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HomeMy WebLinkAboutTIMBERLUX #3 BLK F LT 18Timberlux #3 Block F Lot 18 #018-271-84 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name,*-- DISTANCES ~/~ ~ ~ ~ 0 5Y4~' driveway, water bodies, etc.) TANKS . ~ SEPTIC Mandfa~urer ~dy in gmlons TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~OTHER ~}~.~ / ~ ~ Fil} added above original grade Gravel dep~ ~neath pipe Gravel Total a~orption are~ Dis~nce .twin lines ~ PRIVATE ' ~ ~ Inspections Veaormed by: ' 72-013 (3/85) M U N I C I P A L I T Y 0 F A N C H 0 R A G E Department. of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 ON-SITE SEWER PERMIT Permi'L Number-: 880098 Date Issued: 06/27/88 Upgrade Engineer Designed Owner Address: ROBERT J. & SUZANNE CRONIN 2158 ENCIN8 LOOP SAN ANTONIO, TX 78259-1901 Day Phone: 561-5040 Parcel Id: Lot Legal: Lot Size Max Bedrooms: 018-271-84 Subdivision: ~MB~8~U~ii~i E~:~18 ~!o~k~ F Section: 34 Township: 12N Range: 3W 46174. (sq.{t. or acresi This Permit: 4 Total Capacity: 4 SEPTIC TANK: Minimum total septic tank capacity: 1,250 gallons. Each septic tank must have at least D compartments. Depth to top o£ septic: tank(s) < 4.0 ~eet requires insulation over tank(e). INFORM D.H.H.S. PRIOR TO iST & 2ND INSPECTIONS BY ENGINEER, AFTER OFFICE HOURS~ CALL 545-4681 AND LEAVE A MESSAGE CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN THIS PERMIT EXPIRES 1~/51/88 THIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY IF CERTIFY THAT: 1. I am ~amiliar with the requirements ~o~ on-site sewers and wells as set forth by the Municipality o~ Anchorage (MOA) and the State o~ Alaska. 2. 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 .reguirements ~'or the Set back distances ~pom any existing well, wastewater disposal system or public sewerage system on this o~ any adjacent or nearby lot. 4. I understand that this permit is valid ~or a maximum of~ 4 bedrooms. I also understand that the capacity o~' the total system is 4 bedrooms and any enlargement wiI1 req~e~q additional permit~. ] .............. DA[E: ~n~in¢~m~ 8 I~nui~'onmentol $luclies MUNI SPECIFICATIONS FOR A FIVE-WIDE WASTEWATER TREATMENT SYSTEM JUN 2~ 1988 LOT 18, BLOCK F, TIMBERLUX SUBDIVISION R[CEIVED 1.1 The drawings, sheets 1 through 4, shall be a part of this specification. 1.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department of Health & Human Services, (DHHS), the conditions of the permit, and all applicable rules and regulations currently in effect. 1.3 Ali elevations and depths are advisory and are to be verified or modified in the field by a DHHS approved inspector. It is the responsibility of the installer to adhere to approved designs for installation, maintain the specified separation distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An engineer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC SYSTEM 2.1 The existing septic tank may be used, if it meets the capacity requirements for the residence and the approval of DHHS. Older systems may need tank integrity verified. If not, then specifications 2.2 through 2.6 apply. 2.2 The septic tank shall be a UPC approved two-compartment tank, constructed of 12 gauge steel with bitumastic coating, set level on undisturbed soil and insulated with overlying layer of 2 inch burial type polystyrene. 2.3 The septic tank shall be a minimum of 5 feet from the house foundation, and a minimum of 5 feet from the absorption area. 2.4 The septic tank and drainfieid shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet from Class A or B wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by Alaska Department of Environmental Conservation (ADEC). 2.5 Piping shall be fitted with a mechanical watertight calder coupling of the inlet and outlet of the septic tank. Piping shall be 4-inch AST~ D3034 or cast iron, sloped a minimum of 1/4 inch per foot. 1200 UJcs! 33rd ~u~nue. Suite B e~nchorrJq¢. ~Llesb] 99503,(907) 561-5040 2.6 Cleanouts sha]l be installed as designated, capped with air tight rain caps (Jim caps or equivalent), and extend a minimum of 2 feet above ground level. 2.7 If a lift station is shown on the drawings it shall be Anchorage Tank or MOA approved equal. (See attached specification.) 3.0 DRAINFIEI,D SYSTEM 3.1 The gravel for the drainfield shall be 0.5 to 2.5 inch, screened rock with less than 3% passing the #200 sieve. All substitutes must have prior DHHS approval. 3.2 The bottom and s~de of the excavation shall be raked with the backhoe blade to ensure that it has not been compacted during excavation. The bottom elevation shall be level, 3.3 Monitor standpipe(s) shall be placed as shown in the drawings, and shall be rigid PVC ASTM D3034, or 4-inch cast iron. The section shown with holes may be drilled 0.5 inch holes on the 6-inch centers on opposite sides of the pipe, or a regular section of perforated sewer pipe, clamped to a solid section, with either a no hub coupling or a solvent joint. A rubber rain cap (Jim cap or equivalent) shall be placed over the top of the pipe. 3.4 The distribution pipe shall be 4-inch rigid PVC with a minimum crush strength of 1500 lbs or equal. All distribution pipes shall be laid level. 3.5 If the final grade of tile drainfield is less than 4 feet above the gravel, insulation is required using Bow extruded blue styrofoam board or equal. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least 18 inches of soil cover even though insulation is used. The solid pipe extending from the septic tank or lift station to the drainfield shall also have 4 feet of cover or art equivalent layer of insulation to prevent freezing of the line. 3.6 If insulation is not necessary, the gravel shall be covered with a layer of nonwoven engineering fabric. 3.7 it is recommended that the area excavated in the vicinity of the drainfield shall be planted with a white clover, red rescue mix and Kentucky blue grass. 4.0 INSPECTIONS 4.1 A minimum of three inspections are required for installation of the trench. The first iuspection will be of the excavation to verify 4,2 that the installation will be in the proper soil. The second inspection will be after placement of the gravel, monitor standpipe(s) and distribution pipe to verify proper installation before backfill, The third inspection shall be after the drainfield is backfilled and the ground graded, ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. ! 200 West 33rd Avenue. Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SCALE ' ' ' ¢ "'~.-~: /~v~, , - .... ~..~ ! ~ !.~'-,/¢.,r .... :. : ..... ...~ ....: .... ~ .~ ~..~.._, ~ _ ~:,~..~.~/~/~...~......~...~....~.....':....~...~. ............ ~ .... :. ~ ..... ~.~,~ ..;~.~..:_~ZL.~_~ ;... _._: ~ :--"~" "-~"-'"'-~"-'"; .......... ~ ..........~c";' 'T"-':' 'v - - , . ~: ~ U"'"~""~ ~ ~ ~ : : ....... ~.._ .:........:../~ ~Y_~. ~;~ ~ ..~,., .~ ................ :~ .... L ._.[ ._..._i ..., .~ _. ~ ._. _.~_....._~..~ 2~.~ ,~Z. j~ ~ '._~ ~J.~.~A~/.~w :~. ~,~. ~ .......~. _...~..........~..,._~....,_~. _....~ ........... _ ~ L 1~,[:~; ~ L~:.~ ~ -:~ ~" ~ ......... .............. ~ ,~..J,,-..,i .................... L,..~ ...... :~ ' :" 'T': ~ ]~ ""'/'"'"]'"'-'"~-,~ [' ~ .~ ~ ~ ~ ~ ~//~ ~: ~ .~~ ~ ~F~~~ ~ "~ ...... ~ ........... ~ ~[ .... ~'"'~ T""~" '~ ~ : - ' : · ~,,,,:,. ,,~,,,-~ ,~,,.,:.,,,,, ~ . : : ,, ,, ~ ~ ~ ; ~ : PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS ELOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh te Water Alter / . .. /_ / Mogitoriag~,~ ~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /~" (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN.~ FT AND ~FT . ,, . PERFORMED BY: ~. ~O, .., ~,,~....~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCO"DANCE WITH ALL STATE--AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ I1,l ~¢¢¢ ¢4 TANK FOR  Anchorag~ Tank & Welding, Inc. Anchorage, Alaska 99501 {9O7) 272-3543 ~FT SYSTEMS SEPTIC TANK SHAL, L BE A MOBIFIED ANCHORAGE TA~K STEEL TANK.· THE DESIGN OR ANALYSIS SHALL BE IN ACCORBANCE WITH ACCEPIEJ[ ENGINEERING PRACTICE AND LOCAL R;~]SUCATORY AGENCIES, THE TANKS SHALL BE I)ESISNED FOR LOADING CONDITIONS AS REQUIRED BY MUNICIBAL ANB STATE REGULATIONS. Al,t, WEL~ING SHALL BE IN ACCORDANCE WITH APPLICABLE LOBES AND STANDARDS, COA~'tNG SHALL BE TNEMEC'b6-b65 HI-BUILD TANK ~OATING AND APPLIED AS FOLLOWS: SURFACE PREPARATION ALL SURFACES MUST BE BRY~ C~EAN~ AN[~ REASONABLY FREE OF RUST AND MILL SCAL, E EXCESS RUST, MILL SCALE AND WELDING SLAG SHAL~ BE REMOVEB BY WIRE BRUSH OR OTHER MEANS AS NECESSARY. APPLICATION SHA~L BE AIRLESS SPRAY TOUCH UP WITH BRUSH OR ROLLER, TH:INNING SHALL BE ACCOMPLISHED WITH APPROVED MATERIAL AND WILL NOT EXCEED SURFACE TEMPERATURE SHALL NOT BE BELOW ~OF OR 5 BELOW DEW POINT WHICH EVER IS LOWER. IN'IERIOR SHALL BE COATED TWO TIMES AND SHALL BE A MINIMUM OF 20 DRY MILLS EXTERIOR SHALL BE COATEB ONE TIME AND SHALL BE A MINIMUM OF 10 DRY MILLS. RISER Anchorage Tank & Welding, Inc. 2700 Porcupine Dr. OUTLET RISERS SHALL BE GALVANIZED STEEL CULVERT. AND SHALL BE 5~ INCHES (MINIMUM>, HIGH, SHALL HAVE A MINIMUM NOMIMAL DIAMETER OF 2~ INCHES, AND SHALL BE CAPABLE OF BEING EQUIPPED WITH ]'HE A. A JUNCTION (NEMA ~X) BOX OR EQUAL, BONDED OR ATTACHED TO THE RISER. B. UL LISTED ELECTRICAL, CORD GRIPS, INSTALLED IN THE J-BOX. B. A i..ID - SHALL BE FURNISHED WITH THE RISER. IT -SHAi~L BE CONSTRUCTED OF FIBERGLASS OR EQUIVAI~ENI': AGGREGATE FINISH, RISER INSTALLATION EACH RISER SHALL BE SEALED OR WELDED TO THE TOP OF THEi TANK IN SUCH-A MANNER AS TO PREVENT INFILTRATION OF GROUNB WATER WHERE PRESENT. INSULATION -' 2'~ SHALL BE PLACED LID. RIGID EXTRUBED.POLYSTYRENE~ IN THE RISER ItRECTLY BELOW THE E INSULATION - 2" SPRAYED URETHANE ON CIRCUMFERENCE OF RISER. Anchorage Tank & Welding, Inc. 2700 Porcu lne Dr. 'EFFLUENT PU~ ,"ZNG ASSEMDLY EFFLUENT PUMPING'ASSEMBLY SHALL BE ORENCO" ' SYSTEMS (TM) MODEL OBI WE 1000 SERIES CONSISTING OF FOLLOWING: 1. ~I/S H.P, MYERS SSM25 115 VOLT OR EQUAL, SCREENED PUMP VAOLT (U.S, PATENT #q.;~3932~) 59" lhEEP, 3/16", THICK HIGH-DENSITY PVC CYCI~INDER HOUSES THE PUMP, GEVEL CONTRObS AND SCREEN AND SERVES AS A BAFFGE TO PREVENT THE SCREEN F'ROM CLOGGING, THE VAULT AT A LEVEE THA3 PLACES THEM AT ABOUT ~HE MIDWAY POINT IN THE DEPTH OF THE sEPTIC. ~' '~ F~AP CHECK: AL.t. OWS ~THE VAULT TO DRAIN WHEN REMOVING .FROM I'ANK, ~ :" .' R OF HIGH-DENSITY SCREEN, 1~ DIA, CYLINDE POLYETHYLENE 1/8" MESH CAST-INTO FIBERGLASS ~OTTOM, ' 3. AL, L. PLUMBING SHALL BE PVC OR OTIIER NON- CORRODING MAYERIAL, ~- PUMP CONTROLS AND ALARH SYSTEM ~ONTROL. ~HALL, BE ORENCO SYSTEMS (TM) ML,-3F CONSISTING OF: ' AUDIBLE ALARM PANEL MOUNT WiTH A MINIMUM OF 80 DB SOUND PRESSURE AT 2~-INCHES~ OPERATING TEMPERATURE -3~AO TO 65AC, CONTINOUS SOUND. L~r ~rAT'J~ ~)ATA & G~/Lons per ~ TYP'~AL. PtJ~ PCRFDRKAh'~ CUR~ S'ZZE: SHELL & B C ~5oo i~ 1145 ~ 97" 49' ~ (:4 ~000 . i~ GAUG~ 194~ 1~..9 3/8' 64 5/~' (5 & 6 SIZE CHART - LZF'T ~I'ATZON TANKS ~ nE; ~ C~LI.D~ LARGER :~TAN~AR.]) Ta)~4'~:S FOR ~ ~c)PLZCATL~N PVC bGlt vGtve 24' X~) x 4' 6°r.~tver~ MoJ~hole fl. ex~oLe hose 1/4.' PVC p~e Typ 2 I./4' PVC che:k vGtve SeGt M~h RAH-NEK or £ClUGt steel I 1/4' p;e 2/4' dig dr'Gin i0o. ck hoZ. e I 3/8' hol, es 1/8' Flesh potye'thytene sc::~'een 1,5' dig x 39' hlgh 1/3 hp eFFLuenCe pu~p, various nGnuFac~cures oGREJ JJI R ANCHORAGE AREA B01 JGH D ep ar t me nt ;~3Eon;ir;~r~n,a, Duality Anchorsge, Alaska ggS03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME~;~-~-/~ ~b~Cf' MAILtNGADDRESS ~?-~ 4"/~:)~z~ ~/ PHONE~-~r~--~ LOCATION'8~I~ e~' ~'~"(~J~'LEGALDESCRIPTION ~F'lg ~(..FY- ~ ~-/m~'[~-~ ~J~. ! SEPTIC TANK: DISTANCE FROM WE Lk~/~::~ INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY/-~ GALLONS. TILE DRAIN FIELD: /~-~;/OP_f& DISTANCE FROM WEL -~ FOUNDATION NEAREST LOT LINE TOTAL LENGTH OF LINES NUMBER OF LINES ~:~ DIST~ANCE BETWEEN LINES ~ TRENCH WIDT~ ~-' IN. TOTAL EFFECTIVE ABSORPTION AREA ~'~ SQ. FT. LENGTH OF EACH LINE ~'~( DEPTH OF FILTER ~ ' ~ DEPTH: TOP OF TILE TO FINISH GRADE ' ~ · MATERIAL BENEATH TILE ~q. ABOVE TILE IN, WELL: TYPE _ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE · LOT LINE__ SEWER LINE __ TANK SYSTEM. OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMA RKS:-*~.~ ~ Form EQ-032 DIAGRAM OF SYSTEM DATE '7/~//''']'~' APPROVED. ~ W~g~-~It'~w G.A.A.B. PERMIT NO. DEP~RTMENT~iOF HERLTH RND ENVIRONMENTAL FROTECTION ~,5~-0 Ei TUDOR RD. ~LL ( 76~70 FIN[:-. EIN--S I TE SEL,~IER PERI"1 I FIF'PL I CFtN I LOCHT I ON LELit~L BERNARD TRNDECKI o~'F RABBIT CRK I~D L18 BF -['IMBERLLI;'~ SUB[) #3 LOT SIZE 3:44-3634 44000 SQURRE FEE'[ 'IYPE 0F _~LIL ABSuRBTIEN SYSTEM IS: TRENCH MPIXIHLIM NUMBER 0F BE[.,',ROOMS = 4- SOIL RRTING ,.SI FT,/BR}= tz5 THE LENGTH DIMENSION IS THE LENGTH (IN FEE?') OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND 8ND THE BOTTOM OF THE EXCRVATION (IN FEET). ]'HERE IS NO SET WIDTH FOR TRENCHES· THE ~RAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND ]'HE BOTTOM OF THE EXCAVATION (IN FEE?'). RE QIJIRE[:' SEPTIC TRNK SIZE= 1258 GRLLOr~S BHCKFILLINO OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPAR'¥MEN'I WILL BE SUBJECT TO PROSECUTION. MINIMUM DiSTHNCE BETWEEN 8 WELL 8ND ANY ON-SITE SEWBGE DISPOSAL SYSTEM IS '100 PEET POP 8 PRIVATE WELL OR ~00 FEET FOR A PUBLIC WELL, WEL~LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF '~HE WELL COMPLETION. SPECI~'ICATIONS AND CONSTRUCTION DIRGRAMS PRE 8VBILRBLE TO INSURE PROPER INS]A~LA'1'iON. PEI-~'t'I I'l" ~"I----ILID F'OR CINE ~r'EBR FRO£4 I SSLIE I uER'IIF¥ THRT 1: I AM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORRGE. 2: t WILL INSTALL THE SSSTEM IN ACCORDANCE WITH THE CODES. 3:: ~ UNDERSTAND THAT ]'HE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS, ., . ' 15'-,UED B~~ ........ .'_~_~ D~TE .............. ~/ ~GREATER ANCtlORAGE AREA BOROUGt] ~/ .~partment of Environmental Quality ~'.~ ~'~,- ' 3330 "C" Street ~:i//' Anchorage, Alaska 99503 ~/. , . ~SOILS LOG- PEROLATIONTEST ~erfo~d for~ Legal Description: This form reports:' Soils log~- ' ~ ~ percblation test Depth Feet 5 ;- '/6 7- · 8 - 9- lO- ll - q 2 - 13- 147 /Was ground water encountered? -., /~(? ___ '/ If yes, at what depth? Reading Date Gross Time Depth to Water Net Time Net Drop Percolation rate minute. -Proposed installatlo--~--n¥--S%~a--ge Pit Drain Field · Depth of Inlet ............. . Depth to bottom of pit or trench COI.IHEI.~TS: ' / ........ Pe~-formed By --- ~T~'~-])--~ ]~.T F~7-[-- -- -CYr~Tfl-e~-%-y-( ............................ b-a-{-~-i .... :EQ-040 (6/74) .// · ' :,~//~t .~ ANCI~!AGE, ALASKA 99509_ ~.~ 17 ~ ~-~ ~d . ~ I1~ MUNICIPALITY OF ANCHORAGE Development Services Department `� j' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-271-84 1. GENERAL INFORMATION Expiration Date: [© 1 — Z©zZ Complete legal description TIMBERLUX #3 BLK F LT 18 Location (site address) 4521 TIMBERLUX CIR, ANCH AK Current property owner(s) Mailing address Real estate agent SHOOP SAME 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well [] Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ no (FUS1H Waiver Fee $ Date of Payment 6 1 L'9 9 ao2.2 Date of Payment Receipt Number NWE q Receipt Number COSA # OS (-9-2A 3 D 'I Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 6-27-22 OF is 49TH 6. DSD SIGNATURE °t1il System#1 Approved for 4 bedrooms �•=;••• .............� 1 A, MICHAEL N.:.NDERSCN System #2 Approved for bedrooms CE 9469 Disapproved t�t��•7T��,�;��` Conditional approval for bedrooms, with the following stipulatt 1����� �ttttttcrrrrr ON-SITE 0 A7- `► Q r Wq �_ R ANQ rn �o ROOAAA o O'"a t e: 2 -, 7 011 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: TIMBERLUX #3 BLK F LT 18 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 7111176 Total depth 128 ft Cased to 128 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 6115/22 Static water level at beginning of test 25 ft. Comments B. TANK DATA Age of tank(s) t0""s years Tank type/material SEPTM/STEE Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 10/1312-1 D. ABSORPTION FIELD DATA TESTED WEST TRENCH ONLY Parcel ID: .018-271-84 Structure served by this system Well production at time of test 1.4 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.25 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 6115/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 1012116 Adequacy test date 6115122 ❑ ALL standpipes present per record drawing Results 0Pass For 4 bedrooms Total measured depth from grade 10 ft (max) Fluid depth prior to test 24 , in Measured depth to pipe invert from grade 6.0 ft (min) Water added 600+ gal ❑ N/A — pressurized field New depth 25 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective FBICode-requiredsoil cover over field Final fluid depth 24 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) UK date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓1 Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' M Yes if No It Private Sewer/Septic Line > 25' [✓ Yes if No ft Absorption Field on Lot > 100' ✓M Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' R1 Yes if No ft Q Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Z Yes if No ft E] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [D Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' E] Yes if No ft Water Service Line > 10' [✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' M Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION t 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. COSA Checklist yellow sheet 49TH*•:z;��/y MIC "'E l'N .-NDERSON rad �� •• CE 946 2 4'`•tii JJ.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# L~t¢,-~--)\ _¢~4.\ HAA# GENERAL INFORMATION Complete legal description Location (site address or directions Property owner ~orS~"r~- -J'-'~' A-~i~ _('d~-4¢,~,.4¢ ~'"JDay phone Mailing address Lending agency Mailing address Agent Address Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 further verify that based on the information obtained from the Municipality of Anchorage flies 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 ,zCr-~ ~ ~ ~O,,J -~'-,d ~; ~ ~ c.-~.'-7~,~ ~- Phone Address ~_¢') ~0~- Zc/~O 7'7~' ~ ~0~ 6~ ~ Engineer's signature '~~ ~ ~ ~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage Department of. Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/~ .~oC~ /~I~E;;T4/_U~/Jo.,,~OarceI I.D. A. WELL DATA Well type ~AId~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 7~t/7~ Driller ~-~ Sanitary seal (Y/N) ~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Static water level ~Z' ~ -- ~7' ~ ~ We fow U~o~ g.p.m. ~ / g.p.m. Pump level //~' ~S~ / /j~ ~ / SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /0 Absorption field on lot Public sewer main Sewer service line 1~'~' ; On adjacent lots ; On adjacent 10ts Public sewer menhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ,Z~ C4.,~--~A~'c~E Nitrate Date of sample: C]/IT/~JL ~.. /vi&,//_ Other bacteria 0 Collected by: //~ ~-'~4 B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping .. '.~..~"~ .: ~ . ~_._~,.-~ ~-~-~ , SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 'Tank size /~-'S'"D ~------~A L.. Compartments ~-- Foundation cleanout (Y/N) Y' Depression (Y/l? '~ Alarm teSted (Y/N) ' /~J/A ~/ZJ/4~- Pumper ~ ~J C,~0/'/.,4 G~- Foundation '7 / Water main/service line ~.~1 Well(s) on lot /~) ~, I On adjacent lots To property line ~' ~} Absorption field Surface water/drainage /~Jo M' ~ 72-026 (Rev. 7/x:J1} Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~7~ i Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) t=: Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for ,J~ OtZ. System type ~bi'b Ll. O uO "'~-~JC_4./ Total depth t"/~Z t/~'! If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /10~ ~' Property line To existing or abandoned system on lot Cutbank /~0 ,',d ~' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date M~chael E. Anderson 408 !. E HAAFee$ /7D '~0 Date of Payment Receipt Number '~, ~'/-,]- C/-~/~-~' 72-026 (Rev. 3/91 ) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 17.~~ Box 4-1224 ~E:. AI.~SK~ ggsog Phone 274-4611 ,..,,! c,Ty / 8'// JOI LOCA?*ON COMPLITi WE~LLOO OlffTH WIL& MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~ '~- Applicant Address ~-~- / (c) Applicant is (check one): Lending Institution []; Owner/builder,,~ Buyer []; Other [] (explain); (d) Lending Institution ____ Telephone Address (e) Real Estate Company and Agen~ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~' Multi-Family 1-1 Number of Bedrooms Other WATER SUPPLY Individual Well [~ Community[] Public ~, Note: If corn munity well system, must have ~,'~¢itter~ confirmatio~ fr~om the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] iil;,,i;t Holding Tank Note: If community well system, mus~ have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 [~1 84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my sea] affixed hereto and as of the validation date sh own below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply a nd/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 inspec~tion. Name of Firm- / o ,'/-'~_-~.% ~:~ ~_ ./.~./~;.,~ ~ --Telephone ~ -Z?)~ Address ~e~ ~ )~ ~ ~.~ Engineer's Seal Approved for-~.t~, bedro Approved ~ Disa PP r°ve~---~cOnditiOnal Date Terms of Conditional Approval I~:AbTtONi, The Muncipality of Anchorage Department of Health a~d" . ~:nvironmental 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. ~oe 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~-,,~-/~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth / ~ ~' Static Water Level Casing Height Above Ground '~ '"' Elecirical Wiring in Conduit (Y/N) /t/ Separation Dis{ances from Well: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION, APR 1 2 1985' I~A, B, C, D.E.C. Approved (Y/N) Date Completed 7//////~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N).~_.,M~' Depression Around Wellhead (Y/N) /~'z~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~'~' '" ; On Adjoining Lots To Nearest Public Sewer Line .4/..~ To Nearest Public Sewer Cleanout/Manhole .,4/,,,~_.~ To Nearest Sewer Service Line on Water Sample Collected by Z:~,~r,.-,.c~-q ; Date Water Sample Test Results ..~,~/-'/~' ~.,~_.~. ~ ~ Comments ,.7¢' /;:;/.~... 'f¢:$~'-' Z~ .~-_.?F..;,~.¢~. ¢.//~,../~=...-/ SEP'TIC/HO~DING TANK DATA Date Installed /~ ,~' Standpipes (Y/N) ~ Depression over Tank (Y/N) Size /,~. Air-tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm {Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~'~ ~' To Property Line /~ To Water Main/Service Line '3~ · " Course /~/'~"~ No. of Compartments · Y Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) 'Fo Building Foundation /'~' To Disposal Field / To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026{11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,/~2. ~'- ¢ Type of System Design Date Installed ,/~' ? ~' Length of Field ,¢2'~ ,' Width of Field ~' ~' Depth of Field / Gravel Bed Thickness ~ / Square Feet of Absorption Area '~--/~ ~:~ Standpipes Present (Y/N) Depression over Field (Y/N) /'~ Date of Last Adequacy Test Results of Last Adequacy Test .~-~;~'~:.r/-'~,,-.¢~',-~ (/~ ¢%,j.~,~,-.,. Separation Distance from Absorption Field: To Water-Supply Well ,/~'~'¢ To Building Foundation --~ 5'- ¢' Lot ' ,4../~ ; On Adjoining Lots ~'~ ~'- To Water Main/Service Line //~ ¢- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area /~ ~ To Property Line / ~r C- To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments Page 2 of 2 72-026 (11/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, ve_dfied,~oonformed to a.~I,M~OA a, nd HAA guidelines in effect on the date of this inspection. Signed Date Company ~ MOA No, ~ ~ ~--O~ ! Receipt No. '~(,,~ O.~ ~ oF Date of Payment ~- / ~-~ ~ -- . ., Amount:$ ~5-~ ~*:4~'%~ ~*'~ .~ Engineer's Seal 5"~: ~. 2225-E ~'¢~'. JUNE 25, CONSULTING ENGINEER TELEPHONE: (907) 279-3916 Violet Hulge Commonwealth Totem Realty Anchorage, Alaska April 9, 1985 WELL AND SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 18, Blk F, Timberlux Subdivision #3 LOCATION: Ah~l~ra~Alaska RESIDENCE: Single Family, Four Bedrooms WATER SYSTEM: On site well tested at 1.3 GPM for 4 hours Static water level recovery to 32' SEPTIC SYSTEM: From Municipal Records: Tank: 1250 gallons Absorption System: Trench, 42 feet deep, 6 feet of rock Absorption Area: 504 square feet Soil Rating: 125 Installation Date: 1976 long, 12 feet DATE OF TEST: 4/9/85 TEST PROCEDURE: Drainfield was charged with water at a steady flow of 5 GPM. A total of 240 gallons of water was added directly to the leach field with a rise in the sump water level of 30 inches. Both the septic tank and leach field sumps were monitored during the test. The water level in the tank did not change. Water level in the sump was monitored and recorded during the absorption phase. Absorption rate during the test period indicates this system is capable of accepting 600 gallons of water per day. Due to the age of the system the surge absorption rate is greatly reduced with the surge load being contained in the leach field pipe system.* The well was tested at a recovery rate of 1.32 GPM after total drawdown of the well. TEST RESULT: Both well and septic system meets the requirements of the Municipality of Anchorage for residential use as of the day the system was tested. There is no guarantee that the system will continue to meet these requirements. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. Tobben Spurkland P.E. Violet Hulge Commonwealth Totem Realty Lot 18, Blk F, Timberlux Subdivision #3 Page 2 Note: * The reduced surge load capacity of the leach field indicates impending system failure due to natural septic effluent clogging of the leach field. It is difficult to predict a life span for the leach area, but replacement of the leach area is to be expected in the near future. Chemical rejuvenation of a leach field has only limited sucess. Buyer should be made aware of this condition. 'CF ; g.~.'3 ...... ~"~" ~ 2 '~ ' ' DA~E RECEIVED L' INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTO& m~m~ALf~ OF ANCHORAGE MUNICIPALITY OF ANCHORAGE~., ,.DE¢f' O¢ H~ALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL 82~ L Street - Anchorage, Alaska 99501 MAY O ENVIROnmEnTAL SA~ITATIO~ DIVlSIO~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~ FAclLi~ DIRECTIONS~ Complete all pa~s Oll page 1, Incomplete requ~ will not be proceed, Please allow ten {i0) davs for processing, MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS PHONE LENDING INSTITUTION MAILING ADDRESS 4, REALTOR/AGENT I PHONE MAI LING AD DR ESS 5. LEGAL DESCRIPTION STREET LOCATION Zr 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four /[2~ [] Two [] Five SINGLE FAMILY [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY  iNDIVIDUAL* * ATTACH WELL LOG. A well I0§ 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 13vailable.} 8. SEWAGE DISPOSAL SYSTEM ,~ INDIVIDUAL/ON-SITE** J~/~:)--¢ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-1310 (Rev. 6/79) ~ THIS SIDE FOR OFFICIAL USE ONLY · ~ ,~, 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~""~'SI NG L E FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO ~ FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER ~'~" INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY /~ ~-~ Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ! ~z~rlNDIVI DUAL/ON -SITE DATE INSTALLED [~] PUB LIC UTILITY /? Connection Verified INSTALLER I~;~"~ee[~tic Tan~,o~r []Holding Tank Size: ? ~- ~ IfTankishomemade SOiLS RATiNG give dimensions: TYPE OF TAN~ , MANUFACTURER TOTAL ABSOI~PTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS APPROVEDFOR 5 EDROOMS [] CONDITIONAL APPROVAL {letter must accompany oertificate) [] DISAPPROVED DATE 72-010 (Rev, 6/79) ALASKA eFIUIROIqmE IqTAL CODTROL ~n~i~¢rin§ E- ~nuironm~ntal Studies S~[RUIC~[S~TL~.~LiTY oF ANCHO~AG~ RECEIVED MAY 5 1981 RAINIER MORTGAGE/JENSEN BOX 1200 ANCHORAGE AK 99510 SELLER - VARD JENSEN SUBDIVISION-TIMBERLOX 3 BLOCK-F LOT-18 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 514 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SOILS RATING OF THE SYSTEM AT CONSTRUCTION WAS 125 AND NOW IS 129 SQFT/ BEDROOM. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON NOVEMBER 3 1980 1220 LUest 251h ~uenue · ~nchora~¢, Aloska 99503 · (907) 276-1361 "-0''' ' MUNICIPALITY OF ANCHORAGE. ~ ~e"~.~'i,, DEPARTMI~ OF HEALTH AND ENVIRONMEI~L PROTECTION ,~qu ~,,I;I. - 82~L Street, Anchorage, Alas~a 99501 ~Ac~%%%,~¢~. ~/ ~ 279-2511, ext. 224 or 225 ~ ~ ~'- /~'~D~~ Date Received: June 17, 1977 ~1: Time .~?~ ~2: Time ~3: Time Date . A-~-77 ~ Date Date Insp ~ Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Pacific Bank % Sue Benson Mailing Address: Post Office Box 420 99510 Phone: 276-3110 2. Property Owner: Bernard Tandecki Phone: Mailing Address: % Dynamic Realty, Ken Calhoun 279-7611 3. Legal Description: Lot 18 Block F Timberlux Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Permit # Construction Individual Well (x) Conm~unity/Public System ( ) Depth of Well Well Log on File Bacterial Analysis ( ) Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-s~te System (x) Public Utility Installed ~/~/~_ Installer ~c~ Manufacturer ~ Soils Rate _L~- Material Distances: Well to Septic Tank ~O~ to Sewer Line Nearest Lot line ( ) to Absorption Area~F(l~3 Absorption Area to Nearest Lot Line Pag~ Two, ' ,- Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 18 Block F Timberlux Subdivision Comments: Affadavit Attached: Approved: Disapproved: Letter Attached: ( Date: Date: Department Worksheet: ~NICtPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: VA FHA_.. CONY,.×× Property Owner: Bernard Tandecki Mailing Address: 3. Name of Buyer: Yard D. Jensen Day Phone: realtor 279 7611 Mailing Address: Inlet Towers #803 Name of Lending Institution: Alaska Pacific BAnk Mailing Address: P. O, Box 420 Phone: Name of Realtor or Agent:., Dynamic Realty--Ken Calhoun Mailing Address: 501 W. No, Lights Blvd. Phone: Legal Description: L18 BF Timberlux Subdivision ~3 Location: Timberlux Circle off Rabbit Creek Road 276 3110 279 7611 Day Phone: 7. Type of Facility to be Inspected: SF 8. Water Supply Type of Supply: Public Utility No. Bdrms. Individual xx If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility. If Individual, date of installation Individual (on-site) xx Sue Benson 276 3110 x 40