HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 105kyhills
Block 3
Lot 10
#011-122-36
Municipality of Anchorage Page I of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 o Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990090 PIDNumber: 011-122-36
Name: Wastewater System: [] New [] Upgrade
/ Crown Pointe. Inc.
Address: P.O. BOX 112313 Anch., AK 99511 ABSORPTION FIELD
-- [ No. of Bedrooms:
Phone: 345-6277 Six (6) ~ Deep Trench [3 Shaltow Trench ~Bed ~Mound ~Other
To a Dep h from original grade:
LEGAL DESCRIPTION Boil Rating; . 6 GPD/Sq. Ft 1 3. 5'
~ S~ i ~ion: Depth to pipe bottom f(om ori iflalgrade: Gravel depth beneath pipe
Lot: 1 0 Block: 3 Sky H~[s, it2 3.5~
Ft__ 1 0 ' Ft.
Township: I Range: I Section: Fill added above original grade: Gravel leng,h:
I
0 Ft. 7 8 I Ft~
WELL: ~ New ~ Upgrade Gravelwidth: 3 ' Numberoflines: 0istancebe~w~nEnes:
~a%ilication (Private, A.B.C): Total Depth: Cased To: Total absorption area: Pipe material:
City Water Ft. Ft. 1,248 SO. Ft. ASTM D3034 PVC
~iller; Date Drilled: StaticWater Level: Installer: Date installed:
Ft LH Construction .~/21 /99
~eid: GPM PumpSetat: Ft. ~CasingHeightAboveGround:Ft TANK
SEPARATION DISTANCES s Septic B Holding B S.T.E,P.
TO Septic Abso~tion Lift Holding )ublic/Private :Manufacturer: CapaciW in gallons:
From Tank Fietd Station Tank SewerLines Anchoraq¢ T&nk 2,000
Number of Compa~ments:
Weft Cit~ Watez Material:Steel Two ( 2 )
Sudace >100 >100 H/A N/A N/A LIFT STATION - ~/A
LOt > 5 ' > 10 ' N/A N/A N/A Size in gallons: Manufacturen
Line
~ Electri~l Insp~tions peflormed by:
Cu~ain None 4DEed on Lo' PumpMake&M~el
Drain
Remarks: BENCH MARK
Location and Description:
Front Porch Deck
ENGINEER'S SEAL
Inspections performed by: MEA __ Dates: lsL5/21/99 ,¢j;~&~t; '"?~, .~.oo%oo(
Depadment of Health and Human Se~ices approval ,'¢ ~,~4 ,, ,,~¢~,
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 SW990090
PID No. 011-122-36
37.3
29.0 Alternate
39.8 C4 Site
M1
C5
/
/
/
/
/
/
SiX
Bedroom
Home
/ -
/
/
/
!! .~
/
! ~ ~ ~- c: ~
mO.:'
/
HEAVENLY
S - Septic Vent
C Cleanout
M - Monitor Tube
T - Test Hole
PLAN AS-BUILT
SCALE 1" = 40'
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 SW990090
PID No. 011-122-36
96.15
2,000 Gallon
Septic Tank 8.
88.55
92.2
~ Geotextile
Drainfield
~78.5
Fabric
I '~,9.
Rock
72.5
78' ~
ROF]LE AS-IBUIL'r
HORIZONTAL SCALP' 1" = 10'
NO VERTICAL SCALE
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 10, 1999
Expiration Date: May 09, 2900
Permit Number: SW990090
Legal Description: SkyHills Ph 2 BIk 3 Lot 10
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc.
Owner Address: PO box 112313
Anchorage, , AK 9951%2313
Parcel ID: 011-122-36
Site Address: unknown
Lot Size: 41064 SQ. FT.
Total Bedroomsi.~/~,,).¢~ Permit Bedrooms:/4~
This permit is for the construction of:
E/~ Disposal Field L~ Septic'f'ank [] 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 P, egulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 Irours prior to each inspection. Provide notification by calling
(907) 343-4'744 ( 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.
MEMORANDUM
DATE: May 4, 4099 t ECEI V£'D
TO: Onsite Services Engineer MAy 4 1999
FROM: Mike Anderson, P.E. ?Y~'
Oept' He~l,~"~ ot AnChOr
SUBJECT: Lot 10, Block 3, Sky Hills Subdivision "~ervicea
Septic System Permit
The owner of Lot 10, Block 3, Sky Hills Subdivision has decided to construct a six
bedroom home on the lot. Our previous application for an onsite septic system
construction permit was for a four bedroom home. We have therefore modified the
pertinent pages of the design to reflect the six bedroom home and have changed the
permit application to reflect six bedrooms. Please switch the attached pages with their
counterparts previously submitted and issue the permit for a six bedroom home.
Thank you for your assistance with this matter.
April 26, lg99
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 10, Block 3, Sky Hills Subdivision
Septic System Design Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner' of Lot 10, Block 3, Sky Hills Subdivision intends to construct a six bedroom
home on the Iot. 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.
Tile testholes placed on the property revealed poorly graded silty sands which
percolated at rates between 17 and 18 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 10' of gravel beneath the
distribution pipe. The trench will be '75' long with a total depth of 13'.
Tl~e 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 minimum 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 no adverse impact on the wells
in the area or those to be constructed in tile 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 10, Block 3, Sky Hills Subdivision
April 26, 1999
Page Two
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 Su bdi v isior~ '"-^~
H/~BUBD.
2C
lO
Vacant
I~ACT A
Vacant
Vacant
Vacant
9
EVANSON C~URT
KINCNO ACRES
IH-lB
~o
n~4o ~41
Vacant
Lnt
S PROjEcT
Vacant
Vacant
TH~8 2
13
AREA MAP
SCALE 1" = 200'
UNSUBOJV][~D
N 06*34°25"£ 206.25'
10' T. & E. ESNIT- _ ....
/
/
I
I
N 07°12'46"F-. 75.25'
HEAVENLY 'CIRCLE-
LOT 10, BLOCK 3, SKY HILLS
DESIGN FACTORS:
Six Bedroom Home
Perc. Rate: 18 Min./Inch
Application Rate: .§ GPD/SF
SYSTEM RFQUIREMENTS:
Deep Trench System
2,000 Gal. Septic Tank
10' Drainfield Flock
6 Bedrooms X 150 GPD / .6 GPD/SF = 1,500 SF of Absorption Area
1,500 SF/20 SF/ LF of Trench = 75 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
75' in Length with 10' of Drainfield Rock Beneath the I..ateral.
Distribution Pipe in 'French Placed at 3' Below the Original Ground
Surface.
Natural
Backfill
Geotextile
Fabric
4" Perforated
PVC (Slots Down)
Drainfield
Rock
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Maintain 10' Separation From Lot Line.
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'rEST
PERFORMED FOR: L H Construction,
t
7
8
9-
10-
11
13-
14-
15-
16-
19-
20-
COMMENTS Pert cavity was
Inc. DATE PERFORMED:
Township, Range, Section;
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
Monitoring?
s
L
IF YES, AT WHAT Y O
DEPTH? p
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE / ~ _ {m~nutes/mch) PERC HOLE DIAMETER
p~esoa~ed ~ior ~o
< ,,±ehael E, Anderson ~/Z,~ f~ IN
PEREORMEOB~ , ,M,~ ~ g/~-~Y THA~ THIS TEST WAS PERFORMED
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. ()ATE: .
Municipality of Anchorage.
DEPARTMENT OF'HEALTH & HUMAN SERVICES
825 %." Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L H Construction
DATE PERFOt
LEGAL DESCRIPTION: LT 1~2/BLK~ Sky
1
2
3-
4-
5-
6-
7-
8-
lO-
11
F1L
13-
14-
15-
16-
17-
19-
20-
COMMENTS P e r c
Hills Subdivision
SLOPE
Il.
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
.I
Depth Io Water After
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE I-I
TEST RUN BETWEEN '~' ~'~
cavity was presoaked
(minutes/tach) PERc HOLE DIAMETER __
FT AND ~) FT
Michael E Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE. DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 10, BLOCK 3, SKY HILLS
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 2,000 gallo¢ septic tank. It also includes the construction of a
new 75' long x wide x 10' 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.
2. 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.
4. 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.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Depadment 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 TAN~( INSTALLATION
1. The 2,000 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4' cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Tanks installed without 4' of cover shall have a minimum of 2 of d'rect
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 10, Block 3, Sky Hills SubdiviSion
April 26, 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 ef 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 p png, standp pes, cleanouts and
insulation. No backf should be in place at the time of inspection.
Contractor shall provide a copy of all fie d survey layout and construction
notes for use in prepar ng the certified as-built of the completed system. ·
1[.ot 10, Block 3, Sky Hills Subdivi§t~l~
April 26, 1999
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
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.
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:
1. Septic tank.,; 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
AS'¥M D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
Parcel 1.D. 011-122-36
Certificate of On -Site Systems Approval
Expiration Date:
q_3 cq —2cg ? c)
1. GENERAL INFORMATION
Complete legal description SKYH ILLS PH 2 BLK 3 LT 10
Location (site address) 8130 Heavenly Cir
Current property owners), Fleckenstein
Day phone 830-2580
Mailing address
�
Real estate agent
V
Day phone /r,
nV Hu
2. TYPE OF DWELLING:
a- JUL 6 20119
❑ Single Family (w/wo ADU)
R:
Fj Duplex
cuAj
❑ Multiple Dwellings (Single Family and/or Duplex)
ZZ 01 6 g L 9 51\
3...NUMBER OF BEDROOMS: 6
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well El
Private Septic Z
Water Storage El
Holding Tank El
Community Well El
Community 1771
Public Water System RX
Public Sewer El
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 7/17/19
00
6. DSD SIGNATURE _`�°..r- k °z�'i��
M
k.no en e
System #1 Approved for bedrooms
System #2 Approved for bedrooms `,`y ; Steven w. "n9 �L
V"
J'�.�= PE 256
Disapproved
�~-
Conditional approval for bedrooms, with the following stipulation.,�
4lt((f((y�(
`�V� Oy OFq
l_glTE_
WATER AND
.2.3
B� Original Certificate Date:_
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advispryi
Arsenic Advisory
Other
Legal Description:
SKYHILLS PH 2 BLK 3 LT 10
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ 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) 5'2199 years
Tank type/material Steel
Measured operating fluid level in septic tank 46
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 4/30/19
D. ABSORPTION FIELD DATA 5/21/99
Which system tested (date installed) S21 A99
❑ ALL standpipes .present per record -drawing
Total measured depth from grade. 12.5 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A _ pressufized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 9'
❑ 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:
COSA Checklist yellow sheet
Parcel ID: 011-122-36
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 7/16119
Results R7 Pass For 6 bedrooms
Fluid depth prior to test 18 in
Water added 900 gal
New depth 30 in
Elapsed time 60 min
Final fluid depth 20 in
Absorption rate aee gpd
Any rejuvenation treatment (past 12 months) no
If yes, enter date
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
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' ❑ Yes
if No
❑ Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ✓❑ Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
0 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 _
Water Main > 10'
✓❑
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No
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
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
G. ENGINEER'S CERTIFICATION - t'
1 certify that / 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.
\ �a
.l
COSA Checklist yellow sheet
ft
ft
ft
ft
C", (AAS -M1
CM4 =Tp -r
n0a amnia ,E,aAoc
ME RAmm sszn+ac
RUR OLUMOG SMACK �I
UNDER NO CIRCUMSTANCES MOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
Lor SURVEY TYPE SYMBOLS
FOUtdDA'nON !?A110H t,S-EJ�.,T
SET REBAR DRAINAGE
tTr1AL slmlcruRe AS MMT a FOUND REBAR AS,oHALT
Q PLOT PLAN ... !S-EEIII.T ...CAT S,R%EY .. TCPOMAPHY 'e--9--$ WOOD FENCE '.•.: CONCRETE
As -BUILT . No st r T bs- xo 00 ASSUMED ELEV. I. x y{- METAL FENCE ® MOOD DECK
PLOT PLANS & LOT SURVEYS NC3Ti'
IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICA11ON
PLOT PLAN OF �4
I h.I ty eau? that t nave Pn y . v.�o 1 ��< ,•. ;;'' :. C�_ j��
ma idt d,,- a,d d...Ya�.d harm,, and mot I \ \Y
hew frond « .st.af.hed m of ub [at m "
a whin a the pan and 1. m. best o/my �' `•��.µ{�
.f.dg. and ablttlea w CkVk Ilms haus ban
me..urod tnf. and eorroet L
FOUNDATION AS -BUILT ���+/1y 'y r ' . ••.•er[....:
L R.baf L � .. h-.br a.mfy tae t .. , -
fqw a•'lartnw m Ar-S+tt nr m. �
toa,( tka. a, tfil. iet a+d nwt a( th. • ,•••. .. ,:r::.JJ r' .... ..
d"wnkne W4 efioAn ht4matku m .f.os, haaoni" • ROBE�i.TE.
An. and no afcrwile" w nlst h"W
FINAL STRUCTURE AS -BUILT �� �� "'✓ ;'•��AAI
C Acb.1 E Xhnt &., ,,r.ny o tfPy ty.i I f' "."• Jt ^�
.t.e_ k bt void hwt pCr ^e ,`.... ..•'`• tj �"
mm.,.abn. awe h,anfatsm .. r.a., ,,..v, ���1�°� pro �a�a��•�•
en tn.. ard no vvrarinects .ad, ul.pe i'� �e Sion�a� .�,'�.
.no.., ou+rr.ioc �4r.te�d.�
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN 71HEIR APPROXIMATE LOCATION, ONLY, SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN ANO LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
q _ 50' Rac. Lot S.F.
04/18/14 Drawn by. REJ
04/18/14 Grid: 2222
Lot 10 Block 3
SKYHILLS PH 2
File No.
W.O. 14-125
071,
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UNDER NO CIRCUMSTANCES MOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY,
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
Lor SURVEY TYPE SYMBOLS
FOUtdDA'nON !?A110H t,S-EJ�.,T
SET REBAR DRAINAGE
tTr1AL slmlcruRe AS MMT a FOUND REBAR AS,oHALT
Q PLOT PLAN ... !S-EEIII.T ...CAT S,R%EY .. TCPOMAPHY 'e--9--$ WOOD FENCE '.•.: CONCRETE
As -BUILT . No st r T bs- xo 00 ASSUMED ELEV. I. x y{- METAL FENCE ® MOOD DECK
PLOT PLANS & LOT SURVEYS NC3Ti'
IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICA11ON
PLOT PLAN OF �4
I h.I ty eau? that t nave Pn y . v.�o 1 ��< ,•. ;;'' :. C�_ j��
ma idt d,,- a,d d...Ya�.d harm,, and mot I \ \Y
hew frond « .st.af.hed m of ub [at m "
a whin a the pan and 1. m. best o/my �' `•��.µ{�
.f.dg. and ablttlea w CkVk Ilms haus ban
me..urod tnf. and eorroet L
FOUNDATION AS -BUILT ���+/1y 'y r ' . ••.•er[....:
L R.baf L � .. h-.br a.mfy tae t .. , -
fqw a•'lartnw m Ar-S+tt nr m. �
toa,( tka. a, tfil. iet a+d nwt a( th. • ,•••. .. ,:r::.JJ r' .... ..
d"wnkne W4 efioAn ht4matku m .f.os, haaoni" • ROBE�i.TE.
An. and no afcrwile" w nlst h"W
FINAL STRUCTURE AS -BUILT �� �� "'✓ ;'•��AAI
C Acb.1 E Xhnt &., ,,r.ny o tfPy ty.i I f' "."• Jt ^�
.t.e_ k bt void hwt pCr ^e ,`.... ..•'`• tj �"
mm.,.abn. awe h,anfatsm .. r.a., ,,..v, ���1�°� pro �a�a��•�•
en tn.. ard no vvrarinects .ad, ul.pe i'� �e Sion�a� .�,'�.
.no.., ou+rr.ioc �4r.te�d.�
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
ETC., ARE SHOWN IN 71HEIR APPROXIMATE LOCATION, ONLY, SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN ANO LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
q _ 50' Rac. Lot S.F.
04/18/14 Drawn by. REJ
04/18/14 Grid: 2222
Lot 10 Block 3
SKYHILLS PH 2
File No.
W.O. 14-125
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MUNICIPALITY OF ANCHORAGE
DEPAFITMENT OF HEALTH & HUMAN SERVICES
Oivision of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATF OF HEALTH AUTHORITY _
- . '-" 'AP?ReVAL FOR A SlNG'LE FAMILY'~WELLIbrG ' '
1.'. GENFRAL INFORMATION ',
Complete legal description' Lot:.,10, Block 3, Sky. H~'11s Subclvfsion, Phase T'r
LOCation ('site address'0r'dJrecti~ns)
Propertypwnbr',: Cf~m POfnte, Inc. '~
.. ~:_ ~.'~._~,}~'/ ~.PO ;Box .l12313,Anchorage, AK~99511
· _~Lending agency" ;~ 'L _ Da~ phone
Mailing address ' ~:'' ~ '
Agent
Address
..Day Phone_ 345-6277
Day phone_
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: ~6 (six)' .
r3. .TYPE OFWATER SUPPLY: .. '
Individual well ·
,~i .. ' .i.~....' community well* -'
r --Public water xxk~x ....
NOTE: If community well system, provide'written ConfirrnatiOn from State ADEC attest-
lng to the legality and status of system, r rL .
wAsTE'wATER DISPOSAl..::
4.
TYPE
OF
Individual on-site xxxxx
· Holding tank · '- .
Community on-site .
Public sewer
NOTE-':
If community Wastewater system, provide written confirmation from State ADEC
· attesting to the legality and status of system. ' ' ' ' '
72-025[Ray. l/91) Front MOA#21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and ade(; uate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Munici pality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm : Anderson Engineering Phone 52J~7773
A~sS PO Box 240773 Anchorage, AK 99524 ''
' : '" ' ' 'Date il/11/99
Engineer's signature
ApprOved for ~i ~' bedrooms.
Disapproved.
Conditional approval for
' · ipulafio
:' g st ns:
I~drooms, with the followin
Additional Comments
By:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in 'paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to 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.
Municipality of Anchorage NOV ] ,~"]999/~
DEPARTMENT OF HEALTH & HUMAN SERVICE~nic~^Ln'Y oe
Environmental Services Division ENVIRONMENTAL SERVICES I
82!5 L Street, Reom 502 · Anchorage, Alaska !)9501 · (907) 343-4744
Health Authority Approval Cl~ecklist
Legal Description: Lot 1 0, Block 3, Sky Hills
Phase II
A, WELLDATA - Municipal Water System
Well type
Log present (WN)
Total depth __
Sanitary seal (Y/N)
Parcel I.D.: 011 -1 22-36
IfA, B, or C, attach ADEC letter. Ar)EC water system number
Date completed
Cased to Casing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
FROM WELL LOG
g.p,m.
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Date installed 5 / 21 / 99
Foundation cleanout (Y/N)
Nitrate Other bacteria
g.p,m.
Collected by:
Tank size 2,000 Number of Cornpartments 2 C eanouts (Y/N). Y
Y Depre~ion (Y/NJ N High water alarm (Y/N). N
Date of Pumping New Pumper Construction
C. ABSORPTION FIELD DATA
Date installed 5 / 21 / 99 Soil rating (g.p.d,/ff~ or ff~/bdrm) .6
Length _ 78 ' Width 3 ' . Gravel thickness below pipe
Effective absorption area 1 ~ 248 SF Monitoring Tube present (Y/N) Y
Date of adequacy test New Const, Results (Pass/Fail) Pass
Fluid depth in absorption field before test (in.); __
Fluid depth (ins) Minutes later:
Peroxide treatment [past 12 months) (Y/N) N
System type Deep Tren_ch
1 0 ' Total depth _1 3,5 ' _
_ DePression over field (Y/N) N
For 6 .bedrooms
_ Immediately afte~ gal, water added (in.): __
Absorption rate = .g.p.d.
If yes, giw~ date N?A
72-026 (Rev. 3/96)*
D. LIFT STATION None on Lot
Date instal[ed
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
Public sewer main
Sewer/septic service line
Size in gallons
"Pump on" level at*
*Datum
No Well on Lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation > 5 ' Property line > 5 ' ' Absorption field
Water main/service line > 1 0 ' .Surface water/drainage > 1 00 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 1 0 ' Building foundation > 1 0 '
Surface water > 1 O0 '
Curtain drain None Noted on Lot Wells on adjacent lots >100'
F. ENGINEER'S CERTIFICATION
I certif~
· in conformance with MOA HAA guidelines in effect on this date.
Signature ~ ~tr~t'~'~
Engineer's Name M~chael E. Anderson~ P.E.
Date 11 /11 /99
>5'
Wells on adjacent lots
Driveway, parking/vehicle storage area
"Pump off" level at*
Water main/service line
>10
>100'
>10'
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*