HomeMy WebLinkAboutTIMBERLUX #1 BLK F LT 8
MUNICIPALITY OF ANCHORAGE
DJ, ,RTMENT OF HEALTH AND HUMAN SER~,I~ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na,.e DISTANCES
Add~ess TANK FIELD WELL
Township, Range. Sec[ion
Manulactu,er~x~ SEPTICj~ I~ Capac,ty ~m[~ga,,onsHOLDiNG ~ ~ ~ ~ ~ ~ ~ ~
original grade Z I ~¢~ ~. O
Gravel lenglh Gr~vel w,dth /
WELLS
PRIVATE ~ OTHER (Identify) ~.~ ~ ~ ~ ~ ~.
Scale: [{{~ ~d : ' ~N~INEERSSEAL
17034 Eagle River L~ R~d No. 2~
I Ea;J: ~[';;r, A[~ak~ ~;37Z codify tho this inspection was pedormed according to all
72-0r3 (3/85)
F:'I..iYI. !... Z .'::i E¢CHPt :[ D'f'
F:' ,, (],, i.:)(]X
~'d'~l (:] H ( l~ I~ i:>i(:~ I'Z ~, ~:~I<: ~}' 9 !:=.;;2 q-
;-.' 7 V-..6 xl, zl. a
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERF
LEGAL DESCR'PTION: [.~ ~:~ '~K '~P-~U)/~
1
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18-
19-
20-
Township, Range, Section:--~[~.N.~ ~_..'~..~ ~.~-~.~,~¢-,
SLOPE SIT~: PLAN I
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
/
i)eplh to Water After
Monitoring7 /~,. Date:.
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERFORMED BY:
PERCOLATION RATE (~0~ (minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN '~ FT AND Z~ FT
CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
LEGAL DESCRIPTION: ~,c~T (c~ /~/< ~
1
2
3
4
5
6
7
8
9
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
Township, Range, Section:
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT · O
DEPTH? /(.~ p
E
Depth to Water Alter , /
MO~liloriflg? /0 Dale:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE __
(minutes/inch) PERC HOLE DIAMETER __
TEST RUN BETWEEN FT AND __FT
PERFORMED BY: I?0~4 Ea~lle River i.oep Rea~ No. 204 CERTIFY THAT THIS TEST WAS PERFORMED IN
Eagle Rlver~ Alaska
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
GAAB-HD-I
GR~"~TER ANCHORAGE AREA BOROU~'H
I~, ~'J HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
MATERIAl
NUMBER OF
COMPARTMENTS
INSIDE WIDTH.
GALLONS. INSIDE LENGTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS. / OUTSIDE DIAMETER ~ OR WIDTH
LINING MATERIAL ~-q~.7~/~_,~'""~' d~'//L/,J'"~' DISTANCE FROM WELL
NEAREST LOT LINE.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
LENGTH ,/~ / , DEPTH
BUILDING FOUNDATIOF~
TiLE DRAIN FIELD:
DISTANCE FROM WELT
NUMBER O~
AREA
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
~_~-~-OUNDATION~'~ . NEAREST LOT LINE , OF LINES
DISTANCE BETWEEN LINES ~ TRENCHI'/WIDTH IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH ~ /~/~
DEPTH OF F LTER MATERIAL BENEATH TILE
IN. ABOVE TILE __
r( DISTANCE FROM WATER
WELL: TYPE /~/~'/~///'-~/~"/~'/~ )EI)TH ~ ,BUILDING FOUNDATIOI~ SAMPLE -'4'/~ NEAREST
LOT LINE ./~O' /-~* NEAREST ~ SEPTIC / SEEPAGE -' ~ OTHER
' . SEWER LINE . TANK _/~)~/ , SYSTEM /-~ CESSPOOl SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
GAAB-HD-2 ~
GREATE1(. ANCHORAGE AREA .)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
Case No. c-~-1~'
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
MAI LING ADDR ESS ,/'~X ~/'~
RESIDENCE AODRESS,~'~/[~//' 2~'/ ~"~-Y'/¢' LOCATION OF INSTALLATION
LEGAL DESCRIPTION ,Lz~7~ ~ ~=~-.-' "~y/:~,~-7~.c['~z,~
/
APPLICATION TO INSTALL: SEPTIC TANK ~ ,, SEEPAGE PIT L// , DRAIN FIELD, , OTHER
' TO SERVE THE FOLLOWING FACILITY --'///~>7~,,,~, .7~'~//~
FIN~NCEDTHROUGH L//~ TO BE INSTALLED BY
~ TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS//~/~- ~-~'~//--~-'~" , PERMIT TO INSTALL A
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
'~,~- ~ AREA~,/~ ~'~ 7~TYPE
, SEPTIC TANK SIZE /j~""~-g-&-' TYPE c'zk'~£~-Yz¢-, SEEPAGE
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
OR
LICENSEE) DE$IGI~ER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described ~ystem is in accordance with said code.
ENCROACHMENT AGREEMENT
THIS AGREEMENT, made and entered into this llth day of
June, 1987, by and between CHUGACH ELECTRIC ASSOCIATION, INC., an
Alaska non-profit electric cooperative membership corporation of
Anchorage, Alaska, hereinafter called 'First Party', and Carroll
J. and Phyllis Schmidt of Anchorage, Alaska, hereinafter called
'Second Party', WITNESSETH THAT:
WHEREAS, First Party occupies an easement on the East
side of Lot Eiqht (8), Block F, Timberlux Subdivision, Addition
No. 1, Anchorag~ Recording District, Alaska; and
WHEREAS, Second Party wishes to construct a leach field
for a residential septic system which will encroach approximately
Five Feet (5') onto the foregoing easement.
NOW, THEREFORE, for and in consideration of their
mutual agreements and other good and valuable consideration, the
receipt of which is hereby acknowledged, First Party, for itself,
its successors and assigns, waives its objections to Second
Party's encroachment on the said easement for the purpose men-
tioned, subject to the following conditions:
1. Second Party will hold First. Party harmless from
liability for any injury or damage to any person or property
which may result from such encroachment.
2. The said encroachment will be without prejudice to
Firs% Party's full enjoyment of any and all rights it may have in
and to such easement.
3. Any facilities or property of First Party which
are damaged or destroyed as a result of such encroachment will be
repaired or replaced at no cost to First Party.
4. Second Party will comply with all applicable
safety codes and regulations.
5. Any expenses which First Party may incur in the
relocation or modification of its facilities to accommodate the
said encroachment will be paid by Second Party.
By its execution of this~ Agreement, Second Party
agrees, for itself, its successors, and assigns, that its
encroachment upon the named easement as hereinabove mentioned
will be subject to the foregoing conditions.
IN WITNESS WHEREOF, the parties have caused this Agree-
ment to be executed by their duly authorized representatives and
agents as of the day and year first above mentioned.
CHUGACH ELECTRIC
ASSOCIATION, INC.
(First Party)
V~ick Newland
General Manager
CARROL~J. AND PHYLLIS SCHMIDT
(Second Party)
CarrollJ ~ ~cl
Phy~is Schm
fidt'
WYA/smm
LSRW/37-8
&: S ENGihiEEtT)]N(3
70154 E:i~
I[:]A{DL,{:iF~,]iVERv AK
F:'H(]NE 4+694--2979
PHONE: .~. / . -~:¥.-.-..,
I_L:':()JAI_ DI!LSCI::;~:[P-I :[{3N: I...C) I' 8
SEC 34
I_C)/~ S :1: Z [E ~ i. ::'~; ( ~3(~ I:: I' (iR f.~C~f:~[~S )
HAX~ NUMBI~:R OF' BEDRC)OHS~ 4
SOIl.. l.-,fql.l,l,l(Jg ~5' Sr.) F:i'/BR 4~,
,::~t I_ 'lEST DEI:::"IH~ ,t.,, F:'I
I'IZGHEST I, tl~lEl:~ ]'ABI.._IZ DEP]'H~
'TI'I:(S IS AN UF'GRADI~: OF: 4 BEDRC)I~M 'TO '[FIE EXIS'I'iNb SEPTIC; SYSIEH
W. DRAINFIELD
EI::'F'EC T :[ VI:::: OEP1'H () 4
COVER DI~:I::" [ I-I () 2
T(]TAI.. DEF' '1]'{ 6
I FNGI H 60
W ! D i]-.I 5
S(~ F i. 600
AN ADDI:I ]:OiqAI_ "~ F't. 01::' I:::]:l..L W.[LI [ USED 'YO t~::l~.l,fi-]l-Jl::~l~:- A MINZi"IUI"I C(]VER
(::IF:'-;.~ I::: I:, OVER ]1"11]: I::'RC)F:'CISE]) UPGRADE.
January 18~ 1971
~lr. Carroll J. Smith
Box 2168
Anchorage, Alaska 99501
SUBJECT: Permit and Application for Sewage Disposal
System, Lot 8, Block F, Timberlux Subdivision
Dear ~lr. Smith:
'April 27, 1970, you obtained a permit from this Department
for the installation of a sewage disposal system. As of
this date, the permit is still outstanding.
Please advise this Department if you have installed, or
still intend to install, a sewer system on the subject
property m~d wish your permit kept pending in our files.
Sincerely,
Lynn S. Coad
Sanitarian
,o5:,, !
SLOPE TEST
SIZE
DATE
HRS.
BIT AND COREHEAD RECORD MUD RECORD r TIME RECORD DRILL STEM RECORD
fT.
FT.
SIZE
MAKE
FT,
7-10
[J~T AND CO/~EHEAD RECORI~ MUD RECORO TIME RECORD DRILL STEM RECORD
MUNICIPALITY OF ANCHORAGE
01'
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 018-271-12
Certificate of On -Site Systems Approval
Expiration Date: 10 a-�� 9 y
1. GENERAL INFORMATION
Complete legal description TimberlUX #1, Block F, Lot 8
Location (site address) 15341 Curvell Dr., Anchorage, AK 99516
Current property owner(s) Brian Klassen Day phone
Mailing address 15341 Curvell Drive, Anchorage, AK 99516
Real estate agent Chris Swires Day phone 830-0073
2. TYPE OF DWELLING:
0 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:
Private Well
Q
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 $ 515 O` D D t
Date of Payment /1 0 / a NJ
Receipt Number O I P✓D
COSA# 05m o'3
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
'_&Pj0Lr\_.'
6. 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 Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/9/19
6. DSD SIGNATURE
System #1 Approved for 4
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
bedrooms, with the following stipulations:
OF lrr��ri
-fie
J
NJPTER A�lD
� o VVAS-TEVqATER r_0^ =
J Cn 1
J \ 1
J�Jii��NT SER��G �����\•
By: t, � Original Certificate Date: 7 <V-) "-I
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
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'
60
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' Q Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' 21 Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Q Yes
if No
F/ Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0✓ Yes
if No
ft
Q Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
Q Yes if No ft
Property Line > 5'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'✓Q Yes if No
Water Main > 10'✓0.
Q
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No.
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' Q Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
Q✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q
Yes
if No
ft
Private Wells > 100' Q Yes if No
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
Septic tank to well met separation requirements at the time of install.
1987 upgrade MOA approved to within 5' of property line with utility non -objection letters -see MOA record docs.
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 COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Ilk
................
All
« Lh
p� ,K,x« K3 ked«K9
3 8K3KK,R8K683K3438K36838KK83Kl3,K,a A38�8�a
MICHAEL En ANDERSON
AN0f
O. 4..-43p1
`'•,, 7/9/19
ft
ft
ft
ft
t
Legal Description: Timberlux #1, Block F, Lot 8
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/8/70
Total depth 106 ft
Cased to 94 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 13 in.
Date of flow test for COSA 6/24/19
Static water level at beginning of test 64 ft.
Comments
B. TANK DATA
Age of tank(s) 32 years
Tank type/material SEPTIC/CONCRETE
Measured operating fluid level in septic tank 91"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 6/27/19
D. ABSORPTION FIELD DATA 5` Wide Trench
Which system tested (date installed) 6/19/1987
❑ ALL standpipes present per record drawing
Total measured depth from grade 7.6 ft (max)
Measured depth to pipe invert from grade 3.6 ft (min)
❑ N/A — pressurized field
❑ 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: 018-271-12
Structure served by this system
Well production at time of test 4.9 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes Al N
Al Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by FORGE ENGINEERING
Date of Sample 7/9/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6/24/19
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 2 4 in
Water added 787 gal
New depth 33 in
Elapsed time 1440 min
Final fluid depth 22 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months) None
If yes, enter date
•
•
0.
Municipality of Anchorage
On-Site Water and Wastewater Program a
ski l
(907) 343-7904
Sa cry
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 018-271-12 Expiration Date: /10 —7 ^f 7
1. GENERAL INFORMATION
Complete legal description TIMBERLUX#1 BLOCK F LOT 8
Location (site address) 15341 CURVELL DRIVE,ANCHORAGE,AK 99516
Current Property owner(s) CARROLL&PHYLLIS SCHMIDT Day phone
Mailing address 1120 HUFFMAN ROAD, STE 24-548,ANCHORAGE,AK 99515
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer El
Public Water System ❑
WaiverNariance request for: Distance:
Received by: / 4i4i - Date: 7-/D -/ 7
COSA to be released to the engineer, unles . _ ise requested by the engineer.
COSA Fee $ EjAp - Waiver Fee $
Date of Payment ( ,l 2--ii ii Date of Payment
Receipt Number bafgL Receipt Number
COSA# Oil 10 (0 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 Or-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 ARCTERRA CONSULTING,INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 6/2212017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. a 4 p
Ar
6. DSD SIGNATURE
TIi /�
System #1 Approved for Li bedrooms. - � --
F KENNETH Si. DITET: /
System #2 Approved for bedrooms. � rh 7116
F o ,z)-,
Disapproved. \ 1" FE5310 N''
Conditional approval for bedrooms, with the following stipulations:
----TPAJvrf C,ci to 1 is �-.0 .Q• ``--rwLay
,(,,Da frUv4 -e )ss�e1 c 4,o csedAe_ _afro
A�
C
ON-SITE
(NATER AND 1
1 VI!ASTE1!Il,/\TER o
PROGRAM c
. `C` G�\`
By: �- r 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: TIMBERLUX#1 BLOCK F LOT 8 Parcel ID: 018.271.12
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID # Well Log (Y/N) Y _
Date completed 718/1970 Sanitary seal (YIN)Y Wires properly protected (Y/N) Y(Well is inside house)
Total depth 106 ft. Cased to 94 fL Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 7-8-1970 6/1512017
Static water level 65-70 ft. 70 ft.
Well production 7-10 g.p.m. 4.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform 4,1,/ colonies/100 mL Nitrate AD mg/L
Arsenic: //J ug/L Date of sample: 6/15/17 Collected by ARCTERRA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC 1 CONCRETE Date installed 1970
Tank size 1250 gal. Number of Compartments 1 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 6/15/2017 Pumper_ A+
C. ABSORPTION FIELD DATA
Date installed 6/19/1987 Soil rating (g.p.d./ft2 oft2/bdrmJ 150 System type SHALLOW TRENCH
Length 60 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8.4 ft. (Measured 6/15/17) Eff. absorption area 600 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/15/17 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 _ in. Water added 615 gal. New depth 25 in.
Elapsed Time: 1380 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot *60.65' On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1001+
Wells on adjacent lots 100'±
ABSORPTION FIELD ON LOT TO:
Property line *5' Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway,parking/vehicle storage 104
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
*Well is located in half basement with surface drain. Septic tank to well met separation requirements at time of install. 1987 upgrade
MOA approved to within 5'of property line with utility non-object letters—see MOA record docs.
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in conformance -1111.-'116.1%,
with MOA COSA guidelines in effect on this date. # OF 9I ` 1
Sy
Engineer's Printed Name KENNETH M.DUFFUS - 1,-
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0 n . 0 O NO CORNERS SET THIS DATE
DO%, SHANE A.HOLT. oO
On• LS-6914 o`O I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
O.1%‘,'Ar ' ,°o SURVEY ORDERED BY; OF THE FOLLOWING DESCRIBED PROPERTY
pia Oo
�OOo�o�o KAREN DANNENBRINGO LOT 8, BLOCK F, TIMBERLUX SUB. NO. 1( PLAT 66-152)
NORTHERN TRUST R.E.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE INFORMATION HEREON IS FOR THEU5EOFLENDINGINSTITUTiONSSPECIFICALLYTO5HOWANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS:AND IS EXIST OTHER THAN NOTED.
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES.IMPROVEMENTS.OR FENCELINES. DATED AT ANCHORAGE,ALASKA THIS 19TH DAY OF
EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN _
HEREON(UNLESS INDICATED) _JUNE , 2017.
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DE TERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE
\\----
9309 GROVER DRIVE
\ ANCHORAGE.AK 99607 f
13604, FB 183-21 345-5513 /l
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AN D WATER FACILITY H 8 6-13 2 9
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 8 Block F Timberlux Subdivision
Location (address or directions)
15341 Curvell
(b) Property Owner Phyllis Schmidt Telephone: Home 345-1703 Business 279-6441
561-5277
Mailing Address PO BOX 240063, Anchoraqe, Alaska 99524
(c) Lending Institution First National Bank Telephone
Mailing Address Southcenter Branch, PO Box 4-2090, Anchorage % Rita
(d)
Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the followina address: or: Check here I-I, if hold' for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family [~X
Number of Bedrooms four (4)
WATER SUPPLY
Individual Well:lEkx Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [~x::'Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
attesting to the legality and status. ' ·
Conservation
Page 1 of 2 72~o25 fRev 8/861 Front
· 5.
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S & S Engineerinq Telephone
Address 17034 Eagle River Loop Road, Eagle River 99577
Date
Engineer's Seal
This department has received written confirmation from the
engineer regarding the Conditional Approval of December 17, 1986.
The corrections have been accomplished and an inspection has
been completed by the engineer. The subject property meets
with Municipal standards and is now approved°
DHHS APPROVAL
fo'ur ( 4 ) bedrooms by ,'~'~"~--~ /4:~' "~'/~ Date
Approved
for
Approved /'""" Disapproved('/ Conditional
Terms of Conditional Approval
CAUTION
The Municipa;ity 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.
Page 2 of 2 72-025 fRev 8/861 Back
ROBERTA, SHAFER
June 25, 1987
CIVIL ENGINEER
694-29Zg
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION,
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
JUN 6 1987
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
RECEIVED
REFERENCE: Lot 8; Block Fi Tlmberlux Subdivision
In December, 1986, you issued a conditional Health Authority Approval
for the referenced property. Th~ conditions of that approval have been
satisfied and a copy of the on-s~e s~wage disposal syst~, inspection
report is attached.
E.G,NEEmNOSTUO,ES R~quest~ssue a final HAA at this time.
AND REPORTS
&FLOWTEST ~~SHAFER, P.E.
SITE PLANS
ROAO DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN SRB 196X EAGLE RIVER, ALASKA99577
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
oF ON-S,TE SEWER AND WATER EAClL,TY
264-4720
12-5-86
Application Date
GENERAL INFORMATION
(a)
Legal Description !include lot, block, subdivision, section; township, range)
Lot 8 Block F Timberlux Subdivision
Location (address or directions) 153~1 Curvel l
~cl~u.,~,. Telephone: Home -,4~,- 17c~"4 Business ~-2.~1-5277
(b) Applicant Name 9~¢llis ~ '~ "'
Applicant Address P~O. Box 240063 ~ncho~ag~ ~.. 09524
(c) Applicant is (check one): Lending Institution D; Owner/builder ~; Buyer ~; Other D (explain);
(d) Lending Institution First National
Address South Center Bran~_h/At~n
(e) Real Estate Company and Agent
Address -, ~.
Telephone
Telephone
HOLD
(f) 'fCrafh'the HAA to the following address:
SR ~-196X
TYPE OF RESIDENCE
Single-Family [~ Multi-Family []
Number of Bedrooms 4
Other
WATER SUPPLY
Individual Well ['~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department ol [Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. _
72-025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDIN~*~*~,~SPECTIONS, TESTS, FILE SEARCH, DA~AND INFORMATION
A~ c~rtified by my seal affixed hereto and as of the validation date ShOWn bmow, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or was[ewater disposal system is safe, functional and adequa[e '
for the number of bedrooms and type of structure indicated herein. I further verity 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, ormnances, and regulations in effect on
the date of this inspection.
Name of Firm S & S ENGINEERINC,, Telephone ¢¢ ¢,~'--Z¢';~ ¢'
SRB 196X
Address
Date
EAGLE RIVER, AK 99577
A soil test is required to determine ground water level and to verify
soils for a system upgrade. If the water table is not influencing the
existing crib, then an upgrade of the absorption area for three bedrooms
will be required. If the existing crib is determined to be in non-compliance
than the absorption area will require upgrading for four bedrooms.
A conditional approval is recommended under the above conditions.
Engineer's Seal
DHEP APPROVAL
Approved Disapproved Conditional
Terms of Condiiional Approval ./~¢~"' .~.p,~.~i~/~w.~.w~'~-w-z'z~-~ /.- '" ,'~,~'_/~',/.,
'~ , ,!I ~ i/i/i
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (Md~r/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: f,ot R P,l~nk P q~imh~"ln~ ,~./r~
WELL DATA
Well Classification Private
Well Log Present ON)
Total Depth 106' Cased to
Static Water Level 58'
Casing Height Above Ground 12"+
Electrical Wiring in Conduit (Y~ *
Separation Distances from Well:
Depression Around Wellhead (YJ~J
If~ A, B, C, D.E.C. Approved (Y/N) N/A
Date Completed 7-8-70 '"' Yield
Depth of Grouting UK
Pump Set At UK
Sanitary Seal on Casing ~YN)
No
To Septic/Holding Tank on Lot tOO'+ ; On Adjoining Lots 100'+
To Nearest Edge of Absorption Field on Lot _ 100'+ ; On Adjoining Lots 100'+
To Nearest Public Sewer Line N/A To Nearest Public Sewer
Cleanout/Manhole - N/A To Nearest Sewer Service Line on Lot 30 ~ +
Water Sample Collected by S&S Engineering ; Date 1.2-7-R6
Water Sample Test Results Satisfactory --'
Comments * Well loeah~d in insulatm~ w~ll ho~-~ ~nnn~tc~ tn hn,~-
A four hour yield test was performed and it was determined that the
well will produce in excess of 0.104 gpm per BR.
B. SEPTIC/HOLDING TANK DATA
Date Installed 1-29-79 Size 1250 "'
Standpipes (~N) 'Yes
Depression over Tank (YJ~) No
Pumping/Maintenance Contract on File~t~7-
Holding Tank High-Water AlarmWWN)--
Separation Distances from Septic/Holding Tank:
To Water-Supply Well _ [OQ~+
To Property Line _ 10' +
To Water Main/Service Line 50' +
Course .N/A
Air-tight Caps (~N)
N./A
No. of Compartments 1
Foundation Cleanout (Y/~ No
Date Last Pumped ]
; for ..........
Temporary Holding Tank PermitJo~
To Building Foundation 20'+
To Disposal Field 20'+
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAl. PROTECTION
RECEIVED
C.. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 1-29-?]
Width of Field ].2'
UK
Square Feet of Absorption Area
Depression over Field (Y~_~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well 1 GO' +
To Building Foundation
Lot N/A
To Water MaiR/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments __
Type of System Design
Length of Field 12'
Depth of Field _ 10'+
Gravel Bed Thickness
2BB ,,~ Standpipes Presentt~/N)
No Date of Last Adequacy Test
A~quah~_ fn~ ] h~c]r'~nm
Seepage Pit
] 2-9-86
To Property Line 10'+
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) N/A
~/A
30'+
Soil test--to be perform~pgrade:
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
N
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify th~ I~,~;~jl~l~ji~ or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signed ~ ~--'J 9~X Date /2- -/~ /
Company~l~~ MOA No.
Receipt No. ~.~:~¢,/ ¢
Date of Paym.ent /-.~,//
Amount: $ ~"]~ /
Page 2 of 2
72-026 {11/84)