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WOODRIDGE BLK 3 LT 1
Onsite File Woodridge Block 3 Lot 1 #020-093-01 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211211 PID Number: 020-093-01 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JANICE COBURN ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 16401 VIRGO AVENUE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot WOODRIDGE 3 1 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 FtZ Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ __ NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks 5'+ TANK TO FIELD VERIFIED. <30" H DECK NO DECK SUPPORT CONFLICTS. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer PCN drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspdection 1'` 6/14/21 2 6/15/2021 Location and description 3rd 4th BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date law_' % • • • • • • ...... • Septic System Approve r �•, Curtis Huffman j r 23 _r7 I Date J GG �� Fc •. CE 128991 �� /�'f��• 6/18/2021.-��C_AW �i oPROF E8S10N��-� Note: this approval does not include well permit requirements. PID: 020-093-01 PERMIT: OSP211211 DECOMMISSIONED EXISTING RET WALL S.T. & INSTALLED NEW 1250 -GAL HDPE SEPTIC TANK < 10' FROM FOUNDATIN MH FC $ & 5' FROM FIELD CO WITH NEW DCO. DCO E D A—C=13,4' B—C=13,2' A—D=17,8' B—D=17,2' A—E=20,7' B—E=20,0' 100' WELL \ RADIUS lb hh' SEPTIC SECTION NTS WOODRIDGE BLOCK 3, LOT 1 SUPPORT SERVICES: PREPARED FOR: JANICE COBURN 16401 VIRGO AVENUE ANCHORAGE, AK 99516 FIRST WATER CONSULTING DATE: 6/19/2021 SURVEY: FRONTIER 13030 SUES WAY DRAWN: FWCS 6/19/2021 ANCHORAGE, AK 99516 SCALE: 1" = 20' 907-350-9566 FirstWaterAK@gmaii.com Y, Electric Meter D4 Gas Meter A LE, Elec. Pedestal el Septic iW, Water Well /`)/SO Septic Tank M. H. PAVED DRIVEWAY 101 e- I?'; SHEDS cb cs 9 N89 ° 58'31 "W 381.93' 10' UTILITY EASEMENT L .W, 100'WELL RADIUS - I 1 Lot.1, Block 3 Woodridge Subdivision 40,176 Sq. Ft. +/- 16401 Virgo Avenue 2 Story Wood Frame House With Attached 3 Car Garage A 3� General Notes Disclaimer 1. This document is created for the purpose of a single property transaction This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary and IS SUbJBCt t0 Federal Copyright Laws. survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the 2. Excepting for gross negligence, the liability for this survey shall not exceed responsibility of the Owner to determine the existence of any easements, covenants, or restriction the cost of preparing this survey, which do no appear on the record plat. Under no circumstances should this document be used for 3. All measurements/setbacks are to the visual/apparent building footprint. construction or for establishing a boundary or fence line. 4. All dimensions to property lines are plus/minus 0.1 ft. 0 15 30 60 Scale in Feet ry9 hyo � LOT2 H i ................ ..! Pier M.5t • gier o i �� N . LS- 12 .•• y C'�� 06/12/2021 J /�� F9F • • • • • SJR..= 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: OSP211211 Work Type: SepticTank Upgrade Tax Code Number: 02009301000 Site Legal Address: WOODRIDGE BLK 3 LT 1 G:3337 Site Mailing Address: 16401 VIRGO AVE, Anchorage Owner: COBURN JANICE Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date o .il llepartment 6/11/2021 6/11/2022 Lot Size in Sq Ft: 40176 Total Bedrooms: 4 ❑ 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 field to confirm that the 5' separation between the tank and field will be met. ** Tank shall be at least 10 ft from the foundation or engineer shall submit a scaled profile drawing with the inspection report demonstrating that it is outside the soil bearing prism of the foundation. Received By: Date: Issued By: Date: MUNICIPALITY CIS A S Development Services Department - '' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-093-01 Property owner(s) JANICE COBURN Mailing address 16401 VIRGO AVE, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) WOODRIDGE BLK 3 LT 1 Legal description (Township, Range & Section) Lot Size 40176 Sq. Ft. Number of Bedrooms 'T- Lj APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade F (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 3 C P a Sid Date of Payment: 0 2 Receipt Number: 0 Permit No. ns P i; 1 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc June 10, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: WOODRIDGE BLK 3 LT 1 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211211, Rebecca Carroll, 06/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211211, Rebecca Carroll, 06/11/21 100' WELL RADIUSLot 1, Block 3Woodridge Subdivision40,176 Sq. Ft. +/-16401 Virgo Avenue2 Story Wood Frame HouseWith Attached 3 Car GarageWSSSSL=139.34R=190.00N50° 24' 22"W 112.00'S5 0 ° 1 8 ' 0 1 "W 2 9 7 . 3 1 'N89° 58' 31"W 381.93'44.0 65.55 5 . 6 2 8 . 5 14.94 . 0 7.83 . 4 7.48 . 7 34.23 8 . 632.14.82.84.11.92.02.512.12.012.28.2 34.910' UTILITY EASEMENTLOT 2℄ VIRGO AVENUE3 0 ' R . O .W .PAVED DRIVEWAYSHEDSGEESPREPARED BY:FRONTIER SURVEYS, LLC650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518907-460-1686DRAWN BY: CHECKED BY: DATE: SCALE:DRAWING ID: SHEET 1 of 11.This document is created for the purpose of a single property transactionand is subject to Federal Copyright Laws.2.Excepting for gross negligence, the liability for this survey shall not exceedthe cost of preparing this survey.3.All measurements/setbacks are to the visual/apparent building footprint.4.All dimensions to property lines are plus/minus 0.1ft.General Notes DisclaimerLegendThis survey complies with the ASPLS Mortgage Location Standards. The survey represents visibleimprovements and conditions at the time of the survey. This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is theresponsibility of the Owner to determine the existence of any easements, covenants, or restrictionwhich do no appear on the record plat. Under no circumstances should this document be used forconstruction or for establishing a boundary or fence line.PS1" = 30ft06/06/202121-358SSScale 1" = 30'AN AS-BUILT OFLOT 1, BLOCK 3WOODRIDGE SUBDIVISION16401 VIRGO AVENUE ANCHORAGE, AKCONTAINING: 40,176 Sq. Ft. +/- (RECORD)RECORD PLAT: 1981-234 ANCHORAGE RECORDING DISTRICTEEElectric MeterElec. PedestalGas MeterS T A TEOFALASKA49THROYEVR U SDNALLANOISSEFORPDERETSIGERPierre M. StragierNO. LS-981206/09/2021GSWSepticWater Well MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SI:;R\ -"S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TANKS ,~ SEPTIC TYPE OF SYSTEM DISTANCES ~-'~--~---'-~i SEPTIC FROM ~ TANK WELL LOT LINE FOUNDATION ! (40 I ~ ABSORPTION FIELD WELL dmreWay waler bodies, olc.] I~-~ I~(~ [.~ E N CH ~] BED 0 FT %-/ It 71':f [] W. DRAIN [] OTHER FT WELLS PRIVATE L~J OTHER fldentifv) REMARKS: Municipal aid $1ale guidelines in effect on this date: -- __ Inspections Perlormed b : cerlily Ihat Ihis insgeclion was pedormed according lo all i- Date: ENGINEER'S SEAL I.l::,bl.'ff,. I.)I..,.)LJ,.ll ,,L:HJEII:):[V:I:(3:!:CII',I:NE}[.II)R1D£,I:. [.D"I".' :1. £L[,)I,I-.,, ~.[., I ].1.,)11. "" .... "I'EiNNfiffJ:I;F'~I :1. :I.N F~(,.~FIFJE:." .... I..[TF ~3:l;Zliii:~ J, 2;tt':.~('t (,"3L;!,.F:'f',, Eli::;: ('d,,,l',l:.,) ~ -) DI~:F:'(~R'FMEIxlT (:.IF:' HEAL. TI-t AND IEh. IVIFd:]I',.IMI~i]',ITAL, F:'FiIOTEC"I'ION 8~5 I.. !~H"REIF:T, ANCH[IRAGE, AK 99503. Al I'L.[L, AIII ~ A):):I) RI!~:S S: CONTAC'T I::'tIDNF,: II M ICI::: :1: liii: LOTZE 2()() W ::i,";Zl."l"l't dl:Zl.():L ANI::iHEiI:?AEIE, Al( 99503 I .lEGAl.,, DI..,,. L,h, .t, I ,, I,..O'1 S i ZI]ii:: t¥1AX LI..DI~ .. I. I I,.~. [:IN,~ WOODR I DGE L. OT ~ 3 TOWI',ISH'I F:': :1. :1. N RANGE: (SI:i!. I:::'1'., OR (.:~l:::l~lili:,c-i) DEPTH '1'0 I:::' :I:I::'IZ BI TOM (FI".) Gl::d.:~Vli!':l. DEF:'TH (I::T, T[I'I"AI. DEI::;']'II (1:::"t',, BRAgEL. W]:DTH EiRAVEL.. I,.,.IEIqG'I"H (F"I' ) GF;,'AVli~:I..,. VOLUIflE (E:IJ iDS,. ) ]'ANI< iii I ZIE (liiAI.,..S) S[III,, RAT]:NG (SD,,F!' /BR) ~.l"le Ol:~ticirl that I:l~.~st f':i.'Ls ye)ur ' -'H-' F U-'Il 4. () 1: LUM ...... :, 4.0 () ,, 5 4 ,, 5 :3 ,, 0 :5 ,, 0 /,, 4 , ~:~:~- ,, ' :L 72 ::tE , () 5 · x..~-'I'ANI< MI.tST Al' I,,.EAS'T 'I'll, lEI ARTMlii:I'~ITFi d~'!,, I w:i. ]. ], in~,'LaI I 'l',.l'l~.~ sy~.'l ,',.uid J.l'] comp :1 ia i::e v, JJ.'Li'l 3,, I w:i, ] :1.' adl'm?p'(:~ all qLL ti. I' ~'![ll(~? c:)r'P"-'~a :i. '[:,t~ S~.)Wt~,! I" !-~i c)l' (MOA) arid the State of Alaska. !Ill ],1'] acc::or'Lh:':lrlc:e w;i.'t.h all MOA C:(:]{::IC~Ei design cr'itep:i.a of 'l:.his pemn:H'.,, ~::Xl"l(::l I~i'I',.i:'V~,E, CI {' ~]. a{~iI.::,?:l I' (?))ql.I :i. p t~lilE)i"l'?,~i l' EIP '~.,l'l(.t) ~!iE)'t, I::)~'~Ai::: I.:: sewed'age s~ o~' any atd.:jac;I.~l'l'[:. [:il' near'l::)y ],~'L.,, al'iy ~z~l'i].al',gt::~m[:.)r'Yt, ~J,:l.], r'l.:;H::JLlil'e ali ad[:l~,-I:,il::llia]. IF' A I...II:::'l ~:~IAI .I. 01,1 :1:Ii~ ].I,I,:~IAL..I..[:.D IN AN AREA COVERli~:D BY I"IDA 131JII..DIIqG 'I'HEIxl ( 1 ) AN I ,Ir..J::,l., I I~.I,I.,AI,,, I:::'ERM I"l' AND I hlSF'I:i:[;T I I]lq MIlS'I" WII..I. I~.ll:]'[' BE AI::'F:'F/I]VED N:[TlaC:)UT AN EI...E[FI'I::I]ChI... .I. Nc~l I:.[.,I .I.I)N ....... ' '"' ....... [~[.I [.]F~ r, AND (3) 'l"l.llg: ~t ):) ATE: ........... ......... , .... I ~1 I..]:CAI'qT~ MICK]:I~: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rEST PERFORMED FOR: DATE PERFORMED: {ENGINEER'S SEAL} ~l-~~ 8 ~ LEGAL DESCRIPTION: [*'~ooJ~','~¢~ 55 L / 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: .~'c ,?~ q-;IN /~3 c~ T I'l ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth I0 Waler filler tflenilerin§'/ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop . o 'f ~ o 5 .q (-¢ , :Z O /13¢ ~o 3.q~ ,1~ PERCOLATION RATE I I ¢13('-n~!nutes/~nch) PERC HOLE M~TER TEST RUN BETWEEN ~ '/'~ FT AND 3 CO~ENTS Z°"/ F'-l'rd d) /¢~¢ ¢~'/&. "/G,~'~- /~ ~ II ~, ~,( PERFORMEDBY: ~C~' /,,c-ST~- 0 2 g (~ ~~ ' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 {Bev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (EN GIN~S..~J~ PERFORMED FOR: Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 16- 17- 18- 19- 20- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, ATWHAT .~ I/ 2 ~) DEPTH? ~ p E Depth to Waler Aller Monilorlflg? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (m~nutes/inch) PERC HOLE DIAMETER 'rEST RUN BETWEEN __ FTAND COMMENTS ..~o(I .'~ ~*tj'~i'¢'~61¢ "/~,~, o~. ,¢"'~ 5'e/~'/'7'c J'.2'J'Jr/~-~ FT 72-008 (Rev. 4~85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 %" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENG~ER'S SEAL) '.,...3 LEGAL DESCRIPTION: ~¢oo:h-,'d,?e ~ ~ L ! 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: o L O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? /'[ E Depth to Waler After I~onlloring? Date: Gross Net Depth to Net Reading Dote Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND __ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE~T ON THIS DATE. DATE: 72-008 (Rev. 4/85) S U WC � P A U T EI o F ANCHORAGE Development Services Department 7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-093-01 1. GENERAL INFORMATION Complete legal description WOODRIDGE BLOCK 3, LOT 1 Expiration Date: q— 23 —2� Location (site address) 16401 VIRGO AVENUE, ANCHORAGE, AK 99516 Current property owner(s) JANICE COBURN Day phone Mailing address Real estate agent 16401 VIRGO AVENUE, ANCHORAGE, AK 99516 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 ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .55�% Date of Payment % a 0 Receipt Number n l 13 COSA # O2 11'336 Waiver Fee $ Date of Payment Receipt Number Waiver # 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 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/16/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the •�(� well and septic system. Therefore, any estimate of how long a system will function satisfactory ��g�Q:• • • • • �9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or / JJ discrepancies exist can be given by First Water Consulting & FWGs ' *' Tli •'* /� 6. DSD SIGNATURE �r • Curtis Huffman System #1 Approved for bedrooms �c/s� • CE 128991 ..��aw �l F System #2 Approved for bedrooms F�F�PROSS 1>>ESSI . � Disapproved Conditional approval for bedrooms, with the following stipulations: 171- T -- JI)i) m)) l By: Original Certificate Date: _2 J �� 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: WOODRIDGE BLOCK 3 LOT 1 Parcel ID: 020-093-01 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 1/3/1986 Total depth 205 ft Cased to 46 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/15/2021 Static water level at beginning of test 50 ft. Well production at time of test 3+ gpm Comments B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW' -- Date of Sample 6/14/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Which system tested (date installed) 1/7/1986 Adequacy test date 6/15/2021 ® ALL standpipes present per record drawing Results M 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_8 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 5 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective *5.5' INTO THE 7'ED Elapsed time 1320 min ® Code -required soil cover over field Final fluid depth 0 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 FW°C Comments/Deficiencies: *BASED ON MEASUREMENTS OF TANK DCO TO MT ELEVATIONS . E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Community Sewer Manhole/Cleanout >,100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No _ ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ 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 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. A,,��''� • . cis, �� . Curtis Huffman CE 128991 ..•���� � �kO ROFESSI �4���'��• fF ft MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEAl_TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 1; Block 3... WoodJJ. dge. Sub~:vx'.aion Location (site address or directions) Property owner Mailing address 16401 Virqo Avenue Anchorag~ AK Jeffrey and Suzanne' Chamberlin Day phone_ 345-1653 (h) 276-7512 (w) Lending agency Mailing address Agent REAL ESTATE SUPPORT SERVICES Address 8200 H~bol&~ Su~t~. 101 MinneapoZ~s~ MN Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well ×XX Community well Public water NOTE: Day phone (Debbi¢) Day phone 800-829-7377 55431 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEI"R 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~i_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. $ & S £"6INEERI~6'~ Phone _0""~/7'/"~--~/~' Name of Firm ~7024-.,Eagie..~iveJ, Loop.l~oad No. 204 Address Fagle E,v/ed~J~sl~a 9~77 Engineer's signature Date /O/ /,,'/¢_¢ DHHS SIGNATURE X Approved for ,~oc,/c_~,¢,,) bedrooms. 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. C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANC>~FR~ATION TO: Well o.~-let~'''~ On adjacent lots D. ABSORPTION FIELD DATA Date installed [/? / ~ Length---~( /' Width Total absorption area 7/g¢ ~ Date of adequacy test ~/~© Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Manufacturer ~ Manhole/Access (Y/N) ~ "P u~uJ:~p-olf~evel at Surface water Soil rating (GPD/Ft2) /02 ~'~//"~ System type r Gravelthickness ~ / Total depth /~ / Cleanout present) ~ Depression ever field (Y~ Results~/fa,l) ~4 Z.~ for ~ ~O¢~ Bedrooms ~" After test ~ ~// ~o~ ~8~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /L"~¢.)/-'/~ To building foundation On adjacent Iots_.~ Surface water Curtain drain On adjacent lots /(20 /-7~-~ Properly line TO existing or abandoned system on lot Cutbank /(/o~6- /o/~Z~'~J:/--Water main/selvice line__/O Driveway, parking/vehicle storage area ~ B, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or ( S & S ENGINEERING Signature 17034 Eagle River Eagle River, Alaska 99577 Engineer's Name Date HAAFee$ t~ g~ Date of Payment ¢/O -/7Z ~.~ Receipt Number a ~,~ ~¢, C~/~ 7 ,'~ Waiver Fe/e $ Date of Payment Receipt Number 72-026 (3/93)" Back 10/01/93 1'?:O3 CT&5 ENUIRONHENTRL LRB SERU[CES ~ 90'73761187 NC. il5 COMMERClAL'lr'E FI'ING & ENGINEERING CO. ENVIRONMENTAL LABORATORY ~ERVIGE$ ~ ........... Chemlab Ref,# =93,5~49-7 Client Sample ID =L1 B3 WOODRIDG~ Matri~ :WAT~ ANCHORAGE, AK 99518 TEL: (907) 5§2,2343 FA){; (907) S61-5301 Client Name =S & S ENGINEEI~IN8 P~oJect Name = Progect# ~ PWSID ~U~ S'ample Remar~Z: ROUTIN~"SAMPL.W. CO['L~.C, TED BY; WORK order ~7~549 Report Completed ~10/0~/93 Collected :09/29/93 @ 15=05 hfs, Receive~ ~09/29/93 @ 15~4§ Technical Dlrecter~STE~Hi~N~C. Released By Allowablo Ext, Anal Parameter Results dual Units Methsd Limits Date Date Init Nit~ate,-N 0.23 m~/L EPA 353.2/300.0 10 ~0/01 LLtt See Special Instructions Above UA = Unavailable See 8ample Rer~arks Above NA = Not ~alyzed Undetected, Re.fred value is the practical qu~tification limit. LT = Less ~ Secondary dilution. GT = Greater Thm~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot I; Block 3; Woodridqe Subdivision; CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Location (address or directions) 16401 Virgo Avenue (b) Property owner Fran~ ~ Karen Hic~ Mailing Address 16401 Virgo Avenue (¢) Lending Institution Mailing Address Telephone: (home) Anchorage, Ak. 99516 G.M.A.C. ATTN: earn2 No,~bx'.f~ Telephone 345-1 191 Business (d) Real Estate Company and Agent RE/MC.X PROPERTIFq ATTN_. Da. / ¢~ Address ~0 (~,O~Hnxm Au~ A.~,bn~CrZ~ A~'n.~b~ qq~05 Telephone 257-0115 (e) Mail the HAA to the following address: (or check here [~,Xif hold for pick up.) L. ist contact person and day phone number below: 17034 F. agle River t.6op R~ad/~,~o. 204 Eagle River, Alaska 2. TYPE OF RESIDENCE Single-Family E~X Number of bedrooms 3. WATER SUPPLY Individual Well E](y. Community [] Public [] Note: If community well system, must have written confirmation from the State DePartment o(' E:nvironmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~x 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. 72-028(Rev 7/88) Page 1 of 2 5. 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 Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms end 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. Telephone ~f'~/~7~//Z' ¢--'¢ ~¢;;~ 1) 03=' ,?:gi,~ River Loop Road No, 204 ~acjle :~l'¢erf ,~1~ - Name of Firm Address Date 6. DHHS APPROVAL Approved for __ Approved bedrooms by Disapproved Terms of Conditional Approval 4,~/-~~~C///D at e Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 72-025 (Rev. 7/88) 8ack Page 2 of 2 R, ECEIVED ,JAN b 0 1901 i~.,~u','dc'.pahiy ct/\nchoi'age Dept. Health & I luraan Servioe8 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHI-'CKLIST - FEBRUARY 1984 343-4744 Legal Description: ./~-~'-~ Well Classification ~.-~;~d ~'/~,. ~[~ IW.'~/~ If A, B, C, D.E.C. Approved (Y/N) ~_ _ Date Completed Yield Well Log Present (Y/N) _C~ / -- ~ - Total Depth ~o~'Cased to_~ Depth of Grouting Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) /2 Pump Set At L) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line ~)/~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~---~"~ 5[ -~ ~tO~/tO~¢~c Water Sample Test Results ~~C~?-t~ C Comments / _ To Nearest Public Sewer Cleanout/Manhole _ ,k)/~ / ;Date B. SI='PTIC/HOLDING TANK DATA Datelnstalled !-¢-~ Size Z~_ No. of Compartments Standpipes (Y/N) u~ Air-tight Caps (Y/N) I../ Foundatioa Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped . [ _ ~ _ c.[ / / / Pumping/Maintenance Contact on File (Y/N) /',-)/R ; for / / Holding Tank High-Water Alarm (Y/N) _ N/¢~ Temporary Holding Tank Permit (Y/N) SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well / To Property Line ( (..0 /~- To Water Main/Service Line [ O ' -~- To Stream, Pond, Lake or Major Drainage Course , Comments ._ ": To Building Foundation 'Fo Disposal Field (OO 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata - / '-¢ ~-- ¢'/~'~('~' Type of System Design --~--~ C/~. Date Installed ( - ~'¢- ~ ~~ Length of Field ~/~ ~ Width of Field ~--, ~ Depth of Field Gravel Bed Thickness Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Statndpipes Present (Y/N) ~1 /~ Date of Last Adequacy Test ( SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot /t,)/~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments / OD To Property Line r To Existing or Abandoned System on ; On Adjoining Lots , / ( © ./c To Cutback (if present) (oo fi- D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. Signed Company Date MOA No. 7034 ~ia.:ilo rzivor I.oop F;oa¢l No, 204 :.agl~ River,. Ala~k~t 995]7 Receipt No. P~-/~' Date of Payment Amount: $ 72 026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 this CHEMICAL & GEOLOGICAL LABORATORIES OF AI 4SKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 , TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ! 31499 Date Report Printed: JAN 24 91 ~ 06:14 Client 3ample ID:LI P;~SID Collected JAN 21 91@ 13:00 Received JAN 22 9i ~ 15:46 hrs. Preserved with :AS REQUIRED Client Name Client Aect BPO # Req # Ordered By g & S ENGINEERINO PO 8 NONE RECEIVED R. SSATER Analyele Completed :JAN 23 91 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)S ~ S ENGINEERING RoleaeeO By : ~ ~'/~ ~ Chemlab Ref #: 910228 Lab Smpl ID: 1 Matrix: WATER Allowable Paremetor Tosted Reeult Un~ts Method LiNts NITRATE-R 0.20 ~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: RDJ, Remarks: Teste Performed ' See Special Instruction~ hbove UA,,Unavallable None Detected "See Sample Remarke Above Not Analyzed LT-Lese Than, gT-Groeter Than MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTFI AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~.,~_ (/) ~,,0 ~'/~--6'} / HAA # '~-~ ~'-'~ - ~_,'O ~-~. 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Location (address or directions) Property owner ~ ~-~:~o ~ Mailing Address ~,(¢ ~-/0 /. Telephone: (home) ~: YJ~ 0~..~- Business ~/'¢ r ~ (? (C) Lending Institution (d) Real Estate Company and Agent Address (e) Telephone Mail the HAA to the following address: (or check here~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family/~l/~ Number of bedrooms -~ 3. WATER SUPPLY Well ~ Community [] Public [] Individual Note: If community we'il system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL · On-sit Pgblic [] Community [] Holding Tank [] Nole: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 Legal Description: MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) ~, ,.. {CHECKLIST- FEBRUARY 1984 ,: :5 ,'/IsJCN 343-4744 A. WELL DATA Well Classification Well Log Present (Y/N) ~ Date Completed Total Depth ~ ~; _Cased to ZJ ~ Depth of Grouting Static Water Level _ ) ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on t_ot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Yield t'.,/o ,-./~ Pump Set At __ -¢ oq-To 'l*d Sanitary Seal on Casing (Y/N) __ Depression Around Wellhead (Y/N) N IIQJc To Nearest Public Sewer Cleanout/Manhole ;Date ; On Adjoining Lots V'~OZ-~Ni ; On Adjoining Lots B. SI-'PTIC/HOLDING TANK DATA Date Installed//_~ Size Standpipes (Y/N) Depression over Tank (Y/N) _ Pumpiag/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /,;P..~o __ No. of Compartments Air-tight Caps (Y/N) _ Temporary Holding Tank Permit (Y/N) Foundation Cleanout (Y/N) ~" Date Last Pumped ¢~-/c¢~/ /.q a. ~,~ /¢ ' ;for To Building Foundation To Disposal Field To Water-Supply Well _ // To Property Line Z¢/~/' To Water Main/Service Line __ To Stream, Pond, Lake or Major Drainage Course Comments 72 026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area -7//7' ~ Depression over Field (Y/N) /xt Results of Last Adequacy Test ~.~ % SEPARATION DISTANCE FROM ABSORPTION FIELD: I/O k Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test ; On Adjoining Lots To Cutback (if present) To Water-Supply Well To Building Foundation ///~' / Lot To Water Main/Service Line ~/'~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on r-,'/, Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ / Receipt No. Waiver Fee: $ Date of Payment 72 026(Rev. 7/88) Back Page 2 of 2 Engineer's Seal MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-\(~]~o"" OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) L.egal Description (include lot, block, subdivision, section, township, range) Loo~tion (oddress or direotionB) (b) . Applio~nt Name ~ I~1~ LOTZ~ Telephone: Home ~V~ ~O 7 Business _~-~'~(~ Applicant Address ~OO iU..JV~ ~0/ ~[~, , ~ ~g~ (C) Applicant is (check one): Eending Institution ~; Owner/builder ~; Buyer E]; Other ~ (explain); (d) I.ending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the tollowing address: Telephone TYPE OF RESIDENCE Single-FamilyJ~' Multi-Familyr'] Number of Bedrooms . Other WATER SUPPLY Individual Well ~ Community [] Public I-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and 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. 72-025 (11/84) Page 1 ol 2 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 Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /'~ ~-~=~/~-~ '~ Telephone ,-~-~ I/--.~"C~ ~) Address ~.~00 ~() ,~.¢~~----- ~ ~/, /_~ DHEP Approved for ~ggc(:~ bedrooms by ~ 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 institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or ()missions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNIC)PAIJTy (_ D~p~, O~ R~^~HMUNIClPALITY OP ANCHORAGE (blGA) .ER1.TH AUTHORITY APPROVAL (HAA) NOV 1 2 986 CHECKLIST- FEBRUARY 1984 264-4720 ~C~/v~ Legal Descript,on: WELL DATA Well Classification Well Log Present (~N) Total Depth ~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot lr)~)/_],/'/~- ~~'/~ If A, B, C, D.E.C. Approvea (Y/N) Date Completed _ I/~/_~'g Yield Depth of Grouting _ Pump Set At __ 2, ~ / Sanitary Seal on Oasin~c Depresmon Arot~ qd Wellhead (Y,~ I ~2f"O ' : On Adjoining Lots I/00 t~. I00 ,¢. To Nearest Edge of Absorption Field on Lot J ,~ ~-" _; On Adjoining Lots To Nearest Public Sewer Line /k///~- To Nearest Public Sewer Cleanout/Manhole _ /V'/f) To Nearest Sewer Service Line on Lot Water Sample Collected by ~-~, .~/~'~-fUCK ~/¢rF~C.~..%] ; Date __ Water Sample Test Results _ % ¢rT!s Pll-cFOg Comments ;'91¢' Ci~I~/;'/~4'"IE lt') , ¢JJ /'I'EFt T" o~'V B, SEPTIC/HOLDING TANK DATA Date Insta ed ~/.¢/.//~::~"~ Standpipes (~)/N) _ Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /V/~ separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course 10 ¢.)~ ¢'~ Size j~-'~O NO. of Compartments ~ · Air~tight Caps (~N) Foundation Cleanout ~'~N) Date Las~ Pumpea /fl//,~ Temporary Holding Tank Permit (Y/N) _ J~-O / To Building Foundation z/¢ '¢- To Disposa Field To Stream Pond. Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test 7lq' Type of System Design Length of Field '-~'"/ / Depth of Field /,;2~." Gravel Bed Thickness ' 7 '/ Standpipes Present ~_)N) Date of Last Adequacy Test Separation Distance from Absorption Field: / · To Water-Supply Well To Building Foundation Lot ~V'/~ To Water Main/Service Line /~//~'- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line qO '' '¢''' To Existing or Abandoned System on ; On Adjoining Lots ,2- To Cutbank (if present) /~"/,~' lOO D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N} Comments Dimensions / Ma~h°le/Access (Y/~''~'/ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify t hat..JI ha,~;,~e~ck.e~d, v,,erifled~,or conformed to all MgA arid HAA guidelines in Signed ~~,,¢~ Date / / / ,~/~'~/' Compan, //'/~Lg~____....~ /~. MOA No. ~6-OZ¢ Receipt No. DO O~ ¢¢0 ¢ Dateof Payment ~/ ~/~-~C ~ Page 2 of 2 72-026 (11/84) effect on the date of this inspection. ALASKA eDUIROIqlTleDTAL COFITROL $~RUICe$, IFIC. ~nqineeeinq 6 ~nuironmentol $1udies December 17, 1985 Department of Health & Human Services 825 L. Street Anchorage, Alaska 99501 Attn: Steve Morris Re: Woodridge Subdivision, Block 3, Lot 1 Dear Steve: I feel the development of the subject lot will not impinge on the development of the surrounding lots. If you have any questions please feel free to contact me. Sincerely, Prefident 1200 LUesl 33rd Auenue, Suile B' Anchor~qe, Alnskn 99503 ~'(907) 561-50110 AI. ASKA ENVIRON~ENTAL CONTROL SERVll. ~, INC. 1200 West 33rd Avenue. Suite B ~,NCHORAGE, A[~ASKA 99503 (907) 56~L-5040 SHEET NC OF CHECKED BY DATE HOUSE / 72' /