HomeMy WebLinkAboutSKYHILLS PH 2 BLK 3 LT 155kyhills
Block 3
Lot 15
#011-122-41
Municipality of Anchorage Page 1 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519qS650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report "'
Permit Number:. SW000009 PID Number: 011 -1 22-41
~'~wn Pointe, Inc.' Wastewater System: ~ New[ [] Upgrade
*~: ' - · ABSORPTION FIELD
P.O. Box 1.123i3 Anch., AK 995'11 .
345-6277 ' Five { ) ~Oe~pTr~nc? [~ShallowSrench [~Bed E]Mound E3Other
.. . . - . .. -- .
· '" Departmeht 0~ Health and Human ServiCes.apPro~/al
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 2 of 3
Permit Number SW000009
PID No. 011-122-41
I
1
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'Five'
Bedroom
Home
.TH96
~TH97
~lE~r~ate /
site /
S1 A B
18.6 51.6
SV 26.0 43.4
C4 30.1 48.4
M1 29.3 45.0
C7 41.5 21.7
M2 - 38.7.. 25.3
LEGEND
S Septic Vent
C Cleanout
SV Flow Splitter Valve
M Monitor Tube
TH Test Hole Locati(
PLAN AS-BUILT
SCALEI"=40'
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O, Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Page 3 of 3
Permit Number SW000009
PID No. 011-122-41
Geotextile Fabric
~, Drainfield Rock
98.6
Geote×tile Fabric
Drainfield Rock
85.4
24'
79.0±
24'
PROFILE AS-BUILT
1"= 10'
Municipalily of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L H Construction
3
4
8-
9-
13-
14
15
16
17
18-
19-
20
Sky Hills Subdivision
DATE PERFORMED:
COMMENTS Per~ cavity was
SLOPE
WAS GROUND WATER
ENCOUNTER ED?
SITE PLAN
IF YEN. AT WHAT
o
DEPTH? ~ p
E
Monitoring? _.~"~,q~ Oa~
Reading Date Gross Net Depth to Net
Time Time Wate~ Drop
IH ~ ~.-~ ~,~1 ~,~
PERCOLATION RATE ] ~
TEST RUN BETWEEN ~ ~ FTAND ~" "~
presoaked
PERFORMED BY: ~ ~ Michael E ~.lldersoCnERTIFYTHATTHISTESTWASPEREORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE:
November 3, 2000
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject:
Lot 15, Block 3, Skyhills Subdivision, Phase II
Separation Distance Waiver
Absorption Trench to Lot Line
Dear On Site Services Engineer:
The absorption trench on Lot 15, Block 3, Skyhills Subdivision Phase II was
inadvertently constructed within 7' of the west lot line to provide sufficient area for the
new house on the lot. Lot lines were not well defined during the construction process
and accurate measurements were not available until the final as-built for the house was
surveyed. Soils in this area were found to be very effective for the absorption of septic
effluent.
The subdivision comprising this lot is served by the Municipal water system. No
conflicts exist with water mains or service lines or adjacent septic systems. We
therefore recommend that a waiver be issued allowing the trench to be located 7' from
the west property line.
Sincerely,
Michael E. Anderson, P.E.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Jan 31,2000
Expiration Date: Jan 30, 2001
Permit Number: SW000009
Legal Description: SKYHII-LS PHASE 2 BLK 3 LT 15
Design Engineer: 0014 Anderson Engineering
Owner Name: Crown Pointe, Inc.
Owner Address: PO Box 112313
Anchorage, AK 99511-2313
Parcel ID: 011-122-41
Site Address:
Lot Size: 40660 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be ia 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 ceiling
(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.
5. The following special provisions.
AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM AN ADDITIONAL IMPERMEABLE LAYER
TEST TO A DEPTH OF NO LESS THAN 19 FEET BELOW GROUND SURFACE.
Received By:
MEMORANDUM
DATE:
January 28, 2000
TO:
FROM:
Dan Roth
Mike Anderson, P.E.~
SUBJECT: Lot 15, Block 3, Sky Hills Subdivision, Phase II
Septic System Design and Construction Permit
We have moved the house on the subject lot back approximately 20' to allow more
room for the septic system construction. The trenches are now more than 10' from any
portion of the foundation. We have also provided additional topographic information in
the area of the new absorption trenches. The surface elevation in the area .is
approximately 191' to 192'. The surface then slopes to the northwest corner of the lot
where the elevation is 190'. The surface slope varies from 2% to 4% which is
acceptable for absorption trench placement. Additional topographic information is
shown on the Soils Log - Percolation Test forms submitted with the permit application.
The total depth of the system is designed at 12.5'. Testholes placed on this particular
lot extend to a depth of slightly more than 18'. This is slightly less than the 18.5'
required to verify the absence of bedrock or an impermeable layer. We are confident,
however, based on over 150 testholes placed in the subdivision that no impermeable
layer will be found in the .5' immediately beneath the bottom of the testholes. We will,
however, provide a soils log with the as-built for the system showing that no bedrock or
impermeable layer is located within 6' of the bottom of the absorption trenches.
Please review the revised Site Plan showing the new location of the house and
verifying the 10' separation from the absorption trenches to the foundation. We are
hopeful the permit to construct the system can be issued based on this information.
Jan'uaw 24,2000
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 15, Block 3, Skyhills Subdivision, Phase 2
Septic System Tank Replacement Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 15, Block 3, Skyhills Subdivision Phase 2 intends to construct a five
bedroom home on the lot. We are therefore applying for a permit to construct a septic
system to serve the house. The Site Plan shows the location of the new system with
the alternate site. It also shows the location of the proposed water service line. The lot
is currently served by the Municipal water system.
The testholes placed on the lot revealed silty sands which percolated at rates ranging
from 12 to 15 minutes per inch. No groundwater was encountered nor was any noted
during the monitoring period. We have therefore designed a deep absorption trench
system with 10' effective depth and a total length of 48' with two 24' trenches. A flow
divider valve will be installed to insure even flow to each trench. The distribution pipe
will be placed at 2.5' below the surface and the total depth of the system will be 12.5'
from original ground. A minimum of 3' of cover will be provided over the trench.
The ground surface on the lot slopes from the homesite as shown on the Site Plan.
The new trenches will be constructed across the slope in accordance with Municipal
requirements. Since the subdivision is served by the Municipal water system no
conflicts will exist between the septic system and other wells in the area. Similarly, the
septic system will not conflict with other septic systems on adjacent lots.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, wil-I 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.
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 reserved
' Lot 15, Block 3, Skyhills Phase 2
January 24, 2000
Page Two
Sincerely,
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.
Michael E. Anderson, P.E.
Attachments
10
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LOCATIO~~~~
]RACT 8
Scale: 1 "= 200'
SKYH' LLS': SUBD.,' 'PHASE. 2
."LOT 1.5,..BLOCK 3'
4.0,660.S,F. ' "
HEAVENLY CIRCLE
EL. 190 ,O~i.'R~( EL. 184
kC. DRN~
707 24'
Eff. De
Abs. Trenches.t
./
/
/
Flow Splitte:
Valve
/
/
'/ Gallon
!
Five
Bedroom..
Home
~e Line
10' From Ail Components
Septic System)
/
/
/
Alt., Si~e
LOT 1.5
- 10' UTIL,'
SITE PLAN
SCALE 1" = 40'
LOT 15, BLOCK 3, SKY HILLS NO. 2
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Five Bedroom Home
Perc. Rate: 15 Min./Inch
Application Rate: .8 GPD/SF
Deep Trench System
1,250 Gallon Septic Tank
9' Drainfield Rock
5 Bedrooms X 150 GPD ! .8 GPD/SF = 937.5 SF of Absorption Area
937.5 SF/'20 SF! LF of Trench = 46.9 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With Two Laterals
Each 24' in Length with 10' of Drainfield Rock Beneath the Lateral.
Place Flow Divider Valve to Assure Even Distribution to Trenches.
Distribution Pipe in Trench Placed at 2.5' Below the Original Ground
Surface. Total Depth to be 12~5' From Original Ground Surface. Mound
Over Trenches to Provide a Minimum of 3' of Cover.
NOTE:
10'
Natural
Backfill
Geotextile
Fabric
4" Perforated
PVC (Slots Down)
Drainfield
Rock
t
TYPICAL .DEEP TRENCH SECTION
(NO S'CALE)
Grade Area Over Trench to Drain Away.
Provide 3' Cover Over Trench and 4' OVer Tank or Insulate.
Maintain 10' Separation From Lot Line.
Maintain 10' Separation From Water Service Line.
PERFORMED FOR:
LEGAL DESCRIPTION:
I
2
3
4
5
6
7
8
9
10
11
12
13
14'
15'
16-
20'
COMMENTS
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L H Construction
LT ~/BLK ~! Sky_ Hills Subdivision
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
DEPTH?
Depth to Water After ~1~ -- E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN~* ~ FT AND'" ~ FT
Pert cavity was presoaked
~ichael ./,..,..-/
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; / i '
Municipality o! Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: L tt ' Construction
LE~^L DESCRiPTiON: LT I~/ BLK~
2
3-
4-
5-
7-
8-
9-
10-
11-
13-
14-
17-
20-
COMMENTS Pert cavity was
Sky Hills Subdivision
SLOPE
WAS GROUND WATER
ENCOUNTERED?
SITE PLAN
IF YES, AT WHAT J O
Reading Date Gross Net De~th to Net
Time Time Water Drop
PERCOLATION RATE t ~;~ {minutes~mch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~" +'~ FTAND
presoaked
PERFORMED BY: ~ I ~IFY THAT TH~S TEST WAS PERFORMED IN
Michael E Anderson
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 011-122-41
Expiration Date: /"/
GENERAL INFORMATION ~2\,~B
Complete legal description SKYHILLS LOCK 3, LOT 15
Location (site address) 83,45 HEAVENLY CIRCLE, ANCHORAGE, AK 99502
Current Property owner(s) DOUGLAS & PATRICIA BLATTMACHR Day phone
Mailing address 8345 HEAVENLY CIRCLE, ANCHORAGE, AK 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING: [] Single Family (w/wo ADU)
[] Duplex
[] Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual []
Holding Tank []
Community []
Public Sewer []
WaiverNariance request for:
COS^ to be released/:the engineer, unless ore, requested by the engineer,
Date:
Distance:
COSA Fee $
Date of Payment
Recei
Waiver Fee $
Date of Payment
Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 ARCTERRA CONSULTING, INC.
Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS
Date 4/24/13
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only fo the conditions as of the day tested. The flow and absorption rates may change due fo subsurface
conditions that may not be observed from the surfaco, 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 syslems 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 Arcmerra guarantee that no unseen ~
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
System #1 Approved for .~
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
bedrooms, with the following stipulations:
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.
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 #2 BLOCK 3, LOT 15
A. WELL DATA - PUBLIC WATER
Well type
Date completed __
Total depth f.
Date of test
Static water level
Well production
Parcel ID: 011-122-41
IfA, B, or C provide PWSID # __
Sanitary seal (Y/N)_Y
Cased to __ff.
FROM WELL LOG
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
in.
g.p.m.
g.p.m,
WATER SAMPLE RESULTS:
Coliform coloniesll00 mL
Arsenic: uglL
Nitrate
Date of sample: __
mg/L
Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC ISTEEL
Tank size 1500 gal.
Foundation cleanout (Y/N) Y
Date of pumping 4/22/13
Number of Compartments _2
Depression over tank (Y/N) N_
Pumper A+
Date installed 61512000
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 61612000
Length 48
Total depth i3.5 ft.
Date of adequacy test 4/22/13
Soil rating (g.p.d.fft2 or ft2/bdrm) 0.8
ft. Width 3 ft.
Eft. absorption area 960 ft2 Monitoring tube Y
Results (Pass/Fail) PASS
System type DEEP TRENCH
Gravel below pipe t0 ft.
Depression over field N
For 5 bedrooms
Fluid depth in absorption field before test 75 (MT1) & (MT2) 71 in. Water added 97.__q0 gal. New depth 93 {M]'ll & (MT2) 96 in.
Elapsed Time: 1320 min. Final fluid depth 77 (MTti&(MT2} 73 in. Absorption rate >= 750+ 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 __ in.
Cycles tested
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in,
E. SEPARATION DISTANCES
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:
- PUBLIC WATER
On adjacent lots
On adjacent lots
Public sewer manholelcleanout
Holding tank
Manure/animal excrete storage areas
Property line 5'+
Water service line 10'+
Property line 7' Building foundation 10'+
Water Service line 10'+ Surface water 100'+
Curtain drain 50'+ (NONE KNOWN} Wells on adjacent lots 200'+
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parkingNehicle storage 10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review of
determined through field inspections and review of Municipal records that
inspections and review of Municipal records that the above systems are in
Municipal records that the above systems are in conformance with MOA
above systems are in conformance with MOA COSA guidelines in effect on
conformance with MOA COSA guidelines in effect on this date.
COSA guidelines in effect on this date.
on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 4/24/2013
COSA brown sheeL10-10-12.doc
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
Parcel I.D. 011-122-41
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
SKYHILLS #2 BLOCK 3, LOT 15
Location (site address) 8345 HEAVENLY CIRCLE, ANCHORAGE, AK 99502
Current Property owner(s) MATT & NANCY DIMMICK
Day phone
Mailing address
8345 HEAVENLY CIRCLE, ANCHORAGE, AK 99502
Lending agency
Day phone
Mailing address
Reap Estate Agent
Day phone
Mailing Address
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
5
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 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 serYed 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 ceditled 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 ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 07/08/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 subsudace 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 that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
"/Approved for ~
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments:
By: __
(Rev 11/05)
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Repod
Other
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 CHECKLIST
Legal Description: SKYHILLS #2 BLOCK 3, LOT 15
A. WELL DATA
Well type PUBLIC IfA, B, or C provide PWSID # __
Date completed Sanita~J seal (Y/N)
Total depth ft. Cased to ft.
FROM WELL LOG
Parcel ID: 011-122-41
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
Date installed 6/5/2000 Tank size 1500 gal.
Date of test
Static water level It.
Well production g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100mL Nitrate mg/L
Arsenic: __mg/I Date of sample: Collected by:
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic]Steel
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 7/8/20~1 Pumper A+
C. ABSORPTION FIELD DATA
Date installed 6/6/2000 Soil rating (g.p.d./ff2 or ff2/bdrm) 0.8 System type Deep Trench
Length 48 ff. Width ~3 ff. Gravel below pipe 1_0 fi. Total depth 13.5 lt.
Eft. absorption area 960 ft~ Monitoring tube Y Depression over field N_
Date of adequacy test 7/8/2011_ Results (Pass/Fail) Pass For 5~ bedrooms
Fluid depth in absorption field before test 0(MTn) & 0 (MT2) in. Water added 750 gal. New depth 9.6 & 6 in.
Elapsed Time: 245 min. Final fluid depth 0 & 0 in. Absorption rate >= 75 0+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date __
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off' level at
Cycles tested
Manhole/Access (Y/N)
High water alarm level at __.in.
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorp§on field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+
Water main 10'+
Wells on adjacent lots 200%
Property line $'+
Water service line 10'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 7' Building foundation 10'+
Water Service line 10'+ Surface water 100'+
Curtain drain 50+ (None Known)
F. COMMENTS
Absorption field 5'+
Surface water 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
Wells on adjacent lots 200'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
confon~ance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 07/08/2011
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Depa;'tmanr
On-Site Water and Wastewater Program ......
4700 ~outn Bragaw SL
P.O. Box 196650 Anchorage, AK 99519 6650
www.cLanchorage.ak.us
(907) 343-7904
CERTIFICATE OF PI~A~ TLI Al IT~,q(hP~'i-V A13F..),(~rh\/z~,l
FOR A SINGLE FAMILY DWELLING
Parcel I.D, 0t1-122-41
1. GENERAL INFORMATION
HAA #
Expiration Date:_ __
Complete legal description SKYHILLS #2, LOT 15, BLOCK
Location (site address or directions) 8345 HEAVENLY_ CIR., ANCHORA~GE, AK 99502
Current Property owne~(s)
Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent
SHAYLENE ERNISSE ~PRUDENTIAL-VISTA)Day phone 273-7311
Mailing Address .4241 B STREET, ANCHORAGE, AK 99503
Un/ess otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5~
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ....
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
I.ndividual 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 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 single4amily 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. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties sen/ed 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 hYreto' and as of the validation date' shown below, I 'verify tha't my
· . investigation, ~ based' o'ri proc:edures outlined id the Health Auth'oritv Approva'l: ·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 indicatee' 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, ordiqances, and regulations in effeot at tile time of installation.
Name of Firm KND ENGINEERING. INC,
Address 20441 Ptarmigan BIzd,, E_agle Riv.e_EAK 99577
Engineer s Printed Name Kenneth M. Duffus
Phone __(997.) 696-6111
Date, __ 03/3~1!03
5. DSD SIGNATURE
~ Approved for ~Y bedrooms.
Disapproved.
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:
,(Rev01/02)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box '196650 Anchorage, AK 995'19-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SKYHILLS NO. 2, LOT '15, BLOCK 3
IfA, B, or C provide PWSID # _
Sanitary seal (Y/N)__
Cased to ft.
FROM WELL LOG
A. WELL DATA
Well type Public
Date completed
Total depth __ft.
Parcel ID: 011-'122-4'1
Well Log (Y/N)_
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform __ colonies/'1 O0 mi.
Arsenic: __ mg./l.
B. SEPTIC/HOLDING TANK DATA
g.p.m g.p.m.
Nitrate mg./I. Other bacteria
Date of sample: Collected by:
_ colonies/100 mi.
Tank Type/Material SEPTIC I STEEL Date installed 615100
Tank size '1,500 gal. Number of Compadments 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 3125103 Pumper MCDONALDS
C. ABSORPTION FIELD DATA
Date installed 616100Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type DEEPTRENCH
Length 48 ft. Width 3 ft. Gravel below pipe '10 ft.
Total depth 13.5 ft. Eft. absorption area 960 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 3126103 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test MT'1 DRY & MT2 42 in.Water added 760 gal. New depth '1" & 55 in.
Elapsed Time: 1440 min. Final fluid depth MT1 DRY & MT2 39 in.Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
LIFT STATION
Date installed NA
Pump on level at __in.
Datum
E. SEPARATION DISTANCES
Size in gallons
Pump off level at
Cycles tested
Manhole/Access (Y/N)
__ in.High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
Property line 7'
Water Service line 10'+
Curtain drain 50'+
F. COMMENTS
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main 10'+ Water service line '10'+
Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 200'+
Absorption field 5'+
Surface water 100'+
Water main t0'+
Driveway, parkingNehicle storage 10'+
HAA Fee $~375.00
Waiver Fee $
Date of Payment 04/01/03
Receipt Number ~[~'
(Rev, 12/01)
Date of Payment
Receipt Number
G. ENGINEER S CERTIFICATION
I ce~ify that I have determined thmugh field inspections and
review of Municipal records that the above systems a~ in
conformance with MOA H~ guidelines/n effect on this date.
Engineer s Pnntod Name Kenneth ~uffus
HOUSE WAS VACANT FOR 30+ DAYS. ABSORPTION FIELD PRE-SOAKED WITH 2,000 GALLONS OF WATER ON 3/25/03 & TESTFr)
22 HOURS LATER ON 3126103.
Municipality of Anchorage
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-122-41
1. GENERAL INFORMATION
Complete legal description
HAA# ,. ,,
Expiration Date:
Lot 15. Block 3, Skyhills Phase 2
Location (site address or directions)
Heavenly Circle
Current Property owner(s)
Mailing address
Crown Pointe, Inc. Day phone 345-6277
P.O. Box 112313 Anchorage, AfC 99511
Lending agency
Mailing address
Day phone
Real Estate Agent
Mailing Address
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
NUMBER Of BEDROOMS: Five
TYPE OF WATER SUPPLY:
Individual Well []
individual Water Storage ~
Community Class Well ~
Public Water System ~
(5)
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 ClassA 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.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal afffxed hereto and as of the validation date shown below, I verify that rny investigation
based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval
application show 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 Anderson Engineering Phone
Address P.O. Box 240773 Anchoraqe, AK 99524
Engineer's Printed Name Michael E. Anderson~ P.E.
DHHS SIGNATURE
Approved for ,.~ bedrooms.
Disapproved,
Conditional approval for
522-7773
Date
bedrooms, with the following s~pulabons.
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Reissue Date:
Legal Description: Lot
A. WELL DATA
Well type __
Date completed
Total depth
unicipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 60~I~ E C E I V E
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744 NOV 0 3 Z000
-'- MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL UHECK/~(~i~MENTAL SEEVICESDIVISION
15, Block 3, Skyhills No. 2 ParcelI.D.:
Municipal Water System
If A, B, or C provide PWSID # __
Sanitary seal __
fl Cased to ft
FROM WELL LOG
Nitrate__ mg/I
Collected by:
Date of test
Static water level ft
Well production g.p.m
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed 6/5/00 Tank size
Cleanouts ¥ Foundation cleanout ¥
Date of pumping New Construction
C. ABSORPTION FIELD DATA
011-122-41
Well Log
Wires properly protected __
Casing height (above ground)
AT INSPECTION
ft
g.p.m
Other bacteria
colonies/100 mi
1,500 gal Number of Compartments 2
Depression over tank N High water alarm __
Pumper N/A
Date installed 6/6/00 Soil rating (g.p.d./ft2 or ft2/bdrm) .6
Length 48 ft Width 3 ft Gravel below pipe 10
Total depth 1 3. ~t Effective absorption area 960 ft2 Monitoring tube Y
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test in Water added__
Elapsed Time: min Final fluid depth in
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
N
System type Deep Trench
ft
in.
__ Depression over field N
For bedrooms
gal. New depth __ in.
Absorption rate >= __ g.p.d.
If yes, give date __
72-026 (Rev. 01/00)*
F.
LIFT STATION N/A
Date installed
"Pump on" level at in
Datum
E. SEPARATION DISTANCES
Size in gallons __
"Pump off" level at __
Cycles tested
in
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Municipal Water System
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Building foundation > 5 ' Property line > 5'
Water main > 1 0 ' Water service line > 1 0 '
Drainage >100 ' Wells on adjacent lots > 100 '
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation > 1 0 '
Surface water > 100 '
Wells on adjacent lots __
Absorption field > 5 '
Surface water > 1 00 '
Property line 7 '
Water Service line > 1 0 '
Curtain drain None Noted
COMMENTS
Water main > 10 '
Driveway, parking/vehicle storage
>100'
See Waiver For Lot Line to Absorption Trench Separation
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, Po E.
Date 11/3/00
>10'
HAA Fee $ c.~,
Date of Payment ///
Receipt Number
72-028 (Rev, 01/00)*
Waiver Fee $ ,///~-~
Date of Payment
Receipt Number
Anderson Engineering
ATTN: Michael E. Anderson, PE
PO Box 240773
Anchorage, AK 99524-
November 06, 2000
Subject: Waiver Request for SKYHILLS PHASE 2 BLK 3 LT 15
Waiver # WR000093 Lot Line Request for Parcel ID 011-122-41
Dear Engineer:
Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater
disposal system to the lot line has been approved. The approved separation distance is 7 feet.
This waiver approval applies to the current on-site wastewater disposal system and lot line
separation only. Any future upgrade to the on-site wastewater disposal system and lot line will
require all separation distances to be met or another waiver approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office at
343-4744.
Sincerely,
Je Poet
Engineering Technician III
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
WR#: WR000093 PID#: 0tl-22-41 HA#: HA000560
Date Received: November 3, 2000
Legal Description: Skyhills, Phase 2, Lot 15, Block 3
Engineer: Anderson Engineering
PO Box 240773, Anchorage, AK 99524
Applicant: Crown Pointe, Inc.
Waiver Requested: 7 foot lot-line waiver
Permit: SW000009
Criteria: 1.
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
2. Special Conditions:
3. Other:
Points:
Total:
Waiver is Granted:
List Conditions or Reasons for above:
Waiver is not Granted:
.......... ~_./'N,~ of Reviewer
Date Paid: 11/3/00
Rec~: 06848 Amount: $115.00
~4/~3/20~3 i6:3~ S07696~iii KD~D INVESTMENTS PAGE 02