HomeMy WebLinkAboutPARK HILLS #1 BLK 2 LT 11Park Hills #1
Block 2
Lot 11
#017-112-59
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191252 PID Number: 017-112-59
Dwelling: FE -1 Single Family (SF) El with ADU El Duplex (D) El Two Single Family Project: 1771 New 11K Upgrade
Name
TAMMY COOPER
ABSORPTION FIELD
1771 Deep Trench El Wide Trench El Bed E> ound
Site Address
14727 PARK HILLS *ANCHORAGE, AK
El Other Ze
Phone
Number of Bedrooms
Soil Rating
depth f original grade
14
GPD/SF
ITotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
PARK HILLS #1; BLOCK 2, LOT 11
Fill added above original gr
Ft.,
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
ToSeptic
Absorption
Lift Station
Holding
SewerTotal
a rption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100,+
TANK ®❑ Septic El S.T.E.P. El Holding El Other
Manufacturer
INFILTRATOR
Capacity
1530 Gal.
Surface Water
100,+
000,
Material
Number of compartments
Lot Line
51+
NA
HDPE
2
Fou
Foundation
10,+
LIFT STATION
Manufacturer
Capacity
Remarks OLD TANK DECOMMISSIONED PER
Gal.
UPC PER CONTRACTOR
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 dTankto rainfleidD3034
Installer
ARM SEPTIC SERVICES
Drainfield EXISTING CO/MTD3034
inspector TIM ECKLUND AND DAVID GARNESS
BENCH MARK (Assumed elevation) 100.00 ft
Inspection 15, 7/30/2019
Location and description
dates: 2 nd
TOP OF GARAGE SLAB
31d - 4'h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Ptamp
Conditional Approval: Date
wry �0
C)4
T
...... .........
.......... .......
Ile f ��!e A. or s S,**
CE —.7953
Septic System
Approved Date
0
00),
Note: this approval does not include well permit requirements.
Dr 0 fesslo
#AECC864
1-cev uoluz/ 10)
PERMIT NUMBER:
OSP191252
WELL RADAII AND LOT
LINE WAS NOT FLAGGED
DURING CONSTRUCTION;
RECORD DRAWING PARCEL INUMBER:
017-111 2-59
APPROXIMATE LOCATION OF EXISITNG \
DRAINFIELD PER MOA RECORDS
DBL3&4 \
NEW IM -1530 INFILTRATOR SEPTIC TANK
Nll\NOUT FOR DRAIN AROUND TANK; APPROXIMATELY 10' OF
H DRAINAGE SOCK CONVERTS TO SOLID D3034 13 FEET FROM
S _ DRAINFIELD. ELEVATION OF SOCK DRAIN IS AT MIDLINE OF TANK
/ AS REQUESTED BY THE MOA ONSITE DEPARTMENT. SEE
/ ATTACHED TEXT FROM NATHANIEL AT ARM SERVICES. DRAIN
— LOCATION AND PLACEMENT WAS DISCUSSED WITH THE MOA
_ ONSITE DEPARTMENT EMPLOYEE REBECCA CARROLL, P.E.
�—APPROXIMATE
DBL2
DURING INSPECTION ON
79.9
MH
72.5
84.1
ST1
81.9
92.7
DBL3
84.8
FCO PER AS BUILT SURVEY (ATTACHED)
DBL4 1
OUTFALL LOCATION PER
` :,• i- A
\
CONTRACTOR; SEE ATTACHED IMAGE
• :� _
�+ DRIVEWAY a "
.�
''a:�
.a.a.�.,• EXISTING
'
•..
BEDROOM
HOUSE
I
B
'
I
DBL1 67.1 78.9
DBL2
68.1
79.9
MH
72.5
84.1
ST1
81.9
92.7
DBL3
84.8
95.3
DBL4 1
85.9
1 96.3
O
z
z
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w
W.
0
w
w
W
W
r
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/ 20' TELE & ELEC. EASEMENT
PARK HILLS; TRACT B
a )'
Neilkll:lm 1.4 10 leckwil a 149 10
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 • PHONE (907) 337-6179 -FAX (907)338-3246 - WEBSITE:,
PREPARED FOR: PHONE NUMBER:
TAMMY COOPER -
LEGAL DESCRIPTION:
PARK HILLS #1; BLOCK 2, LOT 11
TYPE OF WORK:
I, SEPTIC TANK RECORD DRAWING SITE PLAN
PAGE NUMBER:
2OF3
DRAWN BY:
D.J.G.
DATE:
5/19/2020
1"=40'
Not
OF
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LICENSE I.. `ss ••
#AECC884 /
PERMIT NUMBER: PARCEL ID NUMBER:
OSP191252 RECORD DRAWING 017-112-59
TOP OF TANK
AT INLET = 91.64
INVERT OF BUNG
AT INLET = 91.02
m
INSULATION PER
CONTRACTOR
IM -1530 2 -COMPARTMENT
INFILTRATOR SEPTIC TANK
ST1
FINAL GRADE = 94.83-95.17
GA"MN'r-"JSS'jr"-JNGIN'I'PlJE"KING GROUP, Ltd
ENGINEERING , SALES , CONSULTING.. . .. ..
3701E TUDOR ROAD, SUITE 101 *ANCHORAGE, AK 99507 -PHONE (907)337-6179 -FAX (907)338-3246 -VVESSITE:games s,ng� , n-nng.com
PREPARED FOR: NE E NUMBER:
TAMMY COOPER T_O NUMBER: PAG30F3
LEGAL DESCRIPTION: DRAWN BY:
PARK HILLS #1; BLOCK 2, LOT 11 D.J.G.
TYPE OF WORK: DATE:
I,, SEPTIC SYSTEM RECORD DRAWINGS 8/19/2019
— TOP OF TANK
AT OUTLET = 91.52
INVERT OF BUNG
AT OUTLET = 90,67
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0
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Here's what it looked like.
The red is sock hose, the green
is d3034. There is a 45 at the Ela
transition, sock hose is A'Oi.ct
approximately 10ft long./000"��
Distance from edge of df to
edge of drain (rock and pipe) is
greater than 10ft,
approximately 13ft.
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SEPTIC `NNF
8C
36A'
36-4'
C4GEYQ:
5fr-TIC STANDPIPE j
C=�Nrr-,�?7 #CO –0
VW ER WELL
Ft"'cE—X—X—
V
1Y
LOT 12 SY�
Q �
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4-0'
E ISTtNG HOUSE
51.5'
�'y
-'-"-2ff
HOUSE DETAIL
EE = 0'
250H 5[reet
Aochorape. Aaska 99501
survey Dapanment
Phcmz:5614-SZ91
MaW ne
inc
Phone: 243-gSi:95
Cci€Lic t !2r {t AECC 668
ORDERED BY: ROB CAr%4PBELl,ARM Sir1'tV:CES
313.1'
LEGAL
DESCRIPTION: AOS -BUILT
LOQ E 1, BLOCK 2,
PARI[ HILLS SUBDIVISION ADDITION NO. I
DRAWN GATS:
5115'2020
'W-GRKORDEF:
`P1+yi$2-196
2w,21,,
DRAWN 8Y:
AP�.--
CHECKED BY:
-
SC
vWGRsD:
_
SW3337
SCALE-
V. - 40' —
FRfPiS: 81 7r26
REF- 20Ni?5
413
94.4?------
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2D` 7ELEC0',•}••M- &
ELECTRIC EA EMEN i
TRACT S
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49TH*'' tl
r -LS-12034
��3fog5§4i!ri1 �"a
NO E;
T1? S ORNA9i'! G SHALL NOT BE MODI RED FOR USE
ASA }LOT PL .N WITHOUTTHE EXPUSSED
W,RII IT kk! CONSTNLT 0�7 LC LAN TECH -
ADDRESS, 14727 PAR: HILLSCIR. PARCEL.: Gel -1`2 -SS
5 1R'r"KV C-t-k7IFICA'ION: L COL.Wi EC'r.. INC HAC-. NDUL. E.7 A P% -HSI
7,u4:EY Or -1=E 5 ROVERTr R5 DPAV4L? ASCCERTVRES
?['AT HE ❑.fPR^'rEi�s ! 145 S1TJ--T,.v :HEREON MY ;S'STI-1- TFsE
PRGFER n' ONES AIN a '4 E NICRO 5CHME T5 EXIST 0 THE-q'F--A.N NO -,G
`.LUSKI ABY ?i'u TE: IT I5 TAF GVMEPS €SPO SI iLI v TO D. Ev,--iNc
?F'E-EXISTE";CE OF AW E,iIENi _Y+n, COVENLAh'YS. Fl:-5Ti2lcs Io -is GR
RIUk-L-O: -sJ,34 T L.'SGS WHICH DO %.0' APPEAR ON –.rcl RECORDED
"JO "IS'1510ti %-A.T 11.1DERLNG CIP.ClUmSTA N', S SNCiu.._ A' DATA
F} REON RE JSED FOR i�?��: c3;Csa4i'�.?OR ESTn6L§5� M- PRO?E.M
L 111!Fs O rG•R PLOT -PLAN PURPCFSES.
�,J"i FACilr OF MUNICIPALITY OF ANCHORAGE
� \ On-Site Water&Wastewater Program S;�
Ir IPO Box 196650 4700 Elmore Road
gjk
/ Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r.
' " J httpa/www.muni.org/onsite
, „.7 /
Department
NN-HOapVE
On-Site Wastewater Disposal System Permit
Permit Number: OSP191252 Effective Date: 6/26/2019
Work Type: SepticTank Upgrade Expiration Date: 6/25/2020
Tax Code Number: 01711259000
Site Legal Address: PARK HILLS#1 BLK 2 LT 11 G:3137
Site Mailing Address: 14727 PARK HILLS CIR, Anchorage
Owner: COOPER LAWRENCE J &TAMMY L Lot Size in Sq Ft: 63339
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: If a subsurface drain is installed to lower the groundwater around the tank it is to meet all
required separations. Show the location on the asbuilt drawing.
•
48
Received By: Date:
61 (9.
Issued By: i�_ . / Date: ♦ Z
13
MUNICIPALITY OF ANCH •� '°'��
O '
•T �
•
., fr�
Community Development Department // 'hone: 907-343-7•b4
Development Services r` Fax: 907- 343-7997
On-Site Water& Wastewater Program `<< �,
Mayor Dan Sullivan 0! 410; L
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 017-112-59
Property owner(s) TAMMY COOPER Day phone
Mailing address 14727 PARK HILLS"ANCHORAGE.AK 99516
Site address 14727 PARK HILLS*ANCHORAGE,AK 99516
Legal description (Sub'd, Block & Lot) PARK HILLS#1; BLOCK 2. LOT 11
Legal description (Township, Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(®all that apply) Initial ❑ Single Family (SF)
Absorption Field ❑
Upgrade (w/wo ADU)
Septic Tank ® Duplex(D) ❑
Renewal ❑
Holding Tank Multiple Dwellings ❑
Privy 7 (SF and/or D)
Private Well
Water Storage n
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: latqlq Waiver Fees:
A25Date of Payment: n a5 Date of Payment:
Receipt Number: 09,145136 Receipt Number:
Permit No.
(35P1c119159 19159 Waiver No.
(Rev.01/11)
Quanics
GARNESS ENGINEERING GROUP, Ltd Advanced TV
ENGINEERING SALES CONSULTING Dealer
June 19m, 2019
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic Tank Upgrade for Park Hills #1; Block 2, Lot 11
To whom it may concern:
The subject lot is served by a private well and a private septic system. Per our client (ARM
Services), the existing premier plastic septic tank is in a state of failure and must be replaced.
We are proposing to decommission the existing septic tank per UPC and install a new IM-1530
Infiltrator HDPE septic tank. See attached design drawings for tank location and other MOA
requirements.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance.
racer:ly,
Jeffre A a e P> ., M.S.
Presi. -n
3701 East Tudor Road, Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
. / / /
GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER PER MOA RECORDS,THE GROUNDWATER IN THE TESTHOLE WAS
THAT PERTAINS TO THIS DESIGN.BY PROCEEDING APPROXIMATELY 8.5 FEET BELOW GRADE.DURING THE INSTALLATION NOTE:THE CONTRACTOR SHALL
FORWARD WITH THIS INSTALLATION,THE OF THE PROPOSED SEPTIC TANK,IF GROUNDWATER IS FOUND TO BE HAVE THE NORTH LOT LINE,AND ALL
ENGINEER,WELL DRILLER,CONTRACTOR AND HIGHER THAN THE INVERT OF THE OUTLET LINE,A DRAIN WILL BE WELL RADII FLAGGED BY A
PROPERTY OWNER AGREE THAT THEY HAVE INSTALLED AROUND THE HDPE TANK.THE PROPOSED DRAIN MUST BE A REGISTERED LAND SURVEYOR
READ THESE SPECIFICATIONS AND AGREE TO \ MINIMUM OF 10 FEET FROM THE EXISTING DRAINFIELD PRIOR TO CONSTRUCTION.
/ACCEPT THE TERMS AND CONDITIONS OUTLINED.
I
ASSUMED LOCATION OF DRAINFIELD PER SEPTIC
CLEANOUTS ON SURVEY AND MOA RECORDS S
PARK HILLS#1;BLOCK 2,LOT 10
\
•:;+. .. EXISTING SEPTIC TANK TO BE DECOMMISSIONED
PER UPC;PROPOSED TWO COMPARTMENT 1530
INFILTRATOR SEPTIC TANK;INSTALL DOUBLE
• • CLEANOUTS BEFORE AND AFTER
- r
••;----.: . // FCO PER MOA
.•.••' • RECORD DRAWINGS
/ • ' /X \ \�\
/ / N ..•' \
/ / •'•
.... •.
/ ••••••
\ :.: • .c.:
/ \
•,. ./• •• r.-!:.'.:•i.•t• ��'
PARK HILLS#1;BLOCK 2,LOT 12 • ••• • �• 41 DRIVEWAYt•'i••bi••••
•
I I 1
I I 100'WELL RADIUS
I 1 ....„„,....../"_,, EXISTING 4
'''-i---_....... BEDROOM HOUSE
I 100' ELL RADIUS I I j ..
1 I i
I I c\I
1 \\ / SLE:
/
0
\ \ / 1"=40'
\ \ /
\ ‘
��•'," '11,1
- ../ to ...,N.. A Ar---// i ,i, ".... .•
GARNESS ENGINEERING GROUP, Ltd fI(
ENGINEERING 'SALES CONSULTING 0 /I•�
3 •
•
701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337.6179•FAX(907)338-3246.WEBSITE:wwwrn.gamessengirbering.co •••
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 Cn •; -, " - •- S "
TAMMY COOPER 907-688-9433 (ARM) 2 OF 2 ••61 '/ C 79 3 .' a
PROJECT/LEGAL DESCRIPTION: DRAWN BY: .�l•••• 6 ( f=
PARK HILLS#1; BLOCK 2, LOT 11 D.J.G. �1 ♦ •'••• 9•0'�•�,4•4
TYPE OF WORK: DATE: •♦11rnF`S`; ns,••
DESIGN OF SEPTIC TANK UPGRADE 6/19/2019 LICENSE
11
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: -S k/ 980 y g0 PID Number: o17 -//a -S9
Name: /
6EOR6ic 3 dleee✓ Adp,,Jes
Wastewater System: D New N1 Upgrade
Address: 1q,-71-7 pfjee Nlus C/Kec�
ABSORPTION FIELD
Nc R - / - v Y�
Phone:, /
& •l
No. of Bedrooms'.
❑Deep Trench ❑Shallow Trench 6. Bed ❑Mound O Other
LEGAL DESCRIPTION
Soil Rating:
60
Total Depth froyym inal grade:
v
GPD/ . Ft.
d,Vorig
Lot: Block: Subdivision:
Depth to pipe bosom fmm original grade:
Gravel depth beneath pipe
/ L(S /
a Ft.
01-1 Ft.
Township:
Range:
Section:
Fill added above original grade:
S
Gravel length:
62
_/ • Ft.
Ft.
WELL: ❑New ❑ Upgrade
Gravel width: c
Number of lines:
Distance be wan litres:
1 S
J Ft.
33
7• Ft.
Classification (Private. A,B,C):
Total
Cased To:
Total absorption area:
Pipe materiI:
P a1E r fSTrNG
Ft.
Ft.
/D S SQ.Ft.
/M %3O F&/0
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
\\
Viela'.
Pump Set at:
Casing Height Above Ground'.
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
® Septic ❑ Holding O S.T.E.P.
To
septic
Absorption
Lift
Homing
PubliciPrivate
Manufacturer:Capacity
in gallons:
From
Tank
Field
Station
Tank
Sewer lines
t1j C M
/ 3 0
WeIF10L)
-t
QL/��
---
—
0).5 i-
Material: _
1-1 ��c Y r//)//
Number of Compartments:
111
Surface
LIFT STATION
Water
0 i
0o/t
Lot
//
Size in gallons:
Manufacturer:
Line
Foundation
(L /_ /
/
9s,
'Pump on" level at:
"P ' level at:
High water alarm at.
Curtain
/%/
////
Pump Ma odel
Electrical Inspections performed by:
Drain
/JOKE
f.VAI
-'
Remarks: Ex,sr,,(. Steve.-IIL r.4 -K
BENCHMARK
Location and Description:
ls�r+Pk4 G,Qv (1�4Q . �.,rt7 .9a /�
M = i CO c -T �A•:
AN O4Nra.0 rt.y.ISTIrf. Lh.;�r�:-fr¢,,n
)�� G.ARne..E r/q.a.� .^e•r,..r A.
Assumed Elevation:
T /iftiC-1•l AB gvDa�24 P�/L r•a e,.s..,r Liy
/GiPt
1 6FliL
GRaw cli tr4 GrervNo t.•,d rot .:
i �t ., •• .,, S
'+
P✓ac.4.0 VIVOCA 5CW401 Aar.K Pill A, L4.vEl,r�vC ,ry�f1
111
S d S ENGINEERING
Inspections performed by: 17034 Eagle Riyer Leen R,,A Me s: 1st
-C.
Eagle River, Alaska 99577 2nd-/ - /a - 99 I -P ROBERT
r
'7or
COWAN7,4v,-
elf i IV -J% 1'c.'` CE•8801 w
Department of Health and Human Services approval It'i`
F;;.
Reviewed and approved by: Date:
]2-013 (flee. 9/91) MOA 25
SW980480 PAGE 2 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 • Tele hone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 11, BLOCK 2, PARK HILLS #1
CNEW
OED
O2
WELL
- 20' TELEPHONE
TRACT B
4
NEW 1300 GAL. P
WELL
P.I.D. NO. 017-112-59
E TANK
PROP
WELL
FCO
EASEMENT
SCALE 1- - 40'
31A'�t�e�RFs7
p ROBERT C. COWAN
�C ' CE -8801
PAGE 3 OF 3
Municipalit of Anchora e
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 Anchorage, Alaska 99519-6650 • Tele hone: 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 11. BLOCK 2, PARK HILLS #I1 P.I.D. NO. 017-112-59
95.6'
FC
14.5'
19.5'
%
ST1
80.0'
139 -
5T2
STI sTz
140.5' -
DBL1
85.0'
141.5' -
DBL
FINAL GRADE
142.0' -
C01
101.0'
!/
MT1
105.5'
154.5' -
CO2
160.5'
.._ „ .
191.0 -
NEW
91.3' 300 GAL
91.1'
S.T.
MT
159.5'
94'1
11T2CO1
CO2
MTI
93.0'
Qe
9
g.� 2' INSULATION
90.5'
SEWER ROCK
89.8'
90.4'
89.9'
15'
84.3'
WATER FOUND
N. T. S.
79.3' BOH
ENGIg4! � 1(P
OF
2
*
l ROBERT C. COWAN f Q
pct CE -8801 �4
til%`,""i ;rye
-
ST1
80.0'
139 -
5T2
83.0'
140.5' -
DBL1
85.0'
141.5' -
DBL
86.5'
142.0' -
C01
101.0'
145. '
MT1
105.5'
154.5' -
CO2
160.5'
196. -
191.0 -
Cpm
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW980480
Legal Description: PARK HILLS #1 BLK 2 LT 11
(,\Ccy-\
Date Issued: Dec 30, 1998
Expiration Date: Dec 30, 1999
Parcel ID: 017-112-59
Design Engineer: 0003 S & S Engineering Site Address: 014727 PARK HILLS CIR
Owner Name: Georgie & Jerry Barnes Lot Size: 63339 SQ. FT.
Owner Address: 14727 Park Hills Circle Total Bedrooms: 4 Permit Bedrooms: 4
Anchorage , AK 99516-4246
This permit is for the construction of:
LSI Disposal Field [✓] Septic Tank L Holding Tank LI 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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.
5. The following special provisions.
Vertical separation between existing absorption field and groundwater must be verified to be a minimum of 4' to
keep the trench in service.
Received By:
Date: I } / ' 9 g
Issued By: Date:/ 2 _90.9e
s&s\
lineeRing ROBERT C. COWAN, P.E.
CIVIL ENGINEERS
(907)694-2979
FAX(907)694-1211
December 15, 1998
HEALTHAUTHOPoTY
APPROVALS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
SEWER&WATER
Anchorage, AK. 99519
MAIN EXTENSIONS
REFERENCE: Lot 11, Block 2, Park Hills #1 Subdivison
SEWER&WATER
INSPECTION
Request you issue a permit to install a septic system to serve the four bedroom
dwelling on the referenced property
ENGINEERING STUDIES
A test hole was excavated and percolation test performed. The approximate location of
ANDREPORTS
the test hole is located on the attached site plan.
At the time of excavation 12/12/98 water was found at 8.5'. After seven days of ground
WELLINSPECTION
water monitoring the water level was at
& FLOW TEST
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
SITE PIANS
construction of this system will not prevent any future development on any of the
adjacent properties.
ROAD DESIGN
If you require additional information, please contact us.
Sincerely,
BORTEST
/
Robert C. Cowan, P.E.
PERCOLATION
RCC/rdp
TEST
Enclosure
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
EG" LOT 11, BLOCK 2, PARK HILLS S41) #1
ORARM W: ECKEO W. GATE: SHEET: 0;: A/
R.D.P. r R.C.C. 12-15-98 1 OF .!�E..................
• ... • • is,�1,
STRUCTURES. EASEMENTS, OR ENCROACHMENTS ,:'1,�/f"'••`.% dA
Engineering DESIGN CRITERIA: I
SHOWN ON THIS SITE PLAN ARE AS SHOWN ON✓ iTL'P
✓,.» .. .
4 BDRM = 600 GPD AN AS-BUILT SURVEY DRAWN BY: A
SOILS = 0.6 GPD/SO.fT. GERALD V. RANDALL JR. AA ..
/ IT IS THE RESPONSIBILTY OF THE CONTRACTOR 'I
600 0.6 = 100d SQ.FT. REQ"D. A ROBERT C. COWAN f
TO VERIFY EASEMENTS, REOUIREO SEPARATION At,''p'S C r /
/{v a
17034 EAGLE RIVER LOOP READ DISTANCES, AND PROPERTY LINES PRIOR TO +•+t`r�y
EAGLE RIVER, 7)694 29777 LOT 17 / V CONSTRUCTION. ' -.,
PHONE/ (,ALASKA 9979 ..,..
FAXj (907)694-1111
IOo' H
WELL ELL RADTU3 Q' _ .
EXISTING TRENCH CONTRACTOR IS REQUIRED TO
BED CRITERIA " OBTAIN UTILITY LOCATES
G MT EXISTING 1250 GAL SEPTIC TANK ARK TO ANY EXCAVATION
2.5' DEEP i / (TO BE PUMPED, CRUSHED AND ABANDONED)
t 1' M.O.A. APPR. SAND
5 DIVERTER VALVE
Z 0.5 EFFECTIVE y O PROPOSED 1250 GAL. SEPTIC TANK
N 15' WIDE /
w 67' LONG CO
K ,o
O ROPOSED BED MT. 0, LOT 10
A TH AE,P 'Sf,
Co
' I
C YT INSTALL @BJ
DBL CO
(PROPOSED
d� WELL
Z
CL LOT 12 �c^�
w p 1p0
In
4�
lreu. 1fE1.Lq �o
0
LOT 13 C
m I
I
O ILO
J
II v
�- - - 20' TELEPHONE k ELECTRICAL EASEMENT
ALL PORTIONS OF SYSTEM THE EAC'NEER NAY VARY THE
11117H LESS THAN 3.5' OF EXACT GIMENSgNS ANA 0ESGN
COVER REQUIRE INSULATION. TRACT B NES To MEEEETFSTTEE' iE
c F`0Ns.
T 11,
BLOCK 2
PARK HILLS S
D #1
CHECKED Bv:
MIE:
SHEET:
Z.D.P.
R.C.C.
12-15-98
2 OF 2
I7 N EAW WEA ILD► DMD
CO MT
J
F MOUND SLOPE
W TO EXCEED 3:1
0
v;
z
FINAL GRADE
4' Dill BCH 40 PVC
7 ** LXVKM. BARD
SIDE VIEW
67' X 15'
BED SYSTEM
�o
ROBERT C. COWAN i `Y f
�g CE -8801
s
4" PERFORATED MONITOR PIPE
4" SOLID CLEANOUT PIPE
MOUND SLOPE NOT
�TO EXCEED 3:1
�owciRAi. GRADE
0.5
4• RRl TO
GROUND WATER
moi? -rs�h
Municipality of Anchorage
DEPARTMENT OF HEALTH &HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: D `iRQi BARNS DATE PERFORMED: 1 }� I 1, D
1-�OT
LEGAL DESCRIPTION: 7"1A/d K N Il L S $It Township, Range, Section:
DEPTH SLOPE SITE PLAN
(FEET)
2
3
4
5
13
14
15
16
17
18
19
S'Lr y / CA4U4-«y
SA�p
Hl t- S' l T-
R. W1. H.
S �rY GQave� y
SA,.o
WAS GROUND WATER
ENCOUNTERED? Y S
S
IF VES, AT WHAT L
DEPTH? •/> p
E
Geo 10 Water After ' i I a/ I 1/-16
Magltering? bete:
N�1Y
Date
Gross Net
Time Time
Depth to
Water
Net
Drop
R4
ASK
1 ,I5
0 _
_
MENEENEEME
G..
}6
y},
}:.
.,d ..
E��ia
t/.. „
/ r/y .
S .
U
7 ,/
1 7,M ..
a
S- u
'
6 J
7'.
7/
NoEEENEEN
MENEENEMEN
��iaasMEMENEEMEN
Reading
Date
Gross Net
Time Time
Depth to
Water
Net
Drop
R4
ASK
1 ,I5
0 _
_
G..
}6
y},
}:.
.,d ..
71)
t/.. „
/ r/y .
S .
U
7 ,/
1 7,M ..
a
S- u
'
6 J
7'.
7/
20 L
PERCOLATION RATE 'S'
TEST RUN BETWEEN i /T
COMMENTS
(mmutes/mch) PERC HOLE DIAMETER
FT AND X i FT
a a a cr.,....�.-....... l A LiZrz
PERFORMED BV:� p ,,�. A �4� ggS7� I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE VftlJ1tL'[ISTPfTE111NCTMUN(CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72.008 (Rev. 4/85)
• WATER WELL RECORD
y STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
LOCATION OF WELL (Plea's complete either la, It, or Ic.)
Io. Borough Subdivision Lot Block Ib. I/4 gtrs.
Anch Park Hil 11 2 _.f_or_ot—
Ic1I DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
Street Address and Arta of Wall Location
Drilling Permit No.
A.D.L. No.
Section No. Township N Range
S ❑❑
S. OWNER OF WELL:
Address:
E❑ Marldion
W❑
R & H Const.
2. WELL LOG
Material Type
Faat Blow
S urlota
Top Boflom
a. WELL DEPTH: (final)
nL _ft.
1ST
S. DATE OF COMPLETION
— — 2—$,�,_
silt gravel
w/boulders
0 30
6. ❑Cable tool )MRatary ❑Driven ❑Duo
C] Auger ❑Jefted ❑Bared ❑Other:
hard pan 50 40
gravely—hard
pan lenses with
7. 1189Si® Domestic ❑ Public Supply ❑ Industry
❑ Irrigation ❑ Netharge ❑ Commerical
❑ Test Well ❑ Other:
cobbles 40 7
a el
bravely H2O
f lb
6
d15 CASING: in. ❑ Threo of
DepthWelded.ight be.� ft.
diom. 55 in. to_ �r ft. Depth Stickup ft.
1 tl 1 76
well producing
10 gpm
9. FINISH OF WELL:
Type: M �'mely+
lotlMssSl:
Sat between 1019 _ ft. and 7_ ft.
Backfilling Grovel pact
_—_—
10. STATIC WATER LEVEL: ", ft. 411-4
❑ Above or ® Below land surface Dale
Equipment used:
I I . PUMPING LEVEL below land surface and Yl
ft.
O
ft. after _bra. pumping I V g. p. m.
_ft, after_hrs. pumping -9-P m.
12.GROUTING Well Grouted: ❑ YesXQ No
Material: ❑ Neat Cement ❑ OtMr:
13. pump: (if arallabta) NP
Length of Drop Pipe 7), 1 fl. capacity 1�g. p.m.
USubm. ❑ Jet ❑ Centriflcal ❑ Other
te.REMARNS:
Perforated @ 691 - 711
16. WATER WELL CONTRACTORS CERTIFICATION:
IS. Water Temperature
This well was drilled under my jurisdiction and this report is true to the bast of my knowledge and belief;
laskaltlow-3Kell/Verna s Drilling & Eat AA 337
Reg,0.rad Business Name Contract License Number
aa,. .1,1222_41- Avio/n Street Anchorage, Alaska 16
Sigma : f/yylnfy A --__ - __ Date:
Authorized 'Representollve
Form 02-WWR(11/8I) Copy Distribution: WHITE -State OGGS, PINK-Oriller, CANARY -Customer
❑ F ❑ C
Aft
MUNICIPALITY OF ANCHORAGE
!�I 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 ❑NEW
N
_ , ❑ UPGRADE
MAILIN DDRESS
811 61,SFIOPA -
9 ysa
LEGAL DESCRIPTION
, 4 < L_L
of -7-1
IQ -
LOCATION
NO.OF EDROOMS
Well
Absorption area
Dwellin
PERMI NO.
Um
DISTANCE TO:
Awl M
— -
7
_
it Q
Manufacturer_
Maters
No. of partments
y
Li . p yY�in gallons
V
IF HOMEMADE:
Inside lengt
�-
Width
Liquid depth
d Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
JU2
O FQ-
Manufacturer
Material
Liquid capacity in gallons
Well
Foundation-Nearegt
f
ine
11
PE MIT NO.
'
T5
DISTANCE TO:
1
J LL 2
No. of lines yy
Long of a ch line
Total lent of lines
Trenc wi th
Distance between lines
' E w
L
Zl
inches
Q HTop
f tile to fi ish grade c.I ^84
a ena, ben--Jjath the
h
Total of %area rit
/
O
WiN
Y7 WIA
( it inches
5 7'
Length
k�SV
WidthLTMN 41
pth
P
W
f7
•
41.-
Type of crib
Crib di t
Crib depth
Total effective absorption
!
Lu
y
Well
Building foundation
Nearest lot line
••
DISTANCE TO:
r••••
J
Class
Depth
Driller
Distance to lot line
•
J
• : -
THOS+
DISTANCE TO:
Building foundation
Sewer line
Septic tank
rplii n aT!I l
OTHER
PIPE MATERIALS
93
CAST R M 27 •
SOIL TEST RATING152-9
INSTALLER
Cnel j u��
r
REMARKS
u
Ltd 0--'/-z
ACc
0,110C war
rvvaL,WW/ TJR �U,4V - -3 `
44:1
OC -T $
APPROVED - DATE LEGAL
/,S7
72-013 (Rev. 3/78)
a '14q J1_4
MUPJ I C I FALL I TY OF ALV CCH0FZAC3E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
C]hJ—S I TE '3 EWE Ft &. WEL L._ F'EF2M I T
PERMIT NO: 640882
DATE ISSUED: 10/16/84
APPLICANT: ROBERT RUNKEL R & H CONSTR. INC.
ADDRESS: 4811 BISHOP WAY
ANCHORAGE, AK 99508
CONTACT PHONE: 3.38-1674
LEGAL. DESCRIP:
LOT SIZE:
MAX BEDROOMS:
SUBDIVISION: PARE':: HILLS #1
SECTION: 34 TOWNSHIP: 12N
63399 (SQ.FT. OR ACRES)
4
LOT: 11 BLOCK: 2
RANGE: 3W
Listed below are the options available to you in designing your septic
system. Choose the option that best fits your site.
* DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
�t* GRAVEL LENGTH :> 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** 'TANk: MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I'understand that this permit is valid for a maximum of 4 bedrooms And
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORE: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT: ROBERT RUNKEL- R & H CONSTR. INC.
ISSIJED BY 6Lc,-d-et
DATE:
DATE:-. v nv
TFIELVCH
W _ L?RA I P4
DEPTH TO PIPE BOTTOM (FT.)
3.0 *
3.0 **
GRAVEL DEPTH (FT.)
3.0
3.0
TOTAL DEPTH (FT.)
6.0
6.0
GRAVEL WIDTH (FT.)
2.5
5.0
GRAVEL LENGTH (FT.)
102.0*
71.0
GRAVEL VOLUME (CU.YDS.)
33.1
46.1
TANK SIZE (GALS)
1,250.0 **
1,250.0 *�
SOIL RATING (SQ.FT./BR)
152
152
* DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION
�t* GRAVEL LENGTH :> 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** 'TANk: MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
1. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I'understand that this permit is valid for a maximum of 4 bedrooms And
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORE: MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED
APPLICANT: ROBERT RUNKEL- R & H CONSTR. INC.
ISSIJED BY 6Lc,-d-et
DATE:
DATE:-. v nv
COMMENTS
PERFORMED BY:
72.006 (6/79)
'G M) 5 i#y 5."yy y/aoe
�-fawrl.
�n �frslitf,J;r•el .o,,,f
r /rnnef 1d&n Oli{e0`5
WAS GROUND WATER Y
ENCOUNTERED? c S
?r' l7•i4�
IF YES. AT WHAT -
DEPTrI?
Reading
Date
Gross
Time
SOILS LOG' "(c'
Depth to
Water
•
'
•
� ( l d v
%
UNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
L PERCOLATION
TEST
—
I
625 L. Street, Anchorage, Alaska 99501 2644720
3.35
,37
LOG — PERCOLATION TEST
tNC
�,,/
FOR: �`'"'�Wk
[SSOIIL,S, DATE PERFORMED
A �9
PERFORMED
,70
—
LEGAL DESCRIPTION. iG
/����s'ar
I t
oIT
ibl�G��•.n)c
SLOPE SITE PLAN
Salt
3-1/3—
r/
�-�
COMMENTS
PERFORMED BY:
72.006 (6/79)
'G M) 5 i#y 5."yy y/aoe
�-fawrl.
�n �frslitf,J;r•el .o,,,f
r /rnnef 1d&n Oli{e0`5
WAS GROUND WATER Y
ENCOUNTERED? c S
?r' l7•i4�
IF YES. AT WHAT -
DEPTrI?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
7 NCO
-71 7
%
1
/
e70
—
I
I
3.35
,37
tNC
'S'.3S
—
,70
—
I t
c
rN 0
3-1/3—
r/
Ci
}
3'
I
._
t 20
s
l z ,
PERCOLATION RATE
rimer e. .ocTnrccn
-9 A d4nS I/ic/gy �J-
[): rive,
G£ 8
• '� Municipality of Anchorage
On -Site Water and Wastewater Program ^„ r
(907) 343-7904 5 A F£ T Y
_ Certificate of On -Site Systems Approval
Parcel I.D. 017-112-59 Expiration Date:
1. GENERAL INFORMATION:
Complete legal description PARK HILLS #1: BLOCK 21 LOT 11
Location (site address) 14727 Park Hills Circle *Anchorage 99516
Current Property owner(s) Larry Cooper Day phone 250-7530
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ . Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 5 G Waiver Fee $
Date of Payment -1Z y �22 Date of Payment
Receipt Number O 913 6 G Receipt Number
COSA # a s c a n Waiver #
C�j
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: Gamess 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: f 2�
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
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 dates of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
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
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
o ��..• "° T)
Q
u � •y
"""'
;� � • .. • • • • • • • • . • • • • . • .
r , Gor nP
Q �.�• .j F 9
e1 o t asst° �o
#AECC884
6. DSIGNATURE
_ System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
r.0nditioonal approval for bedrooms, with the following
E' •e
stipulations:
Y`ea afi4'i t-,,-
S �,t��''r 0'*•�_ �� I�-PGt V` I•�e�fi rid L � I o O
By: J tom,.. ('c`�� Original Certificate Date: �—Z7 z CiZZ
I
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
Septic System Advisory
Well Flow Advisory
OFlII 1;i
Nitrate Advisory
Arsenic Advisory J�—ON- 3717E `9
Other WATER AND
m WAST'_v'ATER Z^
J� PROGF;AM
'moi O,o� /�•• �J\��
0j
Legal Description: PARK HILLS #1; BLOCK 2, LOT 11
Parcel ID: 017-112-59
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Adequacy test date 2/24/22
❑ Well log is filed with Onsite (or attached)
Well production at time of test 5.7+ gpm
Date drilled ""27"4
NIA
Water storage tank volume gallons
Total depth *115.1+ ft
Well disinfected for coliform test? ❑ Yes OR No
Cased to UNKNOWN ft
Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly
Nitrate mg/L Nitrate less than MRL (ND)
❑ Wires are properly protected
Arsenic ug/L PArsenic less than MRL (ND)
Casing height (above ground) 12+ in.
Collected by GEG, LTD.
Date of flow test for COSA 2/24/22
Date of SampleZ )--
Static water level at beginning of test 114.2 ft.
Any rejuvenation treatment (past 12 months) -YES
Comments *PER GEG INSPECTION - WELL DEEPENED
AT SOME POINT, NO DOCUMENTATION IN MOA RECORDS
B. TANK DATA
Age of tank(s) 3 years
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 2— �--
D. ABSORPTION FIELD DATA BED
C. LIFT STATION
❑ Required maintenance corn
Age of lift stationy
Lift station mated aV�
Which system tested (date installed) "12/99
Adequacy test date 2/24/22
❑ ALL standpipes present per record drawing
Results DPass For 4 bedrooms
Total measured depth from grade 4.04 ft (max)
Fluid depth prior to test 5 in
Measured depth to pipe invert from grade *2.0$ ft (min)
Water added 609 gal
❑ N/A — pressurized field
5.5
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
45
depth into effective r ••
Elapsed time min
p
❑ Code -required soil cover over field
Final fluid depth 5 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) -YES
date of test)
Gallons introduced N/A gallons
if yes, enter date 6!14/19 -PRESENT
Comments/Deficiencies: *INSULATED WITH Y OF FOAM - SEE EMAIL FROM OWNER REGARDING FREEZING **SOUTH Mr IN BED IS KINKED & UNABLE TO BE MEASURED
-DRAINFIELD HAS LATERAL AERATION SYSTEM - NO PLUMBING LEAKS OR BACK-UPS NOTED DURING TESTING. ALL CLEANOUTS
STAYED DRY THROUGH OUT TESTING - DRAINFIELD IS APPROACHING THE END OF ITS USEFUL LIFE
i!
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/Uft Station on Lot > 100'
❑✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Cj Yes
if No
ft
I 7v Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' S Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
0 Yes
Animal Containment > 50' R Yes
if No ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' [E] Yes
if No
ft
n Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' M Yes if No ft Surface Water > 100' Yes if No ft
Property Line > 5'
❑✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
�✓ Yes
if No
ft
Private Wells > 100' R✓ Yes if No ft
Water Main > 10'
Cj Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Water Service Line > 10'
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
[7, Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q Yes
if No
ft
Private Wells > 100' Q Yes if No
Water Service Line > 10'
M Yes
if No
ft
Community Wells > 200' S Yes if No
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
',J ' A. Gar ss;
CE 79 3 oil-
0"P
�
e
�Op�� r.. �-7i ��v�,,.��ApG
a bro f ession000
#AEccssa �4O000��
ft
ft
Erik Widger
From: Larry Cooper <cfo@ak.net>
Sent: Thursday, March 3, 2022 5:17 PM
To: Erik Widger
Cc: Sonja Blewett
Subject: Re: 14727 Park Hills Circle - 2022 COSA
Erik:
I understand it was noted that the soil over our drain field may be thinner than desirable. I want to
formally assure you that in the 17 years we have lived in this house there has never been an event of
freezing in the drain field or any other component of our septic system. That includes many periods
over the years where we had deep freezes across the city of Anchorage without snow covering the
ground for any kind of insulation.
Please let me know if there are questions in regard to this that I can answer.
Thanks,
Larry
Larry J. Cooper
14727 Park Hills Circle
Anchorage, Alaska 99516
907-250-7530
On Mar 3, 2022, at 12:57 PM, Erik Widger <erik@garnessengineering.com> wrote:
Hello,
In order to submit your COSA to the MOA we will need the following items:
1
Jeff Garness
From: ARM Septic Services LLC <ARMServicesAK@outlook.com>
Sent: Thursday, March 3, 2022 2:19 PM
To: Jeff Garness
Subject: Re: 14727 park hills
The drainfeild was surcharged and overflowing out of the ground when we first got on site a few years ago.
Mariah
Sent from my iPhone
On Mar 3, 2022, at 2:12 PM, Jeff Garness <Jeff@garnessenginee ring.com> wrote:
Was the drainfield failed?
.... ..............................
From: ARM Septic Services LLC <armservicesak@outlook.com>
Sent: Thursday, March 3, 2022 12:44 PM
To: Erik Widger <erik@garnessengineering.com>
Cc: Sonja Blewett <Sonja@garnessengineering.com>; Jeff Garness <Jeff@garnessengineering.com>
Subject: 14727 park hills
Hello,
Please see attached invoice for park hills and what we did back in 2019 for tank replacement and
aeration of laterals.
Thanks,
Mariah Campbell
Member
ARM Septic Services, LLC
Ph: (907) 688-9433
Cell: (907) 317-8834
Email: ARMServicesAK(ftutlook.com
Website: www.ARMServicesAK.com
Facebook: www.facebook.com/ARMServicesAK/
1
ARM Septic Services, LLC U
17933 Old o"nr"�mw"�
�
Ohugiak,AK 99567
(9O7)G88-S433
ARK8SemioeeAKpoud|ook.00m
vmww.ARK8GomireoAK.com
Tammy Cooper
14727Park Hill Cr
Anchorage, AK 99516 �
1828 06/14/2019 Due on receipt
Excavation Tank Only 1 13,735.95 13,735.95
Estimate for installation of new 4 bedroom septic tank and d lateral
aeration system. _r "n
P�auen»adondo�ntha to this 'ion of work.
contract. ;�
50% down required, Remaining balance due upo pi
14727Park Hill Cr. "
Site Work
-Engineering design, drawings, and submittal for Permit -MOA permit fee
-Inspections f septic tank
-Engineers record drawings
-Submittal o4records package bothe MOA
materials |
Top soil and seed
_HY[dnlJettinQsewer lines
.--
AoJsminterest charge will apply mall invoice over 30 days lam. PAYMENT
BALANCE DUE
ARM Septic Services, LLC
1 2,134.00 2,134.00
1 1,993.75 1,993J5
|
1.50| 275.00 412.50
18,276.20
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20' TELECOMM. &
ELECTRIC EASEMENT
S00° 00'00"E 156.64'
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
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-112-59
1. GENERAL INFORMATION
HAA # (O Ll OO;;Z
Expiration Date: S'— a4 —0t
Complete legal description Lot 11; Block 2; Park Hills Subdivision #1
Location (site address or directions) 14727 Park Hills Circle Anchorage, AK 99516
Current Property owner(s) Pam Buffington Day phone 301-5671
Mailing address same
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Lisa Herrington Day phone 646-0525
702 Barrow St. Anchoraqe, AK 99501
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑✓ Individual On-site ❑✓
Individual Water Storage ❑ Individual Holding tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ 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 sample results. (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.
4. 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 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 time of installation.
Name of Firm S & S Engineering
Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Cowan
Phone 694-2979
Date o / 8 /o y
OF
to
a
.) 7 !
5. DSD SIGNATURE I� �1 ROBERT C. COWAN Fti
1 / 4
0".. C: - 8801 a :-
Approved for bedrooms. y sr�^�, :!<;'
Disappr v ttacp
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
''- nN-RITE;
WATER AND
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date:. ^ •� 1� - 0 Lf
(Rea 01102)
vlunicipality of Anchorage
• ' Development Services Department
% Building Safely Division 1
On -Site Water & Wastewater Program
47CO South Bragaw Sl.
P.O. Box 196650 Anchorage, Al 99519-6650
www.ci.anchorage. ak. us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 407- 11 13LacK A PACK Parcel ID:
A. WELL DATA
Well type PR wnrti If A, B, or C provide PW SID # Well Log &N) _Y y f
Date completed 11 /017/Yy Sanitary seal 61N) Y -r) Wires properly protected ON) YE5
Total depth 130+ ft. Cased to 90 t ft. Casing height (above ground) 18 t in.
FROM WELL LOG AT INSPECTION
Date of test 1 ! }7 SY ;1. // 0 /O y
Static water level %S ft. /Oro _._ ft.
Well production I D 9 P.M. —_ S- H 9 P M
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0- ( mg./I.
Arsenic: A. Date of sample: -d�/%N
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material 5ei'?i4L/ HDPE
Tank size 13 "0 gal. Number of Compartments 7;) -
Foundation cleanout®N) Yd s Depression over tank (YO NO
Date of pumping 1 0 /1 7 10 3 Pumper I S 4-4 C- S
C. ABSORPTION FIELD DATA
Other bacteria O . colonies/100 ml.
Collected by:T_ Rg€NGINEERING
17034 Eagle River COP Road No. 2U
r.&918 River, Alaska 99577
Date installed
Cleanouts &)
iX/91 `t
yes
High water alarm (Ye_ N O
Date installed 1 �1 7 9 q Soil rating p.d./ft r ft2/bdrm)0- (� System type ISE A _
Length G7 ft. Width is fl. Gravel below pipe d- S ft.
Total depth __�J_ ft. Eff. absorption area 100 9-ft2 Monitoring tube YES Depression over field WO
Date of adequacy test X11010 1tResults Pass ail) PR s S For __y_ bedrooms
Fluid depth in absorption field before test in Water addedG0-gal, New depth Iq in.
1
Elapsed Time:ia7 min. Final fluid depth in. Absorption rale >_ __%v d g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nsv�t k"I"
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO.
Septic tank/lift station on lot 1 00 ,+-
Absorption field on lot %00 r�
Public sewer main N( R
r
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
/00 -j-
/00 ',A
Public sewer manhole/cleanout N14
Sewer /septic service line a S -0- Holding tank N AA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 7t. Property line 37 Absorption field +' i
Water main N 1A Water service line / 0 ,4- Surface water / 00 •t
Wells on adjacent lots /00 '4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 37 Building foundation Q S Water main N A
Water Service line /orf' Surface water /00 r+
Driveway, parking/vehicle storage 3( -
Curtain
b
Curtain drain Norve. KI O - Wells on adjacent lots / 0 0 +
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name i 03 t:••LT <. C o w/4AJ
Date a 8/0i
HAA Fee
Date of Payment
a�r9�oY
Receipt Number 0 M SV0 7
1
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
t
T k ROEERT C COWAN i �?
`"C� CE - 8801 r.``"
in.
LA
LOT 12
49TH
�bat�M. Oraye
LS -10392 �+
Po_ ..... _b�
NOTE:
SNOW AND ICE MAY CONCEAL
MINOR SURFACE FEATURES.
LOT 10
m'
m
m
m �
LOT 11
66.4
........
5/m W: i
w/GVB "".,00
hot
nal appear m IM nearded wAEIN+Ian plat NOTE
O
<Ycum+loncww should any data hereon be aced fa
F
� .
on or to, establishing property line
Nab ! TWt a
yam_ %— R —
,.B a
A Zoe I
%0%TY CERMCATION: Ulf TECH hoe aanductwd a
of he property as drown a thiher,
phrl�oWowing and that
4no . ana mal the Mppyr lines n +I[uw[wd uv
property lines and no wrinexA-
an ere wlet
Nom MMS-
[anCRETE-
tn-
- T
z O JO 62�i1
I
w
,D
EXISTING
MWSE
N
wA1O1
IW
ai
3
J41
W
e
O
k7N
-V0
IW
-1
o
20' TELE. & ELEC. EASEMENT
N 89'53'50" W 141.19-
41.19TRACT
TRACTB
PAM BUFFINGTON
with DYNAMIC PROPERTIES. INC.
440 WEST BENSON BLVD. N 103
ANCHORAGE, ALASKA 99503
NOR% OME6 Nitt BER: n!y
. 16. 2004 1
2004 -L -35A ,:f '"
t. ofS y i+ EM ntv, Te tk only 1a t'ltl.. lne
of any esernenb, wesnonlR a r"plat
5/m W: i
w/GVB "".,00
hot
nal appear m IM nearded wAEIN+Ian plat NOTE
O
<Ycum+loncww should any data hereon be aced fa
F
123,
1=a' ALMOL AYOIwIIEN,
on or to, establishing property line
Nab ! TWt a
yam_ %— R —
%0%TY CERMCATION: Ulf TECH hoe aanductwd a
of he property as drown a thiher,
phrl�oWowing and that
4no . ana mal the Mppyr lines n +I[uw[wd uv
property lines and no wrinexA-
an ere wlet
Nom MMS-
[anCRETE-
tn-
- T
ha
mestw al+l *that than Mlb.
MAWt
aAVO _
RPMstu�orvEs-
FNGINEERS
AS—BUILT OF: IFOALOMISPIp,:
wA1O1
561-6626
562-5291
LOT 11, BLOCK 2,
'°
PARK HILLS SUBD.
ADD. N0. 1
k7N
/A A
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE Ak
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section ExTa
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING`
017-112-59" HAA # tV YA n\ C_Yr. l S
1. GENERAL INFORMATION
Complete legal description Lot 11, Block 2, Parkhills #1
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
14727 Park Hills Circle
Georgie & Jerry Barnes
14727 Park Hills Circle, Anchorage,
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well xxx
Community well
Public water
Day phone
. AK 99516
Day phone
Day phone
345-6478
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev 1M) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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
5$ 5 ENGINEERING Phone el y_ a ry-7 G�
Address Eagle River, Alaska 99577
Engineer's signature Date /�/ �.
6. DHHS SIGNATURE _
✓ Approved for ��bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
4UTI0
OF
Si 1
a
V
bedrooms, with the following stipulations:
Date 1. %
The Municipality of Anchorage Department of Health. and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
#MS IBa+. lAt� Back MOA Q1
RCEE^.T C. CO'NAN
�?
CE - U01
,
bedrooms, with the following stipulations:
Date 1. %
The Municipality of Anchorage Department of Health. and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
#MS IBa+. lAt� Back MOA Q1
zLCEIVED
Municipality of Anchorage IAN .1999
oe* DEPARTMENT OF HEALTH & HUMAN SERVICES '
Environmental Services Division MUNICIPALITY OF ANCHO
825 L Street, Room 502 • Anchorage, Alaska 99501 • ( 12*RvICES DIVISION
Health Authority Approval Checklist
Legal Description: Lo T 11 f3 L -ac a a PARa N"`t'0/ Parcel I.D.: OI 7 - /l1
A. WELL DATA
Well type ✓° R I \"f rf- If A, B, or C, attach ADEC letter. ADEC water system number
Log present &N) i zi 5 Date completed I I/} 7 S 7
Total depth 7 6 Cased to
Sanitary seal ON) -Y4, f
Date of test
Static water level
Well production
FROM WELL LOG
it /a7 /S`/
WATER SAMPLE RESULTS:
Gr'
g.p.m.
Casing height (above ground)
Wires properly protected/N)
AT INSPECTION
3/ g8
/o b
3
Yr _�
g.p.m.
Coliform Nitrate r 17 c Other bacteria
i Collected b
Date of sample: f � r Y R y: S & S ENGINEERING
17 U34 age River Loop Road No. 2o4
B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577
Date installed )
'
� I `1 11 Tank size 1 3 d 1) Number of Compartments � Cleanoutsfy�N,) y4 I
Foundation cleanout (JY N) Y c J Depression (41) ^ High water alarm (Y6;
Date of Pumping �1a - ^ 4 Pumper -
C. ABSORPTION FIELD DATA
Date installed 1 /i IJ Soil rating g.p.d./ft' r ftz/bdrm) System type '1)
Length (D I Width I S Gravel thickness below pipe S Total depth Y
Effective absorption area I o u s Fr Z Monitoring Tube presenI Y/N) 1 * 13 Depression over field (Y& ^
Date of adequacy test I"/ 4 - rw w Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid depth
Peroxide
72-026 (Rev. 3/96)`
(ins) Minutes later:
months)(Y/N)
Immediately after
For. Zi bedrooms
rate = g.p.d.
If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N) _
High water alarm level at'
E. SEPARATION DISTANCES
"Pump
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot / 6 0 t
Absorption field on lot / 00
Public sewer main
Size in gallons
"Pump off" level at'
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
/ 0 0 4
Sewer /septic service line °L ' Lift station r 14
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
'rt
Foundation 76 Property line -7 Absorption field
Water main/service line 10 Su4ace water/drainage /o u t Wells on adjacent lots 10 o 4 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 3'7 Building foundation `t Water main/service line
Surface water
Curtain drain rJ 0 a 4 K V° w
F. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
Wells on adjacent lots
I certify that I have determined thru field inspections and review of Municipal
in conformance w'th A ggguidelin in effect on this date.
Signature
Engineer's Name i d!3 E� i �- Co �,4,v
Date 1/1 S / 9 Ci
HAA Fee $ � Z' O
Waiver Fee $
Date of Payment y — /�f Date of Payment
Receipt Number �� / Receipt Number
72-026 (Rev. 3196)'
oc �
JJ f
M
'O. t ROEERt r
are
•MUNICIPALITY OF ANCHORAGE •
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL. CERTIFICATE
1. General Information
Application Date March 4, 1985
(a) Legal Description (include lot, block, subdivision, section, township, range)
Park Hills #1 Lot 11 Block 2 Sec 34 R3W T12N
Location (address or directions)
Park Hills Circle
(b) Applicants Name R & H Construction Telephone - Home Business 344-8042
Applicants Address c/o GEOLAB 1131 E. 76th Ave. #101 Anchorage, AK 99502
(c) Applicant is (check one) Lending Institution ; Owner/builder XX ;
Buyer = ; Other (explain);
(d) Lending Institution Telephone
Ad3Tgss
(e) Real Estate Co. S Agent
Address
Telephone
(f) Mail the HAA to the following address:
Anchorage, Alaska 99502
2. Type of Residence
Single -Family Multi -Family
Number of Bedrooms
3. Water Supply
Other (describe)
Individual Well Q Community Q Public Q
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite =1
Public
Community
Holding Tank Q
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
• • f
5. 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 regula-
tions in effect on the date of this inspection.
Name of Firm GEOLAB
Telephone 344-8042
Address 1131 E. 76th Ave. #101 Anchorage, Alaska 99502
+r
Date March 4. 1985
r_•Cr
6. DHEP Approval
Approved for
Approved
(ENGINEER SEAL)
bedrooms
Disapproved
Terms of Conditional Approval
CAUTION
Conditional
��+IHOM22'0 r
A:iyyi. GMiX F:/i
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21 7-19-84
• CIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA Legal Description: Park Hills #1 Lll B2
Sec 34 R3W T12N
Well Classification Individual If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (Y/N) Yes Date Ccapleted 11/27/84 Yield 10 gpm
Total Depth 76' Cased to 76' Depth of Grouting None
Static Water Level 65' Pump Set At 70'
Casing Height Above Ground 18" Sanitary Seal on Casing (Y/NY"
Electrical Wiring in Conduit (Y/N) Yes Depression Around Wellhead (Y/N No
Separation Distances from Well:
To
Septic/Holding Tank on Lot
152'
; On Adjoining Lots 100'+
To
Nearest Edge of Absorption
Field on Lot 165'
; On Adjoining Lots100'+
To
Nearest Public Sewer Line
NA
To Nearest Public Sewer
Clearout/Manhole
NA To Nearest Sewer Service Line on -Lot NA
Water Sample Collected By AEc-S Date ?/I S/RS
Water Sample Test Results Satisfactory
•.n t
B. SEPTIC/HOLDING TANK DATA
Date Installed 10/18/84 Size 1250 gal No, of Compartments 2
Standpipes (Y/N) Yes Air -tight Caps (Y/N) Yes Foundation Cleanout (Y/N)Yes
Depression over Tank (Y/N) No Date Last Pumped NA - new system
Pumping/Maintenance Contract on File (Y/N) NA for
Holding Tank High -Water Alarm (Y/N) NA Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holdirg Tank:
To Water -Supply Well 152' To Building Foundation 130'
To Property Line 10' To Disposal Field 10'
To Water Mair,/Service Line NA To Stream, Pond, Lake, or Major Drainage
Course NA
Convents
Receipt # 3 2)
Date Paid:
Amount:
JS —
(Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1r,2 cn_ft_/RR Type of System Design Wide Drain
Date Installed 10/18/84 Length of Field 71'
Width of Field 5.01 Depth of Field*3,-5', due to tonoaraohv.
Gravel Bed Thickness -�l
Square Feet of Absorption Area 608 sq. ft. Standpipes Present (YM) yes
Depression over Field (YM) No Date of Last Adequacy TestNone - new system
Results of Last Adequacy Test NA
Separation Distance from Absorption Field:
To Water -Supply Wall
165'
To Buildirg Foundation 150'
To Property Line
10'
To Existing or Abandoned System on
Lot None On Adjoining Lots 1001+
To Water Main/Service Line NA To Cutbank(if present) NA
To Stream/Pond/Lake/or Major Drainage Course NA
To Driveway, Parking Area, or Vehicle Storage Area 50'
COmments * Irregular topography. Insulated where less than 4'
D. LIFT STATION
Date Installed
Size in. Gallons
"Pump Or." Level at
High Water Alarm level at
Tested for
Electrical Codes(YM)
Comments
Dimensiors
Manhole/Access (YM)
"Pump Off" Level at
Vert (YM)
Pumping Cycles during Adequacy Test. Meets MDA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to e
on the da of th' inspection. d
Signed Date 3 7S
CczTpany GEOLAB MOA No. ST85-007
KBl /d5/s
(Page 2 of 21
/VIM�� do A"-,'
2-15-84
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