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NORTH WOODS UNIT 4 BLK 18 LT 3
Northwoods #4 Block 18 Lot 3 #051-064-43 wm.: rr Grr� Tw.ny.p; Well: To From WAN svrRu w,w. LaL w 6 Municipality of Anchorage Development Services Department ;.is Building Safety Division Onsite Water and Wastewater Program, 4700 S. Bragaw SL P.O. BOX 196650 Anchorage, et AK 995136650 I ON-SITE WASTEWATER DISPOSAL YSTEMAND R WELL INSPECTION REPORT, I a ar ��OTD l PID Number. _ 0 - r Wastewater System: ❑New 0 Upgrade ,< v� I r %SG7-S6y ABSORPTION FIELD T1 3 NunDMM8a0par (� / XO«p w� OswW.Trnwh I7 BRd 0Mwnd O Odw. • LEGAL DESCRIPTION B°rR""a ❑ New ❑ Upgrade F1. r,. SEPARATION DISTANCES Fppwpyy� FL Septic Tank Absorption tilt Holding Field Station Tank RVPnvWa Sdrer Lira f )a rf ton I r �13 C~ om.1, i n.�w..: � T bop .S Gawl ftm TANK 181 Septic ❑ Holding ❑ S.T.E.P. ., --D/ r. HIVE LIFT STATION BENCH MARK Inspections performed by: 17034 y:17034 Bayle River Lap Rem tot L n Atat�yss77 " Developm nt Services Department Approval Reviewed aria accroved by •R., .:.h� Date: _(/ 11� �. owwa.n Rrws: 13 FL - rj-0q 0 Other. ZF— W Ga. loo F,. M S ROBERT C COWAN CE • 8801 N. PERMIT N0. SW040153 PACE 2 of 3 Municipalit of AnchorQge DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. hon: 343-4744 ON—SITE WASTEWATER DISPOSAL SYSTEM e, Alaska LAND/OR 9-6650 *e1WELLe INSPECTION REPORT LEGAL LOT 3 BLOCK 18 NORTH WOODS #4 S/D P.I.D. NO. nrli_nQ.1_I4 PERMIT NO. SW040153 PACE 3 OF 3 DEPARTMENT ANDhHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION 6650 0 hon: 343-4744 ON—SITE WASTEWATER DISPOSAL SYSTEM e, A[Qska LAND/OR 9-6650 0 Tele 1WELLe INSPECTION REPORT LEGAL LOT 3, BLOCK 18 NORTH WOODS #4 S/D P.I.D. NO. 051-064-43 ST1 ST2 -,-98.0' FINAL GRADE NEW 94.9 1300 GALLON POLYETHYLENE SEPTIC TANK FINAL GRADE MTI =90.0' ' = OFFSET C01=98.3' CO2=98.4' 2" INSULATION COI=94.2' CO2=94.0' MT2=90.0' NO WATER FOUND 84.0' B.O.H. 2" INSULATION 94.6' CO3=96.1' C04=96.1' CO3=94.0' C04=94.0' N. T. S. i ROBERT C. COWAN 1, ,A MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bmgaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO40153 Legal Description: KORTH WOODS UNIT 4 BLK-18_LT-73-P Design Engineer: 0003 S & S Engineering ry Owner Name: Eric Fisher Owner Address: 23524 Blue Skies Drive Chugiak , AK 99567-5640 Date Issued: May 27, 2004 Expiration Date: May 27, 2005 Parcel ID: 051-064-43 Site Address: 023524 BLUE SKIES DR Lot Size: 27553 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of: Q✓ Disposal Field Q✓ Septic Tank Ej Holding Tank E3 Privy Private Well ❑Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. ?W2 2 Date: L/}7 �0 Issued By. I-Vk-- 1 tU Date:s� 2i o l ZNv Municipality of Anchorage • -• Development Services Department Building Safety Division On -Site Water and Wastewater Program t 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 OiG-SITE ScWER/\A'ELL PERivtIT APPLICAT!n-�t FOR A SINGLE FAMILY DWELLING Parcel I.D. O S ) — 0 fo K —H3 Permit Number SW Property owner(s) Erre /7� 5 A er Day phone5S,-? / / — 73 Mailing address (1) D/3/5�T , ghtN /5�k-,Cs D6ye- Mailing address (2) LG, .1q IA k f k Q Zip Code _ 29547 Legal description (Lot, Block s Sub'd.) L E. R l ocL 19 /llOMxods --*f Legal description (Section, Township & Range) Lot Size^ 22 553 Acre /S9 Number of Bedrooms _ THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 /X)... e...t_ of.... et.&a 00;77 (Signature of property owner or authorized agent) Permit Fees: y 6 O_ a' Waiver Fees: Date of Payment: f /ay /o y Date of Payment: Receipt Number: t.7 S- d G Y fj Receipt Number: (Rev. 12100) May 21, 2004 ROBERT C. COWAN, P.E. CML ENG W EERS (907) 6942979 FAX (907) 6941211 1EAUHAMHORITY MUNICIPALITY OF ANCHORAGE ArmwAM Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWERSWATER AUN E MNSgNS REFERENCE: Lot 3, Block 18, Northwoods Subdivision #4 nRILWATER � It is requested that you issue a permit to install a septic system upgrade to serve the existing four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of STUDIES ENGINEErONGAAGFXPWS the test hole is located on the attached site plan. At the time of excavation 4/4/92, no water was found. After monitoring, ground water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve WEU TEST areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. WE PLANS If you require additional information, please contact us. Sincerely, ROAD DESIGN z RobertC. Cowan, P.E. WkTEST RCC/bjj Enclosure PEACOIATIOR TEST STKXTLAk& ►ECKANI x INSPECTIONS CNSRE WASTEWATER DtSPOMSYSTE4 DESIGN , 17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RNER, ALASKA 99577 15 TELECOM & ELECTRIC EASEMENT ------------ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 n " fes, a- r� ` ON Cr. uu 0 ,O„f ?� ^Y z O 0= �14 NZ fp vo"m 3Sf1ON =!O r -O v=8 3e 4 •zm ONI151%3 DOK r O y la O Z Z x 007Cy 1.1. sp° Z zOzomo ° p C n r �mr ,N•1 Q p Z a o pp om oO Df=f1 x=o O 1 .0& NIP 1 A 31111--5 31VN831ly --'01 min LL--------------- o z 0 r O y ... O H 1" = 40' DESIGN p O mo;z SA SITE -PLAN I rrnr X'V = ° m � • (1 m l�.Ai r D A not cr I $ r y Di o c "= om K ` N O Tl I O �• >n " ,,o x= y 0 N �y A NRD<�N C'1-1 "i '� Co� ,04 l I .I� rl"" j -1 D H.1 -J M NNO o c I C O l IS mD Dr n m x I N —1 I ra�.yy ry °l VI A I� -----------------------'Z--� \OO n 2 � --_D—O m II ... Z> 11011 O O O� v Gi X 15 TELECOM & ELECTRIC EASEMENT ------------ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 n " fes, a- r� ` ON Cr. uu 0 ,O„f ?� ^Y z O 0= �14 NZ fp vo"m 3Sf1ON =!O r -O v=8 3e 4 •zm ONI151%3 DOK r O y la O Z Z x 007Cy 1.1. sp° Z zOzomo ° p C n r �mr ,N•1 Q p Z a o pp om oO Df=f1 x=o O 1 .0& NIP 1 A 31111--5 31VN831ly --'01 min LL--------------- o z 0 r O y ... O H N� f A m p O mo;z SA I rrnr X'V = ° m � • (1 m D A ti Dip r y 2ti K ` N O Tl Ul �• >n " ,,o >1 N N� f A m p O mo;z SA X'V = D A ti Dip r 2ti K ` N O Tl mr Xom >n " ,,o >1 N O Z O I PER LEG E 10 11 12 13 14 15 16 17 19 19 20 TEST RUN BETWEEN -f— FT AND 4�5 FT COMMENTS PERFORMED BY: 17034 Eagle River Loop Road No. 294 ig a Iver, Alaska 99577 CERTIFY THAT THIS TESTWASPERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T IS DATE. DATE: 72-008 (Rev. 4/85) S& FEALTHA.UDRORTy APPROVALS SEWERBWATER IA NDnNSgNg SEWER&WATER INSPECTION RNGINEERINOSTU71ES ANDREPORTS WELLINSPECTION 6 FLOW TEST SITE PWL4 ROAD DESIGN SMTEST PERCOLATION TEST STINICIU AL& MECHANICAL INSPECTIONS ONSRE WASTEWATER DMPOSALSYSTEMT DESIGN RO6ERTC. COWAN, P.E. CML ENGINEERS (907)694-2979 FAX(907)694.1211 ON-SITE NVASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 3, Block 18, Northwoods Subdivision #4 May 21, 2004 GENERAL: 1. The scope of this project includes the replacement of the existing 1000 gallon septic tank with a new 1300 gallon HDPE septic tank, and additional length added to the existing trenches to serve the existing four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems'must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: I. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 Page 2 Lot 3, Block 18, Northwoods Subdivision 04 May 21, 2004 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page 9 Lot 3, Block 18, Northwoods Subdivision 84 May 21, 2004 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1 • Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tyne of Pice Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F8 10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. • Page 4 Lot 3, Block 18, Northwoods Subdivision N4 May 21, 2004 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER 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: `J4��� PID Number: ©4:G i Name: ,J0+k.tG,�j,�r—��f��' ,._t 5�. Wastewater System: New ❑ Upgrade Addr as: Gam' "� 80 ABSORPTION FIELD Phone: No. of Bedrooms: eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: / �'C Total Depth from original grade: 0 GPD/S .Ft. Lot: Block:Subdivision: ' Depth to pipe bottom from original grade: -' Gravel depth beneath pipe 4! Ft. Ft. Township: Range: Section: Fill added above original grade: 'Ft. Gravel length: lb2 U- Ft. WELL: ❑ New ❑ Upgrade Grave4dep+h: Wt p(} q^ f Number of lines: Distance between —.7 ✓ Ft. ,�- Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe matelriiall: i 25I O _• _340 1 Ft. Ft. I/ ( iO SC. Ft. D'S 1 r T! 15+ Driller: Date Drilled: Static Water Level: Installer: 4--n ^- Date install Ft. i� Vim `� Yield:Pump Set at: Casing Height Above Ground: TAN GPM Ft. Ft. SEPARATION DISTANCES" -Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private MaigcXpLlyr �1 Capacityin gallons: From Tank Field Station Tank Sewer Lines `� " —� ` Well �� Zci7-►' �-- ____ Material: Number of Compartments: Surface Water I��-!� I�1-t. — — _-- LIFT STATION Lot ,t n / 2d / Size ons: Manufacturer: Line Foundation 14f f — ____ "Pump on" level at: 'Pump o 1 at: High water alarm at: Curtain t [77' Pump Make & Model I Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description:^,. O�1 LL Lyi �r--r7,�� 1 �*-rG l-I.t✓`J I �!'S �-t l�.ld -� L� . Assumed Elevation: I a ENG�I® 1SSEAL 41. fw ® 0P O ..$$IIIIM Ar• p1�$ Inspections performed by.. 0", 1st'— 2nd P;JRJ. HAFER�� Department of Health and Human Services approval `€'; �,� No a .15 ®®•}^ _� Reviewed and approved b : Oce a Lt pP Y Date: i� �Pz �{` •itl T• 6 \ F�� pRo 72-013 (1/91) MOA 25 Perin;t No. Page 2 of �- Municipality of Anchorage 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 Legal Description: w pa�'S t-�1'i'F` l�iL-i1E� L.&rpSl N0.: of ' q 1 C85 L__-- exp rip 1� Co J Oat. 11 *i^a A 0 `r Q py ,,dgryry /J a®®�® L U4Zl �I' Cd'�Q:w��.yy a9P4Bm •JSA::I� �14�'f� 9` 72-013 A (2/91) MOA 25 1 Z N 72-013 A (2/91) MOA 25 e ���yyy CDU^4 9 sR e ++ fi• �� C`l,F°nb° pM;� off.^�a:J7 ®- m ®S e ���yyy CDU^4 9 sR e ++ fi• �� C`l,F°nb° pM;� off.^�a:J7 PAGE 1 OF MUNICIPALITY OF ANCHORAGE �� q DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 S Los ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920057 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:GARBERSON JOHN M & OWNER ADDRESS:HC 80 BLOCK 5052 CHUGIAK, AK 99567 PARCEL ID:05106443 LEGAL DESCRIPTION: NORTH WOODS UNIT IV BLK 18 LT 3 LOT SIZE: 27553 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 4/17/92 EXPIRATION DATE: 4/17/93 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: THE ABSORPTION SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE ENGINEERS DESIGN DATED 4/13/92. DATE: �Z0� RECEIVED BY: ISSUED BY: DATE: 4A4.1157 _ 1 rZ 0 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 Municipality of Anchorage HEALTH AUTHORITY DEPARTMENT OF HEALTH AND HUMAN SERVICES APPROVALS 825 L Street Anchorage, Alaska 99501 SEWER & WATER MAIN EXTENSIONS REFERENCE: North Woods Subdivision Phase #4, Block 18, Lot 3 Request you issue a permit to upgrade the septic system SEWER &WATER serving the referenced property. INSPECTION An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. ENGINEERING STUDIES A test hole was excavated and a percolation tests was AND REPORTS performed in the area of the proposed upgrade. Attached is the proposed upgrade design. This property is served by a Community water system. There WELL INSPECTION are no protective well radii which encroach upon the property. &FLOW TEST As can be seen from the site plan this lot is large enough for another future upgrade. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. SITE PLANS If you have any questions or require additional information for your review, please contact us. ROADDESIGN Sincerely, SOIL TEST ROGER J. SHA RJS/lsu PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 �,. 30' SCALE UPGRADE BLUE SKIES DRIVE �y' a Z 60 smypr� {{Y�i']H'h'�R'�$�a? `tom C IId` � p O � 3 m 01 �Z yCy r- mzm cb m � ? 0 0 UPGRADE I m a m A ti Ob 9 b O r O D 0 cn (nNTI I_ II Zo „ o)A t o �7 i S- 43 :U O b cl tb ti C� 0 m I oj; ti N ? n o rcb to � n 3 H O Q (1J �y' a Z 60 smypr� {{Y�i']H'h'�R'�$�a? `tom C IId` � � r n •ta o _ cN b n �m b y n z o n n 47' o —h n y 47' o y � O I m a m A ti Ob 9 b O r O D 0 cn (nNTI I_ II Zo „ o)A t o �7 i S- 43 :U O b cl tb ti C� 0 m I oj; ti N ? n o rcb to � n 3 H O Q (1J �y' a Z 60 smypr� {{Y�i']H'h'�R'�$�a? `tom C IId` I PERFO LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST RUN BETWEEN 'T FT AND '-Z—FT COMMENTS S ENGINEERING PERFORMED BY:17034 Eagle River Loop Road No. 2Q4 CERTIFY THAT THIS TEST WAS PERFORMED IN Eagle River, Alaska 9957.7 � \4 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON T IS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME `7/'v'/ s� ,( ,5te e/ � L , �i IQ P/H-OCNCE p ` [PIOd '"�0 �/ NEW ❑ UPGRADE MAILINrq{iESS /, lsYd^^�& LEGAL D/ WOCC�T///N a2mG/ Cs� l l�l /dAhd.. eGod 3 1 G � LOCATIO NO. OF BEDROOMS V DISTANCE TO: II N �U!/� Absorption area Dwelling ` /2 P IT N y WQ Manufacturer / �,n��, Material �� No. o ompartments ,7 Liq. capacity, g lions IF HOMEMADE: Inside length Width Liquid depth 6 J(DZ DISTANCETO: Well Dwelling PERMIT NO. O Z F Manufacturer Material Liquid capacity in gallons D w= DISTANCE TO: Well Foundation ^� Nearest lot line 3S / PE IT NO J z w F_W No. of lines Length of eachu - G / Total lengttyo ,line Trent �id i, 7 �3 Distant etween lines C� cc H In Top of tile to finish grade` Material beneath tile {{ & inches Total effective absor ti n area -. W Length Width Depth PERMIT NO. C7 Q 1- M_ LU Type of crib Crib diameter Crib depth Total effective absorption area W y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER o z b. r Q� 6 -' PIPE MATERIALS ^�� SOIL TEST RATING INSTALLER A REMARKS„_, - AZ 6_1B5' — 4 APPROVED DATE LEGAL 72-013 (Rev. 3/78) y, MUNICIPALITY OF ANCHORAGE Departmentr"� Health and Environmental rotection 825 _' Street, Anchorage, AK. 501 264-4720 Permit #-_s # # # HANDWRITTEN PERMIT *&6 AND/OR ON-SITE SEWER PERMIT Applicant: G r Mailing Address: Location: Phone Number: Legal Description: Ad T' 1 &&,,ft4 r uft dg� -7P—' W lX Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 1.30 The Required Size of the Soil Absorption System'Is: DEPTH LENGTH .�GRAVEL DEPTH 'S WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(W9tfrl"NG) TANK SIZE _ � GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(Z) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require the residence is remodeled to include more tha ed Signed: V , O Issued by: Applican % Date: k-15- t SWP/024(1/81) and wells as i .� SOILS LOG MUNICIPALITY OF ANCHORAGE • .r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: S+ -c iC S ka ! S �,'/� DATE PERFORMED: r� LEGAL DESCRIPTION: No-w=ds PIrx. K 19 L- ot-3 fn 1-1 K $T63 02�} SLOPE SITE PLAN (F EFS 19 1 2 ��M� I'gh� bro v/I Sil Sammy 9ru {I 3- 4- 5- 6- 7- 9- 10 45679 10, Date Gross Net 11 Net :-,f,!ding WAS GROUND WATER Time Time Water ENCOUNTERED? h%o 12 6 -to 2 a8 j49 ►+ .s 17 IF YES, AT WHAT 18ta to DEPTH? 13 L+8 • re Raid, Jr. 4• s'o a 14 Date Gross Net 15 Net :-,f,!ding i •► OF 4L Time Time Water i�P�����••��a��ai� 6 -to 2 a8 j49 ►+ .s 17 Via.-a.w...• 6 N.. 18ta to •. L+8 • re Raid, Jr. 4• s'o a 22-8zi .-20 3O '6 e& Cr 110 C ea Date Gross Net Depth to Net :-,f,!ding Time Time Water Drop 6 -to 2 a8 2 +$ to L+8 4• s'o 22-8zi .-20 3O zZ8 q- 54 2_ 10 2 3a — z ty Aro 2L ZT 2 'T 8 to • 2'/ .2-4 '. I PERCOLATION RATE +S (minutes/inch) TEST RUN BETWEEN FT AND 12 FT COMMENTS _Soz to4ea l� 13ofl �%� 1�na. 1 •2 }v it) PERFORMEDBY: T>arc!j CERTIFIED BY: DATE: 3. 72-008 (6,179) - MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section _ Fax: 907-343-7997 Parcel I.D. 051-064-43 Certificate of On -Site Systems Approval Expiration Date: _ 3 2 `t — z S 1. GENERAL INFORMATION Complete legal description NORTH WOODS #4 BLK 18 LT 3 Location (site address) 23524 Blue Skies Dr Current property owner(s) WILLIAMS Mailing address Real estate agent Amanda 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 982-0545 Day phone 982-0545 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 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. $550 COSA Fee $ i f Date of Payment Receipt Number 031 79 D OSC211148 COSA# Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 3/4/20 OF * 6. DSD SIGNATURE s10 System tl Approved for bedrooms f` stere E^9 Q:: System #2 Approved for bedrooms 3/4/21 'or Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 7 The Municipality of Anchorage Development Services Division (DSD) issues Cenificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional ci:.,il 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 COSA Checklist Legal Description: NORTH WOODS #4 BLK 18 LT 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 17 years Tank type/material seP1CPL= Measured operating fluid level in septic tank 50 ❑Q Standpipes/foundation cleanout /per record drawing Date of pumping 3-30 -Z D. ABSORPTION FIELD DATA 6/9/04 Which system tested (date installed) same ❑■ ALL standpipes present per record drawing Total measured depth from grade 7.5 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field Al Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 051-064-43 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes Q No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3129121 Results S Pass For 4 bedrooms Fluid depth prior to test 23&5 in Water added 600 gal New depth 291,10 in Elapsed time 30 min V Code -required soil cover over field Final fluid depth 2611,8 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet 1411111101MM, 0011KC-61011 From Private Well on Lot to: (Please enter distances if less than required or if cornrnunity weil) Septic Tank/Lift Station on Lot > 100' Yes Neighboring Tank > 100' ❑ Yes Absorption Field on Lot > 100' F-1 Yes Neighboring Absorption Fields > 100' El Yes Community Sewer Main > 75' E] Yes From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Community Sewer Manhole/Cleanout > 100' Yes if No ft rl Yes if No It if No ft Private Sewer/Septic Line > 26 M Yes if No ft if No it Holding Tank > 100' El Yes if No It F/1 Animal Containment > 50' Yes if No ft if No ft Yes if No ft Water Main > 10' M-, Yes Manure/Animal Excreta Storage > 100' ft Community Wells > 200' if No ft C] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' F/1 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' M-, Yes if No ft Community Wells > 200' nv Yes if No ft Water Service Line > 10' El Yes if No I'Adi 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' Q Yes it No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of AXOnicipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 49 TH Steve Eng CE -6,256 I Nt4i, I-A-lpi OD'DE'/ M ,E$,.60 QO N Q�1j spo O < 3HIR N p 1 Fy�L u. W o _ �1 tlo F 3 M6 - n M s K y PU 14 Wr W4 �• m�V—m 5 a "'z 9•at t] N M" [qi �.{ ����N� s/> m o F• � 2 � �i H iiz iZL�Kp>�a2 OtU6 AH yp YQW �2Ns • U, N u'i�. 4u�Hp .................. ................... ._.. �LuW >m� m~W 5° tatW.iP W ,�.Fl- W � WN mo2at;oQn m Q�1j spo N p 1 Fy�L _ �1 tlo F 3 - n M s K y 14 Wr 5 a "'z 9•at [qi �.{ ����N� to iiz iZL�Kp>�a2 OtU6 % �2Ns • p y iil � ag Mag d''{h. QOQ��ppQ�. ------------------------------ ...... ......... 'J.JYS3 X313 9 373t .91 .................. ................... ._.. O 0o EI trio m • � •II � Qpv � �'•�c 3/779 CL to OQ vi zm s J Municipality of Anchorage Development Services Department =` Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 �..Ax www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-064-43 COSA# 1. GENERAL INFORMATION Expiration Date: ? ` � LA Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address 23524 BLUE SKIES DRIVE, EAGLE RIVER, AK, 99567 ERIC FISHER Day phone 23524 BLUE SKIES DRIVE, EAGLE RIVER, AK, 99567 Day phone 688-4662 Real Estate Agent DAR WALDEN W/ KELLER WILLIAMS Day phone 865-6500 Mailing address 101 W. BENSON BLVD, #503, ANCHORAGE, AK, 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System E TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 samples. (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 seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation. GEG, LfD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE 10 Approved for bedrooms. Disapproved. 337-6179 Date b (,7. .gs�oo 94�T Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Llaintenance Agreements Supplemental Engineer's Report Other CEj7153 Ec "rof ess'10— ` OF ON-SITE WATER AND WASTEWATER PROGRAM By: LO(1 r Original Certificate Date: (12— (Rev. IV05) Municipality of Anchorage �`11 pL ab< • 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 ulvir Legal Description: NORTHWOODS S/D #4; BLOCK 18, LOT 3 Parcel ID: 051-064-43 A. WELL DATA PUBLIC WATER Well type If A. B, or C provide PWSID# _ Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (abo round) in. FROM WELL LOG AT I CTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/HDPE Date installed 6/9/2004 Tank size 1300 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 7/11/2012 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed **6/9/2004 Soil rating .p.d./ r ft2/bdrm) 0_6 System type DUAL TRENCH 62 & 64 Length 126 TOTAL ft. Width 3 ft. Gravel below pipe 4 ft. Total depth *7.4-7.5 ft. Eff. absorption area 1008 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/3/2012 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test ***21 in. Water added 650 gal. New depth ***48 in. Elapsed Time: 135 min. Final fluid depth ***41 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **DUAL TRENCHES ORIGINALLY INSTALLED 5/6/1992. TRENCHES WERE EXTENDED IN 2004 TO SERVE 4 BEDROOMS. ***TESTED WEST TRENCH ONLY. FLOW SPLITTER APPEARS TO BE OUT OF LEVEL. EAST TRENCH WAS 997 FULL UPON INSPECTION AND NOT TESTABLE. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service lines PUBLIC WATER On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ 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 1o,+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200+ F. COMMENTS F G. ENGINEER'S CERTIFICATION o 9 p�P .' •.S�oOd I certify that t have determined through field inspections and review of Municipal records that the above systems are in 0""" "" ' ""' """ conformance with MOA COSA guidelines in effect on this date. G.. ess:r p Engineer's Printed Name JEFFREY A. GARNESS �Qo9 C 5 .•'\�0� Date % j 6I12_ Ldp Pti $./. b/// Zo\ Erol _Pr fecsi0� o COSA Fee S U an - Date of Payment g /, " Receipt Number (Rev. 11/05) Waiver Fee Date of Payment Receipt Number m ° k / §) 3 /HG S3 */ 727 § ! o% �\ k!!} S\\ / } t , ME § ! ) §55 \ Wel M! ®G® _ 1.0 N]§| |; ,. , §;|§!• § 2\ \§/| ` §kms i 2 @~i !2§ A � § ! o% �\ k!!} S\\ / MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING/ Parcel I.D. # Qc;1 _064-43 HAA # I„� 1. GENERAL GENERAL INFORMATION Complete legal description Lot 3; Block 18; North Woods Subdivision #4 Location (site address or directions) 23524 Blue Skies Drive Chuaiak. AK Property owner The Associates Relocation Day phone Mailing address C/0 Prudential Jack White Resl Estate Lending agency Day phone Mailing address Agent Sallie Nickerson/ Prudential Jack Why phone .} Address 3901 tto" street- Anrhnraga AN AgSQ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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-M (Rev. 1/91) Front MOA #21 5. 6. By: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ALASKA Address Engineer's signature Alaska Water & WASTEWATER Wastewater Consultants, t, Shall be PAID $�L�� +> or prior to, closing for the Engineerin r.,. s; Provided: DHHS SIGNATURE Approved for THE EE bedrooms. Disapproved. Conditional approval for Additional Comments Phone — Date 9 c ... yy UN. M' • M w bedrooms, with the following stipulations: 122, Date- 72-025 ate a 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. 72-025 (Rev. 1/91) Back MOA a21 provide written confirmation from State ADEC attest- tus of system. 4L xxx �Holding tank,' "M ,,,,.Cornmunity on site 'N V, i F, Ph A Public sewer NOTE: If community wastewater system, provide written confirmation from attesting to the legality and status of system. 72-025 (Rev. 1/91) From MOA #21 9 19 agency Day phone address-' AIX e, Kathy GeActclU Gkea.�and Reattll Day phone 694-9125 1�11 'Ann, .VII U 11411 Oz OennI; Zaglte:!Ri. vek !",V wy,.�-�,lr '::99577 provide written confirmation from State ADEC attest- tus of system. 4L xxx �Holding tank,' "M ,,,,.Cornmunity on site 'N V, i F, Ph A Public sewer NOTE: If community wastewater system, provide written confirmation from attesting to the legality and status of system. 72-025 (Rev. 1/91) From MOA #21 9 v- On AIX e, provide written confirmation from State ADEC attest- tus of system. 4L xxx �Holding tank,' "M ,,,,.Cornmunity on site 'N V, i F, Ph A Public sewer NOTE: If community wastewater system, provide written confirmation from attesting to the legality and status of system. 72-025 (Rev. 1/91) From MOA #21 A. WELL DATA Well type If A, B, I oi,,'C, dakh AD80 16tter. A FROM WELL LOG AT INSPECTION - R MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M},t b 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. # ��� l�� ��—HAA # 1. GENERAL INFORMATION Complete legal description Lot 3; Block. 18; No&th Wood #4 Location (site address or directions) 23524 Blue Siziu Dkive Eaa2e Riven. AK Property owner Kay Addn.ibi Day phone (h) 688-6593 C/0 11411 U2d Glenn Hwy. (w)694-9125 Mailing address Eagle Riven, AK 99577 Lending agency Mailing address Day phone Agent Kay Addkisi (owner/agent) GREATLAND REALTY Day phone 694-9125 Address 11411 U2d Glenn Hwy. EAGLE RIVER, ALASKA 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well XXX Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 1121 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 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 furtherverify 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 5 & s ENGINEERING Phone 17034 I_a jle River Loop Koad Address 3"<,=fie, eZav ce.r, Alaska 99577 /t Engineer's signature Date "f - 61- 6. DHHS SIGNATURE _42L Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Date _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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.1/91) Back MOAN21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:i-6'r3 6L� �S �o�r� �s Pakcel I.D. a:g-6144/- A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number 2► 3 0o I Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protecte FROM WELL LOG AT INSPECTION m Date of test : � o n Static water level 1'11 D n D� Well flow g.p.m. g.p.m. IT7 m •T A D mp level C F rn w N c7 SEPARATION DISTANCES FROM WELL TO: N m tk g Septic/holding tank on lot yoo ; On adjacent lots �k Absorption field on lot �'� o ; On adjacent lots Public sewer main Public sewer manhopout Sewer service line roleum tank WATER SAMPLE RESULTS' Coliform Nitrate Other bacteria D e of sample: Collected by: B. SEPTIC/HOLDING TANK DAT Date installed S 48 3 Tank size 166 6 Compartments 2 CleanoutsOY N)� (,Q '001Foundation cleanout G/N) Depression � High water alarm (Y/l�l 04 Alarm tested (Y/N) �4 Date of pumping i lr - i 3 Pumper ,T_i�. G -E 55Pa a L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot o On adjacent lots Lc Foundation To property line Absorption field 4$ t Water main/service line S 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 "Pump on" level at Meets MOA electrical codes (Y Manufacturer _ Manhole/Access (Y/N) " p off' level at Cycles tested SEPARATIO ANCE FROM LIFT STATION TO: on lot On adjacent lots D. ABSORPTION FIELD DATA Surface water Date installed S- 7,22— Soil rating 0, t. 67Pa� 2_ System type T/LF Lha g b Z � Width Length % 3 Gravel thickness `� Total depth Total absorption area / Cleanouts present &N) Depression over field (Ya r Date of adequacy test 'J/.4- Results (pass/fail) 2-ES5 -1"gd for 3 bedrooms Peroxide treatment (past 12 months) (Y& Al If yes, give date —..4 A - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 26 o t �-- To building foundation o On adjacent lots Surface water S.0 I d— Curtain drain �l o t OL- E. ENGINEER'S CERTIFICATION -On _On adjacent lots 1_�.4_ Property line 3 a � To existing or abandoned system on lot /o /f ri/Cutbank .A- Water main/service line 2S 14-- Driveway, parking/vehicle storage area So t l certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Signature Eagle Raver. Alaska 99577 Engineer's Name Date 4—,(0_q,5 HAA Fee $ L Date of P&yment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 date of this inspection. Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 April 5, 1993 Mr. Ray Shafer S & S Engineering SUBJECT: Northwoods Subdivision Class "A" Public Water System, PWSID 213001 Dear Mr. Shafer: WALTER J. HICKEL, GOVERNOR (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of tha above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on March 4, 1993. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on April 21, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on July 1, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water . eguF ati—T ons. 4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC) were submitted to this Department on June 2, 1992. Based on analysis of the previous VOC samples results have been satisfactory. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # �'� } (�In L j — L� HAA # )> Qq 2L3t]0 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address. John Gatbet6on 0946 Lot 3; Block 18; Notth woods Phase IV 23524 Btue Skies Dxive Day phone Day phone Agent Rae Hatt GREATLAND REALTY Day phone 694-9125 11411 02d Glen Highway Ad d ress Unless otherwise requested, HAA will be held for pickup. 3 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well XX Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone S & S ENGINEERING Address 17034 Eagle River Loo Rn oad No 204 Eagle River, Alaska 99577 . Engineer's signature Date 6. DHHS SIGNATURE X__ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments wOf At- w �s WrNo r Pij ¢ as+ �q 'ilr aasc��'if�ri x.r^i • 9. noGEN 3...FIAFER 15 or. Y`7'G' m�A9i^IMM®0�• ��+6.�ll bedrooms, with the following stipulations: By; Date _15116. 9 -)- 111717 13 - 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 00;2T��0001::'� `T Parcel I.D. oe5I D 18 1 t_oT -;:� A. WELL DATA Well typ�ai .t e::, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller— Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Cased to Casing height FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) AT INSPECTION Septic/holding tank on lot 2r!D +_ ; On adjacent lots Absorption field on lot On adjacent lots _ Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Z 0 "' "'Ly 0,11 w > '3 LL g.p.m.0 F — W >- LL! zo i� UJ Date installed Tank size 1 Compartments Z Cleanouts (�Y N) Foundation cleanou (Y N) Depression (Y/ High water alarm (Y/N) �'J f -P Alarm tested (Y/N) Date of pumping �'Pumper FJrlr- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot rl _On adjacent lots ZOO( Foundation To property line ' ` t Absorption field Water main/service line Surface water/drainage .)0,0'4— FROM )0,0(' — 72-026 (Rev. gist) Front - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANC Well on lot Manufacturer Manhole/Ac s (Y/N) "Pump off' level at LIFT STATION TO: On adjacent lots Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed �'IZ Soil rating.... �� System type�►� Length Width t✓t Gravel thickness 4-- Total depth �o � Total absorption area /o Cleanouts present6 l) Depression over field (Y( Date of adequacy test Results (pass/fail) Peroxide treatment (past 12 months) ( Z5 SEPARATION DISTANCE FROM ABSOR Well on lot �,J�-P On a( for If yes, give date ION FIELD TO: lots Zt4 --Property Property line � U bedrooms To building/ foundation �d L.ZTo existing or abandoned system on lot 1& 14- i On adjacent lots �� Cutbank IJ61-1,; Water main/service line ,;? Surface water I /) D ` Driveway, parking/vehicle storage area Curtain drain I�0t.1.i- V -11-i Q 1_1 E. ENGINEER'S CERTIFICATION I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. trJ�'k rid ��w,. T•�� S & S ENGINEERING • '( iln C f n��qq Signature 17034 Eagle River Loop Road No. 204 G Eagle River, Alaska 995" �: ?I Engineer's Name Date HAA Fee $ / ZD 'C" Date of Payment 5_'—1 .5 !]:� y Receipt Number _Z a7zy—����� 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number F d 1 , /t 1 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: Roger Shafer S & S Engineering April 6, 1992 PWSID # 213001 WALTER J. H/CKEL, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Northwood Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. BR/cf Siin,�ceerely, 4n� ,C,a� Byron Roys Project Engineer Time APPLICNT FILLS OUT UPPER HAL' )ONLY Time Time C3 Date Date Pilwerty Owner Date Phone Mailing Address 'Al 1•? Zip Code 3 5 Buyer Inspector Address Zip Code — Lending Institution Field Notes'. AOAW#kl Phone MUNICIPALITY OF ANCHORAGE Zip Code Address ENVIRONMENTAL PROTECTION Realty Co. & Agent Phone Address Zip Code *CONDITIONS OF APPROVAL Legal Description I DISAPPROVED t,4 Street Location DATE Type of Residence BY: --jD Single Family El Multiple Family No. of Bedrooms —� Date Sewer Installed D Other Well Log Received Septic Tank Size Water Supply 0 Individual Well to Tank ATTACH WELL LOG. A well log is required for all wells drilled log since June 1975. if available). ---Q Community crr_ For wells drilled prior to that date, give well depth (attach Ll Public Utility Sewer Disposal L1 Individual Year Individual Installed: 0 Public Utility When Connected to Public Utility: 0 Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time C3 Date Date Date Date Inspector Inspector Inspector Inspector Field Notes'. AOAW#kl MUNICIPALITY OF ANCHORAGE DEPT.OF HEALTH & ENVIRONMENTAL PROTECTION I APPROVED BEDROOMS *CONDITIONS OF APPROVAL PRFCFIVFD I DISAPPROVED ) CONDITIONAL APPROVAL' DATE BY: Solis Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-023 (3182) January 27, 1984 Aractic Development 446U business Park Anchorage, AK 99503 Subject; Lot 3, Block 18y Northwoodsr 4th Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: �Cuv-e LL!��LNI Submit the original soils_�J�og and a copy of the permit for the on -sit ins is department has no record of the permit being issued, however you may be able to obtain one from your engineer or excavator. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. :sincerely, Cory W1110; Acting Sewer & water Program Manager CW108/ej/El Time APPLI(,wNT FILLS OUT UPPER HAt ONLY Property Owner 5k,uc�y) 4 k(-- rj" Date Phone Date Ilk Zip Code Inspector Mailing Address -J �) inspector Inspector Field Notes: ( APPROVED BEDROOMS Z Buyer ( ) DISAPPROVED !„3 Address Zip Code BY: Phone Lending Institution _ Well Log Received Septic Tank Size00 L� Address - Zip Code Phone Realty Co. & Agent Address-. Zip Code LegalDescriptionQ�-C / j-1.-6�-- Street Location Type ofLe4 mgle Family ❑ Multiple Family` No. of Bedrooms ❑ Other Water Supply..._ El I''dividual '°-,..z, ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community "''ti., For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer D' posal ndividual // f Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector inspector Inspector Field Notes: ( APPROVED BEDROOMS Z 'CONDITIONS OF APPROVAL ( ) DISAPPROVED !„3 ( ) CONDITIONAL APBROVL' DATE BY: Soils Rating Date Se er Installed Well To Absorption Area Well Log Received Septic Tank Size00 L� Well to Tank 72023 (31&)