HomeMy WebLinkAboutHERITAGE HEIGHTS LT 13 itage
Height
Lot 13
#01§-$61-32
• Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water& Wastewater Program
4300 Elmore St. •P.O. Box 196650 Anchorage, AK 99519-6650 •http://www.muni.org/onsite•(907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171206 PID Number: 015-361-32 0 New •Upgrade
Name:
KATHRYN KURTZ ABSORPTION FIELD
Address: 0 Deep Trench I Shallow Trench 0 Bed 0 Mound
5881 CHISANA WAY °ANCHORAGE, AK 99507 0 Other
Phone: No.of Bedrooms: SoII Rating: Total Depth from original grade
223-6722 4 1.2 GPD/Bq.FL 10 (MAX.) rl.
Depth to pipe invert from original grade: Gravel deplh beneath pipeLEGAL DESCRIPTION
SEE DWG. 4 & 4
PL FI.
Subdivision: Block: Lot: Fill added above original grade: Gravel length
HERITAGE HEIGHTS - 13 SEE DWG. FL 35 & 35
FI
Township - Range: - Section: - Gravel width: Beds Number of lines. Distance between lines:
5 & 5 FL - -
FI
SEPARATIONDISTANCES Total absorption area Number of trenches: Dist.between trenches:
To Septic Absorption Lift • Holding Public/Private
From Tank Field Station Tank Sewer Lines 700 SQ.FL 2 1 0+ Fl
Well - - - - - TANK ■ Septic ❑ S.T.E.P. ❑Holding ❑Other
- - Manufacturer: Capacity:
Surface Water 100'+ 100'+ - - ANCHORAGE TANK 1250
Gal.
Material: Number of compartments:
Lot Line 5+ 10'+ - - N/A
STEEL 2
Foundation 5'+ 1o'+ - -
LIFT STATION
Curtain Drain NONE KNOWN Manufacturer C..
I
Gal.
Remarks: PER CONTRACTOR,OLD SEPTIC AND SEEPAGE PIT WERE pump on-level at: "Pump off"level at 1Hrghwateratamrat:
DECOMMISSIONED PER UPC.
Pump Make&Mode• Electrical Inspectors pertormed by:
PIPE MATERIAL
r House to tank D3034 Tank to D3034
drainfield
Installer
WILCO EXCAVATION, LLC Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
Inspection 100.00 Ft
Dates: 1st 8/31/2017 2nd 8/31/2017 Location and Descrgt on:
3rd 8/31/2017 4th 9/1/2017 BOTTOM OF TRIM @ SE HOUSE CORNER
ENGINEER'S SEAL
Community Development Department Approval .�.�` �fiti.
Conditional approval: Date: _ ' •.
0i...... • 0
y A. ess•,Z
� •
4 s C1-7q53
ir
Approve - JZ
Date: 9 "6 'f 7 LICENSE �PROFESS1Ct44
dAECC884 ,` •SI��
Inspection Report t-1-12.doc
i.
PERMIT NUMBER: PARCEL ID NUMBER'
OSP171206 RECORD DRAWING 015-361-32
A B C
DBL1 - 28.0 27.5 - - - - - - -
DBL2 - 27.5 28.2 ABBOT ROAD
ST1 - 25.0 30.7
ST2 - 18.0 38.0
DBL3 - 16.5 40.0
DBL4 - 15.7 41.0
--' FS - 22.0 75.7
MT1 69.2 23.0 •
C01 71.5 26.0 15'SCREENING&UTILITY EASEMENT
-- MT2 39.3 36.3 - - -CO2 36.7 40.0 -
MT3 75.8 48.6 �j/.ice EC C OBL1&DBL2
DECK., // NEW 1250 GALLON
CO3 75.8 46.5 - /././//.i g'� STEEL SEPTIC TANK
MT4 46.8 55.0 %/ 1, �'<� DBL3&DBL4
CO4 43.5 54.3 - '��
EXISTING 4
BEDROOM HOUSE
APPROXIMATE
LOCATION OF WATER B 1
HERITAGE HEIGHTS; SERVICE LINE . •,'� HERITAGE HEIGHTS;
LOT 14 PROFESSIONALLY "
LOCATED BY WILCO •'- •. BM LOT 12
PUBLIC WATER EXCAVATION j! . .''�,' :+; PUBLIC WATER
/ A a . ;..1
IDRIVEWAY
// • ': • . . . ! - GO ---------GO'
.7.- 4 THN1
c,04
7/7"*---....-I11------ .- ..„... ....4. ' .•
a :
10'SLOPE CONSTRUCTION&
1.. MAINTENANCE EASEMENT
NEW DRAINFIELD
CHISANA WAY
F _ _
\\\. I
'11( /
ISCALE:
I , ,
1'=30'
oe%%%1 Skill*
v.
GARNESS ENGINEERING GROUP, Ltd ; : J.•:,'•'-• "
•
CIVIL&ENVIRONMENTAL ENGINEERS % 0
3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507'PHONE(907)337.6179'FAX(907)338-3246'WEBSITE:www.garnessengureenng.com L••. •• • • - u-•M
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 t -r-►-y •, .- -mess :I!
KATHRYN KURTZ 223-6722 2 OF 3 0• -••' CE-795 St
PROJECT/ LEGAL DESCRIPTION: DRAWN BY ♦. • '•. 1 \cr. `
HERITAGE HEIGHTS; LOT 13 L.K.B. / ...... (`' P�, 4,4p
TYPE OF WORK DATE LICENSE , ROF��pBSI
RECORD DRAWING 9/8/2017 #AECC884 ������� J
PERMIT NUMBER: PARCEL ID NUMBER:
OSP171206 RECORD DRAWING 015-361-32
FINAL GRADE=99.8-100.22
ST1 ST2
TOP OF TANK o c TOP OF TANK
AT INLET=95.7 AT OUTLET=95.64
7L\--i '
NEW 1250 GALLON
INVERT OF BUNG SEPTIC TANK INVERT OF BUNG
AT INLET=95.07 AT OUTLET=94.86
\L
NORTH I SOUTH)
MT CO FINAL GRADE= MT CO FINAL GRADE=
TH#1 ORIGINAL GRADE CP 99.74-100.44 ORIGINAL GRADE 0 O 99.65-100.27 TH#1
S HIGHEST POINT=100.09 HIGHEST POINT=100.09
FILTER FABRIC FILTER FABRIC
____, III Firilr 111 _
: Fil
T •:.:.. :.:.:.:.:.:.:.:.:.: .:.:.:„.:.:.:.:.:.:.:.:.:
T :.:.:.,.:.:.:.:.:...:.:.:.
::::::„.::::::::::::::.•:::
,,
.:.:.: :.:.:.:.:...:.:.:.:
:.:.:. .:.:.:.:.:.:.:.:.:.
4' INVERT OF PIPE= 4' INVERT OF PIPE_
y 94.09 94.09
y • • :::::::::::::::::::
.
y 1...__5'--...1F.--BOTTOM OF TRENCH= � —5' BOTTOM OF TRENCH=
i
• 90.09 90.09
i
F 10'+ H
RELATIVE ELEVATION OF RELATIVE ELEVATION OF
BOTTOM OF T.H.=84.09 BOTTOM OF T.H.=84.09
(TH#1 DRY ON 8/31/2017) (T.H.DRY ON 8/31/2017)
*��\\1111
OF
4 144,
GARNESS ENGINEERING GROUP, Ltd * 1 \V.I. ... '\ ..�'* •'0
• •
CIVIL&ENVIRONMENTAL ENGINEERS F •
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE(907)3376179'FAX(907)3383246'WEBSITE www garnessengneering.corn " f _ •
,C•
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: f .. •• - ' A a=[L1�SS . 1u• =
KATHRYN KURTZ _ 223-6722 3 OF 3 �•.--n%••. CE 79 3
•PROJECT/LEGAL DESCRIPTION: DRAWN BY: *♦ .4
�� •�' •�� �
HERITAGE HEIGHTS; LOT 13 L.K.B. . Q•��,•......... (``• ,,
TYPE OF WORK: DATE:
LICENSE,, 1i"S`sw��••
RECORD DRAWING 9/8/2017 #AECC884 I
MUNICIPALITY OF ANCHORAGE ,n,ent
On-Site Water & Wastewater Program s.;
PO Box 196650 4700 Elmore Road
1.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
epartment
4h CH OR0.GE
On-Site Wastewater Disposal System Permit
Permit Number: OSP171206 Effective Date: 8/2/2017
Work Type: Septic Upgrade Expiration Date: 8/2/2018
Tax Code Number: 01536132000
Site Legal Address: HERITAGE HEIGHTS LT 13 G:2438
Site Mailing Address: 5881 CHISANA WAY, Anchorage
Owner: KURTZ KATHRYN M Lot Size in Sq Ft: 16752
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
El Disposal Field Q 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
Received By: Date: - �� /I
Issued By: PCP 6".n'I./ Date: F o? ,�0 11
f /
MUNICIPALITY OF ANCHORAG ,''56 7 8 9
(4 s r I
Community Development Department Phone 907-343- 904 ?
Development Services - Fax: :07- 343-7997
On-Site Water & Wastewater Program
ti
Mayor Dan Sullivan @ c,
6gl;9i
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-361-32
Property owner(s) KATHRYN KURTZ Day phone (907)223-6722
Mailing address 5881 CHISANA WAY *ANCHORAGE, AK 99507
Site address 5881 CHISANA WAY *ANCHORAGE, AK 99507
Legal description (Sub'd. Block & Lot ) HERITAGE HEIGHTS; LOT 13
Legal description (Township. Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(Zall that apply) Initial I I Single Family (SF)
Absorption Field ® ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
Holding Tank Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well n
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A Distance: —
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 7(a' Waiver Fees:
Date of Payment: $ \ l [1 Date of Payment:
Receipt Number: 00c(116‘ Receipt Number:
Permit No. 0540 (204 Waiver No.
(Rev. 01/11)
ale 1 .% Quanics
GARNESS ENGINEERING GROUP, Ltd I;CJtmcvyt Sy_-t Cm
CIVIL&ENVIRONMENTAL ENGINEERS Dealer
July 25, 2017
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Heritage Heights; Lot 13
To whom it may concern:
The existing 4 bedroom house is served by public water and private septic system. The
existing drainfield is in a state of failure and needs to be upgraded. We are proposing to
install a dual 5-wide trench type drainfield and 1250 gallon steel septic tank. One
testhole was excavated and the drainfield is designed within its 30 foot radius.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached 2017 logs which show the soil classifications, groundwater
monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average
topography around the proposed drainfield is flat. North of the proposed drainfield are
slopes X25%, however, we will be greater than 50 feet from these slopes.
5. WAIVERS: No waivers requested at this time.
We are unaware of any adverse impacts this installation or waivers would have on
adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. Thank you for your assistance.
Si, :ly,
Jeffrey , . ' arn_ P.E., M.S.
Presid:� t
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.gamessengineering.com
DESIGN CRITERIA: GEG,Ltd.HAS A 8 PAGE SPECIFICATION
THAT PERTAINS TO THIS DESIGN.
NUMBER OF BEDROOMS:4
LETTER O TAINACOPYOFTHELETTERCONTACTO ABBOT ROAD
GALLONS PER DAY(GPD): 600 GEG.BY PROCEEDING FORWARD WITH THIS -------------------•—•-----------------
-—. PERCOLATION RATE/S:1.1 MIN/INCH INSTALLATION.THE ENGINEER,WELL DRILLER,
PROPOSED APPLICATION RATE:1.2 CONTRACTOR AND PROPERTY OWNER AGREE INSTALL DOUBLE CLEANOUTS
MINIMUM DRAINFIELD SQ.FT..500 FT2 THAT THEY HAVE READ THESE
SPECIFICATIONS AND AGREE TO ACCEPT THE EXISTING SEPTIC TANK TO BE
TERMS AND CONDITIONS OUTLINED. DECOMMISSIONED PER UPC
DRAIN FIELD DESIGN: EXISTING SEEPAGE PIT TO BE
DECOMMISSIONED PER UPC
MAXIMUM DEPTH:10 FEET
WIDTH:5.0 FEET 1
LENGTH:35 FEET 15' SCREENING 504 50 bf 50••� PROPOSED 1250 GALLON
EFFECTIVE:4 FEET & UTILITY EASEMENT I I STEEL SEPTIC TANK WITH
ACTUAL SO.FT.:700 FT2
_ -- _ ---- ---
DOUBLE CLEANOUTS
--- —— —11
--BEFORE AND AFTER TANK
I
CONTRACTOR IS TO HAVE ALL PERTINENT / I o//�"INSTALL DOUBLE CLEANOUTS
WELL RADII,EAST PROPERTY LINE,AND # " /
EASEMENTS PROFESSIONALLY LOCATED /L/ J
PRIOR TO CONSTRUCTION .. ST1ST2 50'4
I EXISTING 4
BEDROOM HOUSE
ASSUMED LOCATION OF WATER
LINE PER KEY BOX LOCATION;TO FS TO REMAIN
BE PROFESSIONALLY LOCATED -- 'i ABOVE GRADE
PRIOR TO CONSTRUCTION
A , MT
:..
�• .r' 1
c CO LATD
:.
DRIVEWAY^ ' ' MT 1 MT CO
HERITAGE HEIGHTS; 0'+— HERITAGE HEIGHTS;
LOT 14 [- CO LOT 12
PUBLIC WATER ` PUBLIC WATER
LAID CO MT
. FLALD
�LAT� 10' SLOPE CONSTRUCTION
& MAINTENANCE EASEMENT
THE EXISTING PTCO IS PROPOSED DRAINFIELDS
APPROXIMATLEY 5.6 FEET BELOW
GRADE.IF GRAVITY FLOW CANNOT FLAT 11
BE ACHIEVED,A 1500 GALLON
STEP TANK WILL BE INSTALLED. CH I SANA WAY
\\\, I
7---------I
SCALE:
IiiEiil
1'=30'
I
I
♦ _ OF 4•
VA
I .1 GARNESS ENGINEERING GROUP, Ltd ' ': •
Ib'� �`
v.
a Ir
CIVIL& ENV'RONMENTAL ENGINEERS • • '� •
3701 E.TUDOR ROAD,SUITE 101'ANCHORAGE,AX 99507'PHONE(907)337-6779'FAX(907)338-3246'WEBSITE www garnessengtneenng r,xn • ••• I.
••• • : }r••'
•
PREPARED FOR. PHONE NUMBER: PAGE NUMBER: 0 • J:f =, ss : Lu
KATHRYN KURTZ 233-6722 1 OF 1 •c.d., 7• .*N
PROJECT/LEGAL DESCRIPTION: DRAWN BY: •0♦ 17 g' 0.< 34,4r
HERITAGE HEIGHTS; LOT 13 L.K.B. t••i 'FrtUF ESS�e'' .4P
TYPE OF WORK: DATE: LICENSE ,1/itu„1*�
SEPTIC DESIGN 7/25/2017 ttAECC884 J
*i01.11111
GARNESS ENGINEERING GROUP, Ltd 4`I 49 * ',
CIVIL&ENVIRONMENTAL ENGINEERS•••••••• `.N •
1'3'E TUDOR ROAD 111TE'"'.'AN(:H()RAGE.AK 99507-PHONE(907)33)-6179'FAX'907)339.32.6'WEBSITE www3&mt Sfl9S�•Mk9,J,
O•
':•
• '. A1.4011-ss, i
SOIL LOG - PERCOLATION TEST •j 6% r C -79
LEGAL DESCRIPTION: HERITAGE HEIGHTS;LOT 13 /,� "•..f3 ZJ ;"•'•C. �
PERFORMED FOR: KATHRYN KURTZ DATE: 7/14/2017 #*1,PROFESSffff`°:..4
DEPTH - "AECC884 �i111a•��
(feet) : ORG TEST HOLE #1
t �
GM/ML SOIL CLASSIFICATIONS SITE PLAN -
GWE,E--
■ ■ EIES GP 1 vML
3 — II • 11:111!11 GM L
4 — ` I V GC / 1' )L C�
■ ■ °.o' o". SW I MH Q
5 —
I
• ' , SP J CH ���
r ■ R���;��� SM .' . OH
■ X44.��..,
6 — • ►a t.' SC rN'
■ %P
7 • DEPTH TO pATL il P��
• • GROUNDWATER ery
(:))
■ 5
8 — • DRY 7/14/2017
• ■
• DRY 7/24/2017 SCALE:
r
9 — ■ i)'-1 r.100'
r
■ •
10 — ■ •
` ■ DATE READING CLOCK NET TIME WATER LEVEL NET DkUf'
11 — • TIME (MINUTES) READING (INCHES)
12 —
I
r 7/14/2017 1 - - 6'
• • 2 - 5 0' 6"
I
13 114,i 3 - - 6" -
i I, i 4 5 0" 6"
14 ••' 5 - 6" -
• 1 • •
• • •�• SM 6 5 0" 6"
1g.5 ;•:• •� (VISUALLY PERMEABLE) 7 6"
:•,• •,• 8 - 6.50 0" 6"
16
0.0.11 9 6"
17 10 0 1.i 0" 0'
11 - 6" -
8 12 - 6.58 0" 6"
PERCOLATION RATE 1.1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
19 —
TEST RUN BETWEEN 5 FT. AND 6 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES • NO
SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: LANDON BRUCE
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I,JEFFREY A.GARNESS,CERTIFY THAT THIS WAS PE
t FOR ED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 7r.a,�
~'~' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
'gUPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Lan§th
,~ I- Type of crib
DISTANCE TO:
Class
LU
Well
DISTANCE TO:
Manufacturer ~~
Liq, capacity in ga Pons I
j ~,.-,~ ,~ I. HOMEMADE:
DISTANCE TO: We
Manufacturer
Well
DISTANCE TO: Length
No. of lines
Top of tile to finish grade
Absorption area
Inside length
Dwelling
Foundation
Width
of each line Total length of lines
Material beneath tile
Crib diameter
Depth
Crib depth
Well
Depth Driller
Building foundation Sewer line
DISTANCE TO:
OTHER
PiPE MATERIALS
SOIL TEST RATING
Building foundation
REMARKS
DATE
Dwelling
Material
Width
Material
Nearestlotline
Trench w dth
NO. OF BEDROOMS
PERMIT NO, ~.~.50 ~ ,~ 3
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
inches
Total effective absorption area
inches
PERMIT NO,
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO,
Septic tank Absorption area(s)
LEGAL
APPROVED
~.~1~ I I'~U/ ~I~I~VI~,~
1200 West 33rd Avenu~rJ~uite B
ANCHORAGE, ALASKA 99503
Phone 276-1361
SHEET NO.
CALCULATED BY 'J TK
CHECKED BY
SCALE
OF
CATE
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
September 16, 1986
DATE:
PWS I.D.#
210087
To Whom it May Concern:
According to records on file in this office the MOA/HERITAGE HGTS./
SERVICE HANSHEW Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
~ames C. Allen, RS
~.~/R~c_t'ional Sanitarian Supervisor
GL.ATER ANCHORAGE AREA E.. !OUGH
Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
- . ' '~ C 'PHONE
SEPTIC TANK:
DISTANCE. ,,.t J ~, NUMBEROF ~_
~ ~ (~) GALLONS.
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH ~'' ~ LIQUID CAPACITY
SEEPAGE PIT:
LINING MATERIALS~'i~(-~ CRIB SIZE: DIAMETER
BUILDING FouNDATION ~l~ , NEAREST LOT
OR W,DT J 7,
DEPTH ~ _ ·
DISTANCE FROM: WELL ~"/'t (t ,,
FT.
ABSORPTION AREA (WALE AREA) -e'-~.
ADDITIONAL ABSORPTION
WELL:
TYPE Q~ ~?(__, CONSTRUCTION
BUILDING NEAREST NEAREST
FQUNDATION -- LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TAN K SYSTEM
Form PW-O:~6
DIAGRAM OF SYSTEM
co'N.s'-/' l%kl O'7 ~ 0 t~
SEWAGE
~r
GREATER ANCHORAGE AREA E~OROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
DISPOSAL SYSTEM . APPLICATION AND PERMIT
NAME OF APPLICANT
PERMIT NO. --
,.STALLATION LOCAT'ON
LEGAL DESCRIPTION ~¢~ /3 t~
SoIL TEST RESULTS ~/~ ~ ~ ~¢ NOTE~ THIs PERMIT I= NOT VALID WITHOUT
PFRHfT VAI.TD ~NE YFAR
FINAL INSPECTION~ 24 HOUR NOTI~ REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN~[CTION
HEALTH DEPARTMENT AUTHORI~ WILL BE SUBJECT TO PROSECUTION.
.
MINIMUM DISTANCES, REQUIREMENTS
5 f~.
FOUNDA'nON TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 20 ftc DRAIN FIELD 10 ft,
SEPTIC TANK TO SEEPAGE PIT WALL 15 ¢t,
SEPTIC TANK 5 f ~ ~ i . SEEPAGE PIT ~I DRAIN FIELD
TO NEAREST LOT LINE'
WELL TO SEPTIC TANK
DRAIN FIELD ' / ~-~/-~ ]~
WATER MAIN TO SEPTIC TANK [0 ¢~
DRAIN FIELD 10 ft*
10 ft.
SEEPAGE P,T /¢4) 2.
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT 10 ft.
~0 ~ t ~ i
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION S FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAP~.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
t'
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID coDE,
D. TE/m¢?-? 2 A.PL,DANT'S .,GNAT...
Performed For
Leoal Descrintion: Lot
This Perm Reoorts Soils
Qeoth
Feet
.~.~
7.,.~._
Soil Characteristics
.~Ias 6round Water Encountered?
I¢ Yes, At what Denth?
Reading
Bate
Net Time
Gross Time
I
Denth to H20 Net Dronl
'
Percolation Rate
Proposed Insta!la~iot,:/ c'eCr, d,'~ Pit mr'.in Field
Ben. th of .rnlet_~/%Z_O_._.Z..._~_~' ;__2e~th .Tfl Rott(:.m .Of Pit Or Tre,ch
Cm.~*ENTS:
•
Municipality of Anchorage -r
/l On-Site Water and Wastewater Program 1
(907) 343-7904 s E
Certificate of On-Site Systems Approval 1
Parcel I.D. 015-361-32 Expiration Date: 7- 2,-7 1
-7 "
1. GENERAL INFORMATION:
Complete legal description Heritage Heights; Lot 13
Location (site address) 5881 Chisana Way*Anchorage, AK 99507
Current Property owner(s) Kathryn Kurtz Day phone 223-6722
Mailing address
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: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well El Community ❑
Public Water System ® Public Sewer ❑
WaiverNariance request for: Distance:
Received by Date: C7/4.‘ it
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ c2(a2 .S7) Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
COSA# (35C 1 tl9 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: 9/6 /i-
In
conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o'z2'
in accordance with the guidelines and regulations established by the Municipality of Anchorage and ,..•......
industry practices. The reported results describe the condition of the system/s on the date/s of the p O5�0
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or O P_ : �� -Ovn
encroachments may exist that were not identified during the evaluation. The operational life of all wells /'. 9-OJ 1 *v
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and ;
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and .
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the � , e�
/if
A. G•mess:
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of 0OCE— 9 3 • `. ,
the well or septic system. GEG makes no representation whether an alternative well or septic system Q,fl •. • coO
can be installed on the property in the event either of the current systems fail to perform adequately in 4p 0r 9..S ,.o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4%eac'rofess\oc\°40
perform the evaluation. Reliance upon the information provided in this report by any other person or �DOOp00o5:'
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE /
\,/' . System #1 Approved for 1- bedrooms
System #2 Approved for bedrooms ` �,�ci,ct,tff; r-
Disapproved -,,C) 15/0'
Conditional approval for bedrooms, with the follow�g s I I
ISE
ER AND R'
WASTFN/ATER }'
- PROGRAM
'i-t� SER��C -
'",,,,,,,�\\\-♦
t— _
By: f^^ �-��GL� Original Certificate Date:7) of- C-, /
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Heritage Heights; Lot 13 Parcel ID: 015-361-32
A. WELL DATA AWWU
Well type If A. B, or C provide PWSID# Well Log (YIN)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(abo - .round) in.
FROM WELL LOG AT IN ' CTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESU
Coliform colonies/100 ml. Nitrate mg./L. Collected by:
ic: ug./L. Date of sample:
B. SEPTIC/HOLDING TANK DATA *Pre—Tank Double Cleanouts
Tank Type/Material Septic/Steel Date installed 8/31-9/1/2017
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) *No Depression over tank (Y/N) No High water alarm (Y/N) N/A
Date of pumping New Pumper —
C. ABSORPTION FIELD DATA *Below Final Grade North Trench/South Trench
Date installed 8/31-9/1/2017 Soil rating kp.d./f 'or ft/bdrm) 1.2 System type Shallow Trench
Length 35 & 35 ft. Width 5 & 5 ft. Gravel below pipe 4 ft.
Total depth *9.6+ ft. Eff. absorption area 700 ft Monitoring tube Yes Depression over field No
Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test New in. Water added NeW gal. New depth New in.
Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circui - .uirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: AWWU
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/se• ervice line Holding tank
mal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+ Public & 100'+ Private
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+
Curtain drain None Known Wells on adjacent lots 200'+ Public & 100'+ Private
F. COMMENTS
0
G. ENGINEER'S CERTIFICATION vpc, ......� 4,/N
t certify that I have determined through field inspections and i":' 4 :1
Of
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
'if r= A. n- s•�
Engineer's Printed Name JEFFREY A. GARNESS OO o f� — 95 /
9 /� •�1
Date $ e, .- -A
�40 professi000
�ODOQO
#AECC884
(Rev.11/05)
ABBOTT------ ROAD - ---
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S 69 57' 20" E 55.84
CHISANA WAY.
OFq� � � 1�
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v P�� CA/s4a I / �
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dAS-BUILT SURVEY 1" =20'
4ra SHANE A.HOLT .• a DO NO CORNERS SET TMS GATE
0,6 •
LS45914 Q
�4op ra o I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
[� �D 7x7110 nRI 4�� OF THE FOLLOWING DESCRIBED PROPERTY
��QO�Oppo LOT 13, HERITAGE HEIGHTS SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
THE INFORMA IKON HEREON TS FOR THE USE OF LENDING vasn TUTIONLS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED,
CONFLICTS BETWEEN EXISTING STRUC1U1ES ANA PLATTED LOT LINES AND/OR EASEMENTS.AND 15
NOTTD BE USED FOR POSITTONMG ADDITIONAL STRJ TONES.IMPROVEMENTS OR FENNCELITES DATED AT ANCHORAGE,ALASKA THIS _18TH DAY OF
EASEMENTS OF RECORD.OTHER THAN THOSE APPEARING ON THE RECORD P1/I T,ARE NOT SHOWN SEPT EMBER , 2017.
HEREON(UWE SS INDICATED) —
NOTE FENCELINES THAT M99 APPEAR ON THIS ORAWTNG ARE NOT TO RE USED TO DETER/ANE
PROPERTY LINES OR POSITION ADDITIONAL IAPROSEME#NTS. HOLT LAND SURVEYING
ANY PRYING SHOWN HEREON MAY RE MROXIMATE DUE TO EXCESSIVE 7NOW AN3/OR ICE 9309 GROPER DRIVE
ANCHORAGE AK 99507
13667, ,5 164-25, 185-6 355513
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Parcel I.D.
1.
CERTIFICATE OF HEALTH AUTHORITY APPROVAL"
FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION Expiration Date:
Complete legal description HERITAGE HEIGHTS SUBDMSION; LOT 13
Location (site address or directions) 5881 CHISANA WAY * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address .
Real Estat~ Agent
Mailing address
SANDRA FREDERICK Day phone 346-1721
5881 CHISANA WAY * ANCHORAGE, AK 99516
Day phone
BOB KIRN w/ KLONDIKE PROPERTY M. Dayphone
P.O. BOX 112871 * ANCHORAGE, AK 99511
522-4342
Unlessotherw~e~quested, HAAwillbeheldbyDSD ~rpick~.
2. NUMBER OFBEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Indi,~i~lual Water Storage
Community Class "A" .Well
Public Water System
TYPE OF WASTEWATER 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 well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ / O ~'"at, or pdor
lo closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified b~/ my ~eal 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 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 Eme of installation.
Name of Firm ALASKA WATER &: WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504
Engineer's Printed Name JEI-'I-I<EY A. GA~NESS. P.E.
Phone 337-6179
En{~ineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious enginee#ng analysis of the system in accordance with ADEC and MOA
DSD 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 life of ali wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. A WWC, Inc. can therefore not provide
any warranty or future estimate of how long the system wi//continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit cf the owner listed above. Any refiance upon or use of this report by any
other person or party is not authorfzed, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for /'7t- bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
bedrooms, with the fllowing stipulations:
'..'o:%
~ - ON SITc
"~" WATERAND : m
- PROGt~AM ,'
..... ·
Manitenance Agreements
Supplemental EngineeCs Reod
Other
Original Certificate Date: "~ - ~ ~ ~'~-'--
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & wastewater Pragram
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cLanc~orage.ak.us
(S0?) 343-T904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
HERITAGE HEIGHTS S/D; LOT 13
Parcel ID: 015-361-32
A. WELL DATA
Well type crass 'A' If A, B, or C provide PWSID~ 21008.~7 Well Log (Y/N)
Date completed Sanltap/seal ~/N mpedy protect~ (Y/N)
_Ti'~t dc~,~sed te .fi. Casing heigM (above ground) in.
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well production
J g.p.m.
WATER SAMPLE RESULTS:
Coliform. coionla~lO0 ~.~:'-,;,~,;~ .,.~,~,;~100 mi.
Arsanic: Date of sample.'. Collected by:
· C/O IN CRAWL SPACE
Date installed
e. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed
Total depth
Tanksize 1250 gal.
Foundation deanout (Y/N)
Date of pumping ' 6/5/2002
ABSORPTION FIELD DATA
19 lt.
Number of Compadments 2
Depression over tank (Y/N) NO
Pumper
6/ 4/ o85
Claanouts (Y/N) YES
High water alarm (Y/N) N/A
CHUGACH PUMPING
**BOTTOM OF SYSY/:~I IS 49" BELOW WHERE WE HOOKED
THE TOP OF THE PIPE EhJ~J<JNG THE CRIB.
Boll rating (g.p.dJfl~or ff~3drm) 105 System type CRIB
Width 17 ft, Gravel below pipe *'6
14.o ff. Eft, absorption area 432 ft~ Monitoring tube YES
Date of adequacy test 6/3/2002 Results (Pass/Fall) PASS
Fluid depth in absorption field before test***41.5 in. Water added 190 gal.
Depression over field
Elapsed Time: 135 min. Final fluid depth ,38.5 in. Absorption rate >-.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
***UQUID LEVEL AJ'(I~K INTRODUCING 5~0 GALLONS OF WAIIU~ INTO SY~I"F..M.
INITIAL UQUID LEVEL WAS NOT RECORDED.
NO
For 4 bedrooms
New depth 44.5in.
600+ g.p.d.
D. LIFT STATION
Date i .nstalled Size in gallons ~~ _
'Pump ~n High water alarm level at _ in.
~ Cycles tested. Meets alarm & circuit requirements?.
E. D,S .CES CO M M U N ITY WATER
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic ~anldlift station on lot
Absoq~on field on lot
Public sewer main
On adjacent lots
On adjacent lots
~nhole/cieanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation. 5'+ Property line 5'+ Absorption field
Water main 10'+ Water service line 10'+ Sudace water.
100'+'
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *g' Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Cu~teln drain NONE KNOWN Wells on adjacent lots 200°+
Water main 10'+
Driveway, parklng/vehicte storage
10'+
F. COMMENTS
*UNKNOWN SEPARATION DISTANCE TO LOT UNE~ PERHAPS OFF PROPERTY
G, ENGINEER'S CERTIFICATION
I cefflfy that I have determined through field inspecSons end
review of Municipal records that the above systems ere in
conformance w/th MOA HAA guidelines in effect on this date.
Engineer's Printed ~llame
Date ~.~.~Z-
aP.,PPKL~q( ~ OARNESS
7953 .."
Date of Payment
Receipt Number
(~ev. 12/ol)
Waiver Fee $ ~
Date of Payment
Receipt Number
Municipality of Anchorage
Development Servlees Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 995194650
www.ci.anchorage.ak.us
(907) 343-7904
Waiver Review Worksheet
WRg: WR020038 PI(~: 015461-32
HAft: HA02~274 Permit;
Date Received: 712/~:~
Legal Description: t f
Engineer:. ff A a e P.E.
Alaska Water & Wastewater Consultants, In;.
Applicant: Sandra Frederick
Waiver Requested: 0 feat from northeast orooen'v line to the dralnflel~J,
Criteria: Geology
A. Waler Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
Points:
Waiver is Granted: L,,/ Waiver is not Granted:
List Conditions or Reasons for above:
Recft: :~g'179 Amount: S150.00 Dale Paid: 712/2002
Municipality of Anchorage
George P. Wuerch. Mayor
Building SafeB' Division
P.O. Box 196650 · 4700 S. Bragaw Street
Anchorage, Alaska 99519-6650 ° (907) 343-8301
htt p://www.ct.anc homg¢.ak, us
7/2/2002
Jeffrey A. Gamess, P.E.
Alaska Water & Waste~vater Consultants, In~.
6901 Debarr Road, Suite 2B
Anchorage, AK 99504
Subject:
Waiver Request for Heritage Heights Lot 13
Waiver Request #WR020038
Parcel ID #015-361-32
Dear Mr. Gamess:
Your request for a waiver of the required 10 feet horizontal separation from the
absorption field to property line has been approved. The approved separation distance is
0.0 feet.
This waiver approval applies to the existing absorption field to property line separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
Engineering Technician
On-Site Water & Wastewater Program
ALASKA WATER & WASTEWATER
CONSULTANTS, INC. '~'~'~'""'"'~
July 1, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Lot Line Waiver for Lot 13, lleritage lleights S/I); 5881 Chisana Wa:},
To whom it may concern:
We request that your department issue a 0 foot lot line waiver from the northeast property line to
the existing drainfield. I am unaware of any adverse impacts this waiver would have on adjacent
wells or septic syst¢ ns. Ifyou have any questions, please contact us at 337-6179. Thank you for
>'our assistanc,~/
~rel'~
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
A__BBO T___[T ROA..___D /
N 90'00'00" [ . 14500' ,
I ,,' ~,~ -J t / I' '
.............................. "L 'I
~' . -- .;~ '+/-
I~S~. ~ ~% ~...~L~.,.~-- --LOT 12
LOT 14 ~
I
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)
Lt.3 r, oE
Locabon '(address Or d~r.ecbons) - . '
(b) ;"Al~plicant N'aFn~'.5tIIVOF, II'..;FRE~R~¢K Telephone: Home ,.~[::,-/72[ Business
(c) [,Appiicafit is (check One): Lending Institution []; Owner/builder ~; Buyer []; Other FI (explain);
(d)/ Len~l'ing ns'tituti0n" .
Address
(e) Real Estate Company and Agent
(f)
Tele phone
2 ?1-6 '72
Address
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-FamilyI~ Multi-Family []
Number of Bedrooms ~
Other
3. WATER SUPPLY
Individual Well[] Community[] Public[] ~ ·
Note: If community well system, must have written co'nfirmation from the State De partment of Environmental Conservation
attesting to the legality and status. ":
Onsite [] Public [] CommunitY, [] :"'Holding Tank []
Note: If community well system, must have written C°nfi~'mation from the State Department of Environmental Conservation
attesting to the legality.and status,
ENGINEERING FIRM PROV D I~, 'NSPECTIONS TESTS~ FILE SEARCH, D.~-,v~AND INFORMATION
~ . .~_~; ' ~ ',:' ' ' ~:~. : i . '
t,s cdr;dried by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address ]ZO¢
Date
Telephone
DHEP APPROVAL
Approved for /¢0'4'"'cC¢,)_ bedrooms by
Approved ~' Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate'is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional er~gineer's wo[k. ~ : !
Page 2 of 2 ': : '
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720 NOI~3,=j O~d i¥{N]WNO~iAN:I
Legal Description'
WELL DATA
Well Classification CO/V~/I/~Ib~/~J~'~~' If A, B, C, D.E.C. Approved ~'N) P/.~J5
Well Log Present (Y/N) Date Completed Yield
Total Depth Cased to
Static Water Level
Casing Height Above Ground
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/
Comments
2t00 7
Depth of Grouting /
Pump Set At /
Sanitary Seal on Ca¢~,~Y~)
Depression ~ellhead (Y/N)
/~t~4 ; O~°iningLots-
/ ~dJ0i~in_gL°ts-----
~"T'd'~eCrv~:~.rine on Lot
Date
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes Q/N) Air-tight Caps ~N)
Depression over Tank (Y~I~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~-OO /~L
TO Property Line ~-0
To Water Main/Service Line
Course /00
Size 12,~--0 No. of Compartments ~-
Foundation Cleanout,(Y,~,
Date Last Pumped ~'//7/~::)~ /
-/
/V'//¢ :for ,~//~
Temporary Holding Tank Permit (Y/N) /L////~ --
To Building Foundation
To Disposal Field ~'
To Stream, .Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(H/84)
'C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y,,~
Results of Last Adequacy Test
Type of System Design
Length of Field I ~' /
Depth of Field 07 /
Gravel Bed Thickness ~'~"
Standpipes Present (~N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~, CO /
To Building Foundation ~ O /
Lot
To Water Main/Service Line ,2. 0
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ~ 7 /
To Existing or Abandoned System on
; On Adjoining Lots ,2 ~' / '1/""
To Cutbank (if present) ,'~//,~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
M a n h ole/Acces~/,,~__ __
"Pum~evel at
p' g Cy es during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav,,e/p~ecked, verified, or conformed to all M CA an.d HAA guidelines in effect on the date of this inspection.
Signed Date
MOA No.
Company /
Receipt No.
Date of Payment
Amount: *
Page 2 of 2
¢¢3-.s/?£ /'/AA[
72-026 (11/84)
ALASKA ealUIROIlmdlTAL COI1TROL SERUICeS, lilC.
~n(linecrin§ ~, ~nvironrnenlol $1udJcs
SANDRA FREDRICK
588! C}IISANA
ANCHORAGE ALASKA
995%6
SELLER-SAME
SANDRA FREDRICK
5881CHiSANA
ANCHORAGE ALASKA
99516
9/17/86
60496
LEGAL:HERITAGE HEIGHTS LOT 13
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-9/16/86
THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AREA OF 422 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 965 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
4 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 9/17/86 ·
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
1200 ~Jcsl 33rd Avenue, ~il~ ~ * Anchora§¢, Alaska 99503 *(907) 561-5040