HomeMy WebLinkAboutTIMBER RIDGE BLK 2 LT 7Timber Ridge Block 2 Lot 7 #050-321-25 r MUNICIPALITY OF ANCHORAGE � DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 127S EW a.L_ it-" "�l(�fis DUPGRADE MAILING ADDRESS 03 1-�l a� �p LEGAL DESCRIPTION M 11> IC LOCATION Sz_d_ `r I L( NO. OF BEDROOMS DISTANCE T0: Well Absorption area l M Dwelling PERMJT NO. D Y 0�'4' t�ot} �� jj 56 a 2Q Manufacturer O Material No. of compartments W ,. Q)Liq, capacity in gallons IF HOMEMAD Inside length 13 I tt Width 11 Liquid depth 11 G Y DISTANCE TO: Well Dwelling PERMIT NO. JC2Z Manufacturer (>t Material Liquid capacity in gallons = DISTANCE TO: Well ppb 1' Foundation 1 } Nearest lot line 14— �. PE 11T N9—)6 S— Cl Z No. of lines Length of each line 1 Total length of lines Trench widt Distance between lines �( j- Ls Jv inches H Top of tile to finish grade4(1 Material beneath tile Total effective absor onra�, 1&0 inches 7 Z 0 Length Width Depth PERMIT NO. W l7 a F w ° Type of crib Crib diameter Crib depth Total effective absorption area U) DISTANCE TO: Well Building foundation Nearest lot line JClass Depth Driller Distance to lot line PERMIT NO. J 3Building foundation DISTANCE T0: Sewer line Septic ta nk Absorption area(s) OTHER PIPE MATERIALS X303 �Ic SOIL TEST RATING INSTALLER Ott ►� � T rl • a'o REMARKS .� f • 'O ��+y� � �( .Z7- �T. \t"R.�1�� !2 O " ''•�4s'� Dp �,�p��• lAlf ?e xe.c1, 44 c> eel it No. 145Y -E 42 0 :;`TOFESS\��� APPROVED 8ABE73GX a1uCi DATE LEGAL AutsK� -VSU 7 72-0131Rev. 3178) G AS r�� DOC Co. doa i SULLIVAN WATER WELLS P.O. BOX 272, CHLIGIAK, ALASKA 99567 • TELEPHONE 688.2759 I j OWNER OF LAND{ ' " /� F ,.S F, .: ��. , _ ) K' � .DEPTH OFWELL�=,).,.�•-i7 ADDRESS/C: .'' j'; , ' I,e:t r' t r �, �' _ STATIC LEVEL OF WATER FT. 1 II LEGAL DESCRIPTION "DRAWDO{VN FT. j DATE • Started `i Ended ;'.:)`''I GALS. PERtill PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From ''� Ft. to �1 Ft. From :;i• Ft. to ' ' Ft. From Ft. to Ft. From I +' Ft. to Ft From Ft. to_: : , Ft From Ft. to Ft. <,•; r From ! Ft. to - Ff From Ft. to Ft From Ft. to Ft FromFt. to , Ft From Ft. to ' Ft From Ft. to e I Ft From ' Ft. to -Ft. From Ft. to "'Ft i i From ' r. Ft. to �' Ft From Ft. to Ft. From , Ft. to 'Ft. From a• j Ft. to :7a. Ft. From Ft. to Ft. I I I, From Ft. to Ft. rrom Ft.lto rt(�' I �From Ft. 10rt From Ft: to Ft.G 7 Ff, From Ft. to_ Fes'�-�O�g'd� 0:6, 7 'u7b�H pNOal�3 From Ft. to F�t.'�TW dQ3Q From Ft. to ! Ft. I, 1 From Ft. to Ft. From Ft. to Ft. i From Ft. to Ft. tai From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. i From Ft. to Ft. I i From Ft. to Ft DRILLER'S NAME Akuniciipc-C Iity "0... - A 6-6:'" —�� ANCHORAGE ALASKA 19G i i 264-41.11 GEFAFIT;.'LILT CIF Of ALTH AND Fr.V In 0N:'ENT4 L on'ATFC' I ON March 20, 1985 Bill Nesheim 103 N. Bliss Anchorage, Alaska 99508 Concerning property: Lot 7 Block 2.T;mberline'Subdivision Dear Mr. Nesheim: Your septic tank plan has been 'reviewed and approved for one single-family resi- dence. This approval in -no way constitutes an approval to manufacture septic tanks. The engineer inspecting your system will verify the as -built tank. Sincerely, C. Benedikttson Civil Engineer CB/ra/d8 0 PERMIT P40: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: -LOT SIZE: MAX BEDROOMS: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 C)"— SS 1 T E ES IE W !E= F=C 850011 v 01/09/85 WILLIAM NESHEIM 103 N. BLISS ANCHHORAGE, AK 99508 "33-7196 SUBDIVISION: TIMBERRIDGE SECTION: 6 TOWNSHIP: 14N 37026 (S(?. FT. OR ACRES) 4 r/ r�eF:z M a T LOT: 7 RANGE: 1W Listed below are the options available to you in.designing system. Choose the option that -best fits your'site. - - - - - - - - - - - - - - - - - --- - - - - - - - - - TRE=P%dCa-1 nr__D DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 10.0 0.5 TOTAL DEPTH (FT.) 14,0 4.5 GRAVEL WIDTH (FT.) 2.5 24.0 GRAVEL LENGTH (FT.) 36,0 45,0 GRAVEL VOLUME (CU.YDS.) :35.0 40,0 TANI: SIZE (GALS) 1,250.0. 11250.0 x* SOIL RATING (SQ.FT./BR) 177p," 177 BLOCK: Your septic 4.0 ti.5 7.5 5.0 77.0 #* 57.1 19250.o *# 177 #* GRAVEL LENGTH 3 75 FT. REQU�RES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) *# TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - -- I certify that: I. I am familizir with the requirement=; 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 regulation, 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 manximum of 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-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED �,(��•�� n�� ------ DATE: APPLICANT: WILLIAM -SHEIM ISSUED BY- DATE: - - -- - - - MUNICIPALITY OF AIORAGE DEPAF.TMENT OF HEALTH AND ENVIRONMENTAL PFOTECTI3N 625 L STREET. ANCHORAGE. AK 99501 !/ " 264-4720 ON-SITE SEWER & WELL PERMIT PERMIT NO: 940746 DATE ISSUED: 09/07/64 APPLICANT: C/O S ° S ENG'G. BILL NEISHIM ADDRESS: S;3 195X EAGLE RIVER. ASC 99577 CONTACT PHONE: 494-2979 LEGAL DESCRIP: SUBDIVISION: TIMBER RIDGE LOT: BLOCK: 2 SECTION: 6 T04NSHIP: 14'4 RANGE: ,1W LOT SIZE: 37026 (SO.FT. OR ACRES) MAX BEDROOMS: : LISTEED BELOW ARE THE OPTIONS AVAILABLE TO Y \,I% DESIGNING YOUR SEPTIC SYSTEM. -CHOOSE THE OPTION THAT FEST -FITS YOU SIT_- TRENCH BED 4.DPAI' - - - - -i- - - - DEPTH TO PIPE 30TTOY (FT.) 4.0 4.0 / 4.0 GRAVEL DEPTH (FT.) .5 3.5 TOTAL DEPTH (FT.) 13.7 4.5 7.5 GRAVEL WIDTH (FT.) 2.5 24.0 5.0 GRAVEL LENGTH (FT.) �4o'.0 45.0 77.0 +* GRAVEL VOLUME (CU.YDS.) 35 \,2; 40.0 57.1 TANK SIZE (GALS). 2:0.0 ** 1.250.0 ** 1.250.0 ** SOIL RATING (SG.FT./BR) � 177\ 177, 177 ** GRAVEL LENGTH > 75 FT. REOU` RES MU}TIPLE PUNS (NOT EXCE=DING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO 0". P 4 RMENTS I CERTIFY THAT: '/ 1. 1 AM FAMILIAR WITH THE P,EAUIREM FOR ON SITE SEWERS AND WELLS AS SET FORTH BY T ,..MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INS ALL THE SYSTEM, IN ACCORDANCE KITH ALL .MO CODES AND PEGULATIONS. AND IN COMPLIANCE WITH THE D)'SIGN CRITE !A OF THIS PERMIT. 3. I WILL ADH6 E TO ALL MOA .AND TATE OF LASKA PEWUIF.EMENTS FOR THE SET BACK DISTANCES FRq.M ANY EXISTING W LL. WAS EWATER DISPOSAL SYSTEM OP PUBLIC SEWERAGE SYSN-N ON THIS 03 4P: ADJACr 4T OR .NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IIS VA .D FOR A MAXIMUM OF 4 3EDROOMS AND ANY ENLARGEMENT REQUIRE N ADD.TIONAL PERMIT. IF A LIFT STATION IS iN'STALLED IN aN AREA COVERED CUY MOA BUILDING CODES. THEN (1) AN ELECTR � PE IT AN INSPECTION MUST BE 09TAINED; (2) AS-9UILTS WILL NOT BE APPR ED ITHOUT ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK. A1UST �Ef,�jYLhiz _.Y A. LICENSED ELECTRICIAN. SIGNED DATE: ---------- APPLICANT: C/WZ a E`4G'G. BILL NcISHI�' ISSUED BY DATE: 9/% /L PERFORMED LEGAL 2- 3 3 4- 5- 6- 7- 10- 11 6 1011 12 13 `� 14- /4 15- 16-, 5 1s .JA- 17 1 19 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE wl) 7 � v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L Street, Anchorage, Alaska 99501 264-4720 /� SOILS LOG - PERCOLATION TEST p B(to// / `� -5,/ 1 Z7 v / DATE PERFORMED: _9 � U is ` - 2 7-/ /vI R 1= /mac c47 e s l %� veyaNi "- ` L6H7 S'/t✓7 175 - QX E'qf .4c N •T '/ sty • t R+berr A. shear, % ari NO. 14,57.E SLOPE WAS GROUND WATER e S ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 2 If /-13 0 �O =7k 3 �'' 3 tt /( q:, /oIq J/- 3 `( //) >�b 1Z6 / ' 8 S� L � /0 Z g' 7� 20 t_j PERCOLATION RATE / (minutes/inch) �% T /U'N ETWEEN FT AND FT COMMENTS /(�/e)V1 Vyz �N�— !�'�P PERFORMS BY: r S •� E 1 It�EEAN CERTIFIED GATE: aLE RtvE� n $tt)i �.57: pH, e� •�s7� 72.008 (6/79) pf 9` • Municipality of Anchorage =' On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 050-321-25 Expiration Date: - - 1. GENERAL INFORMATION Complete legal description Timber Ridge S/D, Block 2, Lot 7 Location (site address) 19445Miline Drive, Eagle River, Alaska Current Property owner(s) Harold L. and Paulette D. Britain Day phone 696-2454 Mailing address 19445 Skyline Drive, Eagle River, Alaska 99577 Real Estate Agent Audrey Mason, Remax of Eagle River Day phone 622-3344 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 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNahance request for: Received by: Cf T(;ML2?Q_ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ —I 10 Waiver Fee $ Date of Payment 3� la �I �J� Date of Payment Receipt Number Receipt Number COSA # pSCI 3 I OP 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 Douglas T. Kenley, P.E. Address 9806 E. Northstar Circle, Palmer, AK 99645 Engineer's Printed Name Douglas T. Kenley 6. DSD SIGNATURE _�z System #1 Approved for _�_L bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907) 746-1073 Conditional approval for bedrooms, with the following e 4 T & e By: Original Certificate Date: 3 ' �? 1'/ The uni ; ali o chorage 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 Septic System Advisory Well Flow Advisory COSA We sheet r i c X Nitrate Advisory Arsenic Advisory Other 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: Timber Ridge S/D, Block 2, Lot 7 parcel ID: 050-321-25 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 11/04. Sanitary seal (YIN) Y Total depth 280 ft. Cased to 156.7 ft. FROM WELL LOG Date of test 11/04 Static water level Well production WATER SAMPLE RESULTS: 174 2.0 Well Log (Y/N) Y Wires property protected (YIN) Y Casing height (above ground) 19 in. AT INSPECTION 3/9/2013 ft. 181.6 ft. g.p.m. 3.08 O.P.M. Coliform Negative colonies/100 mL Nitrate 3.48 mg/L Arsenic ND ug/L Date of sample: 2/5/2013 Collected by: F. Kenley B. SEPTICIHOLDING TANK DATA Tank Type/Material *Septic/Concrete Tank size *1250 gal. Date installed `7/5/85 Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 317/13 Pumper AS Pumping C. ABSORPTION FIELD DATA Date installed *7/5/85 Length *36 ft Soil rating (g.p.d./ftz or ft2 bdrm) Width * 2.5_ *177 System type *Trench ft Gravel below pipe *10 ft. Total depth 14-16 ft. Eff. absorption area *7204 fe Monitoring tube Y Depression over field N Date of adequacy test 2/13/13 Results (Pass/Fail) Pass For4' bedrooms Fluid depth in absorption field before test 61-314 in. Water added 900 gal. New depth 120 in. Elapsed Time: 84 min. Final fluid depth 92-114 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ----- D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: 100+ft Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? Septic tankAi t station on lot On adjacent lots Absorption field on lot 100+ft. On adjacent lots 100+ft. 100+ft. Public sewer main NA Public sewer manhole/cleanout NA 25+ft NA Sewer /septic service line Holding tank Animal containment areas 29 ft. Manure/animal excrete storage areas 100+ft. SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ft• Property line 10+ft. Water main NA Water service line _ Wells on adjacent lots 100+ft. ABSORPTION FIELD ON LOT TO: Absorption field 5 ft. 10+ft. Surface water 100+ft. Property line 10+ft. Building foundation 10+ft. Water Service line 10+ft• Surface water 100+ft. Curtain drain "None Wells on adjacent lots 100+ft. F. COMMENTS *From M.O.A. files G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Douglas T. Kenley Date 3 /it I,* COSA brown sheet 10-10.12.doc Water main NA Driveway, parking/vehicle storage 30+ft. in. PftCPaSFD mUeUD FLOOR S . (ABNYFD) MOPOND BULDNG 00IMM EIEY. (Assam) ZING o4s1FIel FRWT BWUMG SEIBAN I SK BI UNK S A(X REAR BWUNNG SETBACK 8 30' 296,00' N87' 19'05"E Cos 514' n LU Z EXISTING HOUSE E (n :A .......... In UP a ............ WE .... CL — — — — — — — — — — — — — — — — — — — — — — - — — — — — 10' ELEG ESMT S87' 19'05"W 227.52' 6 II UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY 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 ❑ FOUNDAPON AS -BUILT SYMBOLS ❑ FINAL STRUCTURE AS -BUILT SET REBAR 7= DRAINAGE ASPHALT ❑ PLOT PLAIN ... AS -BUILT ... LOT SURVEY ... TOPOGRAPHY 0 FOUND REBAR 8 WOOD FENCE CONCRETE El AS -BUILT ... NO CORNERS SET M REaRTI AS -BUILT ... NO CORNERS SET (f00II ASSUMED ELEV. METAL FENCE WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION gmrE OF q4 4, Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN I hwdy ­Ufy We' naw O�Iy Me let 4re. d . d Od 1 ** �' .................... A 46 X\ Professional Land Surveyors lefeueel W eatelfiewd di m.10 woNn M=w d d' AV 1700 Brink Drive. an d W= thef.-y A' ANCHORAGE, ALASKA 99504 mv 4W, •Soule: in = 50' Rea. Lot S.F. Rea. Plot File No. FOUNDATION AS -BUILT hereley arUfy hat I New We eun== I =d tW =mf P I ........ lk� ftK Date Surveyed: 03/13/13 Drawn b Y' CII b �of .4 hf..UHe W — her� d .4,t .neee ....... F R013ERT N J AN a AV REJ SMK Date Drawn: 03/14/13 Grid: W.O. FINAL STRUCTURE AS -BUILT Af2l " Ar AV NW255 13-83 Legal Description: 1, RaWwi C 4A� J.. Weby .1ty net I haes P.". an As-Bult wreey of We M" I.t d Wd al We ... ... ......... C� 00�00` *Ws.W. �.sen. d M�w� e. . ft. Ofession& �'Oo6 • Lot 7 BLOCK 2 W�mmft eeeet umm 41111111k TIMBER RIDGE MUNICIPALITY OF ANCHORAGE • -- Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES +� 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# aS�- 3:,�-:�L:� HAA# 0(;NR9'n(Wf 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7, Sock 2, TIMBER RIDGE SUBDIVISION Location (address or directions) 19445 Skyti.ne Da i.ve Eagte Riven / (b) Property owner Riff 9 Arlo Nesheirn Telephone: (home)A94-R949 Business Mailing Address P.O.Box 775091 Eagle RtveA, AK / (c) Lending Institution N6ntk2and Mo&tpage Telephone 274-5150 Mailing Address Attn: Donna (d) Real Estate Company and Agent RE/MAX o6 EAGLE RIVER, ATTN: V.ing.in.i.a KokC6iad Address 1.6600 C t_ t66e,9r n, StbEte 201 €ag$e Fives A" 99511 c vcc c ccccz c r , t Telephone 694-4 00 (e) Mail the HAA to the following address: (or check hererA if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 age River, Alaska 99577 2. TYPE OF RESIDENCE / Single-Familyx3 Number of bedrooms 4 3. WATER SUPPLY Individual Well KX Community ❑ Public ❑ Nate: If corrtimunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL r' On-siteJa Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATIOtl 7. 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 hereln.'l further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and, State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address 03q ENGINEERING niy r L � n River Loop Road No. 204 Eagle River, Alaska 99577 Date _ 6."DHHS APPROVAL Approved for _bedrooms Approved Disapproved _ \`1' m I IVCqnditional Approval iv F ` _ N Conditional _ w32'.•E0 The Municipality of Anchorage Department of Heath and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer ;registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oririalyio data be}ore a cc rtificate is issued. The Municipality of Anchorage is not responsible forerrors or omissioris in the profess6ai engineer's work. 72.025 JA*Y. Me) flack Page 2 Of 2 QP��SINICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) �G\QCHECKLIST -'FEBRUARY 1984 �Mti� �9 343-4744 V0 �9 n, Legal Description: ���Lo�TAIo/Ic �� 2 tlfdaE ULal01Slcit.) A. WELL DATA Al Well Classifica{ion If A. B, C, D.E.C. Approved (Y/N) Well Log Present (YEN) ,. Y Date ComplEted %`� Yield o our' c� — i SQ Total Depth �Q� ased to�8 Depth of Grouting Static Water Level 7 6 ✓ Pump Set At i< Casing Height Above Ground 1.2 l� Sanitary Seal on Casing (Y/,N) i Electrical Wiring in'Conduit (Y/N) Depression Around Wellhead (Y/N) 1y SEPARATION DISTANCES FROM WELL: I / To Septic/Holding Tank on Lot 1-00 'f On Adjoining Lots / 00 To Nearest Edge of Absorption Field on Lot 00 ; On Adjoining Lots 10 To Nearest Public Sewer Line To Nearest Public ewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Q5 -1- Water Water Sample Collected by s e ;Date Water Sample Test Results AG� - Comments B. SEPTIC/HOLDING TANK D4TA Date Installed JQ4, Size No. of Compartments Standpipes (Y/N) - / Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) _l Depression over Tank (Y/N) Date Last Pumped IL,g Pumping/Maintenance Contact on File (Y/N) r4 ; for AYA Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well bo 4- To Building Foundation' Z 0 �" To Property Line. C2 ! i" To Disposal Field To Water Main/Service Line d '� To Stream, Pond, Lake or Major Drainage Course bb / Comments �G �!Pti IMA ed 11 ti - 72 -026 (Rev. 7/68) Front Page 1 of 2 C. ABSORPTION FIELD DATA l /- Soils Rating in Absorption Strata 3 —Type of System Design /-%e tic Date Installed $r Length of Field I �?— Width of Field ` 3 � Depth of Field - Gravel Bed Thickness to r Square Feet of Absortion Area Ick O r Statndpipes Present (Y/N) y / ;Depression over Field (Y/N) ate of Last Adequacy T sty X14 'J n ,, (Results of Last Adequacy Test /wed roots r, . t 1 SEPgRATION DISTANCE FROM ABSORPTION FIELD: DO To Water -Supply Well ; O t To Property Lin e To Building Foundati n / O t To'Ezisting or Abandoned System on �1/� o , t Lot E1 ; On Adjoining Lots To WaterMain/Service Line �i� �" To Cutback (if present) N/A J#+ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed ( Dimensions Size in Gallons ' ` Manhole/Access-(Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments 1 "Check Permitted Bedroom Rating Against HAA Request" • certify that I have checked, verified, or conformed to'allrM,OA and HAA guidelines in effect on the date of this inspectiori."' OF~w< t'NGINEERING P� e� Signed 5 & 5 i �,�.•• �,... ...�. � •s b Company 17034 Eagle River Loop Road No. 20400 Eagle ve ♦. 00er Ss Date i ..». „ J MOA No. C �'—�� t .rt A. ib.�q No. 14-57.6 Va 00 E-�S10 .♦ Receipt No. 021oZ ` Receipt No. ;u►.,ra's�'" Date of Payment / >%" �� =2 / Waiver Fee: $ Amount: $ �� _ U�� Date of Payment 72-026 (A".7/88) Back Page 2 of 2 �' ; CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. r � 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 ............ FEDERAL TAX ID fl 92.0040440 ANALISIS REPORT IT SAMPLE for Work Order t 14600 Date Report Printed: JUL 8 89 E 11:54 Client Sample ID:L7 B2 TIMBERIDGE PWSID :UA Collected JUL 4 89 1 13:40 his. Received JUL 5 89 1 16:30 hre. Preserved with :AS REQUIRED Client Name : S & S ENCR Client Acct : SNSENGP P.O.t NONE REC D Req t Ordered By : Analysis Completed :JUL 7 89 Send Reports to: Laboratory Supervisor :STEPHEN CiDE 1)S & S ENGR Released By : �G� Y� 2) ......................................................................................................... Special Instruct: Chemlab Ref t: 6109 Lab Smpl ID: 1 Matrix: WATER Parameter Tested Result/Units ----------------------------------------------------------------- NITRATE-N 1.2 mg/l Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BI HIS Allowable Method Limits EPA 353.2 10 .............................................................................................................. 1 Tests Performed ' See Special Instructions Above IIA -Unavailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GI -Greater Than