HomeMy WebLinkAboutSKYHILLS PH 3 BLK 2 LT 75kyhills
Block
Lot 7
#011 - 122-49
Municipality of Anchorage Page !
Department of Health and Human Services
Division of Environmental Se~aces
On-Site Ser~ces Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage. AK 995196650
w~e~.d.anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number:. SW000267 PID Number: 011-122-49
"'"'*: Wastewater System: New ' Upgrade
Mark Merchant
P.O. Box 211136 Anchorage, AK 99521 ABSORPTION FIELD
338-3668 Three (3) ~ o.,,~ ~,~,,'r,,~ .. ~
LEGAL DESCRIPTION .6 c..o~e10
2 7 Skyhills Phase 3 3 ,. 7
5 ,. 54
We,,: [].ew o.pg .e 3 ,,.
· A .. n. 756 re ASTM D3034 PVC
a. Spinell Homes 8/29-30/00
"~: o~ I~'~s~.. ic.~e, ,,,~,,.c,.~,~:r, TANK
SEPARATION DISTANCES I~ septic F'] Holding D $.T·E.P. ~]'Other:.
T~o Septic Absorp~ioe Uft Holding >ubilc/Prtvate ,~.~,~,~,'e,'.
Tank ' Field Station Tank S~,~U,e Anchorage Tank 1,000
wa >200' >200' N/A N/A >25' Steel Two (2)
s~,,,w,,, >100' >100' N/A N/A ~ / LIFT STATION - NONE ON LOT
~t~. >5' >10' N/A N/A c~.
r~.-- >5' >10' N/A N/A '~"°~"'"'": '~": I
c~.~., None Noted ~P~**"~"
"'"'"~: BENCH MARK
Garage Slab.
Engin ~e~rLs, Stamp
m'~..' '.'..5,~*,
,,., "-, ·
Inspections performed by: Mike Anderson Dates: 2'~1" 8/29/008/30/00
· Department of Health and Human Se..?ic~s approval
~'2c~Dale:, ~' A S' el
Reviewed
and
approved
by:
6
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 SW000267
PID No. 011-122-49
S89'54'50'W 161.33'
iff U~IJTY EASEMENT
20' Tg,~ £A~M[NT
Three
Bedroom
House
LOT'7
I
/
A B
S1 24.5 43.8
S2 32.6 48.4
C4 58.1 62.9
M1 59.2 62.1
C3
=5
/- = THB
8
10
PLAN AS-BUILT
SCALE 1" = 40'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES D~VISION
P.O. Box 196650 - Anchorage, AK 99519-6650 o 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
Permit Number SW000267
PID No. 011-122-49
~1~000 ,. ~
~o.~/lSep T~.~\89.9 .
9' 1' 19'
80.5
Geotexttle
65.0
71.9
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: Jul 28, 2000
Expiration Date: Jul 28, 2001
Permit Number: SW000267
Legal Description: SKYHILLS PH 3 BLK 2 LT 7
Design Engineer: 0014 Anderson Engineering
Owner Name: Mark Merchant
Owner Address: PO Box 211136
Anchorage, AK 99521-
Parcel ID: 011-122-49
Site Address: 007938 SKYHILLS DR
Lot Size: 44811 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
r~ DisposalField [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of AJaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date: (~'~
July 10, 2000
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524-
522-7773 . 522-6779 (FAX)
Municipality of Anchorage.
· Department of Health and Human Services
825 'L" Street
Anchorage, AK 99502-0650
Subject: Lot 7, Block 2, Skyhills Subdivision Phase Ill
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer: '
The owner of Lot 7, Block 2, Skyhills Subdivision Phas~ III intends to construct a three-
bedroom home on the lot. We are therefore applying for a permit to construct a new
septic system on the lot to serve the new house. The 'attached Site Plan and backup
documentation identify the location and configuration of the new septic system and the
parameters used in the design. The lot is.served by the Municipal water system and -
the system will be constructed a minimum of 10' from the water service line.'
The test holes placed on the lot in October of last year at the locations Shown revealed
silty sand with some gravel with a percolation rate of 20 minutes per inch.- No
groundwater was encountered in either test hole and none was found during the
ensuing water-monitoring period. We are therefore proposing to construct'a deep.
trench system with a maximum depth of 10' below the original ground surface. The
length of the trench will be 54' with an effective depth of 7'
The ground surface on the lot slopes from north to South at varying grades sometimes
as steep as 20%. The new trench .will be' constructed parallel to the contours in
conformance with Municipal requirements.' Some grading will be required to flatten
slopes in the area during construction of the home site and the driveway.. Grading will
also be accomplished once the system is completed so drainage is away from the
trench and septic tank but in the direction of the current drainage pattern. No surface
water will accumulate in the trench area.
If the system is constructed in accordance with our design {he following statements
apply:
1. The system, if constructed as designed, will have no ~dverse impact on the wells
in the area or those to be constructed in the future. The 'subdivision is currently
served by the Municipal water system.
2. The system, if constructed as designed, will have no adverse impact on'e~dsting
septic systems in the area or those to be constructed in the future.
Lot 7, Block 2, Skyhills Phase III
July 10, 2000
Page Two
The system, if c~nstructed as designed, will have no adverse impact on reserve
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
- TTHIS PROJECT' ,9.o~'- ....
': 5
42,401 ~.~
21
23'
41.161
6
40.~25
539.78'(R)
40.182 sq,ft.
" 33
35O
.TRACT~
..27
~Water
S89~4'50"w
Three
Bedroom
House
;3' Wid~
:rive De
on Trench
SITE~E~PL~N ~:%
LOT 7, BLOCK 2, SKYHILLS PHASE III
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Deep Trench System
Perc. Rate: 20 MinJlnch 1,000 Gallon Septic Tank
Application Rate: .6 GPD/SF 7' Dralnfield Rock - ~
3 Bedrooms X 150 GPD 1.6 GPDISF = 750 SF of Absorption Area
750 SFI14 SF/LF = 53.6 LF Trench Length
Therefore: Construct a New Absorption Trench 54' in Length With 7' of Drainfield Rock .
Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 10' from Existing Surface. Mound Over.Trench to
Provided Minimum Cover of 3'. Maintain 10' Separation From Water Service Line.
NOTE:
'7 ~ 0".
· NatUral
Backfill
Geotextil~ .
Fabric
4" Perforate~
PVC (Slots. Do%m) '
Drainfield
Rock
(NO SCALE)
· Grade Area Over Trench to Drain Away. ·
Minimum 6' Separation From Bedrock. ·
Minimum 10' Separation From Lot Line. ·
Minimum 4' Separation From Groundwater.
%4inimum 10' Separation From Water Service Line.'
· TYPICAL WIDE TRENCH SECTION
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Bob Klein
Legal Description: Lot 7. 8lock 2. Sky Hills. Phase III
SLOPE
SITE PLAN
1
11
12
13
14
15
16
17
18
OOmT
Silty Sand
SM
Was Groundwater
Encountered?
if Yes, What Depth?
Depth to Water
After Monitoring
Date:
Bottom of
Hole
See Site Plan
No See Site Plan
· None
10/10199
Reading Date Gross Net Depth To Net
Time Time Water Drop
I 23-Sep 14:24 .75"
2 14:54 30 2.25" 1.5"
3 15:24 30 3.75" 1.5'
4 15:54 30 5.25" 1.5"
Perc. Rate: 20 Min./Inch Parc. Hole Diameter: 6"
Test Run Between 7 Ft. and 8 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: ~ I, ~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 10/20/99
Municipality of Anchorage
Department of Health & Human Services
825 L Street,'Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Bob Klein
Legal Description: lot 7. Block ~ Sky HiTla. Phase III
SLOPE
Date Performed:
%
SITE PLAN
12
13
14
15
16
17
18
OG~T
Silty Sand.
SM
Was Groundwater
Encountered?
If Yes, What Depth?
Depth to Water
After Monitoring
Date:
Bottom of
Hole
'See Site Plan
No See Site Plan
None
10110199
Reading Date Gross Net Depth To Net
Time Time Water Drop
1 23-Sep 14:33 .75"
2 15:03 30 2.25" 1.5'
3 15:33 30 3.75" 1.5"
4 16:03 30 5.25" 1.5"
Perc. Rate: 20 Min./Inch Perc. Hole Diameter: 6"
Test Run Between 7 Ft. and 8 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Ed Sanderson. I, ~ Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: '10/20199
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 7, BLOCK 2, SKYHILLS, PHASE III
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the Sit? Plan. It
also includes the construction of a new 54' long X 3' wide X 7 effective
depth absorption trench. Distribution pipe will be placed at 3.0' below
the original ground surface. The total depth of the trench from original
ground will be 10.0'. All components of the system must be a
minimum of 10' from the water line serving the new house on the lot.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special, previsions or
conditions, and all applicabl.e 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. I~efore beginning system installation.
SEPTIC TANK INSTALLATION
1. The new 1,000 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
budal 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 7, Block 2, Skyhills Phase III
July 10, 2000
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabdc must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall vedfy the septic tank and drainfleld are a minimum
100' away from any pdvate water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if ·
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surroundi.ng 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 vedfy this condition pdor to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct budal polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 7, Block 2, Skyhills Phase III
July 10, 2000
Page 3 of 3
5. A permeable geotextile fabdc (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:
Municipal Ordinance requires a minimum of two inspections. 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 Anclio'rage o ' ""-.
" : Building'Safety Div sion : ' - i ,~.~;,' -
· 'on-Site Water and Wa~tewater Pr(:~jram ' · ' -....e'N~s~ ~'~-~,~° . '
; ' · · 4700 South Bragaw St.'~. '. "- ' . . .' ~.~/..
· .. P.O. Box 196650 Anchorage AK ~9519-6650..,,'-~ ~--~ .
·., :www.ci.~nchorage.ak.fis · ... ./~/H~ .'! "': :'
· ... . ..... :....:::.. :.....
CERT. IF'I(]ATE OF HEALTH'AUTHORITY APPROVAL." ." i" '.;
FOR A SINGLE FAMILY DWELLING ".' :" '
Parcel I.D. 011-122-49
' '1. GENERAL INFORMATION , '
Complete legal descript[0n Lot 7, Block 2, Skyhills Phase III
Location (site address or' directions) 7938 Skyhills Drive
Current P. roperty owner(s) Mark Merchant
Mailing address P.O. Bo'x 211136 Anchoraqe, AK9952t'
Lending agency
HAA # . ... ..
Expiration Date: .' ~ '~ ~ -~" O..~.. ·:
Day phone. 250-3958
Day phohe
Mailing address
Real Estate Agent
Day phone
Mailing Address
'Un/ess Otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three {3)
3. TYPE OF'WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
[]
[]
0
[]
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tanl~ []
Community On-site []
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 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
flue (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
vaIid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Cedificates 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
Municipalit~ of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with ail appIicable Municipal and Slate codes, Ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Enqineednq
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name' Michael E. Anderson. P.E.
5. DSD SIGNATURE
Approved for ..~
Disapproved.
Conditional approval for
Phone 522-7773
Date 8119/2002
.O..F,,, A
~ ............... o~' :,~,' ~::.,
bedrooms.
· ;::.. - ~ ~ ~,?'o~'[ss~,~;~
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Repod
Other
Original Certificate Date: ~" ¢~- "~ ' OJ~
Legal Description:
A. WELL DATA
Wea type Public Water
Date completed __
Total depth ft.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w,~w.cL anchorage.ak.us
(SOT) ~43-7m4
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel ID:-011.t22.49
Lot 7, Block 2, $1whms Subdivision Phase III
IfA. B, orC provide PWSlD #
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
g.p.m.
Nlirate mg.fl.
Catlec~ by:
Number of Compartments 2_
Dep _re~__~n over tank (Y/N) N_
Pumper Old MacDonalds
Well LoG (Y/N)
Date of test
Static watar level
Well production
WATER ,~J~4PLE RESULTS:
W,-es properly protected (Y/N)
Casing height (above ~u~nd)*
AT INSPECTION
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1~000 gal.
Foundation cJeanout (Y/N) Y
Data of pumping 8/21r2002
ABSORFrI1ON RELD DATA
Date installed 8/30r2000
Total depth 15 ft.
Data of adequacy test
ft*
Other becterm
in.
Date installed 8/29/2000
Cteanouts (Y/N) Y
High water alarm (Y/N) N
Sm] rating (g.p.d./ft~ or ~redrm) .ii GPD/SF System type Deep Trench
fl. Width $ fl. Gravel below pipe 7
Eft. absorption area 756 fl~ Monitoring tube Y Depression over field N_
Results
.Fluid depth in absorption field before test __ in. Water added gal.
Elapsed Time: min. Final fluid depth __ in. Absorption rate >=
Any rejuvanaflon traalment (past 12 mo.) (Y/N & b~q~e) N If yes, give date
For bedrooms
New depth in.
g.p.d.
D. LIFT STATION
Date installed
Size in gallons
Manhele/Access (Y/N)
'Pump on" level at in.. 'Pump off level at in.
Datum .'Cycles tested
E. SEPARA~'ION DIsTANcEs
sEpARATIoN DISTANCES FROM WELL ON LOT TO:
High water alarm level al
Meet~ alarm & cin~it requirements?
in.
Septic tankailt station on lot
Abserpt!on field on lot
Public sewer main
· On adjacent lots
On adjacent lots
Publio sewer manhole/cleanout
. Sewer/septic service line Holding tank
· SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' '
Water main N/A -
Wells on adjacent lots >200'
Property line >5'
Water service line >10'
AbsorpUon fi&Id
Surface water >100.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >fir
Building foundation >10' Water main >10' . ·
Water Service line >10'
Curtain drain None Noted
Surface water >t00'
Wells on adjacent lots >200'
Driveway. partdng~eNclo stmage. >10'
F; COMMENTS
Septic System has beefl iff ilem'~8 ~liqNly mo~e ~lafl ons veal, Last CerL of Heallh Au~offff Issued.~ll~)~1~ Ii ..
G. ENGINEER'S CERTIFICATION
conformance w#h MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael F_ Anderson. P.E.. .
F. $
Date of Payment 8 -- ~4~ / ~ 7..--
Receipt Number
(Re,. l~J0O)
Waiver Fee $
Date of Payment
Receipt Number
6
S89'54'50"W
10~ UTILITY EASEMENT
20' T&E EASEMENT
161.33'
LOT7
0
EXISTING
HOUSE
~oo
9
' ':' Municipality, of Anchorage
' .- ~ · ,..i. Development Services Dep~rtment
· Bu]ding Sa[ety Division
. ,'i · · . Oh~ite ~ater and Wastecr:at{/r Pro, ram
_' . ..... "" 4700 Sou'th Bragaw St.': ... - .
~" ' P.O. Box 196650 A~chorage, AK 9951,9~650-
..... ,7 . .: ~vww.ci.anchora .a us ,.'
· . . : .'. .... '(907] 343-7904
· CErTiFICATE 6F HEALTH AUTHORITY. APPROVA~ /,..,:,
' 'FOR A SINGLE FAMILY DWELLING- ' '~
Parcel I.D. 011.t22-49- -
1. GENER~L'INFORMATIoN'''
Complete legal, deSCription... Lo, t 7, Block.. ,2' Skyhills. . Subdivision. Phase. 3..
Loea{ion Is te address'or d rectons) SB/hilIS Drive
Current Property owner(s) . Ms~ Merchant
P.O. Box 211i~6 Anchora.qe, AK'99521:
Day phon~ ';~38:3668
Day ph6n~ -
Mailing address
Lending agency,
Mailing address .
Real Estate Agent
Day phone'
Mailing Address'
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
Three (3)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class.
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
I-'1 Individual On-site []
[] Individual Holding tank D
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Depadment (DSD) 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) 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 propedies served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Cedificates 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 b~/my ~b_.al affixe~ ....... ...... · '
hereto and as of the validation date shown below I verify that my nvest gat on,,.
based ion procedures outlin6d ir~ th~'H~afth'Au~dt~ A~r"(J~;al Guid~line~ for,this a~lication, shows that the
on-site wa. ret'supply ai~d/o~.w~i~w~t6r'd!sp'6~l~.~y~te~.i~(~r6)'S~f~0 f'J~ctio~al ~nd ~,d~uat~ for the number of '
bedrooms and lype Of st~cture'indi,~.~ted her~in~ I f[Jrther ve~.if,j that ba{e~J o~' the informati0r~ &b~ain~ed fi:om the '"
Municipality of Anch6rage file~,~r~d iff:0m'~';im;estigAti~n':arid inspecUoi% ,the on'site war,er'supply a~d/or
waste~vater disposal s~stem ~(ar'e) i~ .cor~pliahc(~ With Ail. alJplicable' Municipal and.State c6de~,'ord _n"an~es',
and regulations in effect at the time of installation.. ' · ,.' .: ' ~: .. ..
Name'of Firm A dersonE .qi eedng 15h'one 52~H'/3
Address P.O. Box 240773 c '.
Engineer's Prit~t;d N'am;' Michaei E. Anderson, P.E. ; '~ .'; , -' '.~ Da{e~, '~ ~)/~SilJl ~ .....
Disapproved.'
Conditional appr6v~l for bedr(~oms, with the' folldwing stiPulationsi ·'"
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Cedificate Date:
(Rev. 12~130)
WELL DATA
w~ ty~e
Date ~omMeted
Total depth
Municipality of Anchorage
Development Services Department
Building Safe~ Division
On-Site Water & Wastewater Program
4700 South Bmgaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
w~v.ci.anchorage.ak.u~
(~07~ 343-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 7. Block 2, Skyhills Subdivision Phase 3
If A, B, or C provide PWSID #
Cased to lt.
FROM WELL LOG
g.p.m.
Date of test
Static water level
Well pnxluctlon
WATER SAMPLE RESULTS:
Cdifonn c~lonlas/100 mi.
Date of sample:
B. SEPTIC/tlOLDING TANK DATA
Tank Type/Mate~,al Steel
Tank size 1~0 gal.
Feundat~n deanout CWN) !
Date of pumping
C. ABSORPTION FIELD DATA
Parcel ID: 011422.49
Number of Compartments 2_
Depre~__~_idn over tank (Y/N) N_
Pumper New Construction
Date installed 8130/2000 Soil rating (g.p.dJfl~ or ~Fedrm) .6 GPD~F
Length 54 ff. Width 3 fl.
Total deoth 15 lt.
Date of adequacy test
wen tog (Y/N).
w~res pmlx;dy pmtectad (Y/N)
Casing height (above ground)
AT INSPECTION
ft.
g.p.m.
C~s (Y/N) Y
High water alarm (Y/N) N
System type DeepTrench
Gravel below pipe 7
Eft. absorption area TS~ it; Monitoring tube Y Depre~__$idn over field N_
Resu~ (Pass/F~)
Fluid depth in absorption field before test in. Water added gal.
Elapsed T~e: min. Final fluid depth in. Absorption rate >=
Any mjuvenaiton treatment (past 12 mo.) (Y/N & type) N If yes, give date
colonie~lO0 mi.
bedrooms
New depth in.
g.p.d.
UFT STATION
Date installed Size in gallons
'Pump on' level et __ in. 'Pump off' level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lilt station an lot.
Absomtion field an lot
Public sewer main
Sewer Iseptic seP,/ice line
Manhble/Access (Y/N)
High water alarm level at
Meets alarm & cimutt requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Properly line >5'
Water main N/A Water service line >10'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >t0'
Curtain drain None Noted
COMMEN'FS
Building foundation >10'
Surface water >100'
Wells on adjacent lots >200'
Absorption field >5'
Surface water >100'
Water main >10'
I:~,eway. paining/vehicle storage
G. ENGINEER'S CERTIFICATION
I ce-t/fy that I have determined I/~:~gh fle/d inspeci/ons and
review of Municipal records that the above sy~ems am in
conformance with MOA HAA guidelines in effecf an this date.
Engineer's Printed Name Michael E Andemon, P.E.
Date 6/28/2001
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/0o)
Waiver Fee $
Date of Payment
Receipt Number