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Home My WebLink AboutTIMBERLUX #3 BLK G LT 3Timb rlux Block Lot 3 #018-271-57 liry MPH pi h h I i,!r Y - i; '+:r �! !::1nn 07; F.i* ON-SITE WASTEWATER INSPECTION REPORT I `,esivivi Numbef: OS P24 1319 .:,;Ll N_,*ri,:.i?.-� 018-271-5-7 c-111gle Family (SEI El Vo'ith ADU, n 0upley.; L'I.; -1 aor_, Single Family Liwelling: F_ F'rojeci. E, N�qky El W,-.�: Sean D -_-v.- z-, -;?., S:vo P,vk A ORPTROIN FIELD L. Tr c U-2 Trenc-- F 'ide TW, ch Ued 1 -11 -Id 4805 klanytell Avr-WiLIC ILEOALDESCRIPTION in 1.41.4 fr.�l 1,4 - Co. .."I 71.4pill 1:01,14:01 I I added abvn! anginal. i—aJ2. IfJr !I _,T I cox-,hb Hnre:r -Wkidlhri (Br.A�: Numhef a FT SEPARATION DISTANCES 999 Lit S�juvcr =or, T Liff. 7Ank F�ahj Wk 1 d Ff ri If.- )0' N/A N/A >25I TANK 0 FA -1.:1 H d J! E] 0ih,-.r Anuh,.-j�raq IH-ik 2-50-j 0, Steel Two Sliff0i;f) WOW >50" > 100' N/A NIA N. UA Uile 51 > I .1 or N/A NIA >1 0, 10, N/A NIA ON LIFT STATION 250 Al I (:i;ii 1 trf East Wall AKE Electric PIPEMATERIAL Ex1reme Construction, & Mainteniarece: '..:.-C' jtmrdI,.-,c D30M D3034 U ,Jakob isin BE N CH MARK f,f,. i-If4vaupol t-15pedian Jalfl!;: Slab Parae g ON-SITE WATER A.ND WASTEYVATER SECTION APPROVAL I rrinrer 5 Xk k OF Ak I :,prooal; eona Al.. 49 TH sepok: sysle 10 Approved gate J= b, this approval d�::5 not Inri,x well pt ruquircrn7rnts. liry MPH X X X X X X X X X X X X X X X X X X X X X X X X XXX Benjamin Schiller CE 12592 R E GISTEREDPROFES S I O N A L E N GINEER 1"=40' NEW 2500-GAL COATED STEEL S.T.E.P. TANK W/ (2) AX20 PODS CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO SUMP PERMIT # OSP241339 PID # 018-271-57 TIMBERLUX #3, BLOCK G LOT 3 A B MH1 19.3 POD1 24.7 POD2 28.9 A B MH2 32.0 2CO 20.9 16.6 17.0 16.4 14.8 19.4 FEET 0 40 80 FCO MANYTELL AVE 5-BDRM HOME PLAN ASB 11/25/24 10' UTILITY EASEMENT EXISTING WELL W/ 50' RADIUS NEIGHBORING WELL W/ 50' RADIUS DRIVEWAY SHED EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE NEIGHBORING SEPTIC AREA NEIGHBORING WELL W/ 100' RADIUS (ALTERNATE SITE) CAT III 5' WIDE X 25' LONG X 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH ≥7' ≥5' TH#1 MH2 MH1 POD1 POD2 SEPARATION TO EXISTING FIELD CONFIRMED AT INSTALLATION PROFILE AS-BUILT (NO SCALE) 94.5 89.7 95.1 99.2FC O PERMIT # OSP241339 PID # 018-271-57 TIMBERLUX #3, BLOCK G LOT 3 AX-20 POD Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 11/25/24 AX-20 POD MH MH 2500 GAL S.T.E.P. TANK 2C O PUMP VAULT MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241339 Work Type: SepticTank Upgrade Tax Code Number: 01827157000 Site Legal Address: TIMBERLUX #3 BLK G LT 3 G:3136 Site Mailing Address: 4805 MANYTELL AVE, Anchorage Owner: CHRONISTER HAPPY LYNN Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: 10/8/2024 10/8/2025 54886 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened Closed on th, e day, or b. Cov sea n ated to D int freezina 3edial Provisions: 1. All standpipes shown on the Record Drawing are to be found and repaired if necessary prior to the final as -built survey. 2. The beginning of the trench is to be located prior to construction to ensure that the 5' separation is being met. Received -By: J� S5, LA C3 j +Co> Issued By: Date: Date: D46-zL 5 MUNICIPALITY OF . . . . . . . . . . . . . . . Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-271-57 Property owner(s) Happy Lynn Chronister Day phone Mailing address 4805 Manytell Ave, Anchorage, AK 99516 Site address 4805 Manytell Ave, Anchorage, AK 99516 Legal description (Sub'd., Block & Lot) Timberlux #3, Block G Lot 3 Legal description (Township, Range & Section) Lot Size 54,886 _Sq. Ft. Number of Bedrooms Five(5) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial 0 Single Family (SF) EK -1 (w/wo ADU) Septic Tank EX FRI Upgrade ❑ Duplex El (D) Holding Tank ❑ Renewal M Multiple Dwellings El Privy D (SF and/or D) Private Well D Water Storage El THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: Receipt Number: Permit No. c; Permit App_:-: - :-'.,'c -, Date of Payment: Receipt Number: Waiver No. October 4, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Timberlux #3, Block G Lot 3 – 4805 Manytell Ave Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot intends to upsize their septic system to serve a now 5-bedroom home. A test hole was done on the south side of property but we found high groundwater, old fill, and very poor soils. Due to the lack of room and restrictions from existing wells installing a new conventional system was not possible. The client has thus opted to install an advanced treatment tank and continue using the existing field. The existing field has been adequacy tested and easily absorbed over 900 gallons of water. With the addition of advanced treatment, this field will now be greatly oversized for 5-bedrooms. The attached site plan identifies the location of the home as well as the proposed tank location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new tank will be a minimum of 50’ from all wells and surface water, and more than 5’ away from the existing drainfield. Please refer to the attached septic plan page for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241339, Deb Wockenfuss, 10/08/24 X X X X X X X X X X X X X X X X X X X X X X X X X XX Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=40' NEW 2500-GAL COATED STEEL S.T.E.P. TANK W/ (2) AX20 PODS CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND 2CO SUMP TIMBERLUX #3, BLOCK G LOT 3 FEET 0 40 80 FCO MANYTELL AVE 5-BDRM HOME SEPTIC PLAN 10/3/24 10' UTILITY EASEMENT EXISTING WELL W/ 50' RADIUS NEIGHBORING WELL W/ 50' RADIUS DRIVEWAY SHED S H E D EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE NEIGHBORING SEPTIC AREA NEIGHBORING WELL W/ 100' RADIUS DECOMMISSION EXISTING STEEL SEPTIC TANK ≥10' ≥5' VERIFY FCO INTEGRITY REPAIR AS NEEDED LOCATE START OF EXISTING FIELD & INSTALL NEW 2CO. REMOVE ANY ASPHALT OVER FIELD (ALTERNATE SITE) CAT III 5' WIDE X 25' LONG X 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH≥7'≥5' TH#1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241339, Deb Wockenfuss, 10/08/24 LOT 3 1.269 ACRES FENCE ASPHALT DRIVEWAY S 89056'36" W A125.67' 57.00' R1330.00' — - - - - t,AAKIVTGI I A\/GNI IG — 57.0' w Uj 3 -STORY z o FRAME o SEPTIC v Cl) HOUSE N STANDPIPES 31.0' 26.0' CANTILEVER DECK ASPHALT DRIVEWAY BUILDING DETAIL (1"=20') EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (71-240) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. JOB # 24191 I NO CORNERS SET THIS DATE I SCALE 1" = 50' 0 25' 50' C 499 TH ;......................I � ...09/02/24 ...�...... B u Saliz �o LS -14837 OFESSI OW- AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, BLOCK G, TIMBERLUX SUBDIVISION ADDITION No. 3 ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 29th DAY OF AUGUST, 2024, ATANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 LOT 4 LOT 5 UTILITY N 89056'36" E 182.48' PEDESTALS REBAR EO EO -r ZESLV� EO ^ FO EO EO EO UTILITY L 10' DRAINAGE & UTILITY EASEMENT EO OVERHEAD — — — X_ POLE x — — — — — — — — — — — — — — — UTILITY LINE I x I� x ) WELL x x SyFQ z C/) O O O 69.8' O o SEE BUILDING sties ° o N DETAIL = W N � LOT 4 = 52.7' m LOT 2 W W O O O � O W LOT 3 1.269 ACRES FENCE ASPHALT DRIVEWAY S 89056'36" W A125.67' 57.00' R1330.00' — - - - - t,AAKIVTGI I A\/GNI IG — 57.0' w Uj 3 -STORY z o FRAME o SEPTIC v Cl) HOUSE N STANDPIPES 31.0' 26.0' CANTILEVER DECK ASPHALT DRIVEWAY BUILDING DETAIL (1"=20') EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (71-240) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. JOB # 24191 I NO CORNERS SET THIS DATE I SCALE 1" = 50' 0 25' 50' C 499 TH ;......................I � ...09/02/24 ...�...... B u Saliz �o LS -14837 OFESSI OW- AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, BLOCK G, TIMBERLUX SUBDIVISION ADDITION No. 3 ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 29th DAY OF AUGUST, 2024, ATANCHORAGE, ALASKA. FIXED HEIGHT, LLC C.O.A.122554 Land Surveying Services WWW.FIXEDHEIGHT.COM 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 amm GIL",e. ox t)rInt name) ALASKA, I I 11RD JUDI(IAL DISJ The t6r1,wim-" insti,tilylellt1i t: "cklloi\icdged tAore Ille this o ,2 NOTARY PUBLIC'FOR ALASK'A \MV Con'llilission cxpires-7 . ..... A INJU LUIP-ALFFY� Datc: daN or T R w. olq B Datc: daN or T R w. olq ~ MUNICIPALITY OF ANCHORAGE _ o. DII~TMENT OF HEALTH AND HUMAN SER~ES ' ' ~( 825 "L" Environmental Health Division Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .ar~e DISTANCES ,~P..//:P~ (~.~2J ~'/"~J~ ~ SEPTIC ABS0RPTION Addre~ TANK FIELD WELL L~6AL OESCr'"T,O. LOT LINE Lot J Block SU bdivls~on ~ ~ ~ ~~ ~3 FOUN~A~mN .o~n~.,., .~n.~, ~,,on AS-BUILT DIAGRAM (Show location of well, sepec system, prope~y lines, foundation, TANKS ~ SEPTIC ~ HOLDING Matgna' No o, Compa~ments ~ ~ ,tl TYPE OF SYSTEM ~ TRENCH g BED ~ W. DRAIN ~ OTHER I-~ FT ~,~ FT .u~r o,,,.~ 9~,. ~ FT '~ ~ Fi ' RE~ARKS: I ~,' . "' J'-- - ]- ~JJ, thai J~ J~6pe~Jo~ was pe~0[~ed M~Bt~delines inaim onIhi~ date: - _- __ ( r '- 72-013 (3~85) MUNIC~I~PA[_ I TY OF ANCHORAGE DEPARTME~=0F HEALTH AND ENVIRONMEN]~PROTECTION 825 L STREET, ANCHORASE~ AK 99501 264-4720 ON--S I TEE SEZWEF~ & PERMIT NO: DATE ISSUED: 860090 04/16/86 APPL I CANT: ADDRESS: CONTACT PHONE: BRIAN CHRONISTER C/O LOVELACE EXCAVATING ANCHORAGE} AK 99516 345'-1287 WELL. F"ERM I T LEGAL DESLRIP. SUBDIVISION: TIMBERLUX LOT: 5 BLOCK:SS SECTION: 34 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 548()0 (SQ~FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you in designing .your septic system. Choose the option that best ~its your site. -~RENC~-; BED W. DRAIN DEPTH TO PIPE ~IOTTOM (FT.) GRAVEL DEPTH (ET.) TOTAL DEPTH (FT.) GRAVEL WIDTH (ET.) GRAVEL. LENGTH (FT. GRAVEL VOLUME (CU. YDS. ) TANK SIZE (GALS) SOIL RATING (SQ.FT. /BR) 3.0 ** 5.0 ** 5.0 ** 5.0 0.5 6.0 3.5 6.0 2.5 25.0 5.0 115.0 ** 45.0 57.5 58.4 52.5 1,250.0 *~ 1~250.0 ** 1,~50.0 172 172 17~ DEPTH TO PIPE BOTTOM < 5.5 FT. REQUIRES INSULATION DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE ~ LIFT STATION GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) TANK MUST HAVE AT LEAST TWO COMPARTMENTS certify that: 1. I am ~'amiliar with the requirements 3. 4. ~or on--site sewere and wells as set ~orth by the Municipality o~ Anchorage (MOA) and the State o£ Alaska. I will install the system in accordance with all MOA codes and regulations~ and in compliance with the design criteria o~ this permit. I will adhere to all MOA and State o~ Alaska requirements ~or the set back distances ~rom any existing Well~ wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. I understand that this permit is valid ~or a maximum o~ 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES~ ]'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) ASiBUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (5) THE ELECTRICALWORK' MUST BE DONE~Y A LICENSED ELECTRICIAN. AF'PLICANT: BRIAN CHRONISTER PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Le-~'~ ~1,~ I 2 3 4 5 6 7 8 9- 10- 11 oB e~,~A 5,[%,t 13- 14 15- 16- 17 18 19 2O DATE PERFORMED: Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S ~F YES, AT WHAT DEPTH? ~ O P Depth to Water ADer _ E Monitoring7 [~- Dale: ~ SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ~'~ ( ~.'~o ,~ '~ PERCOLATION RATE // (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ~.~.~O FTAND 'L~~' FT COMMENTS 72-008 (Rev. 4/85} CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~' q--8~ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11- 12- 13- 14- 15- 16- 17- 18- lg- 20- Township, Range, Section: SLOPE SITE PLAN IF YES, AT WHAT OL Depth to Water Alter. _ ~ Monitorin§? ~ Oele: ~ ~,. Reading Date Gross Net Depth to Net Time Time Water Drop / I1;/I /e PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ./.~o_. FTAND 4~--"~ FT COMMENTS 72-008 (Rev. 4/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geo!ogicol ~ Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Please complete either lot lb er lc.) A.D.L. Ne. ~uch, Tlmberlu: 3 6 _e~_o,__of-- sE] wE] Ic-'~.ID~STANCE AND DIRECTION FROM ROAD INTERSECTIONS S. OWNER OF WELL: Brian Chronlster ~e.: 12407 Pintail Anch.~ ~. 99516 Alluvium: ~re~ color~ medium 0 10 s. ~c.~,~ ,.~, Allu~um: ~ey color, medium 20 2~ ~ Till: ~ey ~d hard, 2~ ~0 8. CASING: ~ Threeded ~ Welded Alluvium: grey ~olor, medium 30 3~ ~.. ~ ,,. Till: hl~-~rev ~1o~ ~d h~md. 3~ 55 9. FINISH OF WELL: o~e~ end. Alluvium: grey color, compacted 5~ 126 T~.: Alluvium: brown color~ medium 126 142 set ~e,... ~. S~d: ~rey color, with water; 142 ~8 lO, STATIC WATER LEVEL: 54 ft. 5 ~9/86 10 gpm, ~ ~o~e ............ 100 ,,. ~ ~ & ~ Molerlol: ~ Neet Cement ~ Other: ~U~ DE~CI~,'~ IS, PUMP: (if available) HP Foss Drilling AA 7~ F'ERM t T APPL I CANT LnCAT I ON LEGAL LEE L. HRUNI_ TER blFINYTELL DF.:. L].: BG TIMBERLLIk.: 202:t BELRIR [R.) ' LOT '= ="' 277-482 5000¢~ _,UUHRE FEFT T'¢F'E 0F _,_ILL HB=,uRETION z,'rz,'fEH I=,. TF.EN_,H MRXIMI..IM NLIMBER OF BEDRuGM_, = 4- _,UIL RFITING (bi:.' FT,."BR)=,:,'"=' THE REQ_IRED .... SIZE OF THE 'SOIL RBSORF'TICIN ,=,,c.T_,TEM- I_. [:"EF"TH = 8 L IE:Z I'-~ 131' H = 4 .----~--- · L3 R R'..-" E L_ [:.EF'T'H = -t THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIF'E RND THE BOTTOM OF THE EXCRVRTION (:IN FEET). F-:EL-]IJ I F-:E[:, SEF'T I 6: TRf-~::: S I ZE--- :t25('1.~ , c F.,=; , ,- F'ERMIT RPPLICFtNT HRL-] THE RE.-,PJN-IBILIT'r TO INFIRM THI=. [:,EPRRTMENT DURING THE INSTRLLFITION IN_,FEL. TIuN=, OF FIN'¢ WELLS RDJRCENT TO THIS FR_FEF. T.r RN[:, THE ~UMBER OF REc, IDENE. E=, THRT THE WELL WILL SER',/E. Tl-,.lO ( 2 ::, I [-~SPEn::T I Cffl'-4'_=; RRE RE,]:!Li I RE:I: ........... BR[::KFILLING OF RN'-r' S'T'STEM WITHOUT FINRL INSF'EC:TION RN[:, RPPROVRL BY THIS ' '- 'TI-' -- - DEPRRTrIENT WILL BE :,LI6,_E_.T TO PF.'-C;E-JTI:N. MINIMUM DISTRNCE BETWEEN 8 NELL 8ND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR B PRIVRTE WELL; OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TMPE OF PUBLIC WELL WELL LOGS RRE REQUIRED RND MUST 8E RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRM RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRBf'IS RRE 8VRILRBLE TO INSURE PROPER INSTRL. LRTION. F"EF-:I'"I I T E)--'.F' I F-:ES [:,E~]:E~-IBEF: .~:1.. 19]:-':-:.: I C. ERI'IFY THFIT , Z: I FtM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELL_=; RS SET =ORTH BM THE MUNICIPRLIT¥ OF RNCHORI-]GE. 2': I WILL INSTRLL THE S'.r'BTEH IN F~CCORDRNCE HITH THE CODES. ?.: I UNDERSTRND THRT THE ON-SITE SEWER S'T'STEM MRY REQUIRE ENLRRGEMENT IF THE BESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. HFFLI..HNT LEE UHRON I-,TER [=,=,LIEE. B"r'_ -- DFt'FE "?' 2 ~/ U .......... l- ..... 'r ........ SOILS LOG Performed for Lee Chronisger Date June 50~ 1978 Location Timberlux Subdivision~ Lot ~ ~ Block G 200' N o£ South lot line, 50' W o£ East lot line 4 16 18 2O Soil Type Water Level Remarks GW red clay with some gravel over exceptionally clean mix o£ sand and ~ravel. Groundwater encountered at 12'. Total Depth of Excavation G¥oundwat er ~ ) Not Reached Depth, if Reached 12~ Classification Method ~ ) Visual ( ) Sieve Analysis () Material at Total Depth Bedrock (X) Not Reached Depth, if Reached GW Gary F. Player, Consulting Geologist MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC241503 Parcel ID 018 -271-57 Expiration Date: Legal description TIMBERLUX #3 BLK G LT 3 Site address 4805 MANYTELL AVE Current property owner(s) DAVIS SEAN M & PARK SARA X The On-site system(s) is/are approved for 5 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 12/6/2024 Th s ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject s tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Section 91 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-171-57 Complete legal description Timberlux #3 Block G Lot 3 Location (site address) 4805 Manytell Ave, Anchorage, AK 99516 Current property owner(s) Sean Davis & Sara Park Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: A AWWTS ❑ Bed ❑ Deep Trench A Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑■ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ `S � Waiver Fee $ Date of Payment Z3Zz�1 COSA # () _S Date of Payment Waiver # COSA Application_ June 2022 0.282 Forge Engineering 9/3/24 N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 Ben Schiller <ben@forgecivil.com> Fwd: Leach Field Report 1 message John Wilson <907johnwilson@gmail.com>Wed, Dec 4, 2024 at 6:28 PM To: Ben Schiller <ben@forgecivil.com>, Office Forge Civil <veronica@forgecivil.com> Ben, Below is the seller's statement regarding the leach field. Let me know if you need anything else. ---------- Forwarded message --------- From: Happy Chronister <chronhap@gmail.com> Date: Wed, Dec 4, 2024, 5:40 PM Subject: Leach Field Report To: John Wilson <907johnwilson@gmail.com> Dear John Wilson and the Inspector, I am the original home builder and owner for the previous 38 years. We never had any difficulty with the septic system in all those years. It never backed up or froze or malfunctioned. Thank you, Happy Chronister MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC241503 Parcel ID 018 -271-57 Expiration Date: Legal description TIMBERLUX #3 BLK G LT 3 Site address 4805 MANYTELL AVE Current property owner(s) DAVIS SEAN M & PARK SARA X The On-site system(s) is/are approved for 5 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 12/6/2024 Th s ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject s tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Section 91 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-171-57 Complete legal description Timberlux #3 Block G Lot 3 Location (site address) 4805 Manytell Ave, Anchorage, AK 99516 Current property owner(s) Sean Davis & Sara Park Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: A AWWTS ❑ Bed ❑ Deep Trench A Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑■ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ `S � Waiver Fee $ Date of Payment Z3Zz�1 COSA # () _S Date of Payment Waiver # COSA Application_ June 2022 0.282 Forge Engineering 9/3/24 N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 Ben Schiller <ben@forgecivil.com> Fwd: Leach Field Report 1 message John Wilson <907johnwilson@gmail.com>Wed, Dec 4, 2024 at 6:28 PM To: Ben Schiller <ben@forgecivil.com>, Office Forge Civil <veronica@forgecivil.com> Ben, Below is the seller's statement regarding the leach field. Let me know if you need anything else. ---------- Forwarded message --------- From: Happy Chronister <chronhap@gmail.com> Date: Wed, Dec 4, 2024, 5:40 PM Subject: Leach Field Report To: John Wilson <907johnwilson@gmail.com> Dear John Wilson and the Inspector, I am the original home builder and owner for the previous 38 years. We never had any difficulty with the septic system in all those years. It never backed up or froze or malfunctioned. Thank you, Happy Chronister ATTENTION: Buyers and owners of a property served by an Advanced Wastewater Treatment System (AWWTS) ** TO AVOID SEWAGE BACKUPS** Prior to using the wastewater system, contact the service provider to ensure that regular maintenance is completed. Many of the systems require remote monitoring, the provider will tell you how to provide this capability. Who to contact: • AdvanTex: Anchorage Tank at 907-343-3704 • Quanics Aerocell: Garness Engineering at 907-337-6179 • Biocycle: Biocycle Alaska at 907-274-0314 • BioBarrier: Tim Ecklund at 907-250-0100 • Intermittent Dosing Sand Filter (IDSF): contact MOA onsite 907.343.7904 Please complete the attached document, Advanced Wastewater Treatment System Maintenance and Repair Agreement. When signing this document, you acknowledge that you are required to provide regular maintenance for your AWWTS. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this t6 Day of d 61"lu' of 20 v� by and between Ste+ 1�� fr S S�,-p A r v� , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Sf-/'�, c s it located at (legal description) j+, I / -o d< Lt' T -;r %��" .Cl' �1r� �4 G►iff�'�J/1�rQir� ' "V 2. Maintenance, Repairs and Alterations. 7/' �410 (Owner is required to read, understand and initial each section) e-:&Toughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. �It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 4;21"Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. lar maintenance of an AWWTS reduces the potential Owner acknowledges that regular failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. //4 ONN,ner agrees to grant the Municipality reasonable access to test and inspect the / VAIWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new 0 Ce iticate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing uidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 A Olt AAf PIS ra riiL: thk v ofef I a qk-ri F(lr%,-Vl.ASK A NOTARI"PUB LIC ame Nord*ri I I ;4"nature I LOT 3 1.269 ACRES FENCE ASPHALT DRIVEWAY S 89056'36" W A125.67' o 57.00' R1330.00' o — - - - - MANYTELLAVENUE LOT 4 LOT 5 UTILITY N 89056'36" E 182.48' PEDESTALS MANHOLES REBAR EO EO -r ZESLV� EO ^ FO EO EO EO UTILITY L 10' DRAINAGE & UTILITY EASEMENT EO OVERHEAD — — — X_ POLE x — — — — — — — — — — — — — — — UTILITY LINE I x I� x ) WELL x x SyFQ z C/) C:) 0 _ 69.8' O C:) o SEE BUILDING a;� stip o N DETAIL �_� -' ° W co HOUSE N N) LOT 4= 52 7' � SEPTIC ITl LOT 2 W 31.0' W C:) o p p Ui C:) Cfl O W LOT 3 1.269 ACRES FENCE ASPHALT DRIVEWAY S 89056'36" W A125.67' o 57.00' R1330.00' o — - - - - MANYTELLAVENUE BUILDING DETAIL (1"=20') EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (71-240) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, 0 25' 50' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, BLOCK G, TIMBERLUX SUBDIVISION ADDITION No. 3 ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 26th DAY OF NOVEMBER, 2024, AT ANCHORAGE, ALASKA. THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 24191 B NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 SEPTIC MANHOLES S; 57.0' LU 3 -STORY Q o FRAME co HOUSE N SEPTIC 31.0' STANDPIPES o 26.0' CANTILEVER DECK ASPHALT DRIVEWAY BUILDING DETAIL (1"=20') EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT (71-240) ARE NOT SHOWN HEREON. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION SURVEY STANDARDS. THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, 0 25' 50' AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 3, BLOCK G, TIMBERLUX SUBDIVISION ADDITION No. 3 ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST EXCEPTAS INDICATED. DATED THIS 26th DAY OF NOVEMBER, 2024, AT ANCHORAGE, ALASKA. THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES FIXED HEIGHT LLC COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT. C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 24191 B NO CORNERS SET THIS DATE SCALE 1" = 50' 1 600 W 41 st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-S~TE sEWE~AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name~/,~N ~'J~¢/~//,~'~'~ Telephone: Home ,~¢~"' 1221 Business ,~"'3'-/~,, Ap¢cantAddress ,, ,4/f', (c) Applicant is (check one): Lending Institution []; Owner/builder I~"; Buyer []; Other [] (explain); (d) Lending Institution '~¢ l~.~$K'~ ~$~ ~"~'~. ~.~t"/(,/~/'0~Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms /~'.~ Other WATER SUPPLY Individual Welt [~ Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] 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 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the n umber of bedrooms and type of structure indicated herein. I further verify that baaed on the information obtained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposaJ system is in compliance with al~ Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,~,'~'~(~.,~ ¢ ,~.%~¢-,'~¢¢-.5 Telephone Address /0~1 ~p~ Date /-~- ~ Engineer's Seal DHEP APPROVAL Approved fo,' bedrooms by Approved ~ Disapproved // Conditional Date /-/'~ -~'/-" Terms of Conditional Approval CAUTION 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 engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION A. E D MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORI~TY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification ,("~O/'~/~-- If A, B, C, D.E.C. Approved (Y/N) ~ Well Log Present (Y/N) ~/ Date Completed ~:~-2.~ - ~(~ Yield Total Depth _ _/Z,~ Cased to ./4~,¢;~_ Depth of Grouting ~ Static Water Level ~ ,.~¢ Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing (Y/N) "/ Depression Around Wellhead (Y/N) ~%/ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _~.~; On Adjoining Lots J~'z/- To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole -- To Nearest Sewer Service Line on Lot -- Water Sample Collected by ~%~. ; Date ~-/'~- ~(~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size Standpipes (Y/N) _ ~/ Air-tight Caps (Y/N) Depression over Tank (Y/N) *~/ Pumping/Maintenance Contract on Fil6; (Y/N) Holding Tank High-Water Alarm (Y/N) '- Separation Distances from Septic/Holding Tank: No. of Compartments ' / Y Foundation Cleanout (Y/N) Date Last Pumped .... ; for Temporary Holding Tank Permit (Y/N) '-' To Water-Supply Well ___ ,/~:) ~ To Property Line ~,~.- To Water Main/Service Line ~ Course To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field (~."¢~ Depth of Field ~ ,/ Gravel Bed Thickness ~Y- Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ._~,~/~'~A-~'"/~.y Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~ /¢~1/- TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line '~,,~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank {if present) Comments LIFT STATION Date I nat alled'~"% Size in Gallons ~ "Pump On" Level at ~ Dimensions Manh ole/_A.~i'~) l:~l~Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) J Comments jJ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have c~ck%erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~ ~L.~. Date Company ,~..~-,~.Sc~c.,,~ MOA No. Date of Payment ~ ~/~"~ , Amount: $ ¢/,~-~"~-- ' ~'~'¢ ~ Engineer's Seal