HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 2 LT 4Timberlcxne
Park #1
Block 2
Lot 4
#019-142-29
:1
QGRE/~ER ANCHORAGE AREA BoF~UGH
Department ~3E2~irs~rnen~;ntal Quality
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING ADDRESS ///,~.~ /[/£t~0/~£ DA'~.
PHONE
~LaI'qW~"TA N K:
DISTANCE
FROM WELL
MANUFACTURER
~} NUMBEROF
MATER,^L COMPARTMENTS
INSIDE LENGTH ' INSIDE WIDTH ' LIQUID DEPTH
LIQUID CAPACITY ,~(-~'C2 ~') GALLONS.
SEEPAGE PIT:
NUMBER OF PITS __
LINING MATERIAL
BUILDING FOUNDATION__
DIAMETER---~"~"~% OR WIDTH , LENGTH , DEPTH r-/'
_ CRIB SIZE: DIA~DISTANCE FROM: WELL
, NEAREST ~OB~oANpETIO~~ AREA,
SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ././~ 7
BUILDING
FOUNDATION __
CESSPOOL
C O Ns~ R U C~"0~'Tt~AL DEPTH ~ DISTANCE FROM:
NEAREST ~ ~ SEEPAGE
%:% ELiNsEou~__, SEWER LIN~ ~SYSTEM
APPROVED . DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
DIAGRAM OF SYSTEM
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form No, EQ-031
DATE /¢"/~-~/'~Z APPROVED /r~_'./~.
· %.~,.2. B."
GreaTeR ANCHORAGE AREA Borough
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
SOIL TEST EgSULTS ~ E~[~ ~~ ~ NOT~: THIS PERMIT iS NOT VALID WITHOUT SOIL
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION,
MINIMU~ DISTANCE~, REQUIREMENT~ DIAGRA~ OF ~YSTEM
FOUNDATION TO SEFT~C TANK .
FOUNDATION TO SEEPAGE PIT
_, DRAIN FIELD.
SEPTIC TANK TO SEEPAGE PIT WALL
C~-:~.-~C TANK ,SEEPAGE PIT ., DRAIN FIELD ,
TO NEAREST LOT LINE.
WELL TO ~C TANK , SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO ~IC TANK /~ , SEEPAGE PIT
DEAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP Of
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
I CERTIFY THAT ]AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROU RDINANC NO. 28-68 AND THAT THE ABOVE
DAT' APP,ICAN 'SS'GNATUR'
Performed For -~j~ J~
Legal Description: Lot~/~,~__Block
This Form Reports Soils
- Soil Test Must Be Logged To
Depth
Feet Soil Characteristics
5--
6--
7--
9--
10--
11--
13~
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street
ANCHORAGE, ALASKA 99503
Case #
Dated Performed ~7~2~
Subdivision_-cZ~-~P~t~'~
Percolation Test
Below Proposed Seepage System -,
Was Ground Water Encountered?
If Yes, At What Depth?
Reading
Date
Gross Time Net Time Depth to H20 Net Dro
Percolation Rate Minute
Proposed Installation: Seepage Pit
Depth of Inlet _Depth to
COMMENTS:
Bottom of
Drain Field
Pit or Trenc'h
Test Performed BY .//~J2 ~~ Date Certified BY:
Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 019-142-29
Expiration Date: Ne- C
1. GENERAL INFORMATION
Complete legal description Timberlane Park #1 Sub, Block 2, Lot 4
Location (site address) 11841 Humble Court
Current property owner(s) Sally Ranchlch Day phone (907)441-9201
Mailing address 4901 Fairmont Rd, Anchorage, AK 99516
Real estate agent Brett Renfro Day phone (907) 232-2358
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑■
Waiver request for: W e-� ` i Q udo l` C S e W e—fr n? o h Distance: 5
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ / L{ 5
Date of Payment `3,/2 _5 A 1
Receipt Number Otf305r
COSA# 05G2.1150c-1
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver # 0 SV mo
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
1
By: Original Certificate Date: % J ,2,o,2
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 Checklist blue sheet
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6. DSD SIGNATURE
® ��....
System #1 Approved for .3
bedrooms Benjarr'rySchiller
System #2 Approved for
.Q
CE 12592
bedrooms ��c�srF�Fo ������
Disapproved
�� PROFESS'i
Conditional approval for
bedrooms, with the following stipulations:
J-' OSI -SITE
1
By: Original Certificate Date: % J ,2,o,2
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 Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
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
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
Comments/Deficiencies:
Timberlane Park #1 Sub, Block 2, Lot 4 019-142-29
5.3
1973**
>60**
>60**
1.86
>24 Forge Engineering
7/8/20
34.1
8/4/21
**No Well Log. Data taken from HAA 8/25/86 ***Well disinfected 8/17/21 after testing positive for total coliform
COSA Checklist yellow sheet
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
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
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’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 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 ft
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
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S COMMENTS
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 effect on this date.
--/--/--
[Lot is served by Public Sewer System]
NA ✔
✔
✔
NA ✔
✔
45 ✔
NA NA
NA
✔
NA NA
NA NA
NA
NA
NA
NA
NA NA
NA
Private well located 45' to sewer main east of property line.
✔
\ » ell S
Municipality of Anchorage
� v 1>cp vcmi nt
P.O. Box 196650 0 4700 Elmore Road
Anchoraae, Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
e elo a end Services Department
On -Site Nater and Wastewater Section
XxXIT
v ARIANC77F/WAIVER
Waiver#: OSV211069 COSA#:OSC211509 Permit#:
PID#: 019-142-29
Legal Description: Timberlane Park #1 Block 2 Lot 4
Engineer:
Applicant: Sally Randich
The required 75 feet horizontal separation from the public sewer trunk to the private well has
been waived. The approved separation distance is 45.0 feet. This waiver should have been
requested in 1984 when the public sewer trunk was installed. Granting of this waiver is based on
the waiver granted by ADEC to other wells in the subdivision for lesser separation and water
sample results showing low nitrate levels.
This waiver approval applies to the existing well only. Any future upgrade will require all
separation distances be met or another approval from this department.
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Waiver is Granted: X Waiver is not Granted:
Date:
LS z Approved by:
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Name of Reviewer
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DEPT. OF ENVIRONMENTAL CONSERVA'T'ION
January 27, 1984
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)
BILL SHEFFIELD, GOVERNOR
Telephone: (807)
I` .address: 274-2533
;' 437 E Street
Suite 200
Anchorage AK
99501
We have 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 1. 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 En ineer 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.
Sinc rely,
r t
ruce E. Erickson
Environmental Engineer
ANCHORAGE WATER & WASTEWATER UTILITY
3000 Arctic Boulevard
Anchorage, Alaska 99503
(907)
January 12, 1984
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Tony Knowles Owned by the Municipality
Mr. Reford G. Reid
Construction Grants Project Engineer
Alaska Department of Environmental Conservation
437 "E" Street (Second Floor)
Anchorage, Alaska 99501
Re: Humble Court L.I.D. 143
Dear Mr. Reid,
The Anchorage Water & Wastewater Utility seeks ADEC approval to construct,
maintain and operate portio;-, of the Hixmble 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), Anchorage Water and Wastewater Utility submits the 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 PARI{ 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.
Lot 1, Blk 2 -.approximate distance between private water well and proposed
manhole No. 3:s 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, mailing 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 1. --he
special manholes.
We were able to obtain drilling logs for each of the three aforementioned wells
from the Municipal Department of Health and Environmental 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 completes 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. SUNbQUIST, P.H.
Engineering Design Supervisor
Anchorage Water & Wastewater Utility
JW:AES:dw
attachments)
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 019-142-29
Certificate of On -Site Systems Approval
Expiration Date: I /") V - Z_ d 2a
1. GENERAL INFORMATION
Complete legal description Timberlane Park #1, Block 2, Lot 4
Location (site address) 11841 Humble Court Anchorage, AK
Current property owner(s) Anna Crary Day phone (907) 575-7876
Mailing address
Real estate agent
11841 Humble Court Anchorage, AK 99515
2. TYPE OF DWELLING:
❑w Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
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
9
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_ 910 (CoVit)-11
Date of Payment 1V y a02 0
Receipt Number. 01.2- lid
COSA # O's c 2013 �
Waiver Fee $
Date of Payment
Receipt Number
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 Michael E. Anderson, P.E. Date 7/31/2020
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6. DSD SIGNATURE071i�r, 'C'
0 ............. ................................... m
System #1 Approved for 3 bedrooms MICHAEL E. ANDERSON
�`•� .•_
� NO. CE -4381 �
System #2 Approved for bedrooms ®®��F�••.,,.7/31/20 <�`�'�
Disa roved a��� fROFESSIC�P®®®®
pp �®ism®®®��►e`'
Conditional approval for bedrooms, with the following stipulations:
-
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Arcr-, . =
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Original Certificate Date:: t 0 — zo
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 Checklist blue sheet
Legal Description: Timberlane Park #1, Block 2, Lot 4
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1973'
Total depth '60** ft
Cased to '60** ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) '24 in.
Date of flow test for COSA 7/8/20
Static water level at beginning of test 34.1 ft.
Comments **No Well Log. Data taken from HAA 8/25/86
Lot is Served by Public Sewer System.
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
Lot is Served by Public Sewer System.
D. ABSORPTION FIELD DATA
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: 019-142-29
Structure served by this system
Well production at time of test 5.3 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by FORGE ENGINEERING
Date of Sample 7/13/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
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 Lot is Served by Public Sewer System.
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
NA
if No
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑, Yes
if No ft
Neighboring Tank > 100' ❑✓ Yes
if No
ft
Private Sewer/Septic Line > 25' F71 Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No NA
ft
Holding Tank > 100' F71 Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' 0 Yes
if No ft
❑✓ Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
❑✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Lot is Served by Public Sewer System.
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100'
❑ Yes if No ft
Property Line > 5'
❑ Yes
if No
ft
Wells on Adjacent Lots:
✓❑ Yes
Absorption Field > 5'
❑ Yes
if No
ft
Private Wells > 100'
❑ Yes if No ft
Water Main > 10'
❑ Yes
if No
ft
Community Wells > 200'
❑ Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required) Lot is Served by Public Sewer System.
Building Foundation > 10'
❑ Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑ Yes
if No
ft
Private Wells > 100' ❑ Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
Community Wells > 200' ❑ Yes if No ft
Surface Water > 100'
❑ Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l 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
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Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
Parcel I.D. 019-142-29
Certificate of On-Site Systems Approval
Expiration Bate:
GENERAL INFORMATION L~N
Complete legal description TIMBER E PARK #1 BLOCK 2 LOT 4
Location (site address) 11841 HUMBLE COURT, ANCHORAGE, AK 99515
Current Property owner(s) LARRY HOULE Day phone 223-6806
Mailing address
Real Estate Agent
RONA FLORIO
2. TYPE OF DWELLING: [] Single Family (w~vo ADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
Day phone
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class __ Well []
Public Water System []
TYPE OF WASTEVVATER DISPOSAL:
Individual []
Holding Tank []
Community []
Public Sewer []
WaiverNaria nce request for: NONE
Received by:./l~ ,/~
COSA to be released to the engineer, unless otherwise requested by the engineer.
Distance: --'
Date: / 2'//,~//¢ :
COSA Fee $
Date of Payment
Receipt Number
COSA #
Waiver Fee $
Date of Payment
Receipt Number
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 SPURKLAND ENGINEERING
Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, At( 99501
Engineer's Printed Name LARS SPURKLAND
DSD SIGNATURE
~ System #1 Approved for __
System #2 Approved for __
Disapproved
Conditional approval for
Phone 279-3916
bedrooms
bedrooms
Date
,..
bedrooms, with the following stipulations:
WATER AND
'¥.'ASTEWATER
pROGRAM
By:
The~1~u~r~ja~j~Jnch~r~geDeve~pmentServicesDivisi~n(DSD)~ssues~ertif~cates~f~n~S~teSystems~Appr~va (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
X
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: TIMBERLINE PARK #1 BLK 2 LT 4
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # ---
Date completed ~1973 Sanitary seal (Y/N) Y
Total depth 60+ f. Cased to__60+ ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100mL Nitrate 1.99
ND
Arsenic ug/L Date of sample:
Parcel ID: 019-142-29
Well Log (Y/N) N
W~res properly protected (Y/N) Y
12+
Casing height (above ground)
AT INSPECTION
10131114
32
ff.
5.3
g.p.m.
in.
mg/L
10/31114
Collected by:
ANSON MOXNESS
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material --
Tank size __ gal.
Foundation cleanout (Y/N)
Date of pumping --
Number of Compartments
Depression over tank (Y/N) __
Pumper
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
C. ABSORPTION FIELD DATA
Date installed -- Soil rating (g.p.d./ft2 or ft2/bdrm) --
Length -- ft. W~dth --
Total depth -- ff. Eft. absorption area -- ft~ Monitoring tube
Date of adequacy test -- Results (Pass/Fail) --
Fluid depth in absorption field before test - in. Water added --
Elapsed Time: -- min. Final fluid depth -
Any rejuvenation treatment (past 12 mo.) (Y/N & type) --
System type --
ft. Gravel below pipe -- ft.
__ Depression over field --
For -- bedrooms
gal. New depth -- in.
in. Absorption rate >= '- g.p.d.
If yes, give date --
D. LIFT STATION
Date installed -'
"Pump on" level at --
Datum --
Size in gallons --
__ in. "Pump of~' level at -
Cycles tested --
Manhole/Access (Y/N) --
High water alarm level at -'
Meets alarm & circuit requirements? --
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot -
Absorption field on lot --
Public sewer main 50'
Sewer/septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation '- Property line -
Water main " Water service line -
Wells on adjacent lots -
ABSORPTION FIELD ON LOT TO:
Property line - Building foundation -
Water Service line -- Surface water --
Curtain drain - Wells on adjacent lots -
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank --
Manure/animal excrete storage areas 100'+
Absorption field -
Sudace water -
Water main -
Driveway, parking/vehicJe storage --
F. COMMENTS
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 effect on this date.
Engineer's Printad Name I.ARS SPURKLAND
Date 11/21/14
COSA brown sheeL10-10-12.doc
(H '~ ~1) 0~'91,1, HI,ON
390WI0 St'l~tlAInH
W
d90P8
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Cate
1. GENERAL INFORMATION
(a) Legal Description (include lot, brock, subdivision, section, township, range)
Location (address or directions)
Applicant Address ,//f~/ //~_///',4/~_/?';
(c)
Business
Applicant is (check one): Lending Institution,~J;i Owner/builder []; Buyer []; Other [] (explain); .
(d) Lending Institution J,,¢/~?~Z? ~.UI(//LZ~;~"/.~ Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Fami}y
Number of Bedrooms
Other
WATER SUPPLY
individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [] Public~ community [] Holding Ta~k []
Note: If community well system, must have written confirmation fr~)m the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDIN,., INSPECTIONS, TESTS, FILE SEARCH, DA, ,~ AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliancev,~th all Municipal and State codes, ordinances, and regulations in effect on
the date of th,s ....
Name of Firm ¢. ~~ Telephone
Address I ¢
....
Approved for ~ bedrooms by/~ -u~'/
Approved ~.~..-~ Disappro~d Conditional
Terms Of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALT~H AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAO2
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
264-4720
LegaL_Description:
,~- z¢
WELLDATA
Well Classification /~ If'A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~'~ Date CompLeted I~l,'J~ Yield
Total Depth ~ ~ Cased to ~ ~ Depth of Grouting
Static Water Level ~ Pump Set At
Casing Height Above Ground //~ Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Se.t,c Ho,d,n. o..o, On *d,o,ni.. .o,.
To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots
To Nearest Public Sewer Line ,~/ ~ To Nearest Public Sewer
CleanouVManhole ~/~/ To Nearest Sewer Service Line on Lot ~/
w~r S.m.,. Co,.eoted b. ~.~..~ ~¢~ ~ ~t~ ~ ///~
.... /v
Comments
Date Installed Size /
Standpipes (Y/N) Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
~Eof Co mp&"~ments
Foundation Cleanout (Y/N)
Date Last Pumped
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Instelled
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
D. LIFT STATION
Date Installed_
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
Page 2 of 2
72-026 (11/84)
ENVIRONMENTAL PRO [ECTION
AUO 2 1986
RECEIVED
** Check Permitted Bedroom Rating Against HAA Request **
certify that I have checked, verified, or,~nformed to all MOA and HA..A guidelines in effect on the date of this inspection.
Signed ~ Date A'~.,,~
Company - / 'MOA No; 7 ~ '
Date of Payment ~ "~"' ~'~A~-~
I~W~OTfl~-- : ~ "'~' Engineer's Seal
Amount: $ ~ ~o~
DER'I-, OF HEALIH &
CONSULTING ENGINEER
,~--"~203 W. 15th AVE *'C' SUITE 203
ANCHORAGE, ALASKA 9950[
TELEPHONE: (907) 279-3916
RESIDENTIAL WELL INSPECTION
LEGAL:
LOCATION:
OWNER:
TYPE OF WELL:
WELL LOG AVAILABLE:
INSTALLATION
LOT 4 TIMBERLANE PARK ,~ .o '. · o',','
1184 HUMLE COURT ~,~*"4-~.T~ ~'~}~ '.~
DARLENE HOULE
SINGLE FAMILY -~,:' ~ -.
REQUIREMENTS MET: YES. PUBLIC SEWER INSTALLED IN
1984. WELL 50 FEET FROM SEWER LINE. WAIVER
GRANTED BY DEC.
PUMP YIELD:
7 GALLONS PER MINUTE
WELL YIELD:
7 GALLONS PER MINUTE WITH 2 FEET OF DRAW DOWN
DATE OF INSPECTION: AUGUST 11, 1986
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WIT]{ AN ACOUSTIC PROBE. TBE WELL
WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS
FOUND AT 62 FEET BELOW TOP OF CASING. AFTER 20 MINUTES OF
PUMPING THE WATER LEVEL STABILIZED AT 64 FEET. THE WELL WAS
PUMPED FOR AN ADDITIIONAL 30 MINUTES WITH OUT ANY FUTHER DROP IN
WATER LEVEL. THE WELL RECOVERED 100 % WITHIN 2 MINUTES AFTER WELL
SHUT DOWN.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON
AUGUST 13, 1986. TEST WAS NEGATIVE.
TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCNORAGE.
The Municipal requirement for well flow is 150 gallons of water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use amd other factors that may
impact the conditions of the aquifer feeding the well.
APPLI¢ "NT FILLS OUT UPPER HA[ iONLY
Phone
Prop~$ty
Owner
Address Zip Code
Realty Co. & Agent
Address Zip Code
Legal Description ~ '~ ~L
Type of Residence
[] Other
Water Supply
~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
Community ~- For wells drilled prior to that date, give well depth (attach log if available)·
[] Public Utility
[~ Individual Year Individual Installed: /
[~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED·
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: NtUNICIPALiTY OF ANCHOR~:~
DEPT. OF :~-'LTM ?'
0 982
RECEIVED
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( )DISAPPROVED Conditional approval if monies are .escrowed to
( ~OND)TIOh]ALAPPROVAL* have well casing extended twelve(12) inches
////~/~.f,~ above ground level and reinspection made of
DATE
//~I:~ the property.
BY:
Soils Rating Date Sewer Installed Well TO Absorption Area Well Log Received
Well to Tank Septic Tank Size
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
Ron Houle
SRA Box 190-A
Anchorage, Alaska 99502
November 12, 1982
SEWER ADEQUACY TEST
/V~UNICIPALITY OF ANCHORAGE
[,: OV 1 2 1982
Legal
Location
Residence
Owner
Water
Sewer System
Lot 4, Block 2, Timberlane Park
11842 Humble Court
Single Family
Ron Houle
On Site Well
Holding Tank
No Municipal Records. Tank size 2000 gal.
Marx Enteprices.
RECE! ED
Installed in 1973 by
Pumped regularly by Anchorage Cesspool Pumping
Date Of Inspection. November 10, 1982
TANK: Standpipe and cap in place. No sign of overflow
WATER.Sample collected from kitchen sink. Analysis was satisfactory
Wellcasing is 6~inches above ground. Sanitary seal in place.
Distance to holding tank 77 feet.
Inst~llation meets Municipal requirements in force on date of
installation.
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval 'requested
Mailing Address:
2. Proper~ Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facili~ to be inspected
6. Well Data:
A. Type ~ .....
C. Construction
7. Sewage Disposal System:
A.Installed
~TanK:
D.Seepage Pit:
~ ~ ri y.~ /?0 ~ Phone:
No. of bedrooms
B. Depth ~/
D. Bacterial Analysis ~,~
/
1. Size ~o~ ~-l'~'~'~'~'~'~'~'~'~,
2,
Manufacturer
I. Absorption Area 2. Material
E. Disposal Field: Total length of lines
Distances:
A. Well to: Septic tank
Nearest lot line
k '
B. Foundation to septic tan ~'
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines ,,,
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Re~_.~st for Approval
~Legal Description
of Individual ~ ~er & Water Facilities
Comments
Approved~ ~?/~JX~~/~ .~ ------ Disapproved Date ~ ~.
Ap~l Valid for one year from date signed
Greater Anchora'!~e~Ar6a Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
