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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 15 LT 1North Woods Unit 4 Block 15 Lot 1 #051-064-12 Municipality of Anchorage On -Site Water and Wastewater Section o (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201265 PID Number: 051-064-12 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name Robert Wilkins ABSORPTION FIELD ❑ D Trench El Wide Trench El Bed El Mound Site Address 21910 Sheltering Spruce Chugiak ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 P D/S F Ft. LEGAL DESCRIPTION Depth to pipe invert from origin rade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Northwoods Unit 4 15 1 Fill added above original grade Ft. ravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines istance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. be en trenches From Tank Field Tank Line Ftz Ft. Well p V A t 1v A IV A NA ! TANK ❑® Septic ❑ S.T.E.P. [IHolding ElOther Manufacturer Greer Capacity 1000 Gal. i Surface Water > 100 NA NA I NA Material plastic Number of compartments 2 Lot Line >10' RIA NA NA � NA Foundation 4' NA NA NA LI STATION Manufacture Capacity Gal. Remarks 2" INSULATION OVER TANK Alarm location Elert4GaLinstalled by PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Installer ARM Services Drainfield CO/MT D3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection15 9/17/2020 9/18/20 Location and description es: 2 n bottom of siding 3d 10/26/26 411 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Enginer(n�p 0 A( � Conditional Approval: Date - o-C-'� . 4 �-� '..• Si.'r . ...... b�rtiaA-Date �1ii . No. CE 11904 . •ti Septicstem���b�t Approved Date U 32.00 Note: this approval does not include well permit requirements. (Kev Ub/U2/1 b) 111 Cll( l unicipaUty ®f Anchorage u°parn»°nt P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201076 COSA#: Permit#:OSP201265 PID#: 051-064-12 Legal Description: North Woods Unit 4 Block 15 Lot 1 Engineer: Eklutna Engineering Applicant: Robert Wilkins Your request for a waiver of the required 5.0 feet horizontal separation from the septic tank to the absorption field has been approved. The approved separation distance is 3.5 feet. See engineer's justifications on profile record drawing. This waiver approval applies to the existing septic tank and absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ...............................ww.....................................w..w...... Waiver is Granted: X Waiver is not Granted: f ku"Date: ! 1 oZD D Approved by: 09-JUX Name of Reviewer ■ w w w w w w w w w w■ ............ ■■ ............................... ■ w w w w w w w w w w w w■■■■ w w w w 1 **** VARIAN C E/WAIVER REVIEW **** THERE ARE NO STEEP SLOPES TANKN 50' OF THE PROPOSED SHELTERING SPRUCE LOOP THIS LOT AND ALL NEIGHBORING LOTS ARE SERVED BY A PUBLIC WATER SYSTEM AND THERE ARE NO WELLS WITHIN 200' OF THE SYS EM. NEW DECK SUPPORTS ARE 5' AWAY FROM SEPTIC TANK NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE 2" PRESSURIZED LINE DELIVERS WASTEWATER TO THE SEPTIC TANK. Lot 5 1 NEIGHBORING SEPTIC I IS > 10' FROM PROPERTY LINE N O J 15'1 TELEPHONE XND ELECTRIC EASEMENT 3 BR HOME 1000 GAL SEPTIC TANK — B M T1 X CORNER OF BED LOCATED CLEAN OUT AND MONITOR TUBE PROVIDED X I A B M� X X DCO SS SS I SS f�T2 I SS II 7% SLOPE EXISTING 43' x 21' x 6'L-11 EFFECTIVE DEPTH BED WATER LINE ' L—x--x--x-- WATER KEY Lot 6 NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE Septic Record Drawing Prepared for LLJ U -W- I � SCOPE OF WORK 1. EXISTING SEPTIC TANK REMOVED. 2. PLACED NEW 1,000 GALLON SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEM. THE TANK WAS PROVIDED WITH A MINIMUM 20" 0 MANWAY RISER SERVING THE FIRST COMPARTMENT. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. ROBERT WILKINS 21910 Sheltering Spruce Loop Chugiak, Alaska 99567 NORTHWOODS UNIT 4 BLOCK 15 LOT 1 OSP201265 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 DATE: DRAWN: 12/21/2020 CLT SCALE: 1" = 30' PID: 051-064-12 SHEET 2 OF 3 DF 14 •T4H .............,.�.s....�.�..�.i ...�. 0 : C TIS TOWNSEND ���i % No. CE 1 1 04 S � 2i E fifilt � ► �: �7��:7��1 FG 101 .5 TOP OF TANK 98.8 1,000 G PLASTIC TANK 2" INSUL OVER TANK THE NEW TANK IS 4' AWAY FROM THE HOUSE FOUNDATION. THE HOUSE FOUNDATION IN THIS AREA IS AT LEAST 4' DEEP. THE FOUNDATION SOIL PRISM IS SHOWN TO EXTEND BELOW THE BOTTOM OF THE PROPOSED TANK. 2" INSULATION WAS PROVIDED OVER TOP OF NEW TANK PLUS 2.7' OF COVER. NEW TANK IS APPROXIMATELY 3.5' AWAY FROM EDGE OF EXISTING FIELD. THE EDGE OF THE EXISTING FIELD WAS NOT DISTURBED DURING INSTALLATION OF THE NEW TANK. THE SEPTIC ROCK REMAINED INTACT. MARK A B SV1 23'-10" 28'-10" SV2 24'-10" 28'-7" MT1 41'-4" 12'-5" MT2 38'-6" 55'-2" MT3 2J'-11" 52'-8" Septic Record Drawing Prepared for , ROBERT WILKINS .••�� OF �� 21910 Sheltering Spruce Loop Chugiak, Alaska 99567CD,/ •''�� NORTHWOODS UNIT 4 BLOCK 15 LOT 1 49TH 0 � OSP201265 0.....:.................................:.....No oo . ..... :cn.....................; EKLUTNA ENGINEERING, LLC DATE: 12/21/2020 .8 . CURTIS TOWNSENDc�. 19162 MOUNTAIN ROAD DRAWN: CLT ���� ° No. CE 11904 �` •••. i CHUGIAK, ALASKA 99567 SCALE: 1 1/2" = 1' 1 ..... •1�.�. (907) 406 1058 PID: 051-064-12 SHEET 3 OF 3 4144 N TA; ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONS!SI LI TY OF THE OWNER TO DETERMINE THE E'.0STENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-0829 SCALE: OF Al DATE. Ar �� -���: •;�' ��• / 7 T H ^ !r y GRID Duana erx Seward FB' • q CS - 5 ��'� f���kFT�•'L°oma DRAWN; ��1 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:iiwww.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201265 Work Type: SepticTank Upgrade Tax Code Number: D5106412000 Site Legal Address: NORTH WOODS UNIT 4 BLK 15 LT 1 G:1460 Site Mailing Address: 21910 SHELTERING SPRUCE LOOP, Chugiak Owner: WILKINS ROBERT J Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date: Expiration Date: t„cnt s Q. n C_ ro- * J :i Department Lot Size in Sq Ft: Total Bedrooms: 8/13/2020 8/13/2021 24315 ❑ Disposal Field R1 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 (2417). 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 Special Provisions: Northwest corner of existing bed shall be located at time of construction to confirm separation between septic tank and bed. Received B) Issued By: Date: 20v bate: V /S /_20,6 3 MUNICIPALITY OF ANCHORAGE Development Services Department_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-064-12 Property owner(s) WILKINS ROBERT Day phone Mailing address 21910 Sheltering Spruce Loop Chugiak AK 99567 Site address 21910 Sheltering Spruce Loop Chugiak AK 99567 Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 4 BLK 15 LT 1 Legal description (Township, Range & Section) Lot Size 24,315 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade 0 (D) El Holding Tank F-1 Renewal 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 Codps. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: "? Receipt Number: L9 7Q? 3.D Permit No. OSP201 2 -LS . f / / 5/ Z-0 -Z-_0 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201265, Rebecca Carroll, 08/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201265, Rebecca Carroll, 08/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201265, Rebecca Carroll, 08/13/20 -e-eaz7 I ASSUILT SEWARD I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE - FOLLOWING DESCRIBED PROPERTY- DATE. AND THAT NO ENCROACHMENTS EXIST P_XCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE MCISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS rim/yGo WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN; LINES. ;gavvchA� ()F A( p� r_. Deana Mark"Seward it A LSg- s A, y �Sk%'ici?� Loo Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 i Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5"' 93 PID Number: 651 06glln Name: M AA t M C10eJ-i`-A-!n1",3� Wastewater System: JR'New ❑ Upgrade Address: p00995 C b T ABSORPTION FIELD Phone: GSS 1 ZZ34 No. of Bedrooms: 3 El Trench ❑Shallow Trench Bed EJ Mound ❑Other �+ LEG AL DESCRIPTION Soil Rating: O,5 Total Depth from or c�ipal grade: 3 � h0 S 1 GPD/S . Ft. Lot: Block:Subdivision: 1 l � Depth to pipe bottom from original grade: 6 -5 Gravel depth beneath pipe S 0 Ft. I �+L�Y+kWbbQL 1 1/i1 IL5 7 - It TownshipT� Range: 1 Sections Fill added above original grade: S 18 Gravel length: '�3, Ft. .5 1 Ft. WELL: ❑ New ❑ Upgrad Gravel width: Z►t Number gf lines: `i Distances between lines: ` Pt. Ft. Classification (Private, A,B,C): Total D Cased To: Total absorption area: So✓ Pipe material: -PVG ArTm Z) 3o34 Ft. Ft. SC. Ft. Driller: Date Drilled: Static Water Level: Installer: 1 AA �. r► rdcdit Date install d: 93 Ft. Yield: jjjGPM Pump Set at: Casing Height Above Ground: TANK Ft. FL SEPARATION DISTANCES OdSeptic ❑ Holding o S.T.E.P. To Septic Absorption Lift Holding Public/ mate Manufacturer: �^ p ,` Capacity in gallons: 1006 From Tank Field Station Tank Sewe !'�{11�.PW'ZPf(TG Material: Number of Co�Zartments: WellSurfac S LIFT STATION Water er +tva' -if-I -4-1 DD LotSize 14-7t in gallons: Manufacturer: Line 1 "� "Pump on" level at: "P off' level at: High water alarm at: Foundation �' (n 'Y Curtain + Pump Ma odel I Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: A<4 0V_Pti KE iN 1T9 GAZA &C Pt16 Assumed Elevation: od' qi,� Puy b�9.�I�4 Pgy�V Yii�Yu�� �I's a �'611, 13 �vL�"—�-- Dates: 1st � lT } Inspections performed by: -A-11 —1-93) k '' tl@Ai.fa'SasA @wa'axn.TlA4i4&�L ¢'=,q NO. 1732-E qy'" 1mns22119 e° ,E Department of Healt Hum n j ices approval 'z G Date: Ad Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 Permit No. 93 0Z'1' Page Z 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 Legal Description: LC;,T I By 4 i'�' Noy+kwoad5 PID No.: os 1 0641 17 - (most �ti`�• %te r'V6 �1 8+61 t Fve— A (1193) ` vu"� t�fartM x4e�a.M ee f:tlb Yt44:r �c WO. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE °a(Pol DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930247 DATE ISSUED: 7/23/93 DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 7/23/94 OWNER NAME:NORTHWOODS INC OWNER ADDRESS:709 W. INTERNATIONAL AIRPORT ROAD ANCHORAGE, AK 99518 PARCEL ID:05106412 LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 15 LT 1 l LOT SIZE: 24316 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /S9PTIC 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: Z•(q� t(r Y1.� ; `qtr So R��zMAII.UM O'T,� RECEIVED BY: DATE:_ h73 ISSUED BY: DATE: Z SITE PLAN -- WASTEWATER ABSORPTION SYSTEM ND1 bE��C1.0�>=1� -- — � 13zcPr5rb 3 j7 opb'S�n �dPUCCw\ siTe JO Nos 'DTyt1..00W pKdP0S6�J 2o'x45' 36X9 w rm I Oo o G"Al I*1evK �^ -T _..I INS'rrg•tt�.ry 2 / I�o�Se Vc-+bt'�C I (JoT mvmov" � � Lcr .�cta►�1 24316 s�' — — — — -- LESS f\ouSF Fc�o-S-PR1(N'^t� I � I 3 �/2 �Mrn1�� �•et✓ r,-r�JJ . 0 t�rz avFN YN'91.ta; 7-ove S�PTe s`1S�Ern r 15,�Oo s� SITE PLAN --PROPOSED ABSORPTION SYSTEM RETAILS OF 13ED ABSORPTION SYSTEM OF °Al.�h LOT 1f BLOCK 15° NORTHWOODS SUB *� PREPARED FOR: PAUL MEYERS 688-1236 PO BOX 670485 CHUGIAK, AK, 99567 a aa® .. a...o.aayewes°a e SCALE: 1" = 100' June 22, iSliO J ,p` CONSTRUCTING ENGINEERS 346-2000 '* 9601 BUDDY WERNER IDR 694-9095 ;, ANCHORAGE AKI 99526 DRAWN Bf CAL 7-1-9_i DRAWING # 93-S1-01 3 0 N ABSORPTION SYSTEM DESIGN DETAILS F20M TAN�c 4s, ----d ABSORPTION AREA CALCULATIONS: 3 Bedrooms x 150gpd/bedroom = 450 gpd (soils rating : 0.5 gpd/sf) 450 gpd : 0.5 gpd/sf = 900 sf area Bed design: use 201W x 451L bed (minimum) w/ 4 ea 4" perf pipes @ 5' centers, each 40' in length. IMPACT ON ADJACENT LOTS: This lot is served by a public water system. The proposed absorption system is located such that there is no adverse impact to any adjacent lot. There are no wells, private or public, within 200, of the proposed system. "''" � .,�.�•s g DESIGN DETAILS --PROPOSED ABSORPTION SYSTV14 BED ABSORPTION SYSTEM • w4, LOT 1, BLOCK 15, NORTHWOODS SUB, 0PREPARED FOR: PAUL MEYERS 688-1236 �• • •«+•••••�� PO BOX 670485 CHUGIAK, AK, 99567 NC7. 1732 oR• June 22, j968� NOT TO SCALE DRAWN BY CAL ���� «, • ldA4 •� .�" CONSTRUCTING ENGINEERS 346-2000 ENG 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 7-1-93 DRAWING N 93-S2-07-3 A` CO 9" n 40' pBQF (-Vyo C.0 M r • N co 4s, ----d ABSORPTION AREA CALCULATIONS: 3 Bedrooms x 150gpd/bedroom = 450 gpd (soils rating : 0.5 gpd/sf) 450 gpd : 0.5 gpd/sf = 900 sf area Bed design: use 201W x 451L bed (minimum) w/ 4 ea 4" perf pipes @ 5' centers, each 40' in length. IMPACT ON ADJACENT LOTS: This lot is served by a public water system. The proposed absorption system is located such that there is no adverse impact to any adjacent lot. There are no wells, private or public, within 200, of the proposed system. "''" � .,�.�•s g DESIGN DETAILS --PROPOSED ABSORPTION SYSTV14 BED ABSORPTION SYSTEM • w4, LOT 1, BLOCK 15, NORTHWOODS SUB, 0PREPARED FOR: PAUL MEYERS 688-1236 �• • •«+•••••�� PO BOX 670485 CHUGIAK, AK, 99567 NC7. 1732 oR• June 22, j968� NOT TO SCALE DRAWN BY CAL ���� «, • ldA4 •� .�" CONSTRUCTING ENGINEERS 346-2000 ENG 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 7-1-93 DRAWING N 93-S2-07-3 a +.� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PERFORMF'W'°w^-'°•+� LEGAL DESCRIPTION: Lt�'.lS Nv r?°N,S Township, Range, Section: 5w)/4 53 -1'1 5-tJ Q I U) SLOPE SITE PLAN C-,L_I I_ . _ _ C.•.,.,.. DEPTH _ (FEET) O"7•rwr"' 2 - `�.wt� t/J j t r 2 tlt. 0 RIk1 3 4 5 L}�v� vi lvtih'i17 —• 8 9 10 - 11 12 13- 14- 15- 16- 17 314151617 81920 is- 19 - 20 -4 COMMENTS WAS GROUND WATER ENCOUNTERED? S L 0 E Dale: 7-t`q3 IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? No^'a Reading Date Gross Net Depth to Net Time Time Water Drop 1 4arr„a rn r g„ i B Z. q" "LS n, V: PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER _S. / it — TEST RUN BETWEEN FT AND FT —7 4eO �)C. �'7 sem. .�''V ,_,�Q� W --� l ^T Yyc) i/�.%�c/7'C ry\lb t � "Z ns , /' --0 n — PERFORMED BY: — h�,;vn+c vn� ""J {J� ��t'^ p" I CF-_RTIFY THAT TH.I$TESTZWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _� 7 t 193 9 ✓ 72-008 (Rev. 4/85) • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcell.D, 051-064-12 1. GENERAL INFORMATION Complete legal description +fit€�ltr�i-. Expiration Date: q — a -1 I Lot 1, Block 15, North Wood-: Unit 4 Location (site address) 21910 Sheltering Spruce Loop Chugiak, AK 99567 Current Property owners) William &Sharon Keller Day phone (907) 688-4879 Mailing address 21910 Sheltering Spruce Loop Chugiak, AK 99567 Real Estate Agent Fitzy O'Hare @ Re/Max Dynamic 2. TYPE OF DWELLING: Ej Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 232-6368 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System F-1 Public Sewer ❑ WaiverNariance request for: Distance: Received by: �f�c r i Date: > %lj%'kf ;.�;;f ,? COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ t196 Waiver Fee $ Date of Payment �X113 Date of Payment Receipt Number jla. 'gzfo Receipt Number COSA# 0512,13WI-1 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Pinard Engineering Phone (907) 357-3647 Address PO Box 871347 Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P.E. 6. DSD SIGNATURE L System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By , ,2 Original Certificate Date: ' f Thenicipali` of chorage D elopment 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. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheets . c Nitrate Advisory Arsenic Advisory Other 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: Lot 1, Block 15, North Woods -S , Unit 4 Parcel ID: 051-064-12 A. WELL DATA N/1 pe If A, B, or C provide PWSID # Well Log (Y/N) Date comple Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth t Cased to ft. Casing height (above ground) in. FROM WE OG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA ft. mg/L Collected by: ft. Tank Type/Material Septic/Steel Date installed 8/11/93 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) N Depression over tank (YIN) N High water alarm (Y/N) NA Dateofpumping 3/27/13 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 8/12/93 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.5 gpd/sf System type Seepage Bed Length 43 ft. Width 21 ft. Gravel below pipe 0.5 ft. Total depth 4 - 5 ft.Eff. absorption area 903 ft Monitoring tube Y Depression over field N Date of adequacy test 4/24/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0.0 in. Water added 480 gal. New depth 0.0 in. Elapsed Time: 90 min. Final fluid depth 0.0 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (YIN & type) None Known If yes, give date D. LIFT STATION "Pump on" level at Datum NA Size in gallons in. "Pump off' lei Cycles tested E. SEPARATION DISTANCES fSWF; P VEt NLOTTo NA Septic tank/lift statio n t t Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & On adjacent lots On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain None Known Wells on adjacent lots 200'+ Absorption field 5'+ Surface water 100'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ F. COMMENTS * There is o foundation cleanout; a 2" pressurized line delivers wastewater to the septic tank. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Paul E. Pinard, P.E. Date 5/2/13 COSA brown sheet 10-10-12.doc in. PINARD ENGINEERING P.O. Box 871347 ` Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 1, Block 15, North Woods Subdivision, Phase 4 APPLICANT: William & Sharon Keller 21910 Sheltering Spruce Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Steel/1000 Gallons, per MOA Records ABSORPTION SYSTEM: Seepage Bed, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAL/BR = 450 Gallons TEST DATA JOB NUMBER: 13-115 DATE OF TEST: 4/24113 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments PM (GPM) (GALS) (GALS) Liquid Level * A Level Monitor Tube 1* A SAS Level Monitor Tube 2* A SAS Level 3:25 5.3 - 4.0' - 0.0' - Start Flow - Meter 36760 3:40 5.3 80 80 4.1' 0.1' 0.0' 0.0' 36840 3:55 5.3 80 160 4.1' 0.0' 0.0' 0.0' 36920 4:10 5.3 80 240 4.1' 0.0' 0.0' 0.0' 37000 4:25 5.3 80 320 4.1' 0.0' 0.0' 0.0' 37080 4:40 5.3 80 400 4.1' 0.0' 0.0' 0.0' 37160 4:55 - 80 480 4.1' 0.0' 0.0' 0.0' StopTest- 37240 RECOVERY MT2 *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: Testing on this W WDS found it to be operating satisfactorily. There was no measurable liquid in the SAS MT prior to or at any time during the test. Reviewed by: Paul Pinard1'> Date: 5/2113 C -36 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES t Division of Environmental Services M On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C-131 OC 4t L HAA # iAP)0i 1 ('`I^ zA 1. GENERAL INFORMATION Complete legal description L 1 66 Nd`-i�W000iS It �A Location (site address or directions) 5y\QJ4` Nr\3 Vy"c.Q LADOP Property owner N- t"\4 Day phone 6:9 j Z 36 Mailing address po goy 60495 Chugiak,K1 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, ,provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank t Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 LU vow 10ee (Lsn •Aed) szo-ac •ilaom saaaul6ua leuolssaload ayl ul suolsslwo ao s.ioiaa aol apsuodsaa lou sl a6saoyouy to Al!led!o!unW @14_L'Panssl sl aleolpliao a aaolaq elep azAleue ao suolloadsul lonpuoo lou op SHHo do saa�(oldw3 •sluawa.unbei alels pus leaapal ulel�ao A4slles oliepio ul suo!1n1!lsul bulpual alayl pue sawoy to saasuyoand of �Csolinoo a se slyl saop SHHQ ay1 "e>iselbio a1e1S ayl u! pa)alsibei iaaul6ua leuolsseloid luapuadapul us �Sq anogs g ydea6ejed w uanlb suolleluasaidaa ayl uodn �(luo paseq saleollpao lsno.iddy AC poylnd y11saH sanss! (SHHd) saolnaaS uewnH pus ylleaH ;o luaw eda a6ejo ou � 0 y d do A1!IedlolunW ayl :suolelndlls 6uimollol all l}lnn 'swooapaq w sluawwo0 leuo!1!ppV aol Ieno,idde leuolllpuo0 •panoaddesla swooapaq aol panoaddy 3 nIVNJIS SHHO '9 ainleu6ls s,aaaul6u3 -6 6 :A ��1?j 3 ssa.ippd 4 ^ W v7el /Co 12 84 96-x,-69 c>oez5x6e auold Swaa( wa!J to aweN •uolloadsul sill to alep all uo loalla ul suolleln6ei pue'saoueulpio 'sapoo alels pue ledlolunW P, pm aouelldwoo ul sl walsAs lesodslp aalennalsem ao/pue Alddns aalem alis-uo all 'uolloadsul pue uolle6l;sanul Aw woal pue salll a6eaolouy to Al!led!o!bnW ayl woal paulelgo uollewaolul all uo paseq jell �tluanaallanl i •ulaaal paleolpul ainlonils to edAl pue swooapaq to aagwnu all aol alenbape pue leuollounl 'ales sl welsAs lesodslp aalenr(alsum ao/pue Alddns aalenn alis-uo ayl ley, snnoys uolleolldde lenoaddy �(luoylny ylleal l slyl }o uolle6llsanul �(w jell �(luan l 'molaq umols alep uoilepllen all to se pue olaaal paxllle leas �(w � n palin.iao sy �V F H33NIJN3 A8 N01103dSNl d0 LN3W31d1S 'S Municipality of Anchorage .. Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t aT t gt.oc' 15 Nori-hw"d Js Parcel I.D. 05 f O6 4-1 z A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number. Log present (Y/N) Date completed Driller _ Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION / Date of test _ Static water level Well'flow Pump levell SEPARATION DISTANCES FROM WELL TO: v L Se tic/holdin tank on lot P g Absorption field on lot _ Public sewer main Sewer service line WATER SAMPLE R Coliform Date of TS: B. SEPTIC/HOLDING TANK DATA rr c O m y m � n N y 00 ®� Z _; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed A)6-- 1993 Tank size / 0eo e Compartments Z �v)gtito LtNF Feo*NFko�)';V NJ 1rftN+r Cleanouts (Y/N) i� Foundation cleanout (Y/N) 'Depression (Y/N) High water alarm (Y/N) NJ/k Alarm tested (Y/N) tv Date of pumping tJ fl _ NOLO Pumper v N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N P� On adjacent lots (y Foundation To property line 47' Absorption field Water main/service line Surface water/drainage +100 72-026(3/93)• Front CONTINUED ON BACK PAGE J .p.m. g.p.m. rT 1 �+ .If rr c O m y m � n N y 00 ®� Z _; On adjacent lots On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed A)6-- 1993 Tank size / 0eo e Compartments Z �v)gtito LtNF Feo*NFko�)';V NJ 1rftN+r Cleanouts (Y/N) i� Foundation cleanout (Y/N) 'Depression (Y/N) High water alarm (Y/N) NJ/k Alarm tested (Y/N) tv Date of pumping tJ fl _ NOLO Pumper v N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N P� On adjacent lots (y Foundation To property line 47' Absorption field Water main/service line Surface water/drainage +100 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FR STATION TO: Manufacturer Manhole/Access (Y/N) Level at Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed IAvU 199-5 Soil rating (GPD/Ft) ©. S System type O b Length `43 Width Z1 Gravel thickness G,' Total depth Total absorption area 905 S� Cleanout present (Y/N) Depression over field (Y/N) Date of adequacy test N 8�'^ SY5 Results (pass/fail) — for "" Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: if yes, give date Well on lot N P- On adjacent lots N ('� Property line To building foundation 141 To existing or abandoned system on lot _ On adjacent lots 4--3o Cutbank -+50' Water main/service line Surface water +1 Driveway, parking/vehicle storage area � Curtain drain + So E. ENGINEER'S CERTIFICATION Zt' NP) 410' I certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 414 6�" Y,s c. S r rears Engineer's Name 94,C)k 3Q a,1 D,- r�� K 99 6 Date HAA Fee $ L�db `ejo Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Y��.PZ Ck ✓.p.�� .�;Ff f t a> =s er , f i F yx bi e ! b #�e syxg'*+w on9 qa aeo-�a� ,� � •kf No hBit �c� ¢¢x g Y i 3511 3ut 2, 49ta "..... Waiver Fee $ Date of Payment Receipt Number