HomeMy WebLinkAboutSOUTH HILLS BLK 4 LT 3South Hills
Block 4
Lot 3
#017-072-12
Inspection Report_1-1-1Ydoc
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:l/www.muni.org/onsite • (907) 343-7904
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP141518
PID Number: 017-072-12 ❑ New ❑✓ Upgrade
Name:
ABSORPTION FIELD
Peter Bockman
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound
Address
7635 Old Hillside Way
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
8/6 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
7/4 Ft.
Gravel depth beneath pipe
1.0 Ft.
Subdivision
Block Lot
South Hills
4 3
Fill added above original grade
0-1 Ft.
Gravel length
90.0 Ft.
Township Range Section
Gravel width
5Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
517 Ftp
2
13.OFt.
Well
100+
193.9
NA
N/A
25+
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Existing
Capacity
I 1250G31.
Surface Water
100+
100+
N/A
N/A
Material
Number of compartments
2
Lot Line
5+
12.7
N/A
N/A
NA
FoundationLIFT
5+
176.9
N/A
N/A
STATION
Manufacturer
Capacity
Gal.
Curtain Drain
50+
50+
N/A
N/A
Pump on level at
Pump off level at
High water alarm at
Remarks
in.
in.
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank Tank to 3034
drainfield
Installer
A+ Home Services
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCHMARK (Assumed elevation) 100ft
Inspection„
12/15/14
a 12/15/14
Location and description
dates:
2
Concrete Stair Stoop
3” 12/15/14
0 12/16/14
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
+�"ft,
1
Conditional Approval:
Date
.........
�►ig�P
THOAF
• • ��everi �E$, t�a�ntirae
�o#ti�,/ CE 8149 .Ag/
Y.
i�
Approved
Date
Inspection Report_1-1-1Ydoc
I
DRAIN FIELD (E) IN FAILURE
REMOVED AND REPLACED W/
(I EA) 5'W x 45LF x 1.0'ED x 8.0'TD (S)
& (1 EA 5'W x 45LF x 1.O'ED x 5.O'TD (N) -
REPLACED REMOVED BIOMATT BELOW TO
WITH (1'+) SAND AS NEEDED
12.7
r SEPTIC AREA. (E)
-M
TNO WELLS/ SEPTICS /M M �
WITHIN 200'
OLD RABBIT CREEK CAD
IZ
1
I
N
o V- I WELL (E)
1 16.4 I
M3 1
-M I I \
M TH-4
(ANDERSON 2002)
NOTES:
RECORD DRAWING
PLAN
TH-6
( ANDERSON 2002)
CO AND FS (E)v\ _W—W\
ps
\ I I �,,-5, LOT 3
PREVIOUSLY ABANDONED
WELL (E)
DRAIN
\IFIELD (E) 1 +
7 z
Iw
DRIVEWAY A
4 B
i HOUSEE (E)
WELL (E)
70'DT�1,�ENT -
�� '
90uTh "lLiSiDE Wqy
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOOKMAN
7635 OLD HILLSIDE WAY
ANCHORAGE. AK 99516
2
12509 SEPTIC TANK (E)
yI
SEPTIC AREA (E)
1 s N
I �
OF Al--"�\l h 2/18/2014
StevenR. Pannone pERM1T N0.
�• CE 8149 .'cam// OSPt 41518
Vis' r
�T�PROFES5101��'�� Sheet
2 OF 3
A
B
C1
180.1
194.3
Mi
181.3
195.8
C2
181.8
204.0
M2
180.5
202.4
C3
200.1
211.2
M3
201.3
212.6
C4197.8
216.6
M4
196.5
215.1
I
DRAIN FIELD (E) IN FAILURE
REMOVED AND REPLACED W/
(I EA) 5'W x 45LF x 1.0'ED x 8.0'TD (S)
& (1 EA 5'W x 45LF x 1.O'ED x 5.O'TD (N) -
REPLACED REMOVED BIOMATT BELOW TO
WITH (1'+) SAND AS NEEDED
12.7
r SEPTIC AREA. (E)
-M
TNO WELLS/ SEPTICS /M M �
WITHIN 200'
OLD RABBIT CREEK CAD
IZ
1
I
N
o V- I WELL (E)
1 16.4 I
M3 1
-M I I \
M TH-4
(ANDERSON 2002)
NOTES:
RECORD DRAWING
PLAN
TH-6
( ANDERSON 2002)
CO AND FS (E)v\ _W—W\
ps
\ I I �,,-5, LOT 3
PREVIOUSLY ABANDONED
WELL (E)
DRAIN
\IFIELD (E) 1 +
7 z
Iw
DRIVEWAY A
4 B
i HOUSEE (E)
WELL (E)
70'DT�1,�ENT -
�� '
90uTh "lLiSiDE Wqy
PANNONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOOKMAN
7635 OLD HILLSIDE WAY
ANCHORAGE. AK 99516
2
12509 SEPTIC TANK (E)
yI
SEPTIC AREA (E)
1 s N
I �
OF Al--"�\l h 2/18/2014
StevenR. Pannone pERM1T N0.
�• CE 8149 .'cam// OSPt 41518
Vis' r
�T�PROFES5101��'�� Sheet
2 OF 3
SPECIAL PROVISIONS TO SPECIFICATIONS
1 . ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE
WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL .PROVISIONS.
3. SCOPE OF WORK: REMOVED EXISTING SOIL ABSORPTION SYSTEM AND ALL BIOMATTED MATERIAL, REPLACED BIOMATTED
MATERIAL WITH 1'+ SAND AND INSTALLED UPGRADE SOIL ABSORPTION SYSTEM.
4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17.0 FEET
BELOW EXISTING GRADE.
TH-4
(ANDERSON 2002)
-LO 0� o; ,37 .5
ML
FABRIC
a PERE PIPE
ROCK 6' ABOVE PIPE INV
TH-6
FROM TANK (E)
PROFILE
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO BEDROOM: 4 (600 gpd)
TANK SIZE: 12509 (E)
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH LC'ED
RF: 0.87
MIN LENGTH: 87 LF
USED:
(I EA) 5'W x 45LF x 1.0'ED x 8.0'TD (S)
& (IEA 5'W x 45LF x 1.O'ED x 5.0'TD (N)
TOTAL AREA: 517 SF
33.6
29.6 (N)
7LI0
L TAT 'w,Tl ANDERSON 2002)
-28.6 (N)
29 5 (S)
-7,0
1/
AND REPLACE WITH SAND AS
40
1
-1.0
Og 0
CU
COPPER
1.
s
30.0
1-0
-
'P7`'_28.6
-29.6
TEST HOLE
Mt
FC
FOUNDATION CLEAN OUT
SP/
T#
TANK CLEAN OUT NO.
5
C#
CLEAN OUT NO.
M#
MONITOR TUBE NC.
SM
RIGID INSULATION
DRAIN ROCK
_.
DOUBLE CLEAN OUT
- 4.0
DV
DIVERTER VALVE
FS
FLOW SPLITTER
SAPID AS NEEDED
BELOW FINISH GRADE
Sp/
ORIGINAL GRADE
FG
FINISH GRADE
5.0
TO REPLACE REMOVED 5-0
TOPSOIL & VEGETATE
Op
-14.0
BIOMATTED MATERIAL
-ISO
C+x
-80
110
bL
ML
-17.0
w
SECTION w -;za
P
Y
w
m
F
m
F
FROM TANK (E)
PROFILE
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO BEDROOM: 4 (600 gpd)
TANK SIZE: 12509 (E)
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH LC'ED
RF: 0.87
MIN LENGTH: 87 LF
USED:
(I EA) 5'W x 45LF x 1.0'ED x 8.0'TD (S)
& (IEA 5'W x 45LF x 1.O'ED x 5.0'TD (N)
TOTAL AREA: 517 SF
33.6
29.6 (N)
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOCKMAN
7635 OLD HILLSIDE WAY
DESIGN DETAILS ANCHORAGE, AK 99516
Steven.R,.Pannone•
-P- -. CE 8149 -•Po:
Date
2/18/2014
Scale
NTS
P.I.D. NO
017-072-12
'ERMIT N0.
OSP141518
Sheet
3 OF
-305 (S)
-28.6 (N)
29 5 (S)
-REMOVE ALL BIOMATTED MATERIAL
AND REPLACE WITH SAND AS
NECESSARY
ABBREVIATIONS
CU
COPPER
LEGEND
DIP
DUCTILE IRON PIPE
W WATER LINE/
TH
TEST HOLE
WELL RADIUS
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
SS NEW SEPTIC
C#
CLEAN OUT NO.
M#
MONITOR TUBE NC.
R
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
NOTES: PANNONE ENG SVC, LLC
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOCKMAN
7635 OLD HILLSIDE WAY
DESIGN DETAILS ANCHORAGE, AK 99516
Steven.R,.Pannone•
-P- -. CE 8149 -•Po:
Date
2/18/2014
Scale
NTS
P.I.D. NO
017-072-12
'ERMIT N0.
OSP141518
Sheet
3 OF
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141518
Tax Code Number: 01707212000
Work Type: Septic Upgrade
Permit Effective Dates: December 08, 2014 to December 08, 2015
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SOUTH HILLS
Site Legal Address: SOUTH HILLS BLK 4 LT 3 G:2940
Owner/Address: BOCKMAN PETER JR
7635 OLD HILLSIDE WAY ANCHORAGE AK 995160000
Site Mailing Address: 7635 OLD HILLSIDE WAY, Anchorage
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy
Lot Size in Sq Ft: 51411
Total Bedrooms: 4
N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By.
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
H!Parcel I.D. 017-072-12
Property owner(s) Peter Bockman Day phone
Mailing address 7635 Old Hillside Way, Anchorage, AK 99516
Site address 7635 Old Hillside Way
Legal description (Sub'd., Block & Lot) South Hills, Block 4, Lot 3
Legal description (Township, Range & Section)
Lot Size 51,411 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
i Absorption Field ❑X Initial ❑ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ElUpgrade Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
" Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
property owner or
Permit/Rush Fees: J%I t -NN"D :gI°'yb Waiver Fees:
Date of Payment: 121311s ( Date of Payment:
Receipt Number: M?) (_ (4 Receipt Number:
Permit No. bS19Iq 151� Waiver No.
Permit App_:; 1L..k.
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveCiiloanenaak.com
December 03, 2014
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage, Alaska 99519
Subject: South Hills, Block 4, Lot 3
Septic System Permit Request
Ladies and Gentlemen:
I am writing request a permit to construct an upgrade four (4) bedroom septic system on this property.
Currently the lot is developed. The existing drain field is in failure and will be removed and replaced per
the original design, with sand added as needed to replace removed biomatted material. The surrounding
lots are served by private wells that are over 100' from this system.
Soils. Michael E. Anderson performed two test holes in the vicinity of the drain field in 2002, and
groundwater was monitored for seven days. Ground water was not observed to a depth of 17.0 feet
below the ground elevation in the test hole 4 monitor tube and 12.0 feet below the ground elevation in
the test hole 6 monitor tube. It is my opinion, based on the results of the soils tests and overall soils
appearance; an application rate of 1.2 gallons/day/square feet should be used for a conventional
wastewater system.
1. Soil Absorption System Design.
a. See Sheet 2 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The existing topography slopes from south to north at approximately 35% above the
field with a slope of approximately 15% across the area of the upgrade, and 25% below the drain field.
There are no steep slopes within 50' of the drain field.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
T NO WELLS/ SEPTICS
\M M M\
WITHIN 200' %A, Z
OLD RABBIT CREEK OAD
is •
I N I \
WELL (E)
p� 16.4 I
DRAIN FIELD (E) IN FAILURE 1
REMOVE AND REPLACE W/
(1 EA) 5'W x 45LF x 1.O'ED x 8.0'TD (S)
& (1 EA 5'W x 45LF x 1.0'ED x 5.0'TD ( N ) -
REPLACE REMOVED BIOMATT BELOW TD ss p \
WITH SAND AS NEEDED_...:- s13.0 1
12-7
SEPTIC AREA (E) es TH-6
5 ( ANDERSON 2002)
�v 3
—M TH-4 CO AND FS. (E) \ ��— W� W/
M M \ (ANDERSON 2002) N pN
�\ I I �k LOT \k
PREVIOUSLY ABANDONED //� I L
DRAIN FIELD (E)
z
Z> w
y 1250g SEPTIC TANK (E)
J
H
WELL (E)
SEPTIC AREA (E)
DRIVEWAY I i
4 BR Zj o
HOUSE (E) I p
WELL (E) I H
10' UTILITY EASEMENT
\ ` Sour
W� W� H qs
W E WAY
Z
NOTES: 7�♦7�7�T 7�T�+ �+7�7 �7 T 7 �r s��� �� Date
FOR CONSTRUCTION PAMONE ENG SVC, LLC of qC ill 12/5/2014
P.O. BOX 100217 ANCHORAGE, AK 99510 �� 4S ��
PHONE (907) 272-8218 FAX (907) 272-8211 Scale
j .
... .. ... .. ... P.I.D.NO
SOUTH HILLS, BLOCK 4, LOT 3 017-072-12
•Steven •R�Pannone
PETER BOCKMAN / PERMIT 10.
/ Pte'. CE 8149 .'4�%
7635 OLD HILLSIDE WAY j�cs•, .•�,r OSP141518
PLAN ANCHORAGE, AK 995161ll�RFDasso P: Sheet
1 OF 2
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS,
3. SCOPE OF WORK: REMOVE EXISTING SOIL ABSORPTION SYSTEM AND ALL BIOMATTED MATERIAL. REPLACE BIOMATTED
MATERIAL WITH SAND AND INSTALL UPGRADE SOIL ABSORPTION SYSTEM.
4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17.0 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
FILTER FABRIC
TH-4
(ANOL ll-DRAIN
DERSON 2002) 4" P PERF PIPE
-1A ROCK 6" ABOVE PIPE INV
FROM
PROFILE AND REPLACE WITH SAND AS NECESSARY
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 12509-(E)
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH 1.O'ED
RF: 0.87
MIN LENGTH: 87 LF
USE:
(1 EA) 5'W x 45LF x 1.O'ED x 8.0'TD (S)
& (1 EA 5'W x 45LF x 1.O'ED x 5.0'TD (N)
TOTAL AREA: 517 SF -
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
NOTES: PANNONE ENG SVC, LLC
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOCKMAN
7635 OLD HILLSIDE WAY
DESIGN DETAILS ANCHORAGE, AK 99516
ABBREVIATIONS
CU
MLTH-6
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
7.0(ANDERSON
C#
7 di
o -E
M#
MONITOR TUBE NO.
R.I.
2002)
DCO
DOUBLE CLEAN OUT
I
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
-7.0
FG
FINISH GRADE
TS&V
40
-1.0
00 OL
1.OJI-L
1.01
'�
ML
SP/
SM
DRAIN ROCK
-4.0
SAND AS NEEDED
SPS
-
5.0
TO REPLACE REMOVED
50
CP
-14A
SIOMATTED MATERIAL
SO
- 5.0
13.0 -ML
-17A
M(
SECTION
w -
20
cad
m
m
FROM
PROFILE AND REPLACE WITH SAND AS NECESSARY
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd)
TANK SIZE: 12509-(E)
SOIL RATING: 1.2 GPD/SF
AREA ROD: 500 SF
SYS. TYPE: WIDE TRENCH 1.O'ED
RF: 0.87
MIN LENGTH: 87 LF
USE:
(1 EA) 5'W x 45LF x 1.O'ED x 8.0'TD (S)
& (1 EA 5'W x 45LF x 1.O'ED x 5.0'TD (N)
TOTAL AREA: 517 SF -
LEGEND
W WATER LINE/
WELL RADIUS
— SS — NEW SEPTIC
NOTES: PANNONE ENG SVC, LLC
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
SOUTH HILLS, BLOCK 4, LOT 3
PETER BOCKMAN
7635 OLD HILLSIDE WAY
DESIGN DETAILS ANCHORAGE, AK 99516
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
\\� Date
OF.4 q41 , 12/5/2014
I) NTS
..... .... . .. ..... P LD. NO
............ .. / 017-072-12
Steven R. •Pannone PERMIT N0.
+Pc j CE 8149 •.�=/� OSP141518
+<<lkF,PNOFESSIO Sheet
\ 2 OF 2
all
Municipality of Anchorage Page 1 of 3
Development Services Department
•
On -Site Water and wastewater Program
4700 South Bragaw Street
P.O. Box 198850 Anchorage, AK 99519-6650
www.d.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW020318
PID Number. 017-072-12
Name:
Wastewater System: Upgrade
Sonia r'
Address:
3321SpottswoodAve.ABSORPTION
i N 111
FIELD
Ph":
Number ofBedroane
S' Wide Shallow.Trench
901-327-5734
Four 4
Sol Rating:
Total Depth from original grade'.
LEGAL DESCRIPTION
1.2 GPDIF1s
8/5 Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from orVW grade:
Gravel depth beneath pipe:
4 3
South Hills
7/4 Ft.
1 FL
Township: Range:
Section:
Fa added above original grade:
Gravel Length
1.5 FI.
90 Ft.
Well: Existing
Gravel wMBt:
5
Number of linea:
2
D obetween
once tines:
13
Ft.
Ft.
Classification (Private. A. B. C):
Total Depth:
Cased to:
Total absorption area:
Pipe Material:
Private
Ft.
I Fl
517 FP
ASTM D3034 PVC
Driller,
Date Drilled:
Static Water Leval:
Installer.
Date Installed:
Ft.
Thomas Development,
9/13-17/02
Yield:
Pump Set at
cling Haight Above Grouw:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
ubrKJPdvato
�'a-r
Anchorage Tank
Capacity n Gallons:
11250
From
Tank
Field
Station
Tank
seww Line
wet
>100'
>100'
N/A
N/A
>25'
Steel
Ste
Nur woo Canpetr erNs:
Two 2
Surfaee Waler
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
Lot Lne
>5'
>10'
N/A
N/A
ize:
Gal.
scorer:
>59
>10'
N/A
N/A
-P=P on level at
*Pump on' level at:
High water alarm at:
Foundation
In.
n.
In.
None
Noted
I
I
zS
Pwip Make 'Model
Electrical Inspections performed by:
Curtain Drain
Remarks
BENCH MARK
Existing Septic Tank was Pumped,
Crushedand
Location and Description:
11,
Site..ack-lilled On
Concrete Stair Stoop.
Assumed Elevation:
100.0 FL
Engineers Stamp
�. .......... -,q�1�♦
Inspections performed by: Alan Harala
Dates: 1 a 9/14/02
■' �`a9tn %`�+++
2nd 9/16/02
i ........ ......_..............L!r...
Department of Health and Human Services approval
I+�:ti ICMAEL E. ANDERSON
i� No.
L °7++i�
., CE -4381 r a
••.., ••'''�:
Reviewed and approved by:
Date:
♦f',
(Rev. I"g)
�Sra�„��'••
all
I
?ermi
n
SW020318 PID No. 017-072-12. Page 2 of 3
LOT 3,BLOCK 41 S�UTH HILLS
l
Lower trench' CO 9
CO 10 New
' MT1 (2) 6'W x 45 LF x'1E.D.
CO 7: TH 6 absorption trenches
I13
1 BEL
MT2 Flow Splitter
C08
TH 4
Upper trench ' —co 6 `
P 4" PVC
L . f ASTM 3034
Abandoned _
Trench '� _ -t CO
NEW
3 1,250 Gallon'..
V` SepticTank'
f �
c
CO 1 & 2%
v
3
o
o
r.
LEGEND
CO Cleanout
SP Standpipe
MT Monitor Tube
intercepted : `• 49th•�i
s
driveway � 7'*-* c:.c:�:r .. y
�0M!CHACL E. AVDERso10
N•
��
A`r•;•, NO. CE-�381`' f• =i
Four BR
HsePROFEss
/ I. ���.....a
- .
c �
existing well. PLAN VIEW AS-Blt
Scale 1" _
.30'
Hillside Way —
L
mumupaury ul Anvilulaue
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW020318 PID No. 017-072-12
M
U
77.3
N
N N
1250 Gallon
ieptic Tank
5.17
1
.V .-
f U
UPPER TRENCH
U S U
7
LOWER TRENCH ___
49th N
PROFILE AS -BUILT
;MICIWEL C. ANDERSON
Scale: 1" a 10' 406`f,--.
. f,:,_ Nos EE -4381
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
I s Y_A'5)PrC7-10A1_ ON
McAlcH # Z
711410? /e:304.w.
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW020318
Legal Description: SOUTH HILLS BLK 4 LT 3
Design Engineer: 0014 Anderson Engineering
Owner Name: Sonia DiGregorio
Owner Address: 3321 SPOTTSWOOD AVENUE
MEMPHIS , TN 38111-4224
Date Issued: Aug 30, 2002
Expiration Date: Aug 30, 2003
Parcel ID: 017-072-12
Site Address: 007635 HILLSIDE WAY
Lot Size: 51411 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
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 By:
Issued By:
Date:
Date: (6 OZ
Municipality of Anchorage
00*
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017.072-12 Permit Number SWO203/1
Property owner(s) Sonia DiGregorio Day phone 901.327.5734
Mailing address (1) 3321 Spottswood Avenue Memphis, TN 38111
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) _ Lot 3, Block 4, South Hills Subdivision
Legal description (Section, Township & Range)
Lot Size 51.1411 Acres/Sq.Ft. Number of Bedrooms Four (4)
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: t7/po • a -'o Waiver Fees:
Date of Payment: _ui 2.
Receipt Number: coq
(Rev. 12100)
Date of Payment:
Receipt Number:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: August 30, 2002
TO: Dan Roth
FROM: Mike Anderson, P.E.
SUBJECT: Lot 4, Block 3, South Hills Subdivision
Septic System Construction Permit
Attached are modified plan sheets for the construction of the septic system on the
subject lot. Please substitute these sheets with those previously submitted.
Please let me know if you have further questions.
ANDERSON:ENGINEERING
':'ANCHORAGE; AK 99524
522-7773 522
August 20, 2002
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 4, Block 3, South Hills Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing septic system on Lot 4, Block 3, South Hills Subdivision has failed and
must be replaced to serve the four-bedroom home on the lot. We are therefore
requesting a permit be issued for the construction of a new septic system to serve the
home. The attached Site Plan and backup documentation identify the location and
configuration of the new and existing septic system and the parameters used in the
design. Also identified on the plans are the existing well location, test hole locations
and the locations of the existing wells and systems on adjacent lots. Drainage arrows
are also shown and current drainage patterns will be maintained after construction.
The existing septic tank will be pumped, crushed and backfilled on site.
The test holes placed near the location of the proposed absorption trenches indicated
silty sand with gravel and varying amounts of silt and a percolation rate of less than 1
minute per inch in the accepting layer. We are therefore proposing to construct 2 — 5'
wide by 45' long absorption trenches with 1' effective depth. The distribution piping
depth will vary in the trenches to take advantage of the good soil material. Total depth
of the trenches will be 5' and 8'. A Zabel Flow Splitter Valve will be placed to assure
even flow to each trench.
The ground surface on the lot slopes as shown on the attached Site Plan with fairly
steep slopes from south to north. The new septic tank and absorption trenches will be
constructed on slopes with grades approximating 20%, but in conformance with
Municipal requirements and parallel to ground contours. All components of the new
trench will be constructed a minimum of 100' from the well on the lot. The system will
also be constructed a minimum of 100' from any surface water in the area and 10' from
the water service line.
If the system is constructed in accordance with our design the following statements
apply:
Loi 4, Block 3, South Hills
August 20, 2002
Page Two
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. 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
WLI
r 49th
VCHAEL E. ANCERSCN
. Nn Cf -4391 e
Old
Rabbi tCreek
_
!sz 96
I s2.9
Road
THIS
152.96
P40JECT
well
4t
o septic
C? area
N
•.
m
R
\
/
4
well f
1
�\wellI�
Septic
f
area '
8illsi
Way
153.50
153.30
153.50
4
9
2
1;
-75777�:' a9:n ''� �•
' �•�..,.e ........ ........ ...
snt ..».�
101 uta EY 1... .». .. ... .......
•1 i^ V'CrAEE E. ANDERSON i cu i
S Warranty C
Bk 60 •I��sr:, No. CE -4381 d Now
.�0 1� F,p' E a
ti 1 S ��44 PFES50CA
;:•.
e
o
N 13 ti AREA SYSTEM PLAN
SCALE 1" = 100'
t Existing
Line
S1TE PLAN
SCALL �" = 40'
LOT 3, BLOCK 4, SOUTH HILLS SUBDIVISION
DESIGN FACTORS:
4 Bedroom House
Perc. Rate: LT 1 MinJlnch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,250 Galion Septic Tank
V Drainfield Rock
4 Bedrooms X 150 GPD/1.2 GPDISF (Application Rate) = 500 SF of Absorption Area
500 SF/5 LF (Width)* .87(Red. Factor) = 87 LF Trench Length
Therefore: Construct Two 5' Wide Absorption Trenches Each 45' in Length For a Total
Length of 90'. Flow Line Elevation in Trenches to be 7' and 4' Below Original Ground
Surface. Total Depth to be 7.5' and 4.5' Below Existing Ground. A Zabel Flow Splitter
Valve Must Be Placed to Assure Even Effluent Flow to Each Trench. Maintain 10' of
Separation Between Each Trench. Provide 3' of Cover or Place 2" Insulation and 2" of
Cover Over Trenches. 4' of Cover Required Over Septic Tank.
Natural
3.5' Backfill
or
6.5'
6"
Geotextile
Fabric
4" Perforated
PVC (ASTM 3034)
_Drainfield
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' From Wells in the Area.
Minimum 10' Separation From Water Service Line.
49th n
M;CHAEL E. ANDERSON
No. CE -4381 i
ON ESS
Municipality of Anchorage
Developmental Services Department - On -Site Water and Wastewater Program
4700 South Bragaw, Anchorage, AK 99507
SOILS LOG - PERCOLATION TEST
Performed For. Sonia DiGregorio Date Performed: 8/14/02
Legal Description: Lot 3. Block 4. South Hills Subdivision
SLOPE SITE PLAN
1
1
1
1
1
1
1
1
1
2
OG/OL
Was Groundwater
Encountered? No
If Yes, What Depth?
SP Depth to Water
After Monitoring None
SM Date: 8/20102
Lenses
GM
ML
Bottom of
Hole
See Site Plan
a■
r
.V_ A-- E. AIJERS0% L4,
�Ic� : No. tE-A}9t i
# V . d �
1� PF ' •.. E �•
Reading
Date Gross
Time
Net
Time
Depth To
beater
Net
Drop
1
14 -Aug 2:25
2.25"
2
2:35
10
Dry
12.75"
3
2:36
2.5"
4
2:46
10
Dry
12.5"
5
1 2:47
1
2.5'
6
1 2:57
1 10
Dry
12.5"
Perc. Rate: < 1 Min./Inch Perc. Hole Diameter. 6"
Test Run Between 8 Ft. and 9 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: A. Harala. 1, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8120102
M. -M14
Municipality of Anchorage
Developmental Services Department - On -Site Water and Wastewater Program • ... •••-••......•AEL_^•••••• ......••
4700 South Bragaw, Anchorage, AK 99507 �� % +% y+No. cEA 438'0%
SOILS LOG - PERCOLATION TEST # r/F1%.
#1� Fp'"•....... .....• a".
Performed For. Sonia DiGreciorio Date Performed: 8/14/02 441�i ;;5;.�
� ��
Legal Description: Lot 3. Block 4. South Hills Subdivision
SLOPE SITE PLAN
OG/OL
ML
TESTHOLE NO, 6
SP1GP
ML
Bedrock
Was Groundwater
Encountered? No
If Yes, What Depth?
Depth to Water
After Monitoring None
Date: 8/20/02
LI
See Site Plan
Reading
Date Gross
Time
Net
Time
Depth To
."later
Net
Drop
1
14 -Aug 3:08
1.5"
2
3:18
10
Dry
11'
3
3:19
1.5"
4
3:29
10
Dry
11"
5
3:30
1
1.5"
6
3:40
10
Dry
11'
Perc. Rate: < 1 MinJlnch Perc. Hole Diameter. 6"
Test Run Between 4 Ft. and 5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: A. Harala. 1, Michael E. Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8/20102
ONSITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 4, SOUTH HILLS SUBDIVISION
GENERAL:
The scope of this project includes the pumping, crushing and
backfilling the existing septic tank and the procurement and placement
of a new 1,250 gallon septic tank at the location shown on the site plan
and the construction of 2 - 45' long by 5' wide by 1' effective depth
absorption trench also shown on the Site Plan. The total depth of the
trenches will be 8' and 8' below existing ground and the distribution
pipe will be placed at 4' and 7' below the surface. A Zabel Flow
Distribution Valve must be placed to insure even effluent flow to each
trench. All components of the septic tank and absorption trench must
be constructed a minimum of 100' from the well on this and the
adjacent lots. A minimum of 4' of fill must be placed atop the septic
tank. In lieu of fill 2" of direct bury insulation may be placed with 2' of
fill atop the insulation.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
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.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. The 1,250 -gallon septic tank must be procured from an approved
septic tank manufacturer and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Lot 3, Block 4, South Hills
August 20, 2002
Page 2 of 2
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations' down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or,geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic 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 burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Lot 3, Block 4, South Hills
August 20, 2002
Page 3 of 3
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
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 ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME /
. �-r�C Oji 4 �� C.'Lre-/
PHONE
,9.c. "'ASCO(
NEW
ED UPGRADE
MAI LING ADDRESS /
LEGAL DESCRIPTION
LOCATION a
NO. OF BEDROOMS
V
DISTANCE TO:
Well
5
Absorption area _
�--
Dwelling
PERMIT NO_Q.
�!Y [7 ��� C7
F ZZ
W�
ManufacturerMaterialg
(3 neer
{ ,,,, /
I I
No. of compar;menis
L
ti
Lie. capacity in gallons
�,)
�
IF HOMEMADE:
Inside length —
Width
--
Liquid depth
JaZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_ ..
oz
H
Manufactur �------''— /"�--�'�_..Materia
- Liquidcapacityingallons
O
LU Z
DISTANCE TO:
Well
Foundation
Nearest lot line
PERMIT NO.
J LL z
2 ¢
No. of lines
'(
Length of each line
�
Total length of lines `.. J
L[
Trench width
7j� inches
Distance betwee Danes
H
p
Top of the to finish grade
3 •
Material beneath the �T
S', S }nUr
Total effective absoyp�igfy r a
w
Length
Width
Depth
PERMIT NO.
Q F
Type of crib
ib diameter _
Crib d
Total effective -ab! .,parea-_ -
w
w
DISTANCE TO:
Building foundation
Nearest Iot line
_j
Clas , ) yt
Depth
Driller
Distance to lot linejAt
RMIT NO.
W
3:DISTANCE
TO:I
Building foundation
Sewer line
Septic tank
sorption areas)
()
OTHER
.016
PIPE MATERIALS
_T� C a (r b n
d�
SOI LTEST RATING
INSTALLER
REMARKS
n
4,
/
F
3
APPROVED DATE LEGAL
72� Z� U�C Li A S
72-013 (Rev. 3'/78)
_Al
DEPARTMENT OF HEALT'll AND ENVIRUNMENT'Al.. PROTECTION
325 `L'' STREET, WICFIORAGE: A[.-,, 99501 ti
264--4,"20
0 P-4 T. 1- F"", EE R.4 E`-- F"_" F,_C Irl I IF
F'ERNIT NO. 79("W..10
APPI-TCANT DEGRF,,:(30RIO '-SALVATORE 8960 BLACKBERR'ill
LOCATION HILI SIDE DRIVE
1_0301_ L]" B4 SOUTH HILLS Sey..., t., o, r '5 1 .7 E :15'.02 FEF.r
TYPE OF' SOIL ABscjF',.f.-,,,rION SYSTEM TREr4CH
111FIXIMUM NUMBER. OF BEDROOMS =. 37" =3OIL RATING t: SQ FT,-F.*.'R)=- 1.40
JHERE(..!UIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
F'-F�'-F t -A
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAIr-*:'IE'l D.
THE DEPTH OF A TRENCH OR PIT' IS THE DISTANCE BETWEEt-.1 THE OF THE
.GF'.'OUN[') AND THE BOTTOM OF THE EXCAVATION r'IN FF`ET.).
I'l IERE IS P-40 SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALl... F -'I F E
AN[.') T*HE BOTTOM OF THE EXCAVATION (IN FEET).
F: -,Ml F -H 0 U I U.-.- ` F_'' F" -T* I ('--I- _r 1"I " IK' "=-. 127: F_ -:L IE:'z IL"I CA- F -H PA
Pf; , :'RMIT APPI C
IAt4T HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURIM7.1' THF,
Ihi'STALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS- PROPERTY Atlr.? THE
NUMBER OF' RESIDENCES THAT THE 14ELL 1,111.L. SERVE.
1W c 1.2'" > I I 1--sWE. @ M F'-' C-- FR E C.-FL.0 I
D'ACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DE'.`F*ARTMf]--_.NT WILI BE SUBJECT TO PROSECUTION.
MINIMUM BET14EEN A WELL AND ANY ON- :;ITE: SE1.4AGE DISM...'FIL SYSTEM I�`
100 FEET FOR A PRIVATE WELL.; OR
.. ' 0 FROt
.1-:5C-1 R" 2,00 FEET -1 A PUBLIC WELL DEPENDING UPON 'THE TYPE OF" F -IC WE i I 1__
OTHER REQUIF,.EMENTS MAY APPI Y. SPEC I FICATI ONS AND CONSTRUCI'lor-4
F0,1FULF"IBLE TO INSURE PROPER IN.','..-",'TALLATION.
I _T...FEE- 1>U-- I _,7,::::1L,
:f C'ERTIFY THAT'
.1 1 AM FAMILIAR WITH THE REQUIREMEtcm FOR OWSITE SEWERS AND WELLS AS
FORTH BY THE MUNICIPALITY OF ANCHORAGE'
2: 1 WILL Ira TALL THE SYSTEM IN ACCORDANCE WITH THE 1."ODE_:.
I UNr:,ERSTFlND THAT THE ON--SIT'E SEWER SYSTEM MAY REQUIRE ENl...AR('. iEMEt4T IF' HIE
RESIDENCE-- REMODELE1.1 'TO INCLUDE NOFZE THAN 3 BEDROOMS.
I G N E D
ALVATORE
ISSUED E -.M -A / .. / . . .... 1_Z_Z --- V *'..".. 2
Russell Oyster
694-2774
O & E ENGINEERING & DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Earl Ellis
688-2280
Performed for: Name: / • re -3 u S,;-AA U !` °`` Tel. No. 9 72-
°rW �
Mailing Address: gzle9' A • VDoe ,�/ 1' &C#6'���
Legal Description: Z.-07- -3, 4, d50 rJ'T/f e -s
Depth (feet)
0
1
2
3
4
mw 5
6
7
8
9
12
Soil Characteristics
441 54/40`r) AA/ CUs b
s,q mile r
IlL., �fc r, IDEAI5.c
54AIeaY �GAI/EL® T2s E
4e'�%
F6Lr-
PLOT PLAN
A16 SeAlt-x
PERC. TEST
14 /L ale, e,
15 Sol- ,"
16
Ground Water Encountered: Yes No K� If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by:Date: iso
WATER WELLS
665 W. 87th Avenue
Anchorage, Alaska 99502
WELL CONSTRUCTION LOG
HOWARD TEAL
344-0498
MUNICIPALITY OF ANCHORAGE
DEPT. 07 HALTH &
ENvIRONwcvTAL P.�,rQCTION
DEC 7 1978
RECEIVED
Drilling Co. tZ `Z USGS no.
L r^
Driller��7'_7 t'� �,�gk Type of rig �/r "''- ✓°�` Date well completed
Well owner ��,rjNr��x.�rr�ij �r{ 1t9r�t�rE�. Nearest community
Well location: (address & legal description) V`/ :67 Location sketch or remarks
/
Depth of well it. Casing: depth it. diam..—i n. i
Static water
aver Z— ft. (above, below) land surface. Date
Finish of well: (open-end, screen, perforated, open -hole, other)
Describe intervals and size:
Well yield tested by (pumping, bailing, air) at l gal/min.
Iorj_hours with—./ e ft. of drawdown from static level.
DRILLER'S MATERIAL LOG
Depth below land
surface in feet
Give description of
(size of material, color, hardness
strata penetrated
of drilling, and water content)
cl
to
Ot o 11 o
VV
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A.
f l Q t�> C7
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c to 7 40
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6
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1: _T ��� ������ �0
�PHRTMEN,.JF HEALTH HND PROflasTION
825 'L'
S T R EFET, FNCHORHGE, HK. 99501'
264--472(�*)
PE�MIT �O( 78104� )
RPPLICANT SHLYHTORE D. QREGORICj o/o it TEFFIL (T - 'r LING) �44 04�8
LOCHTION HILLSIDEE DR
LEGAL L] B4 SQUTH HILLS 'S/C) LQT SIZE �45]� SQUHRE FEET
MINIMUM BETWEUN A WELL HND ANY ONSITE SEWHGE DISPOSAL SYSTEM IS
100 FWET FOR H PRIVATE WELL/ OR
150 TO 200 FlEET FROM F) PUFAIC WELL DEPENI)INQ UPON THE TYPE OF PUGLIC
WELL LOGS ARE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS
DF THE WEL� COMPLETION.
OTHER REQUIREMENTS MAY APPLY. FiND C010TRUCTION DIHGR8MS ARE
HVHIL8BLE TO INSURE.* PROPER INSTHLLHTION
��_y_ 1.: FRUMV EDO Q W K M EEO Q oFT �"a ::* IE,"
I CIRTIFY THHT
1: I HM FHMIL�R� WITH THE �EQUI��MENT� FO� ON�SITE S�WER� HND WELLS AS SET
FORTH BY THE MUNICIPHLITY OF HNCH8R8GE.
2: f WILL INSTALL THE IN HCXOMHNCE� WITH THE,.' CODf.,i]:S.
SIGNED� ~~~_~_~~~~.~
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 617-672-12
1. GENERAL INFORMATION
Expiration Date
Complete legal description SOUTH HILLS BLK 4 LT 3
Location (site address) 7635 OLD HILLSIDE WAY, ANCH AK
Current property owner(s) STANCEL
Mailing address
Real estate agent
SAME
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
Z3 -ZZ
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic '
Fx�
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 550
Date of Payment 3 ? 3 ' 2 2
Receipt Number az3 71q
COSA#_'�JG2211 �3
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-$$64
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 3/14/22
,-
�. - ..
F 51
6. DSD SIGNATURE r 49TH
System #1 Approved for 4
,� ......
bedrooms • .... ,
System #2 Approved for
..... �. .
N.
bedrooms
P ti�J,°,.• c� 94 9
Disapproved
Conditional approval for
bedrooms, with the following stipulatii4�t"-
n�
Original Certificate Date:_ 3 _Z 3 - Z Z
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
COSA Cheddist blue sheet
Legal Description: SOUTH HILLS BLK 4, LOT 3
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
OR Well log is filed with Onsite (or attached)
Date drilled 117114
Total depth 92 ft
Cased to 92 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 211522
Static water level at beginning of test 41 ft.
Comments
B. TANK DATA
Age of tank(s) 18 years
Tank type/material "P"C'S r
Measured operating fluid level In septic tank 48
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 3/12/22
Parcel ID: 017-072-12
of Structure served by this system
D. ABSORPTION FIELD DATA TESTED NORTH TRENCH
Which system tested (date installed) 121
15V14
❑ ALL standpipes present per record drawing
Total measured depth from grade 8/5 ft (max)
Measured depth to pipe invert from grade 7/4 ft (min)
❑ N/A — pressurized field
AN Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 3+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate 0.718 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample
2/15/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/15/22
Results Q Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 3 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 800 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
Community Sewer Manhole/Cleanout > 100'
r,7( Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100'�j✓' Yes
if No
ft
Private Sewer/Septic Line > 25' [Z] Yes
if No ft
Absorption Field on Lot > 100'✓Q Yes
if No
ft
Holding Tank > 100' F✓ Yes
if No ft
Neighboring Absorption Fields > 100'
r✓❑
Yes
if No
Animal Containment > 50' Q✓ Yes
if No ft
Yes
if No
ft
if
less than required)
Building. Foundation > 10'
0
Yes
Manure/Animal Excreta Storage > 100'
ft
Community Sewer Main > 75' ZYes
if No
ft
M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'✓Q
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100' ✓V Yes if No
VNiater Main > 10'
Rtl
Yes
if No
ft
Community Wells > 200' M Yes if No
Water Service Line > 10'
El
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on
Lot to:
(Please enter distances
if
less than required)
Building. Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property. Line > 10'
✓M
Yes
if No
ft
Wells on Adjacent Lots:
Water. Main >'10'✓(_j
Yes
if No
ft
Private Wells > 100' ® Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' F✓ Yes if No
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through held inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
-Ry
fir. '!t'•sp.a °a'. �'
� .• A
a, °
�J% MICHAEL N. Af;aLii
9
C
s ,
� c - •,_ lit ' � ,� :;� =', •.
lA �
ft
ft
10
ft
FAGS $G
• Municipality of Anchorage
On -Site Water and Wastewater Program z
(907) 343-7904 *0 S A E r Y
� Je 7
Certificate of On -Site Systems Approval'
41
Parcel I.D. 017-072-12 Expiration Date: ' -2-
1. GENERAL INFORMATION
Complete legal description South Hills, Block 4, Lot 3
Location (site address) 7635 Old Hillside Way
Current Property owner(s) Peter Bockman Day phone
Mailing address 7635 Old Hillside Way, Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Fx1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNadance request for.,
Received by:
El
UA
TYPE OF WASTEWATER DISPOSAL:
0
Individual
Fx I
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ G 2%5b i' I(ol,l0 = �iZ1,Lo Waiver Fee $
Date of Payment (22) VL -IN C&, Date of Payment
Receipt Number t7 l b Receipt Number
COSA# �C (y I��{'1 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 12/19/2014
f *,• Tri 1
6. DSD SIGNATURE '
V System #1 Approved for bedrooms Steven W oris
g CE -8149
System #2 Approved for bedrooms s ••
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: G��eP
Original Certificate Date: 1:�
The i uni alt chorage 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
COSA blue sheet ° c
If more than 1 septic system is on the lot:
COSA Checklist # I of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: South Hills, Block 4, Lot 3 Parcel ID: 017-072-12
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 11/17/14 Sanitary seal (Y/N) Y
Total depth 92 ft. Cased to 92 ft.
FROM WELL LOG
Date of test 11/4/78
Static water level 35
Well production
15
WATER SAMPLE RESULTS
ft.
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24 in.
AT INSPECTION
11/17/14
34
3+
Coliform Neg colonies/100 mL Nitrate 1.23 mg/L
Arsenic ND ug/L Date of sample: 11/17/2014 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
ft.
9 -
p.m -
Tank Type/Material Septic/Steel Date installed 9116/02
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping s =ue tZ t�"q Pumper Ar-�>l u = -Or" "o L ' uc-
C. ABSORPTION FIELD DATA
Date installed 12/15/14 Soil rating (g.p.d./ft2 or 112lbdrm) 1.2 GPD/SF System type Wide Trench
Length 90.0 ft. Width 5.0 ft. Gravel below pipe 1.0 ft.
Total depth 7/4 ft. Eff. absorption area 517 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test New in. Water added New gal. New depth New in.
Elapsed Time: New min. Final fluid depth New in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off' level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 50+
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
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 Steven R. Pannone
Date 12/19/2014
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage11 0+
rip
---- - _ OL_ASBIT CREEK ROAD 8408A
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— — S85052'1011E 152.95 LO
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I
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Septic vents
I s
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rn
ceie Co
+- Septic vents M
M �I e M
M
E °
mSeptic vents Lot 2
l
o WI o
MI M
2 _
0 �I J 0
0 of z
z
i
Lot 4
Septic vent °
I
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SCALE: V= 30'
I C°
I `
3
I N
I e
OF &
hed '•49th •'9 �j
PlT
�/
ktr17.8 � ••,•
� .Fred Walatka. i
�� saF • 3255 - SGravel driveway O Well o9. ' FEsslosm-de\L jhed iZ-Z4-14
0'UtilityfEasement I -- — (�
_ N r;
_ _ _ N
AS -BUILT NO CORNERS SET THIS DATE
Cn S83 042 I hereby certify that I have performed a Mortgagee's inspection
'00"" _
153.50 of the following described property: LOT 3. BLOCK 4
SOUTH HILLS SUBDIVISION
--
OLD _HILLSIDE WAY o Anchorage Recording District, Alaska, and that the
M improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
------ adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN this 24th day of December ,2014.
THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES
PLAT ARE NOT SHOWN HEREON. FB 14-11, pg 49 BE (907-248-1666) Engineers and Surveyors
Municipality of Anchorage k
Development Services Department
°`
Building Safety Division '
On -Site Water and Wastewater Program E ' °
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING47-)
Parcel I.D. 017.072-12 HAA # d K?
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lot 3, Block 4, South Hills Subdivision
Location (site address or directions) 7635 Hillside Way
Current Property owner(s) Sonia DiGreporio Day phone 901327.5766
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
3321 Spottswood Avenue Memphis, TN 36111
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class - Well
Public Water System
Four 4
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
®
Individual On-site
❑
Individual Holding tank
❑
❑
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
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 less than 30 days old. (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 Anderson Engineering Phone 522.7773
Address P.O. Box 240773 Anchoraoe. AK 99524
Engineer's Printed Name Michael E. Anderson. P.E. Date 2/3/2003
'
49th1
�....i........... r..........
• IiY"k!..1.� ... .........
f �n WCMAEL E. ANDERSON } ly s
5. DSD SIGNATURE ,p No. CE -4381
./ •
r
Approved for bedrooms. ♦��� ��0'Essta'P:��•
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
`J
VIV-JIIC ��
Additional Comments 1
tN4 T ER AND M
WASTEWATER
Hl!_ =. f
-NTS_ ,.��.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date: ? 1s1c +
\ 1
(Rev. 12/DO)
Municipality of Anchorage •A,
•' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program `" `*
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchomge.ak.us
(907) 343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 3. Block 4. South Hills Subdivision Parcel ID: Q17-072.12
A. WELL DATA
Well type P1lvate If A, B. or C provide PWSID # _
Date completed 1114/1978 Sanitary seal (Y/N) Y
Total depth JL_fL Cased to fit.
FROM WELL LOG
Date of test 111411978
Static water level 35 f .
Well production 15 g.pm.
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires properly protected (YM) Y
Casing height (above ground) >,24 in.
AT INSPECTION
33 ft.
2.6 g.p.m.
Coliform _g,_colonles/100 mL Nitrate * .20 mgA. Other bacteria . 5 colonies/1 oo ml.
Date of sample: 112912003 Collected by: A. Harsh
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SepfleMeel
Tank size .1.250 gat. Number of Compartments 2
Foundation cleanout (YM) Y Depression over tank (Y/N) N
Date of pumping Pumper ,Now Construction
C. ABSORPTION FIELD DATA
Date installed X312002
Cleanouts (YM) Y
High water alarm (Y/N) H
Date installed 9117/2002 Soo rating (g.p.dAf or ft2/bdrm)1.2 OPDISF System type S Wide Trench
Length 90 ft. Width 5 ft. Gravel below pipe I . ft.
Total depth 215 fL Elf. absorption area RLftz Monitoring tube Y Depression over field N
Date of adequacy test
Results (Pass/Fail)
Fluid depth in absorption field before test _ in. Water added gal.
Elapsed Tlme: _ min. Final fluid depth _ in. Absorption rate >=
For _ bedrooms
New depth_ In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
g.p.d.
D. LIFT STATION
Date installed
"Pump on' level at — in.
Datum
Size in gallons
"Pump ofr level at — in.
Cycles tested
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm 8 drwit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ->-100' On adjacent lots >100'
Absorption field on lot MW On adjacent lots >100'
Public sewer main NIA Public sewer manhole/cleanout NIA
Sewer /septic service line >25' Holding tank NIA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >S Property line >s Absorption field >S
Water main NIA Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >1T Building foundation >10' Water main MW
Water Service line MV Surface water MW Driveway, parking/vehide storage >25'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION Al••�PIC AV
! certrty that 1 have determined through field inspections and : a
review of Municipal records that the above systems are in ; . ..�9........
conformance with MOA HAA guidelines in effect on this date.
MICHAEL E. ADDER!
Engineer's Printed Name Michael E, Anderson. P.E. No. CE -4361
Date 2=3 •♦e�eirec -
HAA Fee 3 3 7 5 Waiver Fee $ —
Date of Payment 2-1-310.T Date of Payment
Receipt Number 3 VAReceipt Number.
(Rev. 12100)
in.
01-31-03 11:44 FROM -CUE ENVIRONMENTAL SRV
CUE Environmental Services Inc.
Cd6A WAVAr"sig AV"AVrAW" r"ArJrii
Cf&E Ref-#
Client Name
Project Name/#
Client Sample ID
Matrix
1030520001
Anderson Engineering
L3, B4, South Hills SA)
13, B4, South Hills S/D
Drinking Water
9075615301 T-597 P.02/03 F-661
All Dates/Times are Alaska Standard Time
Printed Daterrime 01/31/2003 9.10
Collected Date/Time 01/29/2003 10:40
Received Date/Time 01/29/2003 1120
Technical Director Stephen . Ede
Released ay/
Sample Remarks:
Allowable Prep Analysis
PAmmewr Results PQL Units hiedlud Limits Ihte Date Init
Waters Department
Nitrate -N 0.829 0.200 mg/I. EPA 300.0 (<-10) 01/29/03 JS
Microbiology Laboratory
Total Coliform
r-
5 O8, No Cali col/1 OOml. SM 18 92228 (<=1) 01/29/03 KAP
t
5. LEGAL DESCRIPTION
DAfiE RECEIVED
INSPECTION APPOINTMENTS
TIME
NLIMBEfl OF,BEDROOMS
TIME
TIME
DATE
.l
DATE
DATE
INSPECTOR
* ATTACH WELL LOG. A well log is required for all wells drilled
INSPECTOR
INSPECTOR
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
MUNICIPALITY OF ANCHORAGE
INDIVIDUAL/ON-SITE**
DEPT. OF ILALIN
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION
•
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 D E V rir 1979
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DI RECTIONS: Complete al I parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER
QkW7
1&
PHONE
MAILIN DRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
Ml
PHONE
MAILING KESS
/"17 ' /
nS–(—
4. REALTOR/AGENT
711,J AI L
PHONE
MAILING ADDRESS
/)) T
!i/ � ' 4661/ z% r-
5. LEGAL DESCRIPTION
STREET LOCATION
f//CGS/�
6. TYPE OF RESIDENCE
NLIMBEfl OF,BEDROOMS
El One � Four El Other
SINGLE FAMILY
/
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY _
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ' `
(J -}I J
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLEFAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: !'- S_0 If Tank is homemade
give dimensions:
SOI LS RATING
l 1.41
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL _
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
LILY APPROVED FOR _ !i _ BEDROOMS
❑ CONDITIONAL APPROVAL (letter must aq omp ny certificate)
❑ DISAPPROVED
DATE
BY
l i
72-010 (Rev. 6/79)