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Home My WebLink AboutTIMBER RIDGE BLK 1 LT 1Timber Ridge Block 1 Lot 1 #050-321-36 UBMITTA Municipality of Anchorage is APR0 s 2018On-Site Water and Wastewater Program •(907)343-7904 age of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: Q5f'/87 030 PID Number: 05O32/ 3C Dwelling: [g Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New , Upgrade Name: ABSORPTION FIELD EC1S?'/'!G Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed [' Mound 9g3 7 T.4450/u.hve_ .ti/Z [' Other Phone Number of Bedrooms Soil Rating Total depth from original grade 35 -2) 73 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot / Ft. Ft. 7 4i8' g R(ACLC I 1 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line From Ftz Ft. Well / / TANK Septic 0 S.T.E.P. 0 Holding 0 Other ��7` Z.5 Manufact er / Capacity J e Surface Water /Q 0+. 4 V C—itO 4Q 7'V 0 Gal. Material Number of compartments Lot Line / Z �� + NA � T�F�- Foundation Q '-� LIFT STATION A/4 kManufacturer Capacity Curtain Drain 15()r+ ILI Gal. Pump on level at Pump off level at High water alarm at Remarks /l p f.r,L� �`►Ce-046� 7 ` in. in. in. Pump make and model Electrical Inspections performed by Q3°3 PIPE MATERIAL House to tank Tato Installer i 4 drainnkfield �-�o34 L) trm Drainfield ex sfr„, CO/MT WC/34 Inspector n/0(.- `� �n a BENCH MARK (Assumed elevation) /, C) ft Inspection V 'J dates: 1 3 /�� 2nd 3 , C K 3'd /p' 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL � ngirtegr'h'Stamp4 .74�.•••. ••.. •4.'i+' i'4. 1 Conditional Approval: Date co. • "�P� of . .-.1,, '. * fi ,®t o� e Steven Y . Eng 4,:14,00 �v 4 •' 6 �`d•1••• V• _�.. �4 Fo'/P 7•• tip_., A rove -10 12 %,�u ��* �'� pp t �"��`— Date Ll .- Inspection Report_9-1-12.doc 10' Utility Easerient AS-BUILT MEASUREMENTS II A B ST1 36 31 ST2 44 38 DCS 47 41 R101 0 Well S� Teo o 3 Bdrrn /L y MI 1/4%4 o(( 9 / 11 0 ST1''''''' 0:6I.517'..3 S � • . M STco New 1250Galin ll %DCD's 1,�' tillTeo. Septic�y EDecornnissione Old T%,woei, \ Septic Tank R%a9P 1 PER UPC 41 iv ' NORTHRIMPt � °'t,,� TIMBER IDGE 1" = 40' ENGINEERING * 49m *vt ; -r 1 DESIGN SteveEng.com BLOCK 1 L❑ PO Box 770724 LAYOUT WASTEWATER UPGRADE Eagle River, Alaska 99577 �j, ',,, a Dote: : 907. 694. 7028 -lb Q`_ REPLACE SEPTIC TANK 4/5/18 ITEETf 3 Foundation Cleanout Elevation @ 92' Tank Cleanouts Elevation @ 88' Fin ads Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal r� � —Elevation @ 87.5' 1250 Gallon Steel To Trench Zvation @ 90' 'Anchorage Tank' Ele• : ion @ 87.3' slid Pipe Matched Elevations To Existing FCD & Line %NORTHRIM of Ac 4 TIMBER RIDGE ENGINEERING (Pc,; :49m SEPTIC TANK PROFILE SteveEnq.com -� ; BLOCK 1 LOT 1 PO Box 770724 ss.W e� Eagle River, Alaska 99577 Vt.D •••‘7711(7,A� 907.694.7028 4 (/ TANK REPLACEMENT Dote 4/5/18 'Drawn BY: SE Scale: 1• = 5 SHEET'3 o f 3 I SE """rY 00 MUNICIPALITY OF ANCHORAGE "' On-Site Water&Wastewater Program :\'. < S;. PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 - \ - a::) http/lwww.muni.orglonsite3, 1)cpartinenr 4,9CMONP6%. On-Site Wastewater Disposal System Permit Permit Number: OSP181030 Effective Date: 3/27/2018 Work Type: SepticTank Upgrade Expiration Date: 3/27/2019 Tax Code Number: 05032136000 11/3/ I 45 TaJekk. 2:3 U Site Legal Address: TIMBER RIDGE BLK 1 LT 1 G:0255 Site Mailing Address: 19439 TIMBERLINE DR, Eagle River Owner: WEIR TRACI R Lot Size in Sq Ft: 37027 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Prior to installation, the well radius is to be staked by a registered land surveyor. Received By: -----------j5e--- Date: 3 30 I/- aIssued / Date: ®g By: MUNICIPALITY OF :` NCHORAGE • Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water&Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 0,5G-3 Z I- 3‘ Property owner(s) GVG(r< Day phone .350 - 2/ ?3 Mailing address / e-1-3 L/'(),4- A Site address s,¢41,_ Legal description (Sub'd., Block& Lot) j,- 7, /L(,Q c'rr- /'/ c Legal description (Township, Range & Section) Lot Size 3 7 02 ?Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family(SF) (w/wo ADU) Septic Tank Upgrade Duplex (0) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy El (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner o uthorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: 7) i't _� p Date.of Payment: Receipt Number: 02-33(-1. , Receipt Number: Permit No. 041Stio30 Waiver No. Permit App_9-1-12.doc bTf-SIM ENGINEERING SteveEng.com Timber Ridge Block 1 Lot 1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom home.Most of the neighboring lots are developed. The current septic tank has failed-the trench still functions. These lots are near an acre and are served by the private water wells.No adverse impacts are expected from tank replacement.The easements are depicted on the lot. The slope is indicated in the area of the septic system. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC)& State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet&outlet. • 5' minimum between the tank and bed. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank& solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line,in each tank compartment,and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034,PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2%slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HI/equal) ikOa a p • v, ! a Steven W.Eng a; �5o G, 6 . 09 DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Trench. 4. Lots Served by Private Water Wells. 5. No Conflicts Within 200'. Mark 100' Well Radius. 6. Maintain Minimum 5' Separation Between New Tank & Existing Field. x, * .\.o fr7 cot 2 J Well 100 5% Slope R10' 0 Well 3 Bairn 5% Slope /411i,°/ New 1250 Ga Ion w Sep-tic Tank /DCO's 5% Slope �.�,, Decommission I ci ' o Sep-tic Tank 4Q •� PER UPC 57. Slope 111Wiil % Slope ill EQs��t+ C1111111111:ssurne• Irainfield Location Lot 9 .••... WellRid9e Lot 8 1 lir+ber %ell NORTHRIM 476? . TIMBER RIDGE v = 40' ENGINEERING 1,;.:.. , SteveEng.com * m * BLOCK 1. LOT 1 DESI N PO Box 770724 . _; _.___m _ _ __ _ LAYOUT Eagle River. Alaska 99577 0, 7. _ WASTEWATER UPGRADE 907. 694. 7028 •\.6 sr" REPLACE SEPTIC TANK Dcit3/29/18 2 of 3 - — Foundation Cleanout Tank Cleanouts Fin ^ate de Opposing Cleanouts Between Septic Tank & Trench 4 Foot Cover or Equal To Trench 1250 Gallon Steel °Anchorage Tank' Or Equal lid Pipe Match Elevations To DESIGN NOTES= Existing FCO & Line 1. Use Existing Trench. 2. Septic Tank & Solid Pipe to be Placed on Compacted, Stable Soil, Free from Boulders. 3. Sewer Service Line is Minimum 27. Slope & 3' Cover. 4. Water-Tight Couplings. 5. See Specification Sheet. 6. All Work To Conform to Municipality of Anchorage (AMC) Requirements & Specifications. 7. Decommission Old Septic Tank Per UPC. NOR TH RI M •�%%O , F_ !O ENGINEERING ' . I*:49ni *'� SEPTIC TANK PR❑FILE TIMBER RIDGE SteveEng. com • PLogs RJvr.Box 7707,osko99577 3+-24 stir"' BLOCK 1 L❑T 1 90Z 694.7028 ea 40, Dote: Grown By rale' SKEETTANK REPLACEMENT 3/17/18 I SE i• = 5 3 of 3 SE - MUNICIPALITY OF ANCHORAGE - • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE []NEW ❑UPGRADE - — - -- MAILING ADDR SS ;•. LEGAL DESCRIPTION LOCATIONNO. OF BEDROOMS "j DISTANCE O: T Well Cr .y Absorption area Dwelling ) %., PERMIT NO. J,/ l L..i- O _5 _� F Z Manulactu ryr. Materi I No. of compartments Liq. capacity in gallons IF HOMEMADE Inside length Width Liquid depth O X DISTANCE TO: WegDwellipg - - \ PERMIT NO. --� �. _— I z H Man t "' --; - -_ _ Materiae Liquid capjacit�r "In gelLo` /fagtu'rer - ` O Well Foun anon Nearest lot line PERM T NO. w= DISTANCE TO: �'/ r7 /.._ •�- / C' •) -' /�./ .7� J LL Z No. of lines Length of each line Total length of lines Trench width Dista npe getWeon lines P z ul ° C% -'i(` - - i /-' inches FTop the to finish r Material beneath tile rr _ Total of grade n ` / ,, effective absorption area D ',) L`- " f , inches i `) Length Width Depth PERMIT NO. to O Q F Type of crib Crib diameter Crib depth Total effective absorption area go y Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W 9 DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER I r'ilo PIPE MATERIALS SOIL TEST RATING INST LLEfj REMARKS 11I,' `,, f f• �s2 �' re�:y ccep e'-'F, rl�f.''Cn :0tf �a nap raco _;> � o •ire /j�J £ FIR, lr SR, Nn' r arra - pp —� -�• ie �wfi�3 t v APPROVED DATE LEGAL - --' 72013 (Rev. 3/78) V2111MM, lull=m IDoQDA 5136% SWAlLP, )R Zouvr)I+` Lid AN7cmc(DivaA Ci.mq aDD.G(MD SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF --,175 dee t -- DRILLED AT THE RATE OF 319.00 - PER FOOT. PROPERTY OWNER I/Ut. Ran xfnSSF12 694--3273 LOCATION OF WELL SITE— a' .I Ba' 1 Ste" DRILLER 13eAnte GLauj of- Rai*a t & .-Liaq Gio&kd. --- _ WELL LOG: 0----37' SWtf4ce clary and 4. U.L V aue,L to hednack.. Some 44gnj a4 watve at 15' 31--275' 8ed2ack.. n 4VAaten ta)Ub nock. 153-157' Same. 4 i qn4 off' watve p todac tAoa trL a q&anu.La& nock. 1/2 gPIR. 272-275' 1&7/2 ,IPC/i of- y xid in a pwi=4 trype /rack.. 215-275' SexUm ntavj, hack with a poaao" axea at 268 -ta .271 fz t chow -in a aree C/'R! wield. Tata,(, blatm, pnoducr:i.on 4how4 39Plli ain urwm and 4hou.Ld eam.i.Lry inl.¢wve to 4gPl11. The ter ovvuy .itj a i�r Ly �a�ti and -tat<._.L IJat h 4.tand is c" iluy .i6 wd th ieL 50 1ee-t a� 4uA;.ace. Ome kan7e Sat, 3'umli 6hou.Ld be..in i to Ue-d ten Pet o-", hattom.. �. Tn.tvt Cnn.t. n�. �/r ii l irtn,: s522i 00 no Chn�:( n, Pn 1. Gle l i. Sax1L o/r.yJ)h U L Svt Un-, COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF _95225.00 THANK YOU VERY MUCH. BERN.I.E.)CLAUS OF RAMPART DRILLING WORKS DATE pP'u-I. 26.th, 1979\ SERVICE CHARGE 0F 7'/z% PER MONTH•WOL BE ASSESSED ON PAST DUE ACCOUNTS. 4 9 7`1,c ,1, s ;5 — B®X 1e$009 ssTAH2 llou ru A ANCHOitAomv ALAsIcA 00552 344-171714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 24 0 't eeA. DRILLED AT THE RATE OF PROPERTY OWNER 201L 7 L ��ear.� ll£u27CC PER FOOT. LOCATION OF WELL SITE Lt._ 9, RAk. l SLLG DRILLER WELL LOG: Rnn Arinkn nnrl C060140 y�ii in rn,! 42...__940r Cnrl.imonla,,iy lie.d2rrck Gie,LC WtoduceA /<<.i'.Ii1. ur�ith 220 jee�t of- IrateJr. ,jtm.diaur..bt MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 6 1981 RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE A/,vu L 7978 SERVICE CHARGE OF IVa% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. TYPE OF SOlL ABSORPTION SYSTEM lS: TRENCH MAXIMUM NUMBER OF 8EDR0OMS RRTING (SQ FT/BR)� 150 THE REQUlRED SIZE OF THE SOI|- ADSORPTION SYSTEM IS. Qp��07^1 U 1— 71.101 R_��bl"I 8-0=` A A 40, 1:11:11% IN" p 1 E P. If a U I" IF H I= W! THE LENGTH DIMENSION IS THE LENGTH (IN FEFT) OF THE TRENCH OR DR0INFIBv !HIE DEPTM OF 0 TREAC11 OR PlT IS THE PVTOHCE BETNEEN THE SURFHCE OF THE GROUND HND THE BUTTUM OF THE EXCOV8TION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES, THE GRHVEL DEPTH lS THE MINIMUM DEPTH OF GROVEL BETWEEN THE C11.111-HLl PIPE HND THE BOTTOM OF TUE EXCRV8TlUN (IN FEET>. 1"f0du j A 1AFT"A is 14 07 & I - T T 0 1 It f I E41 1 g! 4s p: k1k:= 1 Albowl cArlf.pVvy4n:; PERMl[ HPPLlC8NT 118S THE rY TO lNFORM THIS DEPHRTMFNT oURlNG THE }QaHLLHTlDN INSPECT7OHS Cl ANY, WEL|S RoJHCENT TO was FROPERTY HND T!|E NUMBER UF RESlDENCEO THOT HE WELL WlLL SERVE. --- -1 11 .'. I P,: D! "::� :::" X VVIA"U".0 V- 1: T00015 k1pnKy POVE&AU :v FUTIfs --- hHCKFILLING OF HNY HITHo.1T 111140L INSylCTION AND DPmDYOL AY THlS DEP8RTMENT WILL BE SUBJECT TO PROSECUTION. Q11"0011wU1. 1- VXF0 l FRIAV : A 3.^ A. "? ?" 501 l CERTIFY TM8T 1: I HM FAMILIAR MYTH THE REQUIREMENTS FOR ON-SITE HND WELLS H� �FT FORTH In, THE MUNlCIP0-ITY DF RNCHORHGn 2� l W1LL lNSTHLL THE SYSTEM lN HCCORDHNCE WITH THE CODFS ]: I UHDERSTHND THRT THE ON -KITH S[WER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE lS REMODB'E|) TO INCLUDE MORE THAN ] BEDROOMS. �IGNED� - APPLI1:HNT RoNHLv I:LHN ISSi1E __ DHT ' `.~' ' ' / PERFORMED LEGAL DESCRII DEPTH (FEET) 1 2 3 4 5 6 7 a 9 10- 11 12- 13- 14- 15- 16- 17 21314151617 18- 19- 20- COMMENTS 81920 COMMENTS ' U L9/ SOILS LOG MUNICIPALITY OF ANCHORAGE /El �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch &650, Anchorage, Alaska 99502 276-2221 !�� L SOILS LOG — PERCOLATION TEST ('-/ e/')-')'L'2/Cs DATE PERFORMED: SLOPE SITE PLAN - sLO C�Ecu� 4�he C1Vi.6 7- /L• S ,�i-2 19 J 6) tL)• S ttI ^ / T — WAS GROUND WATER L L ENCOUNTERED? �I / Z_S O - / E IF YES, AT WHAT - -- - DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop I I IL w I i I 6) tL)• S ttI ^ / T — WAS GROUND WATER L L ENCOUNTERED? �I / Z_S O - / E IF YES, AT WHAT - -- - DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: 670//us//`�"� /`-' CERTIFIED BY: //////� 72-008 (7/76) Q/ / `// fil (minutes/inch) FT AND FT zl- DATE: /11cLYZ N� n lL Municipality of Anchorage ti• ,,• � On-Site Water and Wastewater Program o ,t _ (907) 343-7904 mill II . S A E Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-321-36 Expiration Date: 7 - to `i g 1. GENERAL INFORMATION Complete legal description Timber Ridge Block 1 Lot 1 Location (site address) 19439 TIMBERLINE DR, Eagle River, AK Current Property owner(s) Weir Day phone 350-2173 Mailing address same Real Estate Agent Owner Day phone 350-2173 6189 70 2. TYPE OF DWELLING: u`' '� ® Single Family (w/wo ADU) . _°-., 1. ❑ Duplex ff MAR 0 6. 2018 3 ❑ Multiple Dwellings (Single Family and/or Duplex) J 11.2 3. NUMBER OF BEDROOMS: 3 !1 0/ 6 8 L 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Air Received by: /�� _,. Date: if/ , f COSA to be released to the engineer,unless otherw'-e requested by the engineer. COSA Fee $ 6—A& Date: Date of Payment 3l COIN Date of Payment Receipt Number _ 01- tua,b Receipt Number COSA# 05C1'`6 Waiver# • 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 3/6/2018 6. DSD SIGNATURE ...A • System #1 Approved for bedrooms. . � SlovenW"I. Lng System #2 Approved for bedrooms. -rj. • Disapproved. :' 376i' el ''� Conditional approval for - bedrooms, with the following stipul'ations. \SZ\( OFCy \Q • ON-SITE Gvc, WATER ANO :.o WA$iEWRjER o n? PROGRAM \ ,�04f'' nsr Si^R\t\ � By: f'_ 'vim \`-- . '--- Original Certificate Date: 7' 0 I g The Municipality of Anchorage Devlopment 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 9-1-12.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: l7'14IT/ //L CeE e/ ,C/ Parcel ID: CSO 3e f36— A. WELL DATA Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed 1//Z 677f Sanitary seal (Y/N) Wires properly protected (Y/N) (y Total depths 7 5 ft. Cased to 3 �- p �{ ft. �.� ,o Casing height (above ground) l Z in. 6 ac2roc, FROM WELL LOG AT INSPECTION Date of test. 97Z,V--7? 3/2//8 Static water level <<j Q ft. 2.3 ft. Well production 3 g.p.m. c5 +- g.p.m. WATER SAMPLE RESULTS: Coliform N colonies/100 mL Nitrate mg/L Arsenic r'J. ug/L Date of sample: 3 ` P i - 1g Collected by: 11( 1 \ ItCk B. SEPTIC/HOLDING TANK DATA Tank Type/Material .S6../t1 / S7 EL Date installed C/7 9 Tank size MI Ogal. Number of Compartments Z. Cleanouts (Y/N) Foundation cleanout(Y/N) t Depression over tank (Y/N) � High water alarm (Y/N) (/ ' Date of pumping 27Z3//I d Pumper 0--/z C. ABSORPTION FIELD DATA 1.3 Date installed -/7 I Soil rating (g.p.d./ft2 or ft2/bdrm) t TC . System type ;e4-:-/1cIk Length 0 ft. Width 3 ft. Gravel below pipe � S ft. Total depth /2- ft. Eff. absorption area StO ft2 Monitoring tube Depression over field Ai Date of adequacy test 3(./f? Results (Pass/Fail) P ( For 3 bedrooms Fluid depth in absorption field before test C in. Water added 'I Sa' gal. New depth 3 in. Elapsed Time: 3 6 min. Final fluid depth 0 in. Absorption rate >= y O g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N1 If yes, give date • D. LIFT STATION Ah 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 /Q G � On adjacent lots /00 f Absorption field on lot / 2 Q {f— On adjacent lots /a' a f' Public sewer main /Q 1 Public sewer manhole/cleanout • / a 0 (4- Sewer/septic service line Z 5 'f" Holding tank /04 r-F Animal containment areas ,SQ• f Manure/animal excrete storage areas / d SEPTIC/HOLDING TANK ON LOT TO: Building foundation Jt'' 1'f Property line /0 f Absorption field 5 cf Water main /Q '� Water service line /4 *- Surface water / O CC 4- Wells on adjacent lots /o 6 '4- ABSORPTION FIELD ON LOT TO: Property line l4 4 Building foundation /0 '7". Water main Water Service line ( i 'f Surface water /au •F Driveway, parking/vehicle storage /O Curtain drain (1/</14 Wells on adjacent lots /0 O F. COMMENTS G. ENGINEER'S CERTIFICATION 4� OF �� d I certify that I have determined through field inspections and 4 4( °6•°°�•f°C review of Municipal records that the above systems are in ��CP;••• 1 °••,`�.. 11 conformance with MOA COSA guidelines in effect on this date. ' ° :=u"` : T*i? 6:'9 0 Engineer's Printed Name ° ° 0 Date . /0�/ 80Steven W. Eng ' / COSA yellow sheet_2-6-15.doc Lot 1 N 89'50'35"E 45.00' 50.00' N - o J N 0 '\ 10' UTILITY co EASEMENT o J s m 01 / 11 4> O / T 10.2'x8.2' SHED O 00 / �h • Lot z m' . \ <4\ `° / 1:i Lot 1 ,) WELL 37,027 s.f. \ 1 o AD 100 ' PROTECTIVE RADIUS I I = ,2j• •1' 33.0 CONCRETE PATIO ' \RETAINING WALL / o 53.4' \ 25.5 N / 2 STORY o --� 26.0" RESIDENCE •a -t -0 RETAININ\WALL N o / 17l 4.0 x8.0 . •. ' a U' BALCONY' ° v 26•4' 10.2 x10.2 co 10' UTILITY \ ,,,___,./....,-:' 4k) EASEMENT • •uluuu GREENHOUSE SEPTIC PIPE �'' r � \ CONCRETEor \ \ PORCH D: 12.0.x17.7' DECK Z iib... - • / rn o co- ,.. \ \ --....,•\-\ \ A \ SEPTIC PIPES xi POST &-- '\. \ . �l RAIL FENCE 4 94 ' • 30.0' 7s8•4e' \ / \ ?XI, POST & - /A,� FRAIL FENCE • L=62.05' ��YY 40 /1, / R=30.00' 1,F --.. H PLOT PLAN __ AS BUILT _X SCALE _1" 40' GRID _ NW 0255 Project No. 18-115/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 • Lang & Associates , inc . (907) 522-6476 Phone 000p (907) 522-4625 Fax o"O F q ��4 Professional Land Surveyors kenOlangsurvey.com o 9 jonathanOlangsurvey.com ovP� `'' S�QOO I hereby certify that I have surveyed the following described property: �� LOT 1, BLOCK 1, TIMBER RIDGE SUBDIVISION (PLAT No. 70-219) 0 (/).* 49T" �� • *DOD Anchorage Recording District, Alaska, and that the improvements situated thereon are a / J D within the property lines and do not encroach onto the property adjacent thereto, that 0 ' 1 Q no improvements on the property lying adjacent thereto encroach on the surveyed 0.... no KEN ET 1 (" LAtjC premises and that there are no roadways, transmission lines or other visible �` o easements on said property except as Indicated hereon. 04 J'� ..ai,5✓' 11s ••••,p' 0"le pF ''•.LS-5202.•'• c,Jpi Dated this the _ Day of , 2°1(2) , at Anchorage, AlaskaA '•---- 0'0 ..=" OQR° ssioNA�-�a It is the responsibility of the owner to determine the existence of any easements, O'OOoo—" covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-321-36 1. GENERAL INFORMATION Expiration Date: I If -2 i Complete legal description Timber Ridge Block 1 Lot 1 Location (site address) 19439 TIMBERLINE DR Eagle River AK Current Property owner(s) GRACEY JAY RICHARD Day phone 240-8989 Mailing address same Real Estate Agent Owner Day phone 240-8989 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by:J. Date l COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# n5'�- `4 Date of Payment Receipt Num Waiver 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6. DSD SIGNATURE �� System #1 Approved for _ bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following 'OF ip6B4YCC0Bd61®M1M1aF ir¢a? By: U Original Certificate Date: a __122 ('' 1 � The Municipalit' of A chorage Devlopment 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 Nue sheet 9-1-12,doc If more than Tseptic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: rl'"APr )ejo, B1 G! Parcel ID: O5Q-32/-36 A. WELL DATA Well tYPe to If A, B, or C provide PWSID # Date completed 2` Sanitary seal (Y/N) Total depth -L7!; %S ft. Cased to __;iLLft. 8&91rock Date of test Static water level, Well production FROM �,WELL LOG -x24 -71 Sd ft. 3 eM WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Z•S mg/L Arsenic 0• Zsy ug/L Date of sample: (� Well Log (YIN) Wires properly protected (Y/N) Casing height (above ground) / m. AT INSPECTION 22 ft. g.p.m. Collected by: .','tZ-✓ B. SEPTICIHOLDING TANK DATA r Tank Type/Material r*�r S�Dr�,6� Date installed Tank size /0400. gal. Number of Compartments Z Cleanouts (Y/N) Foundation c1eannut_!Y_!N1 Fi Depracsinn over tank lYlNl High water alarm (Y/N) Al Date of pumping 3 Pumper C. ABSORPTION FIELD DATA Date installed !617 1 Soil rating (g.p.d./ft or felbdrm)System type Length So ft. Width 3 ft. Gravel below pipe cp S, ft. Total depth 12- ft Eff. absorption area 5 /D fiz Monitoring tube Date of adequacy test / is Results (Pass/Fail) V' Depression over field For ? bedrooms Fluid depth in absorption field before test in. Water added 5D gal. . New depth Q. in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= SQ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type.) If yes, give date D. LIFT STATION n//9 Date installed "Pump on' level at Datum Size in gallons in. ➢Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on loth Absorption field on lot / /T /I - Public sewer main Nfit Sewer /septic service line Animal containment areas s6'd Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout AlAt Holding tank AJ,4 Manurelanimal excrete storage areas /Oa ,'r SEPTIC/HOLDING TANK ON LOT TO: Building foundation S'� Property line /rD�f Absorption field Water main NN Water service line f O .'V' Surface water Wells on adjacent lots /06 ABSORPTION FIELD ON LOT TO: / r Property line ! � 'f" Building foundation / 4 � Water main Water Service line �O �+ Surface water —/10 o'r Driveway, parking/vehicle storage Curtain drain /Ji(X Wells on adjacentlots r O F. COMMENTS G. ENGINEER'S l certify that / have detennined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name rJ,;:fN 40 Date !�f 13/13 COSA brown sheet 10-10-12.doc OF A41=tpl M7 Steven W. Eng ' ; Mg .PWAWL% AlSolr , and. �VM AAe . 6t t n di'k wielin the prgyerty tv or eneroaeh on the p worty ret0., at no'- vtm1*4 eb. yrop thm�ptu eacr)aoh orf the prmjsis ln, these no maaways, `tsars motion le easements on said excoO , er, Abike MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # CEJ - Q)z \ - ,)Lo 1. GENERAL INFORMATION ASLO k, v/ir.9 fY low } I�ti!�IL Complete legal description Lot 1, Block 1, Timberidge S/D Location (site address or directions) 19439 Timberline Drive Property owner James Snow Day phone 694-6084 Mailing address PO 'Box 774371, Eagle River, AK 99577 Lending agency Northland Mortgage/Gordon Day phone 274-5150 Mailing address 2605 Denali Street, Anchorage, AK 99503 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 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 furtherverify 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. S & S ENGINEERING Ccl 4Y �� Name of Firm 17034 Eagla River ) oon Road No. 204 Phone 1 Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE bl Approved for TR R E bedrooms. Disapproved. Conditional approval for Additional Comments M Date 7 /,) y A E p ROBERT C. COWAN �Q Pi 't CE -8801 p �t.• o a t, .;,`L� �1�2,' �:.�'bi�• meq^' bedrooms, with the following stipulations: Date 0 - 3 " The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rw.1/91) Beck MOAN21 ( I ;.. Municipality of Anchorage dUS DEPARTMENT OF HEALTH & HUMAN SERVIC�yk P 1999 Environmental Services Division A/V/kon/�,��,,,, AUTyoF ti 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 346'$ k4v1 'v /o Health Authority Approval Checklist Legal Description: L07- Re OC/:5 Tlf-10eC' 2IffKL Parcel I.D.: A. WELL DATA 5/1D Well type P2/VA TE If A, B, or C, attach ADEC letter. ADEC water system number Log present &/N) Date completed 7 Total depth 27,5/ Cased to 3l- / TD � P Casing height (above ground) / Sanitary seal (1/N) _/G -.S Wires properly protected/N) Date of test FROM WELL LOG Z6 1,79 Static water level J Well production 3, WATER SAMPLE RESULTS: Coliform AT INSPECTION 7/22/91 43' g.p.m. Nitrate 'a• 161 Other bacteria Date of sample: �Z �� 9 Collected by: S & S ENGINEERING 0 B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River Alaska 99577 Date installed Tank size Number of Compartments Cleanouts (Y/N) \ G S Foundation c%anout Depression (Y& ND High water alarm (Y/N) IV 1A Date of lumping 2 Pumper _74�v i r2l2 C. ABSORPTION FIELD /DATA_ , Date installed 7 el Soil rating (g.p.ddit2 o ft2/bdrm System type /.�ee-,A/cH LengthWidth 3rd/ Gravel thickness below pipe / Total depth Effective absorption area SSU ' Monitoring Tube present((�N)` -S Depression over field (Yu1 N D Date of adequacy test ZZ 9 Results (Pass/Fail) asp For bedrooms Fluid depth in absorption field before test (in.); Immediately after gal. water added (in.): 11,311 Fluid depth (ins) Minutes later: �- Absorption rate Peroxide treatment (past 12 months) (Y/N) /✓e/1/r! u•u�Wd If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Al / /� Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Size in at* On adjacent lots On adjacent lots "Pump off" level at* 00 �f- Public sewer main Public sewer manhole/cleanout Sewer /septic service line 2 5 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation Property line l U is Absorption field Water main/service line /U Surface water/drainage �� Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line / o f Building foundation Water main/service line /U Surface water /U(%''>- Driveway, parking/vehicle storage area i Curtain drain A lel'V6, 1'Nn/0!J n/ Wells on adjacent lots F. ENGINEER'S CERTIFICATION /certify that 1 have determined thru field inspections and review of Municipal recdr4)h9t the a V BgVlVs are in conformance with MOA HAA guidelines in a act on this date. f � j/� f� �r•t IA_ g �z .Ef 'U✓/ / . a ..A Si nature Engineer's Name /� /% •�% C ��✓rFrJ PP, r�� ROBERT C COWAN / CE'-8801Al rrV��y Date 7 HAA Fee $2C�' Date of Payment J --a ��] Receipt Number 6;Z)10 ( � 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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, ordinances, and regulations in effect on the date of this inspection. Name of Firm c a c ❑ISIGINEMUNG Phone 17034 Eagle River Loop Road No. 204 Address Eale alae 99577 Engineer's signature F- DHHS SIGNATURE a Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: dt1TlC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7M25 (Na . V91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: r \ $Lt/-- \ Tl rl&F-C- 14DIA- Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number nil Log present(Y/ ) Date completed 4-7-u -7`7 Driller )2"17OrY2'r Total depth 215—Cased to_1 4' Casingheight ��~y Sanitary seal (SAN) Date of test Static water level Well flow Pump level Wires properly protected &N) FROM WELL LOG 4,- - L, n-1 15-01 g.p.m Z4S� SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main y Public sewer manhole/cleanout Sewer service line �� 1 Petroleum tank ZS 1 k �taJ�D 15 eta. WATER SAMPLE RESULTS: PP��( c� I� T(�l 19� �� 1 u 1P �/ /k 2�� ( t k/Ae' r40T Ge LI n,e -F �JF�ir��'� Coliform a /r 60dwl , Nitrate 3 C' �� Other bacteria Date of sample: 5--14-92- Collected by: S A S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed �' 7c1 Tank size Compartments 7- Cleanouts ON) � Foundation cleanout &N) � Depression (Ya High water alarm (Y/N[)A LI, Alarm tested (Y/N) Date of pumping e-9/ Pumper Sshi-r.4at/t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I`3z' Well(s) on lot ID o On adjacent lots 16 c Foundation To property line /r Absorptionfield % Water main/service line Surface water/drainage /o0 !4- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE AT INSPECTION c O Z 17� G 2 tog' ,G n o 0 2 On adjacent lots 1bz5 On adjacent lots 1 b o% d' Public sewer manhole/cleanout Sewer service line �� 1 Petroleum tank ZS 1 k �taJ�D 15 eta. WATER SAMPLE RESULTS: PP��( c� I� T(�l 19� �� 1 u 1P �/ /k 2�� ( t k/Ae' r40T Ge LI n,e -F �JF�ir��'� Coliform a /r 60dwl , Nitrate 3 C' �� Other bacteria Date of sample: 5--14-92- Collected by: S A S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed �' 7c1 Tank size Compartments 7- Cleanouts ON) � Foundation cleanout &N) � Depression (Ya High water alarm (Y/N[)A LI, Alarm tested (Y/N) Date of pumping e-9/ Pumper Sshi-r.4at/t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I`3z' Well(s) on lot ID o On adjacent lots 16 c Foundation To property line /r Absorptionfield % Water main/service line Surface water/drainage /o0 !4- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y. — Manufacturer Manhole/Access (Y/N) 11 ' level at Cycles tested SEPARATIOI�NCE FROM LIFT STATION TO: n lot D. ABSORPTION FIELD DATA Date installed 1,' 79 Length 3 o Width On adjacent lots 31," Surface water Soil rating 15b I6d- System type -rilA_..il d Gravel thickness 9-57 / Total depth 12' Total absorption area SI1) Cleanouts present &N) Depression over field (Y& ri Date of adequacy test Z Results ail) QD45 for '�r�bedrooms Peroxide treatment (past 12 months) (Y�jV'I) tj,-14F✓ 1,40kw If yes, give date �( SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ��o y On adjacent lots It k� Property line__ t) / To building foundation To existing or abandoned system on lot On adjacent lots 30'� Cutbank /-��4_ Water main/service line lovk Surface water ioD 14- Driveway, parking/vehicle storage area /b r 4. Curtain drain ,_11 E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in A S ENGINEERING Signature 7034 Eaglo River Loop Road No, 204 Eagle River, Aln, kn 99577 Engineer's Name Date 01 `L, HAA Fee $ � ! o .� 7 Date of PaymentReceiptNumber 72-026 (Rev. 3/91) Back MOA 21 of this inspection. Waiver Fee: $ Date of Payment Receipt Number •� MUNICIPALITY OF ANCHORAGE, DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY'APPROVAL CERTIFICATE 1. General Information Application Date (a) Legaly Description (include lot, block, subdivision, section, township, range) ✓7l.ibi,,Z. .�. �.y�R cG2 d�.. �i-•.f Q:..,.— — __—_-.,mom Location (address or directions) J r, O II�o (b) Applicants Name_ s}fLLnv�__`iJ'°-c Telephone _, Home Business Applicants Addr (c) Applicant is (check one) Lending Institution ; Omer/builder M ; Buyer ! ; Other (explain); ---------__-- _ (d) Lending Institution /...L! -c'- %<, :'- f.F%�� Telephone Address /7/ -Ye. r= . •<- (e) Real Estate Co. & Agent Address Telephone (f•) ,Nltff�l the NAA to the following address: 2. Type of Residence Single—FamilyMulti—Family Number of Bedrooms le 3. Water Supply Other (describe) Individual We11 4 Community I= Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public El Community I— Bolding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. (Page 1 of 2] 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-sita 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 regula- tions in effect on the date of this inspection. Name of Firm Telephone--- Address elephone--Address „ w f! 4 X196 t „� , ;'�.• ,. Date (. DHEP Approval Approved for �, bedrooms By Approved Disapproved 1 Terms of Conditional Approval_____-_ CAUTION Condit Date �) THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/Dl8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ,J;`,C7 1085 CHECKLIST - FEBRUARY 1984 Lega�scription: A. WELL DATA(„A1t _raz Well Classification kk/x r/ y • If A, B, or C, D.E.C. Approved ) Well Log Present &4 Date Completed/��/ Yield,/i .rte %� C) Total Depth o�)Vd ° Cased to Depth of Grouting 5 ti Static Water Level Pump Set At (1(_/_'— Casing Height Above Ground " Sanitary Seal on Casing a1N)_ Electrical Wiring in Conduit ) / S' Depression Around Wellhead (*Y ) Separation Distances from Well: To Septic/Holding Tank on Lot /acs On Adjoining Lots_____/rb1 To Nearest Edge of Absorption Field on Lot /,1a '" On Adjoining Lots "V/a To Nearest Public Sewer Line ? To Nearest Public Sewer Cleancut/Manhole t •. To'Nearest Sewer Service Line on Lot 1 G} Water Sample Collected By s Ge- v Ec-- , ,, ,�R_(, Date Water Sample Test Results Comments iIJE' ✓ r B. SEPTIC/HOLDING TANK DATA n Date Installed r7, size 1660 No. of Compartments Standpipes 6Y1;N) Air -tight Caps (Y ) Foundation Cleanout Y111]-) Depression over Tank (XAL,) Date Last Pumped Purrping/Maintenance Contract on File (Y" / for �G L Holding Tank High -Water Alarm (Y ) '( Temporary Holding Tank Permit (yd"-J- /Hold Separation Distances from Septic/Hold hg Tank: To Water -Supply Toll I O S ` To Building Foundation To Property Line jo .f To Disposal Field 7' To Water Main/Service Line d% 4_ To Stream, Pond, Lake, or Major Drainage Course X q CcmmentS Receipt # Date Paid: , Amount: (Page 1 of 21 2-15-84 C ABSORPTION FIELD DATA Soils Rating in Absorption Strata JS'z Type of Date Installedsr)cl� Length of Field System Design �k 67k:6 _ / 3® " Width of Field Depth of Field Gravel Bed Thickness f Co Square Feet of Absorption Area tiS-/o /__ Standpipes Present (YM) Depression over Field W/O Date of Last Adequacy Test Results of Last Adequacy Test V Separation Distance fran Absorption Field: To Water -Supply Well 1361 To Property Line \C31 To Building Foundation Al; '4q To Existing or Abandoned System on Lot �4 ; On Adjoining Lots 61.1—A To Water Main/Service Line/4- To Cutbank.(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, cc Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons ManholTACss (Y, M) "Pump On" Level at evel at High Water Alarm Level at nt (YM) Tested for Pump ngyc ing Adequacy Test. Meets MOA Electrical Codes(YM) Convents "* Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA GuiON4vgss in effect on the date of this inspection. Signed4 tlali+�[ ill`4` Date. -S l S— 4.4 -� ��fd P `°•`��y�� Company MOA No.k y ...• a i / / v d5s G tto�an A. sn"leP KB1 ? 4` I' n No. 1457 F. dd�T°• ° (Page 2 of 2] 2-15-84 INSPECTION APPOINTMENTS INSPECTION ^ED DATE RECEIVED � �`�' TIME TIME TIME � Aw. / ek (� A DATE DATE DATE ❑ One ❑ Four ❑ Other Two ❑ Five ❑ MULTIPLE FAMILY t) INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE IPALITy CE ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEf�' l6r— 825 L Street - Anchorage, Alaska 99501 DEPT. OF -1 •;CCTION • CFfJIRONi\hB.�r.;. ENVIRONMENTAL SANITATION DIVISION ,�:�; (': 7 Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEVVRREE(J1y1IISD DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPE RTV OWNER PHONE e. �r��/�F /j�.� 9 - JVX6 3 MAI LING ADDRESS d190 K /ale . enc PROPERTY RES ENT (If differeslt from abovef PHONE 2. BUYER /+ PHONE JR4 C fG�C MAILING ADDRESS v 3. LENDING INSTITUTION PHONE i `r, MAILI ADDRESS 4. REALTOR/AGENT PHO E /�ar0000 MAI G ADDR ES . D ►X Vq OF 5. LEGAL DESCRIPTION STREET LOCATION -ZitollG � Aw. / ek d D �G♦4;e, 6. TYPE OF RESIDENCE NUMBE OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM X INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 13r- 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ six 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 1000 If Tank is homemade give dimensions: SOILS RATING s -D TYPE OF TANK MANUFACTURER b� TOTAL ABSORPTION AREA MATERIAL 1J 4. DISTANCES WELL T0: Septic/Holding Tank p3 Absorption Area l Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LTJ' APPROVED FOR j BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79) /130'To Z�f'�-kul :t i JL 'lel c- 5. LEGAL DESCRIPTIO 10 MUNICIPALITY OF AN iH& , MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH ION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI�r�J 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION G • ENVIRONMENTAL ENGINEERING DIVISION JUL 2 61979 Telephone 264-4720 D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE AT10- DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. P PERTY OWNER �� - N93 PH NE _ MAILING ADDRE ( (�/ n MULTIPLE FAMILY Three ❑ Six 7, WATER SUPPLY - PROPERTY RESIDENT (If different from above) �Q PHONE 2. ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well PHONE y PUBLIC UTILITY 0. e_ Q_ 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date>_. MA INGOADDR z If system is over two (2) years old an adequacy test is required 0. e fC PUBLIC UTILITY lC 3 ENDING INSTITUTION S -- 11 PHONE MAILING AD RES 4. REALTOR/AGENT - PHONE MAILING ADDRESS 5. LEGAL DESCRIPTIO 10 , p-- VA STRE T LOCA ION 6. TYPE O SIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other__ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7, WATER SUPPLY - - - �Q INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If individual/on-site, installation date>_. INDIVIDUAL/ON-SITE** give If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) I/I THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED Cp ^1 INSTALLER t ❑Septic Tank or ❑ Holding Tank Size: d If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK -MANUFACTURER TOTAL ABSORPTION AREA MATERIAL o 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 10�-'APPROVED FOR 3 BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accom an certificate) El DISAPPROVED DATE BY (Ti LEGAL DESCRIPTION 72.010 (Rev. 3/78)