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Home My WebLink AboutSKYHILLS PH 1 BLK 2 LT 1Sky Hills Block Lot I #011-122-25 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni:orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP211299 Work Type: SepticTank Upgrade Tax Code Number: 01112225000 Site Legal Address: SKYHILLS PH 1 BLK 2 LT 1 G2222 Site Mailing Address: 8015 INGRAM ST, Anchorage Owner: LEVY ALLEN L & OLGA Y Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: iicnt I cp��nnwr 7/27/2021 7/27/2022 41763 ❑ Disposal Field 21 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 Received By: Issued By: Date: Date: 2 7 z U IUPALI Y OF ANCHORAGE Development Services Department^t`Q Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION tom- .-"2f-7-- Parcel I.D. 011-122-25 Property owner(s) ALLEN LEVY Mailing address 8015 IMGRAM ST, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) SKYHILLS PH 1 BLK 2 LT 1 Legal description (Township, Range & Section) Lot Size 411763 Sq. Ft. Number of Bedrooms Lt APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank ElUpgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: #346 Date of Payment: '1122 I IM j Receipt Number: '6125419 Permit No. 6 Si211299 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc July 25, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: New septic tank permit Legal: SKYHILLS PH 1 BLK 2 LT 1 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211299, Deb Wockenfuss, 07/27/21 ASPHALT DRI VEWA Y EVENSON COURT 40' DRAINAGEEASEMENT1"=50' PROPERTY LINE EXISTING HOUSE REMOVE AND REPLACE TANK W/ 1,500 GALLON PLASTIC SEPTIC TANK AND 20" RISER, DECOM. PER UPC, TANK SEPARATION REQ.10' FROM HOUSE & 5' FROM FIELD EXISTING DRAINAGE FIELD DRIVEW A Y SCALE: DJRDRAWN: DATE: SKYHILLS PH 1 BLK 2 LT 1 Anchorage, Alaska ALLEN & OLGA LEVY 7/24/2021 DCO DCO 10' T&E EASEMENT ALL LOTS SERVICED BY AWWU. WELL RADIUS NO ENCROACHMENT Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211299, Deb Wockenfuss, 07/27/21 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211075 PID Number: 011-122-25 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name CURTIS & MICHELLE LYNN ABSORPTION FIELD ® Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 8015 INGRAM STREET, ANCHORAGE ❑ Other Phone71f Bedrooms Soil Rating Total depth from original grade 774 0.6 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot SKYHILLS PHASE 1 2 1 Fill added above original grade VARIES 0 — 0.9 +/- Ft. Gravel length 84 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1 008 Ft' 1 Ft. Well -- 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer EXISTING Capacity Gal. Surface water -- 100'+ Material Number of compartments Lot Line__ __ ___ 10,+ NA Foundation -- 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks 4BR FIELD INSTALLED Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer MIKE N. ANDERSON CONSTRUCTION drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspection 151 3/31/2021 2nd 3/31/21 da:3`d Location and description 4/1/21 4th N CORNER OF DECK ON-SITE WATER AND WASTEWATER SECTION APPROVAL '� OF �A Conditional Approval: Date .® .;� co TH . _ .....�:..�� • Septic em Approved - U Date/ % ��% Curtis Huffman• •:� FG, • CE 128991 �sl'•. 4/2/2021 �� .•' ��,VPROFESSIOA� Note: this approval does not include well permit requirements. kRCv Vuluzi 10) PID: 011-122-25 PERMIT: OSP211075 10' T&E EASEMENT EXISTING INSTALLED WOOD INSTALLED RESERVE /FENCE 1500-GAL SEPTIC DIVERTER CO FIELD TANK \ \ CO D PH 1 BLOCK 2, LOT 1 MT FCO CO CO DCO C E A BM N "TH a w PES-1" w MT 0 AWA O - COC RIflNf ASPHALT 4 B R HOUSE DRIVEWAY B EXISTING -15'- FIELD MT F CO CO G SHED "TI-15" APPEARS o o_ TO BE AN OLD "THY SCALE: 1' = 30 z A—C=30.2' B — C = 71.8' FCO CO CO r -DCO DIV CO MT MT CO A — D = 5 9.6' 98A0 FINAL GRADE 98.90 98.00 B—D=90.7' ORIGINAL GRADE A — E = 5 9.6' FILTER FABRIC 3' ORG/ML B — E = 8 7.7' EXISTING3.50 2.00 92.00 A — F = 8 4.2 ' iSTEELGTANKN SEWER ROCK SM/ML B—F=50.1' A-G=86 3' 86.00 86.00 B— G= 5 0 PES-1 TH PES-1 4' DRY2001 19' SEPTIC SECTION 71.00 BOH SCALE: NTS SKYHILLS PHASE 1 BLOCK 2, LOT 1 SUPPORT, SERVICES: PREPARED FOR: ��OF � 4,( 1 CURTIS & MICHELLE LYNN C. 5 8015 INGRAM STREET * 9 TH ANCHORAGE, AK 99502 FIRST WATER CONSULTING DATE: 4/2/2021 0 -A rtis Huffman A / SURVEY. HOLT 2021 CE CE 128991' `1 Aw 4/2/21 13030 SUES WAY DRAWN: FWCS 1 c4 1 ANCHORAGE, AK 99516 SCALE: 1" = 30' ��sstoN�•v i 907-350-9566 FirstWaterAK®gmail.com PAGE: 1 OF 1 1`_'� OF.A .49 LH h'Ae�— u s SHANE A. HOLT �� G LS -6914 ,\,°fessiona� �Qo AS -BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, BLOCK 2, SKYHILL SUB. PHASE 1( PLAT 99-54) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS THEINFORMA TION HEREON 15 FOR THE USE OFLEVDING INSTITUTIONS SPECIFICALL Y TO SHO WANY EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING STRUCTURESAND PLA TTED LOTLINESAND/OR EASEMENTS,'AND IS DATED AT ANCHORAGE,ALASKA THIS 2 ND DAY OF NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES EASEMENTS OFRECORD, OTHER THAN THOSEAPPEARING ON THERECORD PLAT, ARENOTSHOWN -APRIL , 2021. HEREON ( UNLESS INDICATED) NOTE' FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS HOLTLAND SURVEYING ANYPAVING SHO WN HEREON MA YBEAPPROXIMA TE DUE TO EXCESSIVE SNOWAND/OR ICE. 9309 Gf VER DRIVE 13668. FB 184-1.212-26 ANCHORAGE,AK 99507 345-5513 MUNICIPALITY OF ANCHORAGE Cri-Site Yater & Waste-wiFter Pirog rami PC Sax 190M 47M Elrnwa RnQd AncharagK Alaskso9519-9esu Firma (907) 343'7908 FM- 190T; 34&7997 tKp.JAMAW. Myn..urq.+unLH4� r% -Site Wastewater Disposal System Permit Pamit N -umber: O P211075 Work Type; Septic Llpgreide Tax Code lumbar: 0 1112r eft Legal Address: SKYHILLS PH 1 BLIP 2 LT 1 G:22 ^mite Mailing Add resp: 5015 INGRAM ST, Anchorage Owner; _YNN URTIS W II & MI [IELLL Desig n Eng in@er = FI RST WATER CONSULTa NIG Th is perm i t is for th a construe ort at: Ef LKlive Owls: Ex p i ratlon DAW- IN1 c rr r � � w k�j�.rrkrsa��r�t Lot Sire In !�q Ft: Total hod moms: 3J241202! 31241422 41763 0 Dlsposai Field ❑ ptic 7an1c M Holding Tank ❑ Privy ❑ Private Well ❑ Water 31oratge All construc liotr shall be In accordance with 1. The attached apprcvved design. 2. All roquircrnerr s specif led in Arirhorage Municipal code hapiers 15.!5,5 and 15.85 and the Stale of Alaska Waeewater UisKeal 11"ulallms (18A.AC72) and On5king Water Ragulatiorrs 116AA BO) S. The wastp. water crude requires inspootions dt,rlrlg the inVallalhon. Tho origineer shall noify tlho Development erricae Doparimont per AMC 75.65. I uido nvtiiicalion by calling (907 343-7904 (24Rr . 4. From October 15 to April 15, a sij bs urliace soil absorption sysiern underoDnslruclion durincq free2ing waather shall be eNiher; a. Opened and Cl o: ood on the same day, of b. Covered, sealed, and heated io preverit trwzing Rw7aived By_ Issued By: &Iluv 3/24i20j1 Fla10 I]atp ,? V1,2 0.2 1 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com March 20, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: SKYHILLS PHASE 1, BLOCK 2, LOT 1 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install either a 4 or 5 -bedroom reserve field per MOA documents and soils / groundwater data, which will consist of one deep trench to serve the existing 4-bedroom residence. No groundwater was noted in any of the MOA test holes of record. The slopes are flat at the proposed upgrade location. The lot and area are served by public water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211075, Rebecca Carroll, 03/24/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211075, Rebecca Carroll, 03/24/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211075, Rebecca Carroll, 03/24/21 Municipality of Anchorage Department of Health and Human Services : : Building Safety Division O~-Sit e Water and Wastewater Program, 4700 ~outh Bragaw Sb'eet ~ P.O. Box196650 Anchorage, AK 99519-6650 Page I of 3 · www.ct,anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Numbe~ swSW I0086 PID Number:, 01t.122.25 Jnhn Ma~m~l~,r 1'~.O Wastewater System: [] New [] Upgrade ~f14 (~l~veland Ay: Ru|fe ~d4..q_q.~'17 ABSORPTION FIELD 2 1 SkY Hills 3.2~ n, 7.5 A/Awwu ". - 1260 ., 3034 PVC - John Haqmeier Co. '12/1/2001 SEPARATION DISTANCES [] septic [] Holding [] $.T.E.P. [] Other:, ~eptfc Absorption Lift Put~ic~P~ivate " Tank Re~d Sta~on Tank S.*~U~ Anch Tank 1500c~ c~ w. 200+ 200+ 200+ Steel 2 ~,w. 140 160 ~ / LIFT STATION BENCH MARK Back Door Threshold 100.0 F~ Engineers Stamp Inspections performed by: pannone Enq. Svc Dates: 1'*.'12/1/20Q1 ~' '~,/ 49~ ~ Department of Health and Human Servlces,?~proval ' ~ -~"~"--"""-~ , (',~_ ~.Steven R. Ponnone.-'/'A,~ PERHIT NO, SV01 AS-BUILT WASTEWATER A]~S[3RPTIBN SYSTEM LOT 1 BLOCK P SKYHILLS 011-122-;)5 PROPOSED RESERVE DRAIN B4LFx3'x7,! EFF PRIMARY DRAIN 84LFx3'x7J NEW NEW SEPTIC TANK ND WELLS DR SEPTICS WITHIN 200' PES-1 F( NEW 5OR FC 4.9 T1 9.0 T;) 16.5 67.4 CR ;)7.5 70.6 C3 36.7 80.8 MT 395 45.8 C4 76.6 33.1 '"l C'\Wo r k\I-;)SKYHILL.'n~/~ oo' SET- SURFACE NIITEm D ALLWDRK SHALL - IN-~ ~J21~2]AN~. ~ AMC15,GS. R) MATERIALS USE~ SHALL ~E IN ACCDR:ANC~ ~ TH~ SP~CIFIE~ IN AMC15.65, VAST[~A~R ~ISPDSAL. 3) CB~ECT POST TANK L~E T~ MID- POINT :F ~RAIN FI~L~. TYPICAL. 4) INSTALL ~RIV~VAY AT L~AST AVAY FR~ 2RAI~IEL~. ~B NOT INSTALL ~RI~VAY :~R ~A~FIEL~. 5) MAINTAIN 10' SEPARATION T: ALL LOT LIN~S. PREPARED FOR, J~n John H~gmele~ Co. EEO4 Cleveland Ave, S~e Anchopage, AK 99517 (907) 248-67B9 III ~ EXIS ll~ SEP' III Ill ~TTLING POND 11ESION, PEEr' RATFt 19 MIN/INCH SDIL RATING, 0,6 GPD/SF ;)50 SF/I~EDRDDMo 5 llEI~RnDN 1250 SF REQUIRED,. 1500g TANK DEEP TRENCH~ 75' EFFECT~E 10-11' T~AL DEPTH, B4 LF 2-3' VIDE, 1260 2F TDTAL PANNDNE ENG. SVCo LLC P. 0. ]~OX 102954 ANCHORAGE, ALASKA 99510 272-B21B Phone & F~x PD~MIT NO, S~'OIOO8S AS-BUILT DETAILS ~/AST£VATER AI)SnRPTIrlN SYSTEM LOT I BLOCK 2 SKYHILLS S/D NOTE; 1) ALLVORK SHALL ]~E PERFBRME]) IN ACCORDANCE VITH AMC15,65. 2) MATERIALS USE]) SHALL ~E IN ACCDR])ANCE VITH THOSP- SP£CIFIEll IN AMCI-%65, VASTE.'VATER ])ISPIlSAL. 3) CllNNECT prlST TANK LINE Tn MIn- POINT DF' ])RAIN ¥IEL]). TYPICAL. 4) INSTALL ])RIVI~VAY AT LEAST 5 FT AVA¥ FROM IIRAINF'IEL]). ])D NOI' INSTALL llRIVEVA¥ riVER DRAINF1ELI). 5) MAINTAIN 10' SEPARATION Tn ALL LrlT LINES. 6) AnnITIrlNAL TESTHOLE VILL lie EXCAVATE]) ])URING CONSTRUCTION. Z W C,\~oPk\!-2SKyH.])VG PREPARED FOR, John HQgneler John H~gm~er Co, 2204 ~evelQnd Ave, Suite 204 Anchorage° AK 99S!7 (907) 248-6789 PJ.D. NO' 011-122-25 t d PANNDNE ENG. SVC., LLC P. 0. I)OX 102954 ANCHORAGE, ALASKA 99510 272-821B PHON£ & FAX ~AS MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Apr 26, 2001 Expiration Date: Apr 26, 2002 Permit Number: SW010086 Parcel ID: 011-122-25 Legal Description: *SKYHILLS SUBDIVISION PH 1 BLOCK 2 LOT 1 Design Engineer: 0062 Pannone Engineering Services Site Address: NHN INGRAM STREET Owner Name: JOHN HAGMEIP, COMPANY Lot Size: 41763 SQ. FT. Owner Address: 2204 CLEVELAND AVENUE, SUITE 204 Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE, A 99517- This permit is for the construction of: [] Disposal Field [] Septic Tank [] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ParcelI.D. 011 - Permit Number SW O/00~6 Property owner(s) John Ha.qemeir Co Mailing address (1) 2204 Cleveland Ave, Suite 204 Mailing address (2) Anchoraqe, AK Legal description (Lot, Block & Sub'd.) Lot 1, Block 2 Skyhills S/D P~t ~ Legal description (Section, Township & Range) Lot Size 41,763 sf Acres/Sq. Ft. Number of Bedrooms 5 Day phone 248-6789 Zip Code 99517 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) Waiver Fees: Date of Payment: ~.~eceipt Number:. Pannone Engineering Semices, LLC Consulting Engineers 119077272-8218. 227-3522 P.O. Box 102954 Anchorage, Alaska, 99510 (9o7~*'/2.s2_18 April 10, 2001 Municipality of Anchorage Dept. of ttealth & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 1, Block 2 Sky Hills S/D, Septic System Permit Gentlemen: My fu'rn was contacted to design and install a new septic system for the referenced lot. We conducted a field investigation to locate existing wells and septic system before designing the proposed system. Two test holes were excavated in August of 1998 for the system design, which is on file with your department. No ground water was encountercd. No bedrock was encountered in the test hole. The lot is 41,763 SCl ft in size. Lot 1 slopes to the east at a rate of approximately 1-3 percent. The proposed installation xvill be located on the northwestern portion of the lot on a relatively fiat area. The proposed location is greater than 200 feet away from any wells. This lot is served by AWWU water service. The proposed system will be greater than 10 feet from the water service lines. The proposed installation will not affect the future development of the surrounding or existing lots. There is a setfl/ng pond in the southeast comer of the lot. The proposed system will be instal]ed greater than 100 feet from this settling pond. An additional test hole will be excavated at the time of installation to verify soils in the vacinity of the proposed septic system. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, ~none, P.E. Attachments: PERMIT DESIGN VASTEVATER At)SDRPTIF1N SYSTEM LmgT 1 I)LOCK P SKYHILLS S/D P.I.I). NO, PROPOSED RESERVE DRAINf 84LFx3'x7,5F EFF PRDF'DSED PRIMARY 84LFx3' EFF PROPOSED SEPTIC ND WELLS OR SEPTICS WITHIN 200' HOUSE Ill Ill EXIS I C~\WorkNI-2SKYHILLDW~ 0,5¸ ~TTLING PDND 100' SET-i SURFACE 'G?'¢ 1) ¢ SHALL BE PERFDR~EI] IN ACCnRI]ANCE VITH AMCI~ ~) MATERIALS USE~ ~ BE IN . -~~~DSE SPECIFIE~ IN AMC15.65~ ~ASTE~ATER ~ISPOSAL. 3) CONNECT POST TANK LINE TD MID- POINT OF ~RAIN FIELd. TYPICAL. 4) INSTALL ~RIVE~AY AT LEAST 5 FT A~AY FROM ~RAINFIEL~. ~0 NOT INSTALL ~RIVE~AY ~VER DRAINFIELD. 5) MAINTAIN 10' SEPARATION TO ALL LOT LINES. 6) A~DITIONAL TESTHOLE ~ILL EXCAVATE~ ~URING CONSTRUCTION. PREPARED FOR, John H~gmele~ Johe H~g~ele~ Co. 2204 Cteve~nd Ave, Suite 204 Anchor~ge~ AK 99517 (907) 24B-GTB9 ~ESIGN, PERC RATE, 19 MIN/INCH SOIL RATING, 0.6 GPD/SF ~50 ~F/~E~RDDM, 5 ~E~RBDM 1250 SF REQUIRE~, 15000 TANK ~EEP TRENCH, 7.5' EFFECTIVE 10-11' TOTAL ~EPTHo B4 LF 2-3° ~I~E, 1260 SF TOTAL PANNDNE ENG. SVC, LLC P. O. DBX 102954 ANCHBRAGE, ALASKA 99510 272-8218 Phone & F~x ]ATE, 4-7-01 ) DESIGN I PERMIT Nh, S~Ol DESIGN DETAILS ~/ASTE~/ATER ARSIIRPTIrlN SYSTEM LrlT 1 BLnCK P SKYHILLS S/I) NBTD 1) ALLVORK SHALL BE PERFORMED IN ACCORDANCE VITH AMC15,65. 8) MATERIALS USED SHALL BE IN ACCORDANCE VITH THOSE SPECIFIED IN AMC15.65, VASTEWATER DISPOSAL. 3) CONNECT POST TANK LINE TD HID- POINT OF DRAIN FIELD. TYPICAL. 4) INSTALL ~RIVEWAY AT LEAST 5 FT AWAY FROM DRAINFIELD. DO NOT INSTALL ~RIVEWAY OVER ~RAINFIELB. 5) MAINTAIN 10' SEPARATION TD ALL LOT LINES. 6) ADDITIONAL TESTHBLE WILL DE EXCAVATED DURING CONSTRUCTION. Z 0 W C,\WorN~I-PSKYH,DWG PREPARED FOR, John Hngneler John HQgneler Co. 8804 C[eveLnnd Ave, Suite 804 Anchoroge, AK 99517 (907) 848-6789 P.I.D. ND, W _J PANNONE ENG. SVC., LLC P. 0. ])DX 102954 ANCHORAGE, ALASKA 99510 P78-BSt8 PHONE & FAX DATE~ 4-7-01 NOT TO SCALE DESIGN PERFORMED FOR: LEOAL DESCRIF~ON~ O~ BOH 8OIL8 LOO - PERCOLATION TEST PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907) 272-8218 John 14~-,_~__,4,~ Co DATE PERFO~MmI~: 4-20-01 Lot 1, Block 2 Sky Hrlls S/D TEST HOI2 WA~ GROUND WATER ENCOUNTERED? No IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFr~ MO~TO~O? . D~. DATE: 4-o8-01 I I ~XIST'G i PBN3 [ TEST HOLE PEROLATION RATE ~9 [mtn/inch) PERC HOLE DIAMETER ..6 inch 'I'F-~T RUN BEV~TEEN 7 FTand 8 FT COMMENTS: Test hole excavated by A+ Home 8vc. Test Hole wu p ~r~o~ V-d before perc test PERFORMED BY: Steven R. Pannone~ P.E. I CEI~l!l~ THAT THIS TEST WAS PERFORMED Iii' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDI/NES IN EFFI~'"'T ON THE DATE OF THIS TEST. DEPARTMENT CF HGAL.TH & HUMAN SERVtC£$ SOILS LOG -- PERCOLATION TE-~T I 2 3 4~ L ~ Construction 1! 13. wA~GflOUND wATER TESTAUNB(lwEGi,~ ,'"' '~ 1~1 AND '"~ F~ 14, 19- Yerc ,cavtt~ vas ,oresoake~, g 10 II, 12. 14 17- MUNICIPALITY E 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. 011-122-25 1. GENERAL INFORMATION Expiration Date: W 71 a N 3 Complete legal description SKYHILLS PHASE 1, BLOCK 2, LOT 1 Location (site address) 8015 INGRAM STREET, ANCHORAGE, AK 99502 Current property owner(s) CURTIS & MICHELLE LYNN Day phone Mailing address Real estate agent 8015 INGRAM STREET, ANCHORAGE, AK 99502 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or. Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 280 Date of Payment 3Z31LZ I Receipt Number // I S06 COSA # OSC211139 Date: Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE Date 3/2612021 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 g+ j these various and dynamic characteristics and are outside the control of the evaluator of the low � ,� k i well and septic system. Therefore, any estimate of how long a system will function satisfactory �®��Jk�: • • �,p, $�� for current or future occupants or guarantee that no unseen encroachments, deficiencies or lir discrepancies exist can be given by First Water Consulting& FW'i:S . : TH "• 49 6. DSD SIGNATURE •• ••.. •.• . Curtis Huffman System #1 Approved for bedrooms fit# �Fm��;•. CE128991 System#2 Approved for bedrooms a��F�PROFEssi* Disapproved Conditional approval for bedrooms, with the following stipulations: WATER AND m r WASTE VvJATER z^ J • ;'_SERVVC!' \\� By: Original Certificate Date: a0,? 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 Legal Description: SKYHILLS PHASE 1 BLOCK 2 LOT 1 Parcel ID: 011-122-25 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 3/15/21 D. ABSORPTION FIELD DATA Which system tested (date installed) NA — NEW FIELD ® ALL standpipes present per record drawing Total measured depth from grade 12.9 ft (max) Measured depth to pipe invert from grade 6.9 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Structure served by this system Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by_ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Manure/Animal Excreta Storage > 100' Building Foundation > 10' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *7+ ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL. G. ENGINEER'S CERTIFICATION 1 certify that l 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. AW .. ..� ........ .... .... . Curtis Huffman CE 128991AM AW .•i�`�r ��t�_ pROFESSIONA .,� -b Municipality of Anchorage On-Site Water and Wastewater Program `' C) 1 8r`9;, m;111• (907) 343-7904 l E T y Certificate of On-Site Systems Appr• .:I OCT 1 1 2017 v Parcel I.D. 011-122-25 Expiration D- -t� 7-Se of n4 f 6 8 L. 1. GENERAL INFORMATION: Complete legal description SKYHILLS PHASE 1; BLOCK 2, LOT 1 Location (site address) 8015 Ingram Street*Anchorage 99502 Current Property owner(s) Christi Pavia Day phone 748-6708 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: = Distance: Received by: Date: /0//67/( COSA 'o j(o/(COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ (A Waiver Fee $ Date of Payment 16110'4-f/'4' Date of Payment Receipt Number 65-6/16 Receipt Number COSA# DCj�-'- ft/ 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 procedus 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 of4Attatiagit, 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: /01 /U /, f r QooQ' , In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o� OF A ' in accordance with the guidelines and regulations established by the Municipality of Anchorage and v industry practices. The reported results describe the condition of the system/s on the date/s of the �• • NAA• evaluation: Separation distances were measured to readily identifiable features. Hidden defects or i •. Uencroachments may exist that were not identified during the evaluation. The operational life of all wells ,,I Y,•' ' 9 �/*I" t '•• and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0; groundwater levels (that may fluctuate during the year), quality of construction (materials and V workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and ' ,,:•.:.:.>,./ „� are outside the control of GEG. Satisfactory test results do not guarantee future performance of the !V •, , > Corn-ss,. i systemis; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0 As , / CE779 •• a;Q� the well or septic system. GEG makes no representation whether an alternative well or septic system V 9s./ • / • •(' 7 can be installed on the property in the event either of the current systems fail to perform adequately in �I ,.P i.(,) /. i cc the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4�a pr 1f essi0n°per perform the evaluation. Reliance upon the information provided in this report by any other person or N..�OpQa party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE `� )G System #1 Approved for `I bedrooms tt�ta t I i. / System #2 Approved for bedrooms ```��" A , rAi,r, Disapproved ....-4 c ^StilE G'� 0r Conditional approval for bedrooms, with the followirtlplt��#t WP O: W PS1�G�p,M S% R P 0_. % � ti4 Op(!16-NT S\G FNTg. ter... ,/ By: - 1 '` Original Certificate Date: I (9 ( tE —i 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: COSA Checklist Nitrate Advisory Septic System Advisory _ _ Arsenic Advisory Well Flow Advisory Other '• COSA blue sheet t0-10.12 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 2. LOT 1 Parcel ID: 011-122-25 A. WELL DATA AWWU Well type If A, B, or C provide PWSID# Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (ab. - .round) in. FROM WELL LOG AT I CTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg/L. Collected by: enic: ug /L Date of sample B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 12/1/01 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/15/17 Pumper MCDONALD'S PUMPUNG SERVICE C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MT Date installed 12/1/01 Soil rating ..p.d./''or ft2/bdrm) 0 6 System type DEEP TRENCH Length 84 ft. Width 3 ft. Gravel below pipe 7.6 ft. Total depth *11.6+ ft. Eff. absorption area 1260 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/30/17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 66 in. Water added 793 gal. New depth "78 in. Elapsed Time: 128 min. Final fluid depth 70 in. Absorption rate >_ 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) CHEMICAL TREATMENT If yes. give date "' "1 INCH ABOVE INVERT OF LATERAL "'AROUND 5/15/17 - PER OWNER D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at '• wa er alarm level at in. ■ - • Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: AWWU Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main •.• sewer manhole/cleanout Sewer/septic service line Holding tank •'- - containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 104 Surface water 1004 Driveway, parking/vehicle storage_10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i<P,.•••.... ►i• vs *: i\i o I certify that 1 have determined through field inspections and • • •4� �'; s review of Municipal records that the above systems are in • �� 4A • conformance with MOA COSA guidelines in effect on this ••• • • • date. ♦fi t •f r: A. or ess Engineer's Printed N me JEFFREY A. GARNESS 1f Ste• E—)957.� ��Date J 4 •+IIII'°C4FESS\_.,1,,, , 4:40 LICENSE Ill\twra. MAECC884 (Rev 10112112) EVENSON COURT 4 _ -�..�� _�__....___... N 99 �-' 50• F ?46.17 111 ,A • • ,.„ ,.., ..... --_. •.. .... . • • . • ., ...... ') IT TELE. 1 ELEC.ESN:T. • ,._.. 1 ^. 1 -„-�._r- \ .....,................. ..... ...__, ____,. . .•_,.., .. , i , . . , ..,.. ....., „. . .,. , , ,, - • \.4 \ W , \ Id 47 W \ el 1 .. ... - W W � W N r G \` I Y77 c, \ tN n• TIN ft. ...... ... \--3, ? Ir ._ I t \\\\ i i i 1 14, ?c q:. AS—BUILT SURVEY 1" = 30' ° 4\4 \ tNO CORNERS SET TI-US DATE 4000ppp ` I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF A L' t\ OF THE FOLLOWING DESCRIBED PROPERTY opP'(�! _11, -..1- LOT 1, BLOCK 2, SKYHILL SUB. PHASE 1( PLAT 99-54) 00�*�; 49 TH ii�� .*aQ ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE 0 , VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN V S' 04 ,4" 1 � THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS s . 2-# THE INFORMATION HEREON IS FOR THE USE Of LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. pp CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS:ANO IS DATED AT ANCHORAGE ALASKA THIS 28TH DAY OF VAO� SHANE A.HOLT v� NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES. ANCHORAGE,ALASKA Op LS-6914 ..;40 EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN AUGUST , 2017. i '' • -.• d HEREON(UN-E55 INDICATED) �4, sp s NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGEAK 99507 13668, F8 184-1 345-5513 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (9O7) 343-79O4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.. 011-t22.25 Expiration Date: 1. GENERAL INFORMATION Complete legal description :iLot '1, Block 2 Sky Hills~-~,,. ~k..~,~ I Location (site address or directions) Current Property owner(s) _ John Haqmeier Co. Mailing address Lending agency Mailing address Day phone .248-6789 .2204 Cleveland Drive~ Anch~ AK 99517 Day phone Real Estate Agent Mailing Address Day phone Unless otherwfse requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: .5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (Ha, A) 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal afro(ed hereto and as of the validation date shown below, I verity that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En.q. Svc. Phone 272.82t8 Address .P.O. Box '102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date t2/4/2001 Engineers Comments: In conducting an adequacy t~L I attempt to pro,.id¢ a I~orough, conscientious s~ptic ~'stcms dcpcnd on Ih~ local soil coudition, ground wa~'lcvels I~at may fluctuaicduring ~¢ycar, ~ .." .... ~ ~ ~.~ and ~¢ wetcr usa~ orlhe family bcing served by the ~'stcm. Thcsc conditions arc outside Ihe control o£ ~ .." '+ ~ ~ PES ~ thctcforc aot provide am/s~'t~ .ty tm' ~tur~ pat'orm~c~ nor ~vc a,y cstim~tc o£how long te ~ff~'~,~.$teven R. Po nnone.~/~ svst~nsg condnuctomc~t~copa'~donalmquircmcmso£~¢ADECor[~,lOADHHS Thccontcntor '~?~"'.. No. CE 814g oihcr pcmon or party, is not authorized mx sill it confcr any lc§al fight shatsouvcr. ~0~ ~ '...;.', 6. DHHS SIGNATURE L'~ Approved for ,~"' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiration Date: X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: /~- - / O ' cO ~ Municipality of Anchorage Development Services Department ..,Building Safety Division On-Site Water and Wastewater prOgram ' 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.enchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ Lot I Block 2 Sky Hilts Parcel I.D.: 011.122-~$ A. WELL DATA Bo Well type A Dele completed. Total depth ft ifA, B, or C provide PWSID # ,, Sanitary seal . Cased to. ft FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonias/100 mi Date of sample: SEPTIC/HOLDING TANK DATA ft g.p.m Well Log Wires properly protected Casing height (above ground) AT INSPECTION ft gP.m in. Nitrate mg/I Other bacteria. ~ colonias/100 mi Collected by:. - Tank Type/Material Steel .. Date installed ~ Tank size . 1500 gal Number of Compartments .~ Cleanouts ¥ Foundation cleenout ¥ Depression over tank J3 High water alarm n/a Date of pumping, Pumper NEW ABSORPTION FIELD DATA Date installed ~ Length .{bi ft, ' ' - Width .3 fl Tolal del)ih 11.1 ft Effective absoq~o~ area .1 ~t601t2 Date of adequacy test. Results (Pass/Fail). Fluid depth in absorption field before test in" Elapsed Time: rain Final fluid depth, Any rejuvenation treatment (pest 12 mo.) (YIN & type). (Rev. 11/99) Soil rating (gp.d./ft2 or fl2/bdrm) 0.6 Monito,,ing tube Y · Water added,, in System type .Ip.T. Gravel below pipe .7.5 ff ' Depression1 over t'mk~ ~ Fer bedrooms .. gal. New depth in. Absorption rate >= g.p.d. If yes, give date Do LIFT STATION Date installed 'Pump on' level at Datum Size in gallons NIA in'Pump off level at Cycles tested in Manhole/Access High water .alarm level at in Meets elam1 & circuit requiremenls? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septictanldlift station~on lot NIA Absorption field on lot Public sewer main Sewer/septic service line On adjacent lois On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building four~lafion 7.0 Water main 100+ Drainage Water service line 50+ Walls on adjacent lots 200~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 15 Building foundation ~ Water Service line 50+ Surface water 100+ Curtain drain 100+ Wells on adjacent lots 200+ Absorption field 15 Surface water 140 Water main 100+ Dl'ive~ay, park~g/vehicte storage 50+ F. COMMENTS NI~W IN ~TAI.I.,ATION G. ENGINEER'S CERTIFICATION I certify that I have determined through F~eld inspections and revfew of Mun*~pal records that the above systems are in conformance with MOA HAA guidelines in effect on this date, Engineer's Printed Name ~teyen R. Pannone. P.E. Date 12-4-01 HAA Fee $ '~:~(~ ' m c~ D.e Pa t Receipt Number /'%~-7h' (Rev. 11/99) Waiver Fee $ ., Date of,Payment Receipt Number