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TIMBERLUX #2 BLK I LT 6
Timberlux #2 Block I Lot 6 #018-271-36 Municipality of Anchorage F 6 `' Development Services Department a �a Building Safety Division — — On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW020138 PID Number: 018-271-36 Name'PAMUELA MONTGOMERY Wastewater System: ❑ New ■ Upgrade Address: 15201 LONG BOW DRIVE ANCH., AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-3492 3 CIDeep Trench ❑ Shallow Trench ❑ Bed D Mound 170t LEGAL DESCRIPTION S"g� Total Depth ions aHgi pl GPD/Sq. PL Ft Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth PiPM 1 6 TIMBERLUX #2 FL R Township:— Range: Section: FNI added oboes original grade:a sl Nnptic — — FL Number lines: Distance theism lines: Gravel WELL: ❑ New ❑ Upgrade wWea of ��\S FL FL Close CanTotal De cased To: Total absorption a POO motsrld: n' FIL SQ.DUIaIN \\�\G Dote DdIWk Static Wow Level: Date installed: FL ttsM:Pump Set At Casing Hslght Above Ground: TANK CPM FL FL SEPARATION DISTANCES 13Septic 0Holding ■S.T.E.P. E3 Other T° Septic Absorption Lift Holding Publk/PMate Manufacturer. ANCHORAGE TANK Capac h In gam. 1250 From Tank Feld Station Tank sewer ones Well 100'+ — too'+ — 2s'+ Notarial: STEEL Number of compartment: 2 Surface water 100'+ — too'+ — — LIFT STATION Lot Line 5'+ — 5'+ — — Stye In gallons: 1250 Monulaeturor: ANCHORAGE TANK ORENCO SYSTEMS 'Pump ani level N:'Pump &r Ieval ab Hlgh water alarm al: Foundation 5'+ — 5'+ — — 41 " 41 ° 45" Pump Mob k Model: Electrical Inspections polormed by. Curtain Drain NONE KNOW #20 OSI 05 HHF I M.O.A. BENCH MARK Remarks: Location and Description: TOP OF SILL ® GARAGE MAN DOOR. Assumed! Bambara 100.00 Fc ENGINEER'S SEAL 000�>App �� Inspections performed by: AKWWC, INC. Date: 1st 8/16/02 * '....9 .H.. .... .� a #Q ffr y rn s. P QQDevelopment S rvice Department Approval () Reviewed and approved by: Date: 9 ��� dProfesew�o� o 4�DO0�p060 (Rev. 12/07) MTJ NEW 1250 GALLON S.T.E.P. TANK Ik •` NEW FCO ' ....' A \ p • r/ � I / ' I MH 23.50 44.01 t I ST2 22.32 43.59 ' ST1 17.01 41.46 DBL1 15.22 41.13 DBL2 15.05 41.17 I'I -' ;:. DATE: 8/21/02 060 ie®eloneuuwommm�weo®ew® p C!• ••;7 (1�0�� DRAWN BY: ALASKA WATER & WASTEWATER B.S.G. 5. SCALE: — 1 " 30' CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B ' ANCHORAGE, AK 99504' PHONE (907)337-6179 • FAX (90])338-3246 ' *"' """""' Q "' Q PREPARED FOR: PHONE NUMBER: PAGE NUMBER: PAMUELA MONTGOMERY (907) 345-3492 1 2 OF 3 0 a e f A. rness. o'• LEGAL DESCRIPTION:O • —7953 mp TIMBERLUX SUBDIVISION #2; LOT 6, BLOCK I fe A��oO �� af'rOfess101' 0440000'd TYPEWORK: AS -BUILT OF SEPTIC TANK UPGRADE PERMrrNUMBER: AS-BUILT DRAWING PARCEL ID NUMBER: SWO SW020138 018-271-36 SINAL c4wJ - 105.81 -105,85 511 5f2 MH fOP f f99 � � fOP 0� TANK AT INLET = 99,03 Af OUfl,V = 99,05 I NSW 1250 6&LON ( I Af NLETT = 98.99 OF 6UNG 5 f� p TANK NVE�r o� 6 G INLEAf OUlFf - 98,96 8/21/02 AWN BY: ALASKA WATER & WASTEWATER B.S.G. CONSULTANTS, INC. Ste` 901 DEBARR ROAD. SUITE 20 ` ANCHORAGE, AK 99504 - PHONE (907)337-6179' FAX (907)338-3246 N.T.S. EPARED FOR: PHONE NUMBER: PAGE NUMBER: PAMUELA MONTGOMERY (907) 345-3492 3 OF 3 ;AL DESCRIPTION: TIMBERLUX SUBDIVISION #2; LOT 6, BLOCK I IE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE Sent By: Alaska Water and Wastewater Con; 907 338 3246; Jun -3.02 12:19; ALASKA WATER Fir WASTEWATER .a.s..:..w.v.....vna w..w..i....w..v CONSULTANTS, INC. June 3. 2002 Municipality of Anchorage Developmett Service Deparunent Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Page 111 Ref: SW020138: Timherlux V2, lot 6, Block 1. Separation between pressure line from STEP tank to water service tine. To Whom It May Concern: When preparing the design for the subject STEP tank we failed to take into consideration the separation distance between the pressure line from the STEP tank and the water service line from the well. We are proposing to use HDPE pipe for the new portion of the pressure line that runs from the STEP tank to the existing pressure line. We are proposing to have the water service lino professionally located. The connection between the new and existing portions of the pressure line will be located so that it is at least 10 feet from the water service line. The new STEP lank will be placed so that it is at least 10 feet from the water service line. Please notify us im diatcly if this is not acceptable to the MOA Onsite Department. If you have any questions, please aoPet me at 337 6179. Thank you for your assistance. s M.S. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337.6179 • Fax: (907) 338-3246' Website: akwwc.com Permit Number: SW020138 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 31, 2002 Expiration Date: May 31, 2003 Parcel ID: 018-271-36 Legal Description: TIMBERLUX #2 BLK• I LT 6 Design Engineer: 0041 AK Water & Wastewater Consultan Site Address: 015201 LONGBOW DR Owner Name: Pamela Montgomery Lot Size: 34937 SO. FT. Owner Address: 15201 LONGBOW DR Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99516-4145 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 ). g, 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. Received By: Date: 6 1— 0-2— Issued 7 Issued By: r J Date: �I o -z- Municipality of Anchorage s • Development Services Department Building Safety Division On -Site Water & 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/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 0(9-a'7II-2S(0 Permit Number S'ky 02C/31j Property owner(s) PAMIELA MONTGOMERY Day phone 345-3492 Mailing address (1) 15201 LONG BOW DRIVE Mailing address (2) ANCHORAGE. ALASKA Zip Code 99516 Legal description (Lot, Block & Sub'd.) TIMBERLUX SUBDIVISION: LOT 6. BLOCK I Legal description (Section, Township & Range) N/A Lot Size 3qQ,�> % Acres q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only 0 Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: ' . L90 p Date of Payment: gloms A,2, Receipt Number: D'20 v -b Waiver Fees: Date of Payment: Receipt Number: M NEM"i IC�l*L�� 1 C • May 23, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Tank Upgrade for Lot 6, Block I, Timberlux Subdivision #2 To whom it may concern: The existing 3 bedroom house is currently served by an on-site well and septic system. The existing septic system contains a 1000 gallon septic tank and a 500 gallon lift station. The lift station has become inoperative and needs to be replaced. We are proposing that the existing 1000 gallon septic tank and 500 gallon lift station be replace with a 1250 gallon S.T.E.P. tank. 1. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 2. TOPOGRAPHY: There are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your M.S. NOTE: Attached is a site plan drawing, a design drawing„ and a 5 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com AN OPTIC 1 ARS \ ! ,t 'fit � S€ TIMBERLUX S/D #2 `(ate—' _ TIMBERLUX S/D #2`� \�\ LOT 4, BLOCK I ' /' ` `LOT 3, BLOCK I \ , ,t � kt .07 cl "o i � 1 i TIMBERLUX S/D #2 \ t \ LOT 7, BLOCK F E \( ,i i 1 , k i \t is t TIMBERLUX S/D #2 j 1 % LOT 8, BLOCK F 1 S ' 1 II]DOy" t V I / \ I / \ \l ! 1 1 \\ TIMBERLUX S/D #2 LOT 5, BLOCK I'�, !\\ PROPOSEI UPGRADE. 9 OF 9 FC XISTING SEPTIC TANK AND LIFT STATION — € 1 I I CURVELL 1 I 1\ \ TIMBERLUX ! \ \ LOT 7, BLOCKOCK I i TIMBERLUX S/D #2 LOT 2, BLOCK I SEPTIC .EXISTING THREE BEDROOM HOUSE ^_ /— EXISTING 1 DRAINFlELD r € � I TIMBERLUX S/D #2 € LOT 118, BLOCK R V CREA i ( k (I€ € 1 { TIMBERLUX S/D #2 € LOT 8, BLOCK I ALASKA WATER & WASTEWATER �•.a —. CONSULTANTS, INC. — =z 6901 DEBARR ROAD. SUITE 213 - ANCHORAGE, AK 99504 - PHONE (907)337-6179 ` FAX (907)338-3246 PREPARED FOR PHONE NUMBER: PAMUELA MONTGOMERY 345-3492 LEGAL DESCRIPTION: TIMBERLUX SUBDIVISION #2; LOT 6, BLOCK I SITE PLAN FOR SEPTIC TANK UPGRADE DESIGN K.D.W. \\ Eil RADVUS I RpD' W TIMBERLUX S/D #2 LOT 11 A, BLOCK I (:;EPTIC ARS TIMBERLUX S/D #2 LOT 10, BLOCK I 1 " = 100> .... ......... E NUMBER: n �.... ... ... I....... 1 OF 2 of e A. arness. f'a s. —7953 IJ�a \ewe .........'' VdU��d X,r0 f e ssion& FAV EXISTING SEPTIC TANK - AND LIFT STATION TO BE COMPLETELY ABANDONED \ \ \ \ l �PROTANK 12 ALLON S.T.E.P. TANK INSTALL \ FOUNDATION CLEANOUT T TO EXISTING )M ABANDONED STATION / 24- 0�a�o w \ � i \ f (ISTING DRAINFIELD. ` 'ROXIMATE LOCATION AND ORIENTATION NOTE: THE CONTRACTOR MUST HAVE THE 100 FOOT WELL RADIUS FROM THE SUBJECT PROPERTY FLAGGED BY A REGISTERED LAND SURVEYOR PRIDR TO ANY CONSTRUCTION. ' r �1 DRAWN BY: ALASKA WATER & WASTEWATER K.D.W. SCALE: - ° CONSULTANTS, ..r,.* 1 " — 30' 6901 DEBARK ROAD, SUITE 28 - ANCHORAGE. AS 99504 - PHONE (907)33] 61]9 - FAX (907)338-3266 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: PAMUELA MONTGOMERY (907) 345-3492 2 OF 2 QO J fr rn SS;' O m 7953 4p zp� ' LEGAL DESCRIPTION: TIMBERLUX SUBDIVISION #2; LOT 6, BLOCK I Fa' .. cc� 0df'rofessio�°\ TYPE OF WORK: DESIGN OF SEPTIC TANK UPGRADE 00 �Oppp000�� MUNICIPALITY OF ANCHORAGE DEP,..~rMENT OF HEALTH AND HUMAN SERV , Environmental Health Division ,'" 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES SEPTIC ABSORPTION Address TANK FIELD WELL Phone(s) Permit NO. NO. of Bedrooms WELL '~m hecl~n FOUNDATION '~ 1~ ~l ~ ~ ~ ~¢C ~ AS-BUILT DAGRAM tShow oca oho wel, septic system, propertyhnes, foundabon, dnveway, water bodies, etc.) TANKS ~ SEPTIC ~ 5T~Ti~At ~ HOLDING TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ Depth ~o p,pe bottom from ~Ota[ depth Jrom orLgJnal grade ~'~ I~'~ I : FIll added above original grade Srave, depth beneath pipe ~!Ar / Total absorpt,on area Distance bet .... lines ~ ~¢ .1,~1 ~ WELLS ~ PRIVATE ~ OTHER (Identify) REMARKS: tlc h,p. ~eli ~um/ m Ore. co A~ ~ LEGAL. DESC;F:~II::): ,"SUBDIVISI[)N~ TIMBERI. J-JX LOT: 6 SIZ[;TI[)N= 54 'TOWNSHIP: 12N RANGfC~ :3W LD] SIZE:: 3Zl9::$7 (SQ,,f='f'. OR ACRES) MAX B!EDROOMS fi 3 L. istc.:!d be].cx^l ar'~ the ,:::lp'Lic)r'~s available 'Lo you in designing your' system, Choose the c. pt:i. on tha'L best fits your site., DEP-FH '1"O PIPE BOTTOM (F'T.) GRAVEL_ DEF)TH (F"I"~) TOTAl... DEPTH (F'T:) GRAVEL, NZDTH (F'T.) GR~VEL. LENG1H (F:"T. GRAVEL VQ[..UHE (CU.YDS.) TANK SIZE (GALS) SO:IL RATING (SQ.I:'T. /BR) 4.0 4.0 zl.. 0 11.0 0.5 3., 5 15.0 4.5 7.5 2.5 24 ,, 0 5 ,, 0 :]!;9.0 47.0 9 :t. 0 4 :[. 6 q- 1.8 6'7 ,, 5 000.0 ~. 1,000,,0 ~..~ :[~000,,0 2.8 1 246 2.8 :L ..:;P,A~EL L. EIqE IH :::' /,.¢ I:T~ RI:,u.b¢.RE.~-~ I%JI...I'IPME RUBh:~ (NO'f' EXC;EED]iNG "¢=' FT., E:'AC;FI) -x.¢~. 'FANK MUS'T I-IA..,:. AT I...I...(-,.~ TWO Zl. c~:,r'L:i, fy tha'L~ J.. ~[ aifi faro:i. ], iai" · ,':cmi:;h by the Nunicipallty oF Anchorage (MDA) and tine State of Alaska. ;2,, I ~,¢:i.],].' ir'~stall th~:~ svstem in ~Ecordance yd.'Lb all MOA c:c~des and r'egu:l, atic~ns~ and :i.n c:cm~pliance with tine desigri cr'it~el"ia Df th:i.s pePmit. :S. 1 wi],], adh6~r'e i:.c.) all MOA and State (3f A1asl.::a PequJ. r, emerrLs {(:lP i'.l'ie~ si~:~'L back d:i. stances f'r'om arly ~;,:i~tin(] we~l],i, I.~Ias'[E,W~W[ep disp~s.a. 1 system or publ:i.c .q-. ]: under, s'Larld that 'l:.his per'niit: :i.s va],id For a IrlaxJ. a]Lim of' 3 bedr'oc:mis arid tFA THEN MILL ELEC'I'IR!C, AL WORK MUST BE DC)NIS BY A LICENSED EL. ECTR!CIAN. t 'IF'i" ,::,IAf.[UN ].,::~ IIxlS'f'AL.I...ED ].N AN AREA [,,O~[:,f.I:.D f-rl]A BUlL. DING t.l..)!.z[::.c~ (1) AN EI. JEC'I-RICAL. F;'IEF;d"IIT AND INSF'ECTIOiq MUS'T BE OB'i-A]:NED; (2,) AS--'BUII_.TS NO'f' ~:c AF'F'IRC)VED WI'I"HOLI'T AN ~--Ei,_.IR ....... INSi::'ECTZON [,L.I'-ORI, AND (..:,) 'THE c, ], bl41:b APF:'L I CANT DATE: DA -~ ,.. ~.,~u~ ,[_.1 ,. L.,~.~, E.~ ]: SSUED BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: p ow. ~¢ ~.~._ ~¢c~r*r e ~) o..[ ¢ ~ ~,r~ 0,5 -- Pt' 1 2 3 4 5- 6- 7- 8 9 10 - 11~ 12 13 14 15- 16 17- 18- 19- 20~ .y-l-I '~:I COMMENTS PERFORMED BY: CE-3589 '¢ SLOPE WAS GROUND WATER S ENCOUNTERED? ~ (~ ve/,.,~.~ YlqI~3~ PE IFYES, ATWHAT r)O j¢~?_/b 157' DEPTH? DATE PERFORMED: (-r' ,-, SiTE PLAN t&8. ' Gross Net Depth to Net Reading Date Time Time G(n) Water Drop lo .' 87 7 V~ .~' l/ ~1: ~ ~o ~ '~ / z//E PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~,0 , FTAND '~"~- FT 7~ ~7,.~- ~,'//~{'r/~ ,,~ ~,~ l~' ~'~ ~a,~*/~,~ 4o-ba ¢,o~,t~ b,~ CERTIPIEDB¥: ~/d~( ~' ~'/~%¢/~ DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR; LEGAL DESCRIPTION: 1 0~.. 2~ 3- 4- 6 7 8 9 SLOPE DATE PERFORMED: SITE PLAN 10 11 12 13 14 15 16 17 18 19. 2O wi/. WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time (l~t ,'o ) Water Drop ~,. , ~: ~? ~ ~ ~ ,, CE-3589 PER,~OLATION RATE ~ ~ (minutes/inch) ~ ~ q~/ /.~ '/~,,r~ TEST RUN BE~EEN ~r0 · FT AND ~r~ FT ~ ~i ~'/~o~ ' PERFORMEDB~: ~/~f ~Cbn~Ea/ ~ CERTIFIED BY: ~ ~ DATE: ~/¢/8~ --~:';~ .......... ~:~'~ 14530 Echo Slreet ~nChorage, Alas]ca 99818' 6 S IT~ PLAN LOT 6., BLOC N T TI I"I ~ E R L I_Z,x ~atto~a T~chn{cal Services 14530 Echo Street Anchorage, Alaska 99518 i4 # I WASTEWATER DISPOSAL SYSTEM UPGRADE LOT 6, BLOCK I, TIMBERLUX SUBDIVISION * * * SPECIFICATIONS * * * 1. The soil absorption system shall be a conventional trench, with a total of 9 feet of gravel extending from 3 to 12 feet in depth beneath the. 4 inch perforated distribution piping. 2. The installer shall be responsible for determining the exact location of buried electric and telephone lines which run roughly parallel to the proposed trench, and shall provide for relocation if necessary. 3. Effluent shall be pumped up to the distribution trench from a lift station located adjacent to the existing 1000 gallon septic tank. 4. The Lift Station shall be a Municipally approved package unit consisting of a "High Lift" Orenco assembly installed in a 500 gallon steel tank, as supplied by Anchorage Tank, or equal. (See attached supplier literature) 5. Pump with 202 on switch controls shall be set to provide a 63 gallon dosage, gallons capacity remaining in the tank above the alarm setting. 6. Discharge from the lift station to the distribution trench shall be by means of 2" PVC pipe buried a minimum of 4 feet and sloped to provide complete drainback to the lift station between dosages. The installer shall locate and replace as necessary the electric and gas lines connecting the house and garage. MUNICIPALITY OF ANCHORAGE Hea~%~) and Environmental Pro-hec~ Jbn Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 rePOrT oN-srl'e sewAGe DiSPOsAL SEPTIC TAN t<.: NUMBER OF oI51ANC[. MANUFAClURER~._~-.~LT _~_ MATERIAl. '~x.~f~.~_f~L~% $ _ ]COMPARTMENTS ~ TILE DRAIN FIELD: ~ ~T' TOTAL LENGTH ~'~-' pmTAN(:e FI~OM WELl ....... FOU,NDATION___~_.'~- .... NFARLST t.or LINEN.~ .......... OF LINE ABSOliPIION AREA__~. Sq. FT. LENGTH OF EACH lANE DEPTH OF FILTER DEP'IIh TOP OF TILE ]O I:lNISII GRADE'-~ MATERIAL BENEATH TILE_~_~-- .... IN. ALCOVE TiLE~_~__IN. SEEPAGE PIT: DIAMETER _~ OR WIDTH ..... LENGTH ..... DEPTH .................. Log Crib __Rings__ ~UILDING FOLJNDA'[ION Crib Size: DIA,METEP, .... DEPflt ......... OISTANCE FROM: V, ELL ] OTAI.. EFFECTIVE NEAREST I_OT LINE ______ ABSORPTION AREA (WALL AREA) ~,~-~-~:' SQ. FT, ~11 Lass: Depth: ~11 D~stance To: Lot Line [dg: Sewer Line: __ Lpe Materials: of Bedrooms: lstaller: ~l~ ~, ~marks: L ~ iL H I ~ L:iN i._Et~HL. FI[_PIN L. HI4.::,t. r4 E EL:'F.._ .Jl L, = M~';-:,'If,IlJP1 HJFtE[r_I. I'ZIF' ':. .3 I HE [_ENb~IH L:,]:I',tENE;iUN J. LR 'IHE t_ENL:i"FH (IN FEET> OF 'rile 'ii,::ENI_:H Oi4: 1:)I4:FIZNFJ. ELI.). rile t.:,EHIH OF R IRENL:H I_)N'. P:['l ].S THE t:)IS*I'RNCE E:ETHEEN THE %URFRE:E OF iHE i.jRE)[Jf.~[) ~f.4i) tHE E:[]'I iCIPI OF THE EXCRk,'RTI[JN (iN FEEl>. iHEH'.E 15 MCI SEt' HI[)'rH FOR I'IE:ENCHE5. iHE HRRVEL. DER'IH .~E, I'HE P11N:[P1LIPI E:,EF'iH OF GF:Ft',,,'EL BE'it4EEN THE OLIIFI4Lt... l*'ll*'E HND THE BOf"rEff,'i OF I HE E',:4C~VRIZOM (].N FEET;:,. j H HflU[:..H-~E PL..HF4r r'iR"r' EEC IN:, FL_EL. FFr THE F'EN:H]:rlEE"'2E; iZiPIZON _c_;UE:JEC:i rl.i i Ft31._L EiL,J ];ii. Ji3 J'-41, I J... b l-IbP-' F:I C:LII:IS:E; ;[ 3t4' .1;1 r-4_qF I*IF'F'[,.".[3k~EE:, II;*LHJNI I*"JR"r' E.,b .LN=, H_L_EI .... H ..... hll].i"J[J..U.., I"llZl;[iq'lEF,If:lhlC:[E HGI4:EEJ-,'tENI 1¢' J~:EI;!UiN:Ei). ].F R f,IFt].?.,IIEi'.4FIJ'.,HL:E H~3REEr"IEN-I .[.:, NOt' [::;EF'T ... k.'.[:::ENI "r'[)U HFI'¢ E,b. N.E ~.U.tt,..E[ 'ICI EII'4i. JzlN:~3[- HE:SOI~:F"i 1LiN _-:,'LtEI'I IdJ",t[:,,./C~f'~. '¢1.3U i'IFl"r' E,E ~I.IB..)E_.I r'LLI Fk.._....L._.[JI1.. b.,p...K.F. IL.LlrlIJ it* [':IN'T' ::,'r_., Ell Hi"i'HOLI'II FINHL )N'2F'EC:rtLdq HND PIFP~ ,HL )F ' ' ' ' ' ' 'f ' . ._I*Ph. IPiENr HILL. E:E ~;JEktE 1' J"iIN].HUI"l [;:,L[~;'I'PINCI:¢. E:EtHEEN R 1.4ELL. FIND HJ"4'¢ iEJE~ EEEf F'L:IF~ H F'F~i',/~I'E HELL I_:I~E'. ~C~Ef FEE'i~(FO~: R I*'LIB[...IC: b~ELL. NELL LIjt3S HRE k~Ei=~t.tlt4:Eb RNIJ) HUSF E:E ~'.EI'tJF:NEI]) 'iCI THE L:,EPHN:'fHENT 14J;rHli'.~ 2~:~) E:,F:IY~:, uh tHE HbL_.L CCIF1PL. Ei'iON. .L CEI,:,'i IF'r' 'tHHr i: i Hr,1 F'RM!L.i[4k..' H:["IH I-HE RE:IJ~LJ.Lk..'Ef,IEN'IE; FOR ON-E,J.'tE E;EklERE; f.:IND HELLE, FIE, E;Ei PUF..'tH B'T' THE MUNIUIPHi.-,]:t"r' UF HNE:HON'.I:"tGE. ;~:~: .t HIL[. INE;IFItJ.- IHI:E ~;'-r'E, iI::;H IN RC:E:ORDPIf',IL;E HItH [PIE ~:: j: LJNIJ.',EI4.'2;'IFIf.,II;;:, iHR-i 'IHE. 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HE.:LL. l...()G:i;i; I::tl;NE: I;:E[;¢J:[I;~:l~ii:D FIND t"IUST EiFi:: E'.E::'I"IJI:;ff.,IE:I:) q"CI '1"t.-It:.~: I)IEF:'FII:.?.THEN'r' !.,IZ'TH:[N :ii:E~ E:,F:I'T'S OF 'Ti.iL:: i.,.IIEL.i... '_:5 PiE (:;: ]; F' ]: (;;:FI'I :[ O Nil5 FII'-,I D ]: i'.4:L:;T Fil..L_I':IT ;[ f_qt'.,I. :i: C:I:~F;;:'i']:t'::~'r' THI::tT ::i.: :[ Fff"t i::'1::ti"'1):1~.:[i::1t;~: t.,.!:[-i'H THE RE(;!LI:£1:;?.EHEhlTS I::'or;~: OI'.,!-. .S :[ TIE :SEI.,.IEt~?:-5 Fff.,IE:, I.,.IEL.I..S F:tS SE'f' FCiF;:TH Ei',q.' THE i',ll..IN :[ E: ]: F'I:ql... ]: T'./ OF Iqi'.,ICHC~I:::'.F:IGE. ;::: :1: I.,.i:t.I..t... :[t'.,ISTF:tL.L. 'T'I.IE S'./'_:5-1"E~:H ):i'.,t F:tCCOI:;tDI:::li'..ICI~ !.,.1:[ TI.I 'T'lql~:: CO[:,ES. :~:: ]: iJi'.,I[:,E:RS'f'FII'.,!D TI-.II::IT 't-HIE Ot'.,t-..-:i:;:t:q'~Et.,.1E~: S'T'?I-k:i:H I',IF:I'./ l~:[::::l:;!!...l:l:i:;i:E ENLFqt:;~:GEHEI'-,f']' ]:t'::' 't"~.IE i ?F'::;]'[:,FKIr':F' 'r,::; !:;;'I:~HIql)ii~L.E;I) Tr~'~£~IX;: t,'lEit:;~% THFIi'.,I :5: EfiEDI:;~:EIEd',IS. F:ii:::'I::' L. :!: C FIt:.,I T t:::t t... 1::.~¢4 [ '~;I:JN'' ,,,i PLA'Y'EF CONSULIING GEOLOGIS1 BOX a?6-M, STAR ROUTE A · ANCHORAGE, ALASKA 99507 · PHONE 344-70YI August.23~ d976 SOILS TEST Alan Larson Lot 6~ Block I Timberlu× Subdivision Depth ...... Soi_~l ..... O-fl~ feet Gravel, dense, si].ty~ sandy, grey-brovm (GM)o Puddles of water were standing at the surface from recent torrential rains (date of inspection 8/fl?/76)o No subsurface water was encountered in the backhoe-excavated test pit~ Rock is greater t~an 20 £eet below~ground level in this area. Sincerely, Gary F. Player Consulting Geologist .... ,, 1 ] i..E{NEiE:Ed.,~ [:,R LE; ...L lit'Il EBI. ,.., :E;UE~ 2 L O"F ........ ' _-~:4 4.-.6:1.5:!. 2:,dr:E32i:'~:' '=;{'::!1 IFIF'IZ FEEt' ~r'l=. F'f::":l 'IFf'El> .:.[,..E. CIF 'I"["IE; E;C)ZL. ICb:,-F~.f I.I-N .z ._TEl'3 TJ-lJi~ v L.li!d"4G'Tlq [:' I HEI'.JF~; I 01"4 I '.E; '1'HI!; LENGTH ,:: f. N FEET ) OF= THE TRENCH CIR 'f'HE DiZF:'I"II OF= FI 'TRIENCH Cfi;;'. PIT IS THE 13, iS'I'FIi',ICE BE'TI4EEI',I TI.IE :E;I.JFRFF:IE:IE OF' THE: CiROUN[> FIN[> 'THE: E:EFI""f'OH OF "I-HE E::.<CF:I'v'F'I"I"ION <];N F:'EET). 'i'{-IERE I25 NO SET NI[:,TH I='OR TRENCHE:Ei. 'rI..1EZ i3Iq:i=ib'EI. [},EE~:'-FI'-I 3:5 TI'IE l*'lll"4II'qEJl'¢l DEPTH OF 6RF:I'v'EL. E:ET[4EIEi'-4 THE OU:'I"F'FILL. PII:?E FIN[:' TI'IE E',OTTEd'i OF THE E',:':',CFI'v'FIT I ON ':: :1; N F'EE'T'). JF::I-t"FIE/R Fi CL. FIE;S ! ]7)R 3: i NE;F: 14F I [ .... E[ PL..FII"4T i"lF:l"r' E:E I I,l:,l'f L.L. :[... .L.:, 1_I:SE[::, THE L.ENG'TH1'":';., 2~:' El F:EE!:T. 3:F:' R '" ' '-'" ......... ~.[ =,=, I ,~ : tE. II "'-' ' ....... U=.,E.L 'THE LENGTH -' ...... i.:. .-k 8 F'IEE'T'. .... L. .:,., ii ::r;1E.l'l 3;~'i; ZF: Iq ' ' .... '" ...... ................ }''- E','.r~ r =,.~,_.,...t-ILLZN OF: I::l{",l"r' ?T'!E;TEI'q I.,JII"HEdJT FII",IFII... INSI;:'EEC'I'IEIN F:INI::, dl-~f._ tl. {'1...;, '~-~ ....... ::; IE: fE'""r TO F:'F'-':E'" 'I"]'"N. [.r::.r'r~,,=. ri }E?I {.,JIL. I... DEC ........... i'.l:[l'.,t:[hll_lf,1 DISTI:qNCE: BIE]".t,IEI~.'~I"~ FI 1.4EL. L FIND F:IN'¢ ON.....E;ITE SENF:IEiE [:,IE;F:'E~E;F!I._ ~;'./'_.':~;TEh! :I.~)EI FEEl' F::OR R F:'RI',/F:I]"E I,~E:I._L. OF,~: 213El FEET F'OR FI pI_IE~L. IC I-,.IEL. L. 14ELL_ LOG:F; FIRE I:~'.E:(.;!U!REE:, R[.,I[;, f,'ll...l~T BE: F:.'ETUI:~:I'4E[:, TO THE [:,EF'FIRTHEN-f' OF THE 14ELI.. COHPLETIOI",I. SF:'E;C]:F'ICFITION5 RNE:, E:Ed',I~5]q:;~:UCTION I) 3: RGI,~tI::II"I:E; RRE: FI',,,'FIZL. RE~[...E TO INSURE F'RE~F'E:R Z hlSTFE_I...R'F I Ot'.,I. i _..~ F I ] F "l'l']l::l~l' - . _. L J..: I FIH I-::F:IHIL. IF:IR I.,~I]"H TI..IliFJ REg!L.IIF;flEHEN'T:E; F'OR -t'.I--'::;]71'E _,EI.,LI .... FIN[:, 14Ei...L.E; FEiRTH ~, THE 1Ud.[ ...].FI- L..i J * "IF: '"IN_.H_I..k ~E 2: ! NIL. L II,[ ,1' LL THE!: .:,r.:,tlE.I1 IN FI ......... F:'[',FINE:F£ !.'I~"I"H 'J'HE ..... f,F'E; 3: I UN[:,El:;;x!ii;'r'f:ll'.,If> 'r'HFIT THE Ed'.4.-:i~;I"I'E~ER E;'¢:E;TEH i'"!Fl'.r' RE(;!UZRE E~:NLFIRGE;H!EI",Ff' .IF:' THE RE:E;3:E:,f~:NCE ;I:E; REHO[:'E:I.[d> 'T~~IEmRE 'THFfl'-~ 3 'i '.:;: '::; Fi:, E:'~" ~~%~..~.,~ ............................ DFYr'E ...................................................... ' WELL CONSTRUCTION LOG Drilling Co. erV 5 0 111na En -kr n&E, USGS Drillerlirro 1n L, NU/�-{%l'i�fl Type of rig Qid l� l Date well completed Well owner 'Alam t7. I�� .r5M Nearest community Well location: (address & `legal description) Location sketch or remarks ✓/,.YYI C Ytfa�( 11C `lA 1 L � Lrj�j��fe� Depth of well I-2) it. Casing: depth, ! L_ft. diam. —6--i fl. Static water levelft. (ailsee, below) land surface. Datea`14_757 Finish of well:en-end screen, perforated, open -hole, other) Describe Intervals and size: Well yield tested by (pumping, tLL,ng air) at gat/min. for ' hours with -')IS ft. of drawdown from static level. DRILLER'S MATERIAL LOG Depth below land surface in feet Give description of strata penetrated (size of material, color, hardness of drilling, and water content) to fCLU�I a ( I rz_ve f — ' � to LA S hana L4to 1 — lA V k i )4:14 wagjtc �Lb �o �L�. '�t e t o '1 a. .. r qel d to to to to to to to to to —to to —to— MUNICIPALITY OF HEALTH & t o ENVIRONMENTAL —to NAAY � 19 to v r- -to— I%G\. 6 9 w U. TA AFP 1.5 2015 vE $U • Municipality of Anommmuller On -Site Water and Wastewater Program (907)343-7904 Sa crx Parcel I.D. 018-271-36 Certificate of On -Site Systems Approval Expiration Date: i .;�' - a 1 1. GENERAL INFORMATION Complete legal description TimberlUX #2, Block I, Lot 6 Location (site address) 15201 Longbow Dr Current Property owner(s) Lowell Webb and Pamela Montgomery Day phone Mailing address 15201 Longbow Dr. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ I524a n Date of Payment `� L j&1j55- Receipt Number t� COSA# 05U51579 Waiver Fee $ Date of Payment Receipt Number ►firm;] 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 pn-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. 1 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE ✓IGSystem #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Date 05/08/2015 Conditional approval for bedrooms, with the following stipulations: QV.v i vugliia� vci uucc is atc: 1 6zh 1_S,a! The un' patty ofZcV rage 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheet<. ..� . If more than t septic systel ,is on the lot: COSA Checklist # + of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Timberluz #2, Block], Lpt 6 Parcel to: 018-271-36 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 4/19/1978 Sanitary seal (Y/N) Y. Wires properly protected (Y/N) Y Total depth 73 ft. Cased to 73 ft. Casing height (above ground) .18+ '-in. FROM WELL LOG Date of test 04/19/1978 Static water level 35 ft Well production 6*g.p.m. AS.INSP OCTION 05/05/15 31 1 ft. 3.4+ g.p.m. WATER SAMPLE RESULTS: Coliform �olonies/100 mL Nitrate %s + � mg/L Arsenic A)P ug/L Date of sample: olz/(16,01 S Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material S.T.E.P./Steel Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over ta((n1111k (Y/1N� )_ N (�J" Date of pumping Pumper Jv� \tC4 Date installed 08/1612002 Cleanouts (Y/N) Y alarm (YM) Y C. ABSORPTION FIELD DATA Date installed 09!1511986 Soil rating (g.p.d./itZ or ft2/bdrm)281, SVbr System type Deep Trench Length 49 ft: Width 2.5 ft. Gravel below pipe 9 ft.;, Total depth 13.3 ft. Eff: absorption area 882 ft? Monitoring tube Y Depressioh over field N Date -of adequacy test 05/05/2015. Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 95 in. Water added 461 gal. New depth 108 in. Elapsed Time: 230 min. Final fluid depth 95 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 08/16/2002 "Pump on" level at 41 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO Size in gallons 250 Manhole/Access (YIN) Y "Pump off" level at 41 in. High water alarm level at 45 in. - Cycles tested 3 Meets alarm & circuit requirements? Y Soptic Iank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+. Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots. used tem appears to G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Adunicipal records that -the. abovesystems are In conformance with MOA COSA guidefines in effect on this date. Engineer's Printed Name Stey6h k. Pannorle Date 05/08/2015 COSA canary sheet 2-6-15.doe 4 N O N ❑ c m Q N coa ?� m 12 o m Of p m0LU �o,za�o-o N Gm F m❑ _ ❑ F Y Y N FQ _ W �F gL ay alo NNo- J Nac. E'NX 'g,0 Y v N N VI 0 ? L N d 6 9 y. W 'C N m m O 241 W L p c ° 00'946 MuE0.90o0N O ` aO ¢ _ ° cc ` � � W N O Z ` y m Q C« o T W C J O ag oEo,�n mm LLW �U .dap �° msp p,ay c V �m a NZ L._Q oo C� O R O m C N «N Mm j L_COOo N oc 7nNix �N QLL RN WCN W m oK NE K Q a«_NN Q a "> N 8 c W O> c C C N d C m N , r �e�5�oa w >V rgQ 0 cQ'cmawvmS16m>L`m pm'5" rn a in co ° 3 00 Ce) 1 0 0 I n r U / z o� if /Li \ 3 n ; N / m 000. ow z C7� 00 \Z a ro 145, 0 t t z t i S •REG\5�` ❑ LwLim L O O 0 v>00 5 0 N � J i m a Hp Wco o t i I i M50 w Wx R; gad 0� _ONGgOW v LU Z 0 LL � oa CO 0 z Q �Wa U UJ CO cn aog UJ �O,OZ48 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. # (11 r� - Q-) ) - -2)(D 1. GENERAL INFORMATION HAA # la 1. q J -I (C1Kl.�� Complete legal description Lo -r b SLK T', T I M S E R L UX Ar� Location (site address or directions) 152 01 L O NGSO W ANCHOPAG E Property owner WALCACE d KRIST(N ENGLISH Dayphone "2-77-0'7gE t4 -52, Mailing address i52o( LoNGSow 4NCH AK 99,516 Lending agency __ __AIcu 6ccc Home Day phone 26-/ -3Y Oa Mailing address P.O. Rvx 1968.5-0-,A-nc� AL -C. 94.519 Agent SONWE MEHNER / -AcK WHITE Day phone-K3-S-Sr�n Address 3 2a f C" Sl-. An ch2rao 24 k 97 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 -1 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I f urther verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm FLAT70 P TECH S ✓C S. Phone 3 qS- 13SS Address 111530 ECHO 57 . At4cR. Ai� 99,5/6 Engineer's signature � �-� - Date Tun zi, /99'y 911Th 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. 72-0 5 (Bev.1/91) Back MOA #21 .......... fid._ p4r"' shygo C- G•'j � !11 ...............1..1 ff• .: °C.°. 3: .. . .. .. �.�•.....Q . 7HEODORE F. tA00RE ; X; °•. 4X; CE35£39 +' ('3'40 . 6. DHHS SIGNATURE Approved for ✓'' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By:. ��t _moi ' / t/� u� -Date 911Th 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. 72-0 5 (Bev.1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo-rELK I, 71MBERLUX Parcell.D. A. Well Data Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N. A. Oco/ /la0n � Date of sample: Log present (YIN) i // Date completed `f llq /78 Driller VERN'5 PRiLc WG Total depth 73 Cased to 73 Casing height 48 Sanitary seal (Y/N) Wires properly protected (Y/N) Y FROM WELL LOG ATIi INSPECTION t L4 119 179 1 14 /9 3 z Date of test 1 4o Static water level 35, 33 M > m z Well flow (o g.p.m. 3. 8 g.p.m. e"A N I C m o <> Pump levell > 53 � ti C SEPARATION DISTANCES FROM WELL TO: n 0 Septictholding tank on lot 1'05 ; On adjacent lots > / 00 z Absorption field on lot I D 3 ; On adjacent lots > 100 , Public sewer main % /9Dr Public sewer manhole/cleanout > /00' Sewer service line >/00, Petroleumtank uoNE oBseRvED WATER SAMPLE RESULTS: Coliform 67Cof /100 m-2 Nitrate O. 2 04 /-'e Otherbacteria Oco/ /la0n � Date of sample: 1 b l94 Collected by: FLA770P i EC q 5 VCS . B. SEPTIC/HOLDING/ TANK DATA Date installed 11A TA Tank size IC00 GAL Compartments Cleanouts (Y/N) — Y Foundation cleanout (Y/N) y Depression (Y/N) High water alarm (Y/N) N. A. Alarm tested(Y/N) N.A . Date of pumping (� 1 tt- 143 Pumper frt�3 F Sq gC S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: N Well(s) on lot I o5 On adjacent lots I oo Foundation 47 To property line 30 Absorption field 90' Water main/service line > 50' Surface water/drainage > 100' 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed 9 1(s %g 6 Manufacturer. o RE N cO I A NCHoRAGE -TANK Size in gallons Soo Manhole/Access (Y/N) Y Vent (Y/N) Y "Pump on" level at 't3 "Pump off" Level at 3(0 High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I o 5 On adjacent lots D. ABSORPTION FIELD DATA Cycles tested loo' Surface water /00 ear FJIBPJZM Date installed 41151$6 Soil rating (GPD/Ft2) 0.53 r.P�I/Fr System type TREfqcll Length q9' Width Gravel thickness Total depth t3, Total absorption area U2 FJ Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test a 1/14 )94 Results (pass/fail) f'Ass for 3 Water level in absorption field before test 54 After test rob Peroxide treatment (past 12 months) (Y/N) No rlE K N o wN If yes, give date N •A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 103 On adjacent lots > loo Property line lo' To building foundation 20 To existing or abandoned system on lot /00 On adjacent lots > 3o' Cutbank N . A • Water main/service line 7 z o Surface water > /00 ' Driveway, parking/vehicle storage area 30 Curtain drain NoNg 0 56R✓ED E. ENGINEER'S CERTIFICATION Bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the.dat&Qf4his inspection. a ` �.� w��- J _ s j Signature r, > a * • �^ �t Engineer's Name /h l-rocl� Date 'fan zt, /99 y HAA Fee $ 3Goc� Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number • • MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH id; ! - 1®cq CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date`7 / fl � 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) l e G calor !: j.,r et Location (address or directions) (b) Applicant Name &-ZaK? fr�_r+' D-ICAer Telephone: Home2d"F2'i"FZ? Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder u❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution -A 16,r i re, i—t,4 ALui! 9Q � Telephone a',�'" ��-�'°✓' Address t°3 -0C/ Lam• Ler,,rev Rv V (e) Real Estate Company and Agent Nt't - Fl +c I,-, - rcc.71 i r->, . If, I - k Address f> `93 pie' v Telephone — W 2 f &3 (f) Mail the HAA to the following address: (Mr'te4 f�eP 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well CR Community ❑ Public ❑ Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I9 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 (11184) • 0 5. 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 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 regulations in effect on the date of this inspection. Name ofFirm Ef!ef64114 cAMrece(' rvc_c Telephone 13.6'5 Address f It o != c A EL, e [ ` .- Date _: eo � f.;` r_cac-_—__ (/r 6. DHEP APPROVAL Approved for @ri 1 bedrooms by Approved `�) Disapprove Terms of Conditional Approval •_••_•••^•• nf!inor'sSeal . THEODORE F. MOORE , .. @j CE -3589 ki cid�t' > Z`_a Conditional - 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 72-025 )11/84) • • MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Gc i 6� E3 (Gc le r, Tmn b 0— lcc)c -S fp A. WELL DATA Well Classification Pr �Cf /-e If A, B, C, D.E.C. Approved (Y/N) NIA Well Log Present (Y/N) Y Date Completed "y/ 19/ 7b Yield en«rr« mrd Total Depth ? 9 ? ' Cased to > E ' Depth of Grouting /y IA. Static Water Level GG' Pump Set At 7 See' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ,Y8 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Joy, On Adjoining Lots To Nearest Edge of Absorption Field on Lot %09 ` ; On Adjoining Lots To Nearest Public Sewer Line NeA, To Nearest Public Sewer Cleanout/Manhole Alt A. To Nearest Sewer Service Line on Lot Water Sample Collected by f.1 ; Date Epi 45-/ &e-1- Water Sample Test Results «fT+ �c ry - ncc cr'/ Ae-m a r 0 AAe0- tier cf--" � Comments (. ea S7([' co-g act PZ 04 B. SEPTIC/HOLDING TANK DATA Date Installed P1917-7 Size CCE . No. of Compartments Standpipes (Y/N) ' Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) IJ Depression over Tank (Y/N) d Date Last Pumped I J3 / SSK Pumping/Maintenance Contract on File (Y/N) rY ({ ; for N, A Holding Tank High -Water Alarm (Y/N) Nr /}. Temporary Holding Tank Permit (Y/N) iVrA • _ Separation Distances from Septic/Holding Tank To Water -Supply Well io' To Building Foundation y .7 To Property Line 30,To Disposal Field i To Water Main/Service Line 14" • To Stream, Pond, Lake, or Major Drainage Course '7 EGO Comments Page 1 of 2 72-026(11/84) • C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '261 Ct1 l 'M Type of System Design 7-1-elpc6 Date Installed 9 Length of Field 7 Width of Field 2 5 r Depth of Field Gravel Bed Thickness 9,4 Square Feet of Absorption Area fib= Standpipes Present (Y/N) Y Depression over Field (Y/N) IW Date of Last Adequacy Test AIrA, ( 4 1"J c(-7 Results of Last Adequacy Test_LN Separation Distance from Absorption Field: To Water -Supply Well iv3 r To Property Line fv , To Building Foundation 2G To Existing or Abandoned System on Lot 1610, On Adjoining Lots 30 r To Water Main/Service Line P/rh To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course > c00 r To Driveway, Parking Area, or Vehicle Storage Area 3y Comments New ccbS'cyloo Ecom ,-ietci ',1sfrrllQc-e Jv r!Fe !ecce ung�rncrrble D. LIFT STATION Date Installed -- _ 9 <56` Dimensions fir'° �rcc h>i-� rr fin^ Size in Gallons Manhole/Access (Y/N) Y C r rise- "Pump On" Level at 34 ter, -23YaelI�' "Pump Off' Level at e%01 #_ +M+ r^rnrr High Water Alarm Level at 36 .r '• Z'2 uaf remcl,n.by Vent (Y/N) Y Tested for 4 /}. Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) iTi S fu f(roQ b r erne tiro k t G N G�EtA f -VC i Comments Do&sIye Oe'r cKcfr trtcr-+ecaot-ne :P, -nM 9,- C? v "' Check Permitted Bedroom Rating Against HAA Request " I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed `I �r %'l Date i!!!l&c Company F&'Ar 'rch S"f MOA No. -9e"- C"S P Receipt No. 00/_ 00 /v Date of Payment 9- 16 - Co % Amount: $ ov Page 2 of 2 72-026 (11,'84) -OF A4'�� �� • o eer's Seal vyoQ; .49TH* �............. ..... .d :............. •THEODORE F. MOORE; CE - 3569 ®i: Prolesssos�, ���` ' INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME NUMBER OF,BEDROOMS E:1 One ED Four ❑ Other DATE DATE ;�J' DATE INSPECTOR INSPECTOR ` - INSPECTOR X" INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled it l.0 MUNICIPALITY OF APP' U '1, '1C MUNICIPALITY OF ANCHORAGE DEPT. OF _A' - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTI QM NONMENT 825 L Street - Anchorage, Alaska 99501 IAf� 2�� ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 Y REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER qFS�L.A � LA rzso DJ PHONE s - l 6© CI MAILING e— A {�R V%\ A-14 -F {aNc-4-1 +V K /� PROPERTY RESIDENT (iff different from above) PHONE cZ-A 2. BUYER ��� �osc.J�eGL- PHONE Sys- 2t8Z MAILING ADDRESS��^ 3. LENDING INSTITUTION til n) S 9 �AAN MAILING ADDRESS s3 4. REALTOR/AGENT eim0-'i' -To (_A.1"b PHONE X 076 -.?74/- MAILING ADDRESS 2?v ZMc3�-- 5. LEGAL DESCRIPTION L0 - 3 k 1_ T vvt x STREET LOCATION G7L.'j 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS E:1 One ED Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY XThree ❑ Six 7. WATER SUPPLY X" INDIVIDUAL* * ATTACH WELL LOG. A well log is 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.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** '4 i YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-070 (Rev. 6/79) L� (� A_/1_/ "� THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank v Size: tri If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL n --•I _tom ��� 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E7 APPROVED FOR S BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE f` BY 72-010 (Rev. 6/79) '[ elephorie 284-4720 FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACiLITIEs SINGLE [ AMILY. ~ One [ ] ou~ F , Oth. J ~ . _: . _ . _ : _] ~ Two [.] Five I L, w~uLIh LE kAMIL~ ~ Ihree E~ ~ iNDI~..t ,-,L ' ~ .:G".ACH ~ EL,_ L.~G A wcm ,o~ L, re iLir~J fo, ad we[,_ JAiled ~ ' !_] COMMLiN!TY since Jun~ !975. Fo: v.,eils dri'.Jed prior to that (late, give well p [3 PU8i lC U] I1.i FY depth (al[ach ioO if [J PUBLIC UTI LITY by d~is Dq)artm6nL NOTd: THE INSPE¢IION FEE MUST ACCQ~ViPANY EACH REQUE2 r DEFORE F'ROCESf¢!NG CAN BE J! ] ills SIDF. F.OH OFFIGIAL II. ,:-,I I NSP f-C.'[ ION/xPPOI N'l L1171'FFS DIREC'rlONS: ~. 'rvprs o~: RL~SIDENCE F --- Nt;F/,,[1t:l'l OF BEDrlOOM$ I {.~j ONE [~1 'l'H R F.E [~.] FIVE E.-_] OTHER SINGI..E FAMII.¥ 2. WATriR SUPPLY ~_1 INDIVIDUAl.. ['_-] COMMLJNITY F_q PU[~ LIC UTILITY Col/I)oction Volified 3, SEWAGE DISPOSAL SYS'FEM EZ] INDIVIDUAL/ON -SITE E'3 PLJB LIC uTI I..FI-Y DEPTII OF WELL DA] E [3RILLED I r)G HECEIVED Pf:R MIT N Ufvll3 F: R DATE INSTALLED Ccmneetlort Vm ified .................. T~STA L L[~- ................................... L~Septic Tank ol[:} Holding Tank Size: ...... If Tank is homemade SOILS RATING MANUEACTURER MATERIAL TOTAL ABSORPTION AREA 5. C()MMENT8 [~"' APPROVED FOR .... __~__.__ BEDROOMS [~.3 CON.DI I'[ONAL APPliOV/\L (letlel must accompany certificate) , [~J F)iSAPP[:IOVED ~ ........................ "- ..........................................................
