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Home My WebLink AboutNORTH WOODS UNIT 4 BLK 17 LT 4'Northwood Block 17 Lot 4 #051-064 53 �I.Gv VJ/VG/ I V� Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221209 PID Number: 051-064-53 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Barbara Eaton ABSORPTION FIELD p ❑ Wide Trench El Deep Trench El Bed El Mound Site Address 23535 Blue Skies Drive ❑ Other Phone 907-947-4187 Number of Bedrooms 4 Soil Rating Total depth from original grade Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision North Woods Unit 4 Block Lot 17 4 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well N/A N/A N/A N/A >25 TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 1530 Gal. Surface Water >100, N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1o, N/A N/A N/A LIFT STATION � Capacity Remarks Tank is insulated �turer Gal. Alarm location installed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield Precision General Contracting Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection �5c 7/6/22 dates: 2 nd Location and description aro m th Threshold of back sliding door 4 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 4,9— ..... ........ Septic System Benja"' Schiller �� 'Fc • CE Approved Date 71zq4z 12592 �t /�lF'�Fa,7/29/22 �P .��- PROFESSIONS® Note: this approval C14not include well permit requirements. l, �I.Gv VJ/VG/ I V� // // // // // // Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP221209 PID # 051-064-53 NORTH WOODS, UNIT 4 BLOCK 17 LOT 4 A B MH 52.5 SV 56.7 2CO 59.0 A B 26.0 31.8 37.0 FEET 0 50 100 SNOWFLOWER LOOP BLUE SKIES DRIVE15' T&E EASEMENT EXISTING ABSORPTION BED TO REMAIN IN SERVICE NEW 1530 GAL SEPTIC TANK w/ 20" MANWAY 4-BDRM HOMEPRESUMED WATER SERVICE LOCATION PLAN AS-BUILT MHSV 2CO 7/29/2022 PROFILE AS-BUILT (NO SCALE) 93.3 89.2 93.6MH SV1530-GAL SEPTIC TANK w/ 20" MANWAY 93.2 Benjamin Schiller CE 12592RE GISTEREDPROFE S S I O N A LENGINEER7/29/2022 PERMIT # OSP221209 PID # 051-064-53 NORTH WOODS, UNIT 4 BLOCK 17 LOT 4 2" INSULATION2COFCO97.5 SNOWFL OWER LOOP EAST 158.32 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ASBUILTSURVEY I" = 20' NO CORNERS SET THIS DATE Q000DO��O o�OF At��o 0 bac '49 TH 0� �D SHANE A. HOLT �a Q� LS 6914 r°fessiona� �� DOOoo�� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4 BLOCK 17 NORTHWOODS 4 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 8TH DAY OF JULY '2022 15487 FB 222-77 224-64 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmcre Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni-orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP221209 Work Type: SepticTank Upgrade Tax Code Number: 05106453000 Site Legal Address: NORTH WOODS UNIT 4 BLK 17 LT 4 G.1460 Site Mailing Address: 23535 BLUE SKIES DR, Chugiak Owner: EATON BARBARA S Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: merit _i G f, n j v t�L'l7al'tIt1C11T Lot Size in Sq Ft: Total Bedrooms: 6/28/2022 6/28/2023 22382 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 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 Veronica Pope GE 2022.06.28 Received By: 13:13:44 -08'00' Issued By: Date: / Date: 4 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-064-53 Property owner(s) Barbara Eaton Day phone 907-947-4187 Mailing address 22486 Columbia Lp, Eagle River, AK 99577 Site address 23535 Blue Skies Dr, Eagle River, AK 99567 Legal description (Sub'd., Block & Lot) North Woods Unit 4 B17 L4 Legal description (Township, Range & Section) Lot Size 22,382 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x Septic Tank R Upgrade RX(w/wo AD U) ❑ Holding Tank ❑ Renewal ❑ Duplex (D) Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5 Waiver Fees: Date of Payment: ��15 a 012 2 Date of Payment: Receipt Number: 06 3D Receipt Number: Permit No. 0S P- L 1 �2 0 Waiver No. Permit App_:;- :: _..:c June 14, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: North Woods Unit 4 B17 L4-23535 Blue Skies Dr. Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home and existing septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption field. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221209, Rebecca Carroll, 06/28/22 // // // // // // Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND NORTH WOODS, UNIT 4 BLOCK 17 LOT 4 FEET 0 50 100 ≥10' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM NO EXISTING WELLS - PROPERTIES ARE ON COMMUNITY WATER SYSTEM Jun 28, 2022 SNOWFLOWER LOOP BLUE SKIES DRIVEWOOD FENCE 15' T&E EASEMENT 380 385 390 395 400 EXISTING ABSORPTION BED TO REMAIN IN SERVICE DECOMMISSION EXISTING TANK PER U.P.C NEW 1250 GAL SEPTIC TANK W/20" MANWAY MAINTAIN 5' SEPARATION FROM ABSORPTION FIELD 3-BDRM HOMEPRESUMED WATER SERVICE LOCATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221209, Rebecca Carroll, 06/28/22 SNOWFL OWER LOOP EAST 158.32 THE INFORMATION HEREON /S FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS,` AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLA T, ARE NOT SHOWN HEREON (UNLESS INDICA TED) NOTE.- FENCELINES THA T MA YAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPER TY L INES OR POSI TION A DDI TIONA L IMPROVEMENTS ANY PA VING SHOWN HEREON MA Y BE APPROXIMA TE DUE TO EXCESS/ VE SNOW AND/OR ICE. i QoOF ooDO��O W' oo,`Q�. � ��7" 49 TH 7 oO` s SHANE A. HOLT �O Q�LS 6914 '-OfessionaX �"od i ��DOOoo�� ASBUILTSURVEY r" =20' NO CORNERS SET THIS DATE / HEREBY CERTIFY THA T / HA VE PERFORMED A SURVEY OF THE FOL L OWING DESCRIBED PROPERTY LOT 4 BLOCK 17 NORTHWOODS 4 ANCHORAGE RECORDING DIS TRIC T, ALASKA, AND THA T THE VISIBL E IMPRO VEMENTS SI TUA TED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED A T ANCHORAGE,ALASKA THIS 7TH DA Y OF JUNE .2022 15487 FS 222-77 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 223-8615 : 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 [] UPGRADE 'A'LING ADD ¥. OJ ,O--L ,. AY,. LOCATION >~_. ~ NO. OFBEDROOMS D [l~~~' ~ AbsorptionareaAt,~ ~ Liq. ~pacity in gallons I~ H~ADE Inside length Width No. of compartments ~ / ~ ~O : Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, O ~ ~ Man ufacturer = --~ Material Liquid capacity in gallons ----~ No. oflines VI Lengthofeachl~,_ Total lengthoflines.... Trench~idth ,~, '~ ~ DistancebetweenJi~es~, ~ Top of tile to fi[aJsh grade Material beneath tile Total effectiv a m Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well DISTANCE TO: Building foundation Nearest lot line ~ Class Depth Driller Distance to Jot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOl L TEST RATI~/. ~ ' 'NST~L.LER ' J ~~ REMARKS ' ' APPROVED DATE LEGAL DEF'FtF.".TMENT b HERLTH tgND ~N,,IRUt'~,dENTF-;L .~ ~,OTECTION ,"325 '"L"' ST~:EET., FINC:HORRGE., FIK 9950:1. ....... i, 8NCHORRGE ..-. ,: .4 ..-,.~ -~.. ~:,J*'- ~-~.~..2 ' EFIGLE R I VER F:'EF-:M I T NO. FtPPL I C,"tf"(T: 51':.'FIGL-iS CONSTR PI'"IONE: F:IDDRESS: PO BOM D CHUG I BK., ;=II'.':: 95¢567 LEGF:IL DESCRIPTION ..... SUBDIVISION: NORTPINOOD ~4 BLOCK: 21.7 LOT: 4 LOT SIZE 0 SQ. I:--T. TOP~NSHIP: ..... RFilqGE: .... SECTION: .- MFI;'.':;IMUM NUMBER CFr BEDROOMS = 3: SOIL. RI:ITING = 2Ct0 ::Lg'? 21.3E1 (SC!. FT ,"'BR) LISTED BELO~4 FIRE THE OPTIONS I::I',,,'t::IILI]E,'LE: TO '¢OU IN DESIGI'.,iING ","OUR SEPTIC SVSTEM. CHOOSE THE OPTION THFIT BEST FITS '¢OUR SITE. -r ,.~: ..~ ~,-~ c: ~ .,.,~ ii_-:, E I-4IDTN = 2.". 5 P"T. LENGTH = .l.00. 0 FT. NOTE ' >75 FT. REQUIRES Tt.,.IO TRENCHES TOTFIL DEPTN = ~s. 0 FT. NOTE , .... REQUIRES INSULFiT'IOI'.~ GRFtVEL DEPTH = Z.'.. C~ FT. NOTE ' .... Mt::t:.r' REQUIRE LIFT STFITIOIq GRt-'iVEL VOLUME = 3;-2 4 CU. '¢D5. TF. INI,:.'..~: EIE:,"SIZEE:.', =E..==.::: "-- ::IE ~ ~'..4% OAF1 ..... 0 GFIL. L. Ot'.,tS .: TI.,.IC, F'- i'tF: I ...... F,..T ,:tq,- -r. TFiI'4K')~~~ .~ I.,.I I DTFI = .':,.~, ~.~. 0 FT. LENGTH = 44. ~ Fl-. TOTFtL. DEPTH = 5. 0 FT. GRF1VEL DEPTH = 0. 5 F'T. GRFIVEL VOLUME = TFtNI< SIZE = % 00L-.~. ;.Si GFILLONS (TWO COMPFtRTMENT TFfNK) P.IIDTN = 5. 0 FT. LENGTH = ,S,',=:k ,'._-i FT ! NOTE ~ ::.'?5 F'I" RE6IUIRES TI-,40TRENCHES TOTFtL DEPTH = 6. 0 F'T. GRRVEL. DEPTH = 2. 0 Ff'. GRRVEL VOLUME = 30. O CU. "/DS. TRNI< SIZE = %, 800. 0 GFILLONS (T!.,.IO COMt'-'i'-'IRTMENT TF:Itql.'::) I CERTIF'¢ TI-IRT: i. I FIM FI"-'IMILIFIR t.41TH THE REL.'lPJIREi':IEN'TS F'OR ON--SITE SEWERS RND WELLS RS SET FORTIi B"r' THE MUNICIPRLiT'.,' OF Iq,~;CI.-IORRGE RlqO THE STRTE OF RLRSI<R. I ~41LL If',I:Z';TFtL[_ THE S'./STEM IN i::ICCORDFINCE ~41TI..-t THE CODES RIqD I.tRV~ RECEIVED R COP'./ OF THE CODE L-;UMt'"II'-iR'./ RND DIFIGRRI'I FITTRCI.. !'1ENd'S !.4NICH IS PRRT OF THIS PERI'II T. 3. i UNDERSTRND THFIT THE ON-SITE £;E!.4ER S'.,.'STEM MFI'.r' REEJ. UIRE ENLFtRGEMENT IF Tt-iE ,' ......... ~-~.. I NF:[ I I[:,E t'l JF...E ~ "" BEDROOMS. PERMIT APPLICANT I.ll':rL"; THE RESPOiqSIBILIT'.F TO INFORM PERSONNEL DURING THE iNS]"FILLI-ITIOI'4 It'4SF'ECTIONS OF' Rht'/ P-!ELLS RD,~FICEhtT TO THI:5 'PROPERT'-r' THE NUMBER OF RESIDENCES TNRT THE 1.4ELL. t.4ILL SERVE. II=. R LIFT STFiTIOiq IS INSTRLLED, AN ELECTRICt::tL PERMIT FIND INSPECTION MUST i"3E ODTRINED. RS...BUiLTS CFINhICrT BE I--tF'F'ROVED ~4I'THOUT FIN ELECTRICRL INSPECTION REPORT. THE ELECTRICFiL WORK MUST BE DONE B'.¢ I'::f LICEi',ISED ELECTRICIRN. S t Gi'4ED: FIPPL ,. _.I-.'tN T .... . ....... : ..... IN.:,TF.'. i '~ MUNICIPALITY OF ANCHORAGE .~ Department:~.. Health and Environmenta3~rotection · ~ 825 - Street, >mchorage, AK. .~501 264-4720 Permit ~ ~:'~/~ ~'j * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT Applicant: a Location: ~OP~ ~(,%3 0~ ~ Legal Description: ~--d>'~' q ~k (? Type of Soil ~sorptiOn System Is: Mailing Address: ~ ~ ,'~0'~ ~, Phone Number: . '4 ~;Q, .~7 Size: Trench: Drainfield: ~ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) l~, ~>O~O~ The Required Size of the Soil A~sorption System Is: ' DEPTH ~ ~-_ LENGTH S~ ~_'~-GRAVEL DEPTH ~ WIDTH S-- ~*' The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * ~ REQUIRED SEPTIC(HOLDING) TANK SIZE = /00(3 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 co.unity 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 8 3 ~ ~ * I certify that: (i) 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. · iUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -PERCOLATION TEST SOILS LOG PERCOLATION TEST 6 7 8 9 10 11 12 13, 14 15 16 17 18 19 2O DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER t ENCOUNTERED7 ~0 0 P E IF YES~ AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop / t /// /o .~,,5~ ~ / ~ ~~ -'~/ ~ ~,~ ~.~ TEST RUN BETWEEN '{~ FT AND PERFORMED BY: ~r-ee~ mop CERTIFIED BY: DATE:~ �`\ / Ijjl Ijjl ''n�1 jl�' � (�,, �� /) Ijj �I �{/J r= �� fj��\\Ijjl (�,-(jI ��'�' /_� R�s �� LI U� V ll V LI �:J F )A �'^ IJ LI O W A ll VCM 0 Il � AG V Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-064-53 Expiration Date: 1. GENERAL INFORMATION Complete legal description North Woods Unit 4 Block 17 Lot 4 Location (site address) 23535 Blue Skies Drive Current property owner(s) Barbara Eaton Day phone (907) 947-4187 Mailing address Real estate agent 22486 Columbia Loop, Eagle River, AK 99577 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑® Water Storage ❑ Holding Tank ❑ Community Well ❑o Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $_ 0 Waiver Fee $ Date of Payment t7 1JW, 2 Date of Payment Receipt Number 0 R i 7 N Receipt Number COSA # 0 S C 2 1 3ED Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/27/22 VL I ,or TH 49 6. DSD SIGNATURE System #1 A / .� y Approved for �'(_ bedrooms �� '. BeBenjarrij�ge5chiller �; CE 12592 System #2 Approved for bedrooms �srF-.07/27/22 �`��c,?�/ Disapproved %ROFESSION tt�a"��4 Conditional approval for bedrooms, with the following stipulations: `l`l�lll(((((rrrrrrr( �o /r ern m 1 /J�JI�T `sFRV I C,ES�� By:Original Certificate Date: %1Z q 2 Z The Municipality of Anchorag evelopment Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in pa graph 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 COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft in. Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 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 of Sample Comments __________________________________________________________________________________ C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: B.TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping 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 Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet COSA Checklist yellow sheet E.SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft 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 From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ 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 septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft 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 If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft F.ENGINEER’S COMMENTS G.ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Municipality of Anchorage Development Sen/lees Department Budding Safety Division On-Site Water and Wastewater Pro. gram 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 SI'NG E Parcel I.D. 1..GENERAL 'INFORMATION Complete leg~ldescription Lot 4, Location (site addre~ or directions) Expiration Date: Block 17, Northwoods S/D #4' 23535 blue Skies Drive Current Property owner(s) -M~iling ~ddress ' Lending agency Kathy Griffiths Dayphone 688-9563 23535 Blue Skies Drive~'" ChuF, iak,. AK 99567~' Day phone ' "' · Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 Fortune/Connie Hettinga 10928 Eagle River road, Dayphone 696-7653 EaRle River,'AK 99577 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well [] [] [] [] 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 AJaska. Cedificales 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 sewed 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, st~ows '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. $ & $ ENGINEERING Name of Firm 17034 EagTe River Loop Road No. 204 Eagle K~Yer, Aiasl(a ~'¥5~/ Address Engineer's Printed Name Robert C. Cowan, P.E. 5. DSD SIGNATURE .. ~ ' Appr?ved for J'7L bedrooms. Disapproved. Conditional approval for Phone bedrooms, with the following stipulations:. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~¢, '- /~'~ ' ¢ ! Municipality of Anchorage Development Services Department Building Safety Division On..~lte Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Andlomge, AK 99519-6650 wy~v.ci.anchorage, ak.us (S07) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ~.~' If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanita~ seal (Y/N) JWiras pmpedy protected (Y/N) Total depth f. Cased Io ft. J Casing height (above ground) FROM WELL L~.~'''''~ AT INSPECTION Date of test Static water level ft. ft. Well production / g.p.m, g.p.m. WATER S/~PLE~TS: Coliform .~_colonies/100 mi. Nitrate ' mgJI. Other bacteria __ Data of s~ple: . Collected by:. * · Legal Desc~iption: ~ Parcel ID: in. colonies/100 mi. B. SEPTIC/HOLDING TANK D_ATA/ Tank Type/Material ~ Date installed ,/.~. Foundafioncieanoul(~N,:~ Deprassionovertank(y,~ /V'C) High.teralarm(y/N, C. ABSORPTION FIELD DATA Date Instailed Z..~ ~/_~_. Soil rating (g.p.dJlt2 or~ ~)J~ System type ~ Length ~'~ ft. Width ,~'~ ft. .,~ravel below pipe ~)- ~'' ft. Total depth ~ ft. Eft. absoq:)tion area ~ Monitoring tube ~'~'~ Depression over field Date of adequacy tast 4~_~ Results (Pass/Fail) ?~_~ For ._~ bedrooms Fluid depth in absorption field before test {~ in. Water add'gel. New depth ~ in. Elapsed Time: ~ min. Final fluid depth / in. Absorption rate >= ~/~ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)/~/~W'Lg.-~.//'~/~' If yes, give date. Date of pumping ~ Pumper ~-~ ~¢ Date installed e in gallons 'Pump on" level atp,~in. 'Pump off' level at Datum / Cycles tested E. SEPARATI& DISTANCES in. Manhole/Access (Y/N) High water aterm level at Meets alarm & circuit requirements? · On adjacent lots On adjacent lots Public sewer manhole/demm~t SEPARATION DISTANCES FROM WEU~ ON LOT TO: Septic tenk/fift station on lot Absorption field on lot // Public sewer main / Sewer/septic service I~e Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,,;.~'- Prope~o/line . Water main /~ F-- Water service line Wells on adjacent lots "~/"~' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: .Ii Properly line Water Service line /' O -~- Curtain drain ,/~A~_. F. COMMENTS Building foundation su ce wa , /c p Wells on adjacent lots Absorption field ~" Surface water Water main Driveway, pad.g/vehicle storage G/~l/o t /,., ! ~,.'..,, ., ** r. -a; RO~f, RT C* ( "~,. /:.,',.,~,' Waiver Fee $ Date of Payment Receipt Number HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) I certify that I have determined through field inspections and review of Municipal records that the above systern~ are in conformance wfth MOA HAA guidelines in effect on this date. Engineer's Printed Name Date in. G, ENGINEER'S CERTIFICATION 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 1. GENERAL INFORMATION Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name L~:F~- _~,~._~.~.~._ _ Telephone: Home Business Applicant Address ? c2_ ,¢o .~ '~'~ 2, ~ ~- ~' /~-'-'~ (c) Applicant is (check one): L.ending Institution []; Owner/builder []; Buyer []; Other~.. (explain); (d) Lending Institution ' Address Telephone (e) Real Estate Company and Agent Address ,O O ~ / Telephone (f) ~%~'~HAA to the following address: 8RB ~8~ TYPE OF RESIDENCE Single-Famity~ Multi-Family[] Number of Bedrooms ~ Other WATER SUPPLY ' Individual Well [] Community [] Public/~[- Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND iNFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approvat 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 ~, ~' ~ '~'~mr'=~.%~=~ Telephone Address Date CAUTION The Muncipality of Anchorage Department of Health and EnvirOnmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the ~tate of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHO?-~'~E DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUL 2 2 ,RECEIVED WELL DATA MUN[ClPAMTY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification T-u~ t...~ ~.~ Well Log Present IY/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring m Conduit (Y/N) Separation Distances from Well: TO Septic/Holding Tank on Lot If~) B, C, D.E.C; Approved~.~,h~ Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorpbon Field on Lot ,~E3 "'t""'"~; 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 Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed [--'~-~ Size J~'""~"~' No. of Compartments Standpipes (~,N?- Air-tight Caps tl~.~ Foundation Cleanout ~/,N-) Depression over Tank.('YT~ Date Last Pum ped ~- Pumping/Maintenance Contract an File (Y/N) ~4, [~.. : for Holding Tank High-Water Alarm (Y/N) I~ J.,k.- Temporary Holding Tank Permit {Y/N) Separation Distances from Septic/Holding Tank:_. To Water-Supply Well ~...o<:> 1 ,,e" ,~ j ~-.! To Property Line ~,~ ~" '"~- -' To Water Main/Service Line ~'~-~ ' ~ Course To Building Foundation To Disposal Field To Stream Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026111/84] C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area I ~--.4-~ Depression over Field ¢f/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ~'~'~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field /-~ ~--~ ~ ~ .... Gravel Bed Thickness Stanc pipes Present Date of Last Adequacy Tes! To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (}~.jp~esent) D. LIFT STATION Date Installeo Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments 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 ch ~ec!~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~,~.e..~ ~I~EI~RING¢ Date -2/Zo //~-~¢~''' -- ~ -8RB 196X ' ' , / Com~;~l~'~iVE~ A~8~ ~9~ MOA No. R .~--~ ~ Receipt NO. Date of Payment Amount: $ Page 2 of 2 72-o26 (1/84) .DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 Bi~L SHEFFIELD, GOVERNOR Telephone: Address: 274-2533 To Whom it May Concern: Accordin~ to records on file in this office the _ ~Water System is in compliance with the State Drinking Water Regulations Sincerely, APPLICANT FILLS gU UPPER HAL 'ONLY -Property'Own~r Phone ,- ., ~ ' T & D Construction Mailing Address BOX 252Z~ P~lm~_'r'. Afl Zip Code Buyer ~0~ Address Zip Code Lending Institution ~as~ ~ac~c ~LSa~e Coapa~ Phone Address P.O. BOX 420 ~c~gage, ~ Zip Code 99510 276--3110 Realty Co. & A~nt William Schlegel - Totem Real~y, Inc. Phone Address 73A ~ 1 ~h a,,~..,~ a..~ ..... Ay Zip Code 99510 272-0571 Legal Description LO~, 4, Block 17 No~hwoods IV Street Locati~ Blue Skies Drive Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual ~~~ ~. A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community ~ ~ For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~983 ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: TH~ INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ~'=" ~,,I JN:C'.PAL~TY OF A..NCHOP~.GE - ENVIRONMENTAL PROTECTION c lc RECEIVED (I~) APPROVED BEDROOM8 *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3182) ALASKA 611uIROIqm F1TAL COFITROL SI RblCI S, InC. ~n§in¢¢rinq 8 ~nuironrncntal Studies January 13, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson Dear Robbie: On January 13, 1983 our company inspected the sewer system located on Lot 4, Block 17, Northwoods Subdivision Phase. Ail the standpipes were above ground and capped. The well is located over 200' from the system. The lot is served by a Public well and is approved by Alaska Department of Environmental Protection. Sincerely, Laura Ogar Environmental Health Specialist Approved by: 1200 LUcst 33r¢1/~ucnu¢, Suite [~ ·/tr~chord§¢, J~bsk, 99503 · {907) 276-1361