HomeMy WebLinkAboutSOUTH HILLS BLK 4 LT 7 Onsite File
South Hills
Block 4
Lot 7
#017 - 072 - 16
Municipality of Anchorage 8434
On-Site Water and Wastewater Program • (907) 343-7904 Pag
ON-SITE WASTEWATER INSPECTION REPORT OCT n Page
Permit Number: OSP181299 PID Number: 017-072-16
Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑� Upgrade
Name:
Doug & Nicola Calkin ABSORPTION FIELD
Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
7435 Old Hillside Way, Anchorage, AK 99516 ❑Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
440-9820 3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
South Hills 4 7 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank 1 Field Tank Line Ft2 Ft.
Well >100' N/A N/A N/A N/A TANK ❑p Septic 0 S.T.E.P. 9 Holding 9 Other
1 Manufacturer Capacity
Surface Water >100' N/A N/A N/A Anchorage Tank 1000 Gal.
Material Number of compartments
Lot Line >10' N/A N/A N/A Steel 2
NA LIFT STATION
Foundation >10' N/A N/A N/A Manufacturer Capacity
Curtain Drain None Noted Gal.
Remarks Tank replacement only Pump on level at Pump off level at High water alarm at
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank Exist. Tank to D3034
Installer drainfield
Denali Excavating Drainfield Existing CO/MT D3034
Inspector Michael E Anderson BENCH MARK (Assumed elevation)100 ft
Inspection st
19/12/18Location and description
dates: 2"d
3rd 4th Top of foundation
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date �A4D' 4.
j*'49TH A\ * .4
6• ' Benja's Schiller
7# lfF'.• CE 12592 •�`�%
Q 1 G,JF. 10/1/18 •.••Approved avuzDate /b/2/I r 'kkiFDPROFESS\Ooti
Inspection Report_9-1-12.doc
SOUTH HILLS BLOCK 4 LOT 7
-L=' KVA`
�
` "
A
B
SV2 39.1
K62CO
41.1
87.2
0 50 100
hM MR 00 FEET
LEGEND
CO - CLEANOUT
2CO-DOUBLE CLEANOUT
FCO-FOUNDAT|ONCLEANOUT
FS'FLOW SPUTTER VALVE
MH'MANHOLE
MT'MONITORING TUBE
SV'SEPTIC VENT
TH'TEST HOLE
SOUTH HILLS BLOCK 4 LOT 7
PERMIT # OSP181299 PID # 017-072-16
oCV o
LUL Cn Cn CV
-
' 98.9 ' "
I 94.0
11 I1
93.2
93.4 1000 GAL 93.2
SEPTIC TANK
J
89.2
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_4 1kk
*: 49 TM ;*,
'�
/ Ben'a• ` hiller
PROFILE AS-BUILT ,r
GE I�Fsr•. Caro 292 .••��``���
E N G I N E E R I N G (NO SCALE) klF9F�PROfESS10NA��......'4r
MUNICIPALITY OF ANCHORAGE
NCHORAGE ti�1 n
\\ On-Site Water&Wastewater Program A 5.•
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite Al
aille
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44.CHQHPC''.
On-Site Wastewater Disposal System Permit
Permit Number: OSP181299 Effective Date: 8/31/2018
Work Type: SepticTank Upgrade Expiration Date: 8/31/2019
Tax Code Number: 01707216000
Site Legal Address: SOUTH HILLS BLK 4 LT 7 G:2940
Site Mailing Address: 7435 OLD HILLSIDE WAY, Anchorage
Owner: CALKIN DOUGLAS N & NICOLA L Lot Size in Sq Ft: 47846
Design Engineer: FORGE ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 By: 19} `2,t7 L Date: 0
Issued By: A alt)U4Date: $ATief
al9L141WS
MUNICIPALITY OF ANCHORAGE
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. 017-072-16
Property owner(s) Doug & Nicola Calkin Day phone 440-9820
Mailing address 7435 Old Hillside Way
Site address 7435 Old Hillside Way, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) South Hills Block 4 Lot 7
Legal description (Township, Range & Section)
Lot Size 47,846 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field LJ Initial ❑ Single Family (SF) ❑X
❑X (w/wo ADU)
Septic Tank
Upgrade n
Duplex (D) n
Holding Tank _ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well n
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: 0-15 Waiver Fees:
Date of Payment: 1 102" it g Date of Payment:
Receipt Number: OVPReceipt Number:
Permit No. as P Waiver No.
Permit App_J-
August 29, 2018
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: South Hills, Block 4 Lot 7 - 7435 Old Hillside Way 8/29/18
Septic tank replacement
Dear On-Site Services Engineer:
The septic tank on the above lot is over 30 years old and blocking up, so the owner has decided to
replace it. The existing home is a 3 -bedroom. We are submitting this permit application for the
placement of a new septic tank. The attached site plan identifies the location of the existing home, well
and septic system, as well as the location of the new septic tank. The drainage pattern in general will
not be changed by the construction.
The existing tank will be pumped dry and decommissioned per code. The new tank will then be placed
outside the 100’ well radius, 10’ away from the foundation of the home, and 5’ from the existing trench.
After the new tank, we will install a double-cleanout and connect into the existing absorption bed.
There is an existing foundation cleanout already.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181299, Rebecca Carroll, 08/31/18
CL // // // // // // // // // // // // // // //800.0
810 .0
820.
0
830.0
8 40.0
850
.
0
860.0
870.0
880.080 2.0
804.0
806 .0
808.0
812.0814.06.818.0
822.0824.0826.0
828.0
832.0
834.0
836.0
838 .0
8
4
2
.
0
844.0
846.0848.0
85
2
.0854
.
0
856
.
0
858.0862 .0
864 .0
866.0
868.0
872.0
874.0876.0878.010050 0
FEET
1"=50'
NOTE:
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
SOUTH HILLS BLOCK 4 LOT 7
Aug 31, 2018
OLD HILLSIDE WAY
10' UTILITY EASEMENT
RETAINING WALL
SHED
3-BDRM HOMEFCO
CO
CO/MT
CO
EXISTING WELL
EXISTING 1000-GAL
SEPTIC TANK
ABANDON IN PLACE
NEW 1000-GAL
SEPTIC TANK
INSTALL DOUBLE
CLEANOUT AFTER
SET OUTSIDE
NEIGHBORING WELL
RADIUS
EXISTING TRENCH
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181299, Rebecca Carroll, 08/31/18
NAME~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 154-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND~I~WELL INSPECTION REPORT
TPHONE
t,,k IS'd- Z NEW
~]UPGRADE
LEGAL DESCRIPTION ~_~ /~
LOCATION
DISTANCE TO:
Manufacturer t~
Liq. capacity in g~ons I IF HOMEMADE'
DISTANCE TO:
Manufactur~'~
DISTANCE TO:
· of lines ~ Lenqth of each lin.~
Length ~/idth
area Dwelling ·
.4~[~ T /~./
Material O ~. ~
I nside length Width
Dwelling ~.~'"'
.~ IMaterial
Foundation ..~ / Nearest lot line
Total length of liues Trench widl~
Materia, bene~ t,le P p~ inches
Depth
NO. OF BEDROOMS
PERM,T NO.
No, of compartments
Liquid depth
PERMIT NO,
'~iquid capacity in gallons
PERMIT NO~w OS_dO
Distance between lines
Total effec:dve absorption ar~a
PERMIT NO. CF
Type of crib
Class
DISTANCE TO:
Well /./~ Building foundati~ I Nearest lot line ~./
Depth Driller I Distance to lot line PERMIT NO.
Building foundat on Sewer I ne I Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
REMARKS ~7~- ~---/dk3 [
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
'Th.'F'E [::iF' ZO:I:L FIBS'iOF..'F"TZON S'¢:..:.Tr'EH :t:Z: DRF,~INFZELD
HRF::Ii"!UH NUHBEEF-': OF E:EDROOHS
'THE REC!LIIRED SIZE OF "FHE 5OIL. FIBSORPTION
THE LENGTH [:'tMEN~,ION I~5 THE L. ENGTH ,::]:!'.,1 FEET> OF THE 'TRENCH OR DRR]:NF:[EL[:,.
THE [:,EPTH OF' ¢:f TF;:ENCH OR PIT :[% THE DZSTFtNCE BETt.4EEN THE 5LIRFF~CE OF' THE
GROUND HND 'THE BOTTOH []F' THE E::.::C:R',/FF?' :!: ON (IN FEE'F).
F' ~,.-~ EC -'F' ~: E~Z ~"-,;~ C: ~'-~ ~..,,-~ % ~) T' ~"'-~ % :E;; ~T;. ~E~ ~Z~ ~Z~ F::= EE;Z EFZ T' ..
THE GRRVEL E:,EF'TFI ZE; "FHE H:ENZMUH DEPTH OF' GRRVEL BETP.IEEN 'FNE OUTFRL, L F:'iF'E
fiN[:, THE BOTTOH OF THE E::<C:RVF:tTZON 4I!'.4 F%E'I">.
F'E'[;'"I'!'T FiF'F'LI'::F1N'I" l..iF:l.:::-; THE F.:E'~';,F:'ZN'.E',ZE:r.L:[T? TO INFORH TH:[:~; DEF'RRTi',IENT D_[~'];?.,iE'~ THE
]' N'::: 'T' :::f. t. F:tT I ON ]: i'.!':SF'E' "_':'" l: '"¢.4:E; OF:' RN'T' I.,.IEL.J....:E; FiE, I'R" E:N'F TG "FH Z '5; ~ R. F Et I T FIND "I"HI!E
NL.IME~ER CuP' F...:.=,IDENCE.~; 'r'H¢:fT -f'HE ~,~[:I t !.,.!IL.L ::.:;EF.:',,,'E.
....... It... TH l S
E:F~CKFr]:L.__:[N(.:i CF' FIN? ?,~%"f'Ef'! NI'FHOUT F':[NFIL. IN:.'.-:;F'ECT!ON I::~I'.,![::, F'='*;"""F
DE:F'.¢tF;!THE:NT 1.4iL. L. iiii:E :!:::LJ[~!L:rECT TGFP.'.L.:,EUItl'""-' .......... ] )1'..
HIN.T. MI..JM [:,I:STFINC':E E:E'FP.!EEN FI HELL FIN.r>
::!..O0 FEET F'OR R PRI'v'FITE FIEL. L GR :LSO TO 2(~O F'EET F'l;'.Of,l R PUBL. IC 1.4ELL. DEF:'E:ND:[F4G
UPOH I"HE T'¢PE OF' F'UBL..'[C P.tELL...
hIIr.,~:~HUH DIS"t"RNC':E F:ROM R PRIVR]"E 14E.:L.L. ]"O F! PRIVFFFE SEI.4E:R LINE: :ES 2.?/.; FEE:'T' AND
TO F~. E:OF'!.HUNIT't' :SE:IdEF: L..:[NE IS; 7'.5 FEE']".
HELL LOG:5 RRE RE:Qt,.lIRE!:> F:!N[> MUST DE: t;;;:E:'FURNED TG THE DEPFiF:'."FHENT !.4ITNIhl :'.'i:0 DF:I'T'S
OF TFiE I.,.IEELL cor'!F'L. ETEOH.
OTNER !.?.E!%!UIREHENT:iT, ?lFIh.' FIPPL,'.¢. :E;F'ECIFICta'f.'ION¢_5 FIND CON:E;'I"RUCTION I:::,IRGRF:IM$
R'v'l::1.1: LIABLE: 'TO ]: N:SUF;:E: F:'F:OF"[~:F:': .T. N'E, TRL. L. RT .1.' ON.
:.r E:iEF4:T:[F:'¢ 'T'HFIT
::L: Z !::hH FF!H:[I....!FIF.': ~,IZTH THE F?.!:::.'[;!L~]:F'.E:HE?.,FF':3 F3r.;, ON-:5]:TE :ii.:,EI.,.!ERE; RND I.,.fELL. E; FiE; :E;ET
~ ._, ...... THZ. ,UI...II'-,! :[ C :[ F:'RL :,r. 'T'? OF'
........":" :[ !,.I.]:L..L. ]:NE;TFILI... THE :,""'"'~ .:,'I .... E.i'l !l'.,t F:l-'Z -F.'f:,FII'.,ICE I.,.!:[TN THE CC'IDEZ.
::?: :1: UNDERE;TFIND THF!T THE: ")F...-'::i;TTE Z,E:!.,.tEF..: :!!!;'¢ZTEH i"tFFr' F.'.E6¢JIF:r.i~ ~'i'.,LF]F::3F:ZME':NT :IF' THE
F:EF.i;I[:,r:EN('::E :!::~; REHCd:::,IELE[:, T3 INCL. UDE H'L'RE THFIN 4
':' · ,e-:r:..' .........................................................
RF'F'I._ :[ f-":F!N"! .... f'Cd"l ]'.![::L ':£ '"
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SOILS LOG
PERFORMED FOR:
LEGAL D ESOR,PT,O,:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
2
3
7
8
SLOPE SITE PLAN
[] PERCOLATION
TEST
11
12
13
14
15
16
17
18
19
2O
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCQ LATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
72-008 (6/79)
CERTIFIED BY:
January 5, 1978
Tom Nelson
Box 3-057 ECB
Anchorage, Alaska
99501
Subject: Lot 7 Block 4 South Hills Subdivision
Permit ~77890
A permit issued by this department for well and/or sewer
system has expired°
Permits are issued on a oalendar year basis, as stated on
the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If there are any further questions, please contact this
office at 264-4720.
sincerely,
Health and Environmental Protection
Sewer and Water Section
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H
A 99503
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO.
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH ~ /
'NSTALLA''ON LOCAT'ON /h" :/''-'
INSTALLATION OF: SEPTIC TANK /' SEEPAGE PiT , DRAIN FIELD OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ! · ~
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE~, REQUIREMENTS DIAGRAM OF SYSTEM
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALl
SEPTIC TANK
TO NEAREST LOT LINE.
., SEEPAGE PIT
DRAIN FIELD,
WELL TO SEPTIC TANK
DRAIN FIELD
SEEPAGE Pit
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRA~N FIELD
· SEEPAGE PIT
SEPTIC TANK, , SEEPAGE PiT
TO RIVER, LAKE, STREAM.
., DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND iNTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SO}L.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT
FITTED WiTH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
[ CERTIFY THAT I AM FAMILIAR WiTH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAiD CODE. ,
DATE APPLICANT'S SIGNATU /
CONSULTING GEOLOQIST
SOILS LOG
Performed for~-~ ~ ~/~
Date
Soil Type Water Level
Remarks
16
18
20
Total Depth of Excavation
Groundwater
( ) Not.Reached
Depth, if Reached
Material at Total Depth
Bedrock
~Not Reached
Depth, if Reached
Classification Method
~ Visual
( ) Sieve Analysis
()
Gary F. Player, Consulting Geologist
A~d~HOI2Z INSPEC LE
16" '
,-'"i _
~.NU3T
SANITARY TEE AI
LIQUID DEP~{ (O)
4 ¢.z-.
'"-"S~ITARY ~E
sP, Ecs., T Ks
Co ~' '~CK
4" Pour Thzoughout
REBAR --
5/8 on 24" Grid
1/2 on 20" Grid
.~/8 on 16" Grid
1. 8" Block
2. S/8 R~bar On 16"
Centers Tieing
Floor To First
Two Rows of Block
3. S/8 Rebar Ch Each
Corner - Top Row of
Block To Slab
4. Coat Tank Inside
and Out-with Asphalt
· 5. Ail Voids In Finished
t'/alls To Be Poured
Full }Vith Concrete
6. Floor and Roof - 4"
Pour Rebar Req. Same
As Poured Tank
DESIGN ~AS~S
Capacity
Length
Depth (0)
~llons
Scum Storage (S)..,12"
(40%'o~ D)' '
TABLE OF INSIDE SEPTIC TANK DIMENSIONS
INSIi~ LIQUID INSIDE
~IDTH DEPTH LENGTH
GALLONS
5 5 5 561
3 5 6 573
$ 5 7 785
3 5 8 898
3 5 9 1033
3 5 10 1148
4 5 6 898
4 5 7 1047
4 5 8 1197
4 5 10 1496
4 5 11 1645
4 5 12 1795
4 5 13 1945
4 5 14 2095
4 6 7 1257
4 6 8 1436
4 6 9 1616
4 6 10 1796
5 6 7 1571
5 6 8 1795
5 6 9 2020
5 6 10 2244
5 6 11 2467
5 6 12 2693
5 6 13 2917
5 6 14 3142
5 6 15 3366
6 6 10 2693
6 6 11 2962
6 6 12 3251
6 6 13 3501
6 6 14 3770
6 6 15 4039
e~ ['
WELL DltlLLIiIG
P.O. BOX 3-142 ECB
ANCHORAGE. AK 99501
PHONE 34~-37~2
D R.!;I L:L E R'S::. t~ E L L
CUSTOMER /'~:.,~
·
'SI7E~':~-.,---"~--:-DEPTH~/ .' CASING-DEPTH 7'; -GROUTING 'DEPTH- 7-'~,~'?'Z' ..................
YIELD ~-" :: ~?~/:r' - .. ,?.),--.-:" sTATIc NATER [EVEL{-
~ INSTN ! F-n -~:.'/,----'-~' TYPE' -
FOR~TI ONS ENCOUNTERED AND' APPROPRIATE DEPTHS
EFL -NLS
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 I
Parcel I.D. 017-072-16 Expiration Date: 62"20 ` g
1. GENERAL INFORMATION
Complete legal description South Hills Block 4 Lot 7
Location (site address) 7435 Old Hillside Way
Current property owner(s) Douglas & Nicola Callon Day phone
Mailing address 7435 Old Hillside Way, Anchorage, AK 99516
Real estate agent Mary Cox Day phone 907-440-9820
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well U Private Septic
Water Storage ❑ Holding Tank n
Community Well U Community LI
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 $ 5 2 Waiver Fee $
Date of Payment 012603 Date of Payment
Receipt Number (I Rol Leh Receipt Number
COSA# 05( 17110a3 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 Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 203, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, PE Date 11/20/18
of AC.q'k‘k
Ay,
*: 49 •*
, �
6. DSD SIGNATURE �,.. .� . •••
X' System #1 Approved for bedrooms Benja r> hiller
9 • CE •12592 • `�/�
System #2 Approved for bedrooms f ic�lFFo 11/20/18.•;.,r
Disapproved tl\` pROFESSt4Nt' ""
Conditional approval for bedrooms, with the following stipulations:
`/L
ON-SITE 9G ,
\LAMER AND
WASTFV\IATER c
``2 PROGRAM
f G
SFR\ie
By: L _ . Original Certificate Date: I (-.2132-0
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
COSH Checklist blue sheet
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: South Hills Block 4 Lot 7 Parcel ID:017-072-16
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 7/28/83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 147 ftCased to 76 ft. Casing height(above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 7/28/83 8/6/18
Static water level 62 ft. 74 ft.
Well production 2'9 g.p.m. 2.2 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 1 .87 mg/L
Arsenic ND ug/L Date of sample: 11/8/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/12/18
Tank size 1000 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) N /
Date of pumping Pumper New Tank
C. ABSORPTION FIELD DATA
Date installed 9/15/91 Soil ratingd./ft2 or ftJhdrm) 105 System type Shallow Trench
(g•p•
Length 59 ft. Width 5 ft. Gravel below pipe 2 ft.
Total depth 7.5 ft. Eff. absorption area 420 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/6/18 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 461 gal. New depth 0 in.
Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
None
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
•
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
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 >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field >5
Water main
>10' Water service line >10'10' Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' >10
>10'
Property line Building foundation Water main
10'
Water Service line >10Surface water >100 Driveway, parking/vehicle storage >
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION 11����\\
pP 'q�gil
I certify that 1 have determined through field inspections and .
review of Municipal records that the above systems are in erc-o. ••• `. .,
conformance with MOA COSA guidelines in effect on this date. 0*: 49 N A\ ••*�y
Engineer's Printed Name Benjamin Schiller, PE • • �:• . • Vii-• ••••• 6
Date 11/20/18 r, Benja ' chiller ' •
I# l' •• C.1 /.21 /5.1982
12592 ...
•��Q‘�
d'l•., 1 /2 /18 ,.• V
`tl%PROFESSIO"�... '
COSA brown sheet 10-10-12.doc
8476M
— —_RABBIT CREEK ROAD
O
in
O
S85°52'10"E 152.95 in
LOT 8
LOT 6
N
CO
O O
E
"' a) LOT 7 SCALE: 1"= 50'
w co
^
O
c0
Co o O
Oco
o Co
O O
4.
z F .AL1
.eck ° _�P, • . S #
■ shedJ1
storyI
00 49th i� * /4
hain Log /' .rl
link House septic vent(typ)` r•i.. •J ;
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. # 017-072-16
1. GENERAL INFORMATION
Complete legal description
Lot 7~ Block 4~ South Hills Subdivision
Location (site address or directions) 7435 Hillside Way'
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Chr~nph~r Rsynnr Day phone 345-6697
113062 Anchoraqe~ AK 99511
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
Three (3 i'~
NOTE:
Individual well
Community well
Public water
XXX
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
XXX
72-025 (Rev. 1/91) F¢ont 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.
NameofFirm Anderson Enqineerinq
Phone 522-7773
Address. P,O, Box 240773 Anchoraqe. AK 99524
Engineer's signature ~~' (~ ~ Date 6/10/99
DHHS SIGNATURE
~ Approved for '-/-/'/~ ~F~bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
'f; 'JIIPJI
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections, or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 {Rev. 1/91) Back MOA f¢21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES R E £ E IV
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4~1~ 1 1 1999
Legal Description:
A. WELL DATA
Well type Private
Log present (Y/N)
Total depth 1 4 7 '
Sanitary seal (Y/N)
Health Authority Approval Checklist Municipality ot Anchorage
Dept. Health & Human Services
Lot 7, Block 4, South Hills ParcelI.D.: 01 7-072-16
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 5 / 21 / 99
B. SEPTIC/HOLDING TANK DATA
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed 7 / 28 / 83
Cased to > 76 ' Casing height (above ground)
I 5"
¥ Wires properly protected (Y/N) ¥
FROM WELL LOG AT INSPECTION
7/28/83 6/3/99
69'
1.1
g.p.m.
Nitrate 1 . 05 mq/L Other bacteria 0
Collected by: T. Kimbrough
62'
2.9
Date installed 8/15/81 Tank size 1 ..250
Foundation cleanout (Y/N) y Depression (Y/N) N
Date of Pumping 5/25/99 Pumper A P].~]s
C, ABSORPTION FIELD DATA
Date installed R / 1 5 / 81
Length 59 ' Width
Effective absorption area 420 SF
Date of adequacy test 5 / 21 / 99
Fluid depth in absorption field before test (in.);
Fluid depth 1 6" (ins) Minutes later: 21
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
g.p.m.
Number of Compartments 2 Cleanouts (Y/N) _
High water alarm (Y/N) N
Soil rating (g;p.d./ft2 or ft2/bdrm) 105 SF System type Trench
5 ' Gravel thickness below pipe 2 ' Total depth 7 ' - 8 '
Monitoring Tube present (Y/N) ¥ Depression over field (Y/N) N
Results (Pass/Fail) ?ass For Three (3) bedrooms
18" Immediately after 460ga1. water added (in.): 24"
Hrs. Absorption rate = >450 .g.p.d.
N If yes, give date N/A
Do
LIFT STATION
Date installed
None on Lot
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot > 1 0 0 '
Public sewer main N/A
Sewer/septic service line > 1 0 0 '
Size in gallons
"Pump on" level at*
*Datum
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
"Pump off" level at*
98' (See Waiver)
92' (See Waiver)
N/A
N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > .5 ' Property line > 1 0 '
Water main/service line > 2 5 ' Surface water/drainage > 1 0 0 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
> 1 0 ' Building foundation > 1 0 ' Water main/service line
Absorption field > 5 '
Wells on adjacent lots 9 8 '
>25'
>10'
Driveway, parking/vehicle storage area
Wells on adjacent lots 9 2 '
Property line
Surface water
Curtain drain
__ >100'
None on Lot
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections
in conformance with MOA HAA guidelines in effect on this date.
Signature ~/~ ~ ~
Engineer's Name Mi ~hm~l R ~ An~r.~n; P- E.
Date 6 /9 / 99
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
.rT. =
.
~;.
Z ZZ
I SI
>
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date i/'~--~//~'~-'~
GENERAL INFORMATION
(a)
(b)
Legal Description {include lot, block, subdivision, section,., township, range)
Location (address or directions) .
Applicant Name ,~10¢["~-%'~ ~'-':t-~tL,::'C~T~e~epho"'~e:'-~lome ~ ~us,ness ~ S ~ ~-' ~
Applicant Address
(c) Applicant is (check one): Lending Institution/1E~; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following addressL_.._/C/[_~,~/
2. TYPE OF RESIDENCE
Singte-Famil~,/[~ Multi-~amily [] Other
Number of Bedrooms
3. WATER SUPPLY
Individual WellJ~'~ Community [] Public []
Note: If community well system, must have written confirmation fromthe. State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL '"
Onsite.,~ Public [] ' Community [] Holding Tank []
Note: If community well system, must have written cc nfirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
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 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
Address
Date
Engineer's Seal
6. DHEP APPROVAL
Approved for bedrooms by
Ap~'ed Disap~ed Conditional
Terms of Conditional Approval --7-/.~e~ ".~-,.,~.~ ( ,:~¢-,~/~,,~.-
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: ~"~
A. WELL DATA
Well Classification ' .'~'~\~,,~ ~ If A, ~B~.~,D.E.C. Approved (Y/N) ~ "
Total Depth ~ Cased to~ ~ Depth of Grouting ~ I ~
Static Water Level ~ ~ ~/Z~/~
Casin~ Height Above Ground [~t~
[Ioctrical Wirin~ in Conduit (Y/~) ~
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer 'Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Pump Set At ~;~ ¢ ~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
~ k..~:~ ' ,-~ ; On Adjoining Lots
~c] ' ; On Adjoining Lots
To Nearest Public Sewer
~ ( I~, To Nearest Sewer Service Line on Lot
~ ;Date
SEPTIC/HOLDING TANK DATA
Date Installed ~/I ~-'-/'~:~ I size
Standpipes (Y/N) ~.~"~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Property Line z~ ~
To Water Main/Service Line
Course I ¢.~.t ~
No. of Compadments ~
"¢ ~--"~ Foundation Cleanout (Y/N) "'¢'~---~ ~¢.. J ~--~'~
Date Last Pumped ~k~~z-.--~ (f',~A-- ~¢'
; for ~ I ¢:~
Temporary Holding Tank Permit (y~N) f'J/¢~
To Building Foundation
To Disposal Field ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed . ~/I
Width of Field ~ z
.//A¢.¢.- Type of System Design (--'~ Length of Field ~-~ z
Square Feet of Absorption Area
Depression over Field (Y/I~",-~.. ~
Results of Last ,Adequacy Test
Separation Distance from Absorption Field: L
To Water-Supply Well ~'~'
To Building Foundation ~,,~
Lot ~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments '~ _% cA ¢Y,J,_
Depth of Field ~" '-
Gravel Bed Thickness ~ /~
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line J
To Existing or Abandoned System on
; On Adjoining Lots ~C_~
To Cutbank (if present)
D. LIFT STATION
Date Installed ~. Dimensions
Size in Gallons / ¢lanhole/Access (Y/N)
"Pump On" Lew~l at / "Pump Off" Level at
High Water Alarm Level / Vent (Y/N)
/// Pumping Cycle~quacy Test. Meets MOA
Tested
for
Electrical Codes/~.d(/N)
** Check,C'Permitted Bedroom Rating Against HA~~'
I certify that I have checked, verified, or conf~~d~~ HA/yguidelines in effect on the date of this inspection.
Signed ,"""~. I?r(bv.¢.. ¢¥, ~-'~C.~"~D~~ ;/"~...~'~/~,~
Company fc"~'Cr'l'~c'r? ~
~ NO.
Receipt No. ~ i'-J O~O ~'_;~2
Date of Payment ) - ~ )
Amount: $ /~_.~_~ ~ ~..E.% Seal
Page 2 of 2
72 026 (11/84}
unicipalitYof
Anchorage
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES,
MA YOH
DEPARTMENT OF HEALTH & HUMAN SERVICES
February 14, 1986
Thom Fischer, P.E.
Whitewater Engineering Constructor
11600 Cange Road
Anchorage, Alaska 99516
Subject: Lot 7 Block 4 South Hills Subdivision
Waiver Request, WR86-019
Dear Mr. Fischer:
This Department has evaluated your request for a variance from the
separation distances required between wells and septic system components
by Alaska State Wastewater Disposal Regulations (18 AAC 72-021).
This Department hereby grants waivers to the required i00 foot separation
for the following:
The separation distance between the septic tank on the subject lot
and the well on adjacent lot to the west (Lot 8) has been waived to
98 feet.
me
The separation distance from the end of the leachfield on the
subject lot and the well on the adjacent lot to the east (Lot 6)
has been waived to 92 feet.
These waivers are valid for the existing four bedroom single family dwelling
only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
Stephen Morris
Dept. of Health & Human Svcs.
Municipality of Anchorage
2/10/86
re: HAA for Lot 7 Block 4 Southhills Subd./ Waiver
Dear Mr. Morris
I recently inspected the above mentioned lot and found that the on-
site septic system was closer than i00 feet to the neighboring wells.
The septic system is strategically placed 98' from lot 8's well to
the west, 99' from its own well to the south, 92 feet from lot 6's
well to the east, and 6' from a slope to the north. There is not another
place on this lot to put a legal system. I'd like to request a waiver
from the minumum 100' setback between wells and septics based on the
above and the following.
!) Water Table; from the soils log and well log it appears that the
water table is approximately 40' below the leach field. This would
give a point value of 5.0
2) Soil Sorption; the well log shows that the subsurface soils are
mostly bedrock and clayey. Both of these soil types have very high
point values. I would however give a point value of 5.0
3) Permeability; bedrock, while having a high perk rate, will crack
and channel~while clayey soils just have a high perk rate. Averaging
the soils I would give a point value of 1.5
4) Water Table Gradient; I am going to have to assume that the water
table gradient is 0% because the soils log suggests an aquafer at
62' to 67', the casing is perforated at 62' to 67', and the static
water level is 62'. This would give a point value of 2.9
5) Horizontal Separation; the closest point of septic system to a well
is 92'. This would give a point value of 2.6
Adding the above points gives; 5.0 + 5.0 + 1.5 + 2.9 + 2.6 =Jpoints
According to the charts, bacterial pollution seems remote.
Should there be any questions please contact me at 345-7008
Sincerely,
Thom A. Fischer P.E.
WHITEV ATER ENGINEERING CONSTRUCTOR
11600 CANGE ROAD ' ANCHORAGE, ALASKA ' 99516 · PH. 345-7008
£o~r ,fo