HomeMy WebLinkAboutHERITAGE HILLS BLK 3 LT 1Heritage Hills Block 3 Lot 1 #015-221-17 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page ( of ON-SITE WASTEWATER INSPECTION REPORT Os � c 3l 3 2 - Permit Number: PID Number: g2 / S— 221 - 1-7 Dwelling: Dwelling: [..Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New &Upgrade Name: C�1441 ABSORPTION FIELD C k ® Deep Trench El Shallow Trench El Bed ❑ Mound Address S L-4 S w.0 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade S' • O GPDISF /0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Ft Subdivisi n ( Block Loth Fill added above original grade // Gravel length S Township Range Section FL Ft Gravel width Z, O Beds: Number of Lines ✓ Distance between lines SEPARATION DISTANCES Ft. i Ft. To Septic Absorption Lift.Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line r �- 7 '(O Ftp Ft. Well toot,- (Loth /y 56 t4 TANK ❑Septic ❑S.T.E. P. El Holding [I Other Manufacttt�rer r- /� ci /�Vlt "l 1 W 7-000 Gal. Surface Water (��-� %VIS t / Material Number of compartments 1' Lot Line NA Foundation / �d Zd4 LIFT STATION f Manufacturer 14 vte� R� n Capacity 'Z. IJ O Q Gal, Curtain Drain Remarks- Cv ptwcr +cer tAe�, Pump on level at D Pump off level at y Z 1 High water alarm at _7 CA in. in. in. Pump make and model PF 7—o Electrical Inspections performed by Installer PIPE MATERIAL House to tank Tankto 3173 drainfield 3 03 Lf / ,/{ Mi L�G..r/AtrW+•t�.eYS cti �r�• Drainfeld ;03 Lf COIMT 'i0; Inspector Frine�/10vC� �( ,/ _ ��tw !1 ^�� BENCH MARK (Assumed elevation) too ft Inspection f„ / i _l dates: /t '+--/l3 2 Q 2 / /3Y Location and description tt�� deR L I�44 CW eft f 1�\J Of St 3" 0 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL �`®$���Simp OF Conditional Approval: Date y�P,i•'' °'.d;7d� *"49TH :SBP . .... � • MICHAEL N. ANt1ER0. s C -94 dSPA® �� 1V� 1 Approved �� Date iz 4� -P t`= o.. Permit No. OSP131372 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99 51 9-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: HERITAGE HILLS SUBD. BLK 3, LOT 1 PID No.: 015-221-17 MARK A B col 3 CO2 33 / TCO2 48 P5 MT 50 81 MARK A B col 3 CO2 33 52 TCO2 48 P5 MT 50 81 I— — — 0 BENCH, DOOR SILL A EXISITNG TANK--' DECOMMISSIONED. j I NEW STEP TANK. 1 l ILT SCALE: 1"=30' NJa. �[] /.0"'^ ydm / TC01 �N NA CO2 / TCO2 1� / I � MT1 / .... 419 . EOFq T 49 TH `.�. P/GM ..n/./. ... .m. ..v ... ........... /..6.K..�� . ... f� %MICHAEL N. ANDERSON;- � ♦% No. jE 9yF69 0; ANA♦♦♦■� SS1�••• Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchoraoe ak us (907) 343-7904 Soils Log - Percolation Test * 49TH PO MICHAEL N. ANDERSON C 9869 C �% ri C C7 (t Se7 d LAn u ig1 Date Performed: (S 3 �-'O T ( Township, Range, Section: _ Slope Y& ov �}ahlc5 4- Ldy rag t� 5 14 /67M 6 - 00 l�d(� `f:2 COMMENTS 4 WAS GROUND WATER 9- ENCOUNTERED? 10- IF YES, AT WHAT DEPTH? 11- Depth to Water Aker Monitoring? C." 12- Date: If 7 00 l�d(� `f:2 COMMENTS 4 PERCOLATION RATE_ (minutesMch) PERC HOLE DIAMETER (p TEST RUN BETWEEN _ rte. _FT AND ({ FT 4. f e. .. 1 1 - I A—t A. 1� PERFORMED BY: 1-h14. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: // — _---_-!�® WMWM ® PERCOLATION RATE_ (minutesMch) PERC HOLE DIAMETER (p TEST RUN BETWEEN _ rte. _FT AND ({ FT 4. f e. .. 1 1 - I A—t A. 1� PERFORMED BY: 1-h14. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: // — Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 hftp://www.muni.orgiOnsite Development Services Division On -Site Water and Wastewater Program hent fte C **** VARIANCEIWAIVER REVIEW **** Waiver#: Osp131460 COSA#: _ Permit#: OSPI31372 PID#: 016.221-17 Legal Description: Heritage Hills Block 3 Lot 1 Engineer: Mike N. Anderson Applicant: Chad Gassawav Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 4.0 feet. 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. 0 Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Granted: Date: I Approved by: k,, /- Gt/G 2,1, J Name of Revie er ..........................•........0..................... yf...................� Rae#: 170078 Amount: $200.00 Date Paid: 11/21/13 **** VARIANCE/WAIVER REVIEW **** Michael N. Anderson, P.E. CiviUStructural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Nov 21, 2013 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Heritage Hill Subd. Blk 3, Lot 1 To Whom it may concern: This is a request for a lot line waiver. The system was installed per the permit but during construction the location of the tank and leach field was moved slightly to the south to miss the driveway and this encroached on the south property line. This encroachment doesn't affect any neighbors because its on the Huffman side of the property. We are requesting waiver of 4 feet from the property line for the system, see attached asbuilt. Please call me if you have any questions. Sincerely Michael N. Anderson, P.E. Municipality of Anchorage E Community Development Department - Development Services Division T P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road Info and Help: 1114J.- INSPECTION: Voice: (907) 343-8300 Fax 1(907) 249-7777 W�MOPI.Gt Inspection Report - ElecRgh APPLICATION NO. E12-1847 Subpermit of Master Permit: R12-2059 Permit Type: Electrical New rvotes: i o inspect site tune Tor conourt running to new septic- in response to partial for previous Schedule Date: 12/02/2013 inspection 11/26 Requested by: Chad Gas 764-0535 cdgas@yahoo.com Preference:01I Inspection # 239423 Address of Protect: 12346 FREEDOM RD Parcel: 01522117000 Contacts Owner Comments: INVNR - Replace tailing roof wlenginerred trusses, rebuild interior stairs to code, repair sheetrock ant underlayment, reside house, remodel kitchen, add bathroom, frame and replace all windows to meet egress and code, correct shearwall nailing and framing - to include plumb/mech/electric - BWP OSWALD MADGE & JOHN V Inspector: 6� ( ��� LS�f �i Date: /d: —c:::?; — %' On -Site Wastewater Disposal System Permit 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: OSP131372 Tax Code Number: 01522117000 Work Type: Septic Permit Effective Dates: November 01, 2013 to November 01, 2014 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: HERITAGE HILLS Site Legal Address: HERITAGE HILLS BLK 3 LT 1 G:2737 Owner/Address: OSWALD MADGE & JOHN 12001 AUDUBON DRIVE ANCHORAGE AK 995162421 Site Mailing Address: 5345 HUFFMAN RD, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 14000 Total Bedrooms: 5 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: Testhole #2 shall be completed during construction to substantiate the reserve drainfield design. Special Provisions: The existing driveway located along the south side of the property shall be decommissioned such that vehicles can not drive or park on the septic system drainfield. Special Provisions: PRIOR TO CONSTRUCTION: All 100 foot well radii and property lines within 20 feet of the permitted septic system shall be flagged by a licensed surveyor prior to construction. Special Provisions: The existing drainfield shall be decommissioned in accordance with the code. Received Issued By MUNICIPALITY OF ANCHORAGE 6 Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. OI C�--- 224 — 19' Property owner(s) [� �. AS S Qw R N Day phone Mailing address Site address f Z 1 `'E CP FvTt g or" X CL Legal description (Sub'd., Block & Lot) 14'tv c to ccs A j It s F> 3 C-vf Legal description (Township, Range & Section) Lot Size / 4 0 0 D Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field jg Septic Tank TYPE OF DWELLING: Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) (w/wo ADU) Upgrade FA Duplex (D) E]Renewal El Multiple Dwellings ❑ (SF and/or D) 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. of property owner or authorized Permit/Rush Fees: S30 Waiver Fees: _ Date of Payment: / d Gk+ a11IDate of Payment: Receipt Number: ! koff.a3 Receipt Number: Permit No. 0JP1313%2 Waiver No. Permit App_.:: Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 Oct 7, 2013 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Heritage Hill Subd. Blk 3, Lot 1 To Whom it may concern: This is a request for a replacement septic permit on the above referenced lot. One test hole was excavated at southeast comer of the lot. The old septic system was located off property therefore a new system is required, see site plan. The soils in the test hole consisted of various layers of sandy gravels and silty sands throughout the entire test hole depth. No water was observed during the excavation or after the 7 day monitoring period. A new simple deep trench was designed with 7 feet of effective depth has been proposed with a new 2000 gallon STEP tank. The perc rate was 5 minutes per inch, however for longevity the system will be designed with an application rate of 1.0 GPD/SF. The lot slopes gently downhill to the southeast at about 1 to 2 percent with no cut banks or slopes greater than 25 percent within 150 feet of the site. This new system will not impact any of the neighboring lots. The new system is a 5 bedroom system therefore a new test hole will be excavated during construction at the northeast corner for the secondary system. Please call me if you have any questions. Sincerely, Michael N. Anderson, P.E. DESIGN CRITERIA: 5 BDRM X 150 = 750 GPD SOILS = 750/1.0 = 750 GPD 750 GA/14 = 54' (1) TRENCH 9.0' DEEP 7.0' EFFECTIVE 2.0' WIDE 54' LONG (TH#1) 0.5 ORG 17 OVER FILTFzI FABRIC —2.0 1. 5 0 PIPE 3 15 0 HOLES 048" GM/SM SEWER ROCK PROPOSED SEPTIC / - -_�- H U F F M A N ROAD - - — — — — — BLOCKOR. LOTE3 — — — — 1 � B�OCK02. LOTE1 — — — — — — — — — — — — — — — Septic Design Prepared for .���11kIMIJIM t,, CHAD GASSAWAY ��� . .....F .. # HERITAGE HILLS, BLOCK 3, LOT 1 49TH Anchorage, Alaska low....... • ••••• ......•.•••. Michael N. Anderson, P.E. ,g MICHAE .ANDERSON:µ DATE: 10/30/2013 No. C 9 9 4661 NATRONA AVE. ANCHORAGE, ALASKA 99516 DRAWN: DJR ��1., 345-3377 / FAX: 345-1391 SCALE: 1"=100' too ���� 0 I I 0 w EXISTING WELL ++ r 100' RADIUS of Q H I � 1 HERITAGE HILLS HERITAGE HILLS--�--- D: BLOCK 3, LOT 11 L r----- BLOCK 3, LOT 2��� ��\\ '/ I W / � HERITAGE HILLS / BLOCK 1, LOT 7 y\ Ar—, PROPERTY LINE L L----- ---- --- --J --� .IXISTING HOUSE --> ,4/J ---r— LZ �r --`moi --= `=-- — F----- I HERITAGE HILLS + — I + HERITAGE HILLS BLOCK 3, LOT 12 + ��7 BLOCK 1, a PROPOSED SEPTIC / - -_�- H U F F M A N ROAD - - — — — — — BLOCKOR. LOTE3 — — — — 1 � B�OCK02. LOTE1 — — — — — — — — — — — — — — — Septic Design Prepared for .���11kIMIJIM t,, CHAD GASSAWAY ��� . .....F .. # HERITAGE HILLS, BLOCK 3, LOT 1 49TH Anchorage, Alaska low....... • ••••• ......•.•••. Michael N. Anderson, P.E. ,g MICHAE .ANDERSON:µ DATE: 10/30/2013 No. C 9 9 4661 NATRONA AVE. ANCHORAGE, ALASKA 99516 DRAWN: DJR ��1., 345-3377 / FAX: 345-1391 SCALE: 1"=100' too ���� I i HERITAGE HI LS BLOCK 3, 11 I I I I I EXISTING I I I HERITAGE HILLS BLOCK 3, LO 12 i ---------- I�. I' I' I \l HERITAGE HILLS '\ BLOCK 3, LOT 2 I VACANT I L— — — — — — — — — — — — — PROPERTY UNE— i 10' OVERHEAD POWER EASEME r I �I A WELL EXISTING HOUSE I EXISTING TANK TO BE DECOMMISSIONED PER CODE HERITAGE HILLS BLOCK 3, LOT 1 PROPERTY NEW 2,000 GALLON TANK _---AREA CAN'T BE USED FOR — A DRIVEWAY OR PARKING. EXISTING WELL 100' RADIUS I I �`. DR11�ygY , i SF, 6 — —H ---N ROAD — Septic Design (Prepared for CHAD GASSAWAY HERITAGE HILLS, BLOCK 3, LOT 1 Anchorage, Alaska Michael N. Anderson, P.E. DATE: 10/30/2013 4661 NATRONA AVE. DRAWN: DJR ANCHORAGE, ALASKA 99516 345-3377 / FAX: 345-1391 SCALE: 1"=30' � I DESIGN) CAT II, TE 3 G D/SF, ARI ' EFF. X 21 FEET i i r .\I I i 1 1 TH#2 TO BE COMPLETED DURING CONSTRUCTION. EXISTING SYSTEM OFF PROPERTY {z' 49TH ; �nW_".M1C'H'AEL ......�.. ............. V N. ANDERSON .No. C.E 9069 Municipality of Anchorage Development Services Department �' 1p'••• ��f it Building Safety Division 0y •• •$ yam. On -Site Water and Wastewater Program: 49TH , 4700 Elmore Road........ P.O. Box 196650 Anchorage, AK 99507 w .ci.anchorage ak us (907) 343-7904 �� Soils Log - Percolation Test II Performed For: G/ IX w q Date Performed: Legal Description: 14ecrt 4-44t., A f f 7 P 3 I V'I l C Township, Range, Section: slope y I—IT� %/t' a rq° "tG 5 I 4- 5- SNI /7 ti'l 6- G r76 S C_� 7- Lo v'4ei awriL. 9- WAS GROUND WATER ENCOUNTERED? S 10- IF YES, AT WHAT DEPTH? L Depth to Water After O 'E 11- rQ Monitoring?/V U 12- Date: 15- 0111 Alf 16- '/,4h (` 17 (5014tw. J E 18- 19 - COMMENTS 0NrA • MICHAEL N. ANDERSON ; '._ CE- 9469 u 1 u_, 2 PERCOLATION RATE _� (minutesrinch) PERC HOLE DIAMETER q TEST RUN BETWEEN FT AND I. FT PERFORMED BY: g &( A, CERTIFY THAT THIS TEST .�W PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4 20� f pa, GRE,, <,ER ANCHORAGE AREA BORA,. JGH �,�����,;� Department of Environmental Quality ^°�" 3330 C Street y� Anchorage, Alaska 99503 1 CSP INSPECTION REPORT ON-SITE SEWAGE �DISPOSAL SYSTEM y Q NAME `%ill IJ, CAt � W( Ler MAILING ADDRESS �k f� � �� � PHONE `4q- f 1 nr nri nNI Vx%W\AL^ I EGAL DESCRIPTION �I �%LN9 S SEPTIC TANK: 1A DISTANCE FROM WELL MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. �DRAIN FIELD: N-a� � � S� TOTAL LENGTH DISTANCE FROM WELL 16 -i- FOUNDATION NEAREST LOT LINE �� OF LINES `J � NUMBER OF LINES DISTANCE DISTANCE BETWEEN LINES A TRENCH WIDTHI IN. TOTAL EFFECTIVE ABSORPTION AREA (���\\ � SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_ IN. ABOVE TILE IN. WELL; TYPE__41Ul&nCONSTRUCTION ���� � DEPTH DISTANCE FROM: BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED NEAREST SEPTIC SEEPAGE SEWER LINE--, TANK , SYSTEM_ REMARKS DISTANCES: — ��t +as` INSTALLED BY: to C Lh,64 jI SEWER LINE DEPTH: '-1 PIPE MATERIAL: L K LOT SLOPE: REMARKS: Sol[ I Form EQ -032 'oo e W L4 Surx�p DIAGRAM OF SYSTEM DATE _/_J_!J/_1__- APPROVED up ��-pt�j. N<� k— d 51'b oftq, A*-5)AC % r �' i_of U rw-s G.A.A.B. � " DEPRRTMENT HEHLTH AND ENVIRONMENTHL �OTFCTION STRFET, HNCH0RHGE/ HK9��^1 279~2511 K�5 IS TlF147 S" VE by 17 pit i14 Fin 0711 W~1, PERMIT NO ( 77491 ) HPPLICHNT iOCHTlON |EGHL S FOW|FR SRH RK! 1599 ,77 FRFFVOM7T-HUF�MHN L1 R7 HERITHGE HIi]'S LOT SIZF 24000 SQUHRE FEET TYPF OF SOT!HBS0RRTT(IN SYSTFM IR TRENCH MHXTMi]M NUMBER OF BEDROOMS � SOIL RHTING (SQ FT/BR)� 125 THF RF0DRED ST7E OF THE S;IL HBSORPTION SYSTEM IS: ��, j , 11-11 -1.., �.� V.'��Q -V 1-1 =IV 740 IS kS FQ:, V_ �. -, jj~��= � THF |ENGTH DIMENSION IS THE !.ENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THF )EPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUHD AND THE BOTTOM OF THE EXCHVHTION (IN FFET). THERE IS NO SET WIDTH FOR TRENCH THE GRHVEL DEPTH IS THE MlNIMUM DEPTH OF ARRAY.BETWEEN THE OUTFHLL PIPE HN� THE BOTTOM 0F THE EXCHVHTION (IN FEET). 10 HT Gy 0 T T ". V57 WOO ��674 -w- T 171 �h=VKqH< So 7: 77 117 — � 0 , Not opt gjji ��:::10���� E0 OR FT OR Hot 147 Gy R A : V! P&I 127 03" BHCKFTLLTNi nF HNY SYSTFM WTTH0UT FIHHL INSPECTION RND fPROVHL F.1 THIS DEPHRTMENT WTI T0 PR0SECUT1N. MINIMUM DISTHNCE RETWEEN H NFLL HND HNY ON~SITE SEWHGE DlSPOSHL 5YSTEM IS I FEFT FOR H FOP! 7WSW WFLL OR 200 FEET FOR H PUBLIC WELL � OTHER REQ!)IRFMENTS MHY HPP)Y SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE � AT? 7LARI E TO INSURF PROPER IN51TH|.|HTION. Y P \ % CONSULTING GEOLOGIST BOX 476-M, STAR ROUTE A • ANCHORAGE, ALASKA 99507 a PHONE 344-7071 Date SOILS LOG f 1 Performed for `) tMk's Legal Description Depth (feet)_ w -12- -14 •-16- --18- -20- 4ei �T�c2 f4i1lS Soil Description J sd -3 k -AA �o✓�nn�( V�sz� g-rz" Total Depth I ` feet in J U/ Was groundwater encountered ? What depth c Depth to bedrock > 2-C) a How determined Respectfully subm " ted, ✓� U Gary F. Player Consulting Geologist (�q) t#wiv� v R l ROJ 4e4t�- L-t'll Lc�L, Fq HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME C l.u�i'' 1 ADDRESS �foei lig-d i PHONE,/%J LOCATION LEGAL DESCRIPTION SEPTIC TANK: 11-V I �¢ � NUMBER OF DISTANCE FROM WELL -0 MATERIAL COMPARTMENTS r LIQUID LIQUID CAPACITY { GALLONS. INSIDE LENGTH INSIDE WIDTH-DEPTH- SEEPAGE IDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT f, NUMBER OF PITS I OUTSIDE DIAMETER OR WIDTH LENGTH - ' , DEPTH A LINING MATERIAL /yslid�C •�'`�'��'; .DISTANCE FROM WELL �� BUILDING FOUNDATION, �J tR �� t_ NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA). SQ. FT. TILE DRAIN FIELD: DISTANCE FREY NUMBER OF INES ABSORPTION EP DEPTH: TOP OF TILE TO FINISH /GRADE WELL: TYPE LOT LINE DISTANCES: NEAREST SEWER LINE TOTAL LENGTH FOUNDATION , NEAREST LOT LINE OF LINES 1 ANCE BETWV< LINES `.TRENCHIWIDTH IN. T AL EFFECTIVE 'SQ �Y. LENGTH OF EACH DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE rt ' DISTANCE FROM WATER DEPTH BUILDING FOUNDATION.SAMPLE , NEAREST SEPTIC y°' SEEPAGE /�1 r — OTHER TANK SYSTEM d CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DATE ��-r' �f � � APPROVED— GAAB-HD-2 (ilf!'iA•1.1.' AfNUnVnAk7r AnEjA '1yn"UITII uaseIvo. z �•-�� HEALTH DEPARTMENT i 327 Eagle St. Anchorage, Alaska 99501 279-2511 I 'SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT - AIV ? MAILING ADDRESS F PHONE N RESIDENCE ADDRESS � LOCATION OF INSTALLATION LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT C ,DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FFA,CILI Y FINANCED THROUGH r-? TO BE INSTALLED BY - PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION THIS IS TO SERVE AS BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , PERMIT TO INSTALL A AS DECnnIDnn DLI MAI cn[ n[ TWIT Tn nr Srnvr:n SEPTIC TANK SI DISTANCES: JJ -C. 4- " i LTH AUTHORITY OR rr{ EN5ED DESIGNER I/certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No 28-68 acid that the. above described system is in accordance with said code. .:(. `` f It DATEAPPLICANTS SIGNATURE r,� r ANCH , 'r, Ai rp 7nn'.lr:i y i ` YuA}}rami 3G'a :il iORF:"L i 999*1 Date performedSube llz�.,��..,,� ��: r,�i. Bcscri.ptlOn 'r ;J6 •a � - �erC.. l.'U .0:7 �?`-•"�.,...��., „:.�.....o This Form Reports a: SO! i Depth c, 1 Ch aeer � a'is'_ics e "SD �`I cCsnd r �iDr�S �lE rlt7r fP, coli GUG+S Covn�ose� p�j �'(i £� Lc:^jtic�± :Sketc� Was Ground 'dater Encountered? -14. ? ,-. o0 If Y'ess At 'F!: ~at a P.o Depth c Net Broil - ° a..� t -,, n u i. C Eri.•O a 1, i ate s, v Pit Dr J n 7.L1U Trench /fi r �P •��,,,_ ie'pt, o2.i ..ym�l..ax,a*e...--,....�c'"..- nG�C 1. ti n .4 i E. _ ri,�, c J a G U.u.+N ✓+r'e,'®..a"'r. ------------ Testi Performed Fi�i _ - 4W4 TTC}104AGL AYFA 0 ., .i ' N � �LPLO 1ATU1.3Y A � GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ,--A Date Received C .- e-�, - Time of Inspection 3 c) Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: 2 3 Mailing Address: Property Owner: Mailing Address. v v v Phone: 04 y L( - t, Q Cv�(= Phone: (-, ) i�Ksbq d Legal Description: 4. Location: 5. Type of facility to be ins 6. Well Data: A. Type Z FA No. of bedrooms C. Construction " 0 pet D. Bacterial Analysis Sewage Disposal System:a��/'$� l2eec �� A. Installed 70 B. Installer C. Septic Tank: 1. Size d 2. Manufacturer i� D. Seepage Pit: 1. Absorption Area 2. Material �1.�— E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area 100tf Sewer Lines , Nearest lot line JWlo Other contamination B. Foundation to septic tank *7 Y, Absorption area 3� C. Absorption area to nearest lot line J</ EQ -034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 . REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES ' lq � a d -- 4. Name of Lending Institution: : /7� Mailing Address: y G<�� Phone 171<1- 7s 55 5 Name of Realtor or Agent: /1 � �/' ted(- j b� 9 �v�� sins ,mak v ��c-r sir/ �� Mailing Address:PhoneT/.,1/,'„23 6. sr�r ZY e Se fel, Location: /6k -N O Y 1. Type- of Inspection: CMRO VA FHA CONV 2. Property Owner:'/�> n Me -i —FRg Address: .O Ak 4 (//Z1 d Day Phone — i s /p s 14 J� o27 `z '°Q 7.- Type of Facility to be,inspected:',7No. 3. Name of Buyer: c,,�/�.S , [z,s '8: .Water Mai 1 i ng Address: STS yf'7-A h"r x R/ Day Phone ' lq � a d -- 4. Name of Lending Institution: : /7� Mailing Address: y G<�� Phone 171<1- 7s 55 5 Name of Realtor or Agent: /1 � �/' ted(- j b� 9 �v�� sins ,mak v ��c-r sir/ �� Mailing Address:PhoneT/.,1/,'„23 6. Legal Description: �,�� - /, �/� .; , ZY e Se fel, Location: /6k -N O Y 7.- Type of Facility to be,inspected:',7No. Bdrms. , '8: .Water a Supply Type of Supply: Public Utility Individual r If Individual, number of dwellings presently served a ” If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) s� If Individual, date of installation a e MA ougust Ji), ljb hir. Arvin njoraton c/o nalpa's lKam IV! K. jorthura Lights BouleVard xackoraya, WSW 00503 �IWLOT: Ln, 1, bluck 3, morihagu Wills Suodivisim f;r. oJov'H�011� A r; -wont Nr mproval of indiviWal iv,yr aa; mor mi wiv i-'1 ;v 1, 1, (11101,41polt. T;w m-sicw smar SYSCUM WillLaWay W3 Woo no, W4,11-0 1� appim " by Lhisr jepaAmul W 1 17 for a &4 (j ov.jn mA_ soplic 060 to wh nVINO k ; 11 ;�1101 Link, I U"K A j, Aw oil a Cob (n) v,;_: ),!i 1,-3\1wr Wr as lu -iv iU ­ uwdrum oaju, Upi saklu LvA" sW nil! Nam Ln - V ;a wilo" tam. im awqvp.ipa mo i, lam Q00191 a (3) varano dounp. - IT.' rl"WSL mm" m If you imula hawn a 1MISMIS ""jUv&Q jjis ndtwar, phn am -0 "U. it Ansote to call hm at 04-001, axtuv3W 1Q. Shcorply, �j_ Gunise C. Bast av; Enviramental Control Officer KU/1W cc: State VA Office Alice McFarland, Huggin's Roalty --l- -- "I ..... ...... Date Approved Phdoprnved Approval Valid for unc year from date SignEd Greater "(ichoragn Area A,rGugw, wwartiont of Environmental Quality DTARRAN OF SYSTM ,,,Est for anpryn! a be a frn� nn: 0 -7 ano wA ter faci 1 i ti as and HOW NO V; ---- ----- -- MGE ll 4' JEPARRUIT OF EiVIR0idh1EF•ITAL OuALITY 3530 TUDOR ROAD 11. CHORAGE. ;ALASKA 99507 �G k SATE kECEIVED: 1A INSPECT: it l > RE^UEST FOR APPROVAL OF u INDIVIDUAL SBIER KM WATER FACILITIES FOR Veterans Administration � APPROVAL REQUESTED DY' ass /Nest Mortgage Cornroation ADDRESS :_0A _I;;_6tl)—Ave._�.LVichoraFe, Alaska 99501 PHONE: 7. aQl..__, 2. PROPERTY 01!ilER=planII�ISee PHO_lE' 279 3913 j, I! GAL llESCRIPTIOid: T•pt .I1 rimills S/D 4. TYPE FACILITY TO BE INSPECTED:..._L Family STREET: Corner of Huffman Freedom Road PIUMER OF EDROOh1S:_.—_--_`-- 2 5. tl&L :DATA: TYNE Individual_ B, DEPT, 1 0, SIZEr' ---'— D, CONSTRUCTIONT!_ y_�I v E. BACTERIAL ANALYSIS c S%�r�✓_ L 9 7/ G. SMIAGE ?DISPOSAL SYSTEh1:Individual A. SEPTIC ThK (IF HONGIADE, SI104 DIAGR^dpi ON' LACK) 2. AGE �, �� 7t' 3. f-W,,?UFACTURER 4, IJIST c j �r ADL, OVAL RE U'7.f)T MiR T- 7R 0: ?IUM FAMLITm- ICT-, 'r !o ids 1:k— SIT C DISPOSAL FIELD TOTAL LEN H— ot-OUIRED CASUREMEiN'TS 1 As ..ELL TO soric TA, '!ELL TO SEEPAGE PIT ce l".'ELL TO Sr"Ir-M WELL TO PROPERTY S.r'- Es ELL TO OT"EM r'oqlI','L- CO"T.AJ111 IM ly �7 F, FOUI'DATIO:-, TO SEPTIC TAI T, FOUMATIO1.1 TO SEEPAGE PIT : `f -/ -�7 SEEPAGE PIT TO PROPERTY LIN -- 3, MILE: APPROVIH)' tZ4 DATE,'- AnfMDVAL VALLI, F-011 0:'E YF,.""F?,,'t'-; J., I L GREATER M012RACE AREA .110ROUGH Df.--PAPlTIE[,j'T OF EWIROMMBITAL QUALITY oWl y KASSLER/WEST MORTGAGE CORPORATION 604 EAST SIXTH AVENUE *ANCHORAGE, ALASKA 99501.212-9501 DATE: 9/1/71 = GREATER ANCHORAGE AREA BOROUGH Dept. of Environmental I-tealth Pouch 6-650 Anchorage, Alaska 99502 RE: Legalltf. O , Npritagi-HHills VAC e # FHA VA Case Gentlemen: Per the attached form, we hereby request inspection for Health Authority Approval. Please send your findings to either the FILA offices or the VA Office as noted above for the "Case Number'. Also, please send an exact copy of the report to our office. Your swiftness in expediting this request would be most appreciated. Sincerely, KASSLER /WEST MORTGAGE CORP. r Loan Processing Department Linda McClelland P.S. If you wish to make an appointment before inspection, please call Alan B. McKechnie 279 3913 or Tom Weise- Poe Realty. 272 7551 410 s: 410 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 Parcel I.D. 015-221-17 1. GENERAL INFORMATION Expiration Date: ' Complete legal description HERITAGE HILLS BLK 3 LT 1 Location (site address) 12346 FREEDOM RD, ANCHORAGE AK Current property owner(s) ANDERSEN Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ 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 $ 15,56 Date of Payment R I La 12 a Receipt Number C G (a -T53 COSA #Q5(2)L4q+' Waiver Fee $ 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. 6. DSD SIGNATURE System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date 9-6-22 4`OF Ae� .. o ri0 F, �.: 49TH+ ®� 0 MICHAEL A ANDERSCA! 51— CE 9469 with the following stipulations: o pR0 ` g TE rn Z� �T�JS�Rro,�15\�� By: — Original Certificate Date: `7 Z — ZZ 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 Legal Description: HERITAGE HILLS, BLK 3, LOT 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled UN Total depth **263 ft Cased to *40'+ ft ❑ Sanitary sea] is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 819/22 Static water level at beginning of test 220 ft. Comments *PER MOA DOCS ** ESTIMATE B. TANK DATA Age of tank(s) 9 years Tank type/material SEPTICSTEE Measured operating fluid level in septic tank 36 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 8/9/22 D. ABSORPTION FIELD DATA Parcel ID: 015-221-17 Structure served by this system Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 7.2 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by M NA Date of Sample 8/9/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station g years Lift station material STEEL Comments: SEE MAINTENANCE LOG Which system tested (date installed) 1112113 Adequacy test date 8/9/22 ❑ ALL standpipes present per record drawing Results Q✓ Pass For 5 bedrooms Total measured depth from grade 13.6 ft (max) Fluid depth prior to test 24 in Measured depth to pipe invert from grade ft (min) Water added 750+ gal ❑ N/A— pressurized field 36 ❑ Monitor tubes go to bottom of effective. If not, state New depth in Elapsed 1440 depth into effective time min ❑ Code -required soil cover over field Final fluid depth 24 in ❑ System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' 0 Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No ft Neighboring Tank > 100'✓❑ Yes if No ft Private Sewer/Septic Line > 25'M Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft M Yes if No ft ✓❑ Yes if No ft Water Service Line > 10'✓❑ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ✓❑ Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: ❑✓ Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ✓❑ Yes if No ft 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' a Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *41 ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' E1 Yes if No ft Water Service Line > 10' 7/1 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS * SEE WAIVER G. ENGINEER'S CERTIFICATION I certify that l have determined through held inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ... CSF �� •�}�.. P. Awl • � fir. 49tH .•-: J VO �� MICHAEL N. ANDERSON tt$� •. CE -9 59 ,. Nitrate Advisory Certificate of On -Site Systems Approval # OSC221447 Subdivision: Heritage Hills Block 3 lot 1 A water sample revealed a nitrate concentration of 7.2 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Marling Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org=' From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Madmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 * viiww muni org MUNICIPALITY OF ANCHORAGE Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Owner Street Address/),3q,6 fff a E,' C�a'y% Septic Tank: -Sludge level Jinches -Pumping: required esn -Pumping completed es s no Lift station: -Pump basket cleaned <SS no -Effluent filter cleaned es no -Control floats cleaned s no -Proper float settings confirmed es no •Operation satisfactory a no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling. es na -Alarm system operation satisfactor not satisfacto . Manhole Riser -Ground water intrusion at riser to tank connection Lesf•Ground water intrusion around pipe penetrations •Weep hole functional a no -Manhole lid: Functional es no Insulated es no Properly Secured 0 no Other -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Provider: Technician r�,-q t`M Date of maintenance Company', SparI M,!._ Signature Date 5A, • • 4GS BG, •, t� Municipality of Anchorage z� �' On-Site Water and Wastewater Program 2..Li 1 a z (907) 343-7904 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-221-17 Expiration Date: I I 22.—L 1. GENERAL INFORMATION Complete legal description HERITAGE HILLS BLOCK 3,LOT 1 Location (site address) 12346 FREEDOM ROAD,ANCHORAGE,AK 99516 Current Property owner(s) CHAD D.GASAWAY Day phone Mailing address 12346 FREEDOM ROAD,ANCHORAGE,AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by. Date: ?/2--7/tel COSA to be releas' • o the gineer,unless otherwise requested by the engineer. COSA Fee $ 040 00 Waiver Fee $ Date of Payment 8/1.3,1/1q Date of Payment Receipt Number COt011e Receipt Number COSA# 05C-iN 4'24 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 CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 08/20/2018 •° 6. DSD SIGNATURE .... , `� �j �� MICHAEL N.•ANDLRSCN';;'r IJL System#1 Approved for 3 bedrooms. (� - cE g. v rte` �' System#2 Approved for bedrooms. • Disapproved. klii‘ vEss1�d Conditional approval for bedrooms, with the following stipulations: /• ,,vc. Zl�Y ~�G ON-SITE WATER AND 9 WASTEWATER r PROGRAM By: lti.- '�^�-� Original Certificate Date: S7-2,- The 2 —( 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_10-10-12.doc 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 3,LOT 1 Parcel ID: 015-221-17 A. WELL DATA Well type Private If A, B, or C provide PWSID #_ Well Log (Y/N) N Date completed UNKNOWN Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 263 ft. *EST. Cased to 40'+ ft. *(PER MOA DOCS) Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test -- 8/13/2018 Static water level •- ft. 211 ft. Well production •• g.p.m. 3.33 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 5.85 mg/L Arsenic: ND ug/L Date of sample: 6/11/2018 Collected by: MNA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP I STEEL Date installed 11/2/2013 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 9/19/2017 Pumper McDonalds C. ABSORPTION FIELD DATA Date installed 11/2/2013 Soil rating (g~p.djft2 or ft2/bdrm) 1.0 System type Deep Trench Length 54 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth 13.6 ft. Eff. absorption area 756 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/13/18 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 64 in. Water added 810 gal. New depth 80 in. Elapsed Time: 1390 min. Final fluid depth 62 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 11/2/2103 Size in gallons 2000 Manhole/Access (Y/N) Y _ "Pump on" level at 30 in. "Pump off' level at 24 in. High water alarm level at 36 in. Datum Bottom of Tank Cycles tested _ 2 _ Meets alarm&circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ 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 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 4'+(2013 WAIVER) Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS � ° OF AA G. ENGINEER'S CERTIFICATION „ k`p; y •' �(:14 i0 se I certify that 1 have determined through field inspections and , *; 49 T N SF • .�1 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. MIChiArl N. ANDERsciv Engineer's Printed Name MICHAEL N.ANDERSON,PErt✓J;••• CE- a6 • ��� Date 08120/18 ,���FD •' fq • vs'�.:•' COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ( • I 907-343-7904 On-Site Water and Wastewater Section "C 1.r Fax: 343-7997 www.muni.org/onsite �Fl� Nitrate Advisory Certificate of On-Site Systems Approval # OSC181424 Subdivision: Heritage Hills, Block:3, Lot: 1 A water sample revealed a nitrate concentration of 5.85 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen,which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE =s�� Phone: 907-3r'.� 7904 Development Services Department Fax: 907-34', 7904 97 On-Site Water & Wastewater Section Lift Station/Pump Vault Maintenance Log Street Address 12..3 6 Fr e � o ks8 Owner P1D _ _ Phone Legal Desc._ 52c is an .: •Sludge level kr inches Pumping: required yes -Pumping completed 6. .J. /a �eP �l7 t ift atatlOrl: -Pump basket cleaned 4:D.114 -Effluent filter cleaned &ILo 'Control floats cleaned .2t4 to -Proper float settings confirmed (SLC► -Operation satisfactory t_ c -Dedicated electrical alarm circuit ED no •Audible and visual alarm inside dwelling 4:11n4 •Alarm system operation a ' f- o. s-tsf rtPJ L Manhole Riser ��� -Ground water intrusion at riser to tank connection -Ground water intrusion around pipe penetrations es •Weep hole functional et, _.n •Manhole lid: Functional O.. Insulated no Properly Secured icafr!!2 01= •All manufacturer required inspections and maintenance completed Comments: Maintenance Provider: (,25 erft� /0_ Technician �-a.'c'r y Date of maintenance'�L. ' Company +'S Signature Date L.Y4ar G Mailing Address: P. 0. Box 196650 Anchorage, Alaska 99519-6650 " www.muni.org HI • Municipality of Anchorage On -Site Water and Wastewater Program �, v *AE (907) 343-7904 , „ CERTIFICATE OF -ON-SITE SYSTEMS APPROVAL 9 gip•' Parcel 1. D. 49 f S — Z 21 — I `. `,,. Expiration Date: I 1. GENERAL INFORMATION Complete legal description grst{ct9(:,J Luf Location (site address) ` `I f e4d.-J n kcl Current Property owner(s) 1,4 a uti DS w-4 [ Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ®- Single Family (w/wo ADU) ❑ Duplex €: f ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well [$ indivi(L gal tAhfor Zf,nno J� ❑ Community Class Well ❑ Public Water System ❑ Received by: 7` = L COSA to be released to the engineer, unless otherwise requested by TYPE OF WASTEWATER DISPOSAL: Individual rifiidin� TanK i Community ❑ Public Sewer ❑ Date: a 3 u1i COSA Fee $ b S + Z 0 Waiver Fee $ z 0 D + 120 Date of Payment Receipt Number �� f COSA# 05U31fo1 of Date of Payment 11/x,1 /13 Receipt Number iw d }g Waiver # OS p(3145D 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 /+vt l e-vr rr,4/ Phone Address 44 % 6 / l,f a i" n,h /� / n , k,./+ ki Engineer's Printed Name Wt, % " /-ALXi 1rrti,7 Date r l z1 6. DSD SIGNATURE System #1 Approved forL bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, 4s OW f a ®. a ,.Ro` r",-• �hoERscN ,'c •e r' with the following stipulation. By: AOriginal Certificate Date: Z `/ The Municipality of Anchors 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 e-1-12ADG If more than t septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: 9 y L �a mc� 01 ( t S V� "� W b- ( Parcel ID: 009- - 7-2 ( - / F A. WELL DATA Well type Pf'wa If A, B, or C provide PWSID # / Datecompleted Uv%6v.jn Sanitary seal (Y/N)_Y _ Total depth W-k0JV' Cased to L 0' ft 4- e e 7 tr'3 5e -cam �Avv�D w( �� FROM WELL LOG "t° Yt 0 Date of test Static water level ft. Well production g.p.m, Well Log (YIN) Lo Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION rr 4 /3 Z/r9 ft. Zt O t g.p.m. WATER SAMPLE RESULTS: Coliform --p—Lcolonies/100 mL Nitrate `6 mg/L Arsenic ug/L Date of sample: ` /O /3 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 9%-10 Tank size 2-n9o, gal. Number of Compartments 7 - Date installed ! 2 h 3 Cleanouts (Y/N) Foundation cleanout (Y/N) _� Depression over tank (Y/N) A( High water alarm (Y/N) Y Date of pumping 4 'ttn) Pumper C. ABSORPTION FIELD DATA Date installed Itz 3 Soil rating (g.p.d./ft2 or ft2/bdrm) System type 192r r71 rrh� Lj Length ft. Width 2,0 ft. Gravel below pipe -7 t Total depth dg! 1) ft. Eff. absorption area _Z1(o if Monitoring tube V Depression over field A Date of adequacy test ] J vv J Results (Pass/Fail) For S bedrooms Fluid depth in absorption field before test -� in. Water added-. i gal New depth --� in. Elapsed Time: min. Final fluid depth -min. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed II L Size in gallons `ZO n 0 Manhole/Access (Y/N) "Pump on" level at -3'0 in. "Pump off" level at -Lq in. High water alarm level at 3 to in. Datum (,�fl go v'I Cycles tested Z2 Meets alarm & circuit requirements? _ E. SEPARATION DISTANCES WELL ON LOT TO: r Septic tank/lift station on lot 100 f Absorption field on lot 1 U 0 t i Public sewer main N 2f Sewer /septic service line 5'Z> I �- Animal containment areas U9 e (f On adjacent lots t v D 1 On adjacent lots ty o 1 � Public sewer manhole/cleanout Holding tank k/ . Manure/animal excrete storage areas 11 a SEPTIC/HOLDING TANK ON LOT TO: Building foundation ID r Property line f Absorption field 4P Water main rL/ Lf, , Water service line 0 Surface water Wells on adjacent lots 119 0 14 - ABSORPTION FIELD ON LOT TO: Property line f 1 Building foundation /0 Water main 71/ Water Service line Surface water 100 t f— Driveway, parking/vehicle storage J 10 � f Curtain drain l at Wells on adjacent lots 1100'-F F. COMMENTS �.u� lnc�.w-�lweE� trrqu�a�rC�. @ F `� G. ENGINEER'S CERTIFICATION .r�Pg�, • , ... ° �q a j t certify that 1 have determined through field inspections and o '• .; • :�, )P+ review of Municipal records that the above systems are in i h: 49TH conformance with MOA COSA guidelines in effect on this date. % ° Engineer's Printed Name MI rAdr rer4 MICHAEL N. ANDERSON : O t 1 'j P s, 9 9 Date°• e COSA brown sheet_10-10-12.doc 2366 Lot 11 I Lot 2 Found rebar N89059'00"W 150.00 ate"rebar /-Chain link fence 30 -- � 10' Utility Easement_ Er cI 42.0 _ a. oo I LJ I M Well o� 2 Story Frame 1 1.0 OH \ v W Q Q j� House _ drivewayvel w 0 I LLI o I had �' � o Q 13. 7050 42.0 Porch --� CD O Septic Vents o LULU 0 Lot 12 O I 5 deck o Z Z I SepticVents , IL Set rebar I LOT 1 Septic Tank/ I 30 Septic Vent Wood fence O� N89059'00"W 130.00 I 0 o LO LO HUFFMAN ROAD _ 1 i 49th00 9 00 / j0A *.Fred Wal atka . i AW s� • 3255 - S ��tu%,� SCALE: 1"= 30' 11 \`s`74V� i -z 1`7 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. FB 13-9 pg12 FB 70-11, pg 2 BE RECERTIFIED 11-25-13,,y� 6"'K STAKED AND FLAGGED EAST PROPERTY LINE 9-18-13 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 1, BLOCK 3 HERITAGE HILLS SUBDIVISION Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 4th day of January ,2013 FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) 08/07/2013 00:40 907-345-0202 ALPINE DRILLING AARON PUMP & WER SERVICE, LLC P.O. Boz 110496 Anchorage, AK 99511 Office: (907) 946-9$55 • Fax (907) 345.0202 Eagle RNer: (907) 622-9335 CUSTOMER --I JOB SITE r C_ L. ty f mac✓ �L✓ „� I 7 L mac, -mss J L PAGE 01/01 oadoo�� , No. 9931 INVOICE RATE y/ WELL DEPTH ,,. / � 'SWL j � C 3 J CHLORINATED . � PUMP De SALESPERSON ;70-4. Nd-f"e hh 1 -r a xlrY DESCRIPTION,.' . ':.. , .:. :... '': PRICE;,'` .:;: d': -AMOUNT :..`.; r J 5 7600 / 13 �r �C -f Q�5EYi t 0 to LABOR MOU ATE AMOUNT TOTAL MATERIAL �t 09 TOTAL LABOR WORK.ORDERED BY DATE COMP, TOTAL LABOR 114; 5 PAYTHIS AMOUNT 7 'w Y Thank You SIGNATURE (I Hereby AckmrnMedga. Satisfado(Y OOMPletion of the Above Desoilbed Work and agree that If above Work is not paid for in 90 days I agree to allow Aaraw I. Pump & ell I L.L.. a HgM to remove unpaid for equiprnent and charge for labor already perfomned & labor to'remove unpold for equipment) t' TERM$: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOwINQ PURCHASE. SERVICE CHARGE AT RATE OF 1.9% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.