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HomeMy WebLinkAboutTIMBERLUX #3 BLK F LT 5 ~~ Municipality of Anchorage Page I of ''~ 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 Permit Number: Sbt)l~ ~ OL/~-Z// ~PID Number: Name: ~ ~O'~ Wastewater System: ~New ~ Upgrade ~ ~ - '~Sl~ ABSORPTION FIELD Lot: ~ BIoc~: ~ ~ubdiv~io~:,~/~ ~.~ Depth to pipe bottom from original~ grade: Ft. Gravel depth beneath pipe ~ Ft. Township: I Range: I Section: Fill added above original grade: Gravel length: ~ Ft. WELL: ~,~D New D Upgrad Gravelwidth: ~ Ft. ~ ~/~; Ft. Classification (Private, A,B,C): Total Depth: Cased TO: ' ,~ Ft. Total absorption area: Pipe materiah Yield: ~mp Set at:v Ft. ICasing Height Ab°ye Gr°u~t~:Ft. K ~EPARATION DISTANCES ~s~,t,c ~ Ho,ai,~ ~ S.~.E.~. TO Septic Absorption Lift Holding ..blic/Private Man~cturer: Capacity in gallons: ~ 0 ~ ~ From Tn., Field Statio. Tank Sewer Lines Manufacturer: L~te ~ ~, J~' Size in gallons:I at__water at: Remarks: ~ST,~ ~P)-'~ ~K BENCH MARK Assumed Elevation: Department of Health and Human ~e~ices approvm 72-013 (Rev. 9/91 ) MOA 25 PERMIT No~.SW980454- PAGE 2 OF 3 D ........ H uDiciD .~Li~. y_o. F Anchor'oae I:::I~AN/I'II::N/ Ol- HI::AL/H AND HUIVTAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box i96650 eAnchorage, A~aska 99519-6650eTe~ephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK F, TIMBERLUX #3 P.I.D. NO. 018-271-90 100' WELL RADIUS LOT COS 4 OBL1 )BL2 NEW 1000 GALLON SEPTIC TANK E~STINC THREE BEDROOM HouSE ,DECK EXISTING WELL SCALE: 1" = 40' LOT 16 ROBERT C, COWAN CE-8801 LOT 6 PERMIT NO SW980454 PAGE 3 02" 3 D ........ H u n_, ici p .o,Li ~ y._o. ~ Anchor o,c e I-I-'AI~/MI-N/ UI-' MI-AL/M AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION p,FI. 3ox 196650 mAnchorcge, At~ska 99519-6650eTetephone~ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK F, TIMBERLUX #3 P.].D. NO. 018--271--90 ST1 ST2 /FINAL 97.3' NEW 1000 GAL SEPTIC TANK GRADE A B C FCO 2.0' 22.5' - ST1 10.0' 26.5' - ST2 16.5' 30.5' - !DBL1 18.0' 31.5' - DBL2 19.0' 32.5' - OV 20.0' 33.0' - CO1 28.5' 34..0' - C02 53.5' 36.0' - C03 41.0' 61.5' - C04- 73.0' - 81.0' MT1 41.5' 62.5' - MT2 72.0' - 81.0' MT1 MT2 FINAL GRADE k C03 2" INSUhATION/ ...... ~ = 85.4'/ = 86.2'* 95.6' 95.3' 92.5' * ELEVATION ACTUALLY 85.4' - SEWER ROCK INADVERTANTLY DUMPED INT0 MON1TOR[NG TUBE AND WEDGED INT0 BOTTOM. PUMPER COULD NOT REMOVE. · NO WATER FOUND 79.4' B.0.H. Municipality of Anchorage. ff '~ '"' t;~, '~ 825 "L Street, Anchorage, Alaska 99502-0650 ~,~_ ~?,..:/..~.., SOILS LOG -- PERCOLATION TEST ~,%~ ,O~,,T C. COW~N j,? ~ LEGAL DESCRIPTION:L0~ ~ ~ ~ ' TI~Be~LV~ ~Township, Range, Section: 1 2 3 4 5 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17 18 20- WAS GROUND WATER ENCOUNTERED? SLOPE SiTE PLAN IF YES. AT WHAT DEPTH? Depth to Water After ~ Monitoring? Dale: PERCOLATION RATE J ~, '~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~) FT AND '7 FT ' ' ' '"~'N"E'IN~ ~/;~ CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY'. ..... I ' I/u~ ~agJe River Loop ~oad NO. 2~ ACCORDANCE ~*~I~IA~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C /; ~ / ~ 72-008 (Rev. 4/~) R ea'di&g Date Gross Net Depth to Net Time Time Water Drop / ;l o - " -- :~ 0 30 ,,.,,~ Io '/~" "~ '/.~" 0 -- 7~/~'' -- ~0 ~ ,~,w I0 '~S" ~ ~/~" O - ~ '~/~,, ._ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 23, 1998 Expiration Date: Nov 23, 1999 Permit Number: SW980454 Legal Description: TIMBERLUX#3 BLK F LT 5 Design Engineer: 0003 S & S Engineering Owner Name: Steve Potter OwnerAddress: 15026 Longbow Drive Anchorage, AK 99516-4142 Parcel ID: 018-271-90 Site Address: 015026 LONGBOW DR Lot Size: 45000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date:l~- ROBERTC, COWAN, RE. ROSERT A. SHAFER, RE. ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST ROADOESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE W/~SIEWAT E R DISPOSAL SYSTEM DESIGN November 17, 1998 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Block F, Timberlux #3 Request you issue a permit to install a septic system to serve the three bedroom dwelling on the referenced property. Also request conditional health authority approval. Monies to be escrowed and the septic system upgraded by June 15, 1999. There is no eminent health hazard, no surfacing effluent, and there will be no adverse effects as a result of granting the conditional approval. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 11/12/98 water was not encountered in the test hole. After seven days of ground water monitoring the monitoring tube was dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/rdp Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 SCALE DESIGN C) DETAIL 0 Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: T'-/~' ~j ~' LEGAL DESCRIPTION: LO ~'- 4-- DATE PERFORMED': Township, Range, Section: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Cf- ~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~ - DEPTH? pO E Depth lo Water A(ter ~),.,~ ~ tl/~O/Ol~ Monitoring;' gale: Reading Date Gross Net Depth to Net Time Time Water Drop / / /O/~f; o - ~ '/~, " - ,,gO 3 o ~,,,,v (~ " ~/~ " PERCOLATION RATE 3.J O (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~7 FT AND (~ FT PERFORMED ' ACCORDAN~¢~~ZNJCIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72*008 (Rev. 4186) ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE pLANS ROAD DESIGN SO]LTEST STRUCTURAL & MECHANICAL INSPECTIONS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 5, Block F, Timberlux #3 Subdivision November 17, 1998 GENERAL: The scope of this project includes installing a leachfield and 1000 gallon septic tank to serve the three bedroom residence. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible .for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shitting of the tank. 17034 NORTH EAGLE RIVER LOOP SUITE 204 EAGLE RIVER, ALASKA 99577 Page 2 Lot 5, Block F, Timberlux #3 November 17, 1998 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tmrks installed with less than 4 R. of cover shall be insulated. A fotmdation eleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not mom than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. ~ flew ~,Adcr~ ghallS~ ' ' trench _~_,a remaining4/4 ~cw t~ sh,~e~moh. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page 3 Lot 5, Block F, Timberlux #3 November 17, 1998 Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: T.vpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting eng'meer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 5, Block F, Timberlux #3 November 17, 1998 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work ontlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER oGREr, ,-ER ANCHORAGE AREA BOR .,JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER (/~/~.~-//~ MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPAC ITY/~i~GA LLON S. TILE DRAIN FIELD: /~,T~ TOTAL LENGTH NUMBER OF LINES / DISTANCE BETWEEN LINES - - TRENCH WIDTH~IN. TOTAL EFFECTIVE ABSORPTION AREA SQ, FT. LENGTH OF EACH LINE ~'. DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE ,~.,/~7 MATERIAL BENEATH TILE ~',~ IN. ABOVE TILE .~,, IN. TYPE.~I' ./,"/~'.,~ .¢,/~ CONSTRUCT ON BUILDING NEAREST NEAREST FOUNDATION__ LOT LINE __ SEWER LINE__ DEPTH SEPTIC SEEPAGE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: INSTALLED BY: SEWER LINE DEPTH: DIAGRAM OF SYSTEM DATE~APPROVE© ~ t I,,IELL Eli'-t[> PERMIT NO. ( 76~80 ) APPLICANT ..TAPIES N ~"r~ LOCATION LONGBOW AVE LEGAL L5 BF TIMBERLU::4 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 99507 276-222t 4248 W c,,_,lH LOT ~492t74± 44000 SOUARE FEEt' ¢-- c ,-~ TREN ~.H 'f"*'F'E OF =,uIL RBSORE:TION _,~.~TEH 1EX: ' ' r- MA:.~:IMUM NIJME:ER OF BEDROONS = 5: SOIL RFITING <SQ FT, E,R.- :tSO 'THE REQUIRE[) SIZE OF THE SOIL. ABSORPTION S'¢STEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF TFIE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E)4CRgRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I~ THE MINIMIJM DEPTH OF GRAVEL 8ETNEEN TNE OUTFRLL PIPE BND THE BOTTOM OF THE E)4CAVRTION (IN FEET). E:ACKFILLIN6 OF ANY SYSTEN .WITNOUT FINAL. INSPECTION FtND APPROVAL. BY THIS; [:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUH DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL S:'¢S'rEH IS ~88 FEET FOR R PRIVATE HELL OR 208 FEET FOR B PUBLIC WELL HELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE [:,EPRRTMENT WITHIN ~¢ DRS'S OF THE WELL COHPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE F'ROF'ER I NSTRLLAT I ON. I CERTIF'¢ THAT ,_;~. _,EHLRR.., AN[) WELLS RS ±: I AM FAMILIAR WITH THE REQ[IIREMENTS FOR ON-SZTE ~;:' FQRI'H B'¢ I'HE NI_INICIPALIT'~' OF MNE. HuRMmE.. 2: I WILL INSTALL THE _,t_TErl IN RCCOR[:,RNCE WITI4 THE ]:O[:,E~ ~: I UNDERSTFtN[:, THAT THE ON-SITE SEWER S'¢STEM MR'¢ ,REQ~IIRE EWLRRGEMENT IF ~iE · Performed For Lenat qescriotion: This form Reoorts "0~ ~$t i~ worth a ~housand o~nions" 2204 Cleveland Anchorage, Alaska 99503 James Wahley Date Performed 5/2~/76 Lot 5 8]0ck F Subdivision Timberlux Soils Loq yes Percolation Test yes Pe0th Feet S0il Characteristics ~op~oil Silty Gravelly Sands 4-- (SP-SM) /~ Silty Sandy .Gravels. (GP-GM) 1%, Bottom of Test Hole 20-- r ii' "-- h, ln¢ _ ,I Was Ground Water Encountered? No, ~je I¢ Yes, At what Depth? I Da'te Gross Time Net Time Depth to H20 Net Drop' inches inches 0 48 5/26/76 5/27/76 24 hours 5/27/76 0800 0 54 ___~ ~ 1130 210 min. 73 ll45 5 5/27/76 1205 -- 30 min. 57 -'--'-~.25 5/27/76 1215 40 min. '58 1/4 1.25 ~. ~3.~ 50 min. 59 1/2 1.2', 60 min. 'bo 3/4 1.25 Percolation Ra ~ te Pronosed Installation: Seeoane Pit Drain Field Deoth of Inlet Depth To Bo%tom Of Pit Or Trench CnU~ENTS: 150 $~uar~ feet drainage required per b~droom. No ground water or bedrock encountered. Test Performed By_ James D Mack Data Certified BY: CONSTRUCTION TEST Date: 5228/76 ~%5 PERMIT M[Ir-~I [:I PAL I T¥ OF A~JCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 E. TUDOR RD., ANCHORAGE, AK. 9950? 276-222i 76i~4 ) APPLICANT JAMES WHALE~ 914 EAST ?ATH AYE LOCATION J~ ST ~)~J ~/~ ~ LEGAL L5 BF TIMBERLUX SUBD LOT SIZE 45000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND AN%' ON-SITE SEWAGE DISPOSAL SYSTEI4 IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC W~LL. WELL LOOS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN -~0 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AYAILABLE~ TO INSURE PROPER I NSTALLAT I ON. PERM I T YAL I [~ FOR ONE YEAR FROr4 I I CERTIF~ THAT l: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BM THE MUNICIPALITM OF ANCHORBGE. ~: I WILL INSTALL. THE SYSTEM IN AC~ORD~WITH THE CODES. ISSUED BY--~'--J---rUL~UU-~ ........... ~ .... =~ June ~, lg7~ LCR/1Jh P.O. Box4-1224 · ]310C International Airport Road (907) 274-46! 1 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Jim Whaley Use of We]lDom Location (address of: Township, Range, Section, if known; or distance main road L 5~ Blk F Timberlux Sub. Size of casingf 6" Static watdr level 75 Screen ( ); Describe screen or perforation Well pumping test at 8 gallons per of drawdown from static level. Dhte of completion 14 June 1976 Depth of Hole 1 27 feet Cased to 126.5 feet ft. ~) (below) land surface. Finish of well (check one) open end ( x Perforated ( ). (minute) for 1 hours with 100~ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ); ft. 0 TO 2 2 TO 5 5 TO 15 '15 TO, 19 I q TO 50 50 TO ] oo__ __iDDTO ] 2.2 1 ~2TO. 127 .TO. .TO. TO_ 'TO TO _TO _TO Casinq Stickup Orqanics Silty Gravel Sand & Gravel Silty Gravel: Hard Pan! Cnhhle~ & Bnnlder~; Sandv Gravel-Water Naa. Cobble~ Cemented Hard NW',A'A k:cr~l'icd (Jonh'aclor C(;,J e~ te No's. 814 & 973 1 --CUSTOMER MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-271-90 1. GENERAL INFORMATION Expiration Date: 2, 2 Complete legal description TIMBERLUX #3 BILK F LT 5 Location (site address) 15026 Longbow Dr, ANCH AK Current property owner(s) Mailing address Real estate agent Jeff Shank SAME 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic [Q 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 $(_ Waiver Fee $ — Date of Payment /0 Date of Payment Receipt Number 02 99 %% Receipt Number, COSA # 0_'�2,1 1 6 Ll L-1 __ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-25-21 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for _ Disapproved Conditional approval for _ �6�. •• q `! Owl . . . . . . ...... .. rd bedrooms MICHAELN. ANDLRSCN : r� bedrooms' C -W946 •.' �� '° D k% L. - 4 bedrooms, with the following stipulatiolsr :%g'i�� ,�lttr a rri�,. BY vv Original Certificate Date;_L1/_z_5A The Municipality of Anchora Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA)�basedonly upon the representations given in p ragraph 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 ' 1 ,g0 r/ COSA Checklist Legal Description: TIMBERLUX #3 BLK F LT 5 If more than T septic system on lot: COSA Checklist # of A. WELL DATA ❑Q Well log is filed with Onsite (or attached) Date drilled 1114/76 Total depth 127 ft Cased to 126.5 ft A Sanitary seal is functioning correctly N Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 11/3/21 Static water level at beginning of test 88 ft. Comments B. TANK DATA Age of tank(s) 22 years Tank type/material �Plicly l Measured operating fluid level in septic tank 48 ❑■ Standpipes/foundation cleanout per record drawing Date of pumping 10/26/21 D. ABSORPTION FIELD DATA * new trench tested Which system tested (date installed) *1999 X ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 3 ft (min) f(3i.V w r, M/),t ❑� 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 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 018-271-90 Structure served by this system Well production at time of test 3.5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by MNA Date of Sample 1113121 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 11/3121 Results QPass For 3 bedrooms Fluid depth prior to test 22 in Water added 450+ gal New depth 33 in Elapsed time 1440 min Final fluid depth 22 in Absorption rate 450+ 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' ❑ Yes if No *5 Community Sewer Manhole/Cleanout > 100' ✓Q Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100'[j✓ Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10'✓Q if No Animal Containment > 50' Q Yes if No ft [] Yes if No ft Water Service Line > 10' []✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MV 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 *5 ft Surface Water > 100' 0 Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Absorption Field > 5' Yes Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'✓Q if No Yes if No ft Community Wells > 200' [Z] Yes if No ft Water Service Line > 10' []✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 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 ft Water Service Line > 10'[]✓ Yes if No ft Community Wells > 200' j] Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS * ofd code G. ENGINEER'S CERTIFICATION l certify that / 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 1�� 4.9rt� t kOfL, w.....,..,. MICHAEL N. Ah:DLASGA a� CE -9 9 r Septic Tank Advisory Certificate of On -Site Systems Approval # OSC211644 Subdivision: Timberlux #3 Block:F, Lot: 5 The septic tank for this property is 22 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Mailing Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environrnental 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. # 018-271-90 1. GENERAL INFORMATION Complete legal description Lot 5, Block F, Timberlux #3 S/D Location (site address or directions) 15026 Longbow Drive Property owner Steve Potter Day phone562-2211 Mailing'address 1864~ Guillemot Circle, Anchorage, AK 99516 Lending agency Day phone Mailin. g address Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ××x Community well Public water if community weft system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank ~ Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72A)25 (Rev, 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. $ & $ ENGINEERING Name of Firm Eagle River, Alaska 99577 Address Engineer's signature Conditional Health Authority Approval is requested. cost of septic system upgrade. Phone ~'~"¢ _~t..c/ 7 9 Monies to be escrowed to cover th~ Upgrade to be completed by June 15, 1999. DHHS SIGNATURE Approved for Disapproved. X Conditional approval for bedrooms. bedrooms, with t~e following stipulations: Money shall be put in escrow 1.5 times the amount of the highest bid amn,m~ ~f ~ minimum of three(3) bid~ for the constructicn cf thc proposed wastewater system pursuant to Permit #SW980454 attached. Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Auihority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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 ~F {~ DEPARTMENT OF HEALTH & HUMAN SERVICES~ '~' Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)1~.g~,4499[~~, l ~-~ ~ Municipality of ~, ~., ~,t'"heckli-l~ept' Health Health Authority APproval LegalDescription: ~0"1~ ~- j~Lo¢~ F '/I,'~fJ~z~,~x ~} ParcelI.D.: O~ ~ - 3-11 A. WELL DATA Well type Log present ~N) ¥ ~ J Date completed Total depth I ~- -~ Cased to Sanitary seal (l~) 'V A ~ If A, B, or C, attach ADEC letter. ADEC water system number ! Casing height (above ground) Wires properly protected {~/N) Date of test Static water level -7 Well production WATER SAMPLE RESULTS: Coliform Date of sample: II B. SEPTIC/HOLDING TANK DATA Date installed ~'/~' Foundation cleanoutt~/N) Date of Pumping, FROM WELL LOG g.p.m. AT INSPECTION g.p.m. Nitrate C9 o ~ o ~ Collected by: Tank size /L$ Depression (Y/I~ Pumper I ~',~ ~c_ £ Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River~ Alaska 99577 Number of Compartments ~L Cieanouts (~/N) 'Y~J /,~ 0 High water alarm (Y/~[~ /,~ O C. ABSORPTION FIELD DATA Date installed (o/~-~/7 (. Soil rating (g.p.dJfFo~)5'-0 Systemtype 'T~'~'~/'I Length ~ I Width } ' Gravel thickness below pipe ~3 Total depth Effective absorption area ~ S-0' f~ z Monitoring Tube present (~/N) ¥'~$ Depression over field (Y~-'~ __ Dateof adequacy test ~1/~o / ~ Results (Pass(~) ~',+, L For ~ Fluid depth in absorption field before test (in.); Fluid depth .,c ~/ '/> (ins) Minutes later:. Peroxide treatment (past 12 months) (Y/N) ~ 72-026 (Rev. 3/96)* bedrooms Immediately after)'/?SgaL water added (in.): ~'~ Absorption rate = ~ .3 I g.p.d. ~c,,,o ~,~,., If yes, give date -- LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cyql_es test~j~L-~ Size in gallons "Pump on" level at* ~el at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ! ~ o ' + Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots ) 0 0 rd- On adjacent lots ~/ //A Public sewer manhole/cleanout ~ ~' -,~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~- / '~- ~ ' y-' Property line Absorption field Water main/service line lO -r- Surface water/drainage /00 t- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 ~ Building foundation / t3 "/~- Water main/service line __ Surface water / o o -w Driveway, parking/vehicle sto~age area f Curtain drain ~ `~ '~ ~ tc ,v 0 ~J ~' Wells on adjacent lots / 0 d J 0 ..Y ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with, MOA HAA guicJelines in effect on this date. Signature /'~2 ~'~''""-'~ Engineer's Name ]/~O.d 4/¢ ~ (. Date ,/I//~ /'~ ( HAAFee $ ~'~'~! ~ Date of Payment // Receipt Number /¢~ ~//? ~c~ ? Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* HOU-06-~8 ~G:l? CT&E ESI ~HCHOR~GE ~07~G15~0~ P.O.×lO ZtJCT&E Environmental Servlee~ Inc. CT&E Ret'.// 986487003 Client Name S & S Engineering $'roj~'[ blamed# Client Sample IO LT $ Blk F Timberlux Matrix Drinking Wa[ar Ordered By l~y$1D ~le Remarks: Clleut POg Printed Date/Time 11/06/9g 10:47 Collected Date/Time 11103/98 15:15 Recelved DatedTlme 11/03/98 16:00 Technical Director[ Stephen C. Edt Tote[ Cotiform O Nitrate-N 0.Z05 pOL Unite AtLo~abLe Prep AneLy$i~ co[/lOOmL $M15 92Z2B 0.100 mg/L EPA 500.0 11/05/98 K~P 10 max 11/01/98 11/04/98 GCP NOU-~6-1998 16:18 CT&E ESI ANCHORAGE 90?5615501 P.OV×i~ CT&E Environmental Services Inc. Laborstor/Division 200 W, P0t~er Drive Anchorage. AK 99518.1608 ~nking Water Analysis Report for Total Coition-c, Bacteria T,~: IS071 Se=-2343 MUST BE COMPLETED BY WATt~ SUPPLIER TO BE COMPLL~'TED BY LABORATORY An~lysi~ ~hows this Water SAMPLE to be: PUBLIC WATER SYSTEM 1,D. # PRIVATE WATIgR SYSTEM Send Results ~ Send In~olct Eagle. River, Alask~ 99s77 Et Send Result~ C, Send ln~olc~ satisfactory Unsatiffactory O Sar~le over 30 hourS old, results may b~ unreliable Sample too long in transit: sample nh. Gold not be oV~r 48 hou~ old at ex aminatmn to indicat~ reli~le results. Please s~nd new samplo via ~gecial/d~v c.r,y mail. Analysis Bewail Analytical Method: ~..~embrane Filter n MMO-MUG Client notified of unsatisfactory results'. phoned Spoke with Date: Time: * Number r,f~:nlnni~-/t Pa') :esult* Analyst Heath Day Year ~ SAMPLE ~PE: ~ ~ Fb~s Jun ~ Routine 0 Treated Water "'""T' Faxed O Spedai Purpose ' Time Collett~ / S~PLE LOCATION Coll,~ 'Y BACTE~OLOGIC~ WATER ~YSIS MM~MUG R~UIt:. To~ C~llfom E. Coil. Memb~ae Fll~r: DIr~ Count ~ Colonl~l~ ~ Verifi~aflum LTB BGB COLIFI~. Fecal Coliform Confirmation Final Membrane Filter Re~ul~ Repo.ed~y /~o-.,,.~c..,.~..Date II/~-~/ Time Coliform/100 mi [] Foxed ~B Member of the $~ Group (~0¢i~t/,;~ Gdr~0rale de Sur~illOnce) NVIRONMENTAL FAClLI'TIE$ IN AL.ASK&. CALIFORNIA, FLORI0a, ILUNOiS, MARYLAND. MICHIGAN. MISSOURi. NEW JERSEY, OHIO, WEST VIRGINIA 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (ll R-2'71 1. GENERAL INFORMATION Complete legal description Lot 5, Block F, Timberlux %3 Location (site address or directions) 15026 Longbow Drive, Anchorage, AK Property owner Mailing address Lending agency Mailin. g address Agent Address. - Steve Potter Day phone 18644 Guillemot Circle, Anchorage, AK 99516 345-2378 Day phone Day phone ~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual welt Community well Public water NOTE: XXX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xXx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25 (Rev. 1/91) Front MOA *F21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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, Name of Firm Address Engineer's signature ordinances, and regulations in effect on the date of this inspection. S & S F_NGINEEEING 17034 Eagle River t. oop ~,vdd ~. 934 Ei~gle River, Alaska 99577 Phone ~'~'/-~q 7q DHHS SIGNATURE //' Approved for b drooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: / Additional Comments By: 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 independant professional engineer registered in the State of Alaska. The DH HS 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 Legal Description: ~-DT- ~'- Health Authority Approval Checklist A. WELL DATA Well type !~R Log present Total depth Sanitary seal{~/N) Date of test Static water level Well production WATER SAMPLE RESULTS: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to / ~(~ '/~' Casing height (above ground) B= FROM WELL LOG ~ g.p.m. Wires properly protected ~/N) AT INSPECTION ~ +- g.p.m. Coliform O Date of sample: ~ / 3 / o/ ~ SEPTIC/HOLDING TANK DATA Date installed (o /~/~~) Tanksize Foundation cleanout ~'N) Y~ -J Date of Pumping ,v/A- - ,~ ~J Pumper Nitrate ~ · ~' o ~ Other bacteria O Collected by: $ & S ENGINEERING ~7~3,i Eagle ~iver Loop Road No. 204 Eagle River, Alaska 99577 )000 Number of Compartments "~-- Cleanoutst~N). Depression (Y/~) /'J-0 H gh water alarm (Y/~. ~ O ABSORPTION FIELD DATA Date installed ~) / /~ / ~ ~ Length ~ ~C' Width Effective absorption area -~ ?D Soil rating g~,p..d:.~F,~r fF/bdrm) System type ~ Gravel thickness below pipe -7 Total dePth Monitoring Tube present ~/N) ¥'~J Depression over field (Y~ W 0 Date of adequacy test N/A- - ,~',,/ Results (Pass/Fail) ~/"'~ For ~ , bedrooms Fluid depth in absorption field before test (in.); ~~ly affer~ gal. water added (in.): Fluid depth (ins) M~ Absorption rate =_ _g.p.d. Peroxide treatment (past l_~nths) (Y/N) If yes. give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "P~Pump off" level at* E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,) /OO On adjacent lots On adjacent lots / o O _,L Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: / I Foundation Property line Absorption field Water main/service line ,)0 ~-~ Surface wateddrainage / 08 -~ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '~ ~tt Building foundation 3 '~ /,.~ Water main/service line ] 0 / r Surface water / 0 0 ~ Driveway, parking/vehicle storage area -q- ~''' Curtain drain ~' a ,~ r~ t~ ..v 0-h~ ~ Wells on adjacent lots / o o '4- ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recordg~a},l~.~),~,?_~.'~'~t~ms are In conformance with M~A ~A& ~delin~ in effect on this date. ~c~ Signature Date ~ / , r/q ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY. OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Se~ices Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Day phone Lending agency Mailing address Day phone 4 Un/ess otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site _7~__ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~325(Rev. l/91) Front MOA#21 6. DH2 SIGNATURE "_~--Approved for ~"""--' bedrooms. __ Disapproved. Conditional approval for STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 ~i,on~s in effect on the d,ate of ~,l,l~s inspection. Name of Firm '{ ¢-~/-.44 ~,,c t...~_.~¢¢ c'¢ ~¢,, ~ ~. Phone Address ,;~. O.~ ~/~/~/..Z/ /,~ Engineer's signature f bedrooms, with the following stipulations: Additional Comments 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA¢I21 Legal Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality'of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. 7' Parcel I.D. ADEC water system number Date completed ~/1~ / "7(~ Driller Cased to /~1~'~ Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test ~/! Static water level Well flow Pump level ~'~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line IClPALITY OF ANCHORAGE NMENTAL SERVICES DIVISION RECEIVED g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cieanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'/'~/'~' Tank size /¢~.¢~C2 Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N) High water alarm Alarm tested (Y/N) Date of pumpil Pumper A~'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot i°~ ~ On adjacent lots To property line ~ O ~ Absorption field ~ t Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at · Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length '/7'// Width Total absorption area Depression over field (Y/N) Results (pass/fail) ~ ~.~'.'.~¢t./,~,,~ Peroxide treatment (past 12 months) (Y/N) Soil rating / ~'¢-~ System type 'T,'c--z44~'-/7 Gravel thickness ~ Total depth /~__, J;- /"ii ~1 ~ Cleanouts present (Y/N) O ~ Date of adequacy test JC~'Y/~¢~3~' /¢.'.~J /~ for ~- bedrooms ~'~ If yes, give date On adjacent lots "~ /,~-~ Property line ~ To existing or abandoned system on lot ~')z'~ .... Cutbank N/¢¥ Water main/service line_ .~ -,~¢'&'- Driveway, parking/vehicle storage area ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot To building foundation On adjacent lots Surface water t'Jr///&- Curtain drain ~//~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature .'~--'~- ~, .~ ~-~¢-~ Date ~4 ( HAA Fee $ Date of Payment Receipt Number 72-028 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 205 WEST 15¥H, AVENUE SUITE ANCH0~ASE~ ALASKA ~9502-5~04 (~07} 279-5~1& LEGAL: LOCATION: OWNER: RESIDENCE: SEPTIC SYSTEM ADEQUACY TEST Lot 5, Blc, ck F, 15026 Longbow C. Bauman Single Family, Timberlux S/D 3 Bedrooms WELL: Private~ On Site SEPTIC SYSTEM: DATE OF LAST PUMPING: FROM MUNICIPAl_ RECORDS: 3 Bedroom System TANK: Greer St. eel 1000 Gal. Two Comparts. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 492 Sq. Ft. SOIL RATING: 150 I NSTAI.L. AT1 ON DATE: 6/28/76 Anc:h. Cees Pool Feb. 28~ ].992 DATE OF LAST PUMPING: Anch. Cess Pool Feb. 28~ 1992 DATE OF TEST: Feb. 25~ 1992 TEST PROCEDURE: System was inspected and measured,, Tank was · Found with 3 ~eet o'F cover and with a liquid level e.F 51 inches. Trench clean out was 4 Yeet deep and dry. Trench 6-inch sump was 12.5 ~eet deep with 61 inches o'F water. Trench was pr'echar~ed with 1900 gallons o~ clean water on Feb. 24~ This pred-~arge dicl not alter any water lew.~ls in the system. The next day an add:i, tional 1000 gallens were added te the tr'encb. This caused the level in the sump t~ rise 25 incl~es. When the rise started was not established. An additional 200 gallens caused the level te rise 4 more inches. The level in the tank was 8 :inches above ~u].l tank. The absorption was mor~itor'ed ¥or 90 minutes. Durin~ this time the level in the sump dropped 25 inches~ :indicating that the trench was eperation at a level below "~ull trench" and that the absc)rptien rate was satis.~actory. On Feb. .~.6 the water depth in the sump was 74 inches TEST RESULT: This system meets the code r'equirements o,~ the Health and 8ocial Services Department o'~ the Municipality o~~ Ancl~orage. NQTE The operatior~al ].:i.~:e o~ all septic svz~.~:ems depends on the local soil conditiens~ groundwater levels that may .~luctuate during the year'.~ and the water usage o~ the ~amily being,) served rhc...,~, conditions are outside the contrel e~ the by the system. - .... = E, valL~a~]c~r [_)~ this septic: sy~tem. W~e c:ar~ there~c)r'e not {give any estimate o'f bo~,~ long this system will ~:u~]ctiol'~ satis'Factery ~or current or ~LitL.lre occupants. 203 ~EST 15TH. AVENUE SUITE 206 RESIDENTIAL WELL INSPECTION LEGAL: Lc)t 5 Bleck F Timberlux LOCATION: OWNER: TYPE OF WELL: 15026 Longbow C. Bauman Private~ Single Family WELL LOG AVAILABLE: INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 8 Gallons per Minute PUMP YIELD FROM TEST: 7.5 Ga].lons per' Minut. e DATE OF INSPECTION: Feb 25~ 1992 TEST PROCEDURE: Well was pumped at a constant rate while the dr"awdown was moni toted wi th aF~ a(::OL~ ~ i (: pr'ebe. At the beginning o~ the test water- level was ~Found at 71 {eet below top o~ casing. At a pumping.rate o~ 7.5 gallons per- m:i. nute the ~ater level dropped to 91 -~eet. A total o'f 1900 gal- ].or~s were pumped ~. m"~ a 6.5 hour per:iod. TEST FOR E.COLI AND TOTAL NITROGEN: Water' was t. ested ~or E.Coli and total nitrogen on Fei:),, 26,~ 1992 E.Cc~li 0. Total Nitr'ocjen None Detected ( ND ) Max. allowable Total Nitrogen 10 mg/1. TEST RESULTS: This~, well meets-~ the requirements e~ 'ilhe Municipality o'~ Anchor"age. THIS WELL WILL PRODUCE MORE THAN ! GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Munic:ipal requirement for' well flow is 150 gallons o'~ water per bedroom per clay,, "Fhis well exceed this requirement. The assessment c~ the condition c)~ the well applies only to the cenditic)ns as o-F the day tested. The ~low rate may change due subsurface conclitions 'Ehat may not be c~bserved ~rem the sur~Cace~ and changes in the land use and other ~Cactors that may impact the acp.d~er ~eeding the we].].. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE. ALASKA 99518 TELEPHONE (907) 562-2343 ANKL¥SIS RESULTS £o~ INVOICE ~ 51409 Chemlab ReE,6 92.0734 Sample ~ 1 Matrix: WATER FAX: (907) 561~530' PW$ID Collected 5/F YI~ERLUX Client Name :TOBBEN SPURKLAND. P.E. UA Client Acer :TOBBZNS FEB 25 92 ~ 14:00 h~s BPO~ : POW :NONE RECEIVED FEE 25 92 @ 15:50 h~s. Req$ : AS REQUIRED O~dered By Analysis Completed : EEB 26 92 Laboratory Superviso~ .n_STEPHEN C, EDE i)TOBBEN SPURKLAND. ~.E Parameter Results Units Method Allowable Limits NIT~ATE-N ND(O.iO) rog/1 gPA t53.2 lO Sample ROUYINE SAHPLE COLLECTED BY: STUART. I Test~ Pe~iormed ' See Special In~truotlqns Above UA-Ulmvailable ND- None Detected ** See Sample Remazks Above NA- Not Analyzed LT-tes~ Yhan, GT~Greater Than ~SSS Member of the SGS Group (Soci~t6 GCn~rale de Surveillance) CHEMICAL &,GEOLOGICAL LABORATORY' A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY LABORATORY TO BE COMPLETED BY WATER SUPPLIER [] PRIVATEWATER SYSTEM Narr~ Ph~o NO. Mo. Day Year SAMPLE TYPE: [] Treated Water [] Untreated Water [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE Collected No. LQCATIO~N 2[ I Collected I Analysis shows this Water SAMPLE to be: 'l;.~Satisfactory [] Unsatisfactory cI Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Rece,ved ~'/~ ~-/~2. Time Received /~" ~ Analytical Method: Membrane Filter · No. of colonies/100 mi. Lab Ref. No. Result* I BACTERIOLOGICAL WATER ANALYSIS RECORD · -' E.C. Z-'7-(,0-~'7~ ,q-I~,~C.~.. -. READINSTRUoTibNS~ ........... . ,. , . Membrane~lter: Dlro~t ~Snt ' ' ' EFORE i Verlficatlom LSB Feral Coli[or~ ~n~rBa~o~ '- COLLECTING SAMPLE Final Membrane FIl~esult~ TNTC = Too Numerous To C[ount ONE OF 'I'~/G: PART · RE'.A " RT .... DE 0 FOLLOW:i:,. OB = Other Bacteria Analys/t/ ~- -' ColiforrcJ100 mi Coliform/100 mi a~e approva,~ o Le~.N. BuchhOlz Sanitarian #1: Time Date Insp 'IUNICIPALITY OF ANCHORAGE ~DEPARTMEN~,~'-~JF HEALTH AND ENVIRONMENT~,,.wPROTECTION 825 L Street, Anchorage. Alaska 99501 264-4720 Date Received: November 1, 1977 II:,fi[~ a/H1 - ~ ,~2: Time dt:J~'~ ~)~ #3: Time ~ V REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska Mutual Savinqs Bank Mailing Address: Post Office Box 1120 99510 Phone: 274-3561/244 2. Property Owner: James Mailing Address: 3. Legal Description: Lot P/Margaret A. Bauman Phone: 5 Block F Timberlux Subdivision 274-7522/~r1~,~\. 4: Single Family Residence: (z) Multiple Family Residence: ( ) Number of Bedrooms: ? Number of Bedrooms: Well System: Individual well (x) Community/Public System ( ) Permit # Depth of Well Well Log on File Construction \~, Bacterial Analysis Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Installed Manufacturer Soils Rate Distances: Well to Sewer Line to Septic Public Utility Installer Material Tank /O~~ Nearest Lot line ( ) to Absorption Area /O~- Absorption Area to Nearest Lot Line Page Two Department of Request for Approval Health and Environmental Protection of Individual Sewer and Water Facilities Legal Description: Lot 5 Block F Timberlux Subdivision Comments: Affadavit Att~ached: _~ ) Approved: ~, ./~;~ Disapproved: Letter Attached: ( ) Date: Date:' Department Worksheet: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO. VA FHA .~___~___CONV 5. Name of Realtor or Agent: Mailing Address: ~ , Phone: Legal Description: Location: 7. Type of Facility to be Inspected: ~'-~x~2- No. Bdrms. 8. Water Supply Type of Supply: Public Utility. Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) 72-003(3/76) 06-1220(a) Rev. 1973 DATE ALAS~,_,c1EPARTMENT OF HEALTH AND SOCIAL DIVISION OF PUBLIC HEALTH INDIVIDUAL AND SEMI-PUBLIC BACTERIOLOGICAL WATER ANALYSIS INDIVIDUAL [] .... SEMI-PUBLIC [] CHLORINE RESIDUAL PPM ~ REPORT RESULTS TO ~ODRESS CITY. ADDRESS OP SOURCE i ! ,~': /"- ZiP CODE COMPLETE THIS SECTION ONLY (E WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY ~i (, '~ .£.~-'(? DATE COLLECTED TIME COLLECTED []Tiie Brick or [] Under House []Fibre [] Asbestos Cement Diameter Depth Water Depth From Sottom FeeL' ~nalysis shows this Water SAMPLE to be: [] S~fisfactory [] Unsafisfaclory [] Questionable [] Sample too long in lranslt; sample should nol be over 48 hours old at examination to indicate reliable resulls. Please [] Bolt]e broken in transit, please send new sample. SANITARIAN'S REMARKS PUR?OSE OF EXAMINATION: Illness Suspected? ~ew Source of Supply? [] Yes [] No READ INSTRUCTIONS ON REVERSE ,SIDE BEFORE COLLECTING SAMPLE ~] Yes [] No i Repairs to System? [] Yes [] No Signature ' 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev, ]973 ~. Lactose Broth 10cc 10cc 10c¢ 10cc 10cc 1,0¢c J,0c¢ 24 Hours --48 Hours ',, ~ This analYsiS ind[cate~ Coliform Organisms to be: ~=~-~sent' ~-%- ~re~e.t 4 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received December Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Cony. National Bank of Alaska % Marva 1, 1976 Mailing Address: Post Office Box 3-3859 Phone: 279-2506 2. Property Owner: James Whaley Phone: 279-1502 Mailing Address: Star Route A Box 477-H 99502 Legal Description: Lot 5 Block F Timberlux Subdivision Location: NHN Longbow Avenue, off Rabbit Creek Road Type of facility to be inspected Well Data: A. Type Individual C. Construction Sewage Disposal System: Single Family B. Depth D. Bacterial Analysis On-site system No. of bedrooms 3 A. Installed C. Septic Tank: O. Seepage Pit: B. Installer 1. Size ~ 2. Manufacturer · ~ ' 1 Absorption Area ~ 2. Material E. Disposal Field: Total length of lines ~//, 8. Distances: A. Well to: Septic tank /Db ' Absorption area ]zZ)b ' , Sewer Lines .Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page I of twO pages Page 2 of two pages - Re~__t for Approval of Individual legal Description Lot 5 Block F Timberlux Water Facilities Approved Disappr°ved~sig ed Date /~'~7 Approval Valid for one year from date Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) t'~UNICIPALITY OF ANuhO.,-,AGE DEFAI'~'I'N~ENI' OF ENVIRONMENT;),L QUALITY 2518 Tudor Road Anchoraf.;e, Alaska 99503 REQUEST FOR APPROVAL OF iNDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA _ FHA CONV 2. Properb/ Owner: _~_d,~ ~ Mailing Address: ~ //~"~ -~ ~/2_~/q ~ ~2,g/~,~ Day Phone _,~ 3. Name of Buyer: Mailing Address: 4. Name of Lending Institutio~:~o~g~) Mailing Address: Day Phone 5. Name of Realtor or Agent: __ Mailing Address: Phone 8. Water Supply No. Bdrms. '---~ Type of Supply: Public Utility If Individual, number of dwellings presently served Individual If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-sil. e) If Individual, date of installation EO-03? (1/'/4) ADHW - - 2W DATE BACTERIOLOGICAL. WATER ANALYSIS / NAME TIM~E COLLECTED Well, [] Dug [] Driven [] DriLled [] Bored SOURCE: [] Spring ~ Cistern [] Diker - Dug Well or Cistern Conslruction: Walls [~ Wood J~ Concrete [] Mefa [] Tile [] Concrete Diameter of Well_ Depth Feel Well Casing Mater~al DiameEer .Depth OFFICE Records in thls office indicate this WATER SUPPLY Io be of: Analysis shows lh~s Water SAMPLE Io be; [] SatisfaCtory [] Questionable J~ Unsatlsladory. If an "Unsatisfactory" or "Questionable" slotus is indicated above you should take immediate action as recommended below. 1. Notify consumers water Js polluted. Bo~l or chemically treal Ibis water as ougJned in the enclosed leaflel "Drear It Pure." 2. Increase chJorinalian sufflclently 1o meet recommended residual slandarcis. Determine source of contamination and take action necessary fo mainloin a safe water supply al all times. 3. Check chJorJnaflon and olher mechanical equipment. Make cerlaJn il ~s functioning properly. 4. If aBer checking equipment a dislafecting residual is not oblained, please wire fbJs office for emergency 3ssistonce ar advisory services. 5. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed. 6. Improve your -[] sating [~ dug well [] driven w&lf [] drilled well [] clslern. 7. Relocale your well ia a sale location in relationship lo your sewage disposal syslem [] see enclosure 8. Sample too long in transih sample should nol be over 48 hours old at examination to Jndlcale reliable results, please sene new sample [] Baffle Broken in franslb please send new sample. 9, Contacl your nearest [] Local Health Deperlment ar [] Alaska Division of Publlc Health, sanitalion office for bulletins, consultation and SANITARIAN'S REMARKS Signature ®L READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Date Received ! ~- - ~ '- '~[ ("~ Time Received ~' ~/'f~ ~Lab. No. .r ~ ..... Laclose Broth i: 10cc J 10cc 10cc 10cc 10cc ~ 1.0cc 0.1cc 24 hours I EMB AGAR Lactose Broth, 24 hrs. 48 hrs. Groin's slain Coliform Den~ily (Most probable No. per J00cc.) MF results This apalysis indicates Coliform Organisms to be: