HomeMy WebLinkAboutSOUTH HILLS BLK 5 LT 8South Hills
Lot 8
Block 5
#017 071-17
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904. Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number:. OSP211139 PID Number: 017-071-17
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
A ORPTION FIELD
Brassfield Trust
❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
7400 Old Hillside Way
Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
ISF
Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original a Gravel depth beneath pipe
�• Ft.
Subdivision Block Lot
South Hills 5 g
Fill added above original gradeGr I length
Ft. Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Dist between lines
Ft.
SEPARATION DISTANCES
ToSeptic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between hes
From
Tank
Field
Lift Station
Tank
Line
Ftz
`
WellI
100'+
TANK [Z Septic ElS.T.E.P. El Holding E] Other
Manufacturer
Greer
Capacity
1500 Gal.
Surface Water
1001+
Material
Plastic
Number of compartments
2
Lot Line
I 101+
NA
Foundation
10'+
I
I
ATION
Manufacturer
Capacity
Gal.
Remarks Existing Absorption Field installed 8/13/91
Alarm location
Elects led by
PIPE MATERIAL House to tankTank to
D3034 drainfield D3034
Installer
A+
Drainfield CO/MT D3034
Inspector Arcterra Consulting
BENCH MARK (Assumed elevation) 100 ft
Inspection
11' 6/15/21 6/16/21
Location and description
dates: 2„d
3.d 4t"
Bottom of door frame
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF tR
Conditional Approval: Date
�a�fP�'""'"""+.4yy♦♦*♦+
4912:1 '� ♦>;
------
KENNETH W
Septic
Septis SYStom
oAr
Approve 0 ( Date V_zC�'.Z/
♦♦��� ti��
e♦ +��it��`��••�
Note: this approval does not include well permit requirements.
(Rev 05/02/18)
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit EISP211139
SOUTH HILLS BLOCK 5 LOT 8 PID# 017-071-17
--- - ---- — - - - - ------------
O ---�-
O 0
EXISTING FIELD
O 00
INSTALL NEW
1500 GAL TANK
/ 4 BEDROOM
f BUILDING
1
IC
A -C=3.3'
B -C=11.9'
100.4
A -D=28.1'
BOUNOARI: N A ORA*"- KSD
STAMM N/A wean: KMD
B -D=15.2'
W
N
AOA° nm FILE " N.: 21025
A -E=32.8'
_
O
2
d
B -E=19.6'
7)1500
A -F=33.9'
B -F=20.7
A -G=34.9
GAL
EPTICB-G=21.6'ANK
.... `�
G):•
flo,* :4 TH *
3'. S :
C rv�
♦� ��w�
PREPARED FOR:
BRASSFIELD TRUST
7400 OLD HILLSIDE WAY.
Anchorage, AK 99516
FIELD BOOKS muaulm:
BOUNOARI: N A ORA*"- KSD
STAMM N/A wean: KMD
AMUILT: _ OAT 6 23
DWG. FILE: mo. SW294
AOA° nm FILE " N.: 21025
SCALEt 1' = 30 '
SCALE: NTS
C
rr
a
C
C
C
L
50'
I
ANCHORAGE RECORDING DISTRICT, ALASKA
HILLS p AY _
(HILLSIDE DRIVE p_636)
AS -BUILT' OF:
SOUTH HILLS SUBDIVISION
LOT 8 BLOCK 5 PLAT P-636
SURVEY CERTIFICATE: I, John L. Schuller. Have conducted a
physical survey of this property as shown on this drawing -and that Ute
improvements situated hereon are within the property lines and no
enchroachntents exist other than noted. Under no circumstance should
any information on this drawing be used for construction offences,
structures, improvements, or fitr establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to detennine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
JUNE 25, 2021 1-=30' nhune.c knet
21-084 DRAYM B^. 4f�CKED Br (aiiD HVUEfR BIXXt/PACE
JLS SW2940 210202
OO = FND 518" REBAR
OFAL k%�
1 f1
n tJ6HN L. SCHULLER: o
LS -10408 �Ta
��a°fessionot �'.�®
�D L NDR���l
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
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.murii.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211139
Wor ype' eptic an -- pgra e -
Tax Code Number: 01707117000
Site Legal Address: SOUTH HILLS BLK 5 LT 8 G:2940
Site Mailing Address: 7400 OLD HILLSIDE WAY, Anchorage
Owner: BRASSFIELD THOMAS J & CAROL A
Design Engineer: ARC TERRA CONSULTING INC
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy
Effective Date
Expiration Date: -
Lot Size in Sq Ft
Total Bedrooms
17epaI- till ell r
5/17/2021
5/17/2022-
39356
❑ 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 (2417).
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: 0Date:
Issued By: Date:
4
MUNICIPALITY OF
Development Services Department `
On -Site Water & Wastewater Section
Parcel I.D. 017-071-17
ON-SITE_SEPTIC/WELL PERMIT APPLICATION
Property owner(s) Brassfield Trust Day phone
Mailinq address 7400 Old Hillside Way, Anchorage, AK 99516
Site address 7400 Old Hillside Way, Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Block 5 Lot 8
Legal description (Township, Range & Section) South Hills
Lot Size 39,356 Sq. Ft. Number of Bedrooms 4
Phone: 907-343-7904
Fax: 907-343-7997
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
FZ
(wiwo ADU)
Septic Tank
E
Upgrade [i]Duplex
(D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES
A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
Dea Duffus
(Signature of property owner or authorized agent)
Permit/Rush Fees: 4 d 2 5
Date of Payment:0D �
...__
Receipt Number: 6 SOS (' G
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211139, Deb Wockenfuss, 05/17/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211139, Deb Wockenfuss, 05/17/21
' ' Municipality of Anchorage Page ~ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number:
Address:
/O~o '~
LECAL
Lot: Block: ¢. bdivision:
WELL: [] New [] Upgrade
Classification (Private, A,B,C): Total Depth:Ft. Cased TO: FtFt
Driller; Date Driged; Static Water Level:
Yield: I Pump Set at: I Casing Height Above Ground:
GPMI Ft,I Ft,
PID Number: (~,'"~
~stewater System: [9~ew [] Upgrade
ABSORPTION FIELD
[] Deep Trench [~hallow Trench [] Bed [] Mound [] Other
Soil Rating: n original grade:
ginal grade: dep
Ft,
added above odginal grade: Gravel length:
Total absorption area:
SQ. Ft
6¢~ Date instal]ed~l
TANK
SEPARATION DISTANCES
To Septic
From Tank
Surface
Water
Line
Foundation
Drain
Remarks:
Material: r~
Size in gallons:
"Pump On" level at:
[3 Holding ~ S.T.E.P.
Number of Compartments:
LIFT STATION
High water alarm at:
Electrical ~nspections periormed by: '-~-~
BENCH MARK
Assumed Elevation:
' nspections performed by'./'~/~'~/~./X-
Dates:
Department of Heal. and Hnman Services approval
Reviewed and approved by: U-~. Date: JC-/~f" ¢'/~
72~013 (1/91) MOA 25
;?/,ichaeJ E. Anderson
438 ~. E
Permit .o. ~O-'~l.J~-~~-~ Page
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: ~DT ~ {~i ,~/~JJl'~' ~[1['~. ,~[~)~* PiD NO.:
Mu '},c~ality of Ancho~
Dept. Health & Human S~
~ich~ol E. A~derson 2
E
?~ ~o~ X',' ,.,~
72-O13 A (2/91) MOA 25
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska @9502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCmPTiON:~T~ ~bK ~ ,'~/2L~TH I'HI"I~ Township, Range, Section:
SLOPE SITE PLAN
2
WAS GROUND WATER
ENCOUNTERED?
11 s
IF YES, AT WHAT O
DEPTH? p
E
Deplh to Water A~er~ ,~
13 - MonitorinD? ,,"V~'~,',C-" Date:
I
1,4- ~2
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ~1 ~P ~6.7~ ~.~
15-
"- RECEIVED
18-
AU(; 7 1991
19-
unicipatity of Anchorage
20 - ~ & Human Sei'y ce~
PERCOLATION RATE '~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'~2 "/" FTAND FT
COMMENTS """~'~'7'/'~"~/'~'~ ~ ;~ ~:~/?--~'- -~/~/~'Z) ~/~.~1~_ ~
PERFORMED BY;. , : ._ ~ ERTIFYTHAT~/IS)EgSTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE DATE:
72-008 (Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910208
DESIGN ENGINEER:ROBERT KNIEFEL, P.E.
OWNER NAME:BRADLEY ROBERT C II ~
OWNER ADDRESS:7400 HILLSIDE DR
DATE ISSUED: 7/24/91
EXPIRATION DATE: 7/24/92
PARCEL ID:01707117
LEGAL DESCRIPTION: SOUTH HILLS BLK
5 LT 8
LOT SIZE: 39356 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DESIGN CHANGE BY M. ANDERSON, GRANTED 8/14/91.
ABSORPTION TRENCH TO BE: 5' WIDE 87' LONG AND 3.5' GRAVEL
BELOW PIPE. INSTALLATION MUST PROVIDE 2' ACCEPTING SOIL
CHANGES.
RECEIVED BY:
DATE:
DATE:
ROCKFORD CORPORATION
P. O. Box 111706
~NCHORAGE, AK 99511
(907) 344-4551
ROCKFORD CORPORATION
P.O. Box 111706
ANCHORAGE, ALASKA 99511
(907) 344.4551
FAX (907) 344-2130
/
JOB
SHEETNO.
CALCULATED BY
CHECKED BY
SCALE
DATE
DATE
/ -- .................. i
4381 ,. E
ROCKFORD CORPORATION
P.O. Box 111706
ANCHORAGE, ALASKA 99511
(907) 344.4551
FAX (907) 344-2130
CALCULATED BY. DATE
CHECKED BY DATE
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
SEAL)
DATE PEF
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
2
4
COMMENTS
Township, Range, Section:
SLOPE
ENCOUNTERED?
s
IF YES, AT WHAT ~/,4 ~3
DEPTH? p
E
Depth lo Water Alter
Monitoring? Date:
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ,~{rp~ FT AND ~' 1 FT
..... F T ,T , DATE DATE ~'~//~ ~J
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN E FEC O HS , : ¢~
72-008 (Rev. 4/85)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910208
DESIGN ENGINEER:ROBERT KNIEFEL,
OWNER NAME:BRADLEY ROBERT C II
OWNER ADDRESS:7400 HILLSIDE DR
P.E.
DATE ISSUED: 7/24/91
EXPIRATION DATE: 7/24/92
PARCEL ID:01707117
LEGAL DESCRIPTION: SOUTH HILLS BLK
5 LT
8
LOT SIZE: 39356 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
RECEIVED BY: . ~ ~J
ISSUED BY:
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910208
DESIGN ENGINEER:ROBERT KNIEFEL, P.E.
OWNER NAME:BRADLEY ROBERT C II ~
OWNER ADDRESS:10400 THIMBLE BERRY DR.
ANCHORAGE, AK 99515
DATE ISSUED: 7/24/91
EXPIRATION DATE: 7/24/92
PARCEL ID:01707117
LEGAL DESCRIPTION: SOUTH HILLS BLK 5 LT 8
LOT SIZE: 39356 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
.]
I
l~l~,~ ~
Kniefel
No. 4149- E
i L L- k_.- L. \
SYSTEM DESIGN GUIDELINES AND NARRATIVE
Lot 8, Block 5, South Hills Subdivision
SYSTEM DESIGN
1. System Size = 4 bed x 188 sf/bed x 1.5 = 1,128 sf
2. Absorption Bed = 20 feet x 57 feet = 1,140 sf
The bed needs to be 20 foot in width in order to place the
bed on the flat portion of the upper level of the lot. A
narrower bed would require the bed to be lonqer and it would
fall into the sloping areas of the lot.
Ail materials, construction methods and required inspections
to follow MOA rules and regulations. The contractor is
responsible for notifying the Engineer and the MOA at least
four hours in advance of all inspection needs.
Contractor will insure no additions or changes have been
made to the location of wells and septic systems on the
adjacent lots prior to the time of construction of this
system. If any changes to those systems have occurred, the
engineer should be immediately contacted for review and
possible changes will be made as necessary.
The OB/Fill material will be remoVed to the underlyinq
gravelly sand material under any portion of the bed area.
The lot is generally sloping down to the north with slopes
in the 8 - 10% range and flattening to 2 - 4% by the reserve
area. The installation of the system will have little or no
effect on the surface drainage, ground water, or the
adjacent systems in the area.
The septic system should be properly maintained to include
septic tank inspection and pumping as necessary on an annual
basis and no use of a garbage disposal. If a garbage
disposal is used the tank size should be increased to a
minimum 1,500 gal tank and the tank pumped regularly on an
annual basis.
The well must be installed at least 105 feet from the
nearest point on the septic tank. The existing well is to
be properly abandoned prior to the construction and
operation of the new septic system.
page 3/3
Municipality of Anchorage
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: L~ 8..i~_L,,0~ ~ Township, Range, Section:
4-
5
6
7
8
9
Or- =
7-0
SLOPE
SITE PLAN
10
11
12
13-
14-
15-
16-
17-
18-
19
2O
COMMENTS
WASORO~NOWATEReL ~{
ENCO~.TEREO* -- --
DEPTH? a~ E
Depth to Water Al~er ~ ~
Dross Net Depth to Net
Reading Date Time Time Water Drop
,.,c'o :$z. lo .~$
. ~o 11: I~ /o ,~ ,~1
PERCOLATION RATE _
TEST RUN BETWEEN
(minutes/inch) PERC HOLE DIAMETER ~,~ It
I ~'~ ~'~J ~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "~ --~"~'~ J
72-008 (Rev. 4/85)
P.O. ~,J;: 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-41 I ]
DEPARTMENT OF HEALTH & HUMAN SERVICES
January i0, 1986
TO: Permit Applicant
Subject: Permit # 850526
.Lot 8 BLock 5 South Hills Subdivisin
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date°
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation, of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
eric: Copy of Permit
I:::'E:F~M ! ]
DAli.!!: ISSUE:D:
8DC~526
08/2
CONTAC]" F'HC]NE ~
SUSAN FOX
'7400 H ILL,.,?) I DE WA~'
ANCHORAGE, AK 995:1.6
56 :[-5355
LEGAL. Dk.: .,,t~.1.1~, .... ~l,J~:,Olt. l~].L)l.l,, ,:~OI..IIH,:~ HILL,:~ I,..C)T~ 8 :(:I...UCI'...5
SEC]'ION: 2D I'OWNSHIF': J. 2N RANGEE: 3W
L.C~T S:[ ZE: 40086 (S6~. F'T,, OR ACRES)
PIAX BEDROOM~)~: 3
sysLem. Choose 'Lhe option that best. fi'l:.s yDur' site.
'"IF' F;:'. E}:: ll",a ~::~ ll--.~ ~3: IEFJ:: ][:} tP,,t] .,, ~:::,1, F~','. ,'z?-'l~ ][ ll",,.lt
DEI:::"I"H T(] I:!~IF:'E BOTTC)M (FI",,)
GRAVEL. DEF'TH (FT,,
TOTAL DEPTH (I:::'T~)
GRAVE]..,. N:[)[i)'l"l'"l (F:'T,,
f~;RAVEL. LENGTH (F'I".)
GRAVE;!., ~201_,UMI!i: (CU. YDS,, )
'I'~.~NI:: SIZE (GALS)
SO I L RAT I NG (SQ,, I::'1'. /BR)
· ,~"~' TANK b'lUi~T HAVE AT LEAST '1"NO COMF'ARTMENTS
cer"Lify t. hat:
fc:~l' c)n-site sewer's and ~elts as set
fcn'tl'i by the Municipality of Anchor'~ge (MOA) and t. he State of' Alaska,,
I will ins't, all the system in acc:cmdar~c:e ~i'lt, h all MOA c:odE:'s and r, ecju].at:ic~r~s,
and Jn C:(~iitp ], J, al"ic:E, wi, th the design cr':i, ter':i.a of' th:i.s t:~ePmit.
CJJ. s'Lar'H::E'S f'Pc)m any ex:i. st:i. ng we].].~ ~,~ast. e~ater' disposal system of publ:i.c
s,x,,~}e~'agD system on this oP any adjacent ch', n~ar'by lc)t.
:[ under'stand t. ha'E 'l:.his per. mit :i.s raj. id f'or' a fllaxifi}L~fiT Of' 3 b62dpctoiiJs aw'id
ally [:::)l']:[al'{~j[elJi(:)H"iC ,~:i.:L:l. P{~C:ILIiI"e an add:i,t:i,c~nal i:)er'm:i.t,,
]:1:::' A I.I,r'::'T S'TATION IS INS]'Y:q....L[f:D IN AN AREA COVERED BY MOA BUIL..DIIqG CDDES,
'I'HI:~N (;I) AN EH....EC]'RICAL F:'EF~MZT AND :[NSI:::'ECTIC)N MUST BE OBTAINED; (2) AS-...BUZL]'S
W:[L.t. NO'T ~::¢E AF::'F:"'I:RC)VED WI'I"HOIJT AN EL.ECTRICAL. INSF:'ECTZON REPOF~T; AND (3) 'I"HE
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:
1
2
SLOPE
SITE PLAN
10 FI
13-
14---
15-
16-
17~
18-
19-
20-
ENCOUNTERED?
IF YES, AT WHAT
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
COMMENTS
PE.POR.EDB : taurd A. 5ez, tc,
72-008 (6/79)
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
' ' ' ' I - ' il ' J ' ~'
CERT' FI ED BY: ~~~:TE: "'~
Municipality of Anchorage
V
On -Site Water and Wastewater Program61
(907) 343-7904 A F E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-071-17 Expiration Date. l -2 q-21
1. GENERAL INFORMATION
Complete legal description South Hills Block 5 Lot 8
Location (site address) _ 7400 Old Hillside Way. Anchorage _AK
Current Property owner(s) Brassfiel_d Trust Day phone
Mailing address
Real Estate Agent
7400 Old Hillside Way, Anchor age,_AK_.-
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
N
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
Waiver/Variance request for:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: _ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ g y Q Waiver Fee $
Date of Payment _ _61161Z I _ _ Date of Payment
Receipt Number 02 555 Cr __ Receipt Number
COSA # OSC 2 l_ 1307 Waiver #
stance:
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 ARCTERRA CONSULTING_ INC.
Phone 696-6111
Address-20441_PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date . _.3-C _
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. 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,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen o oil' Z-1
encroachments, deficiencies or discrepancies exist. �<, f`1•Y
TPI
6. DSD SIGNATURE
System #1 Approved for bedrooms. + r xsnl erH 1 "z `' /
System #2 Approved for bedrooms.
l�
Disapproved.
Conditional approval for
bedrooms, with the followin stipulations:
((Wwt
`\ Y OF (((i�
wAT IV-,t;/TE --�y
-- -- o ER ANDrn
M WAS ,
—1
PRp�i-o - -
J .O X95
SERVICES
i
Dy:,— `_.__ V-, Original Certificate Date: (Irl, [ Z�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X _ _ Nitrate Advisory _
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other _
COSA blue sheet -10-1 0-12 doc
• l Checklist
Legal Description: South Hills Block 5 Lot 8 Parcel ID: . 017-071-17
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 9/11/91
Total depth 250 ft
Cased to 78 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 4/21/21
Static water level at beginning of test 31 ft.
Comments
B. TANK DATA
Age of tank(s) New years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
Standpipes/foundation cleanout per record drawing
Date of pumping New 6/15/21
D. ABSORPTION FIELD DATA
Which system tested (date installed)8/13/91 - 8/19/91
ALL standpipes present per record drawing
Total measured depth from grade 8.5 ft (max)
Measured depth to pipe invert from grade 5.5/7.5 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 3.0 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes 0 Nc
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 4/21/21
FT STATION
❑ Requl aintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4/21/21
Results Qo/ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 10 min
Final fluid depth 0 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No It
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
ft Community Wells > 200' ® Yes if No ft
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ❑ Yes if No *5+ ft If absorption field is under driveway comment below
Property Line > 10'
❑ Yes
if No *5+
ft Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*:Per 1991 inspection report and meet code at time.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
017-071-17
HAA #
1. GENERAL INFORMATION
plote i~g fiption
Com al ~esc S~)UTH RILLS SUBDIVISION: LOT 8. BLOCK 5
Location (site address ordir~ctions) 7400 HILLSIDE WAY ANCHORAGE, AK 99516
Property owner STEPHAN AND CATHY- KOPP Day phone
Mailing address '¢./O"(~REG BRODERICK WiTH PRUDENTIAL VISTA
Lending agency - Day phone
Mailing address
Agent
Address 424-1 B STREET ANCHORAGE. AK 99505
Unless othe/wise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
GREG BRODERICK WITH PRUDENTIAL VISTA Dayphone 275-7299/727-9627
NOTE: If community well system, provide wd~ten confirmation from State ADEC a~fest;
lng to the legality and status of system.
4.' TYPE OF WASTE~NATER DISPOSAL:
NOTE:
XXX
Individual on-site
Holding Tank
Community on-site
Public sewer
If community wastewater system, provide wdtten confirmation from State ADEC
lng to the legality and status of system.
72-025 [Rev. 1191 ) Front MOA ¢Y21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,570.00 at,
or prior to, closing for the engineering services provided.
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-sita 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 fram the Municipality of
Anchorage flies and from my !nvestigati0n end inspection the on-site water supply and/or wastewater
disposal system is in compliance with all Municipal ar~l State codes, ordinances, and regulations in effect
°n the date °f this i.nsPecti°n~ _ . ~///
Name'of Firm ALASKA V)/A-T'ER ~/'~ ~S~'E~A,~E~, CONSULTANTS, INC. Phone (907) 337-6179
Engineer's Signature L ~%//~ ~/~'--~- · Date" ~/~b0
In conducting this evaluation, AWW¢; ~C.~tteq ,tedI ~ to pro'~ a thorough, conscientious engineerin~ ~nalysls of the
system in accordance ~fth ADEC and MOA DH ~S Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test, and separation distances
measured to readily identifiable features. The operational lifo of all wells and espfic systems depend
on the local soils condition, ground water levels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outs/de the control of
the eva/uator of the system. Satisfactoq/ test results do not guarantee futui'e performance
of the system, nor do they guarantee that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not prot4de any warranty for future est/mate of how long the
system will continue to meet the operational requirements of theADEC or MOA DHHS.
The content of this report is for the sole benefit of the owner listed above. Any
reliance upon or use of this report by any other person or pafly is not authorized,
nor will !t confer any legal fight whatsoever.
6. DHHS SIGNATURE
i Approved for. 4
Disapproved
Conditional approval for.
bedrooms
bedrooms, with the following stipulations:
Additional Comments
By:
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 A~aska. 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 cedificate is issued. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/gl ) Back MOA fl21 Computer Version
RECEIVED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES SEP 2 5 2
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
NIUNiC~I~ OF ANCHOP, AGE
~q~AL SERVICES
Health Authority Approval Checklist
Legal Description: SOUTH HILL S/D; LOT 8, BLOCK 5 Parcel I.D.:
017-071-17
A. WELL DATA
Well Type PRIVATE
Log present (Y/N) Date completed
Total depth 250' Cased to 78'
Sanitaw seal (Y/N)
If A, B or C, attach ADEC letter. ADEC water system number N/A
YES 9/11/91
Casing height (above ground) 26"
YES Wires properly protected (Y/N) YES
Date of test
FROM WELL LOG
9/11/91
AT INSPECTION
9/13/00
Static water level 18'
55'
Well production 2.5 g.p.m.
3.0
g.p.m.
WATER SAMPLE RESULTS:
Coliform 0
Date of sample:
9/13/00
Nitrate
0.500 mg/L Other bacteria 0
Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Date installed 8/13-19/91 Tanksize 1250
Foundation cleanout (Y/N)
Date of Pumping 9/5/00
C. ABSORPTION FIELD DATA
Date in,tailed 8/13-19/91
YES Depression (Y/N) NO
Pumper A+ HOME SERVICES
*NORTH/SOUTH
Soil rating ~ or ffZ/bdrm)
Number of Compartments 2 Cleanouts (Y/N)
High water alarm (Y/N) N/A
YES
SYSTEM WAS PRESOAKED WITH 2000
GALLON WATER HAUL PRIOR TO TEST.
Length 82' Width
Effective absorption area 589 SQ.FT.
Date of adequacy test 9/13/00
Fluid depth in absorption field before test (in.);
1.2 System type TRENCHES
Fluid depth *4"/3" (ins) Minutes later:
5' Gravelthickness below pipe .3'/1' Total depth 8.5'+/-
Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Results (Pass/Fail) PASSED For 4 Bedrooms
*775/568
*0"/0" Immediately after 1343 gal. water added (in.): .11"/15.25"
1440 Absorption rate = 600+
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date -
72-026 (Rev, 3196)* Computer Version
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Size in gallons ~
"Pump on" ~' level at*
~/~ ~ ~ ~um __
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service tine
100'+
100'+
N/A
25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water main/service line 10% Surface wateddrainage 100'+
Absorption field
Wells on adjacent lots
5'+
100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line *5' Building foundation
Surface water
100'+
NONE KNOWN
Curtain drain
F. ENGINEER'S CERTIFIp,~T,~'~
I certify that/
of Municipal r~cord~ tt#a~j,~.~bb
Signature~
Engineer's Name '_TL~
Date
field inspections and review
systems are in conformance
on this date.
JEFFREY A. GARNESS
*PER INSPECTION REPORT
10'+ Water main/service line 1 o'+
Driveway, parking/vehicle storage area 5'+/-
Wells on adjacent lots 100%
.... .
HAA Fee $ ~)0 ,~'~
Date of Payment c['~~-~0 ~)
Receipt Number G ~ ~/~6-~
72-026 (Rev. 3/96)* Computer Version
Waiver Fee $
Date of Payment
Receipt Number
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
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
,¢/7- ¢,'1/-i7 HAA# ~:~'~
GENERAL INFORMATION
Complete legal description
Location (site address or directions) '7 h/~C' C /'~l'~'Db~' L'~IA~
Property owner
Mailing address
Day phone
Lending agency
Mailing address
Day phone
Address
Day phone
Un/ess otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
MUNiCIpALITY OF ANCHO~u~GE
ENVIRONMENTAL SEP. VICES DIVISION
SEP 1 0 1996
RECEIVED
NOTE:
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.
72~25 (Rev. 1/91) Front 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 A/'~ b ~'-7~SC,~d ~ z,./b/'~ ~-L~I~ ~ L. Phone
Address
Engineer's signature
Date
DHHS SIGNATURE
Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
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.
Municipality of Anchorage /MUNICIPALITY OF ANCHOP, A~
S E RVIU~ONM~NT^L s~v~c~s ~
DEPARTMENT OF HEALTH & HUMAN
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 995010 (90'/) 343-4-~P 7 0 7~}96
RECEIVED
Health Authority Approval ChecklJst
Legal Descriptiou:
A. WELL DATA
Well lype
Log preseut (Y/N)
Total depth
Sanitary seal (Y/N)
gt~{',tt..,~ g'00i'O /4i~d~SParcell. D.:
-i7
If A, B, or C, attach ADEC letter. ADEC water system number
Date coinpleted n/" iq
Cased to 7 ~¢~ Casing height (above ground)
jt4.~
Wires properly protected (Y/N) y
FROM WELL LOG AT INSPECTION
Date oftest ~/t~]~ ~/7
Static water level / ~ ~ ~, ~j ~
Well production 2. ~" g,p.m. Z. ~ _ g.p,m,
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed ~2~ff.~/~j Tanksize /~0
Foundation cleanout (Y/N) '~/ Depression (Y/N) tX]
Date of mumpiug ~/lO/*~ Pumper A r~/.~/~
C. ABSORPTION FIELD DATA
Date installed t~./Pbt~/t~ [
Length ~ g. t Width
Number of Compartments ~- Cleanouts (Y/N) Y
High water alarm (Y/N) /X~
Soil rating (g.p.d./ft2 or ft2/bdrm) lo '~-. ~0gSystem type ~ Gravel thickness below pipe J ,~ .~/~ ~ To~I depth
Effective absorption area g-Monitoring Tube present(Y/N)
Date of adequacy test ~/7/~ 6 Results fi'ass/Fail)
Fluid depth in absorption field before test (in,);
Fluid depth ~ (ins,) Minutes later:
Peroxide treatment (past 12 ~nonths) (Y/N)
Depression over field (Y/N)
For ~k)/L bedrooms
Immediately after qS'OgaL water added (in.):
Absorption rate = ~ 6 O~ .g.p,d,
Ifyes, give date
Date installed ~'~~ , Size m gallons ·
Manhole/Access (Y/N) __ ~ ~Pump off Icvel at
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tauk on lot
Absorption field on 1ol
Public sewer ulai~!
Sewer/septic service line
~100~
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundatiou > 1~ t
Properly tine ~']0 t Absorption field
Water main/service tine ~]~9 ! Wells on adjacent lots
Surface water/drainage ~/~0 t
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water > / 00 ~ Driveway, parking/vehicle storage area ,>
Curtaia draia
F. ENGINEER'S CERTIFICATION
i certiJ) that 1 have determined thrufield inspections and review o
m co~/brmance with MOA HAA guidelines in effect on this date.
Signature ~ ~ ~ .''
Eagineer's Name
Date
HAA Fee $ ~, t/t) Waiver Fee $
Date of Payment 7//~ ~//~ Date of Payment
Receipt Number a~/..~ C~ ~) Receipt Number
Rev. 8/95 eSS: haa.wk.doc
Parcel I.D. #
1,
MUNICIPALITY OF ANCHORAGL
DEP~,RTMENT 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
GENERAL INFORMATION
Complete legal description
,Lot 8; Block 5; South Hills Subdiv~ion
Anchorage, AK '
Location (site address or directions)
7400 HillsideWay
Pro perty owner
Mailing address
Lending agency
Bob Bradley Day phone [h) 345-9594
(w) 563-2500
C/O VISTA REAL ESTATE 3000 "C" Stre&t Suite 101 Anchorage,
Day phone
AK
99503
Mailing address
Agent Barbara Ernisse/ VISTA REAL ESTATE 'Day phone
Address 3000 "C" Street Suite 101 Anchora,qe~ AK 99503
273-7269
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 "v
3. TYPE OF WATER SUPPLY: ..-
Individual well
Community well
Public water
XXX
NOTE:
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
NOTE:
If community well system, provide written confirmation from State ADEC attest-
Holding tank ..~ ::
Community on-site .' .
Public sewer ~' .
If community wastewater system, provide written confirmation from State
attesting to the legality and status of system.
72-025 IRev. 1/911 Front MOA #21
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I:I::I:aNION::I A8 NOI.LOgdSNI dO J.N=IIN=IJ.YJ.S 'g
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo? ~ ~t.~{ o~ ,.~3u7't'~ ~IU.-5 ,.~/~ Parcel I.D.
A. Well Data
Well type p/~ i vA7'E~
Log present~/N) YE~
Total depth ~_..5'0 ~
Sanitary seal ~,~N) ¥/&-.~'
Date of test
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~'////?/ Driller
Cased to '~ ? ' Casing height
Wires properly protected ~0N)
FROM WELL LOG AT INSPECTION
RECEIVED
FEB 2 994
g.p.m.
r.,~!,u??,Pa,q¢~, ct/~,rlchorage
~'"P~, r~ealth &Hurnan Services
SEPARATION DISTANCES FROM WELL TO:
Septic/he~l~tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of samp~le:
Nitrate
(/"}, / ~// Other bacteria
B. SEPTIC/I-titMiCe-TANK DATA
Date installed ~//E/L./
Cleanouts(~N)
H gh water alarm (Y/I~_
Date of pumping
Tank size /~-~O G,"4 ~ Compartments
Foundation cleanout~N) ~/E.~ Depression
Alarm tested (Y/N) ..4~d~
SEPARATION DISTANCES FROM SEPTIC~TANK TO:
Well(s) onlot /(')0 Cf.- Onadjacentlots /00 r7~-
!
To property line ¢~ I Absorption field
Surface water/drainage .,X/O/_~ ~ /Z~/?/]/,~/~/
72-026 (3/93)* Front
Foundation ~' r
Water main/service line //~) ~
CONTINUED ON BACK PAGE
C. LIFT STATION /~ ~[---2~- /2/~g~::~::/L--) ~'~
Date installed Manufacturer
Size in gallons Manhole~)
Vent (Y/N) "Pump on" level at "Pump off" Level at
High water alarm level Cycles tested
Meets MOA electricS__ ¢
~ lot On adjacent lots Surface water
Soil rating (GPD/Ft2) /, ~
Gravel thickness
D. ABSORPTION FIELD DATA
Date insta,ed ?/l+l
Length ~ ''-~ Width
Total absorption area .~'~ ~ ~ Cleanout present(~)
Date of adequacy test '~/lc//~ ¢ Results(~/fail)
Water level in absorption field before test ~.~
System type (L.JID¢~-~
Total depth
Depression over field (Y~
for ~ ~) Bedrooms
After test
Peroxide treatment (past 12 months) (Y/N) ./C?O/~)~-~- ~Q.~.~L~) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot /(~
To building foundation /
On adjacent lots ~
Surface water /,"'X'~
Curtain drain /[.)0/.-)~
E. ENGINEER'S CERTIFICATION
On adjacent lots ,/~ (~,~ Property line
To existing or abandoned system on lot /0OAJ~
~,~tbc,,'~ ~'/'7'O 5'7'£~' ~¢?¢ Water main/service line
Driveway, parking/vehicle storage area /C3 Cf-
I certify that I have checked, verified, or conformed to all~OA /
Signature S & S ENGINEERINO
Engineers Nam~:~le ~[v.r. AI~ ~77 ./
and HAA guidelines in effect on the date of this inspection.
HAA Fee $ ~ ~ '~ ¢;)d-)
Date of Payment
Receipt Number
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
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. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ~ '%'
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
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 ~
NOTE:
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of System.
72q325 (Rev. 1/91} Front MOA #21
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 thi~ inspection.
Name of Firm /~'J b 6'1z--~ O 'J ~'¢J ~ ~¢J~,'J ~ Phone
Address ~::~ O, go*- Z ~/O 77--~ ,4f, JC~OfZ-~,~ /¢~Y--
Engineer's signature /'~c/cCz~- ~ (/~_4~¢(~.- ..- Date
DHHS SIGNATURE
~ Approved for
Disapproved.
//:~,.~-~ (,~'~/) bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By'. Date
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. Em ployees 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.
~'2~O25 (Rev. 1/91) Back MOA ¢¢21
. Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: l'~)]" 9/ ~[c~d/k J~/ '~r~ ~ I ~ Parcel I.D.
A. WELL DATA
Well type t~,-it,>;\~i>
Log proso!~ (Y/N)
~,./L ~
Total depth
Sanitary seal (Y/N) ~"
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed ~JlJ I~1 Driller
Cased to :Z~' ~,~,-~ Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT INSPECTION
~ On ~aj~o~nt Ires ~ I
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot J~?""
Absorption field on lot I jo
Public sewer main
Public sewer service line ~J/~
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: ?/l'4 ~
:0-~,, I~ i~J/L Other bacteria
Collected by: /~, !/[4 . . ~,~/
B. SEPTIC/:r~ TANK DATA
~ ~"_~/ I~'l/o I?1 _Tanksize I~/''(~) ~:~L,L~o~J,~, compartments
Date installed
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression (Y/N)
~(Y/N) 'J/> Ala~(Y/N) ~/-~
Date of pumping ~¢'~
SEPARATION DISTANCES FROM SEPTIC~ TANK TO:
Well(s) on lot Jo'S' On adjacent lots ;> Jig;
Topropertyline ) ~,O Absorption field ~'~f~/'
Surface water/drainage > J.~(~/
Foundation 7l
Water-mill/service line
72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION I~J//-~'
/
'[~ Manufacturer .
.~ze in gallons '-'----. Manhole/Access (Y/N)
High water alarm level ~ -- .~¢~/~les tested __
SEPARATI~~M LIFT STATION TO: '-----~.
~ On adjacent lots Surface water '--"-'--~-----.,
D. ABSORPTION FIELD DATA
Date installed ~ I~-I£'~!~1 Soilrating ~'~h~'/IP(~.' System type Wli')~
I.ength ~ Wid~ ~' Gravelthickness / ~ ~ ~ Totaldepth
Total absorption area _ ~ ~ ~ ~ ~ ~[~ ¢ Cleanouts present (Y/N) '~
Depression over field (Y/N) ~ Date of adequacy test
Results (pass/tail) ~W 4~W~[[u~'lgd for ~
Peroxide treatment (p~st ~2 months) (Y/N) ~ If yes, give date
bedrooms
Surface water ~'~_
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
We, o,~lot Onadjacentlots )'J~'~/ Propertyline, ~'~'
To building foundation )'IL2~ To existing or abandoned system on lot
Onadjacentlots )'~O/ ___Cutbank_ d//J¢ Water~/serviceline_
/
_ Driveway, parMng/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
of this inspection,
Engineer's Name
[)ate
HAA Fee $
Date of Payment
Receipt Number .,'~ ~ Z,~ ~:~ ~ /~;'~...~
72-026 (Rev 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
\
/ 1
I~'amm o~ Al~m..Im.~ capped
pipe a~/o~ rebar
13. 2xZ hub &tack raco~r
· ' tVS" X ~0" tiber met ~i~; Em'~'/
Date . Pmpared by:
S=,e /'--40'O'~-..90-...q:::) r~or~-~
/?.. 1... BU?~'ON
Ref.
Property :
z...q ~,-zP ~'~'"°'~9~o/ .:' '~b
Mayor
/V tunicipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
February 25, 1992
Michael E. Anderson, P. E.
Anderson Engineering
PO Box 240773
Anchroage, Alaska 99524
Subject: Waiver Request for Lot 8 Block 5 South Hills Subdivision
Waiver Request ~WR920008, PID #017-071-17, HA920111
Dear Mr. Anderson:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 5 feet of the west property line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel N. Bolles
On-site Services
Concur :/~
~rogr~m ~na~er
On-site Services
ljm:7
February 25, 1992
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
RECEIVED
FEB , 992
Municipality o~Anchorage
Dept, Health & Human Services
Reference: Lot 8, Block 5, South Hills
Subject: Separation Distance Waiver
Dear On-Site Services Engineer:
The septic system on the referenced lot is located within 10' of the
west property line. This line is also the boundary of the right of way
for the proposed O'Neill Lane. No septic system or any improvement
other than roadway related improvements can be placed in the right
of way. There is no possibility another septic system can be placed
in this right of way and be closer than 10' to this system.~
In its present location lthe septic system has no adverse impact on
any improvements in the area. We, therefore, request a separation
distance waiver to allow the septic system to be less than 10' from
! ,.
the lot line. ~"~,.~..~ ~. t:r,~d~'
Sincerely,
Michael E. Anderson, P.E.
Enclosures