HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 3 LT 4North Woods #2 Block 3 Lot 4 #051-821-08 Municipality of Anchorage • On-Site Water and Wastewater Program • (907)343-7904 / Page 3 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: O-Sjp/d/0 74i PID Number: Q 5/ a 2/ d 8 Dwelling: (Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ,pgrade Name: if' I ,(�44 ABSORPTION FIELD EiC!s `�n c� Address � / .J ❑ 2 2 3�� 5���,�w S1OrL)c e.. Deep Trench [' Shallow Trench ❑ Bed CI Mound `� ❑ Other Phone Nilmber of Bedrooms Soil Rating Total depth from original grade 303 - N5- 997 ?q/ / 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subivision Block Lot Ft. Ft. A/044 Woz /J P4 2 s i Fill added above original grade _Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. WellP06 C— (.vs4-er TANKeptic 0 S.T.E.P. ❑Holding 0 Other Man act rerCapacity Surface Water /00 f 4/ trc/ /azi 16 2 � /Deo Gal. Material Number of compartments • Lot Line /©i.. NA �' / . Foundation ( J4 LIFT STATION /VA . Manufacturer Capacity Curtain Drain ✓A/f(i Gal. Remarks 7 t/ `,, . �2-- 4.0 �•— Pump on level at Pump off level at High water alarm at �! f/V! ( in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank tov j Installer � �� �c3�3�drainfield �`'—"y' T7 Drainfield CO/MT 0 3011 Inspector BENCH MARK (Assumed elevation) / Ca f Inspection 1st /�r r ii t 2nd Ol/s�C !'Location and description �idaates: /1I Q ov1'� Oe...,. `, 3'" 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engines Stamp Cid" At1111p •V•-•00,,,..ase n_R 41. Conditional Approval: Date 4..:'/ v ca , • 0 n : °••M 0,,,-.. Seven W. Ens, i f eli ��QV�`ap' ,. AcF •75 �_(a�•a.�� Approved :�4 Date S'1 ~ig (1,i02.oli, c - ; ✓ -.4,,I.w.k„...m. Inspection Report_9-1-12.doc Mr1 -, I Foundation Cleanout Elevation @ 96' Tank Cleanouts Elevation @ 93.5' Fin ade // DPPosinQ Cleanouts Between Septic Tank & Trench 2.5 Foot Cover w/2" Insulation ��Elevation @ 93' 1000 Gallon Steel To Bed levation @ 93.5' "Anchorage Tank' Elevation @ 92.8' Solid Pipe NOR THRI M ENGINEERING *49m % SEPTIC TANK PROFILE NORTH WOODS PHASE 2 SteveEng.corn , PO Box 770724 • Eagle River, Alaska 99577 f1. cE Stere Eng :40, BL❑CK 3 LOT 4 907.6 94.7028 '++ tt = TANK REPLACEMENT Bate'5/15/18 B': SE role: 1, 5 ' S"�:3of3rill" SE AS-BUILT MEASUREMENTS A B FCO 51 8 ST1 54 11 ST2 57 17 DCO 60 20 New 1000 Gallon Septic Tank vvyy/DCD's Decornrnissioreceld Septic Tank PER UPC Shadowy Spruce Drive 15' Utility Easement —\ ... L to • Approximate Bed Location Flat Slope Flat Slope Lot 3 oX 9 Septic `Of, Flat Slope 'co DCOSJ� ST `� I. \ S DCO r Lot 19 Septic B emit.�s ( Pctn A 3 Bdrm N. 4, Flat Slope Flat Slope s No Conflicts Flat Slope / \ o1 NORTH WOODS PH 2 1' = 40' NOR THRIM l'(; ... � t ENGINEERING s* '49� •• BLOCK 3 LOT 4 ,RECORD Po Box 770724 -tn . - LAYOUT Eagle River. Alaska 99577 +,� � g / WASTEWATER UPGRADE 907. 694. 7028 REPLACE SEPTIC TANK °at5/15/18 1924 of 3 sJt1'1s Tkikk tooP `"' MUNICIPALITY OF ANCHORAGE gent ' On-Site Water&Wastewater Program \o Scar r l PO Box 196650 4700 Elmore Road a Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 Jhttp://www.muni.org/onsite r / epartnlent NCHON pVb On-Site Wastewater Disposal System Permit Permit Number: OSP181074 Effective Date: 5/7/2018 Work Type: SepticTank Upgrade Expiration Date: 5/7/2019 Tax Code Number: 05182108000 Site Legal Address: NORTH WOODS PHASE 2 BLK 3 LT 4 G:1560 Site Mailing Address: 22369 SHADOWY SPRUCE DR, Chugiak Owner: FRAHM KENNETH & Lot Size in Sq Ft: 38000 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy ❑ Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: /7 /e 1 Issued By: 120j0fAtV., 4 Date: 51 1 0 MUNICIPALITY OF ANCHORAGE • m f.+ Community Development Department L ` Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water&Wastewater Program • ON-SITE SEWERM/ELL PERMIT APPLICATION Parcel I.D. S( _ g2/ 6 es Property owner(s) FR4ffA't 1 Day phone}O 3'— 9V{S— 7? Mailing address Z23'? S'kadC.‘--,y Se\-b--1• -LJ,' Site address £c' .e.._ Legal description (Sub'd., Block& Lot) 4/o t4 t.‘) oc�c c lia re.2 R3 L1 Legal description (Township, Range & Section) Lot Size 3�0'4° Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field El Initial ❑ Single Family(SF) Septic Tank Upgrade (w/wo ADU) ;2r. Holding Tank El Renewal Duplex (D) El Privy Ii] �� 9 6 9 4 tiple Dwellings CI n d P; • F and/or D) Private Well ❑ ' 44:40100 Water Storage Eta MAY O v 2013 THIS APPLICATION INCLUDES A VARIANCE/W V` t REQUEST OR: X01681,0, Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C ,,-Gt f)L(Signature of property owner authorized agent) Permit/Rush Fees: 4r2 (s Waiver Fees: Date of Payment: CAI(9) Date of Payment: Receipt Number: 3c0Receipt Number: Permit No. 0-CP I c i 01' Waiver No. Permit App_9-1-12.doc bTFI M ENGINEERING SteveEng.com Steve Eng,PE, PH 907-694-7028 SteveEngPE@gmail.com Date: 5/3/18 Number of Pages: To: MOA On-Site Services Subject: North Woods Phase 2 Block 3 Lot 4 Septic Tank Failure A COSA was submitted. Subsequent inspection by MOA required new septic tank. The existing bed will remain. If there is need for additional information or clarification please give me a call. Thanks-Steve�� \RTF-RI IV ENGINEERING SteveEng.com North Woods Phase 2 Block 3 Lot 4 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom home. Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near an acre and are served by the public water.No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2-compartment, 1000 gallon septic tank. Watertight couplings on inlet&outlet. • 5' minimum between the tank and bed. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank&solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment,and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) OF A` 41 th # F% Steven `N. Eng Pk 9A- Cha PROFGSS'U``,f DESIGN NOTES: 1. Existing Bed Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Bed. 4. Lots Served by Public Water. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. 7. Add Double Cleanouts Before Tank If No FCO. 8. Insulate Tank. New 1000 Gallon Septic Tank w/DCO's Decommission Old Septic Tank PER UPC Shadowy Spruce Drive — \ 15' Utility Easement L (0 Approximate Flat Slope Flat Slope 9 Bed Location Lot 3 ox Septic `o 10 Flat Slope 'Co \ Lot19 Septic 3 Bdrm N. 4, Flat Slope Flat Slope Flat Slope / No Conflicts / :•'�� °F ' ``'�� NORTH WOODS PH 2 1" = 40' NORTHRIM =�P . ... t$ ENGINEERING %*'4sm BLOCK 3 LOT 4 DESIGN PO Box 770724 $ ; 0,4 � Eagle River. Alaska 99577 . - WASTEWATER UPGRADE , LAYOUT T. 907. 694. 7028 3f� Dote /4/18 e' REPLACE SEPTIC TANK 5/4/18 12EEof 3 Foundation Cleanout Tank Cleanouts Fin ^amide Opposing Cleanouts Between Septic Tank & Trench uee 4 Foot Cover or Equal 1000 Gallon Steel To Bed 'Anchorage Tank' Or Equal lid Pipe Match Elevations To DESIGN NOTES: Existing FCC] & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 27. Slope & 3' Cover. 4, Water-Tight Couplings. S. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC, 8. If No FCC], Install DOD's. N OR THRI M .•....����"44 ------ •.�� OF AC ENGINEERING ,''�4sm . *'+,� SEPTIC TANK PROFILE NORTH WORDS PHASE 2 •SteveEng. com , , Po Box 770724 '+ S,.»a,s . 1 BLOCK 3 L❑T 4 Eagle River, Alosko 99577 t � = 907.694.702 8 1 Date: Drawn By: SHEET' TANK REPLACEMENT 5/3/18 SE 1Bcf21.: i• s ' 3 of 3 SE NAME 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 i/ .5 S LEGAL DESCRIPTION MAILING ADDRESS LOCATION PHONE 688 c2e3I ANEW ❑ UPGRADE z ,3 472_ (0004s . NO. OF BEDROOMS Uy aQ W F co _I z DISTANCE TO: Manufacturer C12EEa Liq. capacity in gallons /G't2O DISTANCE TO: ell H, Absorption area Dwelling /e` IF HOMEMADE: Inside length Material Width PERMIT Nr�O. \A-111 No. of compartments Liquid depth Well Dwelling PERMIT NO. TILE HO AINFIELD I1 'RENCH TA Manufacturer Material Liquid capacity in gallons 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 cc r Top of tile to finish grade Material beneath tile inches Total effective absorption area w Length 9 ��) Width j Depth p <3 PERMIT NO. Q M t�J w 11-042 w Twae-ef crU Crib -diameter Crib . ,,ptl, Total effective absorption area /S�2d( co DISTANCE TO: ell 6,70ufi> r' Building fou9dation Nearest lot line /Q W ,2 2tm Degth/ / Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS e' b 3 03 SOIL TEST RATING INSTALLER REMARK u 0I'Sctc.t E.7L-, („e'oJc- /Z. r?i.1 ,r. y2.40fE II 3-5, 1zc 7//��� / K/ .hick .4 pe%/ 1 I/�620 ro �r -2 �� i ic, .fl 3c / p,' g‘ / iiimillk€ p/a'c:t;, ei_�l . APPROVED /(/D?, LEGAL (/J 72-013 (Rev. 3/78f i 7 MUNICIPALITY OF ANCHORAGE Departmentr'f Health and Environmenta,rN2rotection 825 Street, Anchorage, AK. x9501 264-4720 fhsn II -i -Q'1 � �' * * * HANDWRITTEN PERMIT * * * Permit # ,Lc) Applicant: WELL AND/OR ON-SITE SEWER PERMIT -Q Mailing Address: /DC) c Location: Phone Number: 6 dv " Legal Description: -4- t/ (X) y' r? )6OLY Type of Soil Absorption System Is: Lot Size: Trench: Drainfield: Seepage Bed: -` Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) ^7-/<;t"-) The Required Size of the Soil Absorption System Is: 6`i ps- r DEPTH LENGTH 'x :E GRAVEL DEPTH b' ewm)(4 '' 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 thebottom 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 = 06 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 wellwill 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 ersta d what the on-site sewer system may require enlargement if th-resid'c is remodeled to include more that 3.bedrooms. Signed: Applicant SWP/024(1/81) O & E ENL.NEERING & DEVELGIMENT CO. Russell Oyster 694-2774 Performed for: Name. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 f\kkg1(1) { SOIL LOG F-11 L S:CA&6 (-14,61S7-,/1 C.! -r -r Earl Ellis 688-2280 Tel. No t8& -2E/ Mailing Address• tea. go it 4-14/ 1, ,G4,.. WS -4 7 Legal Description: Z-07` , 1L3Al er uk A s 2Z - Depth (feet) Soil Characteristics 0 1 2 3 -rd,LIJFLL6f '! Lo A.r-u 2Lorr/de 7 S--cP4 tee- L, AF A-7- 8 -8 9 10 11 12 13 14 15 16 L-th 7 E `�°r-,onWPi a r( 47- 10 7- PLOT PLAN PERC. TEST 32! RA -re- : 3 3_ MMf/Arc. Ground Water Encountered: Yes No If yes, what depth 7 Proposed Installation: Seepage Pit Drain Field Comments' • Performed by: Date. &, /q r APPLICNT FILLS OUT UPPER HAI`ONLY Property Owner I _ -- . - Mailing Address '"""? '*) c„_4 Ca -v' )f..f AA C.:\- U. { y Zip Code (�) i:-.-� Phone 1 Buyer ^� of -e_1, \-4 ,.' f_aAU Address Zip Code Lending Institution I s4_ fl' � 1 Address r�}Zip Code Phone Realty Co. & Agent (� - - - — Phone Address Pep X ..z_4,E,, l 9- Zip Code (C14 2-00 _f2 Legal Description LIar4""'�%jr Street Location Type of Residence Single Family /E Multiple Family No. of Bedrooms -2.) ( '24 -APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE 1(---3— 1- ❑ Other Water Supply ❑ Individual - Community Public Utility 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). Sewer Disposal Individual Public Utility ❑ Holding Tank I Year Individual Installed: When Connected to Public tility Well To Absorption Area Well to Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time - Time Time Q u L14rYu9 Date Date Date Det j ' I k_u.n,s i I - LI--Cc� Inspector Inspector Inspector Inspector 1t I Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF I'°r'_1,i A ENVIRONMCN;A_ ..0.:CnION f i'OV 2 1982 RECEIVED ( '24 -APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE 1(---3— 1- *CONDITIONS OF APPROVAL BY: (2-CA°'/v Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72-023 (31w) Iq o � rn rn titi c+) M I? � I— ti 0 0 G') CD o x LU fz- o Lis o LL A L V a- NQN Li. TO i U Z LLQ. O Q � C O O U V L � Q o Z o� U 06 U c � E O � DO 1 l J LO N O N LO N ti Lu ((f D C O .Q x W C) 0 0 M W O N 00 i 1r u J a� U (tf d' J ('7 m N W U) !a - V ) O NT - O C: O Q U Ln m Q (U J A OD Q Y co 0) D L 0 a_ O Q U) cY) N N O N _0 ca Cn J M E O IAI LN M. 0 0 0 0 a) -Q � — Q. i a Q. a O 3 +' i a N .� ~ O ~ a) U L c O N W O L CQ- LC Q. 0 > o = Q Q > -0 Q •c N E 0 r NU 3 Q i v O N u o = N i N O 3ar = CL .N � z Q E }' NN Q. 'a o >C O m 0 d Q C Q O U) Q o 0 (pa-• >1a cn _d tocn ) U) E O Q _ O c O' O .> o C U) m (n a� O N > O > C. L +r U LL Q +� M c`a o N U ° Q m Q v "— N *' ' Z W Q O (n M ` o E cLa cLu = U Q O v N N o N Q o v Q 0 I- CD CY) M� CO C7 I-- r - CD O 0') 0') O 4- m U Q Q Q O L. Q Q N U) W CO C O O N U WA Z O 00 �-- O 00 O oz J Q 0 Z i W i� a- T - M m 'IT a) J U N CD - a_ C/) O O z Lid M C: N o N Q N U U v7 � a) Q) O O O a u O U U IN a) (D LL a) i I Mi U_ L f Vi (D ^t J W C D� V/ CY) N a) Rf >, N d U C. L O ❑ OC C "' c E N Q V O 3 O.2 U � a) � � ❑� O N C "D O 0) c ( = O E > > ++ v Ll O U cn N c _ c Ll 0) O c a) a o LL m + cn~ U) a) c U) cv (D N O ❑ =0 a) CD ❑ � N m U) a) o UN aO p _ a) m O0 o El UW m Om G. WL L- q ❑ FEW �� M I .L > U o _2 O N R C: O c m t r E ❑ ❑ ❑ ID ) O c `� +LL a W N J a LU O ❑ Qa) cn fn fn C/)m -j a) d W W ❑� a) W a) N ~ ~ fw- c � Y Z _Lo Q O '° ci U)a3) w H U- O U- O 0 H U a a) c) m c cn wa. a H -a i- W m a) Q O H H tn Q Q a > ca N M wi CO > W m a) (D LL a) i I Mi COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ 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. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 7/25/24 X X X X X X X X X X X X X X X                        N52 ° 0 0 ' 0 0 " E 1 9 0 . 0 0 ' N 3 8 ° 0 0 ' 0 0 " W 2 0 0 . 0 0 ' N 3 8 ° 0 0 ' 0 0 " W 2 0 0 . 0 0 ' N52 ° 0 0 ' 0 0 " E 1 9 0 . 0 0 ' MB TE MBMB SSSSS E /RW%ORFN 1RUWK:RRGV6XEGLYLVLRQ 3K,, 6T)W 6KDGRZ\6SUXFH'ULYH 6WRU\:RRG)UDPH+RXVH :LWK$WWDFKHG&DU*DUDJH 6+ $ ' 2 : <  6 3 5 8 & ( '5 , 9 ( 3$9 ( '  ' 5 , 9 ( : $ < ('* (  2 )  3 $ 9 ( 0 ( 1 7 6+( ' 6+('   7   (  ( $ 6 ( 0 ( 1 7   7   (  ( $ 6 ( 0 ( 1 7   7   (  ( $ 6 ( 0 ( 1 7 /27 %/2&./27 3/$7 %/2&./27 3/$7                /27 T  G   S PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Rachel Shoemake, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. August 15st, 2024. Legend: Scale 1" = 40' Gas Meter Electric Meter Wood Deck Septic Fence Mailbox Lot 4, Block 3 North Woods Subdivision Phase II General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Emily Selix 24-170 08/16/2024 82-204 NW1560 E Elec. Pedestal Tel. PedestalConcrete MB Water Valve G E S x T Culvert Gravel R E GISTEREDPROFESSIO N A L L A N D S URVEYORRachel N. Shoemake No. L.S. - 14646 6HS Pavers A\ GEE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section — Fax: 907-343-7997 Parcel I.D. 051 821 08 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION NORTH WOODS PH2 BLOCK 3 LOT 4 Complete legal description Location (site address) 22369 Shadowy Spruce Drive Current property owner(s) Mailing address Real estate agent WILLETT 2. TYPE OF DWELLING: Fx_1 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: NONE Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment q 12 b 2 Date of Payment Receipt Number 0 a 5`7 1 D Receipt Number COSA # OSC211053 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 2/15/2021 N law • 49 TH 6. DSD SIGNATURE / • • • • • . i .�••• / System #1 Approved for bedrooms rr • >+HARLES G BALZARIKI System #2 Approved for bedrooms ����F��s.•. CE -13854 Disapproved (�liF�PROFE5S1o�4?� Conditional approval for bedrooms, with the following stipulations: `J= ON-SITE G'�+ WA r__ Original Certificate Date: 2 — Z _Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: NORTHWOODS#2 BLOCK 3 LOT 4 If more than 1 septic system on lot: COSA Checklist # 1 of Parcel ID: Structure served by this system 1 nm Rg1 nR A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test gpm Date drilled Water storage tank volume gallons Total depth ft Well disinfected for coliform test? ❑ Yes No Cased to ft I " Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑I Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L L] Arsenic less than MRL (ND) Casing height (above ground) in. Collected by Date of flow test for COSA Date of Sample Static water level at beginning of test ft. Comments NO WELL, HOME IS SERVED BY PUBLIC WATER B. TANK DATA Age of tank(s) 3 years Tank type/material SEPTIC STEEL Measured operating fluid level in septic tank 51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 2/9/21 L • I• C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1982 Adequacy test date 2/11/21 FOR ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 2.5 ft (max) Fluid depth prior to test 2 in Measured depth to pipe invert from grade ft (min) Water added 450 gal ❑ N/A — presst �i,�— New depth 2 in ❑ Monitor tubes go to bottom of effective. If not, state 5 depth into effective Elapsed time min 01Code-requiredsoil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced NA gallons If yes, enter date NA Comments/Deficiencies: " NO CLEANOUTS IN DRAINFIELD, NO CHANGE SINCE PREVIOUS COSA COSA Checklist yellow sheet M E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 7✓ Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' F71 Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' R71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ❑ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 1771 Yes if No ft Wells on Adjacent Lots: El Absorption Field > 5' R71 Yes if No ft Private Wells > 100' F71 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' R71 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 121 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' El Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' R71 Yes if No ft Community Wells > 200' 0✓ Yes if No ft Surface Water > 100' ✓/1 Yes if No ft F. ENGINEER'S COMMENTS PREVIOUS COSAS INDICATE EDGE OF DRAINFIELD IS WITHIN 1' OF DRIVEWAY MONITOR TUBE HAS STANDING WATER IN IT, AND WAS IN USE, SIMILAR TO 2018 COSA. 2014 COSA INDICATES FIELD IS INSULATED. G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 2/15/21 COSA Checklist yellow sheet Olaw F �Lq 419TH CHARLES G BALZARINI ��c •. CE -13854 .• ..`% Aw ��F�'°ROFESSIONP - Municipality of Anchorage •• On-Site Water and Wastewater Program o,' ,t• _ (907) 343-7904 , ..LI1III CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-821-08 Expiration Date: c /P_f 1 1. GENERAL INFORMATION Complete legal description North Woods Phase 2 Block 3 Lot 4 Location (site address) 22369 Shadowy Spruce Dr,Chugiak,AK Current Property owner(s) Frahm Day phone 303-945-9979 Mailing address same Real Estate Agent Owner Day phone 303-945-9979 189Jn 2. TYPE OF DWELLING: r„.` ,�® Single Family (w/wo ADU) . : �. ❑ Duplex ( �`.!'r� re 0 Lli iU ❑ Multiple Dwellings (Single Family and/or Duplex) a i 12\ /" 3. NUMBER OF BEDROOMS: 3 O[ baL - 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank Cl Community Class C Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Received by: "—> Date: ,.514 t COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S2-co Date: Date of Payment 1'f ?-Er lb Date of Payment Receipt Number 018612,b Receipt Number COSA# Or-- _-‘$<<coq Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 4/25/2018 c 6. DSD SIGNATURE 3 . R D System #1 Approved for 3 bedrooms. r` System #2 Approved for bedrooms. Disapproved. • WL2J-i ,v^ ':P Conditional approval for bedrooms, with the following stipulations: • • • 3F AA,G. ON-SVVE G- Rp1D �Jp,S1 W A-TER v nROGR • A�t ten\1\��i B • Original Certificate Date:S I e I The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory • I Septic System Advisory Arsenic Ad,,agory. Well Flow Advisory Other :' ;n COSA blue sheet 9.1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On Site Systems Approval Checklist Legal Description: A/ar-lA h AkJ t / h Z 83 L y Parcel I D:0518 2) 0 A. WELL DATA P t)$4/ 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(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA / 5/i/ r Tank Type/Material S F�'T IC-1 S Tea. Date installed /1/l —12z Tank size M00 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout(Y/N) Depression over tank (Y/N) Al High water alarm (Y/N) /v Date of pumping ( Pumper !4�'re4'J C. ABSORPTION FIELD DATA Date installed, /ll "/ dc'z Soil rating (g.p.d./ft2 or ft2/bdrm) 2CO . System type FE-13 Length 1 Q ft. Width 3e ft. Gravel below pipe ', 5 ft. Total depth 2, .5 ft. Eff. absorption area/5Z0 ft2 Monitoring tube y Depression over field Al' Date of adequacy test ,//9//d Results (Pass/Fail) I ( For 3 bedrooms Fluid depth in absorption field before test . 3 in. Water added !{-SQ gal. New depth t( in. Elapsed Time: 3C . min. Final fluid depth 3 in. Absorption rate >_ 4(--5-4!) g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) 9A/,k. If yes, give date D. LIFT STATION ,AJk Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: A/A Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation / f Property line /0 (1- Absorption field S 4" i Water main /0 f' Water service line /Q Pit- Surface water /DC Wells on adjacent lots /O (4- ABSORPTION FIELD ON LOT TO: Property line /c (1- Building foundation /Q (t Water main /a ('r` Water Service line /011- Surface water /aa (fi Driveway, parking/vehicle storage /O 4 Curtain drain !/N (74- Wells on adjacent lots /Do F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and itt ' Pq� review of Municipal records that the above systems are in '" " A wj conformance with MOA COSA guidelines in effect on this date. �b �: �; _: ' : �` 0 � t / +. Engineer's Printed ame � /�t/. .4-04 � ``r � .- ;••^�9 cnV 41 Date / � • • COSA yellow sheet_2-6-15.doc n, C • -4!,-e and '6747 -"-- \ ./fQ, OQ 1 D, . ' 1: • • '• i-j-- Ere ,,-rfr : -sir, d ° ' •• ti. b 7 G •'w b �� bj '.'.•' ' '.e. ) „ife6 N• r• o. i 1 N ssh • >1 n �� Q )1'1, 32_6�q ,; N N .% 16 # if . . ¢ff JIg2qq1 f1/. . traQooF apo<od.. - .. /may ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: =OLLOWING DESCRIBED PROPERTY: Lot 4 1"' = 30' _ ts"�'�'�`ka4 ' 3iock 3, Nor th'Woods Subdivision Phase�II -� . .� R �4 ND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE: a�� ••.:4,1-40 41 40 NDICATED. IT IS THE RESPONSIBILITY OF THE 1/21/92 �. .•4 , ' ••Air.1;" MINER TO DETERMINE THE EXISTENCE OF ANY GRID: f ••••• •• •••••••. :ASEMENTS, COVENANTS, OR RESTRICTIONS NW15b0 �•• .� �, (RICH DO NOT APPEAR ON THE RECORDED SUBDI- /`'e •••/ ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB �i - ;•Duane ►k ;d:: a NY DATA HEREON BE USED FOR CONSTRUCTION 26-19 a� •. �:± � F FENCE LINES, OR FOR ESTABLISHING BOUND- � Y • '' A + RY LINES. DRAWN: ��qti� ��.'� DNS . 1 Parcel 1.0 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval oc' 1 - 7:),1 - O cb Expiration Date: g — d — ( G 1. GENERAL INFORMATION 1\61/444\ Wo&s Pbos= 2 - Complete Complete legal description Block 3, Lot 4 Location (site address) 22369 Shadowy Spruce Dr. Current Property owner(s) Cheryl VOlden Day phone Mailing address PO Box 670476 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: I x I Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank Community Class Well ❑ Community Public Water System PI Public Sewer 3 U9 M1 AI huut 4 2014 TYPE OF WASTEWATER DISPOSAL: 1.1 n n WaiverNariance request for: Distance: Received by: COSA to be released to theengineer, unless otherwise requested by the engineer. Date: COSA Fee $ 52-6, -- ` r Waiver Fee $ Date of Payment R'1 15t 1 �i (') Date of Payment Receipt Number O(O3q CI Receipt Number COSA# OSCJ q(7%S 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE Phone (907) 272-8218 Date 8/14/2014 System #1 Approved for 3 bedrooms , • • Sleven 'RI 'Ilonnone: ��-F+�,9. GE -8149 .E System #2 Approved for bedrooms s Disapproved �kk; OFESSt� �" Conditional approval for bedrooms, with the following stipulations: (HUM O 6,-_ ON-SITEfi = WATER ANU rts ti`JASTEW.^�ATFR 1. R pi.OV;-cAM RC5<,3 By:CFOriginal Certificate Date: g /" ! q The Municipality o Anc orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_c - If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist /Ve4tH Legal Description: • --- --- A. WELL DATA Well type Public Date completed wc.ps Pira;« .2 _, Block 3, Lot 4 Parcel ID: 051-821-08 If A, B, or C provide PWSID # AWWU Well Log (Y/N) Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to Date of test Static water level Well production FROM WELL LOG ft. ft. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Casing height (above ground) AT INSPECTION ft. g.p.m. in. Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/1/1982 Tank size 1,000 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/28/2013 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 11/1/1982 Soil rating (g.p.d./ft2 or ft2/bdrm) 260 SF/BR Length 40 ,ft. Width 38 tir""' 1,520 Total depth AP ft. Eff. absorption areaffz System type Bed ft. Gravel below pipe 0.5 ft. Monitoring tube Y Depression over field N Date of adequacy test 8/1/2014 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 470 gal. New depth 4 in. Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. No Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic s- e line An ''• . containment areas Size in gallons "Pump off" level at in. Cycles tested SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Water main 10+ On adjac Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Property line 5+ Absorption field 5+ Water service line 10+ Surface water 100+ Wells on adjacent lots 200+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 1°4- Water 0+Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 200+ Water main 10+ F. COMMENTS Vora f ed ,Q 1y -f J .e/AcEt0i&?1 v mir lank and *Ad. v G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 8/13/2014 COSA brown sheet_10-10-12.doc fl 0 s,S:9�4/j�iy soif'C'rf .. , Ilam /la ea _ .4- Q0'se-ay MA, as ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Lot 4, Block 3, North -goods Subdivision Phase II AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE )WNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS NHICH DO NOT APPEAR ON THE RECORDED SUBDI- fISION PLAT. UNDER NO CIRCUMSTANCES SHOULD WY DATA HEREON BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING BOUND - iRY LINES. SCALE 1""= 30' DATE: 1/21/92 GRID: NW1560 FEN 26-19 DRAWN: DMS �stalai li sa•0 �� fl ._yn 1 e 4 •Duane ' .r • r 1- Municipality, of Anchorage Development Services Department Building Safety Division • Onsite Water and Wastewater Program 4700 South Bragaw St • P.O:Box 196650 Anchorage, AK: 99519-6650:.' www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY; APPROVAL FOR A' SINGLE FAMILY;DWELLING Parcel ID. D. 051-821-08 1. GENERAL INFORMATION', Complete legal description Lot 4, Block 3, North • et SA CYT e C Expiration Date:" `7 • / $ - 0 - s Subdivision Phase 2 Location (site address or directions) , 22369 Shadowy Spruce • Current Property owner(s) Larry Weathenvax Day phone '688-2038 Mailing address 22369 Shadowy Spruce Drive • Chugiak;'AK 99567 Lending agency; • Day phone Mailing address. Real Estate Agent • Mailing Address Day phone . Unless otherwise requested, HAA will be 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage .. Community Class A Well Public Water System held by DSD for pickup. Three 731• 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 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 Tess 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. ., STATEMENT OF INSPECTION BY ENGINEER. ,. As certified by,my seal affixed hereto and as of the validations/ate shown below I verify that my, investigation, .based on procedures outlined in the Health Authority Approval Guidelines forthis 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 stricture indicated herein 1 further verify that based on'ihe information obtained from the Municipality of Anchorage files :arid frommy'Investigation and inspection; the onsite water :supply •and/or wastewater disposal 'system is(are) in compliance with all applicable Municipal' and State codes, ordinances, • • and regulations in effect at the time of Installation 'Name of Firm Anderson Engineering= Address P.O. Box 240773 Anchorage, AK 99524 ' Engineer's Printed Name •Michael E. Anderson, P.E. DSD SIGNATURE ,'•- 1 - Approved for • 3 i bedroom_ s Disapproved Conditional approval for Phone 522.7773 Date 71912001- • ". '•;* 4911EIjG1JEER%S., fit/L:� 44 pMICHAEL E.'ANDERSeN :CT , t' ice• CE -4381 :\ .• rt09 C &e EOPeete.000lt... bedrooms, with the following stipulations. • C'� •,• Gie� yor -. nil MI iii;o• • ON -511 E •.r9G>; `�..' WATER AND ; m . WASTEWATER . Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Bylier Pc-ct (Rev. 12/00) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: % — / R - 0 1 1 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 8251L' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 4. Block 3. North Woods Subdivision No. 2 Parcel I.D.: 051521-08 A. WELL DATA Well type Class A If A, B, or C provide PWSID # 213001 Wed Log 0 Date completed Sanitary seal 0 Wires properly pied 0 Total depth 8 Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft ft Wed production g.p.m g.p.m WATER SAMPLE RESULTS: Coliform _colonies/100 m1 Nitrate _ mgll Date of sample: Collected by: Other bacteria colonies/100 ml B. SEPTIC/HOLDING TANK DATA Tank Type/Material SeptldSteel Date installed 1982 Tank size 1.000 gal Number of Compartments Two 12) Cleanouts Y Foundation deanout Y Depression over tank N High water alarm N Date of pumping 8/8100 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 1982 Sod rating (g•p.d.At2 or ft2/bdrm) 260 SFlBdrm System type Shallow Bed Length 40 ft Width 38 ft Gravel below pipe .5 ft Total depth 3 R Effective absorption area 1,5208' Monitoring tube Y Depression over flet N Date of adequacy test 717/01 Results (Pass/Fall) For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 2.75 in. Elapsed Time: 1.320 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 14 If yes, give date NIA D. UFT STATION — NONE ON LOT Date installed "Pump on" level at _ in 'Pump off' level at _ inHigh water alarm level at _ in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: No Well on Lot Size in gallons Manhole/Access Meets alarm & circuit requirements? Septic tank/lif station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Pudic sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Water main >10' Drainage >100' Property line >S Water service line >10' Absorption field >5' Surface water >100' • Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS System Remained it Service During Testina. G. ENGINEER'S CERTIFICATION certify that I have determined 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 719101 Water main >10' Driveway, parking/vehicle storage >25' C^cam `•�d.i G� 'r 4 V •77% ' *: 49TH ,' b®>c„.•MIO'�w E ANDHPSCN•`,'r� P a116te.E sem'•`~� HAA Fee $ Date of Payment Receipt Number 49U, (Rev. 10/99) 300 •• 11910 Waiver Fee $ Date of Payment Receipt Number C N m a O w a m :stinsad tsar ❑❑ {teCD l 0 N ❑ ❑■ z zz 0 0 0 ❑ ❑❑ OD C -• 01 3 m 73 do U.) N O N J n� W N NJ O N 3 3 CD J W O d x CO (0000 O �D;tn N CO > rp i3 d iD 2 O 03 3 e` O °000 N N N Recovery Comptete Begin Recovery Comments C N m a O w a m :stinsad tsar ❑❑ {teCD l 0 N ❑ ❑■ z zz 0 0 0 ❑ ❑❑ CASING ABOVE GROUNC N/A ft. :13A31 OIlV1S 113M z D /Cowed ei&uts • 0 c c T 3 0 1 o 3 o 3 N N DJ IT 0 2 0 Apo toenbapy agdag ■ o :31V3 OVO1 NV3d A N O :SWOOLIG3910 # r 0 0 Z Lot 4, Block 3, Northwoods Subdivision No. 2 :21O133dSNI uosiapuy rs tou—r :31VO # 1O31'O14d O rn 5 A O ( (J( U.) N O N J n� W N NJ O N 3 3 CD CO (0000 A A A rp i3 d iD 2 O °000 N N N ( I" ly O - A 360 240 r I 6� C D rN e - m c m — n — D a -I 01( 7i 0 c N -n . 3 - 0. D. �N .,. N N Ul N_, 0I O O 01 01.1 3 N A 0 ((D C n _. ...- D ... N n D 36 > r.rr-1 a m c a - iS r.) D g D 3y > r3: y m 5 x — d Co D s D 3 In >� m n t - CO 0) V O (D I 36709 36589 36469 36349 Meter Reading 'End Test Start Test Comments CASING ABOVE GROUNC N/A ft. :13A31 OIlV1S 113M z D /Cowed ei&uts • 0 c c T 3 0 1 o 3 o 3 N N DJ IT 0 2 0 Apo toenbapy agdag ■ o :31V3 OVO1 NV3d A N O :SWOOLIG3910 # r 0 0 Z Lot 4, Block 3, Northwoods Subdivision No. 2 :21O133dSNI uosiapuy rs tou—r :31VO # 1O31'O14d O rn 5 A O 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 # 051— 22-4—CA 1. GENERAL INFORMATION Complete legal description Northwoods #2 Lot 4, Block 3 HAA # HAg406 36 Location (site address or directions) 22369 Shadowy Spruce Drive, Eagle River Property owner Julius & Emily Tucker Day phone 688-2097 Mailing address 22369 Shadowy Spruce Drive, Eagle River, AK 99577 Lending agency Alaska Home Mortgage/Dick Mandella Day phone 563-3033 Mailing address P.O. Box 196850, An horag.e AK 99519 Agent Heritage RE/Dave Sellie Day phone 694-4994 Address 16511 Centerfield Drive, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. } NUMBER OF BEDROOMS: 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. \ ,1�1 `+; i { 4 -; TYPE OF WASTEWATER DISPOSAL: ,•' ., Individual onsite Holding tank Community on-site y Public sewer` `°` NOTE: If community wastewater system, provide written confirmation from S'ta a ADE attesting to the legality status of system. °172-025 (Rev. 1/91) Front 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 c, 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 invest gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Date /,/i 7/5v . DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date /2 -5- 77 CAUTION • The M inicipali of, nchbra a Department of Health and Human Services (DHHS)issues Health Authority ty �.., 9 P ;K Approval Certificatesbased only upon the representations given in paragraph 5 above by an independent 1prolipssional enr(Nheir registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and th'eirrtendinghnstitutions 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /1621//W60JS 1t7� A. Well Data Lot 4, 51-14 Well type P & ie Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number 2-/ 5/ Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPEC Date of test Static water level Well flow Pump levell 9.P. SEPARATION DISTANCES FROM WELL T Septic/holding tank on lot j ; On adjacent lots Absorption field on lot ; On adjacent lots 5-6 zc Z 70 el C g.p.m. @n m O -- z m P.cr, v 0 ® Oc Z Public sewer main Sewer service line WATER SAM E RESULTS: Colifor Public sewer manhole/cleanout Nitrate Petroleum tank Other bacteria D. e of sample: Collected by: B. SEPTIC/FSG TANK DATA Date installed / 977, Tank size /0O Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) High water alarm (Y/N) j'//A y Depression (Y/N) Al Alarm tested (Y/N) Date of pumping /I//?J / Pumper S� SEPARATION DISTANCES FROM SEPTIC/I-t6tDWJG TANK TO: Well(s) on lot NM' On adjacent lots -1- 2/60 Foundation gyp/ i To property line 5� Absorption field 3n/ (2LC0(e) Water main/service line -00/ Surface water/drainage t4 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Aj/h Date installed Manufacturer Size in gallons Manhole/Ac = (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTAN Cycles tested ROM LIFT STATION TO: Well on I• On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /987/ Soil rating (GPD/Ft2) 7i(o4 4/&2 System type REG) Length 1-0 Total absorption area Date of adequacy test r Width 3g r Gravel thickness Lo /# Total depth 3 /S Zd Cleanout present (Y/N) Y Depression over field (Y/N) /l/ lAty/H Results (pass/fail) PASS for Bedrooms After test / " Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots r 2.40 Property line / D / To building foundation /7"74 To existing or abandoned system on lot /`//A - On adjacent lots 30' Cutbank /V/A Water main/service line 'f /0 / Surface water ^//A - Curtain drain NONE /9PP/9/ze,&rT Driveway, parking/vehicle storage area / �C EX reei44� E. ENGINEERS CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on,the 'date of this inspection. 0000sny�o Signature Engineer's Name Date LOU/S /// 7/9'f .c3uTer , PC o _ •om° Louis A. Buten. 6 `0, CE -6736 °,t` T Y `v ASA °"4 W_ `�<LF Fp a�[ „„ . °AOFESSI��- HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back aiv 3a I(i7// Q oo5 dr 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 # Wl 8t/ QB 1. GENERAL INFORMATION Complete legal description HAA # #A f! 3 /Z/ Lot 4; B.2ocfz 3; Nonuh lJood4 Subdivi6Lon Pha4e 11 Location (site address or directions) 22369 Shadowy Spruce Property owner Garay Buttezon Day phone 696-4325 w2 #b62-6133 Mailing address 2909 Ancti.c Bbd. #103 Anchorage, A2a/sfza 99503 Lending agency Day phone Mailing address Agent Dawn Daws MCKENZIE REAL ESTATE Day phone Address P.O.Box 772922 Eap.2e Riven, A.2a3fza 99577-2922 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX 694-9035 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 XX 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No.204 Address Eagle River, Alaska 99577 Engineer's signature Date 2- 91' 6. DHHS SIGNATURE Approved for 2 bedrooms. Disapproved. By. OF 44 4 _Pilch Tk n "Is Id tit o• Ntr••a••mao 4•,�. oi eagles Q , e p0 J. 5 AFER u i'• No. 62' •^� i•%i sip's � � .� Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 02/6/ 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) Back MOA #21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lt" -t" 3 I•lag-liStoor�Parcel I D QJ ~l 292/— s1DP E..I A. WELL DATA Well type A If A, B, or C, attach ADEC letter. ADEC water system number r5 tO Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Z Static water level Piz W 2 y Well flowN T 0 gpm Imp mo Pump level .Z -C; fri z n I CD ry "' i0 SEPARATION DISTANCES FROM WELL TO: — g Septic/holding tank on lot Z On adjacent lots Absorption field on lot Zook ; On adjacent Tots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by B. SEPTIC/HOLDING TANK DATA Date installed tc;\ Cleanouts CON) High water alarm (y 4g) Tank size 10DU lien-- Compartments '2. - Foundation cleanout ON) Date of pumping Z 9 Alarm tested (Y/N) Depression (Y,/i #4 Al/A, Pumper X. %SSPD7, L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Zobt+ To property line t Surface water/drainage 72-026 (Rev. 7/91) Front On adjacent lots SIA. Absorption field '3c' 11fi Foundation I Water main/service line l D 14- CONTINUED + CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical code SEPARATI ISTANCE FROM LIFT STATION TO: W- on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 1 `1$'2— Soil rating '7,(o b4)/5iz- System type 5E3::' Length Width 353 Gravel thickness Lo Total depth Total absorption area 1S2a Cleanouts present69N) l y Depression over field (Y(9 > Date of adequacy test 2 — Results faiI) '.AsS for —itA Llzfc_ bedrooms Peroxide treatment (past 12 months) (VW /4r:',3F K,4 l4d4 If yes, give date / SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot �� On adjacent lots '`1 p Property line 1 �t + 1 To building foundation 441To existing or abandoned system on lot "1 IA On adjacent lots 3 O Cutbank /k Water main/service line � -r Surface water Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eft effecisiteM,Idate of this inspection. '' OF 4 fig;, Signature S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's Name Date HAA Fee $ /70 Date of Payment -c?"L Receipt Number 42 ?1 t7 CS ) 72-026 (Rev. 3/91) Beck MOA 21 Waiver Fee. $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 24, 1991 FOR: S & S Engineering WALTER J. NICKEL, GOVERNOR (907) 563-6775 PWSID # 213001 My review of the records on file in this office reveals that the Chugiak Utilities (Northwoods 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 Sincerely, Byron Y Y Environmental Engineer t >� nMUNICIPALITY OF ANCHORAGE r ya D EPW A,y*RT' M�,bk.tEt 3n NTiOFHEA}LitTuE+H AND ENVIRONME NTALPRO TtErtCi T' IOv N df`4ee y{c',: !M kwym ; ,10,`11 1t DIVISION OF ENVIRONMENTALbHEALTH ERTIFICA E'0 SKCTIO OCE LTHU HCR T a • tq I EA ER. N° A R II I f� 264-4720 i3 a. :.'•`i c+`�f h ,£54;':a ,h?,1�".�, p licatio Date di. W. f t f 41 S } J""wllJ k ENERA INFORMATIONr", f N .� }'iz ,t t is �g�oLFa '� �a l�'?�✓l�'R��f �,^r> tdg i; ega Descnpt}on(�nciu.e of • oc •division, sectwn, bwnship, ange ey-1el• 440°Y. ollti i ats 417016v; d'� 6'(i�7i 1'�• filroolOon it 1 +vex°) T:44*, 7i,t0*P1 ;4 i.,i �� a: of a . ii :aa •. ui.aN �i.-n�3sta�ie�x4f� 2 ;aiietna�ieYai^ •:� r„>",rt;.u-•f.n;r*.r-fin... ... e.,.,X.......>,-e-R....+n.,e+o,.:..,-rn+.--.. . 54'I `.1� �.n..l �i tiv'i�Jt `iIl lYf r�i�ld,gnt �i�f • �y�.� °•R!4a(1.00g I � ar �i� 'r t 1t !xl lr4iA • 0111 �4�'ll�•1�i�� ' CQ munt w t�ggatc us3 ave itten confirmation,from” lie tate n 1 aa�6Jt ttestin • o t e to aIit and status 9 Y.`.'.smrrh ,x6 iii'r"+,k,4Frt4'#Ci ar ,',,k -44:1,4,,,,I,.. �A ENGINEERING ., FIRM P$ROVIDIN�G. INS PECTION$, TESTS, FILE SEARCH, DATA AND INFORMATION-", `77w�€�F�' Vr4 i1 3iN.", ,2s ^.. *Iril 1^dxa'� ..3...; f" Yi�•ese�= a 1 .Jw, s i s y�:*'i $` . �,§ ;�i "r ,e.Y'7' :fi�+c elo verifia`iht*o , yinv�stig `ion Health, As certified by my seal aVed,iereto an • as o thevalidatwn date shown below�I verify that my investigation of this Health, `" 44•.'1�ncA"#;;I 90.16::" 44$^ R i-.,'"uF',«' ?ita 4',,,,,'o w , t -•'", ,, ,o-..4,,,„ ;p' i,n"r,,.:a.u4,'k t5arw...a.>" AuthoriityApprovalshowsthattheo -si a vate supply and/o wastewater�disposal,systemissafe,functional ndd''adequate; ABY for tie number. o bedroo s a d'.fy e o t i thure in • ca a erein furthe v "rif hat based o he m ormaati Q�tafne• fro f - Mum jty 0'f Ar a e y� } s eC .t ,�;te', t Mumoi alt o c orag*elfl,eS o v_ stigaUorand sect o t o -site at .su • • a • o 9 s, �",,,-. 6P�`" ad , Wa t water dlsposa( syste is 4 comp is itl i i • and Stat co • es i ces an egli anon e ec • �; ,.: -*444461.4o64;„„4,-..,thse e ate of thisInspeon, . .. ., .-a.wuY iN ., ;..t+i+ -.: 3`f' . " F i '� ""4":..'• The Muncipality�of�Anchorage;Departmentof.Healt 'an• Environmental. ProtectionF(DHEP issuestHealt thhontt pprova 'certrficates based solely upon the r,representat s giveen paragraph 5 above by an independen pyo essionai enyi eer registered m the State o Alaska' The DHEP doesyt is as a courtesytorpurchasersof,homes and;.thea, eendinng institutions in order to satisfy certain federal andstate requirements Employees of DHEP do not conduct inspections o anaCita ata before a'certificate is idssueThe Municipality of•Anchorage is not responsible for errors or omissioi s in' the professional engineer's work ;; r � yCx F vi i i '.! ". ( n 'it A. WELL DATA ("Th M..;MC(PAUTY (Jr ANeUVA43BALITY OF ANCHORAGE (MOA) DEPT. OF HEALj[,I�'�', IH AUTHORITY APPROVALHAA ENVIRONMENTAL PROl'frakm APPROVAL(HAA) CHECKLIST - FEBRUARY 1984 G 2d �, MAY 91987 264-4720 F7 Legal Description: LoT�,f3�pck RECEIVED NIOr+hwooctS ,-?has e. fl ,A Well Classification cam 1+9 „ Well Log Present (Y/N) Date Completed Yield 77s-4/ ,f/A✓ J c 3 If A, 0, C, D.E.C. Approved ON) (Seel a1flled Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer CleanouVManhole To Nearest Sewer Service Line on Lot Water Sample Collected by • Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA • Date Installed 19$2 Size 1000 gal No. of Compartments 2� Standpipes (Y/N) 1 Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 51 8'7 '.--- Pumping/Maintenance Contract on File (Y/N) N/A ; for N/A Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line t Zoo' 58' To Water Main/Service Line f k To Stream, Pond, Lake, or Major Drainage To Building Foundation To Disposal Field 10' 30 / (4 r m re for+) Course N Comments Sate/7,7 '4 r•-4 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2(00 O/( Date Installed C182 - Width 82. Width of Field 38'4 Square Feet of Absorption Area Depression over Field (Y/N) _ Results of Last Adequacy Test Type of System Design "Bed Length of Field L0 / ✓ Depth of Field 31 T 0. Gravel Bed Thickness 1520 � 4^,. ---- Separation Distance from Absorption Field: To Water -Supply Well _ To Building Foundation OcY 44 Co it - Standpipes Present (Y/N) Date of Last Adequacy Test /gam_ -Tnt( 3 bed r-oorr l a, oy r To Property Line It I�1 Lot NtA On Adjoining Lots To Water Main/Service Line 'I- ) ' To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Existing or Abandoned System on +30 To Cutbank (if present) NIA N /A — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have ecl d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 517'7 &nl Company MOA No. Receipt No wa/ OOc3/ Date of Payment 5-7-2 2 ' 7 Amount: $ Page 2 of 2 72-026 (11/84) eN!'ttARibtCMEPkR€ ITEM SIGN MA? 2 9'r907 RECEIVED t*/ CRF A,: ��• Baa soeaetie e" Ato go CO Engltleef a, 85? 141t f+a��{{ =rT ®p 4TI'i g;-( « 9 e •ee•ee•e • a• 440 .1.70$ Yaaoea ••e•••e•e••*. e•e ,12 ® 4' Louis A. Sutura : ti s ® CE -6736 •: w, �' F 9•••• e•m y� ��4J p�0FESS19�A" SEM la&SM DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: May 28, 1987 PWS I.D.# 213001 To Whom it May Concern: STEVE COWPER, GOVERNOR v Telephone: (907) Address: 274-2533 According to records on file in this office the CIIUGIAK UTILITIES Water Regulations Water System is in compliance with the State Drinking Sincerely, Steven UY/Eng, PE District Engineer MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 0g-7- Aga Application Date/3/ef 1. GENERAL INFORMATION (a) Legal Description (includelot block, subdivision, section, township, range) q/ -r L --F Location (address or directions) (b) Applicant Name - Business Telephone: Home Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other 0 (explain); (d) Lending Institution Telephone Address (e) Real Estate Company nd Agent �� /4p,J "�/f� f�tJ�tFt����u &""?.?-t-e_e_J Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING 17034 Ragla Rtvar Loop Road No. 204 Paola River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms t 3. WATER SUPPLY Individual Well 0 Community ❑ PublicM Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public 0 Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION t my ation of s As Approval seal shoaffixed andw of tersupplldaation date shown below, I verify nd/orwastewaterrdisposalsystemi safe,funt do alandadequate for the Authority number bedrooms thattheype of water supply investigation and inspection, the on-site water supply and/or for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of m is nrcoe fiplia and from my 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 Address Date Z'- Si A'> 17034 Eagle River Loop Road No. 204 Telephone /LL 7 z> �u L N.Lj JuY rs /, E3-- 6. DHEP APPROVAL Date bedrooms by 1 Approved for -Approved fid... Conditional 94i -2-f7 s ova Nf-rR..c 5v57a•A-1 C i34s volYr"c_ 7)41•41A Terms of Conditional Approval 1, G -i Sy 71101 1'v' ~fa GDrn/J//e tZC WfJ? aar,`2. Afilk deep CAUTION nmental ion ) issues Approval ovat ce Muncipality t Anchorage solely uponnthetof Health representations g venin paragraph 5 above by anindependentlth professional mes engineer registered in ba State of their lending engineer s in orde to satisfy certain lfederal and state requirements. Employees of DHEP do not conductinspections or institutions in 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. Page 2 of 2 72-025 (11/84) OF P`' a UNICIPALITY OF ANCHORAGE (MOr.) vOS HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L17 /'Jc7tT/- l.Jm,/a p--)14RSis /L A. WELL DATA Well Classification A If A, B, C, D.E.C. Approved (Y/N) �icS Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Z f ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ? ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sam Test Results Comments 1 \N e..J C:.C>l ✓ B. SEPTIC/HOLDING TANK DATA Date Installed I I Size /4,04:1 No. of Compartments z Standpipes (GV) Air -tight Caps 1' N) Foundation Cleanout (Y/a Depression over Tank (Y/62 Date Last Pumped 7/ AI' (A / Holding Tank High -Water Alarm (Y/N) IJ/A Temporary Holding Tank Permit (Y/N) A//.4 Pumping/Maintenance Contract on File (Y/N) �lA ;for Separation Distances from Septic/Holding Tank: To Water -Supply Well a ex" 1 To Building Foundation To Property Line O � To Disposal Field To Water Main/Service Line /6/1 - Course Comments )),I S 1) FP 1C-1 &20-0,J Jo' To Stream, Pond, Lake, or Major Drainage Lou \iJJ rFa C> Or h,J.Sr, 4477 A1/4.1 •••••••••••••••^".•R Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y6 Results of Last Adequacy Test Separation Distance from Absorption Field: I Well _ z 00/4 To Water -Supp y To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 3 =(o12/_ Type of System Design✓G� Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ON) Date of Last Adequacy Test D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for --- Electrical Codes (Y/N) Comments To Property Line To Existing or Abandoned System on D/f ; On Adjoining Lots To Cutbank (if present) — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I cer f t d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ � ��11�f�ifid� � Sig 4103 Date 2 -- iz � Co Eaa��Rivar, Alaska 99571 MOA No. Sc --4 Receipt No. 0 0/ 0 0 6 )l_ ilk Date of Payment , �U Amount: $ Page 2 of 2 72-026 (11/84) A. ;£kwle.R *.6 IVa, !447. ." '• SEM Or MEM DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: FEBRUARY 3, 1987 PWS r.n.# 213001 STEVE COWPER, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the CHUGIAK UTILITIES (NORTHWOODS S/D) Water System is in compliance with the State Drinking Water Regulations Sincerely, MICHAEL P. LEWIS ENVIRONMENTAL ENGINEER