The URL can be used to link to this page

Home My WebLink AboutNORTH WOODS UNIT 4 BLK 18 LT 1 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221285 PID Number: 051-064-45 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name WILLIAM & NANCY SITZ A ORPTION FIELD ❑ De Trench ❑ Wide Trench ❑ Bedi ound Other Site Address 23562 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Phone 907-360-0159 Number of Bedrooms 4 Soil Rating o/sF JTotal depth original grade Ft. LEGAL DESCRIPTION Depth to pipe invert from origin EXISTING` vel depth beneath pipe Ft. Subdivision Block Lot NORTHWOODS #4 18 1 Fill added above original g -ele G a I length Ft, Ft. Township Range Section Gravel w width Beds: Number of Lines Dis a between lines - - SEPARATION DISTANCES - Ft. - - - Ft To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line yam" Tota" sorpFt2tion area Number of trenches - Dist. between renches -k. Well N/A EXIST. - _ _ TANK A Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ EXIST. - _ Material Number of compartments Lot Line rj'+ EXIST. - - NA PLASTIC 2 Foundation 101+ EXIST. - _ L c ATION Manufacturer Capacity Remarks NO GROUNDWATER IN TANK HOLE. Gal. Alarm location Electric i lled by Installer DENALI EXCAVATING PIPE MATERIAL House to tank D3034 drainrield Tank to D3034 Drainfleld EXIST. CO/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 100.00 ft Inspdecct sn 1st 8/10/2022 2�d - 31d _ 4'h _ Location and description BOTTOM OF SIDING BY FCO ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 0060 O o� OF A dap Qo *'. 4Z TH '..7*�4, �� .. off CE-795Y �; o i84�p �ofess100 #AECC8��OOp�o Septic System �� Approve—d t.� 1�_ Dateo Note: this approval does not include well permit requirements. k"w v.nvu lug PERMIT NUMBER: PARCEL ID NUMBER: OSP221285 RECORD D RAW I N G 051-064-45 A e --�-- FCO 23.2 1 20.9 ""------------ --"--' 28.8 38.7 SMHMH 32.3 42.3 DBL1 33.3 43.4 DBL2 34.2 44.3 TANK MT 1 28.8 143.9 _ - - NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS - - - - - - - - - - - TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED INAUTOCAD. - DOLLY AVE_ T I I NEW 1250 -GALLON GREER INSTALLED PLASTIC SEPTIC TANK DOUBLE CLEANOUTS (DBL1 & DBI -2) I � A/ s '� s " EXISTING i . ...... `----- 4 -BEDROOM j • HOUSE ; -- 1 1 t \ 1 \ PREPARED FOR: WILLIAM & NANCY SITZ \ \ 1 EXISTING 47 -FOOT LONG BY \ \\ 25 -FOOT WIDE BED TYPE \ \ DRAINFIELD. DRAINFIELD i PASSED ADEQUACY TEST FOR I � DRAINFIELD APPROVED ASA \ N 4 -BEDROOM SYSTEM. i CONTRACTOR REPAIRED RECORD DRAWING OF SEPTIC SYSTEM UPGRADE I i � FROST JACKETING AND ALSO I ItL--- 1 � I Ur l i 1 � 1 1 \ 1 r r r � � I I � � I 100' WELL RADIUS -- 1 1 t \ 1 \ PREPARED FOR: WILLIAM & NANCY SITZ \ \ 1 EXISTING 47 -FOOT LONG BY \ \\ 25 -FOOT WIDE BED TYPE \ \ DRAINFIELD. DRAINFIELD \ PASSED ADEQUACY TEST FOR 4 -BEDROOMS ON 6/23/2022. NORTHWOODS #4; BLOCK 18, LOT 1 DRAINFIELD APPROVED ASA \ N 4 -BEDROOM SYSTEM. i CONTRACTOR REPAIRED RECORD DRAWING OF SEPTIC SYSTEM UPGRADE CLEANOUTS TO PREVENT 8/15/2022 FROST JACKETING AND ALSO REINSTALLED MT1 TO THE CORRECT DEPTH. F ED I� (� I EXISTING 1984 DRAINFIELD. ABANDONED IN PLACE NOTE: OLD SEPTIC TANK FOR POSSIBLE FUTURE USE. TO BE USED AS A W I I DECOMMISSIONED PER UPC 4 -BEDROOM RESERVE SITE WITH THE USE OF AWWTS PER THE CONTRACTOR Kn I w I APPROX. LOCATION OF WATER SERVICE LINE I N iI SCALE: i i I 1l=40' �� OF �,, .........� 0 El w.,..,. , .. • .......... A, 0� ;• A,Garn ss 01C`AV E-79 / ' -'� AV LICENSE ® ESS o® #AECC884 ENGINEERING -�SALES :-CONSULTING 3701 E. TUDOR ROAD, SUTIE 101 - ANCHORAGE, ALASKA' PHONE (907) 337-6179' WEBSITE: w .gamesseng(needngxom PREPARED FOR: WILLIAM & NANCY SITZ PHONE NUMBER: PAGE NUMBER: C/O DEREK SITZ 907-360-0159 2 OF 3 PROJECTILEGAL DESCRIPTION: DRAWN BY: NORTHWOODS #4; BLOCK 18, LOT 1 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 8/15/2022 �� OF �,, .........� 0 El w.,..,. , .. • .......... A, 0� ;• A,Garn ss 01C`AV E-79 / ' -'� AV LICENSE ® ESS o® #AECC884 PARCEL ID PERMIT NUMBER: RECORD D RAW I N G 051-064-45 NUMBER: OSP221285 FINAL GRADE AAA D7 �11� Ian GARNESS ENGINEERING GROUP, Ltd µ = m ENGINEERING- SALES : CONSULTING 3701 E. TUDOR ROAD, SUITE 101 - ANCHORAGE, ALASKA' PHONE (907) 3376179' WEBSITE: www.gamassongineedng.com.. . PREPARED FOR: WILLIAM & NANCY SITZ PHONE NUMBER: PAGE NUMBER: C/O DEREK SITZ 907-360-0159 3 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: NORTHWOODS #4; BLOCK 18, LOT 1 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 8/12/2022 OF 9w 7 5 ........::..... �0 J, CE 79AV 3 _® LICENSE d®dROFESS� �® 0® #AECC884 S'z7 , 3 e 37z1-11 ¢ -7//YG S-71 S -7n 79 :7k _ :- &• I 3:1 k�:� m9:« ®®:D �(\ \ \/} \ \\\ \ 37z1-11 ¢ -7//YG S-71 S -7n 79 :7k _ :- &• I 3:1 k�:� m9:« ®®:D O: \\«01 / MUNICIPALITY OF ANCHORAGE On -Site Water& Wastewater Program pnBox 1966nn 4ronElmore Road Anchorage, Alaska oen1o'sV5n px '790* Fax: (oo7)owo-7yor nupsww=vmvn/.vmmns/te Permit Number: OSP221285 Work Type: SepboTenkUpgnad* Tax Code Number: 05108445000 Site Legal Address: NORTH WOODS UNIT 4BLK 18 LT 1 G1460 Site Mailing Address: 23562BLUE SKIES OR, Chugiak Owner: SITZ WILLIAM H&NANCY K4 Design Engineer: GARNESSENGINEERING GROUP LTD This permit isfor the construction of: L] Disposal Field Z Septic Tank [] Holding Tank [] Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/4/2U22 8/4/2023 El Private Well El Water Storage All construction shall beinaccordance with: 1. The attached approved 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (1D/AC72)and Drinking Water Regulations (18AAC8U) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.S5.Provide notification bycalling (Q07)343'7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall boeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing ( Special Provisions: . The septic tank is to be placed 5'from the 1984 bed. Received Issued By 4 punt Municipality of Anchorage _ Ur.partment P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221050 COSA#: Permit#:OSP221285 PID#: 051-064-45 Legal Description: NORTH WOODS UNIT 4 BLK 18 LT 1 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well on Stockhausen Lot 3A has been approved. The approved separation distance is 85.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. .................. n K K 0 0 M.......................................... 0 a 0 E M N ...... 1 Waiver is Granted: X Waiver is not Granted: Date: g 21 Z Z Approved by: Name of Reviewe **** VARIANCE/WAIVER REVIEW **** : Development Services Department = Phone. 907-343-7904 On-Site Water Cot Wastewater Section -- ' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-064-45 Property owner(s) WILLIAM & NANCY SITZ (C/O DEREK SITZ) Day phone 360-0159 Mailing address 23562 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Site address 23562 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) NORTHWOODS #4; BLOCK 18, LOT 1 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El Septic Tank 0 Upgrade nX (w/wo ADU) (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: WAIVER FROM DRAINFIELD TO NEIGHBORING WELL Distance: 85' 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: t '9 Q S Waiver Fees: #, is Date of Payment: 91 � 1 I )02 a Receipt Number: 0 `-1 14 b G Permit No. O S P'2 0 11� 8 5 Date of Payment: Receipt Number: Waiver No. OSV 19-10 5 � &0evelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221285, Deb Wockenfuss, 08/04/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221285, Deb Wockenfuss, 08/04/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221285, Deb Wockenfuss, 08/04/22 ........... ................................................... ......... . ............ ......... ....... r. ........... ........ . .---_-:-�-�-..-z-�-�--:--.• . �--�- .-�- ,-�----.�--- . .-•�-�-:-�---- . - .............. ................................................................. .............. ......................... .............. ......... I ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . __.._. _s.._.�_�_..._.. _...._ ...._ _... . . . . . . r . . . . . . . . . . . . . . ' . . . . . . . . . �. _....... _..._�_...__ .......__ _ .. ............... ............... C .......... s ...........•...... ...................... . . . . . . . . . . . . . . . . r" .............. 1' ................ �i ............... ...... V, ............. ....... ................ ....... i. ... ..+.•..... i ..... I. .......... . . . . � . . . . . . . ................. ................. i........ ....... '_'.'.'.'.".'.'.�.`.'.'.'.'.'.'. . r "". PA....... . w . . . . . . . .............. ;......... ........ 1. THIS DRAWING SHALL T BE ;'. c r . a • • .'�' MODIFIED WITHOUT THE EXPRESSED WRITTEN CONSENT F L G LAN ! C# 1. . 2.. FENCES APPEAR TO CROSS LOT LINES. i'.'.'.'.'.'.....'.'.'.' a r A t# #ENEEMEW 250 H Street Anchorage, Alaska 99501 Survey Department CLEAN OUT ! Phone:a #._ Concrete Mainline WATER t (:G Phone: 243-.9s nc Overhang�!.■.... AECC 8 fill fi / .►' fi �N'Ood Deck ORDERED DEREK ADDRESS: 23562 BLUE SKIES DRIVE I I I AS—BUILT SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY of THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED OR SHOWN. EXCLUSIONARY # OWNERS' .# # DETERMINEOF ANY EASEMENTS, COVENANTS, RESTRICTIONS 1R# # RIGHT-OF-WAY 1-t TAKINGS WHICH ie # APPEAR ON THE RECORDED SUBDIVISION PLAT, UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT -PLAN PURPOSES. LEGAL DESCRIPTION: NORTHWOODSSUBDIVISION DRAWN ♦ DRAWN AP/SC CHECKED WORK ORDER:! PLAT: 83-3331 GRID: A FB/PG: 823/66;-67 Municipality of Anchorage Page / 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: PID Number: ~)~) Name: Wastewater System: [] New ~ Upgrade Address: ~ '3~5 ~ ~4~v ~ O Deep Trench O Shallow Trench ~Bed O Mound O Other Lot', / '~ Block:/~ /~~Subdlvlst°n:, ~ Depth to pipe bottom from~,~_original/,5~grade: Ft. Gravel depth beneath pipe ~-~ Ft, T°wnship: I /~ I Range: /~ Isecti°n: 3 FIll added above original grade: Gravel length: Number of lines: Distance ~n lines: WELL: D New D Upgra Grave~ ~10~ ~ Et, ~ ~ Et, Classification (Private, A.B,C): Total De Cased To: Total absorption area: Pipe material: Driller:~ Date Drilled: Static Water Level: Installer: Date installed: Yield: ~M J PumpSetat: Ft. CasingHeightAboveGround:Ft. ~/S~l~h TANK / SEPARATION DISTANCES ~Septic D Holding D S.T.E.P. From Tank Fie~d Station Tank Sewer Lines ~ ~ ~/~ ~ Material: Number of Compartments: Surface Lot Size in gallons: ~ Manufa~turor: Cudain Location and Description: Assumed, Eleyation: Inspections performed by: ~/W~/~ Dates: lst~ Department of Health and Human Services approval Reviewed and approved by: Date://-~-~2 72-013 (1/91) MOA 25 'Permit No. Page 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION of 2 P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Northwood~ UTILITY i0' X 15' CDMMUNITY WATER #4 Lot 1, Blk 18 PID No.: 051-064-45 89'58'19' E 191,09 EXISTING FIELD 23'iX 44' DIVERSIDN LAST SYSTEM, 211,42 · - MONITOR TUBE o - i SEWER CLEANOUT + - i KEYBOX -- ---i EASEMENT ELEVATIDNS ~ SCALE z j Fq I., FILL AD]DE" II II 5' ~ H ~" ' II j ELEV, NDT T~EN FIELD ~ ~ 72~13 A (~91) MOA 25 "LEV = lO0,O0' SWING TtE5 A j C = qq.l' B -~ C lO0.q' ~ ~=~o~.~' B ~ O q1.8' B -~ [ : 2~.8' 1" =40' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920351 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:SITZ WILLIAM H & OWNER ADDRESS:23562 BLUE SKIES DR CHUGIAK, AK 99567 PARCEL ID:05106445 DATE ISSUED:10/15/92 EXPIRATION DATE:10/15/93 LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 18 LT 1 LOT SIZE: 25276 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 UPGRADE MUST BE INSTALLED AS SHOWN ON THE APPROVED ENGINEER'S DESIGN DATED 10/5/92. ISSUED Louis Butera, P.E. Registered Civil Engineer October 5, 1992 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Northwoods//4 Lot 18, Block 1 Narrative Dear Mr. Smith: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The lot has sufficient room for septic replacement sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be effected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907} 694-5195 · Fax (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 1, BLOCK 18 Northwoods//4 GENERAL 1. The well and septic plan are for a 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 Health requirements. 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 or modified 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. BED 1. The bed is to follow the natural land contour to maintain uniform total depth of the bed bottom, and fill in test hole is to be compacted. The bottom of the bed excavation shall be level, plus or minus 1.5". The total depth of the bed excavation is not to exceed 4' at deepest point. The sewer line is to connect to the existing leach line before the existing field with a diversion valve to allow effluent switching between fields. The bed gravel is to be covered with typar fabric material. A combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. A minimum soil depth of 2' is required with 3:1 side slopes and 6" topsoil layer. The area over the bed is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 4' GRAVEL DEPTH = 6 BED LENGTH = 47' BED WIDTH = 24' SOIL RATING = 0.4 GPD/ft2 BEDROOM CAPACITY = 3 SEPTIC TANK SIZE = 1,000 gallon existing NOTE: All flow lines and bed to be insulated with 2" high density foam, 35 PSI minimum. Twenty-four (24) hours notice required for all inspections. ]3FILLY AVENUE ~ N 89°58'i9' E DRIVE ~ %DIVERSIBN ~. ~4,0' ~.~,,~*~,.~ CLASS C~ELL ~ UTILITY 2ii,42 ~EASEMENT NB ~ELL NEIGH SEPTIC ~00 +30' ~ - TEST HOLE · - MONITOR TUBE COMMUNI~ WATER SYSTEM o - SEWER CLEANOUT NO SURFACE WATER + - KEYBOX NO K~NOWN CURTAIN DRAINS m',m',r.',- PROPOSED LEACHFIELD EASEMENT SEPTIC SiTE PLAN LEGAL: LOT 1 BLK 18 NORTHWOODS ~4 JOB ~ 92-1471 DATE: 10/05/921 SCALE 1" = 40' ~~~:~<- ~ ~ - A EA GtE RIVER ENGINEERfNZ SERWCES (907) 694-5195 r~X: (907) 694-329? i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: LEGA, DESCRIPT,ON: 10¸ 11 12 13 14 15 16 17 18, 19- 20 COMMENTS DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN _/ / t / /' / / WAS GROUND wATER ENCOUNTERED;) · ~/~ S L IF YES, AT WHAT O DEPTH;) p E Depth to Water Monitoring? '//O Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~o~,I~. ~/~s I ,/ 11;55';/o - ,~-J~ PERCOLATION RATE TEST RUN BETWEEN . - - (minutes/inch) PERC HOLE DIAMETER . FT AND '~ .~ FT PERFORMED BY: ,~"*~"/~,,~", -~ , ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "'/~/~" '~ ACCORDANCE WITH ALL 72-008 (Rev. 4/85) ,~ 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 [PHONE LEGAL DESCRIPTION LOCATION ~ DISTANCE ~ e~ . ~. J Absorptionjrea ~ / I Dwelling .. ~ PERMIT Manufacturer A -- '' ' ~,~ -- Material ~ ~ Liq' cap)F~3gal'° ns IF H~MEMX~E: inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling ~ Oz PERMIT NO. O ~ ~ Manufacturer ~ -- ~ Material Liquid capacity in gallons ~ WeJl~ ' I. Foundation Nearest lot line ~/ -- ~ ~ Distance between lines ~ ~ ~ Top of tile to finish ,fade ,~.. ~ / ;~ Material beneath die" inches ~ Tota~ effective absorption area ~ Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth ~ ~ Total effective absorption area m Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller Distance to Jot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer Hne Septic tank Absorption area(s) OTHER PIPE MATERIALS D~lh INSTALLER REMARKS ~4~r*~[a ~ 5, ~ ~ ". JU J.o APPROVED DATE LEGAL ~IU~J I CIPALIT~' elf Ar-JCHOR8GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, 8K 99501 264-4720 PERMI'T NO: [)ATE ISSUED: 0r4--$ ! TE 840~i 05?09?84 SEWER RPPLICRNT: ADDRESS: CONTRCT PHONE: STEVEN L SKAGGS CONSTRUCTION P 0 BOX 6?0690 CHUGIRK, RK 99567 688-28~t LEGAL DESCRIP: LOT SIZE: LOT LgCRTION: MAX BEDREOM~, SUBDIVISION: NORTHWOODS #4 SECTION: ~ TOWNSHIP: 25276 (SQ. FT. OR ACRES> BLUE SKIES AND DOLLY LOT: RANGE: BLOCK: LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. BED DEPTH TO PIPE BOTTOM (FT.) 2. 0 ** GRAVEL DEPTH (FT. > 0. 5 TOTAL DEPTH (FT.) 2.5 ~, GRAVEL WIDTH (FT.) 23... 0 GRAVEL LENGTH (FT.) 44. 0 3RAVEL VOLUME (CU. YDS. > ~7. 4 TANK SIZE (GALS> i, 000. 0 ~ SOIL RATING (SQ. FT. /DR) 220 · ~ DEPTH TO PIPE BOTTOM < _~. 5 FT. REQUIRES INSULATION · ~' DEPTH TO PIPE BOTTOM ~. 4. 0 FT. MAY REQUIRE R LIFT STATION ~: TANK MUST HAVE AT LEAST TWO COMPARTMENTS CERTIFY THAT: I. I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MCR> AND THE STATE OF ALASKA. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MCR CODES AND REGULRTION~ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. ~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE.SET BACK DISTANCES FROM ANY EXISTING WELL, WRSTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF ~ BEDROOMS AND' ANY ENLARGEMENT WILL REQUIRE RN ADDITIONAL PERMIT. F R LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ HEN (i> AN ELECTRICAL PERMIT AND INSPECTION MUS~ BE OBTRINE~ (2> AS-BUILTS ILL NOT BE APPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT~ AND (~> THE LECTRICRL WORK MUST BE DONE BY R LICENSED ELECTRICIAN. PPLICRNT: ST CO SSUED BY _~t_~ _~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: STEVEAI L, .~'t'GI~6.-~-_'~ DATE PERFORMED: "~ ---~ O--~ Z~ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 lO 11 12 13 14 15 16 17 18~ 19 2o- LC)T /' /~£n~'.l~ /8 SLOPE __ SILTy i 5~/ql)Y~ (_,ttf~vEc SITE PLAN WAS GROUND WATER ENCOUNTERED? NO ~- O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop +Hzo 4 .' 3~ o, 53 ~;~ /o ~,~g o,// S~ /0 o~1 ~, I~ S: eE I0 o, 4L~ o, 1o +t~zo S: o~ ~, ~ ... S,' / g .10 O,~G O, 09 o, ~ O, Oq (minutes/in~) PERCOLATION RATE TEST RUN BETWEEN ~/~T AND %~ FT ~ / // -// Parcel I.D. 051-064-45 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: < R-)) V 5 � -1 Expiration Date: � —23' Z Complete legal description NORTHWOODS #4• BLOCK 18 LOT 1 Location (site address) 23562 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Current Property owner(s) WILLIAM & NANCY SITZ Day phone 907-360-0159 Mailing address Real Estate Agent 23562 BLUE SKIES DRIVE CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Receipt Number Date of Payment Receipt Number COSA # OSG 2Z 19 2 --; 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Gamess Date: g t 22 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational fife of all wells and septic_ systems depend upon a variety of -variables, including but not limited_ to, _soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE ySystem #1 Approved for bedrooms System #2 Approved for Conditional approval for bedrooms, with the following Original Certificate Date: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: NORTHWOODS #4; BLOCK 18, LOT 1 If more than 9 septic system on lot: COSA Checklist # 1 of 1 ELL DATA'::! ❑ Well to ed 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 Static wat el at beginning of test ft. ments B. TANK DATA Age of tank(S) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA BED Which system tested (date installed) 10/92 (n ALL standpipes present per record drawing Total measured depth from grade 4.25 ft (max) Measured depth to pipe invert from grade 2.54 ft (min) ❑ N/A — pressurized field [� Monitor tubes go to bottom of effective. If not, state depth into effective [� Code -required soil cover over field 0 System presoaked (Required if vacant for greater than 30 days prior to date of test) 4 n7n 9 /_— 1 Gallons introdi Comments/Defici Parcel ID: 051-064-45 Structure served by this system 1 Well production at time of test Water storage tank volu _ gallons Well disinfect coliform test? ❑ Yes no No orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) .. is ug/L ❑ Arsenic less than MRL (ND) Date of Sample STATION ❑ Requi ai Age of lift station Lift station mater Comments Adequacy test date 6/23/22 Results (J Pass For 4 bedrooms Fluid depth prior to test 3.75 in Water added 896 gal New depth 7.5 in Elapsed time 1100 min Final fluid depth 3 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) N/A COSA Checklist yellow sheet I' E. SEPARATION DISTANCES PUBLIC VW _ if No ft �ro��tvate Well on Lot to: (Please enter distances if less than required or if community well) Property Line > 10' Yes if No ft Wells on Adjacent Lots: Septic Tank/Lift Stafia Loot > 100' Community Sewer Manhp -!Cl pout > 100' if No '� Yes if No ft ❑ Yes if No ft if No ft Community Wells > 200' Yes if No ft Neighboring Tank > 100' El Yes if No t _ ,-Wae Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' p _ ❑Yes — j3 '4 ft Rotui:Tank > 100 El Yes if No ft _ Neighboring Absorption Fields -'-1 0 Animal Containm net �,_ ❑ Yes if No ft ❑ Yes if No ft-� Manure/Animal Excreta Storage > C,gbri.=�n y Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No `� ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ 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' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' ® Yes if No x`85 ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS WAIVER GRANTED (WAIVER #OSV221050) G. ENGINEER'S CERTIFICATION / 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 Urofession oa #AECC88A ��Opoo�� Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANC GROUP, Ltd ENGINEERING SALES CONSULTING July 19, 2022 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Northwoods #4; Block 18, Lot 1 To whom it may concern: 21285, Deb Mckenfuss, o8vo4 * Ar,cG43& 4- " i tc, j2z- The existing 4 -bedroom house is served by public water and a private septic system. The existing septic tank and drainfield were installed in 1992; however, the septic system was only sized for 3 -bedrooms. The existing septic tank is almost 30 -years old and needs to be replaced. We have recently tested the 1992 bed drainfield and found it passed an adequacy test for 4 -bedrooms. We are proposing that a new 1250 -gallon Greer plastic be installed, and that the existing 1992 drainfield size be approved to serve a 4 -bedroom residence. Comments regarding the design are summarized as follows: 1. SOILS: See the attached soil log (on file at the MOA) which show the soil classifications, percolation test, and groundwater monitoring. Per Mr. Butera's soil log, the percolation rate of the soils in the area was 11.4 minutes/inch, which would allow the use of a 0.5 gpd/sq.ft application rate. 2. EXISTING DRAINFIELD DESIGN AND WAIVER REQUEST: Per the 1992 Louis Butera, P.E Inspection Report, the existing bed type drainfield has 1,175 sq.ft. (47 -feet long by 25 -feet wide with 0.5 feet of effective). Based upon the fact that the allowable application rate for this drainfield is 0.5 gpd/sq.ft., the required square footage for a 4 -bedroom drainfield needs to 1200 sq.ft. (600 gpd / 0.5). The existing drainfield is 25 sq.ft. short of the minimum drainfield size (1,200 —1,175). In short, the drainfield is undersized by only 2%. We request the drainfield size requirement be waived and that the MOA allow the drainfield to be approved for 4 -bedrooms. 3. SURFACE WATERS: There is no surface water concerns 4. DRAINFIELD TO NEIGHBORING WELL WAIVER REQUEST: During our recent site visit, we measured the distance from the well on Lot 3A; Stockhausen S/D to the north monitoring tube of the1992 drainfield and found it to be approximately 93 -feet. As can be seen on the attached design drawing, we are requesting an 85 -foot waiver from the well on Lot 3A to this drainfield. The last water samples (documented at MOA) for Lot 3A were pulled in 2004 (approximately 12 years from the time of encroachment) and the nitrate levels were found to be 4.93 mg/L. There are two wells on Lot 3A Stockhausen Subdivision, and it appears that the 2004 water samples (per note on the 2004 HAA) were taken from at the subject well (northwest corner of lot). GEG 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Page 2 of 2 consultant Jody Maus talked to the neighboring property owner, and according to her the well only serves the single-family structure just south of the well and does not serve the main house or any other structures on the property. She also stated that the well is currently not in service and will not be in service until the house is gets renovated. Upon reviewing the MOA Nitrate mapping for this area, Nitrate levels are elevated on many of the wells in the vicinity, so it is likely that elevated Nitrate levels throughout the area are attributable to factors other than just the subject encroachment. The topography around the 1992 drainfield does not slope towards this well, so if effluent were to daylight, the travel distance of the effluent would be greater than 100 - feet. Given the cost associated with pulling a sample (generator, pump/flush well, sample) we are requesting you waive the requirement to pull a sample at this time. �N„ t� s.V 5. CLOSING: We are unaware of any adverse impacts thiAnstallation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com I 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 APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Cf 051-064-45 1. GENERAL INFORMATION Complete legal description Northwoods #4 Lot 1, Block 18 T15N R1W Section 3 Location (site address or directions) 23562 Blue_ Skies Drive, Chugiak Property owner William & Nancy Sitz Day phone 694-3454 Mailing address23562 Blue Skies Dr., Chuqiak, AK 99567 Lending agencyN~4~na] Rank ¢~¢ Al~Rka,/Rnhbi~ W4rth Day phone 694-5373 Mailingaddressp. O. Box 6127, Anchorage, AK 99519 Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: X 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 ')~JOM s,JeeU!bUe leUO!SSe~oJd eH1 u! SUO!SS!LUO JO S JO J J8 JOJ. elq!suodseJ ]ou s! 8beJoqouv ,to X~!led!o!unlAi eLI/ 'p@nss! s! @~eo!,t!lJe3 e eJo~aq e]ep eZXleUe Jo suo3oedsu~ ~3npuoo ~ou op SHHQ jo s@eAOldLUEI 'S~U@LUaJ!nbaJ ele~s pue leJapaJ u e~ueo Ajsqes oh jap JO u suo inl~]sul bu puc J~eql pue sauJoq jo sJeseqoJnd oh Xse~Jnoo e se s!q~ seop SHHQ aqL 'e~lSelV jo e~elS eq~ u! pejels.beJ jeeu~bua leuo!ss@joJd luepu@dapu! ue ,~q e^oqe g qdeJl~eJed u~ u@^18 suoReiueseJdeJ eq~ uodn ,quo peseq sa~eo!J!~Jeo leAoJddV X~pOLIlnV q~leeH s@nss! (SHHQ) s@ouueS UeLUnH pue q~le@H jo ~U@LUl~edeQ ebeJoqouv jo X~,.led!o~unJN eq.L S~UeLUUJOO leUO!~!PPV :suo!~elnd!~s §U!MOIIOJ eq~ q~,!M 'SLUOOJpeq ', 'SLUOOJpeq JOJ leAoJdde leUO!j!puoC) .peAoJddes!Q Joj pe^oJddV :~nJ.VN91S SHHO '9 euo~d g6I~-~69 LLg66 · uo!~oedsu! s!ql jo ejep eq~ uo ~oejje u! suo!lelnbeJ pue 'saoueu!pJo 'sepoo e~m,S pue led!o!unlAl lie qj!M eoue!ldLUoo u! s! LUe~SXS lesods!p jejeMe~SeM Jo/pue Xlddns je~,eM e~,!s-uo eql 'uo!~oedsu! pue uop, e6p, SeAU!/,LU LUOJJ pue sel!J eDeJoqouv jo ~),!led!o!un~ eq), uJoJj peu!e~qo uop, euJJoju! eq~ uo peseq ],eqj,~JpeA JaqlunJ I 'u!eJeq pa~eo!pu! ejm, onJ~,s jo edX1 puc suJooJpeq jo JeqLunu eq~ JoJ ejenbepe pue leUOROunj 'ejes s! uJe~sXs lesodsiP jejeMelSeM Jo/pue Alddns Jeje/~ ej!s-uo eq~, ~eq~ s~oq~ uo!leg!ldde leAoJddv/qpoq~nv q~leeH s!ql jo uo!je6RseAu! XLU leq~ Xjpe^ I 'MOleq UMOqS e~ep uoi~ep!leA eq~ jo se pue oleJeq pex!jje leas XLU Xq pel~!lJeo sV t:l~l~NION~ Ag NOI-L3=IdSNI :10 .LN~IlN~J.V.LS I Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A//P~_77-/~O~)A #~ Z4~'I 8L/C'/~Parcel I.D.. O~/- ~ - ~5 A. WELL DATA If A, B, or C, attach ADEC letter. Date completed Cased to Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESU~: Coliform ~ Date of sam,,Fr'e: B. SEPT /~~G TANK DATA ADEC Water system number Driller Casing height Wires property protecteC (Y/N) g.p.m, g.p.m iacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: Date installed / ~/"/ Tank size _//~/')/'2 Compartments ~.~ Cleanouts (Y/N) y/~ Foundation cleanout (Y/N) )/~ ~ Depression (Y/N) High water alarm (Y/N) /~/A Alarm tested (Y/N) Date of pumping ~ ~./~c~/~?.. Pumper -.~' ~- 5 SEPARATION DISTANCES FROM SEPTIC/HCLD=NG TANK TO: Onadjacentlots f' ~,0~ v Foundation Absorption field /.~ '~ ' water mei~/service line Well(s) on lot, To property line '/--7' Surface water/drainage 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 , I ~. ~ Meets MOA electrical codes (Y/N~~ SEPARATION DIS..T.A-f~E FROM L FT STATION TO: Well OD~''~''~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Z~ ?~ Total absorption area //'7 ~'- Depression over field (Y/N) Results (pass/fail) Manufacturer Manho~) "Pump on" level at ,~ "Pump off" level at Cycles tested Width Peroxide treatment (past 12 months) (Y/N) If yes, give date Surface water Soil rating ~' ~ '¢"?/'/¢¢'~- System type Gravel thickness ~-~" Total depth z./ Cleanouts present (Y/N) "/~' Date of adequacy test /V'/,/]' ~/t/'~/-,~ for ~ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N/,4 To building foundation On adjacent lots /~ .;~(~h/ Surface water ~///I Curtain drain ~/~ On adjacent lots .-f- ~-l~) ~ Propertyline ~'0 ~ To existing or abandoned system on lot Cutbank ~,///4 Water ma!n/service line Driveway, parking/vehicle storage area /5/ ~DO ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ / ~g) ' r_) ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 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 10, 1992 Eagle River Engineering P.O. Box 773294 Eagle River, Alaska 99557 SUBJECT: Northwood Subdivision, Class "A" Public Water System, PWSID 213001 Dear Sirs: 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: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 11, 1992. This does meet the provisions of 18 AAC 80.200(a) of the State Drinking Water Regulations. 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). 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 is acceptiable at this time. 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, Keven K. Kleweno District Engineer OOT-- .-2-- 92 FR I I 0 : I 3 GEORGE W I LMOTH P . 8 I CHeil. AB REF # CHEHICAL & GEOLOGICAL LABORATORIES OF ALASKA~ INC. *** Gamplee Received JUL 2 92 *** BPEC IAL INSTRUCTIONS: ORDERED .,~ ),~ VIA Client BPO: AIJKNOW/I nmF&il iklTSE"D '-"____ I CHU6IAK UTILITIE~ Req~ I ~lient PO ) NONE RECEIVED .... ~'''~EPORT~ s ?09 W INT'L AIRPORT RD PO Req,M ~ TO CLIENT ) CHUGIAK UTILITIES A~D. CONTACT PERSON ~ GEORGE WILHDTH REPORT~ BILLING ADDRE88~ ACCOUNTg PAYABLE 70~ W )NT'L AIRPORT ~D, M200 ANCHORAGE~ A~ HAND DELIVERED PWSID #21~001, #200 Chemlab Client Bample# 8ample Description Matrix Parameter Tested ...... ' ......... Method- ....... .'"'": ...... ',' "~" .... I ~ELL HOUBE I 50025 GROg~ ALPHA EPA 900,0 The above samples were received on JUL 2 92 and will receive the test as described above, as per your requmst. These samples will be disposed 30 days after completion of analysis unless previous arrangements have been made. For technical information call) 562-2343 A~k for Stephen Ede or Chuck Homestead, For turnaround time~ or status call~ 562-2343 Ask for Joyce Windebank o~ Gene Yonkin. ,-~,, MUNICIPALITY OF ANCHORAG~ ~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECT[ON~ M~CIP~I~ OF ~O~GE ~czon taG~ess (c) Applicant:s (ahe~ om) ~nding Institution ~; ~er~il~r ~; (d) ~ndi~ Institution ~lepho~ Address (e) R~al Estate Co. & AGent__ Address e e Te le phone Type of l~sidence Single-Family Number of Bedrocks Multi-Family O~er (~s~i~) W~te= Supply_ Individual Well ~ C~n~nity ~ Public ~ Note: If c~inunity mi1 system, must have written confirmation from the State Depa~r~nt of Enviror~nental Conservation attesting to the legality and status. Is the ~11 adequate fo~ the number of bedrocms specified in this' Fi~A (Y/N) ¥:~ Se wa~e Disposal Onsite ~----~ Public ~ Community ~ Holding Tapk r-~ Is the wastewater disposal system adequate fGr the number of bedrocms (Y/N) [Page 1 of 2] 2-15-84 Se Engineerinq Firm Providing Inspections, ~l~sts, Data and Information I certify that I have checked, verified, c~ confo=n-~d to all MOA HAA Guidelines in effect on the date of this inspection. ( ENGINEER SEAL) 6. DHEP Approval Approved for Approved ~ Disapproved ~--~ Conditional ~--~ Terms of .Conditional Approval The Municipality of Anchorage D~part~ent of Health and Environm~=ntal Protection dces not guarantee the continued satisfactory performance of the water supply and/o~ the wastewater disposal system. This approval indicates that, as of the validation date shown abo~, based on the data and information furnished by an engir~er registered the State of Alaska, the water supply and wastewater disposal system is safe and fun< tional fo~t the number of bedrccms and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the follcwing address.' KB2/d5/s [Page 2 of 2] 2-15-84 /_ / /3/--:. /? A® Well Classifi~cation C~/~fl~f'~/ Well Log P~esent (Y/N) Total Depth Cased to Static Water L~vel Casing Height Above Ground Electrical Wi=ing in Conduit (Y/N) Separation Distances'f =cra Well: To Septic/Holdin~ Tank cn Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected By Water Sample Test Results C~,,~nts . MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 pq. Vnd z_+, O flon 5, Tov thstq p ISN, g, cl r de Date Cc~pleted Yield Depth of Groutin~. Pump Set At Sanitary Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N) ; On Adjoining Lots · ; On Adjoining Lots TO Nearest Public Se~r To Nearest Se~ Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~-~ Size No. of Ca,~a~tments Star, pipes (Y/N) ~ Ai~-tight Caps (Y~/N) V~.~~ Foundation Cleanout (Y/N)~ Depression over ~ank (Y/N) ~ Date Last Pumped ----- Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High-Wate~ Alarm (Y/N) ---- Temporary Holding Tank Permit (Y/N)' Separation Distances f~om' Septic/Holding Tank: To Water-Supply Well ~ ! To Building Foundation . To Property Line'-~'~! To Water Main/Service Line Course ~ TO Disposal Field~'/~ To Stream, Pond, Lake, or Major Drainage COn~nts [Page 1 of 2] 2-15-84