HomeMy WebLinkAboutHILLSIDE PARK PUD LT 5Onsite File
#015-122-46
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: 0SP181199 PID Number: 015-122-46
Dwelling:■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
Ravnit Basi-Lachapelle
ABSORPTION FIELD
❑ Deep Trench ■❑ Wide Trench ❑ Bed ❑ Mound
Site Address
7201 Tree Top Cir. Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
227-1814
4
1.2 GPD/SF
9.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6.0 Ft.
Gravel depth beneath pipe
3.0 Ft.
Subdivision Block Lot
Hillside Park PUD 5
Fill added above original grade
0.0 Ft.
Gravel length
60 Ft.
Township Range Section
Gravel width
5.0
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer.
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
517 Ftz
1
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1,250 Gal.
Surface Water
>1 00'
>1 00'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Steel
2
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
A+ Home Services
Drainfield D3034 CO/MTD3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspectio : 15' 8/6/19 2�a 8/7/19
Location and description
3'd 4'h
Bottom of siding @ point A.
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
®®®�
OF 14
Conditional Approval: Date
qS®®m�
A....:� 49th ........ ° 0
1 .....■. . .d..■..
O .1-.
®................................................ O
®� ;MICHAEL E. ANDERSON
*
®��e,•No. CE—1
Septic System �
�
Approved C-C�1 Date Ib aD�o
e°�C��®
•• •�
® 1/7/20
lop
®44 ®Ap.
Note: this approval does not include well permit requirements.
®®PROFEsc,\COo
rRav nF/n7/1 R1
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
PERK TEST 2
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME(minutes)NET TIME(minutes)
DEPTH toWATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
Hillside Park PUD, Lot 5
8/7/2018
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
2.5 6
6 7
015-122-46
FRANCIS LACHAPELLE
Professional Engineers Stamp:
11:18/11:25
8/7/18
1
2
3
4
5
6
10
10
10
6 0
16 / 12 0
16
5 8
16
4
4
11:26/11:36
11:37/11:47
11:48/11:58
11:59/12:09
12:10/12:20
6
4
4 1
1610
6M 41S
10
6 0
16 / 11 8
16
6 0
16 / 10 0
16
6 0
16 / 10 0
16
6 0
16 / 10 1
16
6 0
16 / 10 0
16
1/9/20
10.0'15.0
'
SHED
LOT 5
LOT 4
LOT 4
LOT 6
10' X 15'
C.E.A. EASEMENTS12° 23' 45"E 322.23'N56°
1
0'
0
0"
E
1
5
6.
0
0'N33°
05
'
30
"W
271
.96
'30'30'
TREE
T
O
P
CI
R
C
L
E
TREE TOP
LANE
5 CO
9 CO
EXISTING
HOUSE
N56°
1
0'
0
0"
E
1
5
6.
0
0'
N89° 59' 00"W
50.27
1 CO 28.3
'
12.0'
6.0'
9.4'
2.0'
7.0'8.0
'56.4
'28.1
'
18.7'
21.7'
12.0'6%EXISTING
HOUSE
1 CO
LOT 5,
HILLSIDE PARK PUD SUBDIVISION
AS-BUILT
SEPTIC STANDPIPE
OR CLEAN OUT
FENCE
Asphalt
ConcreteOverhang
Wood Deck
LEGEND:
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR
USE AS A PLOT PLAN WITHOUT THE EXPRESSED
WRITTEN CONSENT OF LCG LANTECH.
DRAWN DATE:
DRAWN BY:
SCALE:
CHECKED BY:
11/18/2019
SC
AP
1" = 40'
PLAT:
WORK ORDER:19106
79-106
FB/PG: 817/4
GRID:SW2539
REF: 11L10
LEGAL DESCRIPTION:EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF
ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY
DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR
PLOT-PLAN PURPOSES.
250 H Street
Anchorage, Alaska 99501
Survey Department
Phone 562-5291
Mainline
Phone 243-8985
AECC 668
PARCEL #: 015-122-46-000 ADDRESS: 7201 TREE TOP CIR.
#CO
ORDERED BY:JAKE MILLETTE, FORGE CIVIL SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE
PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS
SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST
OTHER THAN NOTED.
HOUSE DETAIL
1" = 20'
Pavers
�JN,C,,,,,y.YOF. 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 ,�y16kNo
':
httpa —/www.muni.org/onsite ,� 'J.
1
1)c Martin nt
4''fN OR FC'.
On-Site Wastewater Disposal System Permit
Permit Number: OSP181199 Effective Date: 7/26/2018
Work Type: Septic Upgrade Expiration Date: 7/26/2019
Tax Code Number: 01512246000
Site Legal Address: HILLSIDE PARK PUD LT 5 G:2539
Site Mailing Address: 7201 TREE TOP CIR, Anchorage
Owner: BASI-LACHAPELLE RAVNIT & Lot Size in Sq Ft: 29121
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field El Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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
Special Provisions: A portion of the proposed drainfield is not within the 30 ft radius of a percolation test. An
additional perc test shall be performed at time of construction. If the results require a design change:
construction shall stop pending On-site review and approval of a change order. Please submit stamped and
signed results with the inspection report.
Received By: //✓L� Date: `
Issued By: . � aye/cif/1 l Date: 7 ���
410en
MUNICIPALITY OF ANCHORA
JUL 1 `z
Community Development Department Phone: l�: •!;
Development Services Division Fax: 90 -
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-122-46
Property owner(s) Ravnit Basi-Lachapelle Day phone
Mailing address 7201 Tree Top Circle Anchorage, AK 99507
Site address Same
Legal description (Sub'd., Block & Lot) Hillside Park PUD, Lot 5
Legal description (Township, Range & Section)
Lot Size 29,121 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field IX] Initial ❑ Single Family (SF) IXl
(w/wo ADU)
Septic Tank ❑X Upgrade X
Duplex (D)
Holding Tank Renewal ❑
Multiple Dwellings n
Privy (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: q • op Waiver Fees:
Date of Payment: 1/13 �� Date of Payment:
Receipt Number: (')"Inj O 1 3 Receipt Number:
Permit No. OSel D I 91 Waiver No.
Permit App_.-: ,....'c.
'7P►
GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
July 12, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: Hillside Park PUD, Lot 5 —Tulwar Drivc
Septic system design and permit application
Dear On-Site Services Engineer:
The septic system on the subject lot has failed and must be replaced before a COSA can be issued
on the property. The attached site plan identifies the location of the home and the proposed and
existing septic location. The lot and surrounding properties is served by a community water
system. No conflicts exist between this proposed system and any other well or septic system,
whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the northwest at a grade approximating 10%. There
are no slopes greater than 25% within 50 feet downslope of either the proposed site. Drainage
arrows are shown on the site plan showing the grade and direction of flow. Storm water drainage
will not impact this septic system.The new trench will be constructed parallel to the slope as much
as possible.
The new system will be a minimum of 200' from all Class A wells and 100' from private wells
and surface water and more than 5' away from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed,there will be no adverse impacts to adjacent properties.
Sincerely, Air �OF A�q‘',i
7114-4-Let
Michael E. Anderson,PE F* 49 TH_ \ %ISA
714."-LZa4121r
Michael E.Anderson .
i -A•• 4381-E •`�
�+ �sj •, 7/12/18 ,•'�C,�
HILLSIDE PARK PUD, LOT 5
Sb — _ _
LOT 6
LOT 5 INSTALL FLOW DIVERTER
LOT 4 VALVE FOR FUTURE USE
Q
OF EXISTING TRENCH.
NEW 60'LONG x 5 WIDE x 3'EFF. CLEANOUT AFTER TANK.
INSTALL DOUBLE
DEPTH ABSORPTION TRENCH. MT
MIN 10'FROM LOT LINE AND 12'
FROM EXISTING TRENCH . \,....: EXISTING 1250 GALLON
SEPTIC TANK. DECOMMISSION
Co eTH1 3 IN ACCORDANCE WITH MOA CODE.
M NEW 1250 GALLON
lifi //Il /1X11FSROMC OUN D TION. 10'
... ..,.-,-, • // FROM FOUNDATION.
CEA EASEMENT
EXISTING 57'LONG x 6'EFF. 1//• 7
DEPTH ABSORPTION TRENCH
4-BDRM HOME 7
,,�i��i�/�,,,_
EXISTING WATER SERVICE LINE ' ` /
(EXACT LOCATION UNKNOWN) IV
/ 7Q,5#
1 VQ5%
/
�-O
/ • ��
i*GE -92 /\
NOTE: '0
�,,.�\\\\ NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND
��p7;.9F 4��ii� PROPOSED SEPTIC SYSTEM CO CLEANOUT
%*'�•�}� 4 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO-DOUBLE CLEANOUT
••••••• • • •••• PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FCO-FOUNDATION CLEANOUT
•• •• •• ..• FD-FLOW DIVERTER VALVE
.. SYSTEMS. MH-MANHOLE
'/ '. Benja•'• hiller • / 0 50 100
1�,t 4,.... CE212592 A ,/ MI = = FEET MT-MONITORING TUBE
9 SV-SEPTIC VENT
(ki`�pROFESS1oN*� 1"=50' TH-TEST HOLE
HILLSIDE PARK PUD LOT 5
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 1.2 MIN/IN 1,250-GAL SEPTIC TANK
APPLICATION RATE: 1.2 GPD/SF
600 GPD / 1.2 GPD/SF/3' DEEP* .58 RED. FACTOR = 58.3 LF TRENCH REQUIRED (60 LF SPECIFIED)
BOTTOM OF TRENCH: 9' BELOW GRADE
FLOW LINE ELEVATION: 6 BELOW GRADE
TOP OF TRENCH: GRADE TO DRAIN AWAY
5'-6"
6"
4" PERFORATED PVC
(HOLES DOWN)
3'
DRAINFIELD ROCK
5'
itkGE
TYPICAL TRENCH SECTION �-4'P:
(NO SCALE) /Ali CO: 4 !f' toI
NOTES: *• 49TH �\ •'� ,/
1. GRADE AREA OVER TRENCH TO DRAIN AWAY ��
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' /�` eenjarri(ry chiller
WITH 2" OF INSULATION /
cr'• CE 12592
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHERlJl0...JOFESSION����"�
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY \\\��»1O
MUNICIPALITY OF ANCHORAGE !4(,4�ki"741
DEVELOPMENT SERVICES DEPARTMENT 0).• `jam ..v #1
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *:49TH AN '*9�
SOILS LOG AND PERCOLATION TEST 0/�''•:a ;a. ' hiller ' j
LEGAL DESCRIPTION: HILLSIDE PARK PUD, LOT 5 r'IIi�gFopROFESSWN�� '��
PERFORMED FOR: FRANCIS LACHAPELLE ���\\���~`
DATE: 6/16/2 018 PROJECT No.: Processional Engineers Stamp:
PARCEL ID#: 015-122-46 TECHNICIAN: N. SHAFER
DEPTH TEST HOLE 1
(feet)
1 111111111111 1' OB SLOPE SITE PLAN
3 :;. :::: :1 GRAVEL FILL
'' ''l
.:.:.:::::::
5 ->-"At -' LOAM SEE SITE PLAN
6 '' `'"
7 „::.';:-.!,..•.:.. ,:‘:
8 .�, :;,,4" SANDY SILTY GRAVEL
w;�'
: GM/GW
9 '�'.L
1 0 '�L' WAS GROUND WATER ENCOUNTERED'? NO
7"' IF YES((2.)WHAT DEPTH?
11 '.. ' DEPTH OF WATER AFTER MONITORING: NONE
;�, '�.'' DATE OF MONITORING:7/10/2018
12 .,i'-!:::::;i.:: ::
``;*'''�•%w'. DATE READING GROSS TIME NET TIME EPTER NET DROP
13 �}:i.: : ::::�, (MINUTES) (MINUTES) (INCHES)
-• t (INCHES)
-',:;~
14 ' ''...i 6/16 TEST HOLE PRESOAKED PRIOR TO TESTING:
15
•• 1 10:10/10:16 6:17 4is/ 1016 6
16 2 10:18/10:24 6:26 4/10 6
17 3 10:26/10:33 6:40 4/10 6
4 10:35/10:42 7:10 4/10 6
18 5 10:44/10:51 7:15 4/10 6
19 6 10:53/11:00 7:21 4/10 6
20
PERCOLATION RATE: 1.2 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 6 FT. and 7 FT.
COMMENTS:
MAILING ADDRESS
LOCATION
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
DISTANCE TO:
¢lanufacturer
IF HOMEMADE:
Well
DISTANCE TO:
Manufacturer
IPHONE
Absorption area
I nside length
Dwelling
Well
DISTANCE TO:
No. of lines. Length' of each lir~e
/
Top of tile to finish,grade
¢-
Foundation~¢ ~
Total length of lines
Material beneath tile
Length Width Depth
Dwelling
Materia~_~/~
W dth
Material
Nearest lot line
Trench width ,.
~ ~-~ inches
NO. OF BEDROOMS .
[] UPGRADE
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between
Total e f fective abso.~t ~n a,~
PERMIT NO,
Total effective absorption area
Type of crib Crib diameter Crib depth
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
DATE
LEGAL
PERMIT NO,
HPPLI~MNT
LOCATION
LEGAL
~'~LNF~ I C~IP~LIT~' OF ~NCH,~RP. GE
DEPARTMENT ? ERLTH AND ENVIRONMENTAL ' ~ECTION
825 ~L' STREET, ANCHORRGB AK. ~gb~
264-4720
Cm~4--SITE SEWER PERt~ IT
( 800196 )
SRA BOX 6~5 PALMER
LOT SIZE
MARK WILLIAMS
OMALLEY AND HILLSIDE
:,:LS:'~i;!HILLSIDE',PARKi
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 4
,~'~'~ szG-2e42
26000 SQUARE FEET
SOIL RATING (SQ FT/BR>= 85
THE REQUIRED SIZE OF THE SOIL ~BSORPTION SYSTEM IS:
[:,EPTH= 6 LENGTH= 5}' 6RR~/EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE E~CAVATION <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>.
REm2Li I RED SEPT I C TRr~f~ S I ZE= 1250 G~LLONS
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.
TI~O (2) I ~ISPECTIONS ARE RECaLl IRED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM IS
t00 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T EXP I RES [)ECEMBER 3:-1.. 'm 980
I CERTIFY THAT
t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-S~TE 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~E ON-SITE SEWER SYSTEM ~AY REQUIRE ENLARGEMENT IF THE
S~NE~~. "RESIDENCE~~~TO INCLUDE MORE THAN 4 BEDROOMS. ~ APPLICANT MARK WILLIAMS
ISSUED BY _DATE__ V4.0
PERFORMED BY:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY AppRoVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-122-46
1. GENERAL INFORMATION
Expiration Date: //~/~_~
Complete legal description HILLSIDE
Location (site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PaRK PUD; LOT 5
7201 TREE TOP CIRCLE
NANCY SCHIERHORN
7201 TREE TOP CIRCLE *
Day phone 229-3922
ANCHORAGE, AK 99.507
Day PhOne
CHERI MARSTON W/PRUDENTIAL VISTA Day phone 244-4440
4241B STREET * ANCHORAGE, AK 99507
Unless o-'~J~rwise requested, HAA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
individual Well r-~ Individual On-site ·
Individual Water Storage r-~ Individual Holding tank ~--1
Community Class A Well · Community On-site ['-]
Public Water System ~] Public Sewer [-1
The Municipality of Anchorage DevelOpment Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-122-46
1. GENERAL INFORMATION
Expiration Date: L/t. - 7- O q
Complete legal description HILLSIDE PARK
Location (site address or directions) 7201
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PUD; LOT 5
TREE TOP cIRCLE
NANCY S~HI~RHORN
.. 7201 TREE TOP cIRCLE *
Day phone 229-3922
~N~HORA~E, AK 99507.
Day phone
CHERI MARSTON w/~RUDEh~iAL VISTA .Dayphone 244-4440
4241B s~R~ET * ANCHbRAGE, AK 99507
Unless' otherwis'e requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDi~,~)OMS: 4
.'3.
TYpE OF WATER SUPPLY: TYISI= OF' WASTEWAtER DISPOSAL:
Individual Well [~ Individual On-site ~i'
Individual Water storage r-1 Individual Holding tank [~]
· Community Class A Well ~I' CorfimunityOn-site E~
'Public Water System r-1 Public Sewer r-']
The Municipality of Anchorage DevelOpmerit Services Department (hSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single:family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to hom'eowners. ,Certificates of Health Authority
Approval are valid for 90 days from the date of issue for propertie9 served by a private or Class C well and may
be reissued with new water samples. (Cedificates may be reissued for a period of up to one year with valid
water samples.) Cedificates 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. '
Municipality, ..... of*Anchorage ',
Development ServiCes DePartment
. Building Safety Division . :~ ~,,
,~ ' On=Site Water & wastewater Program . ~ : ::1
4700 South Bragaw St.. '..~ ~
~ P.O.~ Box 196650 AnchOrage, AK 99519-6650
www.ci.anchorage.ak.us
: (907) 343-7904 ~
HEALTH AUTHORITY 'APPRovAL
,CHEcKLLIsT
. Legal eScription:~' HILLSIDE PARK PUD; LOT 5 " .i i~arcel ID: · 015-122-46
A. WELL DATA , . ~ ' . ' .' ' ~ .... '::~i '; , . ·
Well type' Puauc ,; ' IfA, B, or C provide PWSID#2_12461 ': Welt Log (Y/N) ·
Date
~0mpleted __:_ _ Sanitary seal (Y/N)~ . '. W, ires prop'edy P~otected~Y-¢~
Total~depth ft., . . ' Cased to'," , ' 'fl.. , , ., CaSing heighj.(ab~ve ground) · : in.
. ';i!:'i'.!.-" '.. FROM WELL LOG ' . . .',:,¢V~,.~T-'tI~PECT!oN~ r
' : ' ! ' ' " ; : .,,¢'~'~'~/---~'~ ' :" :,i'~' ' ~,t! .iF .. '
ri I ~ , ' , . , Ir'
Stat!ciwaterlevel . C_.,~,.I;' ;: r .ft..
Well produchon ....... g.p.m. . ' i =. :, ;, ! i-': '::'g p m .
WATEF~ SAMPLE RE..,.,.,.,.,.,,~S: , . i. ' ; '; ' '! ':, ! . ' i i'll" ;.~ .
Col Io!~ i ~dnies'100 mi. : Nitr&te "mg.lL. T '. ';: :Other !alc[e'ria colonies,100 mi.
,: ,.I ~. · , ~ . ; , .,* . ;'
.~enic: rog.IL. ' . Date of sample: .... Collected :by:!
"il l':Jt[ .... ·
B.
DATA , , [, , ,:
SE~TIC/HOLDINGTANK~ ' ' ' ":i !:'" !..'~:i~::'~ "'
rikye .STEEL "!; :. = ,' Date in'{t~lled
Ta ~ p/Material {' .~ ..' ! : , !'~ =,~. ,i
Tank size 1250 gal.:. : Number of Compartments YES
!t,, !, i
Foundation cleanout,_IN) YES
,of pumping · 10/08/03
C. ABSORPTION FIELD DATA
,9/1980
·
;" Cleanouts'r(y/N)
DePression Over tank (Y/N); N
~ ;High'water alarm (Y/N)
~ :A+'~'OME SERVICES, INC.'
Pumper
[*BELOW EXISTING::GRADEJ '
Date inst~lled 9/1980 Soil rabng ~r ft lbdrm) 85 ;: ..... System type. TRENCH
Length t, : .u/- -, :.ft. ,. . Width,;" ~ i :.fl.' ::-,;. , .,Gravel below pipe 6 ft.
Total depth ~22 %ft. Eft. absorption area 684 .~ Monitoring tube YES ! .Depression over field NO
'Date0f dequacytest' 1/2/2004 ..'.~'Results(Pass/Fal). PASS.". ~..~=;, !-" For 4 bedrooms
' ~t~ .... ~ ' ',[, F " '
Fluid depth in absorption field before test -.21 in.- . Water added 1286 g~l.~;'~ ~!,. New depth **61in.
Elapsed T~me: 200 mm. ' Final fluid',depth 56 ~n. , ' ~ ,Absorption rate >= 600+ . g.p d.
Any~ eluvenahon treatment (past 12 mo.) (YIN & type) ' SEPTICL~R., 1~ Ifves, ~ive dater'S9/2005
, 11"3 5 BELOw DISTRIBUTION, UNE MT DOES NOT. E~END TO~ BOWOM OF SYSTEMI r
...... , . . ' ~ : : ': '. ~. . , "~i
Municipality of Anchorage
DeVelopment Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET
To: ,Teff &arness
Legal description: Hillside Park PUD Lot 5
The attached paperwork has been reviewed and is being returned for the following reasons:
I'-] Original signature or stamp missing on
J--J Calculation error in design.
I-'-I Additional soils information needed.
I--I Water monitoring results inadequate..
[-I Discrepancy in information submitted.
r-1 Topographic information missing or inadequate.
r'-I Incomplete; missing
F-I Incomplete; missing
J-'l Additional adequacy test information needed.
I-'l Water sample unacceptable.
I--J Measured/proposed distances/dimensions missing..
I--I Locations of all soils, percolation and water monitoring tests not shown.
I--I Proposed system too deep for soils information submitted. __
F"I Well log required.
l-'1 Omission in narrative.__
[--J Insufficient fill over tank or field.
I~ Other. Inspected on 11-19-03 and found water level in MT above the bottom of
distribution pipe.
Name of reviewer: , ,Teff Poet Date: 11-20-03
P/ease supply the necessary information and re-submit your request.
LEA VE THIS FORM ATTACHED TO THE'PAPERWORK
T
· mmROM :
NANCY SCHIERHORN ATTY 'AT LAW
PHONE NO. : ~461311
0c~. 02 2003 08:3~PM Pi
· N 89'59'00" W
50.27'
LOT 5
LOT 6
LOT 4
CEA EA~E'~£NT
EXISllNC
· ' " '* -' : ~ '' :' ' ' :' EXCLUSION NOTES: It i~ the owners' responelblllty to dotc~lne ~GEND: ~ET FNO
- ~ ~: the ~[st~ce of any ces~ts, co~nonts, ~ r~tdctlens 5~'~ w/c~ ~/a' ~'O
~ 0 ~ ~ A ~ ~ ~lch do not oppc~ on ~e r~ded subdi~ron plat. NO~:
w{[h TOTEM REALTY Under no eT~mstences ~ould uny dote h~eon be used for H~ ~ T~
drawing and ~at the impro~cn~ ,]tuated thee- C~-
on are wlth~ ~e prope~y IJn~
m~ts exist o~er ~an noted. ~A~-
LA~D ~ C0NS~UC~ON SUR~YOES-P~ANNERS-ENGINEER5 ~~I~T O~: ~
~0HORAOE, A~SKA 99503 ~907) ~-S=~; LOI 5,
~ ~m NUU~j~y 18. 1997 ~1'=40' .J(foX) 551--6626
~=.~ HILLSIDE P AEK P U D SUBD
I 2539 *
388~55 "
2003 ~:48PM No.2062
P. 2
ALASKA WATER & WASTEWATER
- ' ....... CONSULT4~T$. INC. - .........
SEPT.!C ADEQUACY TEST DATA
~D MEASIL~P-~ME._N'£$: ........
'to? OF MT/$UM~ TO BOTTOM .................... J~ (MTI)/
TO~ OF ~T~[.NP TO DIST~ON LINE .....
STICK-UP OF MT/S~ ......................... __ . ~/~ (~l) / ..... (MT2)
TOP MT/SUMP LEVEL ............ _ (MTI)/ (M l'2) ~ r
~JL'i'S:
_: PASSED A~SOI~ED GALLONS IN MINUTES (
....~_: FAILED - SEE ATTACHED LETTER
·
Nor. IS. 2003 ~:49PNI tto.2062 P. 3,
51"
~mCT-4-~00~ O?:~IA FROM:A+ HOME SERvICEs~ IN 907-868-6770
A~ HOME SERVICES, INC.
7501 E. 140th Avenue
Anchorage, A~aska 99516
345. 1890
CUSTOMER
Ala~lca Water ~ ~XT~w. ~t~ c'_ ~,ltaats,Inc.
3701 E. Tmtor Road, Sui~ #I01
Block Lot
TO: 3383246
· INVOICE #
P: 1"1
23639
DATE DESCRIPTION AMOUNT
! O-fl ~-03 Pmnp s~ptiq,..~.-~l_T_~_.T_~_ ~_ e~. ~ 75.00
~, ~ .-.', ,' .:...
:~'2' """:~';' "."'"' " f ~ .
· "' 1'?'.... ~
· ~.~g. .~.w~.. .....
'~,~.:, -' In-.
~/) Trak located ]0' from NF,
· ' , ..... ,; TOTAL
.. REM/~RKS '.,.~./,' ,.,
;? ,' :.
..t:';<t'.
'~...'" #. , '~,4',.;..-;': ..... "' .. .~.
'"' "
J/.~ Gallons _ b,/~Septic ~ Leach Area -- Holding Tank / Standpipes ~'"~(-,~Time
[] NEEDS TO BE DONE AGAIN IN 6 MONTHS
[] Good Shape '~ sludge buildup on bottom [] Floater on top
[] Jim cap missing or'lX] . Cut standpipe to 1' hbove ground [] Needs Septictrine
needs replacing
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
~LJ('~IP~ LI TY ur
DEPARTMENT OF HEALTH & HUMAN SERVICES ENV~I'AL .SERVICES DIVISION
Division of Environmental Services
On-Site Services Section ~0 1997
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744 R E C E ! ¥ E D
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Day phone
Day phonef
Lending agency
Mailing address.
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
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 #21
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 ~ this inspection.
Address ~nch~ ~504/ ~/ ~ .
EngineeFs signature ~~(/~~ Date ~/~'~
DHHS SIGNATURE
Approved for 4
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: ,-- / , / Date 7-2 2-¢7
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 Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Legal Description:
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Health Authority Approval Checklist
Parcel I.D.:
A. WELL DATA
i ~, or C, attach ADEC letter. ADEC water system number
_ Cased~te c°mpleted___.__~ ~Ca~a b~ve 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.
Nitrate Other bacteria ~
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed C~/~O Tank size /~-'~
Foundation cleanout (Y/N) ~.~----J~
Date of Pumping ~/~/~'=~-
C. ABSORPTION FIELD DATA
Date installed ?/~0
Length ~ '7 / Width
Depression(Y/N) ,~,0
Pumper ~JoC/.~/...41-~J~)
Number of Compartments 2- Cleanouts (Y/N) y ~
High water alarm (Y/N) /~'J~"
Effective absorption area ~) (~__-,~ Monitoring Tube present (Y/N) Y
Date of adequacy test ~[.)~ ~ '~" Results(Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth ~l~ (ins) Minutes ater:
Peroxide treatment (past 12 months) (Y/N) ,',J
~ ~ System type
~c~ /~ Total depth
. Depression over field (WN)
For ~" bedrooms
Immediately after ga. water added (in,):
Absorption rate = ~ ~ g.p.d. If yes, give date
72-026 (Rev. 3/96)*
Soil rating (g.p.d./ft2 or.,,ffzF4~bm)
/
~ Gravel thickness below pipe
Date
Manhole/Access (Y/N)
High water alarm level at* __
,MUNIcIP. ALITY OF ANCHoP, AGE'
ENVIRONMENTAL SERVICES DIVISION
,]UN 3 0 1997
E. SEPARATION DISTANCES
*Datum
Size in gallons
"Pump off" level at*
Septic/holding tan-I~e~l~ On adjacent lots
Absorption field on lot ~_ ~
Public sewer main ~er manhole/cleanout
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /~' ! ~' Property line
Water main/service line ~' Surface water/drainag~
Property line
Sudace water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
f
l~ O Building foundation ~O/4-
~O~
ENGINEER'S CERTIFICATION
I certify that I have deJ~ninej:~u ~ld inspections and review
Signature
Engineer's Name __ ,J ~ ,z~- ~--~'
Date
Absorption field ,/O
Wells on adjacent lots
Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots ~- loc)~ ~ v~--
are
Date of Payment ~--~,/.~~--~
Receipt Number d"~~. ~ · ~(~.~'~. -~f/-'~v.
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Alaska Water & Wastewater
8471 Brookridge Drive - Anchorage ~ Alaska 99504
Phone (907) 33%6179 - Fax (907) 338-3246
Consulting Engineers
RECEIVED
June 29, 1997 JUN 3 0 1997
Municipality oJ Anchorage
Dept. Health & Human Services
Municipality of ~chorage
Depa~ment of Health & Human Se~ces
Division of Environmental Se~ices
On-Ske Se~ices Section
P.O. Box 196650
~chorage, ~aska 99519-6650
Subject: ltAA for Private Septic System. Lot 5, Hillside Park PUD.
To whom it may concern:
The subject lot has a 4 bedroom house on it which is served by a private septic system and a
community well. The results of the field investigation and adequacy test are summarized as
follows:
A. SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 2 foot wide trench, which is 57
feet long, and has an effective depth of 6 feet. Prior to starting the adequacy test the MT was
dry. There has been only one person living in the house (periodically) for the last several years,
consequently, the septic system has been very lightly loaded. Water was added into the trench at
a rate of 7.5 gpm for a total of 223 minutes (1672 gallons). At the end of the pumping period the
liquid level had rose a total of 40 inches. Twenty-six hours later the MT was dry. Based upon
this data, it was determined that the absorption rate of the trench exceeds 600 gallons per day, as
required for a 4 bedroom house.
B: SEPTIC TANK: The existing septic tank was installed in September 1980 (almost 17 years
old). According to the M.O.A records, it is 1250 gallons, has two compartments and is made of
steel. Most tanks of this type have a structural life of approximately 20 years. No warrantee is
made regarding the future life of the tank.
NOTE: The adequacy of a septic system ia' influenced by numerous factors, mc&ding, but not
limited to, seasonal surface water infiltration, groundwater variations, septic system
maintenance (frequency of septic tank pumping, usage of biological additives), condition of
drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age),
type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects),
and the amount of water being introduced on a continual basis. Consequently, the results of this
adequacy test are only valid for the specific day of the test. Furthermore, because of the limited
nature of this investigation, it is possible that there are hidden defects which may not have been
detected No warrantee is made regarding the future performance of this septic system.
If you have any questions, please contact me at 337-6179, 244-9612, or on my digital pager at
o o your ssist .
J~ffi M.S.
Prin d ~J
c.c Totem Realty, Bob Baer
j ) DATE~RECEIVED
I NSPECTI O~?APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DEPARTMENT OFHEALTH&ENVIRONMENTALPROTECTION DEPT. OF HEALTH &
) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION 00T 1 3 1981
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed, Please allow ten { 10) days for processing.
PHONE
1. PROPERTY OWNER
MAILING ADDRESS
( '
4. REALTOR/AGENT ~ I PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~B E~)~
[] Three [] Six
[] Other
7. WATER SUPPLY
[] INDIVIDUAL*
[~'~COMM U N ITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
I~ SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER
[] MULTIPLE FAMILY [] TWO [~ FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[~ PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~['INDIVIDUAL/ON DATE INSTALLED
[]PUBLIC UTILITY '~ --3 I -- ~v'f
Connection Verified INSTALLER
[~eptic Tank or F-iHolding Tank '~.~,t~
Size: /~f-~ If Tank is homemade SOILS RATING
give dimensions: J ~. ~'"~
TYPE OFTANK~~ MANUFACTURER ~ ~'~
TOTAL ABSORPTION AREA MATERIAL i ~-----_
Absorption Area to nearest Lot Line
5, COMMENTS
[~"~-PR OV ED FOR y BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED