HomeMy WebLinkAboutTIMBER RIDGE BLK 2 LT 4Timber Ridge Block 2 Lot 4 #050-321-22 Municipality of Anchorage a` Development Services Department Building Safety Division Onsite Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SlJ ORpt5(o PID Number: OSO -321- 22 Name: SLu /n�in L]E]Wastewater System: New Upgrade an /"I orh Address: 1,31 19415 ufp6(L Sk Drive ABSORPTION FIELD Extsi;n Phone: Number of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/FeFl. Block- Lot. Lot: ,y btlivissloon: j` T1 R Depth to pipe bottom from original grade: Gravel depth beneath pipe: T i r I%�06Su l d e. Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel Length: FL Ft. Well: i: in El New El Upgrade Gravel width: Number of lines: Distance between lines Ft, Ft. Classification (Private, C): Total Depth: Cased to: Total absorption area: Pipe Material: �q :30 3 9 Ft. Ft. Ft' - Dtlllar: Date Drilled: Static Water Level: Installer:/� 1 tt Cuff lrHL Date Inselled: Ft. TI OrI Yield Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES t4Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer. Capacity: From Tank Field Station Tank Sewer Line r\ o �an� Gal. )sol Well 100+ r Material: i Ste Number of Compartments: 2 Surface Water Nx LIFT STATION Lot Line C,' Size: anu cturer: } Gal. r "Pump on" level at: 'Pump orf level at: High water alarm at Foundation S + in. in. in. Curtain Drain N'• a Pump Make & Mode Electrical Inspections performed by: Remarks: ) 1 £ ;,, T„k BENCH MARK eru heal %,A 6"r'cA Location and Description: Cr S o n a Assumed Elevation: 100 Ft. f Inspections performed by: LA95 $Pur R�a..� Dates: tat S 12 n8 EnQpw14�S A�� �-' O� A �� � ...., �� rid p '4 Development Services Department Approval `' 49TH Conditional Approval Date: �. '•►,-' 0 S E. SPURKLAND,' /% �J' •, 1 50 � Reviewed and approved by: Date: 3AIZq (Rev. 04106) SWING TIES F A--F—R C 15.5 21.0 D 24.0 31.0 £ 29.5 37.0 F 30.0 38.0 G 33.0 40.0 H 64.01 70.5 B R R\\ �*. E T B L ❑ Well Lot 3 ABANDONED EXISTING \ SEPTIC TANK PER I, L MOA CODE REOUIRMENTS _ � N7 IIYa IALL-Z LJUU IAL, 11\Y' SEPTIC LANK CONNECT TO EXISTING DRAINFIELD H- 25 011", 25 50 - ♦ ; 5 100T25 150 ' • I - SCALE 1' _ 50 L 1 Septic �-TT TTWfS IS NOT A SURVEYED PLAT. WELL & SEPTIC L Area LOCATIONS TAKEN FROM ON-SITY WATER AND WASTE WATER I DEPARTMENT DOCUMENTATION, ALL LOCATIONS SHOWN APE i 1APPROXIMATL: ---� UP'oER SKYLINE' I/RIVE - - DOUBLE 4 FEET COVER CLEANOUTS I 1 , 1 ELE .= 98.3 L I I I I >F5UND4TIL EV. 94.3 ELE 9'4.31 ; CLEANOUT CONNECTED TO, EXIST DRAINFIELD 1500 gal, septic tank BENCH MARK GARAGE SLAB ASSUMED ELEVATION 100' 203SPURKLAND ENGINEERING TIMBER RIDGE BLOCK 2 LOT 4 SEPTIC SYSTEM ASBUILT A2A((0��1/3 W 15TH. AVENUf SUSAN ARMSTRONG DATE. • AUGUST 20, 2008 /'J�/1 Z/�19161 0041 5 VAOCR SKYLINE SN€€Ti !r3 OR/D: NWA PERMIT # SVO80156 PID # 050-321-22 T1mberR1dgeB2L4D1,dwg I MUNICIPALITY OF ANCHORAGE ob Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street \�� P.O. Box 196650, Anchorage, AK 99519-6650\.>U (907) 343-7904 \111��� ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW080156 Legal Description: TIMBER RIDGE BLK 2 LT 4 Design Engineer: 0007 SPURKLAND ENGINEERING Owner Name: SUSAN ARMSTRONG Owner Address: 19415 UPPER SKYLINE DRIVE EAGLE RIVER. AK 99577 - Date Issued: Aug 06, 2008 Expiration Date: Aug 06, 2009 Parcel ID: 050-321-22 Site Address: 019415 UPPER SKYLINE DR Lot Size: 24938 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by 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. Received Issued B. Covered, sealed, and heated to prevent freezing. f By cum �H\U( 1� Du p Date: By: v o Date: e14191eff Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEPTICMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n5()-- _-'�I- a2 Property owner(s) - SUS An Arm$ Irons Day phone e3 e Mt( 3• CjT• (o 22- 2235 Mailing address I9y15 . UPPEz SKyC;AC IariVe Zip Code '195'7} Site address — s"" & — Code SA "t Legal description (Sub'd, Block & Lot) 7,*,6&a_ V�Jje. $IY. -L LT 4 Legal description (Township, Section & Range) Lot Size 994 .-1358 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms S THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. LAZ5 Sp4r (Signature of property owner or authorized agent) Date of Payment: Receipt Number: Y10 52 Receipt Number: (Rev. 11/05) Environmental Consulting and Design J Municipality of Anchorage August 5, 2008 Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Timber Ridge Block 2 Lot 4 We are submitting an application to upgrade the septic tank for this lot. The submittal consists of one ( I ) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. There are no wells within one hundred feet of the proposed replacement site. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Ct cerely,j�'9 Lars Spurk and, P.E. 203 Nest 151h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng!dgci.net E R RID G E L C K Lot 7 Lot 3 Lot 6 ABANDON well \ T/C TANK ` \ \ MOA CODE ENTS w lk INSTALL 1500 CAL I 4 Wei SEPTIC TANK CONNECT TO EXISTING DRAINFIELD Lot Ns TI AV A I— r4"' I / - 50 0 50 100 150 zoo cW 300 SCALE: I' = 100 FT. DOUBLE lr� (lLrmlvul /— 4 FEET COVER >FBUNVA TION CLEANOUT - # CONNECTED To \ EXIST BRA INFIELB # ... ... 1500 got, septic tank SPURKLAND ENGINEERING --] 20J W 15TH. AVENUE TIMBER RIDGE BLOCK 2 SEPTIC SYSTEM DESIGN (NCH. AK. 99501 SUSAN ARMSTRONG DATE: AUGUST 5, 2008 907 279 279-J916 11 19415 upprR SKn1xr SHEET: 1/3 GRID. N PERMIT # PIP # TimberRida& 4DI.dwo MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION i 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 \ -- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME DALE G,e�/�t/.E4 PHO"NSE ISNEW ,/^ d9y�'3s�s" ❑UPGRADE MAILING ADDRESS PO, t5vx LEGAL DESCRIPTION 46 LOCATION /t%Ei'�f�C�V✓ L�JN}%UN Q�/✓C NO. OF BEDROOMS c�Y Well Absorption area DISTANCE TO: 104 /O • Dwelling . ZO PERMIT N H Z wl ManufacturerQ �2E62 Mater�ia.,IrE�L No. of compartments Liq. / capacity in gallons G7G7C� IF HOMEMADE: Inside length Width Liquid depth O Y Jaz DISTANCE TO: Well Dwelling PERMIT NO. _? F Manufacturer Material Liquid capacity in gallons w= DISTANCE T0: Well �Z Z' Foundation, Nearest lot line X, PERT NO. .j U. W ~ No. of h es Len th of each line - Total length of lines Trench width Distance between lines f o ' Top of rile to finis grade AQh 2 Y21 dt p inches Material b eat the �(/ iJ Total effective absorption area Length Width %2 inches Depth /,Z / 7- fin, FT, W PERMIT NO. a d F Wa W Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIAI§_�pl/e �Ea%E/.'_ /PF 4'-P✓��5� /,v P/,�E SOIL TEST RATING S1.- =>G�• INSTALLER REMARKS c"r '�///rc ' Cve% /.STA�vc xo' 7 7iA f�iF / c c/LT 7o JA I FI _ 37 �•OF q���i oY .•,,.••s� F1 v : s 1 � Jr,...:• . ....... ... ...:... A tv ' i ('n Earl P. Ellis APPROVED q OFFS ","a DATE LEGAL �oi 72-0131Rev 3/781 0' I t e L. ° / �. r- I <A401I ✓ 0 :7. 4 ' MUN I O I I --IL_. I TY OF Rr-J1= 1O�)FZFIGE " DEPARTMENT OF•HERLTH A14D ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 ON—:s ITE SEWER PE R M I T PERMIT NO. C 780391 ) APPLICANT DALE GREINER PO BOX 251 EAGLE RIVER 694 3485 LOCATION MEADOW CANYON DR LEGAL L4 82 TIMBER RIDGE S/D LOT SIZE 24000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR)= 315 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH— 1L0. LEt+LGTH= S4_ O I[>EP_rF 1i s THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH.OF.A TRENCH OR PIT IS THE DISTANCE BETWEEN.THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). REL71U I REL? 'SEPT I G 7r F4 NK E} I ZE= :1.0010, GAL_L_Q"n3 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- TWO <.:;O> I NSPECT I OW55 FIRE RE:GtU I REL? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL.AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO I14SURE PROPER INSTALLATION. PERM I T EXP I REQ [?EOEMBER 1r 3_S07'0 I CERTIFY THAT 1: I All FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS A14D WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE Ott -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. Z! ` SIGtJED:_ -- _ -- ___----------- APPLICANT DAL GREI)NER ISSUED BY --v- �= j ti----_---DRTE_�� V3. 2 0 £t E GEG 'ECHNI CAL & DEVELJPMENT CO. w • Box 90, Davis St., Eagle River, Alaska 99577 694.2774 or 688.2260 Russell Oyster 694-2774 Soils & Foundations SOIL LOG Earl E//is 688-2280 Land Development Performed for: Name: DAG, (5k�6-11/.O2 Tel. No. Mailing Address: -P, O•�ox.7� /, E46ce 4x- 9!s7*7 Legal Description: Lor 4, 67k,<.2, " �lez4 , IOD6,e Depth (feet) Soil Characteristics L 3 4 57 6 7 $ sP- ��� Sicrr G�ilAdcccy 9 sgvv 1��niSt to 11 12 u 13 14 ZOTTdX1 4 7T 15 16 � GgTa. f1 Ala 5evia piz-712C - / is-�5 f Ground Water Encountered: Yes No t,x If yess what depth Proposed Installation: Seepage Pit -. Drain Field Comments: Performed by: Date: 9,7 �/�0P 276 3 4 57 6 7 $ sP- ��� Sicrr G�ilAdcccy 9 sgvv 1��niSt to 11 12 u 13 14 ZOTTdX1 4 7T 15 16 � GgTa. f1 Ala 5evia piz-712C - / is-�5 f Ground Water Encountered: Yes No t,x If yess what depth Proposed Installation: Seepage Pit -. Drain Field Comments: Performed by: Date: 9,7 �/�0P err t ire �ri��txt pop, by A & L DRILLING COMPANI' BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 OWNER OF LAND �_��ruB,(' �,� % DEPTH OF WELL _� 0 --� ADDRESS STATIC LEVEL OF WATER FT. % s LEGAL DESCRIPTIO` L 4 dC/C a 1 m BCC A/061=DRAW DOWN FT. ' DATE. -Started �/� Ended ��17 GALS. PER HR 4 F'P PERMIT NUMBER 79+ O 5-:C%J KIND OF CASING -3Z O O KIND OF FORMATION: From rriFt. to-�Ft. O[ly+Qll�d� ^� From Ft. to Ft. From Ft. to__F_Ft. J /fru O From Ft. to Ft. From S Ft. to_fJ_Ft. �� Y iC�9�E� From Ft. to Ft. From Ft. to_F-49Ft. S�9"jD 6<'-o4a' z V--Ldd`fm Ft. to Ft. From Ft. to_L�L Ft. CC�'i ct g<i9047[ From Ft. to Ft From Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. Froin Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: �3 j 0 C/9 S/ �v 6 Oe�'- /"Oa,�T�O DRILLERS NAME /?,-A/ jc _= 71 U r,d I C: I Fe—`1 I_ I I- ke Ci F n r•.[ i_ t-1 k ' 1=o DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRiTEC:TION • 825 'L' STREET, ANCHORAGE, AK. ?'P501 264-41.20 r� F t_ I_ F• s= F= r•i PERM I T NO. C 780*24 ) I ?' APPLICANT GREINER CONST BO'; 251 EAGLE RIti ER 6 94 -748.=, LOCATION TIMBER RIDGE LEGAL L4 B2 TIMBER RIDGE LOT SIZE 2,1000 SOUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL S'r'_ TEM I 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN '.0 DAYS OF THE I -JELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM= ARE AVAILABLE TO INSURE PROPER INSTALLATION. F• E t=' by I "T' E : F• I 1= r•1 E: E: 1*: == Parcel I. D. 050-321-22 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: 2a Complete legal description TIMBER RIDGE BLOCK 2 LOT 4 Location (site address) 19415 UPPER SKYLINE DR., EAGLE RIVER, AK 99577 Current Property owner(s) RUSSEL ARMSTRONG Day phone Mailing address Real Estate Agent DENNY WOOD Day phone 337-9663 2. TYPE OF DWELLING: © Single Family (w/wo ADU)�� El Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) MAR 4 2014 3. NUMBER OF BEDROOMS: t' 7 _�` 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑x Individual 71 Individual Watef Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance: --- Received by:' l4"), ldiL'vv� Date: !'t �— COSA to be released to the engin e' r, unless otherwise requested by the engineer. COSA Fee $ So`c':' ^ Waiver Fee $ Date of Payment51q t 1� Receipt Number �` r COSA# OSS -N 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE >/ System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Phone 279-3916 Date 3/3/14 y I\ 17 o �^ ( '3 3 E S! UIIF'KILA D 11,500 Conditional approval for bedrooms, with the following stipulations: By: Original Original Certificate Date: The Municipality of Anchors? 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. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: TIMBER RIDGE BLOCK 2 LOT 4 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 9/12/78 Sanitary seal (Y/N) Y Total depth 102 ft. Cased to >40 ft. FROM WELL LOG Date of test 9/12/78 Static water level 75 Well production WATER SAMPLE RESULTS ft. e• Coliform NEG colonies/100 mL Nitrate 5.85 mg/L Arsenic ND ug/L Date of sample: 2/25/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1500 gal. Number of Compartments Foundation cleanout (YIN) Y Date of pumping 2125/14 C. ABSORPTION FIELD DATA Parcel ID: 050-321-22 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 2/25/14 70 aw ui g.p.m. Collected by: ANSON MOXNESS Date installed 8/12/2008 Cleanouts (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Pumper SANITARY PUMPERS Date installed 10/8/78 Soil ratingd./ftz or ft2/bdrm) System stem bpe TRENCH (9 R Y Length 101 ft. Width 2.5 ft. Gravel below pipe 72 ft. Total depth 9 ft. Eff. absorption area 1212 fe Monitoring tube Y Depression over field N Date of adequacy test 2125114 Results (Pass/Fail) PASS For r � bedrooms Fluid depth in absorption field before test 12 in. Water added 850 gal. New depth 29 in. Elapsed Time: 200 min. Final fluid depth 23 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date - D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at— E. t- E. SEPARATION DISTANCES WELL ON LOTTO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50+ Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10+ Wells on adjacent lots100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 101+ Curtain drain 50'+ F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water 100'+ Wells on adjacent lots100+ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 3/3/14 COSA brown sheet 10-10-12.doc Absorption field 5,+ Surface water 100'+ Water main NA Driveway, parking/vehicle storage 10' i . hl �.. ° S E. S?U7i:LAPi^ 11 °0 Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval 4 OSC141063 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of Timber Ridge subdivision. This inspection revealed a nitrate concentration of 5.85 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. V, i; v EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. The information hereon is for the use of lending institutions showing the relationship of existing structures and platted easements and lot lines. It is not to be used for positioning additional structures or fencelines. lixtt" : rime , Ittntatti.w/0/76 I DATE: 1"=30' 1' . .9-23 ' NW 255 Duane Mark S vuardo r LS 1 ' 0 N° zz RECERTIFICATION 4/.8/92 AS -BUILT No corners set this date I hereby certify that I have performed a Mortagee's in- spection of the following described property: Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there• to, that no improvements on property lying adjacent thereto encroach on the premises in Question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 3 say of Sept. lY 89 688-4566 _ SEWARD fl ASSOCIATES LAND SURVEYING Municipality of Anchorage • Development Services Department • Building Safety Division On -Site Water and Wastewater Program 5 T. 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 FORA SINGLE FAMILY DWELLING Parcel I.D. 050-321-22f.• HAA# Expiration Date: - 2 - 1. GENERAL INFORMATION Complete legal description lat 4; B l o r k 2; T i mhP r R i d g P AninTtmmg S„hd i i s i ^n Location (site address or directions) 19415 Upper Skyline Dr. Current Property owner(s) Annie & Landis Tew Mailing address Lending agency Mailing address Day phone 351-3456 1601 Eastridge Dr. 4/103 Anchorage, AK 99501 Day phone Real Estate Agent Kathi Olmstead / R max Day phone 644-42nn Mailing Address �J 99577 Unless otherwise requested, HAA will be held by DSD for pickup. of 2 !— c /-2, /-0 y 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well 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 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply andlor 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 S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loon Ste, 2.04 Eagle River, AK 99577 Engineer's Printed Name ' Robert -C. Cowan Date - S-Axylo I/ .�'"``� �`1'% `���O�r�cOF �s`r��a _ • ON-SITE : Pt ; g : WATER AND r .. ...............�.......... . 5. DSD SIGNATURE WASTEWATER aOBEur C. COWAN PROGFUNM o'. CE -8801 Approved for bedrooms. �O,c, •• •• 44-1 p�� 3�s cd Fj,�; ��; •t� Disapproved. Jii Opn,IENT �•�` �1a�..°c Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concen ra ion is m maximum concentration is 10.0 m ore informatton on niltrates is-avatlable from trie On -Site Services Program, a 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other gy; Original Certificate. Date: �� �. *' �%LL (Rev. 01102) --'---•-------- _ ... --------------- Municipality ------ -- Municipality of Anchorage TB� Development Services Department 6-6,1, Building Safety Division _ ~ On -Site Water & Wastewater Program 5 " "" 4700 South Bragaw St: P.O Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us ' (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST ,Legal Description: ler ;00&,'-0-'9 Parcel ID:05Z I?- ^ Z.2- / A. WELL DATA Well type - If A B, or C provide PWSID # Well Log (Y/N) y Date completed ` Sanitary seal (Y/ '7 Wires properly protected (Y/N) Total depth ,ft. Cased to 4O ft. Casing height (above ground) din. i FROM WELL LOG AT INSPECTION Date of test%iLe /3/04 Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate �+�`( mgA. Other bacteria D colonies/100 ml. Arsenic: `- mg./I. Date of sampler 04Collected by: 'J G % tJ 6a My, B. SEPTIC/HOLDING TANK DATA' Tank Type/Material T/G Date installed 10 Tank size 1.C'W gal. Number of Cornaartments leanouts (Y/N) _ y Foundation cleanout (Y/N), Depression over tank (Y/N) :High water alarm (Y/N) Date of pumping4jaojo4 Pumper C. ABSORPTION FIELD DATA Soil rating ./ft2 2 System type �C tyDate installed g.p.dor tb�sT� Length C7 ft. Width r ft. Gravel below pipe ft. Total depth ft. Eff. absorption area t' Monitoring tube y Depression over field i Date of adequacy test 3 Results (Pass/Fail) For_3 bedrooms Fluid depth in absorption field before test C) in. Water addedYS3 gal. New depth 3 in. Elapsed Time: & 0 min. Final fluid depth O in. Absorption rate >_ S -Z) g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 'y d If yes, give date "'— D. LIFT STATION Date installed A114. Size in gallons Manhole/Access (Y/N) j "Pump on" level at in. "Pump off" level at in.' High water alarm level at Datum Cycles tested Meets alarm & circuit requirements?, E. SEPARATION DISTANCES GIi SEPARATION DISTANCES FROM WELL ON LOT TO. Septic tankfn on lot On adjacent lots I' f ion i Absorption field on lot too r4— On adjacent lots i r -F- II Public sewer main Public sewer manhole/cleanoutAJ _- I Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTICG TANK ON LOT TO: ; 4- Property ! ' j Building foundation perry line Absorption field Water main '`f iWater service line / - ' hSurface water 06 ''-- Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line l © t•�" Building foundation ©'� Water main t Water Service line (O. {-- Surface water © Dr.! 'vway, parking/vehicle storage' ' Curtain drain Nbu F KN e H.! Wells on adjacent lots / 0o - F. COMMENTS j G. :+: rC •.� i r � � t '��' fir`• ENGINEER S CERTIFICATION certify that I have determined through field inspections and ; �...: y ».•... »•�• Y•.••`�i he above s stems are rr..,........a...... ..1.........;� review of Municipal records that f y ' e in conformance with MOA HAA guidelin; s in effect on this date. 1p '*1Rost Rt C. cowAN I, r Engineer's Printed Name r` `�' •�• Date .. cs"�� �y �b �% F i.iZ I'``F,�•FE�S��tA.,-Y HAA Fee Date of Payment �` ( a 9 /o Receipt Number a (Rev. 12/01) Waiver Fee SI'' Date of Payment - I : Receipt Number i s ili i I I i ',I Sent By: RE/MAX OF EAGLE RIVER, INC.; 9076960214; May -24-04 10:39; Page 1/1 r.. J . �TEf�>iC' sT.9ND of w 01 . 3a .' ��Cj •� 6'%�1 :. / i' x•1,1 d?�.� -��R r �� OF A4q 1Aw' i*: •9tH �� ,.•' moo.. 1 .••-%� ���ij% �'•r .sem .4a4. ,�• ....$ Dm 1Ns�k 5•werd ' Jr �: ��j� �s ��;•. LS -6918 •� it w'rp- . �AGs'W ;''z RECERTIFICATION 4/.8/92 AS-BUILT'No Comers set this date EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE I h..by eertlty that I have performed a Mortagsc•s lo - RECORDED PLAT ARE NOT SHOWN HEREON. sPoctlon of the following desvlbed property: Timber Ridge Estates Subd Lot 4 Blk •2 The information hereon is for the use of lending Anchorage Recording Precinct•Aluka, and that the improve. institutions showing the -relationship of exists ments situated thereon are within the property lines and do p noreverlap or -encroach on the propvtr lying adjacent there - structures and platted easements and lot linea.. to, that no lrrt rovcntenta on properpr lying adjacent thereto It is not to be used for positioning additional encroach on the promises in Question and that there are no structures or fencelines. roadways, tranzrn*ion lines or other tlsible ea."monta on said property a:sept as indluted hereon Dated at Mehora`s, Alaska DRAWN: MS RECERT.4/8/92 DATE: 9-3-89 Lhil -yot_ SeAt. _ 19.89 KALE: 6AA-4566 1"-30' FB' .9-23 ' GRID: NW 255 SGWARD & ASSOCIATES LAND SURVEYING it . I i I `- . 't 1, , �LL i;, t� v,tl4 11 to VOL L! it 4 1 to Pard3l'I.Q.0 4111 Wr INERAL INFOAP j 1c to i6ji 1, &�c I i Libcati;n'(site "adds Prop' er*tybwner.�Ii;i �...-Mailing address agency ' .11" I Lending ig It Mailing iddress"! 2 4 11j!1:. Agent 4111 kill a i lit Ad ress1i'll'166-WC I. rt inv Onh il isibthemlsin tj I ZIL N U M 8 ER, E Or� Indiv t"I't Pubil �N I IT-COMMU PE OFWAST %mi 40.: lncl�v "Holdl c(4 }Corm Publi T�!I;.NOTE: 0 com u yy ?2;-M(Rw1A1) row 821,�i It t � " CES 2.'.1 ! W 1%i"I J.' * , , " - 'If, I I i 'I � , I i "l, � 0 MA91) I 1141 Ujfi 0 a 'jil j 1 -VMV"� 111'� I �1 I lit t JiVI'K 1; r rs Yftptive :t1ons; �7 19111 rl i I I,!, JJ VW 11iii J; a ki Day. phone",. 06 A n Jim It .4 2, M V A', f2l; Iv F Day. phons,'i'" X11 2.'.1 ! W 1%i"I J.' * , , " - 'If, I I i 'I � , I i "l, � 0 MA91) I 1141 Ujfi 0 a 'jil j 1 -VMV"� 111'� I �1 I lit t JiVI'K 1; r rs Yftptive :t1ons; �7 19111 rl i I I,!, JJ VW 11iii J; a ki Day. phone",. 06 A n Jim It .4 2, M V A', f2l; If^ 4 'I j',�v a,'Ohoni . D 1 V, Run PL it L My it Ity well a or NA �j :rib t well, �Skotg Otion i .'ADEC tp " status - 4 l 4 Pit., a1h, ten,� tt', A S ikol I Iv F Day. phons,'i'" If^ 4 'I j',�v a,'Ohoni . D 1 V, Run PL it L My it Ity well a or NA �j :rib t well, �Skotg Otion i .'ADEC tp " status - 4 l 4 Pit., a1h, ten,� tt', A S ikol I �i �� } 'ti" r•i:.! t,, , 1i1 III 1 III ! I 711 llllI r�r . r„ „ r� II II , AL r N 1' +�'r I{I ty{!hi• li I �) •... Al {1!da"l yirh, �,� ,i! , 1,,II t,,,. 1 1 4t11 Y�I�,' '' 'r' flvi {,' '.'i Iii. ., I'f ' STATE M(ENT�OF�INSPECTE� {,j x44�N'/ re1'+ It q 3? �fl'I Vn II, ! 1:11,r,1'i." i� ' 1 t ±J /ixl r IfF��'ItYtS:�#il{It(� rIL �11,'tl�Yllr -Y,''�.N 1 1�r97'^Wllki� � 1 Xxil}p�'Gi�,i�rli��itilGiitE� �i7 Ah'!lt ri.11t.11l'�' tl •rf; As CQf�+f �e�,Y n�y seal affix 1{�♦Q$,� c Af I d tion'da4Yp�, rho '1�rpe qw' I, ri1(�]�. hat my;; - , Cyt t 1w4111^.,I rl 1l rl' 11 4 - 1 r., R.•1 11'!^1Vg�y��'i tl� ' ' ' 11 ' A•L ( / ':'4. 1',� - li I 1• fV JIl� ^._ �} t %S rl MiIN 11'•�Ai' ,i Ik •:1 Al l b Y; rl.'}:1r /rpsAl„r IN Ir tr, rI r r•,,..y, 1 w.l..nli.:w ../ lLfw'lJww1�L A •L_�IL I.__. 1__♦ _I_L_..__ .r_ It...k r r.rr .v r .••w• • 1 K7 1 VI 2aRO�i910101 .lY it Ir}, itill"'r ,nry; 'u'IN •,VIII 'llll ll•� ,t. . HutV01r'ilY li #1 }{!1 ill.: /V ''IYI,1111 p11;'1'+'IP. )L Ti VIE-t.JN::rF'M'•"f :1161L1 and/or Wastewater disposal y r�gl 8r� adgQ gta for the mbar of bedrooms 'r' ' 1 Inl.l,lcliingtr•n,„,. n 1,1..,.,..1 N� llr{�j{8R;1 ,I.JI�bflRl��;, ;k • f}''and , /'S' 1 k11Q i F It b 11 It flu 1 44.9`:{ b u n p-' w,}, i 4 } { f structure IndicafT errQ{ R /f ��}t }p{1�yer'F♦]'1(4�1'a bas!p��} '�Yr t Yp I!�1`(ofmatlq 4btai ad from i. i,l"411 t.•'-, il'N;l ill'iP'•I.SI..f,Ir.IMkt ,'1"4i�11.A 1^'NI IIIfit1111ix�1f1lflal,R."nrl •'frl �oItr,�l':�il+rr #.I''1( Inr e'1 b }a;the Mu Igipality of Anchorage f tl ' + ' 1 i 1 •,".,' f # Il, I,t r I,Yr ; }i 1 . '1 9� l�G„��/T1^r�}�ytipes gatlprl ar1�i Inspection; the ori site water i, 1 �, , I , { I..l!. All Fllh.I.INa•.I�r Y•t. l.r{:W•NI rl° , Irl• , 'Jl t....OYslb 1••u1L aIle. .l,r rR'. i'xrF' I{1.1'..1 i full} .�:: , ti I '. ; �. } supply and/or. wastewater:di.� �a aY is'in co({�PI(, ce+Wit tall wr Icipal and State codes, r r r1 '1;' � s , ik} ,I•rF rl•.li.}P; I.IIi 7rHi Il '. Y 11 a r211I `I k�dgl .7f I, 9� 4#rllt!v'11k'i "! }_Ir a��llil•tY1Mw�i1:} it I ' t t1 �i.# �. ordinanc and regulations i p7ect t date q tjjis'ins >..pit .w•' I i Gl ... f 'e•i(il�'!t5 i ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-rrr A 5►.11- Z'�r•�P�F_r!- Parcel I.D. _ OSo- 'S-1-1 - zz- -r_ �tDr.,� syr A. Well Data - Well type ?e t\1 kcf, If A, B, or C, attach ADEC letter. ADEC water system number_ �a Log present ON) .J Date completed `I- 12 st 8 Driller ke4 t -o Total depth 1 �, .Z-` Cased to - N a -L' 61_gL.Casing height t Sanitary seal ON) / Wires properly protected (PN) q B. SEPTIC/HOLDING TANK DATA Date Installed lc> - :6-7t3 Tank size j oo o V, Compartments z Cleanouts QN) _Foundation cleanout((DN) Depression (YQ) High water alarm NOL_!�Alarm tested (YIN) Date of pumping Z -O, 5 S Pumper �Q- . �J �lP , a(, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lo 4 1 On adjacent lots 1 0 o Lt- Foundation t To property tine l o1 4- Absorption field l 'a Water main/service line I o% 4 - Surface Surface water/drainage too %A* 72-MS(M)•Front CONTINUED ON BACK PAGE FROM WELL LOG AT INSPECTION Date of test S o Static water level -7< Well flow f3 , b g.p.m. �. t -t'1 g.p.niow ) - Pump levell OIL S G, t'r1 m a SEPARATION DISTANCES FROM WELL TO: t,'1 "' o Septic/holding tank on lot 1 6 LA I ; On adjacent lots 1 a o � } z CT Absorption field on lotI On adjacent lots o 4- Public sewer main '� [AAI sewer manhole/cleanout '"� A Sewer service line 2s, } Petroleum tank 'ZS �+ WATER SAMPLE RESULTS: Coliform a Nitrate 6-8 Other bacteria O Date of sample: q- o-15- Collected by: S f S B. SEPTIC/HOLDING TANK DATA Date Installed lc> - :6-7t3 Tank size j oo o V, Compartments z Cleanouts QN) _Foundation cleanout((DN) Depression (YQ) High water alarm NOL_!�Alarm tested (YIN) Date of pumping Z -O, 5 S Pumper �Q- . �J �lP , a(, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot lo 4 1 On adjacent lots 1 0 o Lt- Foundation t To property tine l o1 4- Absorption field l 'a Water main/service line I o% 4 - Surface Surface water/drainage too %A* 72-MS(M)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) High water alarm level "Pump on" level Meets MOA electrical codes (Y/N) SEPARATION D�51ANCt FROM LIFT STATION TO: • ",Puha off" Level at ;les tested Well on lot On adjacent lots I Surface water D. ABSORPTION FIELD DATA Date installed l 0 � 9 7S Soil rating (GPD/Ft2) 3�5 I �f� System type TP�� �-►� Length 1 1 ` Width 'y . I Gravel thickness lo__Total depth Total absorption area 121 Z ` Cleanout present ON) Date of adequacy test'2 4Results pas ail) Depression over field (Y/, -� —4 ,V _ for 3 Bedrooms :Water level in absorption field before test b After test D �� Peroxide treatment (past 12 months) CY94 o-L-tJ6 /4C�J''tl^' If yes, give date ^)'A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 122 On adjacent lots /oo 14- Property line 3 ` To existing or abandoned system on lot '� //A To building foundation g On adjacent lots 3 01 Cutbank A Water main/servioe line / i Surface water 1 ` Drivgway, parking/vehicle storage area 2 5 Curtain drain E. ENGINEER'S CERTIFICATION certify Uhat I ha ve checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature CV wq nJ Engineer's Name �a/�f:r.�- C. - Date y /a r / 9 S` HAA Fee $ Date of Payment Receipt Number rt-ozs pM)' Beck 041- A RO££RT C. COV✓AN CE -8801 r' :fir d IN ••vim .1 Waiver Fee $ Date of Payment Receipt Number .. MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # r6q--� — 1 - a.Q — L HAA # n ria+-1�, 1. GENERAL INFORMATION Complete legal description Lot 4; Btock 2; T.imb2n Ridge Location (site address or directions) 19415 Uppet SkyP.ine Dni.ve Property owner A. H. F.C. 088553 Day phone 561-1900 Mailing address 520 East 34th Avenue Anchon.age Ataska 99503 Lending agency Day phone Mailing address Agent Shahon M,i_n_seh RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centet4ietd D4i.ve Eag.te R.iveA, A.taeka 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 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 XX Holding tank Community on-site Public sewer , NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & 3 rNGINEEKING Phone Address 17034 Eagle River Loop Road No. age River, as a 99.577 Engineer's signature Date OF At %I ' J . •N♦N•N• Y •. • ro R SHAFER '$,e► ®i s .• No. 215 6. DHHS SIGNATURE PROFESSI OFESSI Approved for bedrooms. Disapproved. 1 Conditional approval for bedrooms, with the following stipulations: /�� Additional Comments Nnta a The wt -11 for i -hi s r rnnPr}4z moats Pxi of i nq State and Municipal Codes. There are nitrates present. It is The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employeesof DHHS do not conduct inspections or analyze data before a certificate is issued..The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Flev. 1/91) Beck MOA 121 s Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 152 <A 91-1/- 2- '�lt-1t5F.2 R 0159! Parcel I.D. A. WELL DATA Well type 0-1.4 wll- If A. B, or C, attach ADEC letter. ADEC water system number t -k Ls' Logpresent ®/N) Date completed2= I S Driller �>� l -1X_% At, Pte. B3 -ea ' Total depth r�z1 Cased to t o 7�1 Casing height 12� r Sanitary seal &N) J Wires properly protected �N) B. SEPTIC/HOLDING TANK DATA Date installed 6 Tank size t bbb 4"X -L- Compartments -- Cleanouts(DN) Foundation cleanout ON) Depression (Y/( IC� High water alarm Y1�` Alarm tested (Y/N) Date of pumping Pumper Sf2- _ G� c Qa a L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t, On adjacent lots 1 bd Foundation lz�o' To ro ert line Lot ,. p p y Absorption field Io 1 Watermain/serviceiine 16 14 - Surface water/drainage 1 a0 �t '2-0Z' (Rev. 19i�ront F� \4-e T �j I�T>✓�t Zsv CONTINUED ON BACK PAGE I; -L w'3t-tPI.Ly. FROM WELL LOG AT INSPECTION 3 Date of test "1-1'L-18- 13-9y o z ��� i T n Static water level 7 31. Well flow g 0 g•p•m. 'I ,'s h 9 Fes! p Pump level VV-- li1L C m co .n „ D Z rn N y0 o SEPARATION DISTANCES FROM WELL TO: � Septic/holding tank on lot l 0 4 ; On adjacent lots It�D z Absorption field on lot -- 1 2'L, ; On adjacent lots 1 oa Public sewer main � Public sewer manhole/cleanout Sewer service line 2S' i r Petroleum to WATER SAMPLE RESULTS: SODA. Coliform � / .�. Nitr&te S• � Other bacteria �0�� _ Date of sample: 3 Z S , S ENGINEERING clad by: 1., 034 ragle River Loop Rosd No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed 6 Tank size t bbb 4"X -L- Compartments -- Cleanouts(DN) Foundation cleanout ON) Depression (Y/( IC� High water alarm Y1�` Alarm tested (Y/N) Date of pumping Pumper Sf2- _ G� c Qa a L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t, On adjacent lots 1 bd Foundation lz�o' To ro ert line Lot ,. p p y Absorption field Io 1 Watermain/serviceiine 16 14 - Surface water/drainage 1 a0 �t '2-0Z' (Rev. 19i�ront F� \4-e T �j I�T>✓�t Zsv CONTINUED ON BACK PAGE I; -L w'3t-tPI.Ly. C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA'electrical codes (Y SEPARATIONS Wett'on lot Manufacturer Manhole/Access (Y/N) FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA p off" level at _ — Cycles tested Surface water Date installed l'o - S -79 Soil rating 31 S'&�13a-' System type Length (� l l Width 3 Gravel thickness Lot Total depth � Total absorption area Cleanouts present (ON) y Depression over field (Ya Date of adequacy Results as fail) PDcf�S for "1�rkP�+,�— t'3� bedrooms erox)de treatment (past 12 month's)1(Y, f� 14.-1 a a,4 If yes, give date :. (y µ�lnitvd-)zF.9. SIJGA, 'iST SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot �'L2� On adjacent lots ---loan}- Property line lot To building foundation Sat To existing or abandoned system on lot A l,& On adjacent lots 1 Cutbank r� 10- Water main/service line 1pt Surface water > r� t Driveway, parking/vehicle storage area 2S'+ Curtain drain lb E. ENGINEER'S CERTIFICATI,ON..;.., I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. My OF At. 5 & S ENGINEERING p y.��t''.••'••w••••''ys�fh� Signature 17034 Eagle River Loop Road Eagle River, Alaska 99577 No. 204y� f��� •s I Engineer's Nameto ....•...a.•,a. �..., 00 to 0 to Date `'� �-T4 0 �Z '; ROG R J. F' No. I O 16% �'ROfESS10NP�+� . HAA Fee $ Waiver Fee: $ Date of Payment " Z Date of Payment Receipt Number ZP 4 14Z !GG % "Receipt Number 72-028 (Rev. 3/81) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ON—SITE WASTEWATER DISPOSAL SYSTEM INSPECTION ENGINEER FIELD AUDIT DATE: / y TIME : 3,0 LEGAL DESCRIPTION:1 ENGINEER: EXCAVATOR: AUDITOR: SIGNATURE OF AUDITOR: aZ4 2L.61 n . , I p....� �� ...._.....� ..^...._�- / � � SAE � A 17q '1 % �. MUNICIPALITY CF AN MUNICIPALITY OF' ANCHORAGE DEPT. 0' ; :ALiH � ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'f^C)p�,V.r:NTAL Fi•DT 9 S 825 L Street -Anchorage, Alaska 99501 i' •ENVIRONMENTAL MAR 1 Q 1� ENGINEERING DIVISION Telephone 264.4720 RR' j 1 CE DI REQUEST FOR APPROVAL' OF, INDIVIDUAL WATER AND SEWS FACII ITIS i Ilii DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing, I 1. PROPERTYOVVNZg PHONE, 1 ! SINGLE FAMILY ❑ One [3 Four! O ❑ Two ❑ Five I ; MAILING ADDRESS I f ICE5,Three ❑ Sixl 7. WATER SUPPLY I Ii I i ! Y , ATTACH WELL LOG.'A log is for C;Fz--INDIVIDUAL*; well requireii all wellsldlrilled PROPERTY RESIDENT ( f different from above) I PHONI ❑ PUBLIC UTILITY I dl I I f /1 I I I eelf � INDIVIDUAL/ON-SITE" individual/on-site, give installation dated. If system is over,two (2) years old an adequacy test is required1 2. BUYER j i • i I I I f! by this Department. PHONE MAILING ADDRESS I I I 1 3. LENDING INSTITUTION PHON I i ; _ i I I ( 11 1 , MAILING ADDRESS 4. REALTOR/AGENT ,.. '.. i •', PHONE I ) 1' MAILING ADDRESS I f i 5. LEGAL DESCRIPTION I STREET LOCATION / % wto I I I I l ^P ✓ -� 6. TYPE OF RESMENCE NUMBER OF BEDROOMS 1 I I 1 i Elther SINGLE FAMILY ❑ One [3 Four! O ❑ Two ❑ Five I ; ❑ MULTIPLE FAMILY f ICE5,Three ❑ Sixl 7. WATER SUPPLY I Ii I i ! Y , ATTACH WELL LOG.'A log is for C;Fz--INDIVIDUAL*; well requireii all wellsldlrilled F-1COMMUNITYsince June 1975 For wells drilled prior toIthat date, give Well i ❑ PUBLIC UTILITY depth (attach lo64if available.) 1-4-14-E I ! i B. SEWAGE DISPOSAL SYSTEM j I I f /1 I I I eelf � INDIVIDUAL/ON-SITE" individual/on-site, give installation dated. If system is over,two (2) years old an adequacy test is required1 ❑ PUBLIC UTILITY, i • i I I I f! by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I THIS SIDE FOR OFFICIAL USE ONLY _ _ r INSPECTION APPOINTMENTS DATE RECEIVED ," TIME TIME TIME + DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY . ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED i INSTALLER ❑Septic Tank or ❑ Holding Tank Size:I GO 0 If Tank is homemade give dimensions: SOILS RATING . -,,. 3 f'SJ TYPE OF TANK MANUFACTUR TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO:' Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS n^ r n' APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter mus company certificate) f� DISAPPROVED DATE nt7 BY (Title LEGAL DESCRIPTION 72-010 (Rev. 3/78)