HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 185kyhills Phose 2
Lot 18
Block 3
#011-122-44
· Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O_ Box 196650 e Anchorage, Alaska 99519-6650 o Telephone: 343~4744
On-Site Wastewater'Disposal System and/or Well Inspection Report
SWO00003 PID Number: 011-1 22-'44
Permit Number-
Wastewater System: ~ New l [] Upgrade
'~7~ nei 1 Homes
921 0 Vanguard-Drive 'Anch., 'AK 99505 ' · 'ABSORPTION FIELD..
P~,e: .' '344~567~:'. '" I?°~°~s4') ([~Deep~r~nch..OShallow~ren~h QBe ~Mound B'Ot~er
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Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O, Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit Number SW000003
:1
PID No, 011-122-44
'.U~S3 '3 :~ '/ ,OL
SV,~
C6
A B
S1 24.0 15.9
S2 24.8 22.6
SV 32.5 43.5
M1 25.5 52.6
C4 19.2 ' 33.7
C5 44.7 , 42.7
C7 48.6 64.1 ·
Four Bedroom
House
S2
25
C7 o
' ~ TH35
~lte~nate site
PLAN AS-BUILT
SCALE 1" = 30'
370~13
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
Permit Number SW000003
PID No. 011-122-44
~100.3 m
94.6
r
,250
;allon
/ septic Ta
99.5
94.0/
Geotextile Fabric
Drainfield Rock
NORTH LATERAL
LEGEND
C - Cleanout
SV Flow Splitter Valve
S - Septic Riser Vent
M - Monitor Tube
99.5
SOUTH LATERAL
76.0
PROFILE AS-BUILT
1" = 10'
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jan 13, 2000
Expiration Date: Jan 12, 2001
Permit Number: SW000003
Legal Description: SKYHILLS PHASE 2 BLK 3 LT 18
Design Engineer: 0014 Anderson Engineering
Owner Name: Spinell Homes
Owner Address: 9210 Vanguard Drive
Anchorage, AK 99507-
Parcel ID: 011-122-44
Site Address:
Lot Size: 40809 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
JanUary 7, 2000 ;
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK '99502-0650
d&t 0 ? ZOO0
SubjEct:
Lot 18, Block 3, Skyhills Subdivision, Phase 2
Septic System Tank Replacement Permit Application
Impacts to Adjacent Properties .
Dear Onsite Services Engineer:
The owner of Lot 18, Block 3, Skyhills Subdivision Phase 2 intends to construct a four
bedroom home on the lot. We are therefore applying for a permit to construct a septic
system to serve the house. The Site Plan shows the location of the new system with
the alternate site. It also shows the location of the proposed water service line. The lot
is currently served by the Municipal water system.
The testholes placed on the lot revealed silty sands which percolated at rates ranging
from 20 to 30 minutes per inch. No groundwater was encountered nor was any noted.
during the monitoring period. We have therefore designed a deep absorption trench
system with 9' effective depth and a total length of 56' with two 28' trenches. A flow
divider valve will be installed to insure even flow to each trench. The distribution pipe
will be placed at 3' below the surface and the total depth of the system will be 11.5'
from original ground. A minimum of 3' of cover will be provided over the trench.
The ground surface on the lot slopes from the homesite as shown on the Site Plan.
The new trenches will be constructed across the slope in accordance with Municipal
requirements. Since the subdivision is served by the Municipal water system no
conflicts will exist between the septic system and other wells in the area. Similarly, the
septic system will not conflict with other septic systems on adjacent lots.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future. The subdivision is currently
served by the Municipal water system.
The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
The system~ if constructed as designed, will have no adverse impact on reserved
Lot 18, Block 3, Skyhills Phase 2
January 7, 2000
Page Two
space, either surface or subsurface, on any lots located in the area.
The system, ir constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
JAN 07 ~000
ENVII~ONMENT,,~ ~SERVIC~$ DIViSI(¢,
TRACT A
JOHNS'~3~I SUBD.
10
7
10
20
TH~40 ~41
6
8
4
TH-lO2
11t-70
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8
THIS PROJE~
TH-87
1H~22
12
1H~27
14
~ao 2
H-79
IH~24
1]-I-78
1
Scale: 1"= 200'
,0G'69 I. ~A,,~,60oO0 N
Wide
~__ I Four Bedroom "-=--~,
1,. 50 Gallon I~1: I
,'1~ ~' Flow D~ wider Valw
X2 3,28 Lo,g' '
Effec:tive
Absorption
NOTE: Mainta
Betweer
and War
)ep~h
Trench.
z 110' ~paration
Absor tion Trench
er ~ervlce Line.
3-10~J10 X1N3A'V3H
SITE PLAN
SCALE1"=30'
TH35
-,
Alternat.
Site
L~ ne
LOT 18, BLOCK 3, SKY HILLS NO. 2
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: 30 Min./Inch
Application Rate: .6 GPD/SF
Deep Trench System
1,250 Gallon Septic Tank
9' Drainfield Rock
4 Bedrooms X 150 GPD / .6 GPD/SF = 1,000 SF of Absorption Area
1,000 SF/18 SF/ LF of Trench = 55.6 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With Two Laterals
Each 28' in Length with 9' Of Drainfield Rock Beneath the Lateral. Place
Flow Divider Valve to Assure Even Distribution to Trenches. Distribution
Pip~ in Trench Placed at 2.5' Below the Original Ground Surface, Total
Depth to be 11.5' From Original Ground Surface. Mound Over Trenches to
Provide a Minimum of 3' of Cover.
2.5I
Nat~al~3'
Backfill
Fabric
4" Perforated
PVC (Slots Down)
Drainfield.
Rock
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Provide 3' Cover Over Trench and 4' Over Tank or Insulate.
Maintain 10' Separation From Lo~i Line.
Maintain 10' Separation From Water Service Line;
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L HConstruc~ion~
LEGALDESCRtPT,ON: I>, S ,V H"II
6
7
8
9
10
13-
14-
2O
COMMENTS Pert cavity was
DATE PERFORMED:
Township, Range. Section:
SLO
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth 1o Water After ~%,~,~
Moni oring? ~'~'~' Date:.,E~- '~'-~'~
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
TEST RUN BETWEEN~ ~ ~'~ FT AND ~=~ ~ FT
presoaked prior to testing.
PER FORM ED B~-~::~'~'I ~~TJFY THAT ~HI~ TEST WAS PEt~FORMED IN
iiichael. ~. Anderson //. /~g
ACCORDANCE WtTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /7~' '
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L H Construction,
1
3
4
5
6
7
8
9-
16-
17
18
19
20-
DATE PER~CORMED:
Township, Range. Section:
SLOPE SITE PLAN
WASGROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
flepth to Waler Alter
Monitoring?
Reading eate Gross Net Depth to Net
Time Time Water Drop
Il:It,,
I( :4&,
PERCOLATION RATE ~ ' ' ~2)~' ~''
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BI~TWEEN ~ ~Z~ FT AND" ~ '~, FT
COMMENTS Perc cavi,ty was presoaked prior to testing.
Michael E. Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
T/?;7;~]TEST WAS PERFORMED IN
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 18, BLOCK 3, SKYHILLS SUBDIVISION, PHASE 2
GENERAL:
The scope of this project includes the procurement and placement of a
new 1.250 gallon septic tank. It also includes the construction of two
new 28' long x 3' wide x 9' effective depth absorption trenches at the
location shown on the attached Site Plan. A new flow diverter valve
will be required to assure even flow to each trench. The total depth
from original ground of the trenches will be 12' below ground.
Mounding over the trench may be required to provide a mimmum of 3'
of protective cover.
Construction shall be n accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septiC system and verification of the
location of all lot lines,
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. The new 1,250 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access,
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank,
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 18, Block 3, Skyhi!ls, Phase 2
. January 7, 2000
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Lot 18, Block 3, Skyhills, Phase 2
· January 7, 2000
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal Ordinance·
These inspections must be conducted under the supervision of a
professional engineer registered in the State of Alaska. The first
inspection must be conducted after the excavation of trenches, beds or
pits and before the installation of any gravel. A septic tank may be set in
place, but may not be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
•
• 4 s p
• -� Municipality of Anchor
On-Site Water and Wastewater Prog �.,{ v i
(907) 343-7904 a S E P 08 t l l Sar E T r
- J
Certificate of On-Site Systems Ap: ►' 6 fl L `;\
Parcel I.D. 011-122-44 Expiration Date: r- (
1. GENERAL INFORMATION
Complete legal description Skyhills Phase 2 Lot 18 Block 3
Location (site address) 8231 Heavenly Circle
Current Property owner(s) Dana Hendrix/Jason Sosa Day phone
Mailing address 8231 Heavenly Circle Anchorage AK, 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING:
El 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 Well ❑ Community ❑
Public Water System Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: t1Zr 1�
COSA to be released to the engi r,unless otherwise requested by the engineer.
COSA Fee $ 5 U Waiver Fee $
Date of Payment 411/1111 Date of Payment
Receipt Number 62444 QC Receipt Number
COSA# [�J�.1�ILI22 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 Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave. Suite 203
Engineer's Printed Name Benjamin Schiller Date 09108/17
eropPasTig„:. ....
• 1 a51 /,
• +a `-f
49.7H %:'t:" V
'•:
6. DSD SIGNATURE .o
System #1 Approved for t-( bedrooms � • ij�EJR}.�1 & t•l :•••
Y PP 1 ,t,9q .
System #2 Approved for bedrooms d •. .
Disapproved r
.tALt� ��asQ `�a
Conditional approval for bedrooms, with the following stipulations:
rr
C).5(20$'rr
W R AND '
AsrEIN
-�p PRGGRq c is)
8ERvo
.....
By: Original Certificate Date: 9 ^2-1 7
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: +11111 P
COSA Checklist X Nitratur�.
Septic System Advisory Arseni d Isor V
Well Flow Advisory Othersar
COSA blue sheet
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: Skyhills Phase 2 Lot 18 Block 3 Parcel ID: 011-12244
A. WELL DATA
Well type NONE If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (YIN) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 3/14/00
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 9tl/(i7 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 3/14/00 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6GPD/SF System type Deep Trench
Length 56 ft. Width 3 ft. Gravel below pipe 9/7.6* ft.
15/13.6'
Total depth ft. Eff. absorption area 1008 ft2 Monitoring tube Depression over field
Date of adequacy test 8/31/17 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 47779
5 in. Water added 1622 gal. New depth 108/s2 in.
Elapsed Time: 1440 min. Final fluid depth 83 /86 in. Absorption rate >= 600 g p d
N
Any rejuvenation treatment (past 12 mo.) (Y/N &type) 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
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:
5' >5 >5'
Building foundation Property line Absorption field
Water main X10 Water service line Surface water
Wells on adjacent lots 100'
ABSORPTION FIELD ON LOT TO:
10' 10 >10'
Property line Building foundation Water main
Water Service line >10Surface water >1 00 Driveway, parking/vehicle storage >10
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Trench #2 appears to have approximately 1.4' of mud and debris at the bottom of monitor tube.
Lot is served by AWWU public water system.
G. ENGINEER'S CERTIFICATION a°` OF 43rd
at '
1 certify that l have determined through field inspections and i�, „ . • f%
review of Municipal records that the above systems are in • *• 9 Th `t , :7 it
conformance with MOA COSA guidelines in effect on this date. / .. .. ••.:...M
Benjamin Schiller 0 .els
at
Engineer's Printed Name 0 ;�1 A / S.
Date
09/08/17 ®*Io �. if
` •
COSA brown sheet 10-10-12.doc
FORGE ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 8, 2017
• OF ./4 r
Municipality of Anchorage se,t¢.••. • ,
Development Services Dept- On-Site Water& Wastewater Program A 47;'• -+ , ,•;:
4700 Elmore Rd
Anchorage, AK 99507 •
Subject: Sky Hills#2, Block 3 Lot 18 COSA inspection •
• r7
Dear On-Site Services Engineer: .8
1c`.55 ;o'�
The owner of the above property at 8231 Heavenly Circle asked us to perform a septic inspection
in preparation for applying for a Certificate of On-site Systems Approval. They were concerned,
as the trenches had been nearly empty for most of the time they were in service, and yet they
found that both were nearly full after only a few years occupation. They are a couple without
children, and the husband worked on the slope. This would be well below the capacity of the
system.
Our inspection found that one of the trenches appeared to have debris and mud at the bottom of
the monitoring tube. It measured about 1.4' shorter than it should have, based on the effective
depth in the construction as-built information. This trench was completely full of effluent, while
the other trench was more than half-full. It appears the diverter valve may be directing more
water to that trench.
In our discussion with the homeowner, we found that they had been having a problem with one
of the toilets running, but didn't pay much attention to it. We suspect that over time this may
have added hundreds of gallons of water per day into the trenches, overloading them and causing
them to fill. It is possible also that the wet year has soaked the ground with stormwater more than
usual, making the problem worse.
We directed them to either fix the toilet, or shut it down completely. They did that, and at the
same time moved out of the home. We tested the trenches again within 30 days, and found that
each had dropped to less than half their previous levels. Our initial test only put in a minimum
amount of water, and in the overloaded bottom portion of the trenches it did not all soak away.
We filled the trenches to their tops, to take advantage of the less used portions of the trenches,
and they did absorb more than 600 gallons.
Sincerely,
Benjamin Schiller, PE
SKYHILLS PHASE 2, BLOCK 3 LOT 18
LOT 19 r
10'DRAINAGE EASEMENT
—
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c�, • 'cos LOT 18 I 1z
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MT1 B 1 08
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��MNoM� V 11 24.1 16.2
w6
b SV2 24.9 22.8
2C0 26.75 27.9__
o C01 19.3 33.8
MT1 25.5 53.0
z CO2 32.7 60.9_
FS 32.5 43.7
_ i CO3 44.7 42.75
MT2 48.6 61.1
CO4 48.8 64.4
/j'�P• �91 f I LOT 17
i r
Benja Schiller : 0
0`9,,•• A 12592 ••4-i LEGEND
ILII`\;ROFr S'4H14
`A�"`� MT-MONITORING TUBE
FCO-FOUNDATION CLEANOUT
TH-TEST HOLE
0 40 80 SV-SEPTIC VENT
II — - NM FEET SEPTIC MEASUREMENTS CO-CLEANOUT
1"=40' FS-FLOW SPLITTER VALVE
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 %" Street Room 502
P.O. Box 196650 Anchorage. AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 01 1 -1 22-44
1. GENERAL INFORMATION
Complete legal' de~ription not
..... -O, _.., ,._j.~.?
Location [site address or directions)
Current Property owner(s)
Mailing address
Lending agency
Expiration Date:
18, Block ~,~Skyhills Subdivision
Heavenly Circle ~.,
Phase 23'
Spinell Homes 'lbay ph~n~¢ 344-5678'
9210 Vanguard Drive Anchorage, AK 99507
Day phone
Mailing address
Real Estate Agent
. Mailing_Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: Four '(4)
TYPE-OF WASTEWATER DISpOSALi
[] ' ' IndividUal On-site ': []
[] Individual Holding Tank [] -
Well [] . Community On-site []
[] ' pUblic Sewer , []
3. TypE OF WATER SUppLy:
· IndividUal Well
Individual Water Storage
. Community Class
Public Water System
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of
Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an indePendent
professional Civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
requked f, oi~ the tra, nsfer of title. (except between spous_es) on properties served by a, si.ngle fam!ly on-site
wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home 6wners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue fqr properties served by
a private or Class C we and may be re ssued With new water samp e resu ts'ess thah 30 days old. Cedlficates
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.
72-025 (Rev. 01100)*
5. STATEMENT OF INSPECTION BY ENGINEER
As cer/ified 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 the Health Authority Approval
application show 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 filas and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchoraqe, 'AK
Engineer's Printed Name Michael E. Anderson, P.E.
, Phone
99524
522-7773
Date 10/; '00
6. DHHS SIGNATURE
Approved for Lit- bedrooms.
Disapproved.
Conditional approval for __ bedrooms, with the following stiI ~ons.
Additional Comments
Attachments:
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
/
Expiration Date:
Original Certificate Date:
Reissue Date:
Io
75.025 (Rev. 01100)*
Legal Description: T,ot
A. WELL DATA
Well type __
Date completed
Total depth ft
Date of test
Static water level
Well production
~"~MuniCipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
18, Block 3, Skyhills Phase~
Public Water System
IfA, B, or C provide PWSID #
Sanitary seal
Cased to ft
FROM WELL LOG
g.p.m
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed 3/14/00 Tank size
Cleanouts ¥ Foundation cleanout
Date of pumping New Construction
C. ABSORPTION FIELD DATA
Nitrate
Collected by:
Parcel i.D.:
011 -1 22~44
Well Log
Wires properly protected
Casing height (above ground) __
AT INSPECTION
ft
g.p.m
mg/I Other bacteria__
colonies/100 mi
1 , 250 gal Number of Compartments 2
Y Depression over tank N High water alarm N
Pumper
iR.
Date installed 3 / 1 4 / 00 Soil rating (g.p.d./ft2 or ft2/bdrm) .6
Length .56 ft Width 3 ft Gravel below pipe 9
Total depth 1 4 ft Effective absorption area 1,0082 Monitoring tube__
Date of adequacy test New Const. Results (Pass/Fail)
Water added
in
N
Fluid depth in absorption field before test __ in
Elapsed Time: min Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type',
System type Deep Trench
fl
Y Depression over field N
For bedrooms
gal. New depth.__ in.
Absorption rate >= g.p.d.
If yes, give date N/A
72-026 (Rev. 01/00)*
F.
LIFT STATION - N/A
Date installed
"Pump on" level at __. in
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at
Cycles tested
in
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements
Public Water System
On adjacent lots
On adjacent lots
Public sewer manhole/deanout
Holding tank
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field > 5 '
Surface water > 10o '
Property line > 5 '
Water service line> 1 0 '
Wells on adjacent lots > 100 '
Building foundation > 5 '
Water main > 10 '
Drainage > 100 '
Water main > 1 o '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 '
Water Service line > 10 ' Surface water > 100 '
Curtain drain None Noted Wells on adjacent lots > 100 '
COMMENTS
Driveway, parking/vehicle storage
G. ENGINEER'S CERT F CAT ON
I cedify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 10/27/00
HAA Fee' $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*