HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 5 LT 6Hundred Hills
#1
Block 5
Lot 6
#078 - 281 - 01
Municipality of Anchorage Page / of 2
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: 51/1/T76/37 PID Number: 07/3 -ZS— /0/
Name:
Lee's G.A-54-1:71.1 Dens
Wastewater System: LL New ❑ Upgrade
Address:
11517 ofd r;len N Ikwu C,, c ici t/er'
ABSORPTION FIELD
Pnone:No.
tray—�5ra5
°rrBedrooms:
3
Deep Trench ❑ Shallow Trench 0 Bed 0 Mound 0 Other
X
LEGAL DESCRIPTION
Soil Rating /
D W GPD/Sq. Ft.
Depth to pipe bottom from original grade:
I^3 Ft.
Fill added above original grade:
3, 3 Ft.
Total Depth from originaliggrade /
8, I - it /
Gravel depth beneath pipe
.4. / Ft.
Gravel length: ,...
55 Ft.
Lot: ) Block: '/-S/u_bdiviisio/n/ / /
LD 5 liwyL 6-e hf!f/S.I
Township:
Range:
Section:
WELL: tX New ❑ Upgrade
Gravel width:2. FL
Number of lines:
/
Distance between lines:
Fl.
Classification (Private, A, B,C): /Total
7.5- liecyits�
Depth:
/0/ Ft.
Cased To:
/(7 / Ft.
Total absorption area: / r
7e f SO. Ft.
Pipe material: 2) 30 b�
F 8(/(
Driller: / �t//
ULvI// I/aJ') lav lG
Yield: J�
y( GPM
/ ��J %
G�!/v vi /�✓
Pump Set at:
um -4 -Mi
DateDr 7
L
//// Fl.
�ejd:
/ 7
Casing Height
Static Water Level:
�D Ft.
Above Ground:
Z Ft.
Installer: 4/d J 5e'Vu
Date installed: 7 /^7
//L/1
TANK
SEPARATION DISTANCES
XSeptic D Holding D S.T.E.P.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Public/Private
Sewer Lines
Manufacture :
Capacity in gallons:
/000
Well-
/0014"
f
/D(i +
1
/0 1 r
/00 +
f
/DO `r'
/0 --
—
-'
—
—
_
Material:
Ie
Size in gallons:
I Manufac
2 /
STATION
er:
Number of Compartments:
SurfaceLIFT
Water
Lot/
Line
Foundation5'
l0 `
_
_
"Pump on" level a .
'Pump off" level at:
High water alarm at:
Curtain
Drain
f
/00 `-
!
/DP 4'
"-
—
Pump Ma Model
Elec rical Inspect i s performed by:
Remarks: N 16,01,oh
BENCH MARK
Location and Description:
Be..) #b /%"7 0 I LO 0,1'1.
�vq On % u,5•e--
Assumed Elevation: 0
Ft.
ENGINEER'S SEAL
4.
. yy��7= "..
'y5..
® ®4S 1.= :
el .• ...°....e. . .....°.e°,.
,
Inspectionsperformed b : 00 --.'7,,2,j,/ eei/77 Dates: 1st 7-0-91
p Y
2nnd 7-1Z-97
Department of Health and Human Services approval
p pp
Reviewed and approved b : «�. C " Date. i'ZZ' l&—
PP Y
p$ Kenneth M. Du l��°: °�Y6
®� • w6
�®s�,:, CE 7116 ::w�
�49Fo ✓eag°°°° ,
�4®�a�ass)»�"
72-013 (Rev. 9/91) MOA 25
2ofz
3
AS- 3UIL I SYSTEM iETAIES/SITE PLAN Permit SW970137
HUNDRLD I-IILL.S S/D IST ADDN, LIJT 6, BLECI< 7 PID#078-281-01
[J I 6
1 I-1 97-1
AVALANCHE BL E 7 -❑Nr
A-i,=L),3'
B -C==33,0'
A -D=10.0'
3 -D==34.0'
A -E=32.5'
3-6==37.4'
A E=41.1'
3-6,-280'
R 1 •RY SY.
USED RESERV
IC TANI<
TEM
AREA
SCALE: 1" = 50'
90.13
1000 GAL
SEPTIC
TANK
r OF ALS S\
*
US
Wa
.e Air
KENNETH M
CG -7
AROFEsslo° "
6
84.93
FINISHED GRADE
I'IE1EN V'ABRIC\
INSULATION II
£34.14
7 7.0 4
84.16
77.047
SEWER RNCK
55'
PRITPARED FOR:
LEL RAYMOND
LEE'S CUSTOM DESIGN
11517 OLD GLENN HWY.
CAGLE RIVER, AK 99577
(907)694-8565
SCALE: NTS
VARIES
n'
70.16
I-ILLD BOOKS
COMPUTED:
BOUNDARY: -
DRAWN: KMD
STAKING
ASDUIL1:
SEWARD
CHECKED: KMD
SEWARD
DWG. FILE:
DATE:
GRID:
10/30/97
SW1161
ACM FILE: 97033.DWG
CD ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
w13" 97033 907 696-6111/PAX 907 696-8111
I n 111111 r 11111111111 11 11 n ,l rrr r r r 1111, 11, 111 1 11111111 I 1111111111 n n n 1 n,1 „ I, Hill III „ H,,I,,II ,,,,,,,,,,,,,,,,,....... lllllllllll 1111111 llllllllllll„1
JAN -1S-98 07:18 AM P.01
•
OWNER OF LAND
ADDRESS .
LEGAL DESCRIPTION_.” ~ b
DATE - Started
PERMIT NUMBER
ttrrttfjh drilling dug
ffEls
DOC Co. Elba
RECEIVED
SULLIVAN WATER WELLS JAN 161998
P.O. BOX 679272, CHUGIAK, ALASKA 99567 r TELEPHONE 988.2759 Municipality of Ancriorage
Dept. Health & Human Services
/0/ 2— G
41c.)
c,/
Endcd r1
DF.I'I11 OF 15 ELL
�S .\Il(LLi EL01'%sATERFr.
1LCS
DRAW D0% N FT. .___.... .
GALS. PER HR
et'
KIND OF CASING 'v
KIND OF FORMATION:
From . Ft. to
From_;„,,;.
Ft. to
Froin `.; Ft to
--.
From Ft. Ft. to
A r.
:.._ Ft.._,...^rj. 5.+.. J 1 .....�_.. From............ Pt. to Ft
Ft 0 UtEA avltr,2 '' From Ft to_. Ft.
) Ft. S e4,vQ E> 't'1C�-s/,t r4 j.'rum
_ Ft. - L W `r •':*: ' 4 sJ u= , From
From 22 _F!•(o 7F(..•aJn?'��P 7'r' �4ri�..
// ,, �,Qra1
From_._`.L? . Ft. to / �.:1 Ft. L! � 1�J UQ� fq� L • i From
r'
From .. .Ft. to_...._...._Ft._
From FL to _Ft.
From_ .. Ft. tit_ ... _ 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
Fri 'i
Ft to Ft
Ft to Ft
171 to . Ft
Fi. to
Ft,
to Ft.
From .Ft. to1't.
From FI. to F.
From Ft to Ft
From . Ft. to Ft
From ... Ft. lo Ft
From . Ft, to—__ __.. Ft,
From—._ .. Ft. to
From Ft. to _Ft,
From.._.._._._. Ft. to
_
From Ft to
Ft
MISCL. INFORMATION:
DRILLERS NAME
mai c5 y
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:SW970137
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:LEE RAYMOND
OWNER ADDRESS:11517 OLD GLENN HWY
EAGLE RIVER, AIC. 99577
PARCEL ID:07828101
LEGAL DESCRIPTION:
HUNDRED HILLS 1ST ADDITION BLK 5 LT 6
LOT SIZE: 130494 (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:
PAGE 1 OF 1
DATE ISSUED: 6/17/97
EXPIRATION DATE: 6/17/98
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:
RECEIVED BY:
ISSUED BY:
DATE: 7
DATE: 06?'(?
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
May 28, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: New sewer/well permit - Hundred Hills S/D, Addn #1, Lot 6, Block 5
Gentlemen:
On April 22, 1997, we excavated two new testholes for the subject property. There is
one previous testhole which was dug during the preliminary plat process, however
it was not suitably located for the three bedroom house which is proposed for this
lot. The results of these tests and water monitoring are attached.
We propose to install a deep 2' wide trench. Although the original testhole
indicated water it was located in a lower portion of the lot and not representative of
the site. Additional fill will be placed over the system to provide a minimum of 3'
of cover when complete.
There are no public or private wells within 200' of our proposed system location
except as noted. There is neither surface water within 100' nor any curtain drain
within 50'. We do not expect that there will be any adverse effect on adjacent lots by
the development of this system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
IIND Engineering
enneth M. Duffus, . .
attachments:
On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
LOT 11
VACANT
WASTEWATER SYSTEM DETAILS/SITE PLAN
HUNDRED HILLS S/D 1ST ADDN, LOT 6, BLOCK 5
VACANT
LOT 5
93.9'
VACANT
OSLO P
PROPOSED RESE
.V R Wt
4.00
VACANT
.40.....-....4,,Nik
r� OF ALA
�* A9TH/\ *I
S / KENNETH
M. /
# SCE -7116 4'' / f* lei
'RonsSIONA�'
\\_.400:4""
DESIGN DETAILS
ND PUBLIC WELLS WITHIN 200' DE
PROPOSED SYSTEM.
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED.
NO SEPTIC SYSTEMS WITHIN 200' OF
PROPOSED WELL EXCEPT AS NOTED
LOT 7
3 BDRM X 150 GPD = 450GPD
450 GPD/0.6 GPD PER SQ. FT. = 750 SQ. FT
750/(7'X2') (7.0' GRAVEL) = 53.57 FT. TRENCH USE 54'
Total depth of' system is 9.0' From original grade.
Total depth of' gravel is 7.0' ,
NOTES:
1. USE 1000 GALLON SEPTIC TANK. INSULATE TANK IF <4' COVER,
2, INSULATE TRENCH WITH 2" HD BURIAL FOAM IF <3' COVER.
3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INT❑ SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN, 3' COVER IF REQUIRED.
PREPARED FOR:
LEE RAYMOND
LEE'S CUSTOM DESIGN
11517 OLD GLENN HWY.
EAGLE RIVER, AK 99577
(907)694-8565
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER AI<, 99577
(907)696-6111/Fax (907)696-8111
DATE. 5/28/97 DRAWING
SCALD 1' = 100' 97033-51
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
ZErepEnt
110 • ease 0
r �
us /i»
f-4
M e�
swMi.t.taa.•
o;
to a Kenneth M.
i CE 7 16
41441,<b
•OO r qy a ���
PERFORMED FOR: Zee / 2 y'h')D/)c:/ DATE PERFORMEkk //QFESS,�N i' 7/.2/77
LEGAL DESCRIPTION: /00 /41/5 k}
10
11
12
13
14
15
16
17
18
19
20
Township, Range, Section: 7/7
6/14
fa/4_/(./5 !O 2/
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Yes
/ /
S
L
0
P
E
Depth to Water Alter,
Moniloring7 I i 75 Dal a 917
N
cr
5/
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/
'zz-7
/0 ',o0
Ca '/
—
Z
/0 '/O
/0,si,r7
I- /°//
���
3
/O : //
—
G "
ei
/0;2/
/0,11;r)
S/`'//zo"
6'///o„
S
/D ZL.
."
Ca
/O; 3-,
/a ' 3 3--
/0m/'r2
.S /ej„
'/lo /'
—
7
s /p/6°
�-//6,,"
PERCOLATION RATE 26'6'7(minutes/inch) PERC HOLE DIAMETER G
TEST RUN BETWEEN 3
COMMENTS /64 �/-C�O�'/I ep�G� Y/ 0' r- {O 71_47-5/it%G/
FT AND / FT
PERFORMED BY: A�!/
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE
1 4ren/7(9//7 411 2/S CERTIFY THAT THIS TEST WAS PERFORMED IN
72-008 (Rev 4,851
DATE
PERFORMED FOR
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
.Lt"e 4„ in 10/,,/
LEGAL DESCRIPTION /00%4//15 ��J"J LD 7�'
10
11
12
13
14
15
16
17
18
19
DEPTH
(FFC
�
ev �,,pA�
•.• �S
6&�`�,OF�t
.�0••••••.q
•
•• v.. ••••
e •
Kenneth M.
DATE PERFOR
Township, Range, Section_
Z.
•.e•••• r
5*,116— .•
�'Y2-7'
4 A/) /
0u /Wei -3 7/D Z'rave (ez.A.g
,r) ita je
(.4-14 ( Ka si
BaN
kJ CV(
20 - tnJA
PERCOLATION RATE /y/ ? v (minutes/ ncht PERC HOLE DIAMETER
// / TEST RUN BETWEEN/3-S / FT AND 4 1 5.-FT
COMMENTS /o% ,7741,5(746.,", 7 trio' ifl 7/e-,5///./(9
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Alp
VA
O
E
Depth to Water Alter
Monitoring? /, Dale 0,e/17
SITE PLAN
N
/
/
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/
'/"22.97
/o:y9
.-.
—
/a :59
10m,-7
5 '/i, "
-../e,,,,
3
//:D'-
1
//'/0
/an)f'n
.5 ///!o"
57/6 „
5--A-
//.•//
/1;2/
—
/041/,-2
G "
57//6,'
9//(,"
!o
7-
//'z3
—
ec:„,,
—
//: 33
/j> n,;/-.)
5 '/b"-7257/;7
/b
//, yy
/I, mil-)
5 �L/o"
V/4, „
PERFORMED BY A/ _/ //%6�/1;`
J �
ACCORDANCE WI rH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE __
1 //e/itiet4i1-1G! f-!_/ J CFRTIFY t[IAt THIS TEST WAS PERFORMED IN
71
0081H •v T.,
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 078-281-01
1. GENERAL INFORMATION
Expiration Date: 9-/a-/4
9T hvn
Complete legal description Hundred HiIIs'4 , Block 5, Lot 6
Location (site address) 354 Hiland Rd.
Current Property owner(s) Robert Bulger & Don Vanderheyden Day phone
354 Hiland Rd.
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
I] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well E Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
3
JUN 0 9 2014
TYPE OF WASTEWATER DISPOSAL:
WaiverNariance request for:
7
Distance:
Received by. .',°; s Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 62.4 - Q Waiver Fee $
Date of Payment (p 1 ) 11 (may Date of Payment
Receipt Number np 32l C vd Receipt Number
COSA# (iSUv{IV15 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 6/4/2014
CAk
�•
�est• 4'�►
I ' ; S{everi P6riritirie : "%
0+ CE -8149
rr
+� ftrE5S
okboxots
bedrooms, with the following stipulations:
610
jnN-S1TE t
WATER AND
oWAS MER STEATER
r�
nGRAM;
Asa ..-
" )))))1)11is))1''
��
�+ / crt� -- Original Certificate Date: 6- - /
e Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representation- given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r .t c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
!91- 1dolttron
Legal Description: Hundred Hills X, Block 5, Lot 6
A. WELL DATA
Well type Private
Date completed 7/1997
Total depth 101 ft
Date of test
Static water level ft.
Well production 0.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform /v-colonies/100 mL Nitrate 0- / 33 mg/L
Arsenic tii> ug/L Date of sample: 6/3/2014
If A, B, or C provide PWSID #
Sanitary seal (Y/N)
101 ft
Cased to
FROM WELL LOG
7/1997
40
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N){�N
Date of pumping 4 65.(1/..0 L.a Pumper
Parcel ID: 078-281-01
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
6/3/2014
5 a ft.
3.5 g.p.m.
Collected by: PES
Date installed 7/1997
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed
7/1997
Length 55
ft.
Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF
Width 2 ft.
Total depth 14 ft. Eff. absorption area 781 ft2
Date of adequacy test 6/3/2014
System type Deep Trench
Gravel below pipe 7.1 ft.
Monitoring tube 2 Depression over field
Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 42 in. Water added 457
Elapsed Time: 160 min. Final fluid depth 42 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
gal. New depth 45 in.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+
Water Service line 10+
Curtain drain 50+
F. COMMENTS
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
Absorption field 5+
Water service line 10+ Surface water 100+
Building foundation 1°1-
Surface
0+Surface water 100+
Wells on adjacent lots 100+
Water main 10+
Driveway, parking/vehicle storage 10+
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone
Date 6/4/2014
COSA brown sheet 10-10-12.doc
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
Parcel1.D. 078-281-01
1.
GENERAL INFORMATION
Complete legal description Hundred Hills #i Block 5 Lot 6
Location (site address) Site 154 Hiland Rd Eagle River
COSA # HA m 0330
Expiration Date: i€2. -2 3 -0 9
Current Property owner(s) Henry & Jennifer Vancil
Mailing address 2709 Redwing Rd Fort Collins CO. 80526
Lending agency
Mailing address
Day phone
Day phone
Real Estate Agent IEC Realty
Mailing Address
Day phone 1763-4272
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
3
TYPE OF WASTEWATER DISPOSAL:
O Individual On-site
❑ Individual Holding Tank 0
❑ Community On-site 0
❑ Public Sewer 0
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 Pannone Engineering Services, LLC
Phone 272-8218
Address P.O. Box 102g54. Anchorage. AK g9510
Engineer's Printed Name Steven R. Pannone. P.E. Date g//09
Engineers Comments: In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in
accordancc with MOA DSD Guidelines & Regulations. The reported results describe the performance of the systcm undcr the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features. ,QF "aa
The operational life of all wells and septic systems depend on the local soil condition, ground water 44 aaa4
levels that may fluctuate during the year, and the water usage of the family being served by the system. .•�p:r. •
These conditions are outside the control of the evaluator of this system. All systems eventually fail and : as
•satisfactory test results do not guarantee future performance of the system, nor do they guarantee that .0 qq rr, r%��.
there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future :Z' i
•
performance nor give any estimate of how long the systcm will continue to meet the operational �,����� $
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed i tM e
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
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Steven R. Ponnon
y�
No. CE 8149
•
.AN". OF s}r�c
`�•••
ON-SITE ••'• 0-
��• WATER AND ; in:
WASTEWATER •
PROGRAM•
:
(�;ANT
;rel I�
'
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
B.1lA6YY
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
.�� !iL/• Original Certificate Date: 9 "c2 3-0 9
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 CHECKLIST
Legal Description: Hundred Hills ui BlockS Lot 6 Parcel ID: 078-281-01
A. WELL DATA
Well type private If A, B, or C provide PWSID k Well Log (YIN) Y
Date completed 7121 347 Sanitary seal (Y/N) y Wires properly protected (Y/N) Y
Total depth aoi ft. Cased to 101 ft. Casing height (above ground) 16+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/1/1997 X14/2009
Static water level 4o ft. se
Well production Well Log.4 g.p.m. c,6
WATER SAMPLE RESULTS:
Coliform olonies/100 mL Nitrate 0` aQ mg/L' Other bacteria 0 colonies/100 mL
Arsenic: NO ug/I Date of sample: `�� Collected by: 1-QIal-4}t
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank/ Steel Date installed 7/1111997
ft.
' g.p.m.
Tank size soon gal.
Number of Compartments a
Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) 1 High water alarm (WN) N/A
Date of pumping 4/3/2009
C. ABSORPTION FIELD DATA
Date installed 7/'8/1no7 Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type Deep Trench
Length ss ft. Width a 0 ft. Gravel below pipe 7.1 ft.
Total depth 14.1 ft. Eff. absorption area aga ft2 Monitoring tube Y Depression over field N
Date of adequacy test 4/412004 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth In absorption field before test 43 in. Water added45o gal. New depthsas3 in.
Elapsed Time:144o min. Final fluid depth i,3 in. Absorption rate >_ 450 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date
Pumper JR'sPumping
D. LIFT STATION
Date Installed Size in g
"Pump on" level at _ in. "Pump off' ' =1 at _ in.
Datum Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 120'
Absorption field on lot 13o'
Public sewer main N/A
•
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots zoo+
On adjacent lots 100+
Public sewer manhole/cleanout N/A
Sewer /septic service line us' Holding tank N/A
Animal containment areas 100+ Manure/animal excrete storage areas _aoo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 6.5'
Property line 64' Absorption field 13'
Water main NIA Water service line o+ Surface water 100+
Wells on adjacent lots zoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line n' Building foundation 21'
Water Service line 5o+ Surface water 100+
Curtain drain None Known Wells on adjacent lots aoo+
F. COMMENTS
As Built on File
Water main N/A
Driveway, parking/vehicle storage is'
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 Steven R. Pannone. P.E.
Date 0409023
•\Steven R. PonnoneCI
♦""\ No. CE 81 49 C.
•
COSA Fee $
Date of Payment
1/9°
q --/g- Oct
Receipt Number 0 533_20
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SCS Ref.N
Client Name
Project Name/0
Client Sample ID
Mattis
1094692001
Pannone Eng. Srv.
Hundred Hills #1 85,L6
Hundred Hills N 1 B5,L6
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
09/17/2009 15:54
09/04/2009 12:00
09/04/2009 13:10
Stephen C. Ede
Sample Remarks:
Parameter
Results
PQL
Units Method
Allowable Prep Analysis
Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Haters_ Department
Total Nitratc/Nitritc-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND
5.00
ug/L EP200.8
C (<10) 09/14/09 09/16/09 NRB
0.201 0.100 mg/L SM20 4500NO3-F 13 (<10)
0
0
0
col/100mL SM20 922213
col/I00mL SM20 922213
co1/100mL SM20 922213
A
A
A
(<200)
(<1)
(<1)
09/09/09 RJT
09/04/09 DLC
09/04/09 DLC
09/04/09 DLC
rr. 09: ns
ay_
r=ear
‘,1
84992.a.: tJV
ASBUILT
SEWARD
qty
OR
op�
& ASSOCIATES LAND SURVEYING 694-0824
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRI CTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBOI
VISION PLAT. UNDER NO CIRCUMSTANCES SHOILD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE:
DATE:
GRID:
fes.:` -
F&
% 7T
DRAWN:
r�•�F.A�.44t
r •
of
ou n. Mut S. .d ' t
Ito.... . ` .
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
yr
MENTAL SERVICES DIVISI
JAN 16 1998
RECEIVED
Parcel I.D.# 078728'/bL HAA# 4-4A 1Up00
1. GENERAL INFORMATION /j /
Complete legal description /,Gi1d.'rep 2V;VS
(l.S/-
Location (site address or directions) NgA/ A/2/�
//v S2, 3
Property owner ZeeA r1lr,r7Z!
C7 Day phone Z;947-1156.5-
Mailing address
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA e21
5. STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
KND Engineering
20441 Ptarmigan Blvd.
Cayle Plv r. 995
Phone
6. DHHS SIGNATURE
Approved for I 11QEE bedrooms.
Disapproved.
By.
Date
s, OF .. L 4 Sl I
��Q;.• ;f 6
igitoTit
=,
141 t
Wig: Kenerh ,rt.. t hVS cc.
G (., �a�®
CE 7116 '
�f
1S:sltrSe:t410' .*'tel—(
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
le/c3
Date (22 gEr
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
(IRONMENTAL SERVICES DIVISk
Municipality of Anchorage ''QQ
DEPARTMENT OF HEALTH & HUMAN SERVIC N 1 & 1938
Environmental Services Division [lp
825 L Street, Room 502 • Anchorage, Alaska 99501 • (9'6 fj-� E
/ , Health Authority Approval Checklist
Legal Description: J to XPi [ti //5 / JL%5 L-/- Parcel I.D.: 073 - 2.8 " /D I
A. WELL DATA
Well type 1 ✓1d If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed //97
I
Total depth /0/ Cased to /0/ Casing height (above ground) 2.1
Y
Sanitary seal (Y/N)
Date of test
Static water level
Well production
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
7/q7
411D
WATER SAMPLE RESULTS:
g.p.m. / g.p.m.
Coliform C Nitrate (9,/& Other bacteria
Date of sample: 0906 Collected by: KAI D F. V? Irl e e_2_L y
B. SEPTIC/HOLDING TANK DATA vl
Date installed 7/1//97 Tank size /DDD Number of Compartments 2 Cleanouts (Y/N) f
Foundation cleanout (Y/N) )1 Depression (Y/N) !Y High water alarm (Y/N) A/,4
Date of Pumping Pumper —
C. ABSORPTION FIELD DATA /
Date installed 7/// /F7 Soil rating (g.p.d./ft2 or ft2/bdrm) D. (o System type peep t'ei9e-1
Length 55 1 Width 2 ' Gravel thickness below pipe 7. / Total depth 1/ 4 - //. c7/
Effective absorption area 78 / Monitoring Tube present (Y/N) f Depression over field (Y/N) Al
Date of adequacy test
Fluid depth in absorption 'eld before test (in.); I . mediately after gal. water a'ded (in.):
Fluid depth (ins) Minutes later: Absorption rate =
Peroxide tr=: ment (past 12 months) (Y/N) If yes, give date
Results (Pass/Fail)
For bedrooms
72-026 (Rev. 3/96)*
g.p.d.
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) "Pump on" level at* "Pump off' level at*
High water alarm level at* *Datum
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /001* On adjacent lots /00 -I-
Absorption field on lot l OD' -f On adjacent lots
Public sewer main / DU
Sewer /septic service line 1 DO 4- Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation Property line / 0 -1' Absorption field
1001-t
Public sewer manhole/cleanout
NA
NA
-f--
Water main/service line 25 E Surface water/drainage I DO +" Wells on adjacent lots /00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation .51 + Water main/service line 2.5'4
Surface water / 001 + Driveway, parking/vehicle storage area 2514.
i
Curtain drain CDU I + Wells on adjacent lots /Do ±
F. ENGINEER'S CERTIFICATION
I certify that f have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature /l
Engineer's Name lj of r7 i) 12t.c 1C(2 S
•
Date
HAA Fee $ �
�j�
Date of Payment / c1' �! y
Receipt Numberd?.J ! Z y16
72-026 (Rev. 3/96)*
of Municipal records the 4lQjesystems are
,4 4 OF 44.Alit
oca e, •oao.
0.
(2
.6) C[ 7116
p8OFE-SStCO
Waiver Fee $
Date of Payment
Receipt Number
K1111) ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
DATE:
LEGAL DESCRIPTION:
ADDRESS:
PERFORMED FOR:
From: Well Log
WELL FLOW TEST DATA SHEET
1/21/98
Hundred Hills S/D, B5, L6
NHN Hiland Road, Mile 8.3, Eagle River, AK 99577
Lee Raymond, Lee's Custom Homes
Probing Measurements
Q ADEC/MOA Records
# Bedrooms 3 x 150 GPD/Bdrm =
Sanitary Seal/Cap: Ai Casing Height
Pump Wire in Surface Drainage
Conduit: g Away from Well:
Storage/Pressure Depth to Pitless
Tanks: Adapter:
Well Pump Specs.:
Well Depth:
Water Supply Line -
N/A Type & Size:
Static Level:
101'®
450
24"
4.
unk.
unk.
66.5'TOC O
GPD Minimum
above Ground
Time
Time
Int.
Minutes
Cumm.
Time
Minutes
Flow
Rate
Reading
F.R.
Inter.
Gal.
Cumm
.
Gal.
Pumping
Rate
(gpm)
Static
Level(ft)
Comments
1:42p
0
0
5800
0
0
0
66.5
Start ow test/Pump off
1:52p
10
10
5860
60
60
6.0
66.5
Pump off
2:02p
10
20
5921
61
121
6.1
66.5
Pump on
2:22p
20
40
6046
125
246
6.2
66.7
Pump on
2:42p
20
60
6177
131
377
6.5
66.7
Pump on
5:14p
152
212
7117
940
1317
6.2
67.1
Pump on
5:32p
18
230
7229
112
1429
6.2
66.7
Pump on
5:42p
10
240
7293
64
1493
6.4
66.9
Stop flow test/start recovery
5:58p
16
256
0
0
0
66.4
Pump off/Stop recovery
measure.
Total
Time =
256
Total Gal. =
1,493
Avg.
Flow=
DSL=
6.23
0.60'
Comments:
Well is capable of producing in excess of 6 gpm. Limiting factor is the 1/2" hose bib used during the
test. Only minimal draw down observed during well flow test and full recovery in less than 16 minutes.
Performed By: KMD
Checked By: I(MD
JRN 14 '98 03 82PM NTL RNCHORAGE
P.4/5
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE
8000 SCHOON STREET
FAIRBANKS, ALASKA 99701
ANCHORAGE, ALASKA 99518
(907) 450-3116 • FAX 458.3125
(907) 3491000 • FAX 349-1016
KND Engineering
20441 Ptarmigan Blvd.
Earle River. AK 99577-3736
Attn: Ken or Dee
Client ID;
Client Project 4:
Source:
NTL LA*:
Sample Matrix:
Comments:
Hose Bid, N. Side of House
Hundred Hills Block 4 Lot 8
A153743
Water
Report Date: 1/14/98
Date Arrived: 1/6/98
Sample Date: 1/6/98
Sample Time: 14:45
Collected By: Ken
MRL
MCL
13
E
M
D
** Legend **
= Method Report Level
— Max Contaminant revel
= Presort In Method Blank
+Eaaimafed vatoo
= Matrix Imafamw
= Above MCL
= Lost To Dilution
Method Parameter
Units
Result
Date Date
Mktl• Prepared Analyzed
SM 4500 E
Nitratc-N
�lLtii
' - ,4ted By: Jonona K. Kuusisto
C temistry Supervisor
mg/L
0.16 0,10
1/12/98
