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Home My WebLink AboutTIMBERLUX #3 BLK F LT 3Onsite File #018-271-88 Municipality of Anchorage On-Site Water and Wastewater Section ° (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191395 PID Number: 018-271-88 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name JACOB GURNEY ABSORPTION FIELD On Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 14940 LONGBOW ❑ Other Phone Number of Bedrooms Soil Rating — Total depth from original grade 13 1.2 GPD/SF1 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block Lot TIMBERLUX #3 BLK F LT 3 Fill added above original grade 1 + Ft. Gravel length 40 Ft. Township Range Section Gravel width 2.0 Ft. Beds: Number of Lines 0 Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 56O Ft z 1 Ft. Well 100,+ 100'+ 50'+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER TANK 1000 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10,+ 10,+ NA PLASTIC 2 Foundation 101+ 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer MIKE N ANDERSON, P.E. Drainfield —30 CO/MT ?� Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 98.5 ft Inspection ection 1s` 10-11-19 10-11-19 Location and description 2�a GARAGE SLAB 30 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp OF 'S� Conditional Approval: Date ., -° ° ° ° ° , ,� f°mem° e m m m a m e m m w c Septic System ,, � � � " `m° MICHAEL N. A D RSC(d �� ', c� - s 1��1�1� �( Approved Date Note: this approval does not include well permit requirements. O��..�-�,�' kRcv uoiuu ion Permit No. OSP191395 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: TIMBERLUX #3, BILK F, LOT 3 PID No.: 018-271-88 MARK I A 1 B C01 40 25 TC01 43 f 24 TCO2 461 30 CO2 461 31 CO3 47J31 C04 62 45 C05 100 79 MT1 y00 78 / J \ SEPTIC AREA \ BENCH, GARAGE SLAB 0 — _ 1 MT 1 \ 1I NEW 1000 l,' 1 \ C04 h � � \ � \ 02 T 2 0 TC01 1 1 I f I _S1 U_I L_T— — _ SALE: I"=50' I i I _ON P IC NK \ i TOW r F-1 I r ,-11T �r ®® &VALITAIt®® �I z.z , 3 oc ®�� O i /< OOtt �P •�9 ®® Fl�,SR�RaoEi I �� ..5 0 .0 ORO AW M _ m 49 TH ®®� 3 oz z taco . , X&J GALLCN 7.4 97 97 CNa NK TANK 9.4 '9 < 0®��.MICHAEL.N. ANDERSON.- x 0 %'D% No. CE 9469 ®®® SEPTIC SECTION 82 J! ®�•••�'.}......•••'•�� .®®® N.T.S. DRY, OCT ,,to °A"--Yo MUNICIPALITY OF ANCHORAGE `i- F ,,,.0.,:.,,I7( On-Site Water&Wastewater Program �� S.� ti.ate`; PO Box 196650 4700 Elmore Road r / ; ,� i, Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 httpa/www.muni.orglonsite t ) partn7(�nt "'tiCNORA.. On-Site Wastewater Disposal System Permit Permit Number: OSP191395 Effective Date: 9/12/2019 Work Type: Septic Upgrade Expiration Date: 9/11/2020 Tax Code Number: 01827188000 Site Legal Address: TIMBERLUX#3 BLK F LT 3 G:3136 Site Mailing Address: 14940 LONGBOW DR, Anchorage Owner: GURNEY JACOB JOHN & Lot Size in Sq Ft: 53143 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: Il Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: ' ' Issued By: �� ./ / Date: - Ar • MUNICIPALITY OF -ANCHORAGE • Development Services Department' Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-271-88 Property owner(s) GURNEY JACOB & BONNIE Day phone 3 S (9' 6' 71 C' Mailing address 14940 LONGBOW DR ANCH AK Site address SAME Legal description (Sub'd., Block & Lot) TIMBERLUX #3 BLK F LT 3 Legal description (Township, Range & Section) Lot Size 53,143 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field Q Initial ❑ Single Famil ❑ (w/w• 414.). 6 7,9 Septic Tank 0 Upgrade ❑ ex‘ Dupl Q!. ' ' Holding Tank ❑ Renewal 111 Mu i.•- D�ivellings Privy ❑ = and/orb) - Private Well ❑ b Water Storage ❑ �,j� t�, � 9S THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ``irV " (Signature of property owner or authorized agent) Permit/Rush Fees: 695. Waiver Fees: Date of Payment: Q/3//9 Date of Payment: Receipt Number: 2LJ2223 Receipt Number: Permit No. DS/0/91345- Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Sept 3,2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: TIMBERLUX#3 BLK F LT 3 To Whom it may concern: This is a request for a septic permit on the above referenced. A test hole was excavated and found the same material top to bottom GM with no water during excavation and after the 7 day monitoring period. A simple trench system has been designed due to the good soils. The new system is a simple gravity flow 3 bedroom system with an effective depth of 7 feet. This new system will not impact any of the neighboring properties. The slope is less than 1 percent to the northeast, see the site plan. Sincerely Michael N. Anderson 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: IMOUND OVER (TH#1) o -- GRADE 3 BDRM X 150 =450 GPD 10 .ORG 1 SOILS =450/0.8 = 562 GPD W FILTER FABRIC 562 GA/14 =40' 3 0 em•r... ,"0 PIPE (1) TRENCH I GM SEWER ROCK 10.0' DEEP 7' EFFECTIVE 10.0 2.0'WIDE 12.0' 40' LONG 18 SEPTIC FIELD SECTION — ' • WELL 1 �0�,. ��'�/ `\\`� I I / \ / \ / / WELL I 1 --- 1 SEPTIC ' '— ' I ^ I PROPOSED t • / ` \ \ DRAINAGE FIELD :� \ \ ..�y�Mme ' \ / // TTM '/ \ / ^- ~, \ ' EXISITNG HOUSE', ••• \ /` \\ - - - - -, � 1I \1 r \ 4 ,. I I I V • — — — \ • I I • WELL \ \ I .;.-:. WELL I \ \ \ �\ \ 1--- t • i \ \ // ." `. \ / \ / \ / N. / ii \ / / -- \, -- - yam I ��-�_ I \`� \ \ •WELL I \\ \ I Septic Design Prepared for „`Iiik it 4. JACOB & BONNIE GURNEY :..4..\ ._ OF q�.s♦♦♦♦ TIMBERLUX #3 BLK F LT 3 • i 49TH " : �} ♦• Anchorage, Alaska % ,,ht,A. - • • Michael N. Anderson, P.E. DATE: 9/2/2019 ♦♦ •;MICHAEL N. ANDERSON. : 4601 NATRONA AVE 4- •• No. c 9469 ANCHORAGE,ALASKA 99516 DRAWN: DJR 1�� ' •�. II •• (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=100' 44411``SS*". i4 r • SS/I/ r , . r / / __ •• "� SECONDARY 1 �/ . ��--CO'- ' . TRENCH Ii1 \ SEPTIC 1 61 r // •.�...:.. i yv Q�//MT r �\ \\ �" c r;p � is �N� DCO, _�/ �. CO z _ _ , wen �� / NEW 1000 • \ 3 0 ... GALLON J �/ PLASTIC TANK N �� • W/20"RISER . I � i \.—PROPERTYLINE •�� i \ y . " . . . i r \� f~. 1 r 1 � \ •r • I I ® WELL I { 1 r 1 r 1 10'UTILITY / 1 �\ EASEMENT //// �.� / \ \ \ // \\ \ \\ /,/// /. \ \ \/ 1 r\ \ \r \ I 1 \ WELL I \ I \ 1, \ r Septic Design Prepared for oi"`•s%4 JACOB & BONNIE GURNEY .•4� OF /4 14 TIMBERLUX #3 BLK F LT 3 • ti:' 49TH v. �� •••'•:'�41 V • 0 Anchorage, Alaska • : • ` � • i • Michael N. Anderson, P.E. DATE: 9/2/2019 O. ':MICHAEL N. ANDERSONi O. No. C 9469 �a 4601 NATRONA AVE DRAWN: DJR �..#;••..•q• /` , ANCHORAGE,ALASKA 99516 14'44 '''•• ••{- 40 (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' 44 1 E. 44 Municipality of Anchorage ,.~s(E•.•. ., s�6 i IISW Development Services Department „e �P•• j '• �f Ci On-Site Water and Wastewater Section / y•` •' f� �/� �„�,\ 4700 Elmore St. * • 49TH •,'s'r P.O. Box 196650 Anchorage,AK 99519-6650 �. . ( r, , v. - —� www.muni.org/onsite / r, (907)343-7904 MICHAEL N. ANDERSON `, �_� � Z.��'• C 9 69 •,.'i Soils Log - Percolation Test +�,j;,-'•%• //,y•'�.' 1 y OO::pROiESS1 ''"-'/�� Performed For: '�Lt b 1J_ ( S-y v n C Date Performed: \\xx�t� Legal Description: 1\ r1 e I lel Y. ? Township. Range,Section: n ( /_ Slope Site Plan (, 01-- 3 Depth (Feet) v J 9 1'� S fe-- / . 2- GI VI l 3- •4- 5- 6 r'( 7- 8- 4, l 1 WAS GROUND WATER /n 9- \ T ✓& v C ENCOUNTERED? /4 V S 10- IF YES,AT WHAT DEPTH? L Depth to Water After P E - - 11- Monitoring? "tr E 12- Date cy/31,r 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- lO r►u✓► , G '/ S/1 v i 16- z 6--i/ 17- /A // )/18- 2. C1/ 19- 20- C.? PERCOLATION RATE t"'f jminutesimch) PERC HOLE DIAMETER 1 TEST RUN BETWEEN (� FT AND FT COMMENTS 11/ �r i d 1h. t?, vit. 't Ty n - PERFORMED BY: /y/t 11.A.--1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: V 2 Vt 4 GRAPHIC SCALE: 1 Inch = 30 Feet 1 15 0 15 30 60 4Dt, E j) o / v v • o • • / • ' \ 0 23,.9 • , »• E • / 7 • � . • 39.0„..4,,01,1°',..\, ,_ • • • • • • / • 1...3 _ ( ( • 687°13 • / • Z • Z • 0 O N.) GARAGE ASPHALT o r-2. O \ 0 \ • ) 1 -Z- 33 \ w \ • • N0. J \ - \ •WELL Cr?* �� .. \ ' . CSS - \ • LO \ cn 1 Crl 1 -70 CS` 40 *AV ..... • \in • 7L \ COVERED DECK \\ 03 MULTI — LEVEL A \ lA MODIFIED "A” • _ • 01J FRAME HOME \ w u--\ \ °o • `9 • 101.64 • • • • • • O 0 0 0 0 0 0 0 0 0 0 \ N 50°11 '18" E 305. 19 ��_`‘ AiiraliPP OFAL49\1 r*A• •in i\ * �I Date Scale Legal Description / . .�� / 7/22/2019 1° = 30 I hereby certify tngt the property described hereon has been surveyed BOBBY F. BURNETT b me, or at direction, and that the improvements situated thereon soes�r F. BURNETT Grid LOT 3, BLOCK F y y p , Is-5464 2941 Carriage Drive are within the property lines and do not overlap or encroach on the 1 �� / g SW 3136 AS BUILT TIMBERLUX SUBDIVISION #3 property lying adjacent thereto unless otherwise shown. That no Anchorage, Alaska 99507 improvements on the property lying adjacent thereto encroach on the 1 (907) 350-5541 Drawn by Field Book premises in question and that there are no roadways, transmission \ SSIONAL / BFB ASB2019 PLAT # 71-240 lines or other easements on said property ezcept as shown. �``_f / GRE ,.JR ANCHORAGE AREA BOR JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS ~(~ c~OI'-~.-- LEGAL DESCRIPTION ~_<~)'T- ~ ~J~ F PHONE -'FJ~ g~ C41U~ SEPTIC TANK: DISTANCE FROM WELL /A~) INSIDE LENGTH MANUFACTURER ~'~-~ "-' INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS ~ LIQUID CAPACITY__GALLONS. LIQUID DEPTH TOTAL LENGTH DISTANCE FROM WELL'~-/~)~) FOUNDATION NEAREST LOT LINE · OF LINE~ NUMBER OF LINE~$ I DISTANCE BETWEEN LINES . TRENCH WlDTH~ ABSORPTION AREA ~_~'~O SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE ~ / DEPTH OF FILTER MATERIAL BENEATH TILE__/(~) IN. ABOVE TILE IN. TOTAL EFFECTIVE IN, WELL: TYPE _ BUILDING FOUNDATION CESSPOOL APF~ROVED CONSTRUCTION ~ NEAREST NEAREST LOT LINE __ SEWER LINE OTHER SOURCES DISAPPROVED DEPTH_ SEPTIC SEEPAGE TANK__ SYSTEM DISTANCE FROM: REMARKS DISTANCES: " INSTALLED BY: ~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE~ REMARKS: DIAGRAM OF SYSTEM DATE¢)h/~ APPROVED ~ F~J/~ G.A.A.B. Form E0-032 APPLICRN"r LOCATION LEGAL DEPARTMENT ,' ,HEALTH AND EN~¢IRGNMENTRL/ DTEC:TION /V LQNGBOH AND MRNYTELL L_,BLK F TIMBERLUX ~3 LOT S~ZE 5~?-- SQURRE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = -~- SOIL RATING (SQ FTZBR)= t65 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:,EPTH= t4 L. E-[-~(~ TH = 25 GRA'.~'EL DEP-FH= THE LENGTH DI~' NSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEL[:,. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF ]"HE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). .4:-"AIi:I<F1GE ~PLAI'~IT REfiLl I RE[..' EITHER A CLASS I OR II NSF APF'ROVE[:' PLANT f'IAY BE INSTALLED. R CONTINUOUS MRINTENANCE AGREEMENT IS REQUIRED:' IF R MRINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBSECT TO PROSECUTION. i I ~,~.0 FEET. IF A CLASS I _,b~TEM IS I_I~ED THE LENGTH IS F A CLASS II SYSTEM IS USED THE LENGTH IS 2i0 FEET~ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERMIT VALID FOR O~-~E '~'EAR F~:E~ I CERTIFY THAT i: I BM FAMILIAR WITH THE'REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORD8NCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. .............. April 29~ 1977 ~76053 Mike Hayden Box 2012 Anohorage~ Alaska 99510 Subject, Permit Expiration Dear ~Iro Hayden: A permit issued by this depar~uent for well and/or on-site sewer ~%stallation on Lot 3 Block E TlmberluxAddition $3 has expired since the issue date exceeds one (t) year. In the event you still plan to install the well and/or on- site sewer syst~a, a new permit is required. The original soil test ~y be used to obtain a eurr~nt permit. If the ~.~11 has been drilled, a well log should be sent to this department to document the ~,stallation date. If you have ~%y questions regardinq th~ above matter, please do not hesitate to contact this office i~ediately at 279- 2511, extension 224 or 225. Sincerely, Les N. Buchholz, Sanitarian L~B. lJ h E. EFHF..frII::.Nt OF' HEFILTN R!'.,I[:, EN',,,'IROi'.,II'~ENTFIL. PF?"'TE"T:["N !E. ]"UI}OR RE:,.., F~NCHORRGE., RK 9'95L;Y;~ PERt"I l T NCI. i',111.:::E -' ' ",::' · ~ *:" ~ E,C,, ;:? FJ 't 2 RNCFI LOCFIT]:ON LONGE:OW 8. MFIN'¢I'EL.L -' -' [ it IE, EF..L..J,.., RD[:,N L.EGFIL L]: E,F .... ¢ "":' ~ .... ~ '"'" :,t:.F I I..OT :,I;E .._..~..~'~"-";";'=. " 'I:'T'PE OF' '~2 '2~ I I f::IB:~;ORF'T t ON _ _. t !....r t. TRENCH N_IMBE'~a' OF' EE.[..I .... fl:, 2 ................. L~:I}EPTH= ¢L4 t_ENG'f'H= .... 5 THE B'F':{ t REP SIZE; OF ]'HE c;O'f[ THE MINII'dLIM [b.~ IH OF J]RFI',,~EL. ~[L'J"J,.JEEN ]'~ :BLL PIPE FIND THE EXCBV~T]]ON THE:RE IS NO SE]' !.,.IID'f'H FOR ]"RENC:HE~;. THE DEF'TH OF TRENCH Oj:a: PIT :['.E; THE BOTTOM OF ]'HE EXCRVFITION. THE LENGTH DZt,IEN:E;ZON I:E; THE L. ENC4TH OF E LENGTH OF THE TRENCH., OR DRRINFZ[ THE REQUIRED SEPTIC TFINK 2;IZE THE I-,.!):[:,TH :f~; 2:FT. £TNEEN THE 'iR] ND "' '~''-' ....... . =,,. r~.r'n~-c. RND THE ':'J'[I',E F'OI-4: FI '~EEF'FI:~E F'IT CIR THE EITHER R CLRSS I OR II NSF:' P1FI~' E:E IN:STFIL. LED. F~ CONTINUOUS MFIINTENFtNCE F[' i~:; REI;-!UZRED~ IF R P1RINTENFINCE RGREEP'IENT IS KEF'T CURRENT ~,"OU i"iFl'¢ BE RE6]LI];REC, ]'O ENEFIRGE THE S;OIL FIE:~:ORPTIC~N %FtN[:,,-"OR ~r'CIU MF%" BE ~;UE3JECT TO F'RC~:~;ECU]'ZCIN. ZF Z : :VS'rEr.'i ]:S: UDE , THE FEET k BRCKFILLZNG OF Fl~4"r' E;'¢STEf"i F.~'T'HOIj]' F'I}NRL INSPECTZON B~r' ]'H]::5 [:,EPlaRTr,~ENT [,JILl_ 8E SUE:JECT TO F'RCiSECIFJTZE~N. ~ / , , M ] N Z MIJM [) ~ ~;TFaNCE F:ROPt I.,.!ELL~?' Z C 'TFINK,,' F F!CKRGE PL. RNT OR 2;O Z L FIE,~;OR!::'T I ON S'¢S'FEM IS :]..e,E~ FT F'OR F:I F'RZVFI"I'E].,~EL.L. RN[) ;2:e~F~ F'T FOR R F'i..IE:LIC NELL. 1.4ELL LOGS MUST BE RETURNED "fO THE DEF'RRTMENT HITHiN ;]~IZI DFI'¢S; OF' THE NELL. C:OI'4P[_ET Z ON. SPECZFICFITION:E; FIND CONSTRUC]"ION DZRGRFIMS FiRE FIVFIZL. FIE:L.E ]"O ZNSURE PROPER l NS]"RLLRT t ON. ): CERTIF'.r' 'rHFIT I Flr,'i F'FIf,iILIFIR HITH THE REC!LIIREFIENT~; I:'OR CI4-~..,..IE. ~,~I..!E .... RN[) I,.!ELL.~; R=,~'' SETFOR]"H E,r:"' ]'HE M..N]'FtF'FILIT"r'_ . OF RN]:HFd:~'FtGE_ Rl",ll;' WILL. INBTFII...L IN :i]:CEI[eE:,FINCE I.,J I TH THE :[ .~ .~ .F_ [: ....... Z b%S;I._IEI:~ E, ~r.~,:~r,-~-)..g:' '-¢'-~"Z%'~.'~'¢'.~-¢ ....... [:'RTE .......... Performed for ' Mr. Mike Hayden · Date perf0~ned 3/30/76. Lot 3, Block F Timberlux'S~division A~dition~ #3 L~gal. D~scription: This form reports: Soils log '?erco]ation test Yes, Depth Feet 2- ' 3- 8- 9- 10- 13- · Topsoil' Silty sandy G~avels Through depth 'with occasional cobbles Moist 14- Was'ground wa~%r encountered? If yes, at what depth? ....... ,' Reading ' Date 3-29-76 Gro~s Time , 4:1~5 PM 2:3~ PM Net Time 3 hrs. 4 hrs.` Depth to H20 48" 96" Net Drop ~~Percolation ~ce 1"/10.,_ minute.s . Proposed installation: Seepage Pit...... Drain Field '", .. Depth of Inlet . Depth to bot't'om of pit ~Ourirtre~nC)le ' ~ bedroom "' ,CONMENTS: -'.i-~fe. et draina e area e . . No bedrock or ground water encountered. ------------~er ti f i ed B~~ ?¢rform~d 2.~: _u~'.~'~,~-*.,-,.,- .~--~,-' -., Z"-'~'- ~ /3 PERMIT NO. APPLICANT LOCATION LEGAL MIJNI [:IPALITBT' OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 25i0 E. TUDOR RD.~ ANCHORAGE, AK. 9950? 276-222i WELL PEAr4 IT ¢ H SELF OFF ELMORE RD L~ BF TIMBERLUX SUBS 9i4 EAST 78TH AVE ~44-9242 LOT SIZE 40000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAVS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PER~]IT ~/ALID FOR CirCE '~EAR FROH ISSUE I CERTIFV THAT i: I Aft FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH B~ THE MUNICIPRLIT~ OF ANCHORAGE. ~: I WILL INSTALL THE SYSTEM IN. A~OR~ WITH THE CODES. ~P~LICAN¥~ C~H SELF / / Can6Te's Concrete Products of Wasilla, Inc. HON~E & COMN~ERCIAL SEWAGE TREATMENT PLANTS BOX 149 - WASILLA, AK. 99687 - PHONE 376-5919 JET Home Plant Service Policy I~4UNICIgAUT¥ OF ANCHORAQF SEP 3 01976 This Agreement entitles: Owner Street Address City . J~ ;r;ll . :, ' 'i ' Phone to the following service for year(s) from the date of acceptance. Upon receipt of this signed agreement and $ !r~,,. ~, Canole's Concrete Products agrees to perform the following services during the term of the agreement: Canole's Concrete Products will inspect the JET plant at the above address twice a year. These inspections will include: PLANT SERVICE · Removal of aeration unit, inspection, adjustment, cleaning of aerator's shaft, field service of aeration unit, if needed, and re-installation. · Inspection, cleaning, and adjustment, if necessary of surface skimmer and/or tube setter. · Examination of final effluent for color and odor, if there is access at time of inspection. · Check of discharge point and wet weather overflow for blockage (if applicable). · Inspection and adjustment of control panel setti'ng and overload protection, if there is access at time of inspection. · Inspection for sludge accumulation with arrangements for removal when build-up warrants removal. Canole's Concrete Products further agrees to the following: EMERGENCY SERVICE · There will be no charge for emergency service calls. · There will be no service or labor charges for removal or re-installatlon of aerator, if required. · If improper operation cannot be corrected at time of service, homeowner will be notified immediately and given estimated date of correction, · If improper operation cannot be corrected at time of service, the Department of 'Environmental Quality, GAAB, will also be notified. · If necessary, the entire mechanical unit or any parts will be replaced according to the manufacturer's warranty program. Freight charges to the factory or to an unauthorized repair station and aerator repair charges are not covered under this agreement. Owner's Signature Date Accepted for car~ole's Concrete Products Date 4.1 flo~ 20!2 · TIME DRILL LOG CASING ; L~.~=~ ~2, ~ ~D./~ ,. ... _, .. ...... ~ s, ~ x' "-"~ t8 ~ . - ~o~ ' 7/¢.~ .o..OO*T,O. -- / / / / DErTH WELL LOG DEPTH WELL LOG / STATIC LEVEL GPM-YIELD Rus MUNICIPALITY'OF ANCHORAGE Development Services Department _ ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 018-271-88 Certificate of On -Site Systems Approval Expiration Date: VL6 I sJ , � 0 a o 1. GENERAL INFORMATION Complete legal description TIMBERLUX #3 BLK F LT 3 Location (site address) 14940 LONGBOW DR, ANCH AK Current property owner(s) JACOB GURNEY Day phone Mailing address SAME ro 1 B 9 10 77 Real estate agent r, Day phone a NpV .� 2. TYPE OF DWELLING: w ❑ Single Family (w/wo ADU) `yb�� ❑ Duplex 4 01 5 c. L ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ U Waiver Fee $ Date of Payment l 1[5l (q Date of Payment Receipt Number I I (6P Receipt Number COSA # 1�T-t 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. 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. 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 11-12-19 6. DSD ,SIGNATUREh� a 4,9TH V System #1 Approved for 3 bedrooms r System #2 Approved for bedrooms j .°> MICHAEL v. ANDCRSCN CE_ 94 9 Disapproved��' eo 1t Conditional approval for bedrooms, with the following stipulatio�h P a��c3s04 ltl(tt(f , r-,-, By: cj�� Original Certificate Date: 1 5 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 COSA Checklist Legal Description: TIMBERLUX #3 BLK F LT 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled UN Total depth 127.5 ft Cased to 127.5 ft 0 Sanitary seal is functioning correctly ❑. Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/23/19 Static water level at beginning of test 72 ft. Comments * NO DATE ON THE MOA WELL LOG B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW Al Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 10/11/19 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.2 ft (max) Measured depth to pipe invert from grade 5.2 ft (min) ❑ N/A — pressurized field FE -1 Monitor tubes go to bottom of effective. If not, state depth into effective Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 018-271-88 Structure served by this system Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No Q Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date of Sample 10/23/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 0 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 0 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' 7 Yes Community Sewer Manhole/Cleanout > 100' p✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ✓� Yes if No Water Main > 10' Animal Containment > 50' r7l Yes if No ft F,71 Yes if No ft Yes if No. Water Service Line > 10' P/ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ElYes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7 Yes if No ft Surface Water > 100' ❑✓ Yes if No. Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ✓� Yes if No Water Main > 10' F/1 Yes if No ft Community Wells > 200'✓0 Yes if No. Water Service Line > 10' P/ 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS ft ft ft ft ft G. ENGINEER'S CERTIFICATION t ' a a 0 e Ewa �� I certify that I have determined through field inspections and review' a° s of Municipal records that the above systems are in conformance with r; ` ,-i MOA COSA guidelines in effect on this date.,,, .............. ® AMCFlAEi N. G, vD[ R. G;d e,`e CE - 469 COSA Checklist yellow sheet�"�' ft ft ft ft ft