HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 15 LT 4North Woods
#4
Block 15
Lot 4
#051-064-09
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Eknore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
vww.a.anchaage.ak.us (907)9437904
ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. 6WOM5 PID Number. 051-064-89
Rea. ,doe Williamson
Wastewater System: ❑ New ® Upgrade
sae...
23211 Green Garden Circle, Chugiak AK 99567
ABSORPTION FIELD
F +. P m to aeeaaln 4
D Deep Tlerlr m Soto. T..o Dasa 0 ram 0011W
LEGAL DESCRIPTION
sai
flurt
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sow Gm a
FI
eatl Bis Lot 4 Nortt woods q S
°t p° ra P" oma. Som aqw clods
Gn doom beam P
0.17 Fr.
0.5 Ft
Torn.ny Raps SFraort
Fde00ea FomesprW VIK141
GIM L&Vn
428 Fr.
29 Ft.
Well: ❑ New ❑ Upgrade
C".ia
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it
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ees
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AWWU
NA Fl.
NA Ft
145 FT
IPVC
Doer
Dat Omen
Sum wsr L
mrraw
DaF latla.a
NA
NA
I NA Ft
Green Construction
8=8
Yad
Pump Saa
Da•q II.Vx Above Gmm
CN
NA GPM
NA Ft
Ft
TANK
SEPARATION DISTANCES
❑ Septic ❑ Holding O S.T.E.P. ❑ Other.
To
Septic
Absorption
LM
Holding
eEtrlPrrvate
ar w
From
Tank
Field
Station
Tank
Sewer Line
Anchorage Tank
1500 Ge
YOM
NA
NA
NA
NA
NA
M+.+
steel
Raro. a cc.celY.ma
1
swr�W�
+10o ft
+100 a
*10o ft
+100 ft
LIFT STATION
to Lia.
+10 n
+10 ft
+10 ft
+1 o ft
500 gal Gm
Anchorage Tank and Orenco
•Para pn lF.el a
-P m W M KfYgb.a.r
sienn a
FOa'0'0°"
+10 n
+ 10 ft
+l o fl
+10 ft
95.211 n
94.8 ft m
Oren S m,
Co 10.
NA
I NA
I NA
NA
ft l Y sYawl
Oren StD
EYmw..P.raas Pelbmud a/
Walker Electric
RanMF.
Advantex System with 500 gallon fa station hor Adverllex system and
BENCH MARK
toroal..a
Oren Pod to transfer emueni from Oft station to soils absorption
Bottom, left sill of mandoor lower level 100.0
field.
Fl
Inspections performed by: R. Godden Dates: 1" 07/31108
Engi Y t@mp
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Zed 0=0108
Development Services Department Approval
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Conditional Approval Date:
...
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NALD E GDDDEN;
/l577
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Reviewed and approved by ' Date: -�
t�� .-....08
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Environmental & Engineering
Contract No:
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THETA AS-BUILT Drawn SMG y: FIGURE 2 R
Environmental & Engineering LOT 4, BLOCK 15
Contrad NORTHWOODS SUB NO.4 Checked by: Project No:
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WALKER ELECTRIC
CLINT WALKER
10319 Colville St.
EAGLE RIVER AK, 99577
Litems N 1310
Phone 696.8964 Cel N 2236304
Email ClintAlangaol.tom
To: Green General Contracting
Date :8-21-08
Ref :154North Woods
Permit :NA
This is to certify that on site sewer lift station at above mentioned
property has been wired in accordance with the standards of the National
Electrical Code and manufactures specification.
Systems were checked and performed as specified in the systems
manual.
Clint Walker
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Lot 4, Block 15, Northwoods 8 4 Subdivision.
Buoyancy Calculations:
500 -gallon AnchorageTank with Orenco Lift Station
Known:
Calculated:
Tank Buoyancy Calculation:
Feet of soil cover (cf)
Manhole volume(cf)
Tank Displacement (cubic feet)
Tank Displacement (gallons)
Tank Buoyancy (lbs)
Tank Ballast Calculation:
Tank Weight (lbs)
Soil weight ( lbs)
minus loss of riser (lb)
78.67
-12.56
V= pi (d/2?(L)
7.41ga1/1 d
8.41 this 11 gal
(lbs)
500
7,080
.1,130
75.91 I
562.46
Tank Ballast (lbs) 8,450
Tank Buoyancy - Tank Ballast ( lbs)
Therefore, tank does not require additional ballast If there Is 4 k of cover over the tank.
Calculated by Ronald E. Godden, P.E.
lk. NA(DEGODDEN:Z
Ibs/cy
2,430
4,000
2430
(lbs)
7,080
-1,130
4,730
500
7,080
.1,130
6,450
-1,719
It
Ibs1d
Tank Diameter (in): 59
4.92
Tank Length (ft): 4
4.00
Tank Weight (lbs) : estimated
500
Soil Weight ( earth, moist excavated Ibs/cy)
90
Concrete Weight( Ibs/cy)
148
Weight of soil Cover (R)
4
90
Calculated:
Tank Buoyancy Calculation:
Feet of soil cover (cf)
Manhole volume(cf)
Tank Displacement (cubic feet)
Tank Displacement (gallons)
Tank Buoyancy (lbs)
Tank Ballast Calculation:
Tank Weight (lbs)
Soil weight ( lbs)
minus loss of riser (lb)
78.67
-12.56
V= pi (d/2?(L)
7.41ga1/1 d
8.41 this 11 gal
(lbs)
500
7,080
.1,130
75.91 I
562.46
Tank Ballast (lbs) 8,450
Tank Buoyancy - Tank Ballast ( lbs)
Therefore, tank does not require additional ballast If there Is 4 k of cover over the tank.
Calculated by Ronald E. Godden, P.E.
lk. NA(DEGODDEN:Z
Ibs/cy
2,430
4,000
2430
(lbs)
7,080
-1,130
4,730
500
7,080
.1,130
6,450
-1,719
Lot 4, Block 15, Norttnwoods 0 4 Subdivision.
Buoyancy Calculations:
Add-on Oren Lift Station (LM Station Pod)
Known:
Calculated:
Tank Buoyancy Calculation:
Feet of soil cover (d)
Tank Displacement (cubic feet)
Tank Displacement (gallons)
Tank Buoyancy (lbs)
Tank Ballast Calculation:
Tank Weght (lbs) :
Soil weight ( lbs) No Cover
Tank Ballast (lbs)
Tank Buoyancy -Tank Ballast ( lbs)
Therefore, tank requires additional ballast.
Concrete Weight ( Ibsfcy)
Minimum Cubic Yards of concrete required(cy)
Weight of cubic yards of concrete required (lbs)
Cubic Feet of concrete required (d)
Weight of cubic feet of concrete required (IDs)
Calculated by Ronald E. Oodden, P.E.
(lbs)
0.00 0
V= pi (df2?(L) 12.56
7.41 gal/td 93.07
8.41 lbs / igal 783
(lbs)
150
ft
Ibs/d
Ibs/cy
Tank Diameter (in): 24
2.00
633
Tank Length (ft): 6
6.00
Tank Weight (ths) : estimated
150
Soil Weight (earth. moist, excavated Wcy)
90
2,430
Concrete Weight ( Ibs/cy)
148
4,000
Weight of soil cover (ft)
0
90
2430
Assume max water table Is 2.0 ft below grade
4
Calculated:
Tank Buoyancy Calculation:
Feet of soil cover (d)
Tank Displacement (cubic feet)
Tank Displacement (gallons)
Tank Buoyancy (lbs)
Tank Ballast Calculation:
Tank Weght (lbs) :
Soil weight ( lbs) No Cover
Tank Ballast (lbs)
Tank Buoyancy -Tank Ballast ( lbs)
Therefore, tank requires additional ballast.
Concrete Weight ( Ibsfcy)
Minimum Cubic Yards of concrete required(cy)
Weight of cubic yards of concrete required (lbs)
Cubic Feet of concrete required (d)
Weight of cubic feet of concrete required (IDs)
Calculated by Ronald E. Oodden, P.E.
(lbs)
0.00 0
V= pi (df2?(L) 12.56
7.41 gal/td 93.07
8.41 lbs / igal 783
(lbs)
150
160
0
0
150
1S0
633
rii
0.16
633
4.27
641
MUNICIPALITY OFANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
��dD _130
�,11t1
Cyte
�
Date Issued: Jun 24, 2008
Expiration Date: Jun 24, 2009
Permit Number: SW080095 Parcel ID: 051-064-09
Legal Description: NORTH WOODS UNIT 4 BLK 15 LT 4
Design Engineer: 0072 THETA ENVIRONMENTAL ENGIN; Site Address: 023211 GREEN GARDEN CIR
Owner Name: JOE WILLIAMSON Lot Size: 44000 SO. FT.
Owner Address: 23211 GREEN GARDEN CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of:
Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by tailing
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE SAND USED IN THIS SYSTEM MUST BE A CLEAN COARSE SAND WITH 4% OR LESS PASSING THE #100
SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROVIDED ON THE SAND
USED OR OBTAINED FROM AN APPROVED SOURCE.
Received By: �7 kp Date: ` /Lqki
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D. n5'aPU'Oq
Property owner(s) '3e.4 1\ 14M1 su-1 LUD6) (-,(,0 - NLaay phone
Mailing address l 6'cC cF&> C 4, M E-1 C 1v, Zip Code
Site address Sp wt r— Zip Code
1"u„•4 Cel\
qn9- i-yt-a)
`t4 S'(o "1
Legal description (Sub'd., Block & Lot) A)G ti T %L kl uop 5 0410 GIs-. L 44
Legal description (Township, Range & Section)
Lot Size `tai , vSq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
I certi that the
Single mitt'
(Signature o op
Number of Bedrooms __ '7
THIS APPLICATION IS AN:
Initial ❑
Upgrade ,—
Renewal ❑
information is correct. I further certify that this application is being made for a
Is in accordance with applicable Municipal Codes.
Permit/Rush Fees: 14 �n
Date of Payment: �`X'-, q,
Receipt Number.
(Rev. 1 V05)
-XojJnrr may PICk (AP
Waiver Fees:
Date of Payment:
Receipt Number.
pErint --
Theta Environmental & Engineering
660 Maney Drive
Wasilla, Alaska 99654
(907) 242-0755
June 15, 2008
Ms. Deborah M. Wockenfuss
On -Site Services Program
MOA Dept of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 4, Block 15, North Woods #4 Subdivision, On -Site Wastewater Disposal
System Permit Application, 4 Bedroom Single Family Dwelling, Revised June 14,
2008.
In accordance with AMC 15.65.030, the following information is provided in support
of an On-site Wastewater Disposal System Permit Application for the subject
property:
1. The subject property, at 23311Green Garden Circle in Chugiak, Alaska, currently
has a 4 bedroom single family dwelling with public water (AWWU). The existing
septic tank is an Anchorage Tank, steel, 1,250 -gallon double compartment tank.
The soils absorption system is a wide trench. This application is for a 4 bedroom
single-family dwelling.
2. CCC Construction and KND Engineering installed the original system in 1997.
During an adequacy test, it was determined that the system had failed. The
existing soils absorption system will be abandoned in-place, just after the existing
double cleanouts.
3. The property generally slopes from south to north and has numerous compound
slopes. It appears some leveling was accomplished when the lot was developed.
There is a 10- foot cut bank to the west along Voyles Blvd, but does not affect
the proposed onsite system. A 2 -foot cut bank exists in the SW comer of the lot.
The lot slopes are indicated on the plan view of the plan set. The location of the
soils test and percolation tests were in native soils. Both the original test holes
accomplished by KND Engineering and the new test holes accomplished by
Theta Engineering are also indicated on the plan view of the plan set.
4. The area, where the replacement soils absorption system is proposed is located
along the east side of the lot.
5. The new system will be a Category III system consisting of an add-on lifts station
and an Advantex AX -20 pod. A new Anchorage Tank steel 500 -gallon septic tank
with the Advantex pod will be installed and connected to the existing septic tank.
A pump vault will be added after the pod/tank to collect the treated effluent from
the pod and pump the effluent to the wide trench where it will be further treated
and disposed of in the soils absorption field. The owner is considering replacing
Page 1 of 3
8<ilsao08
NoMrmoodsf4-Williamson-MuniSASPermdLtf2.doc
the existing septic tank with a new 1,500 -gallon Anchorage Tank steel septic tank
with the Advantex AX -20 pod and a pump vault. Buoyancy restraint
calculations will be provided to the installer, once this decision has been
made and will be provided with the as -built information.
6. The Advantex AX -20 pod is an approved system, manufactured by Orenco and
Anchorage Tank. The engineer has specified this system and further specifies
that it will be constructed, installed and operated in accordance with the
manufacturers specifications, instructions, and requirements. The engineer will
verify the float operation and various required inverts and provide that information
with the as -built.
7. The soils found during the soils test were silt (ML), silty sand (SM) and gravel and
sand (SP). Ground water was observed in the test holes, and in subsequent
monitoring. This information is provided in the soils logs, attached. The new
system will be installed near Test Hole # 1 R.
8. Percolation tests were not performed in the SP as it was assumed to percolate at
less than 1 minute per inch. Per MOA guidance, the sandy gravel will require a
sand filter. The sand will be assumed to rated at 1 gaVft2/day. The original test
hole #1 by KND engineering was perc'd at approximately 4 minfin. A new perc
test will be accomplished during installation to confirm the permeability of the SP
layer.
9. The SP layer extends from 2 feet below grade to 6.5 below grade. The bottom of
the test hole is at 8.5 feet below grade. Since the bottom of the system must be
4.0 feet above ground water and 6.0 feet above bedrock or an impermeable
layer, the top of the soils absorption system will be at grade. The existing silt will
be removed and replaced with filter sand. This will satisfy the ground water
separation requirement. See Soils Log 1 R.
10.The system will be a wide trench. The Advantex system is a Category III system
and allows an application rate of 6 gaVday/sq ft. The bottom of the bed will be
0.5 feet below the distribution pipe. 4 br x 150 gpd/br = 600 gal/day, 600 gpd/6.0
gpd/sq ft requires 100 sq ft. Then 100 sq ft / 5 ft = 20.0 ft of bed.
11.There will be a single 5 -wide trench and will be at least 25.0 feet long. This will
provide for a total of at least 125 sq ft of absorption area. This will allow the
bottom of the system to be at least 6 feet above an impermeable layer or bedrock
and at least 4 feet above seasonally high ground water.
12.There are no known wells on the adjacent lots. There are on-site absorption
systems on the adjacent lots. It does not appear the system on this property will
prevent development of the adjacent lots or the installation of replacement
systems on the adjacent lots.
13.The owner has signed the Residential Advantex Treatment system Monitoring
and Maintenance Agreement and the original is attached.
Page 2 of 3
wts/2oos
NoMwioodsf W-Williamson-MuniSASPermiLLM.doc
Based upon the data and drawings attached, I recommend a permit for this
wastewater system be granted. If there are any questions, please feel free to
contact me at (907) 242-0755.
Sincerely,
V �
Ronald EGod en, P. E.
Enclosures: Soils Log, Test holes # 1R -4R (June 6, 2008 Submittal)
Figure 1, Overall Plan View, R1
Figure 2, Proposed Soils Absorption System, R1
Figure 3, SAS Details, R1
AWWTS Maintenance Agreement
of
At -11
1 ...
Page 3 of 3
611512008
Nonhwoods#4-Williamson-MuniSASPermdLt2.doc
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Municipality of Anchorage
Development Services Department
Building Safety Damon
On -Sts Water and Wasterrmer Program
4700 South Bragm St
P.0 Box 190650 Anchorage. AK 99519-6650
www mun orgrorLvae
(907) 343-7904
Soils Log - Percolation Test
Performed For JOE WILLNUSON Date Performed 5/2/08
Legal Description. LT4 BUf15 NORTHWOODS /j SUBDMSION TH1R Township, Range, Section.
WL WITH COMES AND BOULDERS
LIGHT BROWN/TAN
SP WITH SOUE GRAVEL
MRK BROWN
GREY SM
au"7d'[.TG17
COMMENTS
WAS GROUND WATER
ENCOUNTERED? YES
F YES,AT WHAT DEPTH? 6.5
Depth b lAfAw AfMr
AMnitems7 4.05
Date 5/15/05
EMENEENEEN
EMENEENEEN
PERCOLATION RATE (mdwhrW PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMEDBY RONALD E. GOODEN I RONALD E GODDEN CERTIFY THAT THISTESTWAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 5/2/08
0F..1
Municlpallty of Anchorage t^ LtNwN ALI'•;P'
\ 1 Development Services Department Buildmp Sarery DNision 4 • ... ..
y. On -Ste Water and Wastewater Program , , , ....
4700 South Bragary St. ALD E GODDF?J:��mav;
P O. Box 196650 Anchorage. AK 995196650 / ,'. F
www mord orgforsile C A
(907) 343-7W4,I. (Pi
Soils Log - Percolation Test t1��\�OFFSSw'
Performed For JOEWILLWNSON Date Performed 3/2/08
LegeIDBSCrip1pom LTL BLN15 Nam+wOODs SUBDNISION TH2R Tovmship.Range.Section.
DEPTH
(FEET)
ML
—BROWN NUMEROUS THIN NL LAYERS
ML TAN
SP FROM NUMEROUS ML LAYERS
WAS GROUND WATER
ENCOUNTERED?
YES
e
F YES.AT WHAT DEPTH?
3.0
L
Depth W WXWAfW
o
P
Nbrttwn7'
1.3
F
Date
3/13/08
E
19
Reading I Dere 1 Gross Time I Net Trne I Depth to Water Net Drop
PERCOLATION RATE fr n ft"te PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS
PERFORMED BY: RONALD E OODDEN I RONALD E. OOODEN CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THS DATE. DATE: 3/2/03
Municipality of Anchorage
-\ Development Services Department
1 Building Safety Division
On.Sto Water and Wastewater Program
4700 South Bragaw St
P.0 Box 196650 Anchorage, AK 995136650
WWW muni orgtorsite
(907) 341-7904
Soils Log - Percolation Test
Performed For: JOE WIUIkUSON Date Performed 6/2/06
44
Legal Desaiption: L74 BUtrS NORrW1OODs 42 SUB0IVISION THM Township, Rango. SBCOon:
M
SP
IANTf LAYERS OF CP
COMMENTS
WAS GR W ND WATER
ENCOUNTERED? YES
6
FYES,ATWHAT DEPTH? 6.5 L
Depth to WYaAfeer O
1.0 F
omp
NbnRT E
Date 5/13/08
0
PERCOLATION RATE PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
PERFORMEDBY. RONALD E- 000DEN I RONALD E. OOODEN CERTIFY THAT THISTESTWAS
PERFORMED IN ACCORDANCE KITH ALLSTATE AND MUNICIPAL GUIDELINESIN EFFECT ON THIS DATE. DATE- 6/2/06
Municipality of Anchorage
Development Services Department
Building Safety Division
i1 On•Ste Water and Wastowater Program
4700 South Bra -low St.
P.O. Box 196650 Anchorage, AK 9951a6650
www. muni.orgfonsite
(907) 3317904
Soils Log - Percolation Test
Performed For. JOE WILLN4SON
Legal Descrpt,on: LT4 BLK15 NORnftOODS
TomShiD. Ranae. Secoon:
WAS GROUND WATER
ENCOUNTERED?
YES
11
9
F YES,AT WHAT DEPTH?
3.0
L
0
Depnbo Weer AfGr
r
Monitorng?
3.0
E
Date:
5/13/08
TomShiD. Ranae. Secoon:
WAS GROUND WATER
ENCOUNTERED?
YES
9
F YES,AT WHAT DEPTH?
3.0
L
0
Depnbo Weer AfGr
Monitorng?
3.0
E
Date:
5/13/08
r -0A--0F.
�•,• • E GODDEN�i
+� •• �•• .
ned: S/2/oa
Fi
Reading I Ode I Gross Time I Net Time I Depth to Water I Net Drop
PERCOLATION RATE TD(T 0v.4"Mlo FERC HOLE DIAMETER TEXT
TESTRUN BETWEEN TEXT FT AND TDR FT
COMMENTS TEXT
TEXT
PERFORM -7D BY: RONAD E. ODDDEN I RONALD E CODDEN CERTIFY THAT THI S TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. 5/2/08
Municipality of Anchorage Page / of 2 -
DEPARTMENT
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: 6W& PID Number: i2;y
Name:
Wastewater System: New ❑ Upgrade
Address
o v ABSORPTION FIELD
Phone: No. of Bedrooms:
❑ Deep Trench AShallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION Soilflating: Total Depth from original grade, 1
r GPD/Sq. FL f
Lot: Block: �, Sub ivision: . L Depth to pipe bottom from original grade: Gravel depth beneath pipe
t UC Ft. A Z Ft.
Township: Range: Section: Fill added above original grade: Gravel length:
WELL: ❑New
El Upgr�t�"`"
ry rt
Gravel width:
Number of lines:
ht.
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total the
Cased To:
Total absorptionareaa:/�
Pipe material:
..
_ Ft.
Ft.
7 - SO. Ft.
Driller: ry d I
7 tt�
ate Drilled:
Static Water Level:
FL
Installer'.
t�.(rLi -!i�B' yli ly
Date installed: y
�C .,7h-.---
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
9Septic ❑ Holding ❑ S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
HoldingPublic/Private
Tank
Sewer Lines
Man facture : ..,
<.r
Capacity in gallons:
Material: j
Number of Compartments:
Surface
Water
p' -t
JW14
—
—
-
LIFT STATION
LotI
Line
1 D f-F�
-
J
Size in gallons:
Manufacturer:
Foundation!%"
W
"Pump on" level at:
" -otP' level at:
High water alarm at:
Curtain
Drain
/y /,
f.
Pump Mak odel
Electrical Inspections performed by:
Remarks: e 16a.,L)n &tj
a ti;,�_ c1 ra,�til-S
BENCH MARK
Location and Description:
Assumed Elevation:
:ENGINEER'S SEAL
OF A
or Co X
Inspections performed by:
/
ates: 1s 0 7
, ..: ... •.. .•.......:...
Department of Heal
2nd
/ t �j
Human
••e e••••so•.• .....�r...
®� • Kenneth f
CE 7116 4,
and Services
appr v
AV�
��
Reviewed and approved by:
Date: ¢ -z2 — f�
"ROf£SSAO'
KD
DJ
A—C=16 0'
B—C=42.7'
A—D=22.8'
B—D=45:5'
A—E=60 0'
B—E=93 8'
A—F=49,3'
B—F=16.7'
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW960359
N❑RTHWS❑DS S/D #4, LOT 4, BLOCK 15 PID4051 064 09
I
MT EO
RESER E
I
T. H. 43 T. H. #1
CO
MT 1.0 T. H#2O
U1 4 BDRM
W I
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SFR
O
—Wa -ERLIN SEPTIC AREA
15' Telephone & Elegy. Esnt.
I
I
I
— - -------------------
I
GREEN GARDEN CIRCLE SCALE: I`
w z
N o
w �
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FINISHED GRADE 97.33
w
FILTER FABRIC 2' INSULATION
L1
J J
N 1250 ''GAL
SEPTIC
/ I TANK
OF ALS *AIor 1
9 TH�1
*
0
KE_. M_...D S
CE 711
112ORESSIO0, dir
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s
FINISHED GRADE 97.33
FILTER FABRIC 2' INSULATION
VARIES
94.52
SEWER RHCK
� 92.81
82'
PREPARED FOR:
MOUNTAIN VALLEY BUILDERS
DAVID NEUSCHWANDER
P.H. Box 671305
CHUGIAK, ALASKA 99567
FIEg96087.DWG
COMPUTED:
DDUNDADRAWN: KMD
STAKINGCHECKED: KMDASBUiLTDATE: 1 19
Dwc. FilGRID:NW1461Ac13 FiJOB No -:96087
SCALE NTS
V V:70 WATER
84.95 BON
iLkI LU ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)69 —6111/FAX (907)696-8111
MUNICIPALITY OF ANCHORAGE
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:SW960359
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:NEUSCHWANDER DAVID & LORETTTA
OWNER ADDRESS:P.O. BOX 671305
CHUGIAK, ALASKA 99567-1305
PARCEL ID:05106409
PAGE 1 OF 1
DATE ISSUED:10/31/96
EXPIRATION DATE:10/31/97,
l Pry-, `'-
Co �i 1
LEGAL DESCRIPTION:
NORTH WOODS UNIT IV BLK 15 LT 4
LOT SIZE: 22933 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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
S. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY
DATE. lob
ISSUED BY: Z zqqa'kv�/ ® /� y�fp /
I IV DATE: -,7
/ (p
X14D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
/FAX (907)696-8111
October 12, 1996
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Sewer Permit - Lot 4, Block 15, Northwoods S/D, #4
Gentlemen:
Attached are soil test and water monitoring results for the above lot. A total of
three holes were excavated on this property to date.
Our water monitoring results shows water present in all three holes. The water
levels appear to be at the same level with variations based on the elevation
differences in the testhole locations. Therefore our design assumes a total depth of
the trenches will not exceed 2.0' from original grade. A single 78' trench will be
installed, and additional fill will be added to insure a total of 3' of cover over the
system.
There are no surface water sources within 100' of the proposed design. Drainage
along Green Garden Court and Voyles Drive will be carried west along existing
right-of-way ditching. There are no known curtain drains within 50' of the
proposed trenches. The development of this lot will not negatively impact lots
surrounding Lot 1. The area is served by community water and there are no public
wells within 200 feet.
If you have any questions regarding this application, please contact me at 696-
6111/FAX 696-8111.
Respectfully submitted,
�D Engineering
Kenneth M. Du s, P.E.
attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WASTEWATER
SEPTlC AREA
ABS❑RPTI❑N SYSTEM DETAILS & SITE PLAN
N❑RTHW❑❑DS S/D #4, LOT 4, BLOCK 15
SEPTIC AREA
�I
SEPTIC AREA
telephone l Elec. Cent.
GREEN G DEN CIRCLE
I
SEPTIC AREA
SEPTIC AREA
NO WELL WITHIN 200' OF PROPOSED SEPTIC SYSTEM.
ALL LOTS ON COMMUNITY WATER,
DESIGN CRITERIA
—_\` 1. 4 BEDROOMS X 150 GAL./DAY/BEDROOM = 600 GPD
OF A�\ \ 1 2. SOILS RATING: 4 MIN✓INCH = APPL. RATE L2 GPD/SF
P 3. 600 GPD/1.2 GPD/SF = 500 SF
4. 500 SF /5 X 0.78(rf) = 78'L
.dr Z'. 1
5. MIN, DESIGN SIZE = 1 TRENCHE — 78' LONG x 5' WIDE x 1,5' DEEP
* A 9 TH *,/ 7, TOTAL DEPTHGRAVEL6. DEPTH OF I
[IF SYSTEM IS2 0'PE I FROM ORIGINAL GRADE.
B. 2" HD INSULATION REQUIRED OVER FIELD <3' OF COVER
9. 2` HD INSULATION REQUIRED OVER TANK <4' OF COVER
10. CONTRACTOR TO VERIFY AND INSURE MAX 21 GRADE FROM HOUSE.
KENNETH M D S :'
/ CE -7116 wx � PREPARED E❑R. KND ENGINEERING
� 20441 PTARMIGAN BLVD
\1j / MOUNTAIN VALLEY BUILDERS EAGLE RIVER, AK, 99577
7'RO1�ggI01yA"' / DAVID NEUSCHWANDER
P,O. Box 671305 (907)696-6111/Fax (907)696-8111
CHUGIAK, ALASKA 99567 DATE: 10/12/96 DRAWING #
SCALE. I' = 100' 95087-S1
11`
i
�I
SEPTIC AREA
telephone l Elec. Cent.
GREEN G DEN CIRCLE
I
SEPTIC AREA
SEPTIC AREA
NO WELL WITHIN 200' OF PROPOSED SEPTIC SYSTEM.
ALL LOTS ON COMMUNITY WATER,
DESIGN CRITERIA
—_\` 1. 4 BEDROOMS X 150 GAL./DAY/BEDROOM = 600 GPD
OF A�\ \ 1 2. SOILS RATING: 4 MIN✓INCH = APPL. RATE L2 GPD/SF
P 3. 600 GPD/1.2 GPD/SF = 500 SF
4. 500 SF /5 X 0.78(rf) = 78'L
.dr Z'. 1
5. MIN, DESIGN SIZE = 1 TRENCHE — 78' LONG x 5' WIDE x 1,5' DEEP
* A 9 TH *,/ 7, TOTAL DEPTHGRAVEL6. DEPTH OF I
[IF SYSTEM IS2 0'PE I FROM ORIGINAL GRADE.
B. 2" HD INSULATION REQUIRED OVER FIELD <3' OF COVER
9. 2` HD INSULATION REQUIRED OVER TANK <4' OF COVER
10. CONTRACTOR TO VERIFY AND INSURE MAX 21 GRADE FROM HOUSE.
KENNETH M D S :'
/ CE -7116 wx � PREPARED E❑R. KND ENGINEERING
� 20441 PTARMIGAN BLVD
\1j / MOUNTAIN VALLEY BUILDERS EAGLE RIVER, AK, 99577
7'RO1�ggI01yA"' / DAVID NEUSCHWANDER
P,O. Box 671305 (907)696-6111/Fax (907)696-8111
CHUGIAK, ALASKA 99567 DATE: 10/12/96 DRAWING #
SCALE. I' = 100' 95087-S1
e
Aw�`IC (OR;IhiayR.
a iY
1 ttI .. je.aNee ose e a
� J o eee
Municipality of Anchorage
i `$ ®eo •ae eooe a mieee
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 ® eee.eeee,e,eO e e e..„�
SOILS LOG — PERCOLATION TEST�® a Kenneth M. D s ?
®d+'s CE 711 sew®
F p e aeseeee P`�®`�
./lN�
PERFORMED FOR:/Y���Q/?C!P✓�/1 DATE PERFORM �ETA\OF S1®®�
LEGAL DESCRIPTION:�� W t7 S �L1/��S/CoJ Township, Range, Section.
1 J
DEPTH prpQn/CS
2 5Nl /ansa/ 6you�n
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16-
17-
18
19
20
5M114�- l r- se'
414
SLOPE
walkr-5eelpL /
�ahsa soil - 6Uf b.a�,P>;
'7d Corls�S�a�c rL
QON WAS GROUND WATER
ENCOUNTERED? es
S
IF YES, AT WHATL
Q / C
DEPTH? P
” E
Depth to Wale r Aber Z';2:5
Monitoring? 6,5 Date: 9"2�
COMMENTS . 11(016
SITE PLAN
N
PERCOLATION RATE _ (mmulminch) PERC HOLE DIAMETER
TEST RUN BETWEEN 2/Z FT AND 3 /2 _ FT
PERFORMED BY�¢LL��_.�.t74/1j 2�(�l n� I � u CERTIFY THAI THIS/T/ST WAS PERFORMED IN
ACCORDANCE. WITH ALL STA It AND MUNICTT'AL GUIDELINES IN EFFECT ON THIS�2 DATE DATE _ ___<�� /(L�__... _... _._
YF �•° .' a ••• �� �®
Municipality of Anchorage ;I61
DEPARTMENT OF HEALTH & HUMAN SERVICES ry • •••ee•®:•. eeee e•eee..ieee®
825 "L" Street, Anchorage, Alaska 99502-0650 ........„,.....&S.
SOILS LOG — PERCOLATION TEST enneth M. D <$A
• CE 7116 0
tri ee• a
_ /Fpp ••......•NPS,
PERFORMED FOR: /vel 'L/Sy�yc,/!'/ Gf�Q %),(/(/� Ppb✓ / DATE PERFORMEd'®o OFES
LEGAL DESCRIPTION: /L'�r/-�lll/�JG1:"lS J �LK�S LO/Township, Range, Section:
SLr_.�.O�P—ESITE PLAN
0
3 �pp�e S�/L/1Jr/iq w//Some S� />L
4 /�✓oui�� Lo66�S L1J �o
3
Pc�c, GoG.
6
ML
7 )t&64's�sy�/
9
10
11
/-, AxJJ ” " leose-
lne" llaL WAS GROUND WATER
ENCOUNTERED?
12-
13-
14
2 1314
51617 15-
16-
17
18
19
20
COMMENTS _�7T1LF_
IF YES, AT WHAT
DEPTH?
S
L
e /A 0
E
Depth to Water After
Monitoring? _ 7 Date: is -y
PERCOLATION RATE (mmute5nnchl PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND -J--FI
PERFORMEDBY _[Y./IL -� LL1�Ar CERIIFY THAI THIS TEST WAS PERFORMED IN
ACCORDANCE. WITH ALI. SIAI[. AND MUNICI LI L C,ES IN EFFECT ON THIS DATE DATE
- .--�O IZ l
__ __._... —_
��=
PERCOLATION RATE (mmute5nnchl PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND -J--FI
PERFORMEDBY _[Y./IL -� LL1�Ar CERIIFY THAI THIS TEST WAS PERFORMED IN
ACCORDANCE. WITH ALI. SIAI[. AND MUNICI LI L C,ES IN EFFECT ON THIS DATE DATE
- .--�O IZ l
__ __._... —_
s [�
Municipality of Anchorage
2 T DEPARTMENT OF HEALTH &HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: eh/SC{7N//,t.Nll �{� _ _ DATE PERFORMED
LEGAL DESCRIPTION:
N AIO�J(Township, Range, Section:
ni//Ir -F
DEPTH o�Aan IGS SLOPE I I 1 1 SITE PLAN
1
-r2
3
4
5
6
7
8 —�-
9
10-
11
12-
13
14
15
1s
17
18-
19
20
COMMENTS
510
am
tti/a fG✓ SGG j�5
N
WAS GROUND WATER
ENCOUNTERED? e 5
S
IF YES, AT WHAT / L
O
DEPTH?
P
E
Depth to Water Alters� Q
Monitoring? � Dale:
®®®®
DepthWater
• ..
�
• , .. r�®sem®
PERCOLATION RATE —,L..— (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN z FT AND 2 FT
PERFORMED BYG..f_i-_ CERTIFY TH
AT THIS TEST WAS PERFORMED IN
ACCORDANCE wl IH ALL SIAII AND MONICIPAGUIDELINES W EFFECT ON THIS DAIS DATE
18
Municipality of Anchors 4''2
On -Site Water and Wastewater Progra ^ q
(907) 343-7904
JUN 10 2015 r
a
C.
CERTIFICATE OF ON-SITE SYSTEMS A a 5�
Parcel I.D. 051-064-09 Expiration Date: (e
1. GENERAL INFORMATION
Complet.e legal description North Woods Unit 4 Block 15 Lot 4
Location (site address) 23211 Green Garden Circle, Chugiak, AK
Current Property owner(s) Semmens Day phone 244-1930
Mailing address. same
Real Estate Agent , Cindy Wilson, Partners Day phone 244-1930
2. TYPE OF DWELLIN9:
E Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual
Individual Water Storage ❑
Holding Tank ❑
Community Class C Well ❑
Community ❑
Public Water System ®
Public Sewer ❑
Received by:/_�'
Date: 1 L S
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52-6 —
Date:
Date of Payment (0110115 CAf,_
Date of Payment
Receipt Number (5,312QJ
Receipt Number
COSA # O5Gl 5 ja-12
Waiver #
S. 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 NorthRim Eng-ineering Phone 694-7028
Address PO Box 770724 Eagle River
Engineer's Printed Name Steve Eng Date 6/9/2015
OF
t ID
rm��? `APA�
6. DSD SIGNATURE TW
/ ,..i :.
V System #1 Approved for bedrooms.
d rn stoven 4W. Eno
System #2 Approved for bedrooms. c ssb -
Gs
aQ ; =z:
Disapproved.10
°-
Conditional approval for bedrooms, with the following stipulatiol"' -� n `
By: /rf/ _ Original Certificate Date: /D Q :Z�
The Municipality of A chorage Devlopment 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. T�,a
Municipality of Anchorage is not responsible for errors or omissionsin the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12. oc
X 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: A'drfA jdajj ",f t1 8 / 5 L 6Parcel ID: 0510 C!V d `j
A. WELL DATA PU13L+'C GJA y5e
Well type If A, B, or C provide PWSID #
Date completed Sanitary seal (YIN)
Total depth ft.
Date of test
Static water level
Well production
Cased to ft.
FROM WELL LOG
ft.
g.p.m.
Well Log (YIN)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
ft.
B. SEPTIC/HOLDING TANK DATA ! Pg 3
prfr„o.�'f'4�% SY
Tank Type/Material 4A ,Lx ILEEL Date installed Ac/✓c,���
Tank size 12-qSj gal. Number of Compartments Cleanouts (YIN)
Foundation cleanout (YIN) I Depression over tank (YIN) —L) High water alarm (YIN)
Date of pumping 7/3'
�
Pumper '1"'feo Ref&i
6/Zi' /S TFf
C. ABSORPTION FIELD DATA
Date installed 9,120108 Soil rating (g.p.d./ft2 or ftZ/bdrm) / 50 System typeeWick- /r&A c �i
Length 27 ft. Width S ft. Gravel below pipe ®• S ft.
Total depth -�L--E ft. Eff. absorption area 6E ftZ Monitoring tube _�_ Depression over field
Date of adequacy test Results (Pass/Fail) P141f For 4— bedrooms
Fluid depth in absorption field before test n in. Water added GOO gal. New depth --- L in
Elapsed Time: -30 min. Final fluid depth 6 in. Absorption rate >= 0 d g. p. d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) 14J0 If yes, give date
D. LIFT STATION
Date installed WZO O g Size in gallons 5 06 'F" PaD Manhole/Access (Y/N)
"Pump on" level at ?1-C lin. "Pump off' level at BD. ,' 7 in. High water alarm level at 7 In.
Datum 1ao Cycles tested 3 Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: Nib
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation 40 .1 f-
Property line 1/0
Absorption field
/6F 1'F
Water main / 0
water service line /D r�
Surface water
l00 `F
Wells on adjacent lots /DU �r
ABSORPTION FIELD ON LOT TO:
Property line /G 1'1CBuilding foundation /0 Water main 0 �`
Water Service line IQ 'fi Surface water 'r Driveway, parking/vehicle storage
Curtain drain 50 T Wells on adjacent lots /00 ,'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name
Date
COSA yellow sheet_2-6-15.doc
114 014 1474,
N 90000'00"W 170.001
i
swc0
PUwP VAULT \
wANw OI[
FILTER POD \ \ \
2
THE INFORMATION HEREON IS FOR THE LRE OF LENDING INSTITUTIONS SPECIFEALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND FLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AOCFTIONAL
S TRUCTURES OR FENCELTNES
EASEMENTS Of RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED FAT. ME NOT SHDYM HEREON (UNLESS INDIGTEDI
NOTE ANY F[NCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES
ANY PAVING SNOVM MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
Bs
1 B• TELE:. A
ELEO. EBMY.
o . OF A
x..........
In
Q SHANE A. HOLT: 0
1
AS -BUILT SURVEY I NO CORNERS SET THIS DATE )
T'•30
I NEWBY CERTIFY THAT 1 HAVE PERFORMED A
MORtOAGLE'S INSPECTION OF THE FOLLOWING
DI'. SCRIBED PROPERTY,
LOT A. BLOCK $5, NORTHWOODS SUB. NO. A
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE RIV ROVEMt NTS SITUATED TREREON AN
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST 01 HER THAN NOTED,
DATED AT ANCHORAGE, ALASKA THIS 16TH
OAYDF 6EclEM8 _
DER ]00
HOLTLAMOSURVEYRIG 167—M- 813111.1]89F
TEL. 3156513
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2
THE INFORMATION HEREON IS FOR THE LRE OF LENDING INSTITUTIONS SPECIFEALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND FLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AOCFTIONAL
S TRUCTURES OR FENCELTNES
EASEMENTS Of RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED FAT. ME NOT SHDYM HEREON (UNLESS INDIGTEDI
NOTE ANY F[NCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES
ANY PAVING SNOVM MAY BE APPROXIMATE DUE TO SNOW CONDITIONS.
Bs
1 B• TELE:. A
ELEO. EBMY.
o . OF A
x..........
In
Q SHANE A. HOLT: 0
1
AS -BUILT SURVEY I NO CORNERS SET THIS DATE )
T'•30
I NEWBY CERTIFY THAT 1 HAVE PERFORMED A
MORtOAGLE'S INSPECTION OF THE FOLLOWING
DI'. SCRIBED PROPERTY,
LOT A. BLOCK $5, NORTHWOODS SUB. NO. A
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE RIV ROVEMt NTS SITUATED TREREON AN
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST 01 HER THAN NOTED,
DATED AT ANCHORAGE, ALASKA THIS 16TH
OAYDF 6EclEM8 _
DER ]00
HOLTLAMOSURVEYRIG 167—M- 813111.1]89F
TEL. 3156513
niiiiis ■■■ arm ■ ■o ■ Z2i■m■■ 4 g loans
so I., ■■� ■ ■■�■■ ■
■■ ■■■ O■■■ ■■■I■ ■ ■ ■ ■■ IBM
vantTexe Field Maintenance Report
Annual Inspection
Prcpeny 0.mrl king 9
Qavid & Lana Semmens
Silo Addreaa
23211 Green Garden Circle, Chugiak AK 99567
Ax Bae IDM QW Vtpe Ppde
AX -118310 SWO80095 4D6453
Retrieve O&M Info
Dally flow
RecirO ratio
Timer settings: /Qt"
Perform Field Sampling/Observations
NTU (15 x LATUS)
pN 0-9)
UO 12,61
a
Recim Amps
Odor of Sample
Typical 91 Musty ❑Earthy ❑Moldy
Non -typical ;FsulNde FICabba9e ❑Decay
Olay film In pvu ❑ yes No
Foam In tank r-1 Yes NO
Inspeouclean Pump System
inspect
..............
Splice Box .................. Y(�Y'
Float Cords ... . ............. • .
Floats ........................
Pump........................
Blotubee Filler ................. jam. fy
eidtube Pump Vault ............�J
Recirculating SPlltler Valve.......
Comments
Clean
AnchorageTank
907-272-3543
cpelater
Mike Blakeslee
FM WUL r
RTU114177
Measure SludgelSaum
er..,__
Canted Phpe
(907)688-3339
-tilealu th.winp
02/03/2014
Scum
1511 Compartment
Current
Check Control Panel
Current
Recim Amps
Olscharge Amps
1
Prevlous
Audible and visual alarmsk
PmWous
Dial tone (telemetry orgy)
es ❑ Na
Inspeouclean Pump System
inspect
..............
Splice Box .................. Y(�Y'
Float Cords ... . ............. • .
Floats ........................
Pump........................
Blotubee Filler ................. jam. fy
eidtube Pump Vault ............�J
Recirculating SPlltler Valve.......
Comments
Clean
AnchorageTank
907-272-3543
cpelater
Mike Blakeslee
FM WUL r
RTU114177
Measure SludgelSaum
er..,__
Canted Phpe
(907)688-3339
-tilealu th.winp
02/03/2014
Scum
1511 Compartment
Current
Previous
Current
Previous
2nd Compartment
Currpld
Prevlous
Current
PmWous
InspactIrClean AdvanTez Filter
Odor: �armal C: Pungent I
Bfamat: onnal ❑Excessive
erkf91119/pondin9: onO7Mloor ❑ Exc9aaive
Inspect/Clean plachange PUMP System
Inspect
Riser/Lid
Splioo Box
Float cards
Inspect/Sarvice Other System Components
Inspect Clean
oai9cas
Pod Bottam
Pod Som
Intake Vent
Inspect Clean
Floats
Pomp
Pump
I
InspectClean Cll��a///n''' Inspect Clean
m 1pc
Disinfection EqulpmeaDispersal Laterals/OdflcA I,c 1
Additional Services Rendered
❑ Cieanod textile sheets? ❑ Raplacod VV Hamel
Repiaced/Used other Hemel
parts Used: W = Warranty, B = Billable (✓ appropriate selection)
w P Ileal Number Description
Final/Safety Inspection
SV rewnstelled anlfoltl reconnected; flush valves closed
Summary/Recommendations
[] System pedomdng; no funher action needed
❑ call for solWce
Date
Fax completed form to 1-866-394-7404
Olds bolted
{X'af`'ontml panel el
reactivated
1$ lank needs pumpinm
❑ Other3
ADVANCED \VAS ('P:AYATER'TKEAT\1ENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALI'T'Y OIT ANCHORAGE
AND
I I il5 MAIN `FENANCL AND REPAIR AGRFl_'.MFNT made and entered into as ofthis
Da.' of of 20 ' by and bettvicen
herein the " OWNIERY and the Municipality of Anchorage. herein the
MUNICIPALITY." In consideration of We numml covenants contained herein. the
parties to this Maintenance and Repair Agrenucut agree as Allows:
1. Advanced Wastewater Treatment Svstems. Municipality grunts permission to
Owner to utilize and operate an AdvSystem
(.Aw\ML described as
located at (legal description).
2. Definitions.
Alteration. Any change to the design or function ofan AVVWTS that
includes the installation nr removal of nny parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
ydunicipality of csisting water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter. "AMC-) 15.65. 'Hiese approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations. Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Reuairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
11. Owner agrees that the AWWTS installation and maintenance rcquireIII cnts as
provided by the AW'WTS vcndor'linswJOrand approved by the Municipality arc
he governing <�uidclincs for the construction, maintenance and repair of the
Owners AW""I'S.
1. Owner agrees to provide and maintain a telephone connection to the AWWTS as
required by the AWWTS approval.
(i. Nonvvaiver. The failure of either party at way time to enforce a provision of this
Maintenance and Repair Agreement shat] in no way consdrute a waiver of the
provisions. nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hcwoG or the right orsuch party Ihcreaker to enforce each and
cvcry provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a wriling, excaacd by authorized representatives of the parties, with
the same Formality that this Maintenance and Repair Agreement was executed
with, and such %v riling shall he attached to this Maintenance and Repair
A2rccmcnl as an nnacndnteni.
B. For the purposes of any amendment modification or change to the terms and
conditions of this Ngwement, the only authorized representatives ofthe parties
are:
a. Owner:
--- _
b. Municipality: Director C'omnnmity Devclooment or deshwimited anthority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Lim. Any civil action arising From this Maintenance
and Rcpair Agreement slialI he Grough I in the Superior Court for clic Third Judicial
District of tltc Stale of Alaska at Anchonige. The laws of the State ol'Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
AarccIII cnt.
9- Severabilitv. Any provisions of this Maintenance and Rcpair Agreement decreed
invalid by a court o competent jurisdiction shall 1101 invalidate the Iell laill ing
provisions of fhe Maintenance and Repair Agreement.
ODYN Is R
�_;
By. __ _ ' �—(stgnalure) Date-
,
(print name)
STATE OF ALASKA )
ss.
THIRD It DICIAL DISTRICT )
The Rnagomg insuumcnt was acl:noNlcdgcd before me thiti '� r_ day of
20 by�� `'--
�S IAi l OF ALASKA
�0 i 1RY PUBLIC I OR AI ASKA RIO fAFIY PIJSLIC
y
My Commission cxpnes i , lessica Lace
Afy Co_ Mssion Fxpiroc Ucccmlto 16, GOiG
IY1 U N I CA VA1,ITY:
By; (signahnc) Dale:
(prin( name) "Title: — _ _—
JRs Pumping
Po Box 773415
FagloRiver,AK 99577
(907)694-6454
Billinliq In ormatton
Table Total
Tax Total -
Anchorage Tank & Welding
Job Description:
1500g
2723 Rampart Drive
P.O. Number
5246.00
Terms:
Net 30
Anchorage, AK 99501-3124
saissrep:
Karlia
(907) 272-3543
Jim -Sam-Torn
Map Bank
Cross streets:
vnvlanBoulevard
Job Site Information
Tom Job Comments:
23211 Green Garden Cirlce
chugiak, AK 99567
(907) 272-3543
ServI& A&ibment
Number: 043326
Order Date: 22 -Jun -2015
Service Date: 26,Jun-2015
Technician: Gary & Mike
Tex %: Q
Job Type: Repeat
Map GO: 22 - -
Last Sery `2125/2014` 1500g
pumped tank only
thick and a lot of solids
back flushed 3 times
Additional Location Comments Dtagram; ea a 543328 bmo
-Need Description e
*Need Drawing
Service Type Qty Price Each Tax?
Septic Sery f 500g 1 $245.00 No
Gallons Planned: 1500
Gal. Actual: ,.-...._._
Hose Length:
Double Tank: ❑
Pump System: Q
Baffles Inlet: CJ
Baffles Outlet:
Extension
$245.00
Actual
Actual Charges:
Customer agrees to the terms end conditions Shown, THIS IS A BINDING AGREEMENT.
r^�
rn nil TNIe of Custer Repreaentafiva e
mar
Accaptedby JRSPumping OaleAccepted
For your added convenience we accept, Dlcover, Visa end Master Card payownts over the phone.
After 30 Days accourtt win be turned over to COLLECTIONS. $30.00 For NSF Checks Retuned.
Table Total
Tax Total -
Grand Total
Nonlrmable Total
Estimated Charges: $245.00
$0:00
$0.00
5246.00
Actual Charges:
Customer agrees to the terms end conditions Shown, THIS IS A BINDING AGREEMENT.
r^�
rn nil TNIe of Custer Repreaentafiva e
mar
Accaptedby JRSPumping OaleAccepted
For your added convenience we accept, Dlcover, Visa end Master Card payownts over the phone.
After 30 Days accourtt win be turned over to COLLECTIONS. $30.00 For NSF Checks Retuned.
Municipality of Anch
Development Services Del
Building Safety Division
Onsite Water and Wastewater Pi
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 051-064-09
1. GENERAL INFORMATION
Complete legal description Lo 4, Block 15 NoMwioods e 4
°
COSA1$ o8023-
Expiration
D 3"Expiration Date:4
Location (site address) 23211 Green Garden Clyde Chugiak AK 99567
Current Property owner(s) Joe a Marywiramson
Day phone
Mailing address 23211 Green Garden Circle C v4ak AK 99567
Lending agency Ur*rx)w'
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup. til„
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑
Individual On-site
r❑i
Individual Water Storage ❑
Individual Holding Tpnk'
- 1 ' ❑
Community Class Well ❑
Community On-site
❑
Public Water System
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite 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 Onsite 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
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Municipality of Anchorage 44,
C Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 4, Block 15, Northwoods a a Parcel ID: 051-064-09
A.' WELL DATA
Well type wA If A. B, or C provide PWSID # AWWU WWII iog (y/pl) WA '
Date completedwA Sanitary seal (Y/N) NAA Wires ro ole wA � 7.
p pe4 protected (YM)
Total depth wA• ft Cased to wA ft. Casing height (above ground) wA* in.
FROM WELL LOG AT INSPECTION
Date of test WA Mie
Static water level wA
ft.
Well production wA g.p•m.
WATER SAMPLE RESULTS:
Coliform wA colonies/100 mi. Nitrate wA mg.A.
Arsenic: wA mg.A. Date of sample: wA
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Anchorage Tank, Steel.l
Tank size 11250 gal. Number of Compartments 2
NIA ~
ft.
N/A g.p.m.
I t
Other bacteria wA colonies/100 ml.
Collected by: wA
Date installed SM197
Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) Y
Date of pumping 08/12/08 Pumper JR Note: There Is an add-on 500 gallon Anc Steel tank and lift station
C. ABSORPTION FIELD DATA
Date installed 8/20/08 Soil rating (g.p,d./fe or fe/bdrm) 150
System type Wide Trench
Length 29.0 ft Wdth 5•
ft. Gravel below pipe 0.5 ft
Total depth 4.45 ft. Eff. absorption area 145 fe Monitoring tube Y Depression over field N
Date of adequacy test wA Results (Pass/Fail) wA For wA bedrooms
Fluid depth in absorption field before test wA in, Water added wA gal. New depth wA in,
Elapsed Time: wA min. Final fluid depth wA in. Absorption rate >= wA g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) wA If yes, give date
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THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN
EXISTING STRUCTURES AND RATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL
STRUCTURES OR FENCELINES
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT. ARE NOT SHOWN HEREON (UNLESS INDICATED)
NOTE ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES
OR LOCATE STRUCTURES
ANY PAVING SHOWN My BE APPROXIMATE DUE TO SNOW CONDITIONS.
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...........................
G SHANE A. HOLT: 0
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LS -6914 G
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AS -BUILT SURVEY (NO CORNERS SET THIS DATE)
T'•30
I HEREBY CERTIFY THAT 1 HAVE PERFORMED A
MORTGAGEE'S INSPECTION OF THE FOLLOWING
BE SCRIBED PROPERTY,
LOT 4. BLOCK 15, NORTHWOODS SUB. NO. 4
ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE, ALASKA THIS 15TH
DAYOF SEPTEMIIER 3008 _
HOLT LANE, SURVEYING 16-7-26-i8131-61.12931
TEL. 3455513
0E2 Theta Environmental & Engineering
660 S Maney Dr.
Wasilla, Alaska 99654
(907) 357-0756
Sept 30, 2008 (907) 242-0755 Cell
James "Jay" Crewdson, P.E.
On -Site Services Program
MOA Dept of Health & Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 4, Block 15, North Woods #4 Subdivision, COSA Comments, 9/23/08.
All references are to the subject COSA Comment Sheet.
Item 1: Submitted via email, 09/23/08. Copy is attached.
Item 2: Added details to include existing septic tank and clean outs and added route of
pressure line from lift station to drain field. Please see Figure 1R, attached.
Item 3: Point D, swing tie location was provided additional detail on Figure 1R. Please see
Figure 1 R, attached.
Item 4: Confirmation Percolation Test: An attempt to percolate the GP receiving layer was
accomplished on 7/31/08. This was done when the bottom of the trench was exposed and
before the sand filter was added. The GP is relatively coarse and a percolation was not
possible, as the material would drain the water as soon as water was placed upon it. The
water would not pond on the material. The percolation rate is estimated to be 5 secondsfin.
The design was based upon the sand filter rating of 1 minutefinch. Therefore a percolation
test is not possible. See attached photo of the exposed bottom of the trench.
Item 5: The dept to the pipe vs. gravel beneath the pipe was verified and a new brown sheet
and inspection report is attached. The problem on the Details Sheet, Figure 2, was that the
original grade was indicated as El. 100.62, but the bottom of the gravel elevation had not been
placed on the detail. The bottom of the gravel under the pipe is EI. 100.45'. A new brown
sheet and a revised Figure 2R, and a revised Inspection report is attached.
Thanks,
Ronald E. Godden, P.E.
Attachments: 1. RLS As -Built Survey
2. Revised Figure 1R.
3. Revised Figure 2R.
4. Revised Inspection Report / c,
5. Revised COSA Brown Sheet �1
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NoMmooks#4-WilliamsonJay Memo4)329-08V1.doc
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77 .....•..
LD E. GODDDN
�Y
MUNICIPALITY OF ANCHORAGE Aak
• -� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section cow
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1. D. #
1. GENERAL INFORMATION
Complete legal description
2.
0
Lo
Location (site address or directions) e-�? 3r;2ZI C✓'eel-) L as rZ�'9
h /
Property owner Day phone
Mailing address
Lending agency Day phone
Mailing address
Ab (n��n S Day phone
At �P _
Address °
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system. -
72-=(Rw.t/91) Front MOA%21
A
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the dateof this inspection.
Name of Firm KND Engineering_
Phone 696-6111
Address 20441 PtarmiganBlvd., Eagle River, AK 99577
Engineer's signature- Date ? %
DHHS SIGNATURE 4,771
�,
Approved for V
R bedrooms. Ro�ssio�' i
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
I AM
Date _%
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues..Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
Professional engineer registered in the State of Alaska. The DHHS does this as.a courtesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage isnot
responsible for errors or omissions in the professional engineer's work.
7Z-025(Rev:;7A1)„Back MOAw11
CEIVED
Municipality of Anchorage JUL 14 1999
DEPARTMENT OF HEALTH & HUMAN SERV mi
Environmental Services Division EIJVIVI IPAurr of aNcrlowAIS
RONAAENTALSERVICES DIYIS
825 L Street, Room 502 Anchorage,, Alaska 99,501 • (907)`343-4744
Health Authority Approval Checklist
Legal Description: 4>`! 15 de iR1�U � Parcel I.D.:
A. WELL DATAj2p
Well type 0.b' I4 If A, B, or C, attach ADEC letter. ADEC water raystem number
Log present (Y/N) Date completed
Total depth Cased to asing height (above ground)
Sanitary seal (Y/N) Wires properly protected (Y/N)'
FROM WELL LOG <AT INSPECTION
Date of test -
Static water level
Well production g.p.m; g.p.m.
WATER"SAMPLE' RESULTS:
Coliform Nitrate Other bacteria
Date of. sample: Collects y:
B. SEPTIC/HOLDING TANK DATA
Date installed -_ 7� ` Tank size D Number of Compartments 2 Cleanouts (Y/N) r
Foundation cleanout (Y/N) y Depression (Y/N) V High, water alarm (Y/N) AJ4
Date of Pumping 2 g Pumper
C. ABSORPTION FIELD DATA �a�L✓oUPG� �ei/��j /
Date installed 4 Soil rating (g.p.d./ft2 orft2/bdrm) System type acJ -r Ch
Length 8Z Width 671 Gravel thickness below pipe - -1.7 Total depth L. Z ' 5
Effective absorption area 60LO+ Monitoring Tube present (Y/N) Depression over field (Y/N) Al
Date of adequacy test Y_ 2 5 Results (Pass/Fail) %SS For 7 bedrooms
Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.):
Fluid depth (ins) Minutes latera Absorption rate _ a.p.d.
Peroxide treatment (past 12 months) (Y/N). If yes, give date
72-026 (Rev. 3(96)'