HomeMy WebLinkAboutNORTH WOODS UNIT 4 BLK 16 LT 21 Municipality of Anchorage Page l of ~---
, , DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'Vt,/'c~7~)l~'~ PID Number: ~-['
Name:~ ~/~/~ ~~~ Wastewater System: DNew ~ Upgrade
Address~/~_/~ ~,~~ ~O~ ABSORPTION FIELD
Phone: rooms~ D Deep Trench D Shallow Trench ~Bed B Mound D Other
Total Depth fromprigina{ grade:
LEGAL DESCRIPTION so, Ratings, ~ GPD/Sq. Ft. ~/~
Lot: ~ / Block:~ ~~'/Su~ion: / ~ Depth to pi~ bottom from originaJgrade:~,~ ~ ~ ~ Ft. Gravel depth beneath p~pe~ ,~ Ft.
Township: Range: Section: Fill added above original gra~ Gravel length:
WELL: D New ~ Upg~ Gravelwidth: Number~ines: Distance between [ines:
Classification (Private, A,B,C): Tot~ Cased To: Total absorption area: Pipe materia{: ~
' . ~ ~t. //~ so. ~. ~
Driller: ~ Date Drilled: Static Water Level:Ft. ,nstal,~. ~~ Date installed:
Yield: ~ Pump Set at: Casing Heighl Above Ground: TANK
GPM Ft. Ft.
SEPARATION DISTANCES a Septic ~ Ho~ding ~S.T.E.P.
TO Septic Absorption LiE Holding ~ublic/Private Ma n u~ ~r~ ~~ Capacity in gallons: / ~
From Tank Field Station Tank Sewer Lines
~ / Number of Compadments:
~ ~ Material:
Sudace ' ' ' LIFT STATION
Lot I , Size in gallons: I uanufacturer~
"Pump on" level "Pump off" level at: High water alarm
Pump Make ~d~l ~ Electrical Inspections pedormed by:
Cudain ~
Remarks: ~, ~¢~ BENCH MARK
Inspections performed by: ~N~ ~;..~. Dates:lst
7116
Department of Health and Human Services ap~F~J
Reviewed and appr°ved bY: ~~~ Date: ~/~/~
72-013 (Rev 9/91) MOA 25 ~
AS-BUILT SYSTEM DETAILS/SITZ PLAN
NORTHWBn]]s SUBDIVISION, ADDN,~4, BLrlCK 16, LraT
- k LINE DIRECTION DISTANCE
¢--'1 ~ lu IN~O°OO'OO'E lao,oo' I
. ~ CURVE LENGTH RADIUS DIRECTION
> oo Ici 150,a7' 150,00' IN17°a4'S7'E
I ~ LDT 26 ~ .. .................. .
) / //~ ~ ~ SEPTIC
0/) .~1 ia56'..6^L $,T','~-,P,
B-D=36,92,
A-E=23,17'
B-E=45,0'
A-F=60,83' J ~
A-G=85,a5' , ?... LOT a6 ~
C-G~60,50' ~1 .."' SEPTIC '".. SCaLB
~ ~ ~ / .~ ~u~ ~.~o. ~u~
~ ~ k d~/ ~ ORIGINAL GRADE
g ~1850 GAL ' ~'
SEWER ROCK 0,~'
' ~ I
SCALD NTS
............
~ ~ ",. / ~ .." ~
~ ~sslO~ ~
ORIGINAL GRADE
SEWER ROCK
PREPARE]] FOR: KN]] ENGINEERING
a0441 PTARMIGAN BLVD
FREI] & PATRICIA RICHARDSON EAGLE RIVER, AK, 99577
21516 SNDWFLDWER LOOP (907)696-6111/F(lx (907)696-8111
CHUGIAK, ALASKA 99567
DATE~ 7/89/97 DRAWING #
SCALE: AS NOTED 97038-gl
.JUL--28--'97 12 I ~ 1 Pf'~ C:C:C:
COhlSTRUCT I CII-q ~2,96 3274
HE~',,,'ENLY I_[GHT$ [L.~T 60 ~8
491 Willow Strcct · Wasil a, A as~a 99654
Phone~ (907) 3734893 · F~x~ 373-3894
RECEIVED
JUL ,3 1 1997
Municipality of Anchorage
Dept. Health & Human Services
I i i
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 (UPGRADE) PERMIT
PERMIT NUMBER:SW970158
DESIGN ENGINEER:KND ENGINEERING
OWNER NA24E:RICHARDSON FREDERICK J &
OWNER ADDRESS:21516 SNOWFLOWER LP
CHUGIAK, AK. 99567
DATE ISSUED: 6/27/97
EXPIRATION DATE: 6/27/98
PARCEL ID:05106428
LEGAL DESCRIPTION:
NORTH WOODS UNIT IV BLK 16 LT 21
LOT SIZE: 20014 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC T/LNK SYSTEM
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN A/qCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18A-AC72) AND DRINKING WATER REGULATIONS (iSAACS0).
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
~. COVERED, SEALED A_ND HEATED TO PREVENT FREEZING
{~.~ USE 4S MOLZS TOTAL, (~ASED ON 0_59 GRM/~OnZ)
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
June 11,1997
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Northwoods S/D, Addn. #4, B16, L21 - Septic Upgrade Permit
Gentlemen:
Following a request from the owner, on May 28, 1997 we dug two testholes for the
proposed upgrade. The septic was tested on May 14th and it did not pass. The area
and lot is served by community water. The results of this percolation test are
attached.
The proposed upgrade system will be placed west of the existing system. As indicated
on the site plan there is sufficient grade to maintain a gravity system. The 1000
gallon tank will be inspected and its integrity verified. If it is necessary to replace the
tank we have provided a proposed design on the site plan.
As indicated by the site plan drainage arrows, natural drainage is away from this site
and will be maintained after construction. There is no surface water within 100' of
the proposed installation. There are no known curtain drains within 50' of the
proposed installation. No wells exist within 100' of the proposed installation and
the community well is over 200' away from the proposed site. This upgrade should
have no adverse effect on development of adjacent lots.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~D Engineering
Kenneth M. Duffus, P.E.
attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
I i
i WASTEWATER DISPOSAL SYSTEM/SITE PLaN
NBRTHWBBDS SUSDIVISION, ADDN~#4, BLOCK 16~ LOT
L~ PRBPflSED REPLACEMENT SYSTEM
RECEIVED
~ %tH w~7-s~/~/ ~ / ~ LOT a6 Municipality of Anchorago
I( SEPTIC }
~ 56,a5'
MT°
SC~LE~ ]'= ~0~
SYSTEM DETAILS ,.'
]/4~ PVC FRHM TANK TB F~EI.~
~ ~/4· ~vc ~/~.
3/i6' HOLES e 6,8' SPACING 1 1/4' PVC- ~~1250STEP TANK
PRESSURIZED DISTRIBUTION SYSTEM HOLE SPACING DESIGN
L RESIDUAL HEA~ = 5'
2, HOLE SIZE = 3/16" = LO0 GAL PER HOLE E 30 PSI
3, 30 GALS (PUMP DELIVERY)/1,QO GALS,/HOLE - 30 HOLES
4, 205 LF LATERAL/SO HOLES = 6,8' SPACING PER 'HOLE
5, ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS,
6, HOLES AT EN~ OF LATERAL SHALL ~E CONST, W/O CAPS AND PLACED DOWN,
7, CONTRACTOR SHALL USE ] ]/4~ PVC.FROM TANK TO F~ELD AN9 IN LATERALS,
8, CONTRACTOR SHALL USE ] ~/2~ PVC FOR MANIFOLD,
DESIGN DETAILS
~__ 450 GPO/O,4 GPO PER S8, FT, = 1,i~5 Se, FT
'~,~.~ Total depth oF system iS 4' Cream o.lglnal grade,
NOTES:
1, USE 1250 STEP SEPTIC TANK. INSULATE TANK IF <4' COVER,
2, INSULATE TRENCHES WITH 2' HB BURIAL FBAH,
3, CBNTRACTBR ~/ILL ENSURE NAXINUH 2% SLBPE INTO SEPTIC TANK,
NIN, 3' COVER,
PREPARED FOR: KND ENGINEERING
2044] PTARMIGAN BLVD
FRED & PATRICIA RICHARDSON EAGLE 'RIVER, AK, 99577
a1516 SNOWFLBWER LOOP (907)696 6111/Fo, x (907)696-811!
CHUGIAK, ALASKA 99567
BATE,G/lO/97 REV, 6/25/97 DR~V/ING ~
SCALE~ 1~ = 100' 97038-21
Municipality of Anchorage · ~ ~: ~
'c~ SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
'11
IF YES, AT WHAT
12 DEPTH?
Depth 1o Water Alters...,,_
13 Mo~ilorinD? ~
Gross Net Depth to Net
Reading Date Time Time Water Drop
, ~/~,~,7 ~:~o - v,,, -
~ ' ~ '~o /~,~;~ .~ ,~,~" e/~-
~ ~ ~.'~/ - ~,, __
~ ~ ~ .'~z - ~" -
, 7 ~ ~.'~5 ~ ~" -
14-
15
16
17
18
19.
20-
PERCOLATION RATE 4/'~.) {m~outes/mch) PERC HOLE DIAMETER
~\L__
,/
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
DATE PERFORMED:
~/,4,:' /& Zo?.~ /
Township, Range, Section:
1
2
3
4
5
7
8
9
SLOPE SITE PLAN
10
'11
12
13
15.
16-
17
18
19
2O
COMMENTS., ~/a & ~,~o~J
/
WAS GROUND WATER
ENCOUNTERED?
s
IF YES, AT WHAT 0L
DEPTH? /'~//~ p
E
Depth l0 Water Aller,T..~ _ ~//~//~
Monitoring? L.-,[_.~ Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ a/~/~ ~:~ - 7. _
3 ~ & :3~ - 7,,, _
y ~: ~ /~,~ ~ ~Z~" ,o~ ,,
7 ~ &:5~ -~'7~0 -
PERCOLATION RATE /~ tm,nuleS, qnch) PERC HOLE DIAMETER
TEST RUN BETWEEN "~ FT AND Y FT
' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
625 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
DISTANCE TO:
LOCATION
Man u factu ret
Liq.
DISTANCE TO:
IF HOMEMADE:
Well
Inside length
Dwelling
IPHONE -'~ C~ [ ~':'NEW
i []UPGRADE
NO. OF BEDROOMS
Dwelling
Width
PERM,T NO.p 4O l O Z.
No. of compartments
Liquid depth
PERMIT NO.
Manufacturer Liquid capacity in gallons
DISTANCE TO:I we mm niN
N°' °f lines 4. ] Length of each lin~k~ ~'~
Top of tile to finish grade 3 5 i
Material
Nearest lot line
[Trench w~.~?~ inches
inches
Width
Length
Foundation Zq ~
Total length of li0e~j.,~
Material beneath tile
Depth
PERMIT NO. ~0
Distance between lines
Total effective absorption area
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line
DISTANCE TO: Building foundation Sewer line Septic tank
Absor~lt~l~[~'(~lXllt-XL ~',r'~O I eCti~JN
OTHER
PiPE MATERIALS
SOl L TEST RATING
INSTALLER
R EMAR KS
APPROVED
7 2 -'O+-3'"'fl~e v- .3/78)
DATE
LEGAL
DEPARTMENT OF' HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET., I::INCHORt::IGE., Al':.'.' ::.4~9501
264-4720
PERMIT NO:
DATE ISSLIEr.):
APPL I CANT
ADDRESS:
E:ONTRC]" F'HI`]NI,E:
L. EGRL. DESCRIP:
L. OT SIZE:
LOT LOCATION:
MAX B EDI:;.: 0 I,] M:.~;:
S401,62
04,,"'i0/04
'STEVEN L SKAGGS CONSTRUCTION
P 0 BO;,',', 6?0690
CIqUI,]i I BI.C, FIK '99E~67'
G:E:8 - ;Z 8Z:::.1.
St. JBD I V I S I ON: NORTH[4OODS I V
SECTION: ZZ TOt4NSHIP: :'I.5N
;.-]:00:;L4 (SQ. FT. OF:'. ACRES)
SNOI.4F'L. OWEI:;~'. LOOP
LOT:
RANGE:
BLOCK:
L. ISTE[:, BELOI.4 FIRE THE OF'"f'IONS H,HILH[..L.E TO '9]1 IN [':,E':']IGNING VFIUF.'. -',EFTI_.
:.T.,"r'STEM. CHOOSE THE OF'TICd",I 'TI`4AT BEST FITS 't'OLIR SI'TE.
DEPTH TO PIF'E BOT]"Ol'd (FT'.)
GRAVEL. DEPTH (FT.)
TOTFIL DEPTN ':.'FT. )
GRAVEL !.4IF.:,TH (FT.)
GRAVEL LENGTH (FT..':'
(:!iRRVEL VOLI'JME (CI'J. "/DS. ::'
TANK SIZE: (GFII`_S)
SOIf_ RATIi",iG '::SQ. F'F. /E:F.':)
4.0 4.0 4.0
2.::. 0 0.5 =.':. 0
7.0 4.5 7.0
2.5 2]:.0 5.0
:1.;:25. 0 :.l,.:+: 45. 0 88. 0 :+::+:
40. 5 '_"¢0. -_'-": 57. 0
l.., 000. 0 :+::+: :1.., 000. 0 $:+: :L., 000. 0
250 228 250
GRAVEL. L. ENGTH > '75 FT. REQUIRES MULTIPL. E RUNS (NOT EXCEEDING 75 FI". EACH)
TANK MUS]" HAVE F:FF L..EF:IS'T TI.,.!O COi"IPRRTMENTS
I CERT I FY TH'I`::IT
i. I FtM cI::IHILIFtR I,.ItTH ]'HE REQUIREMENT'S FOR ON-SITE SEI4E¢.'.S t~3N[.'' WELLS RS SET
FORTH 8'-/ THE MUNICIPFIL. IT'./ OF ANCHORAGE (MOPt) FIND THE ::];TA]~E OF FILASI'.'::A.
2. I i.4ILL INSTFILL. TI-..IE Sh.'F;'TEM IIq FfC:CORDI:::INCE 14ITH I::II,,.L.. MOA CODES AND REGULATIONS.,
F-~ND IN COMPLIFINCE HITH THE DESIGN CRITERIA OF THIS PERMIT.
.7.-':. t I.,.iIL. L t-][:,HERE '1"0 F:II,.J_ PfOFi F:tND STATE OF ALI,:ISKA REQUIREMENTS FOR THE SET BACK
I::,iS'T'F:INCES F'ROM F:tN'T' E::'-';Ii.']TING i.4ELL., !.4AS'T'EI.,.iATE:R DISPOSAL SVS'T'EM OR PUBLIC
SEI*IERAGE S'VSTEM ON TI'"IIS OR RN"r' ADJACENT OR NEARB~¢ L. OT.
· 4..I UNDEF.':L=.;TFIND T'HF4T ]"HIS F'ERi'dI"I' 15; VFIL_ID FOR R I"1FI';.:~IMUM OF Z; E:E[:,ROOi"]S FIND
AN"/ ENI`..ARGEMENT HILL REQLtIRE FIN ADDITIONAl,._ PERMIT.
IF A LIFT STFfTION ZS INSTALL. lSD Il',! AN AREA COVERED B'9 MOA BUILDING CODES.,
THEN (:1.:, AN [ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINE[:,.~ (2) AS-BUILTS
HILL. NOT BE FIi::'PF.:OVED !.,.!ITHOUT Ai'.,I ELECTRICAL IN.SPE:X:;:TION REPORT.~ AN[) (]:) THE
ELEC]]RICAL. NORI< MUST BE DONE B'-r' A LICENSED EL. EC:TRICIRN.
FIF'F'LICF%~T- STEvEN [~t<:FG]S
i:~E;L.IFZI:::, E:"," ~~ ~- [:,FITE
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15-
16-
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN Z FT AND '~ FT
/
•
. SPG _: QG
• c..7 Municipality of Anchorage
On-Site Water and Wastewater Program 2 g,J
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-064-28 Expiration Date: 3 2 - I g
1. GENERAL INFORMATION
Complete legal description NORTH WOODS UNIT 4, BLOCK 16, LOT 21
Location (site address) 21516 SNOWFLOWER LOOP, CHUGIAK,AK 99567
Current Property owner(s) RANDELL&BROOKE COSPER Day phone
Mailing address 21516 SNOWFLOWER LOOP, CHUGIAK,AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class_Well ❑ Public Sewer ❑
Public Water System
WaiverNariance request for: Distance:
Received by: /f �/ � . / .�. i Date: Z o7,g /k
COSA to be released to the engineer,unless oth' is• equested by the engineer.
COSA Fee $ 5.gto Waiver Fee $
Date of Payment 0110401 Date of Payment
Receipt Number 06 ID Receipt Number
COSA# e�c,t106 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M.DUFFUS Date 2/20/2018
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. 41'- ) OF A
* 46TTEI /' �w
6. DSD SIGNATURE 1---
System #1 Approved for 3 bedrooms. �NN� 40,
System #2 Approved for bedrooms. � �� 71e �+�w/
Disapproved. \ ''FF;sS1Of,
Conditional approval for bedrooms, with the following stipulations:
or icy
• J� G.
ON-SITE
WATER AND c.1-'
WASTEWATER z:
PROGRAM
A
0,\).
' SrR\v1Cr_
� �^^-�/ Original Certificate Date: 2 - Z5;)-(�
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 blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: NORTH WOODS UNIT 4, BLOCK 16, LOT 21 Parcel ID: 051-064.28
A. WELL DATA—PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N)Y Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate _mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP I STEEL Date installed 7/1997
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y
Date of pumping 2/19/2018 Pumper SANITARY
C. ABSORPTION FIELD DATA
Date installed 61111984 Soil rating (g.p.d./ft2 or ft2/bdrm) 250 System type BED
Length 45 ft. Width 23 ft. Gravel below pipe 0.5 ft.
Total depth 6.5 ft. (Measured 2/19/18) Eff. absorption area 1035 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 2/19/2018 Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 0.5 in.
Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed 711997 Size in gallons 1250 Manhole/Access(Y/N) Y
"Pump on" level at 44 in. "Pump off' level at 42 in. High water alarm level at 48 in.
Datum BOTTOM OF TANK Cycles tested 2 Meets alarm &circuit requirements? Y
E. SEPARATION DISTANCES - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS
Per owner and observations during testing,the 1984 system is and has been in use. The 1997 field was dry.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
-k, of AL4s
Engineer's Printed Name KENNETH M.DUFFUS ,f~Date 212012018 * 4•, Di • :I
COSA canary sheet_2-6-15.doc , �; KENNETs
s
A% Gtir
2 �'
.'E1 SS[oa
\
\�►f
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • f r�' 907-343-7904
On-Site Water and Wastewater Section `t ,` Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC 181053
Subdivision: North Woods #4 Block:16, Lot: 21
The septic tank for this property is 21 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
I
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section E N
P.O. Box 196650 AnChorage, Alaska 99519-6650
343-4744 JUL ;5 0 ]99?
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY RECEIVED
APPROVAL FOR A SINGLE FAMILY DWELLING
_ ~)/.~ L/_ ~ ~,,~ ~ HAA# ~'~ ~.~'-~ L-~'~ ~'~-~
1. GENERAL INFORMATION
Comptete legal description
Location (site address or directions)
Property owner -~-~K/'CI~C:z~ /~'~,i/tFL/Y'-J~ Dayphone
Mailing address
Lending agency
Mailing address
Day phone
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
Day phone
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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
KND Engin~dn~
2o441 Ra~migan I~vd. '
Phone
DHHS SIGNATURE
Approved for -~
Disapproved.
Conditional approval for
bedrooms.
Date
bedrooms, with the following stipulations:
Additional Comments
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 engineer's work.
72-o25(Rev. 1J91) Back MOA~
I ;
J[/L 3 0 1997
Environmental Seh/ices Division
825 L Street, Room 502 · Anchorage~ A aska 99501 · (907) 343-4744
DIVISION
Legal Description: L.o'{' 21 'l~k I~ '/~bY'~lU]~-- ~ 4'/:' Parcel I.D.:
A. WELL DATA
Well type :~-~:~
If A, B, or C; attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N) J
Date of test
Static water level
Well production
WATER SAM PLE RESULTS:
Coliform
Date of sample:
Casing height (above ground)
FROM WELL LOG
AT INSPECTION
g.p.m / g.p.m.
./
Other bacteria / .
B. SEPTIC/HOLDING TANK DATA
Date installed 7/(~7 Tank s ze / ~,:~-~--~ Number. r of Compartments ~ Cleanouts (Y/N) Y
Foundation cleanout (Y/N) y. ~, Depression (Y/N) /~/ High water alarm (Y/N) ~/
Date of Pumping ~///9~ -,.,?' ', Pumper
C. ABSORPTION FIELD DATA
Date installed 7 7 Soil rating ((, 3ystem type ~ ~. T~
Length ~4~' Width ~ ~::)' Gravel thickness below
Effective absorptionarea ~/J~,~) -~ Monitoring Tube present (Y/N) /!// Depression over field (Y/N) ~
Date of adequacy test ~ /J,/~- ~ Results (Pass/Fail
Fluid depth in absorption fiel¢
Fluid depth
(ins) Minutes later:
Peroxide treatment (past 12 months) (WN) ./
gal. n.):
sorption rate = I.p.d.
If ~
72-026 (Rev, 3/96)*
D. LiFT STATION
Date installed *~/~ 7
Manhole/Access (Y/N)
' 'Size in gallons / ~
"Pump on" level at* z//z.//" "Pump off" level at* ~7/-~"
High water alarm level at*, z/~'' i- *Datum,~-,,~ ~oo'~°'~,~ d'~ ~ ~.
Cycles tested .'~
E. SEPARATION DISTANCES
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELE ON LOT TO:
~< On adjacent 10ts ._on adjacent lots
Public sewer manhole/cie
Lift station _,/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation //~) +' PropeiffY line ~/~;) 4. Absorption field
Water main/service line /'~ ~' Surfac~. water/dra nage ~¢~ _,L Wells on adjacent,lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Propertyline ?~ -~ Building foundation
Surface water /~) -/~ - Drveway~ parking/vehicle storage area
Curtain drain /1,/~ ,,~4),c~ ~ -
;
F. ENGINEER'S CERTIFICATION
Water main/service ne
I certify that I have determined
in conformance with MOA HAA
Engineer'S Name
Date
HAA Fee $
Date
Receipt Numbel
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ,~'~/
GENERAL INFORMATION
(a)
Legal D.escription (include lot, block, subdivision, section, township, range)
(b) Applicant Name 1~ ~ Telephone:Home Business~
(C, Applicant is (check one,: Lendi;~ ,nst;tution ~; Owner/b~ilder ~; Buyer ~; Other~ (explain,',
(d) Lending Institution ~~ ~ T~~
Address ' "'~ ~ ~~
(e) Real Estate Company and Agent J ~~- - ~ -~
Address
Telephone
(frz~.he HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family
Number of Bedrooms 0
Other
WATER SUPPLY
Individual Well I-1 Community [] Public~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
SEWAGE DISPOSAL
Onsite,~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to.the legality and status.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION '
'As certified by my seal affixed hereto and as of the validation date shown below, I verify that my iqvestigation 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 m compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection,
Name of Firm Telephone
S & S Englneerln~,
Address SRB 1~6x
Date
Ea,le ~,iver. Alasl~a 99~f
DHEP APPROVAL
Approved for '~/-.~ bedrooms by
Approved ~' Disapproved
Terms of Conditional Approval
Conditional'
CAUTION
The Muncipality of Anchorage Departmenl 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 purchaser§ of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72~025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
DEPT. OF HEALTH &
ENV/ROHMENTAL PROTECTION
BAR $'IgSt).,
RECEIVED
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Con.duit'(Y/N)
S~paration DistanCes from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleahout/Manhole
Water Sampl~ Collected by
Water Sample Test Results
Comments ~
If A, B. C, D.E.C. Approved ~')'"
Date Completed Yield
pepth of Grouting
I~ ~ Pump Set At
J~-sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
~4:~ I ~ ; On Adjoining Lots
~°~¥" ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
SEPTIC/HOLDING TANK DATA
Date Installed (.o'[~,- ~
Standpipes ~ Air-tight Caps~.
Depression over Tank~'"~
Pumping/Maintenance Contract ow File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ,~--4:) g::> "~"
To Property Line Z,O
To Water Main,~ie~e Line
Course I"J J,JI~''
Size ~.4..~C~ No. of Compartments
Foundation Cleanout
~,~/,4,,~ate Last PumpeC
: for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Parle 1 of 2
72-026~11/84)
ABSORPTION FIELD DATA
SoilsRating in Absorption Strata
Date Installed
Width of Field '~' ~ '
Square Feet of Absorption Area
Depression over Field,~W~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~"" /~..,~4.
To Building Foundation
Lot
To Water Main/~e,~e Line ~"~" / ~
To Stream/Pond/Lake/or Major Drainage Course
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present~N~
D~,~/,~f Last Adequacy Test
. To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if p~t)
To Driveway, Parking Area, or Vehicle Storage Area ~'~0
Com merits ~ y---~ ---~-~_ ~..,..~
D. LIFT STATION
Date I r~stalled
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Man~le/Access IY/N)
/ump Off" Level at
/~?~, Vent (Y/N)
/,~ Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Commems
** Check Permitted Bedroom Rating Against HAA Request **
certify that i have checked~ verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S & S Engineering
Signed ~.R,~ ;?~= Date '~{ ~ ~"~
Com party ,Ea,.la ~.iver, Jlaskt 9~577 MOA No ~::>~--OO ,-~
Receipt No. _ _¢.~'~
Date of Payment
Amount: $
Page 2 of 2
Z2-026 (11/84)
DEPToOFENVIRONMENTALCONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA gg501
BII~L SHEFFIELD, GOVERNOR
Telephone: (~07)
274,2533~
To Whom it May Concern:
According to record.s o,n file in this office the ~//~5/~/
(~.Z~2./~/~System is in compliance with the State Drinking
Water Regulations
Sincerely,
, , " MUNICIPALITY OF ANCHORAGE
DEPF. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTIO~
DrY, SION OF 'mONM NTAL HEaS
'DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION -,.lUll 'i[ ii i0,~,z:!
APPLICATION FOR HEALTH /~rHORITY APPROVAL CERTIFICATE
1. Gene,al Info~',',.tion Application Date~<[~[] v ~7
(a) Legal Description. ~. (include. . lot, bl_ock, Sub~.ivision, .~ection, ~ownship, range)
Applicants Na~e
Appl icants Address
(b)
Appliqant is (check one) Lending I. nstitution
Buyer [-~ ; Other ~ (explain),
(d) Lending Institution
; Owner/builder ~-];
Te le p hone
Address
(e) t~al Estate Co. & AGent
Address
Telephone
Type of ~sstdence
Single-Family
Numbe~ of Bedro~is
Multi-Family
Other(descri~)
Water Supply
Note: If ccrmunity mi1 system, must have w~itten confizi~mtion frcm the State
Department of Enviro~rental Conservation attesting to the legality and status.
Is the well adequate fo~ the number of bedrooms specified in this' ~f~% (Y/N)
Sewage Disposal
Onsite ~ Public ~ C~,,~'~nity ~-] Holding TapX ~--~
Is the wastewater disposal system adequate fcr the number of bedrooms (Y/N)
[Page 1 of 2]
2-15-84
®
Engineering Firm Providinq Inspections~ Tests, Data and Information
I certify that I have checked, verified, c~ confor~d to all MOA ~J% Guidelines in
effect on the date of this inspection.
Signed~/,~(,~(~,~,~_ ~, ~( Date ~- '/~ ~-//~
'
Nam~ of Firm' ~?~//~/,(3~/1/~ -~'E~'V~ f~(~('-~-, Telephone
( ENGINEER SEAL)
~ bedrocks
Disapproved ~
Date
6. DHEP Approval
App~o~d fo=
Approved~_
Terms of .Conditional Approval
The Municipality of Anchorage D~pa~tment of Health and Envi~or~ental lhtotection dces
not guarantee the continued satisfactory pe~fom~ance of the water supply and/o~ the
wastewater disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished ky an engineer registered i~
the State of Alaska, the wate~ supply and wastewater disposal system is safe and fun<
tional fo~t the number of bedro~ and type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
A®
Well Log P=esent (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Grcund
Elect=ical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank cn Lot
To Nearest Edge of Absorption Field o~ Lot
To Nearest Public Sewer Line
Cle anout/Manhole
Water Sample Collected By
Water Sample Test Results
C~u~nts
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUI~ORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Lecjcfl: Le.f Zl, 5~0c~ I~,
Tew~s~:} lSAt. /S/,tt';¢~, Iwl
If A, B, ar C, D.E.C. Approved(Y/N) . 'f
Date C~L~leted Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression A~ound Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewe= Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-/- ~ Size /00,0 ~'~ NO. of Ccmpartments
Sta~ims (Y~) ~5 Aid-tight ~ps (Y~) y~ F~n~tion Cleanout (Y~)
~ession o~ Ta~ (Y~) ~0 ~te ~st ~d
P~ing~intenan~ ~n~a~ ~ File (Y~) ' ; for
Holding Ta~ High-Wate= ~a~ (Y~) ~ra~y Holdi~ Tank ~t (Y~)- '
~p~at~on Distan~s ~' ~ptic~olding Ta~:
To Water-Supply ~11 ~00~ ' To ~ilding F~ndation
To Property Line ~l
To Water Main/Service Line
Course
To Disposal Field /~ !
To Stream, Pond, Lake, ar Major D~ainage
Comments
[Page 1 of 2] 2-15-84
DEPT. OF ENVIRONMENTAL CONSERVATION /
/
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
PWS i.D,
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom It May Concern:
According to r, ecords on file in this office the
~,-~J~i\li~-~lOId Water System is in compliance with the State Drinking
Water Regulations.
Si y,
ncere I
