HomeMy WebLinkAboutHERITAGE HILLS BLK 1 LT 2H
r'il'ag¢ Hill
Block
Lot 2
#015-22! -03
o
Municipality of Anchorage ~"~*
Development Services Department ~~
Building Safety Division ~ ~
On-Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSPiti o31 PID Number: O15 - Z?.I .- 05
Name: r~i&o.~t Y{~6 Wastewater System: [] New ~ Upgrade
Address:
12320 L;~-.F.{~ ~o'~ ABSORPTION FIELD
Phone: Number of Bedrooms: ~ ~ Deep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other:
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION 1,~ ~.~/~,~ ~.O ~.
Block: Lot: Subdivision: Depth to pipe ~ttom from o~gina[ grade: Gravel depth beneath pipe:
Township: RanO~: Section: Fill added above orioinal 9rads: Gmv~l L~n~h:
~:~:~ ~;~((~ ~New ~ Upgrade Gravelwidth: ~ Ft. Number of lines:~ Distance be~een lines:; Ft.
t B. C): Total Depth: Cased to: Total absorption area: Pipe Material:
~,. ,t. 500 ~,~ ~'~io.- A¢/~
Drille~ Date Drilled: Static Water Level: Installer: Date Installed:
Yield: I Pump Set at: I Casing Height ~ove Ground:
GPU[ Ft.I ~. TANK
SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. ~ Other:
ManCa~urer: Capacity:
To Septic Absorption, Lift Holding ~ubli¢Private
Tank Field Station Tank Sewer Line A~c~OC~e T~ Gal.
Material:
Number of Compadments:
su,a w, tOO'+.1,' ' U TSTAT"ON
Lot Line ~ ~ ~/~ ~(~ "Pump on" level at: Gal. High water ala~ at:
Foundation 5J~ lot+ ~/* *~* in. "P~ in.
Cu~ain Drain ~0', 50'+ ~i~ ./~ ~ ~eotd~, Inspections .e,ormed by:
Remarks:
~ WA~LE O~ F,{(. ~xi5~{'¢ ~F~;c BENCH MARK
Assumed Elevation:
Inspections pefiormed by: ~.A~5 u~j~n~ Dates: 1st G-I~-l/ ~
Development Se~ices Depa~ment Approval ~ ~.'4~TH~
Conditional Approval Date: ; :~: :&~/~
¢ ~ .. .'~
ABANDONED EXISTING CRIB ·
TANK PER UPC REQUIREMENTS
Lot 7
8
Lot 2
INSTALLED 3-BEDROOM SEPTIC
INSTALLED I000 GALLON SEPTIC TANK
LENGTH 58 FEET
W/OTH 5 FEET
MAX/MUM OEPTH 6 FEET
ROCK DEPTH 3 FEET
COVER $ FEET
Lot 8
%1 I
I
HUFFMAN ROAD
A 8
32.0 IZ5
33.0'18.0
34.0 18.0
41.0 19.5
43.0 20.5
44.0 21.0
50.0 26.5
50.0 25.0
80.5 44.0
81.5 45.0
100.5 73.5
98.5 72.5
Lo-t 1
N
~.'~ <\~ ...... :_~ ~,
~0~ ~BIS I~ ~0~ ~ ~ P~.
I r~. I ~'~ '
~:~ .o. c~-,,~o0 .~-~i
~.~>.. ...-'~
SCALD l' = 50 F~
SPURKLAND ENGINEERING
205 W 15TH. AVENUE
ANCH. AK. 99501
C907,] 279-$91~
HERITAGE HILLS B£I( I LOT 2
DOUGLAS 80HAC
12520 Lli~£RTY ROAD, ANCFIORAO£, AK 99516
ASSUILT
DA TE: JUNE 28, 2011
~1-1££T: 1/.,,z ~RID:27,.T7
PERMIT #£3Pl11031 Piti #0]5-221-03 HH~B1L2fl~.flWG
Installed ,Doulole ~_0 0 0
-~7~- - New 1000 606 Septic Tank
Shallow rrench~
5' W/de
58' Long
3' Sewer rock
3' Cover
o
, II
0
t L~ngth= 25' I
NO SCALE ~ )0 ~ ....
~ ~FESS~
/ Monitor
/ ~ Oe~nouts
/ / ~In~ul~e
%7, / ..
3,0 Pt oF Septic Rock (gff~tive)
-&O.~.=l~.~' L~n~t~: 2~' N~ $CALE
/ Noni~or
IIII / ~"'.~-~ / IIII
~T HO~ ~ ~
-B&=~.2' ~/.~.=~-' I~" j ' .
SiIt Barrier~ ~ '
~,0 Pt of Septic Roc~ (Effective)
L~n~tb= S~' 1000 6ol, Septic fonk
-&o.~.=7~.2' NO S~LE
BENNUH NARK ~0~0~ S[BIN~ ~SSUNE ELEVAFION 100'
SPURKL~Ng EN~NEERZN~ H~RITA~ HI~S B~ 1 ~OT ~ ~sBu~LT
203 ~15~h Ave DOUGHS BONAC DATE: JUNE 28, 2011
Anchorage Ak 99501 ~2~20 LIBERTY ~OAD, ANCNO~AG~ AK 995~ SHEET, 3/3 aeZD,
279-~91~
PE~ZT ~ fl~Pl1021 PARCEL [~ ~ 015-~1-02 HH~IL2~2.~6
Municipality o Anchorage
ZZ Z -'--Z
Anchoraqe, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Department
On-Site Water and Wastewater Proqram
o~~,
Depart~nenr
**** VARIAN CE/WAIVER REVIEW ****
WR#: OSPl11102 HA#: Permit~: OSPl11031
PID#: 015-221-03
Legal Description: Heritage Hills, Block 1, Lot 2
Engineer: Spurkland Enqineerin.q
Applicant: Dou.qlas Bohac
Your request for a waiver of the required 100 feet horizontal separation from the septic tank to
the private well has been approved. The approved separation distance is 94.0 feet.
This waiver approval applies to the existing septic tank to private well separation only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: .... 6/15/11 Approved by',~. ~,
( ./Name of Reviewer
Rec#: 062047 Amount: $1,050.00 Date Paid: 6114/11
**** VARIANCE/WAIVER REVIEW ****
On-Site Wastewater Disposal System Permit
OSPl11031
01522103000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number:
Tax Code Number:
Work Type: Upgrade
Permit Effective Dates: March 22, 2011 to
Design Engineer: SPURKLAND ENGINEERING
Subdivision: HERITAGE HILLS
March 21,2012
Site Legal Address: HERITAGE HILLS BLK 1 LT 2 G:2737
Owner/Address: BOHAC DOUGLAS K & HELEN I
12320 LIBERTY RD ANCHORAGE AK 995162348
Site Mailing Address: 12320 LIBERTY RD, Anchorage
Lot Size in Sq Ft: 16500
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage
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 (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Proposed drainfield allowed to be within 5 feet of the existing, to be
abandoned, drainfield.
Date:
Date:..~/~?//~]
/
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
Phone:907-343-7904
Fax:907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O t 5 '- 7.7_i -
Property owner(s)
Day phone
Mailing address
Site address
Legal description (Sub'd., Block & Lot) Hcc..T_-r.A(~6 ~z:~¢ 6iK
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms
Lo¢ ;Z
THIS APPLICATION IS FOR:
([] all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of/property owner or authorized agent)
ush Fees:
Date of Payment:
Receipt Number:
Permit No. ~'%
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 )
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
Heritage Hills Block 1 Lot 2
I
Municipality of Anchorage
Development Services Department
On Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, Alaska 99519
March 11,2011
Subject:
Septic System Installation Permit
12320 Liberty Road
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property. The
proposed system will serve a 3-bedroom single-family residence. The existing system was installed in
1973 and did not meet COSA operational requirements. A soils log, design calculations, a site plan, design
drawings and construction specifications are enclosed for your review.
Design Calcs:
No Groundwater observed to a depth of 12 feet below ground surface (March 11, 2011 )
Soil Rating. From Testhole (3/4/2011)
2 min/in = 1.2 gal per sq.fi/day
No. of Bedrooms 3
Required Area per Bedroom: 150/1.2 =125 sq.ft.
Total area required: 125 x 3 -- 375 sqfi
System: We are proposing to leave the existing tank in place, and install a shallow trench absorption
field. The absorption field will be 65 feet long and 5 feet wide and contain 3 feet (500 sq.fi, effective) of
sewer rock.
Soils: A test hole was excavated on March 4, 2011. See the attached soil logs. Ground water was
monitored for through March 11,2011. Ground water was not observed.
Surface Water: No surface waters were observed within one hundred feet of the proposed septic system
upgrade.
Topography: The lot slopes to the west at approximately 5-10%.
Waivers: Due to existing site constrictions we will not be able to meet the set back requirements
between the existing crib and the proposed drain field. The crib will be abandoned per MOA guidelines.
A shallow trench absorption field has been specified so that the entire absorption area is above the
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci.net
Environmental Consulting and Design
I
absorption area of the existing crib. This will ensure that the effluent from the proposed drain field will
enter clean, native soils. Waiver request: existing drain field to proposed drain field 5 feet.
The installation of this septic system will not prevent wells and septic systems from being installed on the
adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or
concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
Lars Spurkland, P.E.
Civil Engineer
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci.net
I
!3!$ T A VENUE
Lot 5
Lot 3
I --
Lof £
I' -,-- , TM ~e~-'
~ ~ ~ ~1 , ,
~ HUFFM~N RDAD
.............
NOTE: THI$ I~ NOT A ~U~V~ED P~ ~ ·$EPT/C
~ LOCATIONS TAKEN FROM ON-SITE WATER AND ~ASTE WATER
DEPARTWENT D~UWENTADON. A~ L~ATIONS SHOWN ARE
SChL& 1' = 100 FE
WURK~ND ENGINEERING ~ZRIrA~Z HILLS B~ 1 LOT 2 SEPtiC SYSTEU DESIGN
205 · ISrH. AVENUE OOUWmS BOHAC roTE: UARCH ~,
ARCH. AK.
(907~ 279-~916 ~2~20 LIBERTY RIND, ANCHORAGE, AK 99518 SHEET: I/$ GRID: 2757
PERMIT ~ DSPXXXXX PID ~ O1S-8~I-OS HHB1L~DI. DWG
% ~, '~ ~ INSTALL FOUNOATION C.O.
!INSTALL AFTER TANK C.O.
//
EX/STING CRIB //
UPC REOUIREMENTS
Lot 2
Lot 7
10'
INSTALL 3-BEDROOM SEPTIC SYSTEM
VERIFY SEPTIC TANK INTEGRITY
LENGTH 58 FEET
WIDTH 5 FEET
klAXIt, tUI~t DEPTH 6 FEET
ROCK DEPTH 3 FEET
COVER 3 FEET
Lot 8
I
HAVE LOT UNES IN SOUTH WEST CORNER AND WEll RADI FOR
LOT 2 & SA STAKED DY REGISTERED LAND SURVEYOR.
Lot 1 ~Y
HUFFk(AN ROAD
N
OF' xT=~
.., %...- .. ~,
LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATERI ~_ .............. ~
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE ~ ~ LA/Rg gPURKLAN~] :',~
,APPROX/,ATE. , .~ ~.
SCALE: 1' = 50 FE "' ~**'
SPURKLAND ENGINEERING
203 14/ 15TH. AVENUE
ANCH. AK. 99501
('907] 279-$916
HERIT,4G£ HILLS BLK 1 LOT 2
DOUGLAS BOHAC
12320 £/BERTY ROAD, ANCHORAGE, AK 9951G
SEPTIC SYSTEM DESIGN
DATE: blANCH 11, 2011
SHEET.. I//.,T GRID:2757
PERMIT # SWO8OXXX PID # 015-221-03 HHB1L2D2.DWG
Install ,~oulole EI~ 0 0 0
7- Ex/sitng 1000 6al, Septic Tank
0 VERIFY TANK INTE6RIIY
2hallo~ Trench~
58' Lon~
3' 2e~e~ ~ock
3' Cove~
II
0
I Length= 23' I
......... ..... .....
ND ~CALE
-E.&=' ~
3,0 Pt oF Septic Rock (Effective)
]~0 6al, 2epfic Tank
-B.O.H.='
ND 2CALE
SPURKLAND ENGINEERING NBRI~JgB ~I~ ~ I ~0~ 2 SEPTIC SYSTEM SCHEMATIC
203 ~15th Ave DOUGHS BONAC DATE, MARCH 11, 2011
Anchorage Ak 99501
~79-2916 12~20 LIBERTY ROAD, AN~NONA~ AK 99516 SHEET, 3/3 GRI3, ~737
PERMIT ~ DSP]]]XXX PANCEL I~ ~ 015-~]-03 HH~]L~3,~V6
Performed For:
Legal Description:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraqe.ak.us
(907) 343-7904
Soils Log - Percolation Test
-~L~I' '2 Township, Range, Section:
Slope Site Plan
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
vi
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring? ,
Date:
Reading Date Gross Time Net Time Depth to Water Net Drop
5" ~, i2',50 ?,~ i0 ¢4;.lo" S"
5'" . j' 10 p,. ~ ¢;. 1o" 5"
PERCOLATION RATE Z (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND 5 FT
PERFORMED BY: L,~Z~ ~';U ~ i( i ~(~1 ' ~/*~5 ¢4~,& CERTIFY THAT THIS TEST WAS
PERFORMED IN AOOORDANO~E WITH ALL STATE AND MUNICIPAL G~0~DEL~NES IN EFFECT ON THIS DATE. DATE:
Environmental Consulting and Design
I
Single Family On-site Wastewater Disposal System
Construction and t4aterial Specifications
Subject Property:
Heritage Hills Block 1 Lot 2
Date:
March 11th, 2011
General:
The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall
be the owner's representative and will inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
The scope of the project includes the procurement and installation of a 3-bedroom on-
site wastewater disposal system at the location depicted on the attached site plan
drawings. The scope of the work also includes the inspection of the existing 1000 gallon
septic tank (to verify it integrity). If the tank is found to be compromised, the engineer
must be contacted before construction proceeds. The drain field is comprised of 2
trenches, 5-feet wide x 35 and 23 feet long, with a maximum depth of 6 feet, with 3 feet
of septic rock below the distribution piping. All components of the proposed septic
system must be constructed a minimum of 100 feet from any surface water or water
wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank
and a minimum of two feet of cover is required over the drain field. In addition to the
required earthen cover, 2-inch thick, 40 psi, direct bury board foam shall be installed
directly over all installed piping.
Construction shall be in accordance with the approved site plan and design drawings and
any special provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality
of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
policies.
The contractor is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also responsible for vegetation of
all areas disturbed by septic system installation activities.
Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Properb/owners installing their own systems
must receive advanced approval from MOA DSD prior to system installation activities.
The contractor shall ensure that ALL materials being used are in compliance with the
most current guidelines established by the Municipality of Anchorage. Refer to
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci.net
Environmental Consulting and Design
i
"Standards and Specifications for Component Parts and Materials Used in the
Construction of On-site Wastewater Disposal Systems", Dated December 2000, as
provided by MOA DSD, On-site Water and Wastewater Program.
Septic Tank Installation:
3.
4,
5.
6.
9.
10.
11.
12.
13.
14.
15.
16.
A new septic tank, of the size specified in the design drawings, shall be procured from a
qualified manufacture/supplier if the existing septic tank is found to be defective.
Construction shall include two 4" diameter cleanouts for pumping access.
The burial rating of the tank shall be adequate for the actual burial depth encountered.
The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank.
All standpipes on the tank shall extend a minimum of 12inches above the final grade.
Tanks installed with less than 4 feet of cover shall be insulated.
The sewer service line from the house to the tank shall have a minimum slope of 2%
unless prior approval is obtained from the engineer.
The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be
sufficiently compacted to prevent future settlement of the soil.
Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings.
A cleanout shall be installed I to 4 feet from the foundation.
Post tank cleanouts shall be installed per MOA requirements. Does not apply to
pressurized lines.
In areas with high ground water, the septic tank shall be sufficiently anchored to resist
buoyancy forces when there is not adequate soil cover to resist uplift force. The
contractor shall refer to the engineer for direction regarding this matter.
The tank backfill shall be graded sufficiently to ensure positive drainage away from the
tank.
All holding tank and lift stations shall have an audible and visible alarm inside the
residence being served.
All lift stations shall be wired in compliance with all MOA guidelines and the Uniform
Electrical Code. A municipal electrical permit and inspections must be obtained where
required by the MOA.
The contractor shall verify that the septic tank/lift station is a minimum of 100 feet from
any residential water well, 150' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
The contractor shall remove or abandon the existing tank in compliance with the Uniform
Plumbing Code.
Drain field Construction:
The drain field shall be excavated to the dimensions outlined in the design drawings. If
any discrepancies are noted, contact the engineer immediately for clarification.
The drain field shall be installed parallel to slope contours.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci.net
9.
10.
Znspections:
1.
Environmental Consulting and Design
I
The bottom of the drain field shall be within 2" of level. Tf the sidewalls or bottom of the
excavation become smeared, they must be raked or scarified prior to the placement of
filter sand or drain rock.
The drain field must be a minimum of 5 feet from the test hole excavation.
Distribution pipe is to be installed level with perforations facing downward, atop a level
bed of drain field rock. Septic rock shall then be placed atop the distribution piping to
provide a minimum of 2" of cover, level across the entire width and length of the trench,
above the piping.
A silt barrier must be installed at between the final drain rock and the native soil backfill.
The silt barrier shall cover the entire drain rock surface.
Monitor tubes must be 4" in diameter, installed in the locations depicted on the design
drawings, and extend a minimum of 12" above final grade. The portion of the monitoring
tube below the septic rock must be perforated and the portion above the drain rock shall
be solid.
Backfill over the final gravel layer must not be less than 2 feet. Insulation must be
installed when the backfill depth is less than 3 feet.
Drain field back fill shall be mounded to prevent depressions from forming due to
subsequent settlement of backfill material.
The contractor shall verify that the drain field is a minimum of 100 feet from any
residential water well, 150' from any class 'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
A minimum of two inspections are required by the Municipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
The first inspection must be conducted after the excavation of the drain field and before
the placement of any gravel. The septic tank may be set in place, but may not be
backfilled.
The second inspection must be conducted after the placement of the silt barrier, gravel,
distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any
backfill.
The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours
notice is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland~gci. net
Municipality of AnchoragePage '/ of
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: ~) ~t ~, ~c~. v~ ~'4 ~-~//' PID Number: ~/~-- ~/--
Name: ~ '~O'~'[ct~ WastewaterSystem: ~ New ~ Upgrade
Address: I ~ ~l '~ ~P__'~-/ ABSORPTION FIELD
Phone: ~ No. of Bedrooms:
~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION GPD/Sq. Ft.
Lot: ~ Block:I j~b~v~on:. ' ~_ [~.~ Deplh to pipe botlom from original grade: Ft. Gravel depth beneath pipe Ft.
Township: [ ~ Range: '~ '~ Section: ~ :ill added above original grade: Ft. Gravel length: Ft.
WELL: ~ New ~ Upgrade Graveldepth: Numberoflines: Distance between lines:
Ft. Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Ft. Ft. SQ. Ft.
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Ft.
Yield: Pump Set at: Ca,lng Heighl Above Ground: TAN K
GPM Ft. Ft.
SEPARATION DISTANCES ~eptic ~ Holding ~ SmTmE.P,
To Septic Absorption Lift Holding Public/Privale Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines /~L~ '~/~ k[l< [ ~
Well q ~ }~ '~ ~/~ ~.b~ Material: S ~ .umber of Com~ments:
Surface LIFT STATION
w~t.r
Lot ~O '~ Size in gallons: Manufacturer:
Line
"Pump on" level at: "Pump off" level at: High water alarm at:
Foundation
CuHainDrai n ~/~ Pump Make A Model Electrical Inspections pedormed by:
Remarks: BENCH ~lV
Location and Description:
ENGINEEW~ ~EAL
Inspections performed by: Dates: 1st K ~~ , .~'~)'~ ·
.e.ar,.en, o,.ea n..u Serv,Cesa..rova, ...... /,,:
Reviewed and approve ~ate: , ..~': ..
d ~":-'~,.;r;:O~¢:
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
r
RECEIVED
MAY ~1
Municipality Of Anchorage
Dept. Health & Human Services
ENGINEER'S SEAL
72-013A(2/91) MOA 25
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
$25 "L" Street
P.O. Box 196650 Anchorage, ^laska 99519-6650
343-4744
July 18, 1991
Tobben Spurkland, P. E.
6751 West Dimond Boulevard
Anchorage, Alaska 99502
Subject: Waiver Request for Lot 2 Block 1 Heritage Hills S/D
Waiver Request %WR910022, PID #015-221-03
Dear Mr. Spurkland:
Your request for waiver of the required 100 foot horizontal
separation of a septic system to a private well has been approved°
The approved separation distance is 93.5 feet from the private
well to the septic tank.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely, ~
Robert W. Robinson
Civil Engineer
On-site Services
Concur:
~usan Oswalt
Acting Program Manager
On-site Services
RWR/ljm %6
6751Wo DIMOND BLVD.
ANCHORAGE, ALASKA 99502-5904
(987) 248-5895
Mull :i. (:: i p.al 5. ty (3'[:
l.)l vi s:i. on o.[: Env:i. r"or'~mc~rY~:a].
Departmen't: o.F I-.leal't:l'~ and Scx::ia]. '::'
82 :) I L ~ e....... L
Anc:i"ior-age,s A] ........ ,ka 9c¢:51' i
[~L.t}~) j E,(::: '~'; ','. R(:aqt.te~F(': -~ c)r Wa 5. VE'F' C~"F ~(.Z~,I:) ar Ett :i. er'i d J. S'{:. awl (:: e
F'ri ,/ate t.~u+:) l 1 to -:=et...,'~,. i" c." t an k
L..ot 2~ BIoc:k 1 Heritage Hills
}])(:)Lt(:} I as ~'~{(:]]'i
J U N - ? 1991
RECEIVED
W E? a i'" E~' !'~i [.I [3 fl i :i. '[?. t.', :i. I] (j:} a I'" (5? q t..t E? ~-:; t ~ (5 F' ¢-J a 5, V (~:, r" {: F' C) Ell t h e !~:, e p a r a '~. :i. [:l F,. {:.~ 5, !~.
-t':ances stat(-:?d J. n ]"i t 1 e 1(iii ,,, A:I. aska Adm:i. n:[ stra't:i ve Code ,~ Chap'~:er-
E',C:, ,, ." ?C',
,=,r c '{:he septJ, c tank was
d:i. st. ar'ic:e I:)etv, x.:z,c=)n the ,,. ~..~] 1 , - "' . ..
;'"ecc, rded d:i. s't:arx:::e on thc-:? as I::x..ti :1. 'ti :i. s I ()5.
r' equ :i. r ed
.f ,-... t.. L ,~ .I..: I"i e
in ~.988 the tank was .'-e:,o].aced w:i. thcmtt the benefit o-F a permit or-
i. ns~sec:'i': :i. ~:)~'~ ,, Afl As iSh..t:~. ]. 't:'. :i. '" = ::' i I'fiay '" ''~ ~
' ~...,I..¢~..(...L.,C)ri or"~ .... :, 199! r"eveled 1'.'.hat
Illll ~.: (,..t. ,
E;y us:i''' .;I ' '~ (.r ~ r~,:.*t..IOri -fr"om w¢l 1 '~ oc.3s '; n 't:he :i. neio" borho,::::,d
a DEC I.":i.s,
L2 BI L1 82 L~ B3 L6 B~ L8 B1 L7 Bl
Install~O 197~ i985 1971 1974 t977 1977
Total Depth 258 220 2t4 224 250 251
Water Level(s} 245 218 198 2t9 218 240
Static Water Level 220 200 t98 202 210 2i0
Distance t(:) Water" Bearing Str-ata 12C;0)
Sc):i. ]. Sorb'k:i. or", (',-.'~:i. 1 ty Sand and E~rave].
Perrnabi ], i ty
Grad:i. err[:: (S].c)pee AvCay F:'r'c)m Well
Sep ar" at :i. on ( 90 )
'T(:) ~:: a ].
I-K ANLHUKAbI' RKI:A PUl' 'uL~rl
Department of Environmental (~uality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
' .' 7/-/-'/?//W' LEGAL DESCRIPTION '~ r~ / ,,~'~ ,//
SEPTIC TANK:
FROM WELL '/(~) ~t MANUFACTURER
INSIDE LENGTH
INSIDE WIDTH
.¢/' <"V NUMBER OF
MATERIAL 7~/ / /4','~ COMPARTMENTS
LIQUID DEPTH ~ LIQUID CAPACITY'-//?),/)~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER
LINING MATERIAL,/--F>~!(,/'Z~ ' }~ CRIB SIZE:
t
BUILDING FOUNDATION ' ~
ADDITIONAL ABSORPTION
LENGTH~'~, DEPTH
DIAMETER ~ ~ ~
DEPTH DISTANCE FROM: WELL /~)C)
NEAREST LOT LINE ~'~ ' TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA) SQ. FT,
WELL: ~'-¢ O~ C~n;/[¢c¢'~
TYPE ~/D/)lg, ~l/-~-~) CONSTRUCTION
BUILDING NEAREST
FOUNDATION -- LOT LINE
C'ESSPOOI
OTHER SOURCES
DEPTH
NEAREST SEPTIC
SEWER LINE TANK__
APPROVED DISAPPROVED REMARKS
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
LOT SLOPE:
REMARKS:
Form No. EQ-031
DIAGRAM OF SYSTEM
DATE &"~./~.2~ f/¢?~ APPROVED '~¢/~,,~ ~/'~- '~'~?'¢-¢CJ'~'
G.A.A.B.
rv~-W DRILLING, Inc.
P.O. Box4-1224 o 1310GInternationalAirport Road
(907) 274-461 ]
ANCHORAGE, ALASKA 99509 ' '
DRILLING LOG
WelI Owner. , ~%9/,~
Location (address a
of: Township, Range, Section, if known; or distance main road
L2, Blk 1, Heritage Hills Subdivision
e;.A ~* o~=;., 6 r~pth of Hole 269 feet. Cased to.__ 2--~ feet
Static wa~r level 220 ft. {~ (below) land surface. Finish of well (check one) Open end ~
Screen ( ); Perforated ( X. )'
Describe screen or perforationEills Knife s~t -erforatians ~ 2/4°-2='4 dovth ~eVel
x );
Well pumping test at 2 gallons per of drawdown from'static level.
'-Date of compleQoL ]._5 May 107.5'
(minute) for' 12 hours with__100~
Sec :2=, T~lv~ R 3v,/, S~'
tv O~ -- 06106
WELL tOG m t ~ ~ Iqq q~.
ft.
Depth in feet from
-'- ground surface
.."..: . ./-'i"
Giv~ details of formations penetrated, size of material, color and hardness
0 TO
?
~ .~o
.... 21 . TO
55 TO
~0 TO
71 TO
128 TO:
!52 TO
165_TO
71_
12/}
175 ,~
178 TO ~ ~8
188 TO '191
.1gl-TO 2/45
~%TO ?~
~'iftv O~ganic Ov, rburden
Silt¢ Ora~e'i
h -- t,¢UNIC1PALh-Y OF ANCHORAGe
- ClmVI' ~ay ~IVIRONME~IA~ vROTECTiON
S02dv'Clav ':
8~ndy 'Gr~vel ' ..-
Loose ),l~dtum Gravel
GreaTEr ANCHORAGE ArEA BoROuGH
DEPARTMENT OF ENVIRONMENTAl- QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
NAME OF APPLICANT
INSTALLATION LOCATION
.A,L,NG ADDreSS S Rf -- × //We "1 P.ONE 27 ?
INSTALLATION Of: SEPTIC TANK ~ ~EEPAge Pit ~ DRAIN FIELD .
., OTHER.
FINANCED THROUGH
SOiL TEST rESULtS
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT ~O1L TES'i'
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL be SUBJECT TO PROSECUTION.
?j, >- :!:" .v. ~,
SEPTIC TANK SIZE //0~O~ TYPE SEEPAGE AREA SiZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK ~-
FOUNDATION TO SEEPAGE PIT - , DRAIN FIELD
SEPTIC TANK ~-~ ~ ~ ] DRAin FIELD
. SEEPAGE PIT
TO NEAREST LOT LINE.
/~o
WELL TO SEPtiC tank /~0
. SEEPAGE Pit
Drain FIELD ALSO CONSIDER AREA WELLS.
WATER Main tO SEPTIC TANK ~/~ ~ SEEPage Pit //~ 2
DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING gAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK and SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BAC;KFILL
CONFORM TO BOROUGH REGULATIONS REGARDINg INSTALLATION.
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
FORM NO, S~-016
~!i~Perform'ed For
Glacier Excavating
Legal ~escrfn~ion: Lot 2 Block
This Form Renorts Soils Loq yes
"C~ t~s~ is ~orth a ~housan& o~.io~s"
Date Performed LF-16-73
1 Subdivision lteritage It±lls
Percolation Test
~enth
Feet
Soil Characteristics
Overburden
Silty Sandy Gravel, moist with
cobbles & Boulders mixed thruout
(G~-22~)
(Becomming siltier below 10 ft.)
Bottom of Test Pit @ 12 ft.
Ground Water Encountered? NO
Yes, At what Denth?
Readinq Date Gross Time Net Time Depth to H20 Net Dro
0
• 'WI '7 Oaf 1tv
•171" Municipality of Anchora y
t. \A
' On-Site Water and Wastewater Progra `7< SLI•
(907) 343-7904 s
l ',l
0. •
ti
Certificate of On-Site Systems Ap ., al
0'�
015-221 -03Ot 6 �— l 7
Parcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description Heritage Hills B1 , L2
Location (site address) 12320 Liberty Rd
Current Property owner(s) Michael Yore Day phone
Mailing address 12320 Liberty Rd, Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
ID Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well • 111 Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System Cl Public Sewer ❑
WaiverNariance request for: Distance:
Received by: i/ (Y%1.IA I )7 Date: q/ // 7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ G2-(P Waiver Fee $
Date of Payment 7 ` tLe 1 I1 Date of Payment
Receipt Number OM c t G Receipt Number
COSA# oSC, 1i 13.)S�J 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.
Name of Firm Anderson Engineering Phone 522-7773
Address 1399 W 34th Ave #203, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, PE Date 8/15/2017
F'.0 11 e1�
Y
6. DSD SIGNATURE ,
r
System #1 Approved for 3 bedrooms E >r • 0°'•°•
•
System #2 Approved for bedrooms fig ;•. '•.11 is
CE-12,54 •.'1:
Disapproved `��Jbbrf r� "c-,-"`��
Conditional approval for bedrooms, with the following stipulations:
of ANC/id'
P � 0
ok0 moo,_=
O'°MEPlf
By. t. G Original Certificate Date: 9
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 blue sheet - • c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Heritage Hills, Block 1 Lot 2 Parcel ID: 015-221-03
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 5/15/73 Sanitary seal (YIN) Wires properly protected (YIN)
Total depth 258*ft. Cased to 258 ft. Casing height(above ground) 15 in.
FROM WELL LOG AT INSPECTION
Date of test 5/15/73 8/5/17
Static water level 220 ft. 219 ft.
Well production 2 g.p.m. 2.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform ND colonies/100 mL Nitrate 0.214 mg/L
Arsenic ND ug/L Date of sample: 8/1/17 Collected by: Anderson Eng.
*Well deepend to 310' on 2/24/93
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 6/17/2011
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
1
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N)
Pumper Northland Pumping
Date of pumping 7/5/17
44 Otttlowgl. FovikerfIot, CtrAtaCrWT WARS ,-a 01,1464e6i) IS`( A PLAP11"0-, 00061.6 CLEAOOT aEr-
Sop ►c, -rAiJ FoaCrk043 AS p FbuN hili J CiWWoUT,
C. ABSORPTION FIELD DATA
Date installed 6/21/11 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/Ft2 System type 5-Wide
Length Total 58' ftWidth 5.0 ft. Gravel below pipe 3.0 ft.
Total depth 6.0 ft. Eff. absorption area 500 ft2 Monitoring tube Depression over field N
Date of adequacy test 8/5/17 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 14 in. Water added 385 gal. New depth in.
Elapsed Time: 930 min. Final fluid depth 13 in. Absorption rate >= 450 g p d
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
*Pump burned out during septic test, preventing inspector from adding the full 450 gal. All of
the water was absorbed in 15.5 hours, indicating an absorption rate fast enough to handle the
full amount.
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
94'* >100'
Septic tank/lift station on lot On adjacent lots 100
Absorption field on lot >100' On adjacent lots 100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas 100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main
>10'10' Water service line >10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
10' >10' >10'
Property line > Building foundation Water main
Water Service line >10Surface water > Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Waiver OSP111102 issued for 94' separation from well to tank.
G. ENGINEER'S CERTIFICATION ��q+� t'rktll41140
I certify that I have determined through field inspections and •'•:4�j+00
review of Municipal records that the above systems are in o •?. `,i • . �Od
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Benjamin Schiller, PE W.Bfitt:.11
•» dDate8/15/2017 j�j��� ,•
•Ati •• v.-12.++72 �• • ss
• IP
COSA brown sheet 10-10-12.doc
NOTE: li
THE DRIVEWAY ENCROACHES ONTO LOT 3
ALONG THE NORTHERLY PROPERTY LINE.
THE NORTHERLY WOODEN PLATFORM
ENCROACHES ONTO LOT 3 ALONG THE
NORTHERLY PROPERTY UNE.
THE SHED ENCROACHES ON LOT 7 AND
ENCROACHES INTO THE 10' OVERHEAD
POWER EASEMENTS ALONG THE WESTERLY
BOUNDARY.
Lot 6 I I Lot 3 I I
WOODEN PLATFORMS / �.+
16.4' _ S Fig'49'nn"F
b ASPHALT ,
Io PAVEMENT
7 38.1.
8.3' Q
CHAIN—UNK FENCE / . L .
n / 3.9' WOODEN
SEPTIC PIPES I Y WALKWAY O
Oce
o H–
lel SINGLE STORY . 21.8' Lv
Lot 7t)\_
VRESIDENCE 27.7' u•
p 77.3 . / 5.9' 12.0' O m
• .10.4' .. �
O �,10.2' x 16.2' SHED ^ 0. J
O I r ASPHALT b
• 1 °D ^ '• PAVEMENT p I
Z WOODEN n "' 01 .
10' DECKS
OVERHEAD I I 80. 62s_7 .
POWER 1'l_
SEC PIPES 6.2' 26.t'EASEMENTS I ( ' •
WELL ij
_ W�l PR�tE N
100
IN 89'59'O0.W 165.00'
— — 1 _ \,_ _
� I
Lot 8 I \ _ _ _1
1
Lot 1 I 30.00'
� \ I
PLOT PLAN AS BUILT x SCALE 1" = 30' GRID SW 2737 Protect No. 17-295/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc . (907) 522-6476 Phone �0000�
(907) 522-4625 Fax 0
Professional Land Surveyors kenOlangsurvey.com v�P F C p�
JonathanOlangsurvey.com G ''' .'' S"Q
v
10
I hereby certify that I have surveyed the following described property: &): j�
LOT 2, BLOCK 1, HERITAGE HILLS SUBDIVISION (Plat No. 63-41) :' 49TH D▪ SD
Anchorage Recording District, Alaska, and that the improvements situated thereon are a 0
within the property lines and do not encroach onto the property adjacent thereto, that (J a
no improvements on the property lying adjacent thereto encroach on the surveyed Q
premises and that there are no roadways, transmission lines or other visible QO�, KENNETH�L�' �▪ �`
easements on said property except as indicated hereon. OQV 4 ••'
Dated this the Ot ' Day of "'-',"-=-1)-(1-4'-% -( " `. � -5**. .c>
at Anchorage, Alaska �pVit) ��oo
4p FE'SSIONA
It Is the responsibility of the owner to determine the existence of any easements, �DO000"
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Municipality of Anchorage
Dovelopment Servieos Departrnont
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
COSA # ¢~
Expiration Date:
Lo~ Z-.
!//! o4 ,
/o
Day phone
Mailing addrbss
Lending agency
Day phone
Mailing address
Real Estate .Agent
Unless otherwise .r,~quebt~t, COSA will be held by DSD for pickup.
NUMB~E. R OF!BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well [] ·
Individual Water Storage []
Community Class Well []
Public Water System []
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-Site
Individual Holding Tank
Community On-site
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an' independent p[ofessional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSM also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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.
Name of Firm
Address ~o3
Engineer's Printed Name
DSD SIGNATURE
/ Approved for
Disapproved.
--'-'~ bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
ON.SITE
WASTEWATER
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: '~'-
Municipality of Anchorage
:Development Services Department
Building Safety Division
On-Site Water & Wastewater program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/Onsite
(907) 343~7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ~-~,~A~r~ I'~\\\5 [~lk I Lo~ 'Z. Parcel ID: O15- 2ZI- 03,
A. WELL DATA
Well type ~)¢~V^~'~ If A, B, or C provide PWSlD # ~
Date completed 5/~ $1-f'5 Sanitary seal (Y/N). Y
Total depth ~-5~ ft. Cased to 'Z.~$ ff.
FROM WELL LOG
Date of test ~/l$1-~3
Static water level 7.?-0 ft.
Well production ~- g.p.m.
WelJ Log (Y/N) "/
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
g.p.m.
Y
-r I'~..~ in.
WATER SAMPLE RESULTS:
· Coliform N'¢~ .colonies/100mL Nitrate/VD mg/L
Arsenic: /v'o ug/L date of samPle:
I
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size I.c~D gal. Number of Compartments '7..
FoundatiOn deanout (Y/N)' "/ Depression over tank (Y/N)
Date of pumping /V'e ~ r ' Pumper -
C. ABSQRPTION FtELD DATA'
Date installed il So!l' rating. ( or ff2/bdrm)
Length ~3;,.,~ Z.5'i ft. i~ Width ,5 ff.
Total depth Eft. absorption area .~00 ft2 Monitoring tube
Date of adequacy test /V'¢ ~ Results (Pass/Fail)
Fluid depth in absorptionfleld before test ~ in.
Elapsed Time: --- min. Final fluid depth ~
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Collected by: L.r2 .~q.c ~-In~
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
System type $ ~1~ l lo~ ~c~ ¢[~
Gravel below pipe ~, O' ff.
)/ Depression over field /V'
For ~ bedrooms
Water added ~ gal. New depth -- in.
in. Absorption rate >= --- .~ g.p.d.
· ---- If yes, give date '----
D. LIFT STATION
Date installed ,, Size in gallons ,/
"Pump on" level at ~n. "Pump off level at
Datum J . Cycles tested.. //
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
septic tank/lift station on i lot ' ¢~/'~' '~
Absorption field on lot 100' ~-
'Public sewer main /v/A
Sewer/septic service line '7..5 I.f
Animal containment areas .50' +
Manhole/Access (Y/N) ~ ,,-/'
High water alarm level at J in.
'aee~s
alarm & circuit r~mments?
On adjacen~ lots
On adjacent lots 10o
Public seWer manhole/cleanout
Holding tank . /v'/A
Manure/animal. excrete storage areas 10o~ + ~'/~/',0~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I
Building foundation .5 ~ Property line 5 -'- AbsorPtion f'mld
Water. main A///~t Water service line J 0 ~+ Surface water
Wells on adjacent lots ~00'+
Property line I0 ~
Water Service line 10'+
Curtain drain 50~ (/V, 0~
SEPARATION .DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation I 0 + Water main
Surface water 18¢' 4 (/V, 0,) Driveway, parking/vehicle storage
t
Wells on adjacent lots 100 +
COMMENTS
E~ER'S CERTIFICATION
· ~ ~.~..' ~ '..~..t~
~ cot§fy' t~at / have ~t.'~.¢r~
~i~ of M~,¢~ea/
Date ~/13/11
COSA Fee $ Waiver Fee
Date of Payment
Receipt Number
(Rev. 4/10)
Date of Payment
Receipt Number
D'~/~ '' ,
~ RECEIVED
, INSPECTION APPOINTMENTS /~_~
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DFPT O~ :'~ 'l.T:~ ,o.
DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECT~iRON~ :Eh.A. ; .,O. SCTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION L;~, o ]g82
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~I~,~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
,~.~- ~ ~ J PHONE
PBOPERTY RESIDENT (If different from ~bow) PRONE
MAI LING ADDRESS
~. LENDING INSTITUTION o // ] PHONE~
I
MAILING ADDRESS - //
5. LEGAL DESCRIPTION
TREET LOCATION ~ . ~ -
'P_d.
TYPE OF RESIDENCE
[~ SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[~ Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
PUBLIC UTILITY
* ATTACH WELL LOG. Awell log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.) r.~ -~ ? ' / ~'Y~'
8. SEWAGE DISPOSAL SYSTEM
I~' INDIVIDUAL/ON'SITE** Iq73
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72 010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
E] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY /'O
Connection Verified
INSTALLER
[]Septic Tank or [] Holding Tank
Size: /~'-r~L) 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
5. COMMENTS
~ APPROVED FOR --~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
/
DATE BY. , '
72-010 (Rev. 6/79)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
Date Received April 23, 1976
9:30 a.m.
4-26-76 ~onday
Les
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Voao
1. Approval 'requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
Coast Mortgage Company
% Melda
4450 Business Park Boulevard Phone: 274-9504
Douglas K. Bohac Phone: 344-4488/277-0731
Star Route A Box 1595-B, Anchorage 99507
Lot 2 Block 1 Heritage Hills Subdivision
Huffman and Birch
5. Type of facility to be inspected
6. Well Data: Individual
A. Type
· Construction /~J [
C
7. Sewage Disposal S~stem: On'site system
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
Single Family
No. of bedrooms 3
B. Depth J<~ -
D. Bacterial Analysis
1973 B. Installer
1. Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines
, Absorption area
, Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
EQ-034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA ,'///~ FHA
2. Property Owner:
Mailing Address: ~)A /5-~.5~-/L'~ /¢~c¢/¥ /)Hi. DayPhone:
3. Name of Buyer:
CONV.
Mailing Address: Day Phone:
4.Name of Lending Institution:
Mailing Address: Phone:
5. Name of Realtor or Agent:
Mailing Address:
Legal Description:
Location:
Phone:
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
No. Bdrms, 3
Public Utility,
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
Individual (on-site)
If Individual, date of installation
72-003(3/76)
st for Approval of Individual ? ~r & Water Facilities
Page 2 of two pages - Ret
Legal Description Lot 2 Block 1 Heritage Hills
Comments
Approved - , ,~ .... ~- Disapproved
Appro.val 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)
L~ GReATeR ANCHOP~AG~ AR£A BOROUGH
~ J [/ Department of ~nvlronment81 Qumlfty
3500 Tudor Road, Anchorage, Alask~ 99507 279~8686
Date Received_
Date of InsDec%ion~~
RSQUESI ~0~ APPROVAL OF
I~IV~DUAL SD~R & WA~R
1. Aoprov~l Re.es%ed By:'
Number of }~edrooms:
6. Well Data: /
A. T~ B. Depth
7. Sewage Disoosal S~ste~: ~~ ' ~"~~3"
D. Seepage Pit: 1.
Disposal Field:
Total Length of Lines
Distances:
6.0 ~ , Other Contamination ~- .
, Nearest Lot Line ~
on ~.. / ~L~,
Bo Foundation to Septic Tgnk~~ AbSorpti Ares~
C. Absorption Ares to Nearest Lot Line__~ /
Request for Approval C ~ndividual Sewer g ~ater raclll
Page Two ~'
6ve~ter Anchorage Are~ Borough, Dep~rtment of ~nvironmenta] flual!~y
~V
DIAGRAM OF o~STE~
] certify that the information contained in this request for appreval to be a true
and ~ccurate representation of the sub.iecC sewer and water facilities located at:
Signed Date