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HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 12kyhl'*lls #2 Block 3 Lot 12 #011-122-38 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services ' On -Site Services Section 825'C Street Room 502 P.O. Box 196650 Anchorage, AK 99519£650 Pagel of 3 www.ci.anchorage.ak.us (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW PID Number: 011-122-38 "'n".Inhn Hagpimpir Cn Wastewater System: ® New ❑ Upgrade Aareaa,'. ABSORPTION FIELD P24 NumbxaBWroam• ®peep Trench OShallew Trench [3 Bled ❑Mwnd 13 Other: LEGAL DESCRIPTION salt Rating TeMl Depth *=algioet grade: a 13 p ! Let SuOdNabn: Depth bipe pbosom ham *nI grade: Growben Growl depth eath pipe: 3 12k TeenNap: Range. section: Fie Wad above anginal grade. G," Length: 2 Ft 48 Ft. Well: El New E] Upgrade GuvN eMth: Number N stance b blines: Dietween anew: 3 Ft. 1 0 Ft Clsaadration (Pnwte, A. S. Cl: Total Depth: CnW te. Total absorption veeApe Male n1w A AWWU Ft. Ft 672 Fz F810/3034 Dnaer Deb DNIW'. Static Water Levet Installer: Date Installed' Ft Ha meier Co. 8/1/2000 yiII Pump Sa v'. using Ki ght Aarve Grapnd'. TANK GPM FL F1 SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Publc/Privat k1iNi1i nirif capantr Fran Tank Field Station Tank Sewer Line Greer 1500 cal. Wieal: Nuenwacampvenena: wee --- -_ "' "' —' Steel 2 sad.w" 100+ 100+ LIFT STATION LN line 36 20 Ste. Manubcturer rata Gal. Favapen 58 70 Yun`p cn kh11 at. Yump ulr levN n Niph eeler alarm N: M In M. 100+ 1 100+ puny Make s Modal Elect" Mpeetbm pedomnad ler Curtem Dain R"e"p Ri id Insulation installed over sewer line where it BENCH MARK crosses under driveway. Sewer line is over 10 feet Leucon and Dncnpo.: Garage Finish Floor from water service line. 115.0 FL Engineer's Stamp .'�r♦�t►��tlf f f f ' „C.... . ... Inspections performed by: Pannone Eng. Svc Dates: 1"8/1/2000agrtt ..: �� • I• A / �' •i 2nd08/01/2000 ». 0 ..... ...•...•.i••...0 Department of Health and Human Services approval 0 ieven R •PCr rapine? iv, IF!,, ••�sj� Reviewed and approved by: /% al Date: S '5=00 •.��]�C{ C�`,- T................ (Rw. IIM) ♦ r I. PERMIT NO, SW990253 AS -BUILT WASTEWATER ABSORPTION SYSTEM il LOT 12 BLOCK 3 SKYHILLS S/D WATER SERVICE NEW SBR �rT HOUSE d W t SEWER LINE INSULATED J rUNDER DRIVEWAY,- : I J \ u/ ............ NOTE, 1) SUED. IS SERVED BY AWWU. TH R ... ..............._.._........ ARE NO WELLS WITHIN 200 FEET OF THE PROPOSED INSTALLATION. T / .._..........._....... _ NEW 1500 SEPTIC TANK! ❑ A B 1 60,6 68.3 2 69.3 78.3 DC 74.1 83,8 Cl 75.7 88,9 MT 87.8 94,9 C2 100.5 104.5 �f !C1 U T'/ !P1 P.I.D. NO, 011-122-38 AIN FIELD , 0.5' TD 48 Fx7''UFi41I0.5' f J �U ,U W 'Z 1) r ,QLi i W � t �A��*,OF sjjjj��� ���p� •••»., 4 �� f✓ •' �� ' TMs.. 4g_ SORL RATIN PEC iG26 MIN/INCH 1.2 GPD/SF 125 SF/BEDROOM, 5 BEDROOM 625 SF REQUIRED, 15008 SEPTIC TANK DEEP TRENCH, 7' EFFECTIVE 9-11' TOTAL DEPTH, 48 LF EACH 2-3' WIDE, 672 SF TOTAL f, ... • Steven No. CE R. Pannonee� �. � 8J49 /%� 1�.or�L'fjl�,.���i ♦ ». ... • • 0Pat..%% 1P��• PREPARED FOR John Ha 9neler John HaOneler Co. 2204 Cleveland Ave, (907)Anchorage,-99517 240-6708 9 Suite 204 PANNONE ENG. SVC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 Fax 272-8218 PhonAS&BUILT ATEA 8 -19 -DD (907) PERMIT N0, SW990253 AS-BUILT DETAILS P.I.D. NO, 011-122-38 WASTEWATER ABS❑RPTI❑N SYSTEM LOT 13 BLOCK 3 SKYHILLS S/D z n n o m m 1nONV3n u c Id L U W I m 3en1 emmaM T-- W d of ,eLl v q O �. )y'2<. W�} Qt Ct<ya.�. fiE�' i n Lli N m U n n Cs m m LZ m M Y a n 0 z x m � a. ti n. rn N N G f7 Y a) 1 I � lm vim 11MV30 P z c r Lrmw= i %a c C:\Work\12-3SKYH.DWG3r ln@!v3'U � S w N p ��� ...• ••• m Q6 x C-2 •i• Nu� MW Iwo 03M �' • »� PREPARED FOR,PANN❑NE ENG. SVC. ♦ iSteven R. Pannone!/ a �••�'�.No.CE 86I ffj? John gneler Co. P. ❑• BOX 102954 John Ha •1���"•�y�� 2204 Cleveland Ave, Suite 204 ANCH❑RAGE, ALASKA 99510 • ••� Anchorage, AK 99517 DATE 8- 91 oOPH❑NE & FAX • (907) 248-6789 AS-BUILT MUNICIPALITY OF ANCHORAGE Department or 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 Permit Number: SW000235 Legal Description: SKYHILLS PHASE 2 BLK 3 LT 12 Design Engineer. 0062 Pannone Engineering Services Owner Name: John Hagmeier Company Owner Address: 2204 Cleveland Ave., #201 Anchorage , AK 99517 - Renewal OW�C-Era�-, sal kao D 8// /OO Date Issued: Jul 17, 2000 Expiration Date: Jul 17, 2001 Parcel ID: 011-122-38 Site Address: 008232 HEAVENLY CIR Lot Size: 41260 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: 7 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: yxtm v—,"Im4tu —7 Date: `$ Issued By: a'4!` -e4/ &/. dr�.L� Date: _% —/ % — O e r: lVil icipality of Anchorage i Department of Health and Human Services 825 "L" Street Rick Mystrom. P.O. Box 196650 Anchorage. Alaska 99519.6650 Mayor hltp://www.ci.anchorage.ak.us June 7, 2000 John Hagmeier Co. 2204 Cleveland Ave., Suite 200 Anchorage, AK 99517 Subject: Skyhilis Phase 2, Block 3, Lot 12 Permit # SW990253 PID # 011-122-38 The subject permit #SW990253 issued by this office for a single family well and/or on- site wastewater system, is due to expire 365 days after it's issuance on August 5, 1999. If this is a well permit and you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If this is an on-site wastewater system and a licensed Professional Engineer has inspected the installation, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. However a new permit can be issued free of charge for a second year if the application for the renewal is received on or before the date of expiration of the original permit for which a fee was paid. When applying for a new permit after the original permit has expired or for more than a second year, the fees are: $320.00 for an on-site wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 3434744. Sincerely, qesCross, PE Program Manager On-site Services enc: Copy of Permit a • MUNICIPAUTY OF ANCHORAGE Department of Health and Human Services OnSde 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: SW990253 Legal Description: SKYHILLS PHASE 2 BLK 3 LT 12 Date Issued: Aug 05, 1999 Expiration Date: Aug 04, 2000 Parcel ID: 011.122-38 Design Engineer. 0062 Pannone Engineering Services Site Address: Owner Name: John Hagmeier Co Lot Size: 41260 SO. FT. Owner Address: 2204 Cleveland Avenue Suite 200 Total Bedrooms: 5 Permit Bedrooms: 5 Anchorage , AK 99517 - This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date:gJ61 q Date: Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska, 99514 (907)272-8218 (907)272-8218 Fax July 25, 1999 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 12, Block 3 Sky Hills Subdivision, Septic System Permit Gentlemen: My firm was contacted to design and install a new septic system for the referenced lot. We conducted a field investigation to locate existing wells and septic system before designing the proposed system. Two test holes were excavated on August 6, 1998 for the system design, which is on file with your department. No ground water was encountered. No bedrock was encountered in the test hole. The lot is approximately 0.95 acres in size. Lot s 12 slopes to the northeast at a rate of approximately 10-18 percent. The south-eastem portion of the lot is flatter (approximately 10-11%). The proposed installation will be located on the eastern portion of the lot. Double clean -outs will be installed after the tank and diverter valve. The proposed location is greater than 200 feet away from any wells. This lot is served by AW WU water service. The proposed system will be greater than 10 feet from the water service lines. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. Please contact me at 272-8218 or 227-3522 if you have any questions about the proposed installation. Sincerely, Steven R. Pannone, P.E. Attachments: CA WORK%I 2.3Skyl lil Is.001.%pd CE -8149 PR9I�ONaw PERMIT NOs SV DESIGN P.I.D. NOi WASTEWATER ABS❑RPTI❑N SYSTEM LOT 12 BLOCK 3 SKYHILLS S/D iI 1 1 NOTE, PROPOSED ` \I 1) SURD. IS SERVED BY AVWU. THERE WATER SER CE 1 ARE NO WELLS WITHIN 200 FEET OF THE PROPOSED INSTALLATION. �vir\ PROPOSED.. ............._....._. 5 BR HOUSE - 'w W' ,w , 1 ® PRIMARY DKA NO FTLLD{ 45LFx7'EFF, _........_.... _ _........_....... RESER E DRAINIFIELD 45LFx 'EFF, \1O'I TD LiJ w Cr f _.� �i v TP PROPOSED 1500gJ0" SEPTIC TANK Q� j I ' W W iLJ J � U 1 C,\Work\12-3SKYH.DWG-� DESI • : i PERC RATE, 2.6 MIN/INCH CF X44 SOIL RATINGi 1.2 GPD/SF 125 SF/BEDROOM, 5 BEDROOM ?���P"�• 625 SF REQUIRED, 15008 SEPTIC TANK :r %•• DEEP TRENCH 7' EFFECTIVE w 49TM L 11-12' TOTAL DEPTH, 45 LF EACH �•. »i... �...... -4-0 2-3' WIDE, 630 SF TOTAL 0 "go.-......•••••»•�••PREPARED F❑R, PANN❑NE ENG. SVC even R. Pannone:John Ha neler• g P. ❑. BOX 102954 •• No CE 8149 •.• �= John Hagneler Co. ••D�Zs ,.•'��� 2204 Cleveland Ave, Suite 204 ANCHORAGE, ALASKA 99510 •�h Anchorage, AK 99517 272-8218 Phone & Fax ��''� (907) 248-6789 ATEi 7-25-99 DESIGN Brei r. 1•-vn• PERMIT NO, SW DESIGN DETAILS P.I.D. NO, WASTEWATER ABSORPTION SYSTEM LOT 12 BLOCK 3 SKYHILLS S/D VONV u ".6i zi C _a u a. i1s>`t4 r t� e -Y Ll t}; W 1. A n1 117 0 i Z N e 3H1Il1011 W d Iit`>St4' a:2 W t' W . •:Y Z ��F}t A Y Ld 4.. . x LJ !ifs>sif` �--1 yyt inwvan v 7 N a FN ti O . Ci N y W 1 mxwV 7 f irlOWTO K}1 d Ci\Work\12-3SKYH.DWG 1noNv3o ��� �..��b ,**1W4\\, OF ^�)a Nalivamaj i a 49TH ° >�L♦ �.. ».»...:ti.» S ♦ Steven R Pannone: PREPARED FOR, PANNONE ENG. SVC. 'G%il N .•...«.....:.»...».....':• - John Hn reeler ♦ o.cE aas. a P. O. BOX 102954 ♦ John♦1 er Co. ANCHORAGE, ALASKA 99510 2204 Clevellevel and Ave, Suite 204 ♦��,,,, 1��r 907) 248e, AK 99517 DA 72-8218 PHONE g FAX NOT To SC LEI DESIGN • v Municipality of Anchorage DEPARTMENT OF HEALTH 3 HUMAN SERVICES 825'L" Street, Anchorage. Alaska 99502 -Mo SOILS LOG — PERCOLATION TEST PERFORMED FOR: L H Construction, ine. DATE PERFORMED: LEGAL DESCRIPTION: L+l �r OL_ 2 3 4 5 :1 • 6 7 -I ' •. S� $L—L M vd/ 9 s 10 11 .+• 5 21314 12- 13- 14 15 � ••• 16 17 / 18 19 20 Range. Section: WAS GROUND WATER ( I ENCOUNTERED? /V S 8 �. IF YES. AT WHAT L DEPTH? P v t1+ 1 E Depm to Water Manaonllp? + 11' Dam t3' 5�i6 J PERCOLATION RATE 8 (minutevintn) FERC HOLE DIAMETER TEST RUN BETWEEN FT ANO �� FT ' COMMENTS Perc cavity was presoaked prior to testing �I a PERFORMED ti) Y ` 1 CERTIFY THAT THIS TEST WAS PERFORMED IN _. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. D TE N `� l •,, —,41.260!sq fL \ , 1 J 18 r ah 1 1 WAS GROUND WATER ( I ENCOUNTERED? /V S 8 �. IF YES. AT WHAT L DEPTH? P v t1+ 1 E Depm to Water Manaonllp? + 11' Dam t3' 5�i6 J PERCOLATION RATE 8 (minutevintn) FERC HOLE DIAMETER TEST RUN BETWEEN FT ANO �� FT ' COMMENTS Perc cavity was presoaked prior to testing �I a PERFORMED ti) Y ` 1 CERTIFY THAT THIS TEST WAS PERFORMED IN _. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. D TE r PERFORMED FOR Municipality of Anchorage DEPARTMENT OF HEALTH 8 HUMAN SERVICES 825 "L" Street. Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST L H Construction, Inc. LEGAL DESCRIPTION: LIG, r—) Par >`w Net Drop 2- 1 2.5 / 3- 4 4- I 2:oi: 8 19.116 6- 7- 79 I Y I 9 10 12- 14- 15 214 16] j 17 18 19 DATE PERFORMED: a-�-gs Township. Range. Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? 71 S / L O COM m Water After/�a}`,,ya Monitoring? - �031C��ts i8 P E I LI _.l12 ` .1 A�. o Reading Date Geoat Time Net Time Depth to Water Net Drop 1 2.5 / I 2:oi: 8 19.116 I Y I 1 I 1 20 -{ ' Iul PERCOLATION RATE `t Immutevmcnl PERC HOLE DIAMETER rr1 �I TEST RUN BETWEEN 27 FT AND—I—SP"� "r4 FT COMMENTS Perc Cavity Was Dresoaked Drior to testin¢. PERFORMED BY: —gtA"' I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL ..ichael ArderSon. LL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS CATE. CATE. Municipality of Anchorage 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 FOR A SINGLE FAMILY DWELLING Parcell.D. 011-122-38 COSA# pSC 1111A91 1. GENERAL INFORMATION Expiration Date: /Z - 3 0 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent SKYHILLS PHASE #2• BLOCK 3, LOT 12 8232 HEAVENLY CIRCLE * ANCHORAGE, AK * 99502 STEVEN HATFIELD & KARA SANDVIK Day phone 522-4689 8232 HEAVENLY CIRCLE * ANCHORAGE. AK * 99502 Day phone LISA HERRINGTON W/ HERRINGTON AND CO. Day phone 646-0525 `Mailing address ik Unless othen%ise requested, 2. NUMBER OF BEDROOMS: 3." TYPE OF WATER SUPPLY: 255 E. FIREWEED LANE, #102 * ANCHORAGE, AK * 99503 COSA will be held by DSD for pickup. 5 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 N 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 samples. (Certificates maybe 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, 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 GARNESS ENGINEERING GROUP, 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, UD. 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 1Z Approved for _.�_ bedrooms. Disapproved. 337-6179 Date t 2 011 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report 45ON-SITE ••��s WATER AND WASTEWATER PROGRAM •` Nitrate Advisory Other By: Original Certificate Date: J — 3 0 11 (Rev. 11M) Municipality ^ U"�xx^���& �n n�o��������n��� ��xx���noorage Development Services Department Building Safety Division - On -Site Water & Wastewater Program 4700DrugmwStreet PD.Box 190550 Anchorage, AK99519'005V vw^nv.muniorU/onoito (907)343'7904 CERTIFICATE OF ON-SITE SySTEMs APPROVAL CHECKLIST Legal Description: Parcel |O: 011-122-38 A. WELL DATA Well type |fA,B urCprovide PVVS|D# Well Log (Y/N) Date completed — Sanitary seal (Y/N)— Wires properly protected (Y/N Total depth —ft. Cased to —ft. Casing height (aboy*,-i;r�ound) —in. FROM WELL LOG AT I Date of test Static water level ft. —ft. Well production g.p.m. —9 -P.M. WATER SAMPLE RES Coliform colonies/100 mi. Nitrate —mg./L. Collected by: Argenic: —ug./L. Date of sample: B. SEPTC8H0LD|NGTANK DATA TankTvpe/yNotoha| Date installed 8/1/2000 Tank size 1500 gal. Number ofCompartments -2�- C|eunou1o(Y/N) YES Foundation cleanout S Depressionover tank (Y/N)NO High water alarm (Y/N) N Date nfpumping r Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA Date installed Soil ratingkEPVorft/bdrm)1.2 System type DEEP TRENCH Length 48 ft. Width Gravel below pipe 7 Total depth *12.3 ft. Eff.absorption area 872 +2 Monitoring tube YES Doprooaionovorfin|d-NO-- Date ofadequacy test 12Z2012011 Roou|to(Pone/Fai|) PASS For 5 bedrooms Fluid depth inabsorption field before test 40in. Water added 1}45gal. New depth 03in. Elapsed Time: 12Vmin. Final fluid depth 5Vin. Absorption rate >= g.p.d. Any rejuvenationtreatment (past 12noo](Y/N&type) NONE KNOWN Ifyes, give date---_��---- D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service areas PUBLIC WATER On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Feld 5'+ Water main 10'+ Wells on adjacent lots 200'+ Water service line *10,+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line lb + Building foundation 10'+ Water main 10'+ P Water service line *10'+ Surface water 100'+ Driveway, parking/vehicle storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *PER ORIGINAL ENGINEER'S INSPECTION REPORT (8/19/2000). 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. Q Engineer's Printed Name JEFFREY A. GARNESS QOD s� Date I'2J COSA Fee $ 06 Waiver Fee $ Date of Payment 1a(a-;�"��l Receipt Number 0/54S6 (Rev. 11105) Date of Payment Receipt Number ?A hi CE -7953 dJ't C w 0 hEAVENLY CIRCLE DECK 121 Parcell.D. 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 APPROVAL FOR A SINGLE FAMILY DWELLING 011-122-38 1. GENERAL INFORMATION Complete legal description SKYHILLS PH 2 BLK 3 LOT 12 X27 COSA # O -t QDX� Expiration Date: a — / Co — a Location (site address) 8232 HEAVENLY CIR., ANCHORAGE, AK 99502 Current Property owner(s) JIM C. & LARA D. BENNETT Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 8232 HEAVENLY CIR., ANCHORAGE, AK 99502 CLAIR RAMSEY, DYNAMIC PROPERTIES Day phone Day phone 907-261-7552 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, COSA 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 ❑✓ TYPE OF WASTEWATER DISPOSAL: Individual On-site ✓❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 andlor 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. 1 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 Watkins Engineering, Inc. Phone 907-349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis, P.E. Date 5. DSD SIGNATURE Approved for _ A bedrooms. Disapproved. 2-I3-07 Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: / /moi/��`�� Original Certificate Date: 41Z (R.. 1 M) Municipality of Anchorage • Development Services Department Building Safety Division On -M Water & Wastewater Program 4700 Sregaw Street P.O. Bax 198850 Anchorage, AK 995196650 www.nrunLorglonske (907) 343.7904 CERTIFICATE OF ONSITE SYSTEMS APPROVAL CHECKLIST Legal Description: SKYHILLS PH 2 SLK 3 LOT 12 Parcel ID: 011-122-38 A. WELL DATA Wen type — Date completed = Total depth Date of test Static water level It A, B, or C provide PWSID 0 A(AW WU) Wed Log (YIN) Sanitary seal (YM) _ FROM WELL LOG WON production WATER SAMPLE RESULTS: Conform coloniesl100 mL Arsenic: mgll B. SEPTICIHOLDING TANK DATA R. 9— P.m- Nitrate m91L Wires property protected (YIN) Casing height (above ground) in. AT INSPECTION R. Other bacteria colonies/100 ml - Date of sample: _ Collected by: Tank TypaiMaterlal STEEL SEPTIC TANK Data ku"Nad 811/2000 Tank size 1500 gaL Number of Compartments 2 Cleanouts (YIN) YES Foundationdeanout (Y1N) YES Depression over tank (YM) NO High water alarm (YIN) NO Dated pumping 1218/2006 purr NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 811/2000 Soil rating (g.p.d.IR° or fe/bdnn)1.2 System type DEEP TRENCH Length 48 fl, Width 3.0 R. Gravel below pipe 7.0 R. Total depth tjj R Eif. absorption area 870 tl' Monitoring tube YES Depression over field NO Date of adequacy test 1418@008 Results (Pass/Fall) PASS For 5 bedrooms Fluid depth in absorption field before teat 49.5 in. Water added 1898.5 gal. New depth 72.5 in. Elapsed Time: 60 min. Final fluid depth 63.25 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date D. LIFT STATION Date installed NA 'Pump on' level at _ in. Size .Pump otP Damon Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/fift station on lot NA Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Manhole/Access (YM) in. High water alarm level at in. Meets alarm 8 crocus requirements? On adjacent lots On adjacent lots sewer manhole/cleanout Holding Manurelanimel excreteZforace areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 50'+ Property line 25_+ Absorption field 10'+ Water main 70'+ Water service line 80'+ Surface water 1000 Wells on adjacent loft 2004. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ane I a+ Building foundation 601+ Water main 40'+ Water Service line 100'+ Surface water 1004. Driveway,paAurplvsnideswage 1Y+ Curtain drain NA Wells on adjacent lots 2004. F. COMMENTS: Original MT could not be found. Installed a new 2" slotted screen MT on 12-5.08 Cleanout at YAW end of drainfleld Could not be found. G. ENGINEER'S CERTIFICATION 4J.".' I Cer* that ► have datermUred through field kWections and ° 49k review of Muni*al records that the above systems are in coMamance wfM MOA COSA guidelines in etled on this date. Engineer's Printed Name Cindy W. Elea, P.E. Cind W Ellis Date 2'13-07 CE. 10V7 COSA Fee $ T Data of Payment Receipt Number (Rev. ItAa) Waiver Fee $ Date of Payment Receipt Number, C Q 'o "m z mrn I m a C= o N +CoCpAr r u $ CD C N A N m Z �fZ*10�yA 2 _ �n s yz��i I� xmoo m x o �Nmzm�� c-��� N �o �Z�gg�I y o g o zo Vlwo-n Z� C z O -� Oo2 0iZ� 9. agssV9 . a° •tea'°:S�•'' � :�Sr ♦i �'' N` •. q (0 f T 7 •r G ♦�. ipM • • % / ♦0> / it En 9 d N O -P O W O r= 0 N (n N` CO N TlO W 0 � > U) m N \ Municipality of Anchorage • �\ Department of Health and Human Services Division of Environmental Services _ On -Site Services Section 825'V Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907) 34313744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING / Parcel I.D. 011-122-38 HAA 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Expiration Date: AAn :z Current Property owner(s) _John Hagemeier Co. Day phone 248-6789 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 2204 Cleveland Ave. Suite 200.99517 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS /or pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ 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 net responsible for errors or omissions in the professional engineers work. (Pw 11V.1 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. . Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 8/1912000 _ �j ,jteves P.nno�eF �i 6. DHHS SIGNATURE �jC� i o. NCF 1 9 ' �� ♦ �i`•.•.CL� t/ Approved for bedrooms. �# ; 0 Disapproved. ♦��h�� ��� Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: �� i �C/. �0'�t Original Certificate Date: 8 ' S- 0 a Expiration Date: R ' Z,5-- 0 Reissue Cate: /Rev. 11.991 Municipality of Anchorage Department of Health and Human Services dim Division of Environmental Services R E C E I V On -Site Services Section 825 OU Street Room 502 EM P.O. Box 196650 Anchorage, AK 99519-6650 twwv.ci.anchorage.ak.us AUG 21 2000 (907) 343-4744 MUNIGPAUTY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHECKLISYONhtEWAL SERVICES DIVISI Legal Description: LOT 12 -BLOCK 3 SKYHILLS SID Parcel I.D.: 011-122-38 A. WELL DATA Well type If A. B, or C provide PWSID # AWWU Well Log N Date completed _ Sanitary seal _ Wires properly protected Total depth ft Cased to ft Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: ft g.p.m MH Coliform colonies/100 ml Nitrate mg/l Other bacteria colonies/100 ml Date of sample: Collected by: S.R.PANNONE B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 8/112000 Tank size 1500 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N/A Date of pumping 8/1/2000 Pumper NEW C. ABSORPTION FIELD DATA Date installed 8/1/2000 Soil rating (g p.d.Kt2 or ft2/bdrm) 1_2 System type D.T. Length 48 ft Width 3 It Gravel below pipe 7.0 ft Total depth 9-12 ft Effective absorption area 672 ftZ Monitoring tube Y Depression over field N Date of adequacy test 8/1/2000 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test NEW in Water added_ gal. New depth_ in. Elapsed Time: _ min Final fluid depth _ in Absorption rate >= _ g p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) AZA9' If yes, give date (Rev. 11199) D. LIFT STATION Date insta lied "Pump on' level at Datum Size in gallons Manhole/Access in"Pump off" level at —in High water alarm level at _ in E. SEPARATION DISTANCES Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 58 Property line 36 Absorption field 10 Water main 80 Water service line 90 Surface water 100+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20 Building foundation 70 Water main 50 Water Service line 90 Surface water 100+ Driveway, parking/vehicle storage 10 Curtain drain 100+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION . ; S • I certify that I have determined through field inspections and •:' .q o r" %� ; review of Municipal records that the above systems are in ""''' << ' "' "' conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. �i� ;�•. NO. (r 9 Date 8-19-00 •i , �� ���._ Frrr: «��v �_.• HAA Fee $_ �5 V7) Date of Payment Receipt Number C07_/4 (Rev. I M9) Waiver Fee $ Date of Payment Receipt Number