HomeMy WebLinkAboutHERITAGE PARK BLK 1 LT 21Onsite File
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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. 050-211-49
Legal description HERITAGE PARK BILK 1 LT 21
Site address 19705 CITATION RD
Current property owner(s) HOELDT JOSHUA N
Expiration Date: 10/27/2024
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: 4- w11 r ,V Oriainal Certificate Date- 10/27/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services 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 work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE K05"
I -A..e
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. 050-211-49
Complete legal description Heritage Park Block 1 Lot 21
Location (site address) 19705 Citation Road, Eagle River, AK 99577
Current property owner(s) Joshua Hoeldt Day phone (907) 854-5607
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 ❑I■ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: FE -1 Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: 9 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑■
Distance:
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 $ QSG 2 3 1 y z0 Waiver Fee $ _
Date of Payment /� �Z�/��7 Date of Payment
COSA 45130 Waiver #
COSA Application—June 2022
Heritage Park Block 1 Lot 21 050-211-49
Property is served by community well.
49"
10/16/23 JR's
6/22/18
9.5
5.4
N/A N/A
N/A
10/23/23
16
861
27
1440
12
>600
48
12
36
Benjamin Schiller, P.E.10/25/23
(907) 522-7773
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904Page
QCT,.
ON-SITE WASTEWATER INSPECTION REPORT .10,2,0
Permit Number: OSP181109 PID Number: 050-211-49
Dwelling: 0 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Joshua N. Hoeldt
ABSORPTION FIELD
❑ Deep Trench ❑9 Shallow Trench ❑ Bed ❑ Mound
Address
18827 Citation Rd. #A Eagle River, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907) 854-5607
7
4
1.2 GPD/SF
7.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
'4.0 Ft.
Subdivision Block Lot
Heritage Park 1 21
Fill added above original grade
2.1 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Fe
1
Ft.
Well
>1 00'
>100'
N/A
N/A
>25'
TANK [CSeptic I it S.T.E.P. El Holding [I Other
Manufacturer
Anchorage Tank
Capacity
11250 Gal.
Surface Water
>100'
>100'
N/A
N/A
MaterialNumber
of compartments
Lot Line
>10'
>10'
N/A
N/A
Steel
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Northern Excavation
Drainfield D3034 CO/MT
Inspector N. Schafer / J. Mlllette
BENCHMARK (Assumed elevation)100 ft
Inspection 1S` 6/20/18 6/21/18
ocation and description
da 2nd
3m 6/22/18 4h6/22/18
Bottom of siding @ point A.
I
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
•4 ll��
Date
i
*: 49 4 :*
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�� • : Benj• min Schiller
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Approved C � Date saIQ60
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Inspection Report_9-1-12.doc
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K.
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# 050-211-49
NEW 50' LONG x 5' WIDE`x 4'
EFFECTIVE TRENCH
o.oi 29. 76/. r EXISTING TRENCH
ALTERNATE SITE
,( f (LEFT IN PLACE QR
MSP FUTURE USE)
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LOT 20 11T.20
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WATER SERVICE LINEj(APPROX LOCATION)
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10' UTILITY�EASEMENT
ITATI N ROAD
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it, Oil flGE
�"�'"r�EHGItiEERiNG �_ _
or -k PLAN AS -BUILT
0 50 100
FEET = SLOPES > 25%
mm �mm SLOPES > 46%
1 "=50'
A B
FCO
23.8
20.8
SV1
18.8
30.6
SV2
24.1
34.0
2C0
25.8
35.2
DV
26.6
35.8
C01
16.5
40.9
MT1
17.3
39.9
CO2
64.6
74.4
MT2
65.6
75.4
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
HERITAGE PARK BLOCK 1 LOT 21
PERMIT # OSP181109
PID # 050-211-49
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97.6 FINISH GRADE
95.5 ORIGINAL GRADE Ov
lop
92.5
- 92.5
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88.5 - , 501 88.5
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ENGINEERING
5/22/18: GROUNDWATER @ 83.5
PROFILE AS -BUILT
(NO SCALE)
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`iIO��PROFESSIONP ,`
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`Municipality of Anchorage
.l th pn-nn nt
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 a Fax (907) 343-7997
http://www.muni.org/Onsite
Develogment. Services Del2aftment
On -Site Water and Wastewater Section
Waiver#: OSV181083 COSA#: Permit#:OSP181109
PID#: 050-211-49
Legal Description: Heritage Park Block 1 Lot 21
Engineer: Forge Engineerinq
Applicant: Joshua Hoeldt
Your request for a waiver of the required horizontal separation between two absorption fields has
been approved. The approved separation distance is 15.0 feet. See engineer's waiver request for
justification.
This waiver approval applies to the existing absorption fields only. Any fixture upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
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Waiver is Granted: X Waiver is not Granted:
Date: lid a0i_ Approved by: �QL o s a_u�
Name of Reviewer
A, ` �a i. 5
Ann
.p z
s A°{
'�G4#,"•.,"°' E N G I N E E R I N G
October 10, 2018
PO BOX 240773
ANCHORAGE. AK 99524
522-7773
677-7766 (FAX)
FORGECIVII.COM
MOA Development Services, On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Heritage Park, Block 1 Lot 21
Septic field separation waivers
Dear On -Site Services Engineer:
o`�
TH
B enj a krySc h i I I r ,
CE 12592
During the construction of the septic system at the above property, all effort was made to keep
required separation distances from the new trench to the alternate site, existing trench, and septic
tank. However, the combination of the small lot with the fixed location of the existing trench made
it extremely difficult to make the separations work, and the new trench ended up approximately
15.7' away from the existing trench. Because that trench has a 10' effective depth, there should be
a 20' separation.
The new trench has a 4' effective depth, with 7' total depth. The soils in the area were sandy silty
gravels, with percolation rates of under 5 min/in. Effluent from either trench would soak downward
faster than it would travel laterally. Even assuming a 2:1 lateral slope for an effluent influence line,
neither trench would influence the other.
There is no additional threat of contamination in any way. We request a waiver for the 15'
separation to the existing trench.
Sincerely,
Benjamin Schiller, PE
I
Lot 17 /
I
Lot 20 _„
WOODEN)
FENCE
10' UTILITY EASEMENT
— — .
NOTE: LOT IS SERVED BY A
COMMUNITY WATER SYSTEM
PLOT PLAN
Lot 16
S 89'55'53"E 100.00'
CHAIN–LINK FENCE
Lot 21
20,000 s.f.
in
M
SEPTIC
PIPES
STORAGE
28.0' wed b
44.2'
0
m 2 STORY m 0.9' CANT N
RES
wIDENCEE u
0.9' CANT -J0.9' CANT
4.0' DECK .u_P
CITATION ROAD
FENCE
Lot 22
11500 Daryl Avenue, Anc
Lang & Associates, in C. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors kenOlongsurvey.com
jonotha nOlongsu rvey.com
I hereby certify that I have surveyed the following described property:
LOT 21, BLOCK 1, HERITAGE PARK (PLAT No. 82-39)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
.= usr
easements on sold property exceptasIndicated hereon.
Dated this the �CF%�i' Day of cTo1?) at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
Alaska 99515-3049
. � F A. ��9`r�OV
�• ••� KENNETH�G.i L4NG\: •o
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-520. yJ�
440nR0 SSIONA1
AECC963
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700Elmore Road
Anchorage, Alaska 89o1 904 Fax: (9o7)3*3-7S8r
PermitNumbnr OGP181109
Work Type: Septic Upgrade
Tax Code Number: 05021149000
Site Legal Address: HERITAGE PARK BLK 1 L 21 G:0055
Site Mailing Address: 1S7O5CITATION RD, Eagle River
Owner HOELOTJOSHUA N
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
WOMEN '110
6/8/2018
6/8/2019
Z Disposal Field Z Septic Tank [lHolding Tank 17-71 Privy [] Private Well [] Water Storage
All construction shall beinaccordance 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 (1 8AAC72) and Drinking Water Regulations (1 8AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.O5.Provide notification bycalling (Q07)343 -70O4(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
o. Opened and Closed onthe same day, or
b. Covered, sealed, and heated hoprevent freezing
Received By:Date:
rd
EPLANS
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division QO Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 050-211-49
Property owner(s) Joshua N. Hoeldt Day phone 907-854-5607
Mailing address 18827 Citation Rd. #A, Eagle River, AK 99577
Site address 19705 Citation Rd.
Legal description (Sub'd., Block & Lot) Heritage Park Block 1 Lot 21
Legal description (Township, Range & Section)
Lot Size 1 20,000 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF) ❑X
Septic Tank
❑X
Upgrade ❑X
(w/wo ADU)
Holding Tank
ElRenewal
ElDuplex
(D) El
Privy
❑
Multiple Dwellings ❑
(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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5(0 17 Waiver Fees:
Date of Payment: Jr 1/ Date of Payment:
Receipt Number: Receipt Number:
Permit No. Waiver No.
Permit App_-'- ::'_. c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
May 23, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Heritage Park Block 1 Lot 21 – Citation Rd.
Septic system design and permit application
Dear On-Site Services Engineer:
The owner of the above lot has an existing septic trench that has failed. Additionally, he intends to
upgrade to a 4-bedroom home from his 3 -bedroom home. Therefore, we are submitting this permit
application for the construction of a new septic system. The attached site plan identifies the
location of the home as well as the existing septic location and the site of the new septic trench.
The ground surface on the lot is relatively flat, although there are some steeper slopes uphill in the
back. There are no slopes greater than 25% within 50 feet downslope of either the existing or new
septic site. Drainage arrows are shown on the site plan showing the grade and direction of flow.
Stormwater drainage will not impact this septic system. The new trench will be constructed parallel
to the slope as much as possible. There is no existing foundation cleanout, so a double cleanout
installed just before the tank.
The adjacent properties as well as the subject lot are all connected to public water. The new system
will be a minimum of 100’ from all surface water, and more than 5’ away from the septic tank.
The tank will be a minimum of 10’ away from the existing homes foundation and the new septic
site is located more than 20’ away from the existing trench.
Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
5/23/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181109, Rebecca Carroll, 06/08/18
x x x x x
// // // //75
0
.0
750
.
0
75 4.0
756.0
758.0
750.0752.0
752
.
0
0.0%
1.4%
1
3
.
0%
1.9
%
29.7%
2CO
10050 0
FEET
1"=50'
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL SURROUNDING LOTS ARE ON PUBLIC WATER. THERE ARE NO
CONFLICTS WITH WELLS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
CO
MT
CITATION ROAD
HERITAGE PARK B1 L21 - 19705 CITATION RD
Jun 08, 2018
SLOPES > 25%
SLOPES > 46%
10' UTILITY EASEMENT
INSTALL DIVERTER VALVE FOR
FUTURE USE OF EXISTING TRENCH
INSTALL NEW 50' LONG x 5'
WIDE x 4' EFFECTIVE TRENCH
REMOVE EXISTING 1000
GALLON SEPTIC TANK AND
INSTALL NEW 1250 GALLON
TANK
3 BEDROOM
HOME
EXISTING 19' x 2.4'
WIDE x 10' EFFECTIVE
TRENCH
(LEAVE IN PLACE FOR
FUTURE USE)
20.0
TH1
PERC2
CO
2CO
SV
SV
ALTERNATE SITE
WATER SERVICE LINE (APPROX LOCATION)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181109, Rebecca Carroll, 06/08/18
HERITAGE PARK BLOCK 1 LOT 21
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 2.2 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE SHALLOW TRENCH SYSTEM
1250-GAL SEPTIC TANK
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC
(HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
2'-6"
4'
May 23, 2018
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 7' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 6'' ABOVE GRADE
600 GPD / 1.2 GPD/SF / 5 WIDE X 0.5 REDUCTION = 50 LF TRENCH REQUIRED (50 LF SPECIFIED)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181109, Rebecca Carroll, 06/08/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TH #1 / PERC #1
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
HERITAGE PARK B1 L21
5/10/18
J. Millette
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
YES
12'
1.8 6
4 5
050-211-49
JOSH HOELDT
Professional Engineers Stamp:
Jun 08, 2018
5/12
1
2
3
4
5
6
10 5 - 10 4
16 5 4
1613:56/14:06
1' OB
SANDY SILTY GRAVEL (SM/GM)
PERKED IN SILTY SANDY GRAVEL
10 5 - 10 6
16 5 6
1613:45/13:55
10 5 - 10 6
16 5 6
1614:07/14:17
10 5 - 10 7
16 5 7
1614:18/14:28
10 5 - 10 8
16 5 8
1614:29/14:39
10 5 - 10 7
16 5 7
1614:40/14:50
12'
5/22/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181109, Rebecca Carroll, 06/08/18
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TH #1 / PERC #2
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
HERITAGE PARK B1 L21
5/10/18
J. Williams
Development Services Department
4700 Elmore Road Anchorage, AK 99519-6650
Municipality of Anchorage
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
NO
-
-
2.2 6
3.5 4.5
050-211-49
JOSH HOELDT
Professional Engineers Stamp:
May 23, 2018
5/12
1
2
3
4
5
6
10 5 - 9 13
1614:10/14:20
-
PERKED IN SILTY SANDY GRAVEL
10 5 - 9 14
1613:59/14:09
10 5 - 9 12
1614:21/14:31
10 5 - 9 10
1614:32/14:42
10 5 - 9 10
1614:43/14:53
10 5 - 9 10
16 4 10
1614:54/15:04
4 10
16
4 10
16
4 12
16
4 13
16
4 14
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181109, Rebecca Carroll, 06/08/18
Lot 17 Lot 16
I
S 89'55'53"E 100.00'
CHAIN–LINK FENCE)
Lot 21
20,000 s.f.
b,
ri
SEPTIC
PIPES
of 0.9' Ci
Lot 20 _,,c'41 2.8'X4.2'
w1l STORAGE
b l m 2 STORY m
0 w RESIDENCE u
Z 12.3 20.7' 27.7'
0 0
0
0.9' CANT 1.2
WOODEN 0.9' CANT
FENCE
4.0' DECK r
10' UTILITY EASEMENT
NOTE: LOT IS SERVED BY A
COMMUNITY WATER SYSTEM
00
06
v
N 89'55'53"W 100.00'
i —
CITATION ROAD
I
I
1 Lot 15
1
1
ED
FENCE
Lot 22
0
b
0
A
PLOT PLAN AS BUILT _1L SCALE –!L= GRID NW 0055 Project No. 18-177/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 000O�O��
(907) 522-4625 Fax o0 0 F A p04
Professional Land Surveyors kenOlangsurvey.com
jonathanOlongsurvey.com
I hereby certify that I have surveyed the following described property:
LOT 21, BLOCK 1, HERITAGE PARK (PLAT No. 82-39) o * 491H OQ
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed 0'A I(ENNETFi .LAN
premises and that there are no roadways, transmission lines or other visible QO c+ Q
easements on said properly except as indicated hereon. Q' S `b118 O
–5202.•' y�p�
Dated this the 1 oN> Day of I�.U`-d k� I ' , at Anchorage, Alaska Q o NOo
4OQRO�SSIONAL �o
It Is the responsibility of the owner to determine the existence of any easements, DOOpO000
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
~._~ MUNICIPALITY OF ANCHORAGE ~_~/
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
Abso~on~area
Inside length
Mate~/~4~
inches
Material
Nearestlotline
Trench width
DISTANCE TO: Well ~/~
Manu facturer~
ILiq capacity in gallons E E
'//~'O IF HOM MAD :
Manufacturer
J Well
DISTANCE TO: I
No of lines Length of each Hne
Top of tile to finish grade
~gth Width
~ -- Crib diamete~
~CI~ Dopth
~ TO: Buildin~ foundation
Dwelling
inches
Foundation
Total length of lines
Material beneath tile
Depth
NO. OF BEDROOMS
PERMIT NO.
No. of c~_artments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
~ ~o/~
Total effective absorption area
PERMIT NO.
Crib depth
Building foundation
Driller
Sewer line
Total effective absorption area
Nearest lot line
Distance to lot line
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTAILLER
REMARKS
.~-/d~ .~
PERMIT NO.
Absorpt on area(s)
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
F'ERH]:T No:
r:,S:TE :[:_~JE[:,'
FiF:'F'L IL:FiI',IT:
F~[:,C,F~:E~S:
C ]i'-,ITFiC:"r' F'HONE: '
:1.
[.':,E',/0 N
44::L:1 OLD SEI.,!F-IR[:,
F-INCHOI:;.:F~GE., F!K
56:J:..'.:1..982
LEGFIL. DESI]:R.T.!::': SLIB[.',Z',,,'ISION: ~I--IEt:~'.ITFtGE F'FIRK LOT: 221.
SECT l Oi',t: 7 TOP.!NSH I F': ::L4. t'.,i RFINGE: ::Lb]
LOT S l ZE: 206)I:i'il}.'I ,:1661. F'T. OR .FIE:F.':ES 1:,
HRX BEC6tOOH.S :' 3
?TEE:, E:E[..C$.I F:If;i:E 'T'HE : F:'T ]' ':' t'-l':~, I:I',,,'Fi ! LFIEd_E TO 'T'OU ]1H DES I Gi{i l Nl!i '.fOl..IF.: 'SEPT ii "'
FEll. E:HOOS';E THE F~F:"TION 'THFIT E:ES'T FITS '.?]1 llq' ':-:T"t'E.
DEPTH TO F'IPE E:OTTCiH ,::FT..':, 4. E1 4. 0 4. 0
C:iF.:Ff,,,'EL DEF'T'H ,:iF']". ::, ::LE.~. E~ C"L 5 '% .".5
TOTRL DEPTH ,::FT. ::, i4. E:~ 4. 5 7. 5
GRF:I',,,'EL I,.IiD'TH ,::FT..':, ;2. 5 :L'?. 6 5. 0
C. iRRVEL LE]',IGTH ,::I-:'T..':,
GRF!VEL. ',/OL. LIME (C::IJ: '.r'l:.':,!FJ. ::, :18. 4 2:1.. 4 3E'L 3
TI:INK
SOIL F.:RTIi',IE.i ,:it.SC:!. FT. ,."SR) ±;;:.:5 :11.25 %25
:+::+: "I-RI'-,!t.i:: MUS]' HI::I',/E t:::IT LEFIST TH:': C:OHF't::IRTMEI'.~,TS
! CERT I F'"r' THI::IT:
:1...I Fff"l F'FIMIL. IFIF.: HITH 'T'HE F.:IEQUII:Zi:EMEI"4TS FOF.': ON-SITE '.SEHEF.:L:"; FIND t.,.!EL.LS FIS SET
FOF;:TH EF,.' THE H IN TF:IF'FIL I"i"¢ OF FINCHORFIGE ,::MOFI) FIND THE :,] H F_ OF F~L.F~'E, KFI.
~:'-' ....... T HZ!...L. It',t::i',TF:II...L ]"HE :.'.~.:,TE.tt IN Fu"':-F~F}E:,Fd',!CE P.IZTH F:IL.L HOFt CODES F!HE:, t:::'.EGULFIT~'ON:S.,
FI.kID 'rl,.,f C:OHF'LIFtNCE HiTH THE [:,ESiGN ...... , c
....... 1, I IEI-.I,t OF THIL:;., F'ERM]iT.
~s. I HILl.~. t:::I[:,HEI:~:E TO FILl.... I"t"_'t¢:1 RN[:, .STF!TF' 01:: FILFISKFf .F.'E}. '!REHENTS FOF-'. TFIE .:,ET E',FIC:K
DZSTFINCES FF.'FM F:tN'¢ EHISTING I.,.!ELI ..... HF.!STEHFFI"ER C, ISF'OSI::tL S'¢"_:;TEH CIR I::'LII:'~LIC:
SEklERFIGE S'¢STEH ON THIS OR F:IF,!'.¢ RIX:,JF!E:ENT 'iD NEFRB"r' L, OT.
· 4... I UNf.::,ERSTFII',!IX:' THFIT ]"HIS !::'Ef';~:HIT 'IS; ',/F~L. ID F":d';' FI HF~HIHL.IH QF 3 EEE,F.'CCMS FIND
FIhi"r' E]'-,tLFIF::C~Ei"1EhFF H ! L L F'E i..U_ t F.'.E I::¢-I F!i:::,E:, i T i ES.IFIL PEFd"I ! T.
IF Fi L. tF'T ?,TI:::FFION tS iNS]TiLl_El:, ii",i R.['.,I FIREF! i-',,,'EF'E[:, E:'¢ I'"tlF~ BLIIL[:,ING 30C, E'S,,
THE:hi ,'i) i::tt",I EI....E:CTF~:tCF:IL F'I:~:RMIT t!:ti'.,l[:, INSPE:F:"FION MUST E:E OES"FliNE[:,.~ ,::2.:, I-_, E, UILT_,
P.iIL.L NOT BE FiF:'F'RCWEI} H)'.]"H(:)U-F FiN ELECTRZCIrq.... INS;F'EETiOi'.4 F..:EF'Cd:;~:'T'.; RN[:, (3) THE":
'- ....... , ....... ' FqZl]"E: .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
LEGAL DESCRIPTI01~h ~..O I '- 4_,
3
4
5
6
7
8
9
10
11
12
13
14
15-
16-
17
18
19
2O
WAS GROUND WATER ~r'-".¢~; Sk
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
:~'~.~D E PTH ?
SLOPE
; Re d~ Date Gross Net Depth to Net
.~fl - _ Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
t t TEST RUN BETWEEN FT AND FT¢.
72-00B (6/79)
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTHCENTRAL REGIONAL OFFICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
/
/
t
t'
BILL SHEFFIELD, GOVERNOR
Telephone: [907)
Address:
274-2533
To Whom It May Concern:
According to records on-file in this office the ~-~x
.Water System is in compliance with'~he
Water Regulations.
Sincerely,
State Drinking
MUNICIPALITY OF ANCHOII%GE
DMSION OF ENVIROP~ENTAL HEALTH
DEPAIVi~MENT OF HEALTH AND ENVII%ONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY Ai~PROVAL CERTIFICATE
1. General Info~l~mtion
Application Date
(a) I~gal Description (include lot~ block, subdivision, sectiont tu~nship, range)
(b)
Location (a~ldress or directions
Applicants Nawe ~C2~ ~%
Telephone ~ % - t 6{~ ~_
(c)
Applicants Address ~ ~-~ ~ ~D~J/~ [~':'J'-(, ~xtC/~o~/[]~, ~%(-- qC~D~.
Applicant is (check one) Lending Institutioh ~-~; C~ner/builder ~;
Buyer ~ ; Other ~_j (explain);
(d) Lending Institution
Te le phone
Address
(e) Rmal Estate Co. & Agent
Address
Te le phone
2. [[~ of ~sidence
Single-Family ~
Number of Bedrooms
3. Water Supply_
Multi-Family~
Other (describe)
Individual V~%ll ~ Con, unity ~ Public ~
Note: If cu~.~nity v~ll system, must haw written confirmation from the State
Depa~tn~nt of Environmental Conservation attestinw to the legality and status.
Is the v~ll adequate fo~ the number of bedrooms specified in this HAA (Y/N)'~)
4o Sewage Disposal
Onsite ~, tk,blic ~ Community ~ Holding Tank ~
Is the wastewater disposal system adequate fc~' the number of bectro~ns (Y/N)
[Pa~e 1 of 2]
2-15-84
5 o E_n_qineerinq. FiNn Providin I_~tions, Tests, Data and Information
oe~tif~__th~ I have~, verified, or conformed to all MOA HAA Guidelirms in
~ffe~t Eon the )date o~ ~his~fnspectiono
Address f~G1 ~~' F"'%~C. _~[. q~7...
Date ~- %~--.-- 8t~
(ENGINEER SEAL)
6o DHE? Approval
Approved for ~ beck'ocms
Approved ~ Disapproved ~
Terms of Conditional Approval
Conditionally.
The Municipality of Anchorage Depa~tn~nt of Health and Envirom~ntal Protection do~s
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal s~.stemo This approval indicates that, as of the validation date
shown above, based on the data and inf~tion furnished by an ec~ineer registered in
the State of Alaska, the water supply and v~stewater disposal system is safe and fun~
tional for the number of bedrooms and type of structure indicated.
( DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Pa~e 2 of 2]
2-15-84
ae
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log P~esent (Y/N)
Total Depth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f=om Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field'~on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Wate~ Sample Collected By
Water Sample Test Results
B. SEPTIC/HOLDING TANK DATA
L~e~g~al Description: ~.cD-~-~, ~tz~-V-
If A, B, = C, proved(Y/N)
Date C~L-~lete d Yield
Depth of G~outing
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewe= Service Line on Lot
; Date
~OllD]lO~d qVlN]WNOW^NJ
· HI]V]H JO '±did
Date Installed ~f%~c~r Size %i~DO ~ ,, NO. O~~dlDINn~
Standpi~s (Y~) ~ Air-tight Caps (Y~) ~ Foundation Cleanout (Y~)~
~pression o~= Ta~ (Y~') ~ ~te ~st P~d ~ ~%~
P~ing~intenan~ ~n~a~ ~ File (Y~) ~ ; for
Holding Ta~ High-Wate~ Ala~ (Y~) ~ra~ Holdi~ Tank ~r~t (Y~)
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Water-Supply ~11 ~ ~ ~ To ~ilding F~ndation ~. ~;
To ~o~rty Li~ ~' To Dis~sal Field ~'
To ~ter-Main/Se=vi~ Li~ ~%~' To S~e~, Pond, ~e, ~ ~jor ~aina~
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata %~ ~c ~=Oe~0~ Type of System Design ~-~%
Date Installed % / ~[~5~ Length of Field ~q '
Width of Field ~.q~ ~"~ ~p~ of Field %~/ C~
Gravel ~d ~ick~ss ~ O ~
S~e Feet of ~so~ption ~ea ~ ~-- Stan~i~s ~esent (Y~) ~
~p~ession ove~ Field (Y~) ~ ~te of ~st A~a~ ~st ~-~k~ ~5~
Results of ~st Ade~a~ ~st ~ ~ ~
~p~ation Distan~ f~ ~so~ption Field:
To ~te~-Supply ~11 ~ ~ ~ To ~o~ty Li~ ~;
To Building Foundation ~,~ ~ To Existing or ~ndo~d System ~
Lot '~ (~ ; ~ ~joining ~ts ~ ~'
To Wate~ Main/~vi~ Line ~ %~ ' To ~tba~(if p~e~nt) ~o~ ~~
To St~e~ond~ke/o~ Majo~ ~ainage C~se ~o~ ~....%~. ~; ~.%~ '
To ~iveway, Pa~ki~ ~ea, ~ Vehicle Sto~a~ ~ea ~ ~O~ ~ ~%~h
C~nts ~ ~~ ~ ~ ~ ~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Dimmnsions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
ConTaents
** Check Permitted Bedroom Rating A~ainst HAA l~equest **
on t~?at_~e ~j~ th~j~cti,. ~
KB1/d5/s
[Pa~ 2 of 2] ~ ..... ,
2-15-84
