HomeMy WebLinkAboutHERITAGE HILLS BLK 5 LTS 7 & 8I R,
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Lot 7 & 8 are Joined as economic parcels
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Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 161260 PID Number: 015-221-90
Dwelling:❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New F011 Upgrade
Name:
JOE BELL
ABSORPTION FIELD
Dee
❑ p Trench E] Shallow Trench F-1 Bed ❑Mound
Address
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
0.45 GPD/SF
10.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
7.0 Ft.
Subdivision Block Lot
HERITAGE HILLS, BLK 5, LOT 7&8
Fill added above original grade
1-2' Ft.
Gravel length
73' Ft.
Township Range Section
Gravel width
2.0 Ft.
Beds: Number of Lines
-
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1022 Ft'
1
Ft.
Well
100'+
50'+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
100,+
Gal.
Material
Number of compartments
Lot Line
10'+
NA
Foundation
10'+
LIFT STATION
Manufacturer
Capacity
Curtain Drain
UN
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank Tank to 3034
drainfield
MIKE ANDERSON
Drainfield 3034 CO/MT 3034
Inspector MIKE ANDERSON
BENCHMARK (Assumed elevation) 99.2 ft
Inspectionddates: 1" 9-22-16 9-22-16
Location and description
2°d
3'd 4`h
TOP OF VALVE LID
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
F
Conditional Approval: Date
(�7•e
id 49T
°oaoaeoo a. o t,J
0............r
V" MICHAEL N. ANDERSCN•�
A
CES 94P9
Approved Date2�
®vphQFESSIO�0_�
IJPuuuulI Rt Fpul l_y-I-IG.000
Permit No. OSP161260
Page 2 of 2
Municipality of Anchorage
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
Legal Description: HERITAGE HILLS BILK 5, LOT 7 & 8
PID No.: 015-221-90
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On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP161260
Tax Code Number: 01522190000
Work Type: Septic Upgrade
Permit Effective Dates: September 20, 2016 to September 20, 2017
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
Subdivision: HERITAGE HILLS
Site Legal Address: HERITAGE HILLS BLK 5 LTS 7 & 8 G:2737
Owner/Address:
BELL JOSEPH M
5221 E 131ST AVENUE ANCHORAGE AK 995162351
Site Mailing Address: 5221 E 131ST AVE, Anchorage
Lot Size in Sq Ft: 34800
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions:
An easement is to be recorded for the septic system on the other lot prior to Inspection Report
approval.
Received By:
Date:
Issued By: vY e (e-1?;dc � _ Date: 9
7//4
2-O/G
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWERNVELL PERMIT APPLICATION
Parcel I.D. 015-221-90 /~ ~' f '¢'~ ~,/'/' ~
Property owner(s) Joe Bell [ J Day phone
Mailing address 5221 East 131th Ave. Anch Ak 99516
Site address same
Legal description (Sub'd., Block & Lot) Heritage Hill BIk 5, Lot 7&8
Legal description (Township, Range & Section)
Lot Size 34800 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
([~ all that apply)
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVI
I certify that the above information is correct. I further
applicable Municipal Codes.
TYPE OF DWELLING:
Single Family (SF) []
(w/wo ADU)
Duplex (D) []
Multiple Dwellings []
(SF and/or D)
stance:
dance with
(Signature of property owner or authorized agent)
Permit/Rush Fees: ~'~"~'
Date of Payment:
Receipt Number: ~)~"- I/'~'
Permit No. (~'¢~ I
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 727-8864
Fax 345-139l
Septl4,2016
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Heritage Hills BIk. 5 Lot 7, Septic upgrade
To Whom it may concern:
This is an application for a new septic upgrade on the above referenced lot. Lot 7 & 8 have a septic
easement aad the system has failed and needs replacing. The test hole material consisted of'silty sandy
gravel (SM/GM) for the entire 18 foot depth, with no water observed during the entire 7 day waiting period.
The perc rate was 12 minutes per inch but an application rate of 0.45 was used for a greater factor of' safety.
The existing lift station will be used and inspected.
There are no public or private wells within i~feet of the proposed system location. There is neither
surface water withiu 100 feet nor any known curtain drains within 50 feet of the proposed system. None of
this development will have any adverse effect on the adjacent lots.
If you have any question please call me at 727-8864.
Sincerely, j,~
Michael N. Anderson, P.E.
[ ~MOUND OVER
DESIGN CRITERIA: (TH~I) ~- ~--.-~//--GRADE
3 BDRM X 150 = 450 GPD
SOILS = .450/0,45 = 1000 GPD -1.o_ 1.5_~ L~-~L~.~.~ FABRIC
lOOO G^/~ 4 = ~2' -~.~- ~ ~,.~, ~,~
~ IS~ER ROCK
(1~, TRENCH SM/GM
9.U DEEP
7.0' EFFECTIVE -9.0 - ~[~5
~.o, w,o~ I~.o'1 ~"~
72' LONG -~8.o ~
SEP~C RELD SE~ION
/ / ESTATES Lm 16 /
/ ........ / / SEPTIC f L LOT 17 WELL
E~ATES LOT 17 / '~ ~ / ~ ~ .... CROSS ~'
CROSS ~
~STA~s ~o~ ~ ~ ~ ~ ~o~ ~ ~ A
_ _ ~ ~ / ~ ~ ~COnO~O W~
...... /~ ~ '~ --~ STATE OF
~/ / k LEXI~NG 1250
~STEM A~NDONED IN-P~CE, { SEPTIC ~
JOE BELL .~ ................
HERITAGE HILLS SUBDIVISION, BLOCK5, LOT 7 '
Anchorage, Alaska ~ ~/ 49~
..~
N,
AH
~.A~ ~CHA~ ~.
Michael . .n_e~n, DAT~: 9/14/2016 ~ No.~E~469
727-88~ / F~: 345-1391 SCALE: 1"=100'
CROSS VIEW /_--'~_
ESTATES LOT 16
VACANT/ ~ /-- EXISTINC WELL
100' RADIUS, 1YP
PROPERTY LINE ~_ __ __ __
t su,vF2
LOCATED
/ LOT 7 LOT 8 PROPERLY UNE
A.o mEME I
) SHOP WELL HERITAGE HILLS SUBD. LOT 8 HAS A
~ ~- SEPTIC EASEMENT RECORDED WITH/
STATE OF ALASKA, JUNE 6, 2011,~
~' RECEIPT NUMBER 3306646~
I 250
OLD UNDOCUMENTED SEPTlC
SYSTEM ABANDONED IN-PLACE,
-131 AVENUE-
JOE BELL
HERITAGE HILLS SUBDIVISION, BLOCK 5, LOT 7
Anchorage, Alaska
Michael N. Anderson, P.E. DATE: 9/14/2016
Performed For:
Legal Description:
Municipality, of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 I ~ ~ICHAE[ N. ANDIRON ~,
~v~i.ancho(¢,e.ak.,s ¢.~ '. CE- 9469 .~
(907) 343-7904 ~ ~.. ¢¢~. %~-~
Soils Log - Percolation Test ~tt.P~'Or~
Slope
3-
4-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
20-
COMMENTS
Township, Range, Section:
Site Plan
WAS GROUND WATER
ENCOUNTERED? ~)
S
F YES, AT WHAT DEPTH'¢ L
Depth to Water After O
Monitoring?Date: ~-~ ~l~ EP
Reading Date Gross Time Net Time Depth to Water Net Drop
¢,/r
PERCOLATION RATE ~ ~ {minutes,~nch) PERC HOLE DIAMETER
TEST RUN [~ETWEEN ~"~ FT AND ~ FT
4,_, [, -_.-TAT *,g/t."
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Permit Number:
Tax Code Number:
Work Type:
Permit Effective Dates:
Design Engineer:
Subdivision:
Site Legal Address:
Owner/Address:
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
OSPl11136
O1522133OOO
Septic Upgrade
July 01, 2011 to June 30, 2012
ANDERSON CONSTRUCTION & ENG'G
HERITAGE HILLS
HERITAGE HILLS BLK 5 LT 7 G:2737
NIEDERER WILLIAM A & PENNY L
5221 E 131ST AVE ANCHORAGE AK 995162351
Site Mailing Address: 5221 E 131ST AVE, Anchorage Lot Size in Sq Ft: 18000
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank
N Holding Tank N Privy N Private Well N 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 (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The entire drainfield is not within 30 feet of a percolation test. A percolation
test shall be done prior to construction to verify the soils for the entire trench. Submit the results
with the final inspection report and as-built drawing.
Received By: /¢
Date:
Date:
UNICIPALITY
Community Development Department
~e;lj~.opment Services Division
~Ip~te Water & Wastewater Program
:~ ' Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
OF ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s)
Mailing address
Site address
Day phone
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size /¢'1 ¢o¢ t~Ft. Number of Bedrooms '~'
THIS APPLICATION
([~ all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
IS FOR:
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
Water Storage []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further 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/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 )
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
June 29, 2011
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Heritage Hills Blk. 5 Lot 7, Septic upgrade
To Whom it may concern:
This is an application for a new septic upgrade on the above referenced lot. Due to the small lot size,
existing well location and the undocumented septic system there isn't enough area for an upgrade therefore
the owner created a septic easement over the entire area of lot 8. The recorded and documented septic
easement has been included with this submittal. The test hole material consisted of silty sandy gravel
(SM/GM) for the entire dePth, with no water observed during the entire 7 day waiting period. The perc rate
was 12 minutes per inch but an application rate of 0.6 was used for a greater factor of safety. A 1250 gallon
lift station has been shown to pump the effluent up to the east side of lot 8..
There are no public or private wells within 200 feet of the proposed system location. There is neither
surface water within ! 00 feet nor any known curtain drains within 50 feet of the proposed system. None of
this development will have any adverse effect on the adjacent lots.
If you have any question please call me at 727-8864.
Sincerely
Attachments:
On-Site Well and Sewer Application
Revised wastewater absorption system design and details
Two new Soils Log/Percolation tests
DESIGN CRITERIA: ~UOUND OVER
(~#1) ~_ /~ ~--OR~DE
4 BDRM X 150 -- 600 GPD OR(~ 5~
SOILS -- 600/0.6 = 1000 GPD -1.o_ FILTER FABRIC
1000 GA/14 -- 72' -1.-~~1.25"¢ PIPE
' -2.0- ~
~SEWER ROCK
(1) TRENCH SM/OM
9.0' DEEP
7.0' EFFECTIVE -9.0
I
72' lONG -~8.o ~ '
SEPTIC REID SECTION
I / / CROSS VIEW /".. / / VACANT
[ ~ / ESTATES LOT 16 / '-_
it' ~vA~ / vA~ / j__ --]--
~ / c~ view / / ~s~.^? ~,.s
EPTIC L LOT 17 WELL
~ ESTATES LOT 17 / F' EXISTING WELL/ CROSS VIEW
/ / lOO' ~lus, ~ / c~ VIEW ESTATES LOT 14
/ / / ESTATEs~o~ 15
i ~/~_ ....
ESTATES LOT 27 .~' ", ! /-- I.OT 8 ~ A
PROPERLY UNE ~ xj / S~lC EASEMENT
// \ /x ~RECORDED WITH
..... 7 ........ ~ 7' - - -~ ..... /~ .... -~ STATE o~ ~
\ [ I I ' I / ~ , SEPTIC //
\ ~ ~ VACANT ~ x ,., 'L~^~~-7
_ \ ', l~i!y / , ,., ,, /
~ / / X / NEW 1250 STEP X ~
SYSTEM TOABANDO~IED IN / ~--EXlS'rlN(; 3 ~ ~ "' '- .......
PI.AC~ TANK WILL BE PUMPED, / ~.~ . - ....... . 9EgROO,h: HOU~ \ =
CRUSHED ANB FILLED PER MOA~ ".'-' ---"~, -' "'- ~ \1
CODE ~ SEPTIC t" %. ~-- PROPOSED BRNNFIEID ~ ~ \
3 ",, ,
Septic Design Prepared for
BILL & PENNY NIEDERER .-~-~.b~" ..... .'~' ............. .*~,LPjJe.
HERITAGE HILLS SUBDIVISION, BLOCK 5, LOT 7 ~"%: 49T" ~
Anchorage, Alaska ~ ..... ~ .................. ., ...........
Michoet
N
.A d~ P.E. AA~,MICHAEL N. ANDERSON/,~
. ,n....rson, DATE: 6/29/2011 ~. ~.A. "-
~ Lox;. No. C~E 9.469
4661 NATRONA AVE. DRAWN: D JR "':¢'~"..,7././Z./..~~ ~:~'~--"~
ANCHORAGE, ALASKA 99516
545-5577 / FAX: 545-1.391 SCALE: 1"=100' .~.L-ACFESS\~
/// CROSS VIEW ",,
ESTATES LOT 16
iiiII/~. VACANT
/ PROPER~ UNE
LOT 7 LOT 8
tSHOP
WELL HERITAGE HILLS SUBD. LOT 8 HAS A
I
~) SEPTIC EASEMENT RECORDED WiTH
I
STATE OF N.ASK& ,JUNE 6, 2011, ! /--EXISTING WELL
RECE,~r .UMBra 3306e46
!
\\ I 5--10~
· . '. ". :- 5-10Z
x I ~ ~."~ :'. / II
. lANK
~ PROPOSED DRNNRELD
~- EXISTING UNDOCUMENTED SEPTIC
SYSTEM TO ABANDONED IN
P~CE. TANK WILL BE PUMPED,
CRUSHED AND RLLED PER MOA
CODE - 1 3 1 AVE N U E -
Septic Design Prepered for
BILL & PENNY NIEDERER ,,.'T~.v';'' - '"'.?T-~.'%
HERITAGE HILLS SUBDIVISION, BLOCK 5, LOT 7
Anchorage, Alaska
Michael N Anderson P.E. DATE: 6/29/2011
ANCHORAGE, ALASKA 99516 ~"=30'
Performed For:
Legal Description:
1
2
3-
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraPle.ak.us
(907) 343-7904
Soils Log - Percolation Test
Slope
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
19-
20-
COMMENTS
~% ~' ;'. ......;',~ ~- ~ ~ I
Date
Township, Range, Section:
Site Plan
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH? L
O
Depth to Water After
P
Monitoring? ~k.J~t ~ E
Date:
Reading Date Gross Time Net Time Depth to Water Net Drop
PERCOLATION RATE ~' ""7... (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" FT AND (.~ FT
PERFORMED BY: ~ /~"'~ I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ('~f? ¢1'(
June 12, 2011
DECLARATION OF SEPTIC EASEMENT
AS OWNERS OF RECORD, WILLIAM A. AND PENNY L. NIEDERER, WE DECLARE A SEPTIC
EASEMENT ON HERITAGE HILLS BLOCK 5, LOT 8, FOR OUR RESIDENCE ON HERITAGE HILLS
BLOCK 5 LOT 7, ANCHORAGE, ALASKA.~ '~-~ 1 ~0 f~ ~C~ GDt ~ ~) t ,~ C'~ ~ ~/¢
RETURN TO:
WILLIAM A. AND PENNY L NIEDERER
5221 E. 131s~' AVE
ANCHORAGE, AK 99516
GRE/ ER ANLI-IUKAbI: AKtA uun
Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /~:Ct~ bi~E/IU~O£d MAILING ADDRESS-"¢(-~D,f' '/2}¢)A'~A/'C'/¢J "~).'~ , PHONE-~'¢'~
LOCATION /,-i/f.~//r'~:~id ~'~. .//~-~,¢¢ LEGAL DESCRIPTION ~.OF-'? /~/.,1~..~ /;/~-,E~FT'/'-/?E /~///,/.~
SEPTIC TANK:
DISTANCE ..
FROM WELL I2~-~p
INSIDE LENGTH
MANUFACTURER ({~i~(~:~;Q Thf¢ E¢ ) ~/d. MATERIAL
NUMBER OF
COMPARTMENTS
INSIDE WIDTH ' '-- LIQUID DEPTH --- LIQUID CAPACITY /¢)00 GALLONS.
SEEPAGE Pit:
NUMBER OF PITS / . DIAMETER -- OR WIDTH ~Z,
LINING MATERIAL/.(~.~d/&lf~ CRIB SIZE: DIAMETER
BUILDING FOUNDATION $2__¢ , NEAREST LOT LINE
ADDITIONAL ABSORPTION
LENGTH ~'~,' DEPTH ,~2 /
DEPTH ¢ '~ DISTANCE FROM: WELL
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) ~7~,~ SQ. FT.
WELL:
TYPE P~¢)/6~ CONSTRUCTION
BUILDING NEAREST
FOUNDATION -- LOT LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DEPTH DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK __ SYSTEM
DISTANCES:.
INSTALLED By:?)0;I~ 31('t~_itdgc~lJ
/
PIPE MATERIAL:
LOT SLOPE:
REMARKS:. ~0//_
Form PW-02$
DIAGRAM OF SYSTEM
~ / ~0 ~~
DATE ~'~-[: '"/,
APPROVED "~P4"U ~ ~. ("J. /~./~J~t',z,;
G.A.A.B.
NAME OF APPLICANT
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
SEWAGE DISPOSAL SYSTEM I APPLICATION AND PERMIT
PERMIT NO.
INSTALLATION LOCATION
LEGAL
.
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT---- ~ , DRAIN FIELD . OTHER
SOIL TEST .eSUlTS ~:0 :~1 .///%~/~ NOTE, THIS PERMIT IS NOT VALID WITHOUT ~IL
COMPLETION DATE ANTICIPATED ' : pFRHTT VAI TB ~NF YFAR
FINAL INSPESTIONI ~4 HOUE NOTI~ EEQUlRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY TH
HEALTH DEPARTMENT AUTHORI~ WILL BE SUBJECT TO pROSECUTION.
WELL TO SEPTIC TANK
DRAIN FIELD
WATER MAIN TO SEPTIC TANK ].0 ft f ,
DRAIN FIELD [0 rte
SEPTIC TANK SIZE '
MINIMUM DISTANCES, REQUIREMENTS
* ~" 5 ft.
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PiT 20 ft. DRA~. F~ELO 10 ft, .
SEPTIC TANK TO SEEPAGE PIT WALL - [5 ft
TO NEAREST ~O~ LINE.
o~ COnCr~.teSEEPAGE AREA S,ZE ~¢ '¢~'~/ ~ 'rYPE / .
DIAGRAM OF SYSTEM '.
SEPT,C TANK, 25 ft,, SEEPAGE PiT 100 ft., DRAm F'ELD 50 ft, ..
TO RIVER, LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF ......... S01L
EXCAVATION 5 FEET INTO UNDISTURBED SOIL. IQ 1'13- 100'
N~ Sr~:~R 1:]:]~- 4~ 6' per 10~ On fl~t
DEPARTMEFiT OF '-~"; fAL QLi~LI I ~' ,.
3500 TUDOR
A~CHORAGE, ALASKA 995~2
Date Performed 28 August, 19Y2
Performed For~o~g D!nkemmo~
Legal Description: Lot ? Block~Subdivision Heritage ~111s
This Form Reports Soils Log XX Percolation Test
9
lO
Depth
Feet
1Top-
Soil
2~
3--
5G-~-
7
Soil Characteristics
................ -
a high silt and clay content.
There was also quanties of
sand and lmrger'sized particl~s~'j
There was t~ much silt and
net enough s~d to classify
graded It as somewhere
between Gm ~nd M1. The ~oll
was wet aue to meltin~ frost.
Was Ground Water Encountered? No
If Yes, At what Depth?
Date
Reading
Gross Time
I
Net Time
I
Slope east
Depth to H20
Net Drool
Percolation Rate Hinute
Proposed Installation: Seex, aqe Pit XX Prain Field
Depth of Inlet.__~Z~ feet Deo~h~T~,,.--~'d-f]¥on} Of Pit Or Trench.~4 re. et
Test Performed By_ _
Municipality of Anchofa
On-Site Water and Wastewater Proorarr~'. '
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-221-90
1.
-~ Expiration Date:
GENERAL INFORIVIATION
Complete legal description HERITAGE )BILt,$ S~ B~OC~ 5, EO~ 8
Location (site address) 5~] EAST ~3L ANC~O~G~, A~ 99516
Current Prope~y owner(s) JO~ BELL Day phone
Mailing address 5~ZI ~AS~ I3h ANC~O~G~, A~ 995~6
Real Estate Agent Day phone
2. TYPE OF DWELLING: F
' R .oH!
[] Single Family (w/wo ADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OFBEDROO~S:
TYPE OF WATER SUPPLY:
Individual Well []
individual Water Storage []
Community Class __. Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual []
Holding Tank []
Community []
Public Sewer []
SEP ~ 8 2016
WaiverNariance request for:
Received by: ~,~?~..~
COSA to be release~ess~e~ise re~d by the engineer.
Date:
Distance:
COSA Fee $ /.-/Z_~).(~O Waiver Fee $
Date of Payment ~/Z.~//(~ Date of Payment
Receipt Number ~¢~ (~(~/ Receipt Number
COSA # O ~ (_..//~ lqff~ Waiver Ct
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of Q~-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. [ further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation,
Name of Firm MIKE N ANDERSON, P.E.
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE
Phone 727-8864
Date 09/27/16
DSD SIGNATURE
X' System#1 Approved for ~
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
bedrooms, with the following stipulations:
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist
Septic System Advisory
WeII Flow Advisory
X
Nitrate Advisory
Arsenic Advisory
Other
If more than I septic system is on the lot:
COSA Checklist # of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: HERITAGE HILLS S/D BLOCK 5, LOT 8
A. WELL DATA
Well type Private
Date completed PRE 19727
Total depth 235 ft.
IfA, B, or C provide PWSID #__
Sanitary seal (Y/N) _Y
Cased to 40'+ ft.
FROM WELL LOG
Date of test
Static water revel ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG .colonies/100 mL Nitrate 5.2 mg/L
Arsenic: ND ug/L Dateof sample: 8/1112016
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal.
Foundation cleanout (Y/N) Y
Date of pumping 9-24-16
Number of Compartments 2_
Depression over tank (Y/N) N
Pumper ,~round:the Clock
ParcelID: 015-221-90
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 24"
AT INSPECTION
9/2412016
175 ft.
2+ g.p.m.
Collected by: Alaska Rim
Date installed 717/2011
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
C. ABSORP!I0? r,E.,D DATA - 1985 SYS~TED
Date.installled 9122/201!~ . , Soil rating (~.d./,,.~. ft2/bdrm) 0.45 System type DEEP TRENCH
Length 7'3. !.ft.:,. .. Width 2 ft. Gravel below pipe 7.0 ft.
,Tgtal'depf[h ~ ft..' ,','i !'-E~ff.-a~sorption area 1022+ ft2 Monitoring tube Y Depression over field ~
Date of adequac~ [e~t;'N~ ' ~' Results (Pass/Fail) NEW For 3 bedrooms
Fluid depth i¢'~b.~o[.ption f e d ~efore test NEW in. Water added NEW gal, New depth NEW
Elapsed'Time~ ~
, . ~in. Final fluid depth NEW in. Absorption rate >= NEW .g.p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWH If yes, give date
in.
D, LIFT STATION
Date installed 71712011
"Pump on" level at 30
Datum TANK BOTTOM
Size in gallons 1250 Manhole/Access (Y/N) Y
"Pump off" level at 24 in. High water alarm level at 36
Cycles tested $ Meets alarm & circuit requirements? Y
in,
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line 50'+
Animalcontainment areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 20'+
Water main 100'+
Wells on adjacent lots '100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water Service line 10'+
Curtain drain 50'+ t'None Known)
On adjacentlots 100'+
On adjacent lots 100'+
Public sewer ma nhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Property line 5'+
Water service line 50'+
Absorption field 20'+
Surface water 100'+
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this Gate.
Engineer's Printed Name
Date 09/2612015
COSA canary sheet_2-6-15.doc
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OS C 161447
A Certificate of On-Site Systems ApProval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 7 &
8 of Heritage Hills subdivision. This inspection revealed a nitrate
concentration of 5.2 milligrams per liter (rog/L) was reported for the
property's well water sample. 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.
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.
DEPARTMENT OF HEALTH & HUMAN SERVICES
· ' Division of Environmental services
.~ ·. On-Site Services Section
P.O; Box 196650 Anchorage, Alaska 99519-6650
343-4744 -
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY' DWELLING
Parcel I.D. # (~/.E'- ~t-
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions) ~\ eL ~._'5\ s~- ~:~t~'Lr~t~L~ C~CL~L~
Property 'owner
Mailing address
Lending agency
Mailing address
Day phone '~ fi/,'- ~ ~ ~ .5-
Day phone
Agent Day phone
"'-.:'~n!ess Otherwise req~Jested, HAA will be held for pickup..'.: · '.
2." :::NuMBEROF BEDRooMS: '""
3. -! TYPE OF.WATER SUPPLY: .:: ......
-' '~'? :::::::' ::::!":: ::-:::i' :'::":::":" ...................
~ .' -~ Ind v dual we . ..
,~.., ~ ~,~ -: . ~...: .. ............. .-~::.: ....... . ......
. -, ,~,~'~':'~':,,'W>~- ......._ _ '.:- ~COmmunity'Well,.- ~'... '
::
? ,~;~ ,' .. ' ~ ..'/~, -', P~bhc water
, .~ ,' ~). · _.. ,% ~ ',, . ,..
; .-~,, ,' , ~ ~OTE: ~f:~ommunity Well sYStem, provide written confirmation from State ADEC attest-
: ~.; ~ ).~ ~;~ '~ ~ tO the legality and status of system. '
~ ~ ~ .~. ,. ~..
. .). ,· ~., .... , ~ ....
".-.'?' 4 :"TYPE'OF~ASTEWATER DISPOSAL:
, '~7 ,, ,~..~ '- , , · v
". 4l', '" t.'~" ::~..:.,',lnd~wdual on.s~te
(.'f~).~,~,~ :~>?.: .'":. :::.::::?:.-.:.::...-.-.~:..:, .::-:~. . .. .. .. :.. .
' - ........ Hom~ngtanK
Community on.site ~ ..-_
:':~" Public sewer ":'
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER :: :
As certified by m~-seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulatiOns in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
Phone
Date
6. DHHS SIGNATURE
~'. 'Approved for ~,~i bedrooms.
..... Disapproved~:' :i' :: :'~ : "'-~':"
Conditional approval for bedrooms, with the following '~fipulafions:
By:
Aflditional Comments '
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 DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Em ployees 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.
72-025(Rev. 1/91) Back MOAi¢21
Municipality o.f Anch. orage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L. ~.~'-J>~ JJr~ ,-r~,, -H~ ~/~
A. Well Data
Well type 'q:"cub
Log present (Y/N) ~
Total depth ~ ~ ~'.~' ,'~
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed [' ~' ~),~-~ Driller
Cased to /--Cc) --r- Casing height
Wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
g.p.m.
Septic/holding tank on lot /-~ ~ i
Absorption field on lot /( '-~-'~
Public sewer main "'~r/A'
Sewer service line ,~z' o ~
AT INSPECTION
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
AUG 1 B 1995
Municipality of Anchorage
Del~t. Health & Human Services
~ loc.)I
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria
,%, ~.~7~ ,,~ ¢j~),~
B. SEPTIC/HOLDING TANK DATA
Date installed q - ? z
Cleanouts (Y/N) "~
High water alarm (Y/N)
Date of pumping
Tank size / ~ ~r~
Foundation ¢leanout (Y/N) 1-~
Compartments
Depression (Y/N)
Alarm tested (Y/N)
Pumper "f--.t ¢~-"~--['1L ~-~b
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 7-~
To property line ..5-~o"
Sudace water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026(3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical CO~aS~
S-TA~CE FROM LIFT STATION TO:
On adjacent lots
Manufacturer
Manhole/Access (Y/N)
at
~tested
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length '~ ~
Total absorption area
Date of adequacy test
Width
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft'")
Gravel thickness
Cleanout present (Y/N)
Results (pass/fail)
.System type ~ , ~'
~l Total depth /
'-¢ Depression over field (Y/N)
'q:~,A ~....% for ::~ Bedrooms
After test ~ q
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //~
To building foundation ~ t
On adjacent lots ~/~ ~
Surface water ~ / 0¢/
Curtain drain
On adjacent lots ~/' c> c:~ Property line
To existing or abandoned system on lot
Cutbank ¢,~,'~"YA Water main/service line
Driveway, parking/vehicle storage area -~--/
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelih'e's in gffect < of this ins~'ection.
Signature~ ~~--
Engineer's Name .~'--~,j
Date
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
