HomeMy WebLinkAboutWOODRIDGE BLK 1 LT 4Woodridge Block 1 Lot 4 #020-093-05 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.oralonsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description wo ©o R p - J — Property Owner Name & Address: Dou5 C4b5Ec l /&o1 V)eyo tjoc rlt7choea6E 4K Pump Installation Date: 1 _ ani iY Pump Intake Depth Below Top of Well Casing: iSO feet Pump Manufacturer's Name: )q (ficD"aL"1 Pump Model: 11,9 Fi )',1 -j0 Pump Size 1l� hp Pitless Adapter Burial Depth: !D feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer:' Well Disinfected Upon Completion? 16es❑ No Method of Disinfection: C j GCI vl j5 J�E 1 Z ET� Comments: Pump Installer Name: 1jY9ChogAgi 6sf1� Fjm Attention: The pump installer shall provide a pump installati'Sn log to the DSD within 30 days of pump installation. Municipality of Anchorage •:_I`. ./ ;, V Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page I of 2 www.ct.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S w 01 O if 0 o PID Number. O 20 —O 9 3 —OS-- Neme Pet ulo/ ecrnkr — Wastewater System: ❑ New ❑ Upgrade Atl ns 166o / v,f o A&,eA.,N AP1011 99ss1U- ABSORPTION FIELD Ptah. lid destrooms 2 SO — 6Y z.S 3 D Deep Tran D shallow Voich D Sol D Marta D Dew LEGAL DESCRIPTION Sal R"'"0 Toy Dpm eon urlprol arta BlorA La SuDOin.on 'f Woua(et( GPDIFI� Dpm to pM aMOm kom alpw areM F,, GravN Oepm D«aNn pipe To vip Ra xis sea F,. FA aeae0 aoowe org" D'a0e FI 131" Lergm FI. Fl. Well: E)UjT ❑ New ❑ Upgrade Grov "n Nunaarullnae oatara•o.l.a•nln.e CaseA�uuan (Pmaa. A a Cl Toa Dpm Cesea to Ft. Tolal soph. arN F, P" MNMaI FI. FI Fr Asr" D -3o 3 Dra« Doeihula0 Sma WN« Lm,ei LalNw Dns Mlalee FL ATt- No~ car✓Fea I d12-1 /0 7 Ya Pump so a Nr cag H q;" ADor. GdeW DPM F,. FL TANK SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding lublwjPnvate L�ty From Tank Field Station Tank Sewer Lina /+n G1TC rG Tank IDoe Gr WN I coo a M.I«w SfY�/ Narew of Campenmems 2 safe' •WN« 7100' LIFT STATION LLotLns r2a , se k aa« I Gal FarWatan ex Pare On a.N N •Pump off 10 N at Hgn.alw Alam et � n n Cunan Draa Pump Mak• 6 MOON Elecom M pe , pa"d by Remarks Old Septic I&OU BENCH MARK Loratlm «n Desval�an </ too It>< /uar �uS Of wStf e iA.w wvwl "rCIP F ana 'fcsor 160.0 FL Inspections performed by: Fla Fkp I <ch Ci.'C Dates: 1" 6/21107 Engineer's Stamp a®vim©e� ne Development Services Department Approval +�.� �•1��' ~r �i m c 4 Conditional Approval PP Date: `� r.e•............��.....:... e. .7ek.......1:...e.�... (, -:. TH:ODORE F. 4600RE•: '.,�.CE - 3589 Reviewed Al eelt;tate: 1. .yam/o7 ,• � �:y and approved by •••^•' tQ��FJ`ar' ,i Vt�`:. `/�"-'...�vv1 y'p�• (Rev O19e)� .3-p �.:..... � PERMIT NO: SW070100 PAGE 2 OF 2 PID NO: 020-093-05 "F" 'E" R ° "o„ "C„ NEW 1000 -GALLON SEPTIC TANK BM EXISTING SOIL ABS. 3-BORM EXISTING- ��: BEDS HOUSE V/°LL ° SWING TIES LOT 4, BLOCK 1 FROM: COR. "A" COR. "B" , WOODRIDGE SID TO: S.T. C.O. "C" 30' 39' S.T. C.O. "D" 34• 41' PLAN VIEW DBL. C.O. "E" 37.5' 45' SCALE: 1" = 30' VALVE "F" 40.5' 47.5• ------------------- 3'+SOILLACTOiIOV... EN R t I GROUNDLEVEL • J a nT0• aaFE r tA,y4 .......... J• J••'►u :.• �^C. ld Ie INV. INV. ...............•••••:d • � • 91.NEW 00-GA92,2' 9'ELO PT SEPTIC TANK � C= 35::9 y' LOT 4, BLOCK 1, WOODRI')GE SID PROFILE VIEW SEPTIC TANK REPLACEMENT SCALE' 1" = 5. I AS -BUILT INSPECTION REPORT FLATTOPTECIFNICALSERVICcS SCALE:ASNOTZD 14530 EC110 CANYON ROAD DFAWN BY TFIvl ANCI IORAGE, ALASKA 99516 1 JUNE, 2007 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 12, 2007 Expiration Date: Jun 11, 2008 Permit Number: SW070100 Parcel ID: 020-093-05 Legal Description: WOODRIDGE BLK 1 LT 4 Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 016601 VIRGO AVE Owner Name: DAVID BANKS Lot Size: 40154 SO. FT. Owner Address: 16601 VIRGO AVENUE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516 - This permit is for the construction of: ❑ Disposal Field ❑Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: CSlti Issued By: Date: ' Date: Z Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 67-e-_�' - 09 3 - o c - Property owner(s) Day',& ( gum lei Day phone 2ro - 6y kr Mailing address 14racyrrro /f-v.fn.i Zip Code 9'7,rIG Site address I*^ -e- Zip Code Legal description (Sub'd, Block & Lot) di g/ (J�a r..�.-(�q� -CIA Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN: Absorption Field ❑ Initial ❑ Septic Tank 9 Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ ❑ P/taut er�eafrl,� eto� ax// 7'.� Water Storage I` e"e tr- i3ts zLA4G,, 1,e -%-.:i Is .y.rer eKieAj.'je/ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 G o Waiver Fees: Date of Payment: �, r--1/-0 % Date of Payment: Receipt Number: 4 7 :201 Receipt Number: (Rev. 11105) iy r4 s:�' s j _ r•� t LAT,TOP TECHNIGAL_SERVICES . CML S ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PHJFAX: (907)3454355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gci.net June 11, 2007 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to replace a collapsing septic tank on Lot 4, Block 1, of Woodridge S/D, located a 16601 Virgo Avenue. A site plan and specifications are enclosed for your review. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. I' I ' I ; I WELL—" LOT 6 ELK 2 ° ' 1 SEPTIC ° I w I SYSTEM ° SEDRIVEi'i:!; m I N I m , I ' , I I__________ - ELK 2 n LOT 5 1 LOT 5, BLOCK 1 I-------- -- I Lu I INSTALL NEW 2 1 1000-GALLON C I SEPTIC TANK O I EXISTING DIV. VALVE r , I m o WELL' , I R'=100' _ EXISTING ° BDRM O� ,SOILABS. ° 1 OUSE — ---- BEDS ; I ° � VACANT ; I ABANDON ; 1 EXISTING LOT 4, BLOCK 1 I1000-GALLON SEPTIC TANK WOODRIDGE SID I I � ; i �MENZ CR EEKEPS � I-------------r LOT 3, BLOCK 1 I AV��:•" LOT 4, BLOCK 1, WOODRIDGES/D I F „ .•��'F'i� �� SEPTIC TANK REPLACEMENT 1 y *• 49 m"k f SITE PLAN I........................ / ------ - - ----- 1 �.. % FLATTOP TECI INICAL SERVICES 1_1INCH =50 FEET : THEODORE F. MOORE ; 14330 ECHO CANYON ROAD I DRAWN BY TFM I �.'.C6/089•.•�= ANCIIORAGE,ALASKA "516 JUNE, 2007 49 �D fe sslo'N`f P, NOTE: THIS IS NOT A SURVEYED PLAT. \" oALL LOCATIONS SHOWN ARE APPROXIMATE. efiattop 7echnicarSerwices 14530 Ecfw Canyon 9i9ad, Anchorage, AX 99516 phone (907) 345-1355 Lot 4, Block 1, Woodridge S/D 16601 Virgo Avenue Septic Tank Replacement Specifications 1.0 General: 1.1 The scope of the project consists of abandoning a collapsing 1000 -gallon steel septic tank and replacing it with a new 1000 -gallon septic tank located as shown on the site plan. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All ccnstruction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The installer shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The installer shall provide adequate cover material and rough grading over th-, tank to ensure that proper drainage is achieved after settlement and that there are no residual depressions. 1.5 The homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1000 -gallon, 2 compartment septic tank shall be Municipally approved aid shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. The tank shall be located a minimum of 100 feet from the existing well. 2.3 A double cleanout shall be installed in the discharge line between the new tank aid the point of connection upstream of the existing diverter valve allowing switching between the two existing soil absorption beds. 3.0 Inspections: 3.1 A total of 3 engineering inspections will be required during the course of the proj.-ct: (1) initial discussion with the contractor to finalize the location of the tank and construction procedures, (2) after the tank is set level and piping connected but prior to backfill, and (3) after rough backfill and grading is complete. The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. Municipality of Anchorage Page F of 7i DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 i Anchorage, Alaska 99519-6650 O Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:y1F �o0 �j :{ PID Number: Nam ' e: � Wastewater System: ❑ New ® — rade pg Address: Ic,(oo I VI ✓Lc�o ABSORPTION FIELD Phon No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ` Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Hating: O'�GPD/S.Ft. Total Depth from original grade: — --___ Lot: Block: Subdivision. Depth to pipe bottom from original grade/ Gravel depth beneath pipe b-G2V-1 a IS Ft. Township. Hang¢ Section: Fill added above original grpde: y —O - Z Ft. Gravel length. Ft. WELL: El New ❑Upgrade Gravel width. It/ f Number of lines: Distance be/lwee2iines: Ft. C�Ia{/ ication (Private. A, C): Total Depth Cased To: 1 �,4, /'l�"I'✓1 Ft Ft. FL Total absorption area: ,�/� 1VV SD. Ft. -7L—O Pipe material. �6I (� T p—'e Driller: Date Drilled: Static Water Level: Installer: � nate installed: Yield: Pump Set at: Casing Height Above Ground: Lill TANK FI Ft. _ _ DISTANCES )eseptic El Holding ❑S.T.E.P. _SEPARATION v TO Septic Absorption Ldt Holding Public/Private Manufacturer acity in gallons: From Tank Field Station Tank Sewer Lines C� ENT Well1�f-F Material: mber of Compartments: LIFT STATIONSurfac urfac Se Lot Line ^� 1 L /t q, / `46 Size in gallons: Manufacturer: --� Foundation 3o r � '� � "Pump on" level at p off' level at: High water alarm at: — Curtain �4 �N ' I _ —. Pump Make 4At5def Electrical Inspections performed by: ®� _Drain Remarks:_ e BENCH MARK I�-IPS\J6� D�PaF�Ei�-�t~l(Lg3�l _®_ Location and Description. Tyr o; r�r-lt- T>�� -- — -- ------ — Assumed Elevation: ENGINEER'S SEAL ol z c. �If , °, S & S ENGINEERING 17034 Eagle River Loop Road, d�t1St. S �� Inspections performed by: r it ) Eagle ver, Alaska 99577 2nd d ° F Y Department of Health and Human Services approval Reviewed and approved by: Date: F.:,. 72-013 (Rev. 9/91) MOA 25 Permit No. SW930047_ Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: WOODRIDGE SUBDIVISION, BLOCK 1 , LOT 4 PID No 02009305 SCALE 1' - 40' / ♦ 78.3' WATER FOUND scft 1" - 10' 72-013 A (Rev. 9/91) MOA 25 4lrz i A.r ' � •tn Y / c J i y PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 1325 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930047 DAI''E ISSUED: 4/05/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 4/05/94 OWNER NAME:VLADIMIROFF DAVID T OWNER ADDRESS:16601 VIRGO AVE / ANCHORAGE, ALASKA 99516 S y/� PARCEL ID:02009305 LEGAL DESCRIPTION: WOODRIDGE BLK 1 LT 4 LOT SIZE: 40154 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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 SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY DATE: L - / ISSUED BY: fl, %� T � _____ DATE: j_-•5 -/� Mun►iCApality of Anchorage Department of Health and Human Services r11h5 Tom rink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 30, 1993 Roger Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River., Alaska 99577 Subject: Waiver Request for Lot 4 Block 1 Woodridge Subdivision Waiver Request #WR930013, PID #020-093-05 Dear Mr. Shafer: Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are leachfield to surface water of 80 feet. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Sincerely, Daniel J. Roth Civil Engineer On-site Services ljm:#5 Concur: n Smi/,I .E. ogram Manager On-site Services MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR930013 PID# 020-093-05 HA# _ Permit # Date Received: March 15, 1993 Legal Description: Lot 4 Block 1 Woodridge Subdivision Engineer: _ Roger Shafer, P. E., S & S Engineering 17034 Eagle River Loop Road, Suite 204,_Eagle River 99577 Applicant: David T_Vladimirof,'ff --- _ Waiver Requested: Leachfield to surface water - 80 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2, Special Conditions: 3. Other: Points: Waiver is Granted: _�__ Waiver is NOT Granted: _ List Conditions or Reasons for. above: &A714R/4L QaPF Of TFI�rl��wil.d EEVENT 9,v)l POTFAIIL)-URElv6. sk w191,9Fi�Q/�_ /NTEnJE(TIa�G r, r r 7-8 ii LAN—U L 1 ON Sf ---- Date : '3_30 --- By: �-� ----- of Reviewer Rec #: 24520 -- Amount: $ 590.00 _ Date Paid: 3•-15-93 ng March 13, 1993 ROBERT SHAFER. P E ROGER SHAFER. PE CIVILENGINEERS 19071694-2979 FAX 694-121 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWER 8 WATER MAIN EXTENSIONS REFERENCE: Lot 4, Block 1, Woodridge Subdivision Request you issue a permit to upgrade the septic system serving the 3 bedroom home located on the reference SEWER &WATER property, and grant a waiver for the horizontal separation INSPECTION distance between the proposed leachfield bed and a surface water source at 80 ft. Upon first inspection of the septic system for Health ENSTUDIES AuthorityApproval roval ur oses we found the leachfield liquid ANOD REPORTS ORTS RTS levels to be abnormally high indicative of a leachfield in a state of failure. A test of the system on February 3-4, 1993 found the absorption capacity of the system to be inadequate for a Health Authority Approval. WELL INSPECTION & FLOW TEST We then excavated a test hole near the system on February 10, 1993 in search of groundwater as a cause of the system failure. No groundwater was encountered. We excavated into the leachfield and found the leachfield to be SIZE PLANS supersaturated. We found a considerable amount of biological matting on the soils within the leachfield which appeared to be preventing the wastewater from being absorbed into the surrounding soils. ROAD DESIGN Due to the lack of available room on the property for a leachfield upgrade outside protective well radii and away from a surface water source setback, we peroxided the SOIL TEST leachfield. Two 55 gallon drums of 50% solution hydrogen peroxide were added to the leachfield on February 2.2, 1993. We then proceeded to test the adequacy of the leachfield PERCOLATION again. From February 26, 1993 to March 1, 1993 we added TEST water to the system while periodically monitoring the liquid levels within the leachfield. From 'the data collected we have determined the current absorption capacity of the system to be approximately 400 gallons per day. Although STRUCTURAL& the peroxide treatment appears to have increased the MECHANICAL INSPECTIONS absorption capacity of the system, the system :is still not functioning adequately to obtain a Health Authority Approval. ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 page 2 Lot 4, Block 1, Woodridge March 13, 1993 On March 6, 1993 a test hole was excavated in an area proposed for a leachfield upgrade. Monitoring of this test hole on today's date found a current groundwater_ level of 16 ft. below the ground surface. From this information we've developed the attached upgrade design. We feel the proposed system should be permitted with the requested waiver for the following reasons: 1. Although the soils percolation rating only minimally varies from the original testing in 1988, due to the absorption area requirements with the Sept. 1990 Municipal Ordinance, the proposed system is 1.5 times larger than the existing leachfield. This should substantially increase the life of the new system. 2. We propose the installation of a diverter valve between the two leachfields. With this valve in place, one leachfield can rest while the other is in use. This dormant period should allow the unused system to rejuvenate itself to some extent. When the system in use fails, the dormant system can be placed into use by use of the diverter valve. This condition should also greatly increase the life of the wastewater disposal system. 3. There is no other place on the property to place a septic system without relocating the well. Even if the well were relocated, due to the proximity of the creek, groundwater levels, and existing grade of the area where the well currently exists, there may still not be room for a septic upgrade. Thus, the alternative would be the installation of a holding tank. It has been seen that holding tanks can cause a greater environmental hazard than an encroachment to a surface water source. 4. There exists a slight uphill grade between the proposed septic system and the creek before the grade slopes to the creek. If in the event effluent; were to overflow from the proposed leachfield, the effluent would not travel toward the creek. Instead, it would travel parallel to the creek and across the driveway. Once across the driveway, the overflowing effluent would be quickly detected and the condition remedied before the surface water source could be contaminated. page 3 Lot 4, Block 1, Woodridge March 13, 1993 If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. cc: David Vladimiroff /•G' ,ZA2 Municipality of Anchorage 0*2 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:L,&v1 Y-1 ,,t TIIz-�F� _ DATE PER LEGAL DESCRIPTION: L 6 1J 1 WIrapp(z-.tqK4_6, Township, Range, Section: iD&PTI1 SLOPE 1- . "o 2 O 0111 3 4- f r 6 v/G 7 d 8_ o a 9 r r� n. to - 4 0 O� 11 - F7 12- o 13 - 14- 15- 16- 17 - 18- 19- 20 4 -15 -16 -17- 18- 19- 20 - COMMENTS (A'F I.A 41-1-f 4511 I --T. 1'k WAS GROUND WATER / G ENCOUNTERED? \ l"/ S IF YES, AT WHAT I L DEPTH? `� O — P E latilh Io Water Alter Monitoring? — Ilale: € E' 1397 rr ! (6NG— EEfl�S 4�, (1 n� n DRMED: SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop -- 1 Z '�'•S� Id t• -iia. 4 z " �' -- 1'1 ' s ov , � � I o z�' y PERCOLATION RATE _ S _ )minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN —� _ FT AND y —VT PERFORMED BY: SR, 9 :NIGINFERIM(y_ GERIIFY THAT THIS TEST WAS PERFORMED IN 170q3�4 SEn``Aale fqt1'vpo,r LoOpp �Aoad N gfld '1j `"j nl3 ACCORDANCE WIJH I LI�"VATEITI� l< W y L GUIB'E'CINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) YJYY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT Name �--_-----_ ����-D�M/�9�� — DISTANCES —� TO fAOhl \ SEPTIC TANK ABSORPTION FIELD WELL Address ' i�NG �%�G Phone(sl poredNo. No. of Bedrooms S M WELL q /OL• LOT LINE -- LEGAL DESCRIPTIDN _ 2BIoc6 Loi 5 bd,,slo,, FOUNDATION --- /0 r� /O — Township. nedye. Sndlon _X� S 77/7 G— TANKSACe' oG��� AS -BUILT DIAGRAM (Show location of well tluv_ewey. water bodies, etc) septic system. pnopedy lines, foundation, SEPTIC ❑ HOLDING _ , Mamlaytwer Gapaclty In gallons /2 \ T 1 5 v Materia _ No. of Compartments') TYPE OF SYSTEM ❑ 'I-RENCH X BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Iron original grade 3 V.,g FT Total depth front onglnal grade FT 't -y 0, 41 _ 13 _ _ of t FII atltled above original grade FT Gravel dopth beneath pipe S FT Gravel length FT korai absoryllon area Nl1ntbe, ul mcs Peoria ---SQ FI ✓5 /Z S Sp FT Ineiall�'q / Ci�ll1 21__N) WELLS Gravel vntlth r B FT t Q U_ ------ — _ _ i Dlsmnce be(weon hnes 6 FT Pipe malella LI) (q3I/ - 116 Date Install d _�29_P> AlS_7/NG r.1 c / 3 rr 2 (6 T, --- 6 2 3 /« s L6 n _ — — 11 --- -- —' C — -� er _ 6 ___ -- X PRIVATE ❑ OTHER (Idenlifv) Classl6cailon Depth Cased to — —FT FT LD11151ailed. C ( tr 16 C 24 —_ if =6' _ — 7 — Inslalle ( / — A REMARKS: �lI 7 / J ,-- S 77c 7A9/ / //n�7nn��11 //''�� /' //''�� _ /vr_(J f.i ��C�Q SS '_'/.�l/�C� L(_//�'-� A0 % Nz FF !T/�J s Tv_ L�_oS� Scale: Inspech ejWrnicd by: - ENGI Mc. 1 +wve1 01 41' . w ' a • •e. c .mne.ome�...G " �. • % Nits r140741;., �'q .•,, r q� adY�� " �' �r • r. ..'t k401 r m °'� Date.' /2 �/� g certily that this aslachoo was performed according to all -------= f ! Date. 's G—�' ._--.r.�- S & S ENGINrEERING — ---- Municipal all a�a( I� �s kLWbN pit tROad til Eagle River, Alaska 9957 r / a Health Department Approval: .�,'� ^� � ,--_ 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DeparLment of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 DN-!5ITE SEWI".R PERMIT Permit Number: 880105 Upgrade Date Issued: ()7/01/88 Engineer Designed Owner Name: DAVID VLADIMIRDFF Day Phone: Owner Address: 16601 VIRGO 263-4197 ANCHORAGE, AK 99516 Parcel Id: 020-093-05 Lot Legal: Subdivisions WOODRIDGE Lots 4 Black: U Section: 3 Township: 11N Range: 3W Lot Size 44000 (sq.ft" or acres) Max Redrooms: This Permit: 3 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INSTALL, PER ENGINEERS DESIGN, A BED TYPE ABSORPTION SYSTEM AND RELOCATE THE TANK ONTO THE LOT SOUTH OF THE DRIVEWAY. WIDTHx 18' ��N[�Tn: 32' GRAVEL THICNESS: �" MAXIMUM D�[,TM� �' , ' - � " NO[IFY DHHS PRIOR TO ANY INSPECTIONS" THIS PERMIT IS ISSUED FOR A SINGLE FAMILY RESIDENCE ONLY AND EXPIRES 12/31/8B" I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2, I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit.. 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4" I understand that this permit is valid for a maximum of 3 bedrooms" I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit" Signea: �—�--�—�-�--�-----'------ -----��r- (Owner) DAVED VLADIv' Issued 9y: __,-____­­...~_......... DATE: DATE: ---r~~�^~-~'---- 6.0 d X 6 E7 cn 71 o�A ,-t Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:—T2 �l [2 Y IiG''171P-I IFnt9jor _DATE PER LEGAL DESCRIPTION: L -q" 121 pp,2? tom F, Township, Range, Section: •-I— ,.� Sr LOPE SITE PLAN 1- d a 2 �. 3_� �o 4 5 � " p- 6 0,0 7 ^ e � { e 9-O pi to - 12 -1 13- 14- 15- 16- 17 - 18 0-12- 13- 14- 15- 16- 17- 18 19- 20 - COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After fAonlloring7 — S L t"L— P (late: Io–?A -ee Reading Date Gross Time Net Time Depth to Net Drop �Water 4 q 3 , N C> 3 2" � 1 VIVN 4 PERCOLATION RATE — ((minutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ,d— F) AND FT PERFORMED RY"""• Eagle River LoCp Road No. EegTn ACCORDANCE WITH ALL STATE AND MUNICIPAL 72-008 (Rev. 4185) Z:::�� CERIIFY THAT TH TEST WAS PERFORMED IN ON THIS DATE. DATE: 7/0y -r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION *0 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ��!- I J/-/� PPH6N/E '7A f? NEW ///(�j� / f� x/(?/1 LII C. IYH.-3774, ❑UPGRADE MAILING A DRESS 130, 3l E,? 4 LEGAL DESCRIPTION Lot ¢_9'vc / W,2vd)_4 e LOCATION- -} """��, LLL / NO. OF BEDROOMS � i r —, Qr� UT (rPe _— Well Absorption area Dwelling PERMIT NO. UY DISTANCE TO: LQ� lO�r /�/ � D03 75- z i= Z Manufacturer Greer Material Sf No, of compartmen—ts�ry G LU FQ- PC W Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth �Dz DISTANCE TO: Well Dwelling — — PERMIT NO. 02< Manufacturer Material Liquid capacity in gallons O w= -- DISTANCE TO: Well 0 Foundation ( s JD/ Nearest lot line 2()i' PERMIT NO.p7 — 020371/^ J LL Z � Z w No. of lines / Length of each line2 q / F I Total length of lines2 �/ Trench width Goinches Distance between lines /,._ Top of tile to finish Material beneath file Total pm. grade / /' � — - 2 inches effective absorption area —_ Lu Length Width Depth PERMIT NO. O n H Type of crib Crib diameter Crib depth Total effective absorption area uJ to DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W J DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS PC V C r SOIL TEST RATING C7 !J 7/4f1 ,i. U� a INSTALLER Mat Alewlah — D f REMARKSJJ COh'tra4or SAGII�0I/c,'' PW Pr e/�• tA Q r / 1 I a 1 " du CI e uh ev Ne drf'veylay. `P° -- APPROVED DATE LEGAL L t; o 02t ;c% -- 72-013 (Rev. 3/78) SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OI= _- 7w"—.�'�-'�_--- DRILLED AT THE RATE OF ..-i O� — PER FOOT. PROPERTY OWNER —_--- —_— --___-- — LOCATION OF WELL SITE --,L' DRILLER-----3�'.•ra�_ Gl.ciu, o.° .'_omorUr�f. 12t�i�(.Lirtn ,,.L.a, WELL LOG: /S1 C GI n _ ( 7171:lf'C LOc L. i 4P.C� 1;'t,^a.f n;L'� lu)C(.. "c- (1,1011.( � 3/., i �,�, ,�� `� 1 ..e.v�+,b '.1 ! �nd.I_e P -I . .1 " ' I I u.lcll.ods1- -1;.y ,1LL-N( =_� .C�l1 _/�_�'lr MUNICIPALITY OF ANCHORAGC DFIT (— ` ENVIRUIJt, J., , .v '-FION 0 C 12 1 198? RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF '3<- 5(', ( n THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE - SERVICE CHARGE 0F 1V.% PER MONTH WILL. BE ASS ESSI-D ON PAST DUE ACCOUNTS. ���X 1:77 1 1=4 f : a p__ x 1 �C�:v Fm!! U -'s I K�i� DEPARTMENT OF HERLTH HHD ENVIROHMENTHL poOTECTION ' 825 STREET/ ANCHORAGE, HK, 95 1 264-4720 / . ' 8^1 Ehc 1.. 1.- sl 141 riv UZI poll a InvaU^VEwo FO FSE Fw 0 1 JF _g PERMIT NO. ( 820275 ) RPPLIC8NT HIGHLHND DESIGN INC SRH BOX ]!&-,-: ]44-574] LOCATION VIRGO LEGAL L4 B1 NOODRIDGE LOT SIZE 44000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRHINFI2LD MHXIMUM NUMBER OF BEDROOMS - ] SOIL RATING (SQ FT/BR), 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 121 EYE IT" 0- 1 -1 — 021 �ETT Toll 1710- 1-1 m� 7515 Con I"! 0=1 qwp to: �a F=- -I - 0-5 3 - THE'. LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFlELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROyND HND THE BOTTOM OF THE EXCAVATION (IN FEET) ��E.E: g 1: 14 110 1-0 0y1 go, 1 01 :1 101v��4, THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL 8'TWEEN THE OUTFHLLPIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET).- ����1 gl­-" EE EA 13 FE F:"I- X iC� �10104`7 all 1: 121 EVE` !E- C" Ca Ca C" tO l. L. K'A P4 FA; 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 �R"URIO < 12 > 1E PA F--� RE,% C'" -0 :E fit 041 KRY 11 FZ EE FR Con Kit 0 1 1: EQ Eon kv BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT - DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 15o TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UF�DN THE TYPE OF PUBLIC WELL � MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 23 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. NELL LOGS RRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY, SPECIFICATIONS AND CONSTRUCTION DIAGRAMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. 9 11, X F Eon >A F" 1 FT IF no �������� ��' �15 E3� SIGNED ISSUED BY PPLICONT HIGHLAND DESIGNINC 7- �'�� ���,�/�?'~~�` / -(�7 ` � 0 I.f SOILS LOG `„� 11) MUNICIPALITY OF ANCHORAGE LI PERcoLnnoN DEPARTMENT OF HEALTH AND ENVIRONMENTAL TEST PROTECTION OTECTION / 825 L Strout, AnchoraU0, SOILS LOG — PERCOLATION TEST (---- - DATE PERFOR NiE D:—�. /------, opmED SITE PLAN__ 3— SLOP AL DESCRIPTION:= -- � _lI_C1_L rjll- -IP@G Tl" 1 '2 3 4 G 7 I// L cco,slvrlu� (- l�dl ""%I'42C� ru C. �PL1 C !,r I \ e,r C�P�GvJ-co4,l�•lzs �-o - r 10 - !� WAS GROUND NIA TER G.o� �' I'P S NCOUNTERED? �- _Y 11 f.0,-.... V1J .— IF YES, AT WHAT (y �� z_.:, DEP III? — --- — I 13 --- I�� RmIlny Dale G ross Time — 16 .a OF P ➢il'x Lrr.Nd rfii 20dq n`c9,c,, pbv. 23D1'ps C'0' GGA _Immo yes/1—... F'ERCOLATION RATE --_--- -- ___� ' _-_ Pi TIIEST RUN EFW EEN FlANDf a� _—_— COMMENTS J 5 �'Z _LOD — --_. �Ce--CE RTIF ED Flv:— _ PERF-ORMED[7v:!L--- E 7 DATF::__5—_ 17'� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 q,1� Anchorage, AK 99519.6650' www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. y -Q0 - C C13 - C) COSA# HA CCI00 y _1 1. GENERAL INFORMATION Expiration Date: 5 a '5= 03 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WOODRIDGE SUBDIVISION, LOT 4, BLOCK 1 16601 VIRGO AVE • ANCHORAGE. AK 99516 ROBERT do JENNIFER KANYUCH Day phone 541-728-1899 2110 CRYSTAL MOUNTAIN LANE 'BEND. OR 97702 Day phone JERRY DEWHURST W/ REMAX Day phone 276-2761 110 W. 38TH SUITE 100 'ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, L(D. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date 2,ZZ D Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory y Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report NitrateAdW'/t�/V Other By: (Rev. 71,05 .................. res c�'++1.,,, ON-SITE .:�G)= WATER AND M: :WASTEWATER PROGRAM Original Certificate Date: �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WOODRIDGE SUBDIVISION, LOT 4, BLOCK 1 Parcel ID:,az 0 ' 0 cr 3- 05' A. WELL DATA ' ASSUMED CASED TO BEDROCK Well type MATE If A. B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/11/1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 175 ft. Cased to •45 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/1/1982 ` 5/11/2007 Static water level 40 ft. 24 ft. Well production 2 —g.p.m. 1 1 8 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate NA mg./L. Other bacteria _N_colonies/100 ml. Arsenic: AJD ug./L. Date of sample: 2/4/09 Collected by, GEG Ltd B. SEPTIC/HOLDING TANK DATA cc I 1 1 Ia W7 .b C. Tank Type/Material STEEL Date Installed 1031982 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depress on overllank (Y/N) NO High water alarm (YIN) N/A Date of pumping Pumper McDONALD PUMPING ABSORPTION FIIELDpATA w EXISTING CRAD I [MTI/MT2] 7/28/1988 125 Date installed 5/9/1993 Soil rating .p.d. r ft'/bdrm) 0_5 System type BED Length 32/50 ft, Width 18/18 ft. Gravel below pipe 0.5/0.5 ft. '2.6-4.4576 l Total depth • –4 ft. Eff. absorption area 900 ft' Monitoring tube YES Depression over field NO •��5/11/2007 Date of adequacy lest Results (Pass/Fail) PASS For 3 bedrooms **DRY / DRY/ Fluid depth in absorption field before lest 4_5 in. Water added 450 gal New depth 4_5 in. i DRY/ II Elapsed Time: 0 min. Final fluid depth 4_5 in. Absorption rate >= 450+ g.p,d• Any rejuvenation treatment (past 12 me.) (Y/N & type) NONE KNOWN if yes, give date – **THE 1993 BED WAS TESTED. 1988 BED SURCHARGED •r01988!BED WAS DRY ON 2/4/09 I: D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at_in. "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field UNK Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water "801+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS •80' WAIVER (WR930013) 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 JEFFREY A. GARNESS Date Z) Zz.%og COSAFeeS L190 Date of Payment a d / o q Receipt Number 3N y`Y r (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 0 SGS Ref.M Client Name Project Namt/M Client Sample ID Matrix Sample Remarks: 1090450001 Gayness Engineering Group, Ltd. Woodridge L4,D 1 Woodridge L4,1)1 Drinking Water Printed Date/Time Collected DattfTlme Receired Date/Time Technical Director 02/192009 15:48 02/042009 15:50 02/042009 16:40 Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date ]nit Metals by SCP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 02/10/09 02/18/09 SCL Waters Department Total Nitratc/Nitritc-N ND 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 mg/L. SM20 4500NO3-F D (<10) col/100ml, SN120 92228 toVI00mL SM209222O coVI00mL SM209222D A (<200) A (<I) A (<I) 02/10/09 JDZ 02/04/09 KAR 02/04/09 KAR 02/04/09 KAR Municipality of Anchorage • Development Services DepartmentL Dom`; (\Building Safety Division . - On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 /„ + Anchorage, AK 99519.6650 (//J www.muni.orglonsile (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Oq3- 65 COSA# bl02(R 1. GENERAL INFORMATION Expiration Date: ir) — 3 — t7 Z Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address WOODRIDGE SUBDIVISION, LOT 4, BLOCK 1 16601 VIRGO AVE ' ANCHORAGE. AK 99516 DAVID BANKS Day phone 16601 VIRGO AVE • ANCHORAGE. AK 99516 Day phone 274-5175 SALLIE NICKERSON w/PRUDENTIAL Day phone 229-1148 3801 CENTERPOINT DR. 11200 • ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the systom in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the systom. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized• nor will if confer any legal right whatsoever. S. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date (6 /Z S/b? Conditional approval for bedrooms, with the Mowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: a Original Certificate Date: (Rev. tIM5) ON-SITE WATER AND WASTEWATER PROGRAM o• ....... c -.J .. f r .............. Go ss: r � aL •' SFO Conditional approval for bedrooms, with the Mowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: a Original Certificate Date: (Rev. tIM5) ON-SITE WATER AND WASTEWATER PROGRAM o• Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 99519-850 www.muni.org/onaite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST -4 Legal Description: WOODRIDGE SUBDIVISION, LOT 4, BLOCK 1 Parcel iD: O 2 0 - 0'7 3 - 0 r A. WELL DATA * ASSUMED CASED TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/1/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 175 ft. Cased to '45 ft. FROM WELL LOG Date of test 9/1/1982 Static water level 40 ft. Well production 2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mgJL. Casing height (above ground) 12+ in. AT INSPECTION 5/11/2007 24 ft. 1.8 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: ND ug./L. Date of sample: 5/11/2007 Collected by: GEG Ltd B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 6/21/2007 Tank size 1000 gal. Number of Compartments 2 Cieanouts (Y/N) YES Foundation deanout (Y/N) NS Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper C. ABSORPTION FIELDDATA [MTI/MT2] 7/28/1988 Date installed �5/911993 Soil rating .p.d. ft=/bdrm) 0_5 System type BED Length 32/50 ft. Width 18/18 ft. Gravel below pipe 0.5/0.5 ft. 02.8-4.4 578 YES Depression over field NO Total depth 63.3-4.8 ft. Eff. absorption area 900 fe Monitoring tubeDe_ p Date of adequacy test 5/11/2007 .*D Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test 44.55 In. DRY/ Water added 450 gal. New depth 4_5 in. Elapsed Time: 5 min. Final fluid depth 4_5 In. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **THE 1993 BED WAS TESTED. 1988 BED SURCHARGED D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump oft" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 1 Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field UNK Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water '80'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS "80' WAIVER (WR930013) G. ENGINEER'S CERTIFICATION I certify that l have determined through held inspections and review of Municipal records that the above systems are in """' ""' """" conformance with MOA COSA guidelines in effect on this Q ' date. •,Je A. rness; Engineer's Printed Name JEFFREY A. GARNESS �Q �,'. 795 a� �R�- Date _ 6h b%-;iL COSA Fee $�• 0 O Waiver Fee $ Date of Payment6 �� 810 7 Date of Payment Receipt Number 000 G 3 Receipt Number (Rev. 11105) SGS Ref.N 1072105001 Client Name Garncss Engineering Group, Ltd Project Name/N Woodridge, L4, DI Client Sample ID Woodridge, L4, Ell Matric Drinking Water PN'SID 0 All Dates/Times are Alaska Standard Time Printed Date/Time 05252007 13:26 Collected Date/Time 05/112007 14:30 Recehed Date/Time 05/112007 16:57 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Pmmetcr Results PQL Units Method Container ID Limits Date Date Imt Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/17/07 05/18/07 TK Waters Department Total Nitratc/Nitrite-N ND 0.100 mg/L SM204500NO3-r D (<10) 05/15/07 JDS Microbiology Laboratory Total Coliform 0 col/100mL SM209222O A (<I) 05/11/07 DLC JUN -28-2007 15:04 Ld z w > oI PRUDENTIAL JACK WHITE P.02 f f/ LOT 3 Lf r ~ e, AT ar AN AS BUILT .� SCALE Lang & Associates, Inc. Registered nd Surveyors La 1 1,Oalasko.nel / Jolangle0 40' GRID bw J` F"A—' ..__ Daryl Avenue. Anchorage. /Uoska 99515-3049 190 522NG 6176 Phone O 907; 522^4625 rax /. kg an0 1 hereby cerllfY that 1 have sunsyed the following LA deo. 61-ibed P Itu LOT A. 9LOCK 1, w000RIDGE SUBDIVISION (PLAT No. Btro234) adJoeeM mento, that Anchorog• Reoordln9ln is d do not encroach the the P Pe tYs slluotsd thenen an within the property croaoent thereto enar000h on the surveyed no Improvements on the Properly lying transmission Rnee or other visible b,.mmland h on that there " sald Property except atroodwIndicated hereon. ^ at Anchorogs• Alaska Dated this the l�— DoY of rl Ions r,hloh do not appear an the recorded subdwlelon plot. ry is the reeponeibtlHY of 1M owner to delsrmine the existence of any •oeemlo , ;: 49Id KONEM G- covenants, or rest TOTAL P.02 JUN -28-2007 15:04 PRUDENTIAL JACK WHITE P•02 A 30.00' + 0� RET NINI OPAL` W 4 p' CAN o C OUTS I si 121.8' I DEC 4.0' MII� H CLLEEA OUTS Upper DECK yl LOT/V RETAINING WALL TWO STORY WOOD FRAME RESIDENCE MAINTENTANCE 2.0' X 24.0' CANT WIRE FENCE 68.8' FENCE I I ry LOT 4 N BB'254WE 108.83' r e61g 10 UTILITY EASEMENT N 87,0913YE 65.88' / / LOT 3 -- .,.... La BUILT I. SCALE _L Lang 8c Associates, inc. Registe redo Land Surveyorseo 0' CRID 5W "oi r.vi—..._ 11500 Daryl Avenue. Anchorage. Alaska 89515-3049 907 522-6476 Phone OF t 907; 522^4625 fox `�,_............. 0 rtr I hLreeby4.e0ify that I haveII SUBDIVISION followingod the ( FLAT dNo. ei �34�� 1t a adjacent thereto, that Anchorage n within the Recording lines and do snot encroach onto the property souathe thereon an wllhtn the property a In od enl thereto encroach on the surveyed no improvements on the prop r h 9 transmission ones or other visible premises and that there are ex0e►ptt°as Indlooted hereon. easements on sold property wo, . at Anchorage. Alosko Dated this the .wt, Day of ' It is the responetb117 of Me owner to determnant the xrecorded subdl*tonce of ivision plat+• Plot- covenants. or nsirieflone which do not appear—� N 4918 KINwETH 0.LANG ' IS -5202 TOTAL P.02 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.sk.us (907)343-7904 N�' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-093-05 HAA# HR d / I) / pO r: 1. GENERAL INFORMATION Expiration Date: - 9-1-0/ Complete legal description WOODRIDGE SUBDIVISION: LOT 4, BLOCK 1 Location (site address or directions) 16601 VIRGO AVENUE, ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SUSAN RUDDY do ED CRAVER Day phone 345-3885 16601 VIRGO AVENUE, ANCHORAGE, AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site N 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 Stale of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $1,555.00 at, or prior to closing for the engineering services provided. 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 lnvestigaUon, based on procedures outlined In the Health AuthodlyApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ls(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated heroin. 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address' 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, AMVC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time c the test and separetion distances measured to readily fdentiflable features. The operational life of all wells and septic systems depend on the local Solis condition, groundwater levels that may fiuctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the ev2luator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc, can therefore not provide any warranty or future estimate of how long the system will continue to meet the Operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the iilowing Attachments: HAA Checklist C__" Septic System Advisory Well Flow Advisory Phone 337-6179 o7 0 - Date 0410101 Manitenance Agreements Supplemental Engineer's Reort Other ON-SITE WATER AND WASTEWATER PROGRAI ' By: Original Certificate Date: S-- O 1 C/ t1l (Rw. two) Municipality of Anchorage Development Services Department Building safely 01vlabn .. . . On309 Weer a Wastewater Program 47110 Soulh Sragow St P.O. Bax 198 W Andwrege, AK M1"M www.d.anchwor.*1r•uo (907) S43-7004 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Des*lp1110111: WOODRIDGE SU8DM510N LOT 4 BLOCK 1 Paroel ID 020-093-05 A. WELL OATA Well type ATE tf A. B, or C divide PWSIDp NIA Wets Log (YIN) YES Date oor VIVied 911/62 SantW 60a1(YIN) YES Woes properly protected (YM) YES Total depth 175 R. Cased to �—t►. Casing height (above WWW) 112"-1- in. FROM WELL LOG AT INSPECTION Date Of test 9/11/82 3/15/01 Static water level 40 fL _ 20 A. Wen production 2 g.p m. 2.12 O.P.M. WATER SAMPLE RESULTS: Conloffn 0 cdonles!100 mi. Nitrate 0.5 mgJL. Other bacteria O Cobnbsl100 ml. Date of sample: C 4/3/01 COliectOdby AwwINC. e. SEFrnerHOLDINO TANK DATA Tank Typamterial STEEL Date installed 10/13/82 Tank size 1000 gaL Number of ComPOMMIb 2 Cfearlotds (YIN) YES Fo mdatioo desnout (YIN) YES Depressbn aver tank (YIN) NO High water alarm (YIN) N/A rxnping 3/15/01 Plrmper ISMCS Dow or MOTE: 1991 eED rMlEp. PRE -+OAK [MT1/MT2] C. ABSORPTION FOM DATA % tESTeo 19ss RED. 12type Data ir>slaned s/�/aa Son rating (g•P•dJRbr®1— 5 System BED Length 32 R. Width 18 R. Gravel below Pipe 0.5 R. Total depth 4 R ER. absorption area 576 d Monkodng tuba YES Depression over field NO Data of adWacy test4/5/2001 Resufb (PaaslFan) PASS For E bed,con Fluid depth in absorption field before lest 1 LO In. Water added 13009e1. New depth V-4 M. Elapsed Time: 316 rein. Final fluid depth 1.75/0.75 In. Absorption rate >• 450+ g.p.d. Any refimnation ftftehl (past 12 mo.) (YIN b type) NONE KNOWN If yes, give date D. LIFT STATION Date installed 'Pump ort' levet at _in. E. SEPARATION DISTANCES -Q High water alarm lml at in. Cycles tested Meats alarm & circuit requirements?— SEPARATION equi ements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Itlt station on lot t OO'+ Absorption flakd on lot 10004- Public 00'+Public sewer main N/A On adjacent lots 100'+ On e4acent kits 100'+ Public saw manholaldeatwult N/A Sewer Iseptic service Ine 25'+ Hddlp tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property Ine 5'+ Absorption field UNK Water main N/A Water service Nne 101+ Surface we 100-+ Wells on adjacent lots 1009+ •80' WAIVER (WR930013). SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ine 10'+ Building faaldstlon 100+ Water main N/A Water service Ilya 10'+ Surface water 080.+ DrNeway, paddngNehkde storage 5'+ Curtain drain NONE KNOWN Wells on sdjacent lots 100'4 F. COMMENTS 0. ENGINEER'S CERTIFICATION I outffy that I have datemdnad ffmoh field kq dlons and review of Mur*W racorda that the above systems are In ........ conformance wRh MOA HAA Quldepnes In effect on fhb date. • r� A. Cornass,, Engineer's JEFFREY A. CARNESS $ '-, 7953 f Date HAA Fee S 300' op Waiver Fee $ Dated Payment 5-6-40, Dare of Payment Receipt Number, 3905 Recelpt Number tR.v. IMM WY -11-01 IMS FRW- G CTBE Emitonawtal Sarvleaa Inc. T-116 P.02/01 F-102 CUE Reta 1012460001 AK Water &Was"'ntrrConsulunrs(ne. Cucat POM C„��xceMmem 12001 Client Name ProjectNamex 16601 ViritoL481 Woodeidtte 05 05/1112001 1233 1323 CIIrntSampklD 16601 VugoL4H 1 Woodridge RaelvedDatdnM Stq*enC e blatrta Dr(nking Water Technical Director Ordered By c RelnaeA PWSID 0 Supple Rcmurts: Allowable- Prep Ar"""c Penmeur ltoaha PQL Unita Mahal Limitr Dau tie, ,it Nates Department Nitrau-N Hlcroblology taboratcrlr Total Coliltmn 0.500 U 0.500 vWL EPA 300.0 0 cot/loomL SNI192220 (<101 OS/IIAt sm 05/11/01 SIM P � MUNICIPALITY ANCHORAGE • � DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 995'19-6650 343-4744 CERTIFICATE OF HEALTH AUTHOR11"Y APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.It _D D_0_0A2La 1. GENERAL INFORMATION HAA ft V� W'I SU c^l b:l Complete legal description Lot 4; Block 1; woodridge Subdivision Location (site address or directions) 16601 Virgo Avenue, Anchorage, A'Laska Property owner Ifladimir-off Day phone 345-4605 hm 16601 Virgo Avenue, Anchorage, Mailing address e, Alaska 99516 249•-4922 wk g g Lending agency Mailing address Agent Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 v 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rov. 1/91) Front MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s a s I 77Q84 Address Engineer's signature Road No. 204 6. DHHS SIGNATURE Approved for �y� bedrooms. Disapproved. Conditional approval for Additional Comments By: Phone Date bedrooms, with the following stipulations: Date 6 — `/- ` e� a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(aev.1/91) Back MOAN21 t ;v /t• 5(1. { V ( �I �• �: �•. " ran. (,,.v.(. .t bedrooms, with the following stipulations: Date 6 — `/- ` e� a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(aev.1/91) Back MOAN21 Municipality of Anchorage sDepartment of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _Y_11SXX� ID&F. s6l. Parcel I.D. 02 9� A. WELL DATA Well type R w IFL If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N)t� Date completed 'I ` 1- 82 — Driller Zam_e az r r r [r Total depth 1 Cased to � S Casing height Sanitary seal (Y/N) Wires properly protected &N) ` Date of test Static water level Well flow Pump level FROM WELL LOG �1-182 SEPARATION DISTANCES FROM WELL TO: g.p.m. AT INSPECTION ?o z .D PTI pTl n co O V ` g.�t. � 7 _ �Z c m O 2 Septic/holding tank on lot 16 2 ; On adjacent lots la) f - r Absorption field on lot lbs ; On adjacent lots 100 1 -1 - Public 001 -1 - Public sewer main --- h)ZA Public sewer manhole/cleanout N Sewer service line _01,54- Petroleum tank _ &NF "ri WATER SAMPLE RESULTS: Coliform 101 Nitrate—�—IE_(P'Ze_P Other bacteria Date of sample: ��� Collected by:S �by-YIt13 t9J K� B. SEPTIC/HOLDING TANK DATA Date installed — Tank size �J tL Compartments 2 Cleanouts (y2N)Foundation cleanout (/N) - Depression (YO �a High water alarm (Y/� N// ---Alarm tested (Y/�I i / _A Date of pumping Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r Well(s) on lot— OD To property line_ 11 Surface water/drainage — 72-026 (Rev. 7191) Front On adjacent lots 100'-4" Foundation r r� _Absorption field 22 Water main/service line 10 120 / CONTINUED ON BACK PAGE C. LIFT STATION Date installed A) 14, Manufacturer Size in gallons Vent (Y/N) 1. , "Pump on" level at High water alarm level Meets MOA electrical Manhoi ess (Y/N) SEPARATION D,I8TANCE FROM LIFT STATION TO: Well on On adjacent lots "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Pate installed — 1,9 6.,5Soil rating �•S GTX-6_!'CSystem type Bo-rp Length SOS, Width 18 ( Gravel thickness �•s r Total depth ? `1 qoo Total absorpti(Sri area - I Cleanouts presenV(Y�/N) Depression over field (Ye rte' Date of adequacy�test Results (pass/fail) ogto Sq s-r:e '1 for - '� bedrooms Peroxide treatment (past 12 months) (Y& ---N If yes, give date�hN SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot (b8 r On adjacent lots I� t'{` Property line LO/ 8 I A / To building foundation To existing or abandoned system on lot ( � On adjacent lots 3o t"+" Cutbank 4-J e r'l •5 Water main/service line Surface water Driveway, parking/vehicle storage area 1-7— Curtain Z Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have Date � r�-gAtJE$ o�rPtt-�G�v �weg3co,3� or conformed to all MOA and HAA guidelines in effect on the date of this inspection. LC.6611312wIV'J"IS 01693 9NIa33N10N3 S Y S HAA Fee $ 70 .JU Date of Payment Receipt Number 2�%3S Sl�lJ� 72-M (A". 3191) Back MOA 21 Waiver Fee: $ — Date of Payment Receipt Number � V 4. � .ob•rt •A• Sh•fx'••�� r 05/27/93 16: 14 CT3E ENV 1 F.'ONhIE19TRL LRB SERV 1 CES 1%10. 932 UO2 COMMERCIAL RCIA L TESTING !3e ENGINEERING CO. ENVIRONWNTAL I_AIWRATORY SERVICES S'NCC 1908 REPORT of ANALYSTS Chemlab Ref.# :93,2411-1 Client Sample XD :WOoni�IDGE SIJB, DIVXSXON G4 B1 Matrix tWATER Client Name :S & 6 ENGINEERING Ordered By :RAY Project Name Project# PWSID :UA Sample RemarksoTROUTINE: SANPLE (;oLLECTE:D QC Parameter Results QU81. -------------- Nitrate-N 2.7.0 U . J.K,B, 5633 B 5TREpT ANCHORAGE, AK 99510 TEL (907) 662.2318 FAX: (907) 551-5301 RUSH Order :66520 Report Completed :05/27/53 Collected :05/25/93 @ 16:37 hrs Received 105/26/93 @ 14:45 hr: Technical Director :W,rEPC, EDE Released By e Allownbl.e Ext, Anal Units mt;thod. (.Jm1t.:3 Date Date Ynit mg/f, EJ1A 353,2/300.0 10 05/26 LL( =—.Z-m=X. 52M==M"..=�_`. i�S3!]CC+m'C.'i ti'�SitSSS-C. Z ':,M==n.`ue :iY-�:=-----.--r=—. T M � C.C.'..".::::=i:.�.i6� See Special instructions Above UA u Unavailable *w See Sample Remarks Above NA - Not Analyzed U m Undetected, Reported value i5 the practical quantification limit. (..T = Less Then D = Secondary dilution, GT = Greater Than 81l WES Member of the SOS Croi,p (S(,cn616 G'3r)�rale ria Survoillanco) -1 A 0 f.`1'l) Sl.\ Time Time — APF'LK NT FILLS OUT UPPER HAl ONLY Time Property Owner /71, �,� / fJ �" /-- Date Phone Melling Address _ S� /J'J , / j� G=— —_ Zip Code 22 rL Date Buyer ,^r> Address Zip Code Inspector Lending InstitutionY�!� T.e. ,,.��. �j Phone j - Address Zip Code y � Y 0.0 Realty Co. & AgentPhone "Insp�tor �bt Field Notes: Address Zip Code Legal Description Street Location— / � Type of Residence RICE -110 9-8firtare Family t *CONDITIONS OF APPROVAL El Multiple Family No. of Bedrooms_1 ( ) DISAPPROVED ❑ Other ( ) CONDITIONAL APPROVAL' ,/— /`BY: Water Su // � //�� B" ndividual ����� S ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give wall depth (attach log if available). ❑ Public Utility BY: Sewer Dispo al. ❑�di iv dual CA K]-1 Year Individual Installed: ❑ Public Utility When Connected to Public Utility: Well To Absorption Area ❑ Holding Tank Well Log Received NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE: INITIATED. Well to Tank -1 A 0 f.`1'l) Sl.\ Time Time — Time ,. & Time Date Date Date Date I C) - "11-1 Q. Lam--) \Q a Inspector Inspector Inspector/,J� y � Y 0.0 "Insp�tor �bt Field Notes: MUNICc RICE -110 ( 3) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' ,/— /`BY: DATE _'?i V BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72 023 PIK)