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HomeMy WebLinkAboutTIMBERLUX #1 BLK B LT 13BTimberlux Block B Lot 13B #018-271-95 MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION " 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT HONE [~'N EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANOETO: ~Well /~ ~ IAbsorpdonaroa~, Dwelling/~ , PERMITNO. ~¢~ Z Mat~ri~ ~ No. of compartments ~ ~ L~q. capac ty n gal OhS inside )ength Width Liquid depth . ~ Well Dwelling PERMIT NO. ~ NO' of lines , / Length °f each line Total length of lines Distance between~llnes ~/p ~ Topoftiletofinish grade~ ~ t ~, inches Material beneath the Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ ~elJ Building foundation Nearest lot Une ~ DISTANCE TO: ~ ~lass Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PI PE MATERIALS INSTALLER ~, I ~ -- REMARKS X APPROVED DATE LEGAL PERMIT NO. RPF'LICRNT BRUCE C. HRRDING LOCRTION RRBBIT CREEK RD. LEGRL ,L~B,:B-B~IMBERLU~ TYF'E OF SOIL 8BSORPTION S~STEM ~27 SIPPRLA TRENCH LOT SIZE 248-076~ 44076 SQUARE FEET MRXIMUM NUMBER OF BEDROOMS SOIL RRTING (SD FT/BR)= ii3 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: -P.~EPTH= ±2 L E[,tI_~ T H--- 22 ~-3 F: R"," E L [:'EF'TH= 8 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 E~CR¥BTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT 8PPLICRNT HRS THE RESPONSIBILIT9 TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF BN9 WELLS 8DJRCENT TO THIS PROPERT9 RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI4C~ (2) I ~4S;PEE:TI L]~-~S RRE REQ[~ I F~E[:, BRCKFILLING OF RN9 SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL B9 THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN 8 WELL 8ND RNV ON-SITE SEWRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVRTE ~ELL OR i50 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITV SEWER LINE IS 75 FEET. WELL LOGS 8RE REQUIRED RND MUST BE RETURNED TO THE DEPBRTMENT WITHIN 30 OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RV8ILRBLE TO INSURE PROPER INST8LLBTION. F"ERM I T E::-~P I RES [:"E~Z'-E~'IBER 2.:1., 19,~21:1 I CERTIFY THP, T i: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS .RND WELLS RS SEI' FORTH Bb' THE MUNICIPRLIT'¢ OF RNCHORRGE. 2; I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3'.: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRb' REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. S I GNED: .................. RFPLICRNT E, RUCE Ii.'. HA~ING ISSUED B"r'_ ~&C?:Z~ -~- ~ - _(~-~_ _ _~"~~ _ _ [:'BT E _ Z~)_ _~_ Z*~2~ ",,'4. 0 [1.5-~*i -cT:,~B,_.?_L~X SUBD. UNZT N0 1, LOT 13A''~ - E'XDI~,D^''¢' ~",,' /DF, ILLiNG ~.,---- ~ --'..Z" r==~ ~---- · ........ :~2L-~ ~_~.~'g~ LOG ~'3. r, ...... , . ~'"--~ - / SW, GRAVELLY[~ ;?,; . , .Z' ..-:',-,~ , · SILTY SANDS, S[LTY GRAV£L'LY SILTY SANDS SANDY GRAVELS ~DS GRAVELY SANDS G ' RAVEL~ SANDS SANDY GRAVELS GRAVELY SANDS ® Municipality of Anchorage = ° On -Site Water and Wastewater Program Q (907) 343-7904 s A r Ei Certificate of On -Site Systems Approval Parcel I. D. 018-271-95 1. GENERAL INFORMATION: Expiration Date: r V Complete legal description TIMBERLUX #1; BLOCK B, LOT 13B Location (site address) 4500 Rabbit Creek Road *Anchorage Current Property owner(s) Derrick Dell Day phone 306-1369 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class^Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55d Waiver Fee $ Date of Payment [ 1- 7--/ 2. Receipt Number GVs: � COSA # © s CV A (0'55 - Date of Payment Receipt Number 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. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the - system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foil OF :.:.911'7..... a......:�'. y A. f10 E-7=7)53 le''N e >o Lv 4'0 Q�Professio^ a #AECC884 P�Yt OFW4�, y0 ON-SITE �G,%. WATER AND Igst 5�i&WATER z Jct PROGRAM S � gy Original Certificate Date: 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 _)4�r Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other LF Legal Deascription: TIMBERLUX #1; BLOCK B, LOT 13B Parcel ID: 018-271-95 if more than 9 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA [ l Well log is filed with Onsite (or attached) Well production at time of test 3.9+ gpm Date drilled 1981M Water storage tank volume N/A gallons Total depth *300 ft Well ' infected for coliform test? ❑ Yes [) No Cased to UNKNOWN ft Coliform bacteria is Negative IN Sanitary seal is functioning correctly Nitrate mg/L Nitrate less than fv1RL (ND) [) lAlires are property protected Arsenic u /L g ,arsenic fess than SRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD Date of flow test for COSA 1012025 Date of Sample 10/20(21 Static Water level at beginning of test 73.5 ft. Comments *PER ALPINE DRILLING RECORD NOTED ON PREVIOUS COSAS B. l AINK DAT A Age of tank(s) 5 years SEPTICWEE Tank type/material measured operating fluid level in septic tank 49° ®! Standpipes/foundation cleanout per record drawing Date of pumping SEE ATTACHED MAINTENANCE D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 6123116 [W ALL standpipes present per record drawing Total measured depth from grade 7.08 ft (max) Measured depth to pipe invert from grade 6.08fi (111ih) ❑ N/A —pressurized field i� Monitor tubes go to bottom of effective. If not, state depth into effective U Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellotw sheet C. LIFT STATION 0 Required maintenance completed Age of lift station 5 years Lift station material STEEL Comments: QUANICS Adequacy test date 10/20/21 Results o✓„ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 994 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A NONE 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'Community ❑ Yes 50 + Sewer Manhole/Cleanout > 100' F-1Yesif No it 17 Yes if No it Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 50'+ ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Private Wells ? 100' ❑ Yes if No Animal Containment > 50' ❑✓ Yes if No ft ✓❑ Yes if No ft ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Manure/Animal Excreta Storage > 100' Yes Community Sewer Main > 75' ✓❑ Yes if No ft✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > '10' ❑ Yes if No *51+ ft Surface Water > 100' El Yes if No 50'+ ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: ft Private Wells > 100' ElYes if No 50'+ it Absorption Field > 5' ❑✓ Yes if No ft Private Wells ? 100' ❑ Yes if No 50'+ ft Water Main > 10'✓❑ Yes if i\lo ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below Froth Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft if absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *� ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ElYes if No 50'+ it Water Service Lire > 10' F71 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > '100' ❑ Yes if No + ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **OSV#161059 G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review e,�� of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. ,... , . . .�..... /..... r ,. ,t Jef e Garness; Gri a 7_ z tt� COSA ChecUst yello:•r sheet 'W""y ire �AECC884 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 8.4'' Day of /Vo Uc r, S — of 20 -? 1, by and between �/ 1 yq ri• t o h u h Lusk-, �, 14Yrinf7u+� Sw,� Ty�� � herein t&ie "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: L Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as LJ o n, r 5 v a c c t/ located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout 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. 511 f 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). 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. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 m4fowner 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. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. 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 ��� Certificate of On -Site Systems Approval. 1! ' n Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines 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. Nonwalver. 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. Jurisdiet#on; 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. Sive blilty. 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 jr OWNER: A. (signature) Date: A/cnt3-t (print name) STATE OF A&�, J) tj -L.Au)*V- ) ss. The foregoing instrument was ac owledsed before me this day of: 201,L, -NOTARY PUBOC FOR My Commission expires:_ MUNICIPALITY: �l (signature) (print name) Date: Title: (rev. 05/18/2018) Page 3 of 3 V�' � ^•'urs J.���"�/�e�G rr,pay �l MUNICIPALITY: �l (signature) (print name) Date: Title: (rev. 05/18/2018) Page 3 of 3 ARil.'i Septic Services, ILC Maintenance Checklist. ,advanced Treatment System Gl.eratiorai Checklist: Advanced Treatment System Legal Description Street Address: 1 r ! `� -ti,. u1 s _l { �? _ �� '"r" k �. Service provided on: Date: "�_ E r ! Time: Service provided by: Company ,Jl3 ;;'� Technician: }t.- Gate of las: service?' ._' By: rYou' {Jitter 1 1. Type of Aerocell Treatment System: Lf Cat If -AeroCell Treatment System Cat III - AeroCell T; eatment System 2. Conditions at media filter: E':�Ncceptable ._! Unacceptable E-Vaivate presence of odor within 10 ft of perimeter of system: Mone i t4ildD Strong _!Chemical Sour b. SOUfCe ..f Jdor, if present! .�� r, 'r•'\.� 3. Manhole Risers and Pipe Caps: -'nK Acceptable _) Unacceptable a. Coverts intact: Yes No I) tvlethod of securing cover: -"`—I . c. Insulation present on all lids? U'1'es ' No cf. Any plumbing ;oaks or water intrusion: Yes � Na e Surface ivatedinfiltration into components: Yes tie 4. Venting/Air supply: !� Acceptable....i -- Unacceptable a Air supply unit operating properly. ~s Yes No b. Venting appears operable. E-)Yei s 0 No 5. Media surface: I. l` %acceptable C Unacceptable a. Bioniat on surface. 1— t_.. Yes No b Uniform spray pattern. -2 Yes ��� No c Pending inion media. Yes No E: Plugging clooning of nozzles. Yes �o f. D:ledia appears to be settling. L. Yes 'rfJo C, . Appropriate maintenance performed. u'Yes No h. Pest activity at surface. Yes No 6. Effluent quality a. Eluent odor after passing through media filter: L�' None __ tv7ifd Strong b. Effluent color after, passing through media filter: Clear D Brown Black en tnutm , errant gau 17933 Old Gtenn Highway 'Chu.aiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outtook.com (PAGE 1 of 31) AR.,VI Septic St't'N'ices, I..I,C 7. Tasks for recirculating/discharge flows: -`L-V ;`ecce table _ Unacceptable P pts a. If applicable, Jandy valve functioning: _1Yes _� No -<I N,t b. if applicable. Jandy Valve basin dry: i� Yes t` Nc ;2 N,'A u;eaned collection system in Aerocell unit _Yes No .5 Not Necessary d. Design recirculation ratio: 80 : 20 MT#4 Liquid Level: _ Inches e 1,ctUal rec11"culalion ratio (Estimated): �a r o 8. Pump System:"acceptable [ Unacceptable a Con!rol panel in Auto: 01} -Yes I_,' No b. Time, settings IFS Panel (No Override timer): `; Yes CN .___'� OFF: Override ON: -,i =-�- QVeI'I;de. O! -F: NiA C Roals in correct placement: - 7Y, Lai d Floats v.,orking property:- L. les _ No F _ e. High water alarm operational:'..— 'No High v.ateralarm count: Pump Run Counts: i^ --------= r- Pump Rain Time: -- i- i :. !Float Error Ccunts. _ L' NIA 1 Total Override Counts _._.__..___--._-- �}�I I,. Effluent Fitter serviced: �Yes L No I. Tank lids secured after inspection: �aYes f,lo m I/Veep Dole functional: }Yes _ No 9. Primary Tank, ccepiaole L! Unacceptable a. Slucge nd sc un level checked: ;1'es No bIuage;Scone levels est __t-I_r 2nd:_.__ i 3rd:... SNIP, c. Tani: needs to be pumped: _-: (es ! (to %vatersoftener backwash discharging on system?' --Yes _ No e, row many people live on the system?: _ -,ank. lidsicaps secured after inspection s es LI No g past Date Tank pumped._ t'Iz. ; f 10. Drainfield: a. Type of Drainfieid (circle one) Bed j'L wide/ Deep Trench b. Design Effective depth: _ jam_ j i ch0feet Checked Liquid Levels in Drainfield-' L}Yes _ No t -11T#1 Liquid Level: _ !`%' Inches MT#2 Liquid Level: ` Inches DAT#3 Liquid Level• _ _ _ Inches MT#4 Liquid Level: _ Inches d. is there any surfacing effluent?. Yes �a r o 17933 Old Gtenn Highway `Chuciak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outtook.com (PAGE 2 of 31 A RNM Septi -)tic Services, f..I.0 'I'l. Is the remote monitoring system functioning? (if no, describe in continents) 1— "�es F., T fes. b P11 -me line %:crkinp? L 1'es 12. Does this system receive an advisory notice/warning? (if so, describe in cornments) 13. Is the system in satisfactory condition/pass inspection? (if no, describe in comments) No Mer Comments Service Provider:' - ------ --- 17933 OW Gtenn'HiphW-a"V 'ChUgiak, AK 99567 officellfax: (907) 688-9433 Emai(: ARAASet-vicesAl<'.-i',,%OLItIODI<.COIII IPAG;:-- 3 3j Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak, us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O[~-,~-7 / - 1, GENERAL INFORMATION Complete legal description LO Location (site address or directions) Current Property owner(s) -'T-~, < Mailing address Lending agency HAA# H/'~ Expiration Date: c~v~c~ ~_~%,,.'_ x_~ ,~'..~, Day phone '~\ ¢~.$(~.c~ %L,.~ '~tX, Day phone Mailing address Rea[ Estate Agent Mailing Address Dayphone _"%% \- Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class__ Public Water System Well  TYPE OF WASTEWATER DISPOSAL: Individual On-site [~ [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civii engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water suppty system. DSD aIso issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates (cay be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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, t 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. Name of Firm ~,~d~- f.~C".'~/-~.z~/~'~/ Phone L/¢'-"~/)~ Address ,¢?,¢¢ ~--; ..¢~..,~.~/.~/z~'.~: ¢?.¢z./--/..~:,~%//,~"' Engineer's Printed Name 5. DSD SIGNATURE ~ Approved for .-~ Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Fiow Advisory X Maintenance Agreements Supplemental Engineer's Repor~ Other Original Ce~ificate Date: ~-- / ~ - 03 ;2_ Municipality of Anchorage 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 HEALTH AUTHORITY APPROVAL CHECKLIST Well type Date completed ~/-~ Total depth ..~ ~' ft. IfA, B, or C provide PWSID # __ Sanitary seal (Y/N) '/ Cased to x/¢ -~' ft. FROM WELL LOG g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~ .colonies/'100 mi. Arsenic: ~ mg./I. B. SEPTIC/HOLDING TANK DATA Nitrate /_,2~ ;z mg.ll. Date of sample: Tank Type/Material Tank size /~'~'g gal. Number of Compartments ,.Z.., Foundation cleanout (Y/N) Parcel ID: Well Log (Y/N) A,J Wires properly protected (Y/N) / Casing height (above ground) /.¢ in. AT INSPECTION ~'~. ~ ft. z,.~, / g.p.m. Other bacteria .,¢4, colonies/100 mi. Collected by: ,~-,-~z.--'~' Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping '5",,,/~,,/~,,z. Pumper ,'~/~',~,-¢~'~' C. ABSORPTION FIELD DATA Date installed /~/ Soil rating (g.p.d./ft= or ft2/bdrm) Length ,Z,Z. ft. Width ..~ ft. Total depth /,Z ft. Eft. absorption area ~',5",~ ft2 Monitoring tube __ Date of adequacy test /'Y'///~/~ ~- Results (Pass/Fail) Fluid depth in absorption field before test ~7//~'~in. Water added ~'/egal. Elapsed Time: ,'~,Z-min. Final fluid depth 7"~ in. Absorption rarelY= Any rejuvenation treatment (past 12 mo.) (YIN & type) System type ~-'~,~'g,,~" Gravel below pipe Depression over field //-'/ For ~ bedrooms New depth ?2'~.~n. ~/~-~P g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at __ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off level a__t Cycles tested Manhole/Access (Y/N) ¢"~ level a--'---t in. Meets alarm & cireu t requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public s,ewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cteanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /&. ,c,¢ Pmpertyline Io/4.'~)~'¢'G' .~?~ Absorption field Water main ,-¢¢-¢-~'~ Water service line ~'-~-'"'~-/ Surface water Wells on adjacent lots /z¢¢ ,,-~-,,z SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ,~',-¢~"',~,¢~,¢' ~"~' ~o,,,.--~-,¢,,j~' ~-----------------~,-/.' Property line /~¢'-'~'~' Building foundation -~ '*,~¢/' Water main Water Service line .¢.¢-¢-/,;x- Surface water Curtain drain 7~ ~'~'· Y~' Wells on adjacent lots Driveway, parkingA/ehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Pdnted Name ¢¢2,¢z.,~/_...c.r- Date HAA Fee $ ?~ Date of Payment Receipt Number (Rev. 12101) Waiver Fee $ Date of Payment Receipt Number ENCROAC~IME-NT PERM IT 1-03.~4C cJ-3136 ~-"~Q~') 14 This permit is between Chug,ach Electric A,~:imioa, Inc.. an Alaska non-profit electric ~o~mtive, ~in ~Ch~eh'), w~ ~s i~ P. O. Box 156~, ~h~)~ge, AI~ ~519- 4500 ~bMt Cr~ Road, An~0~c. M~a 99516, i. ~a~;em~rit Chu~a~h ia thc gr',mtee or mar of an easement fbr th-, cor~trueQon a~tl Described in that ccr~-i.'o wriP. cn instmmem ~o~ on the 15th d~7 of 8~tem~r, 195.3, ~ ~k 96, ~e 37, on ill, in ~e office of~ D~iot Re~, An~ho~g~ R~Ming Dl~Jct, Sewed M~dla~, 8~ of Al~ Dedicated by the plat ofxhe ;uladlvtslon known as Timberlux SubdlvisLonUlakNo. 1, according to Plat N~mber 81-?.~ recorded on the 13th day ol'Februoo', 1981, on file in the o~c of the Di~ct P.e~r,~r, Anchorage R.e~orn;%o DISRtcL Sm~',,rd MeridiaJ}, Thc No.,,'0a Thirty.thr~e (lq 333 of Lot Thimam "B"(13B), Btnek "B" 'rimbcrtux Subdivisina Ual: No. , according to Plaz Number 81-22, on file tn the office of'tho District Recorder. Amchorage RecordMg Diwtti~t, Seward MerJdlan. A l~ka, Lot Thirteen "B" (I3B), Blo~k "B", Timbcrlux Subdivision Unit No. I. according to Pl',g Number $2-102, on ilia in lhe oJ~e~ ofth~ District Recorder, .~ehor~lg¢ Recording District. ~ Mtaidian. Al~ka, (herein 2. .E~rqachmen$, Pcrmittc~ has constructed ~e following impmvernent on or within the real pruperty ~ubjegt to the ~b'ment: A w~er well that cnev~aehea appmrfimatcly Seven F~t (7') into thc ~mth side side of the above tefe.,~lo.,~d eaSement For ~ ~ of' aDpro~matcly Slx Fcet (6'), (herein 'Encro~ehmcut**), 3, Eerrni~ Chlzgtw. h h~cby authorizes PermlReo to {xmfinu¢ the cx. istene~ of the Brtcxo~cluncnt in its current ]oeatlm~ ~u~ject to the covc. nanl.q .,let forth in thls permit. : 9~75~3.4~45 CHUGACH ELECTRIC ,ASSOCIATION, 1NC. By: ,, Tid~: £u~ene N. Bjomstad O o..~ral ~ STATB OF ALASIC4. THIRD 7UDICIAL DISTRICT gn~'~g,hmr.~: P~'mit - ~ 3 of 4 Hay 9, 2002 ACSm Alaska Communications Systems Hr. Terry Irwin 4500 Rabbit Creek Road Anchorage, AK 99516 ACS has ne objection to the encroachment of the water well into a platted easement located on Lot 13B, Block B, Timberlux Subdivision Unit #1, as depicted on the as-built drawing submitted. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ACS will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. Any ACS facility damaged or destroyed as a result of this encroachment will be repaired at no cost to ACS. Any costs incurred by ACS for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude ACS from full use and enjo~nent of its rights within any portion of its right-of-way. Sincerely, .... /1 /2 /Greg Schmid,/Foreman ~('duts~¢il~t Engineering ACCEPTANCE: AC&P ~15 DATE: 600 Telephone Avenue Anchorage, Alaska 99503 6091 tel 907.564.1000 ENSTAR Natural Gas Company A D[vislon of ~ SEMCOEN~'~3V 3000 Spenard Road P.O. Box 190288 Anchorage, AK 99519.0258 (907) 277-5551 5/g/02 Terry Irwin 4500 Rabbit Creek Road Anchorage, Alaska 99516 Re: Letter of Non-objection Grid A3136G To whom it may concern: ENSTAR Natural Gas Company has no objection to well and paving encroachment, situated in the 10 feet gas easement located on Lot 13B, Block B, Timberlux Subdivision, Unit No. 1. Acceptance and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ENSTAR will be held harmless, now and forever for any damages or injury to any person or property as a result of this encroachment. Any ENSTAR facility damaged or destroyed, as a result of this encroachment will be repaired at no cost to ENSTAR. Any costs incurred by ENSTAR for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude ENSTAR from full use and enjoyment of its rights within any portion of its right-of-way. Sincer.ely, M. Manue~L Right-of-W~ ENSTAR N~ cc: File Agent 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.# GENERAL INFORMATION Complete legal description Lot 13B; Block B; Timberlux Subdivision ¢\ Location (site address or directions) 4500 Rabbit Creek Rd. Anchorage, AK Property owner :.Bill Harding Mailing address C/O Seattle Mortgage 4300 Day phone "B" St. Anchorage, AK 99503 Lending agency Attn: jennifer Smith ' Mailing address Day phone 762-3245 kgent Ray Dahl/ Dynamic Properties Dayphone 261-7636 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the tegaiity 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 applicatibn 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 of Firm s & s ENGINEERING 17034 Eagle River Loop Road No. 204 Address Eagle River, Alas~ka 9957~, , Engineer's signature ~/~/'~f~-~'~ Z'~-'-~-- Phone Date DHHS SIGNATURE Approved for Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~/--Z¢~r"/~? , ~ Date 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 Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELLDATA ~,1,~: ,~,:.~:.'~'[ pe~.r,-J'N P_i~.:-.,~p ~/4/'75 5T~7'~c:~b~ P~P~ ~' Well type ~E i VA~ If A, B, or C, a~ach ADEC le~er. ADEC water system number Log present (~ ~ Date completed ~' Total depth -~OO" Cased to '-'o ' Sanitary seal (~N) Date of test Static water level Well production ~¢.A FROM WELL LOG WATER SAMPLE RESULTS: g.p.m. Casing height (above ground) Wires properly protected (~N) AT INSPECTION g.p.m. Foundation cleano,.ut N) Date of pumping ~/fz~,/~/~. C. ABSORPTION FIELD DATA~ Date installed _'~sP i,~!F,[ Coliform 0 Nitrate Date of sample: ~[~5I~' ~- ~/~/97 Collected by: -~ I B. SEPTIC/HOLDING TANK DATA Date installed ~ Tank size ~ Number Depression (Y/I]~ Pumper Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 of Compartments ~ Cleanouts ~(~N)_(~L .,~0 High water alarm ("¢~ Soil rating (g.p.d./ft~ or fF/bdrm) ~ System type Length ,Z,,~, ~ Width Gravel thickness below pipe ?(~ ~ Total depth 2~c~,iv~e~sor~!o, n~r~e~ ~¢ ~ ~, Monitoring ~u~e pre~n, ~N)~ Depression over field (Y~ Date of adequacy test ~/~//~1 / Results~Fail) .... ~A~% For Fluid depth in absorption field he, re test (in.); ~/, ~ ~ Immediately after ~ gal water added (in.): Fluid depth ~, ~ (ins) Minutes later: /~/m/~ Absorption rate = 2~ g.p.d. Peroxide treatment (past 12 months) (Y~ /J~Jg ~Yo~J If yes. give date - bedrooms 65. 5 72-026 (Rev. 3/96)* Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES D. LIFT~ Date installed Size in gallons ~Pump on" level at* "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ '~'' Property line 5/'/' Absorption field Water main/service line /0 / ~L Surface water/drainage /00 / Y' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~(]/'/' Building foundation i~ / ~ Surface water /0~'/~ ~, Curtain drain J~hN~,- K~/ Wells on adjacent lots Water main/service line //~/'~' Driveway, parking/vehicle storage area Wells on adjacent lots /0~ ~ F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records ineonforrnance~_~AH/~elinesineffectonth/sdate. Signature Engineer's Name /~ ~'~ {/¢ ;'- ~''- L~ '~'~',~ Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)*