HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 9North Woods Phase 2 Block 1 Lot 9 #051-801-02 Municipality of Anchorage 3CommunityVd�t Development Department On -Site Water and Wastewater Program ELS 5» 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131417 PID Number: 051-801-02 ❑ New 1 li it -ii " Page 1 0 2015 ❑✓ Upgrade Name: Devin Rafeedie ABSORPTION FIELD Address 22356 Whispering Birch Drive ❑ Deep Trench ❑✓ Shallow Trench ❑Bed ❑ Other ✓Mound Phone Number of Bedrooms 3 Soil Rating 0.45GPD/SF Total depth from original grade 2.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 0.5 Ft. 2.0Ft. North Woods #2 1 9 Fill added above original grade Gravel length Township Range Section 2.0 Ft. 140 Ft: Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 5Ft. N/A N/A Ft, To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 1000 Fe Number of trenches 2 Dist. between trenches 12.2Ft. Well N/A N/A N/A N/A N/A TANK O Septic ■ S.T.E.P. • Holding • Other Manufacturer Capacity Surface Water 100+ 100+ N/A N/A Anchorage Tank 1000Ga1. NA Material Steel Number of compartments 2 Lot Line 36.2 32.6 N/A N/A Foundation *5.3 *13.3 N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ 50+ N/A N/A Remarks * New septic system is installed, but existing Pump on level at Pump off level at High water alarm at system is still in use until house expansion is completed in. in. in. and plumbing is re-routed to the new system. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield A+ Home Services Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspectionc dates: 1s 12/10/13 2^d 12/12/13 Location and description 3d 12/13/13 a'" Bottom of house trim COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date Pp Engineer's Stamp OF Ar'j.4.4.14 " qil� 0* Afros• 49714 /\ :*�4 Approved S� % / / / Date�i • . even 'fki'-'t5annorae/ ',ri �f ''' ICE `sY � r. nspection hteport_'I-1-12.doc r DRAIN FIELD (P) • (2EA) 7OLFx2'EDxS'W, 2.5'TD REMOVE ANY PART OF PREVIOUSLY ABANDONED DRAIN FIELD FOUND W/IN 10'•.\ OF PROPOSED DRAIN FIELD AND REPLACE WITH MoA APPROVED FILTER SAND. A B C T1 18.0 9.7 T2 17.3 15.2 DCO 19.8 18.7 C1 26.3 18.7 M1 27.3 19.7 - C2 — 71.4 45.8 M2 — 71.8 47.1 03 39.4 34.1 - M3 41.0 35.6 04 — 77.3 57.5 M4 - FS . — 78.1 58.8 31.3 37.3 p 231.4 TO CREEK TH-1 (PES) NEW 1000g SEPTIC TANK INSTALLED FC0, DCO, AND FS D00 �7 T2 T1 - 1000g SEPTIC TANK (E)-7 DECOMMISSION PER CODE RESERVE DRAIN FIELD (P) REUSE 2OLFx12'Wx0.5'ED, 4.0'70 (BASED ON CAT 111) LEGEND W WATER LINE/ WELL RADIUS SS NOTES: NEW SEPTIC \ \ RECORD DRAWING PLAN PANNONE ENG SVC, LLC P.0 BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTH WOODS #2, BLOCK 1, LOT 9 DEVIN RAFEEDIE 22356 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 Srer R'Pannone 09F, , CE 8149 .-� +)1l\FDPROFSSSIONP. Date 3/9/2015 Scale P.I.D. NO 051-801-02 PERMIT NO. OSP1 31 417 Sheet 2 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS I . ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALLED NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 7.5' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 7.5' FEET BELOW EXISTING GRADE. REMOVED ORGANICS AND PLACED MOA APPROVED FILTER SAND WITHIN 10 FEET OF DRAIN FIELD WHERE DOWNHILL SIDE OF DRAIN ROCK CONTACTS ORGANIC LATER RIGID INSULATION FILTER FABRIC 4" 0 PERF PIPE DRAIN ROCK 6' ABOVE PIPE INV 9o. 97.5 95.5 95.9 3.0 APPROXIMATE LOCATION OF PREVIOUSLY ABANDONED BED REMOVED ANY PART OF BED ENCOUNTERED WITHIN 10' OF PROPOSED DRAIN FIELD AND REPLACED WITH M0A APPROVED FILTER SAND DRAIN ROCK o 0 za oo 0 0 a FILL R.l. -98 5 -9 NEW 10009 SEPTIC TANK mw 0 0 o' 873 11/18/2013 -7.5 &AOele.a{ avo,:41e14 Is I PQrS• H 12.2 -10.0 85.0 TH-1 (58,5) -V5 .. -0R--0.5 2.0 GM L , 11/12/1992 -8D RIG 1 INSULATION z / -FILTER FABRIC 0 DRAIN ROCK 6" ABOVE PIPE INV of o 1-4" 0 PERF PIPE o' DESIGN PARAMETERS PIMARY SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 31-60 MPI SOIL RATING: 0.45 GPD/SF AREA ROD: 1000 SF SYS. TYPE: WIDE TRENCH 2.0' R.F.: 0.70 MIN LENGTH: 140.0 LF USED: (2EA) 70 LF X 5' WIDE, 2.0' E.D TOTAL AREA: 1000.O,SP NOTES: RECORD DRAWING 95. 2.5' TD TRENCH SEE DESIGN PROFILE DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 15009 S.T.E.P. W/ AX20 POD PERC RATE = 31 -60 MPI SOIL RATING: 2 GPD/SF AREA ROD: 225 SF SYS. TYPE: BED 12.0' W MIN LENGTH: 18.75 LF USE: 20 LF X-12' WIDE, 0.5' E.D., 2-5' TD TOTAL AREA: 240.0 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DESIGN DETAILS NORTH WOODS #2, BLOCK 1, LOT 9 DEVIN RAFEEDIE 22356 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 -13.0 BOH SECTION ABBREVIATIONS CU COPPER DIP TH FC T# Cj M# R.I. DCO DV FS BFG OG PG DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE %'t • 1%it ..... Q+Sip... Steven R. Pannone CE 8149 •��� iv\PRorEsso \\\\ Dote 3/9/2015 Scale NTS P.I.D. NO 051-801-02 PERMIT NO. OSP131417 Sheet 3 OF 3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131417 Tax Code Number: 05180102000 Work Type: Septic Permit Effective Dates: December 05, 2013 to December 05, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: NORTH WOODS PHASE 2 Site Legal Address: NORTH WOODS PHASE 2 BLK 1 LT 9 G:1559 Owner/Address: RAFEEDIE DEVIN 19243 ADAK CIRCLE EAGLE RIVER AK 995778723 Site Mailing Address: 22356 WHISPERING BIRCH DR, Chugiak /2_jo / 3 3. 3J Lot Size in Sq Ft: 59329 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: �yle / Date:1r d E• Date: I Z/�/� Municipality of Anchorage No P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program e C epartme **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131418 COSA#: Permit#: OSP131417 PID#: 051-801-02 Legal Description: North Woods #2 Block 1 Lot 9 Engineer: Pannone Engineering Services Applicant: Devin Rafeedie Your request for a waiver of the required separation between fields has been approved. See the engineers submitted plans for construction details. The approved separation distance is 0.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not G anted: Date:I I/%Z//, Approved by: /y Name of Revi_, er Rec#: 06444G Amount: $200.00 Date Paid: 11/4/13 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-801-02 Property owner(s) Devin Rafeedie Day phone Mailing address 22356 Whispering Birch Avenue, Chugiak, AK 99567 Site address 22356 Whispering Birch Legal description (Sub'd., Block & Lot) North Woods \i2, Block 1, Lot 9 Legal description (Township, Range & Section) Lot Size 59,329 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (EI all that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage0 0 0 Initial 0 Upgrade ❑X Renewal 0 Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Drain Field to Slope Distance: 25 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: ' 536 Waiver Fees: 4 a66 - Date of Payment: J 1/410 Date of Payment: U/4111/4g Receipt Number: 0(491/Cit(4 Receipt Number: 06, 411110 Permit No. 0Msiut-# Waiver No. t'3SPl3 iY f9 Permit App :• Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpanengak.com October 31, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: North Woods #2, Block 1, Lot 9 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The homeowner is expanding the house to three bedrooms. The existing septic tank will be verified and will be abandoned per code and a new 1000g septic tank will be installed. The proposed drain field will be installed in the same location as the original 1982 bed. Any part of the original 1982 bed found within ten feet (10') of the proposed system will be removed. A portion of the existing 1992 bed will be reused as a reserve field based on CAT 111. This lot and the surrounding lots are served by public water. There are no wells within 200' of this system. 1. Soils. One test hole was excavated approximately in the area of this drain field by Russell L. Oyster in August of 1982, and groundwater was encountered at eleven feet (11.0') and bedrock was not encountered in the test hole. One test hole was excavated just to the southeast of this drain field by Roger J. Schafer in November of 1992 and groundwater was encountered at eight feet (8.0') and bedrock was not encountered. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.45 gallons/day/square feet should be used for a conventional wastewater system. PES will conduct a verification test hole at the time of installation. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography slopes approximately from the east to west at a grade of approximately than 6% in the area of the proposed drain field. There is a steep slope just downhill of the proposed drain field. See waiver request. Mailing: P.G. Box 1002.17, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-3218 FAX: (907) 272-8211 Page 2 of 2 5. Waiver Request: I request a waiver to the minimum distance from the drain field to a steep slope to twenty feet (20.0'). Fill will be placed from a point 2.5' above the downhill side of the field at a slope of 4:1 for thirty-five feet (35.0') below the field. See section on sheet 2 of 2. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 200 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, .•••��.• ••0 •5:'• A t p : tit Steven R. Pannone •i E 8749:,". N • 1 ..44‘147%2 �Y•••. Steven R. Pannone, P.E. Owner/Civil Engineer Attachments 49'1_ Mailing: P.O. 60x 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-3211 DRAIN FIELD (P) (2EA) 7OLFx2'EDxS'W, 2.5'TD REMOVE ANY PART OF PREVIOUSLY ABANDONED DRAIN FIELD FOUND W/IN 10' OF PROPOSED DRAIN FIELD AND REPLACE WITH MoA APPROVED FILTER SAND. TH 92-1 (S&S) 10009 SEPTIC TANK (P) INSTALL F00, DCO, AND FS 1000g SEPTIC TANK (E) DECOMMISSION PER CODE RESERVE DRAIN FIELD (P) a. a REUSE 20LFx12'Wx0.5'ED,, CTD (BASED ON CAT III) / LEGEND W WATER LINE/ WELL RADIUS SS NOTES: NEW SEPTIC FOR CONSTRUCTION / PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PLAN NORTH WOODS #2, BLOCK 1, LOT 9 DEVIN RAFEEDIE 22356 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 ,:roC6.eOF`L• gs��'�f stole AIse0 jd� *Tt i .... .s�1 .. t4 I P.I.D. NO % 051-801-02 Steven R. Pannone e PERMIT NO. 0#0-2.• . OE 8149 . i OSP131417 Date / 12/4/2013 Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1 ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 7.5' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 7.5' FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. REMOVE ORGANICS AND PLACE MoA APPROVED FILTER SAND WITHIN 10 FEET OF DRAIN FIELD WHERE DOWNHILL SIDE OF DRAIN ROCK CONTACTS t� ORGANIC YER RIGID INSULATION FILTER FABRIC 4" 0 PERF PIPE DRAIN ROCK 6" ABOVE PIPE INV TH-1 (S&S) 10Wa —0.5-2 --0.5j A APPROXIMATE LOCATION OF PREVIOUSLY ABANDONED BED REMOVE ANY PART OF BED ENCOUNTERED WITHIN 10' OF PROPOSED DRAIN FIELD AND REPLACE WITH MaA APPROVED FILTER SAND zza UU o o 12" z CFILL R.I. 1000g SEPTIC TANK (P) FLOW SPLITTER DRAIN ROCK U z 0 3 50 11/18/2013 —7.5 BOH 16010 INSULATION FILTER FABRIC 10.0 11/12/1992 —8.0 0 0 DRAIN ROCK 6" ABOVE PIPE INV — 4" 0 PERF PIPE 0 GM -13.0 BOH SECTION DESIGN PARAMETERS PIMARY SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 31-60 MPI SOIL RATING: 0.45 GPD/SF AREA RQD: 1000 SF SYS. TYPE: WIDE TRENCH 2.0' E.D. R.F.: 0.70 MIN LENGTH: 140.0 LF USE: (2EA) 70 LF X 5' WIDE, 2.0' E.D., 2.5' TD TOTAL AREA: 1000.0 SF TRENCH SEE DESIGN PROFILE DESIGN PARANETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1500g S.T.E.P. W/ AX20 POD PERO RATE = 31-60 MPI SOIL RATING: 2 GPD/SF AREA RQD: 225 SF SYS. TYPE: BED 12.0' W MIN LENGTH: 18.75 LF USE: 20 LF X 12' WIDE, 0.5' E.D., 2.5' TD TOTAL AREA: 240.0 SF ABBREVIATIONS CU COPPER DIP TH FC T# C# M# R.I. DCO DV FS BFG OG FG DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE NOTES: FOR CONSTRUCTION PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DESIGN DETAILS NORTH WOODS #2, BLOCK 1, LOT 9 , DEVIN RAFEEDIE 22356 WHISPERING BIRCH DRIVE CHUGIAK, AK 99567 �e of A1,4 kk .*) P.I.D. NO .... J�..I�... ... A.. t,., 1-02 Steven R. Pann.one /O PE051-80RMIT N0. O� `P CE 8149 � OSP131417 �1,,1 �'\\ Sheet2 OF 3 *.49TH 0 Date 12/4/2013 Scale NTS TEST HOLE 1 ORGANICS SILTY GRAVEL 11/18/13 DATE PERFORMED: 11111/13 SOILS LOG - PERCOLATION TEST SLOPE X TH 1.'TE PAN T / TH-1 / ,// (PES) �c,94 ,TH 92-1" (S&S) N N. WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -NA'- DEPTH TO WATER AFTER MONITORING? -7.5'- DATE: 11/18/13 EXPANDED 3BR HOUSE SLOPE TH X READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP 1 11/11/13 3:35 --- 5.39 -- 2 3:45 10 MIN 9.33 3.94 3 3:45 --- 5.39 --- 4 3:55 10 MIN 8.91 3.52 5 3:55 ___ 5.39 --- 6 4:05 10 MIN 8.95 3.56 PEROLATION RATE 2.8 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Pere hole was presoaked. Test run for one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: FOR CONSTRUCTION PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTH WOODS #2, BLOCK 1, LOT 9 DEVIN RAFEEDIE 22356 WHISPERING BIRCH DRIVE -AK-199567 Date 1/19/2013 Scale NTS * 49 %* It P.I.D. NO 051-801-02 Steven R Pannone ' PERMIT NO. iyE 8149 =/ SSh3eetOF437 s Municipality of Anchorage Page l of 7 ---- DEPARTMENT P.O. Box 196650 On -Site Wastewater Permit Number: "71 OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 Disposal System and/or Well Inspection Report " // 1 -2-00.5"l2' PID Number. 0.51C40 ((D Name: Wastewater System: ❑New Upgrade Address:ABSORPTION 1.-7, Co lel 1-I't-VA2 i OC) 71 k1 FIELD . Phone: ec'' Q.-.i�^C�-'�-j No. of 8 rooms: 0 Deep Trench 0 Shallow Trench Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: D' GPD/Sq. Ft. Total Depth from original grade:) .4 - Lot: n Lot: V Block: f �,�. (�S..ub I F r`x/ 1�",'r' rvl Ion: /Depth 0 to pipe bottom from original graded .�j Ft..-- Gravel depth beneath pipe r Ft. Township: Range: Section: Fill added above original grade: 1 ©f'^br"q Ft. Gravel length: il-0/ Ft. WELL: ❑New ❑Upgrade Gravel width: �/��r L'L(e —Ft. Numb (lines: Distance betty mines: .J Ft. Classification�l(Private, A, R,C): C.t1- t %"'1 Lt, r -fl l Total Depth: Ft. Cased To: Ft. Total absorption area: 16 SQ. Ft. i Pipe material: I� 1�. �1"'� �o I%4- H'� 170-A030"1" —WL� Driller: l Date Drilled: Static Water Level: Ft. I7tallh'e 1 L,,,,� [.J�C1'rl �M1T dt Kms* Date installed: 4 �2-5" -5/41---- Yield: GPM Pump Set at: Ft. Casing H ight Above Ground: Ft. TANK SEPARATION DISTANCES Nt54.Septic 0 Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sewer Lines Ma�nuffact,uIr—er:n ,�� �(� 11 // Capacity in gallons: .����i �N"'�1�/ 107)0 Well 201.4-.- 20Z1-4- _._. — /I� � Mater�i✓al Number of Compartments: LIFT STATION/ waive 1�'4 fOW "I- — — - — Lot Line f '�✓ �� 1 — Size in gallons: Manufacturer: Foundation le / lb/ _- "Pump on" level at: "` mp off' level at: High water alarm at: Curtain Drain - Nt ro, 44_101,...,1_ - � Pump M. Model: Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: Assumed Elevation: �0 L ` Ft EtiSegitittKAL ,g®g 44 OF 47``®®®! OA ito �"S sseMosse�:S-ok Iv 09.* 1 .t� t• oese•®•o•• t 7r.•...... •• a••••w•• p ROGHAFER `'� °•,, Ho. $}315 •a0 ,,`s ®®vm Wit• �, al 0 •• • o• $ . rv� S & $ ENGINEERING 17034 Eagle River Loop Road, No. 204 Inspections by: Alaska 99577 Dates' 1st 12-4-a performed Eagle River, 2nd l2^ � Lam$M Department of Health a man Ser ' s approval �� Date /2 � Reviewed and approved b : �%��✓ y 72-013 (Rev. 9/91) MOA 25 Permit No 011'6 Page 2- of'z 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 ViCeniS Legal Description: 1-19`/1-- t 1-191- PID No • 06-4 01 Gg Ce I Co i-- 1" -10' A Ct. _� 'mss! -fluor �t r ` 414-13�-' mss. /' _ p.1fvr 1R- �iA ri ti- l2•'1Z 72-013 A (Rev. 9/91) MOA 25 col Got Low co i- riff rrrZ k I' P- 12.6° ---- — — -- 3 ?3.5' iI` Gfr°" 2.6e 41.E ' -- _ 2 oi 125 ,. 72-013 A (Rev. 9/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920392 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MERRILL MARK J OWNER ADDRESS:22356 WHISPERING BIRCH DR CHUGIAK, AK 99567 PARCEL ID:05180102 LEGAL DESCRIPTION: NORTH WOODS PHASE II BLK 1 L T 9 LOT SIZE: 59329 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/19/92 EXPIRATION DATE:11/19/93 /zkk/fZ / °,oma SCS 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: RECEIVED BY: ISSUED BY: palet✓ DATE: ( I l 7 / 2 DATE:a/94Z.__ HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 REFERENCE: North Woods Subdivision Phase II, Block 1, Lot 9 Request you issue a permit to upgrade the septic system serving the referenced property. An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. A test hole was excavated and a percolation test was performed in the area of the proposed upgrade. Attached is the proposed upgrade design. This property is served by a Community water system. There are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. If you have any questions or require additional information for your review, please contact us. Sincerely, 1 ROGER J. SH FER, P.E. RJS/LSU/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 BUM S311ddflS 3/V 60' SCALE UPGRADE V/d3l/2�� NJ/S30 <Q, 9 AL- 0 D z z I- r- 0 0 m m x S,o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 1 ,'1"`4— t L (_C_�r�W'^1 - 1e .OG1G LEGAL DESCRIPTION: t�1W6DD S uipVTownship, Range, Section: (=a� , RoG R J £ HAFER • 0 C VZ, m No. 215 ••.* ��® Arr °8, 70FESSL DATE PERFORMED: I7 .ftFFykf• ( P -ELFT) 8–- 9- 10- 11 – 12- 13 r o/u 14- 15- 16- 17 -• 18- 19- 20 - 411 COMMENTS S & S ENGINEERING PERFORMED BY' 17034 Eagle Ales Loop Road, NO.204 CERTIFY THAT THIS TEST WAS PERFORMED IN E, le Rlver, Alastcs 9`)577 1,1 _ n ACCORDANCE WITH A STATE AND MUNICIPAL GUIDELINES IN EFFECT O THIS DATE. DATE' SLOPE WAS GROUND WATER ENCOUNTERED? r l IF YES, AT WHAT DEPTH? 41 0 P E Depth to Water Alter 1 Monitoring? Date. I-121 `Z - SITE PLAN T N t 491 Reading Date Gross Time Net Time Depth to Water Net Drop IL,U-i LOl-.� 1 thi-Sf'1 Z=Pxa ---• .2 lift — 2. 2'40 It..d to 1 e -I e yie t1 ..v?t/? n hI4-" • - Z) ,3: PERCOLATION RATE TEST RUN BETWEEN [.� (minutes/inch) PERC HOLE DIAMETER 4 FT AND FT 72-008 (Rev. 4/85) ((7;\\ it' \\\'"--,,, \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT —/j— J� �j NAME 4&'�/ SA - ,�' PHONE 15d�JEW � Ei U ❑UPGRADE /,A_O �.< MAILING ADDRESS LEGAL DESCRIPTION6 r 9' e/4 — /(a-LA/el .L S'a,t) N .. LOCATION NO. OF DROOMS SEPTIC TANK DISTANCE TO: Well j�_ l �% Absorption arp� 7 Dwelling. 9/ PF�Fiy9yV67 � l�rt. Manufacturer y Materi ye No. of co,Wpa rtments Liq. capa�it�,yn gallons �TA�� IF HOMEMADE: Inside length Width Liquid depth Ji7Z O z < 11— DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TI LE DRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines Length of each line Total length of lines Trench width inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area EPAGE Length Width •°7 e)--. '�_ Depth i b P.5f��^..,,�� I NjL� Type of crib Crib diameter �n�— Crib depth .,..... Total effective absorption areat9� �� // DISTANCE TO: Well / / `may �/VC'P Building foy id iyn -�. Nearest I��ipe ,,�. _i W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 3o3 I rvc , SOIL TEST RATIN A ID flfr 1` 1 I NSTA L LERb. � • �1 1 gi REMARKS .#4444 V Itlift t.I �33l n APPROVED a DATELEG/AjL F . A� t' /101(.Jl,.l Ci /412' / rA 72-013 (Ij(kv.3/78) Depa Permit # g,(p R a -V 6 Applicant: MUNICIPALITY OF ANCHORAGE tmentc'Nf Health and Environmentaf'Frotection 825 -,` Street, Anchorage, AK. ,9501 - (i1.9._ 264-4720 * * HANDWRITTEN PERMIT * * #L� WEtt— 111 /OR ON-SITE SEWER PERMIT 9' ) -) 'Q -'r K Mailing Address: // Location: c Phone Number: Legal Description: L,761 il5 /±h `.d()C)cy - Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH ,{ .LENGTH , i --i GRAVEL DEPTH `WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pitis 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(HOLDING) 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(2) 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. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that -the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms t. f Signed: ((<<.`f , =.; Issued by: r 7 „ ;,1f'T-,T.: Applica SWP/024(1/81) Date: O & E ENC:IIEERING & DEVELOI MENT CO. Russell Oyster 694-2774 Performed for: Name' Mailing Address • 641 - Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG N' L . £� 4 �> Legal Description. Depth (feet) 0 1 2 -- 3 4 5 6 Soil Characteristics 7 8 9 10 11 !to/WC-0 Earl Ellis 688-2280 G ®A✓ Tel. No 66R -e1931 64715-4,7 e J-1,v6/,Q KI 1 AJJ.e-- e./e,oz) u, . eos4c---2 4 N b y.•t1 60%8L -S /0 / /LQ -�o R,G 47- 12 12 - 13 14 15 16 ©F PLOT PLAN PERC. TEST Y`C °e_ ' = 20 /d2bI/�in/0: Z.10 SQ-//g,Q / Ground Water Encountered: Yes No If yes, what depth 7 Proposed Installation: Seepage Pit Drain Field osnerfew Comments. [? A'— err eo r-1 Performed by: t -o �%..47-e �+�/ /9'Sz Municipality of Anchorage Development Services Department Building Safety Division • • On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-801-02 COSA # oitALUp Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 9. Mod( North Woods Subdivision Phase 2 Location (site address) 22356 whispering Birch Drive Chugiak, AK 99567 Current Property owner(s) Alexandre V. Khokhbv Day phone 841-7409 • Mailing address . 22356 whispering Bird, Drive Chugiak, AK 99567 Lending agency _Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless othoriviso requested, COSA w,71 be hold by DSO for pickup. 2. NUMBER OF BEDROOMS: Two (2) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site (] ❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for 2— bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Phone 522-7773 Date 8126/2D01 >\ OF elAt" A7'yL •49th !\ � PI, MICHAEL E. ANDERSON •No. CE-uaH /k: • alt........ 2�!9T Y Ot r �;% `meg:• Oiu 'E •• V- tz. wATERAND 0_ ��1STEwATER m_ �_Y`/' PROGR41y CCC :9 flair, sEvaso, Attachments: COSA Checldist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (R« 11,05) Original Certificate Date: / - -- U r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.mum.org/onalte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lai 9, Btodi 1. Notthwoode Subdivision No. 2 A. WELL DATA Well type Community If A B, or C provide PWSID # 213001 WeM Log (YIN) Date completed _ Sanitary seal (Y/N)___ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Parcel ID: 061-801-02 Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate melt Other bacteria colonies/100 mL Arsenic: _ mg/ Date of sample: _ Collected by: B. SEPT C/HOLDING TANK DATA Tank Type/ Material Smalcalimml Date installed 121511992 Tank size 1.000 gal. Number of Compartments Two Cleanouts (YIN) Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping =Mr Pumper 'm'' RCMro C. ABSORPTION FIELD DATA Date installed 12/5/1992 Soil rating (g.p.d.Al2 or ft2/bdr m) .3 GPOISF System type Stem Bed Length 40 ft Width 20 ft. Gravel below pipe •5 11 Total depth 4 It Elf. absorption area 1.040 49 Monitoring tube V Depression over field N Date of adequacy test 828/2007 Results (Pass/Fail) Pm For 2 bedrooms Fluid depth in absorption field before test 0 in. Water added 353 gat. New depth 3 in. Elapsed Time: 1m rnin. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (YM & type) N in. Absorption rate >= 300 If yes, give date g.p.d. D. UFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at _ in. 'Pump off' level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & dreuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots NIA Absorption field on lot NIA On adjacent lots NIA Public sewer main N/A Public sewer manhole/cleanout NIA Sewer /septic service line >25' Holding lank N/A Animal containment areas None 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 N/A Water service line >l0' Surface water >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >t0' Building foundation >to' Water main >10' None Water Service line >10' Surface water >taw Curtain drain None Need Wells on adjacent lots >200' F. COMMENTS: Driveway, parking/vehicle storage >25' G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/28/2007 41= 49th Ma7aEL L NaraRlr; ' No. a-raer COSA Fee $ It 2 Waiver Fee $ Date of Payment g /2 i /co 7 Date of Payment Receipt Number q (.Z 0 C Receipt Number (Rev. 11/05) m 0 fr a 1 8 0 0 m 7 fD m B. fC m a °. 0 N 0 N N G 0 0) N :stlnsa8)sa1 0 5 m ❑ ❑❑ -< ;per -< fes/ A N O 011 0 0 0 yN, O) N 0)) � xi < ID pp 0)-&aN a,C.71d O O F J N J Well ST MT#1 Flow Time R Vol. Vo ' Static ST Liquid SAS. Liquid SAS. (gpm) (gal) (gal) Level (inch) Level (inch) Level (inch) (ft) (inch) (inch) 0 W J J i.) N 5 J J J I End Recovery rStart SAS Recovery I g 3 m 3 0 0 0) N :stlnsa8)sa1 0 5 m ❑ ❑❑ -< ;per -< fes/ A N O 011 0 0 0 CASING ABOVE GROUND: N/A fL 0 N ku0 benbapv ol)daS ■ ❑ co O 5 z D0 .P 3: 'C 0 3 a :01V3 OVOI )IV3d J m 0) w > 0 Z (0)) 6 O :SW00803E110 # :HO103dSN1 # 1331'O}Jd a 0 O m pp 0)-&aN J J N J Well ST MT#1 Flow Time R Vol. Vo ' Static ST Liquid SAS. Liquid SAS. (gpm) (gal) (gal) Level (inch) Level (inch) Level (inch) (ft) (inch) (inch) J 0002 6000 J J J 0888 J Jcn - W Con CO 8 4N 8 f loo D• 0000> 0 00000 cn a N N 7 7 7 0 CJ1 0 it 0 it 0> W J • •O O I J it O > 000006CEal et � - v N F1 N 0000> CO §-b �y 0 0 0 0 0 cn r n 7 c A > l N -)-I- O) W amal -) J u N C 9' glgl m E. g a 5 w a m en " 0 3 m z 0 CASING ABOVE GROUND: N/A fL 0 N ku0 benbapv ol)daS ■ ❑ co O 5 z D0 .P 3: 'C 0 3 a :01V3 OVOI )IV3d J m 0) w > 0 Z (0)) 6 O :SW00803E110 # :HO103dSN1 # 1331'O}Jd a 0 O m Parcel I.D. 1. Cmrte5 r*j(2a,Mr Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING OP- S0/- 4'- HAA # h5h3Uok GENERAL INFORMATION Complete legal description : I✓MTH WOOJI C szt2 , 11 B/ Location (site address or directions) Z,z3C6 WFH.YPErin/Cr Bieci 1 C•, tHt4CTiAK Expiration Date: 7- 2.2.- OG Current Property owner(s) an/De iCid1A4c7se,✓ Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent SNSA✓ gicX'14g Day phone. Afo/- 7S7 Mailing Address 911 G. Saw r scam. FAO A-iltiFO,ti44rC, AK 99503 Unless otherwise requested, HM will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well • Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank 0 [ 1 / Community On-site .0 [I�/ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HM) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to Dne year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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. Eagle River Engineering Services 10421 VFW Rd., butte 201 FAO; Rival AK Q9s77 Engineer's Printed Name CH,Ci'roPilre re. tomb Date t/31 /zoos Name of Firm Address Phone /091/-5795 5. DSD SIGNATURE �1 1,7 Approved for ate. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipu Additional Comments .dQQ0��Y OF ot., • J�: • ON -b1 I t • • "GI 7. X WATER AND n'= WASTEWATER s • - PROGRAM - • •• • -• et 1`\`l )1 1 Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: 4#2.v )Rev 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 7- a• %-0.6- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A(ORTN WQ7DS Ae z, L9 e/ A. WELL DATA Well type airiftilinTr If A, B, or C provide PWSID # Parcel ID: DC/ - 701- 0? - Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above FROM WELL LOG AT INSPE Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESU Coliform ic: in. colonies/100 ml. Nitrate mg./I. Other bacteria colonies/100 ml. mg./I. Date of sample: _ Collected by: B. rePTPHOLDING TANK DATA Tank Type/Material St'T7C/ STEEL Date installed /.2. /sit Tank size /, 000 gal. Number of Compartments S Cleanouts (2:1N) 1A1� Foundation cleanout/N) {/GC- Depression over tank (Ye ✓A High water alarm (Y19) 51/10/of Date of pumping 51/10/of Pumper TIC s iLMPin/Gr C. ABSORPTION FIELD DATA Date installed /•2./5/9,Z Soil rating,! •.d.! ' or ft2lbdrm) • 3 System type BED Length 40 ft. Width ab ft. Gravel below pipe • 5 ft. Total depth N ft. Eff. absorption area (04O f9 Monitoring tube Y6S, Depression over field Wo Date of adequacy test lspp'//DS Results lT ail) PASS For Z bedrooms Fluid depth in absorption field before test 1 in. Water added SCO gal. New depth 4 in. Absorption rate >= 500 g.p.d. Elapsed Time: 4min. Final fluid depth 1_ in. Any rejuvenation treatment (past 12 mo.) (Y9& type) /✓0 If yes, give date n fa D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off' level at _ in. High water alarm level at in Datum Cycles tested Meets alarm & circuit - - . irements? E. SEPARATION DISTANCES ; F (I SEPARATION DISTANCES FROM WELL ON LOT T�.a a`"(`( J� Septic tank/lift station on lot C or On adjacent lots Absorption field on lot On adjacent lots Public sewer main . Public sewer manhole/cleanout Sew - -pttc service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation i 1 Property line *S Absorption field d0' Water main -f 10 ' Water service line 4 10' Surface water +100 Wells on adjacent lots + 100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line + /0 ' Building foundation 4' 10 ' Water main + 10' Water Service line + 10' Surface water + 100 ' Driveway, parking/vehicle storage 4 Curtain drain f 50' Wells on adjacent lots +/00' F. COMMENTS A �¶ ttL'f TA! THE 4Tn1E BENNE' 741144 * LShctlfE2-tb s PREP.4fleb_ 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 HAA guidelines in effect on this date. Engineer's Printed Name C/tC47O R61iC it. WOOD Date ✓a#JE 31 r -.1.005- HAA .00S HAA Fee $ y R° Date of Payment Receipt Number 7i1 V3 `11' (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number eae•.P�/F/crz44, eP�� 'ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY •THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENaia cHM� EXIST EXCEPT AS INDICATED. IT 13 THE RESPONSIBILITY OF THE OWNB?I 7D DETERMINE THE .ExI$TENIM OF ANY EABEMWHICH DO NOT APPEAR ON OR THE RESTRICTIONS SUBDI- VISION PLAT, UNDER NO CIRCUMSTANCES SHOULD OOFFFENCE AYA LINA OR FOR E$TA8LI HYING BBDJND- ARY LINES. • SEWARD 6 ASSOC SCALE+ /': 60,E DATE, .sl/n;•4 GRID1 ..vwi„rry FDP • DRAWN! owe TES LAND SURVEYING 688 66 ihQ,••'� t ''4itp *4 %.* 4 0111- •.• L3,6918 ir 1 ' di e 1 r 8 a Thursday, June 02, 2005 1:30 PM www.alaskabfckman.com 907.281.7070 p•02 8 8 Fz • • • .1 'J• N 0 yan s2 g cma) Et; • r Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-801-02 1. HAA# AM0020253 Expiration Date: 072G/o GENERAL INFORMATION Complete legal description Lot 9, Block 1. Northwoods Subdivsion No. 2 Location (site address or directions) 22356 Whispering Birch Drive Current Property owner(s) Chris and Cindy Harsh Day phone 746-0505 Mailing address P.O. Box 2730, Palmer, AK 99645 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by 080 for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A We!I Public Water System Two 2 TYPE OF WASTEWATER DISPOSAL: O Individual On-site O Individual Holding tank Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. Date 6113/2002 11 p y'• E ll^,I 'SC��'7�-�/yy///JJ /��/L/"I.,,, 5. DSD SIGNATURE e�,Jy •, ; ,3 Approved for Z bedrooms. 0?tt� r8CFinItro' ^ -'j Disapproved. Conditional approval for bedrooms, with the following stipulations: 1/40 cc(OF a/1b%7 •E: • • ON-SITE • : • WATER AND . rr Additional Comments — _ WASTEWATER : PROGRAM • lo Jevr�IJJ/11jjN1111}I, Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: N ea? Original Certificate Date: CV -7 a7•z (Rev. 1200) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cianchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 9. Block 1. Northwoods Subdivision No. 2 Parcel ID: 051401-02 A. WELL DATA Well type Mass A If A, B, or C provide PWStD # 213001 Well Log (YIN) Date completed _ Sanitary seal (Y/N) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing height (above ground) FROM WELL LOG AT INSPECTION in. Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform • colonies/100 mi. Nitrate mg.A. Other bacteria colonies/100 mI. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 1215/1992 Tank size 1.000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (YIN) N Date c1 pumping 6/1512002 Pumper ,IN's Pumping C. ABSORPTION FIELD DATA Date installed 12/511992 Soil rating (g.p.dJft2 or ft2/bdrm) .3 GPDISF System type Bed Length 40 ft. Width 26 ft. Gravel below pipe .5 ft. Total depth 4 ft. Eff. absorption area 1.040 ftMonitoring tube Y Depression over field N Date of adequacy test 611012002 Results (Pass/Fail) Pass For 2 bedrooms Fluid depth in absorption field before test 010 in. Water added369 gal. ' ' - New depth4.512.5 in. Elapsed Time: 1.380 min. Final fluid depth 115 in. Absorption rate >= 300 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N N yes, give date D. UFT STATION Date installed Pump on" level at _ in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main Sewer /septic service line Sae in gallons Pump off level at _ in. Cydes tested Manhole/Access (Y/N) High water alarm level at Meets alar & circuit requirements? in. On adjacent lots On adjacent lots Public sewer manholetdeanout Holding tank SEPARATION DISTANCES FROM SEPT1CIHOLDING TANK ON LOT TO: Budding foundation >5' Property line >5' Absorption field >5' Water main NIA Water service line >10' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >101 Surface water >100' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS Driveway, parld g/vehlcle storage G. ENGINEER'S CERTIFICATION 1 certify that I have detemUned through field inspections and review of Municipal records that the above systems am in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson. P.E Date 6125/02 >10' swank ti 1. ..51� i c •▪ 49111 i • ▪ C'J381 •,.N.• HAA Fee $ 3/s. a. Date of Payment G//41/1. Receipt Number DS %I Z Ly (Rev. 12J00) Waiver Fee $ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) June 25, 2002 Chris and Cindy Harsh P.O. Box 2730 Palmer, AK 99645 Subject: Lot 9, Block 1, Northwoods Subdivision No. 2 Septic System Inspection, Testing and Certification Dear Mr. and Mrs. Harsh: At your request we inspected the septic system on the subject lot to determine if it met the requirements for certification by the City. Prior to the inspection we inspected the Municipal records and found the septic system was upgraded in 1992 after the original system on the lot was found inadequate for certification. At that time a new 1,000 -gallon septic tank and a 40' long by 26' wide shallow absorption bed were placed on the lot. Soils encountered in the area of the absorption bed were apparently silty gravel with a percolation rate of 40 minutes per inch. Groundwater was found at 8' below the surface the bed designed accordingly. An adequacy test was performed in 1995 and no water was noted in the absorption bed either before or directly after the test. We performed our test on June 24, 2002. Our initial measurements indicated no standing water in either Monitor Tube. We did note, however, .5" of standing water in Cleanout No. 5. Further inspection of the cleanout revealed a 90 -degree bend attached to a tee at this location which is now out of level and holding water. It does not appear to affect the function of the bed. We injected a total of 369 gallons of water into the bed over the next 40 minutes. The water elevation rose to 2.5" in Monitor Tube No. 1 and 4.5" in Monitor Tube No. 2. The water was then allowed to dissipate into the bed and the underlying soil for the next 23 hours. Measurements taken at that time revealed .5" of water remaining in Monitor Tube No. 1 and 1" in Monitor Tube No. 2. Nearly 80% of the water had been absorbed in 23 hours. This equates to 308 gallons when interpolated over a 24-hour period. The bed is capable of absorbing a minimum of 300 gallons per day at this time and is therefore eligible for certification. It must be noted, however, that the bed barely passes and may be in the initial stages of serious decline. The lot is served by Public Water System Identification Number 213001 and is apparently operating in conformance with ADEC requirements. Attached are copies of our field test results along with an as -built of the bed. Please advise if further information is required or if you have any questions. Sincerely, n D Michael E. Anderson, P.E. Attachments DATE: 6/24/02 LOCATION: Lot 9, Block 1, North Woods Subd. #2 Single Family Multi -Family jJ Commercial WELL STATIC LEVEL: NA ft. CASING ABOVE GROUND: NA ft. VE -Tech Technical Services PO Box 87-3141 Wasltta, Alaska 99687 Tel: 907-357-6304 PROJECT #: M0228 INSPECTOR: T.L. Kimbrough # of BEDROOMS: 2 PEAK LOAD CALC• 2 x 150 = 300 gals. Type of Test: Well Flow Only ■ Septic Adequacy Only Both Time Flow Rate (gpm) Vol. (gal) Cum. Vol. (gal) Well Static Level (ft) ST (inch) inch) ST Liquid Level(inch) (inch) S.A.S. C #4 Liquid Level(inch) (inch) S.A.S. C #5 Liquid Level(inch) (inch) S.A.S. MT#1 Liquid (inch) S.A.S. (inch) inch) MT#2 Liquid Level (inch) Meter Reading Comments 9:16 0.5 NA A NA A 0 A 0.5 A 0 A 0 679 Start Test :26 8.80 88 88 0 0 0.5 1 0 0 0 0 767 :36 9.40 94 182 0 0 0.5 1.5 2.5 2.5 2 2 861 :46 9.30 93 275 0 0 0 1.5 0 2.5 2.5 4.5 954 :56 9.40 94 369 0 0 0 1.5 0 2.5 0 4.5 1048 End Test ---- Recovery: Time C#5 MT#1 MT#2 Comments 9:56 1.5 2.5 4.5 Start Recovery 6/25/02 9:00 0.5 0.5 1.0 End Recovery omo lance' Does Septic Tank Require Pumping ? Is Wire In Conduit ? If Public Water Supply: ❑ Yes ❑ Yes MI No ❑ NA 0 No MI NA Is Water Supply in ADEC compliance ? • Yes ❑ No 0 NA PWS ID# Note: Class: A System charged at Cleanout #2 Test Results: 4Cct97-41 Reviewed By: Date: G- ua-OL 'Test results are indicative of conditions at time of testing. Ve-Tech nor Michael E. Anderson make any representation to the future life of nor components of systems. Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report LEGAL: LOT 9, BLK 1, NORTHWOODS 112 94.66 u 98.41 Page 3 of 3 DATE: 6/24/02 TIME: 10:00 AM x 98.81 / C4 DrainField Rock 94.093 M1 SAS M2 f 1 N N u U N N 8.76 94.73 94.7 x 98.46 / SEPTIC TANK C5 �-Fr=100.00 W 0 O X 99.93 91.21 %-91.06 96.47 to U \-93.91 DrainField Rock PROFILE AS -BUILT Scale: NONE 98.66 4.61 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: June 26, 2002 TO: Joe Goodall FROM: Mike Anderson, P.E..44" SUBJECT: Lot 9, Block 1, Northwoods Subdivision No. 2 Septic System Adequacy Test Our first test of the septic system on the subject lot was apparently completed after a period of heavy use. The second test completed recently indicates similar absorption rates, but the water level in the bed never rose above the distribution piping. Please let me know if you have further questions. a .r MUNICIPALITY OF ANCHORAGE `* • t DEPARTMENT OF HEALTH & HUMAN SERVICES Division, of Environmental Services • • .. ,r On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 4 � _ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR`A SINGLE FAMILY DWELLING Parcel I.D. # C)51-53'1)1—° % uee. it 6140'70 3 e f 1. GENERAL INFORMATION La.t 9; Stock 1; Nak,th Waod6 #2 Complete legal description Location (site addressor directions) 22356 Wh Laming Bitch Chu, Lain, AK • Property owner Pau e 'and Sandy Si-eve/1.4a Day phone Mailing •address "`22356 Wh Aben ing Binch Chug iak. AK r.'�P Lending agency. • Day phone Mailing address Gne Ham . P.ta.n% Hen it/14e e Rea,e .E6tate • Agent • g g • Day.phone Address ' -2 30 "C" S ieee Scat e 102 Anehotag e, AK .99503 �fUnless otherwise requested, HAA will be held for pickup. Public water u t, r ., v. �n.fu'y¢:t .. n of r -row =lRv'� +M(mp rc¢- A . r .r.e+...i .. ...--.: .._v •. ,.. .. � gVY5 � �Y. NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER EWATER DISPOSAL.. � $, ndividual on-site Y ! ll +Hold.tank nsg s Comm unity.on-site f, 1, ,_,• y ' +, r 'F =C�f ^+ ��r�'*'TS Public sewer �) q If community wastewater system, provide written confirmation from State AD attesting to the legality and status of system. 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. Phone 6 - a -q 7 Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Rend Ne.204 EagleRive , AI ka 99577 . DHHS SIGNATURE l Approved for " ' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Date /3/q Additional Comments BL• Date/— CAUTION The Municipality of 4nchorage 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 engifeer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their leiriding 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. "' 79925 (Rev.. 1,91) Back MOA 921 Legal Description: 1--01- A. --0TA. Well Data AA Well type /h Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 4-1 �oPrtii.SOovsa-2- Parcel I.D. 05-0r0/0Z- If S-/ r v/0Z If A, B, or C, attach ADEC letter. ADEC water system number j Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow Pump levell FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/heldi g -tank on lot Absorption field on lot 260' � o Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE R = LTS: -r, m 0 6 D 70 9P M (0 H 6 ® c wH) ® m z Coliform Nitrate Other bacteria e of sample: Collected by: B. SEPTIC/HONG TANK DATA Date installed ' Z' S-oj'L Tank size Cleanouts O(N) High water alarm (Ytl 1(2btt Gifrd.i Compartments Foundation cleanout til) Date of pumping 13 -G Depression (YS) _t Alarm tested (Y/N) Pumper S i?_.. Pzo I� SEPARATION DIST NCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ' On adjacent lots 'Zdot To property line b I Absorption field It�bt Surface water/drainage 72-026 (3/93)* Front Foundation 7 1 Water main/service line 1.01-1` CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pum' • •" -vel at High water alarm level s tested Meets MOA electrical codes (Y/N) SEPARATION DIST FROM LIFT STATION TO: Drell on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA 4FD4-,_ Date installed Y2- -��- Soil rating (GPD/Ft2) CD3 System type �7�ip Length IA's ' Width 2l. I Gravel thickness b,S r Total depth I% % i Total absorption area 7 a itp Cleanout present QN) Y Depression over field (YJ Date of adequacy test 1.'3 -`15- Results ail) ('P4 for '7— Bedrooms Water level in absorption field before test 'l) After test C:)" Peroxide treatment (past 12 months) (Y/ 7 r-\ o QE.-- t-, ,c)vi #, If yes, give date 4 (4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot r1L On adjacent lots 2 e,o t -i- Property line I. 3 / To building foundation ‘a ) To existing or abandoned system on lot 1 0 / t On adjacent lots -z2<:' A -k Cutbank Sze Water main/service line I 0 •t Surface water Curtain drain Naafi I�,a•�s,� E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area \S I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on theslate of this inspection. S OF 'k,` FlYl �•e ..e.......,,•Ai` Signature Engineer's Name ed'Q 4 i--- C . Ca w/9, Date / / 3 / ROBERT C. COWANf'I `<'' "• CE -8801 r;`°.a HAA Fee $ 300 Date of Payment Receipt Number 72-026 (3/93)* Back 00 0s �dJ Waiver Fee $ Date of Payment Receipt Number 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.# fl \-9sn\-Cid, 1. GENERAL INFORMATION Complete legal description HAA # Ii c f1V,Ll 2, Lot 9; Block 1; North Wood Subdivision #CLb.,: Location (site address or directions) 22'156 Whicpfaring R.i rch Property owner Mark Merrill Day phone 694-9805 Mailing address Lending agency Alaska Home Mortgage Day phone 261-3404 Mailing address Agent Rae Hall/ GREATLAND REALTY Address 11411 Old Glenn Highway Day phone 694-9125 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well 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 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. X X 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Eagle River, Alaska 99577 Engineer's signature Date 12-- \ —'1v At P b1.OF 4443.% �*:49715 y . lit 6. DHHS SIGNATURE 74— Approved for 7i 2 bedrooms. Disapproved. By tA^ ROGRJ. HAFER & r ♦ vT"°° No.8 15 i , °•• •J' #mss • 90 --.....••••!!‘k\„ .�r ,S`�ROFESStO'" Conditional approval for bedrooms, with the following stipulations: Additional Comments Date ./Z / CAUTION 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) Beck MOA •21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST I, l or Ft l� 10 st c?�V `Ptt� Legal Description: 'RJ1-R21I t I— Parcel I D O� (g0 IO 1 A. WELL DATA r.Aku Well type- M U t -1I- A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires pr-perly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG gpm Z2 E '$ z AT INSPECTION %® on r -n -,.. gl O C <z 1 9�• N., z' i.' m O Z SEPARATION DISTANCES FRO. WELL TO: Septic/holding tank on lot Z).0 ; On adjacent lots 0/i6- ` � Absorption field on lot --C20'� ; On adjacent lots 0/ Public sewer main Sewer service line Petroleum tank Public sewer manhole/cleanout WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed IS- Tank Tank size 16b (14 t— Cleanout (Y N) Foundation cleanout High water alarm (Y/ Date of pumping -171N. NA V -- Compartments J) y Depression (Y Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line On adjacent lots ) Absorption field Surface water/drainage [ 72-026 (Rev. 7/91) Front Foundation Water main/service line 10 ( CONTINUED ON BACK PAGE C. LIFT STATION Date installed ufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" el at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical cedes (Y/N) SEPARATION 9t5TANCE FROM LIFT STATION TO: Well on I D. ABSORPTION FIELD DATA Date installed I2—g On adjacent lots Surface water Length 40 Width Sto Total absorption area 1(540 Depression over field (Y Soil rating 6 4:;.1 -2 ---System type e� Gravel thickness Results (pass/fail) (`-Le4J CJ7!—✓ I I`'I Peroxide treatment (past 12 months) u o.G / Total depth Cleanouts present&N) Date of adequacy test for 7 - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date 1._i l bedrooms Well on lot I—) (i- . On adjacent lots 7-00 )'r Property line 7 -JD / To building foundation () To existing or abandoned system on lot Io / On adjacent lots Surface water Curtain drain C%'1 1 - 1 csU (-F- Cutbank . 'I' Water main/service line E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 101 1� I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. or Niitvoceis 042, eeseeteee ei11•M• ••1•• • ••• S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Signature Eayle Ri1,e�, Alaska 99577 Engineer's Name Date (ESrn b roe R J. HAFEFI e W S �, J,"0 No.a 15 OJ�� U8110 FE SSO.s."4,11. HAA Fee$ 1%0%' Date of Payment 42' i' ' 4 2 Receipt Number Pi /9 �$.7s-r 72-026 (Rev. 3/91) Beck MOA 21 Waiver Fee: $ Date of Payment Receipt Number 11113 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 Mr. Ray Shafer S. & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 WALTER J. NICKEL, GOVERNOR November 4, 1992 SUBJECT: Northwoods Subdivision Class "A" Public Water System, PWSID 213001 Dear Mr. Shafer: (907) 349-7755 have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on October 1, 1992. 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 doPG 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 Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on June 2, 1992. This doeset the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance, with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II rimed on recycled paper b y G.i3. Time APPLI('NT FILLS C Property Owner /4 y-1 Ttie i- / 2 � ()-,LIC Mailing Address (2A) 0 , \Ross v Buyer Address Field Notes: Lending Institution 616,k,, Ty), (. «-/ �r 01 /0 Address % c Realty Co. & Agent Date Sewer Installed^^ 7- '). '' Well To . Well to 1 Address Legal Description Street Location _8/90 40/ C7 k / . Ir ..j.� f2o d;L. tree e -r Type yf Residence V Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply ❑ Individual ommunity 0 Public Utility Sewer Drsposal Individual 0 Public Utility 0 Holding Tank INSPECTION FEE MUST ACCOMPANY NOTE: THE Time Time Date Date Inspector Inspector Field Notes: (I) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE f'/ 8' "i BY: `'%� Soils Rating 'L Date Sewer Installed^^ 7- '). '' Well To . Well to 1 10 72-023 0821 UT UPPER HA[ ONLY JtJL_ Zip Code 9(-7-1,,,7 Zip Code Phone / 8.g _ Phone Zip Code 9'9 is77 Zip Code 00/5 .5 -(L S. , Ase /J Phone ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Year Individual Installed: rig When Connected. to Public Utility: EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspector L L1 F LQ_i .1_#1_)11_ Ad'C Time Date "t-aG -Qt Inspector �(�J absorption Area ank •CONDITIONS OF APPROVAL Well Log Received Septic Tank Size / U