HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION TR A1Hundred Hills
#1
Tract A -1
#078-191-05
Municipality of Anchorage Page _J_ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SVA/ q -7609_r%_ PID Number: 67,9 / 9/ 25
Name'/"" /
41dopi 'T_ (W
Wastewater System: V New O Upgrade
"°°fB33 L ea9k Ki
ABSORPTION FIELD
Phone: No. of Sedroorra:
O Deep Trench Shallow Trench O Bed O Mound O Other
LEGAL DESCRIPTION
SOII Rating:
Total Depth fro original Breda:
S
GPD/SqFt
lot: Block: Subdivision: 5
Tr V'e
Depth to pipe botto Irpm onguul grade:
Ft
Gravel depth benea� pipe
Ft
Township:
Range:
Section:
Fill added above prigina�rade:
1-�
Gravel length:
Ft
Ft
WELL: RNew ❑ Upgrade
Gravel width: /
$
Number Oflines:
1
tMurKe DelwMn incl:
j'-
Ft
Ft
classil,ca n (Private, A. C):
Total De h:
AN
Cased To:
I
Total absorption area:
S
Pipe material:
h573o5a/ F,AlO
Ft.
Allo * Ft.
SO Ft
Driller.
Date Drilled:
Slat, Water Level:
/
Installer.` (�
SL
Date installed:
J
SuI1luQn
t0
Ft.
r r
Yield:
5e D
Pump Set at: /
cawngl/eght Above Grand:
a
TANK
GPM
.3 Ft.
FI
SEPARATION
DISTANCES
'Septic 0Holding 0S.T.E.P.
To
Sept4
Abwrplion
Lin
Holding
bIINPrlvale
MeWlclUror
1
Gpadty In gallons:
100
From
Tank
FIM
Station
Tank
sewer unn
r G n
Welt
lo�(r
{{(
100+
Matedal:STe�
Number of Co ertments:
Surface
�/�/
LIFT STATION
Water
Water
1 �
V
LotSize
ID
lop
In gallons:
Manufacturer.
Lina
Foundation
I"Pump
� }„
J Q ,
on- level at:
-Pu ' level at:
alarm a
High at:
curtain((..
Pump MakeBM
Elwrical Inspections performed by:
Drain
bA
tAla+
Remarks:
BENCH MARK
Location and Descrlpt �, „
Assumed Elevation: ra0
ENA1LWk%,k!VAL
OF
S -ao
9 ti�1t'+'4
a
Inspections performed by: Dates: 1st 7
� o
17034 Eagle Rtver Loop Red ttidM 2nd 5'c1�'97?✓'
E la River, Alaska 99577
p ROBERT G COy✓AN
''�� CE-8 01 i
Department of Heath a d Human Services approval
Reviewed and approved by: Date: 2
Ikvv��111��
72-013 (Rev. W91) MOA 25
PERIaT No. SW970092
PACE 2 OF 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchoroge, Alnskn 99519-6650 • Telephone, 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL TRACT A-1, HUNDRED HILLS SUBDIVISION P.I.D. NO. 078-191-05
STI ST2
97.7'
NEW
1000 CAL
SEPTIC
TANK
GRADE
)fT CO
/ FINAL GRADE
ALT. SITE,A)
sa.z'TH[v
NEW TRENCH
97.1'
97.2'
COI - 93.6'
CO2 = 93.8'.
�P
NATER FOUND 8 5.8' `
83.6' D.O.H.
WELL
AN
Deu
EW 1000 GAL.
SEPTIC TANK
_R_Pv DBL2 25.0'
C01 11.5't
__ CO2 75.0'
l00 -SE TIC SET BACK i' M T 1 67.5'
----- �30AL.E_I' - 40'
ENC
50' DEVELOPMENT SET BACK / �C'iee A
35. 'C _—__----- ?
RODEO C.
AIENEAA EE CE -8801
�10'�
Doc co. as
SULLIVAN WATER WELLS
P.O. BOX 67027Z CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND�,_ i l= e�)S I j r=jC DEPTH OF WELL 4 9
ADDRESS IN 14 JS " STATIC %iEL OF WATER Ft.
IFr.At.nFcratPTInNJn%l%rrD R14S fiDOrt TQRIRr
awFFnnFFWNFT_
DATE •Started Ended * GALS. PER HR �Uy
i
PERMIT NUMBER KIND OF CASING
KIND OF FORMATION:
FromjL)—Ft. toFt.
�f'�f S ! ICL jP
From
Ft. to
Ft.
From-62_Ft. to -.S- Ft.
IQ
From Ft. to
Ft.
From Ft. top�Ft.
CG.A-f s GQ�JtC
From
Ft. to
Ft.
From -20 Ft. to 70, Ft.
t
Ari --W9 S (SdejQ•J_JE�-
From_Ft.
to
Ft
ltFt. to_jFt.
From_.—
GQR 7 Ft. to
Ft
From Ft. to Ft.
477_'—�4
From -
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Fl.
From
Ft. to
Ft.
From Ft. to Ft
From
Ft. to
Ft.
From Ft. to Ft.
From
Fl. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft:to� Ft.
From
Ft. to
Ft.'
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From Ft.
From Ft. to Ft.
From Ft. to:::yFt
CM
MISCL.INFORMATION: SEP 17 199
Municipality of Ancrtorage
Dept. Health & Human Services
DRILLERS NAME L?I �^'
/ / \ , & J, ROSERTC.COWAN. PE.
V Er►G►neepuJIG ROBERTA.SHAFER,PE.
CML ENGINEERS
Au,,rA (907)694-2979
Date: 5 - :ig - y-► FAX(907) 694.1211
RECEIVED
NEALTHAUTHORITY
APPRwALS JUN 21997
Municipality of Anchorage
Municipality of Anchorage Dept. Health & Human SOrVICeS
SEWER&WATER DEPARTMENT OF HEALTH AND HUMAN SERVICES
MANEIITENSIOEA 825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
SEWERS WATER
NSPECTION
REFERENCE: TRAt r A - 1 �uNDGtEoJtas �/D
ENGINEERNGSTLOES
ANDREPORTS The septic inspections for the referenced property were
performed on zo and 5-tt-q7 Prior to submitting
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the 1^byJQAT,e J ILJru. to be
SRONTEST
WELL N completed.
TEST
If we may be of further service please contact us.
SITEPL" Sincerely,
RDADDESIGN
Robert C. Cowan, P.E.
SOIL TEST
PERCOLAMN
TEST
STRUCTURALS
MECRAN CAL
NSPECNCNS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577
j Cl : PAGE 1 OF 1 Z/o17 G>L
MUNICIPALITY OF ANCHORAGE {jC� �P2,
�[ `c --A
DEPARTMENT OF HEALTH AND HUMAN SERVICEYX�1�
oP.O. BOX 196650, 825 ^L^ STREET, ROOM 5ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970092
DESIGN ENGINEER:S 6 S ENGINEERING
OWNER NAME:OSTDIEK ELDON JOSEPH
OWNER ADDRESS:17034 EAGLE RIVER LOOP RD.
EAGLE RIVER, AK. 99577
PARCEL ID:07819105
LEGAL DESCRIPTION:
HUNDRED HILLS 1ST ADDITION TR Al
LOT SIZE: 621562 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 5/15/97
EXPIRATION DATE: 5/15/98
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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
TOTAL DEPTH OF TRENCH EXCAVATION MUST NOT EXCEED 5 FT.
BELOW ORIG-" -- --
RECEIVED B
ISSUED BY:
DATE: S_/f'r/ 9 7
DATE:,rj
S&
May 5, 1997
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER P.E.
CML ENGINEERS
(907) 6942979
FAX(907)694.1211
MUNICIPALITY OF ANCHORAGE
HEALTH APPROV,"`,s""0ftlr
Department of Health and Human Services
P.O. Box 196650
Anchorage, AR. 99519
1Cc c
SEWER&WATER
REFERENCE: Tract A-1, 'B, Hundred Hills Addn. $1
MMNE%TENSIOW
Request you issue a permit to drill a well and install a
septic system to serve the proposed three bedroom house on
SEWER&WATER
the referenced property.
NSPECTION
A Test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
ENGINEERINGSTUDIES
4r
ANDREPORTS
At the time of excavation, water was encountered A The
monitoring tube within the test hole have been checked and
found ;wA-T t,t. Ar )o ' c..4,e rwo wteA-NTE.C-
WELL INSPECTION
&FLOW TEST
This r0
property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
SITEPLANS
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
If you require additional information, please contact us.
ROADDESIGN
Sincerely
IFC.• [�/Zrs.
SOILTEST
Robert C. Cowan, P.E.
RCC/mg
PERCOLATIONEnclosure
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA99577
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PERFO
LEGAL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
S $ S ENGINEERING
PERFORMED BY:' 70M cagle Yep 56 Ca o' fW I T CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE YGi91OU"14*1•,06 OSS0CI PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: s-
72-008
72-008 (Rev. 4/85)
Municipality of Anchorage
• Development Services Department •'�''"�'
j 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
Parcel I.D.
078-191-05
1. GENERAL INFORMATION
Complete legal description Tract A-7; Hundred Hilts Subdivision #1
Location (site address) 200 wolf Dr. Eagle River, AK 99577
COSA # 10' 19n r)
Expiration Date: _ 9 — L5 -- Q-7—
Current
-7
Current Property owner(S) Jeff a Angie Johnson Day phone 9074MS419
Mailing address 1914 Mill Bay Rd. Kodiak, AK 99515
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSO for pickup. XW Z 4c— cI4107
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
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 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 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. 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 Phone 694.2979
Address 15861 S. Birchwood Loop Chugiak AK 99567
Engineer's Printed Name oBkAT' C. ('0w
5. DSD SIGNATURE
jz Approved for bedrooms.
Disapproved.
Conditional approval for
Date G / I? /a 7
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: (v — r _I – b 7
(n.. 11005)
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
O/N-SATE SYSTEMS APPROVAL CHECKLIST
Legal Description: -r� / [ ' ! tfyA 7Pt?L=i7 g" 4 I Parcel ID: 0 i S . 05--
A.
�
A. WELL DATA
Well type IVhHF If A. B, or C provide PWSID #= Well Lc
g&) 6`S`_
Date completed _O�L Sanitary seal(DN) Wires properly protected&) ICs
I a
Total depth_ft. Cased to ��ft. Casing height (above ground) /B -1 in.
FROM WELL LOG AT INSPECTION
Date of test �o 5/
Static water level 18 ft. ft.
Well production 57.0 g.p.m. 5. to g.p.m.
WATER SAMPLE RESULTS:
Coliform _2_colonies/100 mL Nitrate 01:92 mg/L Other bacteria i] colonies/100 mL
Arsenic: 19 ug/L date of sample: 1 j07 Collected by: 5 S vblKl a1L3G
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SSM L g Date installed ?D 9
Tank size 10W gal. Number of Compartments o2 Cleanouts6h) yL`S
Foundation cleanou&) L� Depression over
rttank
7(Y® High water alarm (Y® ti�
Date of pumping 6 i 3 D Pumper `1 its Ok"I"'Wda
C. ABSORPTION FIELD DATA
t
Date installed ZI 7h Soil rating (g.p.d./ or ft'/bdrm) 04System typey� t0lbi✓ 7a_ CAiGH
Y
Length 66' ft. Width S ft. Gravel below pipe 3` ft.
r `LI
Total depth ft. Eff. abs rption area r Monitotube ��s Depression over field 1J.
Date of adequacy test 6 5 O Resul (Pas ail)715 For 3 bedrooms
Fluid depth in absorption field before test � in. Water added gal. New depth in.
Elapsed Time: AD min. Final fluid depth 0 11 in.t` '' Absorption rate >= f. g.p.d.
�Any rejuvenation treatment (past 12 mo.) () type) NU If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
Cycles tested
at _ in. High water alarm level at
SEPARATION DISTANCES FROM WELL ON LOT TO:
t
Septic tank/lift station on lot 1Co +
I
Absorption field on lot ICO '}
Public sewer main I
I
Sewer /septic service line oZs f
I
Animal containment areas 50 /
Meets alarm & circuit requirements?
On adjacent lots /OCJ f
On adjacent lots /DO /'t'
Public sewer manhole/cleanout V ( H
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation S Property line S� Absorption field S /4.
Water main iJ A Water service line /O Surface water rOO
Wells on adjacent lots 1Q0_
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /D t-- Building foundation /O rf Water main
Water Service line to Q- Surface water t to /-r Driveway, parking/vehicle storage at
I
Curtain drairrnC iauprc AWells on adjacent lots f� -/-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
in.
1 certify that t 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.'l -f,'k ..'Apgar C. COWAN
d.. -.,.Cc -8801 i? i
/J44 T C. Co
XV *A,'Engineer's Printed Name Ro �+ `'•`� `' . •:,; 4=
6 / r �0 7
Date /,,. _ +•
COSA Fee $ 44 3 a, Va Waiver Fee $
Date of Payment to A N /c i Date of Payment
Receipt Number O 4 r 9$ S Receipt Number
(Rev. 11/05)
�1
SCS ReLa
Client Name
Project Name/N
Client Sample ID
Matrix
P%VSID
Sample Remarks:
1072480001
S & S Engineering
Tract A-1 hundred hills No 1
Tract A-1 Hundred I [ills No 1
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/time
06/11/2007 16:10
Collected Date/Time
06/01/2007 13:12
Received Date/Time
06/01/2007 15:45
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results POL Units Method Conuiner ID Limits Date Date [nit
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/04/07 06/07/07 TK
Waters Department
Total Nitratc/Nitrite-N 0.220 0.100
Microbiology Laboratory
Total Coliform 0
mg/L SM20 4500NO3-F D (<I0)
col/100ml- SM209222O A (<1)
06/09/07 JDS
06/01/07 DLC
06-12-2007 14:51 KODIAK LVET CLINIC 9074868445 PAGE:2
Tunrim F TR A
TRACT A-1
Shed
E O S E M
SOUTH FORK EACLE RIVER
35' STREAM PROTECTION 1
AND TRAIL EASEMENT
50' DEVELOPMENT SETBACK FROM
35' STREAM AND TRAIL EASEMENT �J '
100' SEPTIC SYSTEM SETBACK
9a �
y
r ' '
Septic �+ �
Ven1S House (10�Q
0� �� 150.4-
K .d
I I
Well '
AP: VED as being in compliance
with Ne 21, AMC, I the
foll ing uses) '
Dole:.h'
I I
II Bridge
I tj U.5x.no
CiLJ"�t
art L'Q,s: (� UTAatr I r
1"=50'
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TRACT M1 (n AT W1l)
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SmmtWe�VNYY CE�RT>P��ICATM:11M SCHtn�rr M 00. Lr
60 lha the hn o�e� mueeoehown m ads
ECCS.USM NOM:It h tm oween rapaon3d' ity b dalmub"
IMPoe of aa7 oonoama, or rodewou which
do yapp . m >be moatddeed� Diet Noce gR im e"
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2731 SC'AltllSONOUGH 32TIVY, ANC WRAGM
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06-12-2007 14:51 KODIAK UET CLINIC 9074868445
BLK 4 _
LOT 9
BLK 4
LOT 4
BLK 4
LOT 3
\ l I BLK 4
I
LOT 2
BLK 4
TRACT A-1 / �`� \
LOT 1
BLK 4
EXISTING DRAINAGE
"=200'
PAGE:3
.= OF
KEVIN H. SB
IS -9234
4
ISG
Municipality of,Anchorage
• -� Development Services Department *A. Bulding Safety DivisionOn-Site Water and Wastewater Program;4700South Bragaw St:
P.O Box 196650 Anchorage; AK -99519.6650
www.ci.anchorage:ak:us
(907) 343-7904 .
CERTIFICATE OF.HEALTH AUTHORITY•APPkO'
-'FOR A SINGLE FAMILY. DWELLING
ParcellD 07&19i-05 .HAA#
Expiration Date
1 'GENERAL'INFORMATIONC
Complete: legal descriptionTract A-1; Hundred Hills Subdivision 1°t Addition ,
L•oca66n (site address or directions) '•NHN Wolf Drive.
Current Property owners) Cynthia F. Walker= Day phone .522.7773'• ,
Mailing .address P.O. Boz 771408 Eagle Rner. AK 99577
Lending agency Day phone
Mailing address '
Real Estate'Agent Suzanne `Cool� Day phone 689.6964+
Mailing ,Address 16635 Centerfield Dr., Suite 103` Eagle River.'AK • -
Unless otherwise requested HAA will be held by DSD for pickup
2 NUMBER OF BEDROOMS: Three' 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL
Individual Well ® Individual On-site
Individual Water Storage El 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 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) for properties served by a single family on-site wastewater disposal andlor 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 less than 30 days old. (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
Municipalitytiof An chorage•,files and from'my,investigation and inspection, the on-site`watersupply 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 Anderson Engineering Phone 522.7773
Address P.O. Box 240773Anchorage, AK 99524
Engineers Printed Name Michael E. Anderson, P.E. Date '11-114 1 2001
b� OF A�:
A�
49LH J< }�12-5IIGINEERS
9STAMP '
fA'CV&EI E ANDED,EGN
5.1 -DSD SIGNATURE Fp` sr CE oo 43431
Approved for_ bedrooms OQQ11f�4 - PRpfES5t0"��.'o
Disapproved.''. ,
: a Ct,•.�.00�
Conditional approval for: bedrooms with the following stipulations
r , ,
014-S.1F-*
WATER AND m
Additional Comments = W�tST€'N11T€P
•` PROGRAM
/1))ltt��
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: � �+� 0�� Original Certificate Date:
(Rw. 12100)
Municipality of Anchorage
' Development Services Department
Building Safety Division
On-Ske Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99515~6650
www.cl.anchorap.ak.us
(907) 343-79D4
HEALTH AUTHORITY APPROVAL CHECKLIST
Legs) Description: Tract A•1, Hundred Hills Subdivision Addition No. 11 Parcel ID: 078.191-05
A. WELL DATA
Wei type Private M A, B. or C provide PWSID S
Date completed 6MM997 Sanitary seal (YIN) Y
Total depth 45 ft. Cased to >40 ft.
FROM WELL LOG
Date of test 61`11`1997
Static water level 18 ft.
Well production S g.p.m.
WATER SAMPLE RESULTS: �s
n✓
Coliform-2--colonies1100 mi. Nitrate 2:016 mgA.
Wei Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) >18 in.
AT INSPECTION
1HTf2001
10 ft.
Other bacteria 0 colonies/100 mi.
Date of sample: 1119@0(11 Collected by: Mike Anderson
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SeoticlSteal Date instatied 5=997
Tank sae 1.000 gal. Number of Compartments t Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YM) N
Date of pumping 11113 001 Pumper JFrs Pumoino
C. ABSORPTION FIELD DATA
Date installed 5121t199T Soil rating (g.p.dV or ft'lbdnm) A GPDISF System type F Wide Trench
Length S6 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 7 ft. Eft. absorption area eft= Monitoring tube Y Depression over field N
Date of adequacy test 111TOM Results (PassiTail) Pan For I bedrooms
Fluid depth in absorption field before test 1 in. Water added480 gal. New depth5_S in.
Elapsed Time: 30 min. Final fluid depth 2.5 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N N yes, give date
D. UFT STATION
Data installed
"Pump on' level at _ in.
Datum
Size in gallons
'Pump off" level at _in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot >100'
Absorption field on lot >1W
Public sewer main WA
Sewer /septic service line >1S
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100'
On adjacent lots >1110'
Pudic sewer manhole/cleanout INA
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Budding foundation >T Property line >T Absorption field >S'
Water main NIA Water service line >10' Surface water >100'
Wells on adjacent lots MW
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line mo' Budding foundation >10' Water main >10'
Water Service line AV Surface water. >100' Driveway. parking/vahide storage T
Curtain drain None Noted Wells on adjacent kNs >IW
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have defemaned through Held inspections and �7
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in efled on this date.
Engineer's Printed Name Michael E Anderson. P.E. �• � : �. ,;,; � I ,
Date 111`114111111 C :o••• •'
4446 ,f�FCSS.••
-
HAA Fee $ • 1�
Date of Payment
Receipt Number
(Rev. 1200)
Waiver Fee $
Date of Payment
Receipt Number
in.
No. 12609
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
Id,I=1OT, M:7_1►111hA,
DATE: November 14, 2001
TO: Jeff Poet �,�/j, ��,
FROM: Mike Anderson, P.E.V'-"
SUBJECT: Tract A-1, Hundred Hills Subdivision 1" Addition
Certificate of Health Authority Approval
A Certificate of Health Authority Approval was issued for Tract A-1, Hundred Hills
Subdivision 1" Addition on January 25, 2001. The property has changed hands since
that time and we are hereby applying for a reissuance of the certificate. Attached is a
copy of the original certificate and Health Authority Approval Checklist. In addition, a
recent water sample analysis is submitted for your review. JR's Pumping of Eagle
River pumped the septic tank on November 12, 2001 because the tank has not been
pumped within the last year.
Please review the attached documentation and reissue the Certificate of Health
Authority Approval for this property. Thank you for your assistance with this project.
Please let me know if further information is required before the Certificate of Health
Authority Approval can be issued for this lot.
Municipality of Anchorage
• -� Development Services Department
Building Safety Division .
i On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY. APPROVAL
FOR A SING LE`FAWIILYDWELLING.
Parcel I.D. 078-191-05
1. GENERAL INFORMATION
Expiration Date:
Compleie legal description Tract A-1, Hundred Hills S/D 1st Addition
Location (site address or directions) NHN Wolf Drive
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Pete Ostdiek
Dayphone 694-2812
PO Box 771408, Eagle River, AK 99577
Day phone
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup. %tit J /o r
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
x❑
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Individual On-site El
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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) 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 less than 30 days old. (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.
S R S ENGINEERING
Name of Firm t7o34 Eagle River Loop Road No. RIYI . _ Phone G R y —;11-91
Eayla River, Alaska M77
Address
Engirii-er'sPrini NJar a Robert C:' Cowan. P . Date
i l T
",-ROBERT C. COWAN • fk
5. DSD SIGNATURE ,�lf1cs�t� CE -8801
3 -bedrooms :. tttf4) ...........
_z Approved for tt �!�'�..�X
Disapproved. _ ` t, _�•r-
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date:
(R@v. 1DE0(
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995198650
www.ci.anchorage.ak.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 7Q��1rtl�//J SCJ Pareai ID: e7 6
A. WELL DATA .01 ,
Well type LI VA 7-15- If A B, or C provide PWSID — WellLo�Y 1) _
Date completed l7 Sanitary seal5J) Wires property Progo)
rl if
Total depth A!Lft. Cased to �ft. Casing height (above ground) /&-in.
FROM LL LOG AT INSPECTION
Date of test ///?/Of
Static water level /0
Well production g.p.m. 4.4 g•P•m-
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate O • r mg.A. S i S 6INEERI ppi�eerr hh O colonies/100 mi.
EN
Date of sample: 0 / Collected by: 17094 Eapie Pi~ Loop Road No, 204
B. SEPTICIHOLDING TANK DATA
Tank Type/Matertel 5dwric, Date installed 5
Tank size L1� gal. 7 Number of Compartments Cleanouts &1N) YE S
Foundation dea ) Depression over tank (Y& -LD High water alarm (Y/N)
Date of pumping. Pumper �� 'S
C. ABSORPTION FIELD DATA
Date Installed L017 Soli rating r ft Abdrm) Qe40 System type S CLOo %�2EnrGf f
Length &(a ft. Width S ft. Gravel below pipe _ ft.
Total depth -7 ft. Eff. absorption area J-9-3 flr Monitoring tube Depression over field A/ 0
Date of adequacy test I t a/ Results (PasslFaU) F4 S 5 For 3- bedrooms
Fluid depth in absorption field before test in. Water added4i gat. New depth in.
r
Elapsed Time: 30 min. Final fluid depth It in. d Absorption rate >= -7'-457) g.p.d.
Any rejuvenation treatment (past 12 mo.) (YI J� type) 6D &OUVV If yes, give date �
D. LIFT STATION
Date installed
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump ofr level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank) on on lot Z/L :
Absorption field on lot /f
Public sewer main N�A –
SewwJseptic service line
Manhole/Access (YIN)
High water alarm level at
Meets alarm 8 circuit requirements?
On adjacent lots / 6 D rr
On adjacent lots /00 r
Public sewer menholeldeanout /N A
Holding tank �!
In.
SEPARATION DISTANCES FROM SEPTICMeke"TANK ON LOT TO:
r 14 -
Building foundation_ Properly line -1 Absorption field
Water main n/ A Water service line D �� Surface water /O d /
Wells on adjacent lob /OD �"'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10 14- Building foundation i "t' Water main
' Zr
Water Service line Q (" Surface water � � "� Driveway, parkinglvehicle storage
r
Curtain drain AI#A#- J.A/ovt*(Weas on adjacent lob /00 '/
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
tw
review of Municipal records that the above systems are in
+
conformance with MOA HAA guidelines in effect on this date.
�
W.0
p
Printed Name IC 9 ar R ' C • �0 `'rl
F�vgti r
Engineer's
Date
HAA Fee $ -4::�;
Date of Payment
Receipt Number.
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number