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Home My WebLink AboutTIMBERLANE PARK #1 BLK 2 LT 2 (P 71-112)rry Y�142�25 TOTAL P.02 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920339 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:HANSEN ERIK D & DAWN M OWNER ADDRESS:1013 E. DIMOND BLVD. ANCHORAGE, AK 99515 DATE ISSUED:10/08/92 EXPIRATION DATE:10/08/93 PARCEL ID:01914225 LEGAL DESCRIPTION: TIMBERLANE PARK #1 BLK 2 LT 2 SEC 24, T12N, R4W, SM LOT SIZE: 20000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: WELL LOCATION MUST BE 100' FROM SEWER MANHOLE, SEWER MAIN, AND 25' FROM SEWER SERVICE LINE. RECEIVED BY: 75' FROM DATE: DATE: 01 ~0 p N 1�1'� QpGE BGi • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 019-142-25 1. GENERAL INFORMATION Expiration Date: Complete legal description TIMBERLANE PARK#1 BLOCK 2, LOT 2 Location (site address) 11820 HUMBLE COURT, ANCHORAGE, AK 99515 Current Property owner(s) STEPHEN & DEBRA SCHWICHT Day phone Mailing address Real Estate Agent 11820 HUMBLE COURT, ANCHORAGE, AK 99515 2. TYPE OF DWELLING: ® 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: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class — Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Distance: Received by: /G1GGt/// Date: 77 _1� COSA to be released to the engineer, unless othA; quested by the engineer. - COSA Fee $vow Waiver Fee $ Date of Payment 5�//o Date of Payment Receipt Number Receipt Number COSA#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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 7/7/2016 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerm can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen �. OF T� encroachments, deficiencies or discrepancies exist. /�� F� A C) T N 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. VS4 / Conditional approval for bedrooms, with the following stipulations: \i len 1—F16---C� Original Certificate Date:�27 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheat 10-1a12.dw If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: TIMBERLANE PARK#1 BLOCK 2, LOT Parcel ID: 019.142.25 A. WELL DATA* Well type PRVT If A, B, or C provide PWSID # Date completed CIRCA 1993 Sanitary seal (Y/N) Y Total depth 48 ft. Cased to 48 ft. FROM WELL LAG (MOA RECORDS) Date of test Static water level Well production ft. 3.3 g.p.m. Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 7.5.2016 ft. ai g g.p.m. WATER SAMPLE RESULTS: Coliform A5-colonies/100 colonies/100 mL Nitrate 4J;Z mg/L Arsenic: AI � ug/L Date of sample: 7/5/2016 Collected by: ARCTERRA B. SEPTICIHOLDING TANK DATA - PUBLIC SEWER Tank Type/Material Date installed Tank size _ gal. Number of Compartm is CI (Y/N) Foundation cleanout (YIN) Depression/tank tank (Y/N) High water alarm {Y/ Date of pumping Pu er C. ABSORPTION FIELD DATA Date installed _ Length Total depth ,ft: Date of ad( Fluid depth Sgit�rating (g.p.d./If or ftZ/bdrm) _ ft. � Width ft. Eff. absorption area Jf Results absorption Feld before test _ in. _min. Final fluid depth )n treatment (past 12 mo.) (YIN &J System type Gravel below pipe ft. Depression over field r_ For bedrooms added gal. New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at_ in. Datum Size in gallons "Pump off"level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA Absorption field on lot NA Publicsewermain 75'+ Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Property line _ Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: PUBLIC SEWER Property line Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots NA On adjacent lots NA Public sewer manhole/cleanout 1004 Holding tank NA Manuretanimal excrete storage areas 100'+ Absorption field Surface water Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I cerfify 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 Printed Name KENNETH M. DUFFUS Date 07/07/2016 COSAcanary sheet 2-6-15.doc OF ALS * 4P TTYH in. A ,KEN FUS +`\�a 8_�L�o�ir/ FsssioN� i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 01~' ~2.-~ HAA# /~/~)~70~ 1. "GENERAL INFORMATION Complete legal description "~¢,~ ~'~ Location (site address or directions) //o~.O /~C~/~ I~L.~ ~_.~-, /:]k~c~, Property owner Mailing add tess Lending agency Day phc ne Day phc ne Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDRO0 MS: '~:~' TYPE OF WATER SUPPLY: Individual well Community well Public water X = NOTE: ff community well system, provide written confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer lng to the legality and status of system. NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. -, . 72-025 {Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and .from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Eng~ r~eeds signature Alaska Water & Wastewater 73~0 R~f ~2ho~for I-Its. Circle Anchorage, Alaska 99504 Phone Date DHHS SIGNATURE ' '/ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations; Additional Comments ' The Municipality of ArichOrage Department of Health and Human Services (DHHS) issues Health Authority ApProval CertifiCates"!based only upon the representations given Jn paragraph 5 above by an independent professioqal, engineer registered in the State of Alaska. Th.e DHHS does th s as a courtesy to purchasers of homes and their lending institutions in order to satisty certain federal and state requirements. Em pioyees of DH HS 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. , ./IRONMENTAL SERvIcES D~ Municipality of Anchorage DEC r~-: i997 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division j~ j~('~ J []~ .J~lrIFl..~)'~-r~"'~'- 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-"47~'4 Health Authority Approval Checklist Legal Description: Lc)'r ~ ;J~,,T/~E~-LA*J,~ ~/~ S/'d ~'~ Parcel I.D.: A. WELL DATA Well type ~-~{Z[u~-r~._ If A, B, or C, attach ADEC letter. ADEC water system number Log presentCN) V,r-_~& Date completed Total depth ~,O ' Cased to Sanitary seal (~'N) Date of test Static water level Well production FROM WELL LOG g.p.m. Casing height (above ground) ~ z./ ~ L~ Wires properly protected (~N) ~"F---5 AT INSPECTION ~,O g.p.m. WATER SAMPLE RESULTS: Coliform ~ Z~¢o ( ~ ¢~J.i~ Other bacteria Nitrate O' Collected by: ., "~, Date of sample: Date installed ~ Tank size-~~partmmlt-C~ Cleanouts (Y/N) DateF°Undati°n cleanOUtof P ~g[~~(Y/N) F~ssion (Y/N) ~ C. ABSORPTION FIELD DATA /U//~ - ~::'~/~,,.~c ~E_,~.~- Date installed ~ Soil rating (g.p.d./fF or ft~/bdrm) System ~ Length ~ Gravel thickness below pipe ~al depth Effective absorption area ~~e!ression over field (Y/N) ~l~ti~fe~tdheiq~Ystore~iion field~~~added (in.):__Results(Pj~ssfF~_ For~ ~edrooms Fluid depth ~'~r:" : Abs:rpiion late ~..~.p.d. Peroxide treatm past 12 months) (Y/N) If yes, give date ~ ~. 72-026 (Rev. 3/96)* ' i' Manhole/Access (Y/N) __~__ "Pump off" level at* High water alarm level at~_~..--~-~ ~Datum ~ Cycles tested,`,,.`/ ~' E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELLON LOT TO: /U/~ On adjacent lots /~/~ On adjacent lots c':':':'~ ~'A- Lift station Public sewer manhole/cleanout _ (Oo /¢ SEP~N DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: . Water main/se~sdcaui¢~---"-~- Su~ace water/drainage ~ots__ SEPAR~~C~_FROMABSORPTION FIELD ON LOTTO /~//'+ . Property line '"'~----------~~ ~e line Su.ace water riv wa- ' / Curtain drain~ Wells on adjacent lots ENGINEER'S CERTIFICATION ~ /.~oT% /A- 4 //~ ..~Ep.u~.o f~y R.~rS~¢ I certify that I I are Signature HAAFee $ ~0-0 ,L,~ Date of Payment ,,/'~,/~ ~ Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Dec-01-97 12~02P Jack Vanden Berg 907-762-3189 P.O1 .I $ O0'O0'OO" W ;OO.O0' J, h lO.