HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 135kyhills
Block I
Lot 13
#011-122-24
Municipality of Anchorage Page
Department of Health and Human Services
Division of Environmental Services
on-site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW010292 PID Number: 0:1.:1.-122-24
Name:
Design Concepts, Inc. Wastewater System: New
Address:
13:32 Hillcrest Drive Anch., AK 99503 ABSORPTION FIELD
Phone: Number of Bedrooms:
227-4400 Five (5) Deep Trench
Soi~ Rating: TO~ Depth from original grade:
LEGAL DESCRIPTION .8 e~elpt~ 12
B~ock: LOt: Subdivision: Depth to pipe bogota from original grade: Gr~¥el depth beneath pipe:
I 13 Skyhills No. 1 3
3
Well: City Water Gravelwidth: 3rt. Numberoflines:~. [ oistancebe~weeniine$:N/A Ft.
rt. F,. 954 ,t' ASTM D3034 PVC
Ft. Sanders & Sanders 8/10-11/01
Yield ~ GPM IPump Set at:Ft. ICasing I eighD~43ove 'Graunb:Ft. TANK
SEPARATION DISTANCES [] septic [] Holding [~ S.T.E.P, [] Other:
~ Septic I AbsorptionLift Holding 'ublic/Pfii, ate Manumclumr: uapac~ty m uamns:
Tank Field Station Tank SewerLine Anchorage Tank 1,500
we, >200' >200' N/A N/A >25' Steel Two (2)
Su~ac~wa~.r >100' >100' N/A N/A i LIFT STATION - NONE ON LOT
Lot..e >5' >10' N/A N/A
Founda§en >5! >10' N/A N/A 'Bemp o~,~¥.m:~Purnp oW level at: I High water atar~ at:
Curtain Drain None Noted / ~ FurnpMake&Model eeclrlce[Inspectloflspen'ormedby:
BENCH MARK
Deck Surface South Side of Door on East Side of
House.
100.0 rL
Engineer's Stamp
Inspections performed by: Tim Kimbrough Dates: 1st 8/10/0'1
1~/11/n3
Department of Health and Human Services approval
S1
S2
C4
M1
C5
~ DEVELOPMENT SERVICES DEPARTMENT ~:
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904:,
On-Site Wastewater Disposal System or Well Inspection Repo~ .
Permit Number SW010292 PID 'No. 011-122-24
,' N 89°54'50"E 92.10' ·
10' UTIL ESMT.
il
1.6 B
11.3
35.3 16,0
26.2 27.9
55.8 36.1
59.2 39.1
GRAVEL
DRIVE
',',Five
Home
~C% N . /~ ~ ~'"""; ~
'""'"" PLAN AS-BUILT
SCALE 1" = 40'
1"=40'
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW010292
Page 3 of 3
PID No.: 011-122-24
I-
94.2
87.3
.... -= ...... ~G.e o__t ~, x_tlLe. ~b~:: ....................
87.3 / ~' '~ '"'"-~87.3
Dr-~inFieJcl Rock
/
~/ 71.0 78.3
,--
PROFILE AS-BUILT
Scale: 1" = 10'
MEMORANDUM
DATE:
TO:
FROM:
SUBJECT:
Mamh 7, 2002
Jeff Poet
Mike Anderson, P.E.
Lot 13, Block 1, Sky Hills Subdivision, Phase I
Septic System As-Built
Certificate of Health Authority Approval
The owner of Lot 13, Block 1, Sky Hills Subdivision, Phase I, decided after the septic
system construction permit was issued to construct a five-bedroom instead of a six-
bedroom home. The design of the system did not change. A 1,500 gallon septic tank
was placed instead of a 2,000 gallon tank and the field was constructed at 53' instead
of 63' in length. Nothing else changed from the original design. The design calculation
for the trench for a five-bedroom home required a length of 52.08'. The actual length
was constructed to 53'.
Our records indicate inspections were called in on August 10 and August 11 of 2001.
Municipal records only indicate the second inspection. We are unsure why this
discrepancy exists. My technician is sure the inspection was called in on August 10.
Please let me know if you have further questions regarding this matter.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 South Bmgaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Aug 02, 2001
Expiration Date: Aug 02, 2002
Permit Number: SW010292
Design Engineer: 0014Anderson Engineering
Owner Name: Design Concepts, Inc.
Owner Address: 1332 Hillcrest Dr.
Anchorage, AK 99503-
Parcel ID: 011-122-24
Site Address: 008008 INGRAM ST
Lot Size: 40329 SQ. FT.
Total Bedrooms: 6 Permit Bedrooms: 6
This permit is for the construction of:
[] Disposal Field [] SepticTank [] 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 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.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewaier Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.a k.us
(907) 343-7904
ON-SITE SEWER/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-24
Permit Number SW 010
Property owner(s) Design Concepts, Inc.
Mailing address (1) 1332 Hillcrest Drive Anchora.qe, AK 99503
Mailing address (2)
Legal description (Lot, Block & Sub'd.)
Day phone 227-4400
.Zip Code
Lot 13, Block 1, Skyhiils Subdivision No. 1
Legal description (Section, Township & Range)
Lot Size 40,329 SF Acres/Sq. Ft.
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms Six
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
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:
Date of Payment:'~
Receipt Number:
(Rev. 12/00)
Waiver Fees:
Date of Payment:
Receipt Number:
June 26, 2001
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject:
Lot 13, Block 1, Skyhills Subdivision No. 1
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 13, Block 1, Skyhills Subdivision No. 1 intends to construct a six-
bedroom home on the lot. We are therefore applying for a permit to construct a new
septic system on the lot to serve the new home. The attached Site Plan and backup
documentation identify the location and configuration of the new septic system and the
parameters used in the design. Also identified on the plans are the location of the
water service line along with the test holes and the alternate absorption site. Existing
drainage patterns are shown and will not be altered by the development of the lot. We
have surveyed the area and the new system will not conflict with other wells or septic
systems in the area. ~
Two test holes were recently placed on the lot at the locations shown which indicated
poorly graded sand with varying degrees of silt. Percolation tests in the matedal
indicated rates approximating 7 minutes per inch around Test Hole No. 92 to 26
minutes per inch at Test Hole No. 8. No groundwater was found during the excavation
and none was found during the monitoring period. We are therefore proposing to place
an absorption trench 63' long by 3' wide with a 9' effective depth to treat the septic
effluent. The distribution pipe will be placed at 3' below the surface for a total depth of
12'. Additional fill will be placed over the trench to provide the required frost protection.
The ground surface on the lot slopes as shown on the attached Site Plan with grades
from north to south that flatten in the area of the proposed absorption trench. The new
absorption trench will be constructed parallel to the contours of the surface as much as
possible in conformance with Municipal requirements, Grading will be accomplished
to assure surface drainage is away from the new trench. The existing drainage pattern
on the lot will not be affected during development.
If the system is constructed in accordance with our design the following statements
apply:
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
,Lot 13, Block 1, Skyhills No. 1
June 26, 2001
Page Two
served by the Municipal water system.
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.
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.
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
SkyHilis Subdivision
Test Hole Locations
~SUBO_
I
]
PROJECT
'IRACT A
JOHNSTON b-TISQ
10
~1-2 1 C~(~
~ VA T
3H-43
UNSUBDIVIO~D
CE - 43~ 1
7
6
5
4
TH-70
T~75
(~) ~49
1}1-94
8
3
13-1-105
13
17
/
/
AREA MAP
SCALE 1" = 200'
UNSUBDI~]~3
Six
Home
000
ptic Tank k
'~ 63 Lon~ i3' Wide\
TH92 X 9' Ef~eckive Depth
Absorpti~)n Trench \
Alter.nate Site
SKYHILLS DRIVE
SITE PLAN
SCALE 1"
LOT 13, BLOCK 1, SKYHILLS SUBDIVISION
PHASE I
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Six Bedroom Home
Perc. Rate: 6-15 Min./Inch
Application Rate: .8 GPD/SF
Deep Trench System
2,000 Gallon Septic Tank
9' Drain Field Rock
6 Bedrooms X 150 GPD / .8 GPD/SF = 1,125 SF of Absorption Area
1,125 SF/18SF/LF = 62.5 LF Trench Length
Therefore: Construct an Absorption Trench 63' in Length by 3' Wide With 9' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 12' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
Gaotextil~...
~"' Perforated
'PVC (Slots Down}
.Dr~infield-:
· Rock-' · ~ ~. '.'
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line.
Maintain 50' Separation From Slope >25%.
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L H Construction, Inc.
DBSOR,PT,O.: i . ,,
LEGAL
Township,
Range,
Section:
SLOPE
WAS GROUND WATER ~,~1
ENCOUNTERED?
S
IF YES, AT WHAT ~
O
DEPTH? p
E
SITE I~LAN
Date:
1
4-
5-
6-
7- 51=.
8-
9-
10-
13
14-
15-
16-
17-
18- ~
19-
COMMENTS Perc cavity was
Reading Date Gross Net Depth to Net
· Time Time Water Drop
~,~:~ ~ ~,~ ~
PERCOLATION RATE ~ (m,nutes/,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT ANDf ~ FT
presoaked prior to testing.
Michael E, Anderson
ACCORDANCE WiTH ALL STATE AND MUNIC~PAL GUIDEUNES IN EFFECT ON THiS DATE. DATE: 1- -~/'~0 I
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3,
4.
7
8
9
1:3-
14-
19
20
COMMENTS
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L1' Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L ~ Construction
LTI~, BLK ~1 Sky~ Hills Subdivision
SLOPE
II
SITE PLAN
WASGROUND WATER
ENCOUNTERED?
S
L
1F YES, AT WHAT
DEPTH? .~"'~$'~' ~
E
Oeplh to Waer Alter
Reading Date Gross Net Depth to Net
Time Time Water Drop
~:,- II-~ ~ :~;~¢ .~ &.~ ,--
Io~ ~ ~,1~ ~
PERCOLATION RATE '~' ~:> [m,nutes/mchl PERt HOLE DIAMETER ~ ~.~,~t .
TEST RUN BETWEEN ~ ~ FT AND ~'~ FT
Pert cavity was presoaked
Michael E Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
U CC PAUTY OF ANCHORAGE
Development Services Department -1' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 011-122-24
1. GENERAL INFORMATION
Expiration Date: (.--, — 19-ZC9 ZZ_
Complete legal description SKYHILLS PHASE 1, BLOCK 1, LOT 13
Location (site address) 8008 INGRAM STREET, ANCHORAGE, AK
Current property owner(s) JAMES & MICHELLE HAJDUKOVICH Day phone
Mailing address
Real estate agent
8008 INGRAM STREET, ANCHORAGE, AK 99502
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:
Private Well
❑
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ Ay 12- . 50 Waiver Fee $
Date of Payment 6126h O
Receipt Number 7062.20
COSA# D.5G 20)28.5
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 6/20/20
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWCS
6. DSD SIGNATURE
C System #1 Approved for
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
.dOF A
-
49 TM
�J ........
r • Curtis Huffman
CE 128991
i� Fq • .Q/20/2020��
11,FOPROFE5S10N _
bedrooms, with the following
k
WATER AND R`
PROGRAM
9:)
)1'v1
Original Certificate Date: C `_?p '2-0
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: SKYHILLS PHASE 1 BLOCK 1 LOT 13
If more than 1 septic system on lot: COSA Checklist # _of
Parcel ID: 011-122-24
Structure served by this system
A. WELL DATA — PUBLIC WATER
❑ Well log is filed with Onsite (or attached) Well production at time of test _gpm
Date drilled Water storage tank volume_ gallons
Total depth _ft Well disinfected for coliform test? ❑ Yes ❑ No
Cased to _ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate _mg/L ❑ Nitrate less than MRL (ND)
❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height (above ground) _in. Collected by_
Date of flow test for COSA
Static water level at beginning of test _ft. Date of Sample
Comments
B. TANK DATA
Age of tank(s) 19 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 50"
® Standpipes/foundation cleanout per record drawing
Date of pumping 618/2020 -"�
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/11/2001
® ALL standpipes present per record drawing
Total measured depth from grade 13.9 ft (max)
Measured depth to pipe invert from grade 5.4 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective APPROX. 8.5' INTO THE 9' ED
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 6/8/2020
Results N Pass For 5 bedrooms
Fluid depth prior to test 0 in
Water added 750 gal
New depth 12 in
Elapsed time 1260 min
Final fluid depth 0 in
Absorption rate 750 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
FW'C
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well) NA — PUBLIC WATER
Septic Tank/Lift Station on Lot > 100'
® Yes
if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No _
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
_
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
ft
ft
ft
ft
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft
Property Line > 5'
® Yes
if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No ft
Private Wells > 100' ® Yes if No ft
Water Main > 10'
® Yes
if No ft
Community Wells > 200' ® 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'
® Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® 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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
low
' . T-" .......
. Curtis Huffman ;'t"
CE 128991 ,• �w
$� is�F��0 b(22/2Q28-����
Municipality of Anchora
On-Site Water and Wastewater Progran
(907) 343-7904
Parcel I.D. 01%122-24
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF ON-SITE SYSTE
/r~//Z~l
SKYHILLS PHASE 1, BLOCK 1, LOT 13
Location (site address) 8008 INGRAM STREET, ANCHORAGE, AK 99502
Current Properly owner(s) JEFFERY ALAN JOHNSON
Day phone
Mailing address
8008 INGRAM STREET, ANCHORAGE, AK 99502
Real Estate Agent
Day phone
TYPE OF DWELLING: [] Single Family (w/we ADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER Of BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Individual []
Holding Tank []
Community []
Public Sewer []
WaiverNariance request for:
Distance:
COSA to be released to the engineer, unless ore, requested
by the engineer.
Date:
COSA Fee $
Date of Payment
Receipt Number
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicaNe Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS 10/19/15
Engineer's Comments: Thfs investigation was completed in compliance with ADEC and MOA regulations. The assessment ortho condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee [hat no unseen
encroachments, deficiencies or discrepancies exist,
bedrooms.
bedrooms.
DSD SIGNATURE
/ System #1 Approved for .t~--
System #2 Approved for __
Disapproved.
Conditional approval for
bedrooms, with the followiGgtet~ipda, tions:
~y(/¢,~J~, ~ ~/U{/%~ ~ [ Original Ce~ificate Date: ~ t~C~ ¢//
The Bunicipality of Anchorage Development Se~ices Division (DSD) issues Cediflcates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered ~n the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineeCs work.
7.
ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
X
Nitrate Advisory
Arsenic Advisory
Other
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 PHASE 1, BLOCK 1, LOT 13
A. WELL DATA - PUBLIC WATER
Well type
Date completed
Total depth ft.
IfA, B, or C provide PWSID #__
Sanitary seal (Y/N) _Y
Cased to __ft.
FROM WELL LOG
Parcel ID: 011-122-24
Date of test
Static water level ft.
Well production g.p.m.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
ft.
g.p.m
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: ug/L
Nitrate
Date of sample:
mg/L
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1500 gal.
Foundation cleanout (Y/N) _Y
Date of pumping_ 10-16-2015
Number of Compartments _2
Depression over tank (Y/N) _N
Pumper One-Stop Pumping
Date installed 8/10/2001
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 811112001 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8
Length 53 ft. Width 3
Total depth 13.9 ft. (Measured 10/16/15) Elf. absorption area 9§4ff2
System type DEEP TRENCH
Gravel below pipe 9 ft.
Monitoring tube Y Depression over field _N
Date of adequacy test t0-16-2015 Results (Pass/Fail) PASS For 5__bedrooms
Fluid depth in absorption field before test _0 in. Water added 1360 gal. New depth 17 in.
Elapsed Time: 240 min. Final fluid depth 0_ in. Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (WN & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at __ in.
Datum
Size in gallons
"Pump off" level at __ in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
E. SEPARATION DISTANCES - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
SEPTIC/HOLDiNG TANK ON LOT TO:
Building foundation 5'+
Water main 10'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water Service line 10'+
Curtain drain 50'+ fNONE KNOWN)
Properly line 5'+
Water service line
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
10'+
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 200'+
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 10-19-2015
COSA canary sheet_2-6-15.doc
STREET
· "~E'ZO£ Hd. UON
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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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-24
Expiration Date: "~ - :2. 7- O ~
1. GENERAL INFORMATION
Complete legal description !l~!t 13, Block 1, Skyhills Phase I
Location (site address or directions) Skyhills Drive and Ingrain Street
Current Property owner(s) Design Concepts, Inc.
Mailing address
Lending agency
Mailing address
Day phone 2274400
1332 Hillcrest Ddve Anchora,qe, AK99503
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Rye(5)
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
IndMdual 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 ~ample results less than .30. days old. (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, 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
Address P.O. Box 240773 Anchora.qe, AK 99524
Engineer's Pdnted Name Michael E. Anderson, P.E.
DSD SIGNATURE
~/ Approved for ~ bedrooms.
Disapproved.
Phone 522-7773
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ - ~ 7- O 2._
(Rev, 12/00)
Legal Description:
A. WELL DATA
Well type
Date completed __
Total depth __
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.cLanchorage.ak, us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 13, Block 1, Skyhills Phase I
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N) __
Cased to fl.
FROM WELL LOG
g.p.m.
Nitrate __ mg.fl.
Collected by:
Number of Compartments 2_
Depression over tank (Y/N) N_
Pumper
ParcellD: 01t-122-24
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Celiform oolonies/100 mi.
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tank size 1,500 gal.
Foundation cleanout (Y/N) Y
Date of pumping
C, ABSORPTION FIELD DATA
Date installed 8111/2001
Length 53
Soil rating (g.p.d.l~ or ft2/bdrm) .8 GPDISF
ft. Width 3 ft.
Well Leg (Y/N)
Wires propedy protected (Y/N)
Casing height (above ground)
AT INSPECTION
g.p.m.
Other bacteria
Date installed 8/10/2001
Cleanouts (Y/N) Y
High water alarm (Y/N) N
in.
celonies/100 mi.
System type DeepTrench
Gravel below pipe 9
Total depth 1--5 ft.
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test __ in. Water added gal.
Elapsed 'time: __ min. Final fluid depth in. Absorption' rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
Eft. absorption area 954 ft2 Monitoring tube Y_ Depression over field N
For bedrooms
New depth__ in.
g.p~d.
B. LIFT STATION
Date installed
Size in gallons
Manhole/Access (Y/N)
"Pump on" level at __ in. "Pump off" level at __ in. High water alarm level at
irt.
Datum Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
On adjacent lots
Absorption field on lot
On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5'
Property line >5'
Absorption field >5'
Water main NIA
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 >fO'
Water Service line >10'
Surfacewater >100'
Driveway, parking/vehicle storage >10'
Curtain drain None Noted
Wells on adjacent lots >200'
F. COMMENTS
ENGINEER'S CERTIFICATION
I certify that'l 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. Andemon, P.E.
Date 3/7/2002
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number