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HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 14Sky Hill Block 3 Lot 14 #011-122-40 Municipality of Anchorage Page 1 __of 3 DF_PARTMENT 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:~90088 PID Number: 011 -122-40 '~m.: Wastewater System: ]~New [] Upgrade Crown Pointe, Inc. ^ddres~: ABSORPTION FIELD P.O. Bo× 112313 A~ch., A~ 99511 -- [ No. of Bedrooms: Phone: 345- 6277 Four ~ DeepTrench D Shallow Trench ~ Bed ~ Mound ~ Other I ~ Total Depth ~rom odginal grade: LEGAL. DESCRIPTION soi,.~..~: .8 GPD/Sq. Ft. 12' L~t: Block: Subdiv~ion: Depth to pipe bottom from original grade: Grave] depth beneath pipe 14 3 Skyhills Phase 4 ~ Et 8 ~ Ft. T~wnship: ~ Range:' ] Section: Fill added above original grade: Gravel length: ,~ 0 Ft. 47-.5 ' Ft. WELL: D New ~ Upgrade Gravelwidth; 3 ~la~ification (Private, A,B.C): Total Depth: Cased TO: Total absorption area: Pipe material: Class A Ft Ft. 760 SO. Ft. ASTM D3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft LH Construction 7/1 /99 SEPARATION DISTANCES ;~ Septic ~ Holding D S.T.E.P. To Septic Absorption Lift Holding ~ubilc/Privat e Manufacturer: Capacity in gallons: From Tank Field Station Tank SewerLines ~OhO~ ~ 1 ~ ~0 -- Material: Number of Compartments: Wel~ >200' >200 N/A N/A >25' Steel Two Sudace >100' >~oo N/A ~/~ N/A LIFTS'rATION - N/A Water Lot >5 ' > 10 ' N/A N/A N/A Size in gallons: Manufacturer: Line > 5 ' > 1 0 ' N/A N/A N/A "Pump on" level at: J "Pump off"levelat: High water alarm at: Foundation Curtain Drain Remarks: BENCH MARK Location and Descriptlon: Garage Floor Slab 109~ 0 Ft.' Inspections performed by: NRA Dates: Heath and Human Se~ices approval : ,~ v~.. ~*~ .,~.~., 72-013 (Rev. 9/91) MOA 25 Municipality of Anchorage Page 2 of 3 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 Permit Number SW990088 PID No. 011-122-40 C4 TH1A )2 DRIVE si Four Bedroom Hous~ TH28 ~ iii / / / PLAN AS-BUILT SCALE 1" : 20' / / / / / / / / / / / S1 C 48.7 Municipality of Anchorage Page 3 of 3 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 Permit Number SW990088 PID No. 011-122-40 I'1 i ~ 105.0 m 20,_+ 25'+ 5' 2' 95.4 Geotextile Fabric Drainfield Rock k87.2 95.4 PROFIILIE AS-BUILT HORIZONTAL SCALE 1" = 10' NO VERTICAL SCALE ~ ~' Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: Crown Pointe. Inc. Legal Description: LoJ 14, Block 3. Sky Hills. Phase II SLOPE Date Performed: SITE PLAN 1 11 12 13 14 15 16 17 18 2O OG/PT Fine Sand Some Silt TESTHOLE NO. 'lA See Site Plan SM/SP Was Groundwater Encountered? No S If Yet, What Depth? L Depth to Water O After Monitoring None P Date: 7/2/99 E Fine Sand Clean SP Reading Date Gross Net Depth To Net Time Time Water Drop Perc. Rate: 7 Min./inch Perc. Hole Diameter: 6" Bottom of Test Run Between 7 Ft, and 8 Ft, Hole (20') Comments: Soils Encountered in Test Hole are Identical to Test Holes 27 and 28 on the Same Lot. Performed By: Mike AndersoJ:L I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 2~2~00 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: May 07, 1999 Fxpiration Date: May 06, 2000 Permit Number: SW990088 Legal Description: SkyHills Phase 2 BIk 3 Lt 14 Design Engineer: 0014 Anderson Engineering Owner Name: Crown Pointe, Inc. OwnerAddress: PO Box 112313 Anchorage , AK 99511-2313 Parcel ID: 011-122-40 Site Address: NHN Skyhills Circle Lot Size: 40809 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: I~ Disposal Field [] Septic'rank [] 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. '7-/:¢? 9' ANDERSON ENGINEERING: : P,O. BOX 240773 i: i ANCHORAGE AK 99524 522"7773 ' 522-6779 (FAX) MEMORANDUM DATE: July 1, J999 RECEIVED TO: Dan Roth J~JL 1999 FROM: Mike Anderson, P.E. Mumc~pahty o4 Anchorage SUBJECT: Lot 14, Block 3, Sky Hills Subdivision Dept. Health & Human Services Permit Number SW990088 Septic System Design Revision The owners of Lot 14, Block 3, Sky Hills Subdivision is moving the location of the house closer to the center of the lot. 'rhis will require the alignment of the septic system to run from the southwest to the northeast. It will run parallel to the slope which is approximately 1% in this area. Soils in the area are a silty sand which percolate at 7 minutes per inch. Modifying the alignment of the absorption trench should have no impact on its ability to treat and absorb septic effluent since the slope in this area is relatively flat. An additional test hole will be placed closer to the location of the trench to verify soil conditions. The results will be submitted with the system as-built. Thank you for your assistance with this matter. L ~0 0 o ~ o o © May 2, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, At( 99502-o650 Subject: Lot 14, Block 3, Sky Hills Subdivision Septic System Design Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 14, Block 3, Sky Hills Subdivision intends to construct a four bedroom home on the lot. 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 show the location of the new system. The testholes placed on the property revealed poorly graded silty sands which percolated at rates between 7 and 8 minutes per inch. Groundwater was not encountered during the excavation nor was any noted during the monitoring period. We have therefore designed a deep absorption trench with 8' of gravel beneath the distribution pipe. The trench will be 47' long with a total depth of 13'. The ground surface on the lot slopes to the east from the proposed house location at a rate approximating 5%. This is the area of placement for the absorption trench. The trench will be constructed perpendicular to the slope. No conflicts exist with other lots in the area where septic systems have been or will be constructed. All segments of the new system will be constructed a minirnum of 10' from the water service line and 10' from all lot lines. if the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have rio adverse irnpact on the wells in the area or those to be constructed in the future. The subdivision is currently served by a community water system. 2. 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. Lot 14, Block 3, Sky Hills Subdivision May 2, 1999 Page Two Sincerely, Michael E. Anderson, P.E. Attachments 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 pat[ems in the area. The current drainage pattern will be maintained. 11 m-o3 UNSUBDIV1DEO O B 10 ~0 n{~4o 1H~41 7 ~ ~ 4 3 PROJECT UNSLIB~D AREA PLAIN SCALE 1" = 200' Z 0 0 0 Z Z < m~ L t~O 0 o ~ o LOT 14, BLOCK 3, SKY HILLS DESIGN FACTORS: Four Bedroom Home Perc. Rate: 6 tp 7 Min./lnch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gal. Septic Tank 8' Drainfield Rock 4 Bedrooms X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area 750 SF/16 SF/ LF of Trench = 47 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 47' in Length with 8' of Drainfield Rock Beneath the t. ateral. Distribution Pipe in Trench Placed at 5' Below the Original Ground Surface. Natural Backfill ;eotextile Fabric 4" Perforated PVC (Slots Down) Drainfield Rock NOTE: TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 10' From Water Service Line. Maintain 10' Separation From Lot Line. Municipality of Anchorage . DEPARTMEN'r OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: L H Construction, 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19- 20- DATE PERFORt COMMENTS Perc cavity was Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT I~ DEPTH? .~-' pO E Deplh to Water Nlet ~,~/ Monitoring;' ~ ~ Oat~ ~-'J~%~ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE "7 _ (mmutes,'~nch) PERC HOLE DIAMETER TEST RUN BETWEEN -- ~'~ __ FT AND -- '-/ FT presoaked prior to testing. Michael E- Anderson ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE; ;~ /~ "-~'"~ ~r '~' Municipality of ARchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: L ]~ Construction, Inc. DATE- PERFORMED: SLOPE 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS P e z2 c SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES. AT WHAT / O DEPTH? P Deplh to Wa~ Nle ~ , M~nit~ring? ~ ~ Dale: ~-I~--~ PERCOLATION RATE ~ {minutes/tach) PERC HOLE DIAMETER __ TEST RUN BETWEEN --~ '[~_ FT AND "(IP~- FT cavity was p~esoa~ed p~io~ t.o Michael E, Anderson ~'-]~l~? ' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON 'rills DATE. DATE: -~/')/~, ! ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT '14, BLOCK 3, SKY HILLS GF. NERAL: 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 47' long x 3' wide x 8' effective depth absorption trench at the location shown on the attached Site Plan. The total depth of the trench will be 13' below existing ground. Mounding over the trench may be required to provide a minimum of 3' of protective cover. 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. 3. 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. 'rhe 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. ']'he 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 14, Block 3, Sky Hills Subdivision · May 2, 1999 Page 2 of 3 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIEI_D 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. 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 tile 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. 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 so d). 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 14, Block 3, Sky Hills Subdivision May 2, 1999 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. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011 - 122-40 1. GENERAL INFORMATION Expiration Date: Complete legaldescription SKY HILLS SUBDIVISION f~2: LOT 14, BLOCK 5, Location (site address or directions) 8526 HEAVENLY CIRCLE ' ANCHORAGE. AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LE~LAND CHO Dayphone 245-5866 8326 HEAVENLY CIRCLE * ANCHORAGE, AK 99502 Day phone REAGAN RUSSEY w/ REALTY EXECUTIVES Dayphone 341 wEST TUDOR ROAD * ANCHORAGE, AK 99505 244-0225 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class Well [] Community On-site [] Public Water System · Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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. %tA.T:%,,T:,....,. N~.I_T .N .... Address tr..,, U---,.~. bLJ ~c ' AN~iHORAC[_ Al( 9950': V~, _,..IA,',.,_ Engineer's Printed Name J^?E~, ~. ';~ ,~ Phone Date Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: '..,-, ~"~2 WAlt-H, AND : rn ~ : WASTEWATER : ~ : PROGRAM ,' : Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Bu~lng Satet~ OMs~ On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AX 99519-6650 www,ci,enchomge.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA SKY HILLS S/D ~2; LOT 14, BLOCK PUBLIC WATER Parcel ID: 011 - 122-40 Well type If A, B, or C provide PWSID~ __ Well Log (Y/N) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate __mg./L. * Dines/100 mi. · . __ Date of sample: Collected by: Bo SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1250 gal. Number of Comparlmente 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date installed 7/1/1999 Cleanou~(YIN) YES HIgh wateralarm(Y/N) N/A Date of pumping ABSORPTION FIELD DATA Date installed 7/1/1999 Length 47.5 ft. ~'/~Z~ / Pumper. ~~.~~ Soil rating ~'~r ft ~'bdrm) 0.8 Width 5 ft. Toteldepth 15.9 .ft. Eff. absorption area 760 fl= Monitoring tube YES Date of adequacy test ,7,/27/2002 Results (Pass/Fail) PASS Fluid depth in absorption field before test 57 in. Water added 626 gal. Elapsed Time: 7 min. Final fluid depth 51 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN System type TRENCH Gravel below pipe. 8 ft. Depression ever field NO For 4 bedrooms New depth 54 in. 600 + g.p.d. If yes, give date - D. LIFT STATION Date installed Size in gallons M~ "Pump on" level at in. 'Pump ~._~. High water alarm level at 'n. ~ _---- Cycles tested. Meets alarm & c~rcuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: PUBLIC WATEE Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots _._------ Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main I 0'+ Water service line 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NON[ KNOWN F. COMMENTS Building foundation 1 O' + Surface water 100' + Wells on adjacent lots 200'+ Absorption field 5'+ Surface water 100'+ Water main 1 O' + Driveway, parking/vehicle storage 5'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal recorrls that the above systems ere in conformance v,4th MOA HAA guidelines in effect on this date. Engineer's Pdnted Name ~' / JAMES WILLiAMS Date Date of Payment Receipt Number ~). (Rev. 12~01) Waiver Fee $ Date of Payment Receipt Number ~UH-10-2~02 9075457412 Poll MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 011-122-40 HAA# ~L/~_~'~.~' 1. GENERAL. INFORMATION Complete [egal description Lot 14, Block 3, Skyhills Subdivision Phase 2 Location (site address or directions) Pr0pe~y owner _ Crown Pointe~ ]:nc.. Day phone_345-6277 Mailingacldress P.o. Box 112313 Anchorage,. AK 99511 Lending agency Day phone _ Mailir.~g address Agent Day phone_ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Four (4) 'rYPE OF WATER SUPPLY: Individual well NOTF: Community well Public water ××× If ?ommunity 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-925 (Rev, 1/9~) Front MOAtt21 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 flies 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 date of this inspection. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature ~ (~~ Date 2/2/00 DHHS SIGNATURE ~/~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: , 'Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to pumhasers 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. I t th and Human Services ,Division of Environmental ,S, ervices 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-122-40 HAA# Expiration Date: 1. GENERAL INPORMATION Complete legal description Lot 14. Location (site address or directions) Block 3, Skyhills Subdivision, Phase 2 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Crown Pointe, Inc. Dayphone 345-6277 P.O. Box 112313 Anchorage, AK 99511 Day phone Day phone Unless otherwise requested, HAA will be held by DRHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: Four ( 4 ) 3. TYPI-- OF WA'rER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer Individual Well Individual Water Storage Community Class Public Water System Well 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 required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 0//00)* 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 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 files and from my investigation and inspection, the 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 Engineerinq Phone Address P.O. Box 240773 Anchorage, AK 99524 522-7773 Engineer's Printed Name Date 4/20/00 DHHS SIGNATURE ,~pproved for L_~ bedrooms. Disapproved. ' '~ Conditional approval for __ bedrooms, with the following st Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Expiration Date: Original Certificate Date: Reissue Date: 75-025 (Rev. 01/00)* Legal Description: Lot A, WELL DATA Welltype Class A Log present (WN) Total depth Sanitary seal (Y/N) RECEIVED Municipality of Anchorage FEB 02 000 DEPAFITMFNT OF HEALTH & HUMAN SERV CES ..... MUNICIPALITY OF ANCHO Environmental Sen/ices Division NII~ONMENTAI-~RVIcE$ 825 L Stree'I, Room 502 · Anchorage, Alaska g9501 · (907) 343-4744 Health Authority Approv;d Checklist 14, Block 3, Skyhills Parceli.D.:.0']l_122_40 Phase 2 Dm(., of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed 7 / 1 / 99 Foundation cleanout (Y/N) Date of Pumping. New C. ABSORPTION FIELD DATA Date installed 7/1/99 Length 47.5 ' Width If A, B, or C, attach ADEC letter. ADEC water sys[em number Date completed Cased to FROM WELL LOG Public Water _ Nitrate AWWU Casing height (above ground) Wires properly protected ~Y/N) AT INSPECI'ION g.p.m. System - AWWU Collected by: __ Other bacteria g.p.m, Tank size 1 , 2 5 0 . Number of Compartments 2 C eanouts (Y/N) .... Y Depression (Y/N) N High water alarm (Y/N) N Pumper. Construction Effective abserption area 7 6 0 S F Date of adequacytestN_ew Const. Fluid depth in absorption field before test (in.); Fluid depth (insl Minutes ater:. Peroxide treatment (pa,'~t 12 months) (Y/N) 72-026 (Rev. 3/96)* Y Soil rating (g,p.d./fF or fWbdrm) _ , 8 _ 3 ' Gravel thickness below pipe. Monitoring Tube present (Y/N) ¥ __ Flesults (Pass/Fail) Immediately after. Absorption rate = N If yes, giw~ date System type.DeeD Trenc_h 8 ' Total depth. 1 2 ' _ _ Depression over field (Y/N) _ N For .bedrooms gal, water added (in.): .g.p.d. N/A D. LIFT STATION None on Lot Date installed Manhole/Access (WN) High water alarm level at* Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on" level at* *Datum "Pump off" level at* MuniCipal Water System On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line > 5 ' Water main/service line > 10 ' Surface water/drainage > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Proper'b/line > 1 R ' Building foundation > 10 ' Sudace water > 100 ' Absorption field > 5 ' Wells on adjacent lots ~ 100 ' Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots > 100 >10' Curtain drain F, ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance with MOA HAA guidelines in effect on this date. Signature ~ ~ ~ systems are Engineer's Name Date 2 / 2 HAAFee $ ~O¢,Od) Date of Payment Receipt Number ..~'".5-' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number