HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 3kyhl'olls #1
Block 1
Lot 3
#011-122-14
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SWO40048 PID Number. 011.122.14
Crown Pointe Inc.
Wastewater System: New
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P.O. Box 112313 Anchorage, AK 99511
ABSORPTION FIELD
3456277 Five 5°""
5' Wide Trench
LEGAL DESCRIPTION
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Inspections performed by: MEA Dates: 1" 8116104
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Department of Health and Human Services approval
C MICHAEL E ANDERSON ]4W.
♦ if No. CE -4381
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Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage. AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO40048
PID No. 011-122-14
N
0
S In
PROFILE AS -BUILT
Scale: V • 70'
MuAdpality of Anehorage'
7 1'.(). lka t!)((M • Anchorugc, Alaska V9519-RZO • Telephone (!X)7) 3%3.")j • ra.< (!N)7) 3434;.00
47(X) Bmgaw Strccl • .lnchomgc, Alaska !NAi07
,Mayor 31ark Begich nim.munl.or"
Iluilding Safety Dix islon
24 Mar 05
Frances M & Steven C. Jones
8330 Skyhills Drive
Anchorage, AK 99502
Subject: Expired On -Site Water and/or Wastewater Permit.
Permit Number: SW04048
Legal Description: Sky -hills Phase 1 Block 1 Lot 3
Dear Frances M & Steven C. Jones:
An On -Site Water/Wastewater Permit, number SW040048, issued by this office for a single-family
system, expires on 08 April 05. This permit was valid for 365 calendar days.
If this was a well permit and the well has been drilled, a well log must be sent to this office for
documentation of the installation and to close the permit.
If this permit was for a wastewater disposal system, an original as -built inspection report must be
sent to this office for review, approval and documentation. This as -built inspection report must be
signed by the licensed Professional Engineer who inspected the installation of the system. As -built
inspection reports are required to be submitted within 30 days of the completion of the system.
If no system was installed under this permit, and you are still planning to install a well or wastewater
disposal system, a new permit must be obtained from this office. When applying for a new permit,
the fees are: $460.00 for a wastewater permit and $175.00 for a well permit.
If you have any questions, please call this office at 343-7904.
Sincerely,
b��- yQ�T
Daniel J. Roth
Manager
On -Site Water and Wastewater Program
Enc: Copy of permit
C01111111111ity, Security, Prosperity
Permit Number: SW040048
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
")?-oti to g: vA
Date Issued: Apr 08, 2004
Expiration Date: Apr 08, 2005
Parcel ID: 011-122-14
Legal Descriptiont:SKYHILLS SUBDIVISION PHASE 1 BLLOCK 1 LOT 3;)
Design Engineer: 0014 Anderson Engineering Site Address: 8330 SKYHILLS DRIVE
Owner Name: FRANCES M & STEVEN C JONES Lot Size: 45826 SO. FT.
Owner Address: 8330 SKYHILLS DRIVE Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE. A 99502 -
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 specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued
Date: r
Date: '/46/044
Municipality of Anchorage
• 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. 011-122-14 Permit Number SW V 4 0048
Property owner(s)_Crown Pointe. Inc.IfRfW[F S 1 M STEVEN G SODaNES
y phone 727.8167
Mailing address
$/7f
Ma449-address
Legal description (Lot, Block & Sub'd.) Lot 3, Block 1, SkOills Subdivision Phase 1
Legal description (Section, Township & Range)
Lot Size 45,816 SF Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms Five (5)
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: Waiver Fees:
Date of Payment: 41064 Date of Payment:
Receipt Number: a Receipt Number:
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
April 6, 2004
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3, Block 1, Sky Hills Subdivision Phase 1
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 3, Block 1, Sky Hills Subdivision Phase 1 intends to construct a five -
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new septic system to serve the new home. The attached Site Plan
and backup documentation identify the location and configuration of the proposed
septic system and alternate site. The subdivision is currently served by the Municipal
water system and no conflicts exist between the proposed septic system and the water
services and septic systems on the adjacent lots. Existing spot elevations and the
current drainage pattern are identified on the Site Plan. The drainage pattern will be
maintained after development of this lot is complete.
Test holes placed on the lot in the area of the new absorption trench and alternate site
indicated poorly graded sand and gravel and some cobbles to 12" in diameter. The
accepting soils were tested and found to have percolation rates ranging from .5 to 2
minutes per inch. No groundwater was found during excavation and none was noted
during the monitoring period. We are therefore proposing to place a new 1,500 -gallon
septic tank along with a 63' long by 5' wide by 4' effective depth absorption trench to
collect and treat the sewage generated in the house. The bottom of the trench will be 8'
below the surface. A minimum of 3' of cover will be placed atop the trench and 4' atop
the new septic tank.
The ground surface on the lot slopes at grades up to 5% from west to east as shown on
the Site Plan. The absorption trench will be constructed parallel with the slope of the
ground surface as much as possible in conformance with Municipal requirements. The
new septic system will be constructed a minimum of 10' from the water service
Lot 3, Block 1, Sky Hills Phase I
April 6, 2004
Page Two
proposed for the lot and on adjacent lots. It will also be constructed a minimum of 100'
from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
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. The subdivision is currently
served by the Municipal water system.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
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
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LOT 3, BLOCK 1, SKY HILLS
SUBDIVISION, PHASE I
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom House 5' Wide Trench System
Perc. Rate: <5 Min./Inch 1.500 Galton Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfieid Rock
5 Bedrooms X 150 GPD/1.2 GPD/SF (A lication Rate) = 625 SF Absorption Area
625 SF/5 LF (Width)' .5(Red. Factor) = 62.5 LF Trench Length
THEREFORE: Construct a 63' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
Natural
Backfill
3'6'
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
4'0" 1 1 %----- t— Drainfield Rock
5'
I----1
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
di
NOTE: Grade Area Over Trench to Drain Away. Z -V
Minimum 6' Separation From Bedrock. ■
Minimum 4' Separation From Groundwater. i
Minimum 10' Separation From Water Service Line. 0
Minimum 100' Separation From Surface Water or Streams. .
W E. MIOER
No. c 4x
>s
Municipality of Anchorage
DEPARTMENT OF HEALTH d HUMAN SERVICES
825'V Street, Anchorage. Alaska 8°502-DE50
SOILS LOG — PERCOLATION TEST
MICHAEL E. ANDERSON
No. CE -1381 p
PERFORMED FOR* L H Construction DATE PERFORMED: 8/12/98
LEGAL DESCRIPTION:
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PLAN
WAS GROUND WATER A /
ENCOUNTERED? At
IF YES, AT WHAT
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WAS GROUND WATER A /
ENCOUNTERED? At
IF YES, AT WHAT
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UPERCOLATION RATE (mv+utes"ncn) P£RC HOLE DIAMETER
TEST RUN BETWEEN FT AND S FT
COMMENTS Perc. Cavity presoaked prior to testing.
PERFORMED By. 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
Michael E. Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT. ON THIS DATE DATE
PERFORMED
LEGAL DESCR
Municipality of Anchorage .
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
L H'Construction
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SLOPE
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IASL G ANDERSON
No. CE -4381 r
DATEPERFORM ED:
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0 45,826 sq.f, r {�
1
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WAS GROUND WATERi
ENCOUNTERED?
S
IF YES, AT WHAT�. OL
DEPTH? P
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Depth b Water Atter 7 O
Monitoring? 's'
Reading Date Gross
Time
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Time
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TEST RUN BETWEEN --re— FT AND (C FT '
COMMENTS Pere cavity was presoaked .
PERFORMED Bxz 1 CERTIFY THAT THIS TEST WAS PERFORMED IN
Michael n erson
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 1, SKY HILLS SUBDIVISION, PHASE NO. 1
GENERAL:
The scope of this project includes the procurement and placement of a new
1,500 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 63' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 4' below the existing ground
surface. Total depth of the trench will be 8' below the existing ground
surface. The new septic tank and absorption trench must be placed a
minimum of 10' from the water service on this and adjacent lots.
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. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
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. A new 1,500 -gallon septic tank must be procured from an approved source
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.
Lot 3, Block 1, Sky Hills No.1
April 6, 2004
Page 2 of 3
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct 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:
Septic tanks must be constructed by a Municipally approved septic tank
manufacturer.
Lot 3, Block 1, Sky Hills No. 1
April 6, 2004
Page 3 of 3
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).
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.
5.
Municipality of Anchorage --
Ori -Site Water and Wastewater Program
(907) 343-7904 s F T r
Certificate of On -Site Systems Approval
Parcel I.D. 011-122-14
1. GENERAL INFORMATION:
Expiration Date: ! - j -/'2tZZ
Complete legal description SKYHILLS PHASE 1: BLOCK 1, LOT 3
Location (site address) 8330 Skyhills Drive *Anchorage 99502
Current Property owner(s) Amy Jones Day phone 382-8150
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public'Water System, ' :_
®
Public Sewer
❑
WaiverNariance request for. Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $-- 7 �o�, 56 ( COV 16-11
Date of Payment
Receipt Number D D 3 d 2 G
COSA # 0 s C 2015 31
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
rA
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Enginee6nq Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101 -Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the dates of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s: therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6, DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the fo
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ations hO141i,
WATER A
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other
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ations hO141i,
WATER A
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other
CVtn • !s, r I,l � it (: AC 1G. I L—�
Legal Description: SKYHILLS PHASE 1; BLOCK 1, LOT 3
If more than 1 septic system on lot: COSA Checklist # 1 of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for CO
Static water at beginning of test ft.
Parcel ID: 011-122-14
Structure served by this system 1
Well production at time of test
Water storage tank volum gallons
Well disinfected oliform test? ❑ Yes ❑ No
❑ Co ' bacteria is Negative
urate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
AWWU WATER
B. TANK DATA
Age of tank(s) 16 years
Tank type/material " '
Measured operating fluid level in septic tank 5111
H Standpipes/foundation cleanout per record drawing
Date of pumping 2'�1 ?..o
D. ABSORPTION FIELD DATA *AT MONITORING TUBE
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Which system tested (date installed) ""7'04
Adequacy test date 9f17120
X ALL standpipes present per record drawing
Results W Pass For 5 bedrooms
Total measured depth from grade *10.16 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 6.8+ ft (min)
Water added 759 gat
❑ N/A — pressurized field
8
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
15
depth into effective 3.91'p
Elapsed time min
9 Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 750+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced N/A gallons
If yes, enter date N/A
Comments/Deficiencies: DRIVEN MONITORING TUBE INSTALLED IN THE NORTH SIDE OF DRAINFIELD IN 2653 -ORIGINAL MONITORING TUBE WAS NOT FOUND
COSA Checklist yellow sheet
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
if No *5+
Community Sewer Manhole/Cleanout > 10 '
❑ Yes
if No
ft
s
if No ft
Neighboring Tank > 100' El
Absorption Field on Lot > 100' ❑ Yes
if No
if No
ft
ft
Private Sew Sep c Line > 25' [7 Yes
�y X11
olding Tank > 100' ❑ Yes
if No ft
if No ft
Neighboring Absorption Fields > 100'
ft
Private Wells > 100'
Animal Containment > 50' ❑ Yes
if No ft
es
Comm Wer Main > 75' ❑ Yes
if No
if No
fit
ft
Manure/Animal Excreta Storage > 100'
❑ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No *5+
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'�j✓
Yes
if No
ft
Wells on Adjacent Lots:
Q Yes
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
0✓ Yes if No ft
Water Main > 10'✓Q
Yes
if No
ft
Community Wells > 200'
✓Q Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'Cj✓
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Q Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
❑ Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
Q Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL **10'+ PER MIKE E ANDERSON, P.E. RECORD
DRAWING APPROVED ON 8/3/06.
G. ENGINEER'S CERTIFICATION o � 0F 04�
I certify that t 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. .....
O •,Je e Garness-
004 s '•• G 53�c�G
COSA Checklist yellow sheetro f es sio�°\
a
#Aeccsea 44400c��
DATE SCHEDULED (S- IQ -0 Y TIME. INSPECTOR
SUBDIVISION SKYHILLS PH I
INDICATE NORTH
N
QD
BLOCVJLOTrrRACTBLK 1 LT 3
SIZE CONN 1" [2 DOMESTIC ONLY ❑ BOTH FIRE 4 DOMESTIC
CORP. STOP El FIRE LINE ONLY ❑ FIRE'HYDRANT ONLY
CURB STOP C TO C DATE OF TAPE BY
FT. COPPER PIPE SIZE MAIN 0 ALLEY 0 STREET 0 EASEMENT
I 114" OR 2" KEY BOX TYPE MAIN EXCAVATOR
FT. THAW -WIRE DISCONNECTS n YES- NO SIZE OF DISCONNECT
THAW-PLATE/NUT COMMENTS
KEARNY CONNECTOR KEY BOX LOCATION
71-241+ 15,u*14 af Nov2Jff
OTHER
INSPECTION REPORT
J0 LINE BLOWN OUT l I ElINSULATED
INSPECTOR
DATE I I
COMMENTS
0 K.B.&T.W.-OKAFTER -BACK-FILL
❑
OPEN BORE FLUSH
D
200 LB. TEST
0
MAIN CHLORINATED
El
CHLORINE FLUSHED
V
OK TO TURN -ON
DO NOT TURN -ON
INSPECTOR
DATE I I
COMMENTS
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/EMENTS
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MUNICIPALITY OF ANCHORAGE
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE: (907)564-2762
BLOCK/LOT1TRACT BLK I LT 3
SUBDIVISION SKYHILLS PH 1❑
WATER
CONNECT PERMIT 4 -108
DATE OF APPLICATION 08/10/2004
SCHEDULED COMPLETION DATE 12/31/2004
SINGLE FAMILY
MULTI -DWELLING No. APTS
❑ COMMERCIAL
TAX CODE 1112214 GRID SW2222 AS -BUILT
STREET ADDRESS 8330 SKYHILLS DR
OWNER CROWN POINTE INC PHONE
MAIL ADDRESS PO BOX 112313 ANCHORAGE, AK 995112313
CONTRACTOR SANDERS & SANDERS
ASSESSMENTS
❑ Repair Existing Service
X] On Property Only
❑ Hydrant Only
❑ City Tap
❑ 50'orLonger
Main Line Extension
I❑I Have Been Levied
❑ To Be Levied
Lj Main Tap - To Prope—ity Line Only
❑ Main Tap & On Property Connect
Row No.
Comments:
❑ Disconnect
F-1 R & R - Main Tap Only
Owner
CONNECT SIZE I"
ISSUED wwask
INSPECTION FEE $ 103.00
PAID 17 CASH
PERMIT FEE $ 45.20
FICHECK#
$ 0.00
nX OTHER VISA
DEPOSIT $ 0.00
1 N S BY
REIMBURSABLE
TOTAL $ 148.20
IL37"
NUMBER
DATE
REMARKS _12— se,_ -hatGj(a s.,&e
PERMITTEE (Please Print) *SAME AS CONTRACTOR PHONE
MAIL ADDRESS
SIGNATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
AWWU INSPECTOR Original
Municipality of Anchorage -
On -Site Water &Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
�C 2 3 Z013
Parcel I.D. 011-122-14 Expiration Date: -2 — % ?- 15-
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING
SKYHILLS S/D #1 BLOCK 1 LOT 3
8330 SKY HILLS DRIVE, ANCHORAGE, AK 99502
AL & RAINE JOHNSON Day phone
8330 SKY HILLS DRIVE, ANCHORAGE, AK 99502
351-3784
JOHN WAGNER W/ FIRST CHOICE REALTY Day phone 360-4884
Single Family (w/wo ADU)
..5�
4
f
❑ Duplex
*
`,
❑ Multiple Dwellings (Single Family
and/or Duplex)
DEC 2 3
2013
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
0
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ iq0
Date of Payment ) L?4-- 3)�)ff(//�J
Receipt Number d a (ul
COSA# OS�l3i�S
Date:
Waiver Fee $
Date of Paymen
Receipt Number
Waiver #
5, STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name
Engineers Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, GEG, LfD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lest, and separation
distances measured to readily identifiable features. The operational life of ail wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the wafer usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
M
L_ bedrooms.
bedrooms.
Phone 337-6179
Date I2_12o t
oo�Op^�C
o O r'i
0
-1 .'h
...J ... ........ ........
f r Gar ess.
CE -/79 - e
bedrooms, with the following stipulations:
tOF AI&C,
ON-SITE Gt
�Z WATER AND
oSTEWATER 0z z
WAnorRAM Cl)
S-,'1i�C'.,.. .
Original Certificate Date: / 02 "-2 G - / 3
The(MtfniciplitynaA,9r0rorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the repres tations 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 engineers work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
In— 1vnss
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: SKYHILLS S/D #1; BLOCK 1, LOT 3 Parcel ID: 011-122-14
A. WELL DATA
Well type
Date completed
Total depth _
Date of test
Static water level
Well production
WATER SAMPLE
Coliform
PUBLIC WATER
If A. B, or provide PWSID# Well Log (Y/N)-
Wires properly protected
Casing height (abo n
Sanitary seal (Y/N)—
ft. Cased to ft.
FROM WELL LOG
colonies/100 ml
ug./L.
Nitrate mg./L.
Date of sample: —
FWAIIIIII
Collected by:
A
9-p M.
in.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8/16-17/2004
Tank size 1500 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over ta�Ink (YIN) NO High water alarm (Y/N) N/A
Date of pumping f `� 3 Pumper /h 4 e S
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 8/16-17/04 Soil rating EB50r ft2/bdrm) 12 System type TRENCH
Length 64 ft. Width 5-7 ft. Gravel below pipe 4 ft.
Total depth *11.2 ft. Eff. absorption area 640 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 12/17/2013 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 1 in. Water added 850 gal. New depth 1 in.
a —
Elapsed Time:.= min. Ifinal fluid depth I in. Absorption rate >= 750+ g.p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off' level
E. SEPARATION DISTANCES
level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line_
On adjacent
On adjacent lots
Holding tank
PUBLIC WATER
manhole/cleanout
AAWmatcontainment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line
*10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line *10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*PER MICHAEL E ANDERSON INSPECTION REPORT (8/3/2006).
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 JEFFREY A. GARNESS
Date 12,12-0.b3
(Rev. 11/05)
MCI).�9 ..............°i
CE —19n j
98-134
SKYHILLS SUBD., PHASE 1
LOT 3, BLOCK 1
45,836 S.F.
�2t(-
k
�z
va
I
GASTALDI LAND i
SURVEYING, LLC
JEFF A. GASTALDI.
4726 WEST 88TH A
ANCHORAGE, ALASKA
PHONE 248-5454
ORM DATE i
2222 7/27/200S
F.B. JOB 90.
05-09 SHS131
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PIAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
Municipality of Anchorage
• -- Development Services Department r•
Building Safety Division
On -Site Water and Wastewater Program • t
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D.dt1.122.14 HAA# 175D -?yr+
Expiration Date: _ Pi .3 — U 6
1. GENERAL INFORMATION
Complete legal description Lot 3. Block 1. Skvhllls Subdivision No 1
Location (site address or directions) _8330 Skvhilis Drive
Current Property owner(s) Crown Pointe, Inc. Day phone 345 6277
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O. Box 112313 Anchorage, AK 99511
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
Jive 5
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
ED
❑
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 0 Box 240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7/31/2005
5. DSD SIGNATURE
✓ Approved for ,L bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: /V. !� Original Certificate Date: 0—:3
(Rw. 12M
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water 6 Wastewater Program
470D South Bragaw SL
P.O. Boot 19WW Anchorage, AK 99519.WW
www.cLanchorage.ak.us
(9D7)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 3. Block 1. Skvhllls Subdivision No.1 Parcel ID: 011.122.14
1 A. WELL DATA
1
Wen type _ It A, 8, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seat (YIN) _ Wires property protected (YIN)
Total depth ft Cased to 1 Casing height (above ground)
i�
i, FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:-
Conform
ESULTS:Conform colonkW100 ml.
Dais of sample:
S. SEPTICIHOLDING TANK DATA
fL
g.p.m.
Nitrate mg./I.
Collected by:
Other bacteria
fL
g.p.m.
colonies1100 ml.
Tank TYpe/Materkd SeotldSW Date Installed Bf1tNM
Tank size 1.300 gal. Number of Compartments $ Cleanouts (Y/N) Y
Foundation cleanout (YIN X Depression over tank (YIN) N High water alarm (Y/N) N_
Date of pumping Pumper New Constnrctlon
C. ABSORPTION FIELD DATA
Date Installed SMTr 004 Soo rating (g.p.d.W or fe/bdnn)1.2 OPDISF System" S Wide Trench
Length E4 R Wkfth 3.7 A. Gravel below pipe 4 fL
Total depth 12 fl. Eff. absorption area W.A' Monitoring tube X Depression over field IN
Date of adequacy test Results (Pass/Fam For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final Auk} depth _ in. Absorption rate x g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 6 type) N If yea, give date
D. LIFT STATION
Date installed
"Pump on, level at _ In.
Datum
Size in gallons
'Pump o8 level at _ in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septi tankAift station on lot WA
Absorption field on lot WA
Public sewer main NA
•
Manhote/Access (V/N)
High water alarm level at in.
Meets alar b drm* requkements?
On adjacent lots IVA
Public sewer manhole/clesnout WA
Sewer /septic service line WA Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation W Property line >'
Absorption field >T
Water main >10' Water service line >10' Surface water XW
Wells on adjacent kits >2W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property Hne Mir Building foundation >10' Water main MV
Water Service l ne >10' Surface water MW Driveway. psrkhgAroNde storage >S
Curtain drain None Noted Wells on adjacent kits>i00'_
F. COMMENTS
Properly is Served by AWMJ Water System
G. ENGINEER'S CERTIFICATION
I ceAvy that I have determined through field inspections and
review of Munk 4ml records that the above systems are d9
conformance w1M MOA HAA guideffnes in effect on this date.
Engineer's Printed Name Mtchsel E Anderson. RE
Date MirM
HAA Fee S 57 Waiver fee S
Date of Payment �� Date of Payment
Receipt Number UtT_ Receipt Number
(pw. U/M
in
n
to
o
Q
am
N
i
98-134
SKYHILLS SUBD., PHASE 1
LOT 3, BLOCK 1
45,836 S.F.
N 8T4 2 -59-E 285.05' 176.9'
.0
I a i r r
I w 30, U1
I
A.C. DRIVE o O
I � L
mo stn
.I
I EXISTING
w I BUILDING
I
SEPTIC SYSTEM
O
O
10' U11L ESA1T.
S 89'58'51'E 139.81' I
AS -BUIL
GASTALDI LAND
SURVEYING, LLC
JEFF A. GASTALDI, Rj LS.
4726 WEST 88TH AVENUE
ANCHORAGE, ALASKA 69502
PHONE 248-5454
CRID DATE
2222 7/27/2005
F.B. JOB NO.
05-09 1 SHS131
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
IT IS THE RESPONSIBILITY OF THE OWNER TO
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES.
ANCHORAGE RECORDING DISTRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
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