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WOODRIDGE BLK 2 LT 6
Woodridge Block 2 Lot 6 #020-093-14 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131346 PID Number: 020-093-14 Dwelling: N Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New N Upgrade Name: Eric West ABSORPTION FIELD ❑Deep Trench El Shallow Trench ❑Bed ound Address 16500 Virgo Ave. Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth fr original grade 907.223.3252 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Woodridge, Blk 2, Lot 6 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel wIdX Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer I Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 104 - - >100 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1250 Gal. Surface Water >100 v Material Number of compartments Lot Line >10 0� Steel 2 NA Foundation >10 LIFT STATION Manufacturer Capacity Curtain Drain NA Gal. Remarks *** Tank Replacement Installed only *** Pump on level at Pump off Ism High water alarm at **SS G Iv existing field clean out with new graded in. in. opposingclean out within ten feet of tank Pump make odel Electrical Inspections performed by 77 PIPE MATERIAL House to tank 3034 Tank to 3 dreinfield 034 Installer A + Home Inspections Drainfield na CO/MT Inspector Chuck Leet BENCHMARK (Assumed elevation) , 3 it Inspeection fn 9/30/13 9/30/13 Location and description ction 2.d 3m 4'h IIV4.67 o f 7-AY s c- COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: F At 111 Date q . . 9tx Cllalee A. Leet • w + Approved Date 1 1 • • •. • •';� 1111;:::::•��'' inspection Repon_a-1+¢.po� / LOT 6 BLOCK 2 IGO. I,:cn�l R S 1 / LOT 6 BLOCK 1 / LDG 1250 GALLON L A SEPTIC TANK LOT 5 BLOCK 1 (ANCHORAGE K & G) \ BLE I I� C AN OUT rn3 n S� AN OUT 1' - ev MONITORING TUBE Q 0 0 e: S SWING TIES DESCRIPTION BLDG CRN A WELL A SEPTIC TANK 1 44.5 107.6 B SEPTIC TANK 2 49.5 106.5 C DOUBLE CLEAN OUT 52.5 106.4 D CLEAN OUT 91 128 E MONITORING TUBE 91 129 / \ LOT 5 BLOCK 1 JLOT 5 BLOCK 2 LOT BLOCK 1 rPo. J l IFC71 RA US capped vents DHL. CLEAN OUT"OG/FG105IN soli 7.7' absorptionsystembyothersINV. ELEv. 101.1 K (Anchorage Tank & Welding) g000ppp�� ALASKA RIM ENGINEERING, INC. a ❑F9131 q �� E. FRONTAGE ROAD, SUITE 1 > P"��.•°.. ° �9f�� PALMER, AK 99645 PH: (907)745-0222 : FAX: (907)746-0222 IL: akrim®alaskarim.com WEB: www.olaskarim.com ?'49TH *�� ACRE EMAIL:WD: 13-00581 PAGE: 1 ° Charles. A.°Leet °,'� d Englneem: Plannem: Surveyors CE 10480 °.' Single Family Septic Tank Replacement �F �4 WOODRIDGE SUBD. BLOCK 2, LOT 6 ©2013 MUNICIPALITY OF ANCHORAGE' `" ' Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION r ' �7 Parcell.D. 020-093-14 Property owner(s) Eric West Day phone 907.223.3252 Mailing address 2330 Canary Court, Anchorage AK 99515 Site address 16500 Virgo Ave, Anchorage Legal description (Sub'd., Block & Lot) Woodridge Subd. Block 2 Lot 6 Legal description (Township, Range & Section) Lot Size 43747 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank ❑x Upgrade FK1 (w/wo ADU) Duplex (D) ❑ Holding Tank ElRenewal E]Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certi"at the above information is correct. I further certify that this is in accordance with appJ� 6bS a Municipal Cokes. of Permit/Rush Fees: 43,-)0 Waiver Fees: Date of Payment: 912611�3 Date of Payment: Receipt Number: G'0aw} Receipt Number: Permit No. LIL toISJ'�y(a Waiver No. Permit App__ ::L.:c, On -Site Wastewater Disposal System Permit Permit Number: OSP131346 Tax Code Number: 02009314000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Septic Permit Effective Dates: September 25, 2013 to September 25, 2014 Design Engineer: ALASKA RIM ENGINEERING Subdivision: WOODRIDGE Site Legal Address: WOODRIDGE BLK 2 LT6 G:3337 Owner/Address: WEST ERIC R LIVING TRUST 16500 VIRGO AVE ANCHORAGE AK 995165344 Site Mailing Address: 16500 VIRGO AVE, Anchorage This permit is for the construction of: Lot Size in Sq Ft: Total Bedrooms: 6f-30-13 43747 4 N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: Date: q#S �3 / CO: aJ Subject: Tank Replacement Dear Ms. Wockenfuss; An adequacy test was performed on September 17, 2013, on the subject lot. During this testis was determined that the 1,250 gallon steel tank was leaking. This narrative is provided to; request approval to replace the existing tank and how the replacement will be performed. Tank Replacement We propose to remove the existing tank after it has been pump. The tank will be smashed and hauled off site to an appropriate disposal location by the contractor. A new 1,250 steel septic tank will be installed in in the same location as the old one. We will verify that the appropriate cover is placed over the tank. . Clean Outs We will verify that the foundation clean out exists and that there is an opposing clean out after the tank. If there is not a foundation cleanout or opposing clean out they will be installed. Upon completion, we will provide record drawing of the installation. Should you have any questions or comments please do not hesitate to contact me by telephone or email chuck@alaskarim.com. Sincerely tom/ harles A. Leet, P.E. Senior Engineer ALASKA RIM ENGINEERING, INC. ENGINEERS—PLANNERS—SURVEYORS 9131 E. Frontage Road Palmer, Alaska 99645 Telephone (907) 745-0222 Fax (907) 746-0222 Online at: w .alaskarim.com September 20, 2013 Deb Wockenfuss Onsite Water and Wastewater Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 RE: Woodridge Block 2, Lot 6 Subject: Tank Replacement Dear Ms. Wockenfuss; An adequacy test was performed on September 17, 2013, on the subject lot. During this testis was determined that the 1,250 gallon steel tank was leaking. This narrative is provided to; request approval to replace the existing tank and how the replacement will be performed. Tank Replacement We propose to remove the existing tank after it has been pump. The tank will be smashed and hauled off site to an appropriate disposal location by the contractor. A new 1,250 steel septic tank will be installed in in the same location as the old one. We will verify that the appropriate cover is placed over the tank. . Clean Outs We will verify that the foundation clean out exists and that there is an opposing clean out after the tank. If there is not a foundation cleanout or opposing clean out they will be installed. Upon completion, we will provide record drawing of the installation. Should you have any questions or comments please do not hesitate to contact me by telephone or email chuck@alaskarim.com. Sincerely tom/ harles A. Leet, P.E. Senior Engineer ALASKA RIM ENGINEERING, INC. ENGINEERS—PLANNERS—SURVEYORS 9131 E. Frontage Road Palmer, Alaska 99645 Telephone (907) 745-0222 Fax (907) 746-0222 Online at: N w .alaskarim.com September 24, 2013 Jay Crewdson, P.E. Onsite Water and Wastewater Municipality of Anchorage P.O BOX 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 RE: Woodridge Block 2, Lot 6 Subject: On -Site Review Response Dear Mr. Crewdson; Per your request, we will verify that an opposing cleanout is within 10 -feet of the outlet end of the tank if one is not installed one will be installed. Upon completion, we will provide a record drawing, inspection report of the installation. Should you have any questions or comments please do not hesitate to contact me by telephone or email chuck@alaskarim.com. 5arle A. Leet, P.E. Senior Engineer NOTES: 1. VERT% ALL CIEANOUTS AND MONITORING TUBES ARE INSTALLED AND IN OPERATIONAL ORDER. 2. REPLACE EXISTING 1,250 GALLON SEPTIC TANK VITN A NEW L250 GALLON STEEL SEPTIC TNN(. OF 49TH rpeee.eN aee°aae Charles A. Leet CE 10480 .... SEPTIC SYSTEM PLAN AL =4= RADjus. ALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE ROAD, SUITE 1 PALMER, AK 99645 PH: (907)745-0222 : FAX: (907)746-0222 EMAIL: akrim@oloskarim.com : WEB: www.olaskarim.com W0: 13-00581 PAGE: 1 Engineers: Planners: SurMaa Conventional Small Commercial Facility WOODRIDGE SUBD. BLOCK 2, LOT 6 ©2013 1 3 Mov. 3/78) �")' MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ��ENVIRONMENTAL *1W ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE (�/f 0�M '/�,� . P�rW--y— ,/ I7I ] UPGRADE MAILINGf ADDR ESS LEGAL DESCRIPTION /-/ —�.r1S/ ') Zo/ 6 LOCATION NO. OF BEDROOMS J r? > � DISTANCE TO: Well / Absorption area 7 r Dwelling I PERMIT NO. 8�/Caa O'e , EZ Manufacturer/'7 Material / No, of compartments F `�S"/. ` / W Liq. capacity in gallons � IF HOMEMADE: Inside length Width Liquid depth OOz DISTANCE TO: Well Dwelling PERMIT NO. I z F Manufacturer Material capacity Liquid ca q p[ yin gallons a DISTANCE TO: Wel Foundation [' Nearest lot line /� PERMIT NO. TX (A���`3�� J LL z No. of lines Length of each Ine / Total length ofJipQs/ Trench width / Distance between fj�e W :5'--7 inches �(/ Fes- Top of tile to finish grade / Material beneath tile�= � Total effective absorpt}on a� / ASches Length Width Depth PERMIT NO. w O R F Type of crib Crib diameter Crib depth Total effective absorption area uj y Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER VI' PIPE MATERIALS SOILTEST RAMI / `L -- — r✓ , ��t'/I � rxwk t — INSALLER 1/ o L 7 REMARKS / Ld I U� la APPROVED DATE LEGAL. / 3 Mov. 3/78) �")' dR1S WIPAMI Ufflillp(D Tilm m Hox 13099, svrAIt 11ouwE A ANaHIolumm, AN.AsKA 819502 344-7'714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF _-$6a-V4&4.- DRILLED AT THE RATE OF 823+04- =-- PER FOOT, Chatot"44,,;50 Ift. Y 5xt%Y OWNE LOCATION OF DRILLER WELL LOG: a.--,,,,17' S4 -f* 9W—a# 35% c-49#.JJ. 97-36' HoAd aA. R cemented g-.awP.t,- 36--- 2600 Z.*4i ock. SedLnur toyLot ck. Ro mcg C A Lite of 4howt"—w . 195 tea, 9/2 Rau h puducUon .Acm 224 to 239 p, (rte fT. kl.eo 248 .tu �tanu.B r eua<r tie ---J eek..-7�Eeb-ae e.�-yt�,LcE-e Y A �e.6bsno CA4t o{ D&U"n 2 023.00 1" A X 250 4: 15750.00 COST INCLUDES ALI. LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF _ 157501000 _ THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE PO415tAo 1984 7 MUNICIPALITY OF ANCHOxAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL P'ROTEC:TION 825 L STREET, ANCHORAIGE, AK 9950:1 264-4720 �_� f'•d .—_ ,_., 7L 'T E '.:_=* 1� I�-i IE~ F�° �'_ 4:•,M 1. A L L. F=' E Fw� trl T `f" PERMIT NO: 840322 CRATE ISSUED: 05/09/84 APPLICANT: RICHARD M. PARKER ADDRESS: 1083 POTLOTC:H CIR ANCHORAGE: AK 99503 CONTACT PHONE: 243-1.14:1 LEGAL DE:=CRIP: SUBDIVISION: WOODRIDGE LOT: 6 BLOCK: 2 SECTI0N: 3 TOWNSHIP: 11N RANGE: 3W LOT SIZE: 42747 (SQ. FT. OR ACRES? MAX BEDROOMS: 4 LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIONING YOUR SEPTIC SYSTEM. CHOOSE: THE OPTION THAT BEST FITS YOUR SITE. T Fv E; vA co F-1 & E 0 L4. G, F1 IFA IL FA DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 8.0 0.5 3.5 TOTAL DEPTH (FT.) 1.2.0 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 2:2.0 5. 0 GRAVEL LENGTH (FT.) 38.0 41. 0 65.0 GRAVEL VOLUME. (CLI. YDS. ;, 29.9 3:3.4 40.:1 TANK SIZE. {GALS) 0 250. 0 4:W 1, 250. 0 'X•:k 0250. 0 Fh: SOIL RATING (SQ. FT. IBR) 150 150 150 +: r TANK MUST HAVE AT LEAST TWO COMPARTMENTS I CERTIFY THAT: 1. I Alf] FAL'1ILIAR 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 O1= 4 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES; THEN (1? AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED: (2) AS—BI_IILTS WILL NOT BE APPROVED WITHOUT AN EL9CTRICAL INSPECTION REPORT; AND (0 THE ELECTRICAL G4,1OR' MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED DATE: C __ _ / �_- APPLICANT: RIC:HRI K1. P.ARKER ISSUED 8 DATE: V N SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST P'' 825 L. Street, Anchorage, Alaska 99501 7.64-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: .L/1 C TQ ka- r _ '1� I/ DATE PER FORMED: �_C \' LEGAL DESCRIPTI -- ��—j �� A,— e-' . � ISte` /v\ 1 2 4 5 •� 6 SnJ 7 8- 9 :. 10- 12 0 12 13 14 15 16 17 18 19- 201 COMMENTS o('er'e- lo,yef Caw - S ravel I .!Scff\ i very I Ole s,l� 15 O IP/bci rn ML_-++IIdry grey -Vt 6W'SAMe tine 'and ENo 11 WAS GROUND WATER S 'o/p ENCOUNTERED? L 0 E IF YES, AT WHAT DEPTH? `T Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUNIBETWEEN PERFORMED BY: L 6 - CERTIFIED BY: N S J 72-008 (6/79) / (mi--n77utes/inch) FNT 151 an ) [ Gam. Z. — DATE: __01AC P Municipality of Anchorage °... On -Site Water and Wastewater Program a w; (907) 343-7904 „ r E T� Certificate of On -Site Systems Approval Parcel I.D. 020-093-14 1. GENERAL INFORMATION: Expiration Date: 1 V oy lit� 0) Complete legal description WOODRI_DGE; BLOCK 2, LOT 6 Location (site address) 16500 Virgo Avenue *Anchorage 99516 Current Property owner(s) Michelle Barnett Day phone 306-8713 Mailing address 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: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well © Individual Fl Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ -�)� o _ Waiver Fee $ Date of Payment11 zo Date of Payment Receipt Number �� �0 ° cl Receipt Number COSA # _ () �5 G ?_ 1 1-[ 6 �3 Waiver # TO 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. —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: Garness Engineerinq Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system O`o� O in accordance with the guidelines and regulations established by the Municipality of Anchorage and 900 \ industry practices. The reported results describe the condition of the system/s on the date/s of the o �F�L� evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, f:. G,O� groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and I l are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of '" ^HSess. G the well or septic system. GEG makes no representation whether an alternative well or septic system O �' can be installed on the property in the event either of the current systems fail to perform adequately in ('` 9. " CE79(53 c G� the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or s}o��°oma party (including subsequent property purchasers) is not authorized, nor will it confer any legal right ����Q o; esw whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved OF f Conditional approval for bedrlth the fol i stipulations: P rJJJJ) FN) SEI F\ ,��• BY: Original Certificate Date: F I oa 1 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory_ Other 90 Legal Description: WOODRIDGE; BLOCK 2, LOT 6 If more than i septic system on lot: COSA Checklist # of Parcel ID: O20-093-14 Structure served by this system A. WELL DATA �l Well log is filed with Onsite (or attached) Well production at time of test 0-9>+ ~pm � Date ddrilled,mwn> ed - Water storage tank volume N/A ga||ona 1 Total depth^20 _^,�.5 ft Well disinfected for coliform bast? E] Yes FW No Cased to ^°37 ft V o|iform bacteria is Negative �� Sanitary seal is functioning correctly Nitrotemy/L R~5trate less than MRL (ND) FA properly protected / Arsenic ug/L �� Arsenic less than MRL (ND) ~~ �~ Casing height (above gnound)12+ G�(�in. Collected by ' LTD. Date offl7/21/217/21/217/22121o�teatfor�O�A D�teofSamp|e Staticwater 23.9 ft, *PER {�E{� WELL "PER K8�A RECORDS A\RRDVVVVELL & PUMP INSPECTION) Commen� ` ' B. TANK DATA Age cftenk(s) 8yeora Tanktype/mataria| ~~~~EE Measured operating fluid level inseptic tank 50" W Standpipes/foundation cleanout per record drawing Date ofpumpiny D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 5/34/84 0ALL standpipes present per record drawing Total measured depth fr12 from .08 ft (max) Measured depth topipe invert from grade4_.86 ft(min) Fl N/A— pressurized field L-1 Monitor tubes go to bottom of effective. If not, state depth into effective _/s__ Code -required soil cover over field F�System presoaked 'Required ifvacant for greater than 3Odays prior to date of test) Gallons introduced N/A "a||uno Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION R Required maintenance completed Age oflift station yeors Lift station material N/A Adequacy test date 7/21/21 Results [Z]Pass For 4 bedrooms Fluid depth prior to hast O in Water added 844gal New depth 7in B120apsedtima min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12months) N�A |fyes, enter date ____ NO From Private Well onLot to: (Please enter distances ifless than required orifcommunity well) SeodoTank/L�StadononLot>107 —Mv EJ Yes if No *54- CommunhySewer &lonho|eKC|eannut>1OO' ' Yes ifMoft Property Line >5' MYee ifNoft Neighboring Tank >10O' MYes ifNoft Wells onAdjacent Lots: Private Sewer/Septic Line >25'|,7|Yes ifNoft Absorption Field onLot >1OO' MYes ifNoft ifNoft Holding Tank >1OO' MYes ifNoft Neighboring Absorption Fields > 100' Water Main >1O' ifNoft Animal Containment >5O' 0 Yes ifNnft F71 Yes if � Water Service Line >1O' -- ----' &1 onure/Anima|ExorotoStonago>�1OO' comment below Community Sewer Main >75' MV ifNoft [Z] Yes ifNoft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations >1O' EJ Yes if No *54- ft Surface Water >1UO QYes ifNoft Property Line >5' F71 Yes ifNoft Wells onAdjacent Lots: Water Main >1O' Absorption Field >5' Yes Yes ifNoft Private Wells >1OO' [ZIYes ifNoft Private Wells >10O' Yen ifNoft Water Main >1O' ifNoft Yen ifNuft Surface VVater>1OO' Community Wells >2D0' Yes ifNoft Water Service Line >1O' Yes ifNuft |fseptic tank isunder driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation >1O' 0Yee if No ft If absorption field munder driveway comment below Property Line >1O' F71 Yes ifNoft Wells onAdjacent Lots: Water Main >1O' MV Yes ifNoft Private Wells >1OO' [ZIYes ifNoft Water Service Line >1O' R�Yes ifNoft Community Wells >28U' 121 Yes ifNoft Surface VVater>1OO' rV-1Yes if No ft F. ENGINEER'S COMMENTS *MET C[lFlE AT TIME OF INSTALL MEW / certify that / have determined through field inspections and review ofMunicipal records that the above systems are /nconformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Well Water Advisory Certificate of On‐Site Systems Approval # OSC211468 Subdivision: Woodridge, Block: 2, Lot: 6 This well’s productivity was determined to be 0.9 gallons per m inute. The minimum well productivity required under (AMC 15.55) for a 4‐bedroom residence is 0.42 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. Received Date/Time 07/22/2021 17:29 07/21/2021 16:00Collected Date/Time 1214513001 Matrix SGS Ref.# Client Sample ID Woodridge; B2,L6 Client Name Project Name/# Printed Date/Time 08/10/2021 8:44Garness Engineering Group, Ltd (GEG) Technical Director Stephen C. Ede Woodridge; B2, L6 Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS AKA08/06/21EP200.8ug/LArsenic 07/29/21ND5.00 (<10)B Waters Department (Provisional Cert for Nitrate-N) EBH07/30/21SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N ND 0.200 (<10)C Microbiology Laboratory M.A07/22/21SM21 9223B100mLE. Coli Negative 1 A M.A07/22/21SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 Parcel I.D. 020-093-14 P. Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 =a=t=. Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: / - Ii _ Complete legal description Woodridge Subdivision Block 2 Lot 6 Location (site address) 16500 Virgo Avenue, Anchorage, AK 99516 Current Property owner(s) Eric West Day phone Mailing address 16500 Virgo Avenue, Anchorage, AK 99516-5344 Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone WaiverNariance request for: Received by: `✓(�tt iy \ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 491),^ Date of Payment 1612113 Receipt Number 10(ja COSA# ase -13 /baa Waiver Fee $ Date of Payment Receipt Number Waiver # 4 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual a Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: `✓(�tt iy \ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 491),^ Date of Payment 1612113 Receipt Number 10(ja COSA# ase -13 /baa Waiver Fee $ Date of Payment Receipt Number 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 Alaska Rim Engineering Address 9131 E. Frontage Rd. Palmer, AK 99645 Engineer's Printed Name Charles A. Leet 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the Phone 907-745-0222 Date 10/5/2013 �%�....,��tt OF A 4 t t, Sp:. •• .7'•'F eJi •• 49T" � r ; .f Charles 'Leet j,•• CE10680 • �: - By: Original Certificate Date:,%o - / �/ -) 3 The 4 nic' li o nchorage 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r 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 Woodridge S/D Block 2 Lot 6 A. WELL DATA Well type Private Date completed 1984 Total depth 223 ft. Date of test Static water level Well production If A, B, or C provide PWSID # n/a Sanitary seal (YIN) Y Cased to 37 ft. FROM WELL LOG N/A N/A N/A WATER SAMPLE RESULTS ft. Parcel ID: 020-093-14 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 9-17-2013 21.8 ft 1.8 g.p.m. Coliform 0 colonies/100 mL Nitrate <1 , 0 mg/L Arsenic <5 ug/L Date of sample: 9/24/2013 Collected by: Brandon Jones 116 y0/3 Q„ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/30/2013 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Date of pumping NA C. ABSORPTION FIELD DATA Depression over tank (Y/N) N High water alarm (Y/N) NIA Pumper NA Replaced Tank Date installed 5/31/1984 Soil rating (g.p.d./ftz or ftZ/bdrm) ft2/bdrm 150 System type Deep Trench Length 41 ft. Width 5-7 ft. Gravel below pipe 8 ft. Total depth 12.5 ft2 yes 656 No � ft. Eff.. absorption area Monitoring tube Depression over field Date of adequacy test 9/17/20.13 Results (Pass/Fail) Passed For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 1800 gal. New depth 0 in. Elapsed Time: 29 min. Final fluid depth 0 in. Absorption rate >= 600+ g p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date N/A D. LIFT STATION Date installed N/A "Pump on" level at N/A in. Datum N/A E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons N/A "Pump off' level at N/A Cycles tested N/A Septic tank/lift station on lot 100+ Absorption field on lot 100+ N/A Sewer /septic service line 25+ Animal containment areas 50+ in. Manhole/Access (Y/N) N/A High water alarm level at N/A in. Meets alarm & circuit requirements? N/A On adjacent lots On adjacent lots 100+ 100+ Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main N/A Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ B 'Id' f a 10+ Water Service line 10+ Curtain drain Unknown u ing oun anon Surface water 100+ Wells on adjacent lots 100+ Absorption field 5.5+ Surface water 100+ Water main N/A 100+ Driveway, parking/vehicle storage > II F. COMMENTS Septic tank was replaced. A double clean out was installed within 10 feet of septic tank. Monitor tube was replaced on septic field. Clean out was added to the end of the absorption field pipe G. ENGINEER'S CERTIFICATION t 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 Charles A. Leet, P.E. Date 10/4/2013 COSA brown sheet 10-10-12.doc ETsv. <A.wuEa) VRa05Fa BWGNG CalltA n�.v. (nBAaffL) wIING anwcr MONT BANDING SE B am ft, G G SEIBAu ' ..0.E.W gA dNG SEIBAIX LOT`. UNDER NO CIRCUMSTANCES SHOULD AN AS -BUIL- BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG, REPROOUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE - SYMBOLS j ❑ FOUNDATION AS—WILT ❑ FlNAL smucnRe AS -BUILT SET RESAR ;° ORALNAGE D ASPHALT o FOUND REBAR 8 e e WOOD FENCE �..:� CONCRETE (❑1 PLOT PLAN' .. O CWNLT .. LOTSURVEY... TOPDCRA. ,. 00 ff ASSUMED ELEV. )( It it 1 I AS—BOILT .. _ NO OWNERS aEY W RFfFRTGMGTIIN ec—Mln i wn nrouw< tti O METAL FENCE ® WOOD DECK IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS ANO TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS Oi RESTRICT!ONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION F_AT. SURVEY CERTIFICATION ..'� PLOT PLAN O OF xr��f .��F ......... A(\fes" eY.EY e/IIIY tlNl I !q.! mw�Y .Nnw � /�P •" •' N. Im bme. v,E G.CCMJ IIVYn. u1G uo! t T a a w«� ma io m. mr vJ:• -• w•., ma e..t�m m°mwas mum. m atT.•.m. Ib.. e..n � Z4 w ew as cancE •. , _ FOUNDATION AS -BUILT R• T^ ' •. I. Vrort E. John., t.. nsWry m°t: e1 w. Mw pMymp m .0-RuleN }n lOsmllm m Nb 1°t aM Tot rp IN 0 •,•„• '�• •kOBERI mn.•.me. v,e eamaum m uNbn rc. trw mC m nw%mn4 ed.t uM ' •`` Yimn [TSNw. ' FINAL STRUCTURE AS—BUILT s••V ,. I,y S •••••. I. Rmb[ E bmA t. RaiY e✓tIN ewt t ( ^t. •'•r, Fero prlam°0 M Ae-W It rterY el Te tua m b bt m4 NMat V '•""•• .• e�' era ca mr�m�m a •Iw.n n.�.o, p'a (e Va ssional .n«•.a.eom..,la ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTEn. Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 842 E 12 AVE. ANCHORAGE, ALASKA 995M Scale: 1„ a 60' Rea Lot SF. Ree. Plat Fle No. Dcte Surveyed: 10/02/13 Drawn " REJ Checked 4r. JMK Date Drawn: 10/02/13 GNd`SW3337 W'D' 13-513 WOODRIDGE BLOCK 2 LOT 6 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Rraaaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVE FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-093-14 COSA# r75G IQ I X13 1. GENERAL INFORMATION Expiration Date: Complete legal description WOODRIDGE S/D; BLOCK 2, LOT 6 Location (site address) 16500 VIRGO AVENUE * ANCHORAGE, AK * 99516 Current Property owner(s) MIKE & BETHANY FELIX Day phone 336-1445 Mailing address 16500 VIRGO AVENUE * ANCHORAGE, AK * 99516 Lending agency Day phone Mailing address Real Estate Agent JERI JEFFREY W/ PRUDENTIAL Day phone 762-3108 Mailing address 3801 CENTERPOINT DRIVE, #200 * ANCHORAGE, AK * 99503 Unless otherwise. requested, COSA 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 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. 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 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 cerlifled by lily seal affixed hereto and as Of the validation date sihv -o-, kbatluo , i Verify that ,,,y 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 f om 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local 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 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 bedrooms. Disapproved. 337-6179 Date t0/1, �4o�oppp �. 49 O 9; E-79)3 tc>Iji. U44d pro f e s siono� o Conditional approval for bedrooms, with the following stipulations Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisocy Other By: 2" F (Rev- 11/05) YOF a�. ON-SITE •'�; WATER AND ; fn= : WASTEWATER PROGRAM - s ) Original Certificate Date: / U / -_-3 -` Municipality of Anchorage _ A9. Development Services Department Building Safety Division " On -Site Water & Wastewater Program 5 A �' Y 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 S/D; BLOCK 2, LOT 6 Parcel ID:07 A. WELL DATA *PER GEG INSPECTION. **CASED INTO BEDROCK PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N/A Well. Log (Y/N) Date completed 1984? Total depth *223+ ft. Sanitary seal (Y/N) YES Cased to **37 ft. FROM WELL LOG Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: ug./L. B. SEPTIC/HOLDING TANK DATA Nitrate �� mg./L. NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 9/23/2010 27 ft. 0.58 g.p.m. Other bacteria colonies/100 ml. Date of sample: 9/23/2010 Collected by: GEG Ltd. Tank Type/Material SEPTIC/STEEL Date installed 5/31/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) _ N/A Date of pumping 5/14/2010 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 5/31/1984 Soil rating (g.p.d./* 2/bdr 150 System type DEEP TRENCH Length 41 ft. Width 5-7 ft. Gravel below pipe 8 ft. Total depth *12.5 ft. Eff. absorption area 656 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 9/23/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 555 gal. New depth 0 in. Elapsed Time: — ruin. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — NOTE: MT ONLY EXTENDS 43" BELOW INVERT OF DRAINPIPE. TOTAL DEPTH IS CALCULATED. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N L"Pump on" �Ievel in. "Pump off' level High water alarm level at in. tu 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 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 *5'+ 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 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *7.7' PER 1984 INSPECTION REPORT. o`�d�Op G. ENGINEER'S CERTIFICATION . s,�4p0 1 certify that I have determined through field inspections and Q ,� •' 4 �� review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. O A. ss.... Engineer's Printed Name JEFFREY A. GARNESS CE -795 map Date u4O4Ol'ofessi©©c�� �Doo� COSA Fee $ 7 0 Waiver Fee $ Date of Payment U //// O Date of Payment Receipt Number 4 5$S5 Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department _ �y.y W,',z Building Safety Division S A E F Y On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 101243 During a recent COSA on-site inspection and test of the potable water supply well on Block 2, Lot 6 of Woodridge subdivision, the well's productivity was determined to be 0.58 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 0urnar RMT ttMIM 3r1au t AiK alrnaa K?ft of acre rua0" ace^" 4\ 1 LOT 5 UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIDUTY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Lj LOT SURVEY SURVEY TYPE SYMBOLS FOUNDATION AS—&.%T SET REBAR ��� ASPHALT FlNAL STNYCWRE AS -"T DRAINAGE J ❑ PLOT PUN ... AS -11"T ... LOT SURVEY ... TOI.0MWHT O FOUND MAR 0 WOOD FENCECONCRETE 1-1 00 s ASSUMED ELEV. X )( N METAL FENCE WOOD DECK �C—M1LL T _ MA !'CRNL4l CSTI I RF[`FIMflCITM1 �5.�9UILT _ NO CORNEAS qr.? IT IS THE: RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION � PLOT PLAN `ems'` ••O..;;•...r�C44 h I aeaor OWN u.I I eww at Imp wawa"_.••• 'moo +�� �_ "aa Iarla W OW111001 m as aw IN *aeon a aw.r am ft. Wm a" Y•I. twa W a � ew..I.ay..wd 01111416 so ap•Mlalaw M.. a.rl / ►�° alra.I•a tAa am orn.a FCURDATION AS -GUILT I. RrM E Jath*. r. Wm cw% awl I Ilan pafaawa OI Ar."I 0AWY of ma 1M. Eat • ••• tawpatln as ano Npt aY mr 6alraalaaa we YII�ww11al r waw" Ar.In'go wMWa adslY0awl.aKa 4ml we"e , 'p FINAL STRUCTURE AS—BMT I, AOO.fI G JOfliia. t. awwlr arab 911ae 1 Slaw /eII•N. f w A.m IeIala a to We atn.se•n w aVlfa b w memeas 4*m"ia.o a.t AAW"Ve 1 a Nam Nva . Sr. wa no mromemmu "K ~ 121 •°+o °' vl Ar, r par_ ' da$lanoi ONLY THOSE IMPROVEMENT'S ABOVE GROUND AND VISIBLE WILL 6E SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS. SIOEWAUM DRIVEWAYS. ETC.. ARE SHOWN IN THEIR APPRO) MAATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATCO. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 942 E. 12 AVE. ANCHORAGE, ALASKA 90501 Scan; N 601 Roc. Lot S.F. Rom Plot Fitc No. Data Surveyed: 10/5/10 Draw by REJ Ctlockad 9WL Data Drown, 10/6/10 c'Ia°SW3337 W.O. 1231 SGS SGS Ref.# 1105142001 Client Name Gayness Engineering Group, Ltd Project Name/# Woodridge S/D B2,L6 Client Sample ID Woodridge S/D B2,L6 Matrix Drinking Water Sample Remarks: Printed Date/Time 09/29/2010 11:03 Collected Date/Time 09/23/2010 15:30 Received Date/Time 09/23/2010 16:06 Technical Director Stephen C. Ede Parameter Results LOQ Units Allowable Method Container ID Limits Prep Analysis Date Date ]nit Metals by ICP/MS LP Aluminum 44.8 20.0 ug/L EP200.8 C Hardness as CaCO3 ND 5.00 mg/L SM20 2340B C 09/24/10 09/28/10 NRB Waters Department (<6) 09/24/10 09/28/10 NRB Arsenic ND 5.00 ug/L Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 450ONO3-F B 09/23/10 AYC Microbiology Laboratory EP200.8 C (<2000) 09/24/10 09/28/10 NRB Cadmium ND E. Coli Negative 1 100mL SM20 9223B A 09/23/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 09/23/10 DLC Private Individual Analysis Alkalinity 129 10.0 mg/L SM20 2320B D 09/24/10 LP Aluminum 44.8 20.0 ug/L EP200.8 C 09/24/10 09/28/10 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 09/24/10 09/28/10 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/24/10 09/28/10 NRB Barium 3.98 3.00 ug/L EP200.8 C (<2000) 09/24/10 09/28/10 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 09/24/10 09/28/10 NRB Calcium 666 500 ug/L EP200.8 C 09/24/10 09/28/10 NRB Chloride 18.0 0.100 mg/L EPA 300.0 D (<250) 09/27/10 09/27/10 SDP Chromium ND 2.00 ug/L EP200.8 C (<I00) 09/24/10 09/28/10 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 09/24/10 LP Conductivity 346 1.00 umhos/cm SM20 2510B D 09/24/10 LP Copper 155 1.00 ug/L EP200.8 C (<1300) 09/24/10 09/28/10 NRB Fluoride 0.156 0.100 mg/L EPA 300.0 D (<2) 09/27/10 09/27/10 SDP HCO3 Alkalinity 127 10.0 mg/L, SM20 2320B D 09/24/10 LP Iron ND 250 ug/L EP200.8 C (<300) 09/24/10 09/28/10 NRB Aarow Pump & Well Service LLC (907)346-9355 Inspection Report 16500 Virgo Camera well down to 37'. Casing ends at 37' and continues on in bedrock. No perforations in casing. Brian R. Wille Aarow Pump & Well Service LLC Municipality of Anchorage �o .6 .. 4 • 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.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING R FIV 5 t41A L 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 professiona! civil engineer. registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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. t i Parcell.D. 090-093. 1I HAA #. 114AOaO1O Expiration Date: 7- 2 2 - O i 1. GENERAL INFORMATION Complete legal description Loi Lam T3 V_ P_ W100D�1lS Location*" (site address or directions) IA G&_0 ki I 121 O ') 1. Cur ent Property owners) Ze 6er ce , T& r ker Day phone' -3y5- 1,79 1 Mailing address Lending agency ' Day phone Mailing address.. Real Estate Agent . _oLu4s•c %-I 1 tct ter, . a wt' Day phone __fib !- 74, &<2 `J Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: `7 .3. TYPE OF WATER SUPPLY:-- - - - TYPE OF WASTEWATER DISPOSAL:.---' == ' Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Convfiuni •� Class .._..-._. Well ty ❑ Community On-site ❑ - Public Water System ❑ 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 professiona! civil engineer. registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 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 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 1 o bhekf Phone P -T4- 39/j;> Address b S tom/ 151-G� a2O 3 ) Engineer's Printed Name f oh6.e N r 1/1 & k cQ, Date Its 1a 3 P Ct 5. DSD SIGNATURE c iot enN wmaad Approved for bedrooms. ,�Fq •,,•• ��pROfESS S5 NA Disapproved. 1%6vFESS'a Conditional approval for bedrooms, with the following stipulations: � ii Additional Comments —M: NIT R AND WASTEWATER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report _ Well Flow Advisory Other By: Original Certificate Date: (Rev. 0M2) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program . 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 9951 M650 www.ci.enchorage.ek.us (907) 343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST y ` i $A STY Legal Description: 1X/00D7-tDA E S'i? BVLI- LCT Io Parcel ID: O 90 —04 3- ! q A. WELL DATA Well type" If A, B, or C provide PWSID # _ _JA Date completed !&164 164 Sanitary seal (Y/N) � Total depth _JJW ft. Cased to -qkt fL FROM WELL L0G Date of test Static water level ft. Well production �J 9— p.m- WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate k))—mg./i. Arsenic: mg./l. Date of sample: -vil B. SEPTICIHOLDING TANK DATA Tank Type/Material r 0 er / 4.1 Tank size li&5b gal. Number of Compartments Well Log (Y/N) Wires properly protected (Y/N)_ Casing height (above ground) L j_in. AT INSPECTION 11-Ig-oZ 41 ft. I + g.p.m. Other bacteria ��i colonies/100 ml. Collected by: I. S a v r k I. w 4k Date installed 5/3i/S q Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/N) _.LL_ High water alarm (Y/N) 1-I Date of pumping 7i oh `Z- Pumper go �a zao C. AMORPTION FIELD DATA Date installed Soil rating (gee or ftz/bdrm) /!TO System type -i Z NI -H Length W ft' Width 5-7 ft Gravel below pipe � ft. .y„ . • Total depth ,Jj% ft. Eff. absorption area b jL fe Monitoring tube Depression over field Rate of adequacy test i 1 19' Z- Results (Pass/Fail) _L_ For L L bedrooms Fluid depth in absorption field before test -&- in. Water added Y60 gal. New depth -&-in. Elapsed Time: ✓ min. Final fluid depth _jp- in. Absorpticn rate >= b 9,o g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date D. LIFT STATION Date installed 'Pump on" level at Datum E. SEPARATION DISTANCES in gallons "Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: (Y/N) water alarm level at Meets alarm 8 circuit requirements? Septic tank/lift station on lot 10-7 On adjacent lots � /� Absorption field on lot 117 "f On adjacent lots ! U-0 Public sewer main 1' tlf} Public sewer manhole/cleanout N/A Sewer /septic service line > 95 Holding tank H/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ;- b Property line _,1 Absorption field 4 Water main 1-f /A Water service line )t 2 5 Surface water N) O Wells on adjacent lots> /4U Tal SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 j Building foundation Water main N�A Water Service line > Surface water N O Driveway, parking/vehicle storage 10_ Curtain drain I`` 0 Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION :y�Q'��..••••••. I certify that I have determined through field inspections and Oyt • 9 1 review of Municipal records that the above systems are in t 49� conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 1 ©� :o t N A v k� a K d� '9'c6n Date Ll — HAA Fee d Waiver Fee $ Payment Date of Payment Date of Pa Y Receipt Number Receipt Number (Rev. 12101) I 04-19-03 C4:CTPM FROM -ME EOVIROMOTAL SRV S f%- I SCS Refs 1031939001 Client Name Tobben Spsnkland P.E. Project Name/P 16500 Virito Client Sample ID 16500 Virgo !plaids Drinking Watcr OCTS615301 T -24S P.02/C3 F-941 All DateMmes are Alaska Standard Time Printed Date/Time 04/18/2003 13:50 Collected Date(rlme 04/11/2003 9:15 Received Date rime 04/11/2003 9:34 Technical Director Stephrn C. Ie Released t. Sample Remarks. Allu%able prep Analryi3 ?Arametes Results YQL Uiuts Method Umiu ply: put,: Inn Wattera Department Nitratc-N 0.200 U 0.200 mg/L LPA 300.0 (<=po) 04111/03 is Microbiology Laboratory Total Co'ifurm 0 co71OOmL SM189222B (<—j) 04/11/03 KAP 0 �— Municipality of Anchorage o • Services ervices Department onrGE 8 y ` ` r. a 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 LD. 0ec-Oq3-1'-I HAA# 144020610 Expiration Date: 317 /0,3 1. GENERAL INFORMATION Complete legal description Lo T Co` 3 K r I,Yic7c7CF r r'C%vf t '�r Location (sine address or directions) 1& 45 V1 P-47 D X V C Current Property owner(s) _ a Y -V 4t' Day phone ? — 1_5i Mailing address I& SZ' -0 i/t 12!-, t� /kvLf Lending agency Day phone _ Mailing address Real Estate Aaent _Qa yr rS«l D�yAoDay phone p7_& /—"7 6 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:g( 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well Lid Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 verity 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 cf 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 ail applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 4 0 L -e 0 �� j V-va0', K Address ;Lo 3 Li Engineer's Printed Name o lb io -e �t S' u t k,l A k ov 5. DSD SIGNATURE i� Approved for ? bedrooms. Disapproved Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: (Rev. 01/02) Phone A?9 —391 6 Date 11 1,2_1 1 O Z �f •`=� "`;gin, pocu� ^oo r� o O oOOCOCOocoG:::o.^ bedrooms, with the following stipulations: I UFA ON-SITE WATER AND ; rn= 'NA3TE'NATER = PROGRAM Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /.2/Vo ?_ ME Environmental Services Inc. CT&E Ref.# 1027911001 Client Name Tobben Spurkland P.E. Project Name/# Woodridge Bk2 L6 Client Sample ID Woodridge Bk2 L6 Matrix Drinking Water PWSID 0 Sample Remarks: Parameter Results Waters Department Nitrate -N 0.600 U Microbiology Laboratory Total Coliform 0 All Dates/Times are Alaska Standard Time Printed Date/Time 11/21/2002 12:24 Collected Date/Time 11/18/2002 1:00 Received Date/Time 11/18/2002 16:41 Technical Director Stephen.49%Ede Released By Allowable Prep Analysis PQL Units Method Limits Date Date Init 0.600 mg/l, EPA 300.0 (<=10) 11/18/02 JS col/100ml, SM18 9222B (<=1) 11/18/02 KAP Nov 22 02 09:29a The Ramsey Team 90`i-261-7555 P•2 t f I \ L r 1 y T • 5 RV tee A. 011 .10 SZ r rX o- ' 1�� !Y Arlt f �•rA_ LEGEND a O LOT CQIuME )j 4 t= Y -►j Of Ai �,11DRAINAGE AWRQ'YE t ti S i N4T£Sf 1. IT SMALL It Tot POMIlaMnr er TMM 9111 61 Delete to vTOW y t rlY�k . / .. •^ �' uSDUDIbil" LO ATWM YMOwM MMa Ta A1.6 YWOI/fanW COTiMY1Ta AWARE x"RelO I VI " ' 1 A iii '• t.1T 1 TM[ To 66 Ql LHY p/ THE W14 DCR fp VtMVV .L6 KtMrfOlt MI'rP ♦/ TMi NOT To 466 dell Taxi ff wl �' 1M '-�` a tTwoOO rlet .t.11Mtt.Tf r+lt ra.netL I NAT PA v xteWl ane *.Mn ' `` l •�'/ fOPM tlM( OtOCaOW •4' 0l.LG 00 TW 4k r^AYOC L. AT "t MMTa core lO 1. M THAI LA pl AC1tx rwa e'Il1Ya 0+ rwM W(GOY4MO FLAT aat IItT YIlOtO OM! t ry �• l {t oaa��"' T. • TIM I.rowra TO Oft91111111. &JWI C L m Wr uu Of t:.aMa AOXY o e• a+[ur Kat.r TO EI O .Mr tOYUc rt Rreaa UlxnO tt,wxeYllxO uw t I +t•T1t11 LOT LiYti 0. to TOWTIIA . THE MCAT 1a Ytr r0 K LVa4 fM � I ro.+lrlo•Iwa aoalTla.at aTwuerueas wrtruM. r� ETOR'! KtHTI/ICATIQN R'S�A 14 laiOtt !Wy t!Wy ago oI Mwrr tuie alto t"s ,.Yr IW IIOvM IItY Ta b�TYLT[O TMxYM O4 at IIK.Ttp 49 1160YO ON TMIC FLAT. Isle 404A z ; �onrxo THIS�.[� Oxr cT�,.'Ia %d4G'lJiY/D.f.%w $J1o.0/Y!S/O.V , f,i. { f' 8E53EpPB 8 PtiT79 i 2220 E. ea+n AVE { ; MS -61461 ANCHORAGE, ALASKA 9"V 16e&•404 >•A.•AY-AIIIO f/. €f.•rllt^!«': O' C.t O'MG ORIX _ kri OI b'• i./ti `PLC .►t.• l Cr 7 a ry ,' '.,.N,.4. { 'l r ^rte.;? ,.y�-.ry .� y •^• 9 :e S l^ *' � Y J 'a.:'^ .'Ji:� LP � MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date .3ec -3 i'l $ (a) Legal Description (include lot, block, subdivision, section, township, range) y�urlr,'dr ( .,� 6 131oc_k_ t T\IN f-', S4c, . Location (address or directions) V ; r G (-, (b) Applicants Name 'ID is Y_� 'a— ez Telephone Home Business _ Applicants Address ) 'j C) VI p A^ve•,�c /)��_� k � 5 t E, (c) Applicant is (check one) 'Lending Institution BuyerE�:l ; Other E::T (explain); p M1 ; Owner/builder /',L) (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: Vjrc 2. YY2e of Residence Single -Family '�—,Mult:i-Family Number of Bedrooms 3. Water Supply Individual Well1 L: Community M Other (describe) Public Note: If community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite M Public E:l Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 Z 5. Engineering Firm Providing Inaections Tests File Searcht Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 regula- tions in effect on the date of this inspection. Name of Firm Address (2_0o W ;; 3 % ! Date _D -e ( �. 1 K $`L__ Telephone 1 '� uvlb 6t >z-) 1 (ENGINEER SEAL) n �Oes 7 � 6. DHEP Approval v Approved for bedrooms *ya ? _-Q ,L.LCIl Date Approved Disapproved Conditional Terms of Cond tional Approval �y CAUTION Dy C. Rcid, Jr. No. 22,57-E ; THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIF'ICAT'EENT S BASED SOLELY. UPON THE REPRES- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL, ENGINEER REGISTERED IN THE STATE OF ALASKA. TIME DHEP IDES THIS AS A COURTESY TO PURCHASERS OP [TOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-•1.9-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY. APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: Well Classification Arivc? —_ If A, B, or C, D.E.C. Approved(Y/N) �J Well Log Present ( ) _Date CompletedM « 5' 8 `�Yie:Ld Ci PM Total Depth 260 Cased to Z 6 Depth of Grouti g�j w r Static Water Level �4— Pump Set At�R Casing Height Above Ground _— ._--- Sanitary Seal on Casing ) `1 Electrical Wiring in Conduit N) `/ —_ Depression Around 4�llhead (Y iv Separation Distances from Well: To Septic/Holding Tank on Lot los qn Adjoining Lots 1 ' To Nearest Edge of Absorption Field on Lot _1 Z g On Adjoining Lots 1y 0'_ 2_ To Nearest Public Sewer Line —4-10C To Nearest Public Sewer Cleanout/Manhole _ ru h To Nearest Seder Service Line on Lot IPA - Water Sample Collected By —VaDate Nov 30 Water Sample Test Resultsc,p-Fg�(v z� -- Comments �,kz���U l� 2•i /NfaSru _ �`l3o/B — B. SEPTIC/HOLDING TANK DATA x Date Installed 5 A ( S y Size )? No. of Compartments 'Z - Standpipes &) Ll Air -tight Caps/[) Foundation Cleanout a) y Depression over Tank (Y 1�_ Date Last PumpedPumping/Maintenance Contract on File (Y/N) for _ VA -- — Holding Tank High -Water Alarm (Y/N) j,% A_ Tamporary Holding Tank Permit (Y/N) [v'l Separation Distances from Septic/Holding Tank: r To Water -Supply Tull 1 D s To Building Foundation 2- i To Property Line _--� To Disposal Field- �— To Water Main/Service Line _ PA To Stream, Pond, Lake, or Major Drainage Course 0 10()-4 1.) ---- -- Comments rQA, as- bt40;�Sw�e�S Receipt #=`bl�('_l Date Paid: 1a-3 -SSP Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed S - 3 [ - �-`A tr (e Cj 2 UJO 0 do? -i c[ F_ Tit N F. ,w sec. 3� Iso LI'/I - Type of System Design .� ren �h Length of Field L-1 I s Width of Field 5 - -? V Depth of Field Amerw / a 0 Gravel Bed Thickness 1W5 8g , Square Feet of Absorption Area 6 5 Standpipes Present/t'DN) Depression over Field (Y ) N Date of Last Adequacy Test y iv Results of Last Adequacy st Separation Distance from Absorption Field: To Water -Supply Pb11 law 001 To Property Line To Building Foundation q �'7) ' (') To Existing or Abandoned System co Lot N A - To Water Main/Service Line On Adjoining Lots 1 56 00 (.) rU A To Cutbank(if present) ' To Stream/Pond/Lake/or Major Drainage Course 1 To Driveway, Parking Area, or Vehicle Storage Area _ Ccim-ents in Lfz�J-.�/1u, er5 [2�; 0m9aSc-A-4d 11 30k, -L D. LIFT STATION Date Installed ✓V& Dinensions (✓ 4 Si7a in Gallons 1�k Manhole/Access (Y/N) 1)n "Pump On" Level at NA "Pump Off" Level at N/ High Water Alarm Level at NA Vent (Y/N) N A Tested for WA- Pumping Cycles during Adequacy Test. Meets MDA Electrical Codes(Y/N) lvA- Comments ** Check '?ermitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in, effect on the date of this inspection. Signed --(tom` c ?0-a-� Datef— Ccmpany _ = G S (� MOA No. fS' L O Z KB1/d5/s [Page 2 of 2] 2-15-84