HomeMy WebLinkAboutTIMBERLUX #1 BLK D LT 2Timb
flux
Block b
Lot 2
#018-271-20
Municipality of Anchorage Page
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: ~{,~ ,zzr~ PID Number:
Name: ~-~v%'[' i~¢~ ~4,/~--~ o-V~ Wastewater System: D New ~pgrade
Address:
ICZ~o ~vcw{I ~;v~ ABSORPTION FIELD
Phone: ~ ~_ ~'l[ IN°'°~edrOOms: ~Deep Trench BShallowTrench BBed ~Mound BOther
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION o,~ ~PD/s~. ~.
Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth b~e~th pipe
Lot: ~ Block: D ~1~ ~al V~¢;~ ¢'+ Fi,
Township: I.a.g~: Isoc.,o.: Fill added above original grade: Gravel length:
Gravel width: Number of lines: Distance between lines:
WELL: ~0 New o D Upgrade ~" Ft. ~ Vav~ 10+Ft.
~ Total absorption area: Pipe material:
Classification (Private, A,B,C): T~tal Depth: C~ To:
Driller:'
Dat DJ'lied: Installer: Date installed:
I Pump Set at: Casing Height Above Ground:
Yield: ~ GPM Ft. ~e" Ft.
TANK
SEPARATION DISTANCES ~ptio o .o~di.¢'
To Septic Absorption Lift Holding Public/Pdvat~ Manufacturer: ~ . { Capacityin gallons;
From Tank Field S~tlon Tank Sewer Lines ' - ~ [~
we,- 166~ 1OO'~ I~'+. N/A I~0'+ M=t~ri"~: -. ~v=~ N"mb~°fC°~P="~nt':
Sudace
w~t~r ~[h ~/~ ~/~ ~ ~/A LIFT STATION
t Size in gallons: ~ Manufacturer:
LotI T~I~I ~'
"Pump on" level at: "Pump. off" level at: High water slarm at:~
P~mR Make & Model Electrical I nsp~tions ped~ed ~y:
Remarks: BENCH MARK
Location and OescriBtion:
I Assum~ Elevation:
Inspections performed by: Dates: 1st
Department of Health and Human 8ervi:e8 approval
Reviewed and approved by: ~ ~/~/ ~, ~Date: ~ -O ~
72-013 (Rev. 9/91) MOA 25
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650. Telephone 343-¢744
On-Site Wastewater Dispossl System and/or Well Inspection Report
Legal Description:. Lot 2, Block D, Timberlux Subdivision, Addition #1 PID No.:
72-013 A (2/91) MOA 25
Permi± No.
Page ~'- of fl
Municipalify of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 195650 · Anchorage, Alaska 99519-6650. Telephone 34.3-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
Lot 2, Block D, Timberlux Subdivision, Addition //1 PID No.:
SEAL
72 01.5 A (2/'91) MOA 25
Permit No.
Page ~ of Ii
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650° Telephone 34.3-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:. Lot 2, Block D, Timberlux Subdivision, Addition #1 PID No.:
5
72-015 A (2/91) MOA 25
HCO1 Box 6034, Palmer, Alaska 99645
(907) 746-1073
July 15, 1995
Municipality of Anchorage
Health & Human Services
On-site Services
Re'
Revised design for Lot 2, Block D, Timberlux Subdivision Addition #1
Owner~
Kent Anderson
15260 Curvell Drive
Anchorage, Alaska
345-9111
RECEIVED
,JUL 2 0 1995
Municipality ot Anchorage
Dept. Health & Human Services
Gentlemen:
A design for the above referenced property was submitted and approved in Mm'ch of this year.
The percolation test for the property was performed during the winter months with no
groundwater level being observed to a depth of 14-feet. The water level was monitored through
May since the Contractor had not installed the system. It was observed during May that the
ground water level rose to approximately 10-feet below grade. Since the residence has a
basement this level was unacceptable for the proposed design.
We have redesigned the system to include a package lift station manufactured by Anchorage
Tank and Welding. The trenches have been increase in length to 53-feet each. The leach lines
have been changed to 1-1//4" plastic lines with 1/4" holes spaced at 24" o.c. These changes
were discussed with Mr. Dan Roth on July 14, 1995, at which time he asked that we resubmit a
site plan and letter of transmittal explaining the reason for the modifications.
If there should be any questions concerning the design modification please call Doug Kenley at
1-907-746-1073.
Sincerely,
Douglas T. Kenley, . .
C.E. #8176
Y~gVqY
....... ----; ....... ~ ................ PAGE
-- = P,O."'BOX 196650~ 825 "L" STREET,' ROOM 502"
ANCHOR.AGE, J~I~I<A 99519-6650
ON-SITE WAST=WATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW950029
DESIGN ENGINEER:DOUGLAS T. KENLEY,
OWNER NAME:DiNDERSON-V-K~AN
OWNER ADDRESS:15260 CURVELL DR
ANCHORAGE, AK 99516
DATE ISSUED: 3/14/95
P.E. EXPIRATION DATE: 3/14/96
PARCEL ID:01827120
LEGAL DESCRIPTION:
TIMBERLUX #1 BLK
D LT 2
LOT SIZE: 68781 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERF~T IS FOR THE CONTRUCTION OF:
DISPOSAL FIELDSYSTEM
ALL CONSTHUCTIONMUSTBE IN ACCORDAi~CE WITH:
1. THE ATTACHED APPROVED DESIGN;' '
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND T~_E-STATE OF ALASKA WASTEWATER DISPOSAL-;- - - ·
REGULATIONS~t.(i18AAC72)'-AND-DR-INKING WATER REGULATIONS ~-(18AAC8-~) ~-: . ~--"
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRI0~' TO EACH INSPECTION. PROVIDE NOTIFICATION BY;~ -
CALLING.343-_4744 ( 24tHOURS:.)~'_. (NOT REQUIRED FOR WELL ONLY'PERMIT)
4. FROM OCTOB_ER 15 TO_A.PRiL~15-A'iSUBSURFACE SOIL
ABSORPTION-'SYSTEM'-'UNDER~CONSTRUCTION DURING FREEZING -:-'
WEATHER-MUST-BE EITHER: ?" ~ .... ~ ........... --' "-=- --"-
A. OPENED AND CLOSED ON THE SAME DAY ..... ; ,~.
EQUIVILANT ......... - '= - ........... ~ .
RECEIVED
' ~)oaglas T. Kenley, P.E. HCO1 Box 60$4, Palmer, ~laska 99645 (907) 746-1073
March 7, 1995
MUNICIPALITY' OF ANCHOi~:A~i~
ENVIRONMI~NTAL SERVICES DIVISION
",'~ 0 8 1995
Municipality of Anchorage
.Health & Human Services
On-site Services
RECEIVED
Percolation Test Results and General Site Investigation Report of Lot 2, Block D,
Timberlux Subdivision Addition #1
Owner:
Kent Anderson
15260 Curvell Drive
Anchorage, Alaska
345-9111
Site Characteristics
On March 3, 1995, the above-referenced site of approximately 69,034.88 square feet was
inspected in conjunction with soil perk tests being performed for application and approval for
installation of an on-site waste water disposal system. The property is located on Curvell Drive
in the Rabbit Creek area of Anchorage, Alaska. The system is being installed to replace an
existing system serving a four bedroom home. The existing 1,250 gallon septic tank will be re-
used if it is found to be in satisfactory condition.
The site is on the south side of Curvell Drive with a slope ranging from approximately 1% to 2%
in the west-east direction and 1% in the south-north direction. The immediate area that has been
selected for the waste water disposal system has an average slope of 1%. The failed bed system
is in the back yard. The proposed replacement site is in the back yard to the west of the failed
system. It appears that there are no obstructions that would prevent surface water runoff.
The property is served by a private well system. On-site observation and physical survey shows
that there are no private or community water wells within a 100' radius of the proposed system.
No surface water was observed at the time of the inspection.
One percolation test was taken at the site to assess the adequacy of subsurface soils to
accommodate the replacement on-site waste waater disposal system. The results of this test are
attached to this report.
Subsurface soils were found to be medium-dense, silty sand and gravel overlain by 12" of
surface organics.
Lot 2, Block D, Timberlux Subdivision Addition #1
03/06/95
Page 2
The percolation rate for the test hole was found to be approximately 14 minutes per inch.
If there should be any questions concerning the percolation rates or characteristics of the site
please call Doug Kenley at 1-907-746-1073.
Sincerely,
Page 2
NO~gaNV ~NgM '~
I
I
II iii
NO~EI~ONV J.N~ 'EIIN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
4-
5-
6-
7
8
9
10
11
12
13
14
15-
17-
18-
19-
20-
· ~ ~, [.~,~[~ ~ ~[]~[rownship. Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
S
L
DEPTH?IF YES, AT WHAT ~.[f~ pO
E
Depth to Water After t/
Monitoring/' ~//~ Date: __
Gross Net Depth to Net
Reading Date Time Time ~K Water ~t Drop
3' ,, q, ~,, /o f~"
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER ~-~"
TEST RUN BETWEEN ~'( ETAND ~-- FT
COMMENTS
PERFORMED ~Iy; I ,~ U I (/ CERTIFYTHAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEUNES IN EFFECT ON THIS D~TE. DATE: (,.~b I~C [' c~'c:~ '~-
72-008 [Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: Z ~ ~ D "~/~,/.~ Township, Range, Section:
8
9
10
11
12
13
14-
15-
16-
17-
18-
19-
20-
COMMENTS
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT
DEPTH? P~
E
Deph e Wa er After . ~o~
Mon oring? ~ Date: ~/-~'0' ~
Gross Net Depth to Net
Reading Date Time Time ~ Water Drop
PERCOLATION RATE (minutes/inch} PERC HOLE DIAMETER --
TEST RUN BETWEEN ~ FT AND ~'~-~ FT
PERFORMEDSY: ~--:~[ ~ I ~/'~T'~--'/~--CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DA~. DATE:
72-008 (Rev. 4/85)
. GIJ~TER ANCHORAGE AREA BORO~JH
HEALTH DEPARTMENT W ~'? 388
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MA,L,N haxSz&; 5t£r, ,4
ADDRESS PHONE.
SEPTIC TANK:
DISTANCE FROM WELL
UQUlD CAPACITY
MATERIAL C~ ~-~J'7~' V"~-'~ NUMBER OF
_COMPARTMENTS
~?;,~ aaa,. lq 7~
GALLONS. INSIDE LENGTH. INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM:
SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH , LENGTH ~') /' , DEPTH
L,N,NGMATBR,AL D,STANCEEROMWELL /q-¢' BU,'-D,NGFOUNDAT,ON'Y'7',
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) . SQ. FT.
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELl ~ , OF LINES
NUMBER OF D~__g~ST-A~NCE BETWEEN LINES
ABSC)~J~N AREA SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE.
IN. ABOVE TILE
WELL: TYPE ~fi/, DEPTH /~ Cr~ F DISTANCE FROM
~ , BUILDING FOUNDATION
LOT LINE /~ ! ~' NEAREST /./ SEPTIC
SEWER LINE ~., TANK ///~"~'~ / SEEPAGE
, , SYSTEM
~2~) t" WATER /~/'~
SAMPLE /V ~ , NEAREST
~'/~THER ~
/~, CESSPOOL , SOURCES~
DISTANCES:
/
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEI~NCHORAGE AREA ]~)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION 8, PERMIT
APPLICATION TO INSTALL: SEPTIC TANK ~/ , SEEPAGE PIT M''/' , DRAIN FIELD , OTHER ·
TO SERVE THE FOLLOWING FACILITY~
FI~,~ICED THROUGH ~'~ TO SE INSTALLED BY ~
~ TEST RESULTS
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
T.IS IS TO SERVE AS f~- ~. ~~~ ,PERMIT TO ,NSTALL A
~&~ DIAGRAM OF SYSTEM
I certify that I am familiar with the requirements of Greater; Anchorage Area Boroug~ Ordinance No. 28-68 and that the
above described sy~tem isjn accordance with said code. /~,/ ,
, REATER CHOR^ AREA BORO H
HEALTH DEPARTMENT CASE #
327 EAGLE STREET
ANCHORAGE, ALASKA' 99501
Performed Fo~ k~ [ ~ ~ Date Performed
Legal Descrzption: ~ot~Block ,D,. ,S~dzvzszon [ ,~ ~ ~u~ ~ ~/ 7'~>
This Form Reports a. Soils Log ~ , -Percolation TeSz
Depth
Feet
Soil Characteristics
Was Ground Water Encountered?
If Yes, AT What Depth ~
Reading Date Gross Time Net Time
Location Sketch
] I T-' i i
Depth To H20
Net Drop
Proposed Instal z~on.' Seepage Pi~. ~ Drain Field
Depth Of Inlet 3 '-.%' Depth .To Bottom Of Pit Or Trench ~/3 "..
Data Ce tified Bv.~
Municipality of Anchorage
Development Services Department
Building Safety Division
Dn-Site Water and Wastewater Program
4700 Elmore Road
P.O: Box 196650
Anchorage, Al( 99507
www:munLorg/onsite
(907):343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I;D~ 018-271-20
i.
COSA # 02.5 I
piration Oate: / 0 - ,;2, ' 0
GENERAL INFORMATION~
Complete legal description Lot2, Block D; Tirnberlux Subdivision No.
Location (site address) 15260 Curvell D~ve Anchorage, AK 99516
Current Property'owner(s) Marvin and Deidre-Aanonson
Mailing address . 15260 Curvell Drive Anchorage,,AK:gB516
Day phone 349-9391
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless ofhetwise requested, COSA willbe held by DSD for pickup.
2, NUMBER OFBEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DisPOSAL:
Individual'On-site []
Individual Holding Tank []
Community,On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On.Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Dh-Site Systems:Approval ara 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 COSAs upon request to homeowners. Certificates of Dh-Site Systems 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 sample results: (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 enginee(s work.
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 Certificate of On-Sita Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (am) 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(am) in compliance with all applicable Municipar and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P,o. aox 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
$. DSD SIGNATURE
V"'~ Approved for
Disapproved.
Conditional approval for
Phone 522-7773
Da e 7/22/2008
bedrooms, with the following stipulations:
OF
- .
ON-SITE .
WATER AND
WflRTEWATER
PROG M
Attachmentsl
COSA Checklist X
Septic System Advisory
Weli Flow Advisory
Nitrate Advisory
(rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Y~Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O: Box 196650'
Anchorage; AK 99507
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 2, Block D, Timbertux Subdivision No. 1
Parcel ID: 018-271-20
A. ~NELL DATA
Well type Pdvate IfA, B, or C provide PWSID # Well Log (Y/N) "y
Date completed 912/70 san~ary seal (Y/N) Y Wires properly protected (Y/N)
Total depth 68 fL cased to 68 ff. casing height (above ground)
FROM' WELL ~.OG AT INSPECTION.
Date of test 9/2t1970 7/112008
Static water level 30 fL 25 'ft.
Well production 4 g:p.m, t.6 g.p.m.
WATER SAMPLE RESULTS:
Coliform o colonies/100 mL Nitrate N/D rng/L
Arsenic: NID ug/I Date of sample: 6/19/08
Bt SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Concrete Lift/Steel
__ Depression over tank (Y/N) N
Pumper A Plus Home Services
Tank size 1,250/600 gal: Number of Compartments 2/1
Foundation cleanout (y/N) N**
Date of pumping 9/27/2007
C..ABSORPTION FIELD DATA
Date installed 11714/95
Length 108 fL
Total depth 7 ft:
Y
>18 in.
Other bacteria o colonies/10omL
Collected by: J. Davis
Date installed Septic-1972 Lift- 1985
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
Soil rating (g.p.d./f~ er ~/bdrm).8 GPD/SF System type Deep Trench
Width 2 fi. Gravel below pipe 4
Eft. absorption area 864 ~ Monitoring tube Y Depression over field N
Date of adequacy test 711/2009 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 33.75138.25 in. Water added 601 gal. New depth 37.25/41.75 in.
Elapsed Time: 57 min. Final fluid depth 36.5/40,25 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date instatled 7/14/1995
"Pump on~ level at 28 in.
Datum Bot~orn of Manhole
E. SEPARATION DISTANCES
Size in gallons 500
"Pump off level at 28 in:
Cycles tested 5
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on.lot >~ 00'
Public sewer main N/A
Sewer/septic service line >25'
Animal containment areas None
Manhole/Access (Y/N) Y
High water alarm level at 34 in.
Meets alarm & circuit requirements? Y
On adjacent lots >100'
On adjacent lots >~oo'
Public sewer manhole/cleanout
Holding tank NIA
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON EOT TO:
Building foundation >5' Property line
Watermain N/A Water service line >q0'
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation >10'
Surface water >1oo'
Wells on adjacent lots >1oo'
Absorption field >5'
Surface water >1o0'
Water main . >1o'
N/A
None
Driveway, parking/vehicle storage >25'
Property line >1o'
Water Service line >1o'
Curtain drain None Noted
F. COMMENTS: Cleanoutin Crawl Space Where Sewer Service Line. Exits the-Craw/space.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in e~ect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 2/23/2008
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
MEMORANDUM
DATE: July 29, 2008
TO: Jeff Poet
FROM:
Mike Anderson, P.E.
SUBJECT:
Lot2, Block D, TimbeduxSubdivision No. 1
COSA
A pit with a sump pump is located at the southwest corner of the house on the subject
lot. It is upslope from the absorption trench and much shallower. According to the
property owner a hose is placed on the pump in the spring and during periods of heavy
runoff water is pumped away from the foundation. The outlet for the hose is more than
100' from the septic system.
The remainder of the year the sump is dry and is not in use. It has no adverse affect
on the septic system.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
/907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Of~- ,~Tf-,,~O HAA# O 30 L'iL' O /-~
Expiration Date:
I. GENERAL INFORMATION
Complete legal description Lot 2, Block D, Timberlux Subdivision, Addition #1
Location (site address or directions) 15260 Curvell Dr., Anchorage, Alaska
Current Property owner(s) Duane A. & Petrina Peterson
Day phone 345-9204
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
Mailing Address
Becky Powell
2600 Cordova, Anchorage, Alaska
Day phone 257-0123
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
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 sample results, (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.
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 Douglas T. Kenley, P.E.
Address 9960 E. Puffin Dr., Palmer, Alaska 99645
Engineer's Printed Name Douglas T. Kenley
Phone (907) 746-1073
Date ~:~'
DSD SIGNATURE
I,.-'''/' Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: (~ ' l /../L - 0.3
(Rev, 01/02)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 2, Block D, Timberlux Subdivision, Addition #1
A. WELL DATA
Well type Pdvale
Date completed 9a/7o
Total depth 68 ft.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform o colonies/100 mi.
Arsenic: N/A mg./l.
B. SEPTIC/HOLDING TANK DATA
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N) Y
Cased to 68 ft.
FROM WELL LOG
9/2/70
30 ft.
g.p.m.
4
Nitrate 0.1 mg./I.
Date of sample: 7/27/03
Tank Type/Material 1) Septic, concrete, 2) lift, steel
Tank size 1250/500 gal. Number of Compartments 2/1
Foundation cleanout (Y/N) *N
Date of pumping 6/11/03
C. ABSORPTION FIELD DATA
Depression over tank (Y/N) N
Pumper
Parcel
Well Log (WN) Y
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
7/26/03
29.1 ft.
1.34 g.p.m.
Y
18 in.
Other bacteria 0 colonies/100 mi.
Collected by: Fred Kenley
Date installed 1) .~ ~,~'ot 2) 7/14195
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
A+ Home Services
Date installed /7-14-95 Soil rating (g.p.dJft2 or ~/bdrm) 0.8
Length 54+54=108 ft. Width 2 ft.
Totaldepth 7 fl. Eft. absorption area 864 ft~ Monitoring tube__
Date of adequacy test 7/26/03 Results (Pass/Fail) Pass
· ;'~ '~,- ~
Fluid depth in absorptmn field before test 3~'~/~ in. Water added 606 gal.
Elapsed Time: 450 min. Final fluid depth,~'c'3/~,in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
System type trench
Gravel below pipe 4 ft.
Y Depression over field N
For 4 bedrooms
New depth? *¢/~'in.
600 g.p.d.
If yes, give date ~-~
D. LIFT STATION
Date installed 7/14/95
"Pump on~ level at "~.~n.
Datum 82-1t2"
E.
Size in gallons 500
"Pump off' level at $~n.
Cycles tested 3
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 40¢/129'
Absorption field on lot 150+'
Public sewer main N/A
Sewer/septic service line 25+'
Manhole/Access (Y/N) Y
High water alarm level at '~' ~ in.
Meets alarm & circuit requirements? Y
On adjacent lots 100+'
On adjacent lots loo+'
Public sewer manhole/cleanout
Holding tank N/A
N/A
SEPARATION DISTANCES FROM SEPTiC/HOLDiNG TANK ON LOT TO:
Building foundation 16728' Property line 30+' Absorption field 16'/12'
Water main N/A Water service line 25+' Surface water 100+'
Wells on adjacent lots 100+'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 40+' Building foundation 67' Water main N/A
Water Service line 25+' Surface water 100+' Driveway. parking/vehicle storage 70+'
Curtain drain None known to exist Wells on adjacent lots 100+'
F. COMMENTS
*There is a clean out in the crawl space where the line exits the foundatiol~llO~
o.E.G..EE.'SCE.T..CAT,O. ':'.%
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Douglas T. Kenle,, P.E.
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
~:~/ ~ / ~ ~"
,~o,,~,, Robert E. Johns, Or. & Assoc.
~ ~ / ~ ~Id: W.O.
~,~ smuc~,~ ~S-~T .. ./ ~ AUGUST 11 t 2003 3136 23233
· ~:~"~-- ~ LOT 2, BLOCK D, TINBERLUX SUBDIVISION
~~ ~ ~ '"mmm~~ ~DITION ~ 1
~ LOt SU,~ SURLY ~E S~BOLS
PLOT PLANS ~ LOT SUR~ NO~:
Rick Mystrorn.
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
October 19, 1995
Duane A Peterson
Petrina Peterson
PO Box 91451
Anchorage, Alaska 99509
Subject: Lot 2 Block~Timberlux Subdivision
HAA950301, PID #018-271-20
#1
The Health Authority Approval that was issued as a Conditional
Approval on July 31, 1995 has been revoked due to failure to
comply with the conditions of issue. Those conditions were
as follows:
"the well on this property tested positive for O.B (other
bacteria). Within 30 days (by September 1, 1995) the well
must be rechlorinated and test results submitted to this
office showing "0" other bacteria."
If there are any questions, please call our office at 343-4744.
fS~cerely,
~ames Cros§,--P.E.
program Manager
On-site Services
............ TY OFAN OP~G
~. . ?-?C.~ ~-~-'. :~;;:-,: - MUNI IPALI CH
. ~ /j'~ · DvisionofEn~irOnmehtnlS~ices'::'~" :'~-: · :
. . , .4',,: ,.~ On-Site se~i~es SeCtion ' ....
':'~'~;:~ :~ ~' ' P.O. Box 196~0 Anchorage, Alaska" 9951~650
CERTIFICATE OF H~LTH AUTHORI~
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel i.D. ~ * ~-~ ~ -~ ,.-,i 4 H
1. ~- GENERAL INFORMATION .-~ ': :.~: ,.~.~.:n~
~-~' LC0~Plete'legatdescription ~ ~
Lo~Aii0n' (site address or directions) I~'Z~<9;;~rv~{[ '~r'.
Prope~ owner ~ Day phone
address
i~diVidU~l
.NOTE: ff commi, mity
from State ADEC :,
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated heroin. I further veri~ that based on the information obtained from
the Municipality of Anchorage files and from my inves.tgqation 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.' - :... -..
*"~ .... NameofFrm'--*~'~b-t,,~:l~'T:p-c.~,~--~/ ..... Phone~('=lo'l~
.-.::,~'.?'~;Engineer'ssignature- ['_/~[ '~ ' ' "'-Date--~.t'~
SIGNATURE:.
' .} .]'l~e Mu'h~cipahty Of Anchomge DePartme~t~of Health and ~uman. Sei'vices'(DHHS) issues Heal~h~ ~Auth0rity'
=" : ~r~f~ssi0hai engineer registered in the stat~ Of AlaSk~ 3'h® DHHS d°es this as a CourteSy t0Purchasersof homes
: i: :and t~eir lending institutions in order to ~atis~, certain federal and state reduimment*. Employ~ of DH HS do not
- :- :i ~-?Con. duct inspections or analYze data before? Certificate is issUed:~T_~e ~,u,nicipality ofl AnChorage is not
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~-, ~;,I ~ p,"~y. ~l Parcel I.D.
A. Well Data
Well type ~'; v~_~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~p~ Z~ I'~"']~ Driller
Cased to g)~,~wo'~-~ ~6~ Jr Casing height
.g.p.m.
Wires properly protected (Y/N)
~ "~'~ g-P.
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
FROM WELL LOG
'Se { 2,
AT INSPECTION
L'
Septic/holding tank on lot
Absorption field on lot I
Public sewer main ~
Sewer service line [
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed IJ,~J~44~ 1~7?-.gl~.~Tanksize I,~5~D~[. Compartments ~
Cleanouts (Y/N) "1/ Foundation cleanout (Y/N) 1'-[ Depression (Y/N)
High water alarm (Y/N) kt Alarm tested (Y/N) ~/~,
Date of pumping Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO:
Well(s) on lot I ~0 ~ On adjacent lots t~o ' ,~ Foundation
To property line lo'+ Absorption field [o % Water main/service line
Surface water/drainage N/F~
CONTINUED ON BACK PAGE
,C. LIFT STATION
Date installed "7' ~ '-[ ' '~'
Size in gallons ~'C~O
Vent (Y/N) Y "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 [ 0 o/-~ On adjacent lots l oo' -{- Surface water ~J [/~
D. ABSORPTION FIELD DATA
Date installed '7' IH .c~ 5- Soil rating (GPD/FF) O. eo
Length ~'~{ ~ Width ~-'-{ Gravel thickness
Total absorption ama ~/.,,'-{ 4..~, Cleanout present (Y/N) ~'
Date of adequacy test ~/~ ~.,d Results (pass/fail) (q
Water level in absorption field before test ~ ~J
Peroxide treatment (past 12 months) (Y/N) ~
System type [~_p
Total depth, c_ ~_~ - O"
Depression over field (Y/N)
for L~
After test ~///~
If yes, give date ¢J f~
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot [ 0D' 4
To building foundation
On adjacent lots ~q [~
Surtace water {q IA
Curtain drain tt [A
On adjacent lots { o d ' Property line
To existing or abandoned system on lot
Cutbank ~/~ Water main/service line
t
Driveway, parking/vehicle storage area I 0 ~ ~
E, ENGINEER'S CERTIFICATION
Engineer's Name
Date
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,on,--~:~iOf,~b~ inspection.
.
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* ~ack
Waiver Fee $
Date of Payment
Receipt Number
/
/
1
33. 3:6 23"23'3