HomeMy WebLinkAboutTROLL KNOLL BLK 3 LT 3Troll
Knoll
Block 3
Lot 3
#051-521-03
Municipality of Anchorage
Development Services Department
\ Building Safety Division
- On-Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Boz 196650 Anchorage, AK 99519-6650 Page of 3
www.ci.anchorage.sk.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number SWSW060128 PID Number 051-521-03
""n'
Wastewater System: ❑ New ® Upgrade
Aw"'111top nriVe Chilgialk AK, 99567ABSORPTION
FIELD
p,ry Number of Bedoonts
® Deep Ttwr 0 Shallow Trwl, 0 Bed 0 Mand O Otrw
s° "'°"0j.n
Tde&owmkenongnd
LEGAL DESCRIPTION
9-9arae
1.
Bock W S.Aawlaan
I I Troll Knott
Depth to ppe bdlon from onpYW ands
2-0 Ft
Gr" dealt beneath pal
F,
TownWP Rrtaa Soden
Fa added oboe onprW pads
2 Ft
G," Lrtadr
3R F1
Well: ❑ New ❑ Upgrade
Grata wialR
N.nNr d Ina.
Datres between fides
r , ,, I ;, , .,
_FL
claaadoe&pn (Prwate. A B, C)
Total Depth „
Caerr to
Total abaorp o wa
Ppa Material
v r
380 :
3034 PVC
DM1er
Date DnIW
SWM W«r Lev«
btaw
led
Dale metalled
Fury s« « c...q NraM Abov. Grant
TANK
CPM
FL FI
SEPARATION DISTANCES " '''' `''' `
M septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
LIR
Holding
ublictPrlvate
mah`J �
capr^tt,
1000
From
Tank
Field
Station
Tank
Sewer Lim
AnchoracieTank
G.1
MM'"'
11 M dcamprtmwa
web
256.0
223.3
200+
Steel
2
100+
100+
LIFT STATION
s.Hoo,water
Sao.Mrart.a...r
Lot Late
82'
68.9
1 V
God
'Fury on'IavN «.
'Fury ar ovr a[
Hpt w«r MrmM
FaMMnn
23
36
o
N
ti
5o+
s0+
Prep M"a`Mode&
El er" kupedma pr`ormaa by
c.ne D.e
ReAY"aBENCH
MARK
Exist'a tank 8 field abandoned per code. Installed
Lxr and DeooV n.
railroad tie barriers along driveway. Revised 070106.
Garage Floor
Assumed E"v«mn
100.0 FL
Engineer's Stamp
CY
q,
..............1=�41
�i
Inspections performed by: PES, LLC Dates: 1"6112/2006
T"
: �` ' '\ '1
2n'0611312006
... _ ..................0
•
�
Development Services Department approval
-;--i------ -----.................0
`
Steven R. Ponnor.e` I
wi
Conditional Approval by: Date:
00.%
1� No CE 81 no
�3 ••.,.4-�fp��•' (%
Reviewed and approved by: Date: -V-/2-07♦eee\�;;C7
•
�S t�� i��
PERMIT NO:SW060128 RECORD DRAWING P.I.D. NO: 051-521-03
WASTEWATER DISPOSAL SYSTEM
Lot 3 Block 3 Troll Knoll SID
AREA UNDELVELOPED \
2 NO WELLS OR
SEPTICS WAN 100 FT
NEW 10009 INSTALLED LARGE ROCKS
SEPTIC TANK DECK - ALONG EDGE TO CREATE
INSTALLED DOUBLE ABOVE BARRIER FROM VEHICLES
CLEAN -OUTS 8
BALL TYPE VALVE
UPGRADED AREA UNDELVELOPED
5 -WIDE TRENCH 29.0 NO WELLS OR
38LF x 2.3'W x VED, rM SEPTICS W/IN 100 FT
�i
\ 38R
EXIST'G
\ SEPTIC THt Tt HOUSE \,
M1 \
AREA C 2 o \
G O O
000 O 60.4 •�
\ 68.9 /•�r Exim V CLI
82'8 \ �� '\ WATER.SERVICE
5%
98.7 / •k.
•\ \\ \ � OLLAPSED TANK
A13ANDONED-14W
\\ •\ \ � i W/AMC15.65 '
5% � /•� �
EXIST'G CRIB
\ ABANDONED IN PLACE i
I 25 \ PER CODE
\\
AREA UNDELVEL,OPED I 223.3� i• i
NO WELL'S OR j �. �• � � � O
SEPTICS WAN 100 FT j /• �•
CO A B C
195.5 i Tt 22.4 33.7 X ;
T2 27.7 38.1
l i' �• i DC 31.0 40.9 ww "
�.
EAU OCR DV 32.8 42.4 E
�• � NO WELLS OR
�• i S TICS WAN 100 FT M1 36.4 46.2
�• i M2 65.9 72.2
EXIST'G �• �• i Ct 69.3 74.6
CLASS A Well 268.3 288.4
WELL
DESIGN CALCULATIONS:
NOTES:PERCOLATION RATE: 6.15 MPI
3) Maintain 10' separation to all lot
1) Al work shall be performed in lines and proposed water lines. APPLICATION RATE: 0.8 GPDSF
�tl0,• accordance with AMC15.65. 4) Lots served by community (125 SF/BR)•� �� water system. No wells within 200' BEDROOMS: 3
��•(P.••"' # 2) Materials used shall be In of proposed system. AREA REQUIRED: 564 SF
5;•' # accordance with those specified In 5) Exisrg crib distance DEEP TRENCH: 5.0' ED,
. {s ?�Q� TM >} ♦ AMC15.65, Wastewater Disposal. grand -fathered to 150' min from 80 LFx 5' W x 2.0 ED. 5.0' TD
...0 .... .. ...... *% ClassAwell.
----�.- .--- TOTAL AREA 400 SF
• v••••••••:•
PREPARED FOR:
PANNONE ENG. SVC, LLC
Steven R. Pannone
Z•
P. O. BOX 102954
C g
��•P��
Jonathon and Kaycee Hammond
23747 Hilltop Dr.
ANCHORAGE, ALASKA 99510
•
_may �
Chugiak, AK 99587
227-3522 P, 272-8218 Fax
DATE: 06.26.06
1PLAN
830.3250
PERMIT NO: SVV060128 RECORD DRAWING DETAILS P.I.D. NO: 051-521-03
WASTEWATER DISPOSAL SYSTEM
Lot 3 Block 3 Troll Knoll S/D
IM NV313
ON3 HOV31V
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♦ PREPARED FOR: PANNONE ENG. SVC, LLC
♦.....
♦ Steven R. Pannone P. O. BOX 102954
♦♦ CE 8149 i Jonathon and Kayoee Hammond ANCHORAGE, ALASKA 99510
23747 Hilltop Dr.
••�1 rpQ^* �,�pY• Chugiak, AK 99567 227-3522 P, 272-8218 Fax
830.3250 SCALE: 0 NTS -06 DETAILS
Pannone Engineering Services, LLC P.O. Box i02954
Consulting Engineers Anchorage, Alaska, 99510
(907) 272-8218 (907) 272-8211 Fax
January 6, 2007
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 3 Block 3 Troll Knoll S/D
Response to comments
Ladies and Gentlemen:
I am writing in response to comments received January 4, 2007 concerning the record
drawing for the above referenced project. The record drawing was originally submitted to
your offices on July 1, 2006. I will respond to your comments in the same order as they
were presented.
Comment: Incomplete; missing Total depth of system
Response: Total depth of system added to Inspection Report Form. See revised form,
attached.
Comment: Incomplete; missing Test hole and trench location moved from permitted site.
Response: House location was changed based on as -built survey (copy in your records).
Test hole location and septic system remained in relative location to house, thus still in
permitted area. All features are measured from the existing house.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
r
Steven R. Pannone, P.E.
Civil Engineer
Attachments:
Municipality of Anchorage
Development Services Department
• +1 Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: Steve Pannone
Legal description: Troll Knoll Block 3 Lot 3
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on _
❑ Calculation error in design. _
❑ Additional soils information needed.
❑ Water monitoring results Inadequate.
❑ Discrepancy in information submitted. _
❑ Topographic information missing or inadequate.
® Incomplete; missing Total depth of system
® Incomplete; missing Test hole and trench location moved from permitted site.
❑ Additional adequacy test information needed. _
❑ Water sample unacceptable. _
❑ Measured/proposed distances/dimensions missing. _
❑ Locations of all soils, percolation and water monitoring tests not shown. _
❑ Proposed system too deep for soils information submitted.
❑ Well log required.
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
❑ Other.
Name of reviewer: Jeff
Date: 12-22-06
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
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
Permit Number: SWO60128
Legal Description: TROLL KNOLL BLK 3 LT 3
Design Engineer: 0062 PANNONE ENGINEERING SERVI(
Owner Name: JONATHAN & KAYCEE HAMMOND
Owner Address: 23747 HILLTOP DRIVE
EAGLE RIVER. AK 99577-0000
Date Issued: Jun 05, 2006
Expiration Date: Jun 05, 2007
Parcel ID: 051-521.03
Site Address: 023747 HILLTOP DR
Lot Size: 32498 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of.
Disposal Field E Septic Tank E] Holding Tank Ej Privy Private Well E] 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.
Received
Issued By:
Date:%
Date: (! sI°b
Municipality of Anchorage
• Development Services Department 4h,
Building Safety DivisionOn-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcell.D._ 051-5P1-03
Property owner(s)_Jonathan & Kavicee Hammond Day phone 830.3250
Mailing address23747 Hilltop Drive, Chuglak Zip Code 99567
Site address _23747 Hilltop Drive Zip Code 99567
Legal description (Sub'd., Block & Lot) Lot 3, Block 3 Troll Knoll SID
Legal description (Township, Range & Section)
Lot Size 32,498
Sq. Ft.
Number of Bedrooms 3
THIS APPLICATION IS FOR (® all that apply):
THIS APPLICATION IS AN:
Absorption Field
®
Initial ❑
Septic Tank
®
Upgrade El
Holding Tank
❑
Renewal ❑
Privy
❑
Private Well
❑
Water Storage
❑
1 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.
Pannone
LLC
(Signature of property owner or authorized agent)
Permit/Rush Fees: _ 4i�o Waiver Fees:
Date of Payment:
Date of Payment:
Receipt Number: Receipt Number:
(Rev. 11/05)
Pannone Engineering Services, LLC P.O. Box 102954
Consulting Engineers Anchorage, Alaska, 99510
(907) 272-8218 (907) 272 8211 Fax
May 31, 2006
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 3 Block 3 Troll Knoll S/D
Emergency Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing to request a permit to construct an upgraded septic system be issued for
this property. The existing 1000 -gallon septic tank has collapsed and is causing back-up
into the dwelling. A new drain field will be constructed in conjunction with the tank
replacement. The proposed systems will serve an existing three-bedroom house. The
property is served by an approved Class A water system. The well is located southwest of
this property, over 200 feet from the proposed system. The surrounding lots are served
by the same community water systems.
1. Soils. A single test pit was excavated on May 23, 2006. See the attached soils log.
Ground water was monitored for seven days through the end of May. Ground water was
not encountered while excavating the test hole and was did not appear in the monitor
tube during the water -monitoring period. Bedrock was not encountered in the test hole.
A single percolation tests were performed. The water absorbed into the ground as fast as
it was being applied. It is my opinion that the overall soils appearance of the soils, an
application rate of 1.2 gallons/day/square feet should be used using a conventional
treatment system.
2. Trench Design.
a.
Percolation Rate:
b.
Application Rate:
c.
Number of Bedrooms:
d.
Design Flow:
e.
Min. Absorption Area:
L
Total depth:
g.
Effective Depth:
h.
Width:
i.
Reduction Factor:
j.
Minimum Length:
k. Design Length:
1. Effective Absorption Area:
in. Septic Tank Size:
G.T. 1 Min Per Inch
1.2 gpdpsf
3
450 gallons per day
375 sf
7.0 feet
5 feet
2-3 feet
0.0
37.5 feet
38 feet
380 sf
1000 gallon.
Page 2 of 2
3. Surface Water: There is no surface water within 100 feet of the proposed system.
The proposed systems will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The average topography in the area of the proposed septic system is
approximately 2 percent. The northern portion of the lot adjacent to the proposed
system is a steep hill. The system will be installed at the base of this steep hill.
The proposed installation will not affect the future development of the surrounding or
existing lots. There are no wells or septic systems within 100 feet of the proposed septic
location. The existing septic tank has collapsed and will be abandoned in accordance
with AMC 15.65. The existing crib will be reused.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Civil Engineer
Attachments:
C:\Work\Letters\3-3 Troll Knoll.001.doc
PERMITNO: DESIGN DRAWING
WASTEWATER DISPOSAL SYSTEM
Lot 3 Block 3 Troll Knoll SID
AREA UNDELVELOPED
NO WELLS OR
SEPTICS WAN 100 FT
EXIST'G SEPTIC AREA
\ 1
AREA UNDELVELOPED j
NO WELLS OR
SEPTICS WAN 100 FT 1
I
:.
49 TM � •• ':.:}
Steven R. Pannone
X
PROPOSED 10009 3
SEPTIC TANK C
INSTALL DOUBLE \
CLEAN -OUTS d
BALL TYPE VALVE •
2:1 SLOPE
DECK-
P.I.D. NO: 051-521-03
AREA UNDELVELOPED
NO WELLS OR
SEPTICS WAN 100 FT
i
HOUSE •��l
INSTALL RAILROAD TIES
�•� �•�•\• 2%
\ TH7�
.4
\
i
\ 5% \
W/
ALONG EDGE TO CREAT •�
Bi
RIER F. OM VEHI S •�
A�D TANMr EXISTG 1' CIl''
�D 1A WATER SERVICE
d.65 •� �.'
'.D RADE '�,i'
NCH �.
W x 5'ED, 7TD ,• /
EXIST'G CRIB �•
TO BE REUSED
�200'V
201.8 .2
190.0 '
10 R
i
AREA I) DELVELOPED '
T'G CLAS A WELL i NO ELLS OR
SEPTICS WAN 100 FT
/ I
1) All work shall be performed In
3) Maintain 10'separetlon to all lot PLKGULATIDN RATE: GT 1 MPI
lines and proposed water Ines. APPLICATION RATE: 1.2 GPDSF
accordance with AMC75.65.
4) Lots served by community (125 SF/BR)
water system. No wells within 200' BEDROOMS: 3
2) Materials used shall be In
of proposed system. AREA REQUIRED: 375 SF
accordance with those specified In
5) Exist'g crib distance DEEP TRENCH: 5.0' ED,
AMC15.65, Wastewater Disposal.
grand -fathered to 150' min from 38 LFx 2.3' W x 5.0 ED, 7.0'M
Class A well. TOTAL AREA: 380 SF
1000q SEPTIC TANK
PREPARED FOR:
PANNONE ENG. SVC, LLC
P. O. BOX 102954
Jonathon and Ka ycee Hammond
23747 Hilltop Dr.
ANCHORAGE, ALASKA 99510
Chugiak, AK 99567
227-3522 P, 272-8218 Fax
830.3250
DATE: 05.3'146
PLAN
PERMIT NO: DESIGN DRAWING DETAILS P•I•D.NO: 051-521-03
WASTEWATER DISPOSAL SYSTEM
Lot 3 Block 3 Troll Knoll S/D
ino wm
ON3 WJV31V
3afLL tlOLNOW
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...• ... • ............••••••..... PREPARED FOR: PANNONE ENG. SVC, LLC
• i Steven R. Pannone H{ N
♦♦ .'• 2 P. O. BOX 102954
♦ Jj C 8149 Jonathon end Kaycee Hammond ANCHORAGE,
♦♦"�;••.�,jl,,.••'��� 23747HIIItoPDr. ALASKA 99510
♦444�,� Chugiak, AK 99567 227-3522 P. 272-8218 Fax
4�,"„`��� 830.3250 DATE: 05.31-06
SCALE: NTS I DETAILS
SOILS LOG - PERCOLATION TEST .�*���� 44
. 5 P( 40
E.............•...
�
PANNONE ENGINEERING SERVICES ••�'� �j.
P.O. BOX 102954 is 49 TM l V•�1
ANCHORAGE, AK 99510 i' t • • . .. . ......•••••......
(907)272-8218 r= r
W.
Steven R. Pannone? r
PERFORMED FOR: Jonathon and Kaycee Hammond DATE PERFORMED' OS23-06 �j CE 8149 '
�� '.•••��
LEGAL DESCRIPTION: Lot 3 Block 3 Troll Knoll SID ��1,,,,,'_sy.�•
TEST HOLE 1
OR SLOPE SITE PLAN
Oipanks
1
3
3 GP Poorly Graded
Gravels and
4 Sand /
5 2:1 SLOPE
TEST \ �
8 HOLE
\ TH7
7�
S
i
9 Gm Sly Gravel
10 \ v v
i
12 GP Poorty Graded .\
Gravel \ i
1J
WAS GROUND WATER SLOPE
14 ENCOUNTERED? no
15 IF YES, AT WHAT TEST HOLE
18
BOH DEPTH?
X
77 DEPTH TO WATER AFTER
MONITORING? Oil
18 DATE:
19 CLOCK
20
PERCOLATION RATE GT 1 (minAnch) PERC HOLE DIAMETER 6Inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS: Test hole excavated by Flinestone. Test Hole was presoaked before perc test
PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
READING
DATE
TIME
NET TME
WATER
LEVEL
READING
NET DROP
1
012]-08
Parc. Rao G.T.1 mF,krll.
a pa 4.7 nln- RIw a f arms.
wn.rpaa.wmw,«aemr.p..war.
2
J
�
s
S
GREt"ER ANCHORAGE AREA BOP` "UGH
CI I�y/ Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME & GAK.S^,v MAILING ADDRESS &--A S94 E7N/r16 rOrb @ PHONE &W-`2749
LOCATION PerCrf �CC'Ek LEGAL DESCRIPTION lo) 3 6 1-ck 3 7k-// Alwa S4 .
SEPTIC TANK: ULv Ig44S�
DISTANCE 1 NUMBER OF
FROM WELL x?_0 MANUFACTURER STAty STEEL MATERIAL S'rEF(^ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH 1 IQUID CAPACITY 1000 GALLONS.
SEEPAGE PIT: IZ I 12
toll 1
NUMBER OF PITS I DIAMETER 46 OR WIDTH( a._.{ LENGT DEPTH �7
LINING MATERIAL Lo(- CRIB SIZE: DIAMETER-LDEPTH L -
DISTANCE FROM: WELL 00#6IUCU./MU(t)
1 TOTAL EFFECTIVE nn
BUILDING FOUNDATION Sa , NEAREST LOT LINE S3 . ABSORPTION AREA (WALL AREA) ZC� SQ. FT.
ADDITIONAL ABSORPTION
WELL::
TYPE 60014 W IV
BUILDING
FOUNDATION ,
CONSTRUCTION
NEAREST
LOT LINE ,
CESSPOOL , OTHERSOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
AL LArcto
PIPE MATERIAL:
(AKT Troll
LOT SLOPE: r
REMARKS: l,esS of �VQVCI
Lelk, Wa..s t UV4,
Form No. E"31
DEPTH
NEAREST SEPTIC
SEWER LINE , TANK.
REMARKS
DIAGRAM OF SYSTEM
SruEr
E—Z id
DATE '"lAq IIII47q
DISTANCE FROM:
SEEPAGE
SYSTEM
Z e
s
r
APPROVED
.A.A.B.
n n
0 & E ENGINEERING & DEVELOPMENT CO.
' .
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 333-5240
Russell Oyster
Earl Ellis
694-2774
333-5240
Civil Engineering
Surveying
Soils Et Foundations
Land Development
SOIL LOG
Performed
for: Name: Ott Q�� �n2`�a Tel. No.
Mailing Address: t'�i- nx o>s 4
Legal Description: L—b-c 3 c .ncac 3
Depth (feet) Soil Characteristics
0
2
;..
3
4
5
6
�GG4ls�1��i1�/ ��� SIn1M
8
W .: VN +C> ¢4a Gt- N vzc
g
10
11
12
Ground Water Encountered: Yes No—AL If yess what depth
Proposed
Installation: Seepage Pit ✓ Drain Field
Comments:
t`t\4Ae.1�2457 lzvn'tZIN- 14:
�ift7c-�rK a C- r-Ak.�c� Wo« �►J �Lv%P20e-2 �0 ac-fA
Performed
by: a C� �'`�`� ' Date: g nm-s7 74
i
I-.
r
1
(
1
11 _
r' � -., " 1, � c -531 .. r • —
Parcel I.D. 051-521-03
6£ 84
Municipality of Anchorage
On -Site Water and Wastewater Program <
(907)343-7904 SFF ETI n
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Expiration Date: 7 r!D
Troll Knoll, Block 3, Lot 3
Location (site address) 23747 Hilltop Drive Chugiak, AK 99567
Current Propertyowner(s) Jonathan Hammond Day phone 830-3250
Mailing address 23747 Hilltop Drive Chugiak, AK 99567
Real Estate Agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class A Well
0
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request
requested by the engineer.
COSA Fee $ C2 6 Waiver Fee $
Date of Payment
Receipt Number O Z
COSA # '� 1 �f O 9
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.
Name of Firm Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 8/13/14
By: Original Certificate Date:_ %-
The Muni cipa ily o nchorage 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. TheMunicipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r ..i c
all, '• S
AV
„fir 49tH
6. DSD SIGNATURE
Ill
y{�[ ,.
•......see
" Aq��p;YtaLrT�:
System #1 Approved for bedrooms
/.`
MICR\ HJDEQ:ON
System #2 Approved for bedrooms`Oc✓i',
x-4381
.. /0 - Z7- / • -
Disapproved
#iI; pROf`SSI��p� "R
Conditional approval for bedrooms, with the following stipulattiiol ®a®o
By: Original Certificate Date:_ %-
The Muni cipa ily o nchorage 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. TheMunicipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r ..i c
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: Troll Knoll, Block 3, Lot 3 Parcel ID: 051-521-03
A. WELL DATA
Well type Class A If A. B, or C provide PWSID # 210778 Well Log (Y/N)
Date completed Sanitary seal (Y/N) _ Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
ft.
g.p.m.
Tank Type/Material Septic/Steel Date installed 6/12/06
Tank size 1,000 gal Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) _ N
Date of pumping 7/31/14 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Date installed 6/12/06 Soil rating (g.p.d./ft2 or ftZ/bdrm) 1.0 GPD/SF System type Deep Trench
Length 38 ft. Width 2.5 ft. Gravel below pipe 5 ft.
Total depth 8 ft. Eff. absorption area 380 ftZ Monitoring tube Y Depression over field N
Date of adequacy test 8/7/14 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 480 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
i
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons_
"Pump off"level at
Cycles tested _
Manhole/Access(Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOTTO:
Building foundation >5 Property line >5 Absorption fiel
Water main >10, Water service line >10' Surface water
Wells on adjacent lots >200'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10,
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent lots >200'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 4/17114
COSA brown sheet 10-10-12.doc
d >5,
>100'
Water main NIA
Driveway, parking/vehicle storage > 10,
:F --,q too
..If-
E ANDIRSON •,4�
.4381
LOT 3 BLOCK 3 HAS
32,498 SQ.FT. OF AREA
�ov
GRAPHIC SCALE. 1 Inch = 30 Feet
FOR: ANDERSON ENGINEERING
Date
Scale
Legal Description
10-22-14
1" = 40'
Lot 3
Block 3
FORBES& ASSOCIATES, INC.
Grid
As -Built Survey
NW 1360
2140189
TROLL KNOLL
P.O. Box 232293
Anchorage, Alaska 99523
Drawn by
Field Book
SUBDIVISION
(907) 227-5881
cef
244
1 hereby certify that the property
described hereon has been surveyed'�'��•0�,�,}t/��`
by me, or at my direction, and that
the improvements situated thereon
= �� .. a„ •L,
are within the property lines and do
thereto
not overlap or encroach on the
otherwise shown. That no
•
St�
property lying adjacent unless
improvements on the property lying
adjacent there encroach on the
��P•.+,.
premises in question and that there
are no roadways, transmission
*� d9- TH••••
lines or other easements on said property except as shown.%•••+•
+.. ... ........... �
th
b 1d rior to construction
�' ••'•*•• •++•••••••••+•/
It is the responsib�hty of e owner or uL er, p Im
to verify proposed building grade relative to finish grade and utilityCHARLES E. FORBES
connections and to determine the existence of any easements, covenants, ,� ;;0. LS -7326 0
or restrictions which do not appear on the recorded subdivision plat. *+a'•,10-22-14.p�
Listed distances prevail over scaling. r,t `RrOf88Sistrifll\,'4
Reproduction may cause distortion. ;�
Municipality of Anchorage T
• �- 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.sk.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING/ /
Parcel I.D. �/ 7`Ll -03 HAA # 114 Dao /3
Expiration Date:' / 5 = 0 3
1.' GENERAL INFORMATION ////
Complete legal description �3� 3-C ce,AGj /�COLL LIr- D L L SJR
Location (site address or directions) 4 f LJ --710P ice/ G-�t�c G fR k- ,A -!c_
Current Property owner(s) Day phone
Mailing address
Lending agency
Mailing address
2S1�� Arc. Ove -"L_ V47P2 V e—j 4"1.1 -PS? --4
Day phone
Real Estate Agent WIL-t-1 A -m t�_-6Z�4(1/,L/N IT -F_ Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup. TZ Cr,,� yliy �o z
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: '
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class A Well
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-
site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm 5+S&T1jGral t-Ert-J Q G' Phone %iq -7-.7-7-7
Address 2D C,
Engineer's Printed NameCDW AJ Date l I Z/V 2
C4W
5. DSD SIGNATURE r:QO9c> 8801 AN; .�,
Approved for 3 bedrooms. ,�'t y
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
(R". 01103)
�Cr .
��`� • • ON SITE
WATER AND ; �m
: WASTEWATER .
PROGRAM
X Maintenance Agreements
Supplemental Engineer's Report
Other
/f�^Zt Original Certificate Date: 4-t- - / s-- G :2-
(R".
Z
Municipality of Anchorage
• "' Development Services Department
Building Safety Division
On-Ske Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorage.ek.us
(907) 3437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: I�� �c eaG L �} Iwtt �flL4 g 9 Parcel ID:571
A. WELL DATA
Well type 694
Date completed _
Total depth R.
91 O:7 -?$
If A, B, or C provide PWSID # A
Sanitary seal (Y/N) _
Cased to R.
FROM WELL LOG
Date of test
Static water level / ft.
Well production / 9 -P.M.
WATER SAMPLEULTS:
Coliform colonies/100 ml. Nitrate mg.11.
138;94 sample: Collected by:
protected (Y/N)
Casing height (above ground) tn.
AT INSPECTION
B. SEPTICIHOLDING TANK DATA
Tank'fype/Materlslr ' w
Tank size 16 gal. mber of Compartments Z
Foundation cleanout (Y/N) y Depression over tank (Y/N) /J
Date of pumping 1 / bTi Pumper Trz is
C. ABSORPTION FIELD
Date installed 51)(01;4 Sollrating (g.p.dJi
ft.
9 -
p.m -
Other bacteria oolonies/100 ml.
Date installed 51 14/-,X4
Cleanouts (Y/N) /
High water alarm (Y/N) 11-v/11 //1
System type
Length /9 R. Width I Z ft. Gravel below pipe
Cc R.
Total depth i r_i ft. /Eft. absorption area ` J itz Monitoring tube Depression over field
Date of adequacy test `7 q in, Results (Pass/Fail) For 5 bedrooms
Fluid depth k absorption field retest Q in. Water added4"2rgal. New depth¢ In.
Elapsed Time: I� min. Final fluid depth 19 in.)� Absorption rate >= '751 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) A&* 1 /4 WA/ If yes, give date
i
D. LIFT STATION
Date installedA- Size in gallons
'Pump on" level at in. "Pump off" level at ! In.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT
Septic tank/lift station on lot On adjacent I
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm 6 circuit requirements?
/Absorption field on lot On adjacent I
Public sewer main Public sewer
Sewer /septic service a Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I
Building foundation 5 ^} Property line Absorption field
Water main / t '- Water service line l 0t 4— Surface water
I
Ir-
100
r/OCA t -t-
Weiss on adjacent lots 74-IT2 14 -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
1
Properly line /i) �-r- Building foundation 10 1- Water main (� f
Water Service line 10 1" Surface water l res 14- Driveway, parking/vehicle storage S /t
Curtain drain /VOAIE- &IU*/ Weiss on adjacent lotst/C%o ( 72) a*G - /J15r-K49e-
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in
...
conformance with MOA HAA guidelines in effect on this date. INEffi44
Engineer's Printed Name r ` 0'9 i2i (f• �j �q„r A ROT)»51 AN
Date 4'CFt
v •• » .•••'
HAA Fee $ 7j745 -r / SD V-%)
l Date of Payment Ll ii/o 2
Receipt Number Cil ( Cd Z l0 l
(Rev. 12100) .
i+
i
Waiver Fee $
Date of Payment
Receipt Number
^! `t..�an tV,bo,�lo:lV'Ct�.ilU N.pl
' ..t � •i•t,v .. ` ••;. i•.y Sy,y, .; .lam; •a•f: t'. •�,!' , �• •.
•.i, .. AMT • �' � ' �Q, '` ''": .
yy •, t•�rla.v w•a, ,.:.•�.q�.l�y' .-.
_ter. � :' 1 t•�%�w�•CI,7•T')Yr. 11...•••`.'
, • i u. •fly f• �.
.' •' l; 4 60 y As ' .. AS -BUILT
14e� 7,Q�' { ,:• • I Etrabj e*r1ur all t hove euncyed the fo11o\
. ;,' ��'/(� .. doeesibo3 propeety�•er t�itrY
w tr�ta vjZ/nNj
IV Al
,'; + itnehonQe 140rdJnQ Precinct, end twat
Improvements situated thereon are e'tthin the pro;
• tines and co not overlap or tner0aeh
on the prop:
Writ ad)seant thereto, tnat via !m rovetnents on p
' eny 1?•inr adjacer.t Oxfol.o encroach on the preaisc
quest on end Viol the:* ars no roadways, IfanrRtif
d9s311 or Other t'luD1e 41"Mcnu on slid property ee):,a
Post- Drand fax transmittal mono 7671 sotp.ps.. ndit:at*d heron.
i
To n I, Dated et EOlo Rlvert;Alesks . -.. ,
co l s
Co. F.Ob r.T G. Joa.•SO.r ;p_ .c:.
Dspt pis SCAitrf PC. red Land
S _
10
,t c:)t' or•4 .
v � : ;-• O - '' 64- : •3t3 E c Al'•.k
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH S HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
ARL c IL i%v44AEML
4� Y:
NE
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
l� L 2
Parcel I.D. # n\ �� \ n� HAA #
1. GENERAL INFORMATION
Completelegaldescription Lot 3, Block 3, Troll Knoll S/D
Location,(siteaddress ordirections) 23747 Hilltop Drive
':Barbara Seamount 258-8600 ext
'Property owner Day phone
ingaddress••••-25"116 Eagle River Road, Eagle River,AK 99577
g ..9 y ....... _..
Lendin a enc Day phone
'Mailing address.,'
AgehtDynamic/Sharon Been Dayphone 345-0160
Address 3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX"
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
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.
72au(n.+.1/91) From MOARI1
1
5.
6.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
5& 5 ENGINEERING Ci 9 7 q
Name of Firm 17034 Eaglo Rtvar Loop Rood No. 404 Phone y -
Eagle River, Alaska 99577
Address
Engineer's signature
DHHS SIGNATURE
Approved for
— Disapproved.
y"�IL 4
THREE bedrooms.
Conditional approval for
Additional Comments
By: %C,- — ,;,? _'- a'l /1-
111Th
Date 1019619-7
LON
CE - 8801 ter` j
i
�j—
bedrooms, with the following stipulations:
Date 10—.0'1%-q9
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 courtesyto purchasersof homes
and their lendi ng 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.
7VM5M..1/91t e.a Mwm
• RECEIVED
Municipality of Anchorage OCT 76 1999
DEPARTMENT OF HEALTH & HUMAN SERVICESiNicIPAUTr Ur AN'-"
Environmental Services Division ENy1RCX4W&NTAt SERVICES
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: Lor 3 0LocK 3 TROLL k„eeLL SAParcell.D.:
A. WELL DATA
Well type C L 4 SJ A If A, B, or C, attach ADEC letter. ADEC water system number a/ 0 -1 i 8'
Log present (Y/N) Data completed l
Total depth Cased to ng height (above ground)
Sanitary seal (YM) Wires properly protected (Y/N)
FROM WELL LOO AT INSPECTION
Date of test
Static water level
Well production g.p.m. 9—
p.m-WATER SAMPL ESULTS:
Couto Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 07Y Tank size DO D Obi. Number of Compartments Z Cleanouts (qN) WS
Foundation cleanout ®(N) Yd S Depression (Ye N 0 High water alarm (Y,11 tv 0
Date of Pumping O g9 Pumper 7 R J
C. ABSORPTION FIELD DATA, '
Date installed -7 Soil rating (g.p.d./ft' or� 75 System type C it c 4
Length a Width 1 a` Gravel thicimess below pipe G' Total depth /0
•
Effective absorptlon area ? �� 2 Monitoring Tube present GfN) Yrs Depression over field (Ye w o
Date of adequao test 10I a - r' 9 °I Results as` ail) IN rS' For 3 bedrooms
Fluid depth In absorption field before test (in.); O Immediately afterjS3 gal. water added (in.): 1
_ Absorption rate t g.p.d.Fluid depth (ins)
Perwdde treatment (past 12 months) (YM) Nord K,006"N If yes, give date
72-026 (Rev. 3196)'
f
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) `Pump on" F aTr "Pump off" level at'
High water alarm level at* `Datum
Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot On adjacent lots /
Absorption field on lot _O Iacent Tots
Public sewer main Public sewer manhole/cleanout
Sewer /septic line Lifl station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
r �
Foundation S i Property line S` t Absorption field
r ,
Water main/service line / 0 ; Surface water/drainage 10 c }' Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
S
Property fine 1 0 f Building foundation f 0 f Water maintservice line
Surface water 1 o o '+- Driveway, paridng/vehicle storage area
Curtain drain N o h Q IC rN 0 w N Wells on adjacent lots f` 190 r o
4*- C,44...o 1247-N4,tta -
F. ENGINEER'S CERTIFICATION
1 certify that I have deterr=M;�TAdefin
minneeedthru field Inspections and review of Municipal records
in conformance wgs in effecton this date. r2 ...
Signature �t(,'"�� �* th
Engineer's Name R•A'L'tr C- COW04Aa ..,
s+ aceewC.00WAN !Y!
Date I0 a 9 C) if` CE -8801
\ to
1� 4 .• La i
'aoo
to
/0 f
W E w q0V S 4E
S¢9
I` --are
v�7 0_ $=,
HAA Fee $ Waiver Fee $
Date of Payment a — -1 6 % //` 1 Date of Payment
Receipt Number �� J� tP( J Receipt Number
72-026 (Rev. 3196)'
MUNICIPALITY OF ANCHORAGE Ak
• '• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services 91
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcell.D.# hral-!��t-C�°a HAA# �1F�R�ll�f11
1. GENERAL INFORMATION
Complete legal description Lot 3; Btock 3; TaotF Knott Subdivision
Location (site address or directions) 23747H.ctttopDni.ve, Chug.iak
Property owner Ray and Evetyn Ha)tki.6 Day phone ( 209) 768-0184
Mailing address 6230 Stoney Ca.eek Road, Jackson, CA 95642
Lending agency
Mailing address
Agent Bob Wambott/ REMAX EAGLE RIVER
Address 16600 Cente 4iefd Da. suite 201
Day phone
Day phone 694-4200
Eagle Riven., AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XXX
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.
n -M (Rw. 1/91) front MOA 121
S. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage tiles 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
Address
Engineer's signature
6. DHHS SIGNATURE
Approved for
Disapproved.
5 & S ENGINEERING Phone
17034 Eagle River Loop Rud No. 204
Eagle River, Alaska 99577
Conditional approval for
Additional Comments
I) bedrooms.
By: `66
Date 21%i3
bedrooms, with the following stipulations:
Date y1/.713
a
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 purchasers 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.
72-0t MW. Ve11 B, k MOA#21
.r Municipality of Anchorage.
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: "> TA -V-'> Ii.-t,u- 4 °,bu- SID Parcel I.D. L051 5ZI-65
A. WELL DATA
Well type ik
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
If A, B. or C, attach ADEC letter. ADEC water system number ZI D'!1 8
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot %o �+
Absorption field on lot %� 1 `% O,
AT INSPECTION
n N
g.p.m. g.p.m.
Cio
rn w
Z
O m
On adjacent lots Z
On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
l7FiFr t�cTTr rte L&�'� f- GYT� (e 24 S5 FfLpNI �GC• �o �iR 1:5.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
B. SEPTIC/HOLDING TAN ,pATA
Date installed of 7 Tank size \ oco Compartments 2-
Cleanouts &N) Foundation cleanout O/N) Depression (Y/0 01
High water alarm (Y& Alarm tested (Y/N) S�
Date of,pumping 4 ' 1`\ '-`�3 — Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TAN`( TO:
Well(s)onlot 7-0 0,+ Onadjacentlots F� a Foundation \O��
To property line \D, Absorptionfield \ Water main/service line
Surface water/drainage \ o o \ )r
Nitrate
Collected by:
Other bacteria
72.026 (Rev. 7191) From CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size In gallons
Vent(Y/N)
High water alarm level
Meets MOA electrical
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
=P p off- f- level at
ANCE FROM LIFT STATION TO:
on lot On adjacent lots
D. ABSORPTION FIELD DATA
S/
Date installed
S��y
Length ' 1?.1 Width 1V
Total absorption area Zg
Depression over field (Y& a
Results jLi;;�fail) �iRs
Peroxide treatment (pas( 12 months) (YPN
Cycles tested
Soil rating 6-.5" Ailgf-
Gravel thickness V 1
Surface water
System type SEetPrn E P,T
Total depth b�
Cteanouts present a/N)
Date of adequacy test 4 -St ,93,
for T4EKr- 03�) '— II bedrooms
ikv-�6 If yes, give date rS` a
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot �`t�, On adjacent lots ~1� Propertyline tnkIr-
To building foundation �Yo To existing or abandoned system on lot
On adjacent lots 3o v Cutbank `Sk A- Water main/service line
Surface water II o o r Driveway, parking/vehicle storage area
Curtain drain ►,\A
SE.� D-cc-ac►16.J t_Fvr�rh_¢.. D�6A lc-7�(--Q6
E. ENGINEER'S CERTIFICATION
-r......
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
.'�� O,�
S 8 S ENGINEERING - ? �•,,,••� F A4
77074 Engle River Loop Road No 9 Q ••� •�'
Signature e M g f•• 11 `tis'•j
Ea;te 6ivor, Alaska 99577
Engineer's Name
Date
�-ZZfi3
HAA Fee $ /,
?n'
Date of Payment 11-;z 7
Receipt Number
72-026 (RM. 7/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
SENT BY:AOEC MVHORA3E 3-16-83 9:07AM ;ANCHORAGE WESTERN 004S&S'ENSINEERING .__ ;9 2
ANCHORAGEiUF.STERN DISTRICT OFFICE
3601 C STREET, SUITE 1334
ANCHORAGE, ALASKA 99503
June 24, 1988
563-6775
Eagle River Engineering Services
Lou Butera, PE
PO Box 773294
Eagle River. AK 99577
SUBJECT: TROLL KNOLL SUBDIVISION, Peters Creek
Dear hr. Butera:
Upon inspection• and roview, the department has determined that
Troll Knoll Subdivision falls under the o rr. r eceraL.gn
regulations in effect at the time of installation. Therefore,
the separation distances ars as fellows:
i. 150' from the subject well to drainfield.
2. 120' from the subject well to septic tank, and sewers.
If you have any further questions, please contact me at the above
number.
Sinceerreelly,
Steven U -Ano, PE
District Engineer
SUE:pkk
S VE o a USK A/ WALTER J. HICKEL, GOVERNOR
DEIvr.OF ENVIIIONMENTAL CONSE11VAT1ON
ANCHORAGE DISTRICT OFFICE (907) 349-7755
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
April 19, 1993
Mr. Ray Shafer
S & S Engineering
SUBJECT: Troll Knoll Subdivision
Class "A" Public Water System, PWSID 210778
Dear Mr. Shafer:
have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on March 24, 1993. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on April 4, 1992. This q2gLmept the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations. A reading of 8.2
mg/I nitrate was reported in the last sample, additional sampling Is being
requested.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on January 4, 1993. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on May 19, 1992. Based on analysis of
the previous VOC samples results have been satisfactory. This does meet
the provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
Ic��
Environmental Eng. Asst. 11
APPLICNT FILLS OUT UPPER HAI" IONLY
_Property Owner �iPT✓✓ 44/i/j
Mailing Address / Zip Code
Buyer 01a I'7 /.5 '
Address /S�� eZG,e �A AvE FT /12C-11 ZIP Code
Lending Institution /fly(' y5 A C/rE/L! 6!//✓C/L/ ll f lTo // ) �y
Address ,r'4G/C/✓ 6�/3 /i�/t✓C/i� AK. Zip ��
Realty Co. d Agent /✓/'P'l'T/77,11V4A I/ i'P.C�f'G Ty—✓G.{//./ /✓i9.n/J�✓ice/C
Address--? j_S 5'fl,",A�/� ✓t�%G{1S7/:�/�� zip code q'9SG
Legal Description LOT `y�j .3� 1/PvGG /Y✓✓OLG 5'&6
Street Location
Type of Residence
,W Single Family
❑ Multiple Family No. of Bedroom }
❑ Other
Water Supply
❑ Individual
(R Community
❑ Public Utility
Sewer Disposal
R Individual
❑ Public Utility
❑ Holding Tank
Phone
Phonec
Phone
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log If available).
Year Individual Installed: / 9
When Connected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes: c n �j J
rA
dab 04
Lrs
f
11
( jAPPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE I O= O Y�
BY: r, `lam SLSZ..: 2S
'CONDITIONS OF APPROVAL
Well To Absorption AreaWell
WellI Log Received
Soils Rating�L Cc. A
Wall to Tank �'" Septic Tank Size t9 C7
I
Date Sewer Installed
— S�`i
T — (C, —
I 7
VM34M
January 4, 1984
Bertna and David Victoroff
Subject: Lot 3, Block 3, Troll Knoll Subdivision
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° The septic tank pumped with a receipt submitted to this
department.
° An adequacy test needs to be pertormed on the existing
leaching area. This test will determine if the system 1s
adequate according to National Standards. A listing of
private firms performing the test is enclosed. This report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Cory'Willis, R.S.
Acting sewer & mater
Program Manager
CW84/ej/E1
Enclosure
t'1
January 8, 1984
ADEOUACYTEST
WATER AND SEWER INSPECTION
WELL INSPECTIONS AND
FLOW TEST
SITE PLANS
ROAD DESIGN
SOILTEST
DISPOSAL SYSTEM DESIGN
EXCAVATION WORK
Hartman Real Estate
ATTENTION: John Hardwick
3136 Seward Highway
Anchorage, Alaska 99503
Dear Mr. Hardwick,
Reference: Lot 3: Block 3: Troll Knoll Subdivision
ROBERT A. SHAFER
CIVILENGINEER
6942979
A sewer system adequacy test was performed on the system located
on the referenced property, as you requested. The septic tank
was pumped and verified to have a capacity of 1000.gallons. The
seepage pit was charged with 1000 gallons of fresh water and after
a period of 24 hours all the water which had been added to the crib
had percolated out. It can be concluded from this test that the
waste wY disposal serving the three bedroom residence located on
this property is currently funrLie ing—a-� atel . However, the
system cannot be guaranteed against subsequentailure.
If we may be of further service, please do not hesitate to call.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA 99577
9
MUNICIPALITY OF ANCHORAr`� EAGLE RIVER AREA
� >> DEPARTM._, OF HEALTH AND ENVIRONMEN. " PROTECTION
I 825 L Street, Anchorage, Alaska 99501 /,,/(�
279-2511, ext. 224 or 225
/ Date Received: May 25, 1977 l�
#1: Time #2: Time win #3: Time //;, n 4,11.
Date Date /n -Q- -7? 1. �F�� Date
Insp Insp 12, Ins
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Security Pacific Mortgage 8 Bob Fritz
Mailing Address: 1011 East Tudor Road Suite 190 Phone: 276-1933
2. Property (wner: Clinton/Mary Lea Conover Phone: 694-2101/his work
Mailing Address: 688-3441/home
n_Lt _.) La 9t - ni
I%A_Tti,l
3. Legal Description: Lot 3 Block 3 Troll Knoll Subdivision
4: _Single Family Residencc:_(X)_.___-.Number of -Bedrooms:_ 3
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well ( ) Community/Public System (X)
Permit # Depth of Well Well Log on File ( )
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (X) Public Utility ( )
Permit # Installed Installer
Septic Tank Size / O U d Manufacturer , 1E0
Absorption Area ,a 0 Soils Rate gS Material /1 X 1 '-1( (-
7. Distances: Well to Septic Tank Cr,.V - to Absorption Arca
to Sewer Line Nearest Lot line Absorption Arca
to Nearest Lot Line
Pag,e Twc
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3 Block 3 Troll Knoll Subdivision
Comments:
Affadavit Attached: ( Letter Attached: ( )
Approved: C �� Date: V
Disapproved: Date:
Department Worksheet:
S rr
a
J L(
H-ar�'� I oao
D
N
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
S1UN1C1PAUTY C.4r:Cr10?,/,0Z
VPL Or 1! M.T.1
LtP/I OA�� EfiiAl. hnOI:GTICI`I
11AY 2 5197?
RECAEIYED
1. Type of Inspection: CMRO VA %R FHA CONY
2. Property Owner: CONOVER, Clinton & Mary LEa
694-2101— C. G. Conover (w1
Mailing Address: Day Phone: 688-3441 Home
3. Name of Buyer: VICTOROFF, Dabi,d & Bertha
Mailing Address: Sr Box 6002 Park Drive. ChuriakDay Phone: 688-9151
4. Name of Lending Institution: SECURITY PACIFIC MORTGAGE CORPORATION
Mailing Address: 1011 East Tudor Road Site 19O Phone: ?76-19't3
5. Name of Realtor or Agent: none
Mailing Address: Phone:
6. Legal Description: Lot 3. Blk 3. TROLL KNOLL SUBDIVISION
Location: ChuP,iak. Alaka
7. Type of Facility to be Inspected: Sinale PAmi ly No. Bdrms. three
8. Water Supply
Community system
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) xxx
If Individual, date of installation
72.003(3/76)
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 12/8/74
Time of Inspection
Date of Inspection 12/9/74
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: Alan Larson
Mailing Address: Box 594 Eagle River AK Phone:
2. Property Owner: Same Phone:
Mailing Address: Same
3. Legal Description: Lot 3, Block 3, Troll Knoll Subd.
4. Location: Peters Creek
5. Type of facility to be inspected Single No. of bedrooms 3
6. Well Data: "COMMUNITY"
A. Type B. Depth
C. Construction D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed 1974 B. Installer Al LarsOn
C. Septic Tank: 1. Size 1000 gals 2. Manufacturer Stack Steel
D. Seepage Pit: 1. Absorption Area 288 sq. ft. 2. Material Log
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank 32' Absorption area 58'
C. Absorption area to nearest lot line 53'
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - R'e`st for Approval of Individual�ar & Water Facilities
Legal Description Lot 3, Block 3 Troll Knoll Subdivision
Comments
Approve JeS- Disapproved Date 12/9/74
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ -034 (1/74)