HomeMy WebLinkAboutTIMBERLINE LT 16Timb
rline
Lot
#015-164-17
Municipality ofAnchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
On-Site Se~ices Section 825 'L' Street Room 502
P,O, Box 196650 Anchorage. AK 99519-6650
www,cLanchorage.ak,us {907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ' SW010269 PID Number:. 015-164-3.7
"~': Wastewater System: New
Robert and Beverly Vogel
523.B Misty Fjords Circle Anch., AK 99S08 ABSORPTION FIELD
~.: ~: Deep Trench
301-3.366 Three (3)
LEGAL DESCRIPTION .6 r~-o~e 9 n.
3.6 Timberline 2 n. 7
2 ,,. 56
Well: Existing 4 vt. 3. - Ft
Private 47 n. 47 Et 784 ~' ASTM D3034 PVC
Unknown Unknown :13 ~ Red Dog Masonry 7/30-33./03.
¥.: i .,..~ s~.: i ~,~,,,, .~,~. c.,.~: TANK
14 c,.u F~. >2 r~
SEPARATION DISTANCES El septic 1"1 HoMing I-I S.T.E.P. n Other.
Septic Absorption Lift HoMing ~Nic/Prlvate
Tank Field Station Tank S,-,,~U,, Anchorage Tank 1,000
w,, : '!>3.00' >3.00' N/A N/A >25' Steel Two (2)
.LIFT STATION - NONE ON LOT
~,~w~ >3.00' >100' N/A N/A ~'" '
u,~. >5' >10' N/A N/A
~0,.,~ >5' >10' N/A N/A ,,. . ~, , ~,.
c,~.o,.. None Noted ~""~"~"='"' ~'~'~'"'""~"""'""~
~ BENCH MARK
Garage Floor.
100.0
Enginee~"$ Stamp
Inspections performed by: MEA Dates: 1" 7/30/03.
~ 7/31/01
Department of Health and Human Services approval
Reviewed and approved by: //~//~--~-~ ~'/, /"~Date: 2- ~'"~,--Q--
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99~;19.68B0. 343.7904
On-Site Wlltew&ter Dltpoell Syltem or Well Inspection Report
Page 2 of 3
· ~*---_._permlt Number SW010269
LOT 10 '
PID NO. 01S-164-¶7
LOT tl
e:SO'S0'~O"W 28g.4~'
16
2.1;
LOT 1~
FA
$1 45.3 14.7
,S2 40.4 17.4
,M,~I 33.7 ~1.7
34.4 61.1
Cf 68.9 31.1
PLA. A.s.
,.:. · -..,. ' ~'-.7- . ,..,,~. :~ '--~'~'.'.'"- ·
· -~ '..BUILT
'~:..~.,_-~_.-
LOT ,32
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW010269
Page 3 of 3
PID No.: 015-164-17
]
95.35--/
99.7 u~ u u
I948
94.0
98.5
........ ._~eo__t e x_tJLe ,~J3 bCiC ........
00.5
Dr'ein f'ietd Rock
56'
PROFILE AS-BUILT
Stole: . 1' - 10'
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
January 24, 2002
Jeff Poet '
Mike Anderson, P.E.
Lot 16, Timberline Subdivision
Septic System As-Built
Certificate of Health Authority Approval
The design for the septic system for Lot 16, Timberline Subdivision was prepared
without the plot plan. The test holes and proposed house location were located on the
lot with only a rag tape and some estimation due to the extreme size of the lot, the
varied terrain and the heavy trees. The location of the test holes on the as-built
drawings will not coincide with those from the design. They are, however, the same
test holes and are now shown in the accurate location.
The absorption trench was constructed well within the 30' radius of Test Hole Nos.1 and
2. The locations shown on the as-built are true and accurate and based on the
surveyed as-built of the lot. Please let me know if you need further information
concerning the location of the test holes.
FAX MEMO
TO: Jeff
WITH:
On-Site Water and Waatewater
DATE: 2/4/02
FROM:
Mike Anderson
SUBJECT:
Lot 16, Timberline Subdivision
Certificate o! Health Authority Approval
Slope Analyi$
MESSAGE:
Attached is the elope analysis tor the absorption trench on Lot 16, Timberline
Subdlvleion. We checked the elope during the Inspection completed during
construction. The separation distance does meet code. Let me know if you have
any other queefione.
Pages Being Sent Including This Cover Sheet. Please Call 522.7773 With Any
Queetions.
FAX MEMO
TO: Jeff
WITH:
On-Site Water and Wastewater
DATE: 2/4/02
FROM:
Mike Anderson
SUBJECT:
Lot 16, Timberline Subdivision
Certificate of Health Authority Approval
Water Sample Result~
MESSAGE:
Attached is the revised as.built plan showing the location of the alternate site
between the septic tank and the house. Also attached is the latest result for the
water on the subject lot. No choliform and 2 other bacteria. You already have the
nitrate results. You should now have all the Information necessary to issue the
Certificate of Health Autho.rlty Approval. Please let me know If you need anything
else. Thanks for your help.
3_ Pages Being Sent Including This Cover Sheet. Please Call 522-7773 With Any
Questions,
ANDERSON ENGINEERING
P.O. Bax 240773
ANCHORAGE, AK 99524
(907) 522.7773
Cell (907) 441-4000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bregaw Street
P.O. Box 196650, Anchorage, AK 09519-6650
(907) 343-7904
ON-SITE WASTE~NATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jul 26, 2001
Expiration Date: Jul 26, 2002
Permit Number: SW010269
Legal Descriptio;3: TIMBERLINE LT 16
Design Engineer: 0014 Anderson Engineering
Owner Name: Robert & Beverly Vogel
Owner Address: 521B Misty Fjords Circle
ANCHORAGE, AK 99508-0000
Parcel ID: 015-164-17
Site Address: 011161 VOSlKOF PL
Lot Size: 92206 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
Ail 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by caIling
(907) 343-7904 ( 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.
Received By:
Date: 7--2g-Ol
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
wv~v.ci.a nchorage.ak.us
(907) 343-7904
ON-SITE SEWERfWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0t5-164.t7
Permit Number SWOlO
Property owner(s) Robert and Bevedy Vogel
Mailing address (1) 521B Misty Fiords Clrcle Anchorage, AK 99508
Mailing address (2).
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size 92,206 SF Acres/Sq. Ft.
Day phone 301.1366
.Zip Code
L+
Number of Bedrooms Four
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
[] Well Only
Water Storage
Jacuzzi
Water S~ftening Unit
I certify that the above information is correct. I fudher certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev, 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX' 240773
ANCHORAGE~ AK 99524
522-7773 522-6779 (FAX),
July 20, 2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 16, Timberline Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 16, Timberline Subdivision Intends to construct a four-bedroom home
on the lot. We are therefore applying for a permit to construct a new septic system on
the lot to serve the new home. The attached Site Plan and backup documentation
identify the location and configuration of the new septic system and the parameters
used in the design. Also Identified on the plans is the location of the existing well and
alternate site along with the test holes. Existing drainage patterns are shown and will
not be altered by the development of the lot.
Test holes were placed near the Iocati;3n of the new absorption trench and alternate
site. These holes indicated silty gravel and sand with some cobbles. Percolation tests
in the material resulted in a rates between 24 and 30 minutes per inch. No groundwater
was found during placement of th.e test holes and none was noted during the monitoring
period. We are therefore proposing to place a deep absorption trench with 7' of gravel
beneath the distribution pipe. The total depth of the trench will be approximately 10'.
The distribution pipe w!ll be, placed at 3' below the ground surface. Some slope
flattening may be required ~n front of the new trench to provide a minimum of 50'
separation from any 25% break in grade.
The ground surface on the lot slopes as shown on the attached Site Plan with varying
grades from east to west. Th.e new absorption, trenches will be constructed on a fairly
flat surface in conformance w~th Municipal requirements and parallel to ground contours
where possible.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lbt t6, Timberline
July 20, 2001
Page Two
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
VACANT PROPERTY
289.41
Existing
Well
Tank
22,~73' Wide X
Absor
NOTE= Flatten Slope Fronting New
Absorption Trench to Provid
50' Separation to Slope >25~
LOT ]6, TIMBEI~LINE
92,206 Square. Feet.
NOTE: No Wells or Septic Systems
200' of New Septic System.
299.25'
tiono~
ithin
SITE PLAN
.SCALE 1" = 50'
LOT 16, TIMBERLINE SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Deep Trench System
Perc. Rate: 25 Min./Inch 1,250 Gallon Septic Tank
Avg. Application Rate: .6 GPD/SF 7' Drain Field Rock
4 Bedrooms X 150 GPD 1.6 GPDISF = 1,000 SF of Absorption Area
1,000 SF/14 SF/LF = 71.4 LF Trench Length
Therefore: Construct an Absorption Trench 72' in Length by 3' Wide With 7' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 10' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Well.
Maintain 50' Separation From Slope >25%.
~-~ 'uepar~men~ of Health & Human Se~s
825 L SE~t, ~cho~ge, AK 99502~650
SO LS O -.ERCO O. EST
Pe~o~ For: Bob Steohens Date
Legal Description: Let 16 Timberline Subdivision
;LOPE
Nodh
1
11
13
14
15
OG/OL
Loose
GM
15% - 20%
Silt
18
Tighter
South
Was Groundwater
Encountered? No S
If Yes, What Depth? L
Depth to Water O
After Monitoring Dry P
Date: 6/4/01 E
Bottom of
Hole
21
" SITE PLAN
5%
Reading Date Gross Net Depth To Net
'ime Time Water Drop
1 5/22/01 6:02 2.25"
2 6:32 30 3.5" 1.25'
3 7:02 30 4.375" 1.125"
7:32 30 5.5" 1.125'
Perc. Rate: 26.7 MinJInch Perc. Hole Diameter:. 8"
Test Run Between 4 Ft. and 5 Ft.
Comments: Testhole Presoaked Pdor to Percolation Test.
Performed By:. Mike Anderson. 1, ~agLF.=~3~ Cer[ify That This Test Was Performed
In Accordance With Ail State and Municipal Guidelines In Effect On This Date: 6/4/01
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650 ~.~.,,.. CE 4301
SOILS LOG - PERCOLATION TEST ~' ""~
Performed For: ~d3b~,~3.~ Date Performed:
Legal Description: Lot 1G TImberline Subdivision
SLOPE SITE PLAN
North
OGIOL
Loose
GM
15% - 20%
Silt
2
South
No S 5%
L
O
Was Groundwater
Encountered?
If Yes, What Depth?
1 Tighter Depth to Water
After Monitoring
11 Date:
Dry
6/4/01
13
14
17
Bottom of
Hole
Reading Date Gross Net Depth To Net
Time Time Water; Drop
1 5/22/01 6:11 1.5"
2 6:41 30 2.875" 1.375"
3 7:11 30 4.125' 1.25"
7:41 30 5.375' 1.25"
21
Perc. Rate: 24 Min./Inch Perc. Hole Diameter:. 8"
Test Run Between 4 Ft. and 5 Ft.
Comments: Testhole Presoaked Prior to Percolation Test.
Performed By: Mike Andersen. I, ~ .Certify That This Test Was Performed
In Accordance With Ail State and Municipal Guidelines In Effect On Thi§ Date: 6/4/01
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 16, TIMBERLINE SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,250-gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 73' long X 3' wide X 7'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3' below the existing
ground surface. Total depth of the trench will be 10' below the existing
ground surface. The new septic tank and all components of the new
system will be constructed outside the 100' protective radius of the
existing well on the lot.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations,
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines,
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250-gallon septic tank must be procured from an approved
source and installed at the location shown.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4". cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
o
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
. ... '. Lot 16, Timberline Subdivision
July 20, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfleld rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any pdvate water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall vedfy this condition pdor to
placement of the reck. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
· ~ '. -.: Lot 16, Timberline Subdivision
July 20, 2001
Page 3 of 3
5; A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These ·
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabdc, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field s..u. rvey layout and construction
notes for use in preparing the certified as-built of the completed system.
Y=% MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMEN'rAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
Liq. Well Absorption area Dwelling
~' DISTANCE TO: ] I
~ ~ Manufacturer Ma~
~ ~ Inside length Widt[]
IF HOMEMADE:
DISTANCE TO:
Well
Dwelling
NO. OF REDROOM§/
Liquid depth
)ERMIT NO.
Manufacturer Liquid capacity in gallons
Foundation PERMIT NO.
DISTANCE TO: ~/0~o~
Well
No. of lines / Length ofs~.~.each Ii e
Top of tile to finish grade ~/!
Total length of line~
Material beneath tila
Depth
Crib depth
Material
Nearestlotline
Trench wic~.~ )riches
Length
Type of crib
Width
Crib diameter
Total effective absorption area
PERMIT NO.
Total effective absorption area
Well Ruilding foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO,
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L T EST RATING
INSTALLER
REMARKS
APPROV /// /.~ DATE LEGAL
7 ~'-013~1F~e v. 3/78~-
PERMI]" NO. < 8±0985 )
RPPL!CSNT C. L..UCNStNGER
LOCRT ! ON
LEGRL.. Li~ T I MBERL I NE
T'¢F'E OF SOIL B8SORPTION S'.dSTEM
b~F:;ZMUM NUMBER OF BEDROOMS
THE RELT!UtRE[:, _,!,~.E OF' THE z, uIL , E,z, CRF [I..Nz,'rz,.,.~,. ''-'
'['HE L. ENGTH Dt.I`'IENZIOM IS THE LENGTH (Ii'',! FEET) OF THE TRENC:H OR DRFIINFIELD.
THE DEPTH OF R TRENCH OR PIT IS TFIE DIS'TRNCE BETHEEN THE SURFRCE OF THE
GROLIND RND THE BOTTOM OF 'tHE E,'-'<CRVRTiON (IN FEET).
THERE IS NO SET PIiDTH FOR TRENC:HES.
THE GRFIVEL !}EP]"H IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFSL.L F'!PE
RND TME BOTTOM OF THE E'/,C:RVRTION (IN FEET).
PERMIT RPF'L. IE:FINT MRS THE REzF_MzlEILtFr TO INF'nRM THIS DEF'RRTMENT DLRIHG TNF
PR..IF..ET~ RND THE
INSTRLL. RTION I[,,zFE...T.[_I~_ OF RM'¢ HELLS RE:,JRC:EN-F TO THIE; -'." ,F'"
NUMBER OF REz, t..ENL. Ez, "['HRT THE HELL WILL c"-~,,,,:
HINiMUPt DISTRNCE E:ETHEEN £4 t.4Et_L. RND RN¥ OI`.,I-SITE SENI=IGE DISPOSF:IL S'¢S'TEM IS
±00 FEET FOR 8 PRIVBTE HELL OR ±50 TO 20F:~ FEET FROM R PUSL. IC WELL DEPENDING
L.IF:'ON THE TYPE OF PUE:L. IC NELL.
MINIMUM DISTFINCE FROM R PRIVRTE HELL TO R F'RZVFITE SEHER LINE IS 25 FEET
TO F:l COMMUNITY SEIqER L. INE I5 75 FEET.
HELL LOGS RRE REQUIRED RNE:, MUST BE RETORNED TO THE DEPRRTMENT HZTHZN ]:0
OF THE WELL COHPL. ETZON.
OTHER REQUIREMENTS MR'¢ RF'PL'¢. ZPECIFICRTIOI`,IB laN[:, CONSTRUCTION DIFIGRFIMS RRE
FWFdILRE:L.E TO INSURE PROPER INSTRLLRTION.
£. ET L- E. ~ 1 E. F.Z F.. ]~: ! .... ' '=i "::' '
F'F~F.~:bl :E T' E,--.F- Z F: P:E :.:-'; -, ............ . --' -- -" J ..........1,
I CERTIF'~' TFIRT
t: 'Ii FIM
FORTH E,~ THE M
~.":" .... 'r b. IILL Ii`.,
3: I
RES I F.:,ENE:E I~
WITH ]"HE REQUIREMENTS FOR ON-SITE SEI.qERS RND WELLS f:lS E;E-F
CIF'RLI'r'? OF RI`.,ICHORRGE
'THE S'?'E;TEM IN RC:CORDRNCE WITH TFIE CODES.
RT TIdE ON--SITE SEHER S'¢STEM MR'Y REQUIRE ENLFtRGEMENT IF TFIE
TO INCLUB, E MORE THRN 4 F]EDROOMS.
'z- I GNE[:, · _ ...........
RPPL. I !MT C. Lt. CCdHS I NGER
...... F" ~ ................... Z:' ~. '. .......... --~.J .........
iq'::LEf':~ ,~ I HTE
Soil ~est
Da~e ~Sep~embe,r II,. 1981
~ocation~ ~LO~oI6, ~mberline. Subdivision~, SE end of' ~osikof PI~
S'8'$ E it0~ from. property corner at. en~ o£ cui de sac.
Method ~bac'kh.o:e hole -- perc test and sample taker at 8' per
USP~S methods hole wetted 9--i0~ test 9--II.
Re.su~s. :first. 1U minu~es - ~/~' dFawdow~;
last 15 m~nu~es o£' hour -- ~" drawdow~.
I hereby:certify' that
· £mberline, Subdivisfon,,
'o
L 32_
I have, survey, ed Lot 16',.
'~2'...,..-."
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
· www.cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.164-17
1. GENERAL INFORMATION
Complete legal description
Lot 16~ Timberline Subdivision
Expiration Date:
Location (site address or directions)
Current Property owner(s) Robert and Beverly Vogel Day phone 301-1366
Mailing address 521B Misty Fjords Circle Anchora.qe, AK99508
Lending agency Day phone ·
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ·
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding tank []
[] Community On-site []
[--I Public Sewer ,.~.
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Cedificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality cf Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal a~xed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authodly 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
Municipalily of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal systen~ is(are) in compliance with all applicable Municipal and State codes, ordinances,
and r~.gulafions in effect at the time of installation.
Name of Firm Anderson En.qineerinq
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson~ P.E.
Phone 522.77'/3
Date 1/24/02
5. DSD SIGNATURE
L'"/' Approved for 2~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with lhe following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date: ~ - ~ - ~',:"~--
Legal Description:
WELL DATA
Welt type Private
Date completed __
Total depth 47 ft.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchemge, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot t6, Timberline Subdivision
ff A, B, or C provide F'VVSID #
Sanitary seal (Y/N) Y_
FROM WELL LOG
Date of test
Static wate~ level
wea pmducaon
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Date of sample: .1/23/2001
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size t,000 gal.
Foundation cteanout (Y/N) Y_
Date of pumping
C. ABSORPTION FIELD DATA
Date installed 7~31/200t
Total deplh 11 fi.
Parcel ID: 015-164-t7
fL
g.p.m.
Nitrate ~ ~ ~ mg./I.
Collected by: Mike Anderson
W~l Loo (Y/N)/%f
Wires propety proteded (Y/N) Y
Casing height (above ground) >24
AT INSPECTION
13 ff.
t4 g.p.m.
Number of Compartments 2_
Depression ove~ tank (Y/N) N
Pumper N/A
Fluid depth in absorption field before test in.
Elapsed Time: min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Date instatled 7/30/2001
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Soil rating (g.p.dJ~ or ~rodrm).6OPD/SF System type DeepTrench
lt. Width 3 fl. Graval below pipe 7
Eft. absorption area 784 it2 Monitoring tube Y Depression over field N
Results (Pass/Fail) For bedrooms
Water added gal. New depth in.
in. Absorption rate >= g.p.d.
N If yes, give date
D. UFT STATION
Date installed
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenk~ilt station on lot >100'
Absorption field on lot >100'
Public se~er main
Sewer/septic service line >25'
Fe
Size in gallons
'Pump off' level al
Cycles tested
Manhole/A _ _,>~es_ s (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhete/deanout N/A
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Water main N/A
Wells on adjacent lots >100'
Propedy iine >5'
Wate~ se~ice line >10'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10'
Curtain drain None Noted
COMMENTS
Building foundation >10.
Surface water >100'
Wells on adjacent lots >100'
Absorption field >5'
Surface water >100'
Water main >10'
D,ivewa,/, pa~ng/v~hide ~xage >25'
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal recoils that the above ~ystems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E, Anderson, P.E
Date of Payment
Recelpt'Number I ._~[.-'~. C~O~
(R~.
Waiver Fee $
Date of Payment
' Receipt Number
JAfl-28-O2 04:07PU FROt~T&E EKVIRONkENTAL $~V ' 9075el5~01 T-927 P.O2/O~ F-246
,,~t~m~. CT&E Envlmnmen~l ~Ices Inc.
CT& £ Ref.#
Cllen! Name
Project Name/:~
Client Sample ID
Matrix
Ordered By
PWSID 0
"SampIe Remarks:
1020432001
Anderson Engineering
Timberline LI6
Timberline, LI6
Drinking Water
Client PO#
Printed Dare. line 01/28/'2002 15:41
Coltected Date/Time 01/23/2002 13:15
Received Date/Time 01/23/2002 14:05
~ Allowable Prep Analysis
PQL Units Method Limits Datu Date Init
~ut~ ~
Nitrate. N
2.90 0.200 mg/L £PA 300.0 (<10)
01/23/02 .FDT
Microbiolog'y Laboratory
Total Coliform
37 OB, No Coil
col/l OOmL SMIS 9222B
01/23/02 KAP
Received Time Jan.28. 4:IOPM
Feb-Ol-02 36:40 CT&E Ancho~age/M4c~o 907 561-5301 P.02
~rinking Water Analysis Rcpon for To~al Coliform
~
IIACTL~OLOGICAL WATER .~q AL¥SLS P~CORD
v~t LTB ~B __ COU~
F~ C~m C~ ,, -~ '
WATERWELL - TEST PUMP REPORT
Co.d.ct,dby: //,~/~.~ ~,,,.,'~, I,.]~.II 5"o~', ~. c, r~.,~.,
Owner:. ~ ZloC/e· ' Address:
Well Information:
To~l Depth: ~./~t Depth ofCasing: -t.f'~ Screen From '~' To
Casing S~ze: ~ Screen Dinm: Screen Slot:
Remarks:
Pump Information
In~keOepth: '~/',~' PumpSize t~ ~.f/~! Air Line Depth:
St, llc Water Level: /~ Ay. Dischor~e: / ¢/ GPM.lVl,x Dresden:
Pump On
Time: I~~(~ Date: ~"-7'~f'/ PumpOff: .-- Tim~: ~/~.~ Dote: ~--~.-~//
Time Water Flow Remarks
Level GPM
O. oo I~ c,,.
I~,~ ~/0 I ~t