HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 12kyhl'*lls #2
Block 3
Lot 12
#011-122-38
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
' On -Site Services Section 825'C Street Room 502
P.O. Box 196650 Anchorage, AK 99519£650 Pagel of 3
www.ci.anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW PID Number: 011-122-38
"'n".Inhn Hagpimpir Cn
Wastewater System: ® New ❑ Upgrade
Aareaa,'.
ABSORPTION FIELD
P24 NumbxaBWroam•
®peep Trench OShallew Trench [3 Bled ❑Mwnd 13 Other:
LEGAL DESCRIPTION
salt Rating
TeMl Depth *=algioet grade:
a
13 p ! Let SuOdNabn:
Depth bipe pbosom ham *nI grade:
Growben
Growl depth eath pipe:
3 12k
TeenNap: Range. section:
Fie Wad above anginal grade.
G," Length:
2 Ft
48 Ft.
Well: El New E] Upgrade
GuvN eMth:
Number N stance b
blines: Dietween anew:
3 Ft.
1 0 Ft
Clsaadration (Pnwte, A. S. Cl:
Total Depth:
CnW te.
Total absorption veeApe
Male n1w
A AWWU
Ft.
Ft
672 Fz
F810/3034
Dnaer
Deb DNIW'.
Static Water Levet
Installer:
Date Installed'
Ft
Ha meier Co.
8/1/2000
yiII Pump Sa v'.
using Ki ght Aarve Grapnd'.
TANK
GPM FL
F1
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lift
Holding
Publc/Privat
k1iNi1i nirif
capantr
Fran
Tank
Field
Station
Tank
Sewer Line
Greer
1500 cal.
Wieal:
Nuenwacampvenena:
wee
---
-_
"'
"'
—'
Steel
2
sad.w"
100+
100+
LIFT STATION
LN line
36
20
Ste.
Manubcturer
rata Gal.
Favapen
58
70
Yun`p cn kh11 at.
Yump ulr levN n
Niph eeler alarm N:
M
In
M.
100+
1 100+
puny Make s Modal
Elect" Mpeetbm pedomnad ler
Curtem Dain
R"e"p
Ri id Insulation installed over sewer line where it
BENCH MARK
crosses under driveway. Sewer line is over 10 feet
Leucon and Dncnpo.:
Garage Finish Floor
from water service line.
115.0 FL
Engineer's Stamp
.'�r♦�t►��tlf f f f
'
„C.... . ...
Inspections performed by: Pannone Eng. Svc Dates: 1"8/1/2000agrtt
..: �� •
I• A / �' •i
2nd08/01/2000
». 0
..... ...•...•.i••...0
Department of Health and Human Services approval
0 ieven R •PCr rapine?
iv,
IF!,,
••�sj�
Reviewed and approved by: /% al Date: S '5=00
•.��]�C{
C�`,-
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(Rw. IIM)
♦ r I.
PERMIT NO, SW990253 AS -BUILT
WASTEWATER ABSORPTION SYSTEM
il LOT 12 BLOCK 3 SKYHILLS S/D
WATER SERVICE
NEW SBR �rT
HOUSE d W
t SEWER LINE INSULATED
J rUNDER DRIVEWAY,-
: I J \
u/
............
NOTE,
1) SUED. IS SERVED BY AWWU. TH R ... ..............._.._........
ARE NO WELLS WITHIN 200 FEET OF
THE PROPOSED INSTALLATION. T
/ .._..........._....... _ NEW 1500
SEPTIC TANK!
❑
A
B
1
60,6
68.3
2
69.3
78.3
DC
74.1
83,8
Cl
75.7
88,9
MT
87.8
94,9
C2
100.5
104.5
�f
!C1
U T'/
!P1
P.I.D. NO, 011-122-38
AIN FIELD
, 0.5' TD
48 Fx7''UFi41I0.5'
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4g_
SORL RATIN PEC iG26 MIN/INCH
1.2 GPD/SF
125 SF/BEDROOM, 5 BEDROOM
625 SF REQUIRED, 15008 SEPTIC TANK
DEEP TRENCH, 7' EFFECTIVE
9-11' TOTAL DEPTH, 48 LF EACH
2-3' WIDE, 672 SF TOTAL
f, ...
•
Steven No. CE R. Pannonee�
�. � 8J49 /%�
1�.or�L'fjl�,.���i
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PREPARED FOR
John Ha 9neler
John HaOneler Co.
2204 Cleveland Ave,
(907)Anchorage,-99517
240-6708 9
Suite 204
PANNONE ENG. SVC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
Fax
272-8218 PhonAS&BUILT
ATEA 8 -19 -DD
(907)
PERMIT N0, SW990253 AS-BUILT DETAILS P.I.D. NO, 011-122-38
WASTEWATER ABS❑RPTI❑N SYSTEM
LOT 13 BLOCK 3 SKYHILLS S/D
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♦ iSteven R. Pannone!/ a
�••�'�.No.CE 86I ffj? John gneler Co. P. ❑• BOX 102954
John Ha
•1���"•�y�� 2204 Cleveland Ave, Suite 204 ANCH❑RAGE, ALASKA 99510
• ••� Anchorage, AK 99517
DATE 8- 91 oOPH❑NE & FAX
•
(907) 248-6789 AS-BUILT
MUNICIPALITY OF ANCHORAGE
Department or Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Permit Number: SW000235
Legal Description: SKYHILLS PHASE 2 BLK 3 LT 12
Design Engineer. 0062 Pannone Engineering Services
Owner Name: John Hagmeier Company
Owner Address: 2204 Cleveland Ave., #201
Anchorage , AK 99517 -
Renewal
OW�C-Era�-,
sal kao
D
8// /OO
Date Issued: Jul 17, 2000
Expiration Date: Jul 17, 2001
Parcel ID: 011-122-38
Site Address: 008232 HEAVENLY CIR
Lot Size: 41260 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
7 Disposal Field Q Septic Tank ❑ Holding Tank ❑ 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.
Received By:
yxtm v—,"Im4tu —7 Date: `$
Issued By: a'4!` -e4/ &/. dr�.L� Date: _% —/ % — O e
r: lVil icipality of Anchorage
i Department of Health and Human Services
825 "L" Street
Rick Mystrom. P.O. Box 196650 Anchorage. Alaska 99519.6650
Mayor
hltp://www.ci.anchorage.ak.us
June 7, 2000
John Hagmeier Co.
2204 Cleveland Ave., Suite 200
Anchorage, AK 99517
Subject: Skyhilis Phase 2, Block 3, Lot 12
Permit # SW990253 PID # 011-122-38
The subject permit #SW990253 issued by this office for a single family well and/or on-
site wastewater system, is due to expire 365 days after it's issuance on August 5, 1999.
If this is a well permit and you have drilled the well, a well log must be sent to this office
for documentation of the installation and to close the permit.
If this is an on-site wastewater system and a licensed Professional Engineer has inspected
the installation, the original as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports must be submitted within 30
days of construction completion.
A new permit must be obtained from this office for a well and/or on-site wastewater
system NOT installed by the expiration date. However a new permit can be issued free of
charge for a second year if the application for the renewal is received on or before the
date of expiration of the original permit for which a fee was paid.
When applying for a new permit after the original permit has expired or for more than a
second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well
permit.
If you have any questions, please call this office at 3434744.
Sincerely,
qesCross, PE
Program Manager
On-site Services
enc: Copy of Permit
a
• MUNICIPAUTY OF ANCHORAGE
Department of Health and Human Services
OnSde Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW990253
Legal Description: SKYHILLS PHASE 2 BLK 3 LT 12
Date Issued: Aug 05, 1999
Expiration Date: Aug 04, 2000
Parcel ID: 011.122-38
Design Engineer. 0062 Pannone Engineering Services Site Address:
Owner Name: John Hagmeier Co Lot Size: 41260 SO. FT.
Owner Address: 2204 Cleveland Avenue Suite 200 Total Bedrooms: 5 Permit Bedrooms: 5
Anchorage , AK 99517 -
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ 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.
Received By:
Issued By:
Date:gJ61
q
Date:
Steven R. Pannone, P.E.
P.O. Box 142025
Consulting Engineer Anchorage, Alaska, 99514
(907)272-8218 (907)272-8218 Fax
July 25, 1999
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 12, Block 3 Sky Hills Subdivision,
Septic System Permit
Gentlemen:
My firm was contacted to design and install a new septic system for the referenced lot. We conducted a field
investigation to locate existing wells and septic system before designing the proposed system. Two test holes were
excavated on August 6, 1998 for the system design, which is on file with your department. No ground water was
encountered. No bedrock was encountered in the test hole.
The lot is approximately 0.95 acres in size. Lot s 12 slopes to the northeast at a rate of approximately 10-18 percent.
The south-eastem portion of the lot is flatter (approximately 10-11%). The proposed installation will be located on the
eastern portion of the lot. Double clean -outs will be installed after the tank and diverter valve. The proposed location
is greater than 200 feet away from any wells. This lot is served by AW WU water service. The proposed system will be
greater than 10 feet from the water service lines. The proposed installation will not affect the future development of
the surrounding or existing lots. See the attached design.
Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation.
Sincerely,
Steven R. Pannone, P.E.
Attachments:
CA WORK%I 2.3Skyl lil Is.001.%pd
CE -8149
PR9I�ONaw
PERMIT NOs SV DESIGN P.I.D. NOi
WASTEWATER ABS❑RPTI❑N SYSTEM
LOT 12 BLOCK 3 SKYHILLS S/D
iI
1
1
NOTE, PROPOSED ` \I
1) SURD. IS SERVED BY AVWU. THERE WATER SER CE 1
ARE NO WELLS WITHIN 200 FEET OF
THE PROPOSED INSTALLATION. �vir\
PROPOSED.. ............._....._.
5 BR HOUSE -
'w W'
,w , 1
® PRIMARY DKA NO FTLLD{
45LFx7'EFF,
_........_.... _ _........_.......
RESER E DRAINIFIELD
45LFx 'EFF, \1O'I TD
LiJ
w Cr
f _.� �i v
TP
PROPOSED 1500gJ0"
SEPTIC TANK Q� j I ' W
W
iLJ
J
� U
1
C,\Work\12-3SKYH.DWG-� DESI • : i
PERC RATE, 2.6 MIN/INCH
CF X44 SOIL RATINGi 1.2 GPD/SF 125 SF/BEDROOM, 5 BEDROOM
?���P"�• 625 SF REQUIRED, 15008 SEPTIC TANK
:r %•• DEEP TRENCH 7' EFFECTIVE
w 49TM L 11-12' TOTAL DEPTH, 45 LF EACH
�•. »i... �...... -4-0 2-3' WIDE, 630 SF TOTAL
0
"go.-......•••••»•�••PREPARED F❑R, PANN❑NE ENG. SVC
even R. Pannone:John Ha neler• g P. ❑. BOX 102954
•• No CE 8149 •.• �= John Hagneler Co.
••D�Zs ,.•'��� 2204 Cleveland Ave, Suite 204 ANCHORAGE, ALASKA 99510
•�h Anchorage, AK 99517 272-8218 Phone & Fax
��''� (907) 248-6789 ATEi 7-25-99 DESIGN
Brei r. 1•-vn•
PERMIT NO, SW DESIGN DETAILS P.I.D. NO,
WASTEWATER ABSORPTION SYSTEM
LOT 12 BLOCK 3 SKYHILLS S/D
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.•...«.....:.»...».....':• - John Hn reeler
♦ o.cE aas. a P. O. BOX 102954
♦ John♦1 er Co. ANCHORAGE, ALASKA 99510 2204 Clevellevel and Ave, Suite 204
♦��,,,, 1��r 907) 248e, AK 99517 DA 72-8218 PHONE g FAX
NOT To SC LEI DESIGN
• v Municipality of Anchorage
DEPARTMENT OF HEALTH 3 HUMAN SERVICES
825'L" Street, Anchorage. Alaska 99502 -Mo
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: L H Construction, ine.
DATE PERFORMED:
LEGAL DESCRIPTION: L+l
�r
OL_
2
3
4
5 :1 •
6
7 -I ' •.
S�
$L—L
M vd/
9
s
10
11 .+• 5
21314 12-
13-
14
15 � •••
16
17 /
18
19
20
Range. Section:
WAS GROUND WATER ( I
ENCOUNTERED? /V
S 8 �.
IF YES. AT WHAT L
DEPTH? P v
t1+ 1 E
Depm to Water
Manaonllp? + 11' Dam t3' 5�i6
J PERCOLATION RATE 8
(minutevintn) FERC HOLE DIAMETER
TEST RUN BETWEEN FT ANO �� FT '
COMMENTS Perc cavity was presoaked prior to testing
�I
a
PERFORMED ti) Y ` 1 CERTIFY THAT THIS TEST WAS PERFORMED IN _.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. D TE
N
`�
l •,, —,41.260!sq fL
\
,
1
J 18
r ah
1
1
WAS GROUND WATER ( I
ENCOUNTERED? /V
S 8 �.
IF YES. AT WHAT L
DEPTH? P v
t1+ 1 E
Depm to Water
Manaonllp? + 11' Dam t3' 5�i6
J PERCOLATION RATE 8
(minutevintn) FERC HOLE DIAMETER
TEST RUN BETWEEN FT ANO �� FT '
COMMENTS Perc cavity was presoaked prior to testing
�I
a
PERFORMED ti) Y ` 1 CERTIFY THAT THIS TEST WAS PERFORMED IN _.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. D TE
r
PERFORMED FOR
Municipality of Anchorage
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
L H Construction, Inc.
LEGAL
DESCRIPTION:
LIG, r—)
Par
>`w
Net
Drop
2-
1 2.5
/
3-
4
4-
I
2:oi: 8
19.116
6-
7-
79
I Y
I
9
10
12-
14-
15
214
16]
j
17
18
19
DATE PERFORMED: a-�-gs
Township. Range. Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
71
S
/ L
O
COM m Water After/�a}`,,ya
Monitoring? - �031C��ts i8
P
E
I
LI
_.l12 `
.1
A�. o
Reading Date
Geoat
Time
Net
Time
Depth to
Water
Net
Drop
1 2.5
/
I
2:oi: 8
19.116
I Y
I
1
I
1
20 -{ '
Iul
PERCOLATION RATE `t
Immutevmcnl PERC HOLE DIAMETER
rr1 �I
TEST RUN BETWEEN 27 FT AND—I—SP"� "r4 FT
COMMENTS Perc Cavity Was Dresoaked Drior to testin¢.
PERFORMED BY: —gtA"' I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL ..ichael ArderSon.
LL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATE. CATE.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 011-122-38 COSA# pSC 1111A91
1. GENERAL INFORMATION Expiration Date: /Z - 3 0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
SKYHILLS PHASE #2• BLOCK 3, LOT 12
8232 HEAVENLY CIRCLE * ANCHORAGE, AK * 99502
STEVEN HATFIELD & KARA SANDVIK Day phone 522-4689
8232 HEAVENLY CIRCLE * ANCHORAGE. AK * 99502
Day phone
LISA HERRINGTON W/ HERRINGTON AND CO. Day phone 646-0525
`Mailing address
ik
Unless othen%ise requested,
2. NUMBER OF BEDROOMS:
3." TYPE OF WATER SUPPLY:
255 E. FIREWEED LANE, #102 * ANCHORAGE, AK * 99503
COSA will be held by DSD for pickup.
5
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
N
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
N
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 maybe 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, 1 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. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name ,JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering 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 all 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. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
1Z Approved for _.�_ bedrooms.
Disapproved.
337-6179
Date t 2 011
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
45ON-SITE ••��s
WATER AND
WASTEWATER
PROGRAM •`
Nitrate Advisory Other
By: Original Certificate Date: J — 3 0 11
(Rev. 11M)
Municipality
^ U"�xx^���& �n
n�o��������n��� ��xx���noorage
Development Services Department
Building Safety Division -
On -Site Water & Wastewater Program
4700DrugmwStreet
PD.Box 190550
Anchorage, AK99519'005V
vw^nv.muniorU/onoito
(907)343'7904
CERTIFICATE OF ON-SITE SySTEMs APPROVAL CHECKLIST
Legal Description: Parcel |O: 011-122-38
A. WELL DATA
Well type |fA,B urCprovide PVVS|D# Well Log (Y/N)
Date completed — Sanitary seal (Y/N)— Wires properly protected (Y/N
Total depth —ft. Cased to —ft. Casing height (aboy*,-i;r�ound) —in.
FROM WELL LOG AT I
Date of test
Static water level ft. —ft.
Well production g.p.m. —9 -P.M.
WATER SAMPLE RES
Coliform colonies/100 mi. Nitrate —mg./L. Collected by:
Argenic: —ug./L. Date of sample:
B. SEPTC8H0LD|NGTANK DATA
TankTvpe/yNotoha| Date installed 8/1/2000
Tank size 1500 gal. Number ofCompartments -2�- C|eunou1o(Y/N) YES
Foundation cleanout S Depressionover tank (Y/N)NO High water alarm (Y/N) N
Date nfpumping r Pumper ISAACS PUMPING
C. ABSORPTION FIELD DATA
Date installed Soil ratingkEPVorft/bdrm)1.2 System type DEEP TRENCH
Length 48 ft. Width Gravel below pipe 7
Total depth *12.3 ft. Eff.absorption area 872 +2 Monitoring tube YES Doprooaionovorfin|d-NO--
Date ofadequacy test 12Z2012011 Roou|to(Pone/Fai|) PASS For 5 bedrooms
Fluid depth inabsorption field before test 40in. Water added 1}45gal. New depth 03in.
Elapsed Time: 12Vmin. Final fluid depth 5Vin. Absorption rate >= g.p.d.
Any rejuvenationtreatment (past 12noo](Y/N&type) NONE KNOWN Ifyes, give date---_��----
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on
Public sewer main
Sewer /septic service
areas
PUBLIC WATER
On adjacent
On adjacent lots
manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption Feld 5'+
Water main
10'+
Wells on adjacent lots 200'+
Water service line *10,+ Surface water 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line lb + Building foundation 10'+ Water main 10'+
P
Water service line *10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
F. COMMENTS
*PER ORIGINAL ENGINEER'S INSPECTION REPORT (8/19/2000).
G. ENGINEER'S CERTIFICATION
i certify that / 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. Q
Engineer's Printed Name JEFFREY A. GARNESS QOD s�
Date I'2J
COSA Fee $ 06 Waiver Fee $
Date of Payment 1a(a-;�"��l
Receipt Number 0/54S6
(Rev. 11105)
Date of Payment
Receipt Number
?A
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hEAVENLY CIRCLE
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Parcell.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
011-122-38
1. GENERAL INFORMATION
Complete legal description SKYHILLS PH 2 BLK 3 LOT 12
X27
COSA # O -t QDX�
Expiration Date: a — / Co — a
Location (site address) 8232 HEAVENLY CIR., ANCHORAGE, AK 99502
Current Property owner(s) JIM C. & LARA D. BENNETT Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
8232 HEAVENLY CIR., ANCHORAGE, AK 99502
CLAIR RAMSEY, DYNAMIC PROPERTIES
Day phone
Day phone 907-261-7552
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class 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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal andlor water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems 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 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. 1 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 Watkins Engineering, Inc. Phone 907-349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis, P.E. Date
5. DSD SIGNATURE
Approved for _ A bedrooms.
Disapproved.
2-I3-07
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By: / /moi/��`�� Original Certificate Date: 41Z
(R.. 1 M)
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -M Water & Wastewater Program
4700 Sregaw Street
P.O. Bax 198850
Anchorage, AK 995196650
www.nrunLorglonske
(907) 343.7904
CERTIFICATE OF ONSITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SKYHILLS PH 2 SLK 3 LOT 12 Parcel ID: 011-122-38
A. WELL DATA
Wen type —
Date completed =
Total depth
Date of test
Static water level
It A, B, or C provide PWSID 0 A(AW WU) Wed Log (YIN)
Sanitary seal (YM) _
FROM WELL LOG
WON production
WATER SAMPLE RESULTS:
Conform coloniesl100 mL
Arsenic: mgll
B. SEPTICIHOLDING TANK DATA
R.
9—
P.m-
Nitrate m91L
Wires property protected (YIN)
Casing height (above ground) in.
AT INSPECTION
R.
Other bacteria colonies/100 ml -
Date of sample: _ Collected by:
Tank TypaiMaterlal STEEL SEPTIC TANK Data ku"Nad 811/2000
Tank size 1500 gaL Number of Compartments 2 Cleanouts (YIN) YES
Foundationdeanout (Y1N) YES Depression over tank (YM) NO High water alarm (YIN) NO
Dated pumping 1218/2006 purr NORTHLAND PUMPING
C. ABSORPTION FIELD DATA
Date installed 811/2000 Soil rating (g.p.d.IR° or fe/bdnn)1.2 System type DEEP TRENCH
Length 48 fl, Width 3.0 R. Gravel below pipe 7.0 R.
Total depth tjj R Eif. absorption area 870 tl' Monitoring tube YES Depression over field NO
Date of adequacy test 1418@008 Results (Pass/Fall) PASS For 5 bedrooms
Fluid depth in absorption field before teat 49.5 in. Water added 1898.5 gal. New depth 72.5 in.
Elapsed Time: 60 min. Final fluid depth 63.25 in. Absorption rate >= 750 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date
D. LIFT STATION
Date installed NA
'Pump on' level at _ in.
Size
.Pump otP
Damon Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/fift station on lot NA
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
Manhole/Access (YM)
in. High water alarm level at in.
Meets alarm 8 crocus requirements?
On adjacent lots
On adjacent lots
sewer manhole/cleanout
Holding
Manurelanimel excreteZforace areas
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 50'+ Property line 25_+ Absorption field 10'+
Water main 70'+ Water service line 80'+ Surface water 1000
Wells on adjacent loft 2004.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Ane I a+ Building foundation 601+ Water main 40'+
Water Service line 100'+ Surface water 1004.
Driveway,paAurplvsnideswage 1Y+
Curtain drain NA Wells on adjacent lots 2004.
F. COMMENTS: Original MT could not be found. Installed a new 2" slotted screen MT on 12-5.08 Cleanout at
YAW end of drainfleld Could not be found.
G. ENGINEER'S CERTIFICATION 4J.".'
I Cer* that ► have datermUred through field kWections and ° 49k
review of Muni*al records that the above systems are in
coMamance wfM MOA COSA guidelines in etled on this date.
Engineer's Printed Name Cindy W. Elea, P.E. Cind W Ellis
Date 2'13-07 CE. 10V7
COSA Fee $ T
Data of Payment
Receipt Number
(Rev. ItAa)
Waiver Fee $
Date of Payment
Receipt Number,
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\ Municipality of Anchorage
• �\ Department of Health and Human Services
Division of Environmental Services
_ On -Site Services Section 825'V Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.sk.us
(907) 34313744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
/
Parcel I.D. 011-122-38 HAA
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Expiration Date:
AAn :z
Current Property owner(s) _John Hagemeier Co. Day phone 248-6789
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
2204 Cleveland Ave. Suite 200.99517
Day phone
Day phone
Unless otherwise requested, HAA will be held by DHHS /or pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health
Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater
disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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 net
responsible for errors or omissions in the professional engineers work.
(Pw 11V.1
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 Health Authority Approval Guidelines for this Health Authority Approval
application shows that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation. .
Name of Firm Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 8/1912000
_ �j ,jteves P.nno�eF �i
6. DHHS SIGNATURE �jC� i o. NCF 1 9 ' ��
♦ �i`•.•.CL�
t/ Approved for bedrooms. �# ; 0
Disapproved. ♦��h�� ���
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineers Report
Well Flow Advisory Other
By: �� i �C/. �0'�t Original Certificate Date: 8 ' S- 0 a
Expiration Date: R ' Z,5-- 0 Reissue Cate:
/Rev. 11.991
Municipality of Anchorage
Department of Health and Human Services dim
Division of Environmental Services R E C E I V
On -Site Services Section 825 OU Street Room 502
EM
P.O. Box 196650 Anchorage, AK 99519-6650
twwv.ci.anchorage.ak.us AUG 21 2000
(907) 343-4744
MUNIGPAUTY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL CHECKLISYONhtEWAL SERVICES DIVISI
Legal Description: LOT 12 -BLOCK 3 SKYHILLS SID Parcel I.D.: 011-122-38
A. WELL DATA
Well type If A. B, or C provide PWSID # AWWU Well Log N
Date completed _ Sanitary seal _ Wires properly protected
Total depth ft Cased to ft Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
ft
g.p.m
MH
Coliform colonies/100 ml Nitrate mg/l Other bacteria colonies/100 ml
Date of sample: Collected by: S.R.PANNONE
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed 8/112000 Tank size 1500 gal Number of Compartments 2
Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N/A
Date of pumping 8/1/2000 Pumper NEW
C. ABSORPTION FIELD DATA
Date installed 8/1/2000 Soil rating (g p.d.Kt2 or ft2/bdrm) 1_2 System type D.T.
Length 48 ft Width 3 It Gravel below pipe 7.0 ft
Total depth 9-12 ft Effective absorption area 672 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 8/1/2000 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test NEW in Water added_ gal. New depth_ in.
Elapsed Time: _ min Final fluid depth _ in Absorption rate >= _ g p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) AZA9' If yes, give date
(Rev. 11199)
D. LIFT STATION
Date insta lied
"Pump on' level at
Datum
Size in gallons Manhole/Access
in"Pump off" level at —in High water alarm level at _ in
E. SEPARATION DISTANCES
Cycles tested Meets alarm 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots
Absorption field on lot
Public sewer main
Sewer /septic service line
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 58 Property line 36
Absorption field 10
Water main 80 Water service line 90 Surface water 100+
Drainage 100+ Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 20 Building foundation 70 Water main 50
Water Service line 90 Surface water 100+ Driveway, parking/vehicle storage 10
Curtain drain 100+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION . ; S •
I certify that I have determined through field inspections and •:' .q o r" %� ;
review of Municipal records that the above systems are in ""''' << ' "' "'
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone. P.E. �i� ;�•. NO. (r 9
Date 8-19-00 •i , ��
���._ Frrr: «��v �_.•
HAA Fee $_ �5 V7)
Date of Payment
Receipt Number C07_/4
(Rev. I M9)
Waiver Fee $
Date of Payment
Receipt Number