HomeMy WebLinkAboutWOODRIDGE BLK 2 LT 13Woodridg
lock 2
Lot I
020-093
-21
Municipality of Anchorage Page / of /
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5~01~.~/ ~'~ ~ ~5~ PID Number: _~2_.o ,- O~ ~ '- ~1
~ame: j~ ~ ~ ~ ~ ~ ~¢ (; Wastewater System: ~ New ~ Upgrade
Address: ABSORPTION FIELD
Phone: ~ ~ NO. of Be~ms:
~ ~ ~ ~ ~ ~ ~ ~Deep'rrench ~ShallowTrench BBed ~Mound ~Other
Total Depth from original grade:
LEGAL DESCRIPTION so,,.~,.~: . ~ ~/s~.~.
LOt: Block: C ~)diu~ )p; ..... D~;~{~ pi~o bottom from odginal g,ade: Gravel depth beneath pipe
_ I~ ~ ~,~,~ ...... ~ 3,5 ~.
~ownship: ) ~ ~ Range: ~ ~I~ S6cJom ~ Fill added ~bove original grade;~ ~ ~¢ ~, Gravel length: ~O + Ft.
WELL: D New D Upg~ Gravel~ + Numberofiines: ~Dislancebetweenlines:
~ Ft, [ ~ Ft.
~lassiEcatlon (Private, A,B,C): ~ Cased TO: Total absorption area; Pipe material:
~ Ft. Ft. ~ ¢ SQ. ~t. ~" P~e~ PVc.
Driller: ~ Date Drilled: Static Water Level:Ft. Installer:~l~ ~1~ ~ ~ Date installed:
Yield~ ~ Pump Set at: ~C~;,,g .~idht Abave Ground:
~ GPM Ft. I
TANK
SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lilt HOI~g ~ubllc/Priwte Manufacturer: Capacdy in gallons:
From Tank Field Station Tank Sewe¢ Lines ~~ J~
MateHaJ: Number ol Compadments:
well jmm~ 1~~ ~m~+ Io~~ I~ ~C
Surface ~ ~ LIFT STATION ~
Water ~ ~ ~+ JOO~ ~ [~
Size in gallons:~facturer:
Lot ~ + ~
Line ~ ~ ~
"Pump on" level at: mp off" [e · High water alarm at:
Foundation ~ ~ }~ ~ ~
CurtainDrain ~ [~¢+ ..... p~Model Electrical Inspections pedormed by:
Remarks: BENCH MARK
Location a~d ascription:
d
Assumed Elevation:
ENGINEER'S SEAL
Ins~ecti0ns performed by: ~ ~ PP Dates: lst~7'~ ?.~ ¢ ' '~"~'? '~' ......
Department of He'nd HumaWS~rwces~ ' approval/ ~ '~"'~[~%._g~'~ ~-,?,,?'"
Reviewed and approved by: Date:
72-013 (1/91) MOA 25
Permit No. SW920124 EXPIRE 6-4-93 1
SW950155 RE-ISSUED 6-11 93
iSSUE 6--1 I 93 Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMEN1AL SERVICES DIVISION
P.O. Box 196650 Anchorage,
On Site Wastewater Disposal
of 3
Aloska 99519-6650 telephone:543 4744
System ondjor Well Inspection Reporl
Legal Description T. 11 N, R. 3 W, SEC 3 SM AK.
LOT 15, BLK 2 WOODRIDCE
PID No: 020 · 093 21
ASBUII T
SITE MAP
-["=100'
BM A ~M ASW COR BLDG SLAB EI.=IO0
B~.~ e~M ~ ~W TE~7 ~E6-c'::
Permit No. SW92012d
RE ISSUE
EXPIRE 6 4 9.5 Page 2 of 5
SW950155 RE ISSUED 6 11-9.5
6-1 I 95 Municipality of Anchora9e
DEPARTMENT OF HEALYH AN[) HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alosko 99519 6650 Telephone:Sd.5 47dzi
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description r. 11 N, R..5 W, SEC 5 SM AK.
LO-I- 15, BLK 2 WOODRIDGE
PID No: 020-09,5 21
ASBUILT
WELL
SEPTIC SYSTEM PLAN VIEW
/" 50'
NOTES
BM A BM B
D 1 17.4'
BM AIM ASW COR BLDG. SLAB EL=~00]
Permi~ No.
RE ISSUE
P.O.
On-Site
SW92012zi EXPIRE 6-4-93
SW950155 RE ISSUED 6-11-93
6- I 1 93 Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
Box 196650 Anchorage, Alaska 99519 6650 Telephone:543 47qzi
Wostewater Disposal SysLem and/or Well Inspection Report
Legal Description T. 11 N, R. 3 W, SEC 5 SM AK.
LOT 15, BLK 2 WOODRIDCE
PID No: 020 093-2/
6" FILL
EL:lO0
EL:92
SEPTIC SYSTEM PLAN VIEW
HORIZ 1"=40' VERTICAL. 1"=4'
ASI UILT
2.00%
CONTRACTOR TO VERIFY MIN COVERAGE OVER LINES
AND SYSTEM OR INSULATE TO MOA STD'S
ABSORPTION SYSTEM PROFILE_
HORIZ 1"=20' VERTICAL f'=lO'
M-W DRILLING, Inc.
P.O, Box 110378 · 10~30 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner Ada~ and ~ary J~ne ?~e,~] i' Use of We~ Dom
Location (address of: Township, Range~ Section, if known; or distance main road
I, 13, Blk 2 Woodrid~e Sub, Anchorage
Size of casing. 61 Depth
Cased to 4 7 feet
Static water level 5 0 ft.
Screen ( ); Perforated
land surface. Fhtish of well (check one) open end ( X );
Describe screen.or
Well ptunping test
of drawdown from static
Date
Depth in feet from
ground surface
(m~ute) for 1 hours with 100% ft.
As built note: Well was dry grouted with
granular bentonite~-I sack°
WELL LOG
penetrated, size of material, color and hardness
0.TO. 2
2 TO 20
20 TO. 25
25.TO. 35
35-fTO 40
40.TO.
,Mu:~c,??itv oi' Anchorage
Dept, ~e~{h & Human ~e~vi~e~ .
45 .TO. 47
47.TO
__.T~
,TO.
307
water s. eaps in
sporadic f~ac~ures: fr~m 190' down.
__ .TO.
__ TO
__ TO-
TO
Certificate No's. 814 f'~' 973
1 -- CUSTOMER
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930155
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:MERLI ADAM & MARY JANE
OWNER ADDRESS:4911 WOODRIDGE CIR
ANCHORAGE, AK 99516
DATE ]iSSUED: 6/11/93
EXPIRATION DATE: 6/11/94
PARCEL ID:02009321
LEGAL DESCRIPTION: WOODRIDGE BLK 2 LT ].3
LOT SIZE: 67514 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
ISSUED BY:
DATE:
DATE:
[
~ Permit No.
IRE-ISSUE]
SW920124 EXPIRE 6 4-9.5 ~ or
6-1 I 95 MunicipallY)! of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519 6650 Telephone:543-4744
On-Site Wostewalcer Disposal System and/or Well Inspection Repor~
Legal Descripl. ion 'r. 11 N, R. 3 W, SEC 5 SM AK.
LOT 15, BLK 2 WOODR/DGE
PID No: 020-09,5-21
SITE MAP
~"=1oo'
BM A ~ASW COR BLDG. BLAB EL=lO0 ]
BM B B NW COR, BLDG. 7
Permit No.
RE-ISSUE
On Site Wastewater
2 of ~
SW920124 EXPIRE 6-4 95 Page
6-11 9.5 Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
Box 196650 Anchorage, Alaska 99519 6650 Telephone:343 .zW44
Disposal Systern and/or Well Inspection Report
Legal Description r. /1 N, R. 3 W, SEC 5 SM At(.
LOT 15, BLK 2 WOODRIDGE
PID No: 020-095 21
v
WILL
TH 3
TH 4
SEPTIC SYSTEM PLAN ViEW
1" -50'
NOTES
1. CONTRACTOR TO VERIFY MIN. SO, FOOTAGE
PRIOR 10 pLACINg TOPSOIL
2. CAUTION SHALL BE TAKEN TO MINIMIZE
BM A BM B
4.,"~%' OF:
I ~, ~-'~? ......... ~..~ %
/ Z ,,,,
/.~" ~ ".~
/~...~?.%.. ~ .... .:...~
¢...:.: ..:...~
/ %~'. ....
Permit NO. SW920124 EXPIRE 6-4-9.5
RE-ISSUB 6--11 9.5 Municipalif.¥ of Anchoroge
DBPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMBNTAL SERVICES DIVISION
P.O. Box 196650 Anchorage~ Alaska 99519-6650 Telephone;SZi. 5-4-744
On-Site Wostewater Dispos(]l System (]nd/oT Well Inspection ReDort
Legal Description T. 11 N, R. 5 W, SEC 5 SM Al<.
LOT 15, BLK 2 WOODRIDGE
PIB No: 020 095-21
SEPTIC SYSTEM
HORIZ 1"=40' VERTICAL 1'=4'
CLEANOUTS CLEANOUTS
2"INSULATION IF LESS THAN
CONTRACTOR TO VERIFY MIN COVERAGE OVER LINES
AND SYSTEM OR INSULATE TO MOA STD'S
LOCA'rlON OF NEW 1250 GALLON
SEPTIC TO BE DETERMINED IN
FIELD
ABSORPTION SYSTEM PROFILE_
HORIZ 1"-20' VERTICAL 1" 10'
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920124
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING
OWNER NAME:MERLI ADAM & MARY JANE
OWNER ADDRESS:4911 WOOLDRIDGE CIR
ANCHORAGE, AK 99516
DATE ISSUED: 6/04/92
GROUP EXPIRATION DATE: 6/04/93
PARCEL ID:02009321
LEGAL DESCRIPTION: WOODRIDGE BLK 2 LT 13
LOT SIZE: 67514 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINK]lNG WATER REGULATIONS (iSAACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
INSTALL MONITORING TUBE IN TRENCH.
(2) PO ' ANK CLEA S.
RECEIVED BY:
ISSUED BY:
DATE
RSCG-ENGIN. TEL : 9072676596 Fei) 16,93 11:18 No.006 P,01
Permit No,
Page of_
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchoragei Ala'~ka 99519-6650 e Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
PID No,: ,
~00' R^D[U~
Lo 13
14 DLo(~'"
STING F ELD
G SEPTIC
RENCH
Btocl<
TAN
lISTING
T~q~ ........
EXISTING FIEI..I)
SEAL
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERW[CES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920124
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING
OWNER NAME:MERLI ADAM & MARY JANE
OWNER ADDRESS:4911 WOOLDRIDGE CIR
ANCHORAGE, AK
DATE ISSUED: 6/04/92
GROUP EXPIRATION DATE: 6/04/93
PARCEL ID:02009321
LEGAL DESCRIPTION: WOODRIDGE BLK 2 LT 13
SEC 3, TllN, R3W, SM
LOT SIZE: 99999 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
INSTALL MONITORING TUBE IN TRENCH.
INSTALL TWO (2) POST TANK CLEAN OUTS.
RECEIVED BY:
ISSUED. BY:
DATE:
DATE:
June 3, 1992
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
RE:
Septic System Approval
Lot 13, Block 2, Woodridge Subdv.
Dear Mr. Roth:
Attached is the permit application for a septic system on the above referenced lot. The design
has been modified due to ground water monitoring through the first of June. The highest depth
recorded for the water on the lot was 12 foot. The trench was extended 20 feet and brought up
to a total depth of 8 feet.
The well that was noted on the comments has been located and has been noted on the plan view.
The proposed field is outside the 100 foot protective radius of the well on Lot 14.
This revised plan and design resolves the cmnments contained in yonr transmittal letter of
1/23/92. Please issue a septic system permit for this lot.
Very truly yours,
CSM:CC: 1110-0026.013
attachment
(9,37) 349.5148 * kAX {907) 349 4213
DATE:: ' 6/2/92 SHT: 1 OF 1 ~---%~'%,
PREPARED BY: KMA
SUBdECT: WOODRIDGE LOT 13 BLOCK~/2
JOB~:l110-O026-013
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers o Acchftects o Scientists · Suc~/eyors
301 Arctic Slope Avenue Anchorage, AK 99518-3035 PHONE (907) 34-9-5148 FAX (907) .349-4213
A subsidiory of Arctic Slope Regionol Corporotion
Permit No.
Page 1 of ~
Municipality of Anchorage
DEPARTMENT OF HEALTFI AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:Sz~5-47z14
On Site Wostewater Disposal System and/or Well Inspection Report
Legal Description LOT 13,BLOCK 2, WOODRIDGE SUB
PID No:
NOT AN AS BUILT
PERMIT DRAWING
14 Bio{ ~
STING F-:ELD
S SEP rlc
L
NOTE: NO CUR[AIN DRAINS WITHIN
200 FEET OF THE PROPOSED OF
FUTURE ABSORPTION FIELD SITE.
SCALE:
1"=100'
L
.~ co... ~L".~ ~,
~ .. ~ '. ~,~
:~..,:q.!?.% ...~.....:~...~
~ ~'. ~ s. ~ .'~
..'~
%%'.,.
January 14, 1992
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
Re:
Septic System Approval
Lot 13, Block 2, Woodridge Subdivision
Dear Mr. Roth:
Attached is the permit application for a septic system on the above referenced lot. Below is a
narrative of probable impacts to adjacent properties.
i. Wells - There are no existing wells within 100 feet of the proposed new septic system.
Wastewater System - There are no absorption fields with-in 200 feet of proposed system.
The proposed system will have n.._o eff~ect on the future absorption fields of the adjacent
lots.
Reserved Space - A future field could be placed to the south of the proposed field. The
future field would remain outside the well radiuses of adjacent and on lot wells.
Drainage - The lot fairly flat (0-2%). Positive drainage away for the field will be
maintained. No concentrated surface water will be directed toward the field and no
existing streams are within 100 feet of the proposed field.
The installation of this on-site system will have no probable impacts to adjacent well or septic
systems. The proposed system's separation distance radius will include parts of adjacent lots,
but will not interfere on-site systems on these lots.
Very truly yours,
Sr. Civil Engineer
CSM:KMA: 1110-0026
30[ Danner Avenue, Suite 200 Anchorage, Al( 99518-3035 (907) 349 5140 FAX (907) 349-4213
Permit No._
Page of _
Municipality of Anchorage
DEPARTMENT OF HEAl. TH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.o. Box 196650 * Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: .L.,~-~ [~ /~!,-~¢~ Z- ~.d~,~.J, ~,,,. ~,( ~ PID No.:
SEAL
ARCTIC SLOPE CONSULTING GROUP, ['NC.
PERFORMED FOR:
LEG AL DESCRDXlFION:
DEPTH
5-
8-
9-
Per'< Te${-
SOELS LOG - PERCOLATION TEST
(.AJ o o ~ /' I c]~ ~ TownshiLRan~e, Se_edom
SLOPE
SITE PL/~q
WAS GROUND WATER S
ENCOUNTERED? ~ 0 L
[F YES, AT WHAT DEPTH? '~ O
P
Depth to Water After
Gross Net Depth !o Net
Reading Date Time Thne Water Drop
13 }:l~ 2 ~ , ' q ~ I'~ t' 7~ ,,
PERCOLATION RATE ~,(~ m;q/;d (minutes/inch) pERC HOLE DL~viETER ~ #
TEST RUN BETWEEN .~ ~/Z I.'T AND Co I/Z. Fl'
CONfiMENTS
PEKFORMEDBY:_ I/~,,,,,cill / ,:St x,~,, w, J CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL G U1DELINES IN EFFEDT ON THIS DATE. DATE: ~ /7 /~ 'd
SOILS LOG - PERCOLATION TEST
LEGALDESCPdkm!'ION:__~OJ' 13, ~ loc {< g
Townsh[p~_Range~ Sectioa:
2
3
4
5
6
7
8
9
10
15
16
17
20-
DEPTH
SLOPE
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? /tJ o L
O
IF YES, AT W]IAT DEPTH?
P
Depth to Water After
Monltodng? ~oa~ Date t [ '7/q '~__ E
I !
Gross Net Depth to Net
Reading Date Time Time Wamr Drop
t 12/,,3'0 I Z "~/7 - G" -- __
7 12~c/ 2 ~,'~ 3 ~ I '/2
~ I;o~ 2~,'~ 2 %" ~/~ ~
~o ~.'lt ~ ~//~ -
PERCOLATION RATE
TEST RUN BEI~VEEN
(milmles/inch) PERC HOLE DIAMETER
AND FT
COM]MENTS
PERFOP~MED BY: J CERTIFY THAT TH1S TEST \VAS PERFORMED 1-N
ACCORDANCE VTITH ALL STATE AND MUNICiPAL GUIDELINE3 IN EFFECT ON THIS DATE. DATE:
PEILFORMED FOR:___A~ e aO r~,
LEGAL DESCRIFTION: ~-of / ~.~
SOELS LOG - PERCOLATION TEST
Tmv,,ship, Ran~¢,Seetien: 7-nNI r~3CO., .ScoY../
12-
15-
18-
19-
20-
DEFPH
(FEET)
LO'
SLOPE SITE PLAN
N
WAS GROUND WATER S
ENCOUNTERED? AJ o L
IF YF~, AT WHAT DEPTH? -- O
P
Depd~ to Water After E
Gross Net Depd~ to Net
Reading Date Time Time Water Drop
PERCOLATION RATE d,O ,~ ~/,,}4l~. (nunules/mch) PERC HOLE DIAMETER
TEST RUN BE]3VEEN ~ l~F AND 7 FT
COM]MENTS
PERFORMED BY: {(¢*,/~,ie'([I /~, '4¢!<c''',u?'J I CERTIFY TIIAT THIS TEST WAS PERFORMED IN
ACCORDANCE WFFH AL1, STATE AND MUNICIFAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ [ 7 [ ~ ~_
SOELS LOG - PERCOLATION TEST
PERFOKMED FOR:
LEGAL DESCRIFTION:
Townshlp~ Range, Section:
0iF;k'9
3-
5-
8-
9-
20-
SLOPE
SITE PLAN
t
N
WAS GROUND WATER S
ENCOUNTERED? L
IF yES, AT WHAT DEPTH? 0
P
Depth to Waler After E
Monilodng? Dale
Gross Net Depth lo Net
Reading Date Time Time Water Drop
ti Ig'/30 1:.~3 ..q r,Wq 2 g/l!~ I t/~"
PERCOLATION RATE ~ rr,~'-t /;-~obl (minules/ineh) PERC HOLE DIAMETER
TEST RUN BETWEEN 5/ FT AND .,~ FT
COMMENTS
PERFORMED BY: } CERTIFY THAT THIS 'rEST \VAS PERFORMED IN
ACCORDANCE W1TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON Tills DATE. DATE:
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
OERTIFIGATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-093-21
¸1.
GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: ~-//~//'~t
Lot 13, Block 2, Woodridge Subdivision
4911 Woodddge Circle Anchorage, AK 99516
Current Property owner(s) Adam and Mary Jane Medi
Mailing address 4911 Woodddge Circle Anchorage, AK 99516
Day phone
Lending agency
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 ~ 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 COS^s 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 an~ ~tate codes
~,rdiF~s, and regulations n effect at the time of installation.
~'~%~' ~a'~' '~:~: ' ~'e of Firm Anderson Engineering ~ ' Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
bedrooms.
DSD SIGNATURE
~ Approved for ff
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
By:
(Rev. 11105)
Arsenic Advisory.
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
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
Legal Description: Lot 13, Block 2, Woodddge Subdivision
A. WELL DATA
Parcel ID: 020-093-21
Well type Private
Date completed 3/1/93
Total depth 307 .ff.
If A, B, or C provide PWSID # __
Sanitary seal (Y/N).. ¥ ......
Cased to 47 ft.
FROM VVELL LOG
Well Log (Y/N) Y
Wires properly protected (Y/N)
Casing height (above ground) __
AT INSPECTION
Y
>18
in.
11/7/2010
40.2
.8
Date of test 3/1/93
Static water level 5o f.
Well production 3
WATER SAMPLE RESULTS:
g.p.m.
g.p.m.
Coliform o colonies/100 mL Nitrate .427 mg/L
Arsenic: N/D mg/I D~te of sample: 1o12511o
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,250 gal. Number ~f Compartments Two
Foundation cleanout (Y/N) . ¥ Depression over tank (Y/N) N
Date of pumping 8/25/2010 PUmper Isaac's Pumping
C. ABSORPTION FIELD DATA
Date installed 6/12-13/93
Length 80 ~ ft.
Total depth 8 f. Eft. absorptim
Date of adequacy test 11/7/2010
Fluid depth in absorption field before test 0
Elapsed Time: 0 min. Final fluid Jepth
Any rejuvenation treatment (past 12 mo.)!(Y/N 8, type)
Other bacteria 0 colonies/100 mL
Collected by: A. Harala
Date installed 6/13/93
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Soil rating (g.p.d./ff2 or ft2/bdrm) .8 GPD/SF
,Wiith' 3 ft.
area 752 ft~ Monitoring tube
Results (Pass/Fail) Pass
System type Deep Trench
Gravel below pipe 4.7 fL
Y Depression over field N
For 4 bedrooms
in. Water added 620 gal. · New depth 0 in.
0 in. Absorption rate >= 6o0 g.p.d.
If yes, give date
LIFT STATION
Date installed
"Pump on" level at ..
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas >50'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >1oo'
On adjacent lots >1oo' r '
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete stOrage areas >1o0'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A Water service line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field >5'
Surface water >100'
Property line >1o' Building foundation >1o'
Water Service line >1o' Surface water >1oo'
Curtain drain None Noted Wells on adjacent lots >lOO'
COMMENTS:
Water main >1o'
Driveway, parking/vehicle storage >2
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal :records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 11/07/20;10
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On-Site Systems ApprOval (COSA) # OSC 101298
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 13 of Woodridge subdivision, the well's
productivity was determined to be .8 gallons per minute. The minimum well
productivity required by this Department (AMC 15.55) for a 4-bedroom
residence is .42 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
00'14'32"
100.00'
MUNICIPALITY OF ANCHORAGE
DFPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.#
1. GENERALINFORMATION
Complete legal description
Location (site address or directions)
Property owner ¢/¢¢r.¢(.
Mailing addressF ~/~/1
Lending agency
Day phone
Day phone
Mailing address_
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup/~z(~-¢~.~
NUMBER OF BEDROOMS:
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:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~025 (Re'/ 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 inves~d_gation 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.
Engineer's signature Date
!
bedrooms.
6. DHHS SIGNATURE
Approved for ~~
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS 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~)25 (Rev. 1/91) Bsck MOA #21
Municipality of Anchorage
Department of Health and Fluman Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A, Well Data
Well type ~r', U '~
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N). ~
Total depth _ ~¢ "7
Sanitary seal (Y/N)
,,/
Date completed ,~ - I -~/~'~ Driller ~v~
Cased to ~ ~'7 Casing height
Wires properly protected (Y/N)
FROM WFLL LOG
Date of test
Static water level
Well flow ~ g.p.m.
Pump level1
AT INSPECTION
'-~eolAJeS u~unH '~ qll~eH 1.deo
~l~.~tlouV ~o
66t 8 Z d3S
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot I ¢ ~ ~
Absorption field on lot ./ ¢9 dP +
Public sewer main ] 0 o
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~) Nitrate
Date of sample: '~ /2a / ~/' ..~
, ~ Other bacteria /,,/~ ,-v ~-~'
B, SEPTIC/HOLDING TANK DATA
Cleanouts (Y/N) Y Foundation cleanout (Y/N) _ / Depression (Y/N)
High water alarm (Y/N) .... Alarm tested (Y/N) '~'~-~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~¢)E)-~
To property line _ ,~'O
Sudace water/drainage
On adjacent lots
Absorption field
/,Coq.
Foundation I
Water main/service line ..~O'+
72-026 (3/93)' Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level j.,~'¢~'~
Meets MOA electrical codes (Y/N)
D. ABSORPTION FIELD DATA
Manufacturer ~
Manhole/Access (Y/N) ~
"Pump on" level at /' I at
tested
Length ~ O' ¢- Width
Total absorption area <~u~-¢.
Date of adequacy test X/Ez.,.~ -~'¥5 '/,crc
Water level in absorption field before test
Soil rating (GPD/FF) ,
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
Perox de treatment (past 12 months) (Y/N)
Surface water
System type '~¢r~'
.~'~/' '7 Total depth
Depression over field (Y/N)
.... for
After test
Bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~Dc3
To building foundation
On adjacent lots /DC
Sudace water Ioo4'
On adjacent lots J O O Property line
To existing or abandoned system on lot
Cutbank .5-',~ ~ Water main/service line
Curtain drain /".J~,,~ ~-'
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.
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
NORTHERN TESTING LABOFIATORIEiS, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (§07i 456 3116 · FAX 456 3125
2505 FAIRBANKS STREET ANCIIORAGE. ALASKA 99503 (907) 277-8.'~78 · FAX 274 9645
Arctic Slope Consulting Group
310 Arctic Slope Avenue
Anchorage AK 99518
Attn: Kevin
Report Date:
09/21/93
Date Arrivedt 09/20/93
Date Sampled: 09/20/93
Time Sampled: 1030
Collected By: KML
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Lab
Number Method
A126657
~_~wL2atBe~13, Woodridge~
Definitions"
= Below Regulatory Min.
= Above Regulatory Max.
= Estimated Value
= Matrix Interference
= Lost to Dilution
MDL = Method Detection Limit
Date Date
Parameter Units Result * MDL Prepared Analyzed
A126657 EPA 300.0 Nitrate-N mg/1 0.2 0.2 09/20/93
Reported By: Susan
Microbiology Supervisor