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Home My WebLink AboutNORTH WOODS UNIT 4 BLK 16 LT 23Northwood Block ! 6 Lot 23 #051-064-59 '" Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'UJ ¢~7 OT''f ~- PID Number: oSl Name: "J"P,o*l~.~. ~o. ~: L~ ~ Wastewater System: ~ New ~ Upgrade Address: ~5~o ~ ~,~ ~H,, ~ ~1~o~ ABSORPTION FIELD Phone: ~' ~O~ No. of~drooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION ~o,,,~i,~: O' ~ GPD/Sq. Ft. Tota[Depthfr~riginalgrade: LOt: 25 Block: j~ ~OK~ J Subdiv~i~n:~oo~ ~ ~ Depth to pipe boaom~lfrom original grade: Ft.Gravel depth ~eath pipe Ft. Township: -- J. n.e: -- Isec.,o.: _ ,, Fill added above original grade:o'' ' Gravellength: ~5 Ft. Ft. WELL:D New ~ Upgrade Gravel width: ~ t Number of lines: Distance ~een lines: Ft. J ~ Ft. Classif~ion (Private, A,B,C): Total Depth: ~ ~ Total absorption area~ Pipe material: Driller: ~ Drilled: Static Water Level: Installer: Date installed: Yield:/~GPM ~1 Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~ s~pt~c ~ Ho~i,g ~ S.T.E.P. TO Septic Abso~tion Lift Holding Pubfic/Pdvate Manufacturer: ; Capacity iR gallons: From L : Tank Field Station Tank Sewer Lin~ ~~ ~ ~ ~ lOC O Wel~ ~OOl+ ~01~ ~ ~ ~ I~ Material: ~ Number of~Compa~ments: Sudace .Water J001+ ioo~ -- -- ~ LIFT STATION d Lot i~ ~ ~ Size in gallons: Manufa~urer: Line ~O I~ I~ Foundation ~ I ~ I~ -- ~ ~ "Pump on" level ~t: ~: I High water alarm at: Cu~ainDrai~ ~ ~.lJo~ ., -- Pu~Electricallns~ctionspefformedby: Remarks: ~ ~,,~ c~ ~,,,* y BENCH MARK Location and Description: I A~um~ Elevation: /0o. o ~t, InspeCtiOns pedormed bY:s== =~,S;NSS,iN, Dates: 1st '-'1'", 1Z034EagleEiverLeopEead, Ne.~ 2nd. fi-II-W3 ~' '~ .......... , ~-t ROBERT C. COWAN ~,~ Depadment'of Health and Human Se~ices approval ~,'~ ..'~' Reviewed and approved by: Date: ['~ '~ 't~' 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970295 PAGE 2 OF 2 M unic ip. o,l,i-I: oF Ar~chorc~Qe DEPARTMENT OF HEA~THAND HUMAN SFRV~CES ENVIRONMENTAL SERVICES DIVOSION P.E]. Box 19GG50 e~Anchor~ge, A[msk~ 99519-66~0 · Te[eohone: 343-4744 ON-S~TE WASTEWATER VOSPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 25, BLOCK 16, NORTH WOODS S/D UNIT IV P.LD. NO. 051-064-59 IST1 I 35.0' I 23.5' ST2 35.0' $0.0' DBL1 35.5' 52.5' DBL2 55.5' 55.5' C01 / 74.o' 1 66.5' I MT1 70,5' 65,5' IC02 I 29.5' I 73.0' I NEW NEW 1000 (;AL. SEPTIC TAN NEW 5 BDRM HOUSE SCALE 1" = 40' UN£ (/~PROX LOC.) 80X ST1 ST2 NEW 1000 GAL SEPTIC TANK /~FINAL /--CO1 = 97.9' MT1 CO1 /C02 97.9' MT2 C02// GRADE ~ CO1 = 94.4' ~ CO2 MT1 = 89.9',/ {IT1 90.2 --/ NO WATER FOUND 81.9' B.0.H. ROBERT C. COWAN, RE. ROBERT^. SHAFER, RE. CIVIL ENGINEERS HEALTH AUTHORITY APPROVALS SEWER S WATER MAIN EXTENSfON~ ,SEWER&WATER INSPECTION ENGINEERING STUDIES ANOREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE W/L~l EWATER DISPOSAL S'/~TEM DESIGN Date: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 694-297g FAX (907) 694-12 RECEIVED OCT 2 7 1997 MUnicipaliTy ot Anchorage - Dept Health & Human Services The septic inspections for the referenced property were performed on ~--~,-e~ and ~-[~-q ~. Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the ~,4~1 ,?£~,~f to be completed, v ~ If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP ~' SUITE 204 , EAGLE RIVER. ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970295 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:THOM_AS CO. / LARRY THOMAS OWNER ADDRESS:8510 SOLAR DRIVE ANCHORAGE, AK 99507 DATE ISSUED: 9/05/97 EXPIRATION DATE: 9/05/98 PARCEL ID:05106459 LEGAL DESCRIPTION: NORTHWOODS IV BLOCK 16 LOT 23 LOT SIZE: 29075 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) A_ND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SA-ME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ~~- DATE: ~ / ~ / ~ 7 ISSUED BY: /~~ ~' ~~ DATE: cf.7 I i ROBERT C. COWAN, P.E. August 26, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE W,~,STEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 'REFERENCE: Lot 23, Block 16, North Woods Subdivision Unit No. 4 Request you issue a permit to install a septic system to serve the proposed four bedroom house on the referenced property. Test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. The monitoring robes within the test holes have been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. This property is served by a community well. We do not anticip~e any adverse effects on neighboring wells, septic systems or drainage pa~tems by the installation of the proposed sep[ic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. acc/rog AU6 2 7 1997 Enclosure MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION RECEIVED 17034 NORTH EAGLE RIVER LOOP "SUITE 204 · EAGLE RIVER, ALASKA 99577 40' SITE-PLAN o~Oo m~z c~o°m 0 0 0 C) F] FI I I I I I I I I =~-s~ I I I I~ I I _ LJ LJ ~ PROPOSED DRIVEWAY DESIGN I 10' UTILITY EASEMENT PERFORMED FOR: LEGAL DESCRIPTION: L~.~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST _ DATE PERPOR ; /'~//'~ ~,.OO~9.,C Township, Range, Section: SLOPE SITE PLAN I 2 3 4 5 6 7 8 9 10- 11 12 13 14 15 16 17 18 19 2O COMMENTS ENCOUNTERED? . IF YES, AT WHAT DEPTH? Depth t0 Water Monitoring? I S Dale: Reading Date Gross Net Depth to Net Time Time Water Drop I O-t~-'l~ d/ ~ ~ '~ '-z"., '7 ,~,,~. ~; ~,,, PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~>' ~' FT AND ~' ~ FT s & s PERFORMED BY: i~G~4 E~. ~;,.r ~.~p ~gad ~. i~41'/~f-'~/~'/'~'~-'"-~ CERTIFY THA~THIS TEST WAS PERFORMED IN ACCORDANCE WI'[~,~ ~E ~I~L~,L GUIDELINES IN EFFECT ON THIS DATE. DATE: ~)~/~ /~' ~ 72-008 (Rev. 4/85) FOR: DATE PERFORM[ ~;' LEGAL OESCRIPTION:~Z~ ~/~ ~¢~g~ ~ ~ownship, Range, Section: ' 4 5 6- 7 8 9 10 11 12 13- 14 15 16 17 18 19, r 20 - COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN I / WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT j O DEPTH? p Da,l, to W,tor Monitoring?'~'1 ~! Dale: 7 Reading Date Gross Net ~ Depth to Net Time Time ~ Water Drop ~ 7 ~,~. 7~A'' I~" PERCOLATION RATE ~:) (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '-~ FT AND I.~ FT PERFORMED BY: S & $ ENGINEERING THAT .THIS .reST PERFORMED IN 17034 Eagle River L~p Read No. ~ I UIDELINES IN ACCORDANCE WITH ~ ~~ ~ EFFECT ON THIS DATE. DATE: 72-~8 (Rev. 4/85) ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 23, Block 16, North Woods Subdivision Unit No. 4 August 26, 1997 GENERAL: The scope of this project includes the installation of a 1250 gallon septic tank and m,o five foot wide drainfield$-t0 serve the proposed four bedroom residence for the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed t?om soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. o Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 23, Block 16, North Woods Subdivision Unit No. 4 August 26, 1997 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet fi.om the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. fi.om the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away fi.om the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill: Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches'above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 23, Block 16, North Woods Subdivision Unit No. 4 August 26, 1997 The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill, All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the/e200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill: 3. The final inspection is to occur upon final grading of the property. Page Four Lot 23, Btoek 16, North Woods Subdivision Unit No. 4 August 26, 1997 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these spec'rfications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER Municipality of Anchorage • t• On-Site Water and Wastewater Program o t (907) 343-7904 zA CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel 1.0. 051-064-59 Expiration Date: I —/ 7-r 9 1. GENERAL INFORMATION Complete legal.description North Woods Unit 4 Block 16 Lot 23 Location (site address) 21546 Snowflower Loop Current Property owner(s) Douglas Day phone 854-8625 Mailing address Same Real Estate Agent Temple Day phone 854-8625 2. TYPE OF DWELLING: 5 6 7 8 9 70 u >> ® Single Family (w/wo ADU) tiI !. ' ft ‘6,i:‘6,i:❑ Duplex 'x - • ❑ Multiple Dwellings (Single Family and/or Duplex) Q OCT 0 9 2018 a. z t c ti 3. NUMBER OF BEDROOMS: 3 <<°I 6 i? LO 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: /0722//61 COSA to be released to the engineer,unle otherwise requested by the engineer. COSA Fee $ SZ-01) Date: Date of Payment L 0611 (2013 Date of Payment Receipt Number 0 l5 3O Receipt Number COSA# OSG tg Op O 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 10/9/2017 • <• ':. Lt s- b • 6. DSD SIGNATURE ° Q �� --T.•9•C4 f System #1 Approved for 3 bedrooms. Sto.,,m W. Eng w 47 P `'736 ' o System #2 Approved for bedrooms. . lo7g./4�► (,p Disapproved. J Conditional approval for bedrooms, with the following stipulations: • WqT-SITE ) WASrEWANATFpk m �Qo PROGRAM o. 4O • • .SEl 1VtC��' By: ` tM � � Original Certificate Date: l O r2Z11F 6 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 Septic System Advisory Arsenic Advisory Well Flow Advisory Other To.i Os. r,' orr COSA blue sheet 9-1-12.doc 1 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: gar t4 ( 1o0�.r (% i ? 4 8/6 L Z.? Parcel I D:Q 5/O6tf S A. WELL DATA Pv$L l C- Well type A If A, B, or C provide PWSID# 213001 Well Log (Y/N) Date completed Sanitary seal (YIN) 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 - • Tank Type/Material 6 CP71 c_/ cS7,r L Date installed 7/tA7 Tank size I oa gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout(Y/N) I Depression over tank(Y/N) High water alarm (Y/N) Date of pumping /c3(/7! ' a Pumper 'Jr v C. ABSORPTION FIELD DATA Date installed 7//Z/t7 Soil rating (g.p.d./ft2 or ft2/bdrm) Q• ". System type J GA<11.E Length 75 ft. Width .S ft. Gravel below pipe i71 ft. Total depth 1 ft. Eff. absorption area 7565 ft2 Monitoring tube / Depression over field Date of adequacy test /07/f/(4 Results (Pass/Fail) i) For f bedrooms Fluid depth in absorption field before test ,' in. Water added 4sa gal. New depth /Z in. Elapsed Time: 3O min. Final fluid depth in. Absorption rate >= Zitt5-O g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) U/t//C- If yes, give date D. LIFT STATION NA Date installed Size in gallons Manhole/Access (YIN) "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: ,V'.4 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: I i Building foundation 5 -f' Property line /0 f Absorption field S /f ( Water main 0 f Water service line /0 .7- Surface water /G0 !'r' Wells on adjacent lots ZOO '4- ABSORPTION FIELD ON LOT TO: Property line /0 /IL Building foundation /0 7- Water main /0 •'f Water Service line /l/ Surface water ADD /1' Driveway, parking/vehicle storage IL, 7- Curtain Curtain drain 0A//e- Wells on adjacent lots 200/1- F. COMMENTS G. ENGINEER'S CERTIFICATION / 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. Engineer's Printed Name 6-77---5(.16- C Date /W(f7i t , 60/7/ COSA yellow sheet_2-6-15.doc MU ,.,' 8CIPALUTY OF ANC! * RAGE DEVELOPMENT SERVICES DEPARTMENT o €1,y,/.� d 907-343-7904 On-Site Water and Wastewater Section ani Fax: 343 7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC181540 Subdivision: North Woods Unit 4 Block:16, Lot: 23 The septic tank for this property is 21 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. o, , fix, ...•,..4,:,1-,,,,. t i T,� 7� v. 1, • st.`�•��L ¢ 1 ., •• t.~ { � > ' '.'.!Y` t+' a' � Y� ;,+'G_R' Y ;Y' .,,t ~i r.:..04-2'.) t: •':t �..fu `- r ''';:44.z.,>-:,', 4',r� 1Yk i k .4-f."41,,,,, 4 y - .s L' .,,...,..:,.„A.,...,t,,t .' .-t ✓✓�'.'Y ,,.g2r,f7 T-4;4,7_ A'i'r+' ."� , r r,. '.1,Y! 5,:-., • L‘...." �r 1.1 "t - .✓ ,00.'"a j., y N! ,:f, .�+. y? � ,f ' x ,.,•Try�Y' s.. 'W ,{ x.. x.. l�� _r r ryK F f 'S ..' ..ham 37 yr ,. .2, , 4..- jc ..5 sV, �..:r F, s: "a c,' 7^'3 f +S r,.. ' k i ],� a - iV t.tF i?', i- '•1 r r i v.1 t. 1�t ♦ T rvw r^Y -1 i F! 3. . )14t. ft....-.„' ,,.."'"..---'''',,....1? r J, tet,],. ^' 4 1 A -''^`yl'i ' ~ • , `<�`.c, k t .is 1� ''. r sw S' ,rt 46'', 4 S,7 Ma h,a I k y'''' ' )4 6. faX ,• k-. ..4.;,;.$,vci4 , .,1, ., Y NT . ,... . r 'iLlrj + - 4, iYr—..,.�Wi5,'' .2c o ) 4j a i~ , j l� e z- ,�� "L4 {ak. .,.., :f:.,:;...,,,,„,.. .;-,-..--.1,•=1,.--,. ., ..� ,`s, ay 4.t • .. '0 • x.>.vs �. T "'r I.�, i4 ♦ y. „dN b .t. `V '`�' 'tea &;.i,'F ,''a 3 Yv. , y 1• k;,- � °1 , �?' Y'` -ce `i� y� ),. L.•`i. 't" 4 ,,'"''-''.-;'',':!'•-4t Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 A~chorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 051--064-59 Parcel I.D. 1; GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: Complete legal description {' NORTHWOOD SUBDMSION'~'4; LOT 23, BLOCK 16, Location (site addressordlrections) 21546 SNOWFLOWER LOOP * CHUGIAK~ AK 99567 Current Praperty owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SUSAN LANGSTON Day phone 564-6161 c,/o STACIE HERRING wi/ DYNAMIC PROPERTIES Day phone STACIE HERRING w/ DYNAMIC PROPERTIES Day phone 3111 "C" STREET * ANCHORAGE, AK 99503 727--7891 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class '^' Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties 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. Note:Alaska Water and Wastewater Consu/tants, Inc. sha/I be paid ~"cT:~---'--.~-.~' at, or pdor I. to closing for the engineering services provided. I 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I ve#fy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(am) 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 fi/es and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTE'WATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SUFI'E 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JE~-I-~EY A. GAENESS, P.E. Date 337-6179 Englneer's Comments: In conducting this evaluation, AWWC, thc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local coils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the eva/uator cf the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therafora not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any ra/iance upon or use of this report by any other person or party is not authorized, nor wi//it confer any legal #ght whatsoever. 5, DSD SIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other {/} Original Certificate Date: Municipality of Anchorage Development Services Department BuSing Safety Olvtslon On-Site Water & Wastewate; Program 4700 South Bragaw SL P.O, Box 196650 N'K:horage, AK 99519-6650 www.ct.anchorage.ek.us (go?) 343-zg04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: NORTHWOODS S,/D ~14; LOT 23, BLOCK 16, Pan:el ID: 051-064-59 A. WELL DATA Well type T'~:/~' ,T'Z If A, B, or C provide I:~NSID~ ~13oo~' ~ Date completed Sanitary i~_~.(~(~.~~lra$ pmpedy protected (Y/N) ~to ft. Casing height (above ground) in. FROM WI~LL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate __mg~. co onles/100 mi. '- . Collected Date of sample: ~ by: __ B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 9,/11-12,/97 Tank size 1000 gal. Number of Compartments 2 Cteanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping lO/J7 Pumper ~Aw, '?~.~ /OvM A~r''j'' ABSORPTION FIELD DATA Date installed e/11-12//97 SOil rating ~ ft;/bdrm) 0.6 Length 75 ft. Width 5 .lt. Total depth a.o +/- ft. Eft. abeorption ama 750 ft= Monitoring tube YES Date of adequacy test 2,/28,/2002 Results (Pass/Fall) PASS Fluid depth in absoq~tion field before test 21/lg in. Water added 690 gal. Elapsed Time: 140 min. Final fluid depth 22/20 in. Absorption rote >= Any mjuvenatio~ treatment (past 12 mo.) (Y/N & type) , NONE KNOWN System type TRENCH Gravel below pipe 4 ft. Depression over field, NO For 3 bedrooms New depth ZT/2¢in. 450+ g.p.d. If yea, give date - D. UFT STATION Date installed Size ~n gallons I~~ "Pump on" level at tn. "Pump o~ n. High water alarm level at .in. Datum Cyctes tested Meets alarm & circuit requirements?, E. SEPARATION DISTANCES COMMUNITY WATER BEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field. 5'+ Water main 10'+ Water service line 10'+ Surface water. 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ · Water main 10'+ Driveway, parkingNehicie storage 5'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal recoils that the above systems ere/n conformance with MOA HAA guidelines in effect on this date. Engineer's Prin~ed/Name Date JEFFREY A. GARNESS HAA Fee $ ~ Date of Payment ~.~_~Z- Receipt Number (~v. 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 ¢51 ECE)VED Parcel I.D. # 1. GENERAL INFORMATION Complete legal description ~7~ Z3,' ~¢/~/.~ 1~, / ,,~ ~,},¢0,¢~5 ~/'"Z:> :¢E z../Z Location (site address or directions) /L//-/'A,/ Property Owner "'-/"/~Ofyla.'5 ~¢D . Day phone Mailing address. '~' Agent Day phone A~ress Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- . lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 17034 Eagle River Loop Road No. 204 Address E~_ale River. Alaska ~95~7 ~. Engirieer's signature v'"~l;¢~'/J ~//, ~ Phone Date DHHS/~iGNATURE _.~ V/Approved for J~;~/" bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /,-'~~ C' '/~/-~v Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA ~21 Environmental Services Division 825 L Street, Room 502 · AnchorageS-Alaska 99501 ~ (907) 3~t3-4744 ] Legal Description: Lo'r A, WELL DATA .Welltype ~L-A~ "/~ IfA, B, or C; attach ADEC letter. ADEC water system number ~'/ Wires properlypro{ected (Y/N) FROM WELD LOG -AT INSPECTION Date of test Static water level Well production WATER SAM'PLE RESULTS: g.p.m. Coliform Nitrate ~' Other bacteria . Date (~f sample: Collected by: B. SEPTIC/HOLDING TANK DATA ' Date installed ~ ~- I'~ L(t'l Tank size I oo o . Number of Compartmer~t~ ~ ~ · 7_ .... C eanouts (:~D'N) Foundation cleanout {~N) Ye 5 : Depression (Y~) t~ High water alarm (Y~) f'J Date~)[ Pumping r ~ PUmper C. AI~S~RPTION FIELD DATA~:.~ E~ ir{~{alled ~- I?--q'l; Soil rating ~or ff~/bdrm) O.. (= System type V~iblt~~' ~ :. Gravel thickness below pipe Total depth Eff[~tive absorption area~ ~-~) I~ Date of adequacy M~)nitoring Tube present ((~TN) '/'e,~ Depression over field (Y/{~) ~ ~ For -~ bedrooms Fluid depth in absorption field before teSt (in.); ' Immediately after ~"~al, water added (in.): Fluid depth (ins) Minutes later: - Absorption rate = - - g,p.d. '(Y/N) - "' Peroxide treatment (past 12 months) : If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Manhole/Access (Y/NI High water alarm level C Size in gallons "Pump off':ievel at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO SePtic/holding tank on lot ~-oo - ~- On adjacent lots ~ Absorption field on lot Zoo ! -~ Public sewer main ~' Public sewer manhole/cleanout S~e Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO: I+ Foundation ~, Property ne ~,o ~ Absorption field ~E, '_.+ Water main/service line ~ + Surfacewater/drainage loc Wells on adjacent lots ~oo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property ne .. I ~ I +_ Building foundation Z-~ --. Water main/service line '+ 5' SurfaCe water )0 o Driveway, parking/vehicle storage area Curtain drain /,]o,J ~ ~ O~ ~ ~ . r Wells On adjacent lots ;~oo~, + F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections Eng neer's Name Date CE- 8801 HAA Fee ~ Date of J Receipt Number 72-026 (Rev. 3/96)* )ate of Payment