HomeMy WebLinkAboutHOMESTEAD HILLS #1 BLK 3 LT 15
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241336
Work Type: SepticTank Upgrade
Tax Code Number: 01517337000
Site Legal Address: HOMESTEAD HILLS #1 BLK 3 LT 15 G:2636
Site Mailing Address: 4531 TRAPLINE CIR, Anchorage
Owner: WILSON ALLYN & ROXANNE JOINT
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
Effective Date:
Expiration Date:
��,vvrooi`S;.
n
f,
~ 96--iLL
.,
U�rizartrnc:nt
Lot Size in Sq Ft:
Total Bedrooms:
10/18/2024
10/18/2025
44401
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Date:
Issued By: __ .__ Date:
4
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section
ON -SITE SEPTICANELL PERMIT APPLICATION
Parcel I.D. 015-173-37
Property owner(s) ALLYN & ROXANNE WILSON TRUST... Day phone _
Mailinq address 4531 TRAPLINE CIRCLE, ANCHORAGE, AK 99516
Site address 4531 TRAPLINE CIRCLE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) HOMESTEAD HILLS #1 133, Ll 5
Legal description (Township, Range & Section)
Lot Size 44,401 Sq. Ft. Number of Bedrooms 4
Phone.- 907-343-7904
Fax- 907-343-7997
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
F-1
Initial 0
Single Family (SF) Ex-1
(w/wo ADU)
Septic Tank
El
Upgrade 0
Duplex (D) ❑
Holding Tank
El
Renewal
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A 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)
1Z �_
Permit/Rush Fees:,
Waiver Fees:
Date of Payment: 1!?I—❑Date of Payment:
Receipt Number: Receipt Number:
Permit No. Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
October 7, 2024
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: HOMESTEAD HILLS #1 BLOCK 3, LOT 15
The owner has requested that we obtain a septic permit to upgrade the existing aged steel STEP
septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the
attached design to serve the existing 4-bedroom residence.
Groundwater was NOT noted in the MOA on-site file but may be encountered at excavation and
may affect the septic tank installation. If groundwater is encountered during installation that may
affect this septic tank upgrade, an anchored tank, a concrete tank with lift station (LS) or an
epoxy coated steel STEP septic tank or other action may be required.
The lot and area are served by private water and any encroaching wells, easements, … must be
staked prior to construction. The design will not impact any of the neighboring properties.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241336, Curtis Townsend, 10/18/24
FIRST WATER CONSULTING
HOMESTEAD HILLS #1 BLOCK 3, LOT 15
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241336, Curtis Townsend, 10/18/24
PLOT PLAN
AS BUILT)_— SC/a = _50' SW 2= 14-1 *�Pht No. _
Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone 6�opo�0�
Registered Land Surveyors (907) 522-4625 Fax kenOlangsurvey.com / jonathanOlangsurvey.com OF AL��D
�� • • • • ..,.9s�qo
G ,` . , .
I hereby certify that I have surveyed the following described property:'J�'
LOT 15, BLOCK 3, HOMESTEAD HILLS SUBDIVISION (PLAT 78-151) 0 491�1
Anchorage Recording District, Alaska, and that the improvements situated thereon are 0• •. • • ...........................
within the property lines and do not encroach onto the property adjacent thereto, that Q
no improvements on the property lying adjacent thereto encroach on the surveyed i7
premises and that there are no roadways, ttnnamisslon lines or other visible Q to .• KENNEiH G. LANG •: �ar
easements on sold property except as indicated hereon. oo�
G
Dated this the Day of O� "4S-520.•'"•yJpQ
at Anchorage, Alaska 44O�0 10NAL � �
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
U.5,-'24.,"20I:D 2.3- 24
4-PINIE: P-11.iLLTNk-,
Alpine Drilling & Enterprises
w1alum
PAGE 01/0",
Permit Number: NSW
Date, Of lss=
Identificatioll Number,
Date Started:
Date Cow pleted; a--23-18
Is well ioc.;!,ted at approved es L_j
Legal Description, Ht nv-stsad
HNIS, #1 610CT3 i..) 15
Property t*,Aer Name &-
A(Idress- Aftyn & Roxarme
Wilson
4531 Traph,176 Cir*
Archorn-cie.
Alaska P9516
.Borehole )'1'111%;
;'T -C70 —(f t
t ry cable ton rt
'.,i. a -r ro a
Soil Type, Tbiduiess Nkfisaer
Tuxt,;t Ffovl,
To
Casing type- S
e.k is "in Iv C
11Z
Di 6 ilwhts Dm5pth: 2IJ feet
6
62
-
I.Ater Type,:eI
6<.
75
D�IaTlleler: 4 incb-$ Depth: 2.1!,_!v '-2�4 fee't
8 LI)
-; eet
Casing 6tid-;up a5rive iufeet
rclr=t 11 silt
80
99
static water level (from t' ou i id , 1, Vel': 61 feet
sitV.graveify st-md R'20
99
101-1
ke idler
2 laours pumping 2 '�Plrl
L
Silt
107
Recovery RAte.- i2 gprn
PravL Ily 311t
109
NIethod of Teslif�19:,aivl ff
3
Well Intake openingType.
gravel�v'wn�)' silt
268
x Open End opeT" uol�-
w sand & gra rel
watt
74
`.'..topped
.=3'
pa-lbrauons Stars feet fo ev
'
Grout Type;
Purap., Intake feet
Pump size —__ lip Drand Name
Well Nsiofected Upoll COMPICtifli)? X Yer,
.qr
et.h(td of Miit-
,ifeoicm- chim-irie tablers
comments*
WeIlDr!"it-r: 41pint?
,PO -3,ox J 104,96'
"qnrhorqgx� AK 9.0511
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: /~'~J ~ ~. ~';~ PI D Number: ~:::>/~ -'/~ --~
N.m.:~, ~'~Z~ ~15 ~ ~ /~. Wastewater System: ~ew ~ Upgrade
Address: ~'~ ..... ~ ABSORPTION FIELD
Phone: No. of Bedrooms:
~ ~ ~ ~ ~eep Trench C Shallow Trench ~ Bed ~ Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION SoilRating: ~, ~ GPD/sq. Ft.
Lot: Block: ~ Subdivision: ~ Depth to pipe bottom from original grade: Gravel depth beneath pipe
/ ~ ~ ~/~5~ ~/~/ ~ ~ ~t. {~ ~t.
Township: I Range: I Section: Fill added above original grade: Gravel length:
I
I
Gravel do,th: Number of ~ines: Distance ~tween lines:
WELL: ~ New ~ Upgrade ~/D~H ~ Ft. / ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller:~/~ Date/~/ '~ ~D'riJled; Static/~Water Level:Ft.Installer:~ ~/~' ~ , Date installed:/]~/~/~ ~
Pump Set at: Casing Height Above Ground:
Yield: ~ GPM -- ' Ft. ~1~" ~. TANK
SEPARATION DISTANCES c Septic ~ Holding a ~
To ~ Septic Absorption Lift Holding ~Private Manufacturer: ~ in gallons:
From Tank Field Station Tank Sewer Lines
Material: ~ ' Number of Compadments:
we,, ,
Sudace
Line /~ / / S~ze m aa~ons: Manufacturer:
Foundation ,¢~ ; ~/ /¢/ ~/~ "Pump on"~level,, at: "Pump off"¢~level ,,at: High water ¢¢alarm/' at:
Cu~ainDrain ~/~ ~ Pump~ 5 Make~&/~Model ~ Etectrical~ ~lnspecti°ns pedormed by:
Remarks: BENCH MARK
Location and Description:
I Assumod Elevation:
/Od. 0 ~,
Inspections pedormed by: ~ ~ ~ Dates: 1st I///~/~ ~""~';~
2nd I,.//~J?5 ~ ~' . .'.~,~
Deparlmenl of Hea h an( Se~ices approval ~j~;.,..
Reviewed and approved b ~[ ~% Date: ~ S,, '~%;;E.~,~,,~
Permit No; SW950220
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 ° Telephone: 543-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legol Description: HOMESTEAD HILLS LOT 15, BLK :3
PID No.: 015-173-37
WELL
ELEVATTFINS
(NOT, TO SCALE)
i/4'
83'
TOP OF ~/~'LL CAGING
ASSUMED ELEV = 100,00
END 110,3
ORIGINAL & FINISH
/ GROUND
,~/ LEVEL AT, '~,~
"' TRENCH 113,57
1/8' ORFICE
@ l' QC SPACING
S END 110,3 98,S
MT D 104.3
MT E 104,3
SWING TIES
A-C = 40.9
B-C = 21.3
A-D = 75.9
B-D = 55.5
,, MONITOR TUBE
o SEWER CLEANOUT
WELL
LEACHFIELD
__ I _ EASEMENT
SCALE 1" = 60'
11/20/95
ENGINEER'S SEAL
I
I~."' &gTH~ '~{
' w~ o~ , '
..... ~'- ~". -- _ .
D~OPM~T M~D; : .-.~ ...
907)
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t
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950220
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:BERGLUND SCOTT T & JANE A
OWNER ADDRESS:12540 BAINBRIDGE RD.
ANCHORAGE, AK 99516
PAGE 1 OF
3So
PARCEL ID:01517337
DATE ISSUED: 8/16/95
EXPIRATION DATE: 8/16/96
LEGAL DESCRIPTION:
HOMESTEAD HILLS #1 ELK
3 LT 15
LOT SIZE: 44401 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
DATE:
Louis Butera, P.E.
Registered Civil Engineer
August 11, 1995
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Homestead Hills Lot 15, Block 3
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic systems will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for sePtic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absorption capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our officb-at-694-5195. ~
Sincerely,
Louis Butera, P.E.
\G:\WPDOCS\1995\95-O75A.NAR
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATEPERFORMED: ~'Y'~'
LEGAL DESCRIPTION:
2
3
4
5
6
7
8
9
10
11
12
15-
16-
17
18
19
2O
/./.r' ~-$Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTER ED?
IF YES, AT WHAT ~)
OEPTH /1/// p
E
SITE PLAN
Depth to Water k~r
Maiming7 D~"~ Dale ;_E- ,*~- f r'
Gross Net Depth to Net
Reading Date Time Time Water Drop
I ~'-~- 2;>- 7 r'-~,... ~ ~,,.
COMMENTS ~ra~/ I~tw~ ~) ~>'-- i~,
PERCOLATION RATE l' ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~' FT AND ~t/ FT
PERFORMED BY: '~ ~-~- I ~'~'~"'- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS [:)ATE. DATE: ~' - I/- ~ ~-
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
DATEPERFORMED: ~'?'¢~'
'F//2
LEGAL DESCRIPTION:
1
3
5
6
10
11
12
13
15
16
17,
18-
19-
20
/./.r' ~7/~-~'Townsbip, Range, Section:
SLOPE
WAS GROUND WATER/V'~'O
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth lo Water Alter
M~it~ring?
SITE PLAN
Gross Net Oel3th to Net
Reading Date Time Time Water Drop
PERCOLATION RATE I~.,,~ (mmutewincl~) PERC HOLE DIAMETER ~' '/
TEST RUN BETWEEN ~ FT AND ~ FT
COMMENTS
PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN
· . SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL:
Homestead Hills Lot 15, Block 3
08/11/95
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health
requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the
contractor to meet Municipality of Anchorage requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
8. It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
1. SeptiC tank and lift station shal 1,500 gall Orenco/Anchorage Tank model
OSI 05-20-HHF.
2. MOA electrical code inspectiofl receipt reqtfired.
1. The trench is to follow the natural land contour to maintain uniform total depth of
the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 9' at any point.
4. The sewer line shall be laid level within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH = 9' GRAVEL DEPTH = 6' under pil~, 2" over pipe
= TRENCH WIDTH = 3'
TRENCH LENGTH 63' ~4
SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY
SEPTIC TANK = 1,500 with lift
EFFLUENT PIPE = 1-1/4" PVC with 60, 1/8" holes with orifice shields at 1' OC oriented
holes up.
Twenty-four (24) hours notice required for all inspections.
G:~DOCS~i 995~95-075A.SPC
TRAPLiNEI~ ~u-
CIRCLE / PRDP ~ nq
z
pRrlp HSE I
CLEANBUT DETAIL
~ - TEST HOLE
* - MONITOR TUBE
o - SEWER CLEANOUT
+ - WELL
NO SURFACE WATER +100' PROPOSED LEACHFIELD
NO KNOWN CURTAIN DRAINS EASEMENT
WELL a SEPTIC S,TE PLAN
LEGAL: HOMESTEAD HILLS LOT 15, BLK 5
CONTRACTOR: HAGMEIER ~/4~~
~ EAGLE RIVER ENGINEERING SERvIcEs ~'.~ ~ . LOUIS A. SUTERA ' ~
' ~ (907) 694-5195 FAX: (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P,O. Box 773294
EAGLE RIVER AK 99577
(907) 694-5195
SHEET NO OF
CALCULATED BY ~/'~ DATE
SCALE
Homestead:Hills Lot 15,~ Block 3 - 08/10/95
PRESSURIZED 'SYSTEM SIZING
Flo~ rate fromilift station, = 25 gpm
AssUmes 5' he~d at ordice
0.42 gpm per 1/8.~ orifice
25 gpm + 0.42 gpm = 60~orifices
'Spa~ing =!63 ~ 60'orifices":--spacing
G:\WPDOCS\1995\95-O75A.CAL
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 95-075
Calculated By: LB
Date: 8/11/95
Legal: HOMESTEAD HILLS L 15 BLK 3
Single Family 4 Bedroom Dwelling
TEST HOLE 2
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 600 gallons
Percolation rate =
Wastewater application rate =
Required absorption area =
Trench width (W) =
Grovel depth (D) =
12.3 minutes per inch
0.8 gallons per day per square foot
750 square feet
3 feet
6 feet
Required length = Required absorption ama / 2 / D
Required length = 750 /
Required length = 63 feet
Total Excavation Depth = 9.0 feet
2 / 6
SINGLE FAMILY ON-SITE WORKSHEET
ERES PROJECT NUMBER: 95-075 CALCULATED BY:
LEGAL DESCRIPTION: HOMESTEAD HILLS L 15 BLK3
LB
NUMBER OF BEDROOMS: 4
WATER USE PER BEDROOM: 150 GALLONS
PERCOLATION RATE: 12.3 MINUTES PER INCH
DEPTH TO GROUNDWATER: 15 FEET
DEPTH TO IMPERMEABLE LAYER: 15 FEET USABLE SOIL STRATA
ANTICIPATED DEPTH OF COVER: 3 FEET TOTAL USABLE DEPTH: 9
MOUND OR BED SYSTEM USABLE SOIL STRATA DEPTH: 6
WASTEWATER APPLICATION RATE: 0.5 GAL/SQ.FT
ABSORPTION AREA REQUIREMENT: 1200 SQ.FT
MINIMUM BED LENGTH
12 FEET WIDE BED 100 FEET
15 FEET WIDE BED 80 FEET
TRENCH SYSTEM
WASTEWATER APPLICATION RATE: 0.8 GAL/SQ.FT
ABSORPTION AREA REQUIREMENT: 750 SQ.FT
SHALLOW TRENCH OPTIONS DEEP TRENCH OPTIONS
5 FEET WIDE TRENCH 3 FEET WIDE TRENCH
EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH
DEPTH (FT) LENGTH (FT) DEPTH (FT) LENGTH (FT)
1 131 4 94
2 105 4.5 83
2.5 95 5 75
3 88 5.5 68
3.5 81 6 63
4 75 7 NA
8 NA
9 NA
DESIGN SPECIFICS
FIELD SYSTEM: D (B=BED, S--SHALLOW TRENCH & D=DEEP TRENCH)
GRAVEL DEPTH: 6 FEET
TRENCH OR BED WIDTH: 3 FEET
LENGTH: 63 FEET
TOTAL
EXCAVATION
DEPTH: 9.0 FEET
//x
/
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
015-173-37 HAA #
GENERAL INFORMATION
Complete legal description
Homestead Hills
Lot 15, Block 3
Location (site address or directions)
4531 Trapline Circle, Anchorage
Property owner Haqmeier Const. Co., inc. Day phone 248-6789
Mailing address 2i04 cleveland, ,q~',i~e ~,01. Anchorage. AK 99501
Lending agency N/A Day phone
Mailing address
Agent N/A Day phone
Address
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 ~EC attest-
lng to the legality and status of system.
4. 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) Fronl 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 flies 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 Eagle River Enqineerinq Services Phone
Address p.o. Box 773294._Eaale River. AK 99577
Engineer's signature Date
694-5195
DHHS SIGNATURE
Approved for ~L--
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending 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
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES o
Environmental Services Division A'lC4'O'~?&t.,,.
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744
Health Authority Approval Checklist ~
kegalDescnpUon , ~ '- . ' . ~ ~' . .: ' ' - '
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed /~/'-x'3/~,r'
Cased to g'o ~ Casing height (above ground)
Wires properly protected (Y/N)
A. WELL DATA
Well type 29~
Log present (Y/N)
Total depth ~
Sanitary seal (Y/N)
Y
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform ,~ Nitrate
AT INSPECTION
g.p.m.
Date of sample: //2 - 6, -
B. SEPTIC/HOLDING TANK DATA
Date installed ft/i,t [9~- Tank size
Foundation cleanout (Y/N)
Date of Pumping t0 I~,
C. ABSORPTION FIELD DATA
Date installed
Length d.-' q Width
Effective absorption area
Date of adequacy test
Fluid depth in absorption field before test (in.);
Fluid depth ..... (ins.) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
Collected by:
Other bacteria /
/5~¢ Number of Compartments 31. Cleanouts (Y/N) tl/
Depression (Y/N) /~t High water alarm (Y/N) tv
Pumper ~
Soil rating (g.p.d./fl2 or ft2~drm) O, ~' System type 7-)~,°,~da
Gravel thickness below pipe ~3 ~ Total depth ~} ~
Monitoring Tube present(Y/N). ~ Depression over field (Y/N) ,a/
me,,,., Results (Pass/Fail) '~- For ~ bedrooms
.... Immediately ,after ~' gal. water added (in.): ~
Absorption rate = ~ g.p.d.
If yes, give date ~
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level
Size in gallons
"Pump on' level at*
*Datum ~. ~t,~.
"Pump ofF' level at*
Cycles tested ~v la
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tmtk on lot /,¥~ t ; On adjacent lots
Absorption field ou lot ] S ~ ' ; On adjacent lots
Public sewer main N la Public sewer manhole/cleanout
Sewer/septic service line /?.C Lift station /
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation It) ~ Property line 78 ~ Absorption field
Water main/service line ~0 '~ Surface water/drainage -ttoot Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~o / Water main/service line
Surface water .~ or, t
Curtain drain tV ta
~il i
Driveway, parking/vehicle storage area .n~,r t
Wells on adjacent lots /"t,,o t Property line
17 t
F. ENGINEER'S CERTIFICATION
I certify that 1 have determined thrufield inspections and review o
in confor,tance with MOA HAA guidelines in effect on this date.
Signature ~
Engineer's Name
Date /~- /.~- p~'-
HAA Fee $ ~/0, t~
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
Louis A. rSut,~ra ~
C~.6736
Rev. 8/95 OSS: haa.wk.doc