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HomeMy WebLinkAboutHERITAGE HEIGHTS LT 16A(Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191301 PID Number: 015-631-47 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name MAHANEY ABSORPTION FIELD ❑ Deep Trench ❑Wide Trench [:1 Bed El Mound Site Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot HERITAGE HEIGHTS LOT 16A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ftz Ft. Well *200'+ 50,+ TANK 9 Septic ElS.T.E.P. ElHolding ElOther Manufacturer GREER Capacity 1000 Gal. Surface Water 1 100'+ Material PLASTIC Number of compartments 2.0 Lot Line j 1 0'+ NA Foundation�'�- LIFT STATION Manufacturer Capacity Remarks * COMM. WATER Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield CO/MT Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection15t 7/20/19 Location and description 2 ntl BOTTOM OF SIDING 3`d 4'h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Firae�rs,stamp e ftr.a Conditional Approval: Date° # " f 4 O TT EEEee'd551 d IWCIC A.EL N. ANDERSC , � _ System CF-943Septic pp Date Note: this approval does not include well permit requirements.�� ems•. (Rev 05/02/18) Permit No. OSP191301 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: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: HERITAGE HEIGHTS LT 16A ASBUILT SCALE: 1"=30' PID No.: 015-361-47 jrcu �rcui ( cot coz ®®gyp®\®11 ® T�o2 i ®®®�F ®®®®® 6 491H_ 9 i 7,6C0 CAIIOY ...... .. .......................... P(A611C TANK 0 10 .. .. .... ................... .. =•MICHAEL N. ANDERSON QA 44 s'. No. CE 9469 4 SEPTIC SECTION N.T.S. ®� ®' q r N,`,PA '' MUNICIPALITY OF ANCHORAGE `fJ, . ._.,..,�Op ,ttt P n�. / On-Site Water&Wastewater Program Nc <; a„�`: PO Box 196650 4700 Elmore Road J Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ^v r, http://www.muni.org/onsite `" _ r. epartmcnt 'NcHORot On-Site Wastewater Disposal System Permit Permit Number: OSP191301 Effective Date: 7/16/2019 Work Type: SepticTank Upgrade Expiration Date: 7/15/2020 Tax Code Number: 01536147000 Site Legal Address: HERITAGE HEIGHTS LT 16A G:2438 Site Mailing Address: 5801 CHISANA WAY, Anchorage Owner: MAHANEY REBECCA JEAN Lot Size in Sq Ft: 18975 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: ?A le - Pelie/C,i, � ffqIssued By: It a/ Date: l 6 I / RUSH • - MUNICIPALITY OF ANCHORAGE Development Services Department \ / Phone: 907-343-7904 On-Site Water & Wastewater Section — Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-361-47 Property owner(s) REBECCA MAHANEY Day phone Mailing address 5801 CHISANA WAY ANCH AK Site address Legal description (Sub'd., Block & Lot) HERITAG�, GHTS LT 16A Legal description (Township, Range & Secti' Q%\6 18,975Sq. Lot Size Ft. ^ •um� o ' -• room. 3 • APPLICATION IS FOR: A`' ICATION4SAN , TYPE OF DWELLING: (IE all that apply) ;yam �a Absorption Field ❑ , • . £ Z �d Single/wo AADU)amily SF) ❑ Septic Tank Upg -•- 0 Duplex (D) ❑ Holding Tank ❑ 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. 414/‘ (Signature of property owner or authorized agent) Permit/Rush Fees: 634/ Waiver Fees: Date of Payment: �-/1511gq� Date of Payment: Receipt Number: egfi /tr•7&DV Receipt Number: Permit No. osPIq 136 1 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc July 15, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: HERITAGE HEIGHTS LT 16A To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerelyl�i l " Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 PLAT NO. 97-1.56 • HERITAGE HEIGHTS SUBDIVISION LOT 16A 18,975 S.F. \ S 89.57'20'E 124.91' •_Y_x�x—Y—Y_._-. . • • 10' U.G. UTILITY ESMT. I - sem I I.—FENCE(APx) • . • /NI cvJ /000 g(.?Ain f' n It?L� SPXS'SiEu (^// 2 Ott 1+IT• • /� (rr ff I DECK I 1 "" �,Q,�-tom I m., 28.0' 2.J rvwt 11 i TiV N 0 vire I k i�,/l1n' a h , s m CAVI-« ^K W 0 Q U 3 ' W 25 21) nt A W A W Z/---GARDEN O Z o U I wo oow o a _ EXISTING BUILDING &— in 2 0 SHED c u W - •11 z xN:' 2.D s a 5X Q. v Obi• , I U ;n V G 0 r O, N y W & z l 32.0' m IP o ( II Z c It A.C. DIRVE I /L(( e 7 o9°57'20'1 79.91' II ---CONE.CURB i A.C. PAVING I :i op N WI N IWI PEDESTRIAN—. 'b 4 YUKON ROAD _`�tt\M, ACCESS I O O (A.G. PAVING) -sI,q�•OEi4(q��i p . • i ° � g :c.,. �4 •s.71 1 t t_n,/\t • 20' ACC. & PEDESTRIAN / erivyci• T/il_J ACCESS E DE • S 89°57'20"E 20.00' .• • • • ••. . �r,O.•MICHAEL N. ANDERSON . ei f• 74;4/69 '�`L „ •• PROT ,\k‘ ESN—~ AS -BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE ' PROPERTY DEPICTED ABOvE AND THAT NO CASTALDI LAND ♦•11111 ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING. LLC IT IS THE RESPONSIBILITY OF THE OWNER TO •.- OF..q4 • JEFF A. CASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS. 4�G- .••• q`S' 2000 E. DOWLING RO.. SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT • coggTH •.•••:T'j ANCHORAGE. ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. •'` PHONE 248-5454 C�A. Q,-...,/,'12.• UNDER NO CIRCUMSTANCES SHOULD ANY DATA /. J. ./ GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR 0 .0 .•Je!!e,y A.Gay...void, . ESTABLISHING BOUNDARY OR FENCE LINES. O LS-609120 • • SW2438 5/31/2019 . A^ 5/31/2079 �' • ANCHORAGE RECORDING DISTRICT. ALASKA ••ap�... ..... pc' ♦♦♦ F.B. JOB NO. NOTE: NO CORNERS SET THIS DATE •�111��•♦♦� 19-01 HHSI6A DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division $25 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT /.%/f /~ ., /:: Z_ Address ~one[s) ~ Permn No. No. or Bedrooms TownsBip, Range, Seclion '~/3/~ &:~,.' ~ 14- TANKS .~' SEPTIC DISTANCES ~J SEPTIC TANK WELL LOT LINE ABSORPTION FIELD WELL Manulacturer [] HOLDING Capacity ~n gallons TYPE OF SYSTEM TRENCH [] BED [] W. DRAIN [] OTHER Total depth from original grade Fr / :S' Gravel depth beneath pipe FT l/ t Gravel width FT ,'~ ~ Distance between lines Depth to pipe bottom Item original grade /~ \ --/ Fill added above original grade Total absorphon area Number. et hnes I(Sod rat~n9 P~pe material WELLS FT FT FT FT ~ PRIVATE ~iOTHER [Identilv) ClaSslficahon (A,B,C) Total Depth Cased to .ate,ns,a,,ed F, FT REMARKS: zo' Io ' -,X~- FOUNOATION -5- ¢ / Z' AS-BUILT DIAGRAM IShow location of well, septic system, property hnes, foundahon, drweway, water bodies, etc.) by: was pedormed according to all 72-013 (3/85) M U N I C I F' A L .T. T Y 0 F A N C H 0 R A G E Department. oF Health & Human Services 8~25 L. Street, Anchorage, Alaska 995()1 343-~ 0 N .... 5~ t T E S E W E R F' E R M ]] T Er'lg i i"~.per' Des J. gr'i~<~:,c:t [);,,~r~er. Name: .. J ..Lt.: I-,..I .I.L:,ANE: ..... E)wr'i,'.:.~r Acid r' ess: 580 1 (:]1...I I SANA WA'-," AI',ICH[)RA[.:)JiE ~, AK :'>c:,.:: . ,' ,(} a ,/ Phone I:::'ar'(::e ]. I d: () 15'-.':];6 ]..-...;];5 I....c,t:. Leg a 1: Sub d :i. v :i. s :i. ~::~r';: I.,.IEI;;;: I TAE';E I.,-IE I GHTS L.o'L: ;t. 6 B ]. c:!c k n ..... S~.-'ct:i.c,r'~.' 14 7o~,,)nsh~.p: :t. 2N Range: ::!!,W Lo'L Size :1.7D()0 (sq, £'L. of .:~cr'es) Ma>,' Bedr'c:)oms,~ 'f'h:i.s Pe~-mi.'t.~ 3 'T'o'Lal Capaci'Ly,", 3 SEPT ]: C TANK J~ M J. i"1 :i. murn t:. crL. a ]. sep'L :i. (:: tar-~ k c ap ac i t y ~ ]., 000 ga',. ]. i OhS ~ Eacln s(.):.¥)t i c:: · Larlk mus'L have at least 2 compar.'Lments, Depth 'Lc: top o( sept:i.c t. anl.::(s) .::: 4,,0 .t'e(-~t [~eciuJ. r'es ir'isu].at:i, cH"t c~veJ' tank(s). ]:NSTAI....L. PER AF'F:'I::~CJVIE[) ENGINEERS DESIGN, SEE ATTACF.H~ENT,, NOT]:FY DHHS F'RIOR TO EACH :[NSF'ECT:[ON. "FH~S PERMIT IS ~SSUED F:OF~ THE E XIST]:NG 3 BEDROOM S INGL.E F:'AM~I_Y RESIDENCE DNLY AND E XF:'):RES I?./3 ]./S9 ,, ar%/ c:~r't :i, ai?g / j S Jcl '"uatd: / ( 0 w n e ~". :l: CERT I F:'Y 'T'HA"I': :l.,, I am f'am:i, i :i. ar' w:i. tl"~ 'Lhe r'~:~.:quir'enier'rLs for' Dl"l'""'~J,'k~? f'orth by 'k.h¢~> MunJ. c ipalJ, ty c)l:' Anchorage (MOA) arid 'Lhe State of' A].asl.::a, 2, ]; biJ.].;J. J.i]s'k.a].]. the system in ac::(:::(:~r(:lar'tt::e ~.t. tn all MOA cc:~des ar'id r'egu].atic)ris, and in c::c)mp!iarlcs.~ w:Ltl"l the design c:riter':La of this per. mit,, 3,, ]: ~,.Ji].]. ac:Jher'e 'Lc) all MOA and State c:~¢ Alaska r. equirem~:~r'r!:.s fc)r' t:.h[~.~ s6.)t back seuer'age sys'~..em on th:i.s of any adjacen'L Qr near. by lot. "~.)(:]t,.tS. 1"6>, al' add:L ..LLF I Z-o~- Z4 .SEWER SYSTEM LOCATION PLAN ~DT I BLOCK SECTION ~ TOWNSHIP/RANGE /"=5'0' NOTE' THI~ ACCURACY OF LOCATION OF E~(13TING PROPERTY CORNERS, WELLS. AND SEPTIC SYSTEMS INOICATED I': NOT EXACT. DIMER$1ON$ INDICATED HAVE BEEN DETERMINED BY USE OF CLOTH TAPE AHO NOT BY $URYEYINO TECHNIQUES, pREPARED FOR, [.ATE, /;~/,¢: ,HEET / o, / ~ Municipality of AnchOrage i DEPART,,MENT OF HEALTH & HUMAN SERVICES 825 %' Street, AnchOrage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST INEER'S SEAL) LEGAL DESCRIPTION: o 0 o 0 7 ~0 11 o 12 14-~0 15- 16 ~8 . . 19 20 T°wnship'Range'Secti°n: k.ll, ~, .I/~. % l~ '-T' /Z lq ~_ ~ f.~ ) SLOPE SITE PLAN WAS GROUND WATER E.COU.' EREO? h.1 C2 S L IF YES, AT WHAT O DEPTH? p E Oeplh to Waler,~..~,. / Monitoring7 l ~r iv Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (rn~nutes,/inch) PERC HOLE DIAMETER __ . TEST RUN BETWEEN __ FT AND FT ~ ~ - . I "/'~ --I · '· '" · c /~ ::::::::::::::::::::: 72~8 (Rev, 4/85} ? o o SEWER SYSTEM LOCATION PLAN PEOPERTY CORNEE~, ~ELLS, ANO 3EPTIC · 3';' - ~...~ NOT BY SURVEYING TECHNIQUES. GRE/~ :R ANCHORAGE ARI:A BU~ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MATERIAL NUMBER OF ~z~., COMPARTMENTS INSIDE LENGTH / .~ CAPACITY/~-~ ff~ C~ INSIDE WIDTH LIQUID DEPTH __.LIQUID GALLONS· SEEPAGE PIT:/ /'7 ' X/"Y' .X/'~.. I £/'//~z. ' ~ i NUMBER OF PITS ~ DIAMETER ~OR WlDTH~ LENGTH DEPTH i DEPTH ' ~0 -t-~', ~;" ~/~ ~ LINING MATERIAL ~O CRIB SIZE: DIAMETER~ ~ DISTANCE FROM: WELL {~.6j ,. BUILDING FOUNDATION ~ i, NEAREST LOT LINE ~ ~) I TOTAL EFFECTIVE ~ ABSORPTION AREA (WALL AREA) ~ ~ SQ. FT. ADDITIONAL ABSORPTION WELL: 0 1~ TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION -- LOT LINE SEWER LINE TANK SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: pi pE MATE Pla L: ~/6~/~/?/£/2~/ Form No, LQ-031 DIAGRAM Of SYSTEM r , .'/~,~'.:~A ~ 7 .~ l ~ I'0~ '~ ~ ' ' G.A.A.B. SEWAGE GrEATeR ANCHORAGe AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. ~NSTALLATION OF~ SEPTIC TA~K NAME OF APPLICANT SEEPAGE PIT-- , DRAIN FIELD OTHER . FINANCED THROUGH .. . TO BE INSTAL bY ~'~ - / // ~ ' NOT~, THIS PERMIT IS NOT.VALiD WITHOU~ SOIL VINAL I~SP~TION: 24 HOUR NOTi~ R~[~D. ~A~K~ILLING OF ANY SYSTEM WITHOUT ~INAL INSPECTION BY TH~ D~PARTM~NT O~ ~NVIRONM~NTAL QUALITY AUTHORITY W[hL ~ S~BJ~CT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS / DIAGRAM Of SYSTEM TO RIVER, LAKE, STREAM. FOUNDATION TO SEPTIC TANK ! FOUNDaTIoN TO SEEPAGE Plt ~>~ DRAIN field - SEPTIC TANK TO SEEPAGE Pit WALL -/ / SEPTIC TANK ,~ SEEPAGE PIT IC:>~'U DRAIN FIELD TO NEAREST LOT LINE, WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. / DRAIN FIELD /o /o o' SEPTIC TANK, SEEPAGE PIT DRAIN FIELD C~ST tR~j~J~TO .~.[~J~_OUT Of SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL, 4 II'DH D[AJ~E~TER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE Pit FITT~ED ~ AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH F~EGULATIONS REGARDING iNSTALLATION. ;:::TRii;YE:HsAy:Ti~Mi:~I:icAcRO:D[:NHcT:~EHQ~,AiR~McEoNDT: OF GRE~{ER ANC ~a~REA BOROUGH ORD~A~'~E ~/~/2S.68 AND THAT THE ABOVE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For .l~l~C~_ D Y~ Legal Description: Lot]5¢l~Block This Form Reports Soils Log~ Percolation Test__ - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics Was Ground Water Encountered? ~/~ If Yes, At What Depth? Dated Performed SubdivisionJ-~E~1T~B i I I L,.i i I I I ,I I L_L_J! ~_J_ LJ i Reading Date r Gross Time I Net Time i Depth to H20 Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet ......................... D3pth 1:o Bottom of Pit Or Trenc'h' ' COM~ENTS: Net Drop Date: MUNICIPALITY OF ANCHORAGE 1 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-361-47 1 Certificate of On -Site Systems Approval Expiration Date: JH - 102-0 GENERAL INFORMATION Complete legal description HERITAGE HEIGHTS LT 16A Location (site address) 5801 CHISANA WAY, ANCH AK Current property owner(s) MAHAN EY Mailing address SAME Day phone Real estate agent Day phone 3 56� 2. TYPE OF DWELLING: N� Q� y 0 Single Family (w/wo ADU) ❑ Duplex Q ✓�� ❑ Multiple Dwellings (Single Fa and/or &?Osx) i 0 -a 3. NUMBER OF BEDROOMS: 6'9 S'7 Eti 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ rJJWaiver Fee $ Date of Payment �-l2(011R Receipt Number OA -V IN YJ COSA # a5 C(R /3140 Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate 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. 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-23-19 ,w*'47TH •�i+ f� �. �' 6. DSD SIGNATURE e e e e• o• o e o o e o o e. a a P,.ee.•e•.. e.�e..e 3 System #1 Approved for bedrooms ...•.... ���,�• MICHAEL N. ANDERSON ; F� System #2 Approved for bedrooms '•. 9Z94�9 .•'�``" Disapproved Conditional approval for bedrooms, with the following stipulations: ►� lN,gs E AIVp rn ,moo GAPvf o By: �_ Original Certificate Date: 2_/_j7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: HERITAGE HEIGHTS LT 16A 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 COMM. WATER B. TANK DATA Age of tank(s) NEW years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW 0 Standpipes/foundation cleanout per record drawing Date of pumping NEW Parcel ID: 015-361-47 of Structure served by this system D. ABSORPTION FIELD DATA TRENCH SYSTEM TESTED Which system tested (date installed) 1/25/89 ❑ ALL standpipes present per record drawing Total measured depth from grade 15.2 ft (max) Measured depth to pipe invert from grade 11 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 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ 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: Adequacy test date 6120/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 35 in Water added 500+ gal New depth 49 in Elapsed time 1440 min Final fluid depth 36 in Absorption rate 500+ gpd Any rejuvenation treatment (past 12 months) UN If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F/-1 Yes if No ft Surface Water > 100' ft ft ft ft ft ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓❑ Yes if No ft Private Wells > 100' ✓❑ Yes if No _ Water Main > 10'✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No _ 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' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS OF Al G. ENGINEER'S CERTIFICATION��`�° I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with P 497th j MOA COSA guidelines in effect on this date. �/` ° w • ° 2: V. oxo®m°°®••ew ewa •ow•o z iu �e MICHAEL N.'ANDLRSGN c • C 9 69 ``i(d e•q'z`' p�QFESSIQ,�,��- COSA Checklist yellow sheet ft ft ft ft z O V) C) co V) QD U: to In O 00 �J J LLJ C) Q F— ry L.lJ Nr (14 LJ > 01 CV x O 00 x tnI AVM VNVSIHO tV .26*6 L l 3..b t .ZOe00 N l0� IMd JJNVN-IINIVn J( NOuonNISNOO 3d0IS .0 t — —I — — — — — — — — — — — — — — — — — — — — — — — — — — I, I I I I I I I NIVM 'ON AN1N3 n I AJ 0383AOO >- I INV o .5" l Z 5 S£ Ci Y U Z cn � I � 06 � M U Z a dOOIS— M Z X o� • .5"tZ a� w o c�3 I N 5'8£ V) • >- S3'ON00 A330 0383A00 I • S83AVd 'ON00 I a • w I a I w U Z ui S N —x X -=x — — — — — — Xx�X_ 'INS3 Alnun 'o'n .0l .tib VbI J..Vt.GUoUU N MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) (b) (c) (d) Location (address or directions) Property owner Mailing Address Lending Institution Mailing Address Telephone: (home) -'~¢/~ °--~L'~Business Telephone U/A Real Estate Company and Agent Address I'4[A (e) Telephone ~"[/¢'\ ' Mail the HAA to the following address: (or check here ,.~/if I~01d for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public/~/ t,u cdC,~ Note: If community wel! system, must have written/ confirmation from the State Department of Environmental Oonservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site~ Public [] Community [] Holding Tank [] Note:/ ~lf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/as) 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 thevalidation date shown below, Iverifythat 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 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. NameofFirm (312V',JIM ,~ /~(~,; ~1'..~._.~, Telephone -'~-,.¢-~'~/'¢/'~ Date ,/~O(~tY~,'T' I~) I°'~0 Engineer's Seal 6. DHHS APPROVAL Approved for ~ bedrooms by Approved ,~.-~ ___Disapproved Terms of Conditional Approval Conditional "f'4"l/["]i The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data beforeacertificateisissued.TheMunicipalityofAnchorageisnotresponsibleforerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) BSCk Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) MuNicip~I~ ~(~.tl~o~l~B R UARY 1984 ~NVIP, oNMENTAL Legal Description: AUG 1 4 1990 Water Sample Test Results Comments A.-~L DATA RECEIVED Well"e~l~sificatJqn '~_ ....... Well Log~_~.)~. Date Completed _ ~'~----6eC~to __ Depth of Grouting Total Depth Static Water Level'~,,%._ Pump Set At Casing Height Above Qround'~ Sanitary Se~l on O~sing (Y/N) Electrical Wiring in Conduit (Y/N) ~<~ Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL;~'%~., TO Septic/Holding Tank on Lot ~3 ~7~:~...%.. ; On Adjmmng Lots To Nearest Edge of Absorption Field on Lot /~ %~-,. ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Pub)io.Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ;Date~~ ¢ If A, B, C, D.E.C. Approved (Y/N) Yield B. SEPTIC/HOLDING TANK pATA Date Installed ,¢;-~1 / ,©' Size !O(-¥-)(~¢(! No. of Compartments Standpipes (Y/N) '"'~' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on Fi!e (Y/N) ~1/ Foundation Cleanout (Y/N) Date Last Pumped ~ JA~-~ 's<},~}) Holding Tank High-Water Alarm (Y/N) ~!t~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / To Water-Supply Well ~/A- TO Building Foundation ~;" To Property Line ~ ~) / ' ' To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA E~~ Soils Rating in Absorption Strata [~C;) Type of System Design Date Installed '~/ ~)~') Length of Field ./~.~ I Width of Field ~'-~' zl] I Proc Depth of Field . ,~ ~ ~Gravel Bed Thickness II ' . u . Square Feet of Absortion Area ~ Statndpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test ~/~ Results of Last Adequacy Test ~J¢i,'~ ~-~~/1 ' -" - - ~:~/~aRteAr~Ou~p~SwTe~lNCE ~RI¢~ ~BSORPTION FIELD: To'Property Line To Building Foundation I~ To Existing or Abandoned System On Lot I ~' ; On Adjoining Lots .~0 ~ To Water Main/Service Line ~ ~ +//-' To Cutback (if present) ~ To Stream, Pond, Lake, or Major Drainage Course Ik~ t''~ To Driveway, Parking Area, or Vehicle Storage Area ~ l Comments '_-~.' ~"~)i~'~¢',%~¢~,- t.~'z~i~v'~¢~- '~' ,¢~-~1-~''~L1~/~ (.:,t"~,~ ~r~c4r4~L¢~ D. ~TION "Pump On" Level at ~ ~;~ 7~,_ 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) ~L ~ Pumping Cycles during Adequacy Test. / **Check Perrr~tt~d Bedroorr~Rating Against HAA Request** I certify tha/t~//~/v~/c~heck~/e~ified, or conformed to all MOA and HAA on the date of this Engineer's Seal Receipt No, Date of Payment Amount: $ 72~026 (Rev. 7~88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ~ ~-;-- DATE RECEIVED ~' INSPECTION APPOINTMENTS TIM~: TIME TIME DATE DATE DATE MUN~CIPALI~ OF ANCHO~G5 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~NMEN]'AL FF, OTECTION 825 L Street - Anchorage, Alaska 99501 4 1980 ENVIRONMENTAL SANITATION DIVISION DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MAIL~'ADDRESS~ PROPERT~SlDENT (If different from above) PHONE ~AI [{~ O ADDRESS 5. LEG.~L DESCRIPTION /,4 , ;TREET LOCATION 6. TYPE OF RESIDENCE  S INGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY PUBLIC UTILITY *ATTACH WELL LOG. Awell 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. 6179) p¢~ THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY F-I ONE [~] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER I~]INDIVIDUAL/ON -SITE DATE INSTALLED [~] PUB LIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 4. COMMENTS [~3': APPROVED FOR ~: BEDROOMS[.~-~,~ ,,~/1 '(2 [] C..ONDITION'AL APPROVAL (letter must accompany certificate) [~' DISAPPROVED DATE BY 72-010 (Rev. 6/79) June 26, 1980 R&M No. 051001-42 Jack White Company 3201C Street Anchorage, Alaska 99503 Attention: Kay England Re: Adequacy Test on Existing Sanitary Heights Subdivision, Anchorage, Alaska Dear Ms. England: Sewer System; Lot 16, Heritage Per your request of June 19, 1980, we conducted a test of the sanitary sewer system on the above described property. The septic tank was pumped prior to the performance of the test on the seep- age pit. During the test the liquid level in the seepage pit was measured before and after the addition of 400 gallons of water. Ail liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Water Second 5 hour ~-' ~tal Reading (gallons) Added Reading Reading 10.50' 400 9.00' 10.40' 4' The water level rose 16.8 inches with the addition of 400 gallons of water, indicating a capacity of 8.8 gallons per inch. Five hours after the addition of the 400 gallons of water the level in the seepage pit had dropped 1.4 feet or 16.8 inches. This indicates an average effluent acceptance rate of 1792 gallons per day for the surrounding soils. If the 3 bedroom residence on the property is to house 6 people, the average load on the system can be expected to be 450 gallons per day. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom residence. We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&MCONSULTANTS, INC. Project aanager JC:DC/kad/AT&Si-T JUNEAU VALDEZ WASILLA MUNICIPALIIY Ok ANCHUNABL ~EPARTMEN'~jOF HEALTH AND ENVIRONMENTt~,_/PROTECTtON 825 L Street, Anchoraa~, Alaska 99501 264-4720 Date Received: October 27, 1977 ~2: Time _~O :~/~ ;~ ~/[ ~3: Insp _ Time /~/~L~?~3% Date 11- 7 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska National Bank of the North Mailing Address: Pouch 7-010 99510 % Claudia Phone: 278-4581 2. Property Owner: Leroy Miller Phone: Mailing Address: % Ken Boqqs, 276-2766 3. Legal Description: Lot 16 Heritage Heights Subdivision 4: Single Family Residence: (xJ Multiple Family Residence: ( ) Number of Bedrooms: Three Number of Bedrooms: Well System: Permit ~ Construction Individual well (.) Community/Public System (x~ Depth of Well Well Log on File ( ) Bacterial Analysis J Sewage Disposal System: On-site System ~ Public Utility ( ) Permit # Installed /~7,~ Installer Septic Tank Size /.~/~ ~//~d~ Manufacturer ,f~'~r/ N~.F/ ~/~f~ Y~[/[~f Absorption Area ~/~LSS~ ' Soils Rate Distances: Well to Septic Tank to Sewer Line Nearest Lot line Material to Absorption Area Absorption Area to Nearest Lot Line N'~UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorabe, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAG;" DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 9 6 1977 RECEIVED · .-1. ·Type of Inspection: VA FHA CONV xxx Property Owner: Mil let.. Leroy Mailing Address: Day Phone: '·'-3. Name of Buyer: CAUNT; John W. & Virginia R. Mailing Address:. 13230 N.E. 142nd Pl. Day Phone: 206-822-6443 Klrkland, WA 98033 ,. zt, Name of Lenc!in~. Institution:. AL~ ASK~ NA~iONAL 3ANK · Mailing Address: Pouch 7-010 Anchorage, Ak. Phone: 278-4581 99510 5. Name of Realtor or Agent: Ken Boggs - Gallery of Homes-Chuck Johnson & Associates Mailing Address: 1709 Bragaw St. Anchorage, Ak. Phone: 2_____~6-2766 99504 6. Legal Description: Lot 16 Heritage Heights Location: 5801 Chisana Way Anchorage, Alaska 99507 7. Typeof Facility to be Inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation Single Family Dwelling No. Bdrms, 3 Individual XX (Community) X]LXx Individual (on-site) XXX Contact Realtor for access or appointment. 2 NOTE: Please enclose with each request ,Claudia Jona~ the $25.00 fee. We can not begin process Mortgage Loan Processor of paperwork unless they are together. Alaska National Bank Thank YOu. Laura Harrison 264-4720 72-003(3/76) pgg. Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 16 Heritage Heights Subdivision Comments: Affadavit Attached: Approved: ~r~~~ Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received__ Time of Inspection / O~ O O Date of Inspection ~-///~/, ,9 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Phone: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected No. of bedrooms Well Data: A. Type C. Construction Sewage Disposal System: B. Depth D. Bacterial Analysis A. Installed ~... ~./':,,.- /~ B. Installer -." C. Septic Tank: 1. Size /~"' ~ ~'~ 2. Manufacturer ~ /~.~ i~*~2. Material D. Seepage Pit: 1. Absorption Area : .... '~, E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank ~ , Absorption area , Sewer Lines Nearest lot line B. Foundation to septic tank , Other contamination , Absorption area C. Absorption area to nearest lot line __ EQ-034 (1174) Page 1 of two pages Page'? of. tw°~pages - Re~st for Approval of Individual S,._~er & Water Facilities Comments Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)