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Home My WebLink AboutHILLSIDE PARK PUD LT 18Onsite File Hillside Park PUD Lot 18 #015-312-27 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Mage 'I of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201269 Pit) Number: 015-312-27 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex. (D) ❑ Two Single Family Project: ❑ New Upgrade Blame Bank Of NY ABSC]RPTION FIELD ❑ Deep Trench ❑ Wide Trench [J Bed �,] Mound Site address 10501 Treeline Ct [ Other Phone Number of Bedrooms Sail Rating Total depth from original grade 301-8037 4 GPDJSI r LEGAL DESCRIPTION Depth to pipe invert from original grade Ft.Gravel depth beneath pipe F SubdiAsion Block Lot Hillside Park PUD LOT 18 Fill added above ortalnal grade t.l `Gravel lenqth F Township Range Section Gravel width Ft.I Beds= [Number of Lines - Distance between lines - F SEPARATION DISTANCES To Septic Absorption a Holding Lift Station ! Seaver Total absorption area Number of trendies Dist. between trenches From Tank Fold Tank Line Ftz F Well (}a'+ na na na TANK 0 Septic ElS.T.E.P. ElHolding Q Other Manufacturer Greer Capacity 1251 G� Surface '�'�rater i 1 Qp' t- I I I na na Material Plastic Number ofccmpartments 2 Lot Line 1 10.+ I 1 na I na NA F{�untiaiion'+ tic`] ! na LIFT STATION blanufactcfer Capacity 1 Remarks Septic Tank Replacement Gz Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfiald Tank to D3034 Installer Dean Drainfield CU MTD3034 Inspector NarthRim Eng. BENCH MARK (Assumed elevation) las it Inspection 10121.12-010/22J20 10!22!20 Location and description dates- 21" Deck 41!1 OIC -SITE WATER AND WASTEWATER SECTION. APPROVAL ++♦�� s '�,� +1 Conditional Approval: Date •. Ac Ar i* :49TH.. ♦ Steve Eng 4,t CE -6256 =�: ��: Septic System Approve /1—go _ Date Note: this approval does not include well permit requirements. m Q C+ 0 :5 ro CC) CA 0 0 rD rD (D rD N :3 n -7 1C+ 0 :3 0 -N 7 -9 -9--j Irl 0 :5 p -0 0 c C+ Q 0 < p rD -Q- p rD :3 0 Ln ro m< � P < C+ P 0 0 0 :3 M Ln ro 0 :3 p (D 00 Ul ON Q � ro Q :3 0 Ln td ro C+ ro ro :3 0 rD -0 C+ n No / Conflicts AS -BUILT MEASUREMENTS A B T1 13 32.5 T2 12 36 DCO 12 38 Existing 1� 40 \h 110-25% Slope Q `o /Driveway Flat Slope No Conflicts .Decommissioned ❑ld Septic Tank PER UPC & Replaced w/ 1250 Gallon Septic Tank w/ Double Cleanouts f No / I Conflicts NORTHRIMa+�� OF AA 44y4 HILLSIDE PARK PUD 1" 50' ENGINEERING = '�P 444 4RECORD SteveEng, com LOT 18 f * ' 9m *; PO Box 770724 f stm Eng 4= �.....LAYOUT Eagle River, Alaska 99577 Nl1/�.� o _ WASTEWATER 907. s94. X028 UPGRADE SEPTIC e11/20/20 I2 of 3 MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road i. Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsiteJ L)el>artment On-Site Wastewater Disposal System Permit Permit Number: OSP201269 Effective Date: 7/23/2020 Work Type: SepticTank Upgrade Expiration Date: 7/23/2021 Tax Code Number: 01531227000 Site Legal Address: HILLSIDE PARK PUD LT 18 G:2539 Site Mailing Address: 10501 TREELINE CT, Anchorage Owner: CWMBS 2005-25 Lot Size in Sq Ft: 42891 Design Engineer: NORTH RIM 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 -• - •ANDA "le,.< _ ALL IN Date: �� a Date: Hillside Park PUD Lot 18 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: The current septic tank has failed- the seepage trench still functions. No adverse impacts are expected from tank replacement. The easements are depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to neighbor properties. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet. 5 minimum between the tank and trench. 5 to property lines & 10 to house. 4 of cover or insulation is required for tank; an equivalent of 1 ⇤ insulation for 1 foot soil cover. Tank & solid pipe must be set on well compacted, stable soil. No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per MOA- sand or pea gravel. 4⇤ diameter cleanouts with airtight caps are required 1 to 4 from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adj acent opposing cleanouts between the tank and the absorption field, not more than 10 from the tank positioned to provide cleanout access towards the tank and towards the absorption field. All cleanouts must extend to at least ground level. In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. Insulation must be placed over any pipe installed under driveways or parking areas. Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, Sewer Service Line is minimum 2% slope. Septic Tank to be pumped every two years or when required. Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201269, Rebecca Carroll, 07/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201269, Rebecca Carroll, 07/23/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201269, Rebecca Carroll, 07/23/20 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 [PHONE [] UPGRADE NO. OF BEDRyS Absorption area / 7 ! Dwelling Material Inside length I Width Dwelling Foundation ,/7 ! Material Nearest lot line,//__~ ! Trench wdth DISTANCE TO: Well /~/.,~.. Manufacturer ~"~ ~ Liq. ca~c~ns F HOMEMADE: ~ I Well I Top of tile to finish grade Length Width__ ~Type of crib / DISTANCE TO: W~II ~Class ~ Depth DISTANCE TO Building foundation PERMIT No. of compartments ,.~ Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, Distance between lines Total length o~pe.~ · inches Material beneath tile 7~.2' '! inches Total effective ab~c-~a~p ' a~ Depth PERMIT NO. Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ~¢:~ /,Z/~ SOl L TEST RATI N~G INSTALLER REMARKS DATE LEGAL PERMIT NO. RF'F'L I CFtNT L ]CFIT I ON LEGRL JRK L. ON::,]. CROCI<ED C I RCLE LOT :1.8 HILLSIDE F'FIRK SUB 251t E:HIIRKIRT CT. LGT .., I ,-:,.E 4,:-Z.-3OFi "',~.:~URR. E FEET '- __ . '-"~ IS: ', n TYPE GF =,OIL RBC, ORPTIFN =~_TEtl I REN..H MFINIMLIM NLIMBER OF BEDROOMS = 4 "'q ..... 95 ,=,L IL F.'RTING ,:"--',P F['/'BR)= TNE REQUIRED SIZE OF THE =,L IL. HBz, LRPTION .=,.rzTEM I.=,. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DR8INFIELD. THE DEPTH OF R 'TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR~EL DEPTH IS THE MINIMUM DEPTH OF GRR9EL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRMRTION (IN FEET). FEF.,fllT RPPLICRNT HRS THE RE,z, FON_-,IE:ILI TO INFORM THIS [EFRF..TMENT DURING ]'HE · ~' ' I~ I ~NSTRLLRT~ON ~N_,FE_,T]3N_ OF RN'¢ WELLS RE:,JRCENT TO TH~S PROF'ERT'¢ RND THE NLtMBER OF RESIDENCES THRT THE WELL WILL .......... !'.1 :~F E _,.1 ][ L,t'.t_. RF;E -T'I-.-IC, ,:"..=.."-:' .':, I - c -. ', ..... - .~ [4:E;].~LI. ][ F--:E [:. ERCKFILLING OF RNY =T=,TEM WITHOLtT FINRL IN:,FEL. TI.N RND RPF-'ROVRL B'¢ THI':'_, DEF'RRTMENT W. ILL BE SIJBJECT TO PROSEE_TION MINIMUM DISTRNCE BETWEEN R WELL RND RN"r' ON-SITE SEWRGE DISPO':';FIL SN"S'TEM IS &Eib} FEET FOR R PRIVf:ITE WELL OR 450 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T"?PE OF PUE:LIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNIT'¢ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MR"r' RF'PL"r'. SPECIFICRTIONS FiND CONSTRI, JCTION [:'IRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. t CERTIFY TklRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH B9 THE MUNICIPRLIT9 OF RNCHORRGE. 2: I WILL INSTRLL THE SgSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND TH8T THE ON-SITE SEWER SgSTEM MR9 REQUIRE ENLRRGEMENT IF 'THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. V4, 0 LOT [t,srt-~.ar[o~ [h'S~cr[L~'S ~ ah"~ ~:LL~ ~o.r~r ro ri-it-; PR,~r~ ~'~ r~ i PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4- 5- 6- 7- 8 10 11- 13- 14- 15 16 17- 18- 19 20- '- MUNICIPALITY OF ANCHOF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~' O Z,.,),.~" /~ (~__, //'~ O/C~. ,, DATE "ERFOR! [] PERCOLATION TEST SLOPE WAS GROUND W:,ER ENCOUNTERED? IF YES. ATWHAT DEPTH? Reading Date Gross Net Depth to, Net, ' , ' Time Time Water '~ D~'oPr~ ' , PERCOLATION RATE TEST RUN BETWEEN COMMENTS ~ ~TMO/SE J'! 4..'T' /~,~ , m nutes/irtch) FT AND FT PERFORMED BY: ~"~-P/~JJ~' ,E/f"xJ~7 ~'~M~l~ CERTIFIED os pr MUNICIPALITY OF ANCHORAGE � , gli Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-312-27 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date:. Hillside Park PUD LOT 18 10501 Treeline Ct Current property owner(s) Mailing address Real estate agent Bank Of NY Peter Gribbin 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 301-8037 Day phone 301-8037 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 7 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $yU ( �� 1D -1 `�� Waiver Fee $ Date of Payment 25 r LV{ _2 6 Z Q Date of Payment Receipt Number b ( q 2-0-P Receipt Number COSA # 0 5 c a0 l c") 9 9 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown belov;, I verify that my investigation, based on procedures outlined in the Certificale 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. 1 further verify that based on the information obtained from the P;lunicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (arc) in compliance with all applicable rAunicipal and State codes, ordinances. and regulations in effect at the time of installation. I acknovAedge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/17/20 SIR lit wjmt� 7CES DIv�S\v ��\• Original'�e I ate Date: Z�2-f) �— Tho Nlunidpality of AnNhoragu Dcvulopmont Scroc s Division fDSDj issue_ Certificalus of On -Sita Sptorns Approval (COSA) basod only upon tho rt3�presenlalrorS given in parapr. ph oy an independent professcivil engir.�er reclistere;l ir. the State of Alaska. The'&,,nicipaky of Anchorage: is not respons'ble for errors or omissicns in the professional engineer's w3rk. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory V/ell Flow Advisory Other COS4. C , c► yr Ulov t` v s�i�P`-.•• - 944¢ g 6. DSD SIGNATURE System ;,1 Approved for bedrooms 4s . tm CE -em rr 44a4y .. 7117/ 0 ,-r.....� System 402 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: SIR lit wjmt� 7CES DIv�S\v ��\• Original'�e I ate Date: Z�2-f) �— Tho Nlunidpality of AnNhoragu Dcvulopmont Scroc s Division fDSDj issue_ Certificalus of On -Sita Sptorns Approval (COSA) basod only upon tho rt3�presenlalrorS given in parapr. ph oy an independent professcivil engir.�er reclistere;l ir. the State of Alaska. The'&,,nicipaky of Anchorage: is not respons'ble for errors or omissicns in the professional engineer's w3rk. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory V/ell Flow Advisory Other COS4. C , c► yr Ulov t` v Legal Description: Hillside Park PUD LOT 18 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Public Water B. TANK DATA Age of tank(s) new years Tank type/material =e '` Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA 6/22/81 Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-312-27 of Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: New Tank Permit Adequacy test date 7123/20 Results F/ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 19 in Elapsed time 60 min Final fluid depth 7 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date unk E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No it r7 Yes if No ft Neighboring Tank > 100° M Yes if No ft Private Sewer/Septic Line > 25' M Yes if No it Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' if No It Animal Containment > 50' El Yes if No ft El Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No Q [-] Yes if No it From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' 0 Yes if No It Property Line > 5' Yes if No It Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells? 100' Yes if No ft Water Main > 10' Yes if No It Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No - ft Private Wells > 100' Yes if No it Water Service Line > 10' Yes if No it Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that I have determined through field inspections of Municipal records that the above systems are in confoi MOA CASA ouidelines in effect on this date, 1—"N a � F R'P m U Q ti �O�d1 �tlN01ss3dp�d��1111 .= •a�� •' •' fid°' �� OZOZ/SZ/TT r O< ZS 6 -Sl' N a7 ja!E ls'W 'lid d i• ::.. H t/fill( 0 IGGJ ui GIDDS 09 0 54 0 'aug aoua; jo /uepunoq a 6w4s!!gels9 jo; jo uoporulsuoo jo; pasn eq luawnoop s!4l p1no4s saouelswnono ou japun -le!d pjooai a4j uo jeadde ou op 4o!4m uo!pulsaJ Jo 'S;ueuanoo 'sluawasee hue ;o aouals!xa 041 ou!malap o! Jaumo a41 ;o Alg!q!suodsal 041 s! 11 ]WADI Rew /arms tiepunoq luanbasgns a 1e41 sa!oemooeu! Aue of loafgns s! pue lanms /uepunoq a alnl!Isuoo lou scop luawnoop s!!!1 Ranins a41;o owp a4; le suo!l!puoo pue sluawanadwi a!q!s!n sluesaidaj Aanms 041 spiepuejS uo!leool a6e6uoVq SIdSV 8141 (41!m sa!!dwoo /arms s!4;, 'T 00'98Z M„96.60.00N a6eaeE) aeo E pac1oe4jv LlgM emOH GLueaJ pooM ti01s E .Unoo a glaaal 60506 /+ '1=1 'bS k 68 `Zt' uolslnlpgnS O ,n ,d -Vaed ap!sll!H Rt �o-7 R L �8 � x S OZOZ/6Z/l d 'JN12�33NIJN3 WILIHILION AEI 0301A02(d 3d1d0Nb'1S d0 N01IV00I } } x � x x �S 6£•£66 3.,96.60 °OOS aaua1013s10 C,09, -1au>,s14 2ulpJoaab a2e.logouV '99T -6L 'ON leld uo paseq sl juawn:)op sfgl •%duo Aanans }llnq-sV ue jo asodind aq} jol sAan.lnS jafluo.l j Aq pa;eaaa sl;uawmop sfgl ':UT -0 snulw/snld aje saull Alfado.ld o} suofsuawla •%an -fns slq} Oupeda.ld jo jsoa aq} paaaxa jou pegs Aan.lns slgj.lol Ajillgell agI'aaua2ll2au ssojO aoj gulldaax3 Ab'M3AILIG 03/1Vd eAr 6 of}das 511 .lash fuelmjdaS 75 •Z aauaj —x— lejsapad'ua13 V37 v aIajauoD .lajaw seg T 1aa4 ®.lalaw sa4ON IaaauaD o g'917 O N19V0 �•SZ \ °8zs �1WS3 �b” 3'0 CdA -L) -17VM 'NI V13a 00,0 x puaba7 66107 i 0�00� /Od O� 0 1N3W3AVd / d0 3903 L 6107 / OE = „T ale7S / l Z ti •Z� w V---------------- C,09, -1au>,s14 2ulpJoaab a2e.logouV '99T -6L 'ON leld uo paseq sl juawn:)op sfgl •%duo Aanans }llnq-sV ue jo asodind aq} jol sAan.lnS jafluo.l j Aq pa;eaaa sl;uawmop sfgl ':UT -0 snulw/snld aje saull Alfado.ld o} suofsuawla •%an -fns slq} Oupeda.ld jo jsoa aq} paaaxa jou pegs Aan.lns slgj.lol Ajillgell agI'aaua2ll2au ssojO aoj gulldaax3 Ab'M3AILIG 03/1Vd eAr 6 of}das 511 .lash fuelmjdaS 75 •Z aauaj —x— lejsapad'ua13 V37 v aIajauoD .lajaw seg T 1aa4 ®.lalaw sa4ON IaaauaD o g'917 O N19V0 �•SZ \ °8zs �1WS3 �b” 3'0 CdA -L) -17VM 'NI V13a 00,0 x puaba7 66107 i 0�00� /Od O� 0 1N3W3AVd / d0 3903 L 6107 / OE = „T ale7S / l Z MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date 5-31-86 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~ 18 H~'llsid~. Park Location (address or directions) O'M~£~.y... · L~. an C~ook~.d Tree.... Rt. on Trendline (b) Applicant Name T~to.uar' i,~eJ'and Telephone: Home 346-1912 Applicant AddreSs 1 0~;01 T~.¢,o~'J.n¢, C,f:. Ar~chorage, Ak, Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); Telephone (d)' Lending Institution ' ',: Address (e) Real Estate.Company and Agen( Nh~a.- Address Telephone (f) M~l~he HAA to the following address: S g S ENGINEERING sRB !96X ~GLE RIVER; AK 99577' ordered by Sal- C&A Ent. TYPE OF RESIDENCE Single-Family~;~ Multi-Family [] Number of Bedrooms 4 Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~;~] 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. 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, 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 .¢ --'l)- ~ .£ kl t'~. i kll !~ i~ D I kl t3-...~. .. .. .. . .. ,., Address $~ !9_~X Date EAGLE RIVER, AK 99577 Telephone Approved for ~,{~-bedrooms by/, ~ ...ex. - . - Approved ~t/ Disapprove/d// Conditional Terms of Conditional Approval . CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOI~ECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION Legal Description:, ~ \~> JUN 5 198 Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/l=~4~tmg Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhote Water Sample Collected by Water Sample Test Results RECEIVED IfA, B, C, D.E.C. Approved~N) Date Completed Yield De~h/f Grouting APump Set At 'Shnitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ¢,-~:~ ~,.b ;On Adjoining Lots ¢4;>0/mb ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/~TANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Comments Date Installed Standpipes ~/N) Air-tight Caps ~)N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N!~), Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~h,s~ Tank: Size ~'7...-~'o No. of Compartments Foundation Cleanout (Y(~ Date Last Pumped ~ ~ ~/~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ! To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~j;>. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Founda~o~ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design "'"'~. ~1-,~ Length of Field .~.,.¢.~,. t ! Depth of Field [,~ f Gravel Bed Thickness !,¢ Standpipes Presentd~N) Date of Last Adequacy Test Lc--- dC ~ ~, Io To Property Line To Existing or Abandoned System on ;On Adjoining Lots ~'~c> tPi'- ~-)~.Cutbank (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I cert~tE~~ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signe~ J~ 196X Date Con~r~LE RIVER, AK 99577 Receipt No. ~ ~;~ ~:) ~ / ~ Date of Payment ~' ~-~-'--/~"~ Amount: $ ~¢~,.~-, ~)0 Page 2 of 2 72-026 (11/84) MOA No. DEPT. OF ENVIRON MENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 RILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JUN .R 1986 DATE: June §. 1986 RECEIVED PWS I.D.~ 212461 To Whom it May Concern: According to records on file in this office the ~[I~DTVISION Water Regulations HILLSIDE PARK Water System is in compliance with the State Drinking Sincerely, District Engineer 10` C EA_ E51»f.A \-�—�--ZOD__1^lell 5;fc Radcos.. t � LEGEND 0 LOT CORNERS FOUNDATION DRAINAGE ARROWS NOTES: 1. IT SHALL BE THE RESPONSIBILITY Of THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING • .ORDINANCES. E. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RESPECT TO ALL UTILITIES. 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIS PLAT. 4. TOE INFORMATION ON THIS PLAT 18 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS , THE PLAT IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCES. SURVEYOR'S CERTIFICATION 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE .._ LI S B UILT PROPERTY DESCRIBED ON THIS PLAT AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. ---.._ ...._, LOT AS .... . q DATED THIS � DAY OF � �S ,19 _. —'- N/LL 51DA ..PARK _4_0-0. SUED. BESSEI EPPS a POTTS 2220 E. 88th. AVE. v 349-6452 ANCHORAGE, ALASKA 99507 349-6454 DRAWN BY, XML SCALES I = JOS C -C DWG. NO. / '✓ �'� n/ CHK. BY, DATE, 8• `j- $, FLO. BK. "~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE [ :3ATE INSPECTOR INSPECT ,/ INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~IRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 SEP 8 /98 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVE _ .... REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts oil page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE_ M/~I L~ING AE~DR E~SS PROPE~RTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADD'R ESS 3, LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. ~ ~'~,,¢J7'~'~(V,~"~..~)/~' I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET I' OCATION 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ,[~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ INDIVIDUAL/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. TYPI-' OF RESIDENCE NUMBER OF BEDROOMS [] 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 -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size:_ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area ISewer Line [ Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 1/~ DATE BY ~/~ ,