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HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 2 LT 3 (P 71-112)�; • arm �; � [~// 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 LEGAL DESCRIPTION NO. OF BEDROOMS Well ~ Absorp ~area Dwelling DISTANCE TO: /00 ~0 ~0~0 ~ ~Z Manufacturer ~~ ~ ~ Mat~~ial No.~--~°~°mpartments ~ ~ Liq.~ca~t~nooo ga~ons IF HOME'DE: Inside length W Liquid depth ~ ~ DISTANCE TO: Well Dwelring PERMIT NO. OZ~ Manufacturer Material Liquid cspacity in gallons Fo~datio~ ~ / Neares~i~ PER T ~ O ~ DISTANCE TO: Well /OO/ ~ len~h3f~nes Trench~ Distancebetweenlines~ '~ ND. of lines / inches eLJv6abs°rpti°n Length o~ a~Xi n e Total ~ ~ ~ ~ Top of tile to finish grade ~ / Material beneath tile ~ / inch.s Total area ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: OTH~ PIPE MATERIALS REMARKS (q(' ~ _ F'ERH!T H'). 1 _ ]il-j i:iT 1' '] .J'. F:f. !'.,.~... iL.If! NLli"IF]:ER (iF' E:EE)RL][)h'IL:¢ =: ~: . =. ~ --, ) l:.l I T ':; · l']"tl'~; I:;~:[EI]:!I.J ]( I:;i:E;[:, '_"~; l Z[~: OF THE i: O 'J: I FtE:SOF;;:F:'T t ON .......... " . ...... 't"HE LEI",IGTH [)!MIENSION i:E; THE LENGTH '::!N F:'EET) OF: THE "FRENCI'] OR C, RR!hlFIEL_D. THE [)EF:'TH OF I:I TRENCH OR F:'ZF Z:S THE DZS'i"FINCE 8ETI4EEI",I THE ~;IJ[~'.[:'~CE OF: THE GROUNE:' FIN[:' THE E:OTTOM [)F ]"HE EXCF:I'v'F!]'!Oh[ (:[!",! F'EE]"). T'HERE IS l'..IO S;IE'F H!DTH FOl.;: 'I"FRENC:HE~;. THIE EiF;;:I:::iVEL DEP-I'H ZS THE MINIMUM [)EP-FH Eft: GRF~VE!._ BETHIEEN THE C~UTF.'RLL. P!F:'E FINE:, THE I~:~:OTT()M OF:' THE E::.:iCFI'm/F!'T!ON (IN FEET). '"c.*" ;. '" .................................. T T F:IF:'pt. T F':Ft~-,FF HFIS; T'HE F;'F;qF'r" I'-,I'::; T F:: 1' [ T T"r' 'TO I i'-,IF:'L']RM l"H I S [:,EF:'F:IRTT"!ENT [:,LU:4:. :[ t'.,ll]i THE I' I.t._ FmROPERT'T' F:I!",IE:, )Z f',I:~;]]:::!L LI::IT ): 01",1 I N'"_:;F'ECT ! I~lf']~; OF FIN'T' I.,.IELI...S I::I[:,.J'I::IL~:ENT 'T'O ...... ': hUME I_F. O1:: RE':S'I:I::,ENCE'.S THF:!T THE HEL.L H ILL ....... . .... ....................... _ ........ _ ~ , ~ ..=,~ --,. F4::: ii]El ................ ,]' ~: .... ' ..... r ...... .... ILL:, E:l::l'jl.::'F:'l'l_L'fhr:j I~.. ,H,~r , ::,,E!I I.,J'(THOIJT F:' ]' I"JI:::)I ]:NSF'.i!E]]"i]h! F:IF,I[:' t::IF:'F'ROVI:::tI... E',"r' ' ....... t}E!:::mF:IRTMEN]' I.,.I]ZI_L. E:F-"] '::;I L: TF:T'T TO .::'RCrJ:;ECII':f'):ON. i4]:NiMI..IM E:,I~!;'T'Ah!C:E IE:E'FHtEEN FI NEI_L F!I",!D F!l'.,!h' ON-.SI]"E ::SEI4FIEiE I)ISPOSI~I... SMS'TEH :!.6)O FEI'ET [:CIR F~ F:'F;::Z'v'FI'!"E I,.flELt....; OR ::LSO 'TO 2OEI FEET F,r';~'.OM F:t PUE:L!'E: F.IELL. [:,EF'Ei'.,IDING UF'ON TFIE T'.?F:'E OF PLIE:LIC HEL. L.. I.,.IELL LOGS; FIRE REQI. JIRED Iai",![:, MU?f' E',E RIE:'T'LIRNE[:, TO THE DEF'F:IRTMENT 14I'FHIN E:O E:,FI'./S OF' THE !.4EL. I_ COMF:'tl..ETZOI"L OTI'IER REQLJ Z F;'.EM[.EBn"E; MFCr' F)PF'[.."d. SPEC Z F !Cf:iT t:::!VF:I ]: L.F:I[3L[:_' TO Z hI::~';L.IRE F'ROF'ER ! N'.5-!"F:IL!_F:I]" Z ON. :1..: 1[ t::ffd Ft:::!MILiFfR FILTH THE REEQLIIREMENT::S FOR I]N.....'_:SITE ?.',EI.qER:E; F:INC, I.qE~:LL..E; F:I:S :SET ii:: I UNDER:E;TF!N[:, THF:IT T'HE ON-:E;ITE SEI4ER 'E;"?S'f'EEM MFi"r' REIi:¢JtF~E IENL..F:IRGEMENT It:' THE I I 2204 Cleveland Anchorage, Alaska 99503 Performed For A Modular ,, _~ate Performed Lo.al 5-9-78 qescrtntton: LOt3~BlOck2.g___.Subdlvtston~Timberlane Subdtv±sion ;orm Renort$ Soils Lon Yes ,Percolation Test_ Oe.th Feet Sot1 Characteristics Tan Silt 6-- 8-- 20=- ~as If YeS, Tan Sand Tan Sandy Gravel At what Depth? Readtnq :)ate Gross Time Net Time Depth to 8Z0 Net Oron Percolation Rate )1inure ProPosed Installation: Seenaoe Ptt~ ~ ..Oratn Field Oeot~ of Inlet . Depth To ~ot~om Of Pit Or~-~e--~)~ 140 S~a required per bedroom. Cn.~£NTS: .... Performed By~~ ~$t ZNeal Hausam O&tO: 5-9-78 Certified Well For ~T A Realty Location Lot 37 Block 2. Tlmber]ane Sub,Iv%sion , Date Completed 5/~0/78 Depth of well ~0 ~et SJzeo~c~sing ~ ~ ~Oh Distanceto water ~ ~t ~ Distance to water while pumping ~ ~¢~ at rate of ~2 0 gallons per hour. Description of Formation from ' ' to P.l~v ~ Gravel 'Brn' Soft 0 30 ' Cl~ & ~',ravel Dk. Brn. Soft 30 43 Clay & Gravel Grey M~d. ~3 48 Grave]_ W/Water ' 48 ' 50 I certify the a~~ -- 7/'% Driller FOSS DRILLING t336 INGRA PH. 279-2849 ANCHORAGE, ALASKA 99501 We advise you to attach this certificate to your deed. ~to, ~__tO, - to ___to . to ~tO__ ~t O~ .....to_ MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section ANCHORAGE Certificate of On -Site Systems Approval Parcel I.D. 019-142-26 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: C,, I –2—' 1. GENERAL INFORMATION Complete legal description Timberlane Park #1 Location (site address) 11840 Humble Court Sub, Block 2, Lot 3 Current property owner(s) Heidi & AndreW.Van Gilder Day phone Mailing address 11840 Humble Court, Anchorage, AK 99515 Real estate agent Chantelle Smith Day phone (318) 464-2782 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑■ Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 280 Date of Payment 2- – 2 GP Z Receipt Number 0 C,-7 3 0 Waiver Fee $ Date of Payment Receipt Number COSA # OSC211070 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 2/23/21 q�gsTH ll 6. DSD SIGNATURE ' • System #1 Approved for bedrooms / � • / �� '. Benja... chiller j System #2 Approved for bedrooms �� F��s� , CE 12592 Disapproved !ll%PROFESS10NP4 Conditional approval for bedrooms, with the following stipulations: WATER AND � P :v ,A tE�R o - a, 1 1�q By: A, Original Certificate Date: r The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: Timberlane Park #1 Sub, Block 2, Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/30/78 Total depth 50 ft Cased to 50 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 2/22/21 Static water level at beginning of test 40.1 ft. Comments Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A PUBLIC SEWER Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 019-142-26 Structure served by this system Well production at time of test 2.0 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.73 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 2/17/21 C. LIFT CTATIf1A1 ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A PUBLIC SEWER Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No N/A ft Surface Water > 100' ❑ Yes if No N/A ft N/A Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No N/A ft Private Wells > 100' ❑ Yes if No N/A ft Water Main > 10' ❑ Yes if No N/A ft Community Wells > 200' ❑ Yes if No N/A ft Water Service Line > 10' ❑ Yes if No N/A ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No N/A ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No N/A ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No N/A ft Private Wells > 100' Water Service Line > 10' ❑ Yes if No N/A ft Community Wells > 200' Surface Water > 100' ❑ Yes if No N/A ft F. ENGINEER'S COMMENTS Approx separation distances verified at time of testing G. ENGINEER'S CERTIFICATION / certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ® Yes if No N/A ft ❑ Yes if No N/A ft IF low T ' Benja chiller 0 CE 12592 . •���,,sr�"°� �cf'JF • . 2/23/21 , • '��� ���J® PROFESSiONP�.� NOTES: 1) LOT IS SERVED BY A COMMUNITY SEWER SYSTEM. 2) THE DRIVEWAY IS APPROXIMATE DUE TO SNOW & ICE COVER. 3) THE LOT DOES NOT MATHEMATICALLY CLOSE WITH RECORD DIMENSIONS. — (C) = COMPUTED — R = RECORD 1 M I I I Lot 2 IL-10' UTILITY EASEMENT I �f S 88'05'30"E TCHAIN-LINK FENCE (APPROXIMATE) ___LWOODEN FENCE (APPROXIMATE) N M Of Lot 3 27,890 S.F.(C) 27,557 S.F.(R) SOUTH 2O.82'(C) .00' 20.00'(R) WEST 225. 4.7'x5.8' DECK - 1.7' CANT `L SOF' 5 Tract A GRAVEL O LO `1.7' CANT 11.9'x9.1' DECK D O J M 8.2'x10.2' SHED L=52.50'(C) R=50.00' L=54.03'(R) 1--8.1'x10.1' SHED 1.7' CANT .� �rn L WELL -POST & RAIL FENCE w/ WIRE —_—_'/ Lot 4 5' DRAINAGE EASEMENTS 10' UTILITY EASEMENT PLOT PLAN —_— AS BUILT _X_ SCALE _ 1_ =_ 40=_ GRID _ SW 2729 Project No. 21-085/1____ Associates, � 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & A S S o c i a t e S inc. (907) 522-6476 Phone 9 (907) 522-4625 Fax 64©d�pppp�4 Professional Land Surveyors kenQlongsurvey.com o OF A jonathan0langsurvey.com I hereby certify that I have surveyed the following described property: LOT 3, BLOCK 2, TIMBERLANE PARK SUBDIVISION No. 1 (PLAT No. 71-112) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. �T Dated this the _--_ Day of }�'' tk , 202.1 —, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH .y( KENN G. NG ct 04F�Fo ' LS -5202. • 5J©G 04n�°F�ssloNa� `per AECC963 • ",, Municipality of Anchorage •t On-Site Water and Wastewater Program < LV.i i " (907) 343-7904 Certificate of On-Site Systems Approval Parcel I.D. 01914226 Expiration Date: 1. GENERAL INFORMATION Complete legal description Timberland Park #1 , BIk 2, Lot 3 Location (site address) 11840 Humble Ct Current Property owner(s) Takashi & Pfanmiller Azegami Day phone Mailing address 11840 Humble Ct Real Estate Agent Jan Rednall Day phone 9072306343 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex • Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: Date: I 7-1L-1-147 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 6X- / Waiver Fee $ Date of Payment l2// ll7 Date of Payment Receipt Number 0611 Receipt Number COSA# o 1115Th 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 Atwater EngineeringPhone 480.540.0390 Address 3330 E 41st Ave Engineer's Printed Name Lucas Randall Date 12/21/17 ti L 414 �<:••..'A.• it • •• ,..'.* 6. DSD SIGNATURE i : 49TH•• . 1.410044s. System#1 Approved for II bedrooms . ......... e,e �i 9 Lucas M.�RandaIV u,�• System#2 Approved for bedrooms # �` • . # 6> • CE-12595 .; Disapproved AS`���•. n.�zt�rl ,` Conditional approval for bedrooms, with the following stipulations: ,��`G�QPa-ITY Orb, WgsTERqNO PR p"wgTER oo RM moo= S RVIC O' - By: �-- Original Certificate Date: I 2- The The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other • COSA blue sheet S c 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 Timberland Park#1, BIk 2, Lot 3 019-142-26 Legal Description: Parcel ID: A. WELL DATA Privateyes Well type If A, B,or C provide PWSID# Well Log (Y/N) Date completed 5/30/78 Sanitary seal (Y/N)yes Wires properly protected (Y/N) yes Total depth 50 ft. Cased to 50 ft. Casing height(above ground) 14 in. FROM WELL LOG AT INSPECTION Date of test 5/30/78 12/13/17 28' 35' Static water level ft. ft. 1.14 Well production 7.0 g.p.m. g.p.m. WATER SAMPLE RESULTS: 1.49 Coliform ND colonies/100 mL Nitrate mg/L 12/13/17 L. Randall Arsenic ND ug/L Date of sample: Collected by: B. SEPTIC/ • = TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts(Y/N) Foundation cleanout(Y/N) Depression over tank(Y/N) High wa e - - Y/N) Date of pumping Pumper C. AB 6 ' ' ION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. i 'dth ft. Gravel below pipe ft. Total depth ft. Eff. absorption area 12 Monitoring tube Depression over field Date of adequacy test Results(Pass/Fai For bedrooms Fluid depth in absorption field before test in. Water added . . New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT ST' • Date installed Size I •- -• Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. -• .ter alarm level at in. Datum _ _ _ Cycles tested Meets alarm&circuit requir- - E. SEPARATION DISTANCES WELL ON LOT TO: NA 100' + Septic tank/lift station on lot On adjacent lots Absorption field on lot NA On adjacent lots 100' + Public sewer main 31' (See DEC Waiver) 49' Public sewer manhole/cleanout 43' Found CO NA Sewer/septic service line Holding tank Animal containment areas NA Manure/animal excrete storage areas NA S /HOLDING TANK ON LOT TO: Building founda • Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Wa - -..in Water Service line Surface water Driveway, parking/ye - storage Curtain drain Wells on adjacent lots F. COMMENTS Four Hour test completed. Well will produce 1.14 gal/min with no drawdown. G. ENGINEER'S CERTIFICATION �`'C) - C� 14 I certify that I have determined through field inspections and Q = '.• O OI review of Municipal records that the above systems are in '•• •�-'7 conformance with MOA COSA guidelines in effect on this date. • 49 TH *�i Engineer's Printed Name L- �^ &b\� ;...•.• ...� Date �ZIZ���1 ,- Lucas M• . Randall•: p `��' '• CE—12595 • �` • c�av •tzAt.( .••,• ,,, COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE; ' "'::" --" DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 3; Block 2; Timb~rlane Park Subdivision~\ Location (site address Or directions) Property owner Mailing address _ Lending agency Mai[~,ng add~'ess Don Hanna Foot6s Hous6 Moving 7010 O~d ~o~a~d Hdghway Day phone Anoh~ag~t A£aab~z 99518 Day phone Agent Address · Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well NOTE: TYPE OF WASTEWATER DISPOSAL: NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site Holding tank Community on-site Public sewer /~ If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, l/91) Front MOA#21 s~ue~utuoo I~uo!I!PPV :suo!lBInd!js t~U!MOIIOJ eql HJ!M 'SUJOOJp@q 'SLUOOJpeq euoqd i,O~ 'oN peoa doo'l ~e^la .115e-4 l~l~0Z ! eJn3euS!s s,Jeeu!Su=l sseJppv wJpI ~o eWeN *uo!~oedsu! s!ql jo e~ep eq3 uo ~oejje u! suollelnl~eJ pue '$eoueulpJo 'sepoo e~elS pue led!o!un~ lie LII!M eoue!ldUJoo u! si Lue~s~s lesods!p JSJBMeJSBM Jo/puB 41ddns JeleM elis-uo eq~ 'uoRoedsu! pue uo!~el~ilseAu! XLu uJOJj pue sel!J e§eJoqouv ~o X~!led!oiun~ eq3 LUOJJ peu!e~qo UO!1eLUJOJU! eql uo peseq 3eql/~J]JeA JeqlJn~ I 'u!eJeq pmeo!pu! eJnl, onJ),$ ~o edX~ puc SLUOOJpeq ¢O JeqLunu eq~ ~o~ elenbepe pue leUO!~ounj 'ejes s! LUe~eXs lesods!p JeleMe~SeM ~o/pue ,~lddns Je3eM e~!s-uo eqi ~,eq~ SMOqS uo!~o!ldde leAoJddv X3poq~nv qij~eH s!q3 jo uo!je6gse^u! /~uJ j~qJ ~J]JOA I 'MOleq UMOqS elep uo!iep!l~^ eq3 Jo se pue o~eJeq pex!jJe leesXgJ (~q peg!lJeo sv I:I=ItNIgN=1 Aa NOIJ.O~IdSNI 40 .LN~IIN=U.¥J.$ '9  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: //~T ~,, gL.~ ,.~ / ~///~I[EP-~/~JF-- &~ Pa,'cCI I.D. A. WELL DATA ~/~Ve.!l type ~'<t Log present (~N) Total depth '~ ~(~ t Sanitary seal ((~N) YF--., If A, B, or C, attach ADEC letter. ADEC water sYstem number /L'///~ Date completed ~- '~(~ '~ Driller FO,SS, bl~ILL//,Jr,- Cased to ~ ~ / Casing height ~'~ c/If FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ¢ Sewer service line /_/.~.~r~ WATER SAMPLE RESULTS: Coliform(,~ IA'-[ I~ 2.) 0 Date of sample: LDING TANK DATA ~l~/~ ¢1~t.3,[-~Ci C S~_.C,,j~t.x~ . Date installe~ Tank size Compartments Cleanouts (Y/N) ~nout (Y/N) Depression (Y/N) High water alarm (Y/N)~ Alarm tested (Y/N) ~EPTI C/HOLDI~ ~ ~: ~ ~ Well(8) on lot '~cent lots Foundation~~ ~ ~ (r~)p~t~i ne Ab~ Water main/service line. Surface water/drainage ' ; On adjacent lots /~/,A- ; On adjacent lots Public sewer manhole/cleanout c/o etro,e m,an, Nitrate ~l~/~) ~'0~ Other bacteria Collected by: ~ ~ 3 Vent (Y/N) ~evel at High water alarm level ~ Cycles tested Meets MOA electrical codes (Y/N) SZAo%ON ,S','ANC':,:, OM Manufacturer Manhole/Access (Y/N) "Pump off" level at D. ABSORPTION FIELD DATA~/)~. D~ Soil rating System type Length ~_ Gravel thickness Total depth Total absorption area' '~~ Cleanouts present (Y/N) __ Depression over field (Y/N) ~dequacy test __ Results (pass/fail) ~__ _ for ~ bedrooms Peroxide treatment (past 12 months) (Y/N) if yes,~ SEPA~A.~._C E FROM ABSORPTION FIELD TO: ~d~ ~ well on lot ~ On adjacent lots Property line To building foundation ~ To existing or abandoned system on lot On adjacent lots Cutbank ~ Water main/service line Surface water Driveway, parkin~area Curtain drain ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o/ te of this inspection. Signature Engineer's Name Date $ & S ENGINEERING 17034 Eagle River Loop Road No, 204~ Eagle River, Alas[ca 9957~ HAA Fee $ /~']©, ¢ Date of Payment Receipt Number 72-026 {Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE EN/12ONMENTAL PROTECTIO~  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. lA EIN ADD E , PROPERT~ RESIDENT (If differen, from above) 3. LENDING INST~UTION 4. REaLTOR/AGENT ' ~ ~ ~ STREET ~OC~D~TFI ON 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY ~] PUBLIC UTI LITY One ~ Four Two ~ Five Three ~ Six [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM r~ INDIVIDUAL/ON-SITE** '*If individual/on-site, give installation date If system is over two {2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DA'rE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTi LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~]INDIVIDUAL/ON -SITE DATE INSTALLED [~PUBLIC UTILITY Connection Verified INSTALLER []Septic Ta,rt~or E~Holding Tank Size: 1 c'')c If Tank is homemade SOILS RATING give dimensions: -, TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO; Septic/Holding/~ Tank Absorption~,ooArea Sawer Line Nearest Lot Line Absorption Area to ~earest Lot Line 5. COMMENTS APPROVE POR _3 BEDROOMS E~ CONDITIONAL APPROVAL (letter must accompany certificatel [] DISAPPROVED DATE BY (Title) / / LEGAL DESCRIPTION 72-010 (Rev. '3/78) DEPT. OF ENVIRON MENTAL CONSERVATION January 27, 1984 BILL SHEFFIELD, GOVERNOR 274-2533 437 E Street Suite 200 Anchorage AK 99501 Mr. Alfred Sunquist Anchorage Water & Wastewater Utility 3000 Arctic Boulevard Anchorage, Alaska 99503 Dear Mr. Sunquist: Subject: Humble Court L.I.D. 143 (8421-DA-221) We ha~e reviewed the plans and specifications for the subject project. The private well to sewer lines and manhole horizontal separation distances are waived as follows: Lot 3, Block 2, Timberline Park S/D: Well to sewer horizontal separation is waived to 31 ft. Well to manhole horizontal separation is waived to 49 ft. Lot l, Block 2, Timberline Park S/D: Well to manhole horizontal separation waived to 83 ft. Lot 6, Block 2, Timberline Park S/D: Well to manhole horizontal separation waived to 78 ft. The project is hereby approved for construction for the items with which this Department is concerned. This letter constitutes the permit required by A.S. 46.03.720(a) for approval of sewerage systems. It should be remembered that final approval will necessitate the submission of Engineer As-built Plans. This will consequently mandate that a profes- sional engineer conduct basic inspection of this project so as to be able to sign off on as-built plans. Arrangement for this inspection work is the responsibility of the developer. Sincerely, ~ ~ru~6 E. Erickson Environmental Engineer I Tony Knowle$ 3000 Arctic Boulevard Anchorage, Alaska 99503 (907) ANCHORAGE WATER & WASTEWATER UTILIT January 12, 1984 Owned by the Municipality Mr. Reford G. Reid Construction Grants Project Engineer Alaska Department of Enviror~nental Conservation 437 "E" Street (Second Floor) Anchorage, Alaska 99501 Re: Humble Court L.I.D. 1-43 Dear Mr. Reid, The Anchorage Water & Wastewater Utility seeks ADEC approval to construct, maintain and operate portio?,:~: of the Hl~ble Court L.I.D. ~143 Sanitary Sewer closer to drinking water sources than established separation distances specified in State Wastewater Disposal Regulations. In request of a regulation waiver, and in accordance with Title 18 of the Alaska Administrative Code, Chapter 72 (18 AAC 72.021.a), Anckorage Water and Wastewater Utility su~its tl~e following information for your review and consideration. Well Locations The alignment of Humble Court L.I.D. ~143 sanitary sewer main passes close to drinking water sources (wells) at three (3) locations. These locations are graphically illustrated on the attached project plan drawing sheet 1 of 1 (attachment A) and further described below. TIMBERIANE PARK SUBD. NO. 1 Lot 3, Blk 2 - approximate distance between a private water well and proposed sewer line is 31 feet; distance to proposed manhole No. 2 is approximately 49 feet. rot 1, Blk 2 -approximate distance between private water well and proposed manhole No. 3.1is approximately 83 feet. Lot 6, Blk 2 - approximate distance between private water well and proposed manhole No. 3 and sewer main is approximately 78 feet. Within the subject well radii "waiver" areas, all sewer pipe will be 8-inch ductile iron pipe Class 50 with a wall thickness of 0.27. The subject pipe has a working pressure of 350 PSI plus a surge allowance of 100 PSI. This particular sewer trunk is a gravity system which will be 0.0 PSI working pressure, making it ideal for construction within well radii. On a gravity system there is more static pressure on the outside of the pipe than on the inside, thus giving more concern to infiltration than exfiltration. Ductile iron pipe has a life expectancy greater than other conduit materials because of its structural strength and its resistance to abuse, abrasive elements and corrosion. ~,/January 12, 1984 Humble Court L.I.D. ~143 Page Two Manholes constructed within the protective well radii are of special construction (see plan sheet 1 of 1 for details). The sewer line within the manholes is mechanically sealed and gasketed to prevent leakage of any sewage into the manhole, subsequently preventing any leakage of sewage out of special manholes. We were able to obtain drilling logs for each of the three aforementioned wells from the Municipal Department of Health and Enviror~ental Protection. The well logs (see attachment B) for Lots 3, 6 & 1 of Blk 2, Timberlane Park Subd. NO. 1, indicates the depths of the wells to be 50 feet to 65 feet deep. All well logs reveal quite extensive layers of a clay, sand and gravel, and hardpan mixture. The presence of these layers of clay and hardpan provides an impermeable layer between the sewer pipe and the aquifer at the bottom of the subject wells. This cempletes our request for a waiver. Should you require any additional information or have any questions concerning the above information, please contact the undersigned at your convenience. Sincerely, ALFRED E. SU~CQUIST, P.E. 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