HomeMy WebLinkAboutKASILOF HILLS BLK 5 LT 2A
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: OSP261100
Work Type: SepticTank Upgrade
Tax Code Number: 01513328000
Site Legal Address: KASILOF HILLS BLK 5 LT 2A G:2541
Site Mailing Address: 10300 KASILOF BLVD, Anchorage
Owner: ROSS WAYNE A & VIRGINIA L
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
l7epartnient
5/14/2026
5/14/2027
Non -Public
❑ Disposal Field Septic Tank ❑ Holding Tank ❑ Privy ❑ Water 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. Coodinate with On -Site staff regarding preferred method.
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: Make repairs to the existing fields as described in the project documents.
Issued To: GARNESS ENGINEERING GROUP LTD
Issued By: Curtis Townsend
Date: 5/14/2026
Date:
5/14/2026
3
Development Set -vices Department , Phone: 907-343 /904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-133-28
Property owner(s) VIRGINIA ROSS Day phone 623-696-8137
Mailing address 10300 KASILOF BLVD., ANCHORAGE, AK
Site address 10300 KASILOF BLVD., ANCHORAGE, AK
Legal description KASILOF HILLS; BLOCK 5, LOT 2A
Number of Bedrooms 3
Engineering Firm GARNESS ENGINEERING GROUP, LTD.
Building Permit Number Not Applicable 0
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
Holding Tank
❑
Privy
❑
Well
❑
APPLICATION IS AN:
Initial ❑
Upgrade
Renewal ❑
TH10 ADDI ICATICIAI INICI I MCC A IA/AI WEER DCQI 'EST FOR:
� �.w ram.. .• n� r.vvw � •�r-� .� � .�� v v. FOR:
Permit/Rush Fees: Waiver Fees:
Date of Payment:
Permit No. c S( Z b t I
Date of Payment:
Waiver No.
Distance:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261100, Curtis Townsend, 05/14/26
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261100, Curtis Townsend, 05/14/26
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261100, Curtis Townsend, 05/14/26
MUNICIPALITY OF ANCHORAGE
DE -iTMENT OF HEALTH AND HUMAN SER ES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RIEpORT
LEGAL DESCRIPTION
Block SubdlvfsIoR
Lo, .2-/- ~" /Cas;'/° I¢'l~--
Township, Barlgs.
~
TANKS
ELL
T LINE
UNOATION
DISTANCES
WELL
SEPTIC ADSORPTION
TANK FIELD
AS-BUILT DIAGRAM (Show Iocahon of web, septic system property lines, Ioundaboo,
duvoway, wmer bodies, etc)
E]
SEPTIC ~ HOLDING
,--~'~ ~C~p,Cc,%,n ga,o/%~-
TYPE OF SYSTEM
[] TRENCH [] RED '~ W. DRAIN [] OTHER
oog~nal grade '~'~/
I
FT
~ FT
0¢'~ FT
/ FT
FT
$0 Fl'J --.~' FT
0
Numbel elhnos . Soil rating ~-Jt Pipe material ~
~ 16~"' S~F 7230"5 j¢~lo
WELLS
PRIVATE [] OTHER (Identify)
1
FT
REMARKS:
Inspeclions Pealer med by
~_~'/~_~~~__~ cerhly th al this inspection was pad otto ed according to ail
htunJcJpal and Slate g~ ellecl on this date:
ENGINEERS SEAL
12!; 4 (:~ .,. i/.~ ~"/i J:> ~.i!
,,__-~,, GRE., ER ANCHORAGE AREA BOk JGH
~,-~, , .
,,~-,~ ,~, Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION
LOCATION
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL /'~
INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS' ~ __
LIQUID CAPACITY/~C) GALLONS.
TILE DRAIN FIELD:
D,STANCEFROMWEL,/~]d)/ / g /0 / TOTAL LENGTH
_FOUNDATION _0 NEAREST LOT LINE
OF LINES
I
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ ~2 ~¢~__~g4.~<~t~¢z¢Q. FT. LENGTH OF EACI4 LINE DEPTH OF FILTER
DEPTH: TOP OF TILE TO F:INISH GRADE 'i~/ I MATERIAL BENEATH TILE '-~O IN. ABOVE TILE "~"-~ IN.
WELL:
TYP~/,-,~-~'~' /~ __CONSTRUCTION _DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION_____ LOT LINE____ SEWER LINE , TANK SYSTEM
CESSPOOl O-rHER SOURCES
APPROVED _~ DISAPPROVED__ REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY: ¢
SEWER LINE DEPTH:
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
THE: I_..E:I'.,IG'TH I::, :[ I"'lE:l'.,l:ii; ]: CIl'.,I :[ :!i; THE: LI:I'~G"rH ,:: ]: f.,I FEET ::, O1::' Tl...llii~ 'f'I:;i:E:I'.~CH i::)l:;i: E:,I:;i:I:::t :[ I'.,11:::' :[ liE[.[).
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Municipality of Anchorage ~,~_~ ~,
DEPARTMENT OF HEALTH & HUMAN SERVICES '~I~-~ ~['~","~*
825 "L" Street, Anchorage, Alaska 99502-0650 ~1~- ~
SOILS LOG ~ PERCOLATION TEST ~1, .o ~
SLOPE SITE PLAN
WASENCOUNTERED? GROUND WATER
11 S
, L
IF YES, AT WHAT 15 Op
12 DEPTH?
d~l lJ.°~ .- f~,t~ ,d~J ke~( E,
Deplh t0 Waler After ~) uP4.. I O
1 3 Monitoring? Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
2. J~,~ 5/o
'330 ,~¢ -
3 Vo lo , q3 .. t
qoO
14
15
16
17
18
19
20 - 5'00 ' - ~ O
PERCOLATION RATE ¢ Y V/(~rr~,nutes/,noh//P~RC HOLE DIAMETER ~'~"
TEST RUN BETWEEN FT AND % FT
PERFORMED BY: ~ ~c~- /~. S~¢ O I ER~IFY IHA~ THIS TEST WAS PERFORMED iN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECTON THIS DATE. DA~E:
72-008 (Rev. 4/85)
SOILS LOG
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 9950:2. 276-2221'
SOILS LOG - PERCOLATION TEST
DATE PERFORMED:
[] PERCOLATION
TEST
SLOPE SITE PLAN
1
3
7
8
10
11 %¢~¢ ~;/ /~'~ '~ WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
12
13
14
15
16
17
'18
19
20
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
TEST RUN BETWEEN FT AND ---- FT
CERTIFIEDBY: ~O~'NI/t.,i~-~-~I~Z[~Y b¢~ DATE:
~0~,
72-008 (7/76)
ALASKA ENVIRONMENTAL
CONTROL SERVICE" INC.
1200 West 33rd Avenue, ouite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB /~ .~/
SHEET NO _
CALCULATED
CHECKED BY
OF
DATE /I J~''~ /??;~
DATE
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d.: 3: FII'I i::'FII"I.I:I.....TFII;~: !.,.1:1:'1"1'"1 THE RE6!I...I]:I;;?.EHEI',IT'.:i; FOR Efl",t"-:'~!;]:'I"E: :E;IE!41EI:;;::!5 FIN[::, I.,.ll!ii:L..I....:i5 1::I:5 E;E:'T
F'CtR"I"I4 E:"r' "['1"11:~: i'"lUl",1:1: C I PI:rtL..T T"r' Eft:' FIl",lE:lqCIl~F:l[:'i[i:.'.
;;.i'.: :[ I.,.l:[kk ZNE;TFII....L. THE %"r".:i;TEl"l II",t FiC:E:OR[:'FINC:E Iq]:'T'H THE: CODE:E;.
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 HEAl_TH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address _
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
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
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.
NameofFirm '~;/-"/"-~1 ..~,,~./,..~.~,_,~,_~.(.2 i.\= Phone
Address ~)'(:::~ ~ ~' / ~ ~' f~- ~'> (~,
Engineer's signature ¢ - ,~-~( L-¢~-~ ~'~
DHHS SIGNATURE
Approved for ~'~
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date -~' - ~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~)25 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type ~'--
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
, Parcel I.D. /
If A, B, or C, attach ADEC letter. ADEC water system numbe~r Date completed C/~ 4,/~ ,-~ Driller
~ ¢> ~;/ Cased to ~.*r / Casing height
%/' Wires properly protected (Y/N)
FROM WELL LOG AT, I,N~PECTION
Date of test L/ . ¢, /.? --/
Static water level - ~-
Well flow (") g.p.m.
Pump levell t-"~t'.. /'-.:,,-,/.--'i -
SEPARATION DISTANCES FROM WELL TO:
O
[ t~';~' P ; On adjacent lots
; On adjacent lots
Public sewer manhole/cieanout
Petroleum tank
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
/
High water alarm (Y/N)
Date of pumping
Tank size ,//~/t~ d-- Compartments ,~-
Foundation cleanout (Y/N) _ H Depression (Y/N)
Alarm tested (Y/N) h?
'
¢~ '~ Pumper / .~ ~:~ d~. ,~' / ?
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot //
To properly line
Surface water/drainage
On adjacent lots
Absorption field
') ,/(..'a ('-: Foundation ~//:~ ,
/"¥ Water main/service line /, ,, LJ
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date,nsta,,ed
Length ~-¢Z/~ ¢-~-7 Width
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) /~(¢: _~ System type
~ Gravel thickness ~... ~ '~ I Total depth
Cleanout present (Y/N) x/ Depression over field (Y/N)
/
Results (pass/fail) ~ for '~
~.~/ After test ~ r-%~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water ',~.
Curtain drain
Bedrooms
If yes, give date
% /.~?~:~3 Property line
On adjacent lots ~
To existing or abandoned system on lot
Cutbank ~ ~' ~ Water main/service line
Driveway, parking/vehicle storage area . r-'%~ ~%
E. ENGINEER'S CERTIFICATION
I certify that I have checked, var~fled, or conformed to afl MOA and HAA guidefines in effect on the date of this inspection.
HAAFee$ / 7
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number