HomeMy WebLinkAboutASPEN HIGHLANDS #1 BLK 1 LT 10MUNICIPALITY 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 Wastewater Disposal System Permit
Permit Number: OSP231404
Work Type: Septic Renewal
Tax Code Number: 01701321000
Site Legal Address: ASPEN HIGHLANDS #1 BLK 1 LT 10 G:2840
Site Mailing Address: 13101 HILLSIDE DR, Anchorage
Owner: RICHMOND KENNETH A
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�venr
Department
12/1 /2023
11 /30/2024
36750
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: S� L"� TO r-op-r^
Issued By: ,A_
Date:
Date:
5
M UM U a ' U u Y OF
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. 017-013-21
Property owner(s) Ken Richmond Day phone
Mailing address 13101 Hillside Drive, Anchorage AK, 99516
Site address Same
Legal description (Sub'd., Block & Lot) Aspen Highlands #1 131 L10
Legal description (Township, Range & Section)
Lot Size 36,750 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(N all that apply)
Absorption Field X❑
Initial ❑ Single Family (SF) X❑
Septic Tank ElUpgrade
❑ (w/wo ADU)
Holding Tank ElRenewal
❑x Duplex (D) ❑
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
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:41 Li 5 Waiver Fees:
Date of Payment: ///30�2 3 Date of Payment:
Receipt Number: 00.1 n3 (-, Receipt Number:
Permit No. OSP231404 Waiver No.
Permit App_ :- : , _.,:c
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
Mailing: P.O. Box 1807, Palmer, AK 99645-1807
Telephone: (907) 745-8200 FAX: (907) 745-8201
DATE
Subject: Expired On-Site Water and Wastewater Permit
Permit Renewal Request
Permit Number: OSP221251
Legal Description: Aspen Highlands #1 B1 L10
This is a request to renew the permit for the above mentioned lot. All site conditions remain the same.
The construction still will not affect the health, safety, or development of the surrounding lots.
Sincerely,
SRP
Steven R. Pannone, PE, F. ASCE
Owner/Civil Engineer
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231404, Curtis Townsend, 12/01/23
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 Wastewater Disposal System Permit
Permit Number: OSP221251
Work Type: Septic Upgrade
Tax Code Number: 01701321000
Site Legal Address: ASPEN HIGHLANDS #1 BLK 1 LT 10 G:2840
Site Mailing Address: 13101 HILLSIDE DR, Anchorage
Owner: RICHMOND KENNETH A
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date:
menr
v f`
U r^
Department
Lot Size in Sq Ft:
Total Bedrooms:
11/30/2022
11/30/2023
36750
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
1y Special Provisions:
• Registered Land Surveyor to mark the radius of the well on Lot 8 prior to construction.
i'
-P&.Geived-By: 5
Issued By:
Date:
Date: / Z
5
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. 017-013-21
Property owner(s) Ken Richmond
Mailing address 13101 Hillside Drive, Ancho
Site address Same
Day phone
e AK, 99516
Legal description (Sub's., Block & Lot) Aspen Highlands #1 131 L10
Legal description (Township, Range & Section)
Lot Size 36,750 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS -AN: TYPE OF DWELLING:
(® all that apply)
Absorption FieldX❑
Initial ❑ Single Family (SF) X❑
Septic Tank X❑
Upgrade X❑ (w/wo AD U)
Holding Tank El
❑
(D) Renewal ❑
Renewal
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
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.
ignature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: 7 2 (7 2 Date of Payment:
Receipt Number: Receipt Number:
Permit No. os _ ] ) 5 Waiver No.
Permit App__- : ._..:c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221251, Deb Wockenfuss, 11/30/22
PANNONE ENG SVC, LLC (C.I. 1088)N
S
EW J.R.LAWENDOWSKI JRCE-148976REGISTEREDP ROFESSIONALENGINEERJoseph R Lawendowski Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221251, Deb Wockenfuss, 11/30/22
PANNONE ENG SVC, LLC (C.I. 1088)COMMENTS: Test hole excavated by OWNER.
PERFORMED BY: MITCHELL MOHR. I CERTIFY THAT THIS TEST
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL
GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
·8.8 (min/inch)
·6"
·3 FT AND 4 FT
SOILS LOG
INSTALL NEW 1500g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM.
15 FEET
15 FEET
J.R.LAWENDOWSKI JRCE-148976REGISTEREDP ROFESSIONALE NGINEERJoseph R Lawendowski Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221251, Deb Wockenfuss, 11/30/22
J U; ' 10 -, I 14.67(? vie, d mP
�U!'24'60 /42' PA
v
MUNICIPALITY OF ANCHORAGE
rnew ssjvic
On. -Site
.er -Se-cqjor, Phone: 9V-343-7904
Fax 907-343-7997
Well Df*"'j)39 POrInit Number., PL'mp Installation Log.
hirrel %,Urnb oflssue.- 4`0
er:
Legal Ded
cription
Block Lot
F provc-flly Owner Name &
cc)
)
IYA�;tallatlorjD 7 - Ak
P'JMP lUbim; Depth Beloly as
A
feet
Pump Size.
Adapter 1jurial Depth:
feet.
Pitless Adaptel. 11,04,11'er:
!Vveil DjS!jjfecx,�'d
, ljpork
Al"Abod of M'dafertion.- G No
PUMP jusfaller
ANCHORAGE WELL & rUM P SERtjcr:
7640 Stree-
Anchcirage—AK 9?513
PH: (9071 24,34--14o
4aEjing Addrits
State:
12
eta reap i,2stat_ e.
10� tc- t341-3ite within 39 days
C..fPumqn "istaliwiOn.
oGREA
~,NCHORAGE AREA B0Rf
Department of EnvironmentsI Qualitv
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAM~'I \ / ,~ I e u'~'Ul ~' MAILING ADDRESS
LOCAT,ON * LEGAL DESCR,PTION
PHONE
SEPTIC TANK:
DISTANCE
FROM WELL I~_~t MANUFACTURER ¢(~145~'~ MATERIAL
INSIDE LENGTH INSIDE WIDTH. LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY !'~"0~ GALLONS.
. . .'¢. u.c
TOTAL LENGTH
DISTANCE FROM WELL
NEAREST LOT LINE_ I.O/ _OF LINES
NUMBER OF LINES ~ . DISTANC.~ BETWEEN LINES ~ TRENCH WIDTH.~(,c::;IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE - MATERIAL BENEATH TILE-~'l ~¢~ kl~. ABOVE TILE IN.
WELL:
TYPE_ C( ~" I('e'~ CONSTRUCTION
.DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION .... LOT LINE~, SEWER LINE ~, TANK I~'L~(, SYSTEM~
CESSPOOL
, OTHER SOURCES
APPROVED-
DISAPPROVED
REMARKS
DISTANCES:
INSTALLED BY:- ~'~ ~'~-
a~/
SEWER LINE DEPTH: , "~ ~'
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE ~'~ /I'I /"Z~'-"APPROVED ____
G.A.A.B.
Form EQ-032
~'1-W DRILLING, Inc.
P. O. Box 4-1224 · 1310C International Airport Road
(907) 274-461]
ANCHORAGE, ALASKA 99509
Well Owner hJi 11 i am
Location (address of:
LIO~ Blk 1 ~
~-)iemens
DRILLING LOG
Use of Well ~ ~ ' ~ I
Township, Range, Section, if known; or distance main road
Aspen Highlands
Size of casing 6" Depth of Hole 715 feet Cased to 214,3 feet
Static water level 180 ft. (~q~g) (below) land surface. Finish of well (check one)
Screen ( ); Perforated ( ).
open end ( - );
Describe screen or t
Well pumping test (I~U~)
of drawdown from static
Date of completion 26 Aua-: 19'75 I ~
(minute) for 1 hours with
ft.
Depth in feet from
ground surface
0 .TO 25
2.5 .TO 35
35 .TO 69
:;9 .TO 79
79 TO 98
9a TO .].02
___lOt_TO 106
'l 06 TO P. O0
WELL LOG
; of formations penetrated, size of material, color and hardness
~'1 reed, ravel ,Occasional
~tl ~raVel, loose' & cavin9
cobbles
210 .TO 215
TO
.TO
__.TO
Water Gravel
.TO
.TO
2 -- STATE
GREATER ANCHORAGE AREA BOROUGH 3 .' ~).~NO/O/~
DEFARTMENTOF ENVIRONMENTAL QUALITY 7__~.,7~
3330 "C" STREET ANCHORAGE, ALASKA 99503 ~ ~k
S[WAG[ DISPOSAL SYST[M ~ APPLICATION AHD P[RMIT
,.STALLAT,O. LOCAT,O.
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT . DRAIN FIELD OTHER
TYP~ AND ~IZE OF FA~I~ITY TO ~E GKRVED ../
FI~ANGEp THROUGH TO BE INSTALLED BY
~/ ~ ~ t~ / ~ NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
SOIL TEST RESULTS
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO S~-Z.~A:Z P:,~ ~ O ~
SEPTIC TANK TO '~EEPAGE PIT WALL
, DRAIN FIELD
SEPTIC TANK , SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /~ ~ f
DRAIN FIELD f?~O /
WATER MA,N TO SEPT,CTANK /O /
DRAIN
SEEPAGE PiT
SEEPAGE PiT g/'~")~ ~'
, , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFOR~ TO BOROUGH REGULATIONS REGARDING INSTALLATION.
~IC~NS~D D~SIGN~
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. //~ (
1210'
T.H. No. 1
5-6-75
Organics
Organic Silt
Silty Sandy Gravel
Silty Sand w/Some Gravel
(SM) ~ ~--~
Sandy Gravel
Trace Silt (SW)
0.0~
1.0I
.2.0'
· --4 .'0 '
6.0'
13.0'
Note: Test Hole Excavated With Tractor
Mounted Backhoe
Log Represents
Lot 10 Block 1
Aspen Subdivision
Engineering I& Geologic(~l Consultants Inc.
ANCHORAGE FAIRBANKS ALASKA .,U.EAU
William Siemens Property
Log of Test Hole
Anchorage, Alaska
•
• .� Municipality of Anchorage
On-Site Water and Wastewater Program 1111ati,
(907) 343-7904 S A r E T T
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-013-21._ Expiration Date: 17\-0 l ---lE
1. GENERAL INFORMATION
Complete legal description _ASPEN HIGHLANDS #1 BLK 1 LT 10
Location (site address) _13101 HILLSIDE DR ANCH. AK
Current Property owner(s) TONY BROOKS Day phone
Mailing address _SAME
Real Estate Agent Day phone
,0, 56789
2. TYPE OF DWELLING: \� ;r low
® Single Family (w/wo ADU) Q� S' p�''.":%•": •i N
E Duplex . ,
.1 2018
❑ Multiple Dwellings (Single Family and/or Duplex) c
3. NUMBER OF BEDROOMS: IP.'
E�'�
8L 997
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ® Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 9{/./
COSA to be released to the engineer,unless otherwise requested by the engineer.
EINIENIMIRIENVEr
COSA Fee $ 5'060 Waiver Fee $
Date of Payment q/io'Z/`' Date of Payment
Receipt Number 4aq.9-LPI Receipt Number
COSA# O Crg - - Waiver#
•
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm MIKE N ANDERSON,P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON,PE Date 9/12/18
6. DSD SIGNATURE ` " GJ1'%J °
/]zJ System #1 Approved for bedrooms. i` : MICHAEL N. ,NI:IP.c.;:
•System #2 Approved for bedrooms. (('r C 9469
Disapproved. l ,t�°P/'^r Zr
-}1-' +yr
Conditional approval for bedrooms, with the following,stipulations:
ON RAD ��
MATE SER o;
�SEWA
/cc) PROGRAM
/911: se".
• Original Certificate Date: `("� L�—� 7
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other •
COSA blue sheet_10-10-12.doc
. If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: ASPEN HIGI-ILANDS #1 BLK 1 LT 10, Parcel ID:_017-013-21
A. WELL DATA_
Well type PRIVATE If A, B, or C provide PWSID# Well Log (YIN) YES
Date completed 8-26.75 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 215 ft. Cased to 215 ft. Casing height (above ground) 24
FROM WELL LOG AT INSPECTION
Date of test 8.26.75 9.6.18
Static water level 200 ft. 181 ft.
Well production 2 g.p.m. 4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate U 5 mg/L
Arsenic: ND ug/L Date of sample: 9-6.18 Collected by: MNA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material FIBERGLASS Date installed 7.17-75
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N)Y Depression over tank (YIN) N High water alarm (Y/N) N
Date of pumping `t►JS � Pumper /t-
C.
C. ABSORPTION FIELD DATA—1985 SYSTEM TESTED
Date installed 7-17-75 Soil rating (SF/BED) 125 System type DEEP TRENCH
Length 152 ft. Width 3.0 ft. Gravel below pipe 2.5 ft.
Total depth 10-12 ft. Eff. absorption area 684 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9-6-18 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added 800+gal. new depth 0 in.
Elapsed Time: 60 min. Final fluid depth 0 in. Absorption rate >=_800g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES COMM.WATER
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main Nrflt r00 '4 Public sewer manhole/cleanout /(9drt'
Sewer/septic service line 25'+ Holding tank 4Q c 100 f
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 10'+ Absorption field 5'
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
COMMENTS "
Akli
•
de' * • 49TH �W
G. ENGINEER'S CERTIFICATION / 4114/7f,+
I certify that I have determined through field inspections and r A;MICHAEL N. ANDERSCN ;4
review of Municipal records that the above systems are in ��f'•• CE 94 9
conformance with MOA COSA guidelines in effect on this date. +f�qi,:••••qJ �.•���o� �
k,
PRUyf s 1U11"tip-"'
Engineer's Printed Name MIKE N. ANDERSON,PE \�eo��s�
Date 9/12/2018
COSA canary sheet 2-6-15.doc
MUNICIPALITY OF ANCHORAGE
i •
DEVELOPMENT SERVICES DEPARTMENT • 907-343-7904
On-Site Water and Wastewater Section ` ` I Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181478
Subdivision: Aspen Highlands #1, Block: 1, Lot: 10
A water sample revealed a nitrate concentration of 6.75 milligrams per liter (mg/L).
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.
Mailing Address: P.0.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
Municipality of Anchorage
Development serVices DePartment-
Bulldlng Safety Division
On-Site Water & Wastewate~' Program, ' :'*" ..'.
4700 South Bragaw St ' *
P.O. Box 196650 A~choragel AK 99519-8650
,' wWW.cLanchorage.alCus
~*- '(9o7)
CERTIFICATE OF HEALTH AU I--iORITY. APPRo Li.. FOR A'SiNGL'E' FAHILY"DWELLING" ·
Parcel I.D.. 017-013-21
'1. GENERAL INFORMATION
Explration DatE:*'"' ~",- I - O /
Completelegaldescription ASPEN HIGHLANDS SUBDIVISION; LOT 10, BLOCK 1,'.
Location (site addmss or dire~ons) -13101 HILLSIOE DRIVE ANCHORABE,-AK,99516.
ALANNA UHLER
13101 HILLSIDE DRIVE
Dayph~ne..* 349-7485
ANCHORAGE, AK 99516 ' ~
Daypho~o .....
KEN McKEAN w/-REMAX Da~phone '':276-2761
26~0 CORDOVA.'ANCHORAGE, AK 99503
Current Property owner(s)
Mailing address
Lendtng agency
Mailing'address '
Real Estate Agent
Mailing address
Unless othenvtse requested, HAA wi#be held by DSD for plckup.
2..,NUMBEI~ OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
~ Individual Well
· Individual Water Storage
Community Class Well
Public Water System
5
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding tank
Community On-site
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. 'Cer'dficates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a slngle family on-site wastawater 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 er Class C well and may
be reissued with new water sample results less than 30 days old. (Ce~ficates may be reissued for a period of
up to one year with valid water samples.) CedJlicates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the
professional engineer's work.
Note:Alaska Watar and Wastewater Consultants, Inc. shall be pald $1,0OO. OO at, or prior
to closing for the engineering services provided. '
4. STATEMENT OF INSPECTION BY ENGINEER
As cert~ed by my seal affixed hereto and as of the velidab'on date shown below, I vedfy that my
Investigation, based on procedures outlined in the Health Authofi~y Approval Guidelines for this application,
shows that the on-site water supp~/ and/or wsstewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and %ype of structure Indicated herein. I further verify that based on the
information obtained from the Municlpolify of Anchorage files and from my invesb'gation and inspection, the
on-site water supp~/ and/or wastewater disi~osal system is(are) in compliance ~th all applicable Municipal
and State codes, ordinances, and ~egulations in effect at th~ time of installation.
Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone
Address 6901 DEBAR~'ROAD, SUITE 28 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this evalua§on, AWW~, Inc. attempted to provide a thorough,
consclen§cus engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Rngulations. The reported results desctibed the performance o! the
system under tho cond~ons encountered at tho t/me of tho test, and separation
distances measured to readily ldentifiable features. Tho uporational life of all wells and
septic systems depend on the Iocal so~?s condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by ~e sTstern.
These conditions are ex,side the conb'ol of the evaluater of the sTstem. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee %hat
there are no hidden defects or encroachments. AWWC, Inc. can therefore not
any watrenty or futuro eslimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report IS for
the sole benefit of the owner listed above. Any reliance upon or use of this reporf by any
other person or pan~ Is not authorized, nor will It confer any legal tight whatsoever.
5. DSD SIGNATURE
[// Approved for ~'"' bedrooms.
Disapproved.
Conditional approval for .~
~'~.;. ON-SITE
~: WATER AND :
b~ ~h*he ~l~in~ s~ulati~s' ~ WASTEWATER :
.................... '~ ~ ~' ~, PROG~M
,
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
d.//- ,/
Odginal Certificate Date:
Municipality of Anchorage
Development Sewices Department
On-,Site Wa~er & W~stewlller Pro~ram
Legal D~Crll~on:
HEALTH AUTHORITY APPROVAL CHECKLIST
ASPEN HIGHLANBS S/D; LOT 1Of BLOCK If PamellD: 017-013-21
A. WELL DATA
Welltype PRIVATE IfA, B, orCprovidePW~lD# N/A Wall Lng (Y/N). YES
Date completed 8/26/75 Sanltmy seal (Y/N) YES W1rae propedy protected (Y/N) YES
Totaldepth 215 It. Casedto 214,.3 ft. Caslnghalght(abevegmund) 12+ In.
FROM WELL LOG AT INSPECTION
Date of test 8/1975 2/15/01
Stafic water level 180 ft. 185' .ft.
Well pmducfion 8 g.p.m. 5.05 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/lO0 mi. Nllrate 2.69 mgJL.
Date of eample: 2/15/01 Collected by:
D. SEPTIC/NOM)IN6 TANK DATA
Tank Type/Material FIBERGLASS
Tank size 1500 gal. Number of Comperlmente 1
Foundation cleanout (Y/N) YES Depmsalon over lank (Y/N) NO
Date of pumping 10/30/2000 Pumper.
Soil rating (g.p.dJlt~oK~) 125
WldU1 3
C. ABSORPTION FIELD DATA
Date Installed 7/17/75
Length 152 It.
Other bectefla 0 colonlesJlO0 mi.
AWWC~ INC.
Date installed 7/17/75
Cleanouts (Y/N) YES
High water alarm (Y/N) N/^
ROTO ROOTER
Total depffi ~ft. Eft. absorpfion area 684 It= Monitoring tube YES
Date of edequacy test 2/15/01 Resulte (Pass/Fall) PASS
Ralddep~inabsorpflonfieldbefomtest 17 In. Water added1011gal.
Elapsed Time: 1381 min. Final fiuld depffi 17 In. Absorption rate >=
Any mjuvenafion Iraalment (past 12 mo,) (Y/N & type) NONE KNOWN,
System type TRENCH
Gravel below pipe 2.5 lt.
Depression over field. NO
For 5 bedrooms
New depth 20 In.
750+ g.p.d.
ff ~s, give date -
D. UFT ~'FATION ~
Data Installed Size In gallons ~
· Pump on. i~gh watar,larm _level a.t in.
Cycles tested Meets alarm & circuit requlmmenta?
F... SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
SeplJo tank/lift statlon on lot. 100'+
Absorpfion field on lot 100'+
Public ~ewer main
Sewer Iseptlc esndce line 25'+
On adjacent lota~ 100'+
On adjacent lots. 100'+
Publlo sewer manhola/desnout
Holdlng tank N/A
Building foundation 5'+ Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent Iota 100'+
SEPARATION OISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+
Water esndce line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
F. COMMENTS
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field.
5'+
Surface water, lOO'+
Water main. 10'+
Dttveway, parldng/vehlcle storage 5o'+
G. ENGINEER'S CERTIFICATION
I cerUfy that I have determined through field inspecfions end
review of Municipal records that the ebove systems are in
conformance wfth MOA HAA guidelines in effect on this dale.
Englnes eP,ntac, Nanp. jEmmer ,. CaR, S
HAA FenS
Date of Payment
Receipt Number
(Rev.
Waiver Fee $
Date of Payment
Receipt Number
LO1' 11
~ N 89'51'50" W f ..... .
50'
o I re<em mu~ 26.2'
50'
N 89'51'~" W 24~.00'
LOT 9 LOT 8 LOT 7
(RECERTIFIED) ~al~ O
MUNICIPALITY Of ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
017-0'13-21 HAA # ~ ~ ~I ~ ~'~ 1 ~-%
GENERAL INFORMATION
Complete legal description
L°~~ 10,' Block 1, Aspen Highlands No. 1
Location (site address or directions) 13101 Hillside Drive '
Property owner
Mailing address
Lending agency
Mailin. g address
Agent
Address
Raymond and Stephanie Woods Day phone 348-0105
13101 ~] ]sid~ Dr~ve An~h~raq~: AK 995]6
Day phone
,Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Five (5)'~
TYPE OF WATER SUPPLY:
NOTE:
Individual well ~
Community well
Public water
If community well system, provide written confirmation from State ADEC attest'-
ing to the legality and status of system.
4. ~'YPE OF WASTEWATER DISPOSAL:
'NOTE:
Individual on-site ~-~
- Holding tank
Community on-site
Public Sewer
If C ommunity~wastewater system, provide written confirmation from State ADEC
attesting to the legalitY and status of system.
72-025(Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm A~r~,~r.~.,~ ~,~g~,~,m-~ ~g Phone 522-7773
Address p_~. p~Y ?Z[F~77q Anchnr_~ge; _~Z 99524
Engineer's signature %~~ ~ ~
Date 4/26/99
DHHS
SIGNATURE
Approved for /c"'/~/,~_.
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional 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 instituti0ns!n order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or'analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for erro.~.~or omissions in the Professional engineer's work.
72-025(Rev. 1/91) Back MOA#21
Municipality of Anchorage R F C £1V E D
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division APR 2. 8 ~999
825 L Street, Room 502 · Anchorage, Alaska 99501 · (.9.07) 343.747.4..4 ........
Municipality ol ~.c~ua.x~
CheckllaDept't Health & Human Services
Health
Authority
Approval
Legal Description:
A. WELL DATA-
Well type Private
Log present (Y/N) Y
Total depth 215 '
Sanitary seal (Y/N)
Lot 10, Block 1, Aspen Highlands
NO. 1
Parcel I;D.: 017-013-21
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 8/26/75
Cased to 214.3 ' Casing height (above ground)
Y Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
8/75 4/22/99
180 ' 179 '
8 g.p.m. 5.6
Nitrate
~ 67 mt~r~/T- Other bacteria 0
Collected by: Tim Kimbrough
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 4 / 2 2 / 9 9
B. SEPTIC/HOLDING TANK DATA
7/17/75 Tanksize 1,500 Number of Compartments 1
Depre~ion (Y/N) N
High water alarm (Y/N).
Date installed
Foundation cleanout (Y/N) Y
Date of Pumping 11/.24/98 Pumper Roto Rooter
2I
C. ABSORPTION FIELD DATA '
.g.p.m,
Peroxide treatment (past 12 months) (Y/H) N
72-026 (Rev. 3/96)*
, If yes, give date . N/A
Fluid depth 0 (ins) Minutes later: 120 Absorption rate = GT 750 q.p.d.
bedrooms
Data installed 7/17/75, ' Soil rating (g.p.dJft~ or fWbdrm) 125 SF
Length 152 ' Width 3 ' Gravel thickness below pipe 2.5 ' Total depth 5'
Effective absorption area ' 76.0,'S~ Monitoring Tube present (Y/N) Y Depression over field (Y/N)
Date of adequacy test 4/22/~99 Results (Pass/Fail) Pass For Five
Fluid depth in absorption fieldbefore test (in.); 0 Immediately after988 gal. water added (in,):
. System type Deep Trench
- 8~
N
Cleanouts (Y/N) Y
N
D. LIFT STATION None on lot
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
F.
Septic/holding tank on lot C-T 100'
Absorption field on lot C-T 100 '
Public sewer main N/A
Sewer/septic service line Gl" 25 '
Size in gallons
"Pump on" level at*
*Datum
On adjacent lots C-l" 100 '
On adjacent lots Gl" 100 '
Public sewer manhole/cleanout
Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
"Pump off" level at*
Waiver Fee $
Date of Payment
Receipt Number
HAA Fee $ ?ht~_.
Date of Payment
Receipt Number (l~)~Cl~
72-026 (Rev. 3/96)*
I certify that i have determined thru field inspections and review of Municipal record__~~ .systems are
in conformance with MOA BAA guidelines in effect on this date.
Signature 7'1" --- --- - (_~
Ennineer's Name Mic13ael E. Anderson, P.E.
Date, 4/:2-7/99
Surface water GT 100 '
Curtain drain None Observed on lot_
ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area Gl" 5'
Wells on adjacent lots GT 100 '
Water main/service line G~ 10'
Foundation Gl" 5 ' Property line GT ,5 '
Water main/service line Gl" 10 ' .Surface water/drainageGT 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line GT 10 ' Building foundation GT 10 '
Absorption field. Gl" 5 '
Wells on adjacent lots .Gl" 100'
N/A
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
'~/7- ~:)/.~ - ~/ NAA# ~'~C)&[O~I
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lenc~ing agency
Mailing address.
Agent ~f~o u¢1"
Day phone
Day phone
Address "'~'~'Z-~' ~ ~'I'F,~-~'/
Unless othe~ise requested,'HAA will be held for pickup.
:~:.::~:~PE OF WATER SUPPLY: ~.~.
Individual well 'X~ ~- :; ~,,~,,,
..... - . ' Community well '
..... pUblic water . . ' _~'_,
NOTE: If community well system, provide written confirmation from State-~D~C atteS~-
. lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
............. . . ..: '. * ~ ?~:.'(~-zm~,
" : '* Hoidingtank ... -
-. Community on-site "~:
Public sewer
.... :,.-,
NOTE: If community wastewater system, provide written confirmation from State
attesting to the legali~ and status of system.
72-025 (Rev. 1191) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm .~13;;;~.5;o,J ~C-,,~/.,/,J~Z,-'TC~,~C, Phone
Address PO
Engineer's signature ~ ~-- ~ Date
6. DHHS SIGNATURE
'~" App;oved for -~ 0~- ~- 5~)
:"¥" "Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the foll(~wing stipulations:
Date ////~/~ f'"~'
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. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.O25(Rev. 1/91) I~ack MOAf/21
Municipality of Anchorage
E
D
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (90~-47~4199§
Mw~c~p~hiy ut Anchorage
Dept, Health & Human Services
Health Authority Approval Checklist
Legal Description: /..o-r lO, l~coe.,t~.l. ,45,*ox1 /4tl, Ot.~S Parcel I.D.:
<~os~v~s~o~ Mo. I
A. WELL DATA
013-
Well type T~IZI~//l-T'~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Y Date completed
2.lb- / Cased to ZI~,
Y
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
FROM WELL LOG
lbo~
I
Casing height (above ground)
Wires properly protected (Y/N) Y
AT INSPECTION
t
g.p.m. ~,,/, i g.p.m.
Nitrate ~.. ~/a t49 ] L... Other bacteria
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed ?/7/?5 Tank size
Foundation cleanout (Y/N) Y
Date of Pumping ///?/q~'
ABSORPTION FIELD DATA
Date installed
Length /~ 2_t Width
Collected by: ~. //~ R~ g-,4
/~ fiDO Number of Compartments [ Cleanouts (Y/N)
Depression (Y/N) /K/ High water alarm (Y/N)
Soil rating (g.p.d./fi: or ft2podrm) iZ-~:~ 5F' System type
Effective absorption area ~ g5 ~ $~'
Date of adequacy test I~J
Gravel thickness below pipe Z. ~ tTotal depth ~' trO ~ t
Monitoring Tube present(Y/N) Y Depression over field (Y/N) /~
Results (Pass/Fail) ~/~$ For ~"!~o~' bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth '7. ~ o Minutes later: /$L~
Peroxide treatment (past 12 months) (Y/N)
7, ~" Immediately after~$5"gal, water added (in.):
(in3 Absorption rate = >' 75>"O .g.p.d.
/~h] If yes, give date /~//~
D. LllVr STATION
Date installed
Manhole/Access (Y/N)
Size in gallons
High water alarm level at*
"Pump on" level at*
"Pump off" level at*
Cycles tested
*Datum
E. SEPARATION DISTANCES
Fe
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation ,,~ 2. ! Property line O~ ~ t
Absorption field
Water main/service line ~ ~q? ~ Surface water/drainage ~'! t}t) t Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION HELD ON LOT TO:
Building foundation
Surface water
Curtain drain
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots
ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review of Municipal recor~ ~"at thg above
in conformance with MOA H~ guidelines in effect on this date..
Engineer's Name MI~ ~ ~0~
Date
HAA Fee $ ~('~0,
Date of Payment ~('~
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 10; Block 1; Aspen Highlands Subdivision~
Location (address or directions)
13101 Hillside Drive, Anchoraqe, Alaska
(b) Property owner Penn Holsapple Telephone'(home) 345-1360 Business
Mailing Address 13101 Hillside'Drive, ~ncho'ra~e, Ala's~a 99516
(c) Lending Institution City Mortgage
Telephone
Mailing Address ATTENTION: Mike Funell
(d) RealEstate Company and Agent CENTURY 21, PACIFIC NORTH/Nancy
Address 1120 Huffman, Anchorage, Alaska 99515
345-1444 (Mobile - 229-5238)
Telephone
(e) Mail the HAA to the following address: (or check here [], if hold for pick UP.) '
List contact person and day phone number below:
S & S ENGINEERING/694-2979 "'
17034 Eagle River Loop Road, Suite 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Number of bedrooms 5
Single-Family [~
3. WATER SUPPLY
Individual Well ~:
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
c0ns'~r'~ation attesti'ng't~0':th'iegality and status. · : ..... .... ...~ · ~ ....
4.' SEWAGE DISPOSAL.
On-site [~ Public [] Community [] Holding Tank []
NOte: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status,
72-025 (Rev. 7/88) Page 1 of 2
o
Name of Firm
Address
Date
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functiona .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.
Telephone
17034 Eagle River Loop Road No. 204
6. DHHS APPROVAL
Approved for ,_/~" bedrooms by
Approved /,._.~ Disapproved
Terms of Conditional Approval
Conditional
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
Well Log Present (Y/N) ~ Date Completed 6- ~/~- .'~'
Total Depth 2 ~ ~' Cased to .~t/~, ~ Depth of Grouting
Static Water Level
Casing Height Above Ground
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,~J //~
£
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Legal Description: ,L.a? ! O i L2:;)l°c"~/ --~ ':
If A, B, C, D.E.C. Approved (Y/N) 4/
!
Comments
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
/ 'z Jr ~ / ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
/
OO '~
B. SEPTIC/HOLDING TANK DATA
Date Installed -'~'! ~'~Size
Standpipes (Y/N) ~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~
I ~-OO,~ ~ I No. of Compartments
Air-tight Caps (Y/N)
cI Foundation Cleanout (Y/N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N) ~/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well
To Property Line
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
!
'1-
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed "~
Width of Field
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
.~ Gravel Bed Thickness ~~
'~ Statndpipes Present (Y/N)
/~.) Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation "'~ ~--
Lot A)/IA
/
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
~ ~' ' To Property Line
To Existing or Abandoned System on
; On Adjoining Lots _'~O ' '~
To Cutback (if present) /,-) / ~
Comments
D. LIFT STATION
Date Installed "~
Size in Gallons
"Pump On" Level at ~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
inspection.
Signed
Company
Date
MOA No.
Tn~, ~-~r, lc~. P. iv~r Loop Road Ne
River, Alaska 9957~
Receipt No. ~"'-'~' ?~~~
Date of Payment' ~/~/~/~//
Amount: $ //7~:2, -'/~--
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
April 15, 1991
Mr. Kenneth W. Canfield, P.E.
13101 Hillside Drive
Anchorage, Alaska 99516
WALTER J. HICKEL, GOVERNOR
563-6775
.RECEIVED
APR 1 6 1991
Municipality of Anchorage
Dept, Health & Human Serv_io~
RE:
Lot 10, Block 1, Aspen Highlands Subdivision, Anchorage, Alaska, ADEC Project
Number 9121-DW-046 and 9121-WW-059; Review
Dear Mr. Canfield:
This is in response to your submittal, received in this office on April 11, 1991, in
which you requested a letter of approval for the public water and wastewater disposal
systems serving the single family home which will be upgraded to a Bed and Breakfast.
The submittal also requested a waiver for the separation distance between the existing
source well and septic tank of 129 feet and the source well and the soil absorption system
of 146 feet. I have completed my review of the submitted information and have the
following comments.
Based on the submitted information, it appears that the existing public water system
was installed in compliance with the applicable State Regulations at the time of installation.
With the upgrade of the water system from a private to public water system due to the
change to a Bed and Breakfast, there is the separation distance problems that is noted
in your submittal. Since there will not be an increase in the peak flow demand placed on
the existing water and wastewater disposal systems resulting in the change and the
analytical results for Total Coliform Bacteria and Nitrate (as nitrogen) returned satisfactory,
the Class C Public Water System is approved for the concerns of this Department. A Final
Operation Certificate, constituting this approval, is enclosed for the existing Class C Public
Water System.
As a result of my review of the submitted information which includes the fact that
there will not be an increase in the peak flow demand placed on the existing water system
and in the volume discharged to the existing wastewater disposal system, Department has
found the information provided to be satisfactory for allowing a waiver in accordance with
18 AAC 72.035, State Wastewater Disposal Regulations.
The separation distance between the existing Class C Public Water System Source
Well and the existing septic tank has been waived from 150 feet to 124 feet. In addition
the separation distance between the existing Class C Public Water System Source Well
and the existing soil absorption system from 150 feet to 146 feet.
This waiver will remain valid as long as semi-annual analytical results for Total
Coliform Bacteria and Nitrate (as nitrogen) are submitted to this Department. It is
recommended that the samples are collected during May and October of each year.
Any changes to the existing public water system or the discharge volume increases
above that of a~o bedroom Bed and Breakfast and affhree bedroom single family
residence will invalidate this waiver.
Due to the monitoring requirements of the waiver, the following Public Water
System Identification (PWSID) Number is assigned to this Public Water System, 217005.
Please remember that the PWSID Number assigned to your public water system will need
to be on all analytical data submitted to this Department so that the waiver will remain
valid and the results will be properly filed.
In regards to the existing wastewater disposal system, it appears that the system
was installed substantially in accordance with State regulations and guidelines at the time.
The results of the recent adequacy test, also verifies that on the day of the adequacy test
was performed, the wastewater disposal system was accepting the necessary flows. In
addition, there will not be an increase in the volume of wastewater being treated and
disposed by the existing wastewater disposal system due to the change from a single
family residence to a bed and breakfast.
Therefore, the wastewater disposal system is also approved for the concerns of this
Department. The enclosed signed "Approval of On-Site Residential Water and Sewer
Systems" constituting this approval, is enclosed for the existing wastewater disposal
system.
Thank you for your cooperation with this Department. If you have any questions,
please do not hesitate to contact me.
Sincerely,
Keven K. Kleweno
Environmental Engineer
Enclosure: As Stated
cc: John Smith, DHHS, w/o Enc.
KKK/skpf
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received December 29, 1975
Time of Inspection /Z])J~) ~)/7~
Date of Inspection~_j.
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Conv.
1. Approval requested by:
Mailing Address:
Phone:
2. Property Owner: William Siemens
Phone: $49-2290
Mailing Address:
3. Legal Description: Lot 10 Block 1 Aspen Highlands Unit 91
Location: Hillside Drive and De Armoun Road
Type of facility to be inspected single family
No. of bedrooms~~5~ .
Well Data: Ind~,dqa~l
A. Type .~~)~////~ B. Depth '14'
C. Construction D. Bacterial Analysis
Sewage Disposal System: On-site system.~~7~(
A. Installed 1975 B. Installer
C. Septic Tank: 1. Size
2. Manufacturer
D. Seepage Pit: 1. Absorption Area
2. Material
E. Disposal Field: Total length of lines
8, Distances:
A. Well to: Septic tank
, Absorption area
,, Sewer Lines ...... ,
Nearest lot line
, Other contamination
B. Foundation to septic tank
, ~Absorption area
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
'GREATER ANCHORAGE ARt:,~, BOROUGH
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 -
~qO~£DBIO~d I¥1NaYINO~IAN~
REQUEST FOR APPROVAL OF ~HI~WH JolNawi~vaa~
INDIVIDUAL SEWER & WATER FACILiTI~oH~NvJoxmvao~Nnvt
1. Type of Inspection: CMRO Vg. FHA CONV ~><
2. Prope'rty Owner: ,y~~~ ~]~q~~
Mailing Address:
3. Name of Buyer:
Mailing Address:
4. Name of Lending Institution:
Das Phone
/~~7~ Mailing Address: Phone
5. Name of Realtor or Agent:
Mailing Address: ~_~,~J~2
7. Type of Facility to be inspected:
8.
No. Bdrms.
Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well ~>~/~ ~
Sewage Disposal. System
Type ~.of S~stem: Public Utility
If Individual, date of installation
Individual (on-site)
Page 2 of two pages - R( ~st for Approval of Individual 'er & Water Facilities
Legal Description Lot 10 Block 1 Aspen Highlands Unit
Comments ~:.' .' ' '~ : '~ '~'~
Approved Disapproved Date /- ~-?~
Ap~al Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)