Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
SKYHILLS PH 3 BLK 2 LT 10
kyh1*11s #3', Block 2 Lot 10 #011-122-52 Municipality of Anchorage Page 1 of 3 Department of Health and Human Services i Division of Environmental Services Onsite Services Section 8251' Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 3434744 ONSrrE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW000146 PID Number: 011-122-52 1 Marc Kin Wastewater System: New Upgrade AO : 3101 Bettles Bay Anch., AK 99515 ABSORPTION FIELD eaew a Bed�ovo: 344-5944 Four 4 70 s 0° 'r � o &wk. Tw" o tial Llaatl I o oro.: LEGAL DESCRIPTIONTo. DepmaaamwW F+d- 9 .8 c nGre FT. ebdt: Lal: SuDbvman: De MWP"Doran f n", Vada: Cr depm be pie: 2 10 Sk hills Phase 3 1 Ft. 8 FL To-r4hV: fie: Sacoon: F.WaaaeOp on"g,a : Gare, Lergm: i 8 Ft. 52 Ft. Well: p New C3 Upgrade Gl ' 00: 3 r eaDajW Dea,we Da wa rea N/A Ft. FL cwudw (P, -. A a. C): Tool Depm:Coen t: ToW eneo,pson w: P" AWWU Water S ste Fl. n. 832 Fr ASTM D3034 PVC D~ Date D,aed: Sb We Le : baler. Data Yuraled: FL Owner Installed 6/8-9/00 vw,d: Pump Sr M: CA" ADai. G.w,O: TANK GPM it. FI. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. b Other. To From Septic Tank Absorption Field Ult , Station Holding Tank lublidPrivate se rur. w: Anchorage Tank lllipay.; 1,250 WON >200' >200, N/A N/A >25' .a.r: Steel Two (2) s.raa.waW >100' >100' N/A N/A LIFT STATION — NONE ON LOT Flu,,. >5' >10' N/A N/A e. a. Fourod n >5' >10' N/A N/A Aa.r.u. No I 1 I 6'.ti �A Whin Di, None INoted I V P.V M�aM� ~'P° P.%by ".".'WBENCH Owner Installed System with Permission From MARK DHHS. Front Porch Deck 100.0 Engineet'a Stamp Inspections performed by: MEA Dates: Vt 6/8/00 •.... . ' ..... `.. r •' �a�...... ..... 2n46/9/00 r� ;At.C4a°i EA`: CR>GN+• v ey 1381 Department of Health and Human Services approval r�` ; , CE - � Reviewed and approved b V Date: /i'O/ PP Y- S `< . t u r 7i� o (xev. lo9el Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 3434744 Onsite Wastewater Disposal System or Well Inspection Report Permit Number SW000146 �4Y 9 101 A 1rt erns Fe - 10 1 e TH .yZ,74 .% OF w f*: 491" 6 � I. MICHAEL E. ANDEMN : 4fjp j CE - 4381 C5 PID No. 011-12252 fP7C rAAKI• S2 OYD PACED•• pw>E S 1 Four ' 0 � o O 3 O C X34 wi PLAN AS -BUILT SCALE 1"= 40' \ J FA i Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 -Anchorage, AK 99519-6650 - 3434744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW000146 PID No. 011-122-52 , N UU 2' m U 80.2 m 89.4 m U 1,250 •—%_ 83.8 Gallon ry,> Sep. Tank 83-T m 32' 1' 32' 58' 89.55E4 �u Geotextile Fabric Drainfield Rock 52' PROFILE AS -BUILT C% v Ln U U MUNICIPALITY OFANCHORAGE Department o/Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW000146 Parcel ID: 011-12 Legal Description: SKYHILLS PH 3 BLK 2 LT 10 Design Engineer: 0014 Anderson Engineering Site Address: Owner Name: Marc King Lot Size: 40182 Owner Address: 3101 Bettles Bay Total Bedrooms: 4 Anchorage . AK 99515 - This permit is for the construction of: I AT1 iv- (Okll e e Date Issued: un 02, 2000 Expiration Date: ilun 02, 2001 2-52 SQ. FT. Permit Bedrooms: 4 V Disposal Field Q Septic Tank F-1 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. i Received By: Issued By: B. Covered, sealed, and heated to prevent freezing. Date: G o Date: 2 -ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) May 26, 2000 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 10, Block 2, Skyhills Subdivision, Phase III Septic System Design and Permit Application Impacts to Adjacent Properties . Dear Onsite Services Engineer: The owner of Lot 10, Block 2, Skyhills Subdivision, Phase III intends to construct a new • . four bedroom home on the property. We are therefore requesting a construction; permit be issued for a new septic system to serve the house. The Site Plan shows the location of the new system along with the alternate site.. The backup documentation provides the parameters used in the design of the system and provides the configuration of the system.' The lot is served the Municipal water system and the system will be constructed a minimum from the water service line. The test holes placed on the lot in October of last year at the locations shown revealed fine sand with some silt with a percolation rate of 12 minutes per inch. No groundwater was encountered in either test hole and none was found during the ensuing monitoring period. We therefore proposing a deep trench system with a maximum depth of 9' from original ground. The length of the trench will be 50' with an effective depth of 8'. The owner intends to place fill in the area of the trench with a minimum of 3' over the trench for protection from frost and freezing conditions. The existing drainage on the lot is shown on the site plan and is primarily from south to north at varying grades with some slope from east to west. The absorption trench will be placed parallel to the contours in an area with a grade of less than 10%. Grading will be accomplished once the system is complete so drainage is away from the trench and septic tank but in the direction of the current drainage pattern. 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. j Lot 10, Block 2, Skyhilis Subdivision, Phase III May 26, 2000 Page Two 3. The system, if constructed as designed, will have no adverse impact on reserved 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, n J Michael E. Anderson, P.E. Attachments low pr 1---�1?5V8w9ri43['3S,.OvW11Ni 539-.7--•-R-)NCOURT -201.31•- - -- - ` 98.63• --75.3 C43'-' Pi j z w O - 11 •---139.03'---- - (o O 8 0 (R) T1 M 4N 41.573 ad.♦(.' .4 O ; , — a o ^y 1 1ZE +. 6 - a 44,811 sq.tt ; IR w 7. f Ne9sos6t I 40.351 sq.lt o ; 30130' {��• 42.4°I 1.}11. O z 40.169 :a.FL s ji ; b I THIS PROJECT 4uo \ 1 o b ^I � �.►� U9 C•7d p � ta-. •ty. f o •. p �. ; I �' i•1 _ G7 \ ' C.7 iO P .182 sq It J_--� _R t, 33� 22 45.103Sy{ILLS 44525 p.' sq.a 1 a, aa+ 20 Z ; 43.6351 satL S7 Z39 �� I 23 F\ \ �s7 41.161 sq.IL �W' c 1 44' to .�. .oy' J[ ► k11��� / YS .J1�`�.' w (��J V 1 •f 1 ?h �Q' b aWr1.4 G.'al)IT h I. m i uauwirfllnVt �e 'ory �1Mianw132 � o 'T �58175W47-r.:- 40.418_V7 I rwoawT b ___ sgrt. r to ..A ,� 305.47•_ar, e�lu ; LL, 1 N.. /b e' z �iVOII.SI.R �.w9ii.wfi �'- SJ11, . ,..� ` / S.l50RwI LY,{wl o °77. ...I 1 �! . 241 �.o . e �Ir 41.30 sq. (L Ij l a✓ ,� I 31 b7.52'i• . o inU xaare VMIOIMKL 95.2d• 4` `47• p ll-i-. 40.350 17.fL cnv N' 4 wIlI© 1¢ w f ' I Ig 4 as+ 2$ p • 41.625 Sart: sd>� qry try ; .1 40.0411.1.1 .n77bp0i � 1 T � ' Sn75 12 F 4 Q . • ii b 1 1 1 • e O' •b ' / O 5717 �� •hb a. 1 q 141`1 i i^> .. ` `S v w ?.l1 .03 33)•F 26 12. 41.436 sq.fL O 29.'. b b 1 { : i�r+R. T'!• sp ; v`.w �• 40.119 salt IS TRACT A t .t //. /.i •t�w� _ 107.7a0 sq.a ♦i CLQ. ,»->r C/Z 0�� .1'f w , ! - i A��" f •wrJ /'. i Ss,•Ih all 4fi�J` , i `rJ ;. iii r' •• y :6 r 1 1 \¢ f N9E 15958* J j .27 J� w 159.58• `�i•�'Ca '. ..""'. 1 p 4te92 so-iL .. ,0 p •.,��, 1 1 1 d o V �r B-J-A 26 � 2II-3-G ' i w' 44.797 2q.rt e, toTract A.-A. CI 31 AREA MAP ---- Ct.1aYY ,(2L nYla) _==-= ��� t..Y�T .. __ra�t�-A Z=3 =---------- --- - - .-------17..12- - . � �_---165.45'---------- - -�-_--328.77----__--."_� �. SCALE 1" 100N893Y26"E 768.34'(R) i - m 4 82 sq. t' THATHB \ 181 o11 X 1 e \SQ). rptl3n� O .. 1P / P Ga 'oo PFS 169.0 Se ti Tan. ' �' •pR � .0$Eo� �. � \ EnvE Four ... R� " Bedro House PFS 1 .s / �9p J Pf 79 1 1206 i P 204 2QQ Q 198 \\ � 196 \ ^'jam 19� R=20� SITE PLAN SCALE V = 40' M e LOT 10, BLOCK 2, SKYHILLS SUBDIVISION, PHASE III DESIGN FACTORS: Four Bedroom Home Perc. Rate: 12 Min./Inch Application Rate: .8 GPO/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 8' Drainfield Rock 4 Bedrooms X 150 GPD / .8 GPD/SF = 750 SF of Absorption Area 750 SF/16 SF/ LF of Trench = 46.9 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 150' in Length with 8' of Drainfield Rock Beneath the Distribution Pipe. Distribution Pipe in Trench Placed at 1' Below the Original Ground Surface. Total Depth to be 9' From Original Ground Surface. Insulate or Mound Over Trench to Provide a Minimum of 3' of Cover. `7 Natural i Backfill .5' .5' 8.0' � NQS Geotextile • Fabric 4" PVC Roles Dolri — Drainfield Rock TYPICAL DEEP TRENCH .SECTION (NO SCALE) Grade Area Over Trench to Drain Away. A+•3�� Provide 3' Cover Over Trench and 4' Over Tank or Insulate. jr S� Maintain 10' Separation From Lot Line. �//$:� Maintain 10' Separation From Water Service Line. Municipality of Anchorage Department of Health 8 Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST Performed For: Boh Klein Date Legal Description: Lot 10. Block . Sky Hills. Phase III SLOPE 11 1 OG/PT 4 6 Fine Sand 7 1 Some Silt 8 Gross, Time SP Depth To Water Net Drop Was Groundwater 9 Encountered? 1 2 If Yet, What Depth? 10 3.25 Depth to Water 3 11:15 After Monitoring 11 I 2.5" Date: a 10 r1 v 0 N 15 Fine Sand 16 Clean 17 SP U1 as No None 10/10/99 r N ned.—MAZ 'l 58 10% Reading Date Gross, Time Net Time Depth To Water Net Drop 1 1 -Oct 10:15 .75" 1 2 10:45 30 3.25 I 2.5" 3 11:15 30 5.5" I 2.5" 4 11:45 30 8" 2.5" I I I ' I I ' I Bottom of Perc. Rate: 12 MinAnch Perc. Hole Diameter 6" Hole Test Run Between 7 Ft. and 8 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Ed Sanderson I, Michael F Anderson Certify That This Test Was Performed In Accordance With All Slate and Municipal Guidelines In Effect On This Date: 10110/99 1 Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 SOILS LOG - PERCOLATION TEST t-frL Performed For. Bob Klein Date Performedj� f Legal Description: Lot 10. Block 2. Sky Hills. Phase III SLOPE SITE PLAN 1 2 3 4 15 16 17 1 OGIPT Fine Sand I ' Some Silt Depth To Water SP 1 1 -Oct Was Groundwater Encountered? No S If Yet, What Depth? L Depth to Water O After Monitoring None P Date: 10/10/99 E Fine Sand Clean SP 58 — 108 Reading Date Gross Time Net Time Depth To Water Net Drop 1 1 -Oct 12:15 .75" I 2 12A5 30 3.25 2.5" 3 13:15 30 5.5" 2.5" 4 13:45 30 8" 2.5" Bottom of Perc. Rate: 12 MinAnch Perc. Hole Diameter. 6" Hole Test Run Between 7 Ft. and 8 Ft. Comments: Percolation Cavity Presoaked Prior to Testing. Performed By: Fd Sanderson. I, Michael F. Anderson Certify That This Te: In Accordance With All State and Municipal Guidelines In Effect On This Date: f + KINGS PROPERTIES RENTALS. MAINTENANCE MANAGEMENT 3101 Betlia Bay Loop ,Asch. AK 99515 344-5944 Fa: 344-9401 cel. 360-SS59 BUS LICENSE 0250230 Attention: Dan Ross DATE: 5-30-00 INVOICE: N PROPERTIES LOCATION: Skyhiiisjot 10 block 2 phase 3 In request to install own septic system following Anderson Engineering design. Back ground history : Plumbing And Pipefitters local 350 out of Reno Nev. is years. Equipment operating at mine sites along with on farms and misc. Doing residential since 1973. thank you If there are any further questions please feel free to call. Marcos King saT% snatex Tore tte Yv3 tz:oT lu 00/oc/20 Municipality of Anchorage 4 • Development Services Department Building Safety Division On -Site Water and Wastewater Program ,. LT: BStreet Individual On-site P.O. Boxox 19 196650 P.O. Individual Water Storage Anchorage, AK 99519-6650 Individual Holding Tank www.muni.org/onsite Community Class Well (907) 343-7904 Community On-site CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.Oil -122-52 COSA# Oq oZpq Expiration Date: 1. GENERAL INFORMATION Complete legal description Skvhills #3 Block 2 Lot 10 Location (site address) 7900 Skvhills Drive Anchorage AK 99502 Current Property owner(s) Beverly & Michael Wortham Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 7900 Skvhills Drive Anchorage AK 99502 Day phone Kelly ft Keller Williams Day phone 865-6512 Midtown Keybank Building Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. 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 ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. t=rr 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 _Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 6/23/09 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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. 5. DSD SIGNATURE J,,�- Approved for '' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report )ther Original Certificate Date: -7 C Municipality of Anchorage ' 1 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 10 Bk 2 Skvhilis #3 Parcel ID: 011.122-52 A WELL DATA Well type AWWU If A, B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ 'Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground). FROM WELL LOG AT INSPECTION Date of test Static waterleve Well production WATER SAMPLE ft. 9 - p.m - ft. 9.13 -m - U01110 colonles/100 mL Nitrate mg/L ther bacteria colonies/100 mL Arsenic: _ ug/I Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material _Anchorage Tank Steel Date Installed 6/8/2000 Tank size 1250 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/A Date of pumping 6/22/2009 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 6/9/2000 Soil rating (g.p.d./ft2 or ftZfbdrm) 0.8 System type _Deep Trench Length 32 ft. Width OW 3 ft. Gravel below Pipe 8' ft. Total depth 14_16 ft. Eff. absorption area 832 fe Monitoring tube Y Depression over field N �p Date of adequacy test 6/22/2009 Results (Pass/Fail) Pass For 4 bedrooms 19 p Fluid depth In absorption field before test 28 In. Water added 1300 gal.New depth1aIn. Elapsed Time: 1440 min. Final fluid depth 28 in. Absorption rate >= 600+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date LIFT STATION 'Pump on' level�t\ - in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic sere ine areas Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements't In. 0 'scent lots On adjacent t he Public sewer mano Holding tank \ Manure/animal excrete storage areas \ El - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15+ Property line 10+ Absorption field 10+' Water main 25+ Water service line 25+ Surface water 100+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyiine 10+ Building foundation 25+ Watermain 25+ Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain None Observed Wells on adjacent lots 200+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name Steven It. Pannone, P.E. Date 612312009 © C?V b COSA Fee $ / 0 Waiver Fee $ _ Date of Payment _/- L Date of Payment Receipt Number n q 1 O —7 (o Receipt Number (Rev. 11/05) 4,Li .,,,.. iL' .y* NO.CE 8149 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPR FOR A SINGLE FAMILY DWELLING Parcel I.D. O // ^ / 2 2 - S"2 COSA # Q 6 D 3 77 L Expiration Date: - 2 4 = O 7 1. GENERAL INFORMATION Complete legal description Lot 10 Block 2 Skyhills #3 Location (site address) 7900 Sky Hills Drive, Anchorage. AK 99516 Current Property owner(s) Blake & Patricia Hardin Day phone 563-1663 Mailing address 7900 Sky Hills Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone 3. 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 ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer -registered in -the -State of Alaska.-CertfiicatesofOnSiteSystems Approval are required for-thelransfer-of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Pannone Engineering Services, LLC Phone 272.8218 Address P.O. Box 102954 Anchorage, AK 99510 Engineer's Printed Name C, t S t�c9J r' Date S �� Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines &. 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 arc outside the control of the evaluator of this system. All *items eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that therp.arc no hidd Tr encroachments. PES can therefore not provide any warranty for future performance nor give any estimatc:of how 1r) rR > continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole, icnefr u Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any Ic rf? halsoc 5. DSD SIGNATURE ✓ . Approved for 1� bedrooms. Disapproved. Conditional approval for bedrooms, with the following pROfESsV `` > .- -. ON-SITE zE ER AND ' WASTFIA/ATrn PROGRAM .' Attachments:���i COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other' By: -a.&..,� IP&e,* Original Certificate Date: S -2 4 — O C (Rev. lift) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 47W Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 10 Block 2 Skvh0ls /3 Parcel ID: O It — �I 1_;X -5-7- A. S-7- A. WELL DATA Well type A mplated _ Total depth Date of test Static water level Well production WATER SAMPLE If A. B, or C provide PWSID # _ Sanitary seal (Y/N) Cased to ft. OM WELL LOG g.p.m. .TS: 4100 mL Nitrate mg1L Well Log (Y/N) Wires properly d (YM) I Ca ' eight (above ground) ! in. AT INSPECTION Other _ ft. g.p.m. : coloniesll00 mL ArCenic: _ mgA Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed SO= Tank sae 1250 gal. Number of Compartments j Cleanouts (Y/N) Y Foundation cleanout (YM) i Depression over tank (YM) y High water alarm (Y/N) WAI Date of pumping 712712008 Pumper Chugach Pumping I C. ABSORPTION FIELD DATA Date installed 81912000 Soil rating (g.p.d./ie or felbdrm).8 System type Deep Trench Length 52 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 14 ¢ ft. Eft. absorption area Intl' Monitoring tube Y Depression over field y I Date of adequacy test 7/!1= Results (PasslFaii) Pass For 4 bedrooms Fluid depth in absorption field before test 4M in. Water addedU2 gal. New depthUA in. Elapsed Time: a min. Final fluid depth An in. Absorption rate >= 500+ � g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give data FTin ArON Date ed "Pump on level in. Datum Size in gallons 'Pump otr level at _ in. tested E. SEPARATION DISTANCES \ SEPARATION DISTANCES FROM WELL ON Septic tankAt t station on lot Absorption field on lot Public sewer main On Manhole/Access (YM) High water alarm lq* Meets algan't circuit mquiremerns? Public sewer 717 Sewer / service line Holding tank I containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 15+ Property line 10+ Absorption field 10+ Water main 25+ Water service line 25+ Surface water 100+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10► Building foundation 25+ Water main 25+ Water Service line 25+ Surface water 100+ Driveway, paddnglvehide storage ' Curtain drain None Observed Wells on adjacent lots 200+_ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field irrspecOons and review of Municipal records that the above systems are in � 490% conformance with MOA COSA guidelines in effect on thi's1 date. - Engineer's Printed Name -r-T 1, Ctl Olx 1 a eoorr CKWQ t -6491 Date �9 I U �o� S COSA Fee $ 3'O Waiver Fee $ Date of Payment ' 0— d Date of Payment Receipt Number g �.Z % Receipt Number (Rev. I M) in. 1LYTCLL i LICO. LOwT. �-•� • - v U ,Y YOWIVA M AD9VV• ` \ r ASPHALT \� owlrcwwr ,s A L ,Tro, ie 1� a'T 1 \ 1A0 00000pp�O \` v 0 B,�E.�F•:q�g0�0 O Ov,�P. S Opp �` • o 49 01'" '. SHANC A. HOLT: POC/ ` LS•691A a0 Opp�PL,.,oH.L �QL� Op0000�' 1.-;* w �1O F `�O, •4 3 SCALE: I /q �O' THE INPORWTKIN HEREON IS FOR THC USE OF LENDING RISRTUTIOMS EPECIMCALLY TO SHOW ANY CONFLICTS IlloweFII CASTING STRUCTURES AND PLATTED LOT UNE3OR EASEMENTS ANO 13 NOT TO Yb USED FOR FOSITIONHa ADOITKINAL STRUCTURES OR FENCELINES THEREBY MORTGAi DF3CMm LOT 10. [ CASEMENTS OF RECORD. OTHM THAN THOSE SHOWN ON THE RECORDED PLAT, ARE HOT SHOWN MERTON. I ENCROACI NOTE ANY FENCELMES 54OWN ARE LOCATED APPROXIMATELY AND ARE MOTTO BC USED TO DTTBAMNG PAOPGATY UHiS I DATED AT OA LOCATG STRUCTURES OAY OF ANY PAY1N0 SNOWN MAY Be MRONMATE DUE TO SNOW CONDITIONS. NOLT LAIZ TEL 510-0 THAT I HAVE PERFOAMM A VECTION OF THE FOLLOWING RTY. I SKY HILLS PHA5E 3 OVtMEDIS SACT. ED TXA HEAND THAT OVEMMTS AND THAT NO VISIBREONLE MC 7LTY ONES AND THAT NO VISIBLE ALASKA THIS _IST_ 41>. r t♦Y } \I r� i{ l r L T u� 1 Fd `tl t t\ •/ f: !r j ♦ =!L. y �� Y! i �• 'r ✓,1 r r \1� a J 'Y �r� � f //�� q 2+., y r>�.k, f��4 r,:<s!t i9a � i�gE t, r. �� �y..i. - •\Y -/ it 41, i ,rel q f♦� i 14�. .� '� • \.F{1�.�.ly�"! u +.��."'••.l...s�' yy�•_..1�)yl�i .t�i, t''.l :' ti'�4.{y.4 :•ui�L♦'.11zq � P� i4� �'�� 'j, d1 ,�( G\o �\ /�� 1� / t�ilj1l>. �sw..-4l li•. f.Jr �''. ,t� .t'`'k'.r i 6?r 1,.:'.v ql .wt'�'>1I �.."� t .. >, � 1 f y..,� .- r��.y it , t;jr' r .�..- r�..� �•�% �LLr�'�.l �t..i. ,.a:r?:..t l�i•`ri �...%'0 .._ I.. mer ,�\viii_\ai- !'�/�� Municipality of Anchorage Development Services Department e ..� Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: G. Scott Crowther Legal description: Skyhills #3 Block 2 Lot 10 The attached paperwork has been reviewed and Is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing _ ❑ Incomplete; missing ❑ Additional adequacy test information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. There may not be any parking areas over or across any absorption field. Name of reviewer: Poet Date: 5-15-06 Please supply the necessary information and re -submit your LEAVE THIS FORM ATTACHED TO THE PAPERWORK Municipality of Anchorage 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.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 172-- 57 Parcel I.D. 011-t`I =� HAA# 1. GENERAL INFORMATION Expiration Date: % " L 6 Complete legal description SKYHILLS SUBDIVISION Individual On-site ft, LOT `10- BLOCK `2 i ❑ Individual Holding tank ❑ Community Class Well Location (site address or directions) 7900 SKYHILLS DRIVE ' ANCHORAGE, AK 99502 0 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN BLOSSOM Day phone 677-7557 Day phone BONNIE MEHNER & BETH WEISER 317 10710 PRUDENTIAL JACK WHITE Day phone 3201 C STREET, SUITE 200 * ANCHORAGE, AK • 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site N Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal' and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 seat affixed hereto and as of the validation data shown below, I verify that my investigation, based on procedures outlined in the Health AuthorityApproval 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 (les 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 CARNESS ENGINEERING CROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 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: 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory 337-6179 Date -7" bedrooms, with the fllowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other OWSIT ND •: m VMTEWAT PROGRAM = Original Certificate Date: -7- oZ. I"O (Rm. 12101) Municipality of Anchorage e Development Services Department Building Safety Division On -Site Water b Wastewater Program 47W South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.akus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SKYHILLS SUBDIVISION N3: LOT 10, BLOCK 2 Parcel ID: 011-122-52 A. WELL DATA Well type Date completed PUBLIC WATER Total depth ft. Date of test Static water level Well production WATER SAMPLE If A. B. or C provide PWSID# _ Well Log (YIN) Sanitary seal (YIN)_ Cased to ft. FROM WELL LOG Coliform _-�' colonies/100 ml. mg./L. B. SEPTIC/HOLDING TANK DATA Nitrate—OV./L. Date of sample: Wires properly protected Casing height (a ro ATI CTION g.p.m: Other bacteria oolonies/100 ml. _ Collected by: ! Tank Type/Material SEPTIC/STEEL Data installed 6/6/2000 Tank size 1250 gal. Number of Compartments 3 Cteanouts (YIN) !YES Foundation deanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) ! N/A I Date of pumping 6/23/2004 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA Date metalled 6/9/2000 Soil rating .p.d r ft1bdrm) 0_6 System type DEEP TRENCH Length 52 ft. Width 3 ft. Gravel below pipe Total depth '16.3 ft. Eft. absorption area632 fe Monitoring tube YES Depression over field NO Date of adequacy test 6/23/2004 Results (Pass/Fall) PASS ForI4 bedrooms Fluid depth in absorption field before test45 in. Water added 900 gal. New depth 661-75in. I Elapsed Time: 244 min. Final fluid depth 61_75In. Absorption rate >= 600+ g.p.d. I Any rejuvenation treatment (past 12 mo.) (YM 6 type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm 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 line PUBLIC WATER On adjacent lots r071 Public sewer manhole/deanout Holding SEPARATION DISTANCES FROM SEPTICIHOLDING 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 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 25'+ Surface water 100'+ Driveway, parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed IJpme JEFFREY A. GARNESS Date HAA Fee $ Li%b -0 Date of Payment q II � I OU Receipt Number 55#tJ 56,1:xe Waiver Fee $ Date of Payment Receipt Number 10• TELL L ELE0. ESWT. 3 / SCALES V 40' 1 HEREBY CERTIFY THAT 1 H MORTGAGCE'S INSPECTION OF DESCRIBED PROPERTY. LOT ID, BLOCK 2, SKY HILLS PERFORMED A FOLLOWING H THE INFORMATION HEREON K FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS B F AGE RECORDING DISTRICT, ALASKA AND TI EXISTING STRUCTURES AND PUTTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AO d & ISIBLE IMPROVEMENTS SITUATED THERE01 STRUCTURES OR FENCELINES. WITHIN THE PROPERTY LINES �NO THAT NO VLSI EASEMENTS Of RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PUT, ARE NOT SHOWN HEREON. ENCROACHMENTS EXIST OTHER ITHAN NOTED. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DCTERHINE PRO tTgIEJT ANCHORAGE, ALASKA THIS __1ST_____ OR LOCATE STRUCTURES. Y JULY________ 2004___ ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. HOLT LAND SURVEYING 93901 FB113:39 Municipality of Anchorage Development Services Department Building Safety Division On -Site i, Water and Wastewater Program — 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 DWELLING Parcel I.D. 011.122-52 HAA # n D 2 O O `l -2- Expiration Date: 1. GENERAL INFORMATION Complete legal description rLot 10,Block 2 Skvhiiis Subdivision Phase 3 Location (site address or directions) Current Property owner(s) Marcus King Day phone 344.5944' Mailing address 7900 Sky Hills Drive Anchorage, AK 99502 Lending agency . Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Day phone Four 4 TYPE OF WASTEWATER DISPOSAL: Individual Well ED Individual Water Storage ❑ Community Class Well ❑ Public Water System 93 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 ora 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 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 312012002 O : MICHAEL E. ANDEZSON; ti o 5. DSD SIGNATURE `0rCE-4381 Approved forDisapproved. bedrooms. 44�o4CSL.aoa���� 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���,.n/ Original Certificate Date: (R« 12100) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 10 Block 2 Skvhilis Subdivision Phase 3 Parcel A. WELL DATA Well type _ Date completed Total depth ft Date of test Static water levet Well production It A. B. or C provide PWSID # Sanitary seal (Y/N) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. Coliform 0onies/100 ml. Nitrate mg.A. Date of sample: B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) I in. AT INSPECTION Other bacteria Collected by: Tank Type/Material Seotic/Steei Date installed 61812000 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 312012002 Pumper Old MacDonald's C. ABSORPTION FIELD DATA MI. Date installed 61912000 Soil rating (g.p.d./ft2 or ft2/bdrm) .8 GPDISF System type Dees) Trench Length 52 ft. Width 3 ft. Gravel below pipe 8 I ft. I Total depth 17 ft. Eff. absorption area 832 ft? Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) For I bedrooms I Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _min. Final fluid depth _ in. Absorption rate >= I g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons 'Pump off" level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot _ WA Absorption field on lot WA Public sewer main WA Sewer /septic service line WA Manhole/Access (Y/N) in. High water alarm level at in. Meets alar 8 circuit requirements? On adjacent lots NIA On adjacent lots WA Public sewer manhole/cleanout WA Holding tank WA 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 >1W Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >IW Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >iW 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 HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 312012002 HAA Fee $ _ i K Waiver Fee $ Date of Payment a 'L— Date of Payment Receipt Number 3 Receipt Number (Rev. 12/00) /4Y 10 4* dv 119Lt:L '91.011 6E11 leAluey IMSE OETNL SCALE 1' -SO' $$• do o"' . ,crtfia w:�tZ:' � .:.:. rporosi°r•.c0 x �K ..�.,. Q v Z 3o' /♦ 4ai•i ��♦♦'ii®�ii tygy p1 "O M b W .w! rryw.bwY Is M.wW ccKnv. ac l 1l . •w MARCUS KING M. lw[. M wY w.-ww4 Nh.wU. r mYelYn. �w.� :.r.p.�.:ww «I:.�~�Y,.:'I: stra llwo yr b O .rr4wUw v b. wlwMYy IMr1Y Wa �- �1_ � _ LAKY 6[Iln.l('aTp! lwRbl Aw w.1utlN • ��' Yw),I.V wn. M MN r..-IY w wwn w W wm e[OF _ rwM r•. �N W U .IIwIN IM COICALR� w I.;a" • MNY./ M M Prew.- N�Wh MV rlll \Mr Illw rIN. ". Afi—BUILT OFt liar eNtroa°r �.a1r.IgTis- ENONEEAS 440 BEST BENSON MO. 107 ANCHORAGE• ALASKA 9°503 (le.ISTAUCrON ) "I—a0xe LOT 10i BLOCK 2 (007) 562-5x01 SKYHILLS PHASE 3 10 'd 8199199 'ON XVI V MS/H031J i w ENO 0 IOOZ-9I—AVW I �n. 11Zun><cipality�of Anchorage I • -�Department of.H' lth and Human'Services. ' Division of Environmental Services On-Sfte Services Sectaii 825, L' StreetR",502 0.0. " P.O: Box 196656 , Anchorage; AK99519,6650 " , . ' www;ci.anchorage.ak.us ' i (b07)34:P744::.1'. } CERTIFICATE OF,.HEALTH AIJTHORiTY: OPR6v FOR-AISINGLE FAMILY DWELLING Parcel lD-011122.52•:, " HAA#"`:�{R O°10a,i0;3 Expiration Date GENERAL INFORMATION - ; a i Complete legal description'- Lot 10: Block 2, Skyhllls Subdivision Phase 3 Location (site address br dire'bons) Skyhills Drive'and Sky Mountal6 Lane Current Property-owner(s) Marc King Day phone 344 5944 Mailing address '3101 BettlesBay 'Anchorage,AK99515 ' Lending agency Day phone i Mailing address: Real Estate Agent`:' -:.Day phone L_ Mailing Address`` ' Unless otherwise requested, HAA will 6e held by DHHS for pickup. HAA picked 'by.Y 2. NUMBER OF BEDROOMS: Four 4 ( . 3. 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 ® Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on properties served by a single family on-site wastewater disposal'and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. (Rea. low) 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.inveMigation based on procedures outlined in the Health Authority Approval Guideline's for,this Health"AAuthority Approval application shows that:the on'siie,4aler supply'. and/or wastewater•disposal system is safe; functional and. adequate for the numbecof bedrooms and type, of structure Indicated herein: I further•verify thatbased on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on- site water supply and/or wastewater disposal system Is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installalion., Name of Firm Anderson Engineenng • Phone 522.7773 Address - PA: Box 240773•! Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. Date 5A7/01 OF'A� ENGINtE.R*; ' . STH. F�$T�. ^ . r ,,�(j,7r . 6' :MICHAEL E.`,AM'MCT7:� "'- 6. DHHS SIGNATURE�p� s� ,' CE-4381 Approved for, bedrooms. p fro Disapproved tEF�tB�ctiz Conditional approval for. , be Brooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 0_-4&"j /• W Original Certificate Date: S / %� 0 / Expiration Date: .S = y%• ;2— Reissue Date: Municipality of Anchorage • Development Services Department Budding safety Division On-site water & wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 995196650 www.cLandgrage.akus (9DT) 34-0-79D4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lotto Block 2. Skyhms Sub"Im Phase Parcel ID: d11.12252 A. WELL DATA Wed type _ K A. B, or C provide PWSID S _ Wed Log (YIN) Date completed _ Sanitary seat (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. Casing W4t (above ground) FROM WELL LOG AT INSPECTION Date of test Static water level fl. ft I Wad production 9.p -m. g.p.m. I WATER SAMPLE RESULTS: Coldorm colonlasfloo ad. Nitrate mgA. Other bacteria colonies/100 ml. Date of sample. Co WcW by: B. SEPTICMOLDING TANK DATA Tank Type/MaterW Steel Tank size 1IZ0 gal. Foundation cleanout (YIN) I Date of pumping C. ABSORPTION FIELD DATA Number of Compartments 2 Depression over tank (YIN) N Pumper Date installed BIS M f( - Cleanouts (YIN) v i High water alarm (Y/N) N 1 Date installed arm sod rating (9.p d.1ft' or tt"bdrrn) .S GPDIsF System hype No Trench Length ft. Width 3 ft Gravel below pipe 81 ft. i Total depth 17 ft. FJf. absorption area �2 tl2 Mondorin9 tube Y Depression over field N Date of adequacy test Results (Pass/Fad) For bedrooms Fluid depth in absorption field before test _ in. Water added_ gel. New depth_ in. Elapsed Tkne: _ min. Final fluid depth _ in. Absorption rata x 9-p.d. Any rejuvenation treatment (past 12 mo.) (YIN b type) N If yes, give date WA D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons 'Pump otP level at _ in. Cycles tested Mantwle/Aocess (YM) High water alarm level at Meets alarm b circuit requiremanta? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sept tankAdt station an lot On adjacent bb Absorption field on lot On adjacent lots Public sewer main Public sewer manhola/deanout Sewer optic service am Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line >S Absorption field >T Water main WA Water service line >17 Surface water >107 Wells on adjacent Iota *168► 7'40 1 IAO— SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >17 Building foundation AM Water main Air Water Service line >17 Surface water >107 Driveway. paft1g veNde garage >29 Curtain drain None Noted Wells on adjacent lots e4W ) t00 r �v1 tJA. F. COMMENTS Propft a saved by a water system owned and oceraled by AWWU a G. ENGINEER'S CERTIFICATION +' s I ce Nat I have defem*wd Nroagh field inspections and .• : 4 0 TI{1a y °� review of Munldpal records Nat the above systems are in �, conk mrance with MOA HAA guidelines in effect on this date, r" •.AVC y f„ NDE • •i Engineer's Printed Name Michael E Anderson, P.E. J f `�4301 \� Date 50=1.'alit+F� CSSIO�a��v�~ $6iESS1 HAA Fee S 300 Waiver Fee E Date of Payment S- /7-01 Date of Payment Receipt Number Ad o I o zy o4+ 5 Receipt Number (Rev.121o0)