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Home My WebLink AboutHILLSIDE PARK PUD LT 21Liq. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVlRONIVlENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCE TO: I nside length Dwelling IF HOMEMADE: Foundation Depth Manufacturer DISTANCE TO: Well No. oflines / LengthL~e Top of tile to finish grade Length Width PHONE I I~ ~JEW Dwelling Materi~ Width Material Nearest I o?~e/' Trene % Type of crib Crib diameter Crib depth Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line Building foundation Sewer line Septic tank DISTANCE TO: OTHER PIPE MATERIALS./") SOl L TEST RATING ~/.~,.-r~ D~TE / LEGAL inches inches NO. O ~/~)ROOMS PERMIT /4 No. of co~.~.ents Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT .~- ~/ Total effective absorption area PERMIT NO. Absorption area(s) F'ERt',tI ThlO. RPPL I CFIF,!T LOCFIT t ON LEGFIL ( ...... ].... ,_,._ ,..':, DFIHL CO N'.'5 ]". EFIqT ~ FEE,, Ef,:,T TREE CT LOT 2± HILLSI£:,E F'RRK SUB LOT SIZE T"?PE OF :D]IL F"IE~3ORP'['ION z',T..,T~Jl TO,' TF:ENCH t'"IRX]:F1LiI'd I'IUHE,',._R OF BEDROC~MS = E;OIL RR'T'IN(3 "'::¢ F [,. E,F. THE RE[;!LIIF.:ED:,'-'t'"~F.,.~_ OF ]"PIE. E]IL. RE:SCF.:F'TI ]N .:,TzTE!t "'-' 'THE LENC~'TH DIMEhfS!ON IS 'THE LENGTH (IN FEET) OF 'T'HE TRENCH OR DRRINFIEL.D. 'THE DEPTH OF FI TF.'ENCH OR PIT I~; 'THE: DISTRNCE BE'THEEN THE '!'~;LIF,'F'RCE OF "['HE: 13ROUF,ID FIND THE BO]"TOFt OF'THE E',:.::C:FIVFITION (IN F:EE:T). 'THERE :IS NO SET HIE:,TH FOR TRENCHES;. ]''HE GRFI",,'EL [:,EF'TH IS THE HINIMUM DEPTH OF GRF:IVEL BETHEEI",f THE OLi]"FFILL PIPE FIN[:, THE BOT]"OH OF' THE E'XCFIVRTION (IN FEE'T). , -r,- ':RNT h"C. iH_, THE F.:ESF'CN~:iE:!LiT'¢ TO Ik:3":Jf ~iFPI ]HIz," '-' DEPRRTf'EN'T DURING THE F:'ERM ZT H. IN'~TFILL. RTZON IHcpE-T'[J"]Nq OF' FINV kELL ..... F![:,.ZFIC:ENT TO Tt.'{]~: ~-~: .~t RND THE NUMBER OF RESIE:,ENC:E~5 THFIT THE HELL. HILL. SERVE .... : ,-. · ...... ?? i, i "* ~' E;¢,CKFILLIN[3 OF FIN'? S'¢L:;TEH HITHZLT FINRL ~I',1.:[ EL.]'.IJI'I FIND ~FF'F...,,FIL. EFt Ih!:, DEF'FIRTHENT HILL BE 'SLfE.TECT TO F'ROSECUTION. HINtMUM DISTRNC:E BETHE:EN Ft HELL RND FJN¥ ON-:5ITE SEHRGE DI%POSFIL ."~'::.~':'STEi"I t5 tEt~...z.l FEET FOR FI PRIVRTE HELL. OF: ±5(~.~ "FO 2~:ZI(~ FEE'1" F:ROM Ft PUBLIC HEL. L DEPE:NE:'ING UPON 'THE 'T'?'PE OF PUBLIC HELL !"!INZHUH [:'ISTRNCE FROH R PRtVFITE HELL ]"0 R PRIVRTE SEWER LINE tS 2F5 FEET TO FI COHi"IUN:£TY SEHER L:[NE 1'5 ?5 FEET. OTHER REQU:[REHENTS HR'-? FIPF'L'¢. SPECIFICFfTIONS FIND CONS..:TRUCTI. ON [:,IREiRFIH:ii..: FIRE FIVRILFIBLE TO INSUF::E PF.:OPER INSTFILLPTT'I. ON. I CER'T'IF9 THFIT :1.: I Ai',1 FF!MILIFIR HITH 'THE RDT,!U!F:.EMENT:~; FOR ON-SITE SEHERE; FIN[) HELLS F:t~:5 '.BET FORTH B'¢ THE HLINICIF'FIL. iT¥ OF' FINCHORFIGE. 2: I HI!._L INSTFILL THE S'¢::?,'T'EH IN FtCCOF. tDFINCE WITH -['HE CO[:,E.S. Z.: I UN[:,ERD]TSN[:, THFIT THE ON-:.'.:.:I'TE SEHER E:'¢STEM MR'.? RE. QUIRE ENLRRGEMENT IF' ']"HE RESIDENCE IS REMODELED TO tNCLU[)E MORE THRN 4 E,'EDROOMS, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 4 7 8 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ~ ~" % PERFORMED BY: WAS GROUND WATER ENCOUNTERED? /'~ {.~ I~ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water ' Drop PERCOLATION RATE minu, tes/inch TEST RUN BETWEEN , F~T AND ~ FT • Municipality of Anchorage On-Site Water and Wastewater Program ` (907) 343-7904 ra��!S �a . .� c CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-312-15 Expiration Date: ( 0^(g)—/q 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK PUD LOT 21 Location (site address) 7000 EAST TREE COURT, ANCHORAGE,AK 99507 Current Property owner(s) RYAN &CARLA PHELPS Day phone Mailing address 7000 EAST TREE COURT,ANCHORAGE, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: il�/Ar Date: ////1, COSA to be released to the engineer,unless othe i" requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment /0/3///1 Date of Payment Receipt Number (}'q/ Receipt Number COSA# 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/19/2018 Engineers Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,local soil characteristics,groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen O€' encroachments,deficiencies or discrepancies exist. /�� "4 s , 4. T /,\ .arni 6. DSD SIGNATURE �4 _, KENNETH .1. D fir��i/ ti System #1 Approved for bedrooms. 7116 4, �4.-5. . c> System #2 Approved for bedrooms. \o,,' - - �� E. to: .�► Disapproved. Conditional approval for bedrooms, with the following stipulations: ow-SITE , •� WATER AND o WAS TEWATGR , �pROGRAM o� O,o - SFR\I`C• By: t.. — Original Certificate Date: /0 3 I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: HILLSIDE PARK PUD LOT 21 Parcel ID: 015.312-15 A. WELL DATA—PUBLIC WATER Well type If A, B, or C provid: 'WSID# Well Log (Y/N) Date completed Sanitary seal '/N)y Wires properly protecte• (Y/N) Total depth ft. Cased to ft. Casing height(abov- ground) in. FROM WELL •G AT INSPECTION Date of test Static water level ft. ft. Well production _ g.p.m. g.p.m. WATER SAMPL 'ESULTS: Coliform olonies/100 mL Nitrate _ mg/L Arsenic: _ _ ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 6/15/2012 Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/18/2018 Pumper ONE STOP C. ABSORPTION FIELD DATA *BELOW INVERT. MT missing bottom 1'+/-of the 5'ED. Date installed 9/8/1981 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 System type DEEP TRENCH Length 34 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 10.25 ft. (Measured 10/19/18) Eff. absorption area 340 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/19/2018 Results(Pass/Fail) PASS_ For 4 bedrooms Fluid depth in absorption field before test 25* in. (35"of fluid) Water added 600 gal. New depth 25* in. Elapsed Time: 0 min. Final fluid depth 25* in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date 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 - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+PER IR Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 1 kw- Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage_10'+ Curtain drain _50'+(NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS nV' sem tAJ,w. v' (/ h C2cOSc? • Pee IX 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. OF Azt\ t Engineer's Printed Name KENNETH M.DUFFUS j <S,% _, , Date 10/19/2018 *"14 9 Til /\ / -en. KENNETH u. V COSA canary sheet_2-6-15.doc 10% r a Phb•Ess ios'N'. 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 ...~ Parcel I.D.# GENERAL INFORMATION Complete legal description Location (site address or directions) ~000 = Property owner Mail'ing address Lending agency Mailing address Agent ---~ ~/ r~// Day phone ~.5 Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: q 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: .... Pub. C sewer If community wastewater SYstem, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, l/91) Front MOA#21 # 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 /~O.~ v~'. ~ ¢''~ ~ ~;~ Engineer's signature ~----~' ~^~ · DHHS SIGNATURE Approved for /~_~'?? Disapproved. Conditional approval for Phone Date /o///~ 5 bedroomS. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze, data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p?ofessional engineer's work. 72-025(Rev. 1/91) Back MOAfY21 Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: L ~_.l /~;//~/~ P~ ~U.O ParcelI.D. A. Well Data ~-~tga~;:~) Sanitary seal (Y/N)~ Date of test ~WELL Static water level ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Well flow Pump level1 Cased to Casing height SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Nitrate Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ////~' / Cleanouts (Y/N) Y Wires properly protected (Y/N) LOG AT INSPECTION g.p.m, g.p.m. ~~t lots ; On adjacent~ Public sewer man hole/'c~nout Petroleum tank Other Collected by: Tank size /2 ~ O ~'~./. Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) ,AJ High water alarm (Y/N) /V,/A' '~.. Alarm tested (Y/N) Date of pumping Al~,co~'. ~//~/! (~ Pumper SEPARATION DISTANCEs FROM SEPTIC/HOLDING TANK TO: Well(s) on lot C~,~,./,J'/~'~6:k) On adjacent lots ~.~r,~,~///y >Jlt.~' Foundation To property line ..~/ Absorption field ~/(~) / / Water main/service line ~drfaoe-wete r/d r ainage ~ ~O/ .< > 0 72-026 (:3/g3)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ,/'~"///~ Size in gallons -- Vent (Y/N) ~ High water alarm level "Pump on" level at ~ Manufacturer -- Manhole/Access (Y/N) ~ "Pump off" Level at Cycles tested ~ Meets MOA electrical codes (Y/N) -- SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /k///~ On adjacent lots Sudace water - D. ABSORPTION FIELD DATA Date insta,ed ////$/ Length ~/i ~ Width ~ Total absorption area ,~/~ ~7~ Date of adequacy test c//2 7//~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating.(-GPD/F,F) Cleanout present (Y/N) Results (pass/fail) Z-/" (~ 5 ~"T' z//E~R~ Syst em type --'~'-'£ ~/~ Total depth '~ / Depression over field (Y/N) for z./ Gravel thickness After test /~/ If yes, give date /1///~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /'~/'/,,~ To building foundation On adjacent lots /V'/A Surface water /~',//~ Curtain drain On adjacent lots ,/V///~ Property line / -~ To existing or abandoned system on lot /&///[ Cutbank /1,////~ Water main/service line Driveway, parking/vehicle storage area ~ ~ / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~~~ Enginee,s Name Date H~ Fee $ ~g~ ' ~ Waiver Fee $ Date of Payme~ /~'~/~ ~ Date of Payment Receipt Numar ~ ~ 7~ ¢~2 Recei¢ Number APPLI - IT FILLS OUT UPPER HA - ONLY Mailing ,~ddress Buyer Address ~,~) /~ /5--~[ ZiP C°de qq ~'"'~(~7 Lending Institution Phone ¢ealty Co, & Agent ~ '~ ~-~..... ~ {~'T~ Phone Address Zip Code Legal Description L.~ Street Location Type of Residence ~ Single Family [] Mu,t,p,e Fam,,y No. o, Bedroo,,, [] Other Water Supply [] Individual ATTACH WELL LOG. A well log is required for all Wells drilled since June 1975: For wells drilled prior to that date, give well depth (attach log if available), fi~ Community Public Utility Sewer Disposal //~ F/ Individual Year Individual Installed: '~ Public Utility When Connected to Public U'ti~lty: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time .~: ~ y~_../~ Date Ba,e Da,e ~nspecter ~nspector ~nspector ~nspecto~ Field Notes: ~ (~_<~"~ ~,~ ~ ( ~1~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~" I ~:~.-- ~ "~" Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 4:~_ ~ [ Wall to Tank Septic Tank Size (~.::~