HomeMy WebLinkAboutHILLSIDE HEIGHTS LT 1
Permit Number:OSP261222
Tax Code Number:01509274000
Work Type:SepticTank Upgrade
Effective Date:
Design Engineer:
Site Legal Address:HILLSIDE HEIGHTS LT 1 G:2440
Owner:REGNART RONALD I &
Site Mailing Address:9601 HILLSIDE DR, Anchorage
Lot Size in Sq Ft:46436
Total Bedrooms:4
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
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
7/23/2026
7/23/2027
AK Built Construction & Design, LLC.
Expiration Date:
¨þ ¨¨¨¨
Issued To:
Issued By:
Date:
Date:
7/23/2026
7/23/2026
AK Built Construction & Design, LLC.
Isatou B Njie
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
http://www.muni.org/onsite
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-092-74
Property owner(s) Ronald & Alice Regnart
Mailing address
Site address 9601 Hillside Dr, Anchorage AK
Legal description Hillside Heights Lot 1
Number of Bedrooms 4
Engineering Firm AK Built Construction & Design, LLC
Building Permit Number
Day phone
Not Applicable Q
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
Disposal Field
❑ Initial ❑
Septic Tank
Q Upgrade
Holding Tank
❑ Renewal ❑
Privy
❑
Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: Waiver Fees:
Date of Payment: C Date of Payment:
Permit No. 05 P Z i� Z Z. Z Waiver No.
May 2025
AK Built Construction & Design, LLC
General Contracting - Engineering - Project Administration
July 21, 2026
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Section
PO Box 196650
Anchorage, AK 99519
RE: Hillside Heights Lot 1 – Septic Tank Replacement
A permit is requested to replace the existing septic tank on the subject property. A Certificate of
Onsite Approval (COSA) inspection was performed on June 29th, 2026 and found the liquid level in
the second compartment of the existing septic tank to be below normal operating fluid level. The
existing septic tank was installed in 1982 and is 44 years old. A new septic tank is required to replace
the failed septic tank. The system will serve a 4-bedroom, single-family home.
Wells
The subject property is currently served by a private water well. The existing on-lot private well
maintains 100’ of separation from the existing wastewater disposal system. Neighboring parcels are
served by private water wells. There are no neighboring wells within 100’ of the designed septic
system.
Wastewater disposal systems
The proposed work consists of replacing the existing 1,250-gallon steel septic tank with a 1,250-
gallon polyethylene septic tank and reconnecting to the existing soil absorption system. The existing
soil absorption system is a deep trench system with 60 inches of sewer rock below the pipe invert
and a trench length of 58 feet. The COSA inspection performed on June 29th, 2026 determined the
soil absorption system is still adequate to serve a 4-bedroom single-family residence.
Drainage
Site topography slopes east to west. Site drainage will be directed away from the proposed septic
tank location preventing the accumulation or ponding of surface water over the septic tank.
The designed system does not have probable adverse impacts to adjacent properties.
If you have any questions, please contact me.
Sincerely,
Robert Colles, PE
AK Built Construction & Design, LLC
Project Manager/Managing Member
907-854-9115
rlcolles@akbuilt.net
7/21/2026
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261222, Isatou Njie, 07/23/26
SYSTEM DESIGN:
1. DESIGNED SYSTEM IS FOR HILLSIDE HEIGHTS LOT 1. MUNICIPALITY OF ANCHORAGE (MOA) PARCEL ID
015-092-74.
2. DESIGNED SYSTEM WILL SERVE A 4-BEDROOM SINGLE FAMILY HOME.
3. SEPTIC TANK CAPACITY IS A MINIMUM OF 1,000-GALLONS PLUS 250-GALLONS FOR EACH BEDROOM OVER
THREE.
3.1. SEPTIC TANK SHALL BE A MINIMUM 1,250-GALLON CAPACITY TANK.
4. NO MODIFICATIONS TO THE EXISTING SOIL ABSORPTION SYSTEM (SAS) ARE INCLUDED. THE EXISTING
DISPOSAL FIELD SHALL REMAIN IN SERVICE.
MATERIALS SPECIFICATIONS:
1. WASTEWATER DISPOSAL SYSTEM COMPONENTS AND MATERIALS SHALL BE APPROVED BY THE MOA IN
ACCORDANCE WITH THE CURRENT EDITION OF MOA'S PUBLICATION "STANDARDS AND SPECIFICATIONS
FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL
SYSTEMS".
2. COMPONENTS INCIDENTAL TO THE SEPTIC SYSTEM INCLUDING BUT NOT LIMITED TO PIPING, FITTINGS,
PUMPS AND VALVES THAT ARE LISTED OR LABELED BY A MOA APPROVED ACCREDITED THIRD PARTY
LISTING AGENCY FOR THE INTENDED USE DO NOT REQUIRE THE MOA SUBMITTAL/APPROVAL PROCESS.
3. SEPTIC TANKS SHALL BE CONSTRUCTED FROM DURABLE, CORROSION-RESISTANT MATERIALS, INCLUDING
CONCRETE, FIBERGLASS, OR PLASTIC. SEPTIC TANKS CONSTRUCTED FROM STEEL SHALL BE COATED ON
BOTH THE INTERIOR AND EXTERIOR WITH AN APPROVED POLYURETHANE LINING OR SUPERIOR MATERIAL.
4. ALL SEPTIC TANKS SHALL BE FITTED WITH WATERTIGHT COUPLINGS, APPROVED BY MOA, AT THE
PUMP-OUT ATTACHMENTS AND ON THE INLET AND OUTLET OF THE TANK.
5. A SEPTIC TANK SHALL HAVE A 20" MINIMUM DIAMETER MANWAY RISER SERVING THE FIRST
COMPARTMENT. THE RISER, INCLUDING THE COVER, SHALL BE INSULATED WITH 4" MINIMUM INSULATION
EXTENDING 48" BELOW GRADE OR TO THE TANK INSULATION. THE INSULATION SHALL BE OF AN APPROVED
TYPE SUITABLE FOR BELOW GRADE APPLICATIONS. EXPOSED INSULATION ABOVE GRADE SHALL BE
PROTECTED FROM UV DAMAGE. THE RISER LID SHALL BE SECURED TO PREVENT UNINTENDED ACCESS.
6. PIPE AND FITTINGS SHALL BE IN ACCORDANCE WITH NOTE 1 AND "PIPE AND FITTINGS MATERIAL" TABLE.
7. PIPES USED IN GRAVITY DISPOSAL SYSTEMS SHALL BE 4" IN DIAMETER.
8. CLEAN OUTS SHALL BE LONG SWEEP.
9. SEWER ROCK/DRAIN ROCK SHALL BE COARSE, WASHED AGGREGATED THAT MEASURES 1 2" TO 2" IN
DIAMETER WITH NO MORE THAN 1% PASSING THE No. 200 SIEVE.
10. BEDDING MATERIAL FOR SEPTIC TANKS SHALL BE PER MANUFACTURER'S REQUIREMENTS.
11. FILTER FABRIC USED AS A SILT BARRIER IN THE CONSTRUCTION OF ABSORPTION FIELDS SHALL BE A
PERMEABLE GEOTEXTILE APPROVED FOR THE APPLICATION.
12. INSULATION USED IN THE CONSTRUCTION OF SEPTIC SYSTEMS FOR THE PURPOSES OF FREEZE
PROTECTION OF DISPOSAL FIELDS AND SEPTIC SYSTEM COMPONENTS SHALL BE MINIMUM TYPE IV
EXTRUDED OR EXPANDED POLYSTYRENE, 25 PSI COMPRESSIVE STRENGTH.
PIPE AND FITTINGS MATERIAL
PIPE TYPE OR ASTM
DESIGNATION
APPROVED AS PERFORATED
DISPOSAL FIELD PIPE OR
SOLID COLLECTOR PIPE
APPROVED AS CLEAN
OUT OR STANDPIPE
CAST IRON **YES YES
ASTM D3034 (PVC)YES YES
ASTM F789 (PVC)YES YES
ASTM D1785 (PVC)**YES YES
ASTM D2665 (PVC)**YES YES
ASTM D2751 (ABS)YES NO*
ASTM D2661 (ABS)**YES YES
ASTM F628 (ABS)**YES YES
ASTM F810 (HDPE)YES NO
* D2751 MAY BE APPROVED AS STANDPIPE MATERIAL IF THE MINIMUM WALL THICKNESS
IS 0.18", SDR 23.5.
** UNDERGROUND DWV PIPE MATERIALS LISTED IN UPC TABLE 701.1 (2012).
CONSTRUCTION SPECIFICATIONS:
1. SEPARATION DISTANCES AS IDENTIFIED IN THE "SEPARATION DISTANCES" TABLE SHALL BE MAINTAINED.
NOTIFY THE ENGINEER OF DISCOVERIES MADE DURING CONSTRUCTION THAT IMPACT SEPARATION
DISTANCE REQUIREMENTS.
2. FLAG AND SURVEY ALL PROPERTY LINES, WELL RADII, AND EXISTING FIELD SEPARATIONS PRIOR TO START
OF CONSTRUCTION.
3. LAYOUT ALL FIELD COMPONENTS AND LOCATIONS PRIOR TO START OF CONSTRUCTION. NOTIFY THE
ENGINEER IF CONFLICTS EXIST.
4. GROUNDWATER MONITOR TUBES SHALL REMAIN IN PLACE UNTIL CONSTRUCTION BEGINS. ABANDON
GROUNDWATER MONITOR TUBES BY CUTTING ONE FOOT BELOW GRADE AND ABANDON IN PLACE. IF THE
GROUNDWATER MONITOR TUBE IS WITHIN FIVE FEET OF THE DISPOSAL FIELD, REMOVE THE
GROUNDWATER MONITOR TUBE IN IT'S ENTIRETY.
5. TANKS WITH TWO TO FOUR FEET OF COVER SHALL BE INSULATED WITH A MINIMUM OF 2" OF APPROVED
INSULATION PLACED IMMEDIATELY ABOVE THE TOP OF THE TANK. TANKS SHALL NOT HAVE LESS THAN
TWO FEET OF COVER. INSULATION SHALL EXTEND 12" BEYOND THE EDGE OF TANK FOR EVERY 1" OF
INSULATION PROVIDED.
6. A SEPTIC TANK SUBJECT TO BUOYANCY FORCES SHALL BE ANCHORED OR BALLASTED AS REQUIRED TO
PREVENT FLOTATION REGARDLESS OF THE LIQUID LEVEL IN THE TANK.
7. A SEPTIC TANK SHALL HAVE A 4" MINIMUM STAND PIPE PROVIDING ACCESS TO OTHER COMPARTMENTS
NOT SERVED BY THE MANWAY RISER.
8. PROVIDE AIR TIGHT CAPS ON ALL CLEAN OUTS AND MONITORING TUBES.
9. PROVIDE A BUILDING CLEAN OUT INSTALLED ONE TO FOUR FEET FROM THE BUILDING FOUNDATION. IF NOT
PRACTICAL, A DOUBLE CLEAN OUT SHALL BE INSTALLED ON THE UPSTREAM SIDE OF THE SEPTIC TANK
WITHIN TEN FEET OF THE INLET.
10. A DOUBLE CLEAN OUT SHALL BE PROVIDED WITHIN TEN FEET OF THE SEPTIC TANK OUTLET. THE
OPPOSING CLEAN OUTS SHALL BE ORIENTED SUCH THAT THE CLEAN OUT CLOSEST TO THE TANK SHALL
BE TO CLEAN THE LINE AWAY FROM THE SEPTIC TANK, AND THE CLEAN OUT FURTHEST FROM THE TANK
SHALL BE ORIENTED TO ALLOW CLEANING TOWARD THE SEPTIC TANK. THE CLEANOUTS SHALL BE
LOCATED ON UNDISTURBED SOIL. A PRESSURE SYSTEM DOES NOT REQUIRE A DOUBLE CLEAN OUT.
11. SINGLE SEGMENTS OF SUBSURFACE DISPOSAL FIELDS SHALL NOT EXCEED 100 FEET IN LENGTH.
12. THE LONG AXIS OF A DISPOSAL FIELD SHALL FOLLOW THE CONTOURS OF THE ORIGINAL GROUND.
13. THE HORIZONTAL SEPARATION DISTANCE BETWEEN THE CLOSEST EDGES OF WORKING OR
DECOMMISSIONED SUBSURFACE DISPOSAL FIELDS, OR SEGMENTS OF SUBSURFACE DISPOSAL FIELDS,
SHALL BE AT LEAST TWICE THE DEPTH OF THE DRAIN ROCK BELOW THE LEVEL OF THE DRAINPIPE, BUT
NOT LESS THAN SIX FEET.
14. THE BOTTOM OF THE TRENCH SHALL BE LEVEL WITHIN 4". THE BOTTOM OF A WIDE TRENCH OR BED
DISPOSAL FIELD SHALL BE LEVEL WITHIN 2" BEFORE PLACEMENT OF DRAIN ROCK.
15. AFTER EXCAVATION HAS EXPOSED THE DESIGNATED INFILTRATIVE SURFACE, ANY NATIVE SOIL THAT IS
SMEARED SHALL BE SCARIFIED TO IMPROVE ITS POROSITY BEFORE PLACEMENT OF DRAIN ROCK.
16. PERFORATED DISTRIBUTION PIPE USED IN A SUBSURFACE DISPOSAL FIELD SHALL BE LAID LEVEL AND
BEDDED WITH DRAIN ROCK EXTENDING A MINIMUM OF 2" ABOVE THE TOP OF THE DISTRIBUTION PIPE, AND
LEVEL ACROSS THE ENTIRE WIDTH OF THE DRAIN FIELD.
17. NON-PRESSURIZED SUBSURFACE DISPOSAL FIELD PIPING SHALL HAVE A 4" DIAMETER CLEAN OUT
CONNECTED TO BOTH ENDS OF EACH PERFORATED SEGMENT. CLEANOUTS WITHIN 20 FEET AND IN LINE
WITH THE DOUBLE CLEAN OUT DOWNSTREAM OF THE SEPTIC TANK MAY BE OMITTED.
18. AT LEAST ONE 4" DIAMETER MONITORING TUBE SHALL BE INSTALLED IN EACH SEPARATE DISPOSAL FIELD
SEGMENT TO ALLOW MEASUREMENT OF THE FLUID LEVEL IN THE DISPOSAL FIELD. MONITOR TUBES SHALL
NOT BE CONNECTED TO THE DISTRIBUTION PIPE NETWORK. THE PORTION OF A MONITOR TUBE
EXTENDING DOWN FROM THE LEVEL OF THE HORIZONTAL DISTRIBUTION PIPES TO THE BOTTOM OF THE
DRAIN ROCK SHALL BE PERFORATED. THE PORTION OF THE MONITOR TUBE ABOVE THE HORIZONTAL
DISTRIBUTION PIPES SHALL BE NON-PERFORATED. MONITOR TUBES SHALL BE LOCATED AT ALL ANGLE
POINTS OF DISPOSAL FIELDS TO MARK THE LOCATION OF THE ABSORPTIONS SYSTEM. PRESSURIZED
TRENCH DISPOSAL FIELDS THAT DO NOT HAVE CLEAN OUT PIPES SHALL HAVE A MONITOR TUBE WITHIN
ONE FOOT OF EACH END OF INDIVIDUAL TRENCH SEGMENTS. PRESSURIZED BED DISPOSAL FIELDS THAT
DO NOT HAVE CLEAN OUT PIPES SHALL HAVE A MONITORING TUBE WITHIN ONE FOOT OF EACH CORNER
OF THE BED.
19. AN APPROVED PERMEABLE GEOTEXTILE SILT BARRIER SHALL BE INSTALLED COVERING THE ENTIRE TOP
SURFACE OF THE DRAIN ROCK PRIOR TO BACKFILL.
20. THE DISPOSAL FIELD COVER SHALL BE A MINIMUM OF TWO FEET DEEP, OVER THE TOP OF THE DRAIN
ROCK. IF THE DISPOSAL FIELD COVER IS LESS THAN THREE FEET, THE DISPOSAL FIELD SHALL BE
INSULATED WITH 2" OF APPROVED RIGID BOARD INSULATION. MINIMUM SOIL COVER OVER THE INSULATION
SHALL BE ONE FOOT. INSULATION SHALL EXTEND 12" BEYOND THE EDGE OF TANK FOR EVERY 1" OF
INSULATION PROVIDED.
21. THE FINISH GRADE OVER A SUBSURFACE DISPOSAL FIELD SHALL BE MOUNDED A MINIMUM OF 6" ABOVE
ADJACENT GROUND TO PREVENT THE FORMATION OF A DEPRESSION AFTER THE BACKFILL HAS SETTLED.
22. UPON COMPLETION OF CONSTRUCTION ALL CLEAN OUTS AND MONITOR TUBES SHALL BE ABOVE FINAL
GRADE A MINIMUM OF TWO FEET, A MAXIMUM OF 4 FEET, BE WATER TIGHT, AND LOCATED BY SWING-TIE
MEASUREMENTS TO ALLOW YEAR-ROUND LOCATION AND ACCESS.
SEPARATION DISTANCES
SEPTIC TANK SOIL ABSORPTION
SYSTEM
PROPERTY LINE 5 FEET 10 FEET
WATER MAIN/WATER
SERVICE LINE 10 FEET 10 FEET
BUILDING FOUNDATION 10 FEET 10 FEET
DECKS/STAIRS >30" ABOVE
GRADE 5 FEET 10 FEET
SURFACE WATER 100 FEET 100 FEET
PRIVATE WELL 100 FEET 100 FEET
PUBLIC WATER SUPPLY SEE 18 AAC 80 SEE 18 AAC 80
>25% SLOPE >10' TALL -50 FEET
>25% SLOPE <10' TALL -25 FEET
SUBSURFACE DRAIN -GREATER OF 10 FEET OR
TWO TIMES GRAVEL DEPTH
SOIL ABSORPTION SYSTEM -GREATER OF 6 FEET OR TWO
TIMES GRAVEL DEPTH
WATER TABLE -4 FEET
IMPERMEABLE LAYER -6 FEET
INSPECTIONS:
1. AN ON-SITE WASTEWATER DISPOSAL SYSTEM SHALL NOT BE BACKFILLED,
COMPLETED, OR USED UNTIL THE ENGINEER HAS INSPECTED AND TAKES NO
EXCEPTION TO THE INSTALLATION.
2. NOTIFY THE ENGINEER 48 HOURS IN ADVANCE OF ANTICIPATED CONSTRUCTION.
3. THE ENGINEER WILL MEET WITH THE CONTRACTOR PRIOR TO CONSTRUCTION TO
DISCUSS THE FOLLOWING,
3.1. PRECONSTRUCTION MEETING TO DISCUSS CONSTRUCTION PROCEDURES AND
DESIGN REQUIREMENTS.
3.2. VERIFY SITE CONDITIONS CONFORM TO THE DESIGN PLANS AND PERMIT.
3.3. VERIFY THE PROJECT LAYOUT CONFORMS TO THE DESIGN PLANS AND PERMIT.
4. THE ENGINEER SHALL PERFORM A BOTTOM OF HOLES INSPECTION FOR THE SEPTIC
TANK AND DISPOSAL FIELD.
5. THE DISPOSAL FIELD REQUIRES THE FOLLOWING INSPECTIONS,
5.1. AFTER EXCAVATION OF ALL NATIVE MATERIAL HAS BEEN COMPLETED, BUT PRIOR
TO PLACEMENT OF FILTER SAND AND/OR DRAIN ROCK. THE PURPOSE OF THIS
INSPECTION IS TO ALLOW VERIFICATION THAT THE NATIVE MATERIAL CONFORMS
TO THE SOILS LOG AND THE EXCAVATION IS TO THE CORRECT DEPTH.
5.2. AFTER THE PLACEMENT OF FILTER SAND, IF UTILIZED.
5.3. AFTER THE PLACEMENT OF DRAIN ROCK, AND INSTALLATIONS OF DISTRIBUTION
LINES, CLEAN OUTS, AND MONITOR TUBES, BUT PRIOR TO PLACEMENT OF
INSULATION, SILT BARRIER, OR BACKFILL.
5.4. AFTER THE SYSTEM HAS BEEN BACKFILLED TO VERIFY FINAL GRADING AND THE
LOCATION OF ALL STAND PIPES.
6. THE SEPTIC TANK REQUIRES THE FOLLOWING INSPECTIONS,
6.1. AFTER THE TANK IS SET IN PLACE WITH DISTRIBUTION PIPES AND CLEAN OUTS
INSTALLED, BUT PRIOR TO BACKFILL.
6.2. AFTER THE TANK HAS BEEN BACKFILLED TO VERIFY FINAL GRADING, ELECTRICAL
EQUIPMENT INSTALLATION, AND THE LOCATION OF ALL STAND PIPES.
FI
L
E
P
A
T
H
:
C
:
\
U
s
e
r
s
\
B
e
v
e
r
l
y
R
e
e
d
\
O
n
e
D
r
i
v
e
-
A
K
B
u
i
l
t
C
o
n
s
t
r
u
c
t
i
o
n
&
D
e
s
i
g
n
\
A
K
B
u
i
l
t
F
i
l
e
H
u
b
\
P
r
o
j
e
c
t
s
\
0
1
2
3
.
0
2
9
6
0
1
H
i
l
l
s
i
d
e
D
r
S
e
p
t
i
c
D
e
s
i
g
n
\
A
C
A
D
\
0
1
2
3
.
0
2
-
S
p
e
c
s
.
d
w
g
PL
O
T
D
A
T
E
:
7
/
2
1
/
2
0
2
6
AK
B
U
I
L
T
C
O
N
S
T
R
U
C
T
I
O
N
&
D
E
S
I
G
N
,
L
L
C
PO
B
O
X
7
7
1
2
0
3
EA
G
L
E
R
I
V
E
R
,
A
K
9
9
5
7
7
(9
0
7
)
8
5
4
-
9
1
1
5
CE
R
T
I
F
I
C
A
T
E
O
F
A
U
T
H
O
R
I
Z
A
T
I
O
N
#
2
0
4
4
5
1
HI
L
L
S
I
D
E
H
E
I
G
H
T
S
L
O
T
1
T
A
N
K
R
E
P
L
A
C
E
M
E
N
T
96
0
1
H
I
L
L
S
I
D
E
D
R
A
N
C
H
O
R
A
G
E
,
A
K
9
9
5
0
1
AK
B
U
I
L
T
P
R
O
J
E
C
T
N
O
:
0
1
2
3
.
0
2
C3OF
7/21/2026
DATE:
TITLE:
REGISTEREDPROFES S I O N A L E N GINEER
07/21/2026
ROBERT COLLES, PE
No. CE-163739
C1
SPECIFICATIONS
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261222, Isatou Njie, 07/23/26
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
WE
L
L
WELLWELL
WELL
WELL
WEL
L
WEL
L
WE
L
L
WE
L
L
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
EL
L
WELL
WELL WELL
WEL L
W ELL
WEL
L
WE
L
L
WE
L
L
WE
L
L
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
WE
L
L
WELLWELL
WELL
WELL
WEL
L
WEL
L
WE
LL
WE
L
L
WE
L
L
W
E
L
L
W
E
L
L
WE
L
L
WE
LL
WEL
L
WE
L
L
WE
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
WELL
WELL WELL
WEL L
WELL
WEL
L
WE
L
L
WE
L
L
WE
L
L
W
W
W
WEL
L
WEL
L
WE
L
L
WE
L
L
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
LL
WE
L
L
WELLWELL
WELL
WELL
WELL WELL
WEL L
WELL
WEL
L
WE
LL
WE
L
L
WE
L
L
WE
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
WE
L
L
WELLWELL
WELL
WELL
WEL
L
WEL
L
WE
L
L
WE
L
L
HILLSIDE HEIGHTS
LOT 1
HILLSIDE HEIGHTS
LOT 3
HILLSIDE HEIGHTS
LOT 2
HILLSIDE HEIGHTS
LOT 4
PANORAMA TERRACE
BLOCK 1 LOT 1A
NETTLETON
LOT 1C
PANORAMA TERRACE
BLOCK 2 LOT 9
HI
L
L
S
I
D
E
D
R
R100'
R100'
R1
0
0'
R1
0
0
'
R100'
R1
0
0
'
10' UTILITY EASEMENT
1
0
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
1
0
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
1
0
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
PRIVATE WELL
PRIVATE WELL
PRIVATE WELL
PRIVATE WELL
PAVED DRIVEWAY
EXISTING SAS
4-BED HOUSE
5' UTILITY
EASEMENT
PROPOSED 1,250-GAL SEPTIC TANK
FI
L
E
P
A
T
H
:
C
:
\
U
s
e
r
s
\
B
e
v
e
r
l
y
R
e
e
d
\
O
n
e
D
r
i
v
e
-
A
K
B
u
i
l
t
C
o
n
s
t
r
u
c
t
i
o
n
&
D
e
s
i
g
n
\
A
K
B
u
i
l
t
F
i
l
e
H
u
b
\
P
r
o
j
e
c
t
s
\
0
1
2
3
.
0
2
9
6
0
1
H
i
l
l
s
i
d
e
D
r
S
e
p
t
i
c
D
e
s
i
g
n
\
A
C
A
D
\
0
1
2
3
.
0
2
_
S
i
t
e
.
d
w
g
PL
O
T
D
A
T
E
:
7
/
2
1
/
2
0
2
6
AK
B
U
I
L
T
C
O
N
S
T
R
U
C
T
I
O
N
&
D
E
S
I
G
N
,
L
L
C
PO
B
O
X
7
7
1
2
0
3
EA
G
L
E
R
I
V
E
R
,
A
K
9
9
5
7
7
(9
0
7
)
8
5
4
-
9
1
1
5
CE
R
T
I
F
I
C
A
T
E
O
F
A
U
T
H
O
R
I
Z
A
T
I
O
N
#
2
0
4
4
5
1
HI
L
L
S
I
D
E
H
E
I
G
H
T
S
L
O
T
1
T
A
N
K
R
E
P
L
A
C
E
M
E
N
T
96
0
1
H
I
L
L
S
I
D
E
D
R
A
N
C
H
O
R
A
G
E
,
A
K
9
9
5
0
1
PR
O
J
E
C
T
N
O
:
X
X
X
X
X
AK
B
U
I
L
T
P
R
O
J
E
C
T
N
O
:
0
1
2
3
.
0
2
C3OF
7/21/2026
DATE:
TITLE:
REGISTEREDPROFES S I O N A L E N GINEER
07/20/2026
ROBERT COLLES, PE
No. CE-163739
Feet
0 20 40
NOTE:
1. NETTLETON LOT 1C, PANORAMA TERRACE BLOCK 1 LOT 1A,
PANORAMA TERRACE BLOCK 2 LOT 9, AND HILLSIDE HEIGHTS
LOTS 2, 3, AND 4 ON-SITE SEPTIC SYSTEMS AND WELLS DO NOT
INTERFERE WITH PROPOSED SEPTIC SYSTEM.
2. NETTLETON LOT 1C, PANORAMA TERRACE BLOCK 1 LOT 1A,
PANORAMA TERRACE BLOCK 2 LOT 9, AND HILLSIDE HEIGHTS
LOTS 2, 3, AND 4 ON-SITE SEPTIC SYSTEMS AND WELLS ARE NOT
NEGATIVELY IMPACTED BY THE PROPOSED SEPTIC SYSTEM.
C2
SITEPLAN
WE
LL
WE
L
L
WE
L
L
WE
L
L
WE
L
L
WEL
L
WE
LL
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
ELL
WE
L
L
WELL
WELL WELL WELL
WEL L
WELL
WELL
WELLWELLWELL
WEL L
WELL
W ELL
WEL L
WE L L
WEL
L
L
L
W
E
L
L
W
E
L
L
W
E
L
L
W
EL
L
WE
L
L
WELL
WELL
WELL WELL W ELL
WE L L
W
HILLSIDE HEIGHTS
LOT 1
PANORAMA TERRACE
BLOCK 1 LOT 1A
R100.00
R100.00
10' UTILITY EASEMENT
1
0
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
1
0
'
U
T
I
L
I
T
Y
E
A
S
E
M
E
N
T
PRIVATE WELL
PAVED DRIVEWAY
EXISTING SAS
4-BED HOUSE
5' UTILITY
EASEMENT
REMOVE EXISTING TANK AND REPLACE
WITH A 1,250-GAL POLY TANK. DISPOSE
OF EXISTING SEPTIC TANK OFF-SITE.
INSTALL
DCO
APPROXIMATE CUT LIMITS
0+
0
0
0+100+20 0+300+40 0+500+60 0+68
DEC
K
MANAGE EXCAVATION
TO PREVENT DECK DAMAGE
7'
S-1
S-2
S-3
S-4S-5
S-6
S-
7
102"
64"
60"
ORENCO ACCESS LID
4" PLUS URETHANE FOAM
ORENCO ULTRA-RIB RISER TUBING
4" URETHANE FOAM FOR FIRST 4'
FERNCO COUPLING
4" CLEAN OUT
JIM CAP
67"
58"
INTERIOR BAFFLE
WYE
1 8 BEND
CLEAN OUT
SEWER
650
652.5
655
657.5
660
662.5
665
667.5
670
650
652.5
655
657.5
660
662.5
665
667.5
670
S-2
S-3
S-5
S-4
658.49' 658.33'
ORIGINAL GRADE
EXCAVATION
LIMITS
1,250-GAL SEPTIC TANK
PIPE TABLE
ID
S-3
S-4
∅
4"
4"
LENGTH
5.00'
5.00'
SLOPE
2.00%
2.00%
INLET
LOCATION
N:2606313.6638
E:1685707.4377
N:2606313.5375
E:1685696.4590
INLET
ELEV
658.66
658.39
OUTLET
LOCATION
N:2606313.6063
E:1685702.4380
N:2606313.4799
E:1685691.4593
OUTLET
ELEV
658.56
658.29
FI
L
E
P
A
T
H
:
C
:
\
U
s
e
r
s
\
B
e
v
e
r
l
y
R
e
e
d
\
O
n
e
D
r
i
v
e
-
A
K
B
u
i
l
t
C
o
n
s
t
r
u
c
t
i
o
n
&
D
e
s
i
g
n
\
A
K
B
u
i
l
t
F
i
l
e
H
u
b
\
P
r
o
j
e
c
t
s
\
0
1
2
3
.
0
2
9
6
0
1
H
i
l
l
s
i
d
e
D
r
S
e
p
t
i
c
D
e
s
i
g
n
\
A
C
A
D
\
0
1
2
3
.
0
2
-
S
e
p
t
i
c
.
d
w
g
PL
O
T
D
A
T
E
:
7
/
2
1
/
2
0
2
6
AK
B
U
I
L
T
C
O
N
S
T
R
U
C
T
I
O
N
&
D
E
S
I
G
N
,
L
L
C
PO
B
O
X
7
7
1
2
0
3
EA
G
L
E
R
I
V
E
R
,
A
K
9
9
5
7
7
(9
0
7
)
8
5
4
-
9
1
1
5
CE
R
T
I
F
I
C
A
T
E
O
F
A
U
T
H
O
R
I
Z
A
T
I
O
N
#
2
0
4
4
5
1
HI
L
L
S
I
D
E
H
E
I
G
H
T
S
L
O
T
1
T
A
N
K
R
E
P
L
A
C
E
M
E
N
T
96
0
1
H
I
L
L
S
I
D
E
D
R
A
N
C
H
O
R
A
G
E
,
A
K
9
9
5
0
1
PR
O
J
E
C
T
N
O
:
X
X
X
X
X
AK
B
U
I
L
T
P
R
O
J
E
C
T
N
O
:
0
1
2
3
.
0
2
C3OF
7/21/2026
DATE:
TITLE:
REGISTEREDPROFES S I O N A L E N GINEER
07/20/2026
ROBERT COLLES, PE
No. CE-163739
Feet
0 10 20
3
C3
TYP DOUBLE CLEAN OUT
2
C3
1,250-GAL POLY TANK
1
C3
SEPTIC TANK PROFILE VIEW
C3
SEPTIC
NOTE: ELEVATIONS ARE APPROXIMATE BASED ON FIELD MEASUREMENTS.
NOTE: PIPE TABLE QUANTITY IS APPROXIMATE. ELEVATIONS TO MATCH EXISTING CONDITIONS.
MUNICIPALITY OF ANCHORAGE
DEPARTMEN'F OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephonic 264.-4720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORI'
NAME
~AILING ,~DR ESS
LEGAL DESCRIPTION
LOCATION
$ I%) LF/
NO. OF BEDROOMS
I Well~") .... I I Abs0rptien ar. ea "-[ Dwelling~ . , PERMli~'~N~ ......
D1STANCE TO' /
' ...... ~, /0
Manufaot.l~ ~ ....... f ............... q ~at~ , No7 of c~a~FtFnent' s
~L~q ~a~actdn ga o~sl ! Inside~ .... /Widt~ I Liquid~q~th
~ ~ ~ ~f~urer ~aterial Eluid copacity in gallons
~ '~lLm0*h ~¢'' ~;~h I' i;~e Total ~th o~- lines -~rench widt-h [~%tance be~n~ nes
Top of t,le to ffi~,~i~ E~ESd& ~, M~e~eath tile -~ ........ l%t~Fde~%~so~Eion~Fea
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ FI~ Depth Driller Distance to lot line ] PERMIT NO.
~, ~~- ,u,,d,~..,o..~,,o.- ', ~.~,,,n- -~ ~,~,,o,~,,' ~ -,*,,~or,:t,on~,'~,,,
J_
OTHER
PIPE MATERIALS
--SOl L T ES~RATI~N Z,~
REMARKS
APPROV~~: ~~--~'~-'~"'~DATE
LEGAL
'!"l.Iii!}l i.>!.¢N:::"TH OF:' !:::! r!:;;:E!'.!E:N OR F'I'!' ;!iS 'T'HE E:,i'~;TFI!'.:!E:E E:EI!,.!!i{Ei!',! "i'N!iil 5UF;':;!::'!=i!i:tl!ii Il'5!:= 'N..!!E
'!"l~Ei:i:~.:; ;!::~; NO SEN' H!D"NI ~::;'(.}~:;~:
F!HC' ']"Nil E'.O-!"i"C$'! OF: '!'I'J~}~: !i;',:'Oi:FI'v'FKF!ON '::;i:J",~ F:'EE'T'::'.
SOILS LOG
MUNICIPALITY OF ANCHORAGE
~.__.M__'~, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [3 PERCOLATION
Pouch 6-650, Aochorago, Alaska 99502 276-222'[
SOILS LOG - PERCOLATION TEST
SLOPE" ' SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
'17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
COMMENTS
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Readiug Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
-- FT
PERFORMED
72-008 (7/76)
P. O. Box 10-681
Anchorage, Alaska 99511
SIX INCH WATEr WELL DRILLED AND CASED OUT TO TH~ DEPTH OF
DRILLED AT THE rate OF PEr FOOT.
PRoPerTY OWNER ~//~', .... :' .....
LOCATION OF WELL. SITE ',,
DRILLER
WELL LOG:
COST INCLUDES ALl. LABOR AND MATERIAL FOr COMPLETION OF SAID DRILLING.
WRITe CHECK PAYABLE TO RAMPArt DRILLING WORKS For THE SUM OF
THANK YOU very MUCH.
DATE
BERNIE CLAUS OF RAMPArt DRILLING WORKS
SERVICE CI-tARGE Of 1V~:% PER MONTH WILL BE ASSESSED ON'PAST DUEACOouNTS'
Parcel I.D. #
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
CE~RTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
"'HAA#
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Agent
Address
Property oWner..'
Mailing address-
Lending agency
M~iling address'
~--UO~ Day phone -~-o-- 2~'770
Day phone
Day phone --~4~r-77:3 0
Unless otherwise requested, be held
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community welt
Public water
NOTE:
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
' Holding tank ~ '
Community on-site
Public sewer
NOTE:
72-025 (Rev. 1191) Front MOA~21
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system. ," ,~ ,
If community wastewater system, provide wri~en confirmation from State ADEC
attesting to the legalit~rand status O'f
o
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 regulatio~l~llm, e'~et~)n the date of this inspection.
Wastewater Services
8471 Brookridge Dr ,4
Name of Firm '~ Phone -~' ~ 7-6/'~(~
Address ~//'~-~/, ~/'////
Engineer's signature Date
Alaska Water & U///
Wastewater Services
8471 B¢ookrldge Dr
Anch., AK 9¢504 '
DHHS SIGNATURE
~ Approved for
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date /0- 2 / - ~'~-
~'The Mt~r,'fci~,ality of.A¢~tbhorage Department of Health and Human Services (DHHS) issues Health Authority
'APProval C~ificat~§;~a~ed only upon the representations given in paragraph 5 above by an independent
· p~;of~ssional eng ~'registered n the State of Alaska The DHHS does th s as a courtes to urchasers of homes
aha emtendmg~nsttutonsinordertosatsfycertanfedera andstaterequrements EmployeesofDHHSdonot
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..
'/'2-025 (Re~,1/91) Back MOAt21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
or~'- o~'z-74-
Well type '(::'~ ~r~;~'",~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
if A, B, or C, attach ADEC letter. ADEC water system number
Date completed c~/4-/B.3 Driller ~-A~¢,
1 7 ~ Cased to / -7 Z. / Casing height ~ I'Z-~
",/_~?-. Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level1
FROM WELL LOG AT INSPECTION
I0 >,-':8:,
.g.p.m. .g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot /[~' / '+.-:
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots >~ leo
Public sewer manhole/cleanout
Petroleum tank ~//~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
~,~-. ~/~ Other bacteria
Collected by: ~A¢.,./¢,¢'
B. SEPTIC/HOLDING TANK DATA
Date installed -7 / 9 ¢,
Cleanouts (Y/N) ~
High water alarm (Y/N)
Date of pumping
Tank size 17___ ~'0 Compartments Z.
Foundation cleanout (Y/N) x,,/~__._q Depression (Y/N)
,'V/A Alarm tested (Y/N)
c~/z ~/c:zar Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
/
Well(s) on lot FZ..O
To properly line Absorption field
Surface water/drainage
Foundation
Water main/service line
72-026 (~g3)° Front CONTINUED ON BACK PAGE
Manufacturer
Size in gallons ~ Manhole/Access (Y/N) ~
Vent (Y/N)
High water alarm level ~'~~~ed
Meets MOA electrical codes (Y/N) .~ ~
"~ SEPARAT~TION TO:
:~ ~ On adjacent lots
,~.% D. ABSORPTION FIELD DATA
Dateinstalied '7/~?-- Soil rating (~[.~,Ft=) J~-~' Pr/~'~ Systemt,/pe ~
Length ~----------------~'~' (~ Width
Total absorption area 5'~0 ®
Date of adequacy test ~/24-/,+
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Gravel thickness Total depth ///
Cleanout present (Y/N) 5'urn? Depression over field (Y/N)
Results (pass/fail) P/dr~<S for "~-
M/~ If yes, give date ~/~
t~O
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
/
Well on lot (1¢ +- On adjacent lots :~ 1~ Property line
To building foundation ~-~' 'To s~,~P (~ To existing or abandoned system on lot
On adjacent lots > ~0 Cutbank
Sudace water % /OD
Cudain drain
E. ENGINEER'S CERTIFICATION
~ ~ Water mai~se~ice line >~o' o~o~,,~
Driveway, parkinCvehicle storage area /~/~
I certify that I have checkeo verified, or/conformed to all MOA and HAA guidelines in effect on the date el ~this inspection.
Signature 7g)~ ; :'~
/
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
CT&E Ref.#
Client Sample ID
Matrix
Commercial Testing & Engineering Co.
Environmental Laboratory Services ~,,~o?×~.y~7,c;~-/r¥c?/y,~/7×.~/-,;rT/~,zc??~:~7×~~c~
LABORATORY ANALYSIS REPORT
94.4826-1
9601 ItlLLSIDE DRIVE
WATER
Client Nmne AK WATER & WASTEWA'I~R SERVICES WORK Order 82383
Ordered By JEFF GARNESS Printed Date 09/22/94 ~ 10:z~2 hrs.
Project Name Collected Date 09/20/94 ~10:00 lu's.
Project// Received Date 09/20/94 ~ I2:50 lu's.
PWSID UA
Technical Director STEPHEN C. EDE
Released
Smnple Remtu'ks: ROU 11NE SAMPLE COLLECTED BY: GAI~IESS.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Li]nits Date Date hilt
Nitrale-N 3.20 mg/L EPA 353.2/300.0 10 09/21/94 CMR
* See Special Instructions Above
** See Sample RemmScs Above
U = Undetected, Reported value is the practical quantification limit.
D = Secondary dilution.
UA = Unavailable
NA = Not Analyzed
LT= Less Than
GT = Greater 'lhan
5633 B Street, Anchorage, AK 99618-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301
ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, U'rAH, WEST VIRGINIA
I
,PLO~ PLAN~, & L_O~T SUR_VE~J~ ...........
CONSI~UC~ON, TO ~RI~ PROPQ~D BUI~INO ~ADE R~
TO RNI~ ~ADE ~D U~U'~ C~NEC~8 AND TO
~-"'~ ~ ~ ..~.t~-~.l-----~
.~ ~ ~ ~ ,~ ~ ............ . ~ -~'
ONLY '0t0~ IMPROV~MENT'~ 'ABOVE OROUND AND ~SrBLE M~
~lO~, ~ ~, ~0 ~NOU~ ~ID~W~, D~m~WA~
~., AR~ ~O~ IN ~R APPRO~MA~ C~A~ON, ONLY.
MAY PRINT ~E IMPRQ~ ~ B~NO ~k~ AND
' - ........... Pre~ored b~ ........
Robert E. dohns, dr. ~
Professional Land Surve~rs
~.. - ........... I ............
9~23-94 I R~j I
LOT 1, MILLSIDE HEIO~ITS SUBDIVISION
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
. ,.
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
? ,of ,be-;' .
(b) Property owner
Mailing Address
Telephone · (home)
Business
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent ,~.~W/4-× ~-"~,/ ~'.~/
Address ;~..¢a ~,~'.b~, '¢~ ~ /~ ~'~ ~
Telephone ~7~ ~ ~7~ )
(e) Mail the HAA to the following address: (or check here"~if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESlDENOE
Single-Family'~ Number of bedrooms
3. WATER SUPPLY
Individual Wel I"~'
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site'¢~. 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.
~ ,to ~ eSBd
')pOM s,JeeuibuB iBuo!sse,~oJd
SUO!SS!LUO JO S JO J J8 JO~L elq!suodseJ ].ou si ebBJoqou¥,to .L].!lBd!o!u nR eqJ. 'penss! s! e].Bo!J!].Je3 B eJO,t@q B:~Bp ez.LIBUe Jo
suo?].oedsu! ].onpuoo l. ou op SHHG ~.o see.LOldLU3 's].ueuueJinbeJ el.e],s pub IB..lepe~. u!B].Jeo .L,ts!].Bs o:]. JepJo
8u!puel .J!eq:l puc SeLUOq ,tO sJeseqoJnd o1..Lsm. Jnoo e sB siq]. seop SHHG eqJ. 'B>IsBIV ~.o e:IB].S eq]. u! peJe].s!beJ
.Jeeu!l~ue IBUO!SS@,to..~d :].uepued@pu! uB .Lq aAoqB ~ LIdB,,~SB,,~Bd U! ua^ih suo!].e].ueseJdeJ eq]. uodn/~lUO peseq pe],Bo!ipeo
leAoJddv.Ll!Joqlnv qllBeH senss! (SHHQ) seo!AJeS uemnH pub qllBaH J.o lUeLUlJBdac] eSl~JOqOUV .J.o .Ll!lBd!o!u nv',i eq..L
iBAo.Jdd'¢ IBUOR!puoo ,to st.uJel
elea
A. W E L~(i~T~
Well Classification
Well Log Present~N) Date Completed
Total Depth /¢2-- ¢ Cased to /~ Depth of Grouting
Static Water Level
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST- FEBRUARY 1984
343-4744
Legal Description: ~¢)~"
Casing Height Above Ground /
Electrical Wiring in ConduitON)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments ~/~/~-/'/' /~r,J '7~'¢¢
If A, B, C, D.E.C. Ap?roved (Y/N)
Pump Set At
Sanitary Seal on Casingl~N)
Depression Around Wellhead (Yt~
I
; On Adjoining Lots /,'o'O
i¢,f 1
I/~.,,5 '7"~ '~/~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole /.2/4
;Date
SEPTIC/HOLDING TANK DATA
Date Installed ~¢/1~''~'~ Size
Standpipes~.~N)
Depression over Tank
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Aiarm.(Y/N)
/,~.~:' No. of Compartments
Air-tight Caps {~,N)
Foundation Cleanout~.~N)
Date Last Pumped ?'
; for
Temporary Holding Tank Permit (Y/N)
SEPARATION DISTANCES FR'QMSEPT C/HOLDING TANK:
To Water-Supply Well .: /~-o.
To Property Line lO
To Water Main/Service Line . .
To Stream, Pond, Lake or Major Drainage Course
Comments
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7-/¢" ~'"
Width of Field ,,¢0~ ¢~/' /¢'~'b~f/z.'7";
Square Feet of Absortion Area
Depression over Field (Y~__~
Results of Last Adequacy Test
Type of System Design
Length of Field --5'~¢¢//
t
Depth of Field /O
f
Gravel Bed Thickness
Statndpipes Present'N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /I f~"~'~"' ' ~ ''''''~.f-
To Building Foundation
Lot
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
£
To Property Line /O
To Existing or Abandoned System on
; On Adjoining Lots /¢ .r
To Cutback (if present)
Comments
D. LI~.~ATION
Date I n~.L~
Size in Gallon~
"Pump On" Level at ~,
High Water Alarm Level at ~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidel
inspection.
Signed
Company
Date
MOA No,
fect on the date of this
ReceiptNo. c~/¢¢/
Date of Payment
Amount: $ r/,7 ~:~ ~
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
i',, .~E,~gineer's Seal
CE - 2251
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONq~NTAL PROTECTION
APPLICATION FOR H~TH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a)
Legal Description (include lot, block, subdivision, section, township, range)
(b)
Location (address or directions)
Applicants Name o~fL
Applicants Address
(c) Applicant is (chec% one) Lending Institution
Buyer ~--~ ; Other ~--~ (explain);
(d) Lending Institution
~7~
Business
~ ; Owner/builder~ ;
Telephone
Address
(e) Real Estate Co. & ~gent ~/~
Address
(f)
Telephone
Mail the HZLA to the following address:
~.-,~, ~,f_ ~/c~. ~/ct~ ~f~
2. ~ype of Residence
Single2Family~
Number of Bedrooms
3. Water Supp1M~
Individual Well ~-~
Multi-Family ~--~
Other (describe)
Community ~--~ Public ~-~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. 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.
[Page 1 of 2]
5. 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Address ~/ ~/
DHEP Approval
Approved for f"F;C;~- bedrooms '
Approved ~? Disapproved Condition~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T}~ REPRESENT-
ATIONS 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 REQUIRE-'
MENTSo 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.
(DHEP SF~4L)
RR4/ej/D18
[Page 2 of 2]
7 -19- 84
A®
' MUNICIPALITY OF ANCHOr'
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIONMUNICIPALITY OF ANCHORAGE (MOA)
HF~kLTH AUTHORITY APPROVAL {HAA)
MAY 3 2 1986
CHECKLIST - F~RUARY 1984
RECEIVED
WELL DATA
Legal Description:
Well Classification /Pwt ~'-- ~=
Well Log Present (Y/N) ~
Total Depth /??-' Cased to
Static Water Level / 37 '
Casing Height Above Ground ~'
Electrical Wiring in Conduit (Y/N) / ,.
Separation Distances from Well:
To Septic/Holding Tank o~ Lot ~/Dd'
If A, B, or C, D.E.C. Approved(Y/N)
Date Completed
/2z-'
Pump Set At
~-~/- ~'~ __ Yield ~-57.,,.~,~
Depth of Grouting /J~
/&7 '
Sanitary Seal on Casing (.Y/N)/
Depression Around Wellhead (Y/N) /u7
To Nearest Edge of Absorption Field on Lot
To Nearest Public Se.~r Line
Cleancut/Manhole /t///4 To Nearest Sewer ,~rvice Line on Lot
Water Sample Collected By
Water Sample Test P~sults
; On Adjoining Lots ~
; (k7 Adjoining Lots
To Nearest Public Sewer
~f~,~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-//" FZ' Size /ZS-d No. of Ca~partamnts t-
Standpipes (y/N) / Air-tight Caps (Y/N) /~ Foundation Cleanout (Y/N) /__
Depression over Tank (Y/N) A) Date Last P~,ped ~--~-F~
Pumping/Maintenance Contract on File (Y/N) A3 ; for
Holding Tank High-Water Ala=m {Y/N) AJ~ Temporary Holding Tank Permit (Y/N) ~
Separation Distances from Septic/Holding Tank:
To Water-Supply We 11
To Property Line +/~'
To Water Main/Service Line ~/~ '
Course
To Building Foundation ~ ~O
To Disposal Field /~ '
To Stream, Pondr L~e, or Major Drainage
Receipt ~
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed 7- / 9¢ - ~ ~-
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
//3
Type of System Design
Length of Field 56~ '
Depth of Field /D '
Gravel Bed Thickness 5'
Standpipes Present (Y/N)
Date of Last Adequacy Test.
Separation Distance frcm A~sorption Field:
To Water-Supply Well ¢-/~' To Property Line ~/~ '
To Building Foundation ~ 9/~' To Existing or Abandoned System cn
Lot /t; ~ ; On Adjoining Lots + 6/o '
To Water Main/Service Line + ~o' To Cutbank(if present) "~/-~
To Stream/Pond/Lake/c~ Major D~ainage Course +/¢)~ '
To Driveway, Parking Area, o~ Vehicle Storage A=ea + 'LO'
Co~ents ~-'~$P '~F~'~'~ ~- //J ;r/c~'.
D. LIFT STATION -- A~.~'
Installed
Size in
"Puinp Orl" Level at
High Water Alarm Level at
Tested for
Elec~ical Codes
Co~'~nts
Dirrensions
Manhole/Access
"Pump Off" Level
(Y/N)
Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Pequest
I certify that I have checked, verified, or conformad to all MOA HAA Gui
on the date of this inspection.
Signed ~ ~/~w~_, Date ~ f~' ~"
Company ~o~/, ~,¢~/~. _~.. MOA No. F~-~
KB1/d5/s
in effect
[Page 2 of 2] . ..
2-15-84
MUNICIP~fLITY OF ANCHOgAGE
DIVISION OF ~qViRONMENTkL HEALI]~
DEPA3fflMENT OF HEALTH AND ENVI}~DNMENTAL PROTECTION
APPLICATION ~)R HEALTH AUTHORITY APPROVAL CERTIFICA'~E
\
1. General Inform~tion Application Date
(a) [~gal Description (inc].uc~; lot, block, subdivision, sect:Lon, to, reship, range)
Location (ad.ess o~ directions)
(c) Applicant is (check o~) ~nding ~nstitution ~j ~ ~ne,/buil~ ~] ~
(e) mai Estate Co, & Agent
Address
Te le phone
Single-Family
Nt/mbe~ Of ~edroo~
3. Water S~I
Individual ~,~ll
Othe~ (descri[~)
Community L-~ t~3. blic
Note: If co~'~nity ~llL system, must ~ave v~citten ccnfirn~ticn fr~n the State
Departn~nt of 51nviron~ntal Conservation attesting tc the legality and status.
Is tJqe %~11 adequate for the number of bedrocks specified in this H~A (Y/N)
4..Se. urage Disposal
/
~ Is the wastewater disposal system adequate fo: the nurd~e~: of ~drocms (YA'I) ~
[Page 1. of 2]
2.-15-,84
!5. ........ )~!.neer~in_~q t~i..rm Providi~~[t~ions ,_71e. sts ~., Da_t_a_a
I. certify that I have checked, ~?rified, or confozT~d to all MOA NAA Ck~ideline. s in
effect on the date of this inspection.
6. DHEP Approval
Approved for
b'.~ dr c~
Disapproved ~
Terms of Cx~nditional Approval
Conditional
,P~ Municipality of Anchc~a.ge l~partn~.,.,nt of ~,alth and Environn.enta]. Protecticn dces
not guarantee the continued satisfactory ~rforman~ of t~ wate~z supply and/ct the
wastewater dis~sal system. ~is approval indicates that, as of tl~ ~lidation ~te
shom~ ~ b~sed on t~ ~ta and infor~qtion f~nished ~ an e~i~er registered
the State of A ..... ,ka, the ~ater supply ~d wastewate~, disposal sFstem is safe and
tional for the nu~er of ~ ~d t~ of structure indicated.
7. Mail the HAA to the foll
KB2/dS/s
[Pag~ 2 of 2]
A®
,CoS I /4,fi
MUNICIPALITY OF A/~CHORAGE (MOA)
HF2kLTH AUTHORIZer APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
WELL DATA
Well Classification ~'~Y'I k."'~,~ ~t-F-,L·
Well Log P~esent (Y/N)
Total Depth /'7'Z_~ Cased to
Static Water Level /~7 ' Pump. Set At
Casing Height Above Ground ~ '
Electrical Wi~ing in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot ~-/~9 i
To Nearest Edge of Absorption Field on Lot '~'
To Nearest Public Sewe~ Line
Date Completed
/ 7 Li
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
Cle ancut/Manhole AT/~
Wate~ Sample Collected By ~,/ ~J~p'/~% ; D~te
Wate~ S~le Test ~sults _. 3>~ / s ~ ~- ~ "~
To Nearest Se%~ Service Linc on Lot
B. SEPTIC/HOLDING TANK DATA
Date Installed _~-/~~ gT_~ Size /?-50
Standpipes (Y/N) ~/ Air-tight Caps (Y~_~_~__
Depression ove~ Tank (Y/N) ~Q Date Last Pumpe. d_
No. of Compartments ~--
Foundation Cteanout (Y/N)
Pumping/Maintenance Contract on File (Y/N) AT//{; for
Holding Tank High-Wate~ Alarm (~Y/N)/~,//~ Tempo~a~!; Holding Tank Permit (Y/N)~
Separation Distances f~om Septic/Holding Tan~k:
To Water-Supply Well
To P~operty Line 7
To Water Main/Service Line
To Building Foundation 7L~)
To Disposal Field __~ .~"
To Stream, Pond, Lake,, cm' Major Drainage
co=se
[Page 1 of 2]
2-15~84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata TyDe of System Design
Date Installed ~ _ / ~.. ~/~ Length of Field
Width of Field ~ Depth of Field /6> '
Square Feet of Absorption A~ea '~O /Gravel Bed Thickness ~-/
Standpipes P~esent (Y/N)
Depression over Field (Y/N) ~ Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /-/O~) To P~operty Line -/- /69
To Building Foundation ~ ~/O / To Existing or Abandoned System on
Lot /J//~ ; On Adjoining Lots ~
To water Main/Service Line /~,/A To Cutbank(if present) +~ '
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area ~
Comments ~/~/~/~ F~/)z) '~ /~ ~_~
LIFT STATION ~
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
"Pur~p Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedrccxn Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA ~~_n effect
on the date of this lnspe tlC~.
[Pa~ 2 of 2]
2-15-84