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HomeMy WebLinkAboutTIMBERLUX #2 BLK H LT 6
Municipality of Anchorage Page } of
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: ~f.~ ct/ <~ ~)O/(:~ PID Number: (])/~ --
Name: ~14~-- ~*,m~F~/¢[..'c~ ~ ~/~ ~,O~ WastewaterSystem: ~New ~Upgr~de
~ ABSORPTION FIELD
Phone: ~ No. of B~drooms:
~ ~ ~ ~1~ ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~Other
Total Depth fro original grade:
LEGAL DESCRIPTION iso,.~,.~: ~ GPD/Sq. Ft. .~ ~OV~ ~'~
Lot: ~ BIock:~ %¢¢ ~Subdiv~i°n:~ lDepth to pipe bo~ from original grade: Ft. Gravel depth¢ beneat~ pipe
'~ "'~ ~ Ft. Ft.
~ U New U Upgrade lGravelwidth: Numberoflines: lOls~ncebe~eenlines:
/ 0 Ft. ~ ~ Ft.
Driller: ~a~rilled: StatlcWater Level:Ft. Installer:~ ~',~. ~, ;~
Yield: PumpSetat: Casing ' htAboveGround:
SEPARATION DISTANCES u Septic B Holding ~S.T.E.P.
To Septic Absorption LiE Holding 'ubli¢/Private Manufacturer: Capacity in gag~ns:
From Tank Field Station Tan~ Sewer Lin~ ~* ~t~
Wel~ [~0/~ ~00~~ )O0~ ~J~ ~/~ Material~ ~ Number of Compa~ments: ~
Sudace
Water BO/+ %p/¢ D~/~ z¢/~ LIFT STATION
Lot Size in gallons: ~ Manufacturer:
'Pump on" [eve] at: "Pump o~' level at:
Drain
Remarks: ~¢~ ~% ~ ~,,~% BENCH MARK
I A~um~ Eievatiom
Inspections performed by: 41~ ~,uot~S, C-E, Dates: 1st ~/'s/¢¢ - ~'""~";~ t~ ~"~= F
Depadment of Heal.nd Muman Se~ices approval '~;:%,~
Reviewed and approved by: Date: ~- 7-¢¢
72-013 (Rev. g/gt) MOA 25
SW990019 ' 018-271-49
~ ~-- .... -do~E~--
TIMBERLUX SUBDIVISION ¢2, LOT 6, BLOCK H
(~ ..... r?; ~7-'~ ..............
AS-BUILT OF SEPTIC SYSTEM UPGRADE
~.~ ~o. ..o.~ .~.~: rO~/.'..l.- ~_~ ....
CAMPBELL & JILL SCHNEIBER 786-7457/545-6273
A.C.G. 1 = 40' 2 OF 2 Cress
PC B
ST1 10,3.1 43.8
ST2 96.6 4~.4
MH 95.0 4,3.3
MT1 85.1 44.2
MT2 84.0 38.9
MT3 52.0 63.0
brf4 51.1 59.9
!-Z2-~ 1~:£9 ~M ~LASKA TESTLnB
Percent Passing by Weight
9075633953;¢, 2/ Z
~ O01
INSPECTION RF_~ORT
IVIL~ICI. PALITY OF ANCI-IOltAGP. - IlULLDING SAFETY DMSION
a~O0 IgAST TtJDOR ROAD, ANCI-IORA~I~, ALASRA
RECEIVED
JUN 4 1999
Municipality ol'
Oept. Health & Human Services
P/H£N 6'ORP. B~TION. g ARE M.~IDk', I'1.~'~£ G4d. Z FOR/NSP£C'I~ON
DO ArOT RE3IOI'E ]1~II$
6661'[ 'NflP
CONSPICUOUS PLACE
{ MUST BE INSPECTED
~ REQUIRED FOE iNSPECTION SERVICE
~PECTION REQUEST LiNE 563.3484 OR FAX REQUEST 343-8235
MUNICIPALITY OF ANCHORAGE
BUILDING SAFETY DIVISION
3500 EAST TUDOR ROAD
TELEPHONE (907) 343-8211
ELECTRICAL PERMIT
RETROFIT
NO:
Date:
SITE ADDRESS; 4700 MANYTELL AVE
PERMITEE/~)WNER: BRUCE RICHARD L & SALLY M
CONTRACTOR; ALCAN ELECTRICAL ,~ ENGINEERING, INC.
LOT: B BLOCF. J"rRACT: H SUBD: TIMEERLUX#2
TYPE: RETROFIT
PROPOSED WORK: SINGLE FAMILY
WORK DESC. Connec~ sewage lift station {nth) approved by doug
99- -7668
04/19/99
REMARKs:
TOTAL CONSTRUCTION VALUATION:
Permi~ Fee: $77, O0
$.00
Total Fee: $77.00
Date Pair~: 04/1g/99 Permit Issued By; HARTLEY, N~COLE T.
Type: MASTER CARD Approvals:
Number:
Signature of pecmitee or Agent:
Printed Name;
ALL WORK IN STRICT CONFORMANCE WITH PLAN INSPECTION REQUIRED OF
CHECK REQUIREMENTS AS PER JOl$ PRINTS.
FIELD INSPECTION REQUIRED FOUNDATION EXCAVATION PRIOR
TO PLACING ANY CLASSIFIED FiLL
CONTACT THE UTILh"Y FOR APPROVAL OF BERVICE EQUIPMENT AND LOCATION PRIOR TO INSTAL-
LATION, SER~/ICE CHANGES MUST BE SCHEDULED IN ADVANCE WITH YHE UTILITY COMPANY
AND THE BUILDING SAFETY INSPECTION SECTION.
J HAVE REAr3 THE,~,SOVE APPLICATION AND KNOW THE CON'rENT~ THEREOF: THE SAME i$ 7RUE AND CORRECT.
I EURTHER AGREe!THE ABOVE WOP, K WILL ~E DONE IN ACCORDANCE WITH ALI, STATE, MUNICIPAL [,AW3, AND
ORDINANCES.
WORK I$ NOT COMMENCED
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human 9ervices
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.ci.anchorage.ak.us
March 1, 1999
Jeff Garness, PE
Alaska Water & Wastewater Consultants, Inc.
690I De Barr Road, Suite 2B
Anchorage, Alaska 99504
Subject:
Waiver Request for Lot 6 Block H Timberlux Subdivision #2
Waiver Request #¥VR990001
Parcel ID #018-271-49
SW990019
Dear Mr. Garness:
Your request for a waiver of the required 100 feet horizontal separation from the
S.T.EP. tank to surface water has been approved. The approved separation distance is
80.0 feet. Also, a waiver has been granted from the ISF systems to the drainage ditches
located to the north and southwest of the propery of 50 feet.
This waiver approval applies to the existing on-sitewastewater disposal system to
surface water separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
WR# WR990001
Date Received:
Legal Description:
Engineer:
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
PID# 018-271-49
January 11, 1999
HA#
Permit #~ ~he%~((]fqk~
(w/upgrade permit)
Lot 6 Block H Timberlux #2
Jeff Garness, P.E., Alaska Water & Wastewater ConsultantB, Inc.
6901 De Barr Road, Suite 2B, Anchorage, Alaska 99504
Applicant: Bruce Gamble
Waiver Requested: Waiver of 50' from the DroDoses ISF svstems and 80! waiver
from the proposed S.T.E.P. tank et the drainage ditches located to the north and
southwest of the property.
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
Points:
3. Other:
Waiver is Granted: X
List Conditions or Reasons for
Waiver is NOT Granted:
above: ~F ~/,/~/4/E~ ~£~ED
Date: /- /?-9?
Name of Reviewer
Rec #: 04675/0112 Amount: $ 920.00 Date Paid: Jan 11, 1999
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2B N Anchorage ~ Alaska 99504
(907) 337-6179 N Fax (907) 338~3246
Consulting Engineers
RECEIVED
December 16, I998
Municipality of Anehorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O~ Box 196650
Anchorage, Alaska 99519-6650
,l/Xlq 1 3 1999
Ig~UNJCIPALJTY OF ANCHORAGE
~_NVIP. ONMENTAL SERVICES DIVISION
Ref.' Sewer Upgrade and Waiver Request for Lot 6, Block H, Timberlux Subdivision #2
To whom it may concern:
The existing 3 bedroom house is served by an onsite septic system, and a private well. The
existing drainfield will not pass an adequacy test and is believed to be encroaching groundwater.
We are proposing to upgrade the septic system. Comments regarding the proposed upgrade are
summarized as follows:
1. GENERAL: There are a number of site restrictions which limit the available area to put a
new drainfield. These restrictions are summarized as follows:
· The location of the the drainage ditches which periodically have flowing water in them.
· The location of the well serving this property.
· The presence of very shallow groundwater.
As can be seen on the attached site plan and design, there is no available area to install a septic
upgrade without obtaining waivers. On 11/30/98~ a site visit was made with Dan Roth of your
department to determine the direction in which we should proceed. Per conversation with Mr.
Roth, it was determined that the only viable option, that would justify the waivers, would be to
install a innovative septic system. Consequently, we are proposing to install a bottomless
Intermittent Sand Filter (t.S.F.) system.
2. WAIVER REQUEST: We request that your department issue a 50' waiver from the
proposed I.S.F. system anda 80' waiver from the proposed S.T.E.P. tank to the drainage ditches
located to the north and southwest of the property. As can be seen on the design, there is a
natural embankment that has a higher elevation than the grade in the area of the proposed
upgrade. It is our opiniou, that the direct flow of any possible surfacing effluent Will follow a
natural drainage pattern that exceeds 100 feet before reaching any point of the ditch line. With the
use of the I.S.F. system, the effluent should be well treated decreasing the chance of
contaminating any surface water or groundwater.
3. ' SOILS: On October 10, 1998, three test holes were excavated and percolation tests were
performed 'at the area of the proposed septic upgrade. A copy of the logs are attached.
Groundwater was encountered between 4 feet in test holes #1 & #2 and at 7 feet in test hole #3.
After seven day groundwater monitoring, water was found at 2.75 feet in test holes #1 & #2 and
at 6 feet in test hole #3. One percolation test was performed foi both TH#1 and TH#2 between
the depth of 1.0 feet to 1.5 feet and found the pere rate to be 6.7 minutes/inch. One percolation
test was perfomaed in TH#3 between the depth of 2.5 feet to 3.0 feet and found the pert rate to
be 21.8 minutes/inch. Due to the fact that the groundwater is so shallow in the area of TH#1 and
TH#2, we propose placing the I.S.F. system within the 30 foot radius of TH#3.
4. SYSTEM DESIGN: Bottomless Intermittent Sand Filter (t.S.F.)
a. Percolation Rate: 21.8 minutes/inch
b. Allowable Application Rate for ISF: 2 gallons/day/fi2
c. Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. ~um Absorption Area: 225 R2
f. Effective Depth below pressure pipes: 3+ inches
g. Width: 10 feet
h. Length: 36 feet.
i. Effective absorption area = 360 1~2 (>225 ft2 OK)
j. Air Supply: Thomas Industries, Model 5070, "Anchorage Tank".
k. Air Supply Line: "Wasteflow' emitterline, 1/2 inch I.D, "Anchorage Tank".
1. Sand Material: Per Latest Guidance by Municipality of Anchorage
m. Pea Gravel: 100% passing 3/8" sieve, less than 20% passing the 1/4" sieve, and
less than 1% passing the #8 sieve.
We are proposing to excavate down to a depth of 2.0 feet, place a minimum of 6 inches of sand,
install the air supply line, and cover it with 1.5 feet of sand. On top of the sand, we will place 3
inches of 3/8,inch pea gravel above and below the pressure laterals. We will use a conventional
lift station (Amchorage Tank), equipped with a programmable timer so that flow can be
intermittently dosed tO the ISF.
5. TOPOGRAPHY: As you can see from the attached topography site plan, the lot slopes at a
grade of 5% to 10% running from approximately east to west. Also, as can be seen on the
attached design, there is an embankment that wonid prevent any surfacing effluent from directly
flowing into the ditch line.
6. MATERIALS AND CONSTRUCTION' PRACTICES: The materials used, and the
construction practices will comply with DIiHS' "Intermittent Sand Filter Design, Installation &
Maint~riance Manual". The contractor should read this document prior to construction. Copies
are available at the Municipal Onsite Services office (5th floor, 9th & L St.).
7. CLOSING: Given the site restriction, I think the ISF is the most viable option for this lot,
short of install a Recirculating Upflow Filter, which would be more expensive. I am open Io any
suggestions from your department, which would be an improvement to the proposed design. I am
unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If ~you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your
assistance. '
dAN 11 1999
MUNICIPALITY OF ANCHORAOI~
ENVIRONMENTAl. SERVICES DIVISION
'\
LOT 7, BLOCK [\\
'RMBERLUX S/D ~3
,/
LOT 6, BLOCK G
UaEBLUX S/D
MANYTELL AVENUE
/
/
/
I
I
T[UBEBLUX S/D
\
\
DITCH LINE WBH
SURFACE
(WAR/ER REQUESTED)
LOT 2, BLOCK
TJMBERLUX S/D
PROPOSED SEFTIC
SYS~M (SEE BESION,
PABE 2 OF
\
\
LOT 3, BLOCK F,
TIMBERLUX S/D ~2
LOT 4, BLOCK
~UBERLUK S/D
' I
\ ',,
3 ",
BDRU BOUS~E \
LOT 5, BLOCK
TIMBEBLUX S/D ~t2\~
/ /
/ /
/
LOT 7, 8LOCK H,
~'IUBERLUX S/B #2 \
/
PHONE NUMBER:
786-7457/345-627~
PAG E:
= 100' 1 OF ;~
ALASlgt WATER. AND WASTEWA'f~t¢, CONSULTANTS, INC.
6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK 9950~
PHONE: (go7) 337-617B/FAX: (907) 33B-32~6
DESCRIPT[ON:
TIMBERLUX SUBDIVISION #2, LOT 6, BLOCK H
WORK:
SITE PLAN FOR SEPTIC UPGRADE (I.S.F.)
~EPArED FOR: ~;~4~EI.L.
BRUCE ~L & JILL SCHNEIDER
BY:
/15/98 A.C.G./J.L.M. I
I
I ~-'~c
/ \\
/
/ ~/// \
LOT 8, BLOCK t~
~UBERLUX S/O
MANYTELL AVENUE
/ ~ ~> ~ 1~3 I~EOROOM'cO ~ /'
! 3-- D' EH UNE
/ / SURF~E WATER ~ / / I
f /
~, ~ STEP T~K~ I / . / ::,: ':':: '
~ ~ ~
INTERM~EN~ S~D RLTE~, % ' '
~CAVATE 10 WIDE BY 36 tOnG N '% '
A~ ORGANtCS). ~,~_F~ER ~'~ / ~ PRO, DE A O-10 PSI PR~SURE ~UGE AT A LO~O~
THE G~E IN ~E ~ OF
/
~S~ WA~R A~ WAS~WA~ CONS~TA~S, ~C.
T~g~ERLUX ~U~DW~S~ON ~. LOT ~. ~LO~ H ........ - .. · ' ·
DESIGN OF SEPTIC SYSTE~ UPSRADE
PREPARED FOR:
786-7457/~45-6275
C~L · JILL SCHNEIDER '""
eRUC[
A.C.G./J.L,M, 1 = 40' 2 OF
~/4" I~LA, ~14, 40 RV¢
(HOb~, ~HI.~bPS. AN~ ~bLFddlN~
I
l~1~ k N~ PROM
INV~Rf, (t2~ILI. 1/4 INCH PlA,
PbAd[~ CA~ ON I~KTrfOM ANP
:~) (MIN,) 1/4" H~
PLAN VIEW
Mf ~/4" PV¢ LAI~FJ~ (~YP,4) - MY
2' MIN. O~ COVER
PROFILE VIEW
-INSLI.AI1ON
~V~R r~A ~P-AV~b
A~.&SKA ~tATEI~ & ~VASTE~VATEI~ CONS~o?TANTS, INC.
6g01 DEBARR ROAD S,JUrllE 2B. ANCHORAGE, AK. 9B5
PHONE: (907) 337-6179 / FAX: (807) .3~8-3246
LEGAL DESCRIP'iION:
TIMBF'RLUX SUBDIVISION #2, LOT 6, BLOCK H,
1YPE OF WORK:
BOTTOMLESS SAND FILTER (ISF) DETAIL
PREPARED FOR:G~.~,~,~_.~t,[. PHONE NUMBER:
BRUCE ~ AND JILL SCHNEIDER 786-7457/545-627~
DATE: JDRAWN BY: SCALE: IPAGE: ~.~
12/15/98 J A.C.O./J.L.M. N.T.S. I
ALASKA WATER. & WASTEWATER. CONSULTANTS, INC.
7,320 E. CHESTER HTS. CIRCLE * ANCHORAGE. AK, 99504
PHONE (907) 357-6179 * FAX (907) 338-3246
ISOIL LOG - PERCOLATION TESTI ,
PERFORMED FOR: BRUCE ~E-~ AND dill SCHNEIDER ~:~j~~ ~-~..-~..:...~
DATE PERFORMED: 10/10/98
DEPT. r--:-:r 6" 8" I=sT HOLE #1 I
(,~.0 [~ - ORC ~ '~ ..... : o'~
~ SOIL CLASSIFICATIONS MAN.ELL AVENUE rS~TE PL~
[ I": IOO'
~, GC ~OL (
~...~ sw NH
~ SP CH .~/¢~
~ SM OH ~ ~
/IMIIM
~~ B.O.H. ~ ROUNDWATERDEPTHTO DATE ~~C~ ~
2.75' 10/~
10
11 DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TINE (HINUTES) READING (INCHES)
12 9/4/98 PERC. H( .E W~ PRESOAKED 4+ HOJRS PRIOR TO TISTING
13 ..... ~ .... 5:19 6"
2 5:49 50 1 1/8" 4 7/8"
4 ._ 6:19 50 1 1/2" 4 1/2"
16 _ 6 .__ 6:49_ 30 1 1/2" 4 1/2"
17
18
19 PERCO~TION ~TE 6.7 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20
TEST RUN BETWEEN 1.~ FT. AND~~.
COHHENTS: ~!I~~
THIS WAS PERFORMED I~ ACCORDANCE WITH ALL STA~A~D~ I~IPAL~ELINES IN EFFEOT ON THIS
DEPTH TO DATE
GROUNDWATER
~' lO/lO/96
2.75' 10/17/98
AL~SKA WATER & WASTEWATER CONSULTANTS, INC. ~--05
[SOIL LOG - PERCOLATION TEST] ,~(60'.'"~4/:b/~ [" ~'"..'~7.~4
LEGAL DESCRIPTION: TIMBERLUX~.~t~i~e~SUBDIVISION, LOT §, BLOCK H ~/.';.~.,. 1/7
PERFORMED FOR: BRUCE ~ AND dILL SCHNEIDER
I '
DEPTH i ~
(,eet) j~ 6"--8" ORO
1_¢ ....... .
SOIL CLASSIFICATIONS MAN'YTELL AVENUE [SI.T.E P~L~,
2- il 7o~ ew ~ ORe q ........
3- GM/ML ~ GP ~ ML 4~ ~
~ °%° SW IIIIIII NH --
~ SP ~ CH ,
B.O.H. ~ ~.4~ *'~+ ' '
/
DEPTH TO ~.~= . ~ ~
GROUNDWATER u~.~ ~ X ~0, .~ k
~L. T57 .... 10,17,98' ~'~:
~0~
11 -- nAY: D:AnlKI~ CLOCK NET TIME WATER LEVEL NET DROP
12-- ~ ........... TIME , (MINUTES) READING (INCHES)
13-- PERC. BENCH ]~_LOCATED B~EEN_~E~ HOLES
~D ~2. SEE TEST HOLE ~1 FOR PERCO~TION DAT~
14--
15--
16--
17--
1B--
19- PERCO~TION ~TE~ ~N/A (MIN./INCH) ~/~RC. HOLE DIA. N/A (INCHES)
COMMENTS:
DEPTH TO DATE
GROUNDWATER
2.75' 10/17/98
, ALASKA WATEI~ & WASTEWATEI~ CONSULTANTS:, INC.
7320 E. CHESTER HTS. CIRCLE * ANCHORAGE, AK. 99fio4-
]SOIL LOG - PERCOLATION TEST] ,F/-~o:' /4-/; IH_/~I~' .'..?,f~,.,,...~
L.^L .ES*PT,O.: *OC H
...... ,
PERFORMED FOR: BRUC[ ~'"0;~{¢¢/L~_ mD aLL SCM.EIDER
DATE PERFORMED: 10/10/98
I TEST HOLE #3]
I~EPTH ~
· ~ ORG
SOIL CLASSIFICATIONS J MANYTE[ L AVENUE ]SITE PLAN1
ML/GM ;~;:;~ 6W xxxx~ ORG
~SW HH
~ SM OH ,
$.0.H. ~ROUND~ATER
.... Z' ..19110~/98.
6' 10/17/98
10 ·
11 DATE READING CLOCK NET TIHE WATER LEVEL NET DROP
TIME (HINUTES) READING (INCHES)
12 0/12/9! PERC. HOLE WAS PRESOAKED 4+ HO]RS PRIOR TO TEBTING
15 ___ 1 ,5:18 ~._ -- 6 1/2"
.. 2 5:4B 30 5" 1 1/2"
14- __ 3 6:18 50 3 5/8"..__ 1 3/B"
.... 4-_.__ 6:18 -- 6"
~ 5 .~ _~ 6:4B ~0'- 4 5/8" 1 3/~.c -
16
17
18
19 PERCO~TION ~TE 21.8 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
20
3.0 FT.
TEST RUN BETWEEN 2.5 F~.
COHHENTS:
PERFOMED BY A~SKA WATER · WAST~ATER I, ~ ~/~ ~ ~ , CERTI~ THAT
THIS WAS PERFORMED~ ACCORDANCE WITH ALL STAT~ ~UNICI]~GUIDELINES IN EFFECT ON THIS
/
DEPTH TO DATE
~ROUNDWATER
7' 10110/98
6' 10117/98
P~ROPERTY OWNER AGREEMENT
FOR THE~ MAINTENANCE OF AN
ON-SITE WASTEWATER DISPOSAL
SYSTEM
This agreement, dated ~.4 ~V~7199--~-, is made between the Municipality of
A~chorage Depaament of Health and Huma~ Services. (DHH$) and the property
T~ agreement is made for the purpose of maint~inlng an on-site wastewater d~osal
system oa the subject property.
The property owners agree to tl~,e following:
Submit to the Municipality of Anchorage, on an annual basis, an inspection and
operation statement from a registered professional engineer. This inspection and .
operation statement shall verify that the engineer.has inspected all effluent and air
pumps, timers, and alarms, and that any deficiencies have been repaired and that the
system is functioning as designed.
(Signature)
(Signature)
(Printed Name) (Printed Name)
................................ Notarize Here ...................... -- ---- - - --- -----
personally appeared before me, u
O~o~hO is personally known to ma ~' ~)C ~~(
~hoaa Sdant$ty X prov6d on the 6ath/a~$~at$on of
, a credible witness
f ~he aboy~ document, and he/she acknowle%ged tha~ he/she signed i~.
Notary Public
, , DEPARTMENT OF HEALTH & ENVIRONMENTAl.. PROTECTION
ENVIRONMENTAl. ENGINEERING DIVISION
825 L Street- Anchora~e, Alaska 99501 Telephone 264-472.0
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT
NAME
[] UPGRADE
A'"NGADDRESS /3or
DISTANCE T~ Well , ~ Absorption area Dwelling ~ PERMIT NO.
~ Z Manufacturer
=m<D Liq. ~ Material
capTt~&°ns IF HOMEMADE: Inside ,ength Width Liquid depth
~ Z DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer
· -- ~ Material Liquid capacity in gallons
~ I /3 ~. Nearest lot line~ .
~ DISTANCE TO: ~ ~ I'/;~ Foundation
Total ,ength of ~e~ Trench w~th._ Distance between lines
~ ~ ~ Top of tile to finish grade ~ /f Material beneath tile
inches
m Length Width Depth PERMIT NO.
m--~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ m DISTANCE TO: Well Building foundation Nearest lot line
~ Class Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si
OTHER ~ ~.
SOl L TEST R~TI N G
REMARKS 0 [ ] ~ z~I ~ ~
~~~~ . ~,, Mt NIC>ALI Y C AN2HO~AG
APPROVED '~.,~ ~0 ~ DATE LEGAL REL JV'ED
72-013 {Rev. 3/78)
0
0
Z
OF ANCHORAG
IVED
PERMI!' NO.
FiPF'LICFINT JOHN HENSt_.E'¢ F'O. BOX i~2)-2:t. 57
L. OCRTION L. ONGE;OI4 ,E MFf?q"EL
LEGRL LOT .6 B H TIMBERLEX LOT SIZE
'TYPE OF' SOIL RB':];ORPT!ON .Sh.'STEM ):S: TRENCFI
]i:41:i¥,::~t.:.l SQURRE F'EE'."
MR?,:!MIJM N_MEFr4' OF ErEDROOM?, = 2 ,:.;r'lIi RFtT!NG ,"-,!., Fl', I:m ......
THE REI;!IJIRED '..:_i:~ZE OF 'T~-IE.:,uIL.'-' flE, m,..R,:: """' '~T!l.J}~-" __,'r_,lEH':"'c-" ,. ILl;:
THE LENGTH DIHENSION IS 'THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINF:IELD.
THE DEPTH OF R TRENCH OR PIT :.rE; THE DIS'FFINCE BETWEEN THE E.-URFFICE OF' THE
GROUND RND THE BOTTOM OF' THE EXC:Ft',,,'RTION <IN FEET).
THERE IS NO SET !4IDTH FOR TRENCHES.
THE GRR'v'EL DEPTH IS THE MINIMUM DEF'TH OF GRW,,,'EL BETWEEN THE OLq'FRLL PIPE
f~f.,Ig, THE BOTTOM OF THE E~<CRVFtTION (tN FEE'F).
:,: ;,r.:,:-,- ,:- , -, ,HI.=, DEF'FIRTMEN'T DURINC4
F'ERMIT RPF'LICflH'F HH_, THE F..,__,F~r~..IEILtF~ TO INFORM T ,.- -, ~
INcTMLLHIION INSPECTIONS OF RN'¢ I,.tELLS R[:,JRCENT :Ti THIS PREPERT¥ FIND THE
N_IHbER OF RES~:[,ENZES THRT THE WELL 1.4ILL SERVE.
6HL. KFILLING OF Rf.,F,-' c,,,::. :-.
..,-~._,TE. I1 b~ITHOU'F FINFtL INSF'EETI]N RND FIPPRO',,,'RL B'¢ T
[:,EF'RRTMENT I.,.IILL BE" '- ' '-'' ''-'- ....
...::,UE,,)EL. 1 'FO FF.U.:,E__ FI.
MINIMUM DISTFINCE BETWEEN R NELL RND RN"r' ON-SITE SEt4RGE DISPOSRL S"¢S'TEM IS
:LEiE~ FEET FOR R PRI',,,'R]'E k!ELL OR :L5EJ TO 2E~E~ FEET FROM Ft PUBLIC WELL DEPENDING
UPON THE T'¢PE OF PUBLIC WELL.
MINIMUM DISTFINCE FROM F~ F'RI',,,'FtTE WELL TO FI PRIVRTE SEWER LINE IS 25 FEE!'
TO R COMMUNIT? SEklER LINE IS 75 FEET.
WELL LOGS RRE RECK.IIRED RND MUST BE RETURNED 'TO THE DEPRRTMENT I.,.I!THIN 313
OF THE NELL COMF'LETION.
OTHER REQUIREMENTS MR¥ F~PPL.'¢. SPECZF!CF!TIONS RND CONSTRUCTION DIRGRRMS FIRE
BVRILRBLE TO INSURE F'ROPER INSTRLLRTION.
I C:ERTIF¥ THRT
±: i RM F'RMZLIF!R t.4ITH THE RE6!UIREMENTS FOR ON--'SZTE SENERF.; fiND WELLS tis SE!"
FORTH B~.' THE MUNICIPRLIT'¢ OF' I~NCHORfiGE.
2: t P~ILL INSTRLL THE S'T'STEM IN RCCORDRNCE t.4ITH THE CODES.
2: ~ UNDERSTRND THRT THE ON-SITE SEI4ER S?STEM MR? REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED "FO INCLUDE MORE THRN ]: BEDROOMS.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~'//SOILS LOG
[] PERCOLATION
TEST
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DAVE PERFORMED: .~/
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
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COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
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.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 4/26/24
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND �GREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of of 204 4) , by and between
��✓�w %�%(rS herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
I. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as IDSF
located at (legal description)
TIMBERLUX #2 BLOCK H LOT 6
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of
tW Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
102
Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
619, Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
�L Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
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Lot 6, Block H
Timberlux Subdivision
Addition No. 2
36,408 Sq. Ft. +/-
4700 Manytell Avenue
3 Story Wood Frame House
With Attached 2 Car Garage
;
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SEE "DETAIL A"
SHELTERLOGIC SHED
SHED
SHED
METAL COVERED STORAGE
WOOD SHED
LOT 5
S
OVER PROPERTY LINE
OVER PROPERTY LINE
30'
30
'
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20' x 20' ANCHOR EASEMENT
MANYTELL AVENUE
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'
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.
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'
2ND FLOOR
KICK-OUT
2ND FLOOR
KICK-OUT
ARCTIC ENTRY
PREPARED BY:
FRONTIER SURVEYS, LLC
650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518
907-460-1686
DRAWN BY:
CHECKED BY:
DATE:
SCALE:GRID: SW3136
1.Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2.This document is created by Frontier Surveys for the purpose of an
as-built survey for Emily Selix, only.
3.This document is based on Plat No. 70-256, Anchorage Recording
District.
4.Some features may not be shown due to excessive snow/ice coverage.
General Notes DisclaimerLegend
1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible
improvements and conditions at the time of the survey. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the
responsibility of the Owner to determine the existence of any easements, covenants, or restriction
which do no appear on the record plat. Under no circumstances should this document be used for
construction or for establishing a boundary or fence line.
RS 1" = 30ft
04/12/2024 24-066BH
Scale 1" = 30'
AN AS-BUILT SURVEY OF
LOT 6, BLOCK H
TIMBERLUX SUBDIVISION ADDN. NO. 2
4700 MANYTELL AVENUE
CONTAINING: 36,408 Sq. Ft. +/- (RECORD)
RECORD PLAT: 70-256
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORRachel N. Shoemake
No. L.S. - 14646
Apr 16, 2024
DRAWING ID:
MB
"DETAIL A"
SCALE 1" = 20'
Electric Meter E
Gas Meter G
Water WellW
SepticS
Wood Deck
Fencex
SC Septic Cover Sign
E Elec. Pedestal
Tel. PedestalT
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box '196650, Anchorage, AK 995'19-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Feb 26, 1999
Expiration Date: Feb 26, 2000
Permit Number: SW9900'19
Legal Description: TIMBERLUX#2 BLK H LT 6
Design Engineer: 0041 AK Water & Wastewater Consulta
Owner Name: Bruce Camble & Jill Schneider
Owner Address: 4700 MANYTELL AVE
ANCHORAGE , AK 99516-4121
Parcel ID: 018-271-49
Site Address: 004700 MANYTELL AVE
Lot Size: 34000 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AACS0 ).
3. The engineer must notify DHHS at least 2 houm prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE ATTACHED PROPERTY OWNER MAINTENANCE AGREEMENT SHALL BECOME A PART OF THIS
PERMIT.
MUNIMNLITY of ANCHORAGE •, Development Sei vice Department • On -Site Water & Wastewater Program
P: 907-343-7904 • F: 907-343-7997 • P.O. Box 196650 Anchorage, AK 99519-6650 • http:l,,1,�x-x,vw.mttiii.org/building
Intermittent Dosing Sand Filter
Maintenance Log
Owner Street Address �i l k-
Phone L '" �eegal Desc.:// Lg -P )� 4q �'/khz �T PID f) l 92�
Septic Tank:
c+
-Sludge level _inches *pumping: required es no -Pumping completed es n
Absorption Field:
-Liquid level inches -Flushing valves per approved design yes n
-All flushing valves opened, distribution lines flushed, and flushing valves closed yea n
Lift station:
-Pump basket cleaned a no •Biotube effluent filter cleaned a no
-Timer float setting inches -High' level float setting inches -Reference point f oU d14,- !S�
•Pump on 70 seconds -pump off 6Q Minutes
-Cumulative lifetime cycles 1 -Cumulative run time 4 % hours
-Operation satisfactory e o
Air System:
-Air pump filter cleaned e no •Air pressure 15 psi
-Date of latest install or rebuild 4% -Air system operationsatisfa dry not satisfactory
Alarm System:
• le and visual alarm inside dwelling s no
a
Dedicated electrical circuit s o Audib� ,yF
-Float setting inches -Alarm system operation satisfacto not satisfactory
Comments:
......
.. ....... lel- . r....- .. ...
a........ ... .v"..�.:/f.. ...... .. .... h .. n .......... �
N. ....,.•....• . •. .r.i/ ........................
t
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Maintenance Provider:
Technician Date of maintenance 2
Company Z6�Kl
Signature e /<
<//, 51, 2
IDSF Maintenance Log_040313.doc
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Timberlux#2 Block H Lot 6
Dear Ben,
This letter is in response to onsite review comments for the pending COSA for the subject property.
• The tank is scheduled for pumping on May 7. The tank is at the bottom of a hill and is difficult to
access due to snow conditions. Because it is scheduled and the system is on a AWWTS
maintenance program, there is very little risk to approving the certificate. I do not believe a
conditional COSA is warranted.
• Two of the leachfield monitor tubes are jacked and leaning, however this does not impact the
functionality of the system. I was able to push one of the jacked tubes back down. This is likely
due to the shallow effective depth and limited fill over the system. I recommend these be
monitored during normal maintenance. Jacking is likely to be an ongoing issue with this system
unless the monitor tubes are extended below the effective depth or otherwise secured. I would
generally not recommend excavating a mounded IDSF system unless actually necessary due to
the presence of pressure piping and air hose which could be damaged. Further, the buyer has
indicated an intent to replace the system with a modern AWWTS within the next 5 years.
Thank you for your time in reviewing. Please do not hesitate to contact me at 907-854-5558 or by email
cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
4/24/24
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
RELEASE OF CONDITIONAL
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 01 R-271 -49
1, GENERAL INFORMATION
Corn plete legal description
HAA#
Lot 6; Block H; Timberlux Subdivision #2
Location (site address or directions)
4700 Manytell Avenue '
Anchoraqe, AK
PropenTowner Bruce Gambell & Jill Schneide~).ayphone 345-6273
Mailing address ~7~R ~nyt~l ] ArR. Anchorager AK 99516
Lendi6g agency Day ~hone -
Mailin. g address -
Agent Bob Rink/ Dynamic Properties -Day phone 261-7600
Address
Unless oth~_rwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
XX
Community well
Public water
NOTE:
~ , lng tO the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
nd
If community' well system, provide written confirmation fror~'State ADEC attest-
confirmation from State ADEC ;
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my ~eal affixed hereto and as Of the validation date showr~ 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 i~.i,~ COmPl!ance with all Municipal and State codes,
ordinances, and regulations in effeji~§~E~a~}~f)~this inspection,
Name of Firm WasteWater Consultar, ~1~ Phone
Address e~B~,~ ~/~le~ 7/9
Engineer's signature ,, '~--'"~-,, Date
REQUEST A RELEASE OF CONDITIONAL
~ Alaska Water & ~ HEALTH AUTHORITY APPROVAL DATED
~ '-'i 3/17/99. THE SEPTIC SYSTEM HAS BEEN
Wastewater Consultants., It~ '~ UPGRADED IN ACCORDANCE WITH PERMIT #SW990019
$ A ~ ' AND,M.O.A. REGULATIONS.
or'prior to, closing for the '~.~ ~~ ~,
DHI-IS SIGNATURE
pulations:
Conditional approval for bedrooms, with th% fo~il
Additional Comments
' '/,,.:/7
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional elgin eer registered in the State of Alaska. The DH HS does this as a courtesy to pu mhasers of homes
and their lending institutions in order to satisfy Certain federal and state requirements. Employees of DHHS 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.
Legal Description:
Municipality of Anchorage J~ E (~ E I V E D
DEPARTMENT OF HEALTH & HUMAN SERVICF~¥
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501D~'1~. ,~e~P~-..r~l~7~l~lch_orage
· ~ Muman ~erv/cea
Health Authority Approval Checklist
A.' WELL DATA
Well type ~',/~'-'
Log present (WN)
Total depth [ ~'-~
Sanitary seal (Y/N)
FROM WELL LOG
Date of test t~3/~/~/
Static water level
Well production ~' g.p.m.
If A, B, or C, attach ADEC letter. ADEC water ~/stem number ~LJ~Z~ ,
\1 ~-~-- ~ Date completed
/ Cased to ! ~ "7 [ Casing height (above ground) [ ~-//~
Wires propedy protected (Y/N)
AT INSPECTION /
WATER SAMPLE RESETS:
Coliform Nitrate
Date of sample:
B. S EPTIC/Helat~ TAN K/DATA ~'"~
Date installed ~ I; Tank size ) ~-~
Foundation cleanout (Y/N)
Date of Pumping x,J ~.~,~
· ~-~- .~/~ Other bacteria F
Collected by: /~-',~d~, /.-,'J~.
Number of Compartments__'~' Cleanouts (Y/N) ~/
~-~ Depression (Y/N) /',JO High water alarm (y/N) '~
Pumper ~//~
C. ABSORPTION FIELD DATA
Date installed ~dr"/c~~ Soil rating (g.p.d./ft2 or fF/bdrm)
Length ~ ~ Width ./D Gravel thickness below pipe
Effective absorption area ~, ~ Monitoring Tube present (Y/N)y
Date of a'~'-d~~ Results (Pass/Fail)
Fluid depth in absorption~ Immediately after
Fluid depth (ins) Minutes later:
L_-P--eroxide treatment (past 12 months) (Y/N)
System type
/
,'2~ Total depth
~ ~T~? ~A~J'P
Depress!on over field (Y/N) /JO
For bedrooms
gal. water added (in.):
~t~J ~t~')~~ g.p.d.
If yes, give date ~
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level
Size in gallons
"Pump on" level at* T)cd~ "Pump off" level at* ¢~F-t¢l
*Datum f~o", ~¢-i -~JI
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / ~¢ /4-
Absorption field on lot /CO/'+'
Public sewer main .~J //¥
Sewer/septic service line 2~'/+'
/..&
On adjacent lots ¢/:~ -
On adjacent lots
Public sewer manhole/cleanout AY
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ~' ['(- Property line -~ ¢~' Absorption field ~'
Water main/service line /O (~ .
Surface water/drainage. ~O/~ ~Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Surface water
Curtain drain
Building foundation /0 /-¢- Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots l (~O /'~
ENGINEER'S CERTIFICATION
~ certify that~ have/~ef~r¢i¢ed t~i~ inspecti~ns and review ~f Municipa~ rec~;~,,~;~-* ~'~"~
in conformance ~ith MeA~A¢~eli~es in effect on this date.
Signature
Engineer's Nam/
HAA Fee $. Waiver Fee $
Date of Payment
Date of Payment
Receipt Number
Receipt Number
72-026 (Rev. 3/96)*
Parcel I,D. #
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
0182271249
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
NAA # ~~-I~'~-~'~
1. GENERAL INFORMATION
- CONDITIONAL -
Complete legal description Lot 6;
Block H;
Timberlux Subdivision
Location (site address or directions)
4700 Manytell Avenue
Anchorage, AK
Property owner
Mailing address
Lending agency.
Mailin. g addCess
Agent Bob Rink[
Address
Bruce Cam4CDe-!-i & Jill Schneide~Day phone
~5-6273
4700 Manytell Ave. Anchorage, AK 99516
Day Chone
Dynamic Properties
Day phone 261-7600
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well
Community well
Public water
xx
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WAsTEWATER DISPOSAL:
NOTE:
XX
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-O25(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 da
Name of Firm
Address
Engineer's signature
ALASKA WATER
// [ ,/
Alaska Water
Wastewater Consultants. it~c,
Shall be PAID $
or pdor to, closing for the
Engineering Services Provided.
DHHS SIGNATURE
Approved for
Disapproved.
x××× Conditional approval for
bedrooms.
three(3)
! of this inspection.
EWATEI~ Phone ;~ 7~/7~
REQUEST A CONDITIONAL HEALTH AUTHORITY
APPROVAL DUE TO WINTER CONDITIONS.
SEPTIC SYST~,M TO BE UPGRADED NO LATER
T~IAN 15 JUNE 1999o
bedrooms, with the following stipulations:
Money shall be put in escrow in the sum of 1.5 times the amount of the highest
bid cf ~ ~ fr .................. ~^~ by ~ ~==~ ............... the
proposed wastewater SYstem pursuant to Permit #SW990019. Money in escrow shall
not b~ ~l~as~d ut~Li1 Lhls of£1u~ has give[~ £1~al approval. The consurucnion of
the proposed wastewater system shall be completed by no later than June 15, 1999.
Additional Comments
Date -~
The Municipality of Anchorage Department of'Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state raq uirements. Employees of DHHS 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.
RECEIVED
· Municipality of Anchorage MAR 0 5
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 (907)~t3~1~
Lega Description:
A, WELL DATA
Well type ~.t~¥-~F_.
Log present .~N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Health A~u_thority Approval Checklist
"~.,~z~y~ Parcel I.D.:
If A, B, or C, attach ADEC letter. ADH© water system number
[/'~--~ Date completed
I'~ ~F( Cased to ~ I C~'sin~ h~ight (above ground)
NC>
Wires properly protected (Y/N)
/2-
FROM WELL LOG
g.p.m.
AT INSPECTION
g.p.m.
Bo
WATER SAMPLE RESULTS:
Coliform '
Date of samplei
SEPTIC/HOLDING TANK DATA
Date installed
Foundation cleanout (Y/N)
Date of Pumping ~hJ I~-
Nitrate
· ~ z.../ ~ ~/~. Other bacteria
Collected by: 'X~ ~
Tank size { C)O~.~ Number of Compartments
~{~----~ Depression(y/N) ~QC~
Pumper
__ Cleanouts (y/N) ~
High water alarm (y/N) hUg
ABSORPTION FIELD DATA
Date bstall~d I~l ~ I
Soil rating (g~ or ft~/bdrm) ~ ~C) System type
-2., ~-J ~' / /+
Gravel thickness below pipe Total depth
. Depression over field (Y/N) __
For -~
Length 4r~{~ 'Width
Effective absorption area ~O Monitoring Tube present (Y/N) V
Date of adequacy test Results (P
Fluid depth in absorption field before test (in.); Immediately after
(ins) Minutes later:.
Absorption rate =
Fluid depth
gal. water added (in.):
q.p.d.
._Peroxide treatment (past 12 months) (Y/N) If yes, give date
72-026 (Rev. 3/96)*
bedrooms
Date installed ~'~ ~~
Manhole/Access (Y/N) __ .~spd-~p on" lev~_ "Pump off" level at*
;i;~;t,e res~ *Datum ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
~ Public sewer manhole/cleanout
~" Sewer/septic service line ~--'~" ! 'f'- Lift station
~-,'~ /'"SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO.
~l ~ [Foundation S ~" Property line '~ ~ Absorption field. S-- '~
~ ~ Water maiWsewice line /0 ,+ Sudacewater/draina¢O ~ ':* Wells on adjacent lots
~ ~.J SEPARAT~O, ~STANCE FROM ABSO.PT~ON F~LD ON LOT TO:
~ D ~ Prope~ hne. ~ ~ Building foundation ~ Water main/sewice line
Sudace water ~O ~ Driveway, parking/vehicle storage area
~udain drain ,~'ON:~~ ~LU ~ Wells on adjacent lots
R ENGINEER'S CERTIFICATION /
,ce,i~thatlh~,t~in~ ~dinspectionsa,dreview
in confo~anCe wire ~,¢ui~ ~ ~ effect on this date.
Engineer's Nam/ ~ ~ t ~~ ~' ~ ~ ¢
Date
HAA Fee $
Dateof Fa, ment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Rick Mystrom,
Mayor
Municipality of Anchoeagc
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
http://www.cLanchorage.ak.us
343-4744
March 12, 1999
Maurice K. & Carol A. Matthews
Property Owner's of Lot 7 Block H Timberlux #2
3340 Arctic Boulevard #106
Anchorage, Alaska 99503-4550
Re: Separation Encroachment, Lot 7 Block H Timberlux #2, P.I.N. 018-271-48
Dear Mr. & Mrs. Matthews:
During a recent evaluation of the wastewater system and water well on Lot 6 Block H
Timberlux #2 Subdivision, the engineer performing the evaluation discovered that the
well serving the home on this property is being encroached upon by the wastewater
system serving the home on Jot 7. According to our records you are the owner of lot 7.
The separation distance is 95 feet. The required separation distance is a minimum of
100 feet for a private well to a wastewater system. This is in violation of Chapter 15.65,
The Municipality of Anchorage On-Site Wastewater Disposal Ordinance.
The existing well on lot 6 was constructed in October 28, 1981 and the wastewater
system on lot 7 was constructed in December 7, 1983. Because the well on lot 6 was in
place at the time the wastewater system on lot 7 was constructed, makes the
responsibility of resolving this encroachment matter the property owner of lot 7.
Be advised that Lot 7 Block H Timberlux #2 Subdivision i~ not eligible for Health
Authority Approval from this office at this time. The result will be the inability of the
owner to transfer title of the property at the time of sale until the separation
encroachment matter is resolved.
If you have questions of the above, please contact me at 343-4761.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Services Program
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Rd. Suite 2B ~ Anchorage ~ Alaska 99504
Phone (907) 33%6179 ~ Fax (907) 338-3246
March 3, 1999
Municipality of Anchorage
Department of Health & Human Services
P.O. Box 196650
Anchorage, AK 99519-6650
REFERENCE: Lot 6; Block H; Timberlux Subdivision
Conditional Health Authority Approval request
Request you issue a Conditional Health Authority Approval on the referenced
property due to winter conditions. The septic system is to be upgraded no later
than 15 June, 1999.
Based upon the attached as-built surve~it appears that the septic system on Lot 7; Block
H is about 95 feet from the well on the subject property. There is a significant ditch
between the well and septic system which would prevent surface migration of wastewater
to the well. The well was drilled October 28, 1981 and the neighboring septic system was
installed December 7, 1983. Due to the encroachment occurring after the well was drilled,
the burden of obtaining the necessary waivers should fall on the neighbor (Lot 7).
Recent water samples indicated nitrate levels of .24 mg/L and no bacteria, indicating the
well on Lot 6; Block H has been unaffected by the encroachment.
If you have any question
Or require additional information, please contact us.
JAG/gd
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T=08~ P.Ol/Og
CT&E ReL#
Client Name
Project Name/#
Client ~ple ~
Matrix
PWS~
Tir~e ,. ~.,~,,/ Time
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed Permit No. Septic Tank Size
__~:;/ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
~ ~ ~ Z Phone
Property
Owner
Mailing Address ~, '~ ~' ~'~
Buyer
Address
Lending Institution ~ ~te~ . ~V~/~ ~7/~r/ Phone
Street Location, ~C'~ ~~ ~
Type~idence
~ Single Family
~ Multiple Family No. of Bedrooms '~
Wat~r~pply
~ Individual A~ACH WE~L LOG. A well log is required for all wells driJ~ed since Jbne
~ Community 1975. For we~ls drilled prior to that date~ give well depth (attach log if
~ Public Utilit~ available.)
Sew~isposal
~ IndNidual Year individua~ Installed: ~ ~ ~
~ Public Utility When Connected to Public Utility:
~ Holdin~ Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.