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TIMBERLUX #3 BLK F LT 1
( IM6x(3aL A "rx-amt-8e Municipality of Anchorage Page ofd DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5' Te -1 t ��-1(��tC1D PID Number: Name: QavNo lL Wastewater System: ❑ New IgNpgrade Addu S*c>c> -me Av 9�s/� ABSORPTION FIELD Phone: cIS –2 15 No. of Bedrooms: ❑ Deep Trench IitShaibw Trench O Bed O Mound O Other LEGAL DESCRIPTION Soil Rating: I Total Depth from original grade: e GPD/S Ft Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe T 10 Y_ • S Ft. Z-� Ft. Township: Range: Section: Fill added above original grade: Gravel length: Z= Ft 70. Ft. WELL: 11 New ❑Upgrade Gravel width: Numberoflines: r Datancebetweenknev -- s= Ft. Ft. Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe matenat• Ft. Ft. � O SO, Ft. P910 7 303 a Driller. Date Drilled: Snhcweter Lail: installer. Date lnstbl{e �! Ft. Lv2orLA CONST yield:Pump Set al: Casing Height Above Ground TANK GPM Ft. Ft. SEPARATION DISTANCES IR Septic 0Holding OS.T.E.P. To Septic Absorption Lm Holding lublicrPrivate Manufacturer. Capacity in gallons: 1 From Tank Field Sndon Tank Server Lines ra !ZS'C WBIF ! a3 / 3S ,,,�� �S Material: s-re,HE Number of Compartments: 2 Surface Watterer �OOrt looT LIFT STATION Lot2( _ Sizeingallons: Manufacturer. Line Foundation 3 �Zf — � "Pump on" level at: "Pu ey(tl at: High water alarm at Curtain lrypT foo �' Pump Me el I Electrical Inspections performed by: Drain Remarks. T TA vk Lt,vaz -=r BENCH MARK Location and Description: SLfLrI,T Z11 Q21 1 �'�(!�. N dcl i ToP e.=SL Assumed Elevation: ENGIN SEAL•". `tOF A L'�3; ,2 oNa�A Dates: 1 st Inspections performed by: S-�'v P 2nd `121 _.........•• p ?1�1 Steven R. Pannone fes? R dvp Department of Healt end H man S rvices approval s+s`� ogsc) Reviewed and approved by: a A�rDate: r R-98 %,iY1°r`S`T.4 pati - 72-015 (Rev. 21 MOA 25 Permit No. SW 970406 F — — I / AS—BUILT P.I.D. No. 018-271-86 WASTEWATER ABSORPTION SYSTEM Lot 1, Block F Tirhberlux S/D C.L. Manytell Ave. Notes 1) Existing 1250 g Septic Tank was replace out -side the 100' j \\ g No setts or $ptSeptic 1 � \\\\ Septicc Tank. ,.^,.. systems Within 100 of Proposed System I C I W 3 V 4< sj •49TM R. Pani 8149 �2& T2 No Wills er Sptic systems Within 100' of Proposed System NEW UpGrade 5 -Wide, 70 LF 2' Effective. See Design Below. Bruno Kappes 4500 Maneytell Ave Anchorage, AK 99516 (907) 345-8874 No Wells or Septic systw Within 107 If Proposed System CO A / B DCl 33.2 60.8 T1 38.1 65.0 T2 /.46.3 72.8 DC2 50.7 77.2 CI 72.6 92.0 MT 69.5 98.5 C2 72.6 101.7 C WELL 25.7 46.6 AS -BUIL 4 Bedroom House 500 SF Rqd. AS-BUILTI 2' Effective, RF=1 4' Total Depth 5' Wide, 70' Long Total Absorption = 350 sf Pannone Eng. Svc. P. O. BOX 142025 ANCHORAGE, ALASKA .99514 272-8218, PHONE & FAX ATEt 4-30-98 AS -BUILT SCALED 1'=50' Perrot .No. SW 970406 AS—BUILT DETAILS P.I.D. No. 018-271-86 WASTEWATER ABSORPTION SYSTEM Lot 1, Block F TImberlux S/D V? P T Z Drawing V%Work%1-FTIM3.DVG r i 'ai 492L r ? Steven ••R.••PaQo*ne 7f� CE 8149 Z E� U W Bruno Kappes 4500 Maneytell Ave Anchorage, AK 99516 (907) 345-8874 ND NV3'1 3ani balm 1110 NV3 im NV3m Lno NV313 3A1Vn HU113AM MM NV313 1110 NV= U10 NV313 NO11VGW13A I W H tL 0 Q� d c ys; P G d. Pannone Eng. Svc. P. O. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 PHONE &'FAX 4TE1 4-30-98 AS—BUILT 0,4 <OP i Trls�euiiong I-i•2�'ga Yloo�1 x!30 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970406 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:KAPPES BRUNO & OWNER ADDRESS:4500 MANYTELL AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01827186 LEGAL DESCRIPTION: TIMBERLUX #3 BLK F LT 1 LOT SIZE: 59677 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:12/02/97 EXPIRATION DATE:12/02/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY DATE: /z/'r-/f7 DATE:/.2 - 2, " ( F Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax November 1, 1997 Municipality of Anchorage Dept. of Health R Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1, Block F Timberlux Subdivision Septic Upgrade Permit Gentlemen: My firth was contacted to investigate the septic system serving this lot for an upcoming sale. The existing trench system was tested to determine its adequacy for a four bedroom house. The system was found to be in failure. A single test hole was excavated on October 6, 1997 for a system upgrade. The soils report and a percolation test result is attached. Ground water was encountered at nine and a half feet below the surface. After seven days of monitoring, the ground water stabilized at nine feet below the surface. No bedrock was encountered in the test hole. The lot is approximately 1.3 acres in size. Lot 1 slopes to the northwest at a rate of approximately 1 to 3 percent. The proposed installation will be located on the north western portion of the lot. The existing field will be reused. A divcrter valve will be installed between the two fields. The septic tank will be verified during the installation. It will be reused if found competent and replaced if found leaking. Double clean -outs will be installed down stream from the tank. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any, questions about the proposed installation. Sincerely, AS' pr- AZ'%%t� Steven R. Pannone, P.E. 49th, "`• A Attachments: A st"" R. Penn �c CE -8149 PRCf� CAWORKUTimbe 00[.Wpd Permit No. I I Nyoswells or Sep of ProposSyNtt a I m U J 1 U I DESIGN P.I.D. No. 018-271-86 WASTEWATER ABSORPTION SYSTEM Lot 1, Block F TImberlux S/D X� 1 f, I i I 1 I � i I l ' 00. Proposed UpGrode 3 -Vide, 70 LF 2' Effective, See Design Below, �L& — No seUs m• Septic systems within loo' of Proposed System CF 49311 5, -- -md PREPARED FORS %Steven R. Panne ne% i Bruno Kappes E 81401�f�m4 r4500 ell Ave Anchorage tAK 99516 ,lk 1 (907) 345-8874 Weil DESIGN, verc Kerte = n Min/inch Solis= 125 sf/br 4 Bedroom House 500 SF Rqd. DESIGN, 2' Effective, RF=0.70 4' Total Depth 5' Wide, 70' Long Total Absorption = 350 sf Pannone Eng. Svc, P. 0. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 PHONE & FAX ATE, 10-31-97 DESIGN C.L. Manytell Ave. Notes 1) Existing 1250 g Septic Tank Is to be verified for Inegrity. Replace If found leaking out-s1de the 100' well radlus. No wells or Septic systems witwn loo' of Proposed System t`\ - Septic Tank. ,_...-• �„� See Notes ' ' X� 1 f, I i I 1 I � i I l ' 00. Proposed UpGrode 3 -Vide, 70 LF 2' Effective, See Design Below, �L& — No seUs m• Septic systems within loo' of Proposed System CF 49311 5, -- -md PREPARED FORS %Steven R. Panne ne% i Bruno Kappes E 81401�f�m4 r4500 ell Ave Anchorage tAK 99516 ,lk 1 (907) 345-8874 Weil DESIGN, verc Kerte = n Min/inch Solis= 125 sf/br 4 Bedroom House 500 SF Rqd. DESIGN, 2' Effective, RF=0.70 4' Total Depth 5' Wide, 70' Long Total Absorption = 350 sf Pannone Eng. Svc, P. 0. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 PHONE & FAX ATE, 10-31-97 DESIGN Permit No. DESIGN DETAILS P.I.D. No. 018-271-86 WASTEWATER ABSORPTION SYSTEM Lot 1, Block F Timberlux S/D Drawing Lt\Vark\1-FTIMB.DVG pw ar 49M R. Pa 8149 114? - z a U W I4 4500 Maneytell Ave Anchorage, AK 99516 (907) 345-8874 um ma i m retro IM retro 3AIVA wawa um NV= W J L� O M (L MINI Pannone Eng. Svc. P. 0. BOX 142025 ANCHORAGE, ALASKA 99514 272-8218 PHONE L FAX i 10-31-97 DESIGN a I� Municipality of Anchorage •}(,f f a9th l I�' DEPARTMENT OF HEALTH & HUMAN SERVICES T ' 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST -P, srw#n R. ►.noon# CE -8149 PERFORMED FOR, l RV(VB K– S DATE LEGAL DESCRIPTION: 1 — 1 Township, Range, Section: r—T SLOPE SITE PLAN I 2 3 �4 V"1 5- 67 6- 7 8 9 G;P 10 St' If- 12- 13- 14- 15- Is - 17 112131415i617 18 19 SAAn� w�Ce2/aVF3C -tRAta S(LT- CLO-AN cot3>3tes SANtJS 1} G.t2AVBts WASGROUNDWATERS ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water letter lO�l 1 Monitoring? �! Dett 2 T 20 -{ t e• uPERCOLATION RATE �y-c (minutevmcth), PE�RC HOLE DIAMETER G TEST RUN BETWEEN 3•S FT AND `, ti•SFT COMMENTS Ml ey-rAI,,,tma #.2 AtxacoA ny&mT TT% UJAS �0OCOAV,6b _ PERFORMED BY: S •R�ia1NON� j 1�+ . tom` ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 41851 'MUNICIPALITY OF ANCiiORAGEo-A. He_ .h and Environmental Prote ,on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION_ REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME S RJz `p h MAILING ADDRESS R A 1 n 7�T�'; 1' 1 , . PHONE Zg9 - LA ( LOCATION 1'V1 PVA^-�� LEGAL DESCRIPTION LI �� •��h�'r �^^Y SI Q '� 3 SEPTIC TANK: DISTANCE 1 NUMBER OF FROM WrLL 1004- MANUFACTURER (P t—'e MATERIAL Ste- 1 COMPARTMENTS? INSIDE LENGTH INSIDE WIDTH - LIQUID DEPTH LIQUID CAPACITY I.1SOGALLONS. TILE DRAIN FIELD: tt DISTANCE FROM WELL 00%FOUNDATION '20 NEAREST LOT LINE 1 # of Lines ' DISTANCE BETWEEN CAeA')'Z S&0y3 f - — pc:cVJ 9 3r -, TOTAL LENGTH �. / OF LINE � 1 LINES ^1_TRENCH WIDTHHBIN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT, LENGTH OF EACH LINE J DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE __?:___MATERIAL BENEATH TILE _2_1�_IN. ABOVE TILE SEEPAGE PIT: DIAMETER _ OR WIDTH _, LENGTH—, DEPTH Log Crib _Rings_ Crib Size: DIAMETER_DEPTH—DISTANCC FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_. NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: _1,A Depth: Well Distance To: Lot Line 20* Bldg: 0J4- Sewer Line: — Pipe Materials: LC� # of Bedrooms: Installer: trIT Remarks: Sol11 " 4 DATE _jAPPROVED fm I— p�— I��� IV 7 i - DATE _jAPPROVED fm f'1Ur4 I 9-- I' FfL I TY 10 F= F1H17--iECL • DEPARTMENT OF HEALTH AND ENVIRONMENTAL rKOTECTIQN � 2516'E., TUDOR RD., ANCHORAGE, AFL 43507 276-2221 �=�t�J—� I TE-••E4tIER F'ERt•7 I T `/ � od PERMIT NO. C 77005 ) D - 9-77 APPLICANT STEVE KRIZMAN SRA BOX 178P 3,94161 LOCATION MANYTELL LEGAL L1 BF TIMBERLUX 03 LOT SIZE 74000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSL? FT/BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION STIT TS: ��a U>EF Or V1 LEt4CaKFA .r-`- Ca FQ FA I?E=L_ C>EF Or hl THE LENGTH DIMENSION IS THE LENGTH CIN 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). F_EwCA LJ I FQE=E> L•EF•T I Cl THt4K C I a"E= 1 ,«C-1 1:�RLL1=1 r4 T FJ 0 C 2] I t4 F=* E C T I r_,"S:: F=1 F< E I F_ E G - 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 20=1 FEET FOR A PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER IN'=TALLATION. F'EF<:rl I T ti-*F=rL_ I C• F= uDF-* CDr4E YEF=iF r• F= F_C_it•1 I SLUE I CERTIFY THAT 1: I AM FAMILIAR.. WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 2: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED ISSUED BY PCICANT STEVE KR. ` .__ ._. ..__• _ .. �. ... _. • -_ .. .++----...rte_ +--w�rr _ _ _- �'�7 \ GNLATfR ANCIOU'U'L ARRA UGH( 11 fIrl' UcparUucnt of Luvironm,:ntdl Qul 3ity C- Artchoratle, AlesLa 97,tI3 St)II-S MR: • PI:Nt)I-A•I•It)N TEST Perforited for Mr. �tw^ Y•ri�-nn Legal Ucseripiiuni_Lo? ll ?lock �;-T-'"c. 'r. —c•- to Perforimd 4-18-76 1,•�T_� ski. , 0_3-- This fur•rn reports: Soils loij _..X '-'_'"-- I'ercolatioii -•---- teS t DC(�ttl ru-c t _ 'Erovr. h crus -gravel "-- r ---r- --, 2 - Blown hunus-&raval -000�3 - Bro-in Hu7us-grive1 4 - SX �...- 5 - s•�r h - SW 7 - sa' 1s - Slit srr 1 n _ cv 11 - SX 12 - sX 13 - Su .14 - sX % ,,nucJ"L Fads ground water Cncouatered? �•� If Yes. at witat depth? kcadiny Uate Gross TimC_--- Net Time ptir to 1;>•nler Net _ �n - --` t Urop A. I'crtnldtrun rate otinuto. ..._..--•---. ._......._.._..—_. Propnsed.ills lal111 on. ',ci r-im a Pit Drain Field :n:pth of .Irilct _ l:eplh to ht -t Lunt of pat ur• lrt•nt'1. .........-...••.--- r.u>:iltls: ._._.......- ...................... I'�:tfoniKit I:y:/Jarf>Kr��/i lftt���,il� �1 $ ,• ?ScF.ard Dr Y' -19-T I:t1 11•llt trt: /•1) , P. Richard A. �-ahn . I Up W t•1 L_I td I iG I L H L_ I T Y � F FI til E~ H •Y, l? FIG E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 59507 276-2221 FAELL FyEF?tl I T PERMIT NO. ( 76087 ) APPLICANT STEVE KRIZMAN 3104 WEST 34TH AVE 344-8550 LOCATION MANYTELL AVE LEGAL L1 BF TIMBERLUX SUED LOT SIZE 55176 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FyE=F1h7I T %A FA L_ I E] FOF1 CAME YEFiF? FFQQM I Inc, lJEa I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN BCCOT&YCE WITH THE CODES. SIGNED ICANT STEVE K.RI ISSUED BY- -`-'--" V .I� m0 /0' ' - �/' Qoi-1 , I MUNICIPALITY OF ANCHORAGE � . L i-• Development Services Department z: Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-271-86 1. GENERAL INFORMATION Expiration Date: Complete legal description Timberlux #3 Block F Lot 1 Location (site address) 4500 Manytell Ave Current property owner(s) Mailing address Real estate agent Bruce Ehrens & Sara Gaar Day phone 4500 Manytell Ave, Anchorage, AK 99516 Chris Swires 2. TYPE OF DWELLING: ❑i■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 _. Day phone (907)830=0073 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 3Ld 4 o a a Receipt Number 0 0 y Waiver Fee $ Date of Payment Receipt Number COSA # 0.5(,- I I10 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering (MJ) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 3/23/22 OF A/ _qAAge l�l 6. DSD SIGNATURE• . r 4 ..rs :l.j System #1 Approved for bedrooms / Benjamjnn&hiller / System #2 Approved for bedrooms �;��sTF ., 3/23/22 CE Disapproved Disapproved pROFESSW .� Conditional approval for bedrooms, with the following stipulations: 0 F i WATER AND z^ . o WAST m Anr�AM A/7- Original TOriginal Certificate Date: 3 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other 4� f'G aof'✓�SiUc F_. • < 1 Legal Description: Timberlux #3 Block F Lot 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Parcel ID: 018-271-86 Structure served by this system Q Well log is filed with Onsite (or attached) Well production at time of test 3.4 gpm Date drilled Illegible Water storage tank volume gallons Total depth 121* ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to >40* ft ®❑ Coliform bacteria is Negative Q Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND) ®❑ Wires are properly protected Arsenic ug/L Fg] Arsenic less than MRL (ND) Casing height (above ground) 8** in. Collected by Forge Engineering Date of flow test for COSA 3/21/22 Date of Sample 3/21/22 Static water level at beginning of test 44 ft. Comments *Taken from 6/6/85 Spurkland inspection **Previously approved in 1985 and 1986 COSAs. B. TANK DATA Age of tank(s) 23 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49 RI Standpipes/foundation cleanout per record drawing Date of pumping 3/23/22 A+ Home Services D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 4/21/1998 9 ALL standpipes present per record drawing Total measured depth from grade 4.9 ft (max) Measured depth to pipe invert from grade 2.8 ft (min) ❑ N/A — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective STATION ❑ Require aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 2/21/22 Results [I Pass For 4 bedrooms Fluid depth prior to test 9.5 in Water added 798 gal New depth 20 in Elapsed time 1440 min 12 0 Code -required soil cover over field Final fluid depth in Absorption rate >600 El System presoaked p 9pd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: After multiple attempts, unable to find cleanout at south end of trench, possibly hidden by snow. Does not affect operation of the system COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' r✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ✓0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' r7l Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓❑ Animal Containment > 50' 171 Yes if No ft Q✓ Yes if No ft 0✓ Yes if No ft Water Service Line > 10' p Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ®Yes if No ft 0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' ✓v Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' if No Yes if No ft Private Wells > 100'✓0 Yes if No ft Water Main > 10'✓❑ ft Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' p Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U✓ Yes if No ft Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet . 49 TM ¢� .. .. ...,�, ..f:. . . �.: . ~Benja •Irrr chiller : 4 CE 12592 • `� 3/23/22 W'&FppR01+ESS10NP�'�..�.�?� Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221110 Subdivision: Timberlux #3 Block F lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank. Mailing Address P O Box 196650 * Anchorage, Alaska 99519 6650 *www muni org r J O � L '00*002 M,,-VZ,20-ON 02 Lq CO O)CN 00 C'14 v)C4 CN; co_0 r.- 60.8 V) 8 Q:3 IQ) _0 0 co m U) 00 9- m 59.1 > 126.0 9- 121.0 1 0 CN 4-j o) V-* z - c Lo •0 0) -P4 0-0 0 00 LLJ U) E o >, CO W �o W E In < I- I C) 4-j 0 0 U-) oo _j 0. '0 00*09Z M,,-VZ.20.ON ro GAIJ(] ll@Ajno MUNICIPALITY OF ANCHORAGE •'�/ DEPARTMENT OF HEALTH & HUMAN SERVICES r 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. k o IS— 171- 86 HAA # 1\202 C1(Lk 1. GENERAL INFORMATION Complete legal description Ie, -r Hato ck �p -ri�fge�cvtic shy � Location. (site address ordirections) Property owner Z tovroo k A- 'P P-& Day phone Sgs-- 7 Z ts Q, Mailing address uSco MANMY'F-at( / A tV CW , Art q9S/6 Lending agency Day phone -Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water ct NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ' . , 72a25In«.1/911 F. MOA 911 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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' SAA)-2eN49; iv4. svL Phone Z;z2-82r8 Address W-o.eox 4An,cN Al- cSa)S/H Engineers signature sa Date CO 4S;5 V s� CE•8149 6. DHHS SIGNATURE. ?� Approved for — bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date s—A 98 - CAUTION `The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. rams MW wi) s� Mwm Municipality of Anchorage R E C E I V ED DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 4 1998 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90,00VA-430f Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: r 5 /D Parcel I.D.: mtAl- '271 -.94. A. WELL DATA Well" 'T�'Rn VA -T -IS If A. B, or C, attach ADEC letter. ADEC water system number Log present (YM) Date completed /VoT-t�,ATetCi Total depth &? Cased to i5? I Casing height (above ground) 1-2 Sanitary seal (YM) Date of test Static water level Well production FROM WELL LOG it9(v'T -yo i /lr) WATER SAMPLE RESULTS: Coliform ` ©— Nitrate Wires properly protected (Y/N) V 0,t©U AT INSPECTION 3/21/per TJt -i �r 3 ,5 g.p.m. Other bacteria � O Date of sample: SI3 19 f5 Collected by: 6 • R CnA vA_V N or S. SEPTIC/HOLDING TANK DATA Date installed it -21-18 Tank size I-Z.Tn Number of Compartments -e Cleanouts (Y/N) Y Foundation cieanout (Y/N) Y Depression (YM) n / High water aiarm (Y/N) Date of Pumping ✓u ew Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p•dJW or tt2tbdrm) / • 'Z System type S- w ID W Length 'iso Width S= Gravel thickness below pipe zs Total depth ''r` tAd Effective absorption area 3S b Monitoring Tube present (YM) Y Depression over field (YM) - Date of adequacy test N G w Results (Pass/Fail) TaA % S For ef bedrooms Fluid depth in absorption field before test (in.); — Immediately after -_--gal. water added (in.): Fluid depth ' (ins) Minutes later. Absorption rate = k.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3196)' �- If yes, give date — D. UFT STATION Date installed Manhola/Access (Y/N) High water alar I tested E. SEPARATION DISTANCES on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at' Septic/hoiding tank on lot 0 3 ` On adjacent lots /a o -I- Absorption field on lot / 3 �� On adjacent lots / oe -F Public sewer main . 11A Public sewer manhola/cleanout A -, IA Sewer /septic service line G S= Lift station /Co -r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: / Foundation 3? b — Property line 41s Absorption field Zo= Water main/service line ISS Surface water/drainage /& / Wells on adjacent lots /oof SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine Z Surface water 100 Building foundation -�LZ A- Water main/service line /U S r Driveway, parking/vahicle storage area jr,o Curtain drain / 00 t Wells on adjacent lots / moo{ F. ENGINEER'S CERTIFICATION i certify that I have determined thru field inspections and review of Munidpal records are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name STsWrynJ QZi�dyag,�4:� ra p, awe a Date ElZ l4.% . 8149 N `4 D� HAA Fee $ jz - ' Data of Payment U / / 9 Receipt Number o380? 3 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment _ Receipt Number _ MAY -07-1998 1526 ME ESI ANCHORAGE CTBT Snvieornnentsl Services tin. ♦ MI/�MI�IMNM/N�� ME Ret.N Client Name Prolate Name// Client Sample ID Matrix Ordered Ey MID sample xemuxe: 981982001 Pamone Tag Srv. N/A 1.3 Tmtbcrlux Bath Sink DrlWdq Water 907561530: P.02/03 Client PO# Printed Dak/Time 03/07198 14:43 Collected Detafrime 03/03198 13:30 Received Datefllme 05/04198 09:00 Tec6niol Dhwtor: Stephen C. Ede Relewed By j J n . e t. / Allowable Prop Analysts Parsrter Results ►oL units Method Limits cots Dat# Init xltr#t#rx 0.100 u 0.100 "A IPA 300.0 10 trot cs/cs/90 TSV Taut 0011rom a cot/100i. axis 92220 03/04/99 7M4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-0720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _l.oT I e�3 K �I t II•IBF_Rl..t9;f S EG n!X, 7JAN 23 Lel Location (address or directions) (b) Applicant Name LTelephone: Home Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; OwnerA6ti4derX ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution "U64&_OdbL_ Telephone Address �{- •• ,J�__ (e) Real Estate Company and Agent �_ �� �� 1.s�ri r r'u't Address D4_) Telephone (f) Mail the HAA to the following address: n . 1 4' 2. TYPE OF RESIDENCE Single-FamilyMulti-Famil Q Other Number of Bedrooms_ 3. WATER SUPPLY Individual Well �, Community ❑ Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11,84) MQ eol�l: 5. ENGINEERING FIRM PROVIDING INSPECTIONS; TESTS, FILE SEARCH, DATA AND INFORMATION Q As certified by my seal affixed hereto and as of the validation date shown below, I verily that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verily 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 —I ��b'w� Telephone 6 Address k4 Dale r IV *: ggTII 2225-E jl.114� 25. 1971 ,t�'rf`i DHEP APPROVAL�L, Approved for bedrooms b Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. 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 engineers work. Page 2 of 2 72.025111/04) MUNICIPALITY OF ANCHORAG: DEPT. OF HEALTH 8 MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) APR 161986 CHECKLIST - FEBRUARY 1984 284-4720 Legal Description:— S a cayy 7%tLN R A. WELL DATA Well Classification Fes`, If A, B. C, D.E.C. Approved (Y/N) KA Well Log Present (Y/N) Date Completed Q k • Yield —L -w" Total Depth -JO-2— Cased to $02- Depth of Grouting NONE Static Water Level S 9 Pump Set At eTTO H Casing Height Above Ground 8N Sanitary Seal on Casing (Y/N) y Electrical Wiring inConduit (Y/N) —i Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/Holding Tank on Lot I ; On Adjoining Lots ICO { To Nearest Edge of Absorption Field on Lot 1A(P_ ; On Adjoining Lots + To Nearest Public Sewer Line _K0- Nks` To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 6 O + Water Sample Collected by Y. S ; Date Water Sample Test Results Ss rrr Comments B. SEPTIC/HOLDING TANK DATA Date Installed Wig! 72 Size 11260 No. of Compartments C. Standpipes (Y/N) _OAC Air -tight Caps (Y/N) oy_ Foundation Cleanoutt (Y//N) �" � Depression over Tank (Y/N) _bi Date Last Pumped—Lfd_8j Pumping/Maintenance Contract on File (Y/N) N%A ; for W^ Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) WA Separation Distances from Septic/Holding Tank To Water -Supply Well 100 To Building Foundation 349 To Property Line a'a To Disposal Field ID To Water Main/Service Line 00 r To Stream, Pond. Lake, or Major Drainage Course NO Nt� Comments Page 1 of 2 72-0260IJ84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 125 Type of System Design S A L& T21e'N.CW Date Installed N&7 Length of Field /09 Width of Field _TSS Depth of Field 4el Gravel Bed Thickness 2 Square Feet of Absorption Area 1140 Standpipes Present (Y/N) _ y/ As Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test PftAA � ter Frry.t 044th � Separation Distance from Absorption Field: To Water -Supply Well 6 To Property Line To Building Foundation %Z- To Existing or Abandoned System on Lot ;On Adjoining Lots BOO lA To Water Main/Service Line i /p To Cutbank (if present) N O iu ACE- To CTo Stream/Pond/Lake/or Major Drainage Course NO Pi G To Driveway, Parking Area, or Vehicle Storage Area ID Comments D. LIFT STATION N C) N (r Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertify that -I have checked. verified. rconformed toall%OA and HAA guidelines in effect on the date of this inspection. at Signed _ ___ Date Lb l#06 Company MOA No. Receipt No. 2,-7-]R Un Date of Payment 0- I —u� Amount: $ L-� Page 2 of 2 72-026 (11,84) C'F`:: 'fit► `� 1 "'��'� •�, t? Engineer's Seat l ; ��.., o. •2225-L• P'; JU11E 2�. 1971 ;'� el - MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date q74 (a) Legal Description (include lot, block, subdivision, Location (address or directions) (b) Applicants Applicants (c) Applicant is (check one) Lending Institution ; Owner/bwader-M ; Buyer Q ; Other Q (explain); (d) Lending Institution Telephone Address '(e) Real Estate Co. b Agent 11E21T&g w gn4.lES 'P EM L ':A#MV-ATi— Address PPLO -7 A ti 12TH tf2 N : 19 Wr-c Telephone (f) Mail the HAA to the following address: 44o(9 2. Type of Residence Single -Family QMulti-Family Number of Bedrooms A/ 3. Water Supply Individual Well W Community M Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Q Public Q 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 5. Engineering Firm Providing Inspections, Tests, File Search Data and Information 6. 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 obb_... PC Telephone R%4-3'!/6 Address At a u/i /; (� Date `�Ukb P -:s AC +1!11 (ENGINEER SEAL)' - DEEP Approval Approved for &4— bedrooms Approved _K_ Disapproved Terms of Conditional Approval CAUTION ... '.�. 2225-E 1911 ✓ Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIR01ZENTAL PROTECTION (DEEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DEEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR MISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MMFCIPALTTY OF ANCHORAGE DEPT. OF HEALTH 6 ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) 'JUNE 7 19$ T HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 R E-CE I v E A. WELL DATA Legal Description: _L-OT I 1 IK T1 M ==PI,1S/ CCH`ZtiTli_IJ QZVC Well Classification FZc�1c�+���� If A, B, ®r C, D.E.C. Apprcved(Y/N) N/A Well Log Present (Y/N) PJJ Date Completed Q &A"o,an Yield Total Depth 1021 Cased to 102- Depth of GrbutingL E Static Water Level 53 Pump Set At $O-44ON—A Casing Height Above Ground -8 Sanitary Seal on Casing (Y/N) '' Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (YIN) r4N Separation Distances from Well: To septic/Holding Tank on Lot 10 b ; On Adjoining Lots 100 + To Nearest Edge of Absorption Field on Lot 1b) b On Adjoining Lots ( on To Nearest Public Sewer Lire N •D N E To Nearest Public Sewer Cleancut/Manhole NONE TO Nearest Sewer Service Line on Lot 50+ Water Sample Collected By -V�S /; Date 16/yIgs Water Sample Test Results• at5�4 Camients Fr- B. SEPTIC/HOLDING TANK DATA Date Installed 41977 `4 Size 12 50 No. of Ccnpartments 2 - Standpipes Standpipes (Y/N) pmt= Air -tight Caps (Y/N) x Foundation Cleanout (YIN) Depression over Tank (Y/N) N Date Last Pumped 64 IA 5 Pumping/Mainterarce Contract on File (Y/N) N/p. for Holding Tank High -Water Alarm (Y/N) K/*, Temporary Holding Tank Permit (Y/N) n4/, Separation Distances from Septic/Holding Tank: To Water -Supply Well fe 0 To Building Foundation 3 5 To Property Line 2p To Disposal Field 10 To Water Main/Service Line so * To Stream, Pond, Lake, or Major Drainage Course N D h\E Comments s�-\ppb Receipt # X11 Date Paid: Amount: 45 0 (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata U Type of System Design Date Installed 711177 Length of Field log Width of Field 4/8 " Depth of Field r/ Gravel Red Thickness 42 Square Feet of Absorption Area &&0 Standpipes Present (Y/LO Y Depression. over Field (YIN) hf Date of Last Aaequacy Test &A /as Results of Last Adequacy Test F:.tss-eoY Separation Distance from Absorption Field: To Water -Supply Well 12 h To Property Lire D To Building Foundation tj 2 To Existing or Abandoned System or. Lot No N I= ; On Adjoining Lots 190 + To Water Main/Servioe Line 1�JON t To Cutbank(if present) N o N E To Stream/Pond/Lake/Or Major Drainage Course_ NON E To Driveway, Parking Area, or Vehicle Storage Area I O r Cavmnts D. LIFT STATION N o t4L Date Installed Size in Gallons "Pump on" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (YIN) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. gets MDA Electrical Codes(Y/N) Ccnments ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, or ecnfcrrred to all MOA Di4A Guidelines in effect on the cats of this irspectiol. Signed _�-� a+^X A Date 61b $5 Companya�px i�E MOA No. $S Si,011 KB1/d5/s [Page 2 of 2] h:•' �`GiTiE as'':z7�t1 C)- -4 iHSEAL �•* . �. .. �•�� 0••2225-E.. •� JUNE 2S. 19:1 J 14 , ti 2-15-84 40 Ca wG JGnKLAAD9 pGaQ CONSULTING ENGINEER 1203 W. 15th AVE "C SUITE ANCHORAGE, ALASKA 9£ TELEPHONE: 19071279-., R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 1, BLOCK F, TIMBERLUX , LOCATION: MANYTELL/CURVELL OWNER: BOB AND NANCY MCQUARY TYPE OF WELL: RESIDENTIAL WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: NOT GIVEN 9 PUMP YIELD: 6.6 GAL. PER MINUTE WITH 43 FEET OF DRAWDOWN DATE OF INSPECTION: JUNE 6, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6.6 GPM FOR 100 MINUTES. THE WATER LEVEL IN THE WELL WAS MONITORED EVERY 15 MIN. THE STATIC WATER LEVEL WAS 53 FEET BELOW GROUND LEVEL. AFTER 100 MINUTES OF PUMPING THE LEVEL HAD STABILIZED AT 96 FEET. THE TOTAL DEPTH OF THE WELL IS 121 FEET. TEST FOR COLIFORMS: NEGATIVE TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPAL CODE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours. This well surpasses this requirement. F The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change •/ due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. r Co �a ��Qaaaa�y pogo CONSULTING ENGINEER 203 W. 15th AVE ANCHORAGE., TELEPHONE:i S E P T I C S Y S T E M A D E Q U A C Y LEGAL: LOT 1, BLOCK F, TIMBERLUX LOCATION: MANYTELL/CURVELL OWNER: BOB AND NANCY MCQUARY RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS WATER SYSTEM: ON SITE WELL T E S T SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: 1250 GAL GREER STEEL" ABSORPTION SYSTEM: SHALLOW TRENCH ABSORPTION AREA: 657 SOIL RATING: 125 INSTALLATION DATE: SEPTEMBER 1977 DATE OF PUMPING: JUNE 6, 1985 DATE OF TEST: JUNE 6, 1985 TEST PROCEDURE: WATER WAS ADDED TO THE DRAINFIELD AT A CONSTANT RATE OF 6, 67 GAL PER MINUTE. THE LIQUID LEVELS IN THE TANK AND DRAINFIELD WERE MONITORED. AFTER A TOTAL ADDITION OF 600 GALLONS NO RISE IN ANY OF THE WATER LEVELS WERE OBSERVED. TEST RESULT: 1� Or. A!,, tl� "A"y • � y f 2225-E NE 25, 1971 .. THIS SYSTEM MEETS THE REQUIREMENTS OF THE MINICIPAL CODE. The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. APPLIC'NT FILLS OUT UPPER HAL,"ONLY Time Property Owner �h n a Qx �103,C �� Q Y'<��-0rl Phone C/�'Re�A1�� r fc.(ert;1 - .L"'Yt7s tl�ncV �.n—C)r) - ,276 a7(nl Mailing Address a _ , ,- _ , -ZIP Coda , q c Date Buyer�U -• 1�Y� .,, r. t l 11, (`l� tc..v t Date r/C t_',16.1n,�L—�11t,- �Lltr�llIri LO.�tr Fri Da 3a; Address �l..:+ 1-)d ('h - Zip Code 19v'-( Lending Institution C'c: J 1 )„�rtnC Phone Address - . ., 1.. - r 21p Coda Z Realty Co. Q Agent-.. /tia`l f'r L�,, t,r� f Phone ECx- o l Address �. Zip Code ,r 74, a 76 Legal Description L ut 1, L"'lxk. IP, T, -,A),- r (UX Inspector Field Notes: Street Location 1 ,,r -.w 4 l r• r Type of Residence Q Single Family ❑ Multiple Family No. of Bedrooms c ❑ Other Water Supply 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. EIndividual Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility ^ r ^r •• " N � I ^ / .('+' • +� Sewer Disposal r ru Jndlvidual Year Individual Installed: Soils Rating ❑ Public Utility When Connected to Public Utility: Well To Absorption Area ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I Well to Tank qj &V Time Time Time Time Date Date Date Da 3a; Inspector Inspector Inspector Inspector Field Notes: y I 1 APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE 1' t—a) BY:^� Soils Rating Date Sewer installed Well To Absorption Area Well Log Received Q — ? 1 I Well to Tank qj &V Septic Tank Size IM3 pen JAMES B. ROBERTS3 PE, RLS ENGINEER S SURVEYOR [9071 349-2526 SEPTIC SYSTEM ADEQUACY TEST MUNICIPALITY OF ANCHORAGE DATE 4-3-83 S- 8310gPT. CF H`l.LTH & —2ryyIIt-N;d2-NTAL PROTECTION CLIENT: Attention: Marilyn Warren APR 1°03 Name Dynamic Realty, Inc. Telephone RECEIVED. Address 501 West Northern Lights Blvd. Anchorage, AK 99503 LEGAL DESCRIPTION: Lot 1 Block F, Timberlux No. 3 SEPTIC TANK: LEACH PIT: DRAIN FIELD: Material Type Steel (Greer Tank) tnkis Size 1250 gal. (a�equate for 4 BR) Number Bedrooms 3 Surcharge Test 1400 Rate of percolation 950 Sludge condition in tank: Remarks 5' x 125' x 2' 9/9/77 Required Tank Size 1000 gal gal. water; 0.80 (150 x No. bedrooms) min. gal ./day no appreciable ammount System is adequate. 1207 East 74 th Avenue Anchorage, Alaska 99502 r-- March 31, 1983 John and Debbie Nicholson c/o Pc/:lax Prohertics - 'Jancy Cason 2702 Gambell, Suite. 200 Anchorage, M 99503 Subject: Lot 1 iiloci. F :imberlux Subd. Apuroval for the individual sever and water facilities cannot be granted until the following items have hien completed: O KO Exposed electrical wires to the yell head are in violation g7 of the Nunicipality of Anchorage codes and rust be encas_r.? Y -n in conduit. ^'he water analysis retort needs to be eubnitted to this office from the Che- Lab, 5633 D Street, for our roview. :he septic tank pumped with a receipt submitte3 to this 1 de,^.art;:unL.�tH,*rl'- An adequacy tent needs to be performed on the existing �i leaching arca. :'his test will dater -min if the .^.y:ac^s in 01 ade;u.9te according to National Standard:3. A listing, of private firms p^rforiainn the test is enclosed. 'his. report geode to he submitted to this office for our review. Ploaee notify this Department for a rninspcction when the noted discrepancies have been corrected. Ii there are any further questions, please call this office at 264-4720. Sincerely, rolv:rt C. Pratt Acsociatc .nvironm-mtal ^pccillict RP10/p/Eii Enclosure aNfNARAOE rte, DEFT. OF I & ' MUNICIPALITY OF ANCHORAGE ;.,3 Elwlac\f.12R AlL .w1ECTION • \ DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTECTION 826 L Street • Anc wreea, Alee4a SMI 0 E C ;, 'i 1979 r ENVIRONMENTAL ENGINEERING DIVISION ❑ One ❑ Four C3 Other Telephone 2644720 RECEIVED REQU ST FOR APPRQ34AL 9F INDIVIDUAL WATER AND §EWER FACILITIES DIRECTIONS: Complete all pans on page 1. Incomplete re"mu will not be proorwd. P.IE��Il tYi (4�L1►a Mm }leeiWnR. �.; 1. PROPERTY OWNER ' ATTACH WELL LOG. A well 1 s required for all wells drilled ❑ COMMUNITY PHONE 1 -59q - —50 MAI LI G ADDRESS depth (attach log if available.) /, S. SEWAGE DISPOSAL SYSTEM sQ� 1q k 99so individual/on-site, give installation date PROPERTY RESIDENT III tlilterent from above) If system is over two (2) years old an adequacy testi required PHONE by this Department. ei, 2. BUYER PHONE Ott d Dtt�miwise, lyarfin /JicYtdso 3�/ -�/ OS AILING AD SS ILcwL 3. LENDING TIT TIO —T PHONE -OVs MAILIN ADDRESSL� _ G C REALTOR/AGEN PHONE r a DR MAI LI ADOREJSP L lJr r d FA & LEGALDESCRIPTION STRE T L ATI , QgiklA • 6, TYPE OF RESIDENCE i NUMBER OF 8915AOOMS ❑ One ❑ Four C3 Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY 81 Three ❑ Six 7. WATER SUPPLY uN w lvdL q0OGi V rtru)n. 2q INDIVIDUAL' ' ATTACH WELL LOG. A well 1 s required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) /, S. SEWAGE DISPOSAL SYSTEM "If ilS ;71 INDIVIDUAL/ONSITE" individual/on-site, give installation date If system is over two (2) years old an adequacy testi required 13PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/781 994 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENT'S DATE RECEIVED _ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED -7 IN ALLER SOILS RATING �. EJ Septic Tank or ❑ Holding Tank Size: _ / ')Sb If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER �4��•_ TOTAL ABSORPTION AREA MATERIAL ( 4. DISTANCES WELL TO: Sepik Noldina TWk Absorption Area r Line Newest Lot Line Absorption Area to merest Lot Lim S. COMMENTS C& -'-APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 1-� BY (Tole) Jb LEGAL DESCRIPTION R-ulu inev. J/!al