HomeMy WebLinkAboutVALHALLA BLK 4 LT 5
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
Address % TANK FIELD WELL
~ ~ ~-- ~ ,r,veway, water bodies, etc)
TANKS N
~ SEPTIC ~ HOLDING
n
TYPE OF ~YaTE~
~TRENCH g BED g W. DRAIN ~ OTHER
original grade ~ FT
~ FI
WELLS ......
~PRIVATE ~ OTHER (Identify)
FT
installer Date I~s*alled:
REMARKS:
, .miry ,,,, this inspection was pedormed accordi.g to all
municipal ~nd Stat, guidelines in effect en thin daJ6~ ,~ /a
72-013 (3185)
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PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99592-0650
SOILS LOG -- PERCOLATION TEST
D^TE PEI~r~
LEGALDESCRiPTiON:Z'¢"/'_~~ ,~jZ~'-",/ ~//~L,4//LZk'¢ Township, Range, Section: '7~Z.~ ,~'~J -¢~,- ~b.
COMMENTS
.~
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT O
DEPTH?
P
E
Oeplh la Water Alter
Monilorin8? ,,~ Date: ~Z~'-~
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE ~'~'~ '~ (m~nutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~,¢ FTAND ~'/ FT
, ¢'¢~ ~W/¢' CERTIFY THAT THIS TEST WAS PERFORMED '"
GUIDELINES IN EFFECT ON THIS DATE. DATE: ~¢~¢
72-008 {Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
DATE PEREORMED:
Township, Range, Section: '~'~,~)
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth Io Water Alter
Monitoring? Dale:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE /'~1o ¢ (mlnutes/mchl PERC HOLE DIAMETER __
TEST RUN BETWEEN ~' ~', FT AND ,/~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
CERTIFY T'AT THIS TEST WAS PERFORMED IN
DATE: ¢'-'/'¢/'~'~
72 008 (Rev. 4/85)
CONTROL SERVICES, INC,
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO OF
CHECKED BY DATE
SCALE
ALASKA I~FIUIROiflm~FITAL COFITROL SI~RUIC~S, IFIC.
~nqineerinq 0 ~naironmental Studies
[f th( [m~;talle~tJon is liar ]llspeclte(i by am AF. CS en,,~,i!!ae:', A!~fi
1200 I.Uasl a3rd Aucnue, Suil¢ ~ · Ancharoqe, Alaska 99503 · (907) 276-1361
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SCALE:
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~-~E:PA RE[ D FORt
AS- BUILT
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I hereby certify that on accurate sur
described property=
/_or 5' ~3zoc/( .~
was made on /~PCY' /.~"' J~ and that Ihe
improvements situated thereon are within the property lines
and do not overlapor encroach on lhe property lying ad-
jacent therefor that no improvemente on the property lyk~
bd acent thereto encroach on the premises in question and
Ih~l there are no roadways, lransmissloa lines or olher
visible easements on s~id property oxcept as indicaled
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO ~
OF--
DATE
CHECKED BY
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GP~ATER ANCHORAGE AREA BOROI~GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADD RESS~.~'
?
SEPTIC TANK:
DISTANCE FROM WELL__~t/
LIQUID CAPACITY
__MATERIAl )/ ~7~:: NUMBER OF
COMPARTMENTS
GALLONS. INSIDE LENGT' INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM: SEEPAGE P~t:
NUMBER OF PITS _ /~ _ OUTSIDE DIAMETER ~- or WIDTH./~
NEAREST LOT I. INE~[)
/ /
/~___, LENGTH "~' , DEPTH
BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELt .... FOUNDATION. , NEAREST LOT LINE , OF LINES
NUMBE~OF LINES WEEN L · TRENCH WIDTH / _ ~IN,:~[Of~L EFFECTIVE
ABSOR ,-AIWA SQ. FT. OF ACH LINE__
DEPTH: TOP OF TILE TO FINISH GRADE
__DEPTH OF FILTER MATERIAL BENEATH TILE
IN, ABOVE TILE__
~ DISTANCE FROM ' / WATER
WELL: TYP~E'_-Z'~:~/~'~.) , DEPTH - .BUILDING FOUNDATION.~~ ~/' SAMPLE__ ,NEAREST
~ Z NEAREST /~ SEPTIC ~c~. / SEEPAGE ~,~ / OTHER
LOT LINE ) , SEWER LINE '~' ~,TANK ., SYSTEM ~ CESSPOOL ~, SOURCES
DISTANCES:
'/';
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEr'
327 Eagle St.
ANCHORAGE AREA
ItEALTH DEPARTMENT
Anchorage, Alaska 99501
'OROUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
:3 .2 . ,/7
RESIDENCE ADDRESS~5;~( ;/}~:~]fl~E ~ iL LOCATION OF INSTALLATIO"
APPLICATION TO INSTALL: SEPTIGTANK ~ , SEEPAGE PIT_ / ,DRAIN FIELD ,OTHER
TOSERVETHE FOLLOWING FACILITY ::~ /:~/:&O/~f ~¢:-
~ER~~ST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , '--~//f~;r:~,'~)L?',;~-<. , PERMIT TO INSTALL A
_AS DESCRIBED BELOW, SiZE OF UNIT TO DESERVED -
., SEPTIC TANK SIZE ~/~ ~ ?>o TYPE SEEPAGE AREA
DIAGRAM OE SYSTEM
cAS.
GREATER ANCHORAGE AREA BOROUG}
IlEAl,TH DEPAR'FHENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Depth
Feet Soll Charac t¢:ristlcs
if Yes, At What Depth
Reading Date
Gross Time
Net Time
Location Sketch
Depth To H20
Net Drop
Proposed Instal~Seepage Pi~ /~- Drain Field
T~st Performed BS"~&~. = ~ , , ..... _ ,-.-~
Data Certified By
I'~t R IV~LL DRILLD{S LOG I' DO NOT FILL IN
f ~ ( / ~ :~f, ////~, .- usc~ so. .
Drilling Co.
, Driller
Lacat~on (aaa~e~s
, ,,, ~ ~ .... ,,, , . ....
,
8tat~c ~ater level ~:: fee~ (above) (be l~d s~face, Finish o~ well
(check one) Open end ( ~ Screen ~ ): Perforated ( ).
'? :~[': ~ --bepth in feet from
~ .... ,"-'- ground surface
Describe screen or perforations:
l'~ell pumping test at gallons per (hr) (min) for hours
feet of drawdown from static level~
Remarks.. j! ,,/?, ';, ..:. , , ,_,, .. .
~ ~.i ~ "/';.:., '. - / ' ,
Give details o~ formations penetrated, size of material,
color, and hardness.
tO
tO
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to
to
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
OSC261092
Parcel ID 015 -211-06
Legal description VALHALLA BLK 4 LT 5
site address 12215 WILDERNESS RD
Expiration Date: 3/23/2027
Current property owner(s) ERICKSON GLENN & PATRICIA
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or conditions:
0 IST BAIT -71
By:
T
bedrooms, with the following stipulations:
Original Certificate Date:
4/23/2026
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 Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Department ) Phone: 907-343-7904
On -Site Water & Wastewater Section �- �� Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel ►.D. 015-211-06
Complete legal description Valhalla, Block 4 Lot 5
Location (site address) 12215 Wilderness Rd
Current property owner(s)
Glenn & Patricia Erickson Living Trust
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑E Private Well serving #,_1_ dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic A Concrete ❑ Fiberglass
Age 38 -See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed A Deep Trench ❑ Wide Trench 0 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 $ Waiver Fee $
Date of Payment 'q_ �I 2 �' k� Date of Payment
COSA # y S CL (eI U 9 Z Waiver #
COSA Application_Ap2025.doc
COSA Checklist_May2025.docx
COSA Checklist
Legal Description: Parcel ID:
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 Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
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)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
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)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_May2025.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 Phone
Engineer’s Printed Name Date
56.0'
SEPTIC PIPES -
Lot 6
S 89'59'E 168.55'
2.0' CANT L
N 89'
L4
�U`)
M
0
nmM
r
0
�I
330.8'x -
L
168.55'
Lot 4
I'
10' T&E EASEMENT—�
\I
10' UTILITY
EASEMENT
Lot 5
N
O
16,588 s.f. I
o
W
� I
W
M
13.3' 51.4'
0
0
GROUND LEVEL DECKS I
0
O
POTTING SHED I
WELL
NOTES: GROUND LEVEL IMPROVEMENTS SHOWN ARE APPROXIMATE,
PLOT PLAN � AS BUILT _X_ DATE OF SURVEY: 07 APRIL 2026
SCALE 1 " = 30' GRID SW 2736 _ Pro ect No. — J26 -056„(A1
P.O. Box 210005
Lang & Associates inc
• Anchorage, Alaska 99521-0005 og�p0�
Professional Land Surveyors (907) 522-6476 OF ,A
survey@langsurvey.com v
oma,` .•••••. S �
I hereby certify that I have surveyed the following described property:
LOT 5, BLOCK 4, VALHALLA SUBDIVISION (Plat No. P-644)
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
N C. NG o
premises and that there are no roadways, transmission lines or other vlsible G
nj0 ONAT :
easements on said property except as indicated hereon. V '• ,� �
Dated this the Day of -9944.• '
ZlG� at Anchorage, Alaska ��Fo
44�4�Qc
It is the responsibility of the owner to determine the existence of an easements, �0AZSSIONA�
covenants, or restrictions which do not appear on the recorded subdivisionSt
. lotOO�p0000
P ate of Alaska AECC963
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner
Mailing A~Jdre~s -
Telephone: (home)
B usi ness ~ "/-~"'-
(c) Lendi0g Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here"~ if hold for pick up.)
List contact person and day phone.number below:
2. TYPE OF RESIDENCE
Single-Family"~ Number of bedrooms
3. WATER SUPPLY
Individual Wel Ir'j~
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site~:~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
z~-02~ IR6v. Z/e81 Page I of 2
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,MUNICIPALITY OF ANCHORAGE (MOA)
NIQPALIf'Helatth~4t~.tbeJl!ty Approval (HAA)
ONM~NTAI,Gt4ECI~I~/~io~EBRUARY 1984
343-4744
Legal Description:
RECEIVED
A. WELL DATA
Well Classification if A. B, C, D.E.C. Approved (Y/N)
Well bog Present~N) Date Completed '~.~7 Yield ,¢4-- -~,(¢
Total Depth~'O' Cased to /_5'0 t
___ Depth of Grouting /.J//I
Static Water Level --Ye- //_5'
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot _
To Nearest Public Sewer Line . /,,//~4
To Nearest Sewer Service Line on Lot
Water Sample Collected by /'¢-~'-c~'
Water Sample Test Results .~/¢'~'_ "7-- ~--~
Comments '-~ /x~/.:¢- /¢-~-~-J
Pump Set At
Sanitary Seal on Casing N)
Depression Around Wellhead (Y~)
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed /~"~-?~ Size
standp pes N/ _ Air-tight Caps
Depression over Tank (Y,~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
Foundation Cleanout (Y~)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
SEPARATION'DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Sul~pl~/,Well;: ~¢ ,~ /F~//_/ To Building Foundation
To Property Line ' ' /~ ''P To Disposal Field
To Water Main/Servic~ Line /o ¢-
'To Stream, Pond; La~e or Major Drainage Course
Commenis. ' ·
72-026 (Rev 7/88) Fronl Page 1 of 2
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APPLI ~NT FILLS OUT UPPER HA ; ONLY
Address Zip Code
Lending Institution
Realty Co. & Agent /~/)~3 ~ ~ Phone
Address Zip Code
Type of Residence
[~ Multiple Family NO. of Bedrooms~--,~
[] Other
Water Supply
t~ Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
'~ Individual Year Individual Installed:
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time
Date Date Date
Inspector Insp6ctor Insp6clor
Field Notes:
Time ,
Date
RECEIVED
( _~ ) APPROVED BEDROOMS
) DISAPPROVED
) CONDITIONAL APPROVAL'
DATE
BY:
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank .7/~/
Well Log Received
Septic Tank Size ~/~) (~J~