HomeMy WebLinkAboutHILLSIDE NORTH #7 BLK 4 LT 4Hillside North
Block 4
Lot 4
#041-033-11
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: •5W Q803g1 ' S-UJ�`tU3 V PID Number: Oql-"033 —1 1
Na":
Address: ;506 Wd / -06 I,rek,Lie { S17
Phone: a I [S _ 0-76 9 I o ,\. of Bedrooms:
Wastewater System: Q4 New O Upgrade
ABSORPTION FIELD
O( Deep Trench O Shallow Trench O aed O Mound O Other
LEGAL DESCRIPTION }�,
Lot: (.� Block (,� Subdivisio7 1' ^r /
I 1 Hi 11'51Ae Ak.--A
Soil Rating baa GPD/SQ FI.
Depth to pipe bottom from original grade:
-7 s Ft.
Township:
I pangs:
Tank
I Section:
Fill added above original grade: 0• F1.
S
WELL: 5ILNew
0 Upgrade
Gravel width. 3
F1.
Classification (Prl�qte. A,B.CI:y
r� l t✓a { e.
Total Depth:
q'a% FI.
Cased TO:
u / Ft.
Total absorption area:
SV SO. FI.
Driller: n
Data DfIl'leld:9
Q'aQ- 1
Statics W�acIeeer Level:
6 O Ft.
Installer: 1
V/00neWt9�/L 4I 4
Yatd:Pump Set at: Casing Haight Abt vve Ground:
GPM U of
I K F1. Ft.
SEPARATION DISTANCES O(Septic
From
Well
Surface
Water
Lot
Line
total Depth from original lgra let 1
Gravel depth beneath pipe 6
FI
Gravel length: tK3
it.
Number of lines: oistanee belem lines:
1 I
— FI
Pipe material:
�srM D�a3y%FBio
Date Installed: Q_30_Cl 9
TANK
O Holding
To Sepik
Abaonplan Lin
Holding
ryrblkNrFale Manufacturer:
Tank
Field Elation
Tank
Sewer Linn
100%t
1061+
Material:
sYee
Foundation
Curtain
Drain
64%
70% Size In gallons: I
8` I DL 'Pump on -level at:
`I •VfiC Kho{/1:h romp Make
O S.T.E.P.
Capacity In gallons:' .w 5O
Number of Compartments:;
LIFT STATION
High water Nerm at:
Electrical Inspections performed by \
Remarks: SVSTrE,..a DdIsIwe., C.yq, C-" BENCHMARK
Location and Description: s ls
To y /3EAAcua-7 DvA,tic, co,j:ra„r,T- BoxM sfaf✓1�
Sy SEp;rt_ )-A,v,C s/zE) Q�
Poin7"
To /3 '/;,fRa.n
I Assumed Elevation: 100 qN0 DE LP Ee+�d Ft
OAfwlwrlf- GAAOC .
S 8 S ENGINEERING
17034 Eagle River Loop Road, N04% 26 _ Q
Inspections performed by:Eaglitm ar, Alaska "577 Dates: 1st I
2nd,? -30— 99
Department of Health and Human Services approval
Reviewed and approved by: //i,kl� 1�0 Date: IZ'Z7'99
71-013Ins. 9,111 MOA 8
G Of
k
11\
IOeERT C. COWAN ,0
CE -8801
PERMIT NO. SW980341
PAGE 2 OF 3
Municipalityof Anchorage
DEPARTMENT OF HEATH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 •Anchorage, Alaska 99519-6650 • Tele e hon343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 4, HILLSIDE NORTH #7 P.I.O. NO. 041-033-11
LOT 3
UNDEVELOPED
5' SNOW STORAGE ESMT.��
°:
GT HA��. I
NO t 09L3 C0' STI
sn z 9 .1�
TBM
rco C
4Oo�4v
I I$�O
SCALE: 1' 40' I
100' WELL RADIUS
i
PERMIT NO. SW980341
PAGE 3 OF 3
Municipalit of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Tele hone 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 4, BLOCK 4, HILLSIDE NORTH #7
FINAL GRADE
95.1'
NEW
88.6' 1250 CAL
SEPTIC 88.4
TANK
P.I.D. NO. 041-033-11
A
B
C
FCO -
36.0'
3.5'
ST1 -
20.5'
25.5'
ST2 -
13.5'
32.5'
DBL1 -
11.5'
37.0'
DBL2 -
10.5'
38.5'
CO1 -
10.0'
48.0'
MT1 -
10.0'
49.0'
CO2 63.5'
67.5'
-
MT2 60.0'
64.0'
-
CO1
MTl -0O2- MT2 CO1 = 96.0'
CO2 = 96.7'
✓-FINAL GRADE
COl = 88.3'
SR CO2 = 88.3'
MTl = 82.1 "%'�MT2 = 82.1' C�1`•�
r - RO:ERT c COWAN / E
NO WATER FOUND C_-BLOI
76.1' B.O.H. Ott' `
0
NOV-19-99 FRI 01:39 PM T&J—WEISS
A%
fdBoRo cm
Na a. "At..."
LOCATIONISKETCH:
k W!
.4"e'
SeD
GOR OLE.DATA:
:DE?TJ-�.M0%'URFb ROM
'EH" - L®r
Material 'Tyoe.and,
�qnature.bf Authorized -ho;
'A 4
JI M
907 337 436
P.02
Jun 30 11 05:00p Beau Maxim 19073391985 p.2
Development Services Department
... Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Rood
P.O. Box 196650
Mark Begich Anchorage, AK 99507
Mayor www.muni.nrq/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
ILegal Description Property Owner Name & Address:
HILLSIDE NORTH #7 BLK 4 LT 4 SUSAN KRUSE 11
Pump Installation Date: sy11111
Pump Intake Depth Below Top of Well Casing: 403
Pump Manufacturer's Dame: GOULDS
Pump Model: 10SB15 PUMP END
Pump Size 1.5 hp
Pitless Adapter Burial Depth: 9 feet
Pitless Adapter Manufacturer's Name: CAMBEL
Pitless Adapter Installer: RVA
feet
9875 MIDDLEROCK RD
ANCHORAGE, AK
Well Disinfected Upon Completion? Z Yes ❑ No
Method of Disinfection: RECIRCULATED USING CHLORINE PELLETS
Comments:
Pump Installer Name: BEAU MAXIM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
'0.
a
V
'L
G
G
ILegal Description Property Owner Name & Address:
HILLSIDE NORTH #7 BLK 4 LT 4 SUSAN KRUSE 11
Pump Installation Date: sy11111
Pump Intake Depth Below Top of Well Casing: 403
Pump Manufacturer's Dame: GOULDS
Pump Model: 10SB15 PUMP END
Pump Size 1.5 hp
Pitless Adapter Burial Depth: 9 feet
Pitless Adapter Manufacturer's Name: CAMBEL
Pitless Adapter Installer: RVA
feet
9875 MIDDLEROCK RD
ANCHORAGE, AK
Well Disinfected Upon Completion? Z Yes ❑ No
Method of Disinfection: RECIRCULATED USING CHLORINE PELLETS
Comments:
Pump Installer Name: BEAU MAXIM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
' MUNICIPALITY OF ANCHORAGE
Department of Hearth and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW990313
Legal Description: HILLSIDE NORTH #7 BLK 4 LT 4
Date Issued: Sep 02, 1999
Expiration Date: Sep 01, 2000
Parcel ID: 041-033-11
Design Engineer. 0003 S & S Engineering Site Address: 009875 MIDDLEROCK RD
Owner Name: TROY D. & JANET L. WEISS Lot Size: 88427 SO. FT.
Owner Address: 2506 WEST 27TH AVE., APT. 06 Total Bedrooms: 6 Permit Bedrooms: 6
ANCHORAGE. AK 99517-3361
This permit Is for the construction of:
Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by catling
(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.
Received By
Issued By
Date: 4/1— 3 —
Date: ?— 2 — 9 /
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-SRe Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
(:f S - 2 (o - 2 9
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW980341
Legal Description: HILLSIDE NORTH #7 BLK 4 LT 4
Date Issued: Sep 03, 1998
Expiration Date: Sep 03, 1999
Parcel ID: 041-033-11
Design Engineer. 0003 S & S Engineering Site Address:
Owner Name: INNOVATIVE CONSTRUCTION Lot Size: 88427 SO. FT.
Owner Address: P.O. BOX 203145 Total Bedrooms: 6 Permit Bedrooms: 6
ANCHORAGE. AK 99504-3361
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify 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. 11
Y\
C�av�3Q - 1250 ga` +o ,ni is M0\1i
S �1iA" Vit \y
' A -13Z (.
Received By:—
Issued By:
�l4/9(-
Date:
Date: ( 2 —7U
August 19, 1998
APPR AL"NOPoTY MUNICIPALITY OF ANCHORAGE
ArPRovALs
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
SEWER&WATER
MAINDOENSIONS
REFERENCE: Lot 4, Block 4, Hillside North Subdivision #7
ROBERTC. COWAN. P.E.
ROBERrA. SHAFER P.E.
CML ENGINEERS
(907)694-2979
FAX(907)694-1211
SEWER&WATER WALL AND
INSPECTION Request you issue a permit to install a+septic system to serve the six bedroom
dwelling on the referenced property.
A test hole was excavated and percolation test performed. The approximate location of
ENCJREPo� sTuaEs the test hole is located on the attached site plan.
At the time of excavation 08/14/98 water was not encountered in the test hole; After
WELL04PECDON seven days of ground water monitoring the test hole w: - found to be dry.
& FLOW TEST
We do not anticipate any adverse effects on neighboring wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. The
SITE PLANS construction of this system will not prevent any future development on any of the
adjacent properties.
If you require additional information, please contact us.
ROADDESIGN
Sincerely,
y /
SOILTEST 7
a11�(� GG-�
Robert C. Cowan, P.E.
RCC/mg
PERCOLATION
TEST
Enclosure
STRUCTURAL &
MECHANICAL
NsKcnow
ONSITE
WASTEWATER
CISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577
t." = 60,I DESIGN
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Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES E%2% r 7}
825 "L" Street, Anchorage, Alaska 99502-0650 A f
SOILS LOG — PERCOLATION TEST
.e 1 ROBERT
o C
PERFORMED FOR: /NNO v4 T/v/f- CO3, 07/1,. DATE PERFORME&Il<A ... ,-q;'Q���J '
__.
LEGAL DESCRIPTION:J-o7" AI-/C Township, Range, Section: -
DEPTH 4""310E. NO/i 7F/ i/' `J SLOPE SITE PLAN
OA,G.4Ni C3
1 t
2- N
3-
f 1
4- b Str4//riv tt�ry /�Jr�A�aen
% SA N p 4- G-2Av(1 S /YF.
5— l
w / L,4,1 &A, COA8L4 f pLq A,
6-
7-
8-
10-
-7-8-10- WAS GROUND WATER ^/ D
% ENCOUNTEREDT
11- S
tel' IF YES, AT WHAT -. LO
12- DEPTH? P
E
t v wAlter
Monitoring?
I I Y
13 — Depth e mto g7? DA A Dslr fi 3. tt
i1
14 Reading Date Gross Net Depth to Net
Time Time Water Drop
140 ZVI
V
/ -txt« 30 $ t/ ' l'
17— r Rthe, « 40 �r�4 Y
18—
19—
4,40.H.
zD —
PERCOLATION RATE a •• 3 iminutesnnch) PERC HOLE DIAMETER
TEST RUN BETWEEN o FT AND --Cj--FT
COMMENTS
PERFORMED BY: S 3 S ENGINEERING i CERTIFY THAT THIS EST WAS PERFORMED IN
17034 Eacle River LOop Road 6Jg 8 /yo �q
ACCORDANCE WITh eS /1XV6MU *ft GUI �I IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
HEALTHAUTHOWTY
APPROVALS
ng
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 4, Block 4, Hillside North Subdivision #7
August 19, 1998
SEWER d WATER
MAMID(TENSIONS GENERAL:
ROBERTC.COWAN, P.E.
ROBERTA. SHAFER P.E.
CML ENGINEERS
(907) 694-2979
FAX (907) 694-1211
1. The scope of this project includes the installation of a 2000 gallon septic tank, six
SEWERBWATER bedroom leachfield trench and well to serve the residence located on the referenced
INSPECTION property.
2. Construction shall be in accordance with the approved site plan and design drawings,
ENGINEERINGSTUDIES Municipal permit with any special provisions or conditions, and all applicable State and
ANDREPORTS Municipal Wastewater Disposal Regulations.
3. The contractor shall be responsible for obtaining any necessary underground utility
WELLINSPECROI locates.
b FLONTEST
4. Unless specifically agreed otherwise, the property owner shall be responsible for final
grading areas subsequently depressed from soil settling.
SITE PIANS
5. Contractors installing wastewater disposal systems must be certified by the Municipal
Health Department for system installations. Owners installing their own systems must
ROAD DESIGN also receive prior approval from the Municipal Health Department.
SOILTEST
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction
shall include two 4" cleanouts for pumping access.
PERCOLATION
TEST 2. The septic tank shall be sufficiently bedded to prevent settling or shilling of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above final
STRUCTURAL& grade.
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99571
Page Two
Lot 4, Blocky; Hillside North S/D #7
Aug 19, 1998
4. Septic tanks installed with less than 4 ft. of cover shall be insulated.
5. A foundation cleanout shall be installed one to four feet from the building foundation.
In the line between the tank and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic tank). These cleanouts shall
be located on undisturbed soil not more than 1011. from the tank. The first cleanout, in
line, shall be to clean toward the leachfield. The second cleanout shall be to clean
toward the septic tank.
6. Final grading over the septic tank shall be such that a positive slope exists away from
the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
Excavate the proposed trench to the dimensions shown on the design. The bottom of
the excavation shall be within 2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock)
placement.
2. Once the gravel is installed, the distribution pipe is to be installed level with the
perforations faced downward. Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil backfill.
Ensure the silt barrier covers the entire gravel surface before placing backfill.
4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final grade.
The portion of the monitoring tube extending through the gravel shall be perforated
from the bottom of the trench to the invert of the distribution pipe. This is equivalent to
the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four (24) inches.
Insulation must be installed when the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent the formation of a
depression after settling.
Page Three
Lot 4, Block; Hillside North S/D #7
Aug 19, 1998
MINIMUM MATERIAL SPECIFICATIONS:
(4
4.
61
Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
Type of Pipe
Cast Iron
Yes
ASTM D3034 (PVC)
ASTM F810 (HDPE)
ASTM D2662 (ABS)
Yes
Yes Yes
Yes No
Yes Yes
Use of a type of pipe other than listed above must be approved by the inspecting
engineer.
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical
Company Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco,
or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed
between the final leachfield gravel layer and the native soil backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3%
passing the #200 sieve.
When sand is being used as a filter material, its gradation specifications must conform
to current M.O.A. or D.E.C. requirements, which ever requirement applies.
INSPECTIONS:
Typically there will be a minimum of three (3) inspections required during the installation of
the wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
Page Four
Lot 4, Blocky Hillside North S/D #7
Aug 19, 1998
2. The second inspection must be conducted after the placement of the silt barrier,
gravel, distribution lines, standpipes, cleanouts, and insulation, but before the
placement of any other backfill.
3. The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required. Especially with the installation of
multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting
engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a
pre -construction meeting will take place on-site. The inspecting engineer will not coordinate,
direct or control in any way the contractors activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and plans and in accordance with the attached M.O.A. permit. There will be no
contractual arrangement existing between the contractor and S & S Engineering. S & S
Engineering shall be the owner's representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the contractors work rests with the
owner and the M.O.A.
S & S Engineering shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the contractor
to carry out the work in accordance with these construction documents. S & S Engineering's
inspecting engineer will not be responsible for the construction means, methods, techniques,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
• Municipality of Anchorage *A.
On -Site Water and Wastewater Program(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 041-033-11 Expiration Date: /(i��
1. GENERAL INFORMATION
Complete legal description Lot 4, Block 4, Hillside North Subdivision Addn. #7
Location (site address) 9875 Middlerock Road
Current Property owner(s) Susan Kruse Day phone 907-337-4165
Mailing address 9875 Middlerock Road, Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
-4---
--- -- --
-- --
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual
E)
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by: Dater
COSA to be released to the engineer,:unlesq erwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment
Receipt Number
COSA#
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. l 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 DHI Consulting Engineers, LLC Phone 907-344-1385
Address 800 E Dimond Blvd. Ste. 3-640, Anchorage, AK 99515
Engineer's Printed Name Dee High Date 10/16/15 .
By: tl -JC Original Certificate Datej 2'%s l.S
The Municipality of Anchorage Development Services Division (DSD) issues -Certificates of On -Site. Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet ( c
N ' TH :�
6. DSD SIGNATURE
�•• .........'*
V System #1 Approved for bedrooms
!••• ........ .. ... ....
��DENNIS DEE H s
System #2 Approved for bedrooms
�9 •• cE sao� •�� rAr
'�
Disapproved
PrP s ••••.NN• �-.
+� aprofesstia0��
Conditional approval for bedrooms, with the following stipulations:
By: tl -JC Original Certificate Datej 2'%s l.S
The Municipality of Anchorage Development Services Division (DSD) issues -Certificates of On -Site. Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet ( 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: Lot 4. Block 4. Hillside North #7 Parcel ID: 041-033-11
A. WELL DATA
Well type Privatp If A, B, or C provide PWSID # NIA Well Log (YIN) Y
Date completed 9-22-98 Sanitary seal (YIN) N Wires properly protected (YIN) Y
Total depth 427 ft. Cased to 87 ft. Casing height (above ground) 19 in.
FROM WELL LOG
Date of test 9-22-98
Static water level 88 ft.
Well production 3 9 -
p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 2.3 mg/L
Arsenic N _ ug/L Dateofsample: 9-28-15
B. SEPTIC/HOLDING TANK DATA
AT INSPECTION
•b1.iSiF
6.0 9 -
p.m -
Collected by: Dustin High
Tank Type/Material Septic Tank - Greer/Steel Date installed 8-30-99
Tank size 1250 gal. Number of Compartments _2_ Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N
Date of pumping _12-2-15 Pumper A+ Home Services, Inc.
C. ABSORPTION FIELD DATA
Date installed 8-30-99 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type Deep Trench
Length 63 ft. Width 3 ft. Gravel below pipe 6 fL
Total depth 15.1 ft. Elf. absorption area 756 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 9-25-15 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 678 gal. New depth 0 in.
Elapsed Time: 20_ min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons
Manhole/Access (Y/N)
in. "Pump off' level at in. High water alarm level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 100'+
Sewer /septic service line 100'+
Animal containment areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Meets alarm R circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank 100'+
Manure/animal excrete storage areas 100'+
Building foundation 11' Property line 65+/- Absorption field 18'
Water main 1004 Water service line 1001+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 65'+/- Building foundation 11' Water main 100'+
Water Service line 1001+ Surfacewater 100'+ Driveway, parking/vehicle storage 30'
Curtain drain None observed Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I 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.
Engineer's Printed Name
Date
COSA canary sheet 2-6.15.doc
1p
CE 5807
; --......--o'er
in.
lecal description
1.
A Sit%J!CJ_E-- i-AMILY DWELLING
HA -A# 13 D 04a
Expiration' p.ir.ation D. I ate: 11103
S/D 1117; L.bT �4,' BLOCK-f-
M:.DDLER0IX RD.
TROY & WDSS
9875 N!IDDLEROCK RD.
Day phone 564=56134
.'.Day phone
Municipality:of Anchbrage.�,- 40
Development Services Denarfibent
Building Satety Division
VA
On -Silo Water & Wastewater Program
4700 Sou'lh Bragaw St.
P.O. Box 196650 Anchorage; AK 99519-6650
W%"V.ci.anchoragc.ak.us
(q07 )343-. 7904
CER R T !1=IGE1 / i i:,PPOVAL
E OF: I-IFALIF AUTHORI -Y A
lecal description
1.
A Sit%J!CJ_E-- i-AMILY DWELLING
HA -A# 13 D 04a
Expiration' p.ir.ation D. I ate: 11103
S/D 1117; L.bT �4,' BLOCK-f-
M:.DDLER0IX RD.
TROY & WDSS
9875 N!IDDLEROCK RD.
Day phone 564=56134
.'.Day phone
1v
A
4. STATEMENT OF INSPECTION BY. ENGINEER
or t6& validat6i date shown . bolo -w, I verify that my,
As certified : d by my seal affixed hereto.'.an' as.: i
Y. �'- � . .
investigation, based on pro'cedures outfined in the Hdalth Authority Approval Guidelines for this application,
shows that the on-site wator.s�ppiy and/or wastewater disp6s6l systom is(are), safe, functional,
and adequate
..", .;% 1. 0. : , :I'- .. 1. A -,-�
MAI. 14. 1., .. . I
for tho humberdtbe'&(5 , bedrooms . type -of . e -of struciur6'indi&tbdhWr&n. furth6r verify that based oil tho'
I tigatioa and inspection, the
information obtained from th6 Municip6lity or Ahchorage files and from my'inv6s,
on -she water supply'andlor wastewaterdisp
'? 'osa " I systorWis(6io) in compliance with all applicable Municipal
and State codes. ordinances, and regulations . in elle;, at
t the time of installation.
Name of Firm ALASKA WATER & ViASTEVVATER CONSULTANTS, INC.
Address 6901 DEBARK. ROAD, SUITE. :213 ANCHORAGE,, AK 99504
7—
Engineer's Printed N ame JEFF.RLY A.. GMNESS'. R.L.
Engineer's Comments:
It-) conducting tills evaruution, AXWWC, M.C. altOrnpic.d to provide a thorough,
consci-inlious cngimeIstin,, vt.;nlysis of the sys;c[n in 6ccord-atice ADEC and 100A
DSD Curds Ines & R9gL1,'01i01?S. 'ft:,) mporled res;).-'isdescrbed the p6rfornnance of the
SYS, -0177 under the conditions encouhffiled al thd tirno of the test. and separation
distIRIFICeS moasured to readi,y identifiable features. '17,,o operational lire of and
sop-.Iic sys!otns dcpisn . d on the local sorts co"IdiVO-ri, groundviator levels Iliad way
liu,Mtato during ,/?a year, arid tho vi.,ticr usag& of the tal-rdly being served by t/70 SYSIV-177.
'ritese, conditions ire outsidethecontrol cf ih,-. evaluatorofthe.syslem. Salisfacloryle-s'
results clo riot guaratitec futtitto perlon-riance-of the system, n&'do they gi),1170171'C-0 thaa
there are no hidden defects or brjc:roEC.hfflC17,1s. AMWc, inc. cz:;i therefore not provide
any Nantanty or fudwe I esilataW oJrholy long 117o sys!bm towfilcon.inue to tricot the
overwional tm viro/77-em's of the ADEC or MOA DSD. The content of this report, is for
tho so!& bcn-cfi'of 11jo avvner listed atI Anv re!izirice upon or use of this rep Ore by atty
f
01er panicri or party is riot a: nor v.1i.7 it confer any kgo.; rk;ht vdialsouvor.
5. DSD SIGNATURE
Phone_ 337-6179
Date
Approved for bedr6oms.
Disapproved.
Q,
Conditional approval for bedrooms. %vith the f1lowing sfipuIc-;1ion,9: VIZ.
IV -
HAA Checklist Maniteriance Agreements
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: Original Certificate Date:
(Rev. 12101) jr
12-31-02;12:22PM;
Als CT&E Environmental Services Inc.
CT&E Ref.# 1028554001
Client Name AK Water & Wastewater Consultants Inc.
Project Name/# Hilldise North #7 L4: B4
Client Sample ID Hillside North #7 L4: B4
Matrix Drinking Water
PWSID 0
Sample Remarks:
;907 5615301 7# 2/ 3
All Dates/Times are Alaska Standard Time
Printed Date/Time 12/30/2002 14:23
Collected Date/Time 12/19/2002 18:50
Received Date/Time 12/20/2002 10:15
Director—
Technical Direct c—✓� Stephe� C. Ede�
Released BY i!1 ie.
Allowable Prep Analysis
Parameter Results PQL Units Method Limits Date Date Init
Waters Department
Nitrate -N 1.4E
Microbiology Laboratory
Total Coliform 0
LL
0.200 m8/L EPA 300.0 (<=10)
col/100mL SM189222B (<=1)
12/20/02 PLW
12/20/02 KAP
Jan 14 03 12:19p
JAN -10-00 08:51 From:CmuntrywidsHomm
Butler & Butler
10072702651
f�sTyNo �"
�vi°�;t Hpv9f
A7V
AT
907-276-1584
T-028 P.02/02 -107
---------------
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