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Home My WebLink AboutHUNDRED HILLS 1ST ADDITION BLK 4 LT 5Hund d Hills lock 4 Lot 078- ! 9 ! -08 Municipality of Anchorage Page { of ~L 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: ~',.dqqoq'5~ PIDNumber: 0~1~{0~ Name: ~A~A~ ~¢[L~,1~5 Wastewater System: ~ New D Upgrade Address: [[~O ~ ~' A~cHo~A~ ALAS(~A ~1 ABSORPTION FIELD Phone: ~ ~ No. of Bedrooms: ~ D Deep Trench ~ShallowTrench DBed DMound DOther LEGAL DESCRIPTION sog Rating: Total Depth from original grade: Lot: Block: Subdiv~ion: ~ ~ Deplh to pipe bottom trom original grade: Gravel depth beneath pipe Township: ~ Range: ~ ~ Section: ~ Fill added above original grade: Gravel length: WELL: ~New D Upgrade Gravel width: f Number of lines: Distance between lines: Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ~ Pipe material: Driller: Date Drilled: Static Water Level: installer: Date installed: Yield: Pump Set at: Casing Height Above Ground: TAN K SEPARATION DISTANCES ~septic u Holding U S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacityin gallons: From Tank Field Station Tank Sewer Lines ~ cea ¢ ~ ~ ~ Well- ~ o ~ ~ [ o~ t ~ ~ ~ ~ Material:¢%[L Number of Compartments: Surface Water IOO~+ tOOk ~- ~ ~ LIFT STATION Lot t ( Size in gallons: Manufacturer: , "Pump on" level at: ~~~ High water alarm at: Foundation ~1~ ~1o ~ -~ ~ Curtain ,~ Pump Ma~ctrical Inspeclions performed by: Remarks: ~ ~o goouPATIOg f~S¢aUL~ 4g BENCH MARK Location and Description: Assumed Elevation: EE~~AL Eagle River. Alaska 9951Z 2nd ¢-/H -¢5 ~..> ~ ,o,,,~ c. COWA, Department of Health and Human S~rvices approval "-~ ~*~:,'..~ ,..,'" 72-013 (Rev. 9/91) MOA 25 Permit No. SW940456 Page 2 of 2 Municipality of Anchorage 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 LOT 5, BLOCK 4, HUNDRED HILLS #1 07819108 Legal Description: PID No.: ~ ~ NEW 9 .~.7'-~ 1000 G~L ~5, 94.8'-~ I~l SEPTIC . TANK -- ~f ~ 9~' ~'I _ ~ ~87.0' ~A'rER FOUND _ .... 6 13 ¢ NU h-- NU ~UUI4UAIIUN IN~I~LLE~ ~I~AL IN'EMI UN SEf'TIC SYSTEM LOCATED BY A~-BUlLT S~RVEY PERF()RMED ~ W BY FLEMING SUI~VEYING SIR' -NE :TRENCH CO~T2 ~1 FCO NEW 10)0 GAL _ ~SEPTIC TANK 6 h~/~.~- ' ~ .... LOT 5 I'i~,. 72-013 A (Rev. 9/91) MOA 25 PERFORMED FOR: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:j'O'T' $~', ~/' I(' Ii, )i/dH/) ~ /']ILL'j '~-//'~ · Township, Range, Section: 1 2 3 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT t ~'~ oL DEPTH? p E ~eplh to Water After )~' (~/.~)/~ j-_ Monitoring? Date: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop ,r' : '~ V I ~ t /k,~,'),',.a t $- ; ,~."2 ;z_ ,.[ , /~ ~-'; ,7~,i ~ ~; '1,¢ I PERCOLATIONRA'rE __ tminutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~/ / FT AND "~ / ____ FT PERFORMED BY: ..... ~ .¢~L~/ ¢ ,~ /~M~' CERTIFY THAT~HIS TEST WAS PERFORMED 17034 Eagle RJver Loop Road No. ~ ' '~ r - ~--- I) /~1 I~$~ ACCORDANCE WIT~~¢~~ GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85} WED ~:0l AM A&G ENTERPRISES LTD. ~A~ NO, 272 400~ P, 1 OWNER OF LAND SULLIVAN WATER WELLS P.O. BOX 61'0272, CHUGIAK, ALASKA g~156T · TELEPHONE / DEPTH OF WELl., ST.&TIC LIEV][L OF WAYER F'F. ~_ 'c~')~ / GALS. PER HR ADDRESS LEGAL DESCRIPTION DATE. Sta~'ted _ PE~IT NUMBER From,~_Ft. to . · From__Ft. to_ From Ft. to ~rnm --Ft,'to~ From~Ft. From Ft, to From__Ft. to From___Ft, to, From _._Ft, t~ From Et, to__ MI$CL. INFORMATION: Fl, Ft. Ft. __ __ Ft. . Ft. Ft., From ..... Et. to .... F! ....... r,o~ n. ,o ... F,. $ ¢~u,~o~ F,.,,, From =_.- FI, to. FI. , ....... From ~_Ft, to~Ft ........ From ........ Ft. ~ From Ft. to~Ft, ,, From I Ft From Ft, to ........... Ft From__Ft, to ., , Ft ....... From~Ft, to From_~Ft, to Ft NOV 2 2 19,35 MLItlic;palJty ol Anchora e Dept. Health & Iduman Settees DRILLER'S NAME . ;:~ _ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940436 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:GRAPER HENRY E JR & LEANNE OWNER ADDRESS:2300 D STREET APT 225 ANCHORAGE, AK 99503 PARCEL ID:07819108 PAGE 1 OF DATE ISSUED:il/21/94 EXPIRATION DATE:il/21/95 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 4 LT 5 LOT SIZE: 113428 (SQ. FT.) NUlV/BER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 343-4744 (24 HOURS) 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: RECEIVED BY: DATE: DATE: ROBERTC. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN E~TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER OISPOSAL SYSTEM DESTGN November 8, 1994 MUNICIPALITY OF ANCHORAGE Department of H~alth and Human Services P.O. Box 196650 Anchorage, AK 995~9 REFERENCE: Lot 5; Block 4; Hundred Hills Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Requ~t you issue a permit to drdll a well and inst~ a ~eptic system to ~erue tM propo,~ed ttu~ee house on the ref~d p,toper~. A test hole was excavated and a percolation t~st performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to be d~y. This property has enough area for a future septic upgrade which can be seen on the attached plan. We do not anticipate any adverse ef~Bct~ on n~ighbo~ng properties by the i~tallation of the proposed septic system. There a~e no point~ of contamination within the proposed well radius which can be seen on the attached site plan. The proposed 1000 gallon septic tank is to be placed outside the well protective radius. Attached is a site plan which depicts the location of the proposed tank. If you require additional information p£ease contact us. Sincerely, ROBERT C. COWAN RCC/gk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 I zoo, LEGALH U N D R E D DRAWN j. ANDERSON i CKD. -. % DESIGN CRITERIA: 3 BDRM = 450 GPD SOILS = 0.6 GPD/SO.FT. R FACTOR = 0.54 450/0.6 = 750 SQ.FT. REQ'D DRAINF!ELDS: 5' WIDE 6' DEEP ,5.5' EFFECTIVE 81' LONG ALL PORTIONS OF ;YSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION. HILLS SUBDIVISION~ BLOCK 47 LOT 5 R.C.C.J.W. i DATg1--7--94 i SHT- I OF 2 STRUCTURES, EASEMENTS, OR ENCROACHMENTS SHOWN ON THIS SiTE PLAN ARE AS SHOWN ON AN AS-BUILT SURVEY DRAWN BY: FLEMING SURVEYING SERVICES IT IS THE RESPONSIBILTIY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPERTI~OR TO CONSTRUCTION. WATER IN DITCH ~u // // ~'~ /--TH FROM VEl 7/87 XX ~/ "~"g~¢ /~/~/' / ,--PROP. 1000 GAL. ~//~ i/~° '// SEPTIC TANK \ \ 100' WELL RADIUS ~PROP. WELL LOT 100' WELL RADIUS WELL CONTRACTOR IS REQUIRED TO OBTAIN UTILITY LOCATES PRIOR TO ANY EXCAVATION WORK. \~'~'""'~SHOULDER OF ROADWAY CLIENT LE6ALHUNDRED HILLS SUBDIVISION, DRAWN j, ANDERSON i CKD. J.W. BLOCK LOT 5 IDATE11--7--94 i SHT2 OF 2 FINAL MONITOR C LF~4/W $OMD OUT TUBE --ORIGINAL GRADE TANK D3034 SOLID(4") 4"F810 PERF,- 4"D3034 PERF. WIDE 10' MINt WIDE CROSS SECTION ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. HEALTN AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MA~'P~IiIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE:Lot 5; Block 4; Hundred Hills Subdivision 1. The scope of this project includes the installation of a 1000 gallon septic tank and two five foot wide drainfields to serve the proposed three bedroom residence for the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4' of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP . SUITE 204 · EAGLE RIVER. ALASKA 99577 Page Two Lot 5~ Block 4; Hundred Hills Subdivision November 8, ].994 o A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABS(ARPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. o Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MA~I[IAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 5; Block 4; Hundred Hills Subdivision November 8, 1994 The following pipe materials are approved for installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes use in septic system Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (~¥par 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2j The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Lot 5; Block 4; Hundred Hills Subdivision November 8, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LE6AL DESCRIPTION: ~O?'51 ~//~/~/~¢2 /~(f.c&To'-~w'~nship, Range, section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? . p E Oepth Io Water After Monitoring? ____ Dale: I N Reading Date Gross Net Depth to Net Time Time Water Drop ~oo ~5 " ~ ~" ~ '~ " ,' ~ ~ ~ ~ ,, ~,, f ,/~,, PERCOLATION RATE IN,~ (m,nutes/~nch} PERC HOLE DIAMETER TEST RUN BETWEEN ~ F,T AND ~FT COMMENTS % H, PERFORMED BY: '.~d.~:~ ...... . · r ..~,~[~C~¢'CERTFYTHATT. HiS TEST WAS PERFORMED ACGORDANGE WITH ALL STAIE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) (ENGINEER'S SEAL) , ~. c~-.?~ /\ %; LEGAL DESCRIPTION: ( Township, Range, Section: ' '." -. <;;'.. .... . :.:?-,'-' Municipalily o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 3 4 5 6 7 8 9 ~0 '12 13 17 18 2O WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN L IF YES, AT WHAT ~ O DEPTH? p E Depth to Water Afte~ Monitoring? [zh~-J/' Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN -- (mmutesnnch) PERC HOLE DIAMETER __ FTAND 4~-~ FT COMMENTS S & S ENG~N~ /.///_/',.~ PERFORMED B;:;'O~4 ~"~'" "'VOF ~OOp "O"" N,.~ I ~/'~- CERTIFY THAT THIS TES,T WAS ' ~v~r, Alaska ~577 /' r 72-008 (Rev. 4/85) PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: L EGA L DESCRIPTION: L~,,/~/~/, ~/ 9 10 11 12 13 14 15 16 17 18 19 20 DATE PERFORME~ ~ . ~C: ~Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SLOPE SITE PLAN $ IF YES, AT WHAT ~ nL DEPTH? p E Depth In Water Alter 0~(~ Monitoring? DaLe: Reading Date Gross Net Depth to Net Time Time Water Drop ~.,~ .~ i vt' :~ ~ ,. :y¢,' ~ ~ ; 3z /o .' 2 '6" ~- ' ~ ~b - ~l~~ ~1~' PERCOLATION RATE 0~'~ (minutes/tach) PERC HOLE DIAMETER ~Z'~¢ ~ TWRUN~ETw~EN ? ~TAND V ~ 17034 Eagle River Loop Road No. 2~ ~7/1.~ ~ PERFORMED ~ie ~iYer, ~;.,k. ~;Z I /~f,~// TM (-Z/Z ....... CERTIFY THAT]HIS TE~T WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ]1 / ~' ~ ~'~' 72-008 (Rev. 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address ' Blk COSA # 0~-.- Expiration Date: Day phone Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address 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 ~ Public Water System Well 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 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 ,.~Fq~\~.,~ ~e~.r ~,.~- Phone Address ~o,~ ~, lFfk~v~,~, ZoZj A~oO5 ~ Engineer's Printed Name ~¢~ ~r[~ Date DSD sIGNATURE ~/// Approved for ~_~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: ,9-,. ~' ,. '. ON-SITE WATER AND WASTEWATER PROG~M ..... · Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory .X (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~~~original Certifi cate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Date completed. Total depth ~l ft. Date of test Static water level Well production 50 WATER SAMPLE RESULTS: Coliform ~' colonies/lO0 mL Parcel ID: IfA, B, or C provide PWSID #~ Sanitary seal (Y/N). ~ Casedto SI ft. FROM WELL LOG 7.0 ft. g.p.m. O3r8- (~1-O~' Nitrate O, t~ mglL Well Log (Y/N) '~ Wires properly protected (Y/N) casing height (above ground) AT INSPECTION ql212o,O 3, c~ g.p.m. ~10 ug/L' 'Arsenic: B, SEPTIC/HOLDING TANK DATA Tank Type/Material. ~n¢~o-m~p "~n~-/5~t~" Tank size (OCO gal. ~ Number of.Compartments Foundation cleanout (Y/N) ~' ' Date of pumping ~lt~tl2°10 Pumper · C. ABSORPTION FIELD DATA Date installed ('/1~/1~5 Soil rating Length. ~)J Total depth ~r,5 ft. Date of adequacy test. Fluid depth in absorption field before test .~ in. Elapsed Time: ¢~ min. Final fluid depth /(~ Any rejuvenation treatment (past 12 mo.) (Y/N & type) · date of sample: ~/zz/zolo Depression over tank (Y/N) /V" (g.p.d./ft~ or ft~/bdrm) O, (~ fi. Width ~ ft. Eft. absorption area ~,~)ft2 Monitoring tube . Y + I~ in. Other bacteria ,~ 'colonies/100 mL Collected b~: Date installed Cleanouts (Y~N) High water alarm (Y/N) ft. For '3 bedrooms Newdepth O in. ~..~O g.p.d. If yes, give date -- Water added ~50 gal. . in. Absorption rate >= Systemtype SI~I~,.~ ~k Gravel below pipe ,3'oG '¥ Depression over field D. EIFT .STATION . Date Size in gallons "Pump on" level at7~__~n. ump off" level at i.~ High water alarm level at.,,,./" in. Datum .Cycles tested / Meets alarm & circuit re.~qu~ements? E. SEPARATION DISTANCES · SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Ioo 4- Absorption field on lot 1oo -I- · Public sewer main /V//~ Sewer/septic service line ~.5 i+ Animal containment areas =3o~-I- On adjacent lots IOo On adjacent lots 1oo Public sewer manhole/cleanout ./V/A, Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1OO14- Building foundation Water main /V'/~, 'Wells on adjacent lots Property line 5'4. Water service line lc)+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water IOOl.i. Property line |O~+ Building foundation IO~ Water Service line Io'+ Surface water. JOO~ 4-- Curtain drain ~ '-I' Wells on adjacent lots lOo~ + F. COMMENTS Water main Driveway, parking/vehicle storage I IO + G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name L ~c5 $?~¢t~t..[ Date ql'~4 Z°tO COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) i0- I-I-O Waiver Fee $ Date of Payment Receipt Number ........... SG.S SGS Ref.# 1105120001 Client Name Spurkland Engineering Printed Date/Time 09/28/2010 16:43 Project Name/# Hundred Hills #1 B4,L5 Collected Date/Time 09/22/2010 13:26 Client Sample 1D Hundred Hills #1 B4,L5 Received Date/Time 09/22/2010 15:03 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/24/10 09/28/10 NRB Waters Department Total Nitrate/Nitrite-N 0.174 0.100 mg/L SM20 4500NO3-F B (<10) 09/23/10 AYC Microbiology Laboratory E. Coli Ne~zative 1 100mL SM20 9223B A 09/22/10 DLC Total Coliform Negative I 100mL SM20 9223B A 09/22/10 DLC ASBUILT HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: ii A~ Turn NO ~.~CROACH~ENTS E'X,ST m~CEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD II ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISH,~ BOUND- ARY LINES. I GRID: DRAWN: SEWARD & ASSOCIATES LAND SURVE]fING ; J 694-0829 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION ,,~0mlSiet~i~gal description /Z///.~/F~/'/~ :" ' "" :0 Q, Loc~tion (site'a~re~s °r directions) :.~urrent ~ropedy own'er(~) "Mailing 'address Lending a~y'" HAA# 0 /~ 0 Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: Day phone Day phone TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: ,1~ Individual On-site ~ [] Individual Holding tank [] [] Community On-site [] [] Public Sewer ['-I 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. Cedificates 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 /~O¢'-~t/'~'~Y[ Address / 7.~ "7 Engineer's Printe'd Name Approved for ~ Disapproved. Conditional approval for bedrooms. Phone Date bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 6- ~" I" (:::) F (Rev. 01/02) Municipality of Anchorage , DeveloPment Services Department':,~.~ ~,,~ i Building~Safety Division . ~': i On-Site Water & Wastewater Program ~ - ~ " 4700 South Bragaw St. ,i: . 'i ;'P.O. Box 196650 Anchorage, AK 99519-6650 .~,: . : ...... www.ci.anchorage.ak.us ~ * i-;! ~. : (907) 343-7904 ~ : -,~ HEALTH AUTHORITY APPROVAL'CHECKLIST ~/'.i~ Parcel ID: (~'70~~/ Well type ,P ". 'IFA, B, or C provide PWSID # We'll Log'~,(y/U) '. '.'.'1 i'.'i: ./V;.,,- ~ ' !~. !i~} . / Date Corrip eted O/y,.~ ' San tary seal (Y/N) i ' Wires protected (Y/N) Totaldep;h ' (~// fl. Casedie ~O fl.. . . Date of.test :~ Static w'~ tei ievel Well production WATER SAMPLE RESULTS: Coliform i~ colonies/1 I · Arsenic;. ~ '"'" mg./I. SEPTIClILIOLDING TANK DATA FROM WELL LOG g.p.m. · Nitrate ~.:/q5 mg/I Date 'o~ sa'mple:' : . Tank~y~5~/~?terial ,~-tJC[,~ c~ l~. '7'Pa{ I Tankslze~~00 gal. ~ :Number of Compa~ments ~ '; t ~u" . · '., . ' · Foundation c eanout (Y/N)M/~ Depression Over tank (WN) ~ Any rejuvenatiOn treatment (past 12 mo.) (Y/N & type)' Elapsed Time:L~'O min. Final fluid depth in. Dateofpumplng,A,/~-~: /r~'~,,l~ Pumper !'---"- .,: I. ;' · : . . !J! ~'. ,~ C. ABSORPTION'FIELD DATA , ., ;. . !1 '2 I~ . : ~;~1 .:;[ . i .. ! ' : ; ,, Datelnst~lled~//V' ~ Sollratin oDd/ft:Or~l'O,~ ' gv~,~ ~lc~ ' ' ' ' ~ ~'~l' ~ '' : : : ' ~ : ~ ' Length ~ .... __~I:' · fl. Width ' 2. ~,~ ' ~ ~ . ft.- GraVel} belloW_ pipe ~. ~ ft ! ~ ~, ' ' '" , . i ,/ Total depth ~fl... Eft. absorpt,on areaT~ ft' - Monitorin. tube '~ ~l,:'ge~e~sion Over fi.la ~ Date o[ ad,equ~cy test g/ ~/O~ '..: Resfilts (Pass/Fail)~Jg ' ~!'::~? ~' For ~ bedrooms Flu'ddepthln~bs°rpt'°nfleldbef;retes'; O ~n',l WateraddedT~,~ ~ Newdept, ~ in. Absorption r 'i f y~ >~. ~-0~ give date g.p.d. Camng height (above ground) '~T in. AT INSPECTION'. ~ ~': ft. ~:t g.p.m. Other b~ri~l.;,'O colonies/lO0 mi. co,ecte by: Date install ~d Cleanouts (YIN) [: High water alarm (YIN) D. LIFT STATION Date .installed "Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons ~ · "Pump oft' level? in. Cycles tested Manhole/Ac? (Y/N) / ' High waylarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM wELL ON LOT ~T0: SeP~ti~'t'a~l~li~"~i~ii~)n on I°t' /Dd t-'t"",.. "- Absorption field 'on lot /00 Public sewer main /J/,~ Sewer iseptic service line On adjaceni lots ' /0 d'. ~', "" '"' On adjacent lots /0 0 ~ Public sewer manhole/cleanout Holding tank ...... ," SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK .oN LOT TO: Building foundation ,_~' / 4-- ' ' Property line Water main ,42~/~ " " Water service line Wells on adjacent lots /~Q SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: . Propedyline /O ~ Building foundation /~/:'''' Water main Water Service line /O Curtain drain .'_z///~ Absorption field surface water HAA Fee, $ Date of 'p;Yment Receipt Number (Rev. 12/01) Surface water ' ,,/~ t?·~ ' Driveway, parking/vehicle storage Wells'on adjacent lots /t~ 0 ~' Date of Payment Receipt Number Waiver Fee $ COMMENTS ENGINEER S CERTIFICATION ' ' ' . I certify that I have determined through field inspections and ' ". ;'"~" '"" ~ '"o "~ ~'~ : review of Municipal records that the above systems are in. . · . ,~..,,,~,..,~.~.~.~.,,.,.,. .... :.., ~, . conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ,.~Y'"""'~_-42~" ~.~,J~ ¢'"~ .... :'~"' ':"~ ¢~ ~',.... ~, Date ~'//0/0 4 · i'.·: ' _ ......... "~'-" ' "" '""~'~ '~'~ GS Ref.# :l/eat Name ~roject Nameff/ ;lient Sample ID ~[atrlx 'W$ID 0 ample Remarks: 1043191001 ~otfl,Ri,n Enginucrlng tlundred Hills 1.5. B4 Hundred Hi{Is L$, B4 Drinking Water All Date~;I'imcs are ALaska Slandard Time Printed Date/]lime 05/14/2004 8:41 Collected Date/Time 05108./2004 I hO0 Received DatcfTime 06/09./2004 9:45 Techuical DJrecto]~ Stephen C. Ede Releltse~~O~7 ~ Resulu POL Units Nitra~-N 0.!4,5 0,100 mWL EPA300.O ~crobiology 7-n~oratory TotalColi~rm 0 col/100mL SMI8 9222B Allowable Prep Cor. laine.' ID [.imit$ Date DaTe Ir t B (<-10] 06/09/04 IB A (<--1) 06/09104 D~C ,/ ASBUILT I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: ND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES'SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. 'DATE= FB: