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WYNTER PARK #1 BLK 3 LT 10
Wynt r Perk lock Lot 10 051-492 -39 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201325 PID Number: 051-492-39 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Ryan Campbell & Virginia Peterson ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20845 Frosty Drive Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 230-5635 4 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Wynter Park #1 3 10 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5, N/A N/A N/A NA . Foundation *7.3' N/A N/A N/A LIFT STATION Manufacturer Capacity Remarks Tank only permit. Verified 5' separation between Gal. tank and field at construction. *See profile page. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Eagle Glacier Excavation Drainfield Existing CO/MT D3034 Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft Inspection 1st 9/1/20 Location and description dates:2 nd V 4th Bottom of siding @ point A. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 4�®®al� ® OF k� Conditional Approval: Date • ��Q' • ' ' , cS,�. STM•`9�� r Septic Systemr Approved Date Z zk �••• Benla in Schiller •.o, 4♦�j �,,••• CE12592 1�F� . 3/10/21 • ® �k�� PROFESSIONP® Note: this approval oes not include well permit requirements. kr-,UV voiuu 1 o/ WYNTER PARK SUB #1, BLOCK 3, LOT 10 PERMIT # OSP201325 PID # 051-492-39 LOT LOT 16 f ENGINEE0.ING Q9 T BenJ 'ar7fin Schiller CE 125923/10/21 w� ' LOT 9 '% WATER SERVICE. LOCATION NOT EXACT. FOUR BEDROOM HOME B ^ SV FCO EXISTING SEPTIC TANK J �2CO • ° MH REMOVED PER U.P.C. f \\\\\\ NEW 1,250 -GALLON SEPTIC TANK W/20" MANWAY EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. LOT 1 /— 15' DRAINAGE EASEMENT ' LOT 12 A ' B PLAN AS -BUILT FCO 23. 6.8 MH 23.5 22.0 SV 21.7 26.6 2C0 21 21 29.4 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE 1"=3' PERMIT # OSP201325 PID # 051-492-39 WYNTER PARK SUB #1, BLOCK 3, LOT 10 FEET 0 3 6 FOUNDATION TO TANK SLOPE PROFILE 4/6/21 7.3' 7.8' 100.0 (BENCHMARK) 91.5 I N F L U E N C E L I N E 1 1 CD CD r M A �w (n rppi D O�.0) .. j wo •.^ g• �/�0 O _ � m m2 0<n- wD,xc2 -ice I-.WAcMm mmmo<A -�OAiO-fnm ?z�omzZ<O N Z Z N x a O° �m0 tniDr� CC 2 jO Det V/D �.t O imcmi=a i mm0f00-at NOOZSOT.- zom 2 OE,myS�m oo=ym Zm zm�o paz -0°StiO >-M, A�00 Zm y ijr.t A x 2 Ov1 2 m m <Dmo Oa mzmw=� Mm0;0 mmz jtn ZO NZDZNpo y0 _ I22mm:-o moo O z m in 0 00 ym xz m w '0 O z N 0 ti ° iA Zm O A m O o= m m v �> '0mD Z <m r z z N A FROST S2S�9 � � �R m s'w ��00• �� m r 5 �- �2 0 A r- (n rppi D O�.0) .. j m 'N n _ � O m .. m m .. c m I /r � O C�l �C \ z ° ° y o o � \ \ \ \ S r- zm Z O M 0 r F- U �N Z \\ \ O N D0 C t0 n o \ 33• \ x \ c z m c\ ' \\� -- m r r A o -4 D Z 7�.1 m 'N n _ � O m .. m o A x 0 A S D Z 7�.1 -, m O n v D O m .. m m .. c m �?g a � O v fzo �m m o z z ° O 0z y z O �� S n 0 m� a I m= O� x c m m °o Z r J Z =MT m _I m ° x nZ WO o0p mw O_ .. NJ 0p Opo W /Z^\ UJ :EN m - z0 O D lJ °ZOc n� O moon HCl, z 0 Sl >-z� w _ a� C D c, 20 Z -D --I 0Om DD Z O�z �� U) mz=k_ -4 O C �Mc7 W z ;o M m -P0 z M � \ v .� X D v D v m v m �?g a � O v fzo �m D m 0 c NNS e o r Sl >-z� w _ a� C D c, 20 Z -D --I 0Om DD Z O�z �� U) mz=k_ -4 O C �Mc7 W z ;o M m -P0 z M � \ MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201325 Work Type: SepticTank Upgrade Tax Code Number: 05149239000 Site Legal Address: WYNTER PARK #1 BLK 3 LT 10 G:1361 Site Mailing Address: 20845 FROSTY DR, Chugiak Owner: CAMPBELL RYAN L 50% & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: c n C o J Departill ell t Lot Size in Sq Ft: Total Bedrooms: 8/24/2020 8/24/2021 21624 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Locate the beginning of the trench prior to installing the tank to confirm that the required 5' separation is being met. Received By: Issued By: Date: Date: le -2 3 8/24/20 MUNICIPALITY OF ANCHORAGE Community Development Department = Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-492-39 Property owner(s) Ryan Campbell & Virginia Peterson Day phone 230-5635 Mailing address 20845 Frosty Drive Chugiak, AK 99567 Site address Same Legal description (Sub'd., Block & Lot) Wynter Park #1, Block 3, Lot 10 Legal description (Township, Range & Section) Lot Size 21,624 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 19 Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. '4'j'Z E,0" (Signature of property owner or authorized agent) Permit/Rush Fees: 4 1�8' 7 5 (uv) b -1 I Date of Payment: g 18 0,20 Receipt Number: Permit No. 6 Permit App__- : - bba'rs6 SP2D1325 iver Fees: Date of Payment: Receipt Number: Waiver No. PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 18, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Wynter Park No. 1, Block 3, Lot 10 – 20845 Frosty Drive Well and Septic System Design Dear On-Site Services Engineer: The septic tank on the subject property has passed its useful life and must be replaced. We are submitting this application for a permit to construct a new septic tank. The attached site plan identifies the location of the home and the proposed and existing septic tank sites. No conflicts exist between this proposed tank location and any other well or septic system, whether on this lot or adjacent lots. The new septic tank will be placed at the same location as the existing tank. Very little area is available to provide the necessary separation to the new tank from the house foundation and the existing absorption trench. The new tank will be placed a minimum of 5’ from the house foundation and outside the 1:1 soil density influence line. It will also be 5’ from the existing absorption trench which will remain in service. This lot is served by a public water system. The new tank will be a minimum of 200’ from all wells and 100’ from surface water. Storm water drainage will not impact this site. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 8/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201325, Deb Wockenfuss, 08/24/20 // // // // // // //FOUR BEDROOM HOME 1"=50' DECOMMISSION EXISTING SEPTIC TANK PER U.P.C. PLACE NEW 1,250-GALLON SEPTIC TANK w/20" MANWAY AT SAME LOCATION. MAINTAIN MINIMUM 5' SEPARATION FROM HOUSE FOUNDATION AND EXISTING ABSORPTION TRENCH. NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON COMMUNITY WATER SYSTEM CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND WYNTER PARK #1, BLOCK 3, LOT 10 F R O S T Y DRIVE8/24/20 FEET 0 50 100 SHED DECK 15' DRAINAGE EASEMENT10' UTILITY EASEMENTEXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. WATER SERVICE. LOCATION NOT EXACT. NOTE: LOCATE BEGINNING OF TRENCH PRIOR TO PLACEMENT OF TANK TO VERIFY 5' SEPARATION. PLACE CLEANOUT AT BEGINNING OF TRENCH. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201325, Deb Wockenfuss, 08/24/20 1 1I n f l u e n c e L i n e 6' 3.5' BLOCK 3, LOT 10 WYNTER PARK#1 FOUNDATION TO SEPTIC TANK WAIVER SCALE 1" = 3' 97.2 100.0 .5' 8/24/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201325, Deb Wockenfuss, 08/24/20 MUNICIPALITY OF ANCHORAGE DEPARTMEN'r OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SI~S.~F..JI~A.G~E qlSPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~' --~-~---~ JM~ . - / IPHONE I ~NEW ~~s-'/' . ~. ~- ~ ~ ~ LEGAL DESCRIPTION ' '~ ' ' Liq. IF NOMEMADE: ! Inside length ~idth Liquid depth Manufacturer ~]/ ] - ~Material ca~acitv in gallons Top of tile to finJsl gr/~d..tL ff ( ~a~sprption area inches Type of crib DISTANCE TO: Class CO DISTANCE TO: foundation Crib depth Total effective absorption area Building foundation Nearest lot Uno Distance to lot line Sewer line Septic tank ::sRo rMit~o~iea (s) OTHER PIPE MATERIALS _ ,, . ? 72-01 DATE LEGAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18- 19- 20- WAS GROUND WATER IE YES, ATWRAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE {minutes/inch) COMMENTS TEST RUN BETWEEN FT AND FT ,BRFORME SY: L, CERTIFIED BY: da/A~lO,,'~ L, /-"7"~0~']/¢~ DATE: 72~008 {6/79) QGRE/ 'ER ANCHORAGE AREA BOr Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 "JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACT, RER ~'H~<¢/L l/~/,'~ MATERIAL ~' COMPARTMENTS / INSIDE WIDTH .LIQUID DEPTH .LIQUID CAPACITY //~) GALLONS. SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL BUILDING FOUNDATION_ ADDITIONAL ABSORPTION O,AMETER_q¢ OR W,DTN/: LENGT'-'/2: DEPTN U' CRIB SIZE: DIAMETER ~ IDEPTN ~ ! DISTANCE FROM: WELL NEAREST LOT LINE ~f TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE LOT LINE SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: APP R 0~.//G.A.A.B. ¥ f, F'ERMI "F NO. [:,EPFIRTMEI",FF r..IEFILTr-I FIi'.,ID EI'.4',,,'Ir?.'.r]NMEI'.KI'FIL. ".OTECTION 825 '"L.'" STREET., F:ff4CHORRGE, RK. 99601 26,~$-.4720 RPPL I CRNT L. OCFiT I ON LEGFIL.. PEI:'ER SMITH SRFI BO,':':', 4.9?5 FROSTY DF.: L. OT 2.0 BL.K 3 I,,I"r'N]'ER PFIF'.K ~i LO'I" SIZE 9999'S~9 SQURRE FEET 'T"¢F'IE OF SOIL. r:iL::SCIF..'PTZON SYSTEM IS: TRENCH MFI::.::IP'IUM IqUP'IBER OF' BEr::,ROOHS = 4 SOIL RFI]"ING ,::SQ FT,..'BR)= ::1.25 THE REIi!I. JIF..'ED SIZE OF: 'TIDE SOLE.. FIE:SORF'TION SYSTEM IS: THE L..EI'.,IGTr*t DII','IEI'q:SIOIq IS THE LIEN[~'rl4 ,:.'IN r:'EET::, OF THE TRENCH OR [:,RF:IINFIEL[:,. THE [:,EPTH OF FI TREI'.,I[::r..I (:iR PI']' IS THE [:,ISTr:INCE [3ETHEEN THE SrJRF'FICE OF' THE GROLIN[:, Fllq[:, THE BOTTOM OF THE EXCF~',,,'FFI"IOI'.4 (I1'.,I FEET). THERE IS I'.,I0 SET I.,~]:l::,'f'l..I FOR TRENE:I..E~S. TFIE GRRVEL. DEF"TH IS THE MINIHUM [:,EPTH OF' GRRVEL E:ETHEEN THE OUTFFILI_ PIPE RIqD THE BO'rTOM OF ]'FIE E::.::C:FI',,,'FITION (IN FEET). F'ERMI T F~I::'F'L I C:RI'.,IT HFIS Tr-IE RESPON'F.,II31 L. I T'¢ TO INFORM TH I S DEF'RRTMENT BUR I NG TFIE: ZI'.4ST'RI_I_FtTION INSF'EC:TIONS OF FIN'¢ HE:LLS FII%J'RCENT TO THIS F'ROPEI:~:T'¢ RNC, Tr.rE i'.,ILtMBER OF RE'..SI[.':,EI'.,ICE':; THRT THE NEI_L 1.4tLr... SERVE. ............. 'T ~...fl u]:::ll .:: ;;L-%" ;:, ][ II"qt Si; F" E C: T 3: C~ N '-"~i~; ~'-:i [;:?.' E: ~: IF_-:..-: C-.--.~ LJ ): F~i:'. [-:£ Ir.;:, ................... BI:ICKFILLING OF Rl",l"r' SYSTEM r,.IITHOUT FINRL INSPECTION FINE:, RF'PRO',,,'RL B'¢ THIS DEF'F~RTHENT HILL. 13E SUBJECT Ti:) PROSECUTION. I,]INIMUH [)IS'T'FINCIE BETHEEI'.,I R F.IEL. L FIND FrI'.4Y ON-SITE SEI4FIGE DISPOSRL SYSTEM IS :~E~Ed FEET F'OR FI F'I:~:I',,,'FITE HELL OR ::L50 "r'A 2Ii[El FEET F:F.'.OM FI F'LIE:L. IC: HELl_ [:,EF'EN['.,ING IJF'ON THE T'~'F'E OF F'LIE:L. IC HELL.. HII'.,III'IUM [:,ISTRNCE FROM F! PRI',,,'RTE 14ELI_ TO FI F'RI',/RTIE sEr,.IER L.:rNE IS 25 FEET FIND TO FI E:OMMUNIT'¢ SEHER L. INE IS 75 I'u':EET. OTHER REg!UIF:E'MENTS MFt'?' FIF'PL'¢. SPECIFIC;RTIONS RNI::, CONSTRUCTION DIFIr.~iF~'.RI'd::$ RRE FI',,,'R I LF:IB[...E TO I IqSrJRE F'ROF'ER I I'.,ISTF:I[...LFIT I OIq. I CEF'.TIF'¢ THFIT t: ]: RM FFIMILIFIR HITH THE REQUIREf"IENTF:; ['"OR ON-SITE SErqERS RND HELLS las SET FOF:TH B'¢ TFIE HUhliCIF'F]LZT'¢ OF FINCFIORFIGE. 2: I HILL. ZI'.,ISTF]LL. THE S'T'STEH I1'.,t FICCOR[:,RNCE I,.IITH THE CO[:,ES. :g: I UNDER'.~;TFIN[:, THFFr THE OI'.,I-SITE SENER S'¢STEM I',IR~' REQUIRE ENLRRGEMENT IF THE RESI[:,ENCE IS REMOE:,ELE[:, "ro INCLU[:,E MORE THRN 4 BEC, ROOMS. ~~ F'EF'ER SMI TH , . __ ., . .,:.. .... GEOTECHNICAL 8' DEVELOPMENT CO. Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Ear/Ellis 694-2774 688-2280 Soils ~ Foundations Land Development SOIL LOG Perfomed for: Name:..:"~P/z//~/.~ ~/22E/~,'~- ~--~¢~/~//v'C, Te]. No,.. Hailing Add~ess:~x ~J~ ~Z~/Z ~ ~ ~/~/~/<~ :~. Legal Descriptton:~ ~, /_o~ /~ , ~/~& ~j~/~_ .~, De=g~_t h~.fe, et ) 0 g 10 'Il 12 Ground Water Encountered: Proposed Installation: Seepage Pit__._~Drain Field_ Comments: Yes_~ No ~/~ If yes, what depth_ Perfoemed by: Certificate of On -Site Systems Approval Parcel I.D. 051-492-39 Expiration Date: 5-- 23 2 2 1. GENERAL INFORMATION Complete legal description WYNTER PARK #1 BLOCK 3, LOT 10 Location (site address) 20845 FROSTY DRIVE, CHUGIAK, AK 99567 Current property owner(s) RYAN CAMPBELL & VIRGINIA PETERSON Day phone Mailing address Real estate agent 20845 FROSTY 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: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well "A" ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 550 Waiver Fee $ Date of Payment HID �0Date of Payment Receipt Number 1 10 1 a.o COSA# OScaa1 Q&9 Receipt Number Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9,,,,, Address 13030 SUES WAY, ANCHORAGE, AK 99516 `�`�\"�Y ©F ��ii� Engineer's Printed Name CURTIS HUFFMAN, PE Date 22UN 5— - Comments: This investigation was completed in compliance with MOA guidelines, regulations, _� A-SITND �'� and best industry practices / methods. The assessment of the condition of the well and septic WATER _ applies only to the conditions as of the day tested. The flow and absorption rates may change y W,qs` j (_' v'l, r TE ff] due to subsurface conditions that may not be observed from the surface, changes in land use, : G R Z -� local soil characteristics, groundwater levels that may fluctuate during the year, quality of �� PROG construction (workmanship & materials), the water usage of the family being served by the .� R A� system and maintenance. The operational life of all well and septic systems are subject to �`� o these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ��p'• • • • • �)} V�C'���1,,, for current or future occupants or guarantee that no unseen encroachments, deficiencies or Q9.'• ) })�lll discrepancies exist can be given by First Water Consulting & -49 TH 6. DSD SIGNATURE Curtis Huffman- /'- System #1 Approved for _Y_ bedrooms ����Fc�� •, • CE 128991 • •,w��®'`'� TFC • .Q/9/2� . • F� System #2 Approved for bedrooms �l>i�ROFF�SSI* Disapproved Conditional approval for bedrooms, with the following stipulations: BY IM �� Original Certificate Date: (0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: WYNTER PARK #1 BLOCK 3, LOT 10 If more than 1 septic system on lot: COSA Checklist # _of Parcel ID: 051-492-39 Structure served by this system _ A. WELL DATA - PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Well production at time of test _gpm .-Date-drilled- _. Water -storage- tank volume ----gallons--- - Total depth _ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate _mg/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) _in. Collected by_ Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tanks) 2 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank 58" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/23/2022 "1 D. ABSORPTION FIELD DATA Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: NEW HDPE ST 9/1/2020 Which system tested (date installed) 9/17/1983 Adequacy test date 5/23/22 ® ALL standpipes present per record drawing Results El Pass For 4 bedrooms Total measured depth from grade 11.3 ft (max) Fluid depth prior to test 1 in Measured depth to pipe invert from grade *5.2 ft (min) Water added 600 gal ❑ N/A - pressurized field New depth 9 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective *APPDX. 6XED OF Will ED Elapsed time 25 min ® Code -required soil cover over field Final fluid depth 1 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date NES Comments/Deficiencies: MT AT GRADE. *BASED ON DCO / MT ELEVATIONS. .,. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑ Yes if No Septic Tank/Lift Station on Lot > 100' Surface Water > 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ® Yes ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft - Neighboring Absorption -Fields >-100' -- - --Animal Containment > 50' - ❑ Yes -if No - ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community 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 *7+ ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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 ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER RECENT MOA IR DOCS. G. ENGINEER'S CERTIFICATION I certify that I have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. _-Al _dq lk Curtis Huffman f CE 128991. . � k�ROFESS OOO,r�,.o N\`i�0'a� WYNTER PARK SUB #1, BLOCK 3, LOT 10 . PERMIT # OSP201325 PID # 051-492-39 j LOT 8 LOT 16 LOT 9 WATER SERVICE. LOT 15 .` LOCATION NOT EXACT. [[„ - FOUR BEDROOM HOME ID QI I DECK B j / — SV FCO EXISTING SEPTIC TANK' f CO • ° MH REMOVED PER U.P.G. NEW 1,254 -GALLON SEPTIC LOT 14 j TANK w120" MANWAY LOT 10 ~ 13EXISTING A ORPTION TRE REMAIN !NJ~� SERVICE. /o 'f 5' DRAINAGE EASEMENT LOT �q- i 1 �.q 6 _Zd LOT 12 1 � A ' B lNGIN / FCO 23. 6.8 MH 23.5 22.0 SV I 21.7 1 26.6 2C0 1 2112 1 29.4 LEGEND PLANAS -BUILT CO- DOUBOLE CLEANOUT .49 *; FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE 0 50100 MH -MANHOLE MT- MONITORING TUBE B a in Schil El 592 `� �� FEET I �r ' • . 3110/21 • . �� 1N =50 TH - TESTIHO ENT • / t r Municipality of Anchorage 0 - i i- On-Site Water and Wastewater Program (907) 343-7904 s A E TY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-492-39 Expiration Date: , ?"--2 1. GENERAL INFORMATION Complete legal description WYNTER PARK#1 BLOCK 3,LOT 10 Location (site address) 20845 FROSTY DRIVE,CHUGIAK,AK 99567 Current Property owner(s) KIMBERLY ISLEY Day phone Mailing address 20845 FROSTY DRIVE,CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 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: Date: `V /t COSA to be released to the er,unless otherwise requested by the engineer. COSA Fee $ 5a Waiver Fee $ Date of Payment 131 ) 1 Date of Payment Receipt Number 4- to ( Receipt Number COSA# I 9 1 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 ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 08/29/2018 r. � 7 t 6. DSD SIGNATURE e System #1 Approved for17 bedrooms. E�`; '''`c"`'�� � .r;+��� nsc:,: •�,,� System #2 Approved for bedrooms. �; Zq • Disapproved. c` ` Conditional approval for bedrooms, with the following stipulations: 61;--/------17k`. P�{ �G — � 1 S 3 S- /y ea VS 032d . A-V24-9WV al/-6.40 be VI ,c-c-62... .-ep+IC- 4--zrAAL 1 c9‘,0 V / Sae ViS iv pN-SITE �C WATER ANS _. —) WASTEWATER C. QRC)GRAM BY �- Original Certificate Date: `7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisoryso / her[ Well Flow Advisory Ota^A-{C COSA blue sheet 10.10-12.doo 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: WYNTER PARK#1 BLOCK 3,LOT 10 Parcel ID: 051-492-39 A. WELL DATA Well type A If A, B, or C provide PWSID#211431 Well Log (YIN) Date completed _ Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test _ Static water level ft. _ ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by:_____ _ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 12/29/1983 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping /maintenance 812012018 Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA Date installed 12/29/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type DEEP TRENCH Length 35 ft. Width 2.5 ft. Gravel below pipe 8 ft. (MT EXTENDS 5.3'+1-INTO 8'ED) Total depth 12.2 ft. (Measured 8/20/18) Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/20/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 33 in. (INCL.MISSING ED) Water added 600 gal. New depth 37 .in. Elapsed Time: 20 min. Final fluid depth 33 in. Absorption rate >= 600+ g.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: - CLASS A WATER SYSTEM Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 8'(Per IR) Property line 10'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage Under Drive Curtain drain_ 50'+(None Known) Wells on adjacent lots 200'+ F. COMMENTS Tank fluid level in second compartment was 49", Elevations measured between ST level and bottom of MT indicates steel MT pipe extends approximately 5.3'into the 8'effective depth. G. ENGINEER'S CERTIFICATION -a 4� OP I certify that I have determined through field inspections and •' �/t, •• � d 1r'_n Z review of Municipal records that the above systems are in ,1%.*:. 's`,;4 9TH .� 'f f, conformance with MOA COSA guidelines in effect on this date. 2 Engineer's Printed Name MICHAEL N.ANDERSON,PE el� ;•. MICHAEL N. ANDERSON Date 08/29/2018 f,• CE 9409 is k \ F ESS`iv• �""' COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • ,f r,�� 907-343-7904 On-Site Water and Wastewater Section \ i ` Fax: 343-7997 www.muni.org/onsite `—` � Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181446 Subdivision: Wynter Park #1 Block: 3 , Lot: 10 The septic tank for this property is 35 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. a S. c ... • ,' _:•. ;. e7 eta ''``' -{':‘,.,„: -. , ,,V. -tik-4,., a' . •WT X .c A 14 . - y LF^" �iLC'T/ - . jI;r • i 1 ..r `N �, t d/ ;a. . 4 s, ... ,,;&,-, .. ,.., - . i '' AN .A -. ‘' : ♦ N. '3 ' Q T �� 1•" '. ,:. '. !. ' -:.V^." M. "P''-`0,4 .{., 4F c t 4;y � fi '. bi Fd a . y�• ral8' 74 13 i" "* ,q �, r4(.....:4:1„..„, �r. r Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-492-39 GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: '7 - Lot 10, Block 3, VVynter Park Subdivision No. 1 20845 Frosty Drive Chugiak, AK 99567 Current Property owner(s) Elisabeth and Russel Weston Mailing address 20845 Frosty Drive Chugiak, AK 99567 Lending agency Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class A Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 74/2011 a ~:~ ~.~81 · .~'~ bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory By: Well Flow Advisory Nitrate Advisory (Rev 11105) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 7 - ~// ANDERSON ENGINEERING P.O, BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) MEMORANDUM DATE: TO: FROM: SUBJECT: July 5, 2011 Jeff Poet Mike Anderson, P.E. Lot 10, Block 3, Wynter Park Subdivision No. 1 Certificate of On Site System Approval (COSA) The improvements to the septic system on Lot 10, Block 3, Wynter Park Subdivision No. 1 have been completed. The vent on the second compartment of the septic tank has been located and raised to a minimum of 1' above ground. In addition, the monitor tube in the absorption trench has been relocated to the bottom of the trench. A new 2" steel monitor tube is now in place. We hereby request the conditional status of the COSA be removed. A new COSA is attached for your review. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-492-39 GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: Lot 10, Block 3, Wynter Park Subdivision No. 1 20845 Frosty Drive Chugiak, AK 99567 Current Property owner(s) Elisabeth and Russel Weston Mailing address Lending agency Mailing address Real Estate Agent Day phone 20845 Frosty Drive Chugiak, AK 99567 Day phone Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: Four (4) TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class A Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one.year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 11/6/2010 -I; ,r~'k'...___,..: %-- ~ bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory I/ I at~ .:;.'. / .:~ · _~. ON-SIT '~: WATERAND · ' · WASTEWATER :,, '.,. PROGRAM X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Lot 10, Block 3, Wynter Park Subdivision No. 1 IfA, B, or C provide PWSID #211431 Sanitary seal (Y/N) Cased to f. FROM WELL. LOG Legal Description: A. WELL DATA Well type C!as,,s,.A Date completed Total depth g.p.m. Date of test' Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: mg/I B.~ SEPTIC/HOLDING TANK DATA . Tank Type/Material Septic/Steel Nitrate ~ mg/L Date of sample: Parcel ID: 051-492-39 Tank size 1,250 gal. Number of Compartments Two Foundation cleanout (Y/N) Y Depression over tank (Y/N) Date of pumping 1/18/2010 Pumper JR's Pumping C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) __ AT INSPECTION g.p.m. Other bacteria Collected by: colonies/100 mL Date installed 12/29/83 Soil rating (g.p.d./ft2 or ~/bdrm) 125 SF/BDRM Length 35 ff. Width 2.5 ft. Total depth 15.2 ff. Eft. absorption area 600 ~ Monitoring tube Date of adequacy test 11/3/2010 Results (Pass/Fail) Pass Fluid depth in absorption field before test 0 Elapsed Time: 0 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type Deep Trench Gravel below pipe 8 ft. Y Depression over field N For 4 bedrooms in. Water added 1,230 gal. New depth 0 in. in. Absorption rate >= 600 g.p.d. If yes, give. date in. Date installed 12/29183 Cleanouts (Y/N) Y N High water alarm (Y/N) N LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES Fo Size in gallons "Pump off' level at~ Cycles tested in. SEPARATION DISTANCES FROM VVELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas Manhole/Access (Y/N) High water alarm level at Meets alarrc & circuit requirements? in. On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >$' Property line >5' Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage. Under*** Curtain drain None Noted Wells on adjacent lots >200' COMMENTS: The absorption trench was installed under the driveway in 1983 in accordance with the approved design and permit issued by the Municipality of Anchorage. The septic vent to the front compartment of the septic tank is missing. The monitor I ~ that I have dete~ined thmu h field inspections and ~v/ew or Municipa~ m~ms that the above systems are in constance w~h MOA COSA guidelines in effe~ on this date Date 11/07~o10 COSA Fae $ H Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number WBD/OO?/27/2010 PAX No. ~ Or ,4/,. t · .'e:.'" .- '~;.~'LI, st~tc~on~ ~h~eh do not a~p~ar on the recorded ~u~ d~vls~on ~la~. ~nder no c~yc~tances ~hould any ~OTE ~~ /1' ttshtng boundary or fence lines. The surveyor takes SHOWN ~ THE RECORDED P~Ti ARE NOT re~ponsib~ltt~ for the initial transaction only.' SHOWN Hm~0N. . LOT /~ BLOCK ~ ~ ..,,, c~ .o...~.r ..- ' ANCHORAGE RECORDING DISTRICT o ~., r,.~ 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 DWI=LLING 051-492-39 HAA# ~-~ ~q,~ 63 L~ ©~Z'~ GENERAL INFORMATION Complete legal description Wynter Park #1, Lot 10, Block 3 T15N R1W Section 10 Location (site address or directions) 20845 Frosty Drive, Chu§iak Property owner Pepper Smith Day phone msg 694-5195 Mailing address HC 799 Box 4979 Frosty DrJ~e~ Chugiak. AK 99567 Norwest Mortgage/Cat Day phone 694-1144 Lending agency Mailing address 16635 Centerfield Drive, Eagle River, AK 9957'7 Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well × Public water 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: x If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) Fronl MOA #21 s),uewwoo leUO!l!ppv :suo!~elndl~s 8U!MOllOJ eq~ q~!M 'suJooJpeq Joe leAoJdde leUO!l!puoo 'pe^oJddes!Q 'SLUOOJpeq ~2' JoJ. peAoJdd¥ 7 ~I:InJ.¥NglS SHHa eJnleuB!s s,Jeeu!l~U=l "9 ££§66 Ay 'Za^T~ e-~beA '96E££/ ×o~ 'O'c~ sseJppv g6Ig-~69 eU°qd S@OT~Z@S bUT.,ZeauTbu,A A@^T~/ aTbL:~2 U. IJ!-I Jo eLUeN 'uof~oadsu! s!q~ Jo e~ep eq~ uo ~oej~e u! suoilelnbeJ pue 'seoueu!pJo 'sepoo e~e]S pue led!olunF~ lie ql!M eoUe!ldLuo3 u! s! uJe~sXs lesods!p JeleMm, SeM Jo/pue Xlddns JeleM e~!s-uo eLl~ 'uo!~oedsu! pue uoileb!~se^u!/,uJ LUOJ~ pue sel!~ a6eJoqou¥ Jo X~!led!o!unlAI eq~ uJoJj peu!e~qo uoi~euuJoju! eq~ uo peseq ~eqi XJ.Je^ Jeq~Jnj I 'u!eJeq pe~eo!pu! eJn~onJ~s jo edX1 pue SLUOOJp@q JO JeqLunu eLl~ JOJ e~enbape pue leUO!~ounj 'e~e@ 9! gue~gXs lesods!p Je~eMe~seM Jo/pue Xlddns JeleM al!s~uo aLI~ ~eql SMOqg uop, eo!ldde le^oJddv XlpOLl~n¥ qlleeH S!LI~ JO uo!~eb!~se^u! XLU leq~ XCpe^ I 'Moleq uMoqs elep uo!lep!le^ eq~ jo se pue o~eJeq pexg~e legs XLU /,q pe!~!lJeo s¥ I:I~NIgN~I A8 NOIJ. O~ldSNI :lO J.N~t~.I.~'J.S Legal Description: A. WELL DATA Well type ,~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller Total depth Cased to Casing height /- Sanitary seal (Y/N) _ Wires properly protected (Y//.0X~ FROM WELL LOG AT/iI~SPECTION level Well flow ~.,¢'. m. __ ~m. Pump level -- ~' ,'~ SEPARATION DISTANCES FROM WE/I,L~'TO: Septic/holding tank on lot / ; On adjacent lots Absorption field on lot / ; On adjacent lots Public sewer main ,,// Public sewer manhole/cleanout / Sewer service line / Petroleum tank WATER SA~RESULTS: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDiNG" TANK DATA Date installed / Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size / ~ ~ 0 Compartments Foundation cleanout (Y/N) ~//~ ~ .Depression (Y/N) Alarm tested (Y/N) /"//~ ~(£/~-' ~/~ ~ Pumper SEPARATION DISTANCES FROM SEPTIC/H~,E'Df~ TANK TO: Well(s) on lot ,A//-~ To property line ~ ~ I Surface water/drainage On adjacent lots Absorption field' /" ¢'¢)D / Foundation "~ / ~¢O~Water main/service line 72-026 (Rev. 7/9Q Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes ~(.Y~.N~)/~'~ SEPARATION~I,~TA~NOE FROM LIFT STATION TO: Wefhd~-lot On adiacent lots Surface water D. ABSORPTION FIELD DATA Soil rating /~¢~ ¢ System type Gravel thickness ~// Total depth //, Cleanouts present (Y/N) k//~ Date of adequacy test for ~ bedrooms If yes, give date Date installed Length ~ ~ 1 Width -~(-') Total absorption area ~¢0~ Depression over field (Y/N) Results (pass/fail) /D/~ S .~' Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on Pot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /. ,~¢/~ / Property line ,,¢/~, ~ t To existing or abandoned system on lot Cutbank ~//~ Water main/service line Driveway, parking/vehiole 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. Engineer's Name HAA Fee $ ~-) (~, ('Y",, Date of Payment ~_o-.'z..(-.,,, ~1 ,~ Receipt Number ~k '~OA ~,~ 72*028 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number ANCHORAGE DISTRICT OFFICE 800 E, DIMOND BLVD,, SUITE 8-470 ANCHORAGE, ALASKA 99518 W, L rER J, HtCKEL, GOVERNOR (907) 349-7755 August Vlcky Not'wear Mortgage SUBJECT: Dawn Water Co, Class "A" Public Water System, PWSID 211431 Dear Vleky: I have completed a review of tills office's files concerning the status on the above- referen0ed Class "A" Publb Water System and found following: Inorganic Chemical Contamlr~apts; Date of last samples on record: Organic Chemical Contaminants; Date of last samples on record', Volatile Organic Chemicals (VOC's): Date of last sample on record: Radioactive Contaminants: Data of last sample on rooord: Total Coliform BaCteria: Date of last sample on record: F}na{ Operation Certlfloate; Date Issued', 18 AAO 80,200 lO/o8/8o 18 AAC 80.200 Ce/lO/e2 18 AAC 80,400 08/10/92 13 AAC 80.200 OO/lO/92 18 AA(2 80.~00 07/22/92 Present In fife 09/07/84 Outstanding Violations; NO · Lifted 08/20/92 Auou t Page Based on the above Information, thio Public Water System I$ In compliance with State Drinking Water Regulations (18 AAC 80). If you have any questions on the above comments, please do not hesitate to contact this office at 349-7755, ML/pf C~; Hal Jaoks0n, Heritage Real Estate Sincerely, Michael Lu Environmental Eng, Asst, 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. # 051-492-39 CERTIFICATE OF HEALTH AUTHORITY APPROVAl_ FOR A SINGLE FAMILY DWELLING HAA # ~1 ¢~°[.fT, k-~l', ;~ GENERAL INFORMATION Complete legal description Wynter Park #1, Lot 10, Block 3 T15N R1W Section 10 Location (site address or directions) Property owner Mailing address Lending agency Nn~'h ~o~gage./cat Day phone Mailing address 16635 Center ¥±eld Drlve, Eagle River, A~ 995?? 20845 Frosty_ Drive, Chuqiak Pepper Smith Day phone msg 694-5195 HC 79, Box 4979 Frosty; Drive, Chugiak, AK 99567 694-1144 Agent Address N/A Day phone 2, NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 4 NOTE: Individual well Community well Public water × If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: x 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. 72-025{Rev. 1/91) Front MOA~21 'HJOM s,Je@u!eue leuo!sseJoJd eH1 u! suojse!uuo Jo SJOJJe JOJ elq!suodseJ lou s! ebeJoqouv Jo Al!led!o!unbl eq/ 'penes! s! eleOiJ!~Jeo e eJoleq e~ep az,qeue Jo suo!loedsu! ~onpuoo ~ou op SHHQ jo see/~oldLU3 'siueLueJjnbeJ eieis pue leJepeJ u!epeo,~e!)es o~, JepJo uf euo!~n~!~eu! 8u!puel J!eq~ pue eeLuoq ;o e~eseqo~nd ol,~selJnoo ~ se sfq~ seop SHHQ eqj.'e~lSelV jo @~e~S eqi u! pe~e~sjl3aJ JaaU!eUe leUO!SSejoJd ~,uepuedepu! ue ,~q e^oqe cj qdeJOe~ed u! Ua^lB suo!~e~ueeeJdaJ eq~, uodn ,quo p@eeq se~eogflJeO le^oJddv /4poq~n¥ qlleeH sensei (SHHQ) seo!AJeS ueuJnH pub qlleaH jo ~ueLulJedeQ e6eJoqou¥ jo ,q!ledio!unl~ eqj. '.¢.1,¢,¢/'/ ..( / /'/ .J ~/ 41f n 2t .-~ ..r.' I../ .f / .¢.,.4 .¢ ,~.1~ .~ t;;¢ ,"d :suo!~elnd!~s 6UIMOIIOJ eql HJ!M 'sLuooJpeq 'suJooJpeq Jo~. leAoJdd'e leuo!l,!puoo 'peAoJddes!C] ~ Joj p@AoJddv ~Id~.I.'CNOIS ~Hl-la '9 ~~__/~ eJn~eue!s sjeeu!Bu3 LL§66 :cf 'z@^T~ eZbe2 "¢6E£LL ×o~ 'O'c~ sseJppv §6~§-969 euoqd S@ATZeS bL, T...~eeLq..bu2 .~eA.L~ elbe2 WJ!-I JO 8WeN · uogoedsu! s!ql ~o e~ep eq~, uo ),oejje u! suojlelneeJ pue 'seoueulp.lo 'sepoo e~e19 pue ledlo!unl~ lie q~JM eoue!ldLuoo u! s! LUe~S,~S lesodsip JeleMelSeM Jo/pue ,~lddns JeleM el!s-uo eq~ 'uol~oedsu! pue uo!le6!~SeAU! ,~uJ LUOJJ pue sel!J eeeJoqouv jo Xl!led!o!unlAI eql uJoJ¢ peu!elqo uolleLUJOJU! eq~ uo peseq leq~,~pe^ Jeq~Jn~ I 'u!eJeq peleo!pu! e~n~onJ~s jo ed,~l pue suJooJpeq Jo ~eqLunu eql ~o~ elenbape pue leuo!lounj 'ejes s! Luels~S lesods!p Je~eMelSeM Jo/pue ~lddns ~ejeM el!s-uo eql ~eql SMOqB uogeo!ldde leAoJddv ,~poqlnv q~leeH s!qj ~o uo!le6!~seAu! ,~LU ~eq~ ~JpeA I 'MOleq UMOqS e~ep UO!lep!leA eq~ Jo se pue oleJeq pax!ire leas/~LU Xq pe!j!lJeo sV H=~=INI!DN=I ,AB NOIJ. O~dSNI 40 /N=IIN=I.I.~.I.S '~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~//~ !4/Y~£~¢ t~'g~ ~..¢ Parcel I,D. A. WELL DATA Welltype //' Log present(Y/N) If A, B, or C, attach ADEC letter. Date completed ADEC water system number Driller Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL T, Casing height · Wires properly protected (Y/N) AT IN~ g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main __ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer service line Petroleum tank RESULTS: ,~ate of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Date installed /¢'/~ Cleanouts ¢;~/N ) Collected by: Other bacteria Tank size /,,2 ~"O ¢,Llf Foundation cleanout ~-')'N) ~/¢ $ Compartments Depression (Y,~ High water alarm (Y/N) Date of pumping Alarm tested (Y/N) Pumper_ Foundation Water main/service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot h//~1 On adjacent lots To property line 6''Ol Absorption field Surface water/drainage / ~D ) 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 Meets MOA electrical co~e¢~/N' ) SEP~NCE FROM LIFT STATION TO: y on lot On adjacent lots Manufacturer ~ "Pump on" level at F..~''~'~ "Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed /2,/~ ¢' Length -¢5- ~ Width Total absorption area ~ ~,/ Depression over field (Y~i Results~/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating /?$ f¢z.- System type Gravel thickness ~, ~' Total depth /./.2. Cleanouts present ~:t)/N) y~'.S Date of adequacy test ~'/z for ~ bedrooms If yes, give date To building foundation On adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot /¢~/~£ /¢-/~/~'~'¢"¢,"- On adjacent lots ,'¢~/'"~' ~'¢'A'1'4'~//" Propertyline ~~''5- ~ To existing or abandoned system on lot Cutbank '¢//4 Water main/service line Surface water Curtain drain 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 th~t~,t~ of this inspection. Engineer's Name ~'( ~¢' HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, AK 99503 WALTER J, HICKEL, GOVERNOR FOR: Eagle River Engineering May 18, 1992 PWSID # 211431 My review of the records on file in this office reveals that the Dawn Water Company Class "A" Public Water System is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200 only. At this time, they are not in compliance with either the volatile organic chemical sampling or the radiological sampling listed in 'Fable B of 18 AAC 80.200. Sincerely, Rachel Clark College Intern APPLIC* NT FILLS OUT UPPER HA[ ONLY Buyer Phone Address Zip Code Realty Co. & Agent Zip Code Address Zip Cede Type of Residence ,~Single Family t'3 Multiple Family No. of Bedroor~s L3 Other Water Supply (3 Individual ~(~Community [] Public Utility Sewer Disposal [~ Holding Tank ATTACH WELt. LOG. A well Icg is required for all wells drilled since June 1975. Fer wells drilled prior to that date, give well depth (attach Icg if available). Year Individual installed: ) 4i ~' ~:'~ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Date Date Date Inspector Inspector Inspector Insp6ctor ( [~ ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE BY: *CONDITIONS OF APPROVAL Soils Rating [ ' Date Sewer Installed ~t{on Are~3,'~' Well To Absorption Are ~ c/-17-93~ We, to T~nk Well Log Received Septic Tank Size Octobor 3~, ~''' Strata, Inc. c/o Harry Davis SI{ l]ox 18 Eagl(; River, Alasl<a DD577 Sub]oct: ]hot J. 0, I}lo :;% 3, ~'iynter [)ar};: til This (le[)artfllent is ul]ab].o, to al)prove tho above on-siLo installai:io~] until St['ata, Inc., h~s obt~ined pro/.)e~' cer- Lification for instalJ.~:~tion fl'om this depa~ftn%ent. it you have any further questions .le~,~e caJi this office at 264-4720. 4975 Chugiak, AK Popper Smith b'rof~ty Drive '~ Chu9iak, AK 99567 Subject: Lot 10, u, lock 3, Wynterparl< o ~ubmit ~ ].otter fro,] N?~o lJike t~ahho\.;s with tllo Stat~ of reqll:i.l?e!~ec~t~, YO~.I ~ay call hJ, m at 27~%-.-2533 tot J~urther iniormation, Please notif, y thi~: i)eDartmont i:or a roinsDectli, ou v;l]en tile .,all this oi~fic(~ at 264-,t720 Since r~.~ 1 y, CWt (.)7/e :)/ii', t