HomeMy WebLinkAboutLILAC PARK BLK 2 LT 4
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP251186 PID Number: 015-211-28
Dwelling: Z Single Family (SF) n with ADU El Duplex (D) n Two Single Family Project: n New E Upgrade
Name
PEDRO & CATHY VALDES
ABSORPTION FIELD - EXISTING
Z Deep Trench El Wide Trench [:1 Bed El Mound
Site Address
12210 LILAC CIRCLE, ANCHORAGE
E] Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
1 6
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
LILAC PARK 2 4
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
ToSeptic Absorption Holding Sewer
Lift Station
Total absorption area
Number of trenches
Dist. between trenches
From Tank Field Tank Line
Ft'
Ft.
Well100'+ 25'+
TANK 0 Septic El S-T.E.P. El Holding [I Other
Manufacturer
ANCHORAGE TANK
Capacity
2500 Gal.
Surface Water 100'+'
Material
EPDXY STEEL
Number of compartments
2
Lot Line 10'+-- NA
Foundation 10+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks Tank with 2 Manholes.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 drainfield Tank to 3_034
Installer PCN
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspectes:tion 1s' 7/16125 nd 7/17/2025
Location and description
da2
3`d 4'"
ITOP OF 1ST MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
sr!�
- 4 -;P"- N
Conditional Approval: Date
J0 . .........
Septic Systery,
Approved-,
Curtis Huffman
�06 CE 128991
Date
02/26/26 -
Note:
.
'Aw
this approval does not include well permit requirements.
(Rev 05/02/18)
23.
9
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11
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5
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17
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FIRST WATER CONSULTING
PID:015-211-28 PERMIT: OSP251186
LILAC PARK BLK 2 LT 4
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: OSP251186
Work Type: SepticTank Upgrade
Tax Code Number: 01521128000
Site Legal Address: LILAC PARK BLK 2 LT 4 G:2736
Site Mailing Address: 12210 LILAC CIR, Anchorage
Owner: VALDES PEDRO J & CATHY S
Design Engineer: FIRST WATER CONSULTING
This permit is for the construction of:
❑ Disposal Field R1 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
Ueparnnc�nt
6/17/2025
6/17/2026
63876
❑ 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
Received I
Issued By:
Date: 6/17/2025
Date: 6/17/2025
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-211-28
�
PEDRO & CATHY VALDES
Property owners) Day phone
Mailing address 12210 LILAC CIRCLE, ANCHORAGE, AK 99516
Site address 12210 LILAC CIRCLE, ANCHORAGE, AK 99516
Legal description LILAC PARK 132 L4
Number of Bedrooms 6
Engineering Firm FIRST WATER CONSULTING
Building Permit Number Not Applicable J01
APPLICATION IS FOR: APPLICATION IS AN:
(Z all that apply)
Absorption Field r_1 Initial El
Septic Tank Upgrade FX1
Holding Tank ❑ Renewal F-1
Privy 0
Well 0
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
Permit/Rush Fees: 00, gloo Waiver Fees:
Date of Payment: (t /to /2 S— Date of Payment:
Permit No. OS P a S-1 is -u Waiver No.
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / FirstWaterAK@gmail.com
!
!!
June 10, 2025
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: LILAC PARK BLOCK 2, LOT 4
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 2,500-gallon epoxy steel septic tank
per the attached design to serve the existing 6-bedroom residence.
Groundwater was not noted in the MOA on-site file and is not anticipated to affect the septic
tank installation. If groundwater is encountered during installation that may affect this septic tank
upgrade, an epoxy coated steel septic tank or other action may be required.
An existing deck greater than 30” high (2-story deck) is partially over the tank & is also partially
covered with concrete. Any deck supports within 5’ of the tank must be installed or driven to the
bottom depth of the tank elevation.
The lot and area are served by private water and any encroaching wells, easements, … must be
staked prior to construction. The design will not impact any of the neighboring properties.
Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251186, Ben Cogger, 06/17/25
23.9'
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29.
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17
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1.5'
13.6'
9.4'
20
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55.6'
4.
0'
16.0'
30
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2.7'
19.
8
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6 B
ED
FIRST WATER CONSULTING
NO WELLS WITHIN
100' OF PROPOSED
SEPTIC TANK.
LILAC PARK BLK 2 LT 4
DESIGN DETAILS:
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP251186, Ben Cogger, 06/17/25
) 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 I~.. ,~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION N~OF BEDROOMS
Well Absorption area Dwelling PERMIT NO.
~ ,-~ Manufacturer C)/e ~=e--/~ - MS,~,/ No. of com~ments
Liq~al~acity in gallons Inside length Width Liquid depth
~ ~ IF HOMEMADE:
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
Length~f eag),jIbe $' ~ Total iges Trench.~i~tb¢ Distance between lines
~1'; Top of tile to finish grade ~ ~ Material beneath tile /~ inches Total effective~¢/absorption~ area
Length Width Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
~ Buildin f ~ ation Sew~ / Septic ta ~ ' Absorption area(s)
OTHER
PIPE MATERIALS
J
REMARKS ~ ~ /
72-013 (Rev. 3~78)
rV~-W DRILLING, Inc.
P.O, Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
Well Owner
Location
DRILLING LOG
fi~ ~i ',Vi'~ ~: 'v','l 'N ~ '[ ;'-'ii 'r &~ j
· ' ' Use of Well
address of: Township, Range, Section, if known; or distance main road
Size of casing · Depth of Hole
Static water level .. 2., ft.
Screen ( ); Perforated (
I, ,, feet Cased to 16 I feet
(below) land surface. Finish of well (check one) open end (
).
Describe screen or perforation
Well pumping test at "(] gallons per ~I~b~Qi
of drawdown from static level.
Date of completion ('~a~'~:~ber 3, ]
(minute) for 1 hours with
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
?;J, lt.'/
0 .TO.
2 .TO
26 .TO.
x.~ _TO.
.50 .TO.
6:; _TO.
911..TO.
i31 .TO.
] 55 .TO.
.TO·
__.TO.
.TO.
__.TO.
__.TO.
26
35
50
91!.
131
16!
Silty
~.? J':e'.U] ),~,(i~3:[ !.¥:' .('r;
3--CONTRACTOR
]O/"c
L. EYI' S) l ZE: ~
!!!i!..IB:(:) IV I !3:1: OIq: I..~ I I_AC PARK
SE[CT I (:)FI: 2~":] 'T'[:)l...'aq~3H :[ F':
(!3[;!. 1:::'1". []1::~ ~:~[:ff:;:llii:!~ )
Fc~r"M"l i::~y i'..he I"h..u"l:i.c::i. pal:i.'Ly c:~F (.~r'l(::l"lor~agi~:? (I"I[:)F%) and l'..hc.]
and :i.n c:c~mp]. :i. anc:(s) v~J.i'..h i:.he) c:lex~:i.c~r'l [::p j.'l:.~.)r :La c)F 'Lb :[% pcer'm:i.i:.,,
:::.~,, Z ~]J.].]. adl"~ere 'La a:l.]. MC]h and S'La'Le (::~' ~:La~[~l.::a r'eqL.t:i.P(eme-u'q'L?~ f(:n~ 'Lh(.:g s~(z-)'L [:)ac:l<
c:J :i:E[~t. atl'l(:::(.~% f' r'c)m any e)x J. sst:. ~.rig ~.:.)]. ]., ~a~s'Le~,.,Ja't. car' d :i. spc)~;a]. %ys~i:.~.)m (:~r' pub ]. :i.c:
q-,, [ L.Lf'ldl:.)r's~'['..arld /ha't. i'.lq:i.~T, pe~r'm~'L :i.~ va].:i.d for a max:J, mum c:)[ ~) J:t~.~,dr'cx:)nn~ and
any (~-wi].ar'g(~un¢.)nt. v~:i.:l.], f'C.:H:]LIJ, r'(:~ arl adct:i.'LJ.c~r'laZ
N]:I...L.. lq[Tl" I.:':~l[~ ~:q::'I~C:)VE~]) N]'T'~ ]L .... ~x '~: ~Cff'l:~IC:~l.. :[IxlS~F'E:CTZ[)~I F~F~'I:::'C)FUF[ F.~IqD Cq) Tr..IE~
"' ['"'~T~ .... ~ N ..... ', c" ~ ..... x- ~ ........ ' ..................... " ' .... ' ....
:::.-. :::.- ' .......... :"~ . ~: I I:.t::., I)[.)l tE: :E.Y ~ L...[[.,I::.IxL::~I:::D E:.L.I::.L, t IX.I.L.:.I.j..~Ixl,
Permit
'~NICIPALITY OF ANCHORAGE
Department ~ Health and Environmental . otection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
Applicant: ~._~7~
Location: /~9~- _~ ~. ~ ~//~.~_//~,~ PhotO. er: ~'~ Z ~ ~/Z
Legal Description: ~ ~''f~~'x ~ '~ d~ ~ Lot Size: ~ ,~ ~/
Type of Soil Absorption System Is: ~ . k,,
Trench: ~ Drainfield: Seepag~ Bed. ~ Holding Tank'
Maximum Number of Bedrooms: ~ ~ S~}~,,,~a~n~(~.~fDr) /~
depth of a krench er p~ is~Sho dS~ance~okwoen ~ho ~ur~ace o~ ~ho ~rCun~ and
· he ~rave~ depth ~s ~he m~nS~[fim d~h ~f ~r~el between ~ho ~u~fail p~pe and
· * REQUIRED SEPTIC(HOLD~N~ T~N'< SIZE = I~7~0 GALLONS'~*
P~rm~ ~=~nt h~ t~po=~N=~tyk~o =n~o=m ~h~ a~r~m~=~ ~u=~n~ th~
instal, la,ion inspections of~ny we~s ad[acen~ to this ~roperty and [he numbe~
we .=l N
· *.* TWO(~) INSPEC~NS ARE REQUIRED * * *
Backfilling o% any system w~th[ut fina]_ inspecCion and approval by this departmen(
~in~mum d~sCan~e between a woll {nd any on-s~e sewage dSsposal sysCem ~ 100 foet
~r a pr~vako w~ll or 150 ~o 200 ~ee¢ from a pubiic well depend~n~ upCn Che ~TPe
of public wel~. ~ Minimum ~istanc~ from a private well to a private sewer line
is 25 feet and t~ a co~un~ty sewe~ line is 75 feet. Well logs are required
and must be retu[~ed to this d~ar%ment within 30 days of the well completion.
Other require~entskmay apply. Spe~J. fications and construction diagrams are
available to ~s~e~prop~ instail~tion.
_ * D C MB R 1 9 * *
I certify tha~: ._ . ~ . ~ / =
(1 I am familia~~e requirements for on-oite sewers and wells as
set forth by the Municipality of Anchorage.
(2I will install the system in accordance with codes.
(3I understand that the on-site sewer system may ~equire en~ement if
ce is remodeled to include more ~3 bed[oo~ ~
t t~ re side~ _~ Issued y ~~~~/~
Si~ne~:
Appl~cank
Date: _ ~/¢/~
SWP/024(1/81) ./) _ /
WELl_ AND/~II ON-SITE SEWER PERMIT
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
PERCOLATION
TEST
LEGAL DESCRIPTION: ~ q
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER ~
ENCOUNTERED? /~.)O,
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
0o¢¢ o o ~" -
o~.~ ~ 'z~ 0 ~/" '-
" 'z. ~ 6 ~/~ o ~ ff.~,~ 5" I"
" ~30,~ o~ ~f,~ ~" 1"
FT AND
(minutes/inch)
~ ET
72-008 (6/79)
4
5
6
7
s
& ENGINEERS, INC.
s
7125 OLD SEW/~RD HIGHWAY
ANCItORA6£, ALASKA 99502
SOIL LOG
PERCOLATION TEST
'~¢ SOIl. LOG
b-// PERCOLATION
~ ES7
(907) 349.6561
JoB NU,~BER:_
PER'PORMED FOR: ~___ Z ................. TE PERFORMED:
11-
12-
SLOPE SITE PLAN
Gross Net Depth to , Net
Reading Date Time Time Water 'Drop
f
15--
16--
17--
18--
19--
20--
16,a,o~ Sq.
PERFORMED BY /{×J ~,/'~,4~/'/~//~, '~'~-~/,,~. GERTIFIED BY ......... DATE:
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
OSC261048
Parcel ID 015 -211-28
Legal description LILAC PARK BLK 2 LT 4
Expiration Date: 6/3/2027
Site address 12210 LILAC CIR
Current property owner(s) VALDES PEDRO J & CATHY S
X The On-site system(s) is/are approved for 6 bedrooms
By:
This
systems) 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.
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
MUNICIPALITY OF ANCHORAGE
4.
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.015-211-28
Complete legal description LILAC PARK BLOCK 2 LOT 4
Location (site address)
12210 LILAC CIRCLE ANCHORAGE, ALASKA 99516
Current property owner(s) VALDES PEDRO & CATHY
2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: RN Private Well serving # 1 dwelling units
R Other Non-public well as regulated by MOA El Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic Fj Private Septic serving 2 dwelling units
F Holding Tank F Community Septic or Public Sewer
5. SEPTIC TANK: FE -1 Steel R Plastic ❑ Concrete Fj Fiberglass
Age NE _See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑AWWTS FjBed FE�Deep Trench [:] Wide Trench RSeepage Pit
Waiver request for: Distance:
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.
t
COSA Fee
Date of Payment
COSA # ®-S(
Waiver Fee $
Date of Payment
Waiver #
COSA Appfication—Apr2025.doc
COSA Checklist_May2025 copy 2.docx
COSA Checklist
Legal Description: LILAC PARK BLOCK 2 LOT 4 Parcel ID: 015-211-28
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 10/3/1984 Total depth 161 ft
Cased to 161 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 17 in.
Date of flow test for COSA 6/3/2025
Static water level at beginning of test 109 ft.
Well production at time of test 4+ gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 2.90 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 6/3/2025
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW TANK
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. DISPOSAL FIELD DATA
Which system tested (date installed) 10/18/1984
ALL standpipes present per record drawing
Total measured depth from grade 13.7 ft (max)
Measured depth to pipe invert from grade 3.3 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective (ED).
If not, state depth into effective 10.5
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 6/3/2025
Results Pass
Fluid depth prior to test 21 in
Water added 900 gal
New fluid depth 27 in
Elapsed time 1440 min
Final fluid depth 19 in
Absorption rate 900 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 144 in (MOA 12’ ED)
Effective depth used 37 in (Missing ED + Final Fluid Depth)
Effective depth (ED) remaining 107 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximately 1.5’ (18”) of ED is missing – not measurable.
COSA Checklist_May2025 copy 2.docx
E. SEPARATION DISTANCES
From Well on Lot to: (Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Disposal Field on Lot > 100’ Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required)
Tank to Foundation > 10’ Yes if No ft
Field to Foundation > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main/Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 03/03/2026
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
03/03/26
23.9'
11.
4
'
29.5'
17.4'
1.5'
13.6'9.4'
20.6'
55.6'
4.0'
16.0'
30.2'
2.7'
19.8'
8.1'
3
6.5'
2 6.8'
5
8
.
1'
R/O
R
/
O
R/O
R /O
CANT.
RESIDENCE
G
A
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E
TW
O
S
T
O
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Y
LEGEND
UTILITY PEDESTAL
DECK
CONCRETE
FENCE
PADMOUNTED TRANSFORMER
EDGE OF ASPHALT
RECORD DATA PER PLAT #83-484
SEPTIC PIPE
WELL
ROOF OVERHANG
CANTILEVER
R/O
CANT.
SEPTIC TANK LID
TIMBERLINE SURVEYING AND MAPPING
17035 BARONOFF AVE
EAGLE RIVER, AK 99577
907-242-5320
ryan@timberlinealaska.com
FILE NO.: 25.136
SCALE: 1" = 40 FEET
DATE: 7/22/2025
SHEET: 1 of 1
MOA GRID: SW2736
SCALE: 1" = 40 FEET(11"x17")
40'0' 80'
AS-BUILT OF:
ADDRESS: 12210 LILAC CIR, ANCHORAGE, AK
LOCATED IN: ANCHORAGE RECORDING DISTRICT
LOT 4, BLOCK 2LILAC PARK SUBDIVISIONPLAT #83-484
(
MUNICIPALITY OF ANCHORAGE . ..
DEPARTMENT OF HEALTH &~ HUMAN SERVICES_
Division of Environmental Services
............ On-Site Services Section
P.O, Box 196650 Anchorage, Alaska 99519..6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# /"1 ~,- ~1-r'3~ HAA# t~ ~,<:~t'~ ~--~
1. GENERAL INFORMATION
Complete legal description ' ~t B 2, Lilac p~k S~.vision
"LocatiOn (si;~e address or directions) 12210 Lilac Circle Off Huffman Road
· '' ' ': :-:,--,,'prOpe~y-'"OWner ~Le~n&- Canqe : rh~v 229:-5636
...: ., . . : -_. phone
Mailingaddross~ - -
Day phone
-- .'- -':" ,,,'%-. dd ess~--" -'--- · ............
. ""~=;ff: ",2,' ?tNUMBER OF BEDROOMS:· ;...
~" 3, ~PE OF WATER SUPPLY: ' ~
Individual well X
. . Community well
' , . . Public water -
. '.. '.:~,.,:': .'.,.: ..,,.:. ~; '. ~.. · -,.,..::: _ ---_~-' ~- . . :.~ ·
." : ';" NOTE: ;If Community Well system, provide wri~en confirmation-fro
~ng to the legali~ and Status of system :
-.., .... · .....
4. :'TYPE OF WASTEWATER'DISpOSAL: - :.,.."_'.... ".
_- . ...... _
Individual on-site.,
. .-.- ._. - , ...... - -: ._,-..~'., ::;_: . .- ..... ..... : -. .... .'.. .,
· .......... .,.Hodngtank - ~-'"~..,::: ' . :. ;.- ;-. ~
' NOTE: If community CaCt~water system, Provide wri~en confirmat~o~ a~esting to the legality and status of system.
72-025 (Rev. 1/91) Fron~ MOA #21
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' of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage 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 Firm Environmental'Manaqement,~Inc. Phone 272-9336
Address 206 E. Firewe4L~', ~te 201~,/Anchoraqer AK 99503
. ' . · · " ,,?,,% OP'4~ -~,
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...... : ~ DHHS.S~GNATU~E .... .... ,
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. ..... --' ~'~..." ' ....... ?'~' ' "' :"Cond~t"~' '; ;onal a' pro~ '~al .... 'for ' .-' ....... '"- ' 'b~roOms;
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Additional Comments
-~i.':~ -::-: .: ' !:::':?;~" ~,:i'! ' ' ": '
~ .... " ' Dep~rtme~it Oi Heaiih ~nd HUrnanse~/ices (DHHS)issues Health AuthoHty
Oerti' only upon the representations given in paragraph § above bY an .independent
istered in the 8tate Of Alaska~ The BHH$ d~es th s as a courtesy to purchasers of homes
iiit~ficns in orde~ t~ticn/~rtain ~ed~rai and-stat~ requirements, EmPloYees of BHH8 do not
· c~6dsot inspect OhS 'or ana y~e data before a certificate'is i~ed; ,The Municipality of Anchorage is not
resPOnsible for errors or omissions in the professional engineer's work, ·
72-O25(Rev. 1/91) Back MOA~21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. Well Data
Well type Private
Log present (Y/N)
Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed Oct. 3, 1984 Driller M-W Drilling
Total depth 161 ft. Cased to
Sanitary seal (Y/N) Y
161.1 ft. Casing height 12 inches
Wires properly protected (Y/N) Y
FROM WELL LOG
Date of test Oct. 3, 1984
Static water level 133 ft. below land
Well flow 10 g.p.m. .g.p.m.
Pump level1 no record
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 100 ft. +
Absorption field on tot 135 ft.
Public sewer main none observed
Sewer service line none observed
April 18, 1995
113 ft. below land
6-7 g.p.m.
u~no~
; On adjacent lots
100 ft. +
; On adjacent lots 100 ft. +
Public sewer manhole/cleanout none observed
Petroleum tank none observed in area
WATER SAMPLE RESULTS:
Coliform O ¢01~ ~Or'm/100ml Nitrate
Date of sample: April 18, 1995
O. 8~ ¢"%~/L Other bacteria O col/IOOml
Collected by: Simon Schroeder
B. SEPTIC/HOLDING TANK DATA
Oct. 1984
Date installed Tank size
Cleanouts (Y/N) ¥ Foundation cleanout (Y/N)
High water alarm (Y/N) none found
Date of pumping /~cit ~// IClCt~
2,000 gal. Compadments 2
Y Depression (Y/N) N
Alarm tested (Y/N) N/A
Pumper /9) Oc¼ o r'c~3 ¢._
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 148 ft. On adjacent lots 100 £t. +
To property line 82 ft. Absorption field 7 ft.
Surface water/drainage none observed in area
Foundation
Water main/service line
6 ft.
10 ft. +
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (WN)
High water alarm level
Not Applicable
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Soil rating (GPD/Ft~) 0.40
2.5 ft. Gravel thickness 12.0 ft.
Cleanout present (Y/N) Y
Results (pass/fail) Pass
60 inches
Surface water
I certify that I have checked, verified, or conforFed to all MOA and HAA guidelines in effect on
Signature ~ ~ L.---<_../~'-I¢- ~
HAA Fee $ ~' ~ Waiver FeeS
Date of Payment
Date of Payment
Receipt Number ~ ~¢~ Receipt Number
72-026 (3/93)* Back
Well on lot 135 ft.
To building foundation
On adjacent lots N/A
Surface water none observed
Curtain drain none observed
E, ENGINEER'S CERTIFICATION
On adjacent lots
15 ft.
100 ft. + Property line 24 ft
To existing or abandoned system on lot 'N/A
Cutbank 50 ft. + Water main/service line 50 ft. +
Driveway, parking/vehicle storage area
16.0 ft.
N
Bedrooms
80 ft. +
~te of this inspection.
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Date installed Oct. 1984
Length 95.0 ft. Width
Total absorption area 2,280 SF
Date of adequacy test April 18, 1995
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N) N
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
System type Trench
Total depth
Depression over field (Y/N)
for si× (6)
After test 60 inches
If yes, give date N/A