HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 15 LT 9No th Wood
Block ! 5
Lot 9
#051-064-04
Municipality of Anchorage ."',
Development Services Department
Building Safety Division
On~ite Water and Wastewater Program, 4700 Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2
w~w.ci.anchorage.ak.u$ (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:. SW070321 PID Number. 051-064-04
DANISE PODVIN Wsstewater System: [] New [] Upgrade
23212 GREEN GARDEN ABSORPTION FIELD
LEGAL DESCRIPTION ~'""~ 4 o,o~eI
3.9
t 5 9 NORTH WOODSY4 2.7 n. 1.2
14~ 1E ;~2 1.5 [ri. 5~ FI.
Well: [] New [] Upgrade a~"'*'~"5 n. "~'"~"2 I ~"""~"~"'"3
PUBLIC WATER n. n 300 Fe ASTM-3034
FL GREY'S CONSTRUCTION 12/20/2007
'~"~ c,~ ~"n.Ic''m"'~ *"~' c'''~F~ TANK
SEPARATION DISTANCES [3 septic n Holding [] S.T.E.P. [] Other. ADVANTEX
Tenk Field Station Tank ,~,L~e ANCHORAGE TANK 1500
w. ..... STEEL 2
~.,.w..,+100' +100' - - ~ / LIFT STATION
- 250 ~ ORENCO
F..,,~,.,, +5' +10' - - 44 . 40 ,,
- OSI.P30-05 Alaska Electrical Contractors~ LLC
14' SAND BELOW SEWER ROCK. BENCH MARK
BOTTOM STEP OFF OF DECK
Inspections per fo rmed by: E RES Da tes: l~t 17J19/2007.&.. m~.jl~.......~
12/'20/2007
Dovolopmo.t Sor.,i o Dop a...o.t Approwl :f.?h
Conditional Approval Date: ~ L~: _~/x...~/~..~_.._~,~/~0
Permit No. SW070321 Page.. 2 of
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
ON-SITE WATER &: WASTEWATER PROGRAM
4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650
On-Site Wastewater Disposal System and/or Well Inspection Report
2
Legal Description: NORTHWOODS#4 BLOCK 15 LOT 9 051-064-04
· B c GREEN GARDEN CIRCLE
ox
I
ADVANTEX \ ~,,,,,~"~/l~,,~''~ \
W/ AX-20 RLTER POD ~ ~
0 - eH
- WE .L N P A K
· - ~O~tTOR ~e[ ELEVATIONS ~' 12/20/2007
mDT Tfl ~C~E) DRI~INAL GRDUN~ [N~NEER'S ~AL
LEV[L ~T, 99.8
/ X ~ O~.A/'~'~.
~ ~.o.t~~ .... · ..........
t"/;'~'u;'~h~ ~ '~' 0 ~'" ~-~o~ .'~
0~ ~.... ........... ....~
Atuka ~ Contr~_ ~rs T.1'4~
P.O. ~o~ 87~3~4
(907)
MUNICIPALITY OF ANCHORAGE
Development Services Depa~lment
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Dec 13, 2007
Expiration Date: Dec 12, 2008
Permit Number: SW070321
Legal Description: NORTH WOODS UNIT 4 BLK 15 LT 9
Design Engineer: 0848 EAGLE RIVER ENGINEERING SEI
Owner Name: DANISE PODVIN
Owner Address: 23212 GREEN GARDEN CIRCLE
CHUGIAK, AK 99567-
Parcel ID: 051-064-04
Site Address: 023212 GREEN GARDEN CIR
Lot Size: 20494 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
Ail 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 calling
(907) 643-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By;.
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
ON-SITE SEPTICANELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~5 1¢ ~'J~ oq- ~
Property owner(s) ~J~ ~J~$ ~- ¢O bV~J'
Mailing address ~1~ ~¢~ ~A¢~-¢
Site address ¢ ~¢-
Legal description (Sub'd, Block & Lot)
Legal description (Township, Section & Range)
Lot Size ~, qqq Sq. Ft.
Number of Bedrooms
Day phone
Zip Code .~'~<J/= 7
Zip Code c~ ~ ~'g 7
THIS APPLICATION IS FOR (~3all that apply):
Absorption Field [~
Septic Tank
Holding Tank ~
Privy
Private Well ~
Water Storage
THIS APPLICATION IS AN:
Initial [~
Upgrade
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single F~wel/~ling a/nd is in~cordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Waiver Fees:
Date of Payment:
Receipt Number:
Eagle River Engineering Services
Chvlstopher R. Wood, P.E.
PO box 773664 (907) 694-5195 tel
Eagle River, AK 99577
December 1 I, 2007
Dan Roth
Manager, On-Site Services
Municipality of Anchorage
4700 Elmore
Anchorage, AK 99519
Re:
Northwoods//4 Lot 9 Block 15
Septic System Upgrade Permit Application and Narrative
Dear Mr. Roth:
The owner of the above property has contracted with Eagle River Engineering Services (ERES)
to design a 4 bedroom septic system. The size of the lot and the terrain of the lot severely limit
the location in which a replacement septic system may be located. We propose to utilize a
Category III (Advantex) wastewater treatment septic system to utilize the limited space available.
Soils are a silty sand and gravel (GM), siltier with depth, which is typical of Northwoods
Subdivision. No ground~vater was noted during excavation or after 7-day water monitoring. The
proposed Advantex septic system will have very limited impact on adjacent properties for the
following reasons:
The surrounding lots are connected to public water, eliminating 100 foot
protective well radii, allowing sufficient room for septic sites if planned
accordingly.
Immediate neighboring septic systems are all +30' distance, and wells +100'.
This permit is for a septic system upgrade only.
Drainage will not be affected and is not a major consideration in our design.
This work will not affect the reserve area on adjacent lots. If you have any questions please call
our office at 694-5195.
Sincerely,
L
Cfi~ristopher R. Wood, P.E.
Principal
~2003\07- 109S EPTICNARRATIVE.DOC
TO BE/ABANDONED '~"~,~ J uJ S
~ LOT9 '"'4. ~_ \ 6.
' BE ABANDONED '~,.
>EPTIC +30 o ·
.., ~~~ .:. ~ ~ ~. LOT 8
-..: :, :'
EPLACE EXIS 'lNG TANK I / ~ ~ /
~ITH NEW 1500 GAL ~6 / ~ ~ I ~
)VANT~X ~ ~ ~~/ ~
/ AX-20 FILER POD~ ~ ~ ~ ~ ~
qB LIFT BASIN ~o~ ....... ~ ~ ~ SEP~C
INSTALL NEW
) mr NECESSARY J ~ ~ ~
i~ 0 ~ ~/ - ~ INSTALL
~I ~ ~ ~NEW 5'X50' D~INFIELD
o5
> SEPTIC +30'
. - ~ .o~ LOT 10
· - MON~OR
o - S~ER C~ O~ /SEPTIC AR
~EME~ I. NO KNOWN SURFACE WATER +100'.
, PROPOSED ~CH R~ 2. NO KNOWN CURTNN D~NS
~ - ~IS~NG ~CH RE~ 3. NEIGHBORING LO~ SER~CED BY PUBMC WATER~
~ - DR~AY 4. NO WEL~ W~IN 200' UN.SS NOrD
W LL/S T C
LEGAL: NORTHWOODS~4 BLOCK 15 LOT 9
OWNER: DANISE PODVlN
CONTRACTOR: 'UNKNOWN ~.~ '. ...'.
EAGLE RIVER ENGINEERING SERVICES ' ' '
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (90~) 694-3297
Eagle River Engineering Services
Christopher R. Wood, P.E.
PO Box 773664 (907) 694-5195 tel
Eagle Riwr, AK 99577-3664
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Northwoods #4 L9 BI5 December 11, 2007
A. GENERAL
I. The well & septic plan is for a 4 bedroom 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 Building Safety, On-site
Divistion codes.
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 in the field by the contractor to meet
Municipality of Anchorage 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.
9. Any remaining open test hole excavations shall be filled.
B. ^DVENTEX SYSTEM AND SEPTIC TANK
I. Septic tank shall be a fiberglass or steel 1500-gallon tank capacity of MOA approved construction for
use with Advantex system. Install as per current manufacturers recommendations for conditions in
Alaska.
2. Install one AX-20 filter pod over septic tank capable of treating 600 gallons per day of waste flow.
3. Install Orenco 24" pump basin PB-2496 outside septic tank, with OSI pump model P30-05 and
controls to allow :23 gallon dosing of septic leachfield. Set pump float to 13.5" above pump, timer for I
minute dose time. Controls to be installed to MOA code by licensed electrician familiar with OSI
applications. Controls to include a dedicated phone line and web based monitoring system. (
4. A municipal inspection report or receipt from a licensed electrical contractor shall be provided
to the engineer verifying lift station wiring to all applicable cedes.
C. DRAINFIELD
I. The drainfield is to follow the natural land contour to maintain uniform total depth of the drainfield
bottom.
2. The total depth of the drainfield excavation is not to exceeddr'at any point with relation to ground
surface, and shall be level, plus or minus 1.5".
3. One foot of imported filter sand is to be installed in tbe bottom of excavation.
4. A 15 inch layer of sewer rock is to be installed over this sand layer.
5. The effluent line shall be placed within the drainfield gravel with 2" cover, and shall be laid level
within 0.03'.
6. The drainfield gravel is to be covered with typar fabric material.
7. A combination of 2' of soil and 2" extruded board insulation to an equivalent depth of 3' is to be
placed over the leachfield.
8. The area over the drainfield is to be finish graded to prevent ponding of surface water runoff.
9. The septic tank and leachfield must not be closer than 100' to any existing private well, or 100 feet to
any surface water, spring or outfall.
\1997~07- 109AdvantcxDrain fi¢ldSpecs.doc
Eagle River Engineering Services
Christovher R. Wood, P.E.
Continued:
.,,~. 0
RECOMMENDEI~ LEACIIFIELD DIMENSIONS:
TOTAL DEPTtl =~4~Y'max. ¢,~J FILTER SAND DEPTII= I'
GRAVEL DEPTH -- I' under pipe, 2" over pipe
DRAINFIELD LENGTiI = 50' DRAINFIELD WIDTII = 5'
SOIL RATING -- 4 GPD/ft2 BEDROOM CAPACITY-- 4
SEPTIC TANK = 1,500 Gal Advantex compatible tank w/AX-20 filter pod and lift basin
EFFLUENT PIPE TM i.25" PVC with I/8" holes oriented down spaced at 1.5' OC. 2 runs of I" effluent
pipe in each leachfield 2' between pipes 1.5' from sidewall of drainfield. Provide 2" insulation over piping
run from tank to manifold, and on manifold.
Twenty-four (24) hours notice required for all Inspections.
[1997~07- 109AdvantcxDraln fieldSpecs.doc
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(~07) S~4~tS5
ERES Project No.: 07-109
Calculated By: CB
Date: 12/06/2007
Legal: NORTHWOODS #4 LOT 9 BLOCK 15
SINGLE FAMILY 4 BEDROOM RESIDENCE
Shallow Trench Subsurface Was~ewater Disposal Field
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate = 28 minutes per inch
Wastewater application rate = 4 gallons per day per square foot
Required absorption area = 150 square feet
Trench width (W) = 5 feet
Gravel depth (D) = I feet
Required length = Shallow trench factor * Required absorption area I W
Shatlow trench factor = (W + 2) I (W + 1 +2 D)
Shallow trench factor = 0.88
Total Excavation Depth = 4.0 feet
Required length = 50 feet
Use 1' bedding sand beneath leach rock
07-109 NORTHWOODS.xls 5:44 PM12/06/2007
A
PERFORMED FOR:
EAGLE RIVER ENGINEERING ~....'~.....~._ ~..,.,'-.. ~,
EAGLERIVER, AK.99577
A .~--./..?~..,'.~. j ·..,,/.~
~.~ '.c..,sTo..~....~oo.' ~.~
SOILS LOG;PERCOLATION TEST ,,,~ .. c~-,o3s, ..y.~
%.... ..... .: ?
DANISE PODVIN DATE PERFORMED 12/4/2007 ~.~.'~.'~.'~'
LEGAL DESCRIPTION:
TOPF>OILy~ROO~J
NORTHWOODS#4 BLOCK 15 LOT 9
TEST HOLE ~ 1 SLOPE
BROWN GM
S~LTY GRAVEL
AND SAND
TOWNSHIP RANGE SECTION T15N~ RlW, SEC. 3
SITE PLAN(NOT TO SCALE)
SLOPE
20--
22--
COMMENTS:
PERC TEST RESULTS
READING DATE GROSS TIME NET TIME DEPTH TO WATER NET DROP(IN)
'1 : 12/04/2007 11:30 0:00 5' 2 112 0
2 12/04/2007 12:00 0:30 5' 3 518 1 1/8
3 12/04/2007 12:01 0:00 5' 2 1/2 0
4 12/04/2007 12:31 0:30 5' 3 9/16 1 1116
5 12/0412007 12:32 0:00 5' 2 112 0
6 12/04/2007 1:02 0:30 5' 3 9/16 I 1116
PE~COL~'~ TION IR*ATE= 28 M~NCH) I~C HOLE D~A Iv~-IIr.;x'=6'
TEST RUN BETWEEN 5 FT AND 6 FT
PRE-SOAKED PRIOR TO TEST
SOILS )~OGGEO..B¥1 CHRISTO~W~ PERCOLATION TEST BY: CHRISTOPHER WOOD
AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~/0.'.'.~
o~ z
Municipality of Anchorage Page ' [ of'~-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVI(~ES DIVISION
P.O. Box 196650 · Anchorage, Alaska 995~9-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~L~J~ l ~ PID Number:
Name:
[~, [,~. ~ ~ ~¢~ ~.~ Wastewater System: ~New D Upgrade
~ ~ ~ ~ ABSORPTION FIELD
Phone: ~.~{~ No. of B~0ms: ~ Deep Trench ~ShallowTrench~Bed ~Mound ~Other
LEGAL DESCRIPTION soi, Rating: ~ GPD/Sq. Ft. Total Depth from origin~de:
Lot: ~ BIock:)~ ~[~J Subdivision:~.~ ~~". Depth to pipe bottom from original ~ra~e:~.~ Ft. Gravel depth beneath P~'~/Ft.'
Township: J Range: I Section: Fill added above original grade~ Grave, ,ength:
WELL: D New ~ Upgrade Gravel ~ ~ ~. Number of lines: Distance betwee~ lines:
Classification (Private. A,B.C): ~ ~ Total Depth: Cased To: Total absorption area: Pipe materiak ~
~ ~ ~ ~ '~ ~,. ~,. I~ I~ so. ~,. ~ ~~ ~
Driller: ~ Date Drilled: Static Water Level: installer:
Date installed: I
GPM Ft. Ft. TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Privat~ anufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~~~
Material: Number of Compartments:
Surface
Water I~ I~ -- -- LIFT STATION
Line j ~ I~ I~ I~ ~ -- ~ Size in gallons: Manufacturer:
Foundation ~ [ / / ~ ~ ~ Pumpon leve~el~t High water alarm at:
CurtainDrain ' _~~ ~ ~[~ ~ ~ P~del J Electrical lnspections performed by:
Remarks: BENCH MARK
~~ ~~ ~ ~~~, Location and Description~~ ~'~
Assumed Elevation:
ENGI~SEAL
Inspections performed by: s s s ENGINEERING
Department of .ea~ and Human Services approval
Reviewed and approved by: ~~ ~~ Date/~ ~/~ ~2
(1/91)
Permit No. '~-~ ~ ~ ~ ~,~-'~ Page ~-
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
of
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:~~.-{Z.-- [ ~ ]~¢:3-T- c~ PID No.: 4:3 .~:~
72~013 A (2/91) MOA25
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
!15
1
-L
PAGE 1 OF 1
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:SW920165
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:FOX LEE W & KATHLEEN M
OWNER ADDRESS:HC 80 BOX 206 GREEN GARDEN
CHUGIAK, AK 99567
DATE ISSUED: 7/01/92
EXPIRATION DATE: 7/01/93
PARCEL ID:05106404
LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 15 LT
9
LOT SIZE: 20494 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
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:
THIS BED MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED
REVISED ENGINEER'S D~SIGN DATED 06/29/92.
RECEIVED BY: .--'~
ISSUED BY:
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
June 29, 1992
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ATTN: Rob§ie Robinson
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
JUN 3 0 1992
Municipality of Anchorage
Dept Health & Human Services
REFERENCE: Lot 9; Block 15; North Woods Subdivision #4
Dear Robbie,
At your request we have re-deslgned the proposed septic system to serve
the referenced property assuming a seaSonally high groundwater table of
7 ft. b~ow the ground surface.
The n~wly proposed leachfi~ld consists of a bed type syst~minthe
location of the test holes. However, there is insufficient room in
this location for an alternate site, therefore, the alternate
leachfi~ld site is higher on the property behind the proposed house.
This location may need an effluent lift station to be utilized.
Also required is another soils test in the area of the proposed
alternate site. This test hole is to be excavated during property
development to ensure the usefullness of the site. Since the soits
within this subdivision are generally consistant with the soils found
within test holes #I and #2, we do not anti,pate any surprises within
the proposed test hole #3.
If you have any questions or require additional information fcr your
review, please contact us.
Sincer~y,
RJS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
June 16, 1992
ROBERT SHAFER, P,E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Stre6t
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Lot 9; Block 15; North Woods Subdivision #4~
Request you issue a permit to install a septic system to s~rve the
proposed 4 bedroom house for the referenced property.
Attached please find a site plan and soils testing results for your
review.
The property is to be served by a community water system with the
source w~ll more than 100 ft. from the proposed septic system.
We do not anticipate any adverse effects on n~ighboring properties by
the installation of the proposed septic system.
Sincerely,
ROGER J. SHAFER, P. E.
RJS/gm
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
7
8
9
10
11
12
13
14
15
16
17,
18-
19
20
GOMMFNT,~
DATE PERFORMED:
I~'-~ ~/~0c/~Township, Range, Section: '~--~4
WAS GROUND WATER
ENCOUNTERED?
S
I L
IF YES, AT WHAT gPt 0
DEPTH? ! . p
E
Depth t0 Water Alter,~I ~
Reading Date Gross Net Depth to Net
Time Time Water Drop
~:~ \~ ,~..,~, 4~ - ~/~-
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
ENGINEERING
PERFORMED
BY:
I ~ '(~ CERTIFY THAT THIS TEST WAS PERFORMED IN
17034 Eagle Rive. Loop Road No.. 204~ ~:~:'~ / ~ _,c~ ~
ACCORDANCE WITH Aj~a~,~i~e~[~I~Ji~UiDELiNES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
1
2
3
4
7
8
10-
11-
12
13
14
15
16
17
18
19
20
DATE PERFORMED
Township, Range, Section:'~!~.~
"~t'" SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to WalerAA0¢.~ ~
~onitoring? 'VY~ Date: ~'""~'~'~'"
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE '~'1 (minutes/inch) PERC HOLE DIAMETER __
COMMENTS
PERFORMED
BY:
$
&
$
ENGINEER'ING
I "~'---' ~ -,.~ CERTIFY THAT THIS TEST WAS PERFORMED IN
11034 Eagle River Loop Road No, 204
ACCORDANCE WITH .~l~T~-~..e~N,i~l~J~l C~,~U DEL NES IN EFFECT ON THIS DATE. DATE:
72~008 (Rev, 4/85)
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DVVELLING
Parcel I.D. 051-064-04
GENERAL INFORMATION
Complete legal description
Expiration Date:
NORTHWOODS #4 BLOCK 15, LOT 9
Location (site address) 23212 GREEN GARDEN CIRCLE, CHUGIAK, AK 99567
Current Property owner(s) ERIN O'HARA & JAMES REED
Day phone
Mailing address
23212 GREEN GARDEN CIRCLE, CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
MATTHEW KANE w/Prudential Day phone 244-1876
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
:~ Individual Well
Individual WaterStorage
Community C!ass __ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site ~]
[] Individual Holding Tank []
[] Community On-site r~
[] Public sewer ["-]
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued
'with new water sample results. (Certificates may be reissued for a pedod 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.
DSD SIGNATURE
~/ Approved for
Disapproved.
Conditional approval for
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 01/26/2011
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 notbe 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 Iong a ' ' .~~."
system will function satisfactory for current or future..
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist...:~.~.~.!"~' ..~:..:~ ..~....,~ 7 ~~
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
ON-SEE
, STEWAT .
'.
Arsenic Advisow , ,~/~,)~ ,v
Maintenance Agreements
Supplemental Enginee¢s Repod
Other
(Rev. 11/
riginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety. Division
On-Site Water &.Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF O.N-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: NORTHWOODS #4 BLOCK lS, LOT 9
Parcel ID:
A. WELL DATA
Well*type PUBLIC
Date completed
Total depth f.
IfA, B, or C provide PWSID #
Sanitary seal (Y/N)
Cased to f.
FROM WELL LOG
Well Log Of/N)
Wires Properly PrOtected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date of test
Static water level ft. ft.
Well production
WATER SAMPLE RESULTS:
g,p.m, '~ g.p.m.
Coliform colonies/100mL Nitrate rng/L Other bacteria
colonies/100 mL
Arsenic: __mg/I Date of sample; Collected by:
B. SEPTIC/HOLDING TANK DATA
TankType/Material STEP/Steel Date installed 12/20/07 Tank size 1.$00 gal.
Number of Compartments _2 Cleanouts (Y/N) Y__ Foundation cleanout (Y/N) _Y Depression over tank (Y/N)
High water alarm (Y/N) ¥ Date of pumping 9/?/10 S~stem Sen;ced* Pumper A+
C. ABSORPTION FIELD DATA
Date installed 1.2/20/2007 Soil rating (g.p.d./ft2 or ft2/bdrm) ~. , System type T~each
Length 50 ft. Width _5 ff. Gravel below pipe 1.2 ft. ' Total depth 5.1 ft. (Measured 1/25/11)
Eft. absorption area 300 fi2 Monitoring tube Y Depression over field N__
Date of adequacy test 1./25/2011. Results (Pass/Fail) Pass For ~__ bedrooms
Fluid depth in absorption field before test [ in. Water added 8SO gal. New depth $.5 in.
Elapsed '13me: 1320 min. Final fluid depth 0__ in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date __
D. LIFT STATION
Date installed 12/20/2007
"Pump on" level at 44 in.
Datum Bottom of Tank
E. SEPARATION DISTANCES
Size in gallons 250
"Pump off' level at 40
Cycles tested :2
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer.main
Sewer/septic service line
Animal containment areas
in.
Manhole/Access (Y/N) ~
High water alarm level at 45 in.
Meets alarm & circuit requirements?
On adjacent lots.
On adjacent lots
Public sewer manhole/cleanout
Holding. tank
Man:ure/a nimal:excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5%
Water main 10'+
Wells on adjacentlots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water Service line 10'+ Surface water 100'+
Curtain drain 50'+ (None Knowa)
F. COMMENTS
Property line 5%
Water service line 10'+
Absorption field 5%
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage. 10'+
Wells on adjacent lots 200'+
Vacant system surcharged Drior tO testin!;l. *Attached Advantex Field Maintenance ReDort - A+
CE.TI.CATIO.
I ce~ that I have determined throu field Ins ctio s
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KF.~N'ET~ [Vi. Dt.rFlq~S
Date 1/26/20~1
Waiver Fee $
Date of Payment
Receipt Number
COSA Fee $490.00
Date of Payment
Receipt Number 0
(Rev~ 11/05)
GARDEN
GREEN
CIRCIoE
1
;.52'
00'
>l
LOT
40.4'
9
A.C. D/W
bJ
.,.-
0
0
1.5'xl.7'
FP
MHI
67.5'
EXISTING
HOUSE
30'
ANCHORAGE RECORDING DISTRICT
N89'56'OS"W
(NBO°OO'OO"W
LOT 10
ASBUILT OF:
NORTH WOODS SUBDMSION UNIT IV
L.OT 9 BLOCK 15 PLAT 83-333
SURVEY CERTIFICATION: I, John L. Schuller, havc conducted a
physical survey of this property as shown on this drawing and that the
improvements situated thereon are within the prol?erty lines and no
encroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundazy lines.
XCLUSION _NOTESilt is thc owners responsibility to determine
e existence of any easements, covenants, or resuiefions which
do not appear on the recorded subdivision plat. '
WORK
NUMEIERi
ORDER
DEC 24, 2007 / 1"=50' kndeng~k.net
JLS / NW1460 0704/29
1.5'x2. f
FP CANT
170.1~'
170.00'1 R)'
LOT 8.
LOT 11
Attachment, 128 KB
1~434
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~ III I IIII II I · · I I · i I I ~-~
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~tiva~x' Flal Maintenance Report AnchorageTank & Welding, Inl~
Annual Ins :)ection 907-272-3543
/'-~I I I I~II~II I I t~'~rv'''*'v'" '--
I Operator
property ~klnB ~
Eri~OHara ~ ~~ ~C~ ~~ Mike Blak. lee ._
s~. ~d~ (907) 862-6858
23212 Green Galen Circle, Chugiak AK 99567 ,,
~-115308 8~70321 211074 I RTU 113127 02/05~009
Retrieve O&M Info Measure Sludge/Scum
Daily flow 81ud~e
1at Compartment I Cumaflt, 1PmVtou*
Reclm mt}o , /~.~
Timer settings: 2nd Compartment I Currenty } Pmvk~us
Mspeet/Oleen AdvanTex Filter
Perform Field Sampling/Observations
'NTU (¶ 5 + NTLIs) pH ~-~ DO (2-6)
I0,1
Odor o! ~m~le
Non-~pi~al ~ Su~e ~ ~bb~e ~ Oe~y
O1~ film in
Foam In
Check Control Penel
Re, elm Amps Discharge Amps
/// ,,, I/,(
Audible and visual alarms ~
Dial tone (telemetry only) ~
~No
Iou~_~, I Previous
Curm,~/' ,, [ Prevlou~
Odor. ~4t~Tnal [] PungeM
E~omat: ~ermal [] ~e~slve
Bd~onde~' [.J ~in~ ~ Ex~a~
Inspe~Ole99 Dlscha~e Pump ~em
Ins~
~rlLi~
Float ~s
Insae=~e~l~ Offier ~m I~p~t
~n~n Squ~m~t
Clean
Inspect Clean
Dlepemal t.xtemls/Odflees [] []
Obsewatlons
Additional Set~tcae$ Rendered
[] 0leaned textile sheets? ~ Fle~laced I. IV Items?
,,~:j4aeplaced/Used other items?
Pari~ U~ed; W - Warranty. B - Billable (v/ al~pmprlate selection) w B Item Number' Oe~crlptIM~
tI I
I I
Final/safety Inspentien
~4;LH'V teiflstallad
~J~ant~old meonn~; fl~h ~lvee closed
SummawIR~omme~ions
~~ D~o~lng; no fu~her a~ion n~ed
~ Call for a~lee ~ ~ ~ ~
a bolte, d on
ntrol p~rml reactivated
[] Tank needs pumping
Fax completed form to 1-866-384-7404
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND '~'~-~/,,,J
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
/-I Dayof fi'ebr~,c~rx// of 20/O, by and between '~-t,,.,-q ~,/ Cc/cl~/a ,
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AWWTS), described as /~V0. rl ~¢,x located
at .A[,o£-/-}qtwoos~_~ ~c{ ~/_¢ z_ o/ ,Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of an AWWTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AWWTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On-Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These 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.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. 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.
E. Permit (Construction) An On-Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On-Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of ~ ~'r t?
($_t~.00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AWWTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AWWTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On-Site approval is issued to
the new owner or transferee of the property.
5. Alterations~ Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AWWTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AWWTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
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.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AWWTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AWWTS
Operating Permit is: ~ Ct r} n {,t0,~
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AWWTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AWWTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AWWTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
8. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner:
Anchorage: Purchasin~ Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding shall be brought in the Superior Court for the Third Judicial District of the
State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and
obligations of the parties under this Memorandum of Understanding.
10. Severabilit~. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
Date:
MUNICIPALITY:
Title: c_~ -
Date:
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
The foregoing instrument was acknowledged before me this ~7 day of L~?(:;2
20 i[ ,bY ,the
NO,ARY PUBLIC FOi~-ALA~X
My Commission expires:
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O 5-"/
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
COSA# 070
Expiration Date: / ' O
Day phone
Mailing address
Lending agency
q~67 -
Day phone
Mailing address
Real Estate Agent
Mailing Address
0 Fcwz~ ,~ ~,~ Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site DD
Public Sewer
The'Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a pdvate 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
Address ~.0- ~, -'7"7 3(, u,4
Engineer's Printed Name ~:/~'~r~S'i~'~'F/T~ r' ~---. I,L)¢(~CJ' Date /,,~./,2~,/o-"-~
5. DSDSIGNATURE[~.~ Approved for L.~ bedrooms. '~'~.~..,
-- '
Disapproved.
Conditional approva~ for bedrooms, with the following stipulationS:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: /,~- - ~ i - 07
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water'& Wastewhter~P~C~gTam __.: ......... ......
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
A. WELL DATA
Well type p¢,[?~. ~- If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/~N)
Total depth ft. Cased to __ft. Casing height [a.I;)ove ground) in.
FROM WELL LOG AT INSPE'~'~ION
Static water lever ~fL~ ft.
Well production . .-// g.p.m, g.p.m.
WATER SAMPLE RESULTS:
: ~Coliform -~< - colonies/lO0 mL Nitrate .. mg/L - · Other bacteria colonies/lO0 mL:
.- Arsenic: mg/1 Date of sample: Collected by:.
B. SEPTIC/HOLDING TANK DATA
Tank size }~ ~ ~ ¢"' gal. Number of Compadments ~ Cleanouts (?IN)
Foundation cleanout [~/N) ~ Depression over tank (Y~ /~0 High water aIarm (~N)
Date of pumping · /3/~t Pumper ~ ~ ,~,o,;t_;,
C. ABSORPTION FIELD DATA
Date installed .t,.~./.~.0/o-'-'~ Soil rating ~oJ' ft~4bdrm) ~- System type ~tt~.~¢7,c'
Length 5'C, ft, Width -~ ft. Gravel below pipe I. o-L ft.
Total depth ~. c~ ft. Eft. absorption area ,~O ft~ Monitoring tube ~,,~ ?~ Depression over field
Date of adequacy test r}/'~ Results (Pass/Fail) r~/~ For ~- bedrooms
Fluid depth In absorption field before test r)]g in. Water added r')/¢[ gal. New depthm/<"l in.
Elapsed Time r'l/S'1 min. Final fluid depthrl/,,'1 in. Absorption rate >= f].tf(t g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~'~. x/~ If yes, give date
D. LIFT STATION
· · '- - Date installed ...... Size in gallons .
'Pump on' level at __ in. 'Pump oft" level at __ in. High water alarm level at ,,,,'"'""/ in.
Datum . Cycles tested Meets;,~~ents?
E. SEPARATION DISTANCES '
Absorption field on lot ~ ~
Public sewer main
Sewer/septic'~e~-~ice line
...~nta~nment areas
SEPARATION DISTANCES FROML~HOLDING TANK ON LOT TO:
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
~ Absorption field
Building foundation ~ Property tine + ~ '
Water main .~ ~3,,~ Water service tine -t- I 0 ~ Surface water
Wells on adjacent lots 2-.o 0 I
SEPARATION DISTANCE FROI~I ABSORPTION FIELD ON LOT TO:
Building foundation 4 I0
Watermain {~ D-~ ~
Driveway, parking/vehicle storage -F .3..c~ t
Surface water -~-
Wells on adjacent lots
Properly line
Water Service line
Cudain drain
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 /3./~ f ¢"'-'-~--
COSA Fee $
Date of Payment
Receipt Number
(Rev, 11/05)
f,¢ 7.4.3,-/
Waiver Fee $
Date of Payment
Receipt Number
Parcel I.D. # 4~"/- ~ -/
1. GENERAL INFORMATION
~ ComPlete legal description
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
. On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
cERTIFICATE OF HEALTH AUTHORITY
A SINGLE FAMILY DWELLING
Location (site address or directions)
P' ~e~y o,?m,_":r /~'"~'~ "~-~'~---.-:~."; .................. Day phone
Mailing address -~.-~'~/~ ~"-~'~-,~--'
Lending agency
Mai ng
Agent
Address
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community we
Public water
RECEIVED
MAY 0 7 1997
DeMunicipalhy ct Anchora
Pt. Health & Hum~,," g.e .
....... ~e~lcee
NOTE:
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
If community well system, provide written confirmation from State ADEC attest-
Individual on-site
Holding ta:., :, .
Comm unity on-site
Public sewer
OTE: If community waSteWater syStem~pr°viSe~Written confirmation from Stat~ i
attesting to the legality and status o~ system.,
72-025 (Rev. 1/91) Front MOA ~21
the MunicipalitY of
supply
Name of Firm ~
Address '~'~ ~ ~'' ~'~'"
5, STATEMENT 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 )lication shows that the on-site water supply
and/or wastewater disPosal system mctional and adequate for the number of bedrooms
3at based on the information obtained from
.igation and inspection, the on-site water
11 Municipal and State codes,
~nspection.
Phone ("~.,~ ~.~ .-/.y'~' -/z~ ~'~'
Date ~,7' ~7
6. DHHS SIGNATURE
· X Approved for 4
Disapproved.
Conditior~al approval for
.. bedrooms.
bedrooms, with the' following stipulations:
Additional Comments
'Date ~z''L 2.2- ?7
I and Hum~nServic~ (DHHs~ 'issues Health Authority
pa ty .............. ,~---~-'iven in naranr~nh 5 abOve by an independent
';Annrov~l"~-~,rtif cates based ! upon '[n~ [up,~..~ma~,v,o ~ ~' ~ - ~ . ..
=~: 'p ~o~sSiionAI ~n~i~ee~ registered nthe Sta. t.e.of Ala. s.ka: The D, H H~S ~_o~s.~ ~ ~1~1 ;~ ~/r nY;~o~Ue~..sC h(~s~ ~1~1 ~d°o~;
' ndm msbtutonsin0rdertosatstycenam~e~era anas[a~[~ · ~'
and~heir!~_-g .... . ~;. ;' ~' L;~ei~,~t; i_~ i.~euea ~h~ auniCiPality Of Anchorage is not
Conduct insPections or ana yze aata De,ore ,,~S;'~; ;;~i~g;~v=(~k .... · ~
: roi;errors or omissions in the profe .... g' ."
72-~25(flev. I/91) Back MOA~21
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal
Description:
A. WELL DATA
Well type ~
Log present (Y/N)
'~ Ai'B?or C; attach ADEC letter. ADEC water system number
corn
Total depth
Cased to
Sanitary seal (Y/N)
Date of test
Static water level
FROM WELL LOG
~ protected (Y/N)
AT INSPECTION
Well production
WATER SAMPLE~:
Coliform /'
D~e of sample:
g.p.m.
Nitrate
Collected by:
.Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed .//,x~.~,//?;~_.., : Tank size /,z,~'~ ,~'~,~ Number of Compartments ~ -g- C eanouts (Y/N)
Foundation cleanout (Y/N).)/ Depression (WN)' ~ High water a arm (Y/N)
Date of Pumping ///-~'~'/~'~-~ Pumper ,../,~':r
C. ABSORPTION FIELD DATA
g.p.m
Date installed ~'/.z,~//,~,/,.. Soil rating (g.p.d./fF or ft~/bdrm) ~. x.// System type
Length ~ ~'~ ~ Width '~ ~'z>~' ; Gravel thickness below pipe ~/ ~ Total depth /-/~,~
Effective absorption area /~ ?' ,,~/ Monitor ng Tube present (Y/N) ,Y' Depression over field (Y/N) ,4/
Date of adequacy test ~/~ ~/~ Results~(Pas~Fail) ~ For ~ bedrooms
u~d depth in~¢[~ption field before test (in.);~/ ~ Immed a=Y after/~ga, water edded (in.):
F
Fluid depth ~ (ins) Minutes later:' ~ 'Absorption rate:
Peroxide treatment (past 12 months) (Y/N) ~ If yes, giVe date -
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
· ._ i, Pump on'~
Manhole/Access (Y/N)
H ~gh wate~ .
siZe. in gallons
MAY 0 7 1997
E. SEPARATION DISTANCES Municipali'ty of Anchorage
SEPARATION DISTANCES FROM WELL ~--(~--T-~: Dept. He~ th ~. Human Services
Sept c/holding tank on lot
Absorption field on lot -~ ~ o ~,~'~ On adjacent lots _
. Public sewer manhole/cleanout
Public sewer main
~ ~ Lift station ~//~'~ ·
Sewer/septic service line ,~ oD ,~, ..-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK' ON LOT TO:
Foundation //~''~ Property line /5- ~',~ Absorption field .~ 7' .~,~
.~,.,~'~',~ Sudace water/dra nage ,4~,~ Wells on adjacent lots
Water main/service line . · -
SEPARATION DISTANCE FROM ABSORP~ION FIELD ON LOTTO:
Property line / ~ '~' . Building foundation /.~' ~',,~ . Water main/service line
.. DrivewaY, parking/vehicle storage area
Surface water ,,c/~ ,~'
~/'~x.~' ,~",~v~,~ ~'~ ~"x~/'~' Wells On adjacent lots ,~ 0 ~
Curtain drain
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Date
HAA
Date of
Receipt ~
72-026 (Rev. 3/96)*
,:Waiver Fee $
Date of Payment
Receipt Number_
.Douglas T. lfenley, PE
9960E. Puffin Drive, Palmer, Alaska 99645
(907) 746-1075
May 20, 1997
Mr. Daniel Roth
Municipality of Anchorage
Health & Human Services
On-site Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re:
Septic adequacy test on Lot 9, Block 15, Northwoods Unit//4 Subdivision.
23212 Green Garden, Chugiak, Alaska 99567
Owner: Mrs. Kathleen Fox
Dear Mr. Roth:
An adequacy test was performed on the septic system on the above-described property on April
21, 1997. The absorption system is a bed system. Intitial readings showed that the monitoring tube
(MT-l) had 8-1/2" of water in it and monitoring tube (MT-2) had 2" of water in it. MT-1 had a clean, out
located within 12" from the tube. No water was present in the clean-out. The documentation from the
Municipality indicated that there was 6" of gravel below the 4" distribution pipe; however, with no water
present in the clean-out, the test was commenced to see what would happen.
A total of 602 gallons was introduced through the double clean-out after the tank over a period of
approximately two hours. Approximatley 1/2" of water was observed in the clean-out during the test.
The water level in MT-1 rose to a height of 10-1/2". Twenty-four hours later, on April 22, the water
level was at 9-3/4". This represented a daily absorption rate of only 220 gallons.
A second test was conducted on April 28, at which time elevations were taken to verify the
discrepancies between the two monitoring tubes and the total depth of gravel that existed by MT-1.
There was a .55' difference between the two monitoring tubes and approximately 1.2' difference between
MT-1 and the clean-out. During the second test, the readings were 7-3/8" at MT-1 and 1-3/8" at MT-2.
A total of 1,045 gallons of water were introduced over a period of five hours. The total height on the
monitoring tubes were 11-7/8" and 5" respectively. Still no water, other than the 1/2" of water originally
noted, was observed in the clean-out during the course of the second test. The reading taken twenty-four
hours later, on April 29, had 8-3/4" in MT-l, which gave an absorption rate of approximately 757
gallons. It was on the basis of this second test that the system passed.
Sincerely,
Douglas T. Kenley~ P~E
CE #g 176
Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8176
Legal Description
SEPTIC SYSTEM ADEQUACY TEST
Applicant
Date of Test
, System Data
Tank Volume ,,,/X,5'Z~ ,~'.~_ Absorption System z~'~'<?
Number of Bedrooms ., z~' Absorption required (~6-daily flow) , ~ ~ d ~,~ ~
TEST DATA
TIME VOL. DIFF. FLOW TANK TUBE LEVEL DIFF. COMMENTS
System Passed
System Failed
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Lot 9; Block 15; Northwood Subdivision 94, Peters Creek
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Double M Construction
Day phone
P.O. BOX 670095, Chugiak, Alaska 99567
688-3113
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~
TYPE OF WATER SUPPLY:
Individual well
Community well 7,3:
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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.
72-025 (Rev, 1/91) Front MOA #21
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 date of this inspection.
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
17034 Eagle River Loop Road No. 204
=~~,A ~: .... ^,~.,.~ 0~577
Phone
_ Date
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: / / , ~
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional enginee¢s work.
72~)25 (Rev. 1/91) Back MOA #21
Legal Description:
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
L~==,'T '~ ~t,-~{,,-. ~' ~'""¥~ Parcel I.D.
if A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
AT INSPECTION
; On adjacent lots
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
; On adjacent lots
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
g.p.m.
Public sewer manhole/cleanout
Petroleum tank
z_V ~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by.'
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts~N)
High water alarm (Y/N)
Date of pumping
Tank size ~.'~. ~:~:
Foundation cleanou~)
Alarm tested (Y/N)
~ //~"~ -- ~/~ Pumper
Compartments ~
Depression (Y/~]:~ ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~ /~ On adjacent lots '~::::;;i~ ~r~ Foundation I~
To property line ~c:>~ ~' Absorption field '">-~' Water main/service line
Surface water/drainage \ ~ ~ Jr'
I
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
,,pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N) _
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length '~
Total absorption area
Depression over field (Y/~J~'
Resu It.~3~ail)
Width
Peroxide treatment (past 12 months) (Y~j~
Soil rating ~ zlc ~ Pt~~'- System type
Gravel thickness I I Total depth
Cleanouts present~;~N)
Date of adequacy test
for
bedrooms
If yes, give date
SEPARATION DISlT~,NCE FROM ABSORPTION FIELD TO:
Well on lot On adjacent lots "~¢:~'/-Jr" Property line
To building foundation /'~t To ~xi/sting or abandoned system on lot
On adjacent lots "~z::~ -'lF' Cutbank /~/'~ Water main/service line
Surface water I ~;:)c> t Jr'
Curtain drain ~c~ ~--1~C:::,~.[,~ ~
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
Signature
Engineer's Name
Date
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
Eagle River, Alaska 99577
HAA Fee $
Date of Payment
Receipt Numbe[
~t (3D~l.J~8~4~t~e of this inspection.
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA21
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
September 21, 1992
Mr. Roger Shafer
S & S Engineering
SUBJECT: Northwood #2
Class "A" Public Water System, PWSID 213001
Dear Mr. Shafer:
I have completed a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on September 10, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on April 21, 1992. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on August 9, 1990. This does not meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations; however, it is conditionally
acceptable at this time.
4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on June 2, 1992. This does meet the
provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above-referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
Michael Lu