HomeMy WebLinkAboutSANDI HEIGHTS LT 8A,,ndi H
ight
Lot 8A
#011 - 222- 50
Municipality of Anchorage ,....:~,
'~'
Development Services Depadment :'
Su ding Sal'e y Division
On-Sile Water and Waste~let Pt~fam. 4700 S. Bmgaw
P.O. Box 196650 An~orage. AK 99519-6650 Page
~.cl. ancho~age.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: ~0~ IO~ PIONumbeE OII-
"- ~3~ F;~ ~ WastewaterSystem: ~New ~Upgrade
'~ "~ ~: "~'~"
Well: ~New ~ Upgrade ~"~
SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P. ~ Othec
To Septic Abso~pltor Lift Holding Pu~r~l~
Tank Field Station Tank S~r [~e ~ ~ ~
,-,- 37'13' V'"'~
L~7,~ $~re~ ~4~ ~v~t~ BENCH MARK
_ ~ ~ A-.....,~
S & $ ENGINEERING
nspect ons pe,ormed by. 17034 Eagle River L--P Road, "o.~
DevelOpme~ ~ Services Department Approval ,~. ~
· h ~'- ............. ,~'~
Reviewed and approved by: ( ~
PERMIT NO SW020105 PAGE 2 OF 5
Municip. oLit.. _y_..oF' ,A,n c:h,o,? ~ig,e'
DEPARTMENT OF HEALTHAND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ®Anchorage, A.~l~sk~ 99519-665,0~ Te.l.e, Ohone:. 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LECAL LOT SA, SANDI HEIGHTS S/D P.LD. NO. 011--222-50
DRIVE ~ I m
, I ~ ~ I I
ZO~
~ ~.> (OK roR
I ~-~-~-~-~-~-~-~-~F~- I
, 9 4 th C 0 URT
PERMIT NO.Sw020103 PACE 3 OF' 5
D........ N_u Q ic ip. g I, i";. y_.o. F .A. nE h.o..r' g g.e'
I-I-'AI-R/MI-'NI OI'- HEAL]~H AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
· P.a. Box 196650 ~.,Anchorage, A~!l~ska 99519-665.0 · Te.[ephone: 343-4744
ON-SITE WASTEWATER DISPOSAL :SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT SA, SANDI HEIGHTS S/D
P.LD. NO. 011-222-50
ST1 ST2 /99.5'
FINAL
A, ,,/'1 NEW 1000' ~
94'4'/ I GALLON 94.2
I SEPTIC TANK
FINAL GRADE~----
MT1 = 87.9' -/
COl =99.5'
02=99.5'
·
NO WATER FOUND
81.q' B.O.H.
A B
FCO 19.5' 11.0'
ST1 21.5' 9.5'
ST2 27.5' 9.0'
DBL1 29.0' 10.0'
OBL2 50.5' 11,0'
C01 44.0' 51.0'
MT1 4-4.0' 52.0'
C02 14.5' 40.5'
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-?904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: May 10, 2002
Expiration Date: May 10, 2003
Permit Number: SW020103
Legal Description: SANDI HEIGHTS LT 8A
Design Engineer; 0003 S & S Engineering
Owner Name: John Fishbeck
Owner Address: 9405 ENDICOTT STREET
ANCHORAGE, AK 99515-1043
ParcellD: 011-222-50
Site Address: 009405 ENDICOTT ST
Lot Size: 12241 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Issued By: ~
Date: -'c' /l ° /c ~"
Date:
Municipality of Anchorage
Development Services Department
Building Sal'ety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ct. Rnchorag e.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ParcelI.D. Oil - ~3,~ - 5-0
Permit Number SWO~ O/O.~,
Properly owner(s) ~-'O
Mailing address (1)
Mailing address (2)
Legal description (Lot, Block & Sub'd.) Lo'f-
Legal description (Section, Township & Range)
Lot Size I '~,1 ~ f'lt' ! AcreO
Day phone
¢/,~ .s-o 2..
Zip Code
Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Well Only
Water Storage
Water Softening Unit
I cedify that Ihe above Information is correct. I fudher cedify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes,
$ & $ ENGINEERING
~/~/2 ~ 17034 E.gl. Rlver Loop Road No. 204
(Signature of property owner or authorized agent)
Permit Fees: t/¢00 C~. e $ # ) Waiver Fees:
Date of Payment: ~'//~'/ o Z... Date of Payment:
Receipt Number: ~ I fi ¥ $' 7 Receipt Number:
(Rev. 12/00)
May 8, 2002
ROBERT C. COWAN, P.E.
CML ENGINEER~
(907) 694-2979
FAX (907) 604-t2t t
SEWER&WATER
8OILTEST
MUNICIPALITY OF ANCHORAGE
Development Services Department
P.O. Box 196650
Anchorage, AK 99519
REFERENCE: Lot SA, Sandi Heights Subdivision
It is requested that you issue a permit to replace th~ septic tank (if necessary) and
install a new trench to serving the existing three bedroom dwelling on the referenced
property.
A test hole was excavated and a percolation test performed. The approximate location of
the test hole is located on the attached site plan. At the time of excavation 4/26/02 no
water was found. After monitoring, ground water was not found.
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic tank. The installation
of this septic tank will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
RCC/b
Enclosm'e
· t7034 IqORTH EAGLE RN~R LOOP; SUITE 204 ~ EAGLE RIVER ALASKA ~9577
B.J.J. R.C.C. 5-8-02 1 OF 1
,
.~o~,,,..,..-... , LOT 10A ,,
DRAINFIEL[ CRITERIA:
~2.~' ~P ', I I I
I
z 6.0' EFFECTIVE I
I
Zl
q 3.0' WI~[,
~ mi I~ I
~ LOT 3 ~1 ~, ~_ ,
' _SEP
~ ~1 I I1 EA
~ I I~ I
,SCPT~ T~K I I
GRAVEL ~ (TO ~ vtnJ¢~OI J J
z I I o o . EA
z o ~ .r~ I I
-- -- I I
' I I I
~ J
~, , ,,
, I I h~* I I
I . ~o~ ~o/ I
...... F'- I
~1 , ,..
: LOT S 94th COURT
Municipality of Anchorage I
Development Services Department
Building Sa fety Division . ,..
On-Site Water and Wastewater Program
4700 so~th ~=gaw S~ "~:" '-'~ ' ~.Z;..' ' '. ....../.,~-'~'~
P.O. Box196650 Anchorage. AK~9519-6650www.ct.anchomaeak.us ~.~ ..,~,~o RC:;;~T C CO'.:A.~ .. ,-~.
(9O7)
343-79O4
/
/
Soils Log - Percolation Test /
/
Performed For: ~1'~I Ft.5,1~HBRcK Date.Performed: ~/~
Legal Description: J-'~'7'* ~'~ .,('/L~',J I H'~ I ~:/~ r $ ~'t*/.O Township, Range. Section:
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
18.
19-
20-
5~
SIoDe Site Plan
WAS GROUND WATER
ENCOUNTERED? /'~ 0
S
IF yES. AT WHAT DEPTH? ~ L
O
Depth to Water After p
Monitoring? D/q'~ E
Date: ~'/3/0~-
COMMENTS ~i C.~.
Reading Date Gross Time Net Time Depth lo Water Net Drop
PERCOLATION RATE /~ I (n~ute~'~c~) PERC HOLE DIAMETER
TEST RUN BEI~/EEN ~:) '/3-- FT AND
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ,~'-'/~/0 ~--
ROBERT C. COWAN. P.E.,.
CML ENGINEERS
(907) 694-~7B
FAX (907) 694-12t i
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
· REFERENCE: Lot 8A, Sandi Heights Subdivision
May 8, 2002
GENERAL:
The scope of this project includes the verification of the existing 1000 gallon
septic tank, replacement with a 1000 gallon minimum septic tank if required,
and installation of a new trench to serve the existing three bedroom residence
located on the referenced property.
Construction shall be in accordance with the approved site plan and design
drawings, Municipal permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any necessary underground
utility locates.
Unless specifically agreed otherwise, the property owner shall be responsible
for final grading areas subsequently depressed from soil settling.
Contractors installing wastewater disposal systems must be certified by the
Municipal ttealth Department for system installations. Owners installing their
own systems must also receive prior approval from the Municipal Health
Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be gonstructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
17034 NORTH EAGLE RIVER LOOP 4 SU1TE 204 · EAGLE RIVER. AI.A~KA ~9577
Page 2
Lot SA, Sandl Heights Subdivision
May 8, 2002
All standpipes on the septic tank shall extend a minimum of 12 inches above final grade.
Septic tanks installed with less than 4 fl. of cover shall be insulated.
A foundation cleanout shall be installed one to four feet from the building foundation. In
the line between the tank and the leachfield there shall be two adjacent cleanouts (unless
an effluent pumping system exists within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 fl. from the tank. The first cleanout, in line,
shall be to clean toward the leachfield. The second cleanout shall be to clean toward the
septic tank.
Final grading over the septic tank shall be such that a positive slope exists away from the
septic tank.
ABSORPTION TRENCII/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of the
excavation shall be within 2 inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock)
placement.
Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced do~mward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt ban'ier covers the entire gravel surface before placing backfill.
Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations
shown on the design, and extend a minimum of 12 inches above final grade. The portion
ofthe monitoring tube extending through the gravel shall be perforated from the bottom of
the trench to the invert ofthe distribution pipe. This is equivalent to the effective depth of
the gravel as noted on the design.
Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The
finish grade over the trench must be mounded to prevent the formation of a depression
after settling.
Page 4
Lot 8As Sandi Heights Subdlvlalon
May 8, 2002
The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading ofthe property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer
is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-
construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or
control in any way the contractors activities.
The owner shall contract with the contxactor to perform the work outlined in these specifications
and plans and in accordance with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be
the owners representative and will inspect the work as stated above to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor to
carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR / INSTALLER
Page 3
Lot SA, Sandl Heights Subdivision
May 8, 2002
MINIMUM MATERIAL SPECIFICATIONS:
I. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
e
Municipality of Anchorage:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM FSI0 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type ofpipo other than listed above must be approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or
equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the//200 sieve.
When sand is being used as a filter material, its gradation specifications must conform to
current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follmvs:
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
OSC251074
Parcel ID 011 -222-50
Legal description SANDI HEIGHTS LT 8A
Site address 9405 ENDICOTT ST
Current property owner(s) BRIDGES TANYA
Expiration Date: 1/31/2026
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
�y: �i� :.0 �L-�� Original Certificate Date: J/ 1 U/LULO
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,
Z
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 X 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
Parcell.D. 01122250000
Complete legal description SANDI HEIGHTS LT 8A
Location (site address) 9405 ENDICOTT ST
Current property owner(s) BRIDGES TANYA
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone 916-704-4177
3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑■ Community Well or Public
❑ Water Storage
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 ❑ Concrete ❑ Fiberglass
Age 23 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $5D
Date of Payment
1
COSA # D 5C. a 5107 LI
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: SANDI HEIGHTS LT 8A Parcel ID: 01122250000
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.
Comments No Well On Lot- Water Provided By Public Water
B. TANK DATA
Measured operating fluid level in septic tank 50
Date of pumping 1/31/25
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/15/02
Q ALL standpipes present per record drawing
Total measured depth from grade 12 ft (max)
Measured depth to pipe invert from grade 7 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
0 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
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes 400@66
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/26/25
Results Q Pass
Fluid depth prior to test 0 in
Water added 450 gal
New fluid depth 4 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 60
Effective depth used 0 in
Effective depth remaining 60 in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
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 ft
Neighboring Absorption Fields > 100'
Yes
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No ft
Water Main > 10'
❑■
Yes
if No
Manure/Animal Excreta Storage > 100'
Community Wells > 200'
Community Sewer Main > 75' ❑ Yes
if No ft
r] Yes
if No ft
❑■ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'■❑
Yes
if No
ft
Surface Water > 100'■❑
Yes if No ft
Tank to Property Line > 5'
❑■
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑■
Yes
if No
ft
Private Wells > 100'
Q 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 tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & STATENIENT 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 NorthRim Engineering Phone
Engineer's Printed Name Steve Eng Date _
COSA Checklist June 2022
694-7028
2/5/25
4!1111� OF
S1
#
.•49 TH.. *.
r Steve En
,,® CE-6256;Fi
2'1 29'
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT r�'On-Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC251074
Subdivision: Sandi Heights Block: , Lot: 8A
907-343-7904
Fax: 343-7997
The septic tank for this property is 23 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
I
I
30.0' I
I
I
M
Z
I
�-z
v
o
O
0
0
O
m
O
N
�
�
;0
o
M
M
o
i
ASPHALT
PAVEMENT
3.8' DECK
42.1'
Lot 8A
12,241 s.f.
Lot 9A
Nq
I� 4.0'
a 24.2'
,W
U
�W
24.2'
10' UTILITY EASEMENTS
X 8.0' STORAGE
S 89'58'00"E '135.86'
CHAIN-LINK FENCE
x 72.4' DECK
_-3.7' x 8.0' STORAGE
CV
N
N 89'58'00"W 135.86
W. 94th COURT
WOODEN FENCE
I �
Lot 6A
I�
(n
O
O
O
C
o Lot 7A
M
O
0
u -i
04
NOTES: GROUND LEVEL IMPROVEMENTS SHOWN ARE APPROXIMATE. DATE OF SURVEY: 27 FEBRUARY 2025
PLOT PLAN ___ AS BUILT _X_ SCALE _ 11 30__ GRID _ SW 2424__ Project No. J25=0481A1
P.O. Box 210005 ��}}
Lang &Associates, inc. Anchorage, Alaska 99521-0005
soopI, _ 1
Professional Land Surveyors sure y�a64surve com �.F.'�.���4�
surve g y.
I hereby certify that I have surveyed the following described property: ��P Soo
8A, SANDI HEIGHTS SUBDIVISION (Plat No. 71-134)
lo -
LOT y�0o
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 surveyedQO
premises and that there are no roadways, transmission lines or other visible NATHAN LANG• 0 Z
easements on said property except as indicated hereon. OD
S-9944. • J
Dated this the J Day of RG– –_____, - at Anchorage, Alaska o p o
40oR��fSSIONA� dao
It is the responsibility of the owner to determine the existence of any easements, DOpppoo�
covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P,O. Box 196650 Anchorage, AK 99519-6650
wv~,v, ci.ancho rage.a k.us
(907) 343-7904
Parcel I.D. Oil -~.3.~ - 5-0
1..G. I~N ERAL INFORM.ATION
'. Complete legal desc~dption
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING':
Expiration Date:
L0c~tion (site addr6{'s' or directions)
"Current Property owr~ei-(s)
· --' Mailing address
Lending agency
c qO 5-
Dayphone (:,~(~-0 3'J-O
,4 ,~c.~' 4,c' ~q.to .2.
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Un/ess otherwise requested, HAA wi/I be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
3. ;i'YPE OF WATER SUPPLY: '
Individual Well []
Individual Water Storage []
Community Class ,A Well []
Public Water System []
TYPE OF WASTE~NATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site ' []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C we!l and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Ceffdficates are valid for one year for properties served by Class A or B we!Is or a public water system. The
Munic!pality of Anchorage is not responsible for e,,Tcrs or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that t~e 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
i~.v,~ ~le Ri,tot L~p Road No, 2~
Address ~l. River. al,,u~
Engineers Printed Name ~0~gA~
bedrooms.
DSD SIGNATURE
V'/ Approved for ~'
Disapproved.
Conditional approval for
Phone
Date ,,~'/;L //0 Z-
~.~:,~.,~;L.:.,..~,.~ %..
.~,,. ~- ..... :..
~"rY'~'~'~'""~ x._..~,.~
~it.'"/',;,': ' - ';%',~"'~.'"
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HA,& Checklist
Septic System Advisory
Well Flow Advisory
..-
,..~,~.:'-ON-SITE "~"
~': WAI~-r~ANU : ~'
~ ; WA~TEWATER :
-- PROG~M .'
.... .."2
X
By: ~,.,~L ~,~
Maintenance Agreements
Supplemental Engineer's Report
Other
Odginal Certificate Date: 5'/Z ~/C 7_
Municipality of Anchorage
Development Services Department
Building Safety DIvision
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 19665O Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7004
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDesoflption: LeT' ~/~ $,4,~el q t~t6-~IrJ g/9 ParcellD:
A. WELL DATA
wen type A
Date completed
Total depth
Date of test
Static water level
If A. B, or C provide PWSID # ~, I O'¥ fJ" wen Log (Y/N) ~
Sanitary seal (Y/N) Wires pmpe~.rt~o~3T~ected (Y/N)
ft. Cased to ft. ~si~l~etght (above ground)
wen production J g.p,m.
WATER SAMPLE RES~~.'
Coliform ,,,""colonies/100 mi. Nitrate mg./I.
Ara~ rng./L Date of sample:
B. SEPTIC/HOLDING TANK DATA
TankTyba/MaterlaI .,Y~,~T /C // ~'T' & ~. C-
Tank size 'i° e,o. - gaL" .' :'. Number of Comparlments
Fo-ed'atio. ~Jea.out(~) ~ D~pra,,ion ovar tank ~'~
Date of pumping H~J~- - ~ ~ Pumper
C. ABSORPTION FIELD DATA' '
g.p.m.
in.
Other bacteria
Collected by:
colonies/100 mi.
Date instened ,.~ / ,.r"/o ~
Cleanouts~/N) 'Y/-' J
High water alarm (Y/I~ ~, o
Date =tenedr/~A ?-"
Totaldepth f 3.. ft.
Date of adequacy test
$~nrating (g.p.d./ft2orft2/'Ddrm)'~?~_--~"__-~-~t'_~.) Systemtype T,<e~,c"
ft. Wldth ~ it. Gravel below pipe ~ fl.
Eft. absorption area'~/~- ~ Monitoring tuba ~'~'J' Depression over field ~/o
/~///t' -/''4~ Results (Pass/Fan) For __ bedrooms
Fluid depth in absorption field before test ~ gal. New depth
Elapsed ~me: min. F~epth in. N~sorption rate >=
Any rejuve~3~l~ (past 12 mo.) (Y/N & type) If yes, give date.
in.
g.p.d.
D. LIFT STATION
Date installed
"Pump on" level at
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/A~s~*~~
in. 'Pump off'~alarm level at
Cycles tastad Meet~ alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lit
Absorption field on lot
Public sewer main
On adjacent lita
~e/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 7 / Property line 'j '7 / Absorption field
Water main I b (+ Water service line / 0 ~c Surface water
Wells on adjacent lots
leo
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I ~ ~
Building foundation
Water Sewice line / 0 /~L Surface water
Curtatndrali/o~,~4~ /~o,.,x Wells on adjacent lits
Water main /0 ~
D~iveway, paddng~ehlcla storage
/o +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/ cerSfy ~a! / have detenn/ned through field/n~s and
~an~ ~ MOA H~ gu~e//nes /n eff~ ~ ~/s da~. ~'~~::'""'~
Engin~fsPdnt~Na~ ~0~ ~. ~0~
Oa~ ~/~ //O ~
Date of Payment
Receipt Number
(Rev. 12mt)
Data of Payment
Receipt Number