HomeMy WebLinkAboutHERITAGE PARK BLK 1 LT 15AMunicipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211450 PID Number: 050-211-81
Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑® Upgrade
Name
GLASPELL JAMES AND SANDRA
ABSORPTION FIELD
9 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
19738 IVY HOME CIRCLE, EAGLE RIVER, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from origi nal grade
907-830-0124
4
0.8 GPD/SF
11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
8.0 Ft.
Subdivision Block Lot
HERITAGE PARK 1 15A
Fill added above original grade
0.5 Ft.
Gravel length
47.0 Ft.
Township Range Section
Gravel width
3.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
752 Fe
1
N/A Ft.
Well
N/A
NIA
N/A
N/A
>25'
Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
N/A
>100'
N/A
N/A
Gal.
Material
NO f compartments
Lot Line
N/A
>4'*
N/A
N/A
NA
Foundation
N/A
>1 0'
NIA
N/A
qEIATATION
Manufacturer
Capacity
Remarks *OSV211089 REDUCED SEPARATION TO 4'.
Gal.
Alarm location
Electri tailed by
PIPE MATERIAL House to tank N/A Tank to D3034
drainfield
Installer JR'S SEPTIC
Drainfield D3034 CO/MT D3034
Inspector L.TIDWELL
BENCH MARK (Assumed elevation) 100 ft
Inspection 15ectio} 11/4/21 11/4/21
Location and description
2�d
3m 4th
TOP OF FOUNDATION AT SW CORNER OF HOME
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF
Conditional Approval: Datep'
49 i7-1
•
Septic System
�•.. Benjarrinchiller .•:�
�� CE 12592
Approved Date 12 b a02 t
�sl • .. 12/01/21 , . •'vim
FpAW
PROFESSO��.
Note:
this approval does not include well permit requirements.
trcev uoivu_ta)
// // // /
/
//
/
/
/
/
/
/
// // ABANDONED ABSORPTION
TRENCH
Benjamin Schiller
CE 12592R
E
GISTEREDPROFES S I O N A LENGINEER1"=50'
47' LONG x 3' WIDE, 8' EFFECTIVE
DEPTH ABSORPTION TRENCH
CONTOURS ARE ESTIMATED FROM
MUNI MAPS
TRENCH INSTALLED PARALLEL TO
ACTUAL SLOPE
EXISTING 1250 GAL.
TANK TO REMAIN IN
SERVICE
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
PERMIT # OSP211450 PID # 050-211-81
HERITAGE PARK, BLOCK 1 LOT 15A
A B
C01
46.0MT1
47.2
CO2 68.8
A
B
MT2 69.5
CO3 40.3
33.1
33.9
26.7
27.5
22.0
FEET
0 50 100
Dec 05, 2021 IVY H
O
M
E
CI
R
C
L
E
3-BDRM HOME
780
780
770
760
750
10' UTILITY
EASEMENT
TV PEDESTAL
SHED
SHED
DECK
MT1
MT2
CO2 CO1
PRIVATE WATER SERVICE
CO3
PLAN AS-BUILT
PROFILE AS-BUILT
(NO SCALE)
88.3 FINISH GRADE
47'MT276.8
84.8 CO2CO176.8
84.8
87.8 ORIGINAL GRADE MT1Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A LENGINEER11/17/21
PERMIT # OSP211450 PID # 050-211-81
HERITAGE PARK, BLOCK 1 LOT 15A
TH#172.8 GROUND WATER 11/14/21
70.8
I
x
I
�V
N
LOT 16 (+�
h
h
0
Co
O
x
I SHED
x
I
x SHED
I
ALUMINUM
MONUMENT
LOT 22
\ IVY HOME CIRCLE- -
TV
PEDESTAL
N �
A50.69'
R125.00'
10' U IT LITY EASEMENT
x y
�\ 2
m
x �
G
7�
LOT 15A
22,551 sq. ft.
T
24.0' 7.T
0
Sq 9
24.0' o x
SEPTc 2 -STORY
STANDPIPES N FRAME
3 -
13.5, HOUSE x
o
21 0, 0 13.5'
Dx
DECK ECK
� I
x
X I
�co,
x
I
x x
I
x
k I
1,3(9.09, k x
x�l
LOT 23
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (83-243) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY AND IS
SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY
SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE LOCATION
SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ADDITIONAL USES ATA LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR ISA
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED,
THE LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
JOB # 21196 I NO CORNERS SET THIS DATE I SCALE 1" = 30'
m
REBAR
0 15' 30'
LOT 14A
4 L
�'. Bu u Sali �o
LS-14837��
1,312021
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 15A, HERITAGE PARK SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 3rd DAY OF DECEMBER, 2021, AT
ANCHORAGE, ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services 907.290.8949
225 VV 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM
MUNICIPALITY OF ANCHORAGE 1»cnt-
On-Site Water & Wastewater Program° Sf
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite2) 1:..1
Department
On -Site Wastewater Disposal System Permit
Permit Number: OSP211450 Effective Date: 10/22/2021
Work Type: Septic Upgrade Expiration Date: 10/22/2022
Tax Code Number: 05021181000
Site Legal Address: HERITAGE PARK BLK 1 LT 15A G:0055
Site Mailing Address: 19738 IVY HOME CIR, Eagle River
Owner: GLASPELL JAMES A & SANDRA D Lot Size in Sq Ft: 22551
Design Engineer: FORGE ENGINEERING Total Bedrooms:
This permit is for the construction of:
Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b_ Covered, sealed, and heated to prevent freezing
Special Provisions:
The water service line location is to be located to ensure that the tank meets the required separation. Show the
service line on the Record Drawings.
Received By:
G✓
CO Trench
/-3/ZJ
CO,7;1 Sh �Iec� �slelC� to GveSfi. See UJaiVeV,
Veronica Pope
TWP41�'RGE 2021.10.22
..., 12:37:33 -08'00'
Date:
Issued By;, t— Date: Z2
12l
'.,z-/ 6--
/
/ 1/ql-z l
— nticnt
Municipality of Anchorage
\ 1)r p'rtment
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http:1/www.muni.o,rq/0nsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV211089 COSA#: Permit#:OSP211450
PID#: 050-211-81
Legal Description: HERITAGE PARK BILK 1 LT 15A
Engineer: Forge engineering
Your request for a waiver of the required 10 feet horizontal separation from the absorption field to
the property line has been approved. The approved separation distance is 4.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
from this department.
............................................... ■ ............................. ■ 1
Waiver is Granted: X Waiver is not Granted:
Date: �-i Z� Approved by:
Name of Reviewer
.......................................................... ■ ............... ■ .
**** VARIAN C E/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
_Community Development -Department--- _. _________ _---------.Phone:-907-343-7904--------
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-211-81
Property owner(s) James Glaspell Day phone 907-830-0124
Mailing address 19738 Ivy Home Circle, Anchorage, AK 99577
Site address 19738 Ivy Home Circle
Legal description (Sub'd., Block & Lot) Heritage Park Block 1 Lot 15a
Legal description (Township, Range & Section)
Lot Size 22,551 Sq. Ft. Number of Bedrooms Li
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑x
Initial ❑
Single Family (SF)
❑x
(w/wo ADU)
Septic Tank
ElUpgrade
❑x
(D)
El
Holding Tank
❑
Renewal ElDuplex
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
certify that the above information is correct. I further certify that this is in accordance with
applicable
jMunicipal Codes.
i
(Signature of property owner or authorized agent)
Permit/Rush Fees: �2 Waiver Fees:
Date of Payment: 01za A I Date of Payment:
Receipt Number: r-)Sa l80 Receipt Number:
Permit No. 0332 11 `f 50 Waiver No.
Permit App_'-'-:- . _..:c
LT
October 19, 2021
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
10/19/21
Subject: Heritage Park Block 1 Lot 15a- 19738 Ivy Home Cir.
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot has an absorption trench on the property has reached its end of useful
life. We are submitting this permit application for the installation of a replacement trench. The
attached site plan identifies the location of the home, existing septic system location, as well as the
proposed absorption trench location. No conflicts exist between this proposed system and any
other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the southern portion of the lot. There are no slopes
greater than 25% within 50 feet downslope of the proposed absorption trench location. Elevations
are identified on the site plan showing the grade and direction of flow. Stormwater drainage will
not impact this septic system. The new absorption trench will be constructed parallel to the slope
as much as possible.
The home is serviced by a public water supply and the water service line is identified on the site
plan. The new system will be a minimum of 100’ from surface water, and more than 5’ away from
the septic tank. The new absorption trench if located more than 16’ away from the existing trench.
Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211450, Deb Wockenfuss, 10/22/21
E N G I N E E R I NG
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
November 3, 2021
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Heritage Park Block 1 Lot 15a - 19738 Ivy Home Circle
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On -Site Services Engineer:
L�p�Z
�'"3,•ij
of Aqsl��
419 TH
... ..........
r Benda in Schiller .
r� �F'�•. CE 12592//
��'s'l�c • . 11/3/21 �-w
tPROFESSIONPI
t\\\eon
Permit #OSP211450 was recently issued for the subject property. The permit details the
replacement of the septic absorption trench that has failed on the property. While performing the
site layout prior to construction it was determined that due to field conditions the new absorption
trench would need to be shifted to the west. A waiver is required to allow for the trench to meet
field conditions.
The new absorption trench will be constructed 4' from the western property line. The
neighboring septic system is greater than 16' feet away, twice the effective depth of the new
absorption trench. The subject property and the neighboring homes are serviced by public water
and there is no concern for separation distances from wells or water service lines. Should a lot
line waiver be issued, there will be no negative impact to this or neighboring properties. We
hereby request a lot line waiver be issued.
Sincerely,
Benjamin Schiller, P.E.
HERITAGE PARK, BLOCK 1 LOT 15A
CO �x
LOT 13
10' UTILITY
EASEMENT
TV PETAL
i �� LOT 14A
PRIVATE WATER SERVICE
(APPROXIMATE LOCATION)
LOT 16
LOT 1 A\ �
EXISTING 1250 GAL. `
TANK TO REMAIN IN
3-BDRM HOME`
\,
ABANDON EXISTING', ---,SHED DECK
ABSORPTION TRENCH
SH
TH
47' LONG x T WIDE, 8'
LOT 21
f F' RGE
E HG I H!! RING
AMW 4W
� 7H
Benja i Schiller
�'F •• CE 2592
,tc�JjF�FO •11.2r21••.���C��
,1\�_ PROFES510NP .�.
LOT 22
750 I
n
(VOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
NO EXISTING WELLS- PROPERTIES ARE ON COMMUNITY WATER
SYSTEM
0 50 100
FEET
1 "=50'
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
HERITAGE PARK, BLOCK 1 LOT 15A C0 -4t
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW 8' DEEP TRENCH SYSTEM
PERK RATE: 10.9 MIN/IN
APPLICATION RATE: 0.8 GPD/SF
600 GPD / 0.8GPD/SF / 8 DEEP/ 2 SIDES = 46.9 LF TRENCH REQUIRED (47 LF SPECIFIED)
BOTTOM OF TRENCH: 11' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
ILE FABRIC
,ATED PVC (HOLES DOWN)
3'
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
�GE
E N GIN E E R I N G
. ' • . BenjanSchi ller
CE 12592
OPES SIONP�s
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
J. Millette
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
10.9 6
3 4
---
1
2
3
4
5
6
GM (SILTY SANDY GRAVEL
12" MINUS COBBLES)
Professional Engineers Stamp:
NO
15'
10/14/21
Heritage Park, Block 1 lot 15a
10/6/21
050-211-81
Jim Glaspell
11:001
2
3
4
5
6
3 0
16
11:30
11:32
12:02
12:04
12:34
OB
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER10/19/21
30 7 12
16 3 12
16
3 0
16
30 6 12
16 2 12
16
3 0
16
30 6 12
16 2 12
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211450, Deb Wockenfuss, 10/22/21
I
x
�V
N
LOT 16 (+�
h
h
0
Co
0
x
I SHED
x
x SHED
x
ALUMINUM
MONUMENT
LOT 22
\ IVY HOME CIRCLE— —
N �
A50.69'
T� R 125.00'
'V� x
10' U IT LITY EASEMENT
f
r\
i
m
x
LOT 15A
22,551 sq. ft.
5q y,
N
24.0 7.T
0
N
24.01-
2-STORY
4.0'-2-STORY
SEPTIC N FRAME
STANDPIPES HOUSE
13.5' x
3 -
"21 r-
xLLJ
M
W o
pCb' x O
x I N
X x
I
x
k I
/ x
38 09, x \ I
x
\ x
REBAR
LOT 23
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (83-423) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY
SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
JOB # 21196 I NO CORNERS SET THIS DATE I SCALE 1 "= 30'
0 15' 30'
LOT 14A
OF
�'. Bu Saliz o
LS -14837 _-
+' f
lit O
tMO`I M `
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 15A, BLOCK 1, HERITAGE PARK SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 30th DAY OF SEPTEMBER, 2021, AT
ANCHORAGE, ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services 907.290.8949
225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM
2
r
N
�
p�
G
O
�
c9
Q
m
1
�
24.0 7.T
0
N
24.01-
2-STORY
4.0'-2-STORY
SEPTIC N FRAME
STANDPIPES HOUSE
13.5' x
3 -
"21 r-
xLLJ
M
W o
pCb' x O
x I N
X x
I
x
k I
/ x
38 09, x \ I
x
\ x
REBAR
LOT 23
EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
RECORDED SUBDIVISION PLAT (83-423) ARE NOT SHOWN HEREON.
THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEYAND
IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY
SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE
USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR
ESTABLISHING PROPERTY BOUNDARIES.
JOB # 21196 I NO CORNERS SET THIS DATE I SCALE 1 "= 30'
0 15' 30'
LOT 14A
OF
�'. Bu Saliz o
LS -14837 _-
+' f
lit O
tMO`I M `
AS -BUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
LOT 15A, BLOCK 1, HERITAGE PARK SUBDIVISION
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
WITHIN THE PROPERTY LINES AND NO VISIBLE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
DATED THIS 30th DAY OF SEPTEMBER, 2021, AT
ANCHORAGE, ALASKA.
FIXED HEIGHT, LLC C.O.A.122554
Land Surveying Services 907.290.8949
225 W 23rd Ave., Anchorage, AK 99503 WWW.FIXEDHEIGHTCOM
Municipality of Anchorage Page
Building Safety Division
On-Site Waler and Wastewa~er Progi~.
4700 South Bragaw Stme(
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchora~.ek, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. ~O_;5_15 PID Number.
N~rne:
James GlasFell Wastewater System: Tank & Holding Tan Only
1973E~ Iv~, Home Clrcla Ea~lla F. ive% AK 99577 ABSORPTION FIELD
P~,,. .~t~ ~ a~.: Existing Trench
O94-2127 Four
LEGAL DESCRIPTION c~o;e
1 15/~ Hcrit;a~l¢ ?ark ~,.
FI. Ft.
Well: Mu,iclFal W~;gl- Fto
I
Ft. Ft
n Dart Cont;racl;in0 8/'i9/2005
SEPARATION DISTANCES I~ Se~ic r-I Holding [] S.T.E.P. [] Othec.
To Septic Absorption LEt Hdding ~ublic/Pflvate
Tank Field StaUon Tank SewerUne Anchora~3e Tank 1,250
w~, N/A N/A N/A N/A >25' j 5t.c¢1 Two (2)
s...=w~.>100' >100' N/A N/A ~ / LIFT STATION - NONE ON LOT
~L~. >5' >10' N/A N/A
F,,.~ >5' >10' N/A N/A
c~,. ~,.None Nor.~
"'~'~ BENCH MARK
2" Insular, ion ?laced Over .~col;ic Tank,
NorChcael; Corner Door Jamb. W¢~1; 5lac of Houe¢.
100.O
Eng~neeCs Stamp
Inst>~ions per[ormed by: ME^ Dates: a't ~
2nd _..___~/19ZO~.~ ~.. uo. c~-,~, /~__~
Department of He; Itel and Human Services approval
Reviewed and approved by: . Date:
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage AK. 99519..6655 - 343-7904
O~te Wastewater D sposa System or Well Inspection Report
Permit
Number.
SW03031
5
Page 2 of 3
PID No. 050-211-81
Four Bedroom
Home
0%
A B
S1 11.0 16.8
S2 17.2 20.2
15
138.09
PLAN AS BUILT
SCALE 1" = 30'
LOT 15, BLOCK 1, HERITAGE PARK SUBDIVISION
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bmgaw Street Anchorage, AK. 995196655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW030315
Page 3 of 3
PID No.: 050-211-81
~ 100.6~ u u
2" Insul.
Tank Only Replaced Under Thls Perm;t
PROFILE AS-BUILT
Scale: 1' - 10'
MUNICIPALITY OF ANCHORA GE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Aug 19, 2003
Expiration Date: Aug 18, 2004
Pen'nit Number: SW030315
Legal Description:[HERITAGE' pARK BLK i;11 iLT i;115A
Design Engineer:. 0014 Anderson Engineering
Owner Name: Jim Glaspell
Owner Address: 19738 IVY HOME CIRCLE
EAGLE RIVER, AK 99577-3126
Parcel ID: 050-211-81
Site Address: 019738 IVY HOME CIR
Lot Size: 22551 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
['-] Disposal Field ~'1 Septic Tank ~ Holding Tank N Privy
[] Private Well [] Water Storage
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 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.
Received By: ~ O,~tf.~: ,o~ O/'J~l!
Date: 8//~//
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o5o-211-81
Permit Number SW
Property owner(s) .Jim Gla~pell
Mailing address (1) 1973/~ Iv.v Homg Clrclg
Mailing address (2)
EaEI~ Eiwr. AK 9957'7
Day phone 694-2127
Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size ~'~'1 ~ I Acres/Sq. Ft.
THIS APPLICATION IS FOR:
Sewer Only r"l
Sewer and Well r-1
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool []
Lo~. 1~. Dlock 1. H~rlt;a~e ?aH¢ 5ub~livteton
Number of Bedrooms Four (4)
Well Only
Water Storage
Jacuzzi
Water Softening Unit
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
August 5, 2003
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Su~ect:
Lot 15, Block 1, Heritage Park Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The septic tank on Lot 15, Block 1, Heritage Park Subdivision is near failure and must
be replaced. There is currently a 1,250 gallon septic tank on the lot that was placed
1983. We are proposing to replace the tank with a new 1,250 gallon tank to serve the
four-bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic tank to serve the home. The attached Site Plan and
backup documentation identify the location and configuration of the existing septic
system and the location of the new tank. Also identified on the plans are the locations
of the existing water service line on the lot. The new tank will be placed in the same
location as the existing tank and the existing tank will be removed from the property.
The drainage patterns will be maintained after construction.
The ground surface on the lot slopes at varying grades. The new septic tank will be
constructed near the location of the existing tank and as parallel with the slope of the
land as possible in conformance with Municipal requirements. The new septic tank will
be constructed a minimum of 10' from the existing water service on the lot and those on
the adjacent lots.
If the system is constructed in accordance with our design the following statements
apply:
o
The system, if constructed as designed, will have no adverse impact on the walls
in the area or those to be constructed in the future.
Lot 15, Block 1, Heritage Park Subdivision
August 5, 2003
Page Two
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
12
11
17
10
13 ~
14A
18
100,00
~ ;..' ~ ".. ¥.
AREA MAP -'-"-'"~ '~'~'~
SCALE 1" 2 ~ ~ ..,~.., .
~.....~o. c~4~ ./~
%~.... ,~..-'~;:
Four Bedroom
Home
Remove Existing Septic Tank
Replace With New 1,250 Gallon
Tank and 2 Post Tank Cleanouts.
15
~*~ 49ih .~_ ?~ 138.09
'" " I~ PLAN
LOT 15, BLOCK 1, HERITAGE PARK
SUBDIVISION
E;,.:': '<:'.::'ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT
''- ~ ,C . · S -~ ~ ~ ,". ~ ~.- ) '. ~ ",'
, , '-~ , '-. ~ I'" .:. 2~ ,-" "~:-:~/ i',-;'. ",).
_ ~,.- .... ;]: ~ ~ ~.: -i- ' : -, ) -: ~ I >-'.' ~ .
'~-~' ~s ........... ! De~ ..... Driller D,s~a,,ce to lot line PERMIT NO
OTHER
SOIL 7EST RATING
,
::I
JOHN
DATE
1834-E
I I
LEGAL
22013
~"~ ~' ~ 825 '.~- Street, Anchorage, AK. ~950
~' 264-4720
* * * HANDWRITTEN PERMIT * * *
Permit,~ ~F WEk-L--~ND~QR- ON-SITE SEWER PERMIT
Type of Soil ~sorption System Is:
Trench: Drainfield: ~._ .Seepage Bed: Holding Tank:
Maxim~ N~ber of Bedrooms: ,q Soil Rating(sq.ft/br)
' ~L The Required Size of the Soil ~sorption System Is: '
The length d~ension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface' of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The g-ravel depth is the m~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED S5PTIC(~OLDI~G) TANK SIZE = ~l~O GALLONS
~ermit applicant has the' responsibility to info~ this department during the
Lnstallation inspections of any wells adjacent to this property and the n~er
~f residences that the well will ~erve.
* * * TWO(2) INSPECTIONS AR5 REQUIRED * * *
Backfilling of any syst'em without final inspection .and approval by this department
~ill be subject to prosecution.
4in~ distance between a well and any on-site sewage disposal system is 100 feet
~or a private well or 150 to 200 feet from a public well depending upon the type
)f public well. Minim~ distance from a private well to a private sewer line
is 25 feet and to a co--unity sewer line is 75 feet. Well logs are required
~nd must be returned to this department within 30 days of the well completion.
bther requirements may apply, specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31. 1 9 8 B * * *
I certify that:
(1) I ~ f~iliar with the requirements for on-site sewers and wells as
set forth by the M~icipality of ~chorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 ~drooms,'
Signer: Issued by: ~ ~;- Applicant
~-~ : gl ~. 8.2., ~L ~Stre~:t,.~Anchorage, A~.~
' ~.. ~ .... ~ .... .. ~::~ ~ ..... _...~:.~.,,~:~: ...... - ;~. ~ ~ -.._- . .: .:.~'
~' .~ ~-- f A -.- . _~ --~':-HAND~BI~TTEN:>/.:~EMiT - -,-,...~.:~-, ' -~
- ', ' , / · ~ .'WELl" AND/0R.'~O.N'rSI' ER PERMIT"
- - ' i ' ' -:- . ......
Location: Phone Numar: Y?gF, -
Type of Soil ~sorption System Is:
Trench: Drainfield: ~,._ Seepage Bed: Holding Tank:
Maxim~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Szze of the Soi~ ~sorption System Is:
The length d~ension is the !dngth(in feet) of the trench or drainfie~.~ : The
depth Of a trench or pit is the distance between the surface of the ground an~
~he bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the m~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
· * REQUIRED SEPT'IC(HOLDING)"TANK SIZE =-::/~'(.-'~~ GALLONS * * -.
P~mit applicant has the' responsibility tO in:f~'~this 'aepartment...durin
~'~:~llation inspections of any ~et'ls-adjacent to '%his property and the:n'~.-:
o~Zesidences that the well will ~erve. - -- , ~ .~..- . .~' . _.. '
for a private well'-].Gr 150 to 200 feet' from. a'public well dependin~.'-uPG~;~;~:h~-.~type
of public well. Minim~ distance from a private well to a private se~?~ine
is 25 feet and to a co--unity sewer line is 75 feet. Well logs are ra~i~ed
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagr~s are
available to insure proper installation.
· * ' PERMIT EXPIRES DECEMBER 31,
I certify that:
(1) I ~ f~iliar with the requlrements for on-site sewers and wells as
set forth by the M~icipality of. ~chorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms, ..
Signe~: Issued by:
-.,
-j? Applicant , ]"
Date: (. f [ t '"'
_ . ~ ~,,,~ ,~.:;~ . _,' . .
. ' . ~ ':~-t . ' - ~ ' -7 .- ~-. ~_ .
. :.... /.-
' · :_~ -~',....; ' ~- .'.:? .,,: ._ - ,: - ...
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
LEGAL DESCRIPTION: LO~-
5
6
7
8
9
10
11
12
13
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
DATE PERFORMED:
SITE PLAN
14'
16'-
17
18
19.
20-
COMMENTS ~¢ ~, ~- ~-¢'t/ -%'~ :/
PERFORMED BY: P. 0, Bf~ 773294
694-5195
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE ~ (minutes/inch) I '"~'~ ~.,~.
TEST RUN BETWEEN /~ FT AND J ( FT
CERTIFIED BY: /'~~ DATE:
72-008 (6/79)
14'
15
16
17
18
'19
2O
~L~. -" MUNICIPAl ..... OF ANCHORA~J~E
DEPT. OF H~,,',LTJl &
MUNICIPALITY OF ANCHOR~]~NM~NI'^L PROTECTION
SOILS LOG
DEPARTMENT OF HEALTH AND ENVIRONMENTAL Pt, I~,~TECT~LON [] PERCOLATION
· 'V ~ ~]~ TEST
825 L. Street, Anchorage, Alaska 99501 264-4720J
SOILS LOG - PERCOLATION TES~EC ~ ~ [] ~ ~'
SLOPE SITE PLAN
0
P
E
Oross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY:
TEST RUN BETWEEN
BY:
FT AND ~ FT
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
bL)l L.% LOG
[] PERCOLATION
TEST
LEGAL DESCRIPTION:
///o <~ /
1
3
5
6
7
~o
14
' 17
COMMENTS
PERFORMEO BY:
72.008 ~6/79J
DATE PERFORMED:
/F, z~,
SLOPE
WASG.OU.OWATE. j~. ~
ENCOUNTERED? 0
P
IF YES. AT WHAT ~ E
DEPTH?
7
SITE PLAN
Reading Date Time ' Time Water Drop
PERCOLATION RATE ,', ~'%)J"... · ' ' ' · ~,'nirl'~lt~s,/'inchl
TEST RUN BETWEEN T' rr";J~' AND ''~ ",:'~'~ '.
' CERTIFIED BY: ', ,~, '"*" "'." ' ':' ...'Y, DATE-I~)- 2--~
' · ~, '~m ~-,i.~ ,"~;' ,. '- - :~
,,x .~.~. . S%-~.'
MUNICIPALITY OF ANCHORAGE
Development Services Department �
.Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 050-211-81
Certificate of On -Site Systems Approval
Expiration Date: J u-oe
1. GENERAL INFORMATION
Complete legal description Heritage Park Block 1, Lot 15a
Location (site address) 19738 Ivy Home Circle
Current property owner(S) James and Sandra Glaspell Day phone 907-830-0124
Mailing address 19738 Ivy Home Circle, Eagle River, AK 99577
Real estate agent Day phone
2. TYPE OF DWELLING:
❑■ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
A q
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
❑■
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
Q
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee,") 2 SSU
Date of Payment 112 2 0-� 1
Receipt Number 03 5 9 9b
Date:
Waiver Fee $
Date of Payment
Receipt Number
COSA # 0SC2 l 16 7q Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date
49
6. DSD SIGNATURE All[
J
System #1 Approved for bedrooms I>enja'
iryciller • f
System.#2 Approved for bedrooms 0���T iE/ii5zi ,�����`�/
Disapproved tkkF, PROFiSSVO'
Conditional approval for bedrooms, with the following stipulations:
\\`� c-4 OF
l (<<�r.
o WASTw';rATER o
PR
By: (� Original Certificate Date: 19, % L2 6) 2
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 Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
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
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 of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION 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
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
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
HERITAGE PARK BLOCK 1 LOT 15A 050-211-81
11 1
MUNICIPAL WATER
18
SEPTIC/STEEL
51
■
6/1/2021 JR's Septic
DEEP TRENCH
NEW
■
11.5
3.5
■
■
N/A
COSA Checklist yellow sheet
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 ft
Neighboring Tank > 100’Yes if No ft
Absorption Field on Lot > 100’Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/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
From Septic/Holding Tank on Lot to:(Please enter distances if less than required)
Building Foundations > 10’Yes if No ft
Property Line > 5’Yes if No ft
Absorption Field > 5’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’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 ft
Property Line > 10’Yes if No ft
Water Main > 10’Yes if No ft
Water Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
F. ENGINEER’S COMMENTS
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.
12/01/21
5'*✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
4'**
✔
✔
*Met code requirement at time on installation. **OSV211089
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name :~'~ /~_cso Telephone: Home '~r¢¢-//~5-3> Business
Applicant Address '
(c)
Institution []; Owner/builder'S; Buyer []; Other [] (explain);
Applicant
is
(check
one):
Lending
(
(d)
(e)
Lending Institution ,~/~'~ ~
Address /~o/ ~ ~
Real Estate Company and Agent
Address /~_~/~ ~ ~
Telephone g? ~ - ~ ~ ~)
(f) Mai. I the HAA to the following address:
TYPE OF RESIDENCE
Single-Family/~' Multi-Family []
Number of Bedrooms /~z
Other
WATER SUPPLY
Individual Well [] Community [] Public~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
· Onsite/~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to ihe iegality and status.
Page 1 of 2 72-025 (11/84)
'ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. '~''-
EAGLE RIVER ENGINEERING SERVICES
Name of Firm EAGLE RW~.R, AK ~95ii Telephone
Address P. ti. ROuX 773:~§4
Date ~f,'-' ,94-5195
Engineer's Seal
ApprovedDHEP APPROVAL b~
for ~ bedrooms
Approved ,.~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered Jn the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
'~UNICIPALITY OF
DI~PT, OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL pROTECTION
HEALTH AUTHOmTY ^. 'ROVAL
CHECKUST- FESRU^R¥
264-4720
WELL DATA
Well Classification
Well Log Present (Y/N).
Total Depth
Static Water Level
Casing Height Above G~ound
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
If A, B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Cased to Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed /~ ~' -~ Size /..Z 5-0 No. of Compartments
Standpipes (Y/N) /~// Air-tight Caps (Y/N) '~/ Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /~/ Date Last Pumped ~"~'--~ 5-
Pumping/Maintenance Contract on File (Y/N) '4////-'~ ; for
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ¢,~o '~
To Property Line /'~ ~-
To Water Main/Service Line /'~
Course
Temporary Holding Tank Permit (Y/N)
To Building Foundation _...~_ z
To Disposal Field .//~ r
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84}
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /"~ ~
Width of Field 4/ ,'
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ~)-e~,¢~'
Separation Distance from Absorption Field:
To Water-Supply Well o~'¢~' '~''-
To Building Foundation .~,) /
Lot
Type of System Design
Length of Field '~ E' /
Depth of Field / '.3' /
Gravel Bed Thickness ~' /
Standpipes Present (Y/N) ..J/'
Date of Last Adequacy Test
To Cutbank (if present)
To Property Line ./¢ 2z
To Existing or Abandoned System on
; On Adjoining Lots ~,d "/'
To Water Main/Service Line ?~'~ '/'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have.checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S,gned.~¢.~, x'~-~--¢- *~-¢~-.. Date ~,~/~/'~ ~"~
Company ~, ¢,~ ,/.E ,~' .
Receipt No..~k~ ¢:~)~ .
Date of Payment , ~///~/¢~
Amount: $ ~ ~
Page 2 of 2
72-026 (11/84)
Engineer's Seal
EAGLE RIVERENGINEERIINGSERVI[CES
Lou ~utera P.E.
/~.M~ P.O. Box 773294
~~ Eagle River, Alaska 99577
Mr. Robbie Robinson
Municipality of Anchorage
825 L Street
Anchorage, Alaska 99501
Ref: Lot 15 Block 1, Heritage Park
Dear Robbie:
I have tested the soil layer in question on the above
referenced lot and have found the soil to perc. out at a rate
equal to 6 minutes per inch or 138 square feet per bedroom
Based on the results of this soil test I s~k ~a~ you assign
a rating of 4 bedrooms to the HAA application .,
If there are any questions or concerns please call me at 694-
5195.
Sincerely,
MUNICIPALJD' OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1985
RECEIVED
EAGLE RIVER ENGINEERING SE VI CES
~ Lou Butera P.E.
Mr. John Kennedy '~
Municipality of Anchorage
Department of Health
825 L Street
Anchorage, Alaska 99501
Ref: Lot 15, Blk 1, Heritage Park
Dear John:
I am submitting paperwork necessary for Health Authority Approval on the above
referenced lot. This Lot had an original permit written for a 3 bedroom dwelling.
It appears that the design was changed by the engineer in the field to make the
original installation adequate for a 4 bedroom home. The soil rating as designated
by the engineer and soil log is an average of 150 square feet per bedroom. The
system has an absorbtion area of 608 square feet. This makes the system adequate
for 4 bedr6oms. The leach field was tested by myself and found to be adequate.
If there are any questions please call 694-5195.
Sincerely,
Lou Butera, P.E.
APPLI~ .~',NT ~F~I'~i['S'-O'UT UPPER HA...' ONLY
Propert~ Owner /./j /- ~/'?,.-?~F / / '~ - //~ {"// ~ /" ' ~ ~/ Phone
Address ~ Zip Code
Phone
Lending Institution.,/~':' ~/~, .~;: )~/,/ ~/~"--- .~ ,, ~._ ~_. ~,: - /~-
.~/~
Phone
- . ..~ ~. ~ ~.)
Realty Co. & Agent ~:{ . ~-"~ ,/~ ~~-~ ./ ~//~ / ,. /(--_ ,'~' ~: ~' .~ ,C)?: / ~ .~
~, ~//," ,.i~::-./c'~ i:~/~ ,;
Legal Description ~ ~
Street Locatim ~¢' ///~ .,')~ 4 ff'::-'/'r~~ ~'(~.~:"r '-.'/~ ~//-:.: -~/ /'~' :/:
Type of Resi~nce
~' Single Fsmily
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975·
~' 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 RE~EsT BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORA(~E
DEPT. OF H~/',LTH &
ENVIRONM2NI'AL PROTECTION
OCT 2~ '?· ~98':', .,~
REC[IVED
(.~' ) APPROVED BEDROOMS *CONDITION8 OF APPROVAL
( ) DISAPPROVED
( I CONDmONALAPPROVAL'
DATE /~ 0 ~,~
"x Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size J ..~ ~ (~