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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 4Hillside Park Lot 4 #015-122-47 MUNICIPALITY OF ANCHORAGE 'L11ent On -Site Water & Wastewater Program `o So PO Box 196650 4700 Elmore Road r Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Urparcment On -Site Wastewater Disposal System Permit Permit Number: OSP231353 Effective Date: 10/17/2023 Work Type: SepticTank Upgrade Expiration Date: 10/16/2024 Tax Code Number: 01512247000 Site Legal Address: HILLSIDE PARK PUD LT 4 G:2539 Site Mailing Address: 7141 TREE TOP CIR, Anchorage Owner: SIEGEL SEAN C & ERIKA L Lot Size in Sq Ft: 34703 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ 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 Wil: n� 5 5 c, e c to Issued By: fit/ Date: Date:7� 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. 015-122-47 Property owner(s) Sean Siegel Mailing address 7141 Tree Top Circle, Anchorage, AK 99507 Site address 7141 Tree Top Circle, Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Hillside Park PUD, Lot 4 Day phone (907) 258-0165 Legal description (Township, Range & Section) Lot Size 34,703 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank El Renewal❑ (D) ElRenewal 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: -# 2 2 Waiver Fees: Date of Payment: /0// 3�Z 3 Date of Payment: Receipt Number: O/ 3 Z D Receipt Number: PermitNo. f 2 3 % ?,� Waiver No. Permit App_::- : October 12, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Hillside Park PUD, Lot 4 -Tree Top Circle Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with the same size designed for 4 bedrooms. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231353, Deb Wockenfuss, 10/17/23 // // // / / // // // // / / // / / // / / / / // // // // // // // // // // // // // // // // // // // Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HILLSIDE PARK PUD, LOT 4 FEET 0 50 100 NOTE: THIS LOT AND ALL OTHER LOTS IN THIS SUBDIVISION ARE ON A COMMUNITY WATER SYSTEM. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. TRE E T O P C I R C L E SEPTIC PLAN 10/12/23 EXISTING 35' LONG TRENCH TO REMAIN IN SERVICE DECOMMISSION EXISTING 1250 GAL SEPTIC TANK CO CO NEW 1,250-GAL SEPTIC TANK WITH NEW 2CO INSTALLED AFTER EXISTING WALK-OFF DECK <30" HIGH 10' CEA EASEMENT WATER SERVICE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231353, Deb Wockenfuss, 10/17/23 T R E E T O P C I R C L E ∆ Taylor L. Dosch No. 189892 R E GISTEREDPROFESSIO N A L L A N D S URVEYOR / MUNICIPALITY OF ANCHORAGE / • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE.DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEPHON??E JA), � e-� J� S�� - NEW ❑ UPGRADE MAILING ADDRESS j� N O V LEGAL DESCRIPTION / LOCATION // - %ree- NO. OF BEDROOMS U Y DISTANCE TO: Well A t- JA Absorption are / Dwelling J PERMIT NO. F Z CL F Manufacturer ,,��^^++ C 7 ree_iZ.17- Material No, of compartments y Liq. capacitL.i )gallons �S IF HOMEMADE: Inside length Width Liquid depth Y J V'Z DISTANCE TO: Well Dwelling PERMIT N0, O F Manufacturer Material Liquid capacity in. gallons IO = DISTANCE TO: Wel„�� IJ ` G�Z _ j. �r// ! 'f°fL Foundation Nearest lot I' PERMIT NO. J Y z F Z w No. of lines Length of each line Total le th of lines Trench wi th inches Distance between lines xTop 0 of tile t finish gra a �, Material beneath tile // b inches Total effective bporption area SZO Lu C7 Length Width Depth PERMIT NO. Q 1— w° Type of crib Crib diameter Crib depth Total effective absorption area w w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W i: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER �• PIPE MATERIALS Q7 -- Ph51-/ c SOIL TEST RATING' i a»• INSTALLER REMARKS i APPROVED DATE LEGAL / c� / / / / 7 .`7i 1 -g-1 / ( ! 11 �/s/ old ��^l� S6 Nn . ~ ^ PERMIT NO. ( �-IU PA 1 9--- 1 L_ I~I- Y 0 F` F FEE nco�o�mcm� / HER �4 ��m ENVIRONMENTAL 'QTECTION��'«�� ..�'°~`'' '~`~ �~� ~�~�`—�� — 825 /L' STREET, ANCHORAGE/ HK. 99501 264-4720 { C-1 r_4 t -.j E_- V-�* F=m E"Fz? M I~F /> ^~ 810688 > \�tp�E~ (��.�Cvz/0cc`J^ `s, ^] APPLICANT WINTER WISE INC LOCATI('.*iN TREETOP CIRCLE LEGAL LOT 4 f4HILLSIDE PARK SUB TYPE OF SOIL ABSORPTION SYSTEM 15 4 7400 E. 20TH AVE. 333-5877 LOT SIZE 28749 SQUARE FEE � TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 241 � THE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM IS: �E-F F --ft -T- F_='r-4 0 _F n IF - THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEL[\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL, BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). �����I���� ������ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON--SITESEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO HPRIVHTE SEWER LINE IS 25 FEET 8ND TO H COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAIL -ABLE TO INSURE PROPER INSTALLATION. �����l� E���l ��� ����������� ��" ���� I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2^ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.`� I UNDERSTAND THAT THE OM -SITE SEWER SYSTEM MAY REQUIRE ENLHRQEMEN� I� THE `--S%[>EN��� IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. W.,` APPLIISSUED WINTER WISE INC V4. 0 _� �=-����1 0 ��� r��� �������� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON--SITESEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO HPRIVHTE SEWER LINE IS 25 FEET 8ND TO H COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAIL -ABLE TO INSURE PROPER INSTALLATION. �����l� E���l ��� ����������� ��" ���� I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2^ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.`� I UNDERSTAND THAT THE OM -SITE SEWER SYSTEM MAY REQUIRE ENLHRQEMEN� I� THE `--S%[>EN��� IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. W.,` APPLIISSUED WINTER WISE INC V4. 0 _� ,r�rs' �,� � r���� r '241rAFt 7 s 6J jpFi I. # 1 f# -50 tL_ �I�i'iORP r ION SEf� r I a. 7 ■ yµ ++a_; :p �-y ,-^� yam— �y `"''' 6._-s tl S S 9 _""" ..E.-' A.� E a.., # 3 #""! "'::.,.« t^u`Y _i.. 7'.'F'R. X1 4 %. ,.... r' • t Tr S it a eHEITL N ), I,D gNv t p# NpjEN Tt--f. 1; _ r� T#� IAF" T #€�-,N oR P t T IS T 0 t 5 $r' M# LTi^a rt THE f1 tprEr, says ## F1 AND T BOTTOM 1 ° Tt CXrr#�=Ar I'JN t FrV T . r 99510-t t IS do SET 1410'rH FOR Tit`# WSJ t s rte p r F t! I t'pjN CWp Tj4 C*� 13RH rViEN rte€ OU TFFA-L $ t sti r rL #- a _ DEPTH M4-47,8 AND rte 80T Ts, M sem' TW O`XC:8VAT I ON "N ��� t �. O PERM I r 1-40_ 9 T t# s TIS L T's?N I #: T [ L+raM } i N's! i LL t= •lt +: Fir To Tti t � t'#�s jqp#'L I t"t ti i =i t r€ Tt t t' INC,1400 =? f; 3 R •cN 313 �-5s3?,� . lf LO13ATEON T?e.'E: TOP C tRs-DLE LLAT 3I ' ;?,S749 SQ#JARFE F L GFp- LOT 4 MULL'-. tib^ ,ARK :51-18r PR I YF#TF- WELl- TO !� I t�� T� }•�! L t r� t'� 25 �>� I #�r`� B'; I N I pjU" Ct I S TA�Is-P� FROM N T°ar c'`. so FL fis5s)pp r 1 --ves mji t S . TREMN TO ,;,�riMNI a'f'i�r� � i1 `PLY. #�avt�ie #�TI�r�� r�t�_ 3r€LCTit�rt t�trn�#�t� ARE ,r�rs' �,� � r���� r '241rAFt 7 s 6J jpFi I. # 1 f# -50 tL_ �I�i'iORP r ION SEf� r I a. 7 ■ yµ ++a_; :p �-y ,-^� yam— �y `"''' 6._-s tl S S 9 _""" ..E.-' A.� E a.., # 3 #""! "'::.,.« t^u`Y _i.. 7'.'F'R. X1 4 %. ,.... r' • IG �t T# L tia"a3'P� C�it'ftwtals N t^ rte' Lt_M-11TH (IN r lc --T) OF THE T?UX" OR DPAtWIF-Lo- `€JFWkX 'IF 1; _ r� T#� IAF" T #€�-,N oR P t T IS T 0 t 5 $r' M# LTi^a rt THE says ## F1 AND T BOTTOM 1 ° Tt CXrr#�=Ar I'JN t FrV T . t IS do SET 1410'rH FOR Tit`# WSJ t s rte p r F t! I t'pjN CWp Tj4 C*� 13RH rViEN rte€ OU TFFA-L $ t r rL #- a _ DEPTH AND rte 80T Ts, M sem' TW O`XC:8VAT I ON "N ��� t �. EFF ` EERM E T APPLICANT HW—i THE f SPlJ r � 18 F! l r? rs� i l Ut�t� THIS t�� r�� Tri T C�U�' I t #i THF. o t''� ANDTt�e 9 T t# s TIS L T's?N I #: T [ L+raM } i N's! i LL t= •lt +: Fir To Tti t � t'#�s r4UMER s -F PP-SIDENCei THAT THE WELL WILL -X ell MIS R Y SYS TEN W I `HOU T r L tib I NSM �� T I 13N AND i dF � F�►34ddtI. ,��#R'T#�wt4r wiLL. 3+_#s-zes�r I°I� ��r_ #:#JTY(3Na MtrMAlii OISTA IE ecrWeN R 14ELL Rr-o At4y #3M-SSITE SEWHIX 0 L' Prt's`M 73te5TEM I � r'#J� IP t=fi�I L p h�iiia`a 00 FEST F13P A P't�'I' ATE fu�LL OR V-513 ri3 200 FLEET FROM PR I YF#TF- WELl- TO !� I t�� T� }•�! L t r� t'� 25 �>� I #�r`� B'; I N I pjU" Ct I S TA�Is-P� FROM N TO ,;,�riMNI a'f'i�r� � i1 `PLY. #�avt�ie #�TI�r�� r�t�_ 3r€LCTit�rt t�trn�#�t� ARE MR4 VAILAE- TO ENS' J RO Itr r rL,r#Tia rd i s RT EFF THAI F #9 �LRs SET !F`3-�� )##ti_I k br; r- !i rsl B4 sY L'W t�iljNEs� tPf [Tse 13' is:t-ts'3�;�s t WILL rNSTFOLL THE '3Y$ TEM IN WITH TM r :.#ND8R, S rAND MAT T ON --SITE 7� t= R �'��� t�ht t•1Ay RF -la -Hl I � E r-�..Ht�j r rpt c� r m' ICit11�` r5 To LFII L# MORE THAN 4 BEORIZIOPri 4 --------------- Lam. ,.r 3 ::� �I V 8TH A��E ST�.0 /� ANUHDRAG ALASKA 98,5'03 a g l�T LAB cc 248-3'33 -> REG7RMED FOF?: Miles Fujimoto DATE _PERFORMED; July, 1981 _E A"Lk.DESCf_1f1TION:' LDt 4:. _ _ Block, Tract A Subdivision Ijillside Parr'?P.U.D. `HIS F©RM REPORTS D:Vrsuol:gollsIPXPercolation Test81-1584 r' DF PTH SOIL NOTES = EET "DESCRIPTION Y' Brown Silt Damp: 2 - Fine Fine Sand - ML - = - w ..: ,. J - ..--- -u) I -- Lj .• I �— -- – -- --. ui 8'0 _ -_ - -V Brown-Grey Gravelly Damp_ - Silt - :GM _ -=-- -- -- -- - - IL - 161 Ap— BOTTOM OF HOLE =S GROUND WATERENCOUNTERED .No a° `4971+ ® '. ®.`71. - YES, WHAT .DEPTH N/A.� Glut =GEND 3 6 67 Perc zone - Somple token -s Frozen zone pr »Gu4a�at�p�� GENERAL SITE SLOPE —, �� R01 t Woter gable =ADINGDATE GROSS TIME, " DEPTH"TO H2O NET DRAINAGE Initial 7/6/81 3:00 Primed Hole 7 7/81 8:30 - 82'-1/2" - 1 " 9:00 i " 2 9:30 .30 min. 85 2" -1 /8 3 - 10:00 -30-min. 86 8" 1 3/8 4 j 10:30 30 min. 88" 1 1/8 RCOLATION `RATE:. 27 Tin/inch.. REQUIREMENTS: 241 SF/Bedroom =:DPOSED INSTALLATION: a7 SEEPAGE PIT ' '0"{TRAIN "FIELD 0 OTHER ;MMENTS -L-T.:PERFORMED BY Kevin Braun ' DATA CERTIFIED BY: M; chaP1 Aiutex_Sen_e P r DATE: July 8, 1981 • Municipality of Anchorage On -Site Water and Wastewater Program < (907) 343-7904 =, CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-122-47 Expiration Date:.__L— 1. GENERAL INFORMATION Complete legal description HILLSIDE 4 Location (site address) 7141 TREETOP CIRCLE, ANCHORAGE AK 99507 Current Property owner(s) WEICHERT RELOCATION RESOURCES INC Day phone Mailing address Real Estate Agent 120 LONGWATER DRIVE NORWELL MA 02061 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A_ Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: /?v F el ✓ COSA to be released to the engineer, unless �,yAse equested by the engineer COSA Fee $ 5 I. Date of Payment Receipt Number O��J a i O COSA # oe'o q i oo Date: 10 /"", Waiver Fee $ Date of Payment Receipt Number 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 117/14 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future _ Off. A occupants or can ArcTerra guarantee that no unseen �� L� encroachments, deficiencies or discrepancies exist. ��'� 4 n T r{ n 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the fo FF'A r � l 3a lBy: !� . O Original Certificate Dater / / ® — / Th un' of orage 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet te-1a-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: HILLSIDE PARK PUD LOT 4 Parcel ID: 015.122.47 A. WELL DATA — CLASS A Well type A If A, B, or C provide PWSID # 212461 Well Log (YIN) Date completed Sanitary seal (YIN) Y Wires properly protected (YIN) Total depth ft. Cased to _ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: ug/L Nitrate _mg/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 1/312014 Pumper A+ C. ABSORPTION FIELD DATA Collected by: Date installed 711981 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 711981 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 System type DEEP TRENCH Length 35 ft. Width 4 ft. Gravel below pipe 8 ft. Total depth 14.6 ft. (Measured 1/4114) Eff. absorption area 560 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1/6/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 880 gal. New depth 32 in. Elapsed Time: 660 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 54 Property line 5'+ Absorption field 54 Water main 10'+ Water service line 104 Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main 104 Water Service line 104 Surface water, 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 200'+ F. COMMENTS Vacant system presoaked prior to testing. G. ENGINEER'S CERTIFICATION 1 certify that 1 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 date. Engineer's Printed Name KENNETH M. DUFFUS Date 11712014 COSA brown sheet 10-10-12.doc Rant, ZONING olsmcl FRONT CIUNNG SGIBAIX Sm 9Uiuma WIBAC( REM 6ULLLYNa mmRA 10 CE, UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. El LOT SURVEY SURVEY TYPE SYMBOLS Q FOUNDA➢ON AS—BUILT rxc maaa� El FINAL STRUCTURE AS—BUILT SET ftEBAR ♦ pRAINAGE ASPHALT ❑ PLOT PLAN ... AS—BUILT... LOT SURVEY... TOPOGRAPHY O FOUND REBAR 8__8__B. WOOD FENCE CONCRETE m .1 1.. c T fl TOOg ASSUMED ELEV. j( --x )E METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS IT 15 THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION +`.*yr`Cr��Irtt� PLOT PLAN ��'OI r'4<['�I hsMY mNfY that I IKq MHIn6Y yu»IeG TWX Y` .,,•• ••••• ..... I, \/•� Pwa ma ro aw a«. a< wY MIMNm mJ menta. an evM..lm> mw den maau,ae w. ma mmen. + M Y j FOUNDATION AS—BUILT •Mir I. ftmxl E .Mnk J. hsmr w 'y flrP, 1 W.�!_ lotaM Noi M Nema bf_.t m ae.a NseenRT me U.a M ro yWmmmmb adAt wYyw HN "*y wan aMmx. P 21 FINAL STRUCTURE AS—BUILT•+` a ,• . �`� `'•. t, amen E doom, x. h.rmv c.rdb Mae I ha,. prlamN m Ae-CWt y=+ar et Me a •`••.. ., a Wmre m Mb rot me Cwt •R Me me laamama m y,am n.rm ✓< Professional ma,aamlamb .y.r aM„. �4�aarw�� y,aM nxw m: NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive, ANCHORAGE, ALASKA 99504 ,.ale. 1 i1 C 601 Rec. Lot S.F Rea Plat File No. IDate Surveyed: 01/06/14 IDrawn by. REJ ICheaked "SmK IData Drown: 01/06/14 jG`ld: 2539 IW.O. 14-04 1 Lot 4 HILLSIDE PARK PUD 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 . CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# Q\1--)— �`l HAAInQ`7\ lnfn 1. GENERAL INFORMATION Complete legal description Lot 4, Hillside Park Subdivision Location (site address or directions) 7141 Tree Too Circle Property owner Miles Fujimoto Day phone 343 4609 Mailing address 7141 Tree Ton Circle Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 4 y 3. TYPE OF WATER SUPPLY: Individual well Community well Public water. MUNIGIPALI IT UP ANCHORAGE ENVIRONMENTAL SERVICES DIVISION FRAY 0 7 1996 XXXXXX RECEIVED NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXXXXXX Holding tank 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 x21 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 Anderson Engineering Phone Address P.O. sox 240773 Anchorage, AK 99524 563-7155 `n l"J a, Cao'k' 5/7/96 Engineer's signature Date 6. DHHS SIGNATURE Approved for — 4� bedrooms. Disapproved. Conditional approval for Additional Comments By: %OTIC r Y"SCA �(J(/� �ae4 - OJ009n�M�4/ bedrooms, with the following stipulations: Date 5- /d 1'z 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. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division34 U IpALITY OF ANCHOR 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) Ehl t, OENTALSERVICES DI t-.,rinY Q 7 1996 `// Health Authority Approval Checklist RECEIVED D `r Legal Description: Lo7- , %11t.Si-IIjE P4R.;L SuiS. Parcel I.D.: A. WELL DATA Well type P VJ - S If A, B, or C, attach ADEC letter. ADEC water system number ;?-/Z 4/ Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g•p•m• WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Date installed L7/147, / Tank size i, Z-50 Number of Compartments Z— Cleanonts (YN Y Foundation cleanout (Y/N) �_ Depression (Y/N) N High water alarm (Y/N) Date of Pumping 11 /7 q 5 Pumper 4 M C44 , ( 5S Pp p L i�v An P i,J la C. ABSORPTION FIELD DATA Date installed 7/81 Soil rating (g.p.d./ft2 or ft2/bdrm)12S F -T. System type brt' �tZ �NU i Length Width 4 Gravel thickness below pipe 8 Total depth / Effective absorption area J �1 Monitoring Tube present(Y/I�� Depression over field (Y/N) Date of adequacy test l 6? Results (Pass/Fail) FSA 5S For Po U'Z- bedrooms Fluid depth in absorption field before test (in.); Immediately after?50gal. water added (in.): 0.3 - s Fluid depth l® % 5' (ins.) Minutes later: 2 L lets_ Absorption rate = % 1,00 g.p.d. Peroxide treatment (past 12 months) (Y/N) /V If yes, give date 4M D. LIFT STATION � tj r 1,J C Date installed Manhole/Access (Y/N) _ High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot > "LOOi Absorption field on lot Public sewer main X10 On adjacent lot On adjacent lot: "Pump off' level at* rt LOT �Puft IG �J A r I c , Z170 / J Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I I Building foundation > 10 Property line > t o Absorption r Water main/service line > /0 Surface water/drainage >/04 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation > 10 t Water main/service line } i0 t S� > Z00 Surface water >/00 Driveway, parking/vehicle storage area Z-0 / J0 � Curtain drain /y 0 AJ C Wells on adjacent lots > 7- O t Property line > td F. ENGINEER'S CERTIFICATION "14 certify that I have determined thru field inspections and review of Municipal records tlra f 6bbvegs Mems are in conformance with MOA HAA guidelines in effect on this date. Signature Engineer's Name 4/t°.rFA&—L. 4GS77,S0 A" mee'ri pp°}Ql1°P Date �;/7f 6 ®JIM 49AV AO)n;-:';; G �4� °'� HAA Fee $ v Waiver Fee $ Date of Payment O p/7"/ /� Date of Payment Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc