HomeMy WebLinkAboutHERITAGE HILLS BLK 2 LT 1Heritage Hills Block 2 Lot 1 #015-221-11 (Rev 05/02/18) ( Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP241250 PID Number: 015-221-11 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New N Upgrade Name Susan G Cross Living Trust ABSORPTION FIELD El Deep Trench El Wide Trench El Bed ❑Mound Site Address 12215 Freedom Road ❑ Other Phone Number of Bedrooms ating Total depth from original grade TWO(2) GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe in from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Heritage Hills 2 1 Fill added above original grade Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Line Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption LiftStation Holding Sewer Total absorption area Number of trenches Dist. betwe renches From Tank Field Tank Line Ft2 t. Well >100' N/A N/A N/A >25 TANK g Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Greer 1000 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >rj' N/A N/A N/A NA Foundation 8.9'* N/A N/A N/A LIFT STATION Ma rer Capacity Gal. Remarks Deep burial tank *See profile showing foundation influence Alarm location installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer A.C.E.S. Drainfield D3034 CO/MTD3034 Inspector J. Opheim BENCH MARK (Assumed elevation) 100 ft Inspection 1- 9/19/24 Location and description dates: 2 nd Bottom Siding Point A 3r 4m th of @ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date TH .. ... .....� ............::.:/ � �• Benjamin Schiller c�CE 12592 r Septic System p y Approved �`�— Date . �,'srF9 ..1./15/25 , •�w�� t�1F�PROFESSION�, Note: this approval does not include well permit requirert'�/ ents. (Rev 05/02/18) ( Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A L E N GINEER 1"=20' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP241250 PID # 015-221-11 HERITAGE HILLS, BLOCK 2 LOT 1 A B MH 24.6 SV 28.9 2CO 31.5 A B 11.7 13.4 15.2 FEET 0 20 40 PLAN AS-BUILT 12/17/24 10' UTILITY EASEMENT 1-BDRM HOME NEW 1000-GAL SEPTIC TANK FR E E D O M R O A D E 131ST AVENUE EXISTING WELL w/ 100' RADIUS EXISTING TRENCH MT CO FCO CROSS VIEW ESTATES LOTS 12 & 13 WELLS OUT OF VIEWPORT NEIGHBORING 100' WELL RADIUS HERITAGE HILLS BLOCK 3 LOTS 5 & 6 WELLS OUT OF VIEWPORT 2CO 6.3 SV MH CO PROFILE AS-BUILT PERMIT # OSP241250 PID # 015-221-11 HERITAGE HILLS, BLOCK 2 LOT 1 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A L E N GINEER 1/14/25 99.4 95.4 (EST) I N F L U E N C E L I N E 1 1 8.5 4.3 90.1 1"=3' FEET 0 3 6 94.5 (INLET) 94.3 (OUTLET) 95.1 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 Permit Number: OSP241250 Work Type: SepticTank Upgrade Tax Code Number: 01522111000 Site Legal Address: HERITAGE HILLS BLK 2 LT 1 G:2737 Site Mailing Address: 12215 FREEDOM RD, Anchorage Owner: CROSS SUSAN G LIVING TRUST Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/27/2024 8/27/2025 14000 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 2 Received By:713 PO 19---tn Date: Issued By: Date: ' MUNICIPALITY OF .......... Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON -SITE SEWER/WELL PERMIT APPLICATION Parcel 1. D. 0 15-221 -11 Property owner(s) Susan G Cross Living Trust Day phone Mailing address 13317 Stephenson Street, Anchorage, AK, 99515 Site address 12215 Freedom Road, Anchorage, AK, 99515 Legal description (Sub'd., Block & Lot) Heritage Hills, Block 2 Lot 1 Legal description (Township, Range & Section) Lot Size - 14,000 _Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial R Single Family (SF) (w/wo ADU) Septic Tank IK RX Upgrade ❑ Duplex ❑ (D) Holding Tank R Renewal R Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. V (Signature of property owner or authorized agent) Permit/Rush Fees: 2 291 Waiver Fees: Date of Payment: ��o Ay Date of Payment: Receipt Number: )0906 Receipt Number. - Permit No. (25 P2- ut i z 6-0 Waiver No. Permit App_'-'- :- :-'.,:c ; August 6, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Heritage Hills, Block 2 Lot 1 – 12215 Freedom Road Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with another tank sized at 1000 gallons. The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241250, Curtis Townsend, 08/27/24 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=20' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HERITAGE HILLS, BLOCK 2 LOT 1 FEET 0 20 40 SEPTIC PLAN 8/6/24 10' UTILITY EASEMENT 1-BDRM HOME NEW 1000-GAL SEPTIC TANK FR E E D O M R O A D E 131ST AVENUE EXISTING WELL w/ 100' RADIUS EXISTING 50' LONG x 3' WIDE, 4.5' EFFECTIVE DEPTH ABSORPTION TRENCH TO REMAIN IN SERVICE EXISTING 1000-GAL STEEL TANK TO BE DECOMMISSIONED PER CODE MT CO FCO FCO VERIFY THAT PIPE IS A CLEANOUT AND TIED TO THE SYSTEM CROSS VIEW ESTATES LOTS 12 & 13 WELLS OUT OF VIEWPORT NEIGHBORING 100' WELL RADIUS HERITAGE HILLS BLOCK 3 LOTS 5 & 6 WELLS OUT OF VIEWPORT 10.0 2CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241250, Curtis Townsend, 08/27/24 EAST 131ST AVE FR E E D O M R O A D HERIT A G E H I L L S SUBD I V I S I O N BLOC K 2 Taylor L. Dosch No. 189892 R E GISTEREDPROFESSIO N A L L A N D S U R VEYOR T Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program fient �o F e i J n epartmcnt **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131128 COSA#: Permit#: PID#: 015-221-11 Legal Description: Heritage Hills Subdivision Block 2 Lot 1 Engineer: Anderson Engineering Applicant: Owner Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation of the proposed addition has been approved. The approved separation distance is 8.4 feet. See the site plan by Michael E. Anderson dated 6/8/13 for the location of the proposed addition. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ..............................................................................I Waiver is Granted: X Waiver is not Granted: Date: Z / Approved by:tom(/ r Name of Revie r .......................................................... 0 ..................1 Rec#: 08296G Amount: $200.00 Date Paid: 6/12/13 June 8, 2013 (��h-221-11 Municipality of Anchorage Development Services Department I�Q 08Z96 Building Safety Division 05P13 Ilzs 4700 Bragaw Street Anchorage, AK 99507 Attention: On Site Services Engineer Subject: Lot 1, Block 2, Heritage Hills Subdivision Proposed Foundation to Septic System Waiver Dear On Site Services Engineer: The owner of Lot 1, Block 2, Heritage Heights Subdivision intends to construct a 25' x 32' addition to the house on the lot. The footing along the northern edge of the addition will come within 8.4' of the existing absorption trench on the property. A waiver is now required to allow the septic system to remain in its current location. The attached drawings show the location of the proposed house foundation and its proximity to the septic system currently serving the house. The location of the septic system was determined based on a surveyed as built completed by Gastaldi Land Surveying. . The drawing shows the septic tank is more than 5' from the proposed house foundation and meets the 5' required to comply with current Municipal Code. The absorption trench is 8.4' from the foundation at its nearest point which is less than the 10' required. The influence line of the footing when projected down at a 1:1 slope will not encroach into the absorption trench area. The bottom of the footing will be a minimum of 3.5', below ground and will be founded on well compacted silty gravel (GM). The bottom of the absorption trench is 11' below ground and the tank is nearly 9' below ground. We therefore conclude the location of the septic tank and absorption trench will have no adverse impact on the proposed foundation. We hereby request a waiver be issued allowing the house to be 8.4' from the edge of the absorption trench. Sincerely, Michael E. Anderson, P.E. Attachments .• 0� MICHAEL E. ANDERSON . 4 0 s: CE -4381 =�® ,�,iI `oa�so PLAT N0. 63-41 HERITAGE HILLS SUBDIVISION LOT 1, BLOCK 2 S 89'59'00"E 120.00' 10' UTIL. ESMT. ___ ___ ------------------------------- SHED _____________________________sxm — ----- EREENHOL5E B.t' From I&SrP'on xireo.h 2 PROPOSED ADDITION � N O n GRAVEL DRN Y K w o og 30' c n 3 DECK w � EXISTING f o BUILDING g z O b 0 I z SHm p r x a?� R WELL e20'0' S 89.59.00`E 100.00' M EAST 131ST AVE. •.•'•� OF •• �E ..qCq��� .....49th•�� �:�.. SITE PLAN MICHAEL E. ANDERSON •:'= SCALE 1" = 30' ♦. �•:, No. CE -4381 �� Tom�,,•. o•�� Q.,11FES;;�••• HERITAGE HEIGHTS SUBDIVISION BLOCK 2, LOT 1 FOUNDATION TO ABSORPTION TRENCH WAIVER SCALE 1" = 3' MUNICIPALITY OF ANCHORAGE I) • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I/ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW 1) C 'C� 7 O� ❑ UPGRADE MAILINGADDRESS 13(]? /�/" //�ltl.[.-•C., LEGAL DESCRIPTION LOCATION 4/ �r p NO. NO. OF BEDROOMS W IAbsorption area Dwelling PERMIT NO. Uy DISTANCE T0: IL" 3' Z a wF Manufacturer G r-Gc� Material No. No. of compartments y Liq. capacity in allons �A IF HOMEMADE:^- Inside length Width Liquid depth /GOD z DISTANCE TO: Well Dwelling PERMIT NO. 2 z F Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well �/ L —� Foundation q Nearest lot linne�1 4- PERMIT NO. S w= J LL' No. of lines [ Length of each line/ Total length of lirges Trench 'doh Distance between lines F z w 1 Q inches jJ finish Material beneath til Total effective b orption area cTop of tile to grade �/ 0 6f+ inches Length Width` Depth PERMIT NO. Lu a Qa F- Type of crib Crib diameter Crib depth Total effective absorption area wa w N Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS A 4 SOIL TEST RATING I-7 Z 71 INSTALLER fAREMARKS .7 d°��0���ab *. a aoe fla 17 i�eeeeee 000eeeo 00000a o '+ l veoe •---- o 0 o JAMES 6 80801 s .CE - 1516 .'0-60 V ��f► 0e � qy I V v: 'iCSC,r3� 1.. APPROVED DATE LEGAL 72-013 (Rev. 3/78) WELL LOG Date Drilleds 10-2-85 Static Water Level 200 feet Draw Down N/A feet Type Material Drilled: 0 feet to 65 Brw. Silty Gravel 65 feet to 120 Grey Clay 120 feet to 132 Grey Clay Lot 1 Blk. 2 Heritage Hills Gallons Per Minute 10 Total Feet of Casing 220 132 feet to 795 Gravel (loose. 140 to 160 ) 195 feet to 209 Grey Clay 209 feet to X18 Gravel Clay 218 feet to 220 Sand, Gravel w/water Hefty Drilling S.R.A. Box 1553 x Anchorage,Alaska 99507 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION B 0 71986 RECEIVE© - ~ �� ������ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ` 825L STREET, ANCHORAGE� Al," 99501 264�4720 PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: ��� ������� ;&: 850519 08/21/85 ` SUSAN qCROSS ' 1307 38TH PL ANCHORAGE, AK 99503 243~3302 SUBDIVISION: HERITAGE HILLS SECTION: 22 TOWNSHIP: 121\1 "33A (SQ.FT" OR ACRES) 2 LOT: 1 BLOCK: 2 RANGE: 3W * Listed below are the optioris available to you in designing your septic system" Choose the option that best fits your site" I~ 1"'.0 FA W~ I".10 FZ e--4 .1 DEPTH TO PIPE BOTTOM (FT") 4"0 4°0 4�0 GRAVEL DEPTH 4,0 0"5 3^5 TOTAL DEPTH (FT") 8"0 4,5 7"5 GRAVEL WIDTH (FT. > 2.5 17.0 5.0 GRAVEL LENGTH (FT.) 43^0 31"0 38"0 GRAVEL VOLUME (CU. YDS 18.0 19.6 28.2 TANK SIZE (GALS) 1,O00"0 ** 1,000,0 ** 1,000.0 ** SOIL RATING (SQ"FT"/BR) 172 172 172 �+* TANK MUST HAVE AT LEAST TWO COMPARTMENTS - I certify that: 1. I am aw �amilir ith the requirements for on. -site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of' Alaska" 2" I will ainstall the system in accordance with al). MOA codes and regulations, and in compliance with the design criteria of this permit° 3. I will adher� to all MOA and State of'Alaska requirements �or the set back dkstances from any existing well, wastewater disposal system or, public sewerage system on this or any adjacent or nearby lot, 4" I understand that this permit is valid For a maximum of 2 bedrooms and any enlargement will r*4quire an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT ANC^ INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BEDONE BY A LICENSED ELECTRICIAN" ^ DATE: SIGNED APPLICANT SUG)ANnt 'Ros's DATE: ISSUED BY L�� k ^ 1-2-0-04 (/-^ ) 1:�q ' r�0 W —12-O.oy (2) 30 A/ �1 � I 4 - o 0 a 1 W O L >%P(E•F 4�41,11 Q z ••.. •.r••••., ......... a .. •.o ..� � ✓ Oot v t Gerold V. Rondoll Jr. 0 1 % •• NO. 4053-5 �jrF'v ••• .a'•JQ,� 1,; ROFFSSIONAL -'� + \ww% l (Q MUCIP LITY OF ANCHORAGE I DEPT. OF HEALTH & gNVIRONMENTAL PROTECTION fE-e q, 1986. RE-cEN ED a DNI= ri S /0F Y M 1-ta�sE- Q 4 L-5 E PT S G-. Of 14 N I r r OD q9�—S`1 ' b0" W Wo, 00 EXCLUSION NOTE: It is the owners' responsibility to determine the existence of any easements, covenants, or restrictions which do not appear Q on the recorded subdivis!on plat. Under no circumstances Ehocid any data hereon be used for construction or for establishing boundary of fence lines. til -I'T AvE C. SURVEY CERTIFICATION: I hereby certify that I have surveyed the property shown and d scribed hereon and that the Improvements situated thereon are within the property lines and r encroachments exist other than noted. ENGINEERS • PLANNERS SL.IRVEYORS PLEASE NOTE: It Is the contract -or's responsibility to check top LEGEND: SET FOUND 5/8" REBAR A Q wO'' _ ^L n DRrv. aY. tT1L 440 WEST BENSON BLVD. 272-9231 ANCHORAGE, ALASKA 99503 562-529,1 of foundation In relation to finish Breda and building set- backs In relation to lot lines andeasements. HUB & TACK O ® MONUMENT AL -CAP Q e PK NAIL X IRON PIPE O° =ELEVS.-DATUM C.KD.: GR,D: 27..37 / LEGAL DESCRIPTION: Tpr�TI4ASSUMED LT /, SCALE: I'� �O DATE: H.�12TTAEE NZ LL -5 10-/445 y� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5o'k ,L4f—e'.SS DATE PERFORMED: "•%°1"$� LEGAL DESCRIPTION: /5��� • " /Y%+•�%j��I Township, Range, Section: 4�- LL H SLOPE SITE PLAN ( JE 6111- 6 oL;I' L 5 cn't 1 P11 5 by S v --'tidy 2 ! ?A I ri �- CGbbl<n- 3 4 5 6 7 8 9 10 WAS GROUND WATER Nv ENCOUNTERED? 11 S L IF YES, AT WHAT O 12 DEPTH? P E Depth to Water After 13 Monitoring? Date: 14 15 16 17 18 19 4 t� Reading Date Gross Time Net Time Depth to Water Net Drop e=-( a 333 30S t 34 D 2, F S y-2- 43 4 2-,z s3iD (8 .S 3 3a6 423 z.� ,12-3 3LO - 43 is L2'S I� 20 „ PERCOLATION RATE � � (minutes/inch) PERC HOLE DIAMETER �L /^ TEST RUN BETWEEN FT ANDr FT COMMENTS M i z 168 /7 PERFORMED BY: % /;IV*S rYs—&'2'y CERTIFY THAT THIS TEST WAS PERFORMED IN ✓� ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251011 Parcel ID 015-221-11 Expiration Date: 6/28/2025 Legal description HERITAGE HILLS BLK 2 LT 1 Site address 12215 FREEDOM RD Current property owner(s) CROSS SUSAN G LIVING TRUST X The On-site system(s) is/are approved for 4 bedrooms By: Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments Original Certificate Date: 1/17/2025 This erfikficafef On -Site Systems Approval (COSA) is intended to demonstrate the subject systdm(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section \�— Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-221-11 Complete legal description Heritage Hills Block 2 Lot 1 Location (site address) 122115 Freedom Road, Anchorage, AK 99516 Current property owner(s) Susan Cross Living Trust Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Separation from tank to foundation Distance: 8.51 Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ � S --D Waiver Fee $ Date of Payment (// y l25 Date of Payment COSA # 05 C2- Waiver # COSA Application_June 2022 2.01 Forge Engineering 6/28/24 NEW N/A N/A 26 28 (907) 522-7773 Benjamin Schiller, P.E.1/15/2025 EAST 131ST AVE FR E E D O M R O A D HERIT A G E H I L L S SUBD I V I S I O N BLOC K 2 T Taylor L. Dosch No. 189892 R E GISTEREDPROFESSIO N A L L A N D S U RVEYOR MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE Or. INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION (a) Legal Description (include lot, block, su n, Application Date g6 Location (address or directions) 13 / 47- (b) T(b) Applicant Name <%.oftw K.y.e.4f' Telephone: Home l '33 Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f), Mail the HAA to the follow ling address: kr-,% I1,1 6<e,e'ep_ - 3---2,C6 - 3--�' q 2. TYPE OF RESIDENCE Single -Family IW Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual..Well Community ❑ Public ❑ i' f Environmental Conservat on Note: If community well system, must have written confirmation from the State Department o , 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 72-0251 (11/84) 5. EvyGINEERING FIRM PROVING INSPECTIONS, TESTS, FILE SEARCH, (TATA AND INFORMATION . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adegi`a for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained'" c,_ from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. / Name of FirmTelephone Address c) ��✓ SD3 Date G �,&,1'rZ`3'C3 U TA,4 ® 3 A4 rN ® •° • a`S�Q Engineer's Seal Vp �® ' ° • CE -4488 6. DHEP APPROVAL a Approved for bedrooms by06C e Ll O Approved Disapproved Conditional Terms of ConditionalsXeproval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Ac Approval certificates based solely upon the representations given in paragraph 5 above by an independent profei engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their'I institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conductinspecti analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omiission, professional engineer's work. x r> :; v Page 2 of 2 72-025(11/84) MUNICIPALITY Ot ANUIUrAl�c MUNICIPALITY OF ANCHORAGE (MO)* DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 FEB 0 7 1- 264-4720 Legal Description: a A. WELL DATA Well Classification—L/"�iy��u If A, B, C, D.E.C. Approved (Y/N) „l Well Log Present (Y/N) —— Date Completed GO Yield Total Depth 2O / Cased to ZZ0 Depth of Grouting Static Water Level .2_e'>0 / Pump Set At Z/O Casing Height Above Ground �- cg/H Sanitary Seal on Casing (Y/N) r Electrical Wiring in Conduit (Y/N) r Depression Around Wellhead (Y/N) A/ Separation Distances from Well: To Septic/Holding Tank on Lot SOC / ; On Adjoining Lots /p0 / f l� gAdjoining To Nearest Edge of Absorption Field on Lot ; On Lots F �O + To Nearest Public Sewer Line To Nearest Public Sewer �® Cleanout/Manhole �%- To Nearest Sewer Service Line on Lot Water Sample Collected byc�64 o4e ; Date 2 n i Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ___4 l47 Size too No. of Compartments _2__ Standpipes(Y/N) ---L-- Air -tight Caps (Y/N) —_ r_ Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) y ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)� Separation Distances from Septic/Holding Tank: To Water -Supply Well a ® To Building Foundation Z .3v/ To Disposal Field To Property Line ? To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) l To Stream, Pond, Lake, or Major Drainage 00 / C. ABSORPTION FIELD DATA 41 Soils Rating in Absorption Strata 7Z -p4& Type of System Design -z'-FRIP�NG4 Date Installed � �% Length of Field p Width of Field 3 Depth of Field 3� Gravel Bed Thickness g of Square Feet of Absorption Area '� S� Standpipes Present (Y/N) r�5 Depression over Field (Y/N) Date of Last Adequacy Test Ne�J Results of Last Adequacy Test N Separation Distance from Absorption Field: p ( O To Water -Supply Well /1/49 To Property Line l To Building Foundation 35- To Existing or Abandoned System on Lot /%G Ne- On Adjoining Lots �°� ! 4 - To Water Main/Service Line 0 To Cutbank (if present) /1/arvl�G To Stream/Pond/Lake/or Major Drainage Course ��'�� wo LOc To Driveway, Parking Area, or Vehicle Storage Area Jr' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments N/ Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I ha a ch ed, rif d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sign Date Company MOA No. Receipt No.S Date of Payment o1 j �'� v °° r ' Amount: $ ,�• �S Engineer's Seal �°°�°°®°®° °°°° °°° °°° a H. YN ' F ARSON o CE -4 88 Page 2 of 2 72-026 (11/84) .