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Home My WebLink AboutTIMBER RIDGE BLK 2 LT 5Timber Ridge Block 2 Lot 5 #050-321-23 Municipality of Anchorage Development Services Department Sultding Safety Division " On-Site Water and Wastewaler Program• 4700 S. Blagaw St. P.O. Box 196650 Anchorage. AK 99519-6650 Page ` 0l3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: dS0qqC)o:3q PID Number: N' j, t% [ Co Wastewater System: New rade Y ❑ Upgrade Aed... a.II S, rTITKOG 1.oaP tgt-&4 4144 ABSORPTION FIELD Plvr' TI°"a" x a°dOOni1 7 bi( p.,p T,w o ShO . T,..r . o e.0 o M.W o oo w* LEGAL DESCRIPTION l:q Sol RaO.8 TMeID@vTk monVWgra 10 P IFI FI abck'� LM'� $�M.lo.r Tr be Depth b, 11, eom Mlpi.Mp�['• G.w.l&Pp b* .h plea. r�- r Irl. ,Jri Townho' Rwge S dA Faaddedeb. ong. qr d. Grwel t"V• 67 Ft. rl. Well: ❑ New ❑ Upgrade Grar.l .lent S Mn4NaIMr l� ol.IwKe UaW.w. eN.' FI. FL CI...'�G[M.�rPrNM.,A 9. Gk TN* D.pw:1 CH.d�a67F Too M*apnan M.a �3g �/� �/� 303% 8 0 111�er 1. W1109.5P 14Y S JI' ,< DM. d.MQ J.i-.(`1 J $IMK WMNrMI'. ^Q� 6 Mlarlw ii 11L,J COrl1 DM. MIMN' t/ / FI YW L pumpr : Ua$KnM c""I" AEw. �rFL TANK T GPM own FI. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding PuNkJPrlval MaM.[Nw: IRS�•C cw 'y. '3 O&W. From Tank Field Slallon Tank Sewer Line /' `4 116, I o3' 1! 6' 5 MMw M . / ^� 1(J IMS e ea gwlmMs "v)l $vraeewm. IQQ`+ 1Opt 1004' LIFT STATION La LM 53 Iql S/ r SS(M Premre� �a5 SGS vo rand*. ^^ ^L ��, 'P.mpon'M v P. 01FM m /I.�.www Alam M. O•`/5 Oil Yl •�" Yr In. clM,w.awn N011e. f:' 1 Pwro MMa {Mae. Elven kM Yr@P U pwt ar N/A ,0 •-1E h%/BBI.CA tarts» ugr�elZ BENCH MARK TRkA mr_-r S?STa!-r I+ sTA&L-eJ lorMun anJ D..ap. To- Of (JaYA e. -Roor 1A1 rrFAT /Qt dtR7 7ArK . !I N M.urrrM EMM.. �D4r/1� 100 FI FAt-1Setial .;;:= :,7t 0, S 3 S ENGINEERING g, 1M S_ -3 Inspections performed by: 117034 Eagle River Loop Road is h't .. �� •^� r�i �'\• ROBE0.T G COWAN Devel6pmejlt Service Department Approval / Reviewed and approved b Dale: `� Z Ll 0Z PP Y� <�, CE-8801 ,+ltff"• a��.: 11��1;Zi�aot'��.• rxw r_ml f1: PERMIT No. SW990039 PACE 2 OF 3 Municipalityof Anchora ge DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone+ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 2, TIMBER RIDGE S/D P.I.D. NO. 050-321-23 V/ I , r LOT 6 I LOT`* I 100' WELL RADIUS I /' 1 , 1 1 . Z BLOWER UNIT ('1 O IN CRAWL SPACE 1„ / C I A FCO IBM l J ' I NEW 1300 GALLON ~ 1 1� HOPE SEPTIC TANK CO2 -_.._ I T1 EW TRENCH art • T2 -._ NEW 550 CALLON FAT O MI1 _ •Tx ALBERT WITH NIBBLER ^ _ X79 C 1 1 I / SAMP (SAMPLE PORT) 1 I I I � SCALE: ` 40' , ssra.... l OBERT C. COWAN •',4 CE-8801To 2=� Ile 11j��L\asaz�1 �~ PERMIT No. SW990039 PACE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, BLOCK 2, TIMBER RIDGE S/D P.I.D. No. 050-321-23 ST1 ST2 FINAL GRADE 98.1' — 71.5 100.5' ST2 100.8' 74.0 2" INSULATION-N,,I- MH — FLEX UNE (AIR IN) 62.0 NT1 — 1' FLEXUNE (AIR RETURN) 62.5 NEW — OUTLET 95.5' 1300 GALLON — u GRAVITY DISCHARGE ° 64.5 POLYETHYLENE 43.5 85.5 — SEPTIC TANK 95.2' 95.0 109.0 550 CALLON FAT ALBERT 108.0 — WIT11 NIBBLER A 8 C CO1=90.6' FCO — CO2=84.6' STI FINAL GRADE C01= 81.7' SR CO2=81.4' N. T. S. rl AM .............. •. rSi?l�, C MT1=74.0' r;�T —, z•'�'F0 NO WATER FOUND...Fi�,�..•F 67.0' B.O.H. I,0i IJlL ROBERT C. COWAN l� CE-8801tt — 71.5 54.0 ST2 — 74.0 56.5 MH — 79.5 62.0 NT1 — 78.5 62.5 NT2 — 81.0 62.5 SAM — 82.5 64.5 C01 43.5 85.5 — 0O2 95.0 109.0 — MT1 92.5 108.0 — M 1. C�QxttftEb by A DOC Co. tlbe SULLIVAN WATER WELLS P.O. BOX 870272, CHUOIAK, ALASKA 99587 • TELEPHONE 888-2789 (� `1. y �, - OWNER OF LAND L FF L O I BORE HOLE DATA r� `.,- LEGAL DESCRIPTION ?rl."r36C K146C as r PERMITNUMBER 47'701Dateoilssue3-.�3-_ TAX INDENTIFICATION NUMBERc�S o `��/_� - Is well located at approv permit location? � res Q No Method of Drilling: fv rotary ❑ cable toot Depth of well 3 60 > " Casing Typei e c' L Wall Thickness S J inches Diameter (o // inches, depth 5?6� feet Liner Type: n)1Ac Casing Stickup Above Ground: .2 feet Static Water Level (from ground level): feet Pumping level:—feet after hrs. pumping _gpm Recover Rate: 4 qpm Method of Testing: 41A Well Intake Opening Type: ❑ Open End blC�—n Hole Q Screened; Start feet Stopped feet Q Perforations Start .-q 3 feet,. Stopped feet i Grout Type: Ac ^ i a" I rE C glume. at) JCaS Depth: from feet, to feet Pump Intake Depth: Pump Size hp Brand Name *�. Well Disinfected Upon Completion? f!IrIes Q No Method of Disinfection: C14L,a4,e J E SO-OP� Comments: Drillers Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. t ,7,,g 0_,,9S1,j t: F71etV J P '�i OJti2 (3 1QQc..� _: 3 i L&I Cl3 f14xa3 i9 CY 3 Cf6 WCTO Clv -7T 9AA-41141+ s S14.7 Y 0A.P44.1 as�r 398 _RrdQjCr 13 604) ce- Q Screened; Start feet Stopped feet Q Perforations Start .-q 3 feet,. Stopped feet i Grout Type: Ac ^ i a" I rE C glume. at) JCaS Depth: from feet, to feet Pump Intake Depth: Pump Size hp Brand Name *�. Well Disinfected Upon Completion? f!IrIes Q No Method of Disinfection: C14L,a4,e J E SO-OP� Comments: Drillers Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. t HEALTIIAUTIIDRTY APPROVALS SEWERS WATER WUNDRENSIONS SEWERS WATER NSPECTTON ENGINEERNGSTLIDIES ANDREPORTS WELLNSPECTIDN S FLOW TEST SITEPLANS POADDESIGN SOILTEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPCSALSVSTEM DESIGN Date: Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Cots, Block a , ;rn6ert ROBERT C. cowAN, P.E. ROBERTA. SHAFER P.E. CMLENGINEERS (907)694.2979 FAX(907)694-1211 RECEIVED MAY 24 1999 Municipality of Anchorage Dept Health & Human Services The septic inspections for the referenced property were performed on 5--;13-q9 and $-1q-9q . Prior to submitting the On-site Wastewater Disposal System and/ Well Inspection Report we are waiting for the s- SN/bf' to be completed. If we may be of further service please contact us. Sincerely, 14eff6owan, P.E. 17034 NORTH EAGLE RIVER LOOP -SUITE 204 -EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Sire Services Program 625 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW990039 Legal Description: TIMBER RIDGE BLK 2 LT 5 Design Engineer. 0003 S & S Engineering Owner Name: Lee Coy Owner Address: 19211 S. Mlkof Loop Eagle River. AK 99577- Date Issued: Mar 23, 1999 E)piration Date: Mar 22, 2000 ParcelID: 050-321-23 Site Address: 019425 UPPER SKYLINE DR Lot Size: 27980 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of. ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy✓❑ Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specked 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 sol absorption system under construction during freezing weather must be ether. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: —) g° J -' Date: 3 7a / 9 q Issued By: Date: -23 - 99 FFB 25 1999 f v Ot 17 tAUN1CIPALIiY Oh AM—HQKAGE EngineeRlnG el foipgp@AENTALSFawrFS DIVISION ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 FAX(907)694-1211 February 17, 1999 WATHAUTHORITY "PPRM&S MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER Anchorage, AK. 99519 MANMNSIONS REFERENCE: Lot 5, Block 2, Timber Ridge Subdivison SEWERaWATER LOTION Request you Issue a permit to install a septic system to serve the five bedroom dwelling on the referenced property ENONEERWGSTUCIES Two test holes were excavated and percolation tests performed. The approximate ANOREPORTS location of the test holes are located on the attached site plan. At the time of excavation 1/22/99 water was not found. After seven days of ground muff,encnGN water monitoring the monitoring tube was dry. & FLOW TEST 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 SITE PLANS construction of this system will not prevent any future development on any of the adjacent properties. ROAD DESIGN If you require additional information, please contact us. Sincerely, SOILTEST / Gf1J�� Robert C. Cowan, P. E. PERCOLATION RCC/rdp TEST Enclosure STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM CFSIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 J a w Piing LOT 4 LOT 5, BLOCK 2, bv; LM LKLD 8T. R.D.P. R.C.C. SIGN CRITERIA: 80M - 7,50 GPD ILSS = 0.8 GPD/SQ. 0/0.8\ FT. = 937.5 SQ.FT. REQ'D. t k\fl, CRITERIA: 1o' DEE �\ 7' Err EC VE 2.5�N/10 \ 67 Lorl \ \\ LOT 6 EXISTING WELL \ �� \ PROPOSED �5 WELL Q� 1 PROP( 4 WELL I I c ZSEPTIC \ AREA/ ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. TIMBER RIDGE WL 2—,D"3-99 I i of a STRUCTURES, EASEMENTS, OR ENCROACHMEI SHOWN ON THIS SITE PLAN ARE A5 SHOWN AN AS -BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING IT IS THE RESPONSIBILTY OF THE CONTRACI TO VERIFY EASEMENTS, REQUIRED SEPARATII ,,DISTANCES, AND PROPERTY LINES PRIOR TO CONSTRUCTION. I 1PROPOSED I SEPTIC 7 I `ovs LOCATION/ I D I _ ^ 1 �•C A O c � FCO ~"I co n /0 PROPO D 1300 CAL. 0 POLY. TANK A MT / / • INSTALL DBL CO I CO '" ° /553 PROP. 550 AL. 51,E FAT ALBERT ` w/NI9aLER PROPOSED TRENCH PPER�, V-1 !f RCEERT C. COWAN a • E201 CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. LOT 6 ZSEPTIC AREA/ LOT 5 WELL RADIUS [SEPTIC AREA/ LOT 4 R WY V 90X5 m "THE TO MEET Z 0 N W 0 RWD CO LOT 5, BLOCK 2, TIMBER RIDGE nv: cnccaco nv: wu: R.D.P. R.C.C. 1 2-23-99 CO 1300 GALLON POLYETHYLENE TANK ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. OUTLET 2' FOAL 2OF2 NOTE: BLOWER UNIT TO BE INSTALLED IN HEATED AREA/CRAWL SPACE OR GARAGE. BLOWER SWITCH TO BE INSTALLED ON OUTSIDE OF HOUSE. RECIRCULLTLON SPOONS /—DISCHARGE SPOON TRICKLE MEDIA RECIRCULATION i!'I11! OF A ROEERT C. COWAN CE -C801 ?` i CONTRACTOR IS REOUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. ,I' FLEX LINE (AIR IN) I' FLEX LINE (AIR RETURN) --LIFT DISCHARGE N —GRAVITY DISCHARGE —GRAVITY LINE BOTTOM OF REMOVEABLE SCREEN VAULT SUBMERGED MEDIA 550 GALLON FAT ALBERT W/NIBBLER UNIT EXACT DIMENSIONS AND DESIGN PM ETENS IN INE FIELD. IF NECESS . TO MEET SITE CONDOTOMS. PERFO LEGAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST RUN BETWEEN 1) FT AND '/j FT COMMENTS PERFORMED BY: 17034 Eagle River Loop Road No. [ua /yr A A („ /�� CERTIFY THAT T IS TEST WAS PERFORMED IN Eagle River, Alaska Ct ?�1_L �L x 9 ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72.008 (Rev. 4185) (ENGINEER'S SEAL) a ..r Municipality of Anchorage . �i f,+ »"��• DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650: SOILS LOG — PERCOLATION TEST/. / ,� ROBERT C. gOCOWAN PERFORMED FOR: l 62 DATE PERFORMEIf�'X:- ,GL;`�T"I 1 LEGAL DESCRIPTION: L,0 's (31.1- 2 ��6.f? Township, Range, Section: •••.-_~c• p TU PIP,,rt-SLOPE SITE PLAN ��- 1 1�1C ENCOUNTERED? Net Time o� 31, DEPTH? or.E— rl R,io0 p,• 4 . 5 6 1-2; �� 7 qIt P 8- 9- 9 '1" 3 10 10- s to 3 ^ 11 it •0' 0 12 is w •N d .d 13 14 3^ 15 G' 9 17 18 19 20 COMMENTS WAS GROUND WATER 1�1C ENCOUNTERED? Net Time IF YES, AT WHAT 31, DEPTH? or.E— Depth to witer Monitoring? .VT D+tc2.•1i Reading Date Gross Time Net Time Depth to Water Net Drop �F or.E— rl R,io0 1-2; qIt z SO„n.A '1" 3 3 s to 3 ^ is w •N -7 S' to 3^ PERCOLATION RATE to (minUteStInCh) PERC HOLE DIAMETER to TEST RUN BETWEEN 95 FT AND G FT 5 & S ENGINEERING PERFORMED BY: 1 - n✓�� CERTIFY THAT Tt/1S TEST T WAS PERFORMED IN ACCORDANCE WITHWTC0iMffAAIi&kX &9M GUIDELINES IN EFFECT ON THIS DATE. DATE. - /;'O C 9 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department- v Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-321-23 Legal description TIMBER RIDGE BLK 2 LT 5 Site address 19425 UPPER SKYLINE DR Expiration Date: 7/27/23 Current property owner(s) CHRISTENSEN VAL D & SHAUNA B X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 4/27/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 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 Application 1. GENERAL INFORMATION Parcel I.D. 050-321-23 Complete legal description TIMBER RIDGE BLOCK 2, LOT 5 Location (site address) 19425 UPPER SKYLINE DRIVE, EAGLE RIVER AK 99577 Current property owner(s) VAL & SHAUNA CHRISTENSEN Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ PTO Waiver Fee $ Date of Payment / Z OZ � Date of Payment COSA # O S C Z'3 1 `o 2 Waiver # COSA Applicalion.doc COSA Checklist - ORIGNAL MOA DID NOT LIKE.docx COSA Checklist Legal Description: TIMBER RIDGE BLOCK 2, LOT 5 Parcel ID: 050-321-23 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/3/1999 Total depth 360 ft Cased to 267 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/13/2023 Static water level at beginning of test 299 ft. Well production at time of test 3.5 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.51 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/4/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 47” Date of pumping 3/15/2023 Required maintenance completed, if AWWTS Comments: SEE MAINT REPORT OF NIBBLER - C. LIFT STATION Required maintenance completed Age of lift station 24 years Lift station material HDEPE / PLASTIC Comments: NO PUMP, BUT MAINT PER MOA D. ABSORPTION FIELD DATA Which system tested (date installed) 5/14/1999 ALL standpipes present per record drawing Total measured depth from grade 9.8 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. (ED) If not, state depth into effective 6.2’ OF 7.5’ ED Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 3/15/2023 Results Pass Fluid depth prior to test 2 in Water added 860 gal New fluid depth 6 in Elapsed time 1300 min Final fluid depth 1 in Absorption rate 750 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 90 in (MOA 7.5’ED) Effective depth used 17 in (Missing ED + Final Fluid Depth) Effective depth remaining 73 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots with approximate 16” missing ED. No lift station but serviced by L&S Services per the attached report. Winter time conditions. COSA Checklist - ORIGNAL MOA DID NOT LIKE.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 4/26/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 4/26/23 MUNICIPALITY OF ANCHORAGE Development Services Department T Phone: 907-343-7944 On -Site Water & Wastewater Section Fax: 907-343-7997 Owner Septic Tank; -Sludge level ,Z( inches I W �4�finn Lift Station/Pump Vault Maintenance Log Street Address L} -Pumping: required es ri -Pumping completed yes no -Pump Basket cleaned yes no -Effluent filter cleanedey s no -Control floats cleanedyep s not /i •Proper float settings confirmedey s noI -Operation satisfactory yes nv ,! Alarm System: -Dedicated electrical alarm circuitey s no -Audible and visual alar} inside dwellinge_y s no -Alarm system operation satisfactory not satisfactory Nll� Manhole Riser -Groundwater intrusion at riser to tank connection esnd -Groundwater intrusion around pipe penetrations esno -Manhole lid: Functional es no Insulated Q@no Weep hole functionaleY s no Properly Secured es no Other -All manufacturer required inspections and maintenance completedeY s no Comments: {qualified Maintenance Provider: Technician kar, W,L' Company y,Cy Signature 0 ■ A I rl �. I CiI1A SOCA 02 Apt l� Ar) rk«ry fF Date of maintenance -Pa Date Municipality of Anchorage Development Services Department „`•, Building Safety Division - w On -Site Water & Wastewater Program 4700 South Bragaw St (� P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak us' <zgQxY�/� t (907) 343-7904 �� ( 000 480 s -'CERTIFICATE .OF HEALTH AUTHORITY APPROVAL F FORA SINGLE ,FAMILY DWELLING F r.' Parcel I.D. 050-321-23 1. GENERAL INFORMATION - Expiration Date -41 Complete legal description' TIMBER RIDGE SUBDIVISION* LOT 5 BLOCK 2 ` Location'(site address or directions) 19425 UPPER SKYLINE 'DR + EAGLE' RNER °AK 99577 ' - Current Property owner(s) _ LEE do LINDA COY <"f Day phone 694-2697 Mailing address 19425 UPPER SKYLINE DRIVE • EAGLE RIVER 'AK 99577:' Lending agency_ , Dayphone" 4 1•' r ' Mailing address Real Estate Agent Day phone , Mailing address Wess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL Individual Well Individual On-site ` Individual Water Storage ❑ Individual Holding■ tank ❑ ` Community Class Well ❑ Community On-site Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority } Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid . water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. - 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate, for the number of bedrooms and type of structure indicated herein. 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. - Add r . ess NC.Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide *.any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the own* erlisted above. Any reliance upon or use of this report by any ether person or party is not authorized, nor will it confer any legal right whatsoever. kGarn ssr :7 3' a 31 0 5. DSD SIGNATURE Approved for .L bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ttvtY OF A Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ✓ Manitenance Agreements Supplemental Engineer's Reort Other ON-SITEWCER AND =�Gi WASTEWATER 1)) r Original Certificate Date: T — 0L V-03 (Rev.1 1) ._._.__.....__..,.............„.........:...„v..+•T........w...Y+m....o.....-..........-.-.-...._...........................-,..........,...._.........�..._............«........... Municipality of Anchorage �Y Development Services Department Building Safety Division y " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ~4.anchorage.ak.us (907)843-7904 HEALTH AUTHORITY APPROVAL CHECKLIST t' Legal Oesc liption: TIMBER RIDGE _S/D: LOT 5, BLOCK 2 Parcel ID: 050-321-23 k WELL DATA *TEST DATA LESS THAN 2 YEARS OLD Well type PRIVATE It A. B. or C provide PWSID# N/A Date completed 5/3/1999 Sanitary seal (Y/N) YES Total depth 360 ft. Cased to 267 ft. FROM WELL LOG Date of test 513/1999 Static water level 286 ft. Well production 4 g.p.m. WATER SAMPLE RESULT'S: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION *6/20/2002 295 _ft. 3.4 g.p.m. Coliform O colonies/100 ml. Nitrate 2 4.09mgJL. Other bacteria colonies/100 ml. 1 4/10/2003 Arsenic: N/A mg./L. Date of sample:2 6 20 2002 Collected by: AKWWC, INC. S. SEPTIC/HOLDING TANK DATA Tank Type/Material PLASTIC Date installed /14/1999 Tank size 1300 gal. Number of Compartments .? _ Cleanouts (YIN) YES Foundation cteanout (YIN)YES Depression over tank (YM) NO High water alarm (Y/N) . NO Date of pumping 6/22/2002 Pumper JR's PUMPING G. ABSORPTION FIELD DATA *BELOW FINAL GRADES PER S&S INSPECTION REPORT Date installed 5/14/1999 Soil rating p.d r ftlbdrm) 0_8 System type DEEP TRENCH Length 67 ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth•_., X6.6 .ft. Ef. . absorption area 938+ ft' Monitoring tubeYES Depression over field NO Date of adequacy test *'6/26/.2002 Results (Pass/Fall) PASS For 5 bedrooms Fluid depth in absorption field before test B in. Water added 1384gal. New depth 22.5 in. Elapsed Time: 984 min. Final fluid depth 110 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **TEST DATA LESS THAN 2 YEARS OLD. D. NIBBLER TANK NO LIFT STATION Date installed 5/14/1999 Size in gallons 550 Manhole/Access (Y/N) YES "Pump on" level at N/A in. "Pump off" level at N/A in. High water alarm level at JA in. Datum N/A Cycles tested N/A Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100"+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS i �o G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in ........ ................. conformance with MOR HAA guidelines in effect on this date. Q J G mess. Engineer's Printed Na a JEFFREY A. GARNESS �d�s E- 3 � Date �t Z3 ..° �' 44 �ofeae��a HAA Fee $ 3 7rJ Date of PaymentrJ i 0 a Receipt Number a iO g (Rev, 12/01) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 6 x(907) 343-7904 k.us CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-321-23 HAA#4 ZK 2 2a 0 e -q 1. GENERAL INFORMATION Expiration Date: 61 —a %" 02 - Complete legal description TIMBER RIDGE SUBDIVISION: LOT 5. BLOCK 2 Location (site address or directions) 19425 UPPER SKYLINE DRIVE • EAGLE RIVER, AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LEE & LINDA COY Day phone 694-2697 19425 UPPER SKYLINE DRIVE ► EAGLE RIVER, AK 99577 Day phone LES BAILEY w/ PRUDENTIAL VISTA E. R. Day phone 16635 CENTERFIELD DRIVE • EAGLE RIVER. AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 689-6464 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. U - Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S IBCp�at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspdction, 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 Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SURE 2B " ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. A W WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE Approved for !2— bedrooms. Disapproved. 337-6179 Date 6-i acti Conditional approval for bedrooms, with the fllowing stipulations: Attachments: / �� O•, �� HAA Checklist _�L Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort 1[11111 tx___. ti11� Well Flow Advisory Other / Bam/ �y J (+�� Original Certificate Date: to ' 7- C� IRO.. 12101) Municipality of Anchorage • Development Services Department Building Safety Division onsite Water & Wastewater Program ` 470D South Bragaw SL P.O. Box 196850 Anchorage, AK 9951945= www.cLanc orage.akus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: TIMBER RIDGE S/D: LOT 5. BLOCK 2 Parcel ID: 050-321-23 A. WELL DATA Well type SATE If A, B, or C provide PWSID# N/A Date completed 5/3/1999 Sanitary seal (YM) YES Total depth 360 ft. Cased to 267 ft. FROM WELL LOG Data of test 5/3/1999 Static water level 286 ft. Well production 4 9.p -m. WATER SAMPLE RESULTS: Collfonn 0 colonies/100 ml. Nitrate 4.09 mgA. Well Log (YIN) YES Wires properly protected (YM) YES Casing height (above ground) 18+ in. AT INSPECTION 6/20/2002 295 ft. 3.4 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 6/20/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material PLASTIC Date installed 5/14/1999 Tank size 1300 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) 8S Depression over tank (YM) NO High water alarm (YIN) NO Date of pumping 6/22/2002 Pumper JR's PUMPING C. ABSORPTION FIELD DATA *BELOW FINAL GRADES PER S&S INSPECTION REPORT Date i atalled 5/14/1999 Soil rating 402Pr ft')bdnn) 0_8 System type DEEP TRENCH Length 67 ft. Width 2.5 ft. Gravel below pipe 7.5 ft. Total depth 016.6 ft. Elf. absorption area 938+ fe Monitoring tube YES Depression over field NO Date of adequacy test 6/25/2002 Results (Pass/Fal) PAS For 8 bedrooms Fluid depth in absorption field before test 6 in. Water added 1384gal. New depth 22.5 in. Elapsed Time: 984 min. Final fluid depth 10 in. Absorption rate >- 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN If yes, give date - D. NIBBLER TANK NO L,tF•r- S rVPM*4 0 Date installed 5/14/1999 Size in gallons 550 Manhole/Access (Y/N) YES "Pump on" level at N/A in. "Pump off* level at N A'n. High water alarm level at N/A in. Datum N/A Cycles tested N/A Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main On adjacent k ds 100'+ On adjacent tots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION �G V. - I certify that 1 have determined through field inspections and* !• ••. 7* review of Munidpal records that the above systems are in ""' "• ' . • ..... • •""" conformance with MOA HAA guidelines in effect on this date. r A ess.* Engineer's Print d Na le JEFFREY A. GARNESS `• —79 •f •, matt Date %� 7i2 Q • eo �° �[orenlo°d HAA Fee $ 37� t �"S� # Waiver Fee $ Date of Payment b zr v2 Date of Payment Receipt Number 2-14306 Receipt Number (Rev. loot) I 30 i l G a2z�iEr�� Moo AM A1A51(A 99502 Friorr[ er]-sew 1/10/02 1 AS BUILT 54-04 GATE �nC i\�� FTD. BK. R Fiss Lq NOTES: Easements rot oppewlng on record subdivision ptot ers not shown wless desviptim of casement is provided by c9eM. R b the nsponst ay at the owner r brAder, WW to consbvetlorl to vett proposed buliding grass retotive to flrJsh grade and U09Use ewneNfor,% one to determine tM esislsnce of arry easements. cc + wts. or resbictbns which do not appear on Bre recorded subdrvlelon plat Dwoaons Dosed w assumed datum Unless DOWW" indicated. cad bearings and distwees are record data. CLIENT' LEE COY LEGAL. DESCR TM LOT 5, BLOCK P. TWR RIDGE _ PIAT NO. SCALE CRD TO -2i9 1e-30 W 255 t