HomeMy WebLinkAboutNORTH WOODS PHASE 2 BLK 1 LT 8North Wood Phas lock I Lot 8 051-741 -27 ;/  Municipality o£Anchorage ...--r Development Services Deparlmenl ' ". Buildihg Safety Division On-$ile Water and Waslewater P~rogram, 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page ~.cl. anchorage.akus (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Pe,mit Number: 6 ~O~O0 ~ d PlO Number: "-- ~ &~r ~ ~ ~ ~ Wastewater System: ~ New ~ Upgrade ~ ~B~ ~h;~;~u~;ct~. ~r:~ ~.~,~K ~q~ 57-5~ ABSORPTION FIELD Well: ~ New ~ Upgrade '~ ~~s~.. ~. ~t 'TANK SEPARATION DISTANCES ~ septic D Ho~m.g D S.T.~m. D Other: ~ Seplic Absorption Lift Holding PU~t~ M~:e ~ , C~tv ,-- e' 7' · m.s".l BENCH ~ARK .. S & S ENGiNEER;NO ~ )/ ~%..,~ Insp.ection~ p erf ormea'-oy: ~~ 170~ E,gle River Lo~ R~d, No.~ Ua~s: Develbpmept Services Department Approval Reviewed and approved by: ~///~/ ~ ~Date: PERMIT NO. SW020096 PAGE 2 OF Municip. ali't of' Ancho,r'gg.e' DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONHENTAL SERVICES DIVISION P.O. Box 196650 eAnchor'~ge, At~sk~ 99519-6650eTeteohone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 8, BLOCK 1, NORTH WOODS #2 PJ.D. NO. 051-741-27 TH//1 · EXISTING 1000 GALLON SEPTIC TANI -- rco~ ---NEW PUMP BASIN LOT 9 / / / / / / / / / / / / . / iI I I I I I I I I I I I I I I I I , I / / / / / 40' LOT 7 / (APPROX) , / / / C. COWAN CE.8801 PERMIT NO. SW020096 PAGE 3 OF 3 UnlClpoh~ o¢ .A.n c:h.o.c ~ g e DEPARTMENT OF HEA~TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 OAnchoPoge, AI(3sk(~ 99519-G650®Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L~'CAL LOT 8, BLOCK 1, NORTH WOODS #2 P.I.D. No. 051-741-27 FINAL GRADE.-~ ST1 % 93 5'// EXISTING 1000 ' GALLON SEPTIC TANK $T2 CO 1 MTI 100.6'--~ ,~...--FINAL GRADE ~-~ 2" INSULATION DISTRIBUTION PIPE 97.9 ~MT1 = 96.4' A ~ fCC 29.0' 22.0' - ~T1 36.5' 16.0' - ~T2 42.0' 12.0' - 201 44.5' 10,0' ~4H 46.5' 9.0' - · ~T - 70.0' 48.5' · WATER FOUND 85.9' B.O.H. 86.9' PRESSURE DISTRIBUTION SYSTEM: PUMP = 20 051 05HH - 5 STAGE (~30 CPM) Me~ 24 02 04:28p flllted 81aske Electric May 24, 2002 Elec~cal work performed ~ r~u~st of: On behalf of: To v&om it may concern: TWEED Excavating & Consm~cfion 17034 E~Ic River Loop Rd, Suite 202 Ea~le River, Ahska 99577 S & S Eng~eet~g The eleclrieal in.stallation of Ibc 1~ station at lot 8, block 1 - Northwood, located in Peters Creek, Alaska was performed by a licensed electrician, ia accordance with lhe current national electric code. Under penalty ofpe~ury, I certify the above information to be mae and correct. S~ncc~-ely, ALLIED ALASKA ELEC'ERIC, LLC Sanette L Bwwnf ~ ~t/Owner Tweed Excavating & Construction File P.O. Box $76310, Wa~illa, Alaska 99687 O~fwe (~07) $73-3595 / Cell 252-$657 /Fax SrJ-JS94 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bregaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 08, 2002 Expiration Date: May 08, 2003 Permit Number: SW020096 Legal Description: NORTH WOODS PHASE 2 BLK 1 LT 8 Design Engineer: 0003 S & S Engineering Owner Name: LARRY FINGAR Owner Addrass: 22336 WHISPERING BIRCH DRIVE CHUGIAK. AK 99567-5449 Parcel ID: 051-741-27 Site Address: 022336 WHISPERING BIRCH DR Lot Size: 58333 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 calling (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. 5.'Th~ following special provisions. , :; THE EXISTING BED SHALL BE PERMANENTLY DECOMMISSIONED OR GROUND WATER MONITORING ' ~,"DONE ON MAY 15, 2002 IN ACCORDANCE WITH AMC 15.65. Municipality o.f Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www .cl.anchorage .ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit N u mb e r SW Z_...~0_~q_.(z__ Property owner(s) ~.~/Z./Z."/ ~""J~-/~--- Day phone Mailing address (1) ~'~)~, {/~/..1, ,SP',C--"a..-I~-/~-' '7~tr'z-Ct4; Mailing address (2) Zip Code Legaldescription(Lot, Block&Sub'd.) ~0~ ~ ~10~ ~ It ~OF +~ ~00~ Legal description (Section, Township & Range) Lot Size~~ S Acre~ Number of Bedrooms ~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool  Well Only ~ Water Storage ~] Jacuzzi ~[] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Slngle Family Dwelling and is in accordance with applicable Municipal Codes. S & $ ENGINEERING (Signature of property owner or authorized agent) Permit Fees: t~ O O. ~ ' Date of Payment: 5-/"/ Receipt Number: 0 ~.~ (Rev. 12J00) I ~ Waiver Fees: Date of Payment: Receipt Number: ltmq May6,2002 ROBERT C. COWAN. P.E. CML ENGINEERS (907) 694-297B FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 8, Block I, North Woods Subdivision /~ Z_ It is requested that you issue a permit to upgrade a septic system to serve the existing two bedroom dwelling on the referenced property. A test hole was excavated and a pemolation test performed on 4/30/02. The approximate location of the test hole is located on the attached site plan. At the time of excavation, water was found at 6 feet. Ground water was monitored and after seven days water was found at feet as shown on the a~tached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. lfyou require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. Rccroii Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577 DRAINFIELD 3.5' DEEP 1.5' EFFECTIVE 5.0' WIDE 41' LONG LOT 8, BI,OCK 1, B.J.J. R.C.C. DESIGN 'ERIA: 2 BDRM = 300 SOILS = 0.8 GPD 300/0.8 = 375 SQ.FT, D, CRITERIA: THtlA N()RTII ~'OOI)S 5-15-02 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR 1'O ANY EXCAVATION WORK. DOUBLE CLr'ANOUT~ £XlSTING 1000 GALLON SEPTIC FCO S 1 OF 1 300 PUMP BASIN WITH S.T.E.P. LOT PRESSURE DIST. DATA: 1) LATERAL 39' LONG 1.25"~ 30) 3/16"~ HOLES 0 15.5" APART MANIFOLD 1.25"~ / /. 9 / / / / / / / / LOT 7 / / / / (APPROX) / CE-8601 / / / / / / / / / / / / / / / ~'// / / / / / / Municipality o~ Anchorage e~~'s'~ '~.~,,,p~, Development Servlces Depadment I ~?' "~ ~ ~ Bu~dngSafe~sl~ ~~--~~~'h~ ~ ~ ~ ~., ......... 6650 ....................... * ........ *'*~ P.O. Box 1966~ ~ge. ~ ~u- I ~ ; I · ~ ~ ROBEET C COWAN ~ (~7).3-7~ I '/J~,:',.. ~-ss~, ..~ I ' ~' "' "''' ' Soils Log Percolation Test I 2- 3- 4- 5- 6- 7- 8- 9- 10- 1~- 12- 13- 14. 15- 16- 17- 18- 19- 20- / I Silo Plan COMMENTS WAS GROUND WATER ENCOUNTERED? · IF YES, AT WHAT DEPTH? Depth to Water After Monllorlng? Date: Reading Dale Gross Time Nel Time Depth lo Water Net [hop /-- /0 Io I1" 5" /o /o ~7~" io /o ~" PERCOLATIO~I RATE TESTRUNBETWEEN ~;~.~"" FT AND 4.¢ FT PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON TNIS DATE. DATE: Municipality of Anchorage Development Services Department Building Safety Dtvislo~ On-Site Water and Wastewaler Program ~3s,~--.v. ~ ................. P.O. Box 196650 Nlchorage. AK 99519-6650 't "~.-, % ./,rD "" Soils Log - Percolation Test , Slope Site Plan 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- COMEIENTS ~H WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? . Depth to Water After Reading Date Gross Time Net Time Depth to Water Net Drop o 0 ~' 0 0 PERCOLATIOH RATE ~ (mmum~nc~! PERC HOCE DIAMETER TEST RUN BETWEEN~. FT AND ~"-- FT PERFORMED IN ACCOR~)ANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,,,~'"/~- ~ "Z.. ROBERT C. COWAN, P.E~, ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CML ENGINEEI'~ (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 8, Block 1, North Woods Subdivision -~ 2_. May 6, 2002 GENERAL: The scope of this project includes the installation of an absorption bed to serve the existing two bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit or ADEC Authority to Construct 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 speciftcally agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing waste~vater disposal systems must be certified by the Municipal Health Department or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septi6 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, A~J~KA 99577 Page 2 Lot 8, Block 1, North Woods S/D May 6, 2002 4. Septic tanks installed with less than 4 ft. ofcover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts. These cleanouts shall be located on undisturbed soil not more than 10 ft. from 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 from the septic tank. LEACHFIELD BED INSTALLATION: Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (rafted-up) before gravel or sand placement. Ifa sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches oflevel. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. Silt barrier material 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 at 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 depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. The monitoring tube should not extend below the bottom ofthe gravel surface. 7. 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 finished grade over the bed must be mounded to prevent the formation ora depression after settling. 8. A mound system is to have the upper six inches oftop soil and be seeded for vegetation. Page 3 Lot 8, Block 1, North Woods S/D f~ ?'' May S, 2002 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 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 F8 i 0 (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 Ill 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% igth ' pass n e #200 steve. When sand is being used as a filter material, its gradation specifications must conform to current MOA or ADEC requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation ofthe 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. Page 4 Lot 8, Block 1, Notlh Woods May 6, 2002 3. The final inspection is to occur upon final grading of the property. 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 ogler shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached MOA permit or ADEC Authority to Construct. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance ofthe contractors work rests with the oxvner. 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 / INSTALLER ~-~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION LOCATION Manufacturer ~ ' ILiq. capacity in gallons c u~c~A ~= /~2~2o ........ ~ ..... : D STANCE TO' Well ' I Manufacturer Well DISTANCE TO: I No. of hnes I Length of each hne Top of tile to finish grade Length ~ j Width , / Type o~ J Cri.~er PHONE Absorption area Dwelling ¢~' ~ / Material Inside length Width t~'~: ~ NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation Nearest lot line PERMIT NO, Total length of lines Trench width Distance between lines Material beneath tile inches Total effective absorption area inches Depth ~ ~.~ PERMIT~)) ~- //~ ~:'~ NO. Crib depth- [~NEW [] UPGRADE Building foundation Driller Sewer line Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS . SOIL TEST RATING INSTALLER REMARKS I.) ¢ 72-013 (Rev. 3~78) 0 ~---~/ ' DATE LEGAL //9 " - DEPARTMENT HEALTH AND ENVIRONMENTAL .;OTEF:TIF '~3N-~ ' ~ ' ' ' 825 "1-" STREET, ANCHORAGE., AK. 9950t~Q,/~~ "~ "~4-4720 PERMIT NO. ( 82105b ) aPPLICANT STEVEN L SKRGSS CONST PO BOX C, CHUGIAK 9--q75~,,-''%~GBB-28J.1 LOCAT I ON LEGAL LSB'I NORTHWOODS I I LOT SIZE 999999 _,QLRRE FEET TYF'E OF SOIL ABSURFTIUN =,-r_TEM IS: DRRINFIELD MAXIMUM NUMBER uF BEE. R_ICM_ = ? _uIL RATING (._,Q FT/BR)= ' - "' - ' I '-' '~ I S THE REQUIRED SIZE OF THE SOIL HB=.URPTIEN .~z_TEM : [:'EPTH= 7- LEi%I6TH= 77 GF-.'R %-'E L [:.EPTH= __- -:"' THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TREt4C:H L. JI[)TH I5 5. 0E~0 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) REL-J. LI I REE:, SEF"T I C TR[-~K $ I ZE= t01ZI0 6RLLOI'-.IS PERMIT APPLICANT HAS THE RESPUN=,IBILIT~ TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSFECTILN=, OF ANY WELLS ADJRE:ENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THRT THE WELL WILL TWO ,~ 2 ) I FISPEL'~-"~ I l_~r-J$ ARE RE~LI I RFD BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE _,LIBJE_.T TO PROSECUTION· MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A'PRIVRTE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET· OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT :L: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. -~: I UNDERSTAND, THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN -?- BEDROOMS. , '"~ ~ ~' ~-' C ~ " ' S GN D:_. O & E ENG,.NEERING & DEVELO, MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oysler Earl Ellis 694-2774 SOIL LOG 688-2280 8__ 9__ 13 14 Depth (feet) 0 Soil Characteristics 's P- 5/t4- 2.20 Ground Water Encountered: Yes Proposed Installation: Comments: ~' No If yes, what depth Drain Field Seepage Pit Performed by: PLOT PLAN PERC. TEST • a �E e • Municipality of Anchorage ° On-Site Water and Wastewater Program 2` " (907) 343-7904 s A E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL t Parcel I.D. 051-741-27 Expiration Date: Cjc '-Zl r1 1. GENERAL INFORMATION Complete legal description NORTH WOODS PHASE 2 BLOCK 1, LOT 8 Location (site address) 22336 WHISPERING BIRCH DRIVE, CHUGIAK,AK 99567 Current Property owner(s) ARNOLD &JOY CULBERSON Day phone Mailing address 22336 WHISPERING BIRCH DRIVE, CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 (TESTED AS 3) TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ❑ Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System Waiver/Variance request for: Distance: Received by: ,, • Date: 7/4-//' COSA to be released to the engineer, unless othy�11'requested by the engineer. COSA Fee $ S Waiver Fee $ Date of Payment (p1 /il Date of Payment Receipt Number (A (00 Receipt Number COSA# 0(e.1 1 (7 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 6/23/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING._Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ��\ encroachments,deficiencies or discrepancies exist. OF Az Ar * 4 9 JiH K 6. DSD SIGNATURE /- - Amm�= �'3. System #1 Approved for bedrooms. �� t:Et`r:r. pis DL!�US71 System #2 Approved for __ bedrooms. 4 if", ���� ;� ()�� '�bFF;ssio':O" Disapproved. � 41.' Conditional approval for bedrooms, with the following stipulations: .��( OF A!N , U S1�E C Wp\l'ER AN ER zo _ S70A '7� W PROGRAM U •,<„, .c j. By: � �^-� Original Certificate Date: 7 5 r1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.tloc 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: NORTH WOODS PHASE 2 BLOCK 1, LOT 8 Parcel ID: 051.741.27 A. WELL DATA — PUBLIC WATER Well type If A. B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N)Y 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 olonies/1 00 mL Nitrate v15 g/L Arsenic: D ug/L Date of sample: _4/2,..0 7 Collected by: 4yG'/e-r IA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC /STEEL W/LS Date installed 10/1982&5/21/2002 Tank size 1000&280 LS gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 6121/2017 Pumper ONE STOP C. ABSORPTION FIELD DATA Date installed 5/21/2002 _ Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH Length 41 ft. Width _5 ft. Gravel below pipe 1.5 ft. Total depth 4.5 ft. (Measured 6/22/17) Eff. absorption area 263 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/22/2017 Results (Pass/Fail) PASS_ For 3 bedrooms Fluid depth in absorption field before test 7 in. Water added 450 gal. New depth 16.5 in. Elapsed Time: 1440 min. Final fluid depth 7 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 5/21/2002 Size in gallons 280 Manhole/Access (Y/N) Y "Pump on" level at 48 in. "Pump off' level at 51.5 in. High water alarm level at 44.5_ in. Datum TOP OF LS CASING Cycles tested 2 Meets alarm &circuit requirements? Y E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO. Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS Vacant system presoaked per code prior to testing. G. ENGINEER'S CERTIFICATION I certify that l 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. 411 OF � AarL `1 Engineer's Printed Name KENNETH M. DUFFUS Date 6/2312017 ` 49 TN .40/1 x'%37/ 9 KEN L'TH , . DU' / COSA canary sheet_2-6-15.doc 1 �� e /4.4' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. (~ I'- "-) L~ { _ ~ 1. GENERAL INFORMATION ~'~ Complete legal description Nort¢oods ~ S/D,4~k-~'L'~ Location (site address) 22336 Whispering Birch Dr., Chugiak, AK Expiration Date: Current Property owner(s) Hans Leukuma Day phone 688-0407/H, 350~9519/C Mailing address P.O. Box 671965, Chugiak, AK 99567 Lending agency Residential Mortgage Day phone 694-8818/0, 317-8814/c Mailing address 11901 Business Blvd., Eagle River, AK 99577 . RSa[ Estate Agent FSBO ,,': Mailing AddreSs P.O. Box 671965, Chugiak, AK 99567 Unless'otherwise re:'q'uested, COSA will be held by DSD for pickup. 2. NUMBEROF'BEDROOMS: 2 Day phone 688-0407/H, 350-9519/C 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water · samples:) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name DSD SIGNATURE ~'/ Approved for Disapproved. Conditional approval for Phone (907) 746-1073 Douglas T. Kenley Date '7_ '-/ . [ I. bedrooms, with the following stipuleS: ' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Departmerrt ,Building Safe,Division On-Site*Water & Wastewater Program 4700 Eimore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. munLorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: No~lhwoods#2 S/D, Block 1, Lot8 A. WELL DATA Well type Public Date completed Total depth Well production WAT . Coliform / colonies/100 mL Nitrate If A, B,-or C provide PWSID # Well Log (y/N) seel (Y/N) ....... V~re~ p~e.y pro~ed~ SanitarY Cased to ~ __ff. Casing' hei~round) in. FROM WELL LOG ~cTIO~ ~ mg/L Collected byi B. SEFnC./HOLDING TANK DATA Tank Type/Material Septic/Steel/* Date insteik~d 10/82-5/21/02'* Tank size 1000 gat. Foundation cleanou.t (Y/N) Y Date of pumping. ~,'3/8/11 Number of Compartments 2 ~ .._.Cleanauts (Y/N) Depre~i?n og~r tank (Y/N) N ' High water alarm (Y/N) Pumper JR'S Pumping Y Y Length 41 Total depth 4.4 Date of adequacy test Fluid depth in absorption field before test 0. ir~... Elapsed Time: 75 min. Final fluid depth , ,4 Any rejuvenation tmatmem (past 12 mo.) (Y/N & type) ~ rating (g.p.d./f~or'f~2/bdrm) 1.2 fL Width 5 fL Eft. absorption.area 263 .fi2 Monitoring tube 7/6/11 . Results (Pass/Fail) Pass Water added, 493 gal. ,, in. Absorption rate >= System type Shallow Trench Grav~ beJow p~e 1,5 Y Depreseion over field N , N For 2 bedrooms New depth6-7/8 in. 300 g:p.d. If yes, give date .... UFT STATION Date inStalled 5/21/02 'Pump on" level at., ,46, in. Datum Top of lift station casing E. SEPARATION DISTANCES Size in gall~.ns. 280 - "Pump off' level at 51.5 in. Cycles tast~:] ~ 3 SEPARATIO~i.. DISTANCES EROM~ ,LL ON LOT TO: Septic tank/lift station on lot Absorption 'field on lot Public sewer main ~ Animal containment areas 50+~ff. Manhole/Accass (Y/N) ,,, High water alarm level at 44.5 Meets alarm & circuit requirements? Y in. On adjacent lots On adjacent~' ' Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas l~+ff. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK'ON LOT TO: Building foundation 8 ft. Property line 53 ff. Water main 10+ ff. Water service line lO+'ff. Wefts on adjacent lots'i, 200+ fL SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 42 ft. Building foundation 20 fi. ~ater ~ line 1~+ ff. Surface water 100+ ft. Cai"lain drain None known Wells on adjacent lois ' 200~ 100+ lt. Water main 10+ 'ff. Re~ Numar (Rev. 4110) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY'APPROVAL FOR A SINGLE FAM'I~.Y'D~VELLi~G'."..i., Parcel I.D. ¢,,O.C'/-'7~[- ~-7 .l. GENERAL INFORMATION :' Complete legal description LO 7- .... "Location (site ~'~ldress or directions) Current Property owner(s) HAA # Expiration Date: Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ;Z 3. TYPE OF WATER SUPPLY: ' Individual Well J--J Individual Water Storage [] Community Class J~ Well [] Public Water System ~ TYPE OF WASTEWATER DISPOSAL: Individual On-site J~ 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 flue (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 hcmeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C we!l and may be reissued with new water sample results. (Certificates may be reissued fcr a pedcd of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B we!Is er 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 vedfy that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. ENGINEERING Name of Firm 17034 E~ile River Loop Read No. ~0~ Phone. Address £~le River, Alaska Engineers Pdn~ed'Name ~08~ ~- ~o~ Date ,, 5. DSD SIGNATURE Approved for Disapproved. ×X Conditional approval for bedrooms. bedrooms, with the following stipulations: Money in the amount of 1.5 times the high bid of a minimum of three bids from approved contractors shall be put in escrow to construcl' a new ,wc~stewater di~pos(~l ~y~lem pur~uunl to p~,'m;l ' SWO20096 " " ' [lUntUci' ul lu~l~u. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other £g~T Ivu~E~, 5c~O~OOq~ Odginal Certificate Date: ,~1~1~ ·m ~ Municipality of Anchorage Development Services Department Building Safety DMston On-Glta Water & Wastawater Program 4700 South Bmgaw GL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (g07) 343-7g04 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescdption:L07- ~' ,G~.oc~c I /vdAT-H l~,o/O.c ~. ParcellD:.O~"/-'Tffl-~7 Re WELL DATA Wall type ~ Date completed Total depth Date of test Static water level Wall production WATER 8.~~: If A, B, or C provide PWSID # ~/3ool Wall Log (Y/N) SanltaP/seal (Y/N) Wires properly p~ fL Cased 1o fL ~ (above ground) in. FROM WELL LOG ~.~AT INSPECTION J g.p.m, g.p.m. Nitrate mg./I. Other bacteria __ Date of sample: Collected by: colonies/100 mi. e. SEPTIC/HOLDING TANK DATA TankType/Matedal Se.,e;-jc. / s;'7-~.~. & Tankilze )ooo gal. Numbar of Compadments ~- Foundation cleanout (Y(.~0 ~uo Depression over tank (Y~.~)/v e Oataofpumplng ,~/~.~/o ~- Pumper. 1'/Z j C. ABSORFTION FIELD DATA' Date installed Cleanouts (~fN) High water alarm Date installed/e/~"~. Sail rating (g.p,d./ff~ or~~_~O Leng~ · * ,~ ~. fL Width '5 ~" fL Total depth fl ~'/ fL Eft. absorption area/0~ ~ ~ Monitoring tuba Data of adequacy tast '~/,~%fl/o~- Results(Pass/Fall) F,~/-. '~' Fluid depth in absorption field before test )~- in. Water added -- gal. Elapsed Time: min. Final fluid depth Any rejuvenation fl~lment (past 12 mo.) (Y/N & type). ~stem ~ ~ ~ O Gravel below pipe CO - 5'- ff. Depression over field ~v o For ~-' ,bedrooms Now depth" in. in. Abaorpflon rate >= $#r~,,~O g.p.d. ~ If yes, give data ~ D. UFT STATION Date installed Size in gallons ~ 'Pump on' leve~ in. High water alarm ~vel et Da~_~m Cycles tested Meets alarm & circuit requirements? ee SEPARATION DISTANCES SEPARATION DISTANCES FROI~I WELL ON LOT TO: Septic tanYJliff station on lot Absorption field on lot Public sewer main On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: · / Building foundation Water main I Water sewice line /o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I 0 + Building foundation J o -/.- Water main Weter Service line !0 -f- Surface water JoO ')- Driveway, parkingNehlcle~tomge Wells on adjacent lots Curtain drain F. COMMENTS in. G. ENGINEER'$ CERTIFICATION ~ .~. revfew or Municipal mcoro$ met the above systems am in ,~.-~'"'~....~/~?,..~,~..~ I-IAA Fee $ Date of Payment Receipt Number (~ev. ~2m~) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05' I -'7 '/I - ~'-7 1.:' i3ENER~L INFORMATION 7.- Complete legal description Lo 7' · ' Locatk/r~ (site address or directions) Current Property owner(s) · .. Mailing address Lenc~i~g agency HAA # 14 ,~ 0 ~-0 t $ 0 Expiration Date: _A"-- 3 o - (.3 '~ Day phone ¢o 5',¢- o/77 Day phone Mailing address Real Estate Agent /vM~fl,~ ~,~,~.c,~,.~ '-VtSr,~. Dayphone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: ' Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Deve!opment 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 cf Health Authority Approval are required for the transfer of title (except be,Wveen 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 prcperties sewed by a private or Class C well and may be reissued with new water sample results· (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties se.wed by CZass A or B we!Is or a public water system. The Municipality of Anchcrage is not responsible fcr errors cr omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage flies 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 $ & $ ENGINEERING Phone 370,14 Eagle River Loop Road No, 204 Address Engineer's Pdnted Name R0p/~A7- C. ~'o,,.u,4.,,., Date, ,?'/,~'~/o "'-- O.q r e,~o, ,'-',,,,,~.~. )./~. ~. /'~ ,~. ~,.,~, .s'~',Z. 4 . DSD SIGNATURE J Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-~fiite Water & Wastewafer Pro, mm 4700 South Bmgaw SL P.O. Box lg6650 Anchorage, AK 99519-6650 www.cLanchorage.ak.u$ (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDascflption:LeT <~ f~LeC~ I HoAr/t~/OO/J #2_ ParcellD: A. WELL DATA Well type ~ Date completed Total depth ft. Date of test Static water level IfA, B, or C provide PWSID #L.~ J ;)oo / Wall Log (Y/N) fj Sanitary seal (Y/N) Wires pmpe~ pm~/N) Cased to tt Cesing~.l.l~ (above ground) in. FROM WELL LOG ~,,~K~NSPECTION ff. J g.p.m. ~; g.p.m. 1Nell production WATER SAMP ..... Coliform ./'"'- colonies/100 mL Nllmta mg.A. Other bacteria ~ mg./t. Data of sample; Collected by: B. SEPTIC/HOLDING TANK DATA ' " Tsok Type/Matadal Tank size / 4o O gal. Number of Compartments · 'Fsunda~ion deanout~N) ¥~ Dapm~ion over tank (Y~) · oate of pumping 3/~-~/ oo.. Pumper C. ABSORPTION FIELD DATA Le~gth, ~1 ft. Wtdm colonies/100 mi. Date installed Cioanouta ~1) High water alarm Total depth . Date of adequacy test ~/~ -/~ ~/ Results (P~.~~ Fluid depth in absorption field be~ Water added gal. Elapsed Time: ~lnal fluio dep~ in. Absorption rate >= Any~atment (past 12 mo.) (Y/N& type) If yes, give date System type $/J4~.L,I ~ Gravel below pipe / - ~ ft. Eft. absorption area~.6.~ ~ Monitoring tube >Y.-,~ Depression over field ~' ~ For ~ bedrooms New depth in. g.p.d. D. LIFT STATION 'Pump on' level at ~ ~' in, Datum 7-~/ ~ /~ E. BEPARATION DISTANCES Size in gallons ~t. 'Pump off' level at ~'l*-;"in. Cycles tested Manhole/A~cess ~/N) ¥~ High water alarm level at '~- ~ in. Meets alarm & circuit requirements? '~ ~'. SEPARATION DISTANCES FROM WELL ON LOT TO: C oa ~u,., ~ y On adjacent lots Septic tank/lift station on lot Absorption field on lot Public sewer main ~eanout ' Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~ Property line [' J Absorption field Watermain /0 '/- Water service line /O '''/- Suffacewater Wells on adjacent lots ~ {) O '+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: PropeAy line ~ ~- / ~ ' Building foundation ~-O Water main / 0 -F Water Service line / 0 -A Surface water ,/O O -/- Driveway, parking/vehicie storage O · Curtain drain~a~'e *:"~"~ Wells on adjacent lots ~-4)0 -/ F. COMMENTS G. ENGINEER'S CERTIFICATION , cer~ tha,,.ave ~aterm,... ~..u.,.o,.,..~o.. a.d~'};/ ~:;" ~"'~'~\' review of Municipal records that the above systems are in conformance w#h MOA HAA guidel/nes in effect on this date. ~ ,~... c~...o.'-/..~.~ Data -f"/~' HAA Fee $ Waiver Fee $ Date of Payment Data of Payment Receipt Number Receipt Number (Rev. ~2/0e2 H~IY-~-L:~2 10:t2 ~.S ENG IhEF_R I NG cj~'] 694 1211 P.02 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON, THE INFOI~MATION HEREON I$ FOR THE USE OF [ENDING INSTITUTIONS SPECIFiCALLy TO sHOW ANY CONFUCTS BETWEEN EX~$TINO STRUCTURES AND PLATTED LQ'I' LINE8 DR EAEEMENTa AND IS NOT TO BE USED FOR POSlT~ONINQ ADDrlqONAL S"~RUCTURES OR F£NCELINES. "ASBUILT" Nocorne~$ set Book Pg F/CC ~ ~., / ~OT~ P.~ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING CS"i ~'-1 HI- ~'7 HAA# ,~'~1 ~-~' ~"\~ ~ -~, -~ 1. GENERAL INFORMATION Complete legal description Lot 8; Block I; North Woods Subdivision #2 Location (site address or directions) Property owner Mailing address Matth~v Werner 22536 Whisperinrq Birch Chugiak, AK Day phone Lending agency Mailing address Day phone Agent Address .,' Don McKenzie Real Estate 13135 01d Glenn Hwy. Eagle River, AK Day phone 99577 694-9055 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well ×XX Public water MUNiCiPALITY OF ANCJ-tORAOt~ ENVIIiONMENTAL SERVICES DM$1ON JUN 13 t995 RECEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & S ENGINEERING 17034 Eagle River Loop Read .No. 2(',4 Address Ea~_le River, Alaska 99577 Engineer's signature -~ . _ ,,/--~..- Phone Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: AdditiOnal Comments / By: ~/~/...¢..~,.--~/...~-.,'.-~2,~,~,~.,~-._ Date g //~/-' f Mumcipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Certificates based only upon the representations given in paragraph 5 above by an independent L""'~J meer registered in the State of Alaska. The D H HS does this as a courtesy to purchasers of homes ~-~,~,m(:j ,nst~tutions in order to satisfy certain federal and state requirements. Employees of DHHS do not ~'z'~"='~-"~,~ns or analyze data before a certificate is issued. The Municipality of Anchorage is not en'~s o, om~s~ons in the professional engineer's work. 825"L" Street. Legal Description: L-o-C ¢ ~D~tc- [- /~h::)~ 2 Parcel LD.: ~>~l A. WELL DATA .. - :: Well ~e IfA. B o~C Log present (Y~ : Date complete4 Total depth C~sed to Sanitary seal (Y/N) - - - FROMSWELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. - . g.p.m. WATER SAMPLE Coliform Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA :. Date installed {,O ~'7-~ ' Tank s3ze [ oD 0 Number ofC0mpartments' Z Cleanouts [CAN) Foundatiqn~.~leaflO'~(~.~, / Depression (Y~) p/ HigtiWater.~larm~(Y/N) Date of, pumping ~ ~ I% c~:~ ~mper 2,~fe~ . (~OOaf, ~ h C. CBSOR~ION .... . ...... ~ ) 6ate installed to ~ a~ ~' Sdl rating (g p d/fl2~or a%am) System me Len~ ~ W~dm.?~ ~ Gravel tMckness beloW p~peO,m~on~ 'TotM depth O~q~ ~Moffitbrin TUbe~;ese ~'~ De ressionoverfi;ld EffectiVe abso~tion~ ~ area ] ,: g p. n~.:. ~ p ~ Date of adequacy test ~-x~ ~ b. Result~aij) ~ For ~ ' bedrooms. Fluid depth in abso~tion field before.test (m.): . hmediately ~e~ ¢-~al. mate~ a~ded (in.): Fluiddepth It~ (ins',l Minutes ~iate~: ~ Abso~tionmte =' *.~ ~: , g.p.d,' Peroxide treatment (past 12 months) (~ /O ~ ~ ~ ~a ~ [f yes, give date ' D, LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on~ High water alarm level at* ~ *Datum "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ On adjacent lots Absorption field on lot : On adjacent lots Public sewer nmin ......~ manhole/cleanout S~ervice line Lift station SEPARATION DISTANCES FROM~rrI'-OHOLDING TANK ON LOT TO: Building foundation ~.. i4- Property line Io ~ ~' Absorption field Water main/service line \o ~- Surface water/drainage ~ o~ ~ ~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ o ~& Surface water ~,c> ~ Curtain drain ~ g~o o90 Water main/service line Driveway, parking/vehicle storage area 5-~ Wells on adjacent lots ~ ~ x P- Property line F. ENGINEER'S CERTIFICATION 1 certi~ that I have determined thrufield inspections and review of Municipal recora~~ems are in conJbrmance with MOM HAA guidelines in effect on this date. ~~""~C,~n$, Signature ~ ~ ~ ff~gt~ ~ '}~ ....................................................................................................... ~'~&'mxx-~"~ .......... HAAFee $ ~ "~, ~ Waiver Fees Date of Payment ~ Date of Payment Receipt Number ~~ ~ ~ ~ Receipt Number Rev. 8/95 DSS: haa.wk.doc J J i APPLIC-~NT FILLS OUT UPPER HA(-~ ONLY Proper~y oW P,~,r Phone Buyer ,/~~ ~ ~..~'~,~,j~,--~ · '~ Zip Code Address Lendinglnstitution ,~,~L,~,~,.~/?_ ~'~ ~'"~.,~. ~ Phone Address r)-) ~'--~'0 ~ R,'~.~.-~ ~ Zip Code ¢ 7~-'~) · - Phone Realty Co. & Agent ~0~..~~ Address F~,~ )/'~,/~. ~ /-.~.~:~,,~. ~I J,~ ~ Zip Code Street Location Type of Residence [~ngle Family [] Multiple Family No. o[ 8edroom~ [] Other Water Supply [] Individual . ATTACH WELL LOG. A well log is required for all while drilled since June 1975. [~'ommunity For wells drilled prior to that date. give well depth (attach log if available). [] Public Utility Sewer Disposat Year Individual Installed: u dividual blic Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ~,~ Date Date Date Date ~ Inspector Inspector Inspector Inspector Field Notes: J~UNIClPALITY Of ANCHORAGE DFPT OF I~E&l-T~l & ENViROi qMs:i,4 i-AL p¢.O i ECTION gOT ~ lg8~ RECE! ED ( '~.~APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL AP.~,~ROV~,L* DATE f O~--- ~1~ ~c~ ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received /0~-9 Z.- We,,toTan~ Sep,c T~.~ S,zs 72-023 (3182)