametwee lines NONNI-- _L ijk-- Type of crib Crib diameter DISTANCE •DISTANCE .. , ®ff— IN •Building • foundation• Absorption area(s) .N■.■■■E■■■I■■■■■ ■■■■■■■■■■■M■■■. ■■■■R■■■■■■■■■■■ 01 ff�awn MENEM ..� .. 3 MUNICIPALITY OF ANCHORAGE Department f Health and Environmentai Protection 825 Street, Anchorage, AK. 9501 264-4720 Permit # # # # HANDWRITTEN PERMIT # # # WCxtt/OR ON-SITE SEWER PERMIT Applicant: s` \e Q � kc,ci S Mailing Address: i� n`X 'IS �1g5�7 Location: o.OT4X Number: 67 - J Legal Description: L5 BL ( 4 1 1`orl-kAe. DD35 Lot Size: -- Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) /--7 !! I The Required Size of f the Soil Absorption System Is: H DEPTLENGTH �x GRAVEL DEPTHro 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 of residences that the well will serve. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department; will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet; fora 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 3.bedrooms. Signed: Issued by:�`I vU \ (ZS Applicant k — Date : - -8 5WP/024(1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Sieve SiCa DATE PERFORMED: JUT 30 I�83 LEGAL DESCRIPTION: tVor�woac $Ia K 1q- L-bi-S VY)OR ST 83 0 2Ci SLOPE SITE PLAN / D 4F ��L� or.,�ge mown Or'Mi'C toil ;2 a A (cam) Ibose (;9ti� I.,-. co'My �rwvt� y�ryh } Ili ■■ 00 Nom 10 Date iHN.N NM wi.yp �. �iiliio . r. 11 77 Z Leroy C. .♦ jy� aid, Jr. R/ 8 � ENCOUNTERED? 72 ' No. 251.9 -g'�✓� Ll 2.� �- IF YES, AT WHAT it33— ..9646•. �Pi40FESS%rj sw , Ili ■■ 00 Nom 10 Date Gross Time Net Time 11 Net Drop WAS GROUND WATER ND ENCOUNTERED? 72 ' [/31 Ll 2.� 31 IF YES, AT WHAT it33— 3.06 :DEPTH? 13 rty{ t, Reading Date Gross Time Net Time Depth to Water Net Drop [/31 Ll 2.� 31 it33— 3.06 rty{ /3 Z. 7.1 /Zoy r} 2.81 23 /2 vy 00 t2Y tU Z• r 12 20 11 '/ _ JI PERCOLATION RATE �Z Z (minutes/inch) r/ TEST RUN BETWEEN `�. FT. AND �.FT. COMMENTS S00 r-i*W LQl ELI �61 M 2 8 PERFORMED BY: CERTIFIED BY: DATE: 72-008 (6/79) Certificate of On -Site Systems Approval Parcel I.D. 051-732-33 Expiration Date: 70 Z Legal description NORTH WOODS UNIT 3 BLK 14 LT 5 Site address 23006 Live Alder Ave Chugiak Current property owner(s) Jordan Falcon and Alexa Hayes X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: gYOriginal Certificate Date: 3/7/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY 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 Parcel I.D. 051-732-33 Complete legal description NORTH WOODS UNIT 3 BLOCK 14, LOT 5 Location (site address) 23006 LIVE ALDER AVENUE CHUGIAK, AK 99567_ Current property owner(s) JORDAN FALCON & ALEXA HAYES Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 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: ®_Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 0 - 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 $ ISIT6 Waiver Fee $ Date of Payment �;J ( x3 Date of Payment COSA #�J (r�.� f%!A Waiver # r X13, COSA Application—July 2022 copy.doc COSA Checklist 2022.docx COSA Checklist Legal Description: NORTHWOODS UNIT 3, BLOCK 14, LOT 5 Parcel ID: 051-732-33 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC / CLASS “A” WATER Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NA – NEW SEPTIC TANK Required maintenance completed, if AWWTS Comments: NEW HDPE 1000-GAL S.T. C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 3/20/1992 ALL standpipes present per record drawing Total measured depth from grade 2.2* ft (max) Measured depth to pipe invert from grade 2* ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 2/6/2023 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time <5 min Final fluid depth 0 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: *South end of 1992 absorption bed and shallowest portion. No known freezing issues per owner and past COSAs. Shots show 0.5’ of effective depth and the original 1983 monitoring tube was dry. Northern pipes were extended above grade by JRs at recent tank upgrade. 1992 bed insulated per inspection report. COSA Checklist 2022.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 3/6/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 3/6/2023 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s A F t r Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-732-33 Expiration Date: 1. GENERAL INFORMATION - Complete legal description Northwoods #3 Blk 14 Lot 5 Location (site address) 23006 Live Alder Ave Current Property owner(s) Joshua & Sharlotte Hightower Day phone Mailing address 23006 Live Alder Ave. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank . ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -I12_150 C&)U/9 Waiver Fee $ Date of Payment ZO ZC? Date of Payment Receipt Number 7 i! Receipt Number COSH Waiver # Distance: 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 andlor wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AIC 99577 Engineer's Printed Name ICENNETH M. DUFFUS Date 10/512020 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen Awl OF A,�� \ encroachments, deficiencies or discrepancies exist. / 5. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the foil 7 lot,C101* TIC s' -d KENNETH td. l , 1 Cis 116 w °Rolac sto�.*y .�- SIR�,Fiii ON-SITE n vV/AI Ct'( ANI) r'1 '1/"))))Wi1'' B Original Certificate Date: 10-1—_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10.10-12.doo Nitrate Advisory Arsenic Advisory /� r" -30W Othe-Aq 09 Pl,eaX%_ 1L-ee U XkA� K-o(Avisc 0v 1 t COSA Checklist Legal Description: NORTHWOODS #3 BLK 14 LOT 5 If more than 1 septic system on tot: COSA Checklist # of I a 11111-0-14 Elsa" MANN ❑ Well log is filed with Onsite (or attached) Date drilled M Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are property protected Casing height (above group in. Date of flow to SA _ _ ._.. .... _ ..._ ... level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material S Etic/Steel Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 9/30/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/24/92 IN ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field FN Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-732-33 Structure served by this system 1 Well production at time of test Water storage tank vol gallons Well disinfe r coliform test? ❑Yes _ No i orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _... _._ Date of Sample _ _._ _.__... _ . __ ... ... ........ . . . C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NA Adequacy test date 9/34/20 Results F0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 500 gal New depth 0 in Elapsed time 10 min WECode-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced gallons if yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES �` ~ From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer 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 septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water >'100' ® Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200'j Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes 'if No ft Water Service Line > 10' V1 Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water> 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet DEVELOPMENT SERVICES DEPARTMENT o �� � On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201548 Subdivision: NorthWoods #3 Blk 14 Lot 5 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Mailing Address P O BoxT196650 *Anchorage, Alaska 99519 6650 *www Muni.,org' • ag70.. • • /c ---- (‘3 ' • 4 f� ;':"7:1;71T7 A . . • • ,'G°f�' AUG� �A : �e •� .'� Municipality of Anchorage a On-Site Water and Wastewater Program � a �-d (907) 343-7904 c'� s a . CERTIFICATE OF ON-SITE SYSTEMS APPROVAL �� 9 . Parcel I-D. 051-732-33 Expiration Date: 3 .c2 C) l S 1. GENERAL INFORMATION Complete legal description NORTH WOODS UNIT 3 BLOCK 14, LOT 5 Location (site address) 23006 LIVE ALDER AVENUE, CHUGIAK,AK 99567 Current Property owner(s) DERICK& HEIDI COLEMAN Day phone Mailing address 23006 LIVE ALDER AVENUE, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 2 //7 COSA to be release h gineer, unless otherwise requested by the engineer. COSA Fee $ 540, Waiver Fee $ Date of Payment 126/i Date of Payment Receipt Number GCO9 1) Receipt Number COSA# 6607 13741Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER • As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. _ Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 8/9/2017 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface,changes inland use,local soil characteristics,groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future OF 1 occupants or can ArcTerra guarantee that no unseen encroachments,deficiencies or discrepancies exist. ,C 1 y 111:6. DSD SIGNATURE tci ntTHtlsDUE �w _ System #1 Approved for bedrooms- I s`/ 'moo /iii System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SiTE WATER AND - V STFI+\!ATFR - PROGRAM ,c. By: PIZ akirilaret Original Certificate Date: g/2 8/)o 1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10.10.12.doc If more than 1 septic system is on the lot: COSA Checklist # of_ • Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: NORTH WOODS UNIT 3 BLOCK 14, LOT 5 _ Parcel ID: 051-732.33 A. WELL DATA— PUBLIC WATER Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (Y/N)Y 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 Arsenic: ugiL Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC l STEEL Date installed_ 3/20/1992 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 8/912017 Pumper SANITARY C. ABSORPTION FIELD DATA Date installed 3/20/1992 Soil rating (g.p.d lft2 or ft2lbdrm) 0.5 System type BED Length 50 ft. Width 18 _ ft. Gravel below pipe 0,5 ft. Total depth 3 ft. (Measured 8/9/2017) Eff. absorption area 900 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8!9/17 Results (Pass/Fail) PASSFor 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 470 gal. New depth 0 in. Elapsed Time: 1 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) _N _._ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) _ _ _ ___ "Pump on" level at __ in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas 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'+ 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 50'+(NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS Absorption bed has 3'cover most of the field-the very southern portion of the sloping field has less with no known freezing issues. Original field's monitoring tube was inspected and found to be dry. 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. OF AL Engineer's Printed Name KENNETH M.DUFFUS y Date 8/9/2017 9 Ti l NIS � KENNET14 . . Dt, COSA canary sheet_2-6-15.doc T rs ,116 AEI LIVE ALDER AVE e 10 N R'/75 N90'00'00"W "7-.24, _11 62.92' F N. N. PAVED 1,/'I• +I DM x 2' x 20.5' COVERED U') CANT ENTRY 0 to 2' x 11.5' r, x 29.5. CANT CoN rn �Bw__JIl/,� x x—x—x 42.0' b EXISTING b d' _ N HOUSE N LOT 5 C° 30 3' — BLOCK 14 0 x H 42.0' a 0 x _ DECK • C.O. x-x--x--x1x-- x—x x-x—x— cci a I 14.5' 1.5' x 1.9' • CANT x W I 1 ; t d x • O o I � o • SEP O O x VENT O u7I (trp) < p x O Z I Z 12.0• X I 131 CNV c • • g8 c • • • W Ji- ` 0 –x—x—x c; • .. , ., ., ,. ,x—x—x—x– S89'59'03"W 151.00' -x—x----x-----x.----x-------x----x-.-.----x—x..--x--1 T ANCHORAGE RECORDING DISTRICT,ALASKA AS-BUILT OF: NORTHWOODS SUBD. UNIT III O =FND 5/8"REBAR LOT 5 BLOCK 14 PLAT 83-68 '_��"`` SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a =�� OF A `, Dla, L S DR� physical survey of this pmperty as shown on this drawing and that the / .••' ,tP ' �L ti0 ‘9%,):?,� improvements situated hereon are within the property lines and no ��tC; ' (_ # 5y �1 enchroachments exist other than noted.Under no circumstance should / Gj.•' 49TH '.y �t 1-4 off' e, y any information on this drawing be used for construction of fences, �, I. it ys; structures,improvements,or for establishing boundary lines. x0.' 0 C" r EXCLUSION NOTES: It is the owners responsibility to determine r'pb . AP• ^'`� n the existence of any easements,covenants,or restrictions which 0 ',...(A-- SCHULLER: v/ •`do not appear on the recorded subdivision plat. ��+af -10408 _PR� .........- r e^ ' ��/ 1831 Talkeetaa Street R o NUMBER: a,t JLE E-NAI: 1 as '8'Pr..'rT a_i Anchorage, Alaska 99508 AUG 22, 2017 1'=30' 1, 17-037 w By:p+ECXFD By crao mum* BeekmBE: `,"Ofessi0Rn1 \' (907) 227-1455 office ,ILS NWI459 170146 \k"��w (907) 274-4992 fax Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 JF,e,f-AIW, CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._osiaa _R.91 COSA# �t'r,0152- Expiration Date: S— yi — O 7 1. GENERAL INFORMATION Complete legal description .• 1.. ••• • • Location address) ••. 1 IVE At • i AVE..I IGIAK, S. •• Current Property owner(s) MARGARET rOLFMAN Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 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 Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer n 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 KND ENGINEERING INC Phone F;4&*§§'1 M Engineer's Printed Name KENNETH M DI IFFIIS Date Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a OF �� %ti) system will function satisfactory for current or futurego ••,,,,,• ,4 occupants or can KND guarantee that no unseen �'�p;•••' ''•• s'f �f encroachments, deficiencies or discrepancies exist. --W — •';9 0, 5. DSD SIGNATURE Approved for _3_ bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: ONVE W�-PR86 A4iA1�R Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. a ✓e - z / Original Certificate Date: S' (a.. I VM Municipality of Anchorage Development Services Department Building Safety Division •: On -Site Water & Wastewater Program ¢ 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-8650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type PUBLIC Date completed If A, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (YIN) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: ft. Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. Coliform colonies/t00mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: mg/l Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 03/20/92 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) jl High water alarm (YIN) B—Date of pumping 4/20/06 Pumper JAI C. ABSORPTION FIELD DATA Date installed _3/20/92 Soil rating (g. p.d./ft' or ft2/bdrm) O.5 System type _ a" Length 30_ ft. Width jj_ft. Gravel below pipe &S ft. Total depth A,5 ft. Eff. absorption area 900 ftr Monitoring tube Y Date of adequacy test 4/20/06 Depression over field j( Results (Pass/Fail) Pass For 3_ bedrooms Fluid depth in absorption field before test &_ in. Water added 490 gal. , New depth-Q.5—in. Elapsed Time: _U min. Final fluid depth Q in. Absorption rate >= 4504\. ' g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) _N If yes, give date ..... D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at in. `Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout 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'+ Surfacewater 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 10 0'+ Driveway, parkingivehide storage 1 '+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots _2 00'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and J * 'f'g review of Municipal records that the above systems are in •« .i: . ••• conformance with MOA COSA guidelines in effect on this / «•t•,.w •�•� date. Atn: K.n�riA L 4Pi Engineer's Printed Name KENNETH M. DUFFUS f h'•.�r� 4� % .....•• . Date 04/25/AA `ft \\`�� •+C~ COSA Fee $430 .00 Date of Payment art �;Z . 6 Receipt Number d 7J %1. (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LIVE ALDER AVE_ \ N90'00'00"W 2' x 20.5' CANT 24 A.C. D/W COVERED ENTRY 2' CANT EXISTING WOOD FRAME HOUSE C.O. • 1.5'x1.9' FP CANT t -X—X—X—X—X—X—X 1 X ANCHORAGE RECORDING DISTRICT • C.O. "W 151.00' ASHUILT OF: NORM WOODS SUBDIVISION UNIT III LOT5BLK14 PLAT83-68 SURVEY CERTIFICATION: I• John L. Schuller have conducted a physical survey of this property as s�town on this drawing and that the improvements situated thereon are within Ne property lines and no encroachments exist other than noted. EXCLUSION NOTES:It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 62.92' LOT 5 BLK 14 1zo• SHED N iU-) 0 tp n L0 N L0 N K(N)D —x—: OF ....... ..4 . JOHN L. SCHULLER! LS -10408 1 1a x—x—x- E D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 MA7 01, 2006 1-.30• s"a.ngq►.n.1 (907)868-3791/FAX (907)868-3793 06-028 '" •„ �� •, : aoa .o JLS Nw1439 0601/09 SEPTIC 6' 12.2• VENTS F-V- -X—X—X—X—X—X—X 1 X ANCHORAGE RECORDING DISTRICT • C.O. "W 151.00' ASHUILT OF: NORM WOODS SUBDIVISION UNIT III LOT5BLK14 PLAT83-68 SURVEY CERTIFICATION: I• John L. Schuller have conducted a physical survey of this property as s�town on this drawing and that the improvements situated thereon are within Ne property lines and no encroachments exist other than noted. EXCLUSION NOTES:It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 62.92' LOT 5 BLK 14 1zo• SHED N iU-) 0 tp n L0 N L0 N K(N)D —x—: OF ....... ..4 . JOHN L. SCHULLER! LS -10408 1 1a x—x—x- E D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 MA7 01, 2006 1-.30• s"a.ngq►.n.1 (907)868-3791/FAX (907)868-3793 06-028 '" •„ �� •, : aoa .o JLS Nw1439 0601/09 u "1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date J" 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L.a-r /'V A104e-�-iwaops *'�3 Location (address or directions) loq L(v1� i4La�r2 (b) Applicant Name _5k7e me /�e Telephone: Home Business Applicant Address Jr2 r7A&dr P�40 w1E,e (c) Applicant is (check one): Lending Institution 0 ; Owner/builder 0 ; Buyer ❑ ; Other (explain); (d) Lending Institution Telephone Address /21� ' / (e) Real Estate Company and Agent M& ( 22-6 � pM r Address . / & Telephone / 4 J/— L�ej S hr (f) Mail the HAA to the following address: S & S Engineering Ear4n °liver, Alaska 99377 2. TYPE OF RESIDENCE Single -Family 0 Multi -Family 0 Other Number of Bedrooms 3. WATER SUPPLY Individual Well 0 Community[] Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community ❑ Holding Tank 0 Note: Ifst Community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status: Page 1 of 2 72-025 (1184) 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 Firm _ S & 5Telephone Address F.rrg111cer1r�g SPO ?96X Date E--.0- r,.. AljSka 995777 6 uV 4 /Y ale 7` �f`yfj l SGc !1 F~ Y" A, e� tW" �w ' b 4 � o- DHEP APPROVAL Approved for �(E -3 edrooms by _ Approved Disapproved Terms of Conditional Approval �a a .a s Seal R sbt ate' V Rb9 Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) mumCiPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA1 EWIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 IAN A y 264-4720 Legal Description: vV62r-Hfrvaabs � 3 A. WELL DATA Well Classification K If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield — Total Depth Cased to Dp of Grouting Static Water Level n Pump Set At Casing Height Above Ground anitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Zcx�. t *- ; On Adjoining Lots zoo r'f To Nearest Edge of Absorption Field on Lot 7-"0 t 4- ; On Adjoining Lots 2,0c> To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed _41-2,1763 Size apo a No. of Compartments Z Stand pipes (19/jam Air -tight Caps 011) Foundation Cleanout/Ar- Depression over Tank (1yo Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for N Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well �a } ����/C To Building Foundation 12, �i To Property Line !D To Disposal Field /0 r To Water Main/Service Line % O r� To Stream, Pond, Lake, or Major Drainage Course e01 Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA `1 Soils Rating in Absorption Strata �9 U VSR- Type of System Design _ D Date Installed � � Z.d _ g3 Length of Field S i Width of Field SdJ Depth of Field ys u 0 Gravel Bed Thickness Square Feet of Absorption Area /0 Standpipes Present Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well Zoo �ydc3t c!- To Property Line �� d To Building Foundation 36 ` t To Existing or Abandoned System on Lot ; On Adjoining Lots 30 t.G To Water Main/Service Line (� } To,Cutbank (if prre$ent) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area IWI C mm nt _- JU 9�y Depression over Field,((/oj D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pum Off' Level at High Water Alarm Level at Vent (Y/N) Tested for P,ping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date 6 S@1B 196X — d1� � CompanFa1,sea�,-=;..ter°®y: MOA No Receipt No. F.7h(odt5 Date of Payment I -n-%(o U, - Amount: $ ` , 5s- Robp,*i f A, $yli8 f s No, i40 -f J Page 2 of 2 72-026 (11/84) y U pBILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: Zb �q�ua PWS I.Dy# (2I�Od� To Whom it May Concern: According to records on file in this office the -km&Jitw/ Water System is in compliance with the State Drinking Water Regulations Sincerely, , a ,AtClUcowi �i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ffN10I.I. ltrol 7 Application Date )� f� (a) Legal Description (include lot, block, subdivision, section, township, range) k i LA- tc7t c�2�f Location (address or directions) 0C�c1 �t\t�r-bits (b) Applicant Name '52 ' naPr � �+ Telephone: Home u L� ZZ�� Business Applicant Address t 2�L-z� ��rr^►nr.c� �g L.�-t t/�✓( (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ;Other (explain); a, (d) Lending Institution Telephone Address (e) Real Estate Company and Agent�7 Address Telephone � `� d i t e'A — (f) fi40 the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Number of Bedrooms 3 Other 3. WATER SUPPLY individual Well ❑ Community ❑ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84)' 5. ENGINEERING FIRM PROVIDIK NSPECTIONS, TESTS, FILE SEARCH, Da, 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 Firm ?t & P EYCIWEER1 Telephone 5363 iSGit ^.I_E t�1VtR, ALASeG+� dg577 Address PH 6ut4-4ulu i 6. DHEP APPROV4L Approved for f bedrooms by Approved Disapprove Terms of Conditional Approval m�^V A�e��1ge Conditional CAUTION .Y Date �/— The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) a< MUNICIPALITY OF ANCHORAGE (MOA, Eft"� ` rn1 �tA� PRa1EGT1O� HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ALVA tj 264-4720 Legal Description: �Q2..Tl1WC�c7PS A. WELL DATA Well Classification If A, B, C, D.E.C. ApprovedON) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water LevelPump Set At Casing Height Above Ground knitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Hekiirng Tank on Lot Zoe �` t ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot Zoo �'� `' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments I��o2-rrl-.ito,��� ��� Pia/ -S Ip 1* 2_13r_>o t B. SEPTIC/MOLD M4G TANK DATA Date Installed q -7-9 - 83 Size I -"i52o ✓ No. of Compartments 12 - Standpipes Standpipes ON) Air -tight Caps 4DN) Foundation CleanoutON) Depression over Tank (YQ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) "`� ; for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Hel>: M Tank: To Water -Supply Well ���� }`✓ ���>-� Y To Building Foundation 17- �+ To Property Line \tom I+ To Disposal Field ►�� To Water Main/Service Line l a t+ To Stream, Pond, Lake, or Major Drainage Course A Comments Page 1 of 2 72-026(11/84) C ABSORPTION FIELD DATA Soils Rating in Absorption Strata +���I�� Type of System Design c� Z�j g 3 6. Length of Field Date Installed 4 � ` Width of Field J Depth of Field Gravel Bed Thickness ( ~ Square Feet of Absorption Area 81 O� Standpipes Present (9/N) Depression over Field (Ya) Date of Last Adequacy Test Results of Last Adequacy Test /A Separation Distance from Absorption Field: Ip'+ To Water -Supply Well 4 To Property Line 3p' To Existing or Abandoned System on To Building Foundation I Lot On Adjoining Lots > 7J'o To Water Main/Service Line % a, To Cutbank (if present) a lA To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Manhole/Access (Y/N) Size in Gallons "Pump Off' Level at ,Pump On" Level at Vent(Y/N) High Water Alarm Level at Pumping Cycles during Adequacy Test. Meets MOA Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �. EEAINO Date 8 �y°r�^►d�q�� Comps �/ SRB 196X AA a MOA No. tyAV PFI. 694-2079 122— Date Receipt No. ° Date of Payment Amount: $¢ m.ewem ..°¢°ee°, at¢w es s Robert A. Shafer k ¢ p ' n No. 1457-15 _ A Page 2 of 2 72-026 (11/84) °"e ww a°°•�"P � !'RRFE35���,�•" 1. 1 ♦ i� I our �'(�Q,1eBILL SHEFFIELD, GOVERNOR U lJ �U u DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: PWS I.D.# CZ 362Z To Whom it May Concern: Accordin to records on file in this office the Water System is in compliance with the State Drinking Water Regulations Sincerely, 0 juj�) �J 41�', J-2� Time APPLI(" AIT FILLS OUT UPPER HAI` -ONLY Property Owner "- 1.1 Phone x}✓i'..7 --��. / ' �= C -T'- C Address �, 0 Bijti } p (_ G )� Zip Code / 6 / h Mailing Date --4�3 Buyer Inspector Inspector Address Zip Code Lending. Institution r dtl� � nn nn Phone Address _ Zip Code Realty Co. &Agent �� /� } j L:y ©/"' C�YY"j L-,� 0/0 G,..T Phone Zip Code S� Address ( 3) APPROVED BEDROOMS / . }.:. "—"- , 1 /< Legal Description }, O 7" S }C�'C Street Location ( ) CONDITIONAL PPRO-6� Type of Residence DATE Z�—�� 17 Single Family (�I BY: � " _v ❑ Multiple Family edrooms❑ No. of Bedrooms— Date Sewer Installed ElOther Area Well Log Received A-) A Septic Tank Size Water Supply El Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. to that date, well depth (attach log if available). 5-<ommunity For wells drilled prior give ❑ Public Utility Sewer Disposal 3 Eiisrdividual ❑ Public Utility Year Individual Installed: When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time CR (9J Date Date Date Date --4�3 Inspector Inspector Inspector Inspector nn nn Field Notes: 'k C • v MUNICIPALITY OF ANCHORAGE G� L _ 1 SC DEPT. OF fL p ENVIRONtJ=N1APROTECTION RECEIVED ( 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL PPRO-6� DATE Z�—�� (�I BY: � " _v Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received A-) A Septic Tank Size Well to Tank CC) 72023 (3182) APPLI('"NT FILLS OUT UPPER HA['' ONLY Phone I?top`erty Owner Harkey Construction 99567 688-2831 P. 0. Box 410 Chugiak, Alaska Zip Code Mailing Address Buyer Zip Code Address Phone Lending Institution Alaska mutual Bank Zip Code Address - - Phone Code ECO.&Zip Lot 5. Block 14, Northwo©ds SUM, Phase III Labrador Street Type of Residence X1 Single Family ❑ Multiple Family No. of Bedrooms 3 ❑ Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. depth (attach log if available). ❑ Individuals For wells drilled prior to that date, give well X] Community ❑ Public Utility Sewer Disposal Year Individual Installed: 1983 X) Individual When Connected to Public Utility: ❑ Public Utility ❑ Holding Tank PROCESSING CAN BE INITIATED.. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE i ALASKA el 101RO11 nTAL WOOL OURS, InC. engineerinq & 6nuironmental Studies November 4, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On October 311 1983 our company inspected the sewer system located on Northwoods Phase III Block 14, Lot 5. All the standpipes are, capped and protrude above ground level. The finished grade looks good and surface drainage is away from the septic system. The well is a community well and did not require our inspection. According to Mr. Bruce Erickson of Alaska Department of Environmental Conservation, the community well is up to standards at this date and no water sample is required. �y ��•OF •A`:4� r" ®� Vi •6• � •♦ MY.y�.-�OYV•yai• �• `L M L oy C. Reid, Jr.k g /�T e• No. 2251-EAW •,�j • •N (.� �Qi@ �OROFESS\aj MUNICWALITY OF r LPT. EWIR 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 • (907) 276-1361