HomeMy WebLinkAboutHERITAGE HILLS BLK 3 LT 8�.;4 � � E_,.,,
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(Rev 05102/18)
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP241187
PID Number: 015-221-22
Dwelling: X Single Family (SF) F� with ADU El Duplex (D) 0 Two Single Family Project: F171 New F-1 Upgrade
Name
Alicia Trevithick
ABSORPTION FIELD
FJ Deep Trench Fil Wide Trench n Bed n Mound
Site Address
12221 Heritage Rd
El Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
'�7A
951-303-73, 4
Four(4)
5 GPDISF
ITotal
3.0 Ft�
LEGAL DESCRIPTION
Depth to pipe invert from original grade
2.5 Ft.
Gravel depth beneath pipe
0. 5 Ft.
Subdivision Block Lot
Heritage Hills 3
8
Fill added above original grade
1.0 FL
Gravel length
25 FL
Township Range
Section
Gravel width
5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To Septic Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field
Lift Station i
Tank
Line
125 Ftl
One(l)
N/A FL
Well >50'�j >50"I
N/A I
IN/A
>25
TANK El Septic [) S.T.E.P. C7 Holding E) Other
Manufacturer
Orenco/Advantex
Capacity
1,500 Gal.
Surface Water >501 >501
N/A
N/A
Material
Plastic
Number of compartments
Two(2)
Lot Line >51 0. 5'
N/A
N/A
NA
Foundation >10" >10'
I
N/A
N/A
LIFT STATION
Manufacturer
N/A
Capacity
N/A Gal.
Remarks See waiver request
Alarm location
Electrical installed by
Next to FCO Iftrina
Up AK
Tankto
PIPE MATERIAL House to tank D-3,03,4 drainfield D30134_
Installer
Red Dog Masonry
Drainfield D 11 3 0 34 CO/MT D30 1 34
Inspector M. Jakubisin
BENCH MARK (Assumed elevation) 100 ft
Inspection 1,t 7/8/24 7/8/24
Location and description
dates: 211d - 1.111111111111
th
-
Bottom of Sid
Jing @ Point A
31d 4
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
, _qbl�
-low :%F
Conditional Approval:
Date
law
law,
TH
-_---_--_- -_ --
......
Septic Syste
Approved Date7//O
BenjarR�,, S�chiller A0,
CE 19592
.7112/24
Note: this approv4l�/dXoes not include
well requirements.
PROFESSOO
permit
(Rev 05102/18)
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP241187 PID # 015-221-22
A B
FCO 1.1
MH 16.1
POD 19.4
A
B C
C
11.6
CO 21.1
CO1 35.5
MT1 33.3
CO2 32.0
17.9
17.3
22.2
23.0
21.6
32.0
1"=30'
4-BDRM HOME
FCO
HERITAGE HILLS, BLOCK 3 LOT 8
FEET
0 30 60Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N G INEER
HE
R
I
T
A
G
E
R
O
A
D
685
7/15/2024
PLAN ASB
E. 131st AVE
10
'
T
&
E
E
A
S
E
M
E
N
T
680
675
TH#1
NEW WELL W/
100' & 50' RADIUS
ALTERNATE SITE
1500-GAL ADVANTEX FAP 2.0
SEPTIC TANK
25' LONG x 5' WIDE x 0.5' EFFECTIVE
DEPTH ABSORPTION TRENCH
CO2
CO1
CO
MT2
MT1 MHPOD
MT2 33.231.8
BM
PROFILE AS-BUILT
(NO SCALE)
96.4
91.6
97.8
100.2
FC
O
MH
PO
D
PERMIT # OSP241187 PID # 015-221-22
HERITAGE HILLS BLOCK 3 LOT 8
99.6 FINISH GRADE
25'
DRAINFIELD ROCK
MT
TH
#
1
NO GROUNDWATER 6/7/23
95.6
96.1
CO CO
87.6
95.6
96.1
98.6 ORIGINAL GRADE MT
CO
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
1500 GAL ADVANTEX
FAP 2.0 TANK
AX-20
FILTER
POD
7/12/24
97.6
2" FOAM INSULATION
MOA APPROVED SAND
93.6
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Well Log
Permit Number: #__________ Date of Issue: ________ Parcel Identification Number: __________________
Date Started: _________ Date Completed: _________ Is well located at approved permit location? Yes No
Legal Description:_________________________________________________________________________
Property Owner Name & Address: _______________________________________
_______________________________________
_______________________________________
Borehole Data: Depth (ft)
Soil Type, Thickness & Water Strata From To
Method of Drilling air rotary cable tool
Casing type: _________
Wall Thickness: inches
Diameter: inches Depth: feet
Liner Type: _________
Diameter: inches Depth: feet
Casing stickup above ground: feet
Static water level (from ground level): feet
Pumping level: feet after
hours pumping gpm
Recovery Rate: gpm
Method of Testing: _________
Well Intake Opening Type:
Open End Open Hole
Screened Start feet Stopped feet
Perforations Start feet Stopped feet
Grout Type: _________ Volume: _________
Depth: _________ Start feet Stopped feet
Well Disinfected Upon Completion? Yes No
Method of Disinfection: Comments:
Well Driller: _____________________________
Company: _____________________________
Mailing Address: _____________________________
Water Sample Results:
Arsenic: _________ ug/L
Nitrates: _________ mg/L
Total Coliform Bacteria:_________ colonies/100mL
Attention: The well driller shall provide a well log to the
On-site Water and Wastewater Section within 30 days of
completion.
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
N
Pump Installation Log
Well Drilling Permit Number: � c� P 2:�? Date of Issue:
Parcel Identification Number: &_21__L2_
-22
lDescription
ni O_T_W ��el
r
� -. 2T �J1
Block
Lot
Property Owner Name & Address:
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: Z 10 feet
Pump Manufacturer's Name:
PumpModel: In �� (� �✓��
c
Pump Size: l -'D hp
Pitless Adapter Burial Depth: V feet
Pitless Adapter Manufacturer's Name: ft( SII C, -2e `
Pitless Adapter Installer: &A -00
Well Disinfected Upon Comle1tion? Yes ❑ No
Method of Disinfection: �jY 1 tor- pnrx Ipn
Comments:
Pump Installer Name: V * Y1 ()U 6, (�
brl((incl
Company:
Mailing Address: Pox, l l 2 ( 30
City: PMCh State: _Zip: "Ic�(
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
�r }
Municipality of Anchorage
I)eparUncnt
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
Development i Division
On -Site Water and Wastewater Program
* * * * VARIANCEIWAIVER REVIEW * * * *
Waiver#: OSV241031 COSA#:OSC241253 Permit#:OSV241187
PID#: 015-221-22
Legal Description: HERITAGE HILLS BILK 3 LT 8
Engineer: Forge engineering
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the property line has been approved. The approved separation distance is 0.0 feet.
This waiver approval applies to the existing absorption field and reserve field only. Any future
upgrade to the on-site wastewater disposal system will require all separation distances be met or
another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: Approved by: & fes; �._
Name of Reviev�
**** VARIAN C E/WAIVER REVIEW ****
July 17, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Heritage Hills B3 L8 - 12221 Heritage Rd
Absorption Field to Lot Line Waiver
Dear On-Site Services Engineer:
The property at the above address is a smaller lot at 15,000 SF, and the septic design was very
tight. During the installation of the septic trenches, with a slight shift in building location and some
re-grading, the trench was placed within 1’ of the south lot line. In addition, the alternate site has
been pushed to the west, leaving only 2.0’ to the west lot line.
The location of the alternate site should not have any significant effect on the ROW. In the case
that the primary trench fails, it is possible that it could be rebuilt in place. If the alternate site were
constructed, it could be built without any damage to structures in the ROW.
The primary trench also does not cause any difficulties for the property to the south. Currently it
is undeveloped. If there were a home there on the future, the location still wouldn’t have a negative
effect. The relatively shallow depth (5’ total from original grade) would make this fairly easy to
maintain if it ever needed to be excavated.
We respectfully request that a waiver be issued for a 0’ separation from the trench to the south lot
line, and 2.0’ for the alternate site to the west lot line.
Sincerely,
Benjamin Schiller, PE
AsBuilt
7/10/24
Feet
0 30 60
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP241187
Work Type: WellSeptic Renewal
Tax Code Number: 01522122000
Site Legal Address: HERITAGE HILLS BLK 3 LT 8 G:2737
Site Mailing Address: 12221 HERITAGE RD, Anchorage
Owner: TREVITHICK ERIC
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
7/3/2024
7/3/2025
15000
CSI Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
-Received-By: _ J. % Lw'P -ro Date:
Issued By: Date: 7
6
4
Property owner(s) Alicia Trevithick Day phone 951-303-7374
Mailing address 12240 Freedom Road, Anchorage, AK 99516
Site address 12221 Heritage Rd, Anchorage, AK 99516, USA
Legal description (Sub'd., Block & Lot) Heritage Hills Block 3 Lot 8
Legal description (Township, Range & Section)
Lot Size -15,000
—Sq. Ft.
Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field
RX
Initial R Single Family (SF)
RX
(w/wo AD U)
Septic Tank
FX]
Upgrade R
Duplex
❑
(D)
Holding Tank
F]
Renewal FX]
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
RX
Water Storage
R
THIS APPLICATION INCLUDES A VARIANCE WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: $ ?__5E
Date of Payment: 7/7— Az
Receipt Number: L3 70727
Permit No. 05 P Z'J 11`3 7
Permit App_'-'- : - :_'..:c ,
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
July 3, 2024
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Heritage Hills Block 3 Lot 8 - NHN Heritage Rd
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 4-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site.
The ground surface on the lot slopes up from the road sharply, from 15 -25% for a very short
distance, but then flattens out in the center of the lot. It is in that flatter area that the new home and
septic system is located. There are slopes greater than 25% immediately adjacent to the alternate
site, but only with a drop of 5’. The primary and alternate design meets the criteria for steep slopes,
as long as the disturbed slopes are revegetated with erosion-control vegetation. There are no slopes
greater than 46% within 100 feet downslope of either the primary or alternate site. Contours are
shown on the site plan showing the grade and direction of flow. The new trench will be constructed
parallel to the slope as much as possible. Due to separation requirements from the foundation and
lot lines, the trench may need to be installed slightly into the slope. There is enough separation
distance from the bottom of trench to allow for the trench to be installed deeper at one end if the
grade rises one or two feet. Notes have been added to the profile and the plan for the installer.
Stormwater drainage will not impact this septic system. Wells on this and adjacent lots are shown.
The new system will be a minimum of 50’ from all wells and surface water and more than 5’ away
from the septic tank. The alternate site is located more than 6’ away. Please refer to the attached
test hole log, plan and profile pages for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241187, Deb Wockenfuss, 07/03/24
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
1"=30'
4-BDRM HOME
FCO
HERITAGE HILLS BLOCK 3 LOT 8
FEET
0 30 60Benjamin Schiller
CE 12592REGISTEREDPROFESSIONA L E N GINEER
HE
R
I
T
A
G
E
R
O
A
D
685
6/13/23
SEPTIC PLAN
E. 131st AVE
1
0
'
T
&
E
E
A
S
E
M
E
N
T
680
675
TH#1
PROPOSED WELL
ALTERNATE SITE
>6' SEPARATION
NOTE: FOLLOW MAXIMUM DEPTH
CRITERIA IF GRADE CHANGES AT ONE
END OF TRENCH
NEW 1,500 GAL ADVANTEX FAP
2.0 SEPTIC SYSTEM
MIN 10' FROM FOUNDATION
AND 5' FROM PROPERTY LINE
25' LONG x 5' WIDE x 0.5' EFFECTIVE DEPTH
WITH 2' SAND FILTER ABSORPTION TRENCH
MIN 5' SEPARATION FROM SEPTIC TANK
AND 10' FROM LOT LINES/FOUNDATION
CO
CO
2CO
MT
MT
REVEGETATE WITH SOD OR EQUIVALENT
EROSION CONTROL VEGETATION
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241187, Deb Wockenfuss, 07/03/24
HERITAGE HILLS BLOCK 3 LOT 8
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DESIGN FACTORS:SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: <1 MIN/IN
APPLICATION RATE: 5 GPD/SF
5' WIDE TRENCH SYSTEM
1,500-GAL ADVANTEX FAP 2.0 SEPTIC TANK
BOTTOM OF TRENCH: 4' BELOW GRADE
FLOW LINE ELEVATION: 3.5' BELOW GRADE
NOTE: MAXIMUM DEPTH 5' TO BOTTOM OF SEWER ROCK IF GRADE AT ONE END RISES
600 GPD / 5 GPD/SF / 5' WIDE * 1.0 RED FACTOR [0.5 DEEP] =
24.0 LF TRENCH REQUIRED (25 LF SPECIFIED)
6/9/23
5'
PROVIDE ADDITIONAL MIN 6" FILL TO ACCOUNT FOR SETTLEMENT
3'
4" PERFORATED PVC
(HOLES DOWN)
6"
6"
GEOTEXTILE FABRIC
DRAINFIELD ROCK
MOA-APPROVED SAND FILTER
2'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241187, Deb Wockenfuss, 07/03/24
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
0.8
5/31 1
2
3
4
5
6GM (SILTY SANDY GRAVEL)
Professional Engineers Stamp:
NO
Heritage Hills Block 3 Lot 8
5/31/23 015-221-22
Alicia Trevithick
9:45 3
9:50
9:54
9:59
10:03
10:07
OB
4:00
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: M. Jakubisin
9
-
None
6/7/23
COMMENTS:
SITE PLAN
6 0
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
5/31/23
B.O.H.
34:02 9 6 0
16
34:12 9 6 0
16
34:49 9 6 0
16
34:39 9 6 0
16
34:50 9 6 0
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231159, Curtis Townsend, 06/30/23
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATiMEN`I' SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this S1 Day of of 20
3 , by and between
� 1 6+ o, i1�; ri% herein the "OWNER," and the yMunicipality of
Anchorage, herein the "MUNICIPALITY". in accordance with Anchorage Municipal Code
(ANIC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AW�NrrS),
described as Advantex System
located at (legal description)
Heritage Hills Sub, Block 3 Lot 8
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
7 Throughout the tern 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, adiustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically S400 to $600).
f -I 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 AW�N7S reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfreld
replacement.
(rev. 05/18/2018) Page I of 3
e
t
-`' Owner acknowledges that the Ivlunicipality may request records of maintenance and
r.
repairs from the manufacturer's representative or maintenance provider.
r Owner acknowledges that the line for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Vii; Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at ]cast 24-hour notice.
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.
r 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 AWW"I'S is operational or until title is transferred.
4. \onwaiver. The failure of the Municipality at any tithe 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 tllc
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
OWNER:
By: _� 1'� �— (signature) Date:
(print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 2i day of
20?3, by hw%c. ,,
VOTARY IJBLIC FOR ALASKA
My Commission expires: tw 20-Z5 � * : _ jA0TA,5�
OF A.LPs.�,,,
�'fit .... I00
MUNICIPALITY:
By: 1= (signature)
s 611,0 (print name)
Date:
Title:
C
(rev. 05/18/2018) Page 3 of
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site W
Permit Number: OSP231159
Work Type: WellSeptic Initial
Tax Code Number: 01522122000
r & Wastew ter
Site Legal Address: HERITAGE HILLS B • K 3 LT G:2737
Site Mailing Address: 12221 Heritage RD, Anchorage
Owner: HALEY BETH E &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
m Permit
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
Cnl-
r-
DCI)artment
6/30/2023
6/29/2024
15000
Q Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date:
4
MUNICIPALITY OF ANCHORAGE
Community Development Department - Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I. D. 015-221-22
Property owner(s) Alicia Trevithick Day phone 951-303-7374
Mailing address 12240 Freedom Road, Anchorage, AK 99516
Site address NHN Heritage Rd, Anchorage, AK 99516, USA
Legal description (Sub'd., Block & Lot) Heritage Hills Block 3 Lot 8
Legal description (Township, Range & Section)
Lot Size 15,000 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑X
Single Family (SF)
❑X
(w/wo AD U)
Septic Tank
FAUpgrade
ElDuplex
(D)
ElHolding
Tank
ElRenewal
ElMultiple
Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑X
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: $ g2CJ Waiver Fees:
Date of Payment: C2 Z3 Date of Payment:
Receipt Number: 0013-S5 D Receipt Number:
Permit No. Waiver No.
Permit App_::- : ,�.:c
Certificate of On -Site Systems Approval
Parcel I.D. 015-221-22
Legal description HERITAGE HILLS BLK 3 LT 8
Site address 12221 HERITAGE RD
Current property owner(s) TREVITHICK ERIC
Expiration Date:
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for
Comments or advisories:
n
By:
7/9/2025
bedrooms, with the following stipulations:
Original Certificate Date: 7/18/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory X
Tank Age Advisory Arsenic Advisory
Other Property line waiver
COSA Approval_June 2022
MUNICIPALITY OF
I 'Ail
Development Services Department
On -Site Water & Wastewater Section
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-221-22
Complete legal description Heritage Hills Block 3 Lot 8
Location (site address) 12221 Heritage Road, Anchorage, AK 99516
Current property owner(s) Eric Treyithick Day phone (951) 303-7374
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel FNI Plastic ❑ Concrete ❑ Fiberglass
Age New - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench FN� Wide Trench ❑ Seepage Pit
Waiver request for: 1'n 2., Distance:
Expedited review requested: ❑■
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ _y_
Date of Payment
COSA # 05 G 2 Lt 12 !� :5
Waiver Fee $
Date of Payment
Waiver # 05 V 2 910 31
COSA Application—June 2022
Heritage Hills Block 3 Lot 8 015-221-22
15
6/5/24 230
230
5.26
24
6/15/24 Hefty Drilling
188 7/9/24
N/A N/A
N/A
>
6
0
6
(907) 522-7773
Benjamin Schiller, P.E.
MUNICIPALITY Of ANCHORAGE
DEVELOPMENT SERVICES €HEPAR TME "� 907-343-7904
Cin -Site water- and Wastewater Section � � � Fax: 343-7997
www.rnuni.org/onsite \ —
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC241253
Subdivision: HERITAGE HILLS, Block: 3, Lot: 8
A water sample revealed a nitrate concentration of 5.26 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
NN * N
Nl 0'FA CHORAGE
U)NANCED \VAS SYSTIF'.'�l
74AINTENANCE AND
RITAIR A(TIONEN E howili Me -AGRFFNTNTnwdv and
101h Day or' July, 2024 bV and ha"Ven
Ivan M. Bland
hen"iu !lie and thcNimlicipality of
Amchk'nra,chea.,in the-` I NIC'EIW 1117 in ac"A"CC "Ah \"unicipal Cod,:
ANU KWA5. In COVIACIVIAW Of WIC M11ULd C001MUS uolluliricd i1creiii, [he toJ-Iis
Azg.rcenn�_'nt agree as tollo"vs,
1. Advanced LVastcwatei- Ti-vatment SN'stems. Fhe N tunic ipal it� ill ol'. to the
rarits Per i, ss i.
nor 0) unlize and opmHo an Whowed "Astewater Freatmen: SyhtQ:!n (A'vV"V'I S).
dewribed as --Advantex System ------
lociit'2'i at de'_al description)
Heritage Hills Sub, Block 3 Lot 8
Alaintenance. Revidi, and lons.
Kim= is mariNd R) waL under' -1 "A and indial ca ch seciWO
lbroughwo To terni A As A;rewrer:,_ the sliall z'nitr n110 a 'erf ie i1oZ7reell Ci -.t
"th an ATAVTS service ami mainwalwc pan ider ailpro\ zj h,\ the ),--',,un icipa I it\ or We
rum nifacurreKs \\VV,7`t :haP he maintained in a sadMicutry
cnn�!inon c,tpahle oFpedQuAng an dcogned and prvduciu!; ti-cated .scptic in
"Ah dw cqwpnwnCs approvat foi, oineraiion in !Ile Nfilnrcipaln�'
i, 11, sha�l be the responsibillity of the Owner during the tow of this Agreernent to pay For all
repair(� i. waiwenance, uiu,,,ttmmYsj. wplaccinent coos. aN AISI)CCLAMI UWS. IN,
includes nin annual rnairuenai,Ct- fto ", tt picllk S'PiO lo
Owner ag'reos that only n1a i litclia lice and ropm, r pawmem , i ppan ed nN i he N In n ic ipall it\
or the manufacitirer's representative will, inspec, and make an, necessary maintenance.
repairs of Lilterations to the wstoln.
Owner acknowledges that regular rnairitelmnce of an AVUVJS re -duces tiic potential
Cailurc fIC 11w 't S;c1n, \Oich could include Sn\agz� hacktrp anti noth repwirs x drainhel"i
rePlaccm.,mi,
fro v 13 1XV1`ti Page 1 03
0" ner ickno" Injes Tra Tv Mmuctahiy niat.0 i,eqncsi rti'cords
rcpair., from Me nonslAnum's 1VPrcSCImtitc of Irtaill-c-nance
(Win- ackmOdges that the line Q Shng n, n3z!mt"1n*, and" rcj)�!ir >w, "V"I" S rua.` be
as�esscd in accordance \vith .NIG 14.60 OR
Owmcr agms to gnus the NluilicipaQ n,,ilsonal)ie aci:es`. to test i1nd illspet-"t the
AWWTS I he Nlunkomlit,, will give pit least 24-hour notiee-
agr,%!s ti -.al mp sale or mm�d'ei oflitit :ll 'the pRTany wil mq occur " itlmm a nm
Owner agrecs that the A W "' 7S instl latm anxi rnnintarmet reclOrmnents a, pro% Ked
by the AWW-P-, vcndor installer c<und aMmmd by iho Munice -allity are th, 4_TC mmin,
-:.ndelinns �o). th�: nlaintenal',Ce :uid of tilt, O"viler's -A%V%VFS,
(),"InCr Igrzes I,() nla!1,!Tain ronote monimring of the AMUS as rnqWred hy the
al.
3 Term. Th—, x!m oifthns Agromm shall Kevin on the date cg approwl by thte
1l1mAcif0h; h, cTerwe the instaAcd sysml, x upon tralls", Cr ot,tillc, and shall Continue
ihk-, A\'�W1 S is overmhmml or until Pik is tramQual-
4. Nonivaiver. The hHum or the MuNcyMy at any We it`, oMbNe a pawkion of Ws
Agnmem shAl in no way consti-,s: a -,viii%cl oftilc �,rovisions. In Lm�,, \%a" af! cct
10 % whdAN of the Agivernew or an, part hmof. or the l-Whi of the Nlmiicyvin�
to enf6r,"O o -cry pro" ision hereor.
5. Amendment. A hin Agrecircm shall only be amendod by nithorized rcpresenmtiv,�s of
the ()'+mer and Municipality. Any anempt to anwnd this a,-,reement by either an
unamhorived rcIvesciaM a or um-outhori/ed nicans shall be void,
6. Jurisdiction: Choice of La". Any ckil action, nrisn-q:), from this Ag-rcenlenl Shall lot
WOH in the Stwomy Clun Air the Mird Judicial District ot,the `sate ofNalasl,:il pit
Whomue, Fhe laws ot' the State of MW MH gown the B'''its and obli,-'ations orthc
parties undet- this Aggreement,
7. ScivraWito Az*, lmovisions of this Agrcemant (1cc1acd in%and In a mun ofcompeten!
jtj I -j � di e I I I I S I I , I not jn%r ;
aialicc Hic rzrnainint-, provi,'iolli of the 'Agreenlelli
(!-V% ()� 18 201-i j Pagc 2 off
S I A I F CUM ASKA
DAUCTAT DISTRICT
Dan
SEE ATTACHMENT
FOR NOTARIZATION
MUNICIPALITY
(mgmuma Dwx-
711-71
z q-
fre% (15,18 70181 Pap C'S
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 11189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California )
SaDUie(Y)
County of )
Dn ' ' ~" � `'�^- before me, Holmes,Quinlin R. Notary Public
Date Her nser and, Title of the Officer
personally appeared
Name(s)of8ignmns)
who ved to me on the basisofsatisfactory whosenane(s) is/ere
subscribed to the within instrument and acknowledged me that he/she/they executed the same in
his/heo/theirauthorized c and that byhis/he»/thei,aignotu instrument the pereon(s).
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OFPERJURY under the laws
ofthe State ofCalifornia that the foregoing paragraph
is true and correct.
WITNESS myhand and official seal.
C :M
OMAk #2433273
�Ry:�C >L) 0 tm
NOTARY PU%1C-CAL1FOFRMA
NOT
Signature
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment ofthis form toanunintended document.
Description of Attached
Title orType ofDo ^/aDocument Date:
Number of Pages: �^Signer(s) Other Thar Named Above: ji _
Capacity(les) C
Signer's Nanna� ��gner's '^�
[]Corporate Off icer — Tit{e(s):Corporate Officer — Title(s): _
Partner Limited [lGenar�|
Partner, Limited [](�enara|
��hyd�vidua{ []Attorney in Fact [!Individual [] Attorney in Foot
[]Truatee [] Guardian or (�ono�,vm1nr []Truatee []Guardian or Conservator
[]Uther'_J Other:
Signer Is Repreaerd� % Signer Is Representing:
(D2U14National Notary Association ' www, National Notary, mg^ 1-8UOUSNOTARY (1-8OO-87G-6827) Item #5907