HomeMy WebLinkAboutSKYHILLS PH 2 BLK 2 LT 35kyHI*IIs #5
Block 2
Lot 3
#011-122-34
inspection K po _1-t-t2.doc
Municipality of Anchorage
Community Development Department Page 1 of 4
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSPI51002
PID Number: 011-122-34 ❑ New ❑✓ Upgrade
Name:
Wesley Roberts & Stephanie Tauzell-Robert
ABSORPTION FIELD
❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
8016 Skyhills Dr.
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
1.2GPD/SF
12 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4 Ft.
Gravel depth beneath pipe
8Ft.
Subdivision
Block Lot
Shyhills Phase 5
2 3
Fill added above original grade
0 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
3Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Numbef•of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
800 Ft2
2
13.8 Ft.
well
N/A
200+ -
N/A
N/A
N/A
TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Existing
Capacity
Gal,
Surface water
N/A
100+
N/A
N/A
Material
Number of compartments
Lot Line
NIA
10.2
N/A
N/A
NA
Foundation
N/A
55.4
N/ANIA
LIFT STATION
Manufacturer
Capacity
-
Curtain Drain
N/A
50+
WA
N/A
Gat.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer -
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
JR's Septic
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 100ft
Inspection „
dates: 10/26/15
-
2 d 10/26/15
Location and description
aro
4th
Top of Transformer
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
Date
,
`4
........
�*
i�e'ven ' "
ApproveAvg
Date
j*% CE $14� f►
lt� 'gq.....
inspection K po _1-t-t2.doc
A I B
71 26.0 1 12.4
T2 33.5 22.9
DC 34.24.5
DV 36.44 26.3 -
C 1 64.4 60.2 /
M 1 65.5 61.1
C2 68.1 56.8
M2 67.3 56.1
C3 81.3 75.3 - I.
M3 82.5 76.3 TH--1 10.2 I M3
C4 87.3 75.8 C3
M4 88.5 77.1 11.8 M1
C1
M4
SS
13.8
C4 1 i 10.4
NEW DRAIN FIELD (2EA) S (ANDERSON 2001) Q,
25LF x 3'W x 8.0'ED x 12.0'TD
FLOW SPLITTER CAPPED C2 �
AT TOP OF FIXTURE. DRAIN FIELD (E) /
NO PIPE TO SURFACE. / iP i IN FAILURE
_ DC RE—USE AS RESERVE
`'1L TRANSFORMER BM DV, T2
/ 1500g SEPTIC TANK (E)
T1 VERIFIED INTEGRITY AND
INSTALLED DIVERTER VALVE
UNDOCUMENTED
SEPTIC AREA (E), FC
A
5B \ \
w HOUSE (E)
/ LOT 3\
2 I.
DRIVEWAY
04 \ 3
NOTE4 - PANNONE ENG SVC, LLC OFA,, Dote
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 � . • ... t9"_ �/5/zo16
PHONE (907) 272-8218 FAX (907) 272-8211
C-) Scale .�y�) Scale
DRAWN BY: *.'t} TH 1"=30'
NJC """ " � P.LD. NO
SKYHILLL PHASE 2, BLOCK 2, LOT 3
011-122-34
STEPHANIE & WESLEY ROBERTS S'teven R: Pannone' j PERMIT No.
8016 SKYHILLS DRIVE �) acs. GE 8149 ��� OSP151002
PLAN ANCHORAGE, AK 99502 +j'Fp0S50 P� sheet
\� "� 2 OF 4
SPECIAL PROVISIONS TO SPECIFICATIONS
1, ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE
WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS.
3. SCOPE OF WORK: VERIFIED INTEGRITY OF EXISTING 1500g SEPTIC TANK AND INSTALLED DIVERTER VALVE. INSTALLED
SOIL ABSORPTION SYSTEM. -
4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. NO APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19.0 FEET BELOW
EXISTING GRADE.
TH-3A
(MICHAEL ANDERSON 2001)
-1.5
SW
VERIFIED
1500g SEPTIC
TANK
R FABRIC
m PERE PIPE
PES TH-I
PIPE INV 2015
L. 93.8 EL. 93.8DRAIN
PROFILE r=:
-19AL—� -EL. 78.8—
z
o-0
0
o w0
EL. 85.8 -
Ow
w
w mw
w>
� FILTER FABRIC
w
m
�U
U
U DU
nJ
VERIFIED
1500g SEPTIC
TANK
R FABRIC
m PERE PIPE
PES TH-I
PIPE INV 2015
L. 93.8 EL. 93.8DRAIN
PROFILE r=:
ROCK
IEL
858 EL 85.8
EL 858 n —""
EL. 85.8 -
DESIGN PARAMETERS
7.0
SECTION
�EL. 78-8
� FILTER FABRIC
w
m
0 4'. m PERF PIPE
s 0
z �
OF z
Q z DRAIN ROCK 6"
z Q
`ABOVE PIPE INV
FLOW SPLITTER
EL.
93.8
0
-140
PROFILE r=:
EL 858 n —""
EL. 85.8 -
DESIGN PARAMETERS
LEGEND
UPGRADE SEPTIC SYSTEM
W WATER LINE/
NO. BEDROOM: 5 (750 gpd)
WELL RADIUS
TANK SIZE: 1500g
PERC RATE = 2.5 MPI
SOIL RATING: 1.2 GPD/SF
SS — NEW SEPTIC
M#
MONITOR TUBE NO.
AREA ROD: 625 SF
ABBREVIATIONS
R. 1.
RIGID INSULATION
SYS. TYPE: DEEP TRENCH 8.0'ED
Cu COPPER
DCO
DOUBLE CLEAN OUT
MIN LENGTH: 39 LFDIP
DUCTILE IRON PIPE
DV
DIVERTER VALVE
TH TEST HOLE
FS
FLOW SPLITTER
USED:
FC FOUNDATION CLEAN OUT
BEG
BELOW FINISH GRADE
(2EA) 25 LF X 3' WIDE, 8.0• E.D.,
12.0' TD
OG
ORIGINAL GRADE
TOTAL AREA: 800 SF
T# TANK CLEAN OUT NO.
FG
FINISH GRADE -
-
C# CLEAN OUT NO.
TS&V
TOPSOIL & VEGETATE
NOTES:
7�E N SVC,LLC
PAM
rp•Q
4���
oF'A/—,,
\\
Date
7/5/2016
RECORD DRAWING
BOX100217 ANCHORAGE, AK 9 510
PHONE (907) 272-8218 FAX (907) 272-8211
r (�
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Steven '
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"Pannone' j
Scale
NTS
P.LD. NO
it- tzz-a4
DRAWN BY:
SKYHILLL PHASE 2, BLOCK 2, LOT 3
STEPHANIE & WESLEY ROBERTS
NJC
PERMIT NO.
8016 SKYHILLS DRIVE
%9 CE
8149
OSP 151002
Sheet
DESIGN DETAILS
ANCHORAGE, AK 99502pROS$OWPV
3 OF 4
TEST HOLE 1 SOILS LOG - PERCOLATION TEST
SLOPE N
OR ORGANICS I
1
ML BROWN SILTS /
2
TH-1
3 I
q I
5
6 x
TH
TH -
T I (ANDERSON 200
9 GRAYPOORLY
GRADED SAND
10 SP/SM TO SILTY SAND ,
CLEANER ❑ / _
11 WITH DEPTH
12
13
WAS GROUND WATER _ - SLOPE
14 ENCOUNTERED? N
15 IF YES, AT WHAT TH
DEPTH? -DRY x
16
17 DEPTH TO WATER AFTER
MONITORING? -DRY
18 DATE: 11/2/2016
9 BOH
20
DATE PERFORMED: 10/26/2015
PEROLATION RATE 3.8 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 6 FT AND 7 FT
COMMENTS: Test hole excavated by Flintstone Enterprises. -
PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPA�L�G7UUIIDL7IINEES IN EFFECTON THE DATE OF THIS TEST.
NOTES: ate
PA `Il`IOl`IL' L'1`IG SVC, LLC .'� OF A�4 k - 03/17/2016
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 r . "". q5' 11
PHONE (907) 272-8218 FAX (907) 272-8211 %g�P �y�� Scale
DRAWN BY
49 •*�/ NTS
NJC / ....... ... .... P.1.D. NO
SKYHILLL PHASE 2, BLOCK 2, LOT 3 011-122-34
Steven Pannone
STEPHANIE &WESLEY ROBERTS / PERMIT N0.
9nc. E 81491��/� OSP151002
8016 SKYHILLS DRIVE f
SOILS LOG ANCHORAGE, AK 99502 �,isi Pte' Sheet
4 of 4
READING
DATE
CLOCK
TIME
NET TIME
WATER
LEVEL
READING
NET DROP
1
0!26!201
12:08
--
3.90
-
z
12:18
10.0
6.50
2.60 _
a
12:18
-
3.90
--
4
12:28
10.0
6.52
2.62
s
12:29
--
3.90
--
s
12:39
1 0.0
6.55
2.65
On -Site Wastewater Disposal System Permit
Permit Number: OSP151002
Tax Code Number: 01112234000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Upgrade
Permit Effective Dates: January 13, 2015 to January 13, 2016
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SKYHILLS PH 2
Site Legal Address: SKYHILLS PH 2 BLK 2 LT 3 G:2222
Owner/Address: ROBERTS WESLEY &
lo1Z�y rnKa�„
TAUZELL-ROBERTS STEPHANIE 8016 SKYHILLS DR ANCHORAGE AK 995023989
Site Mailing Address: 8016 SKYHILLS DR, Anchorage Lot Size in Sq Ft: 40158
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
COs� 1s
c � � � t 1, �i�•^ bra ^e�avid celdl
Received
Issued By
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Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steveftoaneneak.com
5 July 2016
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Sky Hills Phase 2, Block 2 Lot 3
Drain Field Separation Waiver
Ladies and Gentlemen:
I am requesting a waiver for the subject property for a separation distance from an adjacent drain field to be less
than twice the affective depth, in this case 16 feet to a distance of 13.8 feet
Drain field separation distance: The code requires that two adjacent drain fields be separated by ten feet or twice
the affective depth. The contractor installed the two drain fields on this property only 13.8 feet apart. The soils in this
area are typically Hydrologic Soils Group A which contains organics underlain by silty sand and gravel. PES conducted
a percolation tests on the lot and found a percolation rate of under five minutes per inch (3.8 mpi) at the depth of
the drain fields. The soil composition and percolation rate confirms the soil classification of HSG A.
Due to the nature of and drainage capacity of the soils found in the area (HSG A) the designed infiltration line of 45%
for septic system installation in these soils should be used instead of the assumed/worst case soil classification
infiltration line of 25%. The slopes and soil types enable installation of any conventional system without the system
effluent affecting the adjacent drain field located 13.8 feet away.
As a result of the separation distance of 13.8 feet with a 45% infiltration line that will not affect the adjacent drain
field. If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 011-122-34
Property owner(s) Wesley Roberts & Stephanie Tauzell-Roberts Day phone
Mailing address 8016 Skyhill Drive, Anchorage, AK 99502
Site address 8016 Skyhill Drive
Legal description (Sub'd., Block & Lot) Skyhills Ph2, Block 2, Lot 3
Legal description (Township, Range & Section)
Lot Size 40,158 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply) -
Absorption Field ❑x Initial ❑ Single Family (SF)
❑X
(w/wo ADU)
Septic Tank ❑x Upgrade ❑X
Duplex (D)
❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings
❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Drian field to lot line Distance: 3'
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: R —
Date of Payment: /h//5
Receipt Number: 6;13-5106
Permit No. oe')P15-106Z
Permit App__- y
Waiver Fees:
Date of Payment:
Receipt Number: g�(x&
Waiver No. c&)olS( DOB
Pannone Engineering Services uc
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
January 06, 2015
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Deer Park, Block 2, Lot 5
Septic System Upgrade Permit Request
Ladies and Gentlemen:
I am writing request a permit to construct an upgrade five (5) bedroom septic system on this property.
Currently the lot is developed. The existing drain field is in failure and will be re -used as a reserve. An
upgrade drain field will be constructed. The existing 15008 septic tank will be verified and a diverter valve
will be installed. This lot and the surrounding lots are served by AWWU. There are no wells within 200' of
this system.
Soils. Michael E. Anderson performed one test hole in the vicinity of the drain field in April of 2001, and
groundwater was monitored for seven days. Ground water was not observed to a depth of 19.0 feet
below the ground elevation in the test hole monitor tube. It is my opinion, based on the results of the
soils tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used
for a conventional wastewater system.
1. Soil Absorption System Design.
a. See Sheet 2 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The existing topography slopes generally from south to north at approximately 5%
on this lot. There are no steep slopes within 50' of the drain field.
4. Waiver Request: Due to the confined area of the upgrade drain field there is insufficient space
available to maintain 10' separation to the lot line. I request a waiver to construct the drain field three
feet (3.0') from the lot line. Granting this waiver will not affect the development of the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and 'Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 200 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
UNDOCUMENTED ( /
SEPTIC AREA (E)
\ / \1
NOTE: BOTH LOT LINES MUST
BE STAKED BY A LICENSED I /`
LAND SURVEYOR BEFORE
CONSTRUCTION OF THE \
DRAIN FIELDI
1/ k
DRAIN FIELD (P) 10-0 -
(2EA) 25LF x 3'W x 8.0'ED x 12.0'TD 01 \
( v z
TH-3A \ DRAIN FIELD (E) \
- oV "(ANDERSON 2001)
IN FAILURE
� - RE—`SE AS RESERVE �z
I/ 1500g SEPTIC TANK (E)
UNDOCUMENTED 'j VERIFY INTEGRITY AND INSTALL
SEPTIC AREA (E) I - DIVERTER VALVE
-95
w
5 eR LOT �9
\^ -I HOUSE (E)
IDRIVEWAY
s
I
I SKYHILLS DRIVE W/
WSW 3 —W�
W W W W_J_ W_ W W
NOTES:
PtllV1VONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
., sl
? �� q 1
*. *r,
�....... . .... ...
/y Steven R Pannone j
r �PF.l CE 8149
t)
+�l��FD-6F'-O
Date -
9/22/2015
CHANGE ORDER
Scale
1..=50'
SKYHILLL PHASE 2, BLOCK 2, LOT 3
STEPHANIE & WESLEY ROBERTS
8016 SKYHILLS DRIVE
ANCHORAGE, AK 99502
P.LD. NO
-1zz—aa
PERMIT N0.
OSP151002
PLAN
Sheet
1 OF 2
cv.L
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS.
3. SCOPEOFWORK: VERIFY INTEGRITY OF EXISTING 1500g SEPTIC TANK AND INSTALL DIVERTER VALVE. INSTALL SOIL
ABSORPTION SYSTEM.
4. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18.0 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. _
rFILTER FABRIC - - -
TH-3A
(MICHAEL ANDERSON 2001)
-IS
0 PERF PIPE
RAIN ROCK 6" ABOVE PIPE INV
ROCK
1 16.0
SECTION
zo
COPPER -
j
j
TH
TEST HOLE -
m
FILTER FABRIC
ro
QO
0
0
w0
w
w
RIGID INSULATION
DCO
DOUBLE CLEANOUT
DV
DIVERTER VALVE
FS
m
w
3
o Q
4" 0 PERF PIPE
o 0
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
fou
o>
0�
z
z
DRAIN ROCK a"
z
z w
LLo�
FI
n
1
1 1
In
�vai
n
J 00
v
`ABOVE PIPE INV
VERITY 1
SEPTIC 1
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
NO. BEDROOM: 5 (750 gpd)
TANK SIZE: 15009 (P)
PERC RATE - 2.5 MPI
SOIL RATING: 1.2 GPD/SF
AREA ROD: 625 SF
SYS. TYPE: DEEP TRENCH 8.0'ED
MIN LENGTH: 39 LF
USE:
(2EA) 25 LF X 3' WIDE, 8.0' E.D., 12.0' TD
TOTAL AREA: 800 SF -
PROFILE
LEGEND
W WATER LINE/
WELL RADIUS
— SS NEW SEPTIC
NOTES: PANNONE ENG SVC, LLC
CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510.
PHONE (907) 272-8218 FAX (907) 272-821
SKYHILLL PHASE 2, BLOCK 2, LOT 3
STEPHANIE & WESLEY ROBERTS
8016 SKYHILLS DRIVE
DESIGN DETAILS ANCHORAGE, AK 99502
ABBREVIATIONS
CU
COPPER -
DIP
DUCTILE IRON. PIPE - -
TH
TEST HOLE -
FC -
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R. 1.
RIGID INSULATION
DCO
DOUBLE CLEANOUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG-
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
OF. AG_SkL
9/22/2015
lll
Scale
TH
*. . *rlI
P.I.D.TNO
- -34
..................
Steven R. Pannone
!PF.'. CE 8149
,,�lFgFa
PERMIT NO.
OSP151002
•......�E''r
R?OFES51
Sheet
2 OF 2
Municipality of Anchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
Onsite Services Section 825 V Street Room 502
P.O. Box 196650 Anchorage. AK 99519-6650
www.d.anchorage.ak.us (907) 34&4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10014 PID Number: 011-122-32
WSens:
inell Homes
Wastewater System: New
Addreile:
9210 Vanguard Drive Anch., AK 99507
ABSORPTION FIELD
P, :tAmea a eed Dome:
344-5678 Five 5
Deep Trench
LEGAL DESCRIPTION
Sad PaenR:
1.2
T" Depo can ong" erode:
C.PD/FP
11 Ft.
Black: LN: subdnMM:
Depth m ppe eoeom trmn onends:
C/ depN eenestn ppe:
2 3 Sk hills No. 2
3 Ft.
8 Ft.
70-nMS: ft": Ssclan:
Fr eWed eoevs ane�nd tyW :
Gnm lL"M
2.5 Ft.
48 Ft.
Well: City Water
n
Gw..am:
4
Fkenbvdrtea:
1
DWance tlelwsen ones:
N/A
Ft.
Ft.
Ws+dciltan (Rrvela. A S. C):
TNaI Depen:
Coiled m:
Tdd ,bwpeen ens:
Ppe Mal";
Ft.
Ft.
768 Fe
ASTM D3034 PVC
DNler:
vita Dneed:
Steno Weto Leal:
ftww:
Dille Nelalbd:
Ft.
S inell Homes
5/01/01
Ynm:
Pump SN at:
Ceem, kl At o Cwow4:
TANK
I
Fl.
Ft
SEPARATION DISTANCES
® Septic Q Holding Q S.T.E.P. ❑ Other.
To
Septic
Absorption
Litt
Holding
lubbdPrivale
° ".
pd°7n .
From
Tank
Field
Station
Tank
Se erurle
Anchorage Tank
1,500
wan
>200'
>200'
N/A
N/A
>25'
Steel
Two ( M-
sNrece Wet«
>200'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
LN LNe
>5'
>10'
N/A
N/Axw
Gel.
Fcuntaeon
>5'
>10,
N/A
N/A
'l.
p .:...INeLNmet.
th.
m.
th.
None
Noted
P• pWke8 Mo0a1
EbancM kmpeaanil petmnned by..
cvnein ails
"""brit
BENCH MARK
Ian srnpeon:
Back Deck Bottom Step East Side. Southwest Corner
of Step.
Maenad El v ban:
100.0 FL
.FttgO�er s S®rpp
eA' t.• V
-+- 1
0....
Inspections performed by: Mike Anderson Dates: list 5/1/01
•r
0ANDERSON .
2n° 5/1/01
"•• CE .4381
�0's: •.
Department of Health and Human Services approval
.,: ,�`o
OQ f9F0•' •• •••+`
Ao'•.
P�!=toy
Reviewed and approved by: a Date:
sib
(Re.. ta9sl
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 995195650 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SWO10014 PID No. 011-12252
1':=40'
. � OF ...... e I
...
r * 491 '7 -- -
WCHAEL E. ANDERSON
CE -4341
V,`Ro
SKYHILLS
.LOT
�F
99-33
SUBD., PHASE 2
3, BLOCK 2
40.158 S.F.
B A
80 0
e "- Se s
GRAVEL. DRNE
L195.66'CAR=570.00.
0
SKYHILLS 95
PLAN AS -BUILT
SCALE 1" = 40,
O
d
0
M
M
G)
O
O
O
PFA
A
B
S1
25.2
12.3
S2
32.9
22.5
M1
41.6
40.4
C4
40.3
39.3
C5
64.2
46.4
L195.66'CAR=570.00.
0
SKYHILLS 95
PLAN AS -BUILT
SCALE 1" = 40,
O
d
0
M
M
G)
O
O
O
PFA
Municipality of Anchorage Page 3 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519.6650 -343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number SWO10014 PID No. 011-12232
•- .- N N rn
U. W N UU
.33,' 15,
�k - .OF A4q
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ANDERSCN
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PROFILE AS -BUILT ``�`�s=•• CE. -4301 �,_��
I" —
1 —1O `�C�49
�`RO owt��''•
Permit Number: SWO10014
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
� sr Iry tPE� Tioiv
S1 �
2� 1 N SPE C T /o ry
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT _ /77
Initial
Date Issued: Feb 01, 2001
Expiration Date: Feb 01, 2002
Parcel ID: 011-122-32
Legal Description:' SKYHILLS SUBDIVISION PHASE 2 BLOCK 2 LOT 3
Design Engineer: 0014 Anderson Engineering Site Address: 8016 SKYHILLS DRIVE, ANCH., AK 995
Owner Name: SPINELL HOMES Lot Size: 40158 SQ. FT.
Owner Address: 9201 VANGARD DRIVE Total Bedrooms: 5 Permit Bedrooms: 5
ANCHORAGE , AK 99507-3390
This permit is for the construction of:
Disposal Field F,/ 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.
J� - y-O� SEE E�f.(,I�F�R'S S�ipt,lwtE�v7AL REPORT !71}%rI Mir 9� zo0�,
Received By:
Issued By:
Date: 9
Date: 2—% _Q
ANDERSON' ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773. 522.6779 (FAX)
MEMORANDUM
DATE: May 9, 2001
TO: Dan Roth �,n ,' ,�
FROM: Mike Anderson, P.E. " "'--
SUBJECT: Lot 3, Block 2, Skyhills Subdivision Phase 2
Revised Septic System Design
Test Hole Water Monitoring
On May 8, 2001, 1 checked the groundwater levels in the monitor tubes surrounding the
new septic system on Lot 3, Block 2, Skyhills Subdivision Phase 2. No groundwater
was noted at any location. More than 100 test holes have been placed in Skyhills
Subdivision. None of these holes have ever shown groundwater. The soils vary from
clean well graded sand with some gravel to siltier sands and gravels. In every case,
however, the soils are dry and free draining. We can therefore conclude that no
groundwater will encroach within 4' of the bottom of the new septic system on Lot 3,
Block 2, Skyhills Subdivision Phase 2.
Please review the attached soils log with the water monitoring information and let me
know if you have further questions.
OF,A� t1j,
Municipality of Anchorage
Department of Health & Human Services FO ;MICHAEL E. ANDERSON; r
825 L Street, Anchorage, AK 99502-0650 �# s� CE - 4381
SOILS LOG -PERCOLATION TEST Pf i�f0 FgOfES ...
�0
\x .cae�'
Performed For: Sminell Homes Date Performed: W/01
Legal Description: Lot 3. Block 2_ Sky Hills. Phase 2
SLOPE SITE PLAN
11 I OG/PT
Well Graded
Sand with
Gravel
SW Was Groundwater
9 Encountered? No
If Yes, What Depth?
10 Depth to Water
After Monitoring None
11 Date: 518101
1
1
1
1
1
1
1
See Site Plan
Reading
Date Gross
Time
Net
Time
Depth To Net
Water Drop
1
30 -Apr 1:15
.75"
2
1:30
15
Dry 6-
3
1:31
.625"
4
1:46
15
Dry 6.125"
5
1:47
.75"
6
2:02
15
Dry 6"
19� Bottom of Perc. Rate: 2.5 Min./Inch Perc. Hole Diameter: 6"
Hole Test Run Between 6 Ft. and 7 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I, Michael . Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/30/01
Municipality of Anchorage
--rl Development Services Department
\ Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-/22-32 Permit Number SWO1001¢
Property
344.5678
SOI WEST- 12lal C//tCtr_,
Mailing address (1)9-210-1/angmWDrive ny(ocl?pGr, nk 9950'7_3390
Sfrr ANdttsS
Mailing address(2) Sffiff,80y10 Ski Nl u.5 DR.) AVCN., fik Zip Code .115-021
PHASE 2 -
Legal description (Lot, Block & Sub'd.) Lot 3, Block 2, Skyhills Subdivision.W&. -
Legal description (Section, Township & Range)
Lot Size 40, 15 F3 —Acres/0
THIS APPLICATION IS FOR:
Number of Bedrooms Five (5)
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: ?fY' Waiver Fees:
Date of Payment: ' 9 � Date of Payment:
Receipt Number: `—, I Receipt Number:
(Rev. 12100)
AIDE_ RSOR ENGINEERING°
P.O. BOX240773
ANCJORAGE, AK 99524
5224773- 522.6779 (FAX);.
April 30, 2001
Municipality of Anchorage
Building Safety Division
On -Site Water and Wastewater Program
4700 S. Bragaw Street
Anchorage, AK 99507
Attention: Dan Roth/Jeff Poet
Subject: Lot 3, Block 2, Skyhills Subdivision Phase II
Permit No. SWO10014
Dear Dan:
The owner of Lot 3, Block 2, Skyhills Subdivision Phase II has decided to place the
septic tank and absorption trench in the back of the house rather than in the front as
shown on the original design. Test Hole No. 3A was placed in the area of the new
trench and found to contain well graded sand with gravel. The material was loose to
compact and percolated at a rate of 2.5 minutes per inch. This is consistent with the
majority of the soils found in Skyhills Subdivision. We have therefore redesigned the
absorption trench to be 40' long by 3' wide with an effective depth of 8'.
The attached revised site plan shows the location of the test hole along with the septic
tank, absorption trench and alternate site. Please review this information and revise
Permit No. SWO10014 to include the new design. Thank you for your cooperation with
this modification
Sincerely,
Michael E. Anderson, P.E.
Attachments
- - yea•
I \
I
I
i
I
1
teFnate
site�
jC013' LEf fede
ctiveWDepth
t Absorption Trench
F
I 1 500 Ga
1 Septic.T
Jr.
1
Five'
Bedroom
..
Home .. ...
,p
CINI
�1
'-
Z
.- I
I ; .. A.C. DRIVE
�c'
F.
... ..
Water.
Servide'
1
A.
R=570.0' •:.:
L.195.66'.
:OF qi�t.�
SITE PLAN ....`
O y . MICHAEL E ANDERSON : a� �
SCALE 1" = 40'
aB`%l • CE - 4381
LOT 3, BLOCK 2, SKYHILLS SUBDIVISION NO.2
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Perc. Rate: 2.5 Min./Inch 1,500 Gallon Septic Tank
Application Rate: 12 GPDISF 8' Drain Field Rock
5 Bedrooms X 150 GPD 112 GPDISF = 600 SF of Absorption Area
600 SF/16SFILF = 37.5 LF Trench Length
Therefore: Construct an Absorption Trench 40' in Length by 3' Wide With 8' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 11' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
r /a.av Baa ay• a. /i/ a. av/ a ^r
Natural. ' . ..
' Backfill
3f Geotextilci
6" Fabric
O
4" Perforated
PVC (Slots -Down)
8.
/ Drainfield
Bock
3@.
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. w �� 0......
Minimum 6' Separation From Bedrock p.•'S
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater. k : 49u •'• *Jy
Minimum 10' Separation From Water Service Line. e... .... ,
"�, •,M� MSCN
-4 CE - 4381 •�
� SFO•'••.....• •E, �
EsS� ��'
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For: Spinell Homes Date Performed:
Legal Description: tot 3. Block 2. Sky Hills. phase 2
SITE PLAN
1
2
Date Gross
Time
OG/PT
Depth To Net
Water Drop
3
30 -Apr 1:15
TESTHOLE N0.3A
4
2
y,,
5
Dry 6"
3
6
.625'
4
1:46
Well Graded
7
5
Sand with
.75"
Gravel
8
15
Dry 6'
SW Was Groundwater
9
Encountered? No
If Yet, What Depth?
10
Depth to Water
After Monitoring None
11
Date: 5/1101
1
1
1
1
19�Bottom of
Hole
, .. .
A1ICHAEL E ANDERSON •,�, v
CE-4381VA
ev
4/30101
See Site Plan
08 — 18
Reading
Date Gross
Time
Net
Time
Depth To Net
Water Drop
1
30 -Apr 1:15
.75"
2
1:30
15
Dry 6"
3
1:31
.625'
4
1:46
15
Dry 6.125"
5
1:47
.75"
6
2:02
15
Dry 6'
Perc. Rate: 2.5 MinAnch Perc. Hole Diameter. 6
Test Run Between 6 FL and 7 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I, Michael E_ Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/30/01
January 15, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3, Block 2, Skyhills Subdivision Phase 2
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:,
The owner of Lot 3, Block 2, Skyhills Subdivision Phase 2 intends to construct a five
bedroom home on the currently.vacant 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.' It also shows the location of the
alternate site and the water service line. The subdivision is currently served by the
Municipal water system.
Two test holes were placed on the lot at the locations shown which indicated silty sand
with some gravel to depths of 18': No groundwater was noted in either testhole during
excavation or during the monitoring period. We are therefore proposing to place two 3'
'wide by 40'..Iong deep absorption trenches with 8' of*drainfied rock beneath the
distribution pipe. The pipe will be placed at 3.5.' below the existing ground surface and
'the total depth of the trenches will be 11.5'.' A minimum .of 3' of cover will be placed
over the trench to prevent frost penetration and possible freezing. A Zabel Flow Splitter .
Valve will be placed to insure equal flow to each trench:
The ground surface on the lot slopes as shown on the attached Site Plan. The area for
the new absorptiontrench, however, is fairly flat. The new trench will be`constructed
parallel to the contours of the surface in conformance with Municipal requirements..
Grading will be accomplished to assure surface drainage Is away from the new trench:
If the system'is constructed in accordance with our design the following statements
apply
L, '.The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future. The subdivision is currently
served by the Municipal water system,
2. The system, if constructed as designed, will have no adverse impact on existing
SkyHills Subdivision
Test Hole Locations
IC
mi I laNCXD ACRES
Wvwssum wrr-M MGM
------------I - J �f-------=---� w
� 1RACT A I I
1 THIS PROJECT
xC I I a
1
1
-------------
111-1030
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10
t
tm-93
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7GPW-10
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714-e9
2 11017
AREA
MAP
moe2
I III 3
DWI
1 e. 1' 1 2 111073 n/Q74 . .
SCALE 1" = 200'
LUSUBOMCCO
• I '
I
I \
I
1 .
1
I S .
I
I LOT 3
I F
A.
U) I +
Five
Bedroom
MHome
W 6 I • 1 Sep iclTanTv
CV
WI p
Z . 1 �'. A.C. DRIVE
1 �
1 � •o
1
I abel' low Splitter
` ¢ halve
1 Alter Q9TH44
\ S TH43
Water �\
I Servide 2 - 40''Lon $� 3' Wide
\ X 8' Effect Ve Depth
I Absorption 'renches
I' I 16' Separat'on From
Sidewal Sidewall
1 1 . 200 ..
1..•195.66'
203'
SKYHILIS DRNE- l �K����i
SITE PLAN.�''.:P
SCALE 1" = 40' o-kt �1•, iSl:t ; :;` w
LOT 3, BLOCK 2, SKYHILLS SUBDIVISION NO.2
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System . .
Perc. Rate: .19 MinAnch 1,500 Gallon Septic Tank
Application Rate: .6GPD/SF 8' Drainfield Rock
5 Bedrooms X 150 GPD 1.6 GPD/SF = 1,250 SF of Absorption Area
1,250 SF/16 SF/LF = 78.1 LF Trench Length
Therefore: Construct Two Absorption Trenches Each 40' in Length by 3' Wide With 8' of
Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3.5'
Below Existing Ground. Total Depth of Trench to Be 11.5' from Existing Surface. Place
Zabel Flow Splitter. Valve to Provide Equal Flow to Each Trench. Mound Over Trench if
Necessary to Provided Minimum Cover of 3'.
///.a\/
•\aa \w
Natural
\ /// as av/ a ^�
'
Backfill
3'
Geotextile_
Fabric
O
4^ Perforated
PVC (Slots gown)
8'
zz
Drainfield
3'.
TYPICAL DEEP TRENCH SECTION wa
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. ,off =
• Minimum 6' Separation From Bedrock.. '
Minimum 10' Separation From Lot Line.
Minimum 10' Separation From Water Service Line.
Minimum 4' Separation From Groundwater.
•,.
zdE.§L r
t
1 10
r Municipality of Anchorage ;
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: L H Construction
LEGAL DESCRIPTION: LT BLKI.I Sky Hills Subdivision
�g
N/
3-
4-1/-
5-
6-
7-
8-
9-
10-
13-
14-
15-
16-
17 a /-
678 910 131415 1617
1s
19
S � '
�t3
.rte h (ENGINEER'S SEAL)
y t n 1- •1
Ile 11 1"
DATE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
lkpm b Water After go
S
L
O
P
E
®®®®m
'®'
�►,�flESC���v
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INMERINMERIN
i
Ci
MERIN
�I
MEMO"11111111
-mm
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
lkpm b Water After go
S
L
O
P
E
®®®®m
'®'
�►,�flESC���v
20 { I r�iZll PERCOLATION RATE _�� (minufevrncl+) PERC MOLE DIAMETER
TEST RUN BETWEEN L FT AND FT
COMMENTS-_ Pere Cavity Was presoaked -
PERFORMED BY: 'w 1r Ti Y THA THIS ST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.DATE %��sto
.�{` •r�!,-'tom ':1»n /��
v GINMEPkIlAw
Municipality of Anchorage , „r „ < T 7 •'
DEPARTMENT OF HEALTH &HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 ✓t�,,{LiT 3c .Jw
SOILS LOG — PERCOLATION TESTS. ± 3 •4' p
PERFORMED FOR: L B Construction DATE PERFORMED:
LEGAL DESCRIPTION: LT 3/ BL% Z , Sky Hills Subdivision
f SLnPF SITF Pi ev
1 ^ NN^
2
3 5%'(
5-
6-
7-/1 67
8-
9-
10-
11 91011
12
•.• Y
13
• r-
14 `
• 15 �;, •
16 w�•,.
17-
'91
7 19
20
WAS GROUND WATER
ENCOUNTERED? /V
/CP
IF YES, AT WHAT
DEPTH?
IIWW b W>trc•A ter Klkt-o t�Q
Manilorinq? catcG!_�s•
PERCOLATION RATE !.L_ (minulesnncn) PERC HOLE DIAMETER /)
TEST RUN BETWEEN— FT AND FT
COMMENTS- PerC Cavity Was presoaked
PERFORMED Fly 1 I ' ' TIFY THA THIS TEST WAS PERFORMED IN
iC IIe II er80II
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 1 1V V
4
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, BLOCK 2, SKYHILLS SUBDIVISION No. 2
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,500 gallon septic tank at the location shown on the site plan.
Work also includes the construction of two new 40' long X 3' wide X 8'
effective depth absorption trenches at the location shown. The
distribution line in the trench will be placed at 3.5' below the existing
ground surface. Total depth of the trench will be 11.5' below the
existing ground surface. A Zabel Flow Splitter Valve must be placed to
insure even flow to each trench. All components of the septic system
must be placed a minimum of 10' from the water service line on the lot.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,500 gallon septic tank must be be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial'insulation. '
Lot 3, Block 2, Skyhills Subdivision No. 2
January 15, 2001
Page 2 of 3
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets ana outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 3, Block 2, Skyhills Subdivision No. 2
January 15, 2001
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
. T
Q
• Municipality of Anchorage
\a
On -Site Water and Wastewater Program r
(907)343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 011-122-34
1. GENERAL INFORMATION
Complete legal description
67
✓u�
Expiration Date: (c , P I0 - 1Z
Skyhills, Phase 2, Block 2, Lot 3.
Location (site address) 8016 Skyhills Drive
Current Property owner(s) Wesley & Stephanie Roberts Day phone
Mailing address 8016 Skyhills Drive. Anchorage, AK. 99502
Real Estate Agent
2. TYPE OF DWELLING:
x] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual x❑
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public Water System
71
Public Sewer ❑
Waiver/Variance request for:
Distances:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ c2 (op�� ��il%
Date of Payment
Receipt Number C�3)b�lst
COSA # 0lbC610 I2 '13
Waiver Fee
Date of Payment
Receipt Number
Waiver# 0S ref
5. STATEMENT OF INSPECTION BY ENGINEER
As certifie.jbq't� seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the L�e�tificale 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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot. provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 6/2912016
6. DSD SIGNATURE * • • • .
System #1 Approved for 41 bedrooms . S}even ESo none
System #2 Approved for _ bedrooms �$$9 • CE -8149
Disapproved Q��EDpiyq�
Conditional approval for bedrooms, with the following stipulations:
Original CertificateDate: S '
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
COSA blue sheets'- .: c
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 2, Block 2, Lot 3. Parcel ID:_ 011-122-34
A. WELL DATA
Well We Public If A, B, or C provide PWSID # AWWU Well Log (Y/N)
Date'completed Sanitary seal (Y/N) Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g:p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L .:
Arsenic ug/L pate of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel 'Ijate installed 5/01 /01
Tank size 15007 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N
"bate of pumping Pumper
C. ABSORPTION FIELD DATA-
Date
ATA -
10126/1,6 1.2 /s. Deep Trench
Date installed Soil rating (g.p.d./fP or ft?/bdrm) g.p.dfSystem type
Length 500 ft. Width 3 ft. Gravel below pipe $ ft.
Total depth 12 ft. .Eff. absorption area 800 ' fe Monitoring tube Y Depression over field N
Date of ad . a. y est *W`- Results (pass]Fail) NeW For -5 bedrooms
Fluid depth in absorption field before test New in. Water added New gal. New depth New. in.
Elapsed Time;
New min. Final fluid depth New in. Absorption rate =New. g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date
D. LIFT STATION
Date installed
Size in gallons Manhole/Access (Y/N)
"Pump on" level at in.
"Pump off' level at ' in. High water alami level at in.
Datum
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/liff station on lot
On adjacent lots
Absorption field on lot
On adjacent tots -
Public sewer main
Public sewer manhole/cleanout
Sewer /septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+
Property line 5+ Absorption field 5+
Water main 10+
Water service line 10+ Surface water 100+
Wells on adjacent lots 200+
ABSORPTION FIELD ON LOT TO:
Property line 10+
Building foundation 10+ Water main 10+
Water Service line 1 P+
Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+-.
Wells on adjacent lots 200+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven Pannone
Date 6/29116
COSA canary sheet_2-6-15.doc
(am)
MAX NO: 99--33
SKYHILLS SUBD., PHASE "
LOT 3. BLOCK 2
40,168 S.F.
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1C
SKYHI�1d »�-
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vI•�'�{n' u�i� i
MAX NO: 99--33
SKYHILLS SUBD., PHASE "
LOT 3. BLOCK 2
40,168 S.F.
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OASTALDI LAND
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BOUNDARY OR FENCE LINs.
ANCHOWE IRECOROMr
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NOTE: NO CORNERS SET THISATE
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�m i Jaft�ry JL Gttsfaldi : ' �. �
'�',�yrP7rbsaiort+vl4" ��Y
BUILDING DETAJL
SCALL -4 1 "=20'
Municipality of Anchorage
• Development Services Department
Building Safety Division *A.
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 AP OVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011-N-$4 HAA # n q ooq [ 1
Expiration Date: 3 --a. q — 0 ✓r
1. GENERAL INFORMATION
Complete legal description _Lot 3, Block 2, Skyhills Subdivision Phase 2
Location (site address or directions) _8016 Sky Hills Drive
Current Property owner(s) Craig Cozad Day phone 522.5469
Mailing address 8016 Sky Hills Drive Anchorage, AK 99502
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class . _ __ Well
Public Water System
Five 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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska: Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validationoGuidelines fodate shown r this application. I vt my investi
that the �on-
based on procedures outlined in the Health Authority App
site water-ropply-supplydisposal-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 En4ineerina Phone '522.7773
Address P.O. Box 240773 Anchors a AK 99524
.Engineer's Printed Name Michael E. Anderson P.E. Date' 31.1812004
A
.'--• 44th
�I cam'• MICHAEL. E ANDERSON R% '
f♦c :,.,' No. CE -4381 •••1=
5. DSD SIGNATURE ♦ �:
Approved for bedrooms. ♦♦����Ss;:�'�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
�.�` 'jy OF �i/�
\`��� •.•' .•rye,
ON-SITE
Additional Comments •. WAR AND m=
. WASTEWATER
PROGRAM
S�
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
•
Original Certificate Date:
By:
(Rev. 12/00)
Municipality p ty of Anchorage
' V PACE •B `'�O
Development Services Department
Building Safety Division ; r
5 ^
On -Site Water & Wastewater Program `* •
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995 -
. g , 19 6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST !
Legal Description: Lot 3, Block 2, Sky
hills Subdivision Phase 2 ',Parcel ID:011.122-9 31Y -
A. WELL DATA
I
Well type � .
yp If A, B, or C provide PWSID # Well Log (Y/N) '
Date'completed Sanitary seal (Y/N) Wires properly protected (Y/N)
i; ;
Total,depth' ft. Cased to ft. �"
!, l' Casing height (ab'ove ground) in.
FROM WELL LOG AT INSPECTION
Date of test
I L.1 k i e
Static;water level ft. ft.
j. Well'productionm.
9 P 9.P. M.
WATER SAMPLE RESULTS:
I
Coli "
form i' colo
Hies/100 mi.' m ./I. Other bacteria- acteria
9 colonies/100
ml.
Date' of sample: Collected by:
I
;I ,
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Setic/Steel
n Date installed 5/1/2001
Tank size .�'1 500 al
Nu
tuber of C
9 om artments 2
' P _ Clean
outs (Y/N) Y
Foundation�cleanout (Y/N) Y . Depression over tank (YIN)' N High water alarim (Y/N) N
Dat
y °
epfpu'mping 3/11/2004 Pumper Chugach Pum in '
C. ABSORPTION FIELD DATA
Date installed 5/112001 Soil rating: .d./ft2 or ft2/bdrm
. , ,I !, (9 P ) 1.2 GP DISF System type _Deep Trench
Length 48.1 .111 ft. Width 4 ft. GraV- 1. below pipe 8 ft.
Total;depth';13.5 ft. Eff. absorption area 768 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 311512004 Results (Pass/Fail) Pass For 5 bedrooms
I
Fluid depth �i!n; absorption field before test 38.75 in. Water added— 759 al.
New depth46.5 in.
r . .
Elapsed Time: 1,440 min. Final fluid depth 38.75 in. Absorption rate >= 750
9•P d,
,i
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N L,I If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in., "Pump off" level at - in. High water alarm level at in.
Datum Cycles tested' Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
A ,
On adjacent lots NIA
of NI 1
t nkhift station on I .
Septic a
Absorption field on lot NIA On adjacent lots NIA
Public sewer manhole/cleanout NIA
Public sewer main NIA ,
Sewer /septic service line NIA Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line>5' Absorption field >5' P
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >200'
ABSORPTION FIELD ON LOTTO:
SEPARATION DISTANCE FROM
f.
Property line >10' Building foundation >10' Water main >10'
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >5',, I'
Curtain drain None Noted Wells on adjacent lots >200'
I4 F. COMMENTS
Property is Served by AWWU Water System....����_���e,+
OF y
' G. ENGINEER'S CERTIFICATION. :,�+4�••"' ....... p
certify that I have determined through field inspections and 4th (,
f' :•�j
,.
review of Municipal records that the above systems are in .••••• ••••••••• •� ••• •••�
r conformance with MOA HAA guidelines in effect on this date. • •.• •••••• •••• e• nrinERsaN • • '
0 ;
14 ; MICHAEL
41
Engineer's Printed Name Michael E. Anderson, P.E. No. cE-dael' i
�.
Date 311812004 ♦�+ye�"ROFESSI�•.
Baia..• .
HAA Fee : $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Rnroint Meimhar I' I'
March 18, 2004
Craig Cozad
8016 Sky Hills Drive
Anchorage, AK 99502
Subject: Lot 3, Block 2, Sky Hills Subdivision No. 2
Septic System Inspection and Testing
Dear Craig:
The septic system serving Lot 3, Block 2, Sky Hills Subdivision No. 2 was originally
constructed in May of 201. It was composed of a steel septic tank with a capacity of
1,500 gallons and a deep absorption trench approximately 48' in length by 4' average
width with an effective depth of 8'. This information is taken from records found in the
Municipal files and completed at the time of construction in 2001. The records further
indicate the trench was constructed in soil materials composed of well graded sands
and rated with an absorption capacity of 2.5 minutes per inch. The groundwater table
wa`s not found during construction of the system.
Our initial probing of the monitor tube in the absorption trench indicated a water depth
of 38.75", which was unexpectedly high considering the age of the system. We then
injected 759 gallons of water into the septic tank and allowed it to flow into the
absorption trench. After the injection the water level in the monitor tube was measured
at 46.5". Water was then allowed to settle in the trench over night while the system
remained in service and accepting effluent generated in the house.
Measurements were taken in the monitor tube the next day and the water level had
receded to the original elevation. Based on this evidence we conclude the system is
capable of absorbing at least 750 gallons of water in a 24-hour period and currently
meets Municipal requirements for certification.
Sincerely, /
Michael E. Anderson, P.E.
Attachments
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. 011-122.32 HAA # d zo S -P -q
Expiration Date: / D —.2 — O.P-
1. GENERAL INFORMATION
Complete legal description 'Lot 3, Block 2, Skyhills Phase 2
Location (site address or directions) Skyhills Drive
Current Property owner(s) Sainell Homes Day phone 3445678
Mailing address
Lending agency
Mailing address
Real Estatc Accent
Mailing Address
9210 Vanguard Drive Anchorage, AK 99507
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual W4 er Storage
Community Class Well
Public Water System
Five(S)
Day phone
Day phone
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering _ Phone 522-7773
Address P.O. Box 240T73 Anchorage, AK 99524
Engineers Printed Name Michael E. Anderson, P.E. Date 9f29/01
OF At,
a t: 42Et3GtNE.: w
VOMICHAEL E ANJEISCN;�7 s
0��•>
CE 4301 v'a
5. DSD SIGNATURE �ps�f�•. ��y
_ Approved for bedrooms. 30ilt PRO,E`a soe
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory .
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: GfJ Original Certificate Date: /0 —
(R•v. I7100)
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.d.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 3. Block 2. Skvhilts Phase I Parcel ID: 011422-32
A. WELL DATA
Well type _
Date completed _
Total depth ft.
Date of test
Static water level
If A. B, or C provide PWSID # _
Sanitary seal (YM) _
Cased to ft.
FROM WELL LOG
Well production
WATER SAMPLE RESULTS:
ft.
9 -p.m -
Coliform -colonies/100 mi. Nitrate mgA.
Date of sample: - Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material _ Sepdc#Steel
Tank size 1.500 gal. Number of Compartments 2
Foundation deanout (YM) Y Depression over tank (YM)
Date of pumping
C. ABSORPTION FIELD DATA
Well Log (YM)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
It.
g.p.m.
Other bacteria colonies11W ml.
Date installed $H12001
Cleanouts (YIN) Y
High water alarm (Y/N) N
Date installed 51112001 Son rating (g.p.d./ft2 or ft2lbdrn)12 GPDISF System type Deep Trench
Length 48 ft. Width 4 ft. Gravel below pipe 8 ft.
Total depth 15.5 ft. Etf. absorption area 768 IF Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/F80) For _ bedrooms
Fluid depth in absorption field before test _ 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.) (YIN & type) N If yes. give date
D. UFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' level at —in. 'Pump ofr level at _ in. High water alar level at in.
Datum Cycles tested Meets alarm 6 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Sewer /septic service line Holding tank _
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >S Property line >S Absorption field >S
Water main WA Water service line >10' Surface water >1W
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line >10' Building foundation >70' Water main Air
Water Service line >1ly Surface water >100' Driveway, parkinglvehlde storage >10'
Curtain drain None Noted Welts on adjacent lots >2W
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineers Printed Name Michael E Anderson, RE
Date t1fM1
HAA Fee $
Date of Payment LQ X010 C`
Receipt Number c&f T
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
I
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