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Home My WebLink AboutTIMBERLANE PARK #1 BLK 1 LT 10Timberlane Park #1 Block 1 Lot 10 #019-142-15 O Municipality of Anchorage Development Services Department .-~ ~.'. Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519--~650 Page of www. ci.anchorage.ak, us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S~ 0'2.0 [e~.~ PIDNumber: Ne~e: ('~"~rc~ I~ /-/o,rt,~. WastewaterSystem: I--]New ,,~Jpgrade ^.dress: / O e,' ( O ( ~ /'C. ( * '/"{-' ~P~-- ABSORPTION FIELD Phone: Number of Bedrooms: ~ Deep Trench I-1ShallowTrench [] Bed [] Mound [] Other:. SoN Rating: I Total Depth from oriGnal grade: LEGAL DESCRIPTION [t ~ Block: Lo[: Subdivision: % t ~:) Township: Range: Sedion: F~II added above original grade: Gravel Length: Gravel ~dtJ'~ Number of lines: Distanc~ between lines: Well: [] New ~., c9 F~. tz --'------ R.' Classifica/ion(Pfivate, A,B,C):t ~".,,~ _~'~YLe'~ FL Casedto: FL T°telab~r~ti°narea:~;?~O' Driller. ~ Installer. : Date Installed: ! ~' GPMI FL Fl. SEPARATION DISTANCES [] Septic [] Holding fii~'S.T.E,P. [] Other: T~ Septic Abs°rpti°n Lift I Hdding Pub'idPdvate V~*¢a~u'e~ ,:~¢ R .... kS: BENCH MARK Lc~on and Des~p~om Assumed E~evation: . Engineer's Stamp Development Se~ices DepaAment Approval ?~5 ~HAEL N. ANDEESON Permit No. SW020195 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description' LOT 10, BLOCK 1, TIMBERLANE PARK SUBDIVISION PID No..019-142-15 ELI PANEL / / \ \ ELECTRICAL / INE LOCATION 3TRICAL \ LOCATION \ HOUSE ASBUILT SCALE: 1"=50' -OLD KLATT ROAD~ / / X6' LEACH FIELI ~ESSURIZED 500 GALLON LIFT STATION / ED SEPTIC SYST~/M SEPTIC EXISTING SEPTIC AREA / )N / / AND TAN K NOTE: ALL SURROUNDING PROPERTI SERVED BY PUBLIC WATER LOT 11 ~ SEWER ROCK 88.5 II -I ] SEPTIC TANK LIFT S/AnON ~ ~ ~ ~ ~ SEPTIC SECTION N.T.S. 'I~RKA A B ELEV. ELEV. GRND. PiPE c01 ~I i,,o I,~9.2 110~.2 96.1 COlA ~J,~7., 18.9 1101.2196.8 TCO~ 122~J~.~ TO02 34.5 ~ 1101.2 I TCO~ 1¢~.6 1~2.7 ~.~1--~ LID 143.8 1~2.6 1~01.21 MT 120.8 86.0 98.8 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.Q. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 25, 2002 Expiration Date: Jun 25, 2003 Permit Number: SW020193 Legal Description: TIMBERLANE PARK#1 BLK 1 LT 10 Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Gerald Harris Owner Address: 1001 W. Klatt Rd Anchorage, AK 99515-3254 Parcel ID: 019-142-15 Site Address: 001001 OLD KLATT RD Lot Size: 47480 SQ. FT. Total Bedrooms: 7 Permit Bedrooms: 7 This permit is for the construction of: ~'~ Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. 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. B. Covered, sealed, and heated to prevent freezing. ,ssuedBy: ~~,~ ~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) ~ ~ ¢- ~ I ~ ¢ f ¢, Mailing address (1) //¢ of~ ~-~J-. ~l~'l~ Mailing address (2) ~.~_O !\_O ~ ~Z. , Legal description (Lot, Block & Sub'd.) t]~-.-¢ 1(- Legal description (Section, Township & Range) Lot Size L.~/-~/~ ~' O Acres!~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Number of Bedrooms f~ Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 12,2002 Munic~alityofAnchorage DepartmentofHealthand Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 10 Block 1 Timberlane Park Subd. To Whom it may concern: This is a request for a new septic permit for the above residence. Two test holes were excavated to 17 feet with simular results and no water observed during the 7 day monitoring period. The first test hole had 3 feet of fill placed over the lot then clean sandy gravel to 13 feet, then tight sandy silts to the bottom of the hole. The second test hole had no fill just natural loam or organic in the top 1 foot then clean sandy gravel down to 13 feet, then sandy silt to the bottom of the hole at 17 feet. The perc was 1.1 minutes per inch at 5 feet down fi.om the surface in the good sandy gravel material. A new 7 bedroom trench has been designed with 6 feet of effective in the sandy gravel material. The existing 2000 tank was excavated 3 years ago and look in excellent condition per the owner but this will be revarified again by myself per the code. If the existing tank does not have any holes a 500 gallon lift station will be added after the existing 2000 gallon tank to lift the effluent up to the new leach field. The existing system will be abandoned in-place and the pipes removed. All the surrounding properties are served by public water as far as I can determine. This new system will not affect the future development of the neighboring properties or shadow out any neighboring septic replacement areas due to the public water system and lot sizes. If you have any question please call me at 345-3377 MicHael N. Anderson, P.E. 'f ~MOUND OVER DESIGN CRITERIA: ~ ~ fORADE 7 BDRM X 150 = 1050 GPD -1.o __OR Jl~.',~ % ~/---FILTER FABRIC SOILS = 1050/1.2 = 875 SQ FT REQ'D FILL f 875/12 = 75' TRENCH -3.0 ~ (1) TRENCH 9' DEEP GM 6' EFFECTIVE ~DRAIN ROCK 75' LONG SM - KLATT ROAD- NOTE: THIS AND SURROUNDING PROPERTIES SERVICED BY PUBLIC WATER. NEW SEPTIC SYSTE~ ~~x_~ /~EXI~;TING SEPTIC ~ > ~EXISTIN( HOUSE ~ -OLD KLATT ROAD- I 0 j Septic Design Prepared For JERRY HARRIS TIMBERLANE PARK SUBDIVISION M~CHAEE N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=200' JUNE 12, 2002 '~¢UBLE C~ ~ / STErL TANN ..... ~ ~ ~ ~' ~C.O. . TANK C.O.~.~ ~ ~. TH S AND SURROUNDING I PROPERTIES SERVED -OLD KLATT ROAD- Septic Design Prepared For JERRY HARRIS ~. ~f. LOT 10, BLOCK 1 .' ~ '. TIMBEr.NE PARK SUBDIVISION Prepared By, ~--~ .,------~ ;~' '~J~/*~'~*'' "~"~ MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE *, ~' MICHAEL N. ANDERSON 2.~ (007) a4s-aa77 / F~ (~o7) a4s-~a~ t~j.. c~ ..~A ~ ~D~'~../... ~.~ PERFORMED FOR: LEGAL DESCRIPTION: (FEET) ~' £~ ~ f ~' ¢"7 2 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17~.~ 18- 19- 20- Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ ~W~e · e e e e~e '-1_~ ~ A - , .~/-t~ ~/-' .... ~ Township, Range, Section: COMMENTS ~ ~'/.,~ C C~ -~----/ ~/~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water AIt~,/~ ~ ~:'"C/~ Monitoring? Date: ~-- I A Reading Date Gross Net Depth -t-e. o~ Net Time Time Water Drop ~, d,~,,. (.,, ,~,.,, pZ,~ PERCOLATION RATE /r / (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN /'~ FT AND ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~--'~ LEGAL DESCRIPTION: 2 3 7 8 10 12 ~3 14 '17 18- 19- 20- COMMENTS U ~ ~'"~ C [ Township, Range, Section: WAS GROUND WATER/"'~'~'O ENCOUNTERED? SLOPE SiTE PLAN S L IF YES, AT WHAT O DEPTH? p E; Depth to Water Alter. / /_ /~.,, / Monitoring? /q 0 ~ ~ Date:t~/l~/O~ Reading Date Gross Net Depth -t-e-~ Net Time Time Water Drop ~,,5~,,,¢~. >fo P,c,~,,,L //~? ~ ~"1 ~,~1 ~ ,, ~,~ ~,,~1 PERCOLATION RATE /./ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN z.-/¢ ~ ET AND ~', 4~- FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERTIFY THAT THI¢ TEST WAS PERFORMED IN DATE: -~' MUNICIPALITY OF ANCHORAGE (~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE / ~NEW MAILING ADDRESS . LEGAL DESCRIPTION~ ~ / - ' LOCATION NO. OF BEDROOMS Well Absorption area Dwelling~ PERMIT NO. O DISTANCE TO: /~// ¢ ~ /~ ~ [ ~ Manufacturer Material -- No~ of compartments ]Liq. capacity in gallons Inside length Width Liquid depth - , ~ . IF HOMEMADE: ~ DISTANCE TO: Well Dwelling : PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO. ~=~ ~Z No. of Ii nes / Length of~). each li~ ne Total length of li~,~ .'nes~ ~'- Trench~,~width inches Distance bet~2~es ~ ~ ~ Top of tile to finish grade ~ ~ ~ ~ ~ Material beneath tile ~ ~-inches Total effective~z~bs°rpti°n~area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO~ = DISTANCE TO: Building f=nda=n~7 ' Sewer ,¢ne W~ Septic/i~/,tank . Absorption area(s57 OTHER PIPE MATERIALS ~..¢~-~ ~ ~ ~ ~' ~¢ SOIL ~EST R~TING ~ ~- ' ..... u -:~'=~--; ' INSTALLER R EMAR KS ~ ~ ¢,' ~ / A.~ROVED DATE .~ ~ ~_~. L ~ 72-013 (Rev. 3/78) F'ERMI T' NO. l"lLIli'-.I T C: 'Ir F~illil_ T T'-r' DEF'FIRTI"IE~T '-'FIFILTH FII'-,ID EpIv'IRF'~NMEI'.4TFIL F'/EC:TIF, N/~'~ 82._, "L'" STREET, FINCHC'F.:FtGE, FIK. 9950"~"" FIPF'L I CFINT LOC:FIT I ON LEGFIL KFITHEF.: I NE HRRF.: I S 3:6:_-:5 SF'F.: I NGER ST. LOT~I~ 7:~' ~ TII~IE~,.~¢ .... LOT SIZE T'¢F'E OF SOIL RBSCIRPTIF~N S'¢STEM IS' TRENCH 561 t3:73: 22:0000 SQL FIRE FEET MFI::.:,'IMI_IM NLIMBER OF BEDROOMS SOIL RFITING ,'SQ FT,.."BF.:)= ±50 THE REQUIRE[:, SIZE OF THE SOIL FIBSORF'TION '-"~ z,T_ TEM IS' [:,EF'TH= 7. 5 LEI'-.It3TH= I~Z~::-: m~RR%.'EL [:'EF']-H= -----=:. 5 THE LENGTH DIMENSION IS THE LENGTH ,:: IN FEET) OF THE TF.:ENCH OR [:,F.:FIINFIELD. THE DEPTH OF Ft TRENCH CR PIT IS THE E:,ISTFINC:E BETWEEN THE SURFFICE OF THE GROLIND RND THE E;OTTOM OF THE E::-:;C:FtVFtTION (IN FEET::,. THERE IS NO SET W I[:,TH FOR TRENCHES. THE GRR',,,'EL DEF'TH IS THE MINIMUM DEPTH OF GRFIVEL E:ETWEEI'..I THE OUTFRLL PIPE FIND THE BOTTOM OF THE E,', _.H ,,'F - ' ,' -HT I ON ,:IN. FEET':,.. F-:ELT.,LI I E:E[:, SEF'T I C: TRI'-,II-=:.' S I ZE= ::L 5 LE-~ ~-l'~ PERMIT FIF'F'LIF:FINT HRS THE RESF'rINStBILIT'¢ TO INFORM THIS [:,EF'FIRTMENT [:,URING THE INSTRLLRTION INSPECTIONS OF RN'¢ WELLS FIDJRCENT TO THIS PROF'ERT'¢ FINE:, THE NUMBER OF RESIDENCES THFIT THE NELL WILL SERVE. Tb~C~ ,:: '2 ::, I I'-~SPEC:T I C~I'-IS RF-:E I~:Eg!i_! I F-:E[:, BRCKFILLING OF FIN'¢ S'¢STEM WITHOLIT FINFIL INSF'ECTION FIND FIPPROVFIL B'¢ THIS [:,EPFIF.:TMENT WILL BE SUBJECT TO F'ROSECLITION. IdlNIMLIM DISTFINCE BETWEEN FI WELL FIND FINY ON-SITE SEWFIGE DISPOSRL SMSTEM IS ±00 FEET FOR R F'RIVRTE WELL OR t50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WEEL MINIMUM DISTFINCE FROM FI F'RIVFITE WELL TO FI PRIVFITE SEWER LINE IS 25 FEET RND TO FI COMMUNITS' SEWER LINE IS 75 FEET. WELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ~0 DFIYS OF THE WELL COMPLETION. EITHER REQUIREMENTS I'IFIM FIPPLM. SPECIFICRTIONS FIND CONSTRUCTION DIRGRFIMS FIRE FIVRILFIBLE TO INSURE PROPER INSTFILLFITION. F'EF-:r-1 I T E:=-=:F' I I~:ES E:,E,Z:EI--1E:EF_: ---::1.. t'3:E:__---:: I CERTIF'¢ THFIT t: I BM FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS SET FORTH B'¢ THE I"IUNICIPFILIT'¢ OF RNCHORFIGE. 2' I WILL INSTFILL THE S'¢STEM IN FICCOR[:,RNCE WITH THE CO[:,ES. -]:: I UNDEF.:STFIND THFIT THE ON-SITE SEWER S'¢STEM MR'¢ REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMO[:,ELE[:, TO INCLUDE MORE THFtN 5 BEDROOMS. iF'F'L I CFINT/3~THER I NE HFIF.:F.: I S L IfEa S SUlV ORS 1610 ' Di.~ond Dr:l,v~, Anchorage, Alaska Phone 344-68~ 99507 -'SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 ---- 4 5 6 7 8 9 10 11 12 13 14 15' 16 18 · 19 20 / / DATE PERFORMED: 7/3//~ "/,.., ,.. ,"' ....,,,~,L.,.s .,.,-,-,- SLOPE S,TE .LAN O P E IF YES. AT WHAT DEPTH? Readi~ Date Gro~ Net Depth to Net Time Time Water Droo PERCOLATION RATE (minute~/inch) TEST RUN BETWEEN . , FT AND FT COMMENTS PERFORMED ElY: ~"~"~'7' CERTIFIED BY: ~> 7-' Box 1369, ~TAR I~OI.TTE A ANCHORAGE, ALASKA 99502 344-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF ~'~. O0 PER FOOT. PROPERTY OWNER LOCATION OF WELL SITE DRILLER B~ C,tat~ o~ ~.cur~pw'~ 1),,ddddr~ l~a,~..~. WELL LO(~: 0 .... 18' 18---39' C. oa,'t~e c/./mtreA., 39---53' ~x.~e` ~.~wed_ ~Z~ 359'0 1/:2 flo,v~e` Stdrr2e,~ddy, Le. Ptur~p ,~h.oudd' be_ Co,~,t o¢ 1),vdddd.~: I123.00 ~ $;a X 53 ~t~e,e,t: S1219.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATF ~ ~P_n.~ 7~O83 ,~ NTHY~ ~ SERVICE CHARGEOF 1~% PER MO L BE ASSErtED ON PAST DUE ACCOUNTS. PropertyO~-,ner ~.~::~.T~Z~ ~j~ ~j/'¢~,' ~ ~~/~/~ ¢~'~ ,~./, /Z~/~.j~//'~_._./.~' Phone Mailing Address . Zip Code Address .~.~ ~ ~_... ~x~l..'- Zip Code Lending lnstitution /~2~_.-.L~/~.~h~...~' l~.-~.j~ ~ ~'~_~/ ~. Phone Realty Co. & Agent ~ Phone Address Zip Code _._.--.-.~ .... Legal Description .~./_~TZ ,~"~ _~//~ / ///--.~ ~/~/~.-~,~? ~.~, ~ z.j~' :.,~' / Street Location .,~.,,~../ F///) ,~/~;;~ ~.~. Type of Residence /[~,~ Single Family Multiple Family No. of Bedrooms [] Other Water Supply lndividual A'ClACH WELL LOG. A w~l is for all wells drilled since June 107§. log [] Community F6r wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal Utility When Connected to [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF ENVi RO,"~M'-~i-AL PF. OTFCi'ION, RECEi. ED (~'~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72-023 (3/82) JAMES B, ROBERTS, ENGINEER & SURVEYOR PE, RLS (907) 349-2526 Nov ember 4, 1 ';"="=', ,_,._, Municipality of Anchorage Dept. of Health & Environmental Protection Environmental Engineering Division 825 "L" Street Anchorage, AK ?7501 Subject: Septic System & Water. Well Lot 10 Block I Timberlane Park Subd. No. 1 Gert t I emen: I have personally inspected the installation of the improvernents made on the subject property under permit no. 8300,_47 issued by you on Feb,. 15~ 1'.;'83 and hereby certify the following: 1. Al! standpipes have seat ed caps on them. A standard welt seal is installed on the top of the E." ,.,.,ell casing. Electrical wiring to the submersible pump is encased in condu i t, The distance from the well to the septic tank is 101 feet, and to the absorption trench is 111 feet. The water sample was collected by me at 2:I5 PM on October 20, 1783 and delivered to the lab at 3:30 PM the same date. The analysis was completed at 2:00 AM ON 10/21/83, and found to be satisfactory. In summary, I find the well and septic system to be in accord- ante with Municipal and State codes. "/" O Li r S 1207 99502 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmere Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL ,,--) .,~.~/j.~ ~ ~...____~_...~ FOR A SINGLE FAMILY DWELLING c.~*~,~/'' ~ IH'Z-- 15' GENERAL INFORMATION Complete legal description ,, Location (site address) / COSA# Expiration Date: / ~,,//1//// Current Property owner(s) Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone , Mailing Address ' Un/ess otherwise requested, COSA will be held by DSD for pickup.( ¥ ~,.,-'~.- ,,.¢, ,"/[,',.fv'~, . NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer [] [] [] [ I The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that,~_y, investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines fe.~ ,this .application, shows that the on-site ~ter supply and/or wastewater disposal system is (are) safe, functional .and adequate for the number ~ bedrooms and type of structure indicated herein. I further verify that based on th(~'fnformation obtained fro~' tb.~e~'~unicipality of Anchorage files and from my investigation and inspection, the on-si[e Water supply and/~,i'"W~tewater disposal system is(are) in compliance with all applicable Municipal and State cod'es, ordinances, a~d regulations in effect at the time of installation. NameofFirm /'~/~,"~o-¢~7~(~=r,0~ 1~, ~A'. Phone Address /--J-~ (~ / )L[. ~. J~ro ,.,,,.. Engineer's Printed Name ~.,'r~ ,-~-1--,- ("/%I/~ I c,,;~,~ .P, /'~'~, Date ,5. DSD SIGNATURE ~ Approved for "7 Disapproved,. Conditional approval for bedrOoms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original certificate Date: (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343'7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Date completed Total depth .~ Date .of test - If A, B, or C provide PWSID # Sanitary seal (Y/N)__ yperly protected (Y/N) ' ff. Cased to ~ Casing height !above ground) in. FROM W~ AT INSPECTION Static water level ~ ft. Well ~ g.p.m. · WATER SAMPLE RESULTS: . Coliform ~ ~ .... , ~ ug/L date of sample: B, SEPTIClI~I~:I~O TANK DATA Tank Type/Material ~-~ -[-- ~- ~, ~. Tank size 'z c,~ ~ gal. mg/L Collected by: ft. Monitoring tube . Number of Compartments . .Depression over tank (Y/N) Foundation cleanout (Y/N) ,.. 'Date of pumping . (,/~g/O Pumper ~~ C. ABSORPTION FIELD DATA Date installed (///f~ 7,,- Soil rating (g.p.dJft2 or ft2/bdrm) I Length ? '~ ff. Width ~, Q Total depth tO/t ft. Eft. absorption area ~1~ ft2 Date of adequacy test ti fI3~o Results (Pass/Fail) Fluid depth in absorption field before test O ,,. in. Elapsed Time: ! eL0 min. Final fluid depth (~ in. Any rejuvenation treatment (past 12 mo.) (YIN & type)' g.p.m. System type [~ ,ee p '/,~ ~-k,"~. ~ Gravel below pipe ~,~' ft. Water added/t oo g,al. AbsOrption rate >= Depression over field /~ For ~)/Z. bedrooms New depth 43 in. //~0 + g.p.d. If yes, give date. / Date installed (~/(2 'Z_.- cleanouts (Y/N) ~ High water alarm (Y/N) ~' A/' LIFT STATION Date installed "Pump on" level at '~ 0 in. Datum Size in gallons 5-o Q Manhole/Access (Y/N) ~ "Pump off' level at Z,-~ in. High water alarm level at '~G in. Cycles tested ~ Meets alarm & circuit requirements? ~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot · Public sewer main /~/ , On adjacent Io.9~.~ ... Public sewer manhole/cleanout Sewer ~i~containment areas Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC~G TANK ON LOT TO: Building foundation Water main ~' o Wells on adjacent lots , Property line · to o Absorption field Water service line /~ ~ 4- Surface water F, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line tO ~ '(-- Water Service line /~ '~ Curtain drain O-O ' Jr COMMENTS ~ ~ {' ~'~' Building foundation /0 Surface water Water main / O ~/- Driveway, parking/vehicle storage /P Wells on adjacent lots 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 Date COSA Fee $ ~ C~ C) '~-~ q Receipt Number ~__~'77 ~ ~" Waiver Fee $ Date of Payment Receipt Number (Rev. 4/10) LOT 9 89 57 30 W 162.00' LOT 1 0 BLOCK I NE PARK NO.J (P-209A) .-Car Port 61.7' Wood Sun Deck &: Stairs ,, Manhole j Conc. Wall 0.6 --~.., '<: ) High (Approx.) t /-Riser Pipe .... 'x ! O' 15' ,30' 60 LOT 11 Cleon (Typ.) Asphott ~¢ 5/8" Rebar-x~ ~ , 'x-'-xx, x' -- 162-09' (Record! i: % "~ N 88'05 50 W \ 2-Level )od Frame House w/Daylight Bsmt.,? Found~ i~ /-- Wood .¢~ / Utility Pole , t~,/ w/Anchor o L__ Wood Posts "-- Found ~o w/Yard Lights ~ 5/8" Rebor (typ.) -- -- _,, KLATT ROAD I hereby certify that on accurate survey of the following described prap;~rty: LOT 10, BLOCK I TIMERLANE PARK NO. t (P-2OgA) indico 2010 and that the thereon ore within the property lines encroach on the property ying no imprOvements ~n {he property transmission lines property except os day of Novermber 2010 PREPARED FDR: Somoyo Mcroine AR BUTLT DATE GRID ii/24/2010 2729 JSP FILE ND, F.B. I JOB NB, 2019 D,C, 1 1053 SU/~ bx£ Y_fNJr ~ - Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6650 www. ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. (2{c:f~ /~%- f%'"- I. GENERAL.INFORMATION .C°'['nplete~ ec~'a' description Expiration Date: ,. Location (site address or dLrections) Current Property owner(sJ 'Mailing address Lending agency ~v~. l~.- r,', '5 Day phone Day phone Mailing address Real Estate Agent Day phone__ Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: "~ TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage CommUnity Class ~ Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services DepaC. ment (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 dis~)osal 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 ne~v water sample results. (Certificates may be reissued for a period of up to one year with vali~ water samples ) Certificates are valid for one year for prepert:,es served by Ciasa A or B weils or a public ,:rater systeml The Municipalib/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 site water supply and/or wastewater disposal system is(are) safe, functional and adequate for tl~¢,'humber of bedrooms and type of Structure indicated herein. I further verify that based on the information obti~i~'~ ¢~m the Municipality of Anchorage files and from my investiaation., and inspection, the on-site, wa:er, su~ply'an4j'~o~. , wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordir~es'?" and regulations in effect at the time of installation. ~;~$- ~- ~_n ~ ~ Name of Firm Address 4 G L/. O '~ Engineer's Printed Name bedrooms. DSD SIGNATURE / Approved for Disapproved. Date 7,,'~_/Z{~ Conditional approval for bedrooms, with the following stipulations: Additional Comments ' ~ ! ON-$ITp .~ ~ ' WA.CT ? Attachments: HAA Checklist Septic System Advisory Well Fiow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Ce~ificate Date: (Rev. 01102) P.O. Box 196650'?Anch0i~{]-e;AK 99519-6650 ~Jci.anch°rage[ak. us TM (907) 343-7904 Legal Description: A. WELL DATA ~ JO ('~' ~.L.t,-/ " · Well. type. . If A, B, or C provide.· PWSID. ct . . ~ Well Log (YIN. ) ~:~r~plete erly proteCted (Y/N) FROM WELL LOG ~/"' "~ ?:.~AT INSPECTION Date of test - StatiC'water level WATER sAMPLE REsI HEALTH AUTHORITY APPROVAL .CHECKLIST in. g.p.m. - Coliform es/100 __. colonies/100 mi. · Arsen~ ~'"' ~....: : Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/.Mat~r,~iT...*;- ~.~,. ~ ( , ~, ,,:~ '~: ';". ,' ,.: ,. ,: ;'--~ . Date installed C Tank .siJ:~ ~"~:~ 'gal. :,':'" :'?.,~umber of Compartments ~ Cleanouts (Y/N) Foundation cle~t . ' ~'' ' ~./N) :",~" ~i~Depress~on over tank (Y/N) A/ High water alarm (Y/N) Da.te of Pumping,.. ·. '~,~o ,-~ Pumper Oatei~:st~lled'-'(~[q'ff/e.'-'f~': ,$°iirating (g.p.d./ft2or~/bdrm)/~ Z. Systemtype f~-e~rp Length "~' "~ .' .~' .: ~[ Width "~ 0 ft. Gravel below pipe. (.,,, ~'~ ft. Total depth ~JOft. Eft. absorption area ~D ft2 Monitoring tUbe Y Depression over field Date of adequacy test ~,.(..eJx.2 Results (Pass/Fail) ~ For-----bedrooms Fluid depth in absorption field before test '--'-'Tn. Water added,,--~ gal. New depth_.,.,~n. Elapsed Time: ~in. Final fluid depth-~ in. Absorption rate >= / g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) ~ If yes, give date Date installed ~.~ pon" level at ~"~. Datum ~ ~.,.~. ~, ~,~,~. Size in gallons '~ °O Manhole/AcCess (Y/N) "Pump off, level at High water alarm level Cycles tested ~%~ e'" Ee SEPARATION DISTANCES SEPARATION DISTANCES FROM~A~'E ON LOT TO: Septic tank/lift station on lot /c~O Absorption field on lot Public sewer main Sewer/septic servic~ lihe On adjaCent lots / o o ! -~- /c~ ~ ('/- On adjacent lots /c~O /~ ,~ { 1[-- Public sewer manhole/cleanout ~f uo / '/-- I ~ ~l ~L' " Holding tank Absorpti°n field ~'- /-- Surface Water [0 o ! '~ Building foundation. ~/g I./. Water main /o~= t J SurfaCe''~ater': :,., [.00 ,4 -Driveway,. parking/ye, hi:cie storage SEPARATION DISTANCES FROM SEPTIC/NOL=i~NG TANK ON LOT TO: ' ~ "" ':'~ '%'"~ ": ~ ~ 'fl ~ ill ~"" :'~ '* foundation_ ;,.:~7..,0 1~: ~r . ::~'. '"'water' m~in t';I)''iO'?'/'' ' Water service'line I, ~ t~ ' ~ells"Oh:a~jacent Io~'" / ~, -'.~ 8EPA~TION DISTANCE FROM ABSORPTION FIELD ON LOTTO: F. COMMENTS G. ENGINEER'S CERTIFICATION Icertifythatlhavedeterminedthroughfieldinspectionsand' review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed. Name /"/*[{c~,~e~'/~/~.~ ~'f,t,'l ~j~,... c~~ .~ Date' '~///o 'Z.-' HAA Fee $ 3 7,~"" ~ 1~"--0 /~u~:~. Waiver Fee $ Date of Payment . '~- / ~ ~ 2_ Date of Payment Receipt Number ,~. ~ ! Z7~'" Receipt Number (Rev. 12/01)