Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
NORTH WOODS UNIT 4 BLK 18 LT 2
Onsite File #051-064-44 Municipality of Anchorage Community Development Department Pagel of 3 On -Site Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number. OSP191479 PID Number: 051-064-44 ❑ New ® Upgrade Name: CLINTON & ANDRIA HOLBROOK ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound Address: 23554 BLUE SKIES DRIVE, CHUGIAK, AK 99567 ❑ Other Phone: No. of Bedrooms: Soil Rating: Total Depth from origin de: 606-205-8115 4 GPD/Sq. FL FL LEGAL DESCRIPTION Depth to pipe Invert from original grade: F Grave plh beneath pipe: FL Subdivision: Block: Lot: NORTHWOODS UNIT 4 18 2 Fill added above original grade: C7 Greve1 length: �� FL FL Township: - Range: - Section: - Gravel width:Beds 1� FL Number of lines: Distance between lines: FL SEPARATIONDISTANCES Total absorpI area: Number of trenches: Dist. between trenches: To Septic Absorption Lift Holding Public/Private From Tank Field Station Tank Sewer Lines S4. Ft. FL Well N/A - - - 25'+ TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑ Other Manufacturer. Capacity. Surface Water 100'+ - - - GREER TANK 1250 N/A Gal. Lot Line 5'+ - - - Material: Number of compartments: HDPE PLASTIC 2 LIFT STATION Foundation 10'+ - - - Manufacturer. c Gal. Curtain Drain NONE KNOWN Remarks: 'Pump on' level at Pump otP level at High water alarm at 7Pumpke & Model, Electrical Inspections performed by. PIPE MATERIAL D3034 D3034 House to tank (FOR NEW) Tank to (FOR NEW) drainfield Installer D3034 WILCO EXCAVATING Drainfield EXISTING CO/MT (FOR NEW) Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 FL Inspection Location and Description: Dates: 1st 11/1/2018 2nd - 3rd - 4th - BOTTOM OF SIDING NEAR FCO ENGINEER'S SEAL Community Development Department Approval pF��°°° '�♦ ..��.�� ��'••: Conditional approval: Date: Y ♦♦ �.....:.... t ........ `....... = goo y .t..1��1.! ......................: ♦ A /1/J ♦ e arness c �v ��•f°_: ♦♦ ....� C 793 `� J, ♦� Approved: L� l n n <"r��' Date: �� 1 PP "ROF Ok ,� ! LICENSE \\\•�• EC #AC884 Inspection Report_1-1-12doc PERMIT NUMBER: OSP191479 RECORD D ill y V I 1 tl PARCEL ID NUMBER: 051-064-44 \ i \ i a) \ i � I � NORTH WOODS UNIT 4; BLOCK 18, LOT 1 \ I ^od I \ I \ I \ I NOTE: THE OLD SEPTIC TANK I \ WAS EXCAVATED AND REMOVED I APPROXIMATE LOCATION OF AND DISPOSED OFFSITE. I KEYBOX PER AS -BUILT SURVEY I I I I I m SUMP1 � O J I NEW 1250 GALLON w HDPE GREER TANK Y I INSTALLED DOUBLE U I A CLEANOUTS (DBL1 & DBL2) Olo- w w ' DRNl�WAY.. f '�:.•�.,., EXISTING 4 BEDROOM EXISTING TRENCH Z I HOUSE B o ® ' W y � I W I U) Q W W ata I � I r I SUMP REQUESTING 5 FOOT LOT LINE WAIVER A I B I C FCO 24.4 8.0 33.7 MH 32.9 20.6 38.2 STI 36.7 25.3 40.7 DBL1 37.6 26.7 41.8 DBL2 38.0 27.3 42.2 SUMP1 50.3 66.5 92.2 SUMP2 72.0 49.9 36.7 NORTH WOODS UNIT 4; BLOCK 18, LOT 3 GARNESS ENGINEERING GROUP, Ltd =-- - ENGINEERING o SALES o CONSULTING -- 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: www.gamessengineering.00m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLINTON HOLBROOK 606-205-8115 2 OF 3 PROJECT/LEGAL DESCRIPTION: DRAWN BY: NORTH WOODS UNIT 4; BLOCK 18, LOT 2 J.L.M. TYPE OF WORK: DATE: �, RECORD DRAWING OF SEPTIC TANK UPGRADE 11/5/2019 I I I I I I I I I I I N I I I SCALE: 1"=40' I STOCKHAUSEN; I LOT 5 I ■1�� �. ..L •.. ..�...... 0. ®% .. �0, . J ; amesswi r• C -79 3 0• ��AV e Fp ••.(Ar ...... . LICENSEe�klxk ESe���• O. #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP191479 RECORD DRAWING 051-064-44 TOPF M OH �,. CIAIAI CDAnG GARNESS ENGINEERING GROUP, Ltd ENGINEERING- SALES= CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 33&3246 • WEBSITE: v .gamessengineering.mm PREPARED FOR: CLINTON HOLBROOK PHONE NUMBER: 606-205-8115 PROJECT/LEGAL DESCRIPTION: NORTH WOODS UNIT 4; BLOCK 18, LOT 2 TYPE OF WORK: RECORD DRAWING OF SEPTIC TANK UPGRADE PAGE NUMBER: 3OF3 DRAWN BY: J.L.M. DATE: 11/5/2019 OF �1 •:�v ...... .....0 ..... .. ........................ 60 ) - r Cy J-7Garn ss ;� � = %' : �� • • �'��� 9: •: P OFE• LICENSE ,, o 1 ya\\S\\*� •• #AECC884 MCD MX Q LM 4% (A Z -i dry (CA 4m Pc, X -q m A 0 U) > m (n c: Vi M.. Ca z >* 0 w 52 r-2 8c BASIS OF BEARING Z9. ri OZ 0 z ZZ - V) z M M --';g 2 SOO*00'00"E 280.00(R) 279.90 z r) vl:c BLUE SKIES DR. -q M m COW S�o OMO 0 �< NOWWWE 120.00'( 2 v mm � r." - &I — — R&C) 5cz,m Uri z F— . .>.. ; i Z --i 4000K r-1 f 7 . L Lad F X -.4 M iN3VQSV3 3Vi t 0 Lm, 0 < c0 o: X -n ;u r- 00 LA ----------^-- m T OnEzo MFz. i M U) C) 0 m n Z Fnp =�i U),;) z Mz0 Cpm F 00 z 0 �mem to -,2vz Gn)!z -n > rri 0 M0,591sil -no >0 m a x X m 1 0 I co, _mom 8 Zj§ j OF a -V 00 a 0 Z ;OK > > HM 0� 0 M* r id -02.80 0 coz c= >� 0 0 :1 0;0 zzc z m U) 0 0 (n m Z:E 0 > C 0W r'17'± z 0 (A 0 0 z 0 z to XOP w C 0 > z Z;u 0 z m V) ,z,K z CA) 0 W Ct m 0 z > m IF- r, E U) -i M rri z z c: mm m z c -04 z 0 ;m E! 0– cs --n >0z 0 n z o 0 X z > m >;ar C m M 0 0 m ,0 Ln 30 : ; 0 r- C -11 z 0. 0 > > 3: m Ut m m > z 4z Fn 3! > z 0 C 4 0;0 co 1zz Wm M� om z A 0 > X z x x c > SOO'09'43"E 120.00'(R&C) 0 M., 0 M 6 z cill On -Site Wastewater Disposal System Permit Permit Number: OSP191479 Work Type: SepticTank Upgrade Tax Code Number: 05106444000 Site Legal Address: NORTH WOODS UNIT 4 BLK 18 LT 2 G:1460 Site Mailing Address: 23554 BLUE SKIES DR, Chugiak Owner: HOLBROOK CLINTON D & ANDRIA L Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft 01erlt S . M L f-, Department Total Bedrooms: 10/22/2019 10/21/2020 25391 ❑ 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 B) Issued By: to Z� 9 Date: Date: 4 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road s ` 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: OSP191479 Work Type: SepticTank Upgrade Tax Code Number: 05106444000 Site Legal Address: NORTH WOODS UNIT 4 BLK 18 LT 2 G:1460 Site Mailing Address: 23554 BLUE SKIES DR, Chugiak Owner: HOLBROOK CLINTON D & ANDRIA L Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft 01erlt S . M L f-, Department Total Bedrooms: 10/22/2019 10/21/2020 25391 ❑ 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 B) Issued By: to Z� 9 Date: Date: 4 MUNICIPALITY OF ANCHORAG Community Development Department Phone: 907• Development Services Fax: 907 - On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 051-064-44 9 70 ry0 pw� 4 };• A 8 LUIJ 7904 Property owner(s) CLINTON HOLBROOK Day phone 606-205-8115 Mailing address 23554 BLUE SKIES *CHUGIAK, AK 99567 Site address 23554 BLUE SKIES *CHUGIAK, AK 99567 Legal description (Sub'd, Block & Lot) NORTH WOODS UNIT 4; BLOCK 18, LOT 2 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: ( ® all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A 6 2 L TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: t�xs- Date of Payment: L Waiver Fees: 61 Date of Payment: Receipt Number: Permit No. W 9 Receipt Number: Waiver•No. (Rev. 01 /11) GARNESS ENGINEERING GROUP, Ltd ENGINEERING- SALES o CONSULTING -- October 1611, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for North Woods Unit 4; Block 18, Lot 2 To whom it may concern: The subject lot is served by public water and an onsite septic system. Per MOA records, the existing septic tank is approximately 34 years old. Per MOA memorandum, a septic tank of this age must be physically inspected and/or replaced prior to COSA approval. Based upon this fact, we are proposing to replace the septic tank. We are proposing to decommission the existing septic tank per UPC and install a new 1250 -gallon HDPE Greer tank rated for 10' burial. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have anv questions, please contact us at 337-6179. Thank you for vour 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: .(907) 338-3246 * Website: www.garnessengineering.com GEG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. BY PROCEEDING 1 FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE \ READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. \ WELL RADIUS DOES NOT ENCHROACH NORTH WOODS UNIT 4; BLOCK 18, LOT 1 \ UPON OUR LOT; SEE ATTACHED PUBLIC WATER PER MOA RECORDS AS -BUILT SURVEY wAPPROXIMATE LOCATION OF \ KEYBOX PER AS -BUILT SURVEY \ Q y I APPROXIMATE LOCATION OF EXISTING TRENCH co ! o 1 PROPOSED 1250 GALLON HDPE ! w WGREER TANK RATED FOR 10' BURIAL; D EXISTING SEPTIC TANK TO BE _ 1 DECOMMISSIONED PER UPC OR Y 1 HAULED OFFSITE; TANK TO BE 5' 0 DECK FROM DECK POSTS, 10' FROM THE FOUNDATION, AND 5' FROM THE DRIVEWAY EXISTING 4 •'r DRAINFIELD BEDROOM W HOUSE � p o Z I M T1 W I •:,: W 1 T w_ t U) MJ w W w 06 IPUBLIC WATER PER MOA RECORDS I NORTH WOODS UNIT 4; BLOCK 18, LOT 3 N ISCALE: 1"=40' STOCKHAUSEN; LOT 5 OF AV 0 ---- — — .' 14 Id �0 GARNESS ENGINEERING GROUP, Ltd �............�.......::.....; .....:......... `` — - ENGINEERING SALES o CONSULTING —___� 1 o 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907)337 -6179 -FAX (907) 338-3246'WEBSITE:www.gamessengineedng.com ••••••• ••• ••••••••••••••.•••••••••••••0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Vffft ey ,A -Garness FCLINTON HOLBROOK 606-205-8115 1 OF 1 jx CE953 ;' ?:Q a PROJECT/LEGAL DESCRIPTION: DRAWN BY:1 p I_ �'{•��� NORTH WOODS UNIT 4; BLOCK 18, LOT 2 D.J.G. 1� c4Q p'•••••••• P�, �� TYPE OF WORK: DATE: LICENSE PROFESS\��� DESIGN OF SEPTIC TANK UPGRADE 10/17/2019 #AECC884 1 ED.Z7m u� GIN -'z mix • p Sg y} ia "Mc x�zS'�*�' D N�Zuy�m.. C D o • -P '°T9 n z o c D o c 21 BASIS OF BEARING v � r�+ a ° ° • .� �,z � z nz� � o rn �0 °�� c 3r c � � 10 �F O �]�{ A�S00'00 00 E 280.00 (R) 279.90'(M) > c N c; cr CT `: e� uziz_ om<-�rnm BLUE SKIES DR. Ul ro ° ne 0 as y io XV'a N0o'00'00"E 120.00'(R&C) �d •° ro e� 0. M o zzEla.. : oDm�sovz 1N3w3Sd3 381 ,94;:. X I -uL3pon0S0C: -------------- — ---- --- m J Z z mU cziC!"N�i0 Om �7 w ` Z 2 z iTl D U) --I (n'OZC— b ciz-i �z Fri ;a V� .. ', � D vz CCOZz to >-i� prn -n a �rr+a 94. 0 cox m2 D< O m , t.;;.,:,.. 6ZZ vo--I M. Z�� Ll -n 0� CD �r�*m m 2t. �z� r n oDmc11 m _ r710 G0M r-0 ot�nr 1, 4 m zvMv,:A c�;o M:0 O-< ~ cope zR D m 'JNPi�3M ���r0M,;Zo,a �O n m Om6�r� i_�'� p O c� zzc.D.l Z GIEn --_u� `�e° m c (A� n to c Z sz .Z'sZ '_ Z a v ro a -coo me ©0 CA C � O bn Z -9t PL° 17'± z z Nro A .p z D to � _ � za� tno i�N� Oy �ro > -t? O (� j�< D 'm�l mzx �z wZ< x ��� m cn O 0=054- a' 0roz r.-, c-i� ��) Wr�i > v m o -moo ro m�rn rnm� V Q� 0 z m r • Ri D 0�" iK mCm C -4vF z Q o i� 1 co oc)C Z7 U? -0 !L i' o X v O m O [) Z'0l m :p z c Q p N r C0M°-10G7 zm o �-P, p m N p.Z�i 7 C m�_r-D y j Q oz l C o m C.) m R. TJo om OT D z�rn rr zz Ju :� — O 00 D<cJ -` >-0 vO CJi N fl p co:* Z Z = OLPJ Tt c 'q z cGs = N �7 PC)o -gyp II W >- � �z �i v D� W CJ rn CD O vX 0n _p. N '^� m 0 X I7 O u� .Z�7 .Z�7 m I°y m n m m 0 U) v m 00 0 V O p v ►� in m m � $ N z1-1 Z7z : � ui =Z a E, m a -IOM�RI f ul7Z M CN Y .� (n =n O D G7 �` O n Z C `n' r Q N�f'1 to M DO ,;u CO 3 N�'� G -<Z p X - X � Op � 0 �" a Z >z 0 m z S00ro9'43"E 120.00'(8&C) Cfl Q D ? 0 Gl > 4 mA c Q mn o C 0 z CAD ~ MUNICIPALITY OF ANCHORAGE ~-~ D~ ~RTMENT OF HEALTH AND HUMAN SEE ~ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address Phonets) Township, Range, Section LEGAL DESCRIPTION Subdivision ,.~. DISTANCES SEPTIC ABSORPTION TANK FIELD TANKS ~SEPTIC [] HOLDING Aaterial No. o Compadments TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER original grade ~l~ L~ FI ~ ~[0 d FT Grave~ length Gravel width FT - FT WELL LOT LINE FOUNDATION ( rtveway-'¢ aterbode$,e ~-AS'BU/LTDIAGRAMt(Sh°w ~ocation ol well, septic system, property lines, foundation, Total absorption area nstaller SQ FT Distance between lines t,~/' ~, FT Pipe material WELLS [] PRIVATE "~ OTHER I'ldentifv) ~~B,C) Total Depth Installe~ Date Installed: ET REMARKS: 72-013 (3/85) HEALTH AUTHORITY APPROVALS SEWER & WATER MAiN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER CIVIL ENGINEER 694-29Z9 December 15, 1985 MUNICIPALITY OF ANCHORAI3E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION BEC 1 6 1985 Municipality of Anchorage Department of Health anE ~uman Services 825 L Street Anchorage, Alaska 99501 RECEIVED ATTENTION: Susan Oswalt REFERENCE: Lot 2; Block 18; Northwoods Subdivision #4 At your request t~o test holes with monitoring tubes were installed for the purposes of monitoring ground water in the vicinity of the newly~-~ installed trench on the referenced property. Test holes were excavated to a depth of fifteen feet and no water was encountered. After several days the monitoring tubes at the end of the absorption trench were checke~ and found to be dry (house not occupied). The additional monitoring tubes were checked and also found to be dry. If we may be of further service, please contact us. SRB 196X EAGLE RIVER, ALASKA 99577 Address 1 Permll NO. No. Gl Bedrooms r~ MUNICIPALITY OF ANCHORAGE ~-~',~ DE~ ~,'TMENT OF HEALTH AND HUMAN SER~. JS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-S~TE SEWAGE D~SPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES SEPTIC AB$OFIPTION TANK FIELD WE _L f LOT LINE .~'"~ / ~ O LEGAL DESCRIPTION Subdivision AS-BUILT DIAGRAM tShow Iocahon Gl woil. sep[Jc system, property hnes. lo,mc ,,~, ,. driveway, water bodies, etc) TANKS ~,SEPTIC [] HOLDING TYPE OF SYSTE~ Depth tO p~pe bottom lrom ~ Total depth from original gr~de Fiji adOe~ above Ofl~lnAJ gra~e Gravel ~epth beneath pipe ~ FT ~ ~ FT Gravel length ~ravel w~th FT - FT Number ol hnes ~j~ P,pe materia~ WELL WELLS "~ OTHER ¢ldentifv) [] PRIVATE Class~flcahO.~..~B.C/ ]7oral Depth FT Cased to Fl' Installo [ Date Installed: REMARKS: Hea~ ttment Approval: Date: PERMIT NO,* DATE ISSUED: DEF'ART'MENT ~-~ HEALTH AND ENVIRONMENTAL ~OTECTION 825'~ STREET, ANCNORAGE, AK 99bdl 850344, 06/21/85 264-4720 APPL I CANT: ADDRESS: CONTACT PHONE: BALTIC BUILDERS P.G. BOX 774089 EAGLE RIVER, AK 688-3751 99577 LEGAL DESCRIP: LO'F SIZE: LOT LOCATION: MAX BEDROOMS: SUBDIVISI-ON: NORTH WOODS ~4 SECTION: ~ TOWNSHIP: 15N 55391 (SQ.FT. [IR ACRES) BLUE SKIES [)RIVE 4 LOT: 2 BLOCK: 18 RANGE: 1W Listed below are the options available to you in designing your septic syst. em. Choose the option that best fits your site. DEPTI~ TG PIPE BOTTOM (FT. GRAVEL DEF°TH (FT.) TOTAL DEPTH (FT.) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) GRAVEL VOLUME (CU. YDS. TANK SIZE (GALS) SOIL. RATII'4G (SQ.. ET'. /BR) 'T"RENf3I-t BED W. DR;~ I N 4.O 4.0 4.0 10.0 0.5 .5.5 14.0 4.5 7.5 2.5 51.0 5.0 80.0 ** 60.0 172.0 ** 77,8 68, 9 127.5 250..0. ~'~' 1,2750.0 ** 1,250.0 ** 597 307 397 '~'.~. GRAVEL. LENGTH > 75 FT', REQUIRES MULTIPLE RUNS (NOT' EXCEEDING 75 Fl". EACH) .~* T'ANK MOST' HAVE A'T' LEAST TWO COMPARTMEN"r's I certify that: :1.. I am Familiar with the requirements for on-site sewers and welIs as set ~opt. h by the Municipality of Anchorage (MOA) and the State o£ Alaska. 2. I will. install the ~yst. em in acc{~rdance with all MOA codes and negulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements fc~p the set.back distances Er'om any existing well, wastewater disposal system or public sewerage system on this or any adjacent' or nearby lot. 4. I understand that this permit is valid for a ma;.:imum of 4 bedrooms and any er!largement will require an additional permit. IF A LIFT STA'T'ION IS rNSTAL:LED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELEL, TRICAL..PERMIT AND INSPECTION MUST-BE OBTAINED; (2} AS-'BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPEC¢ION REPORT; AND (5) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. ...... OA, , AF:'F'L. I CANT: BAL.~BU I LDER~ ]: ~UI ]) EY DATE: 825 ' ' Street, Anchorage, AK. 950 .~/] * * * HANDWRITTEN PERMIT * * * Perm _ W.F~L AND/OR ON-SITE SEWER PERMIT Applicant: "~'~ q~o~u~-~ .-- ZaiZing Aaaress: {,a',~%ffI~,~ ,, Type of Soil ~sorption System Is: Trench: ~ _ Drainfield: Seepage Bed: _ Holding Tank: Maxim~ N~ber' of Bedrooms: ~... soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: DEPTH ~ LENGTH ..-~z~f GRAVEL DEPTH ~' W~DTH t~e bottom o~ t~e exo~v~o~(~ ~eet). ~be~e ~s ~o set ~t~ ~o~ ~ ~ REQUIRED S~PT]C(HOLD~NG) TANK SIZE = ~ GALLONS * ~" ~ T~O(2) INSPECTIONS ARE REQUIRED ~ ~ ~ Backfilling of any system without final ~nspect~on.and approval by this departm~ will be subject to prosecution. Min~ distance between a well and any on-site sewage disposal system is 100 f~ for a private well or 150 to 200 feet from a public well depending upon the typ~ of public well. Minim~ distance from a private well to a private sewer line is 25 feet and to a co,unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. are ' S Other requirement may apply. Specifications and construction diagr~s available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31~ i 9 * * i certify that: , (1) I ~ f~iliar with the requirements for on-site sewers and wells as 'set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3,bedrooms. Issued by: S igne'd: Applicant SWP/024 (1/81) Date: , "77/4 ':: '"~'~ , i~ ': MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST ~ISOI LS LOG ~""~PERCO LATION TEST PERFORMED FOR: LEGAL DESCR,PT,ON: 10¸ SLOPE - '~TE PLAN / / / / ! / / / 11 12 13- 14- 15- 16- 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUNDWATER ~ 0 [ ENCOUNTERED? O P E AT WHAT Gross Net Depth to Net Date Time Time Water Drop ALASKAN ENGINEERS AND SURVEYORS P.O. BOX 875144 · WASILLA, ALASKA 99687 I. (907) 376-3667 Bus. PERCOLATION TEST DATA FORM PERCOLATION TEST DATE: LOCATION:L~ ~ ~¢ I~ TEST HOLE NO.: [ PERCOLATION TEST BY: ~ DEPTH, INCHES SOIL TEXTURES . . · r . " Drop 'In Percola- Time Measure- Water tion Rate. Interval merit Level- Minutes rIME Minutes Inches Inches Per Inch REMARKS SOILS LOG ooq ~qlOS Municipality of An.cho—T On -Site Water & Wastp!r Pro ran) A <: (907) 343(177�G. 4 10;-��� ; m CERTI1`I64TE OF ON -SIT SYSTEMS APPROVAL' Parcel I.D. 051-064-44 Expiration Date: 1. GENERAL INFORMATION Complete legal description NORTHWOODS UNIT 4; BLOCK 18, LOT 2 Location (site address) 23554 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Current Property owner(s) Mailing address Real Estate Agent CLINTON HOLBROOK 23554 BLUE SKIES DRIVE, CHUGIAK, AK 99567 Day phone CHANELLE ADLEFPERGER / KELLER WILLIAMS Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 606-205-8115 719-651-2178 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ i Waiver/Variance request for. 1� dti�! `� v� Distance: S_ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. f&4 COSA Fee $ 14 5 - 4' '� '] /� 71- ' 2,52 Date of Payment 111-1;?-Iq Receipt Number oqsi?D6l COSA # OSG I " 1 1540 Waiver Fee $ ';)'9 --t 1 ':�5' 3W Date of Payment_I 1-1?1A Receipt Number e: 161 G Waiver # QSV 1110 1 -2- 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 Municipally of Anchorage and industrypractices. The repoded results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readilyidentifrable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on 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 systems. 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 aftemative well or septic system can be installed on the properly in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE J I/ S stem #1 A roved for / bedrooms By: Phone 337-6179 Date Lll'r"Or _`\11"®a_- 9AECC884 y pp System #2 Approved for bedrooms. \jY (OFllgn��r(i//' Disapproved. _` ON-SITE 61'� Conditional approval for bedrooms, with the following stipulations WATER AND m J WASTEWATER oz Original Certificate Date: /// /3 Z 1Y The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: C6 SA Checklist \ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10/12112) COSA Checklist Legal Description: NORTHWOODS S/D UNIT 4; BLOCK 18, LOT 2 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA PUBLIC WATER �drilled ith Onsite (or attached) D Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected / Casing height (above ground) r� Date of flow test for COS Static water le eginning of test ft. B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW X Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 5-31-85 X ALL standpipes present per record drawing Total measured depth from grade 15.5 ft (max) Measured depth to pipe invert from grade **5.1 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ASSUMED Parcel ID: 051-064-44 Structure served by this system 1 Well production at time of test gpm Water storage tank volume allons Well disinfected for rm test? ❑ Yes ❑ No ❑ Colifo acteria is Negative rate mg/L ❑ Nitrate less than MRL (ND) Arkenic ug/L ❑ Arsenic less than MRL (ND) Date of Sample C. LIFT STATION maintenance completed Age of lift sta lfibn years Lift station material Comments: Adequacy test date 3/19/18 Results ❑✓ Pass For 4 Fluid depth prior to test *`*45 it Water added —soo+ gal New depth "*"62 in Elapsed time 1350 min i`**43 bedrooms ❑■ Code -required soil cover over field Final fluid depth in Absorption rate "'soo+ gpd El System presoaked � (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: "SUMP/MONITRING TUBES APPEAR TO BE INSTALLED DEEPER THAN EFFECTIVE DEPTH. -INVERTS WERE NOT APPARENT. MEASUREMENTS ARE TO PIPE TRANSITION FROM SOLID PIPE TO PERFORATED PIPE. —SEPTIC ADEQUACY TEST PERFROMED BY MICHAEL N. ANDERSON, P.E. ON 3-19-2018. GEG, LTD. CHECKED LIQUID LEVELS IN BOTH SUMPS ON 11/4/2019 AND FOUND THE NORTH SUMP TO BE DRY AND THE SOUTH SUMP TO HAVE 54.75' OF LIQUID LEVEL. GEG DID NOT - �, ASSESS THE ADEQUACY OF THE DRAINFIELD. ��nt�Ly-� sG'�.3Z- Ste- 1 S tv v C_aZ _�� COSA Checklist yellow sheet /� ,� E. SEPARATION DISTANCES CONNECTED TO AWWU WATER Private Well on Lot to: (Please enter distances it less man require❑ or it community well) ❑r Septic Tank/Lift on Lot > 100' if No ft Community Sewer Manhole/Cie > 100' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes i ft Priv er/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft ing Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > IAnimal 0 Yes Contain > 50' ❑ Yes if No ft Yes if No ft El Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage _ Com ewer Main > 75' ❑ Yes if No ft ❑ Yes i ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑r Yes if No ft Surface Water > 100' E Yes if No ft Property Line > 5' v Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' El 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5+ ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS *REQUESTING A 5 FOOT LOT LINE WAIVER. G. ENGINEER'S CERTIFICATION o�OF / I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance withi MOA COSA guidelines in effect on this date. * 4 g,................ * 0 ef4 A. Go�ness,- -50 QO 9. CE— •,. �� 4 s •' ,/ CI •mac G COSA Checklist yellow sheetr �Q o ofessio oc #AECC884 400��0000 Municipality of Anchorage L)eparunent P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http:/Iwww.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: 0SV191092 PID#: 051-064-44 COSA#:OSC191540 Permit#:OSP191479 Legal Description: North Woods Unit 4 Block 18 Lot 2 Engineer: Garness Engineering Group Applicant: Clinton Holbrook Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. See engineer's waiver request for justifications. 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. ■.................s............................■■.............................1 Waiver is Granted: X Waiver is not Granted: Date: 1 1 / Approved by: Name of Reviewer **** VARIANCEMAIVER REVIEW **** • SGE U<i Municipality of Anchorage • On-Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-064-44 Expiration Date: 1. GENERAL INFORMATION Complete legal description _NORTHWOOD #4 BLK 18 LT 2 Location (site address) _23554 BLUE SKYIES DRIVE , CHUGIAK AK Current Property owner(s) _MARY LOU TRUST Day phone Mailing address _SAME 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: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: *M/ D- Date: y//4/7l41/ COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 917.11k CJ( 1oyG ) Date of Payment Receipt Number 2_23 1 11 Receipt Number COSA# (1-1-\ \\G‘t 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 MIKE N ANDERSON.P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON,PE Date 3/28/18 R.> �1 5 lC�Y 1 C 010 0 i°0 O�`°. .' f. 'If •49Tf 1.,,,:_i O°rl rr I' aect °o °o o a o v o o ao '+ 6. DSD SIGNATURE ' a (� c_" AI\.DERSCN °^�if: System #1 Approved for ( bedrooms. ri'%., C -9469 -;;;;•:" System #2 Approved for bedrooms. vtt I` �•- 711 .-.* `�'`' Disapproved. �Vb0. , u,EsSi`!t`' . yNVbey;N- Conditional approval for bedrooms, with the following stipulations: AlteA,0-, nerfCl< s S .pat.v� CSLp .� .x c 01% 71.- ii 1 P��N (-)\-- Mr h'O Q -v ..-, 1A-S\I Le <<‘ . • By. _) e ?" Original Certifice D'it&IER - o \NPry (CO r The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Sife%stem 9'COSAased only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State gf<R aska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. r C'P\1\ 7--'-1e 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheel_10-10-12.dac 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: PREUSS #2 BLK 2 LT 16 Parcel ID: 050-572-09 A. WELL DATA Well type A If A, B, or C provide PWSID#213001 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) 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 STEEL Date installed 5.31-85** Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N)Y Foundation cleanout(YIN)Y ./ Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping Il! $1/75 Pumper 12` b vik��►n�. C. ABSORPTION FIELD DATA Date installed 5-31-85 Soil rating (SF/BEDROOM) 397 System type DEEP TRENCH Length 99.5 ft. Width 2.5 ft. Gravel below pipe 8.0 ft. Total depth 13* ft. Eff. absorption area 1592 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3.19.2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 45 in. Water added 600+gal. new depth 62 in. Elapsed Time: 1350 min. Final fluid depth 43 in. Absorption rate >=_600g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES 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 TANK ON LOT TO: Building foundation /O'er Property line 5'+ Absorption field 5' Water main 10'+ Water service line 104 Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10 Water main 100'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 200'+ F. COMMENTS * TOTAL DEPTH A GUESS DUE TO MT HAS SOLIDS IN THE PIPE. ** STEEL TANK IS VERY OLD, THE MOA WILL ISSUE AN ADVISARY. G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and �t H review of Municipal records that the above systems are in ..•; 4 . •;• '1 ••••; , conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MIKE N. ANDERSON, PE / •* �•MICHAEL N. ANDLRSCN ..-7 i'' r ., Date 3/31/2018 ��81W£p• ��' 69 K���f • st, COSA canary sheet_2-6-15.doc r i - \ 0E1 r I (� uQN�pGG,.I r { ' .. :,...,.:,. ..H.I ••-• • a ts.& t I . ' s9=S6 P:,� g —7 G ou t 4)-m 3" j' • t. • ��/ o" ISI/`/. . `,-4 ` . � \ •. • ',i 1 1,-. a ,• iA Yo r 44 • ' }( • s -V' \ ' h N1O \vV { 11 I \ i o 1 N T , `'-- 1 • le • ASBUILT-NO CORNERS SET THIS DATE. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' .10,010%%‘‘‘14 FOLLOWING DESCRIBED PROPERTY: 4.4%, OF A it* ,1/-' 7",%.t,/.:,.-,: - _r- ...,7i17i2--- /07-- zx�'' DATE: w ....,' tS e AND THAT NO ENCROACHMENTS EXIST EXCEPT AS ,/ .52,--- --;,,,-:;., e•R ..T ,`� -.:f- 4 INDICATED. IT IS THE RESPONSIBILITY OF THE s *'; !✓V / X6 OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: 0 '" •$ EASEMENTS, COVENANTS, OR RESTRICTIONS ✓f.�----;.'----25-,::; 9� ,1 EASEMENTS, . �; .' WHICH DO NOT APPEAR ON THE RECORDED SUBDI- #j Duane Merk Se are 1 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ` �'•.. tS-b9 �i;` � ANY DATA HEREON BE USED FOR CONSTRUCTION �tt3,�.'^i •��''`'_ 4" OF FENCE LINES, OR FOR ESTABLISHING BOUND- �% $\-;,�" ARY LINES. DRAWON`%J �aEaam,*•ts MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 2; Block 18; Northwoods Subdivision Location (site address or directions) 23554 Blue Skies D_rive Property owner Re,., ~wc. nmb Day phone 509-466-2089 Mailing address 6903 East Weile, Spokane, Washington 99207 Lending agencY Mailing address Day phone Judy Olmstead/JACK WHITE COMPANY Agent Address 10928 Eagle River Road, Eagle River, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 \/ TYPE OF WATER SUPPLY: NOTE: Day phone 99577 694-5500 Individual well Community well ××× Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA #21 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 S& $ ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Ea-.!e ~.iYer Alas.~a 99577 Engineer's signature Date DHHS SIGNATURE ~/,// _~._ Approved for / Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date//¢./¢//~ ~.__ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. Legal Description: ~ ~ 1~-~-- t ~ A. WELL DATA Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system n'umber Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATI ON DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTI ON REC£1V£D .MuPlnipa~itY of Anchorage Dept. Health & Human Services ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed z~'~t '" ~ Cleanout~/N) ~/t High water alarm (Y/N) Date of pumping Tank size \~'Z"~:~ ~ Compartments Foundation cleanout~N) ~ Depression (Y,~ Alarm tested (Y/N) ~ ~ 'Z--~. - ~ 2,- Pumper .~._~_._x ~_~ SEPARATION DiSTANCIES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '/~ /k On adjacent lots ~ I '7b Foundation TO property line ~ C~ '~ AbsOrption field \ o ~ ~ Water main/service SUrface water/drainage .~, ~ t .~ 72-026 (Rev. 7/91) Front , CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at ManUfacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LiFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ ~"~ Length <:~ '~ Width Total absorption area Depression over field Soil rating ~"7 '~'~'~--System type Total depth Gravel thickness ~:~ { Cleanouts present::[~N) Date of adequacy test for ~ Result;,~;~_ fail) ~'"'~,~,.,.~ c.~ Peroxide treatment (past 12 months) (Y/<~ I~C)~ If yes, give date bedrooms SEPARATION DISTAI'~CE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~c>~ '~ Cutbank Surface water On adjacent lots Curtain drain /~JO/J~ Property line To ex)sting or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area. E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date S & $ ENGINEERING 17034 Eagle River Loop Road No. 204 E. agie River, Alaska ~577 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 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 21, 1992 Mr. Roger Shafer S & S Engineering SUBJECT: Northwood #2 Class "A" Public Water System, PWSID 213001 Dear Mr. Shafer: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on September 10, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on August 9, 1990. This does not meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations; however, it is conditionally acceptable at this time. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on June 2, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu I ~ MUNICIPALITY OF ANCHORAG~ MUNICIPALITY OF ANCHORAGE (MO~i DEPT. OF HEALT~ & ~N~II~)NMENTAL PROTECTJOI~ HEALTH AUTHORITY APPROVAL [HAA) CHECKLIST- FEBRUARY 1984 [JEC (} ~ ~, 264-4720 WELL DATA Well Classificatio~:~#~a~'g'~'~'/' ~'~"-If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Corn plated ~ Yield Total Depth Cased to Depth of/Grouting 1 Static Water Level Sa~:tU:yp::: In Casing Dep~ Casing Height Above Ground ](yN) / Electrical Wiring in Conduit (Y/N) ~on Ar/3und We~ead (Y/N) // Separation Distances from Well: To Septic/Holding Tank o~ Lot '-'~,% On ~djoirfFSg Lots jo/n i n, Lots on Lot To Nearest Edge of Absorption fie~n Lot ,~ ;O: To Nearest P~blic Sewer Line / _~.X~TO To?eare. Sewer Water Sampte~Collected by ~ ~: ~;Date Water Sample Results / Comments B SEPTIC/HOLD G TANK DATA Standpipes (Y/N) Depression over Pumping/Maintenan( Holding Tank Separation To Water-Supply To Property Line To Water Main/Service Line Course .~' __ Air-tight (Y/N) ,~ Contract on File (Y/I · Alarm (Y/N) Lnk: Compartment Date Cleanout (Y/N) ? : for Tank Permit (Y/N) -'~ Foundation Field /4~ To Stream. Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~.~¢7 /¢~ :2.-~~ Type of System Des,gn,J~'/,A/~ . D~e Installed ~ /¢~ ~ Length of Field Width of Field ~,~ ~ ' Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area /'~"'""¢~-""-- Depression over Field (Y/N) Results of Last Adequacy Test ,/'/~/'/ Separation Distance from Absorption Field: To Water-Supply Well ~----------------~,~'. ~r/~z~/7'~ ~--')~¢"~'~--"~%- To Property Line To Building Foundation Lot .,'¢~,~,~-.. ; On Adjoining Lots To Water Main/Service Line /'/7 ¢' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ,.;~/,¢~:~ To Driveway, Parking Area, or Vehicle Storage Area ~'c¢ '~ To Existing or Abandoned System on Comments LIFT STATION Date Installed Size i~ Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments "Check/. / Bedroom.~g Against HAA Request'* I certify/ha~e.C~,~eCed.~r conformed to all MOA and HAA guidelines in effect on the date of this ,nspection. Compan~~ ~ ~ MOA No. ~'~%~ Receipt No. ~ ~ qt ~ . . Date of Paymen[ I ~--~-~ · ¢ Amount: $ G ,¢~ ~' 72-026 (11/84~ Page 2 of 2 (c) MUNICIPALITY OF ANCHORAGE ~'NT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH TIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name~.--'~ ~ Applicant Address ~'- ~)' ~/~ Applicant is (check one): Lending Institution []; Owner/builder,[~; Buyer []; Other [] (explain); Telephone: Home Business Lending Institution . Telephone Address (e) Real Estate Company and Agent ;;~,~/~..4.,~ ~ - Address - ~ ~/--'<E ,~ U"~,~''~ ' Telephone ~ ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,J~ Multi-Family [] Number of Bedrooms F Other 3.. WATER SUPPLY Individual Well [] Community [] Public'~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality aha status. 4. 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. Page 1 of 2 72-025 (~1/84) 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 investigation of this 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 corn pliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date .:..~ Telephone Approved for ~"~Z.¢'.~ bedrooms b 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 restitutions 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 ~ MUNICIPALh~' OF ANCHORAGF: DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ~NVIRONMENTAL PRC, TECT[ON HEALTH AUTHORITY APPROVAL (HAA) o 4 I985 CHECKLIST- FEBRUARY 1984 264-4720 WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level A Cased to If A. B. C, D.E.C. Approved~N) Date COmpleted Yield Dej~th of Grouting / Pump Set At //,,~anitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/J:L~,e~g Tank o~ Lot '~--~ ~ To Nearest Edge of Absorption Field on Lot ~ ~-~' To Nearest Public Sewer Line Cleanout/Man hole Water Sam pie Collected by ; Date Water Sample Test Results Comments B. SEPTIC/J:LOE-Bff~rG TANK DATA Date Installed ~"/-'~"J¢ ' ~2J~'Size |~O No. of Compartments '~' Standpipes~C~N) Air-tight Caps ~N) Foundation Cleanou¢~/N) Depression over Tank (Y/,.I.I.I.I.I.I.I.I.I~) I~ ~- Date Last Pure ped for Pumping/Maintenance Contract on File (Y/N) ~-~ / Holding Tank High-Water Alarm (Y/N) /~ Tern porary Holding Tank Permit (Y/N) Separation Distances from Septic/,~ Tank: To Water-Supply Well To Property Line TO Water Main/Service Line~ Course To Building Foundation /'~ To Disposal Field To Stream. Pond. Lake, or Major Drainage Comments Page 1 of 2 72-026,11/84) ABSORPTION FIELD DATA 7-x2 , I_ Soils Rating in Absorpt on Strata,._~ ll~/~'~ T pe of S stem D. esian Y Y_ _ ~-. Date Installed ~ -~ ~ ¢~ Length of Field Width of Field ~ ~ Depth of Field '~..-I'~;- ~---~-~-. Gravel Bed Thickness Square Feet of Absorption Are{ I ~ ~ Standpipes Present ~N) Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation, Lot ~ ~ To Water Main/Service Line 1, ~ ~ .1~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area pate of Last Adequacy Test To Property Line I To Existing or Abandoned System on ; On Adjoining Lots To ~utbank (if present) Comments 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) "Pure p 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. Date MOA No. Signed Receipt No. Date of Paymenl Amount: Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL'CON§ERVA?]ON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, C~OVERNOR Telephone: (907) Address: 274-2533 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~e Drinking .I Water Regulations Sincerely,