HomeMy WebLinkAboutSKYHILLS PH 1 BLK 3 LT 7Skyhills
Phase 1
Lot 7
Block 3
#011 - 122-29
Municipality of Anchorage
On-Site Water and Wastewater Program •(907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT Page of
Permit Number: OSP181136
PID Number. 011-122-29
Dwelling: ®Single Family(SF) 0 Duplex(0) 0 Multiple(SF and/or 0)
Project: ❑ New ® Upgrade
Name:
DAVID J. ZUKER ABSORPTION FIELD
Address
0 Deep TrenchED Shallow Trench 0 Bed ❑ Mound
8233 SKYHILLS DR., ANCHORAGE, AK 99502
Phone Number of Bedrooms Soil Rating 0 Other
4 Total depth from original grade
LEGAL DESCRIPTION 0.8 GPD/SF 8 Ft
Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot
SKYHILLS PHASE 1 3 7 6 a 4 Ft.
Township Fill added above original grade Gravel length
Range Section
Varies 4.7 - 6.5 Ft. 75 Ft.
Gravel width Beds.Number of Lines Distance between lines
SEPARATION DISTANCES
5+ Ft, Ft.
To; Septic Absorption I NA NA
Lift Station ' Holding I Sewer Total absorption area Number of trenches Dist between trenches
From Tank Field Tank Line 750 Fe
Wall -- 200'+ __ TANK ®Septic 0 S.T.E.P. 0 Holding 0 Other Ft.
Manufacturer Capacity
Surface Water : -- 100'+ -- ' NA I EXISTING
Gal.
Material of compartments
Lot Line • -- 1 0'+ -- NA •
1NumberFoundation __ __ NAj NAUFT STATION
Curtain Drain i -- Manufacturer
I"50'+ , I NA f Capacity
1 1 Gal.
NA
Remarks *None known.Diverter added. Extensive p I
Pump on level at
i Limp off level at High water alarm at
fill over original and secondary fields. in.!! in
in.
Pump make and model (Electrical Inspections performed by
Installer A+ Services PIPE MATERIAL House to tank 3034 Tank to
drainr id ___
Inspector ARCTERRA Drainfield 3034 GorMT 8034
BENCH MARK (Assumed elevation) 100 ft
Inspection 1N 6/18/18 Location and description
dates. 2�a 6/18/18
3`0 6/19118 4"6/19/18 Bottom of door sill
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En in
Conditional Approval: Date / �� OF ALS�
___ ____ _•____ / X 4 9`rH /* '7* 0
#�t KtNN.'H M. DU;,Pr4.. 1111� ,f
c.- ____ Date�c —22"( �,� e. �`,i
Approve
A •".ssiolp
Inspection Re �'�►.',w'.►.•►
ap port_9-1-12.doc ears Stam
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AS-BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP181136
SKYHILLS PH LOT 7 BLK 3 PIU# 011-122-29
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+ -�2G.7 l a•�/- FROMW
'-.--•r CRiG.GRADE V
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"t lin_ '
SCALE, 1' = 30'
A-C=99.5'
ti
B-C=110,5'
A-D=98,711
, ig ig i 1 gi 1 i
A-E=76.1' 0 92.14 FINAL GRADE 93.9
87.4•!
1 WOK LRAM
B-E=80.2' ra.T01 rune -.—.4.1-
--_Gni . Guo-,;w►T 1 1
0-7
n A-F=91,4' 9 —EXISTING
B-f`=74.0' SEPTIC 83.4•!
8 3.4 1
A-G=90,2' TANK
i; B-G=72,3' /(22,13)
SEWER ROCK • 4'
79.4
46°`d'`�.Nk 75 69,4* 104
Air `�� �F � PREPARED FOR! SCALES NTS
/e<S • DAVID J. ZUKER �C�
5 4 - 8233 SKYHILLS DRIVE ti t" k
E 4* •4 g H 9' r , * ANCHORAGE, AK 99502 `µo ��� r��
I' 907-865-6406
C� XENNET'FI /LI'D' • •� FIELDBOOKSpoy
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• Ak 89577
Municipality of Anchorage Page 1 o! 3
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: SW990155 __ PIDNumber:---011-122-29
%me: .... ! Wastewater System: ~New [] Upgrade
The Petersen Group
~ddress~820 Lake Otis Pkwy., Suite 204 ABSORPTION FI[:LD
-- I No, of Bedrooms:
Phone: 5 62-1170 Four ~ Deep Trench [3 Shallow Trench E] Bed [] Mound [3 Other
Total Depth from original grade:
LEGAL, DESCRIPTION Sci, Rating: , 8 GPD/Sq. Ft. 1
_ _~u~c[~v~sion: gepth to pipe bottom from original grade: Gravel depth beneath pipe
~'ot: 7 Block: 3 Skynl±±s, No. 1 4 I Ft. 8 I Ft.
-- Section:
Township: Range; Fill added above original grade: Gravel length:
2 ' 4 i Ft. 5 0 i Ft.
WELL: [] New [] Upgrade Grave]width; 3 ' Number of lines:l Distancet~tweenlines:_ Ft
Ft.
~lassification (Private, A,B.C): Total Depth: Cased TO: Total absorption area: Pipe material:
City Water Ft. Ft. 800 SO. Ft ASTM D3034 PVC
~riller; Date Drilled: StaticWater Level: Installer: Date installed:
Ft. Kincaid & Son 12/lr2/99
Yield: GPM PumPSetat: Ft, CaslngHeightAboveGroUndFt. TANK
SEPARATION DISTANCES ]~eptic D Holding [3 S.T.E.P.
TO Septic Absorption Lilt Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank SewerLine$ Anohora,~'e r~a~tk I ¢. 250
Material: Number of Comparlments:
Wel~ >100' >100' N/A N/A >25' Steel Two
s~aoe >~00' >~00' N/A N/A N/A LIFT STATION - N/A
Water
Lot > 5 ' > 1 0 ' N/A N/A N/A Sizein gagons: [Manufacturer:
Line
I
Foundation > 5 ' > 10 ' N /A N / A N / A "Pump on" level at:
off"
at:
High
water
alarm
Curtain None ~]oted Dn Lot PumpMake&M0del Electricallnspectlons pedormed by:
Drain
Remarks: BENCH MARK
Location and Description:
Top of First Floor
Assumed Elevation: 1 0 0 . 0
Inspections performed by: HEA Dates: lsL12/1 /99_
Department of Health and l;luman Services approval
Reviewed and approved by: Date' ,~ --¢ --¢¢
73-013 (Rev. 9/9~) MOA 25
Municipality of Anchorage Page 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICFS DIVISION
P,O. Box 196650 Anchorage, AK 99519-6650 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990155 'SKYHILLS DRIVE PI[) No. 011-122-29
L= 124.93'
20' GAS &
TRAIL ESMT.
PLAN '
SCALE 1" = 3C
R=770.00'
Municipality of Anchorage Page 3 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMFNTAL SERVICES DIVISION
P.O, Box 196650 Anchorage, AK 99519-6650 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW990155
PID No. 011-122-29
93.3
17'
24'
81 .6 /
87.4
Geotextile Fabric
D~a~lnfield Rock ~-~
~ ,66.0
50'
PROFILIE AS-BUILT
HORIZONTAL SCALE 1" = 10'
NO VERTICAL SCALE
~ 81 .5
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Sarvices Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Jun 18, 1999
Expiration Date: Jun 17, 2000
Permit Number: SW990155
Legal Description: SKYHIt. LS PH 1 BLK 3 LT 7
Design Engineer: 0014 Anderson Engineering
Owner Name: The Paterson Group
Owner Address: 3820 Lake Otis Parkway, Suite 204
Anchorage, AK 99508-
Parcel ID: 011-122-29
Site Address:
Lot Size: 40817 SQ. FT.
Total Bedreoms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[~ Disposal Field ~_~ Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
Ali 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.
June 14. 1999
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 7, Block 3, Sky Hills Subdivision
Septic System Design
Impacts to Adjacent Pr'operties
Dear Onsite Services Engineer:
The owners of Lot 7, Block 3, Sky Hills Subdivision intend to construct a
four bedroom home on the lot at the location shown on the attached Site
Plan. We are therefore requesting a permit to construct a septic system
on the lot to serve the house. The subdivision is served by the Municipal
water system so a well permit is unnecessary. The attached site plan and
backup documentation describe the proposed system and the location of
the new system.
The testholes placed on the lot revealed poorly graded sands with some
silt. Percolation rates ranged from 8 to 12 minutes per inch. No
groundwater was encountered during excavation and none was noted during
the monitoring period. We have therefore designed a deep absorption
trench with 8' of gravel beneath the distribution pipe. ']-he trench will be
50' long, 3' wide and have a total depth of 11.5' from the original ground
surface.
The ground surface of the lot slopes from west to east at rates from 8% to
10%. The absorption trench will be constructed across the slope toward
the northeast corner of the lot to provide sufficient fall from the house
for gravity flow. All lots in the subdivision are served by the water
system and no conflicts exist between any septic systems currently under
construction or planned for the future.
Lot 7, Block 3, Sky Hills Subdivision
June 14, 1999
Page Two
If the
1.
system is constructed as designed 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 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 space, either surface or subsurface, on any lots
located in the area.
The system, if 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
SkyHills Subdivision
Test Hole Locations
HANKS SUBD.
2C
K]NCA]D HI~IGHTS --~ .... ~1
11
10
9
JOHNSTON SUBD.
THIS PROJECT' ~-~
5
4
.+_ ....... -~
]H-102
TH-6g
TH-70
0
4E
KINC&ID ACRES
4D
TH-94
t0
PO
m~4o
11 19
TH-90
t ~I'H - 1 0
_AREA__M___A__P_
SCALE 1" = 200'
UNSUBDIV~DEB
/
Service
Bedroom
50' Long X 3' Wide
X 8' Effective Depth
Absorption Trench
· 1,250 Gallon
Septic Tan~'~
ernate
Site
TH105
si'rE PLAN
SCALE 1" = 40'
LOT 7, BLOCK 3, SKY HILLS
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom System
Perc. Rate: 6 - 12 Min./Inch
Application Rate: .8 GPD/SF
4 Bedrooms X 150 GPD / ,8 GPD/SF
750 SF/16 SF/ LF of Trench = 46.9
Deep Trench System
1,250 Gal. Septic Tank
8' Drainfield Rock
= 750 SF of Absorption Area
LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
50' in Length with 8' of Drainfield Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 3.5' Below the Original Ground
Surface. Total Depth to be 11.5' from Original Ground.
Natural.
3' Backfill
Geotextile
Fabric
6"
4" Perforated
PVC (Slots Down)
nfield
Rock
3 t
NOTE:
TYPICAL DEEP TRFNCH SECTION
(NO SCALE) ,,;?%
Grade Area Over Trench to Drain Away.
Minimum 4' From Groundwater.
Maintain 10' Separation From Lot Line.
Municipality o! Ancho~ge
D=._.PARTM£NT OF HEALTH & HUMAN S--]:{VIC~S
825 "L" Street. Anchora9e, At~sk~ 99502-0650
SOILS LOG' -- pERCOLATION TEST
FORt. L B Construction DATE
LEGAL DE$CRiPTION:___Lot 7, Block 3r Sky Hills Subdivi. sion
' SLOPE
OG/Ot,
3
4
5
6
7
8
9
10
11
12
13
14
15-
16
18
19
20
ML
sP/sM
SITE PLAN
TH ~105
Perc.
wAS GROUND wATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
I
d,'o/
D~ch ~o
pSRCOLATION RATE -- / ~".. (rmnut~',nc~) P.SRO HOLE DIAMk--~ER ~"
TE~T RUN BETWEEN --' ~' - FT AND ~ _ FT
Cavity presoaked prior to tes__ting.
~~/~=R~tFY THAT TH/iS TI-~T WAS pERFORMED
pERFORMED BY: ,_ I Michael E. Anderson '~ /~ ~
ACCORDANCE. VCtTH ALL S;AI'E ;,ND MUNICIPAL GUIDELINSS IN £FFFC7 ON Ti-~t$ DATE- DATr"
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
L H Construction
LT ~l BLK 9, .Sky_ Hills Subdivision
DATE PER FORtV
SLOPE
SiTE PLAN
1
3-
4
5
6
7-
8
9
10
11
13
14
15-
16
17
18
19-
20
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ~
DEPTH? P~
Depth m Waler klter~!~
cavity was
'1
Date Gross Net Depth to Net
Reading Time Time Water Drop
PERCOLATION RATE L~ ' 0 (minutes/tach) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND
~resoaAe~
COMMENTS
~J~.~"I~RTI F Y T HAT THiS T EST WAS P ERF OR MED IN
PERFOsMEDBY'~'~/:~/~ ' ~[icbsel ~ Anderson ~/~/~
ACCORDANCE WITH ALL STATE AND MUNiCiPAL GUIDELtNES iN EFFECT ON THIS DATE DATE: ~
ON-SITE WASTEWATER DISPOSAL SYSTEIVI
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 7, BLOCK 3, SKY HILLS SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and
placement of a new 1,250 gallon septic tank. It also
includes the construction of a new ,50' long x 3' wide x 8'
effective depth absorption trench at the location shown on
the attached Site Plan. Distribution piping will be placed at
3' below the surface. The total depth of the trench will be
11.5' below existing ground.
Construction shall be in 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 nstalling wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Serwces for system installations. Owners installing
their own systems rnust receive prior approval from [:).H.H.S.
before beginning system installation.
SEPTIC
1.
TANK INSTALLATION
The 1,250 gallon septic tank must be procured from an
approved source and installed at the location shown on the
plans.
Lot 7, Block 3, Sky Hills Subdivision
June 14, 1999
Page 2
2. A septic tank is to be constructed by a certified
manufacturer. Construction shall include two
for pumping access.
septic tank
4" cleanouts
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
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.
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.
A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
5. 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.
Lot 7, Block 3, Sky Hills Subdivision
June 14, 1999
Page 3
6. 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.
8. 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:
Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
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).
Insulation shall be at least 2" thick extruded direct
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted
watertight couplings (Caulder, Fernco, or equal).
burial
with
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.
Lot 7, Block 3, Sky Hills Subdivision
June 14, 1999
Page 4
INSPFCTIONS:
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.
•
EfC).1"
Municipality of Anchorage Q*
On-Site Water and Wastewater Program a G£; IMaF
(907) 343-7904 eo°
S A A E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 011-122-29 Expiration Date: 9- i q_/ 7
1. GENERAL INFORMATION
Complete legal description SKYHILLS PHASE 1, BLOCK 3, LOT 7
Location (site address) 8233 SKYHILLS DRIVE,ANCHORAGE,AK 99502
Current Property owner(s) DAVID J.ZUKER Day phone
Mailing address 8233 SKYHILLS DRIVE,ANCHORAGE,AK 99502
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
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community 0
Community Class Well ❑ Public Sewer ❑
Public Water System
WaiverNariance request for: Distance:
Received by: �-� Date: —Z C-/
COSA to be release a eggtfieer,unless otherwise requested by the engineer.
COSA Fee $ cG l Waiver Fee $
Date of Payment (o'Z 1 *--( g Date of Payment
Receipt Number Receipt Number
COSA# OSC. ( 71 2CLC 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 6/20/18
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's 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 unseenASP-
�+�\
encroachments,deficiencies or discrepancies exist. OF ALS
(s��
/* .,gam * #
6. DSD SIGNATURE
System#1 Approved for if bedrooms. 4 .p, KENNET71M. Dui s ) /
System#2 Approved for bedrooms. , ,���P/GG �i
Disapproved.
Conditional approval for bedrooms, with the following sttippl� ons:
ON-SITE
•
WATER AND c"
WASTEWATER c
PROGRAM U
By: �� (� l— Original Certificate Date: Cr,2-2_ qg
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: SKYHILLS PHASE 1, BLOCK 3, LOT 7 Parcel ID: 011-122-29
A. WELL DATA-PUBLIC WATER
Well type If A, B, or C provide PWSID # Well Log (Y/N)
Date completed_ Sanitary seal (Y/N)Y 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 SEEPTIC/STEEL Date installed 1212/1999
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 5-17-2018 Pumper McDONALD'S
C. ABSORPTION FIELD DATA
Date installed 6/18/2018 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type SHALLOW TRENCH
Length 75 ft. Width 5'+ ft. Gravel below pipe 4 ft.
Total depth 14.5 ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NA-NEW FIELD Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test__in. Water added _gal. New depth, in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= d.
9-P.
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.
DatumCycles 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 10'+ 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 10'+ 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
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.
AirOF AL \
Engineer's Printed Name KENNETH M.DUFFUS �� ���1
Date 6120/2018 * 4* �
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NO CORNERS SET THIS DATE
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''''' OF ALN I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
.. SURVEY ORDERED BY
o � DAR WALDEN @ OF THE FOLLOWING DESCRIBED PROPERTY
v�P� 0_.'Qs�Q KELLER WILLIAMS LOT 7, BLOCK 3, SKYHILLS SUB. PHASE 1 ( PLAT 99-54)
c/).-
.49 TH .XVOA JUNE 6, 2018
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
g S' "&i—1 VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
�'�, 4(!� ,;,-p
-, THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SNOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
O°� CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AMD/OR EASEMENTS; AND IS EXIST OTHER THAN NOTED.
QA a SHANE A.HOLT ,e�O NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
VQa LS-6914 • • JkO EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS 21 St DAY OF
��� HEREON I UNLESS INDICATED)
40 a 0 NOTE: FENCELINES THAT MAT APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERNME JUNE , 2018
AA'O/ORSIOM3S Loo PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
40ppp0��0 ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
13924, FB 188-52,189-1 345-5513
MUNICIPALITY OF ANCHORAGF.
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 995'19-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
01 _ 22- 9 HAA# H/9
1. GENERAL INFORMATION
Complete legal description
Lot 7, Block 3, Skyhills Subdivision Phase 1
Location (site address or directions) Skyhills Drive
Propedy owner __The Petersen Group, Day phone 562-1170
Mailing address 3820 Lake Otis Parkway, Suite 204 Anchorage, AK 99508
Lending agency
Mailin..g address
Day phone.
Agent Day phone _
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual welt
Community well
Public water
NOTE:
Four (4)
XXX
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
Public sewer
NOTE:
XXX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
?2-O25(Rev. 1/91) Front MOA#21
o
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. ['egulations in effect on the.(~at~ of th!s, ji~spection.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's signature ~~--~' ~
Date 2/22/00
DHHS SIGNATURE
,~ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
'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 DH HS does this as a courtesy to pu rchassrs of homes
and their lending institutions in order to satisfy certain federal and state req uirements. 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.
RECEIV[D
FEB
Municlpahty of Anchorage ...........
Environmental Services Diwsion
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-474.4
Health Authority Approval Checklist
Legal Descriptien:__Lot 7, Block 3, Skyhills No. 1 Parcel I.D.: 011-122-29
A. WELLDATA - Municipal Water Sys~.em
Well type If A, B, or C, attach ADEC letter. ADEO water system number
Log present (Y/NJ Date completed
Total depth Cased to
Sanitary seal (Y/N)
[-"ROM WELL LOG
Date of test
Static water level
Well production g.p.m.
W,~TER SAMPLE RESULTS:
Coliform Nitrate _
Date of sample: Collected by:
B. SEPTIC/HOLDING TAN K DATA
Date installed 1 2 / 1 / 9 9
Foundation cleanout (Y/N)
Date of Pumping New
C, ABSORPTION FIELD DATA
Date installed 1 2 / 2/. 9 Soil rating (g,p.d./ff~ or fta/bdrm) .8
Length 5 0.~_' _Width 3 ' Gravel thickness below pipe.
Effective absorption area 8 0 0 SF Monitoring Tube present (Y/N) Y
Date of adequacy test _~.C.o_a~sJ:_._ Results (Pass/Fail)
Fluid depth in absorption field before test (in.);
Fluid deoth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N) _ N
Casing height (above ground)
Wires properly pretected (Y/N)
AT INSPECTION
g.p.m,
__ Other bacteria
Tanksize 1,250 Number of Compartments 2 Cleanouts (Y/N) ....
Y Depression (Y/N} N High water alarm (Y/N) N
Pumper Construction
Y
Immediately after.
Absorption rate =
If yes, give date
System type Deep Trench
8 ' ___Total depth 14 '
Depression over field [Y/N) __
For
gal. water added (in,):
.g.p.d.
N
bedrcoms
72-026 (Rev. 3/96)*
D. LIFT STATION - None on Lot
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E, SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Size in gallons
"Pump on" level at*
*Datum
"Pump off" level at*.
Manic'it)al Water
On adjacent lots
On adjacent lots
System
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 ' Absorption field > 5 '
Water main/service line > 10 ' Sudace water/drainage > 100 ' Wells on adjacent lots >
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line > 10 ' Building foundation > 10 ' Water main/service line
Surface water > 100 ' Driveway, parking/vehicle storage area > 2
Curtain drain None Noted (3n Lcd- Wells on adjacent lots >100'
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review
in conformance with MOA HAA guidelines in effect on this date.
Signature ~ ~ ~
Engineer's Name Michael E. Anderson, P, E.
Date 2/22/00
HAA Fee $
gate of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number