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HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 12Northwoods #4 Block 16 Lot 12 #051-064-24 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201458 PID Number: 651-064-24 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name ANTHONY &CHARITY MOLLISON ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 21675 SHELTERING SPRUCE LOOP, CHUGIAK AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot NORTH WOODS UNIT 4 BLK 16 LT 12 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft2 Ft. Well * I TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. I Surface Water 160,+ Material PLASTIC Number of compartments 2 i Lot Line 1101+ { NA Foundation 10'+ l LIFT STATION Manufacturer Capacity Remarks TANK DECOM. PER UPC. Gal' * AWWU WATER SERVICE Alarm location Electrical installed by PIPE MATERIAL House to tank 3634Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection ,Isz 11!7/20 Location and description dates: 2rd a WOOD DECK 3 r4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date f j. ._.... R..: .. '7 Septic System Approved Date.j Note: this approval does not include well permit requirements.'i (Rev ub/uzl18) Permit No. OSP201458 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: NORTH WOODS UNIT 4 BILK 16 LT 12 PID No.: 051-064-24 MARK A B C01 28 32 TC01 29 36 TCO2 30 39 CO2 31 40 CO3 32 41 C04 23 67 C05 61 45 AWWU WATER LINE BENCH, WOOD DECK DRIVEWAY i= E a� ``' C04 LU o T O1 C 2 CO02CO3 NEW 1250 GALLON PLA IC TANK C05 ASBUILT SCALE: 1"=50' FCOC01 TC01 CO CO3 CO2 OF 1 • ••............... AF �,• AV 49 TH` �� 1,250 ........! GALLON 92.8 PLASM TANK ... .. .... • • •. ... .0 88-7-��MICHAEL N. ANDERSON: A ��� % No. CE 9469 AV �� s�•'•.J 1-10-20 ,o•• SEP11SSECTION N T•♦�.,1.1� .0 :���•• SHEL TERING SPRUCE LOOP 14 a coil. okpE S\�'G N8958'19"E226.36 • AS -BUILT SURVEY 1" =20' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT12, SLOCKI6, NORTHWOODSSUR. UNITIV 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 10 TH DAY OF NOVEMBER , 2020 14851, FS 209-49,SWING TIES 11.10.20 HOLT LAND SURVEYING 9309 GROVER DR/VE ANCHORAGE,AK 99507 345-5513 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. SNE 16.2 o� pF qtN o o�0 M *CO.49 TH 0 z QO�s SHANE A. HOLT ` �� n"dl LS -6914 C_ � �ofessiona\ �D�OOoo�a MUNICIPALITY OF ANCHORAGE. On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201458 Work Type: SepticTank Upgrade Tax Code Number: 05106424000 Site Legal Address: NORTH WOODS UNIT 4 BLK 16 LT 12 G:1460 Site Mailing Address: 21675 SHELTERING SPRUCE LOOP, Chugiak Owner: MOLLISON ANTHONY R & CHARITY H Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: _vs r' f> DeI)artment 10/22/2020 10/22/2021 30372 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Q Date: 4 MUNICIPALITY F ANCHORAGE Rv5fi Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-064-24 Property owner(s) ANTHONY & CHARITY MOLLISON Day phone _ Mailing address PO BOX 16132, CHUGIAK AK Site address 21675 SHELTERING SPRUCE LOOP, TRENTON, NJ 08641 Legal description (Sub'd., Block & Lot) NORTH WOODS UNIT 4 BLK 16 LT 12 Legal description (Township, Range & Section) Lot Size 30,372 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade F. Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z70, U/ Date of Payment: 10 2 S 2- 02 D Receipt Number: 0 �2 3 (o 2 Permit No. 05pZo l q 50 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Oct 20, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: NORTH WOODS UNIT 4 BLK 16 LT 12 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201458, Rebecca Carroll, 10/22/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201458, Rebecca Carroll, 10/22/20 ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS LEGAL DESCRIPTION LOCATION ' Well /~ Absorption area, Dwelling O,~ DISTANCE TO: I ~C~>' .J~'O ~//)f/~ I ~' M~ ~ Z Manufacturer ~ I ~ i c c gallonsIF HOMEMADE: ' Inside '~g'h , Widt~ ~ -- ~ DISTANCE TO' Iwell LDw¢IIIng ~Z I' I ~ I. ~ ~ ~ Manufacturer //~ · I I Well I Foundation ~ Z I DISTANCE TO: I ~ ~ ~ ~ I ~ ~ ~ ~ I No. of lin~s Length pf ~h,line Total len~hlof lines ~ ~ I Top of ti~ to finish qrade I Material beneath tile ~ I Length Width ~ Depth < ~ I Type of crib Crib diameter ]~ Crib depth ~ Well Building foundation DISTANCE TO: ~ CI~ ~ De~th ~ Driller ~ DISTANCE TO: Building foundation Sewer line Material Nearest lot line Trench wid~:~ inches PHONE ~-NEW ~,..1L' - ~-j~J~ ~ [] UPGRADE Nearest lot line inches NO, OF BEDROOMS PERMIT NO. No. of compartmen~ Liquid dep..t.h PERMIT NO. Liquid capacity in gallons PERMIT NO. , Distance b~I~ lines Total effective absorptiEn area PERMIT NO. ITotal effective absorption area Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING. INSTALLER REMARKS DATE ,, LEGAL PERM I T NO: DATE ISSUED: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8~5 L STREET, ANCHORAGE, AK 99501 850534 08/22/85 APPLICANT: ADDRESS: CONTAC'I" PHONE: L. EGAL DESCRIP: LOT SIZE: MAX BEDROOMS: GIBBS EXC. 5 S&S ENGINEERING EAGLE RIVER, AK 99577 694-2979 SUBDIVISION: NORTHWOOD ~4 SECTION: .'3 TOWNSHIP: l'5N 50372 (SQ. FT. OR ACRES) 4 LOT: 12 RANGE: 1W BLOCK: 16 Listed below ape the options available to you in designing your se. ptic system~ Choose the option that best fits your site. I)EP"FH TO PIPE BOTTOM (FT.) GRAVEl... DEPTH (F'T.) TOTAL DEPTH (FT.) GRAVEL.. WIDTH (FT.) GRAVE'.L LENrSTH '(FT. ) GRAVEL. VOLUME (CU. YDS. ) TANK SIZE '(GALS) SOIL RATING (SQ. FT. /BR) 4.0 4.0 4.0 6.0 0.5 3.5 10.0 4.5 7.5 2.5 2.7.0 5.0 90.0 ~ 54.0 '116.0 ** 54. ~ 54.0 86.0 250.0 ~ 1,250.0 *~ 1.,2.50.0 *.~. GRAVEL. LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certif'y that: 1.. I am familiar with the requirements for on-site sewers and wells as set. forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2.. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements fop the set back distances from any existing well~ wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4a I understand that this permit, is valid ~'of a maximum ~f 4 bedrooms and any enlargement will require an additional permit. IF A LIFT' STATION IS INSTALLED IN AN AREA OOVERED BY MOA BUILDING CODES, THEN ('1) AN EL. ECTRICAL PERMIT AND INSPECTION MUS~ BE OBTAINED; (R) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRII]AL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. APPLICANT: GIBBS F' ". , j I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE PE~ Township, Range, Section: ~ ~ PLA~ SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water Alter Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~'? (minutes/inch) PERC HOLE DIAMETER COMMENTS PERFORMED BY: ~. ,.~_~ t~l~R, AL~t~;(;~ ~oI7 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) �usN MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-064-24 I. GENERAL INFORMATION Expiration Date: b 6�_ \- ` l6T� Complete legal description NORTH WOODS UNIT 4 BLK 16 LT 12 Location (site address) 21675 SHELTERING SPRUCE LOOP, CHUGIAK AK Current property owner(s) ANTHONY & CHARITY MOLLISON Day phone Mailing address PO BOX 16132 TRENTON, NJ 08641 Real estate agent 2. TYPE OF DWELLING: Fx_1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Dupiex) 3. NUMBER OF BEDROOMS: y Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System © Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless othervAse requested by the engineer. COSA Fee $ ,6 COV 1 D Date of Payment 1.l l a a a C-) Receipt Number d 1 a I COSA # _0S C, 2,0 16 17 Waiver Fee $ Date of Payment Receipt Number Waiver ## 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 11-5-20 Aj 6. DSD SIGNATURE ...: -' r`o . ` • t J System #1 Approved for 'I bedrooms ' • : , , ... z tucNA! • • • • • • System #2 Approved for bedrooms C"I tiU. tzsc'y F � - C ��9 ,4�; • a* Disapproved 4; . I 20 . •'co• Conditional approval for bedrooms, with the following stipulat 0r�1�`"" �lllll(t �((i((((•,, By.PJIU,/dvtrl6'1Original Certificate Date: 1 a -2002 b r The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: NORTH WOODS UNIT 4 BLK 16 LT 12 Parcel ID: 051-064-24 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments AWWU WATER SUPPLY B. TANK DATA Age oftank(s) 2020 years Tank type/material — Measured operating fluid level in septic tank NEW N Standpipes/foundation cleanout per record drawing Date of pumping " new plastic septic tank installed D. ABSORPTION FIELD DATA Which system tested (date installed) 8/25/85 V ALL standpipes present per record drawing Total measured depth from grade 12.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A – pressurized field ❑� Monitor tubes go to bottom of effective. If not, state depth into effective — Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 No ❑ Coliform bacteria is Negative Nitrate Arsenic _ Collected by mg/L ❑ Nitrate less than MRL (ND) ug/L ❑ Arsenic less than MRL (ND) Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station — years Lift station material Comments: Adequacy test date i0n4rz0 Results ElPass For 4 bedrooms Fluid depth prior to test 24 in Water added 600+ gal New depth 58 in Elapsed time 1440 min XCode-required soil cover over field Final fluid depth 24 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) 0 If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No _ ft Neighboring Tank > 100' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No_ ft Neighboring Absorption Fields > 100' El Yes ifNo_ft Community Sewer Main > 75' ❑ Yes if No _ ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No _ ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Animal Containment > 50' ❑ Yes if No ft Manure/Animal Excreta Storage > 100' ❑ Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No —ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' Q Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' ED Yes if No _ ft Private Wells > 100' ❑✓ Yes if No _ ft Water Main > 10' v❑ Yes if No _ ft Community Wells > 200' ❑✓ Yes if No _ ft Water Service Line > 10' ❑v Yes if No _ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No—ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No_ ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No _ ft Private Wells > 100' Q Yes if No it Water Service Line > 10' Yes if No _ ft Community Wells > 200' ❑v Yes if No ft Surface Water > 100'✓0 Yes if No _ ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet i 99TH i 8 e °�NGf • °p •••....•• ;. �• •+.=_te... ++ r A :"'NI1C7fiAEL N. ANDERSCN i' CE 9 9 4a Municipality of Anchorage ,.• ••, Development Services Department. j Building Safety Division • • • • • •• On -Site Water 8 Wastewater Piogiam 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. ni 1-1)(6L4 - ay COSA# 1. GENERAL INFORMATION Expiration Date:O S ' — — Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address . NORTHWOODS SUBDIVISION #4 LOT 12 BLOCK 16, 21675 SHELTERING SPRUCE LOOP • CHUGIAK, AK 99567 JAN MAULDEN Day phone 688-0162 21675 SHELTERING SPRUCE LOOP * CHUGIAK, AK 99567 Day phone FSBO Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 engineers 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 onsite 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 riles and from my investigation and Inspection, the onsite 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Date 3 / 2 (o c-7 Conditional approval for bedrooms, with the flloWng stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other o ;• PROGRAM By. Original Certificate Date: — O % (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water b Wastewater Program 4700 Sragaw Street P.O. Box 196SW Anchorage, AK 99519-650 www.munhorglpopnqsite CERTIFICATE OF ON-SiTf07lCMS APPROVAL CHECKLIST Legal Description: NORTHWOODS SUBDIVISION #4 LOT 12, BLOCK 16, Parcel ID: 0rI - 0 (11/ -z 1� A. WELL DATA PUBLIC WATER Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal Y Tres properly protected (YIN) T Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production —9 -P.M. -9 -P.M. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Other be Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 8/25/1985 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 3/20/2007 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA iI N Date installed 6/25/1963 Soil rating (g.p.d./Wortl!� 268 System type TRENCH Length 67 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth • 12.56 ft. Eff. absorption area 1072 fe Monitoring tube YES Depression over field NO Date of adequacy test 3/21/2007 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 29 in. Water added 1147 gal. New depth 56 in. Elapsed Time: 220 min. Final fluid depth 53.5 in, Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump off" leve Highwater alarm level at in. Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line PUBLIC WATER On adjacent On adjacent sewer manhole/cleanout Holding tank AN ment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 'I I -X : /o ? COSA Fee S Li �aC) . o CD Waiver Fee $ Date of Payment_ i d -% Date of Payment Receipt Number_ K -l(7 Receipt Number (Rev. 11/05) ../.. .. ... ......... • y A. Garness.: • E7773 �A. 139 Ot•s '' b. 3.( 1 f0 1F11�r• O ? I I K.89 38, E. TVCf C] HIM. M . 'HIM. � �oo aNpy.0 4J• (7U G~ y V ►�x7p 1y.Q �"tl pnW� M �Q]M�yO�NY64 5oY 64 L. i yy '%32�.�•ca tv Wii 19. Ra� EB1. o H E; wa�ee jg'' 6£ LB L00L/TZ/ TO 39Vd NOS213" I/OINOdDf 6S0L889-L06 ~IUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name /~Z.,/ 4~/~.~/~_~-~ _ Telephone: Home Applicant Address Business (c) Applicant ~s (check one~: Lending Institution []; Owner/buildercJ~ Buyer []; Other [] (explain); (d) Lending Institution .... ~ ¢ A.z ._4~'.~_ Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: " .... ~A% ~-,'~?,;~ ...... TYPE OF RESIDENCE Single-Family/~ Multi-Family [] Number of Bedrooms _ ~'/ Other WATER SUPPLY Individual Well E] Community b-J Publir~ Note: If community well system, rnust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~... Public [] Community [] Holding Tank Note: If comm unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5o ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORNIAT;ON As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~' ~ ~, Address :...:,,~;:: .... ~,,~ ,~ __ Telephone Approved for ,/~..2~¢' ~ bedrooms ~.-, ~ ate Approved_ ,~, __ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professiona~ engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL. PROTF'CTION: 09 lg85't Legal Description: /-.,/Z ~J~iJ~,Jr~~e.~ WELL DATA Well Classification /¢'¢ ¢'~- ! Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot -'2...cx¢, To Nearest Edge of~ Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A. B, C, D.E.C. Approved (Y(~CN) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ ; On Adjoining Lots Z.o~ To Nearest Public Sewer TO Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed J2/~'$"'/~-r'' Size ,/~..~"0 No. of Compartments 7_ Stand pipes(~/N) Air-tight Caps ~/N) Foundation Cleanout~/N) Depresmon over Tank (Y6 Date Last Pumped /('/~ ~J Pumping/Maintenance Contract on File (Y/N) ~ //¢}' ; for ~ /,+' / Holding Tank High-Water Alarm (Y/N) J~/ Temporary Holding~Tank Permit (Y/N) · '/~ f~' Separation Distances from Septic/I k,;d;,,~ Tank: To Water-Supply Well ~..~.o To Property Line / o ~ '/- To Water Main/Service Line / To Building Foundation ~ ~/- To Disposal Field ~ ~ To Stream Pond, Lake, or Major Drainage Course Commems Page 1 of 2 72-026(11/8~) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /OTZ Square Feet of Absorption Area Depression over Field (YN~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~--~ '~' To Building Foundation Lot ~ 0 ,,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Comments Type of System Design Length of Field ~-~ '~ Depth of FielC /J'~' Gravel Bed Thickness Standpipes Presen~N) Date of Last Adequacy Test To Property Line / O /- 2 ~ "/- ) To Existing or Abandoned System on ; On Adjoining Lots ,,~ r~. To Cutbank (if present) /,,.,/ o ~ ~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company Receipt No. ~ Date of Payment Amount: $ Page 2 of 2 [ I DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907} Address: 274-2533 DATE: PWS I.D.# TO Whom it May Concern: According to records on file in this office the Water System is in compliance with the St,a~e.Drinking W~ter Regulations Sincerely,