HomeMy WebLinkAboutHIGHLAND HILLS #2 BLK 2 LT 4 Onsite File
Highland Hills
# 2
Block 2
Lot 4
#050 - 382 - 35
The undersized 1984 field may not be tested for any
future COSAs.
2020
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171109 PID Number: 050-382-35
Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade
Name
John Doran
ABSORPTION FIELD
®❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
5525 Hiland Road
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
4
1.2 GPD/SF
JTotal
10.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Highland Hills #2 2 4
Fill added above original grade
0.0 Ft.
Gravel length
45 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
n/a
Distance between lines
n/a Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
540 Ftz
1(N) & 1(E)
18.0 Ft.
Well
100'+
100'+
TANK ❑® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1250 Gal.
Surface Water
100'+
100'+
Material
Number of compartments
Lot Line
5.0'+
10'+
NA
Steel
2
Foundation
5.0'+
101+F
LIFT STATION
Manufacturer
Capacity
Remarks Existing drain field is undersized and shall not
Gal.
be tested in order to obtain a Cosa
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 drainfield Tank to
3034
Installer
Jr's Septic Services
Drainfield 3034 co/MT 3034
Inspector Pannone Engineering
BENCH MARK (Assumed elevation) 100.5 ft
Inspdection 1s` 9/20/17 9/21/17
Location and description
2"d
3°' 9/21/17 41" 12/5/19
Bottom of Siding at Foundation Clean out
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
OF q�����
A�P'� . s
.....
�.
''E 814-0,
Septic System
�ez�
Approved/�1/'� Datelk
Note: this approval does not include well permit requirements.����``�
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NOTES: PANNONE ENG SVG LLREVISIONS DATE
RECORD DRAWING P.O. BOX 1807 PALMER, AK '99645 .;�`�k-4 � 1/2/20
PNONE 907) 745-8200 FAX (907) 745-8201,.^'�P• ' i4� REV 1: 1/29/2020 SCALE
REV 2: 3/18/2020 1" = 60'
HIGHLAND HILLS #2 B2 L4 ".... .. P.I.D. NO
DRAWN ACP JOHN DORANS•teven'R.'Pan n.oAe050-382-35
SITE PLAN 5525 HILAND ROAD �Ij�'g cE 8149 ---
PERMIT
EAGLE RIVER, AK h,rh.► 2 of 2
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NOTES: PANNONE ENG SVG LLREVISIONS DATE
RECORD DRAWING P.O. BOX 1807 PALMER, AK '99645 .;�`�k-4 � 1/2/20
PNONE 907) 745-8200 FAX (907) 745-8201,.^'�P• ' i4� REV 1: 1/29/2020 SCALE
REV 2: 3/18/2020 1" = 60'
HIGHLAND HILLS #2 B2 L4 ".... .. P.I.D. NO
DRAWN ACP JOHN DORANS•teven'R.'Pan n.oAe050-382-35
SITE PLAN 5525 HILAND ROAD �Ij�'g cE 8149 ---
PERMIT
EAGLE RIVER, AK h,rh.► 2 of 2
%,"""`-"Yo MUNICIPALITY OF ANCHORAGE
i. -- Oent
\, On-Site Water& Wastewater Program N o s�;
l PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
\ 44, "� http:llwww.muni.orglonsite
I)clutrtinch[
4NCHON °E
On-Site Wastewater Disposal System Permit
Permit Number: OSP171109 Effective Date: 6/20/2017
Work Type: Septic Upgrade Expiration Date: 6/20/2018
Tax Code Number: 05038235000
Site Legal Address: HIGHLAND HILLS#2 BLK 2 LT 4 G:0558
Site Mailing Address: 5525 HILAND RD, Eagle River
Owner: DORAN JOHN L & Lot Size in Sq Ft: 72973
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
11 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The Inspection Report shall have a note stating that the undersized 1984 field shall not be
tested for future COSAs.
1
Received By: �. I�_ �' ► � I �� Date: (.L/ / /l
Issued By: / _z_..1. (10--t_.) _..--_.,-_,__-__ 41 Date: 72--0/7
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 050-382-35
Property owner(s) John & Barbara Doran Day phone
Mailing address P.O. Box 772753, Eagle River, AK 99577
Site address 5525 Hiland Road
Legal description (Sub'd., Block & Lot) Highland Hills #2, Block, 2 Lot 4
Legal description (Township, Range & Section)
Lot Size 72,973 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) ❑x
(w/wo ADU)
Septic Tank 0 Upgrade 0 Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
111110
(Signature of property owner or authorized agent)
Permit/Rush Fees: 56 GI Waiver Fees:
Date of Payment: 5130 7 Date of Payment:
Receipt Number: loq �13G Receipt Number:
Permit No. OS P j 7 II 09 Waiver No.
Permit App_ • .: .,c;
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
June 12, 2017
Subject: Highland Hills #2, Block 2, Lot 4
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property.
The proposed system will serve an existing four (4) bedroom house. Currently the lot is developed. The
existing 1000 gallon tank will be decommissioned and replaced with a 1,250 gallon septic tank. A new field
will be installed. This lot and the surrounding lots are served by private wells. There are no wells within
100' of the proposed septic system.
1. Soils. One test holes was conducted in the area by PES in May of 2017. Bedrock was not encountered
in those test holes. Ground water was not encountered to a depth of 16 feet in May of 2017. Based
on the results of the percolation tests and overall soils appearance; an application rate of 1.2
gallons/day/square was used for a conventional wastewater system in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography on the lot generally slopes from east to west, with a slope
of approximately 20%to 25% in the area of the drain field. There are no steep slopes within 50' of the
proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
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• U� ( 1 \ ., PRIMARY/RESERVE DRAIN FIELD (P)
Iy\
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45LF x 2.5'W x 6.O'ED x 1O'TD
0 INSTALL MT AND CO AT EACH END
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wt �, \. � 5 f w
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DECOMMISSION 1000g SEPTIC TANK (E) \ s TH-1
PER CODE AND INSTALL 1,250g \ I
SEPTIC TANK (P) WITH DCO AND DV` t) ',, i [ \ ,
DRAIN FIELD (E) IN FAILURE \ \ y u N /
RE-USE AS RESERVE �`� �t 1!
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Jr SEPTIC AREA (E) I
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM LEGEND
NO. BEDROOM: 4 (600 gpd) w- WATER LINE/
TANK SIZE: 1250g WELL RADIUS ABBREVIATIONS
PERC RATE: 3.8 MPI
SOIL RATING: 1.2 GPD/SF TH TEST HOLE
AREA RQD: 500 SF SS NEW SEPTIC (P) PROPOSED
SYS. TYPE: DEEP TRENCH- 6.0'ED — _ -GB- - — GRADE BREAK (E) EXISTING
MIN LENGTH: 41.7 LF CO CLEAN OUT NO.
USE: 0 0 RETAINING WALL MT MONITOR TUBE NO.
TYP TYPICAL
45 LFx2.5'Wx6.0' E.D., 10' TD
TOTAL AREA: 540 SF
NOTES: �__�����\ Date
PANNONE ENG SVC, LLC -- OF AC� .1 6/1 6/201 7
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, A99510 ,'�%. •�S l0
PHONE (907) 272-8218 FAX (907) 272-8211 igoP .4i .!. Scale
DRAWN BY: *••...,•• 11014 (0 P.I.D. NO
DRM ��. / 050-38 -35
HIGHLAND HILLS #2, BLOCK 2, LOT 4 'teven •F�. annorae
JOHN & BARBARA DORAN / PERMIT NO.
5525 HILAND ROAD r4, ,i,, CE 8149 ...A-�/ OSP171109
PLAN EAGLE RIVER, AK 99577 �glcrp•' •Pk .� Sheet
1 PROFES5100
l 1\\�.-\���-. 1 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: REPLACE 1000G TANK WITH 1250G TANK. INSTALL UPGRADE DRAIN FIELD.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE
SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16 FEET
BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF
EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE
ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN
DEFECTS BY THE CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE: .
NOTES: Date
PANNONE ENG SVC, LLC
OF ACq�l s�,6201
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 '�. S
7
r'cP' •'�+4 Scale
PHONE (907) 272-8218 FAX (907) 272-8211 raj • •,y
DRAWN BY: *: ..*I0 NTS
DRM • "' P.I.D. NO
HIGHLAND HILLS #2, BLOCK 2, LOT 4 050-382-35
Steve•n•• •�a none SIT NO.
JOHN & BARBARA DORAN CE 8144 • Al
5525 HILAND ROAD f+ cs . � OSP171109
fFSICN DETAILS EAGLE RIVER, AK 99577110.400904
� '„, f Sheet
1, 0090 I
� 3 OF 3
SOILS LOG - PERCOLATION TEST
TEST HOLE 1
SLOPE SITE PLAN
OR ORGANICS
1
2
3
4
5
6 x
TH
GM SILTY GRAVEL
7
8
9
10
11
12
13
POORLY WAS GROUND WATER SLOPE
14 SP GRADED ENCOUNTERED? N
SAND —
15 IF YES,AT WHAT TH
DEPTH? -DRY x
16
BOH
17 DEPTH TO WATER AFTER
MONITORING? -DRY
18 DATE: 5/26/17
WATER
19 READING DATE CLOCKTIMENET TIME LEVEL NET DROP
READING
DATE PERFORMED:5/19/17 1 5/19/17 11:25 -- 6.80
2 11:35 10 MIN 10.31 3.51
3 11:35 --- 6.80
4 11:45 10 MIN 9.69 2.89
5 11:45 --- 6.80 --
6 11:55 10 MIN 9.44 2.64
11:55 --- 6.80
12:05 10 MIN 9.40 2.60
PEROLATION RATE 3.8(min/inch)PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3 FT AND 4 FT
COMMENTS:Test hole excavated by JR'S SEPTIC
PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE4 ENGSVANCHORAGE,C, L9LC 'C��F ALgs1�, Dote 20,7
OR CONSTRUCTION
PHONE (907) 272-8218 FAX (907) 272-8211 ig�- 4 .. Scale
DRAWN BY: - - *: . • I *I� NTS
DRM #10$ L P.I.D. NO
HIGHLAND HILLS #2, BLOCK 2, LOT 4 •bteven P 00 050-382-35
�� .
JOHN & BARBARA DORAN CE 8149 �'�/ PERMIT NO.
OSP171109
5525 HILAND ROAD Of esu
SOILS LOG EAGLE RIVER, AK 99577 ���'� pAtti` y Sheet
1tt �4 20F3
MUNICIPALITY OF ANCHORAGE
, e DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
!/ ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ~.. PHONE j~l~ EW
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
Well Absorption area ~ Dwelling PERMIT NO,
~ DISTANCE TO: ~.~ 1~ ~- ~/~/ 840669
P Z Manufacturer ~ Mat~lial No, of compartments
Liq. c~pa~ty in gallon~ Inside length Width Liquid depth
/ ~ ~ IF HOMEMADE: ,. ~ . .......
~ ~ DISTANCE TO: Well ~/ Dwellie9 PERMIT NO,
~ Well ~oundation Nearest lot line
~ DISTANCE TO: ~)~ //~ ~.~ /~/ /~ -/'- 840669
Total lechgf)ines Trench wiO~o Distance between lines
~ ~ .__ . inches
Total effecti~ ~qrpti~rea
~ Top of tile to finish gra~ ~ I Material beneath tile
inches
~ Length Width I / Depth PERMIT NO.
%
~ P Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth ~iller //. I Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING · /
REMARKS
APPROVED 8R~{ 1~[~ ;DATE / ~AL///////
lEE F;,1 ;~.: 11¢,8 lEE: IL_.. t ..... IF::" IEE: ~:~t Ib~ It: T'
F'ERId ]: T' I~l(] ."
840AA?
08/07/84
(-~F::'I:* L I C;(~IqT:
C, OIII~E,] PHONE
SOLJ"FH I=C)RI< CONST.
% E;8,.S IEl',lf::') I NEIER I Iq(i;
IE~BI_IE R I VER, Al'::: ~79577
I...li!:E~(.~l_ X ::'c, ~,.", ..... .
)E.. C,F~ 1F ,,
SUBDIVISION: HILAND FI]:L, LEi
.~!~EC]":I:ON: 4 TOWNSHIF:': 1:51q
64000 (SD. I::'T. Eff:~ ~4CRES)
I_(]T: 4.
R{.~NI3E ~" 1W
E L..C.ICI ......
L. ist. E~d be],ow ape t, he] (31]t. ions ava~i].able t.(::} yoL~ irt de~;igrling your
ssystel. Chc)os~e tmhe op'Lic]n that. bes'L fi'Es yoLtP
DEF'TH TO F'IF'E BOTTCIM (FT.)
GFd.-~V1SL. OEPTH (F'T.)
TEll'AL DIEF:'TH (FT.)
['.~Fd~VE:L.. WIDTH (FT',,)
GRAVEL L.IEIq(STH (P-T.)
"f'~Nl<: iS I ZE (ECALS) 1, [ C I" ,, 0 .~.~' 1, O01) ,, ] .~-}l- 1, OOC ,, (: ,~.~
SC)IL I:;tA'I']:NI}:~ (SD,, Fr]". /El',:) 159 :tAt5 :[6,[5
*',~ TAI',II< MLIST FI(~VE AT I_E'."AST TWD CEII"IF'AIRTMEI',I"FS
:11 c:ert, ify t, hat:
1. I am t'am:LliaP wi'l.h t, he: reqL~:i. Pement, s fc]r, orl--.~:;it, 6~ ~.:iew6?l',s;;
fQr'th by 'Ehe) Iqur~icil:a].it,y c:~l' (.~nch(:)n[:~ge (MCJ~) a~"l[~ t. he Stat. e
2. I ~i],], :i.n~;~t. all th(,~ s;y~it, em in accoPdanc:e ~:i.'t. ln all I~lC)(~ c:odes
3. I v,¢il], adhePe 't.o a],l IdO(.~ ancl EJt. ate o¢ AI¢¢~H.::a r'equil-emen'ts~ t'ol" t.h~,~ ~et. back
sewerage ~yst, em or'~ t. his Ol- ~tny ad.ja(::e~rlt, c~P near'by
4. I undepst, and 'tl"l¢~.t'. 'f. his pePmil: is valid ~'Qt;' a maximum c)f :3 I:edr'c)c:)m~ and
any enlaPgement, will i-equiPe an addit,:i.c~na], per'mi'L,,
IF: A LIF:T ST(.YT]:OIq I,fi3 IN,~TAI...L. IEI:) liN (~1',1 ARIE¢~ COVEI:rdED BY I"1[)~ BUIL...DIIXlG C{]DI'ZS,
THEN (1) AN IELECYTR:I:C;AL. F'EF~MIT AI',ID ]:NSF'ECT:rEII,,I I"IIJ,ST. BIE O}3TAIIxI[.~D; (,=) (.~,~ EU.I.I_I,.~
W:t:L..I_ NDT BE ~F'F'F~OVED WITHCIUT rqN EI_E'CTF~IC(.~I_ It',ISF'E~CT]:f]N FdEF'OiR'I',.I F'q'.ID C:.!;) THE:
IEL. E;.CTF~IC:f~L.. WC)RK IqLIEFF BE DC)NE BY
, .......... .................................................................. .......................... ,
j ..................... ...........................
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTN AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
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COMMENTS
SLOPE SITE PLAN
72-008 {6/79)
WAS GROUND WATER ~ 0 ~
ENCOUNTERED?
O
P
E
IF YES, ATWHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~,,.,,. ? ~ /~ 6~ ~- _
PERCOLATION RATE
TEST RDN BETWEEN 4¢ ~T AND --ZT____ ET
V.,atiArb
by
DOC Co. dba
SULLI"N WATER WELLS
P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTIO^'
DATE. - Started Ended
PERMIT NUMBER
KIND OF FORMATION:
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MISCL. INFORMATION
DEPTH OF WELL
STATIC LEVEL OF WATER FT
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
From
Ft. to
Ft.
FMUNICIPALITY OF ANCHORAW
From
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DEPT.
ENVIRONMENTAL PROTEECTIOM
From
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From
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Ft IAN 7 1985
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DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
Development Services Department ? Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-382-35-000
Expiration Date:
Legal description HIGHLAND HILLS #2 BLK 2 LT 4
Site address 5525 HILAND RD Eagle River AK 99577
Current property owner(s) DORAN JOHN L &BARBARA ELIZABETH
1/6/2023
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
M
Original Certificate Date: 10/6/2023
is Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist
Absorption Field Advisory
Tank Age Advisory
Other
X Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
COSA Approval June 2022
MUNICIPALITY OF ANCHORAGE
off, E
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 050-382-35
Complete legal description HIGHLAND HILLS #2 BLOCK 2, LOT 4
Location (site address) 5525 HILAND ROAD, EAGLE RIVER AK 99577
Current property owner(s) JOHN & BARABARA DORAN Day phone
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
3: TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 6 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ Waiver Fee $
Date of Payment 9 / Z 5 Za L 3 Date of Payment
COSA # OS C Z!3 / 3 3/ Waiver #
COSA Application.doc
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5+ ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*Per code at installation & inspection report.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/02/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
10/02/23
COSA Checklist.docx
COSA Checklist
Legal Description: HIGHLAND HILLS #2 BLOCK 2, LOT 4 Parcel ID: 050-382-35
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 9/1984 Total depth 160 ft
Cased to 44 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 9/20/2023
Static water level at beginning of test 65 ft.
Well production at time of test 2.8 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 2.40 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by & SULLIVAN Date 9/11/23 & 9/28/23
Comments Sullivan shocked / chlorinated the water system & collected negative coliform water sample.
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 9/11/23
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/21/2017
ALL standpipes present per record drawing
Total measured depth from grade 10.9 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2000 gallons 9/19/23 date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 9/20/23
Results Pass
Fluid depth prior to test 39 in
Water added 600 gal
New fluid depth 56 in
Elapsed time 1400 min
Final fluid depth 37 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 72 in (MOA 6’ ED)
Effective depth used 37 in (Final Fluid Depth)
Effective depth (ED) remaining 35 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots with
visual observations and appears approximate.
Parcel I.D. #
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
1. GENERAL INFORMATION
Complete legal description L~lf~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phon.e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ,~
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 legalify and status of system.
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) Fronl MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of ~'he 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.
NameofFirm 1'"~o/¢b6~ ~Fu~t4.~c~¢ ~-~.~
Address
Engineer's signature
Phone
Date
DHHS SIGNATURE
Approved for
DisapProved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: -,,./OH-N, _~-t-/llT'/~r Date ~/'(~/¢/7_..,
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 professional engineer's work.
72-025 (Rev. 1/91) Back MOA ~¢21
( Municipality of Anchorage
Department of Health & Human Services
HEAL'I"H AUTHORITY APPROVAL CHECKLIST
LegalDescription: L.~/~¢. t4il~lo.,v~.. Hi'Il-& ParcelI.D.
A, WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
IfA, B, orC, attach ADEC letter. ADEC water system number
'"/ Date completed Q/~L¢ Driller
/
~ (¢ C2 Cased to t~ t~ Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
SFPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
N/A
FROM WELL LOG
g.p.m.
AT INSPECTION
; On adjacent lots _
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATFR SAMPLE RESULTS:
Coliform (~
Date of sample: '3~ ~'
Nitrate_ C~.O
/='/ 1(?'¢'~ ~" Collected by:
Other bacteria
_/
B. SEPTIC/HOLDING TANK DATA
Date installed ~'jr' , ;' ~..~ ~
Cleanouts (Y/N)
Tank size J O'O~"t-~
Foundation cleanout (Y/N) /
Compartments '¢~,~,
. Depression (Y/N) b~l
High water alarm (Y/N)
Date of pumping ~ :.~:t?,~,~., ~t/I /¢~ ['~ ~"- Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wetl(s) on lot t
To property line
Surface water/drainage
Alarm tested (Y/N) ht/;~
On adjacent lots
Absorption field
Foundation ~ff.~
Water main/service line ~ ~,-,J
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~i~/'? /D ~/
Length .' ': Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail) ~' ~,~.',-
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness
Cleanouts present (Y/N)
System type
Total depth
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I ,~-~ ~-
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots ~ 0~ [~ Property line
?~ ~:' To existing or abandoned system on lot
Cutbank ?'~..~ d,~ ;-.t ~t Water main/service line
Driveway, parking/vehicle storage area '~2~ ¢?'¢~?
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec_t~.~¥t~,,rJa,.~ of this inspection.
Signature
Engineer's Name
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF I{EALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
General Information Application Date /~
(e) Real Estate Co. & Agent
Address
(a) Legal D~cription (include lot, block, su~divis?n, se~ction,~ township,, range)
Location (addr~ess or directions)~
(b) Applicants Nam ~ Telephone- Home~7/~
(c) Applicant is (check one) kena~ng Institution ~ ; ~mer/builder ~ ;
Buyer ~ ; Other ~ (~plain);
T~lephone
o:ow g ress:
2. T_~ of Residence
· Single-Family ~]
Number of Bedrooms
3, Water Sup 1p~ji-
Individual Well :~
Multi-Family~
Other (describe)
Community ~ Public ~--~
Note: If community well system, must have written confirmation from the State
Department of Enviromnental Conservation attesting to the legality and status°
4. Sewage Disposal
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. ~ngineerin~ Firm Providing__InspectionsL.Tests~ File Search, Data and Information
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 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 M~nicipality 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 regula-
tions in effect on the date of this inspection.
Telephone
Name of Firm_~__~. ~~[~,h~{~
Address ! ~.~k~ ~1~, A~lSFv~ ~$$7F
DHEP
Approved for ~~
Approved ~ Disapproved ~ Condition~ ~
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I~ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEW~-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. T~ DHEP DOES THIS AS A COURTESY TO PL~CHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
WELL DATA
Total Depth ~//~O ~ Cased to
Static Water Level ?~) ~
Casing Height Above Ground 50 /r
Electrical Wiring in Conduit .~')
Separation Distances from Well:
To Septic/N~3~Tank on Lot /~ ,Z~
Legal Description:
DS~r. OF HF-A[TH &
ENVI~ON/vlENTA~
RECEIVED
To Nearest Edge of Absorption Field on Lot.//J~ /
To Nearest Public Se~r Line
Cleanout/Manhole /O [' I~~ To Nearest Sewer Service Line on Lot
Co~nts /~
; On Adjoining Lots
; C~% Adjoining Lots
To Nearest Public Sewer
SEPTIC/HOLDING TANK DATA
Date Installed ~/~ ~
Standpipes~~/ Size //k~(~ No. of Ccmpartments '~
. Air-tight Caps~.(~Y~} Cleanou~Th,
. Foundation,
Depression over Tank .( Date Last P. ~umped ,/~_.J~-iL'--/
Pumping/Maintenance Contract on File (Y/N~J/~- ; for ~
Holding Tank High-Water Alamn (.Y/N?J//~_ Temporary Holding Tank Perr~it (Y/N)/~//$%~
separation Distances f~om Septic/H~'ank:
To Water-Supply Well z/t3~O ~ To ~ilding Foundation ~' ~
To Property Line
To Water Merlin/Service Line
Course
Comments /~ ~ ~,3 ~'
To Disposal Field %~'"'-'/
TO Stream, Pond, Lake, Or Major Drainage
O
Receipt %
.
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ,~
Square Feet of Absorption Area
Depression over Field (%~N~
Results of last Adequacy, Test
~ength of Field ,~ / /
Depth of Field //
Gravel Bed Thickness ~/~
Standpipes ihs, esent ~_~)
Date of last Adequacy Test
Separation Distance from Absorption Field:
TO Water-Supply Well /~ '/- TO P~operty Line /O '7L
TO Building Foundation ~,~· ¢ To Exishing or Abandoned System on
Lot ./J~J;7~3~ ; On Adjoining Lots ~o ~
To Water Main/Service Line ~ '-?' TO Cutbank(if present)
To Stream/PoDd/Lake/or Major Drainage Course /L/~p ,~'/_~-
To Driveway; Parking Area, or Vehicle Storage Area ~q3 /--
Cor~Nants /x3 o ~_) ~
DJ" LIFT"STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dimensions
"%Pun!b Offf" Level at
~/t/~ //~i~t (Y/N)_
Pumping Cycles' du~ing Adequacy Test.
Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Date /~'~"'~¢
MOA No.
[Page 2 of 2]
2-15-84