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HomeMy WebLinkAboutSKYHILLS PH 1 BLK 3 LT 2Skyhills # 1 Lot 2 Block 3 #011-262-38 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Rw9c)¢)411 PIDNumt~er: 011-262-38 Name:Wastewater System: [] New [] Upgrade Crown Pointe, Inc. Address: P.O. BOX 112313 .Anch., AK 99511 ABSORPTION FIELD I NO. of Bedrooms: Phone: 345-6277 Five (5) X:Y-JDeepTrench D Shallow Trench OBed DMound ~Other LEGAL-DESCRIPTION Soil Rating:. 6 GPD/Sq. Ft. TotalDepth from originalgmde:l 1 Ft ' Ft Township: I Range: ISection: Fill add~ above original g fade: Gravel ,eh th: 9 Ft. ~ . 5 Ft. WELL: ~ New B Upgrade i Gravel width: 3 Ft 1I ~e~ Ft. Muni. Water Ft Ft. 1,310 SO. Ft ASTM D3034 PVC Ft.~Sanders & Sanders 4/2-10/00 . SEPARATION DISTANCES . ~Septic ~ HoldingD S.T-E.P. From Tank Field Station Tank ~werM~ Anchorage Tank I , 500 Numar of Cum a~nts: WelF > 100 > 100 N/A N/A > 25 i Material: Steel Two ( 2 s.~ao~ >~00 >~00 N/A N/A N/A MET STATION N/A Water Lot >5 ' > 10 ' N/A N/A N/A Sizein gallons: ~ Manufacturen Foundation I Remarks: 2" INsulation Over Tank. BENCH MARK Inspections pedormed by: MEA Dates: 1st 4/2/00 2nd Depadment of Health and Human Se~ices approval 7'2-013 {Rev. 9/91) MOA 25 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 Permit Number SW990411 A B S1 11.5 26.0 S2 22.3 30.2. C4 75.0 89.2. M1 z 74.4 66.2 · C5 76.1 662 · Page 2 of 3' PID No. 011-262-38 'o I ' N 00°00'11"W 168.85' PLAN AS-BUILT SCALE 1" = 40' Z 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 Permit N umber SW990411 PID No. 011-262-38 Page 3 of 3 96.4 89.42 93.02 2" Insul ,500 Gallo] Tank 92.85 8 4.~.' 39' 89.4 80.5 Geotextile Fabric Drainfield Rock 60' PROFILE As-BUILT 1" = 10' 69.9 5.5 '~ 62 O 80.5 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P. O, Box ~96650, Anchorage, AK 995~9-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Nov 16, 1999 Expiration Date: Nov 15, 2000 Permit Number: SW9904'11 Legal Description: SKYHILLS PH 1 BLK 3 LT 2 Design Engineer: 0014 Anderson Engineering Owner Name: Crown Pointe, Inc. Owner Address: PO Box 112313 Anchorage , AK 99511-2313 Parcel ID: 011-262-38 Site Address: Lot Size: 40721 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 in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: '~/'~~' Issued By: Date= ?? November 1, 1999 Municipality of Anchorage Department of Health and Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 2, Block 3, Sky Hills Subdivision Septic System Design Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owners of Lot 2, Block 3, Sky Hills Subdivision intend to construct a five bedroom home on the property. We are therefore requesting a permit to construct a septic system on the lot to serve the house. The subdivision is served by the Municipal Water System so a well permit is unnecessary. The attached Site Plan and backup documentation describe the proposed system and show the location of both the primary and alternate absorption trenches. The testholes placed on the lot revealed poorly graded sands with some silt. Percolation rates were very good and ranged from 2 to 19 minutes per inch. The absorption trench has been designed for the lower percolation rate with an absorption factor of .6 gpd/sf. No groundwater was encountered during placement of the testholes nor was any noted during the monitoring period. We have therefore designed a deep absorption trench with 10' of gravel beneath the distribution pipe. The total depth of the trench will be 12.5' below the existing ground surface with the distribution piping at 2.5'. The ground surface on the lot slopes in varying directions at varying grades.. The new absorption trench will be placed parallel to the slope of the ground in accordance with Municipal design requirements. The slope in the area of the absorption trench ranges from 2% to 5% to the southwest. The water line serving the house will be constructed a minimum of 10' from all components of the septic system. All wells in the area are more than 100' from the proposed upgrade and no conflicts with other septic systems were noted. If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The subdivision is currently 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. Lot 2, Block 3, Sky Hills November 1, 1999 Page Two The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments UNSUBD{VIDEO 7 ~-G2 ]H-63 5 4 TH-70 Vacant 12 IH-t1 8 L L 3 ]H-94 2O 19 13 3 V~c~n~ 14 ¢ TH-79 PROJECT UNSLIBDR/[DED LOCATION MAP I SFJ~.VIEW J HEH~TS ~ I Scale: 1 "= PO0' 'IPIS:I '-ILLI3 .0 I. Five Bedroom Home 1,500 Gal. Sep..Tank 63' Long X 10~ Eff. Depth Alternate Site SITE PLAN SCALE 1" = 40' LOT 2, BLOCK 3, SKY HILLS DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Perc. Rate: 19 Min./Inch Application Rate: .6 GPD/SF Deep Trench System 1,500 Gallon Septic Tank 10' Drainfield Rock 5 Bedrooms X 150 GPD / .6 GPD/SF = 1,250 SF of Absorption Area 1,250 SF/20 SF/ LF of Trench = 62.5 LF Trench Length ? Therefore: Construct a Deep Absorption Trench System With One Lateral 63' in Length with 10' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 2.5' Below the Original Ground Surface. Total Depth to be 12.5' From Original Ground Surface. NOTE: Natural Backfill Geotext±le Fabric 4" Perforated PVC (Slots Down) Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Provide 3' Cover Over Trench and 4' Over Tank or Insulate. Maintain 10' Separation From Lot Line. Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502~0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: L ~ Construct±on LEGAL DESCRIPTION: 3 ' >:": 4 5 8- 9 10 12- 13- 14- 15- 16- 17 18 19 20- LT ~/ BLK 31 Sky~ Hills Subdivision DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? COMMENTS . Reading Date Gross Time Time Depth to Water Net Drop PERCOLATION RATE ~ (m~nutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN F~ AND -- ~%~/FT Perc cavity was presoaked Michael E Anderson Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: L H Construction LT ~ BLK ~/Sky Hills Subdivision DATE PERFORMED 4 5 6 7 8 9- 15 16 ; 17. 18- 19- ~ 20- COMMENTS cavlty was WASGROUND WATER ENCOUNTERED? SLOPE S IF YES, AT WHAT ~ DEPTH? ~ ~ Depth to Waer After/%/~L? Monitoring? ~"~ Date: ~'~'~-'? ~ ~ SITE PLAN Reading Date Gross Net I Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN presoaked __ [rn,nute~inch) PERC HOLE DIAMETER -- · FY AND~ ~ FY Michael g Anderson ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, BLOCK 3, SKY HILLS SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,500 gallon septic tank. It also includes the construction of a new 63' long x 3' wide x 10' effective depth absorption trench at the location shown on the attached Site Plan. Total depth of the trench is 12.5' with the distribution pipe placed at 2.5' below the surface. 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. 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. 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. 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 The 1,500 gallon septic tank must be procured from an approved source and installed at the location shown on the plans. Lot 2, Block 3, Sky Hills November 1, 1999 Page 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. = 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: The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 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. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. = 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. Lot 2, Block 3, Sky Hills November 1, 1999 Page 3 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. 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 and outlets shall be fitted watertight couplings (Caulder, Fernco, or equal). with 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. Lot 2, Block 3, Sky Hills November 1, 1999 Page 4 INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. 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. CERTIFICATE FOR A · ''' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Braoaw Street _,,- Anchorage,www.muni.org/onsite 'AK 99519-6650 /cz '(907) 343-7904 OF ON-SITE SYSTEHS APPROVAL SINGLE FAHILY DWELLING Parcel I.D. 011-262-38 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SKYHILLS #1; BLOCK 5~ LOT 2 8445 SKYHILLS DRIVE * ANCHORAGE, AK * 99502 KATHERINE MINER Day phone 8445 SKYHILLS DRIVE * ANCHORAGE, AK * 99502 Day phone C/O AGENT KATHI JOHNSON W/ PRUDENTIAL Day phone 762-5123 3801 CENTERPOINT DRIVE #200 * ANCHORAGE~ AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF wASTEwATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class__Well [] Community On-site [] Public Water System · Public Sewer E~ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the.representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates 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. o 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the valldafion date shov,;'~ below, l 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 appficable Municipal and State codes, ordinances, and regulations in effect at the time of installationo Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone Date 337-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance With ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features, The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE ~/'~ Approved for ,~ Disapproved. Conditional approval for bedrooms. E~..-' ON-SITE S~:" WATER AND : ~ : WASTEWATER ~ %. PROG~M., bedrooms, with the following st~pulatlons:.:.~.~ ,, .. .... Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Arsenic Advisory. Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (9~) 34~7eo4. CERT-tFt:,CATE :'OF ON~SI,.T,'E SYSTEMS AP:PR:OVA:L CHECKLIST PUBUC WATER I~ A, ,B; er':,C provide PWSID# ID: 011-262-38 P~.: W~LL 'bOG ft. g.p.m. .ft. g,p.m~ .il3. Ni~ate . mg.lL. Date of ~mple: . Other b~a ' ..colon~l~ mi. Collected.by: ~,(¥!N)'.' '~N~,, '[~J~'~©W - ~-E~IS33N;G ,~' Date. iinsta!led,, ..'. 4,/2-~7/18/200,0 ~uts,:~) 'YEs '~'~~'e~'~) ,., ~,/A,. :"~. :.~th 3 r ~ .fL Result' (Pass/~i)', " Abso~¢i~ '~e>= Dep!ressien overfield NO FOr 5_-, bedrooms ;~.depth 97 in. 7§9+ ..g.p.d. I~ONEii ~'NO~N:, If yes~; give. date. - .D~ L~T,STATrON SEPARATION D'iS~ES FROM:WELL ON ,LOT TO: PUBLIC WATER Septic. tan~l~ff star,eh on .lot Absorption field-on let Public sewer main Se~er/septic, service:~ine On adjacent lots On adjacent lots _.----- ~nout ---"'" Holding tank Manure/animal ,excrete storage, areas SEP'AEATrON DISTANC. ES :FROM;~PTIC/HOLDING T,~NK'ON LOT TO: ,Bui~ng3oundation Pmpert~ I{ne 5'+ AbSorption ,field 5'+ Wa{er main 10'+ · Water.service line *'10'+ surTace water 100'+ Weils On a~acent lots 1007+ SEPARATI;ONDIS~CE ,l=R~ A'-BSORPTION 'FIELD =ON LOT TO: .Property line : t'~+ Building foundation. 10'+ Water main 10'+ Water service tine Surface water 1'00'+ Driveway;.'parking/vehicle storage 10'+ Curtain drain NO~EI K. flO~N Wells'on adjacent lots. 100'+ F. C~~,~ *~ER:"M~KE ANDERS~ P.,E, AS BUI:LT ~DRAWINGS. G. E~ER'.S ~~'F~ date. E '~r'-r~ fS ~inted Name ,DATe t 2,./.~ ~ ~ on this JEFFR~' ~A: ~(~Al~l~ ESS COSA Fee $' L{ Da{eof:Payment Receipt:;~Number (Rev;' 11/05) Waiver Fee $ Date of Payment Receipt. Number ,gg'g9!, /~1,1.,00o0 S i / / / I I / I / i I 1 / t 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.munl.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-262-38 1. GENERAL INFORMATION Complete legal description Location (site address) COSA # Expiration Date: SKYHILLS PH 1 BLK3 LOT2 8445 SKYHILLS DRIVE, ANCHORAGE, AK Current Property owner(s) DAVID J. PRITCHARD Day phone Mailing address 3705 ARTIC BLVD #397, ANCHORAGE, AK 99503 Lending agency Mailing address Real Estate Agent Mailing Address JANELLE PFLEIGEPJ REMAX 110 W. 38th Ave., Anch~oge, AK 99503 Day phone Day phone 907-257-01~>6 Unless othen~,ise requested, COSA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage 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 sewed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request lo homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for eh'ors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my Investigation, based on procedures outlined in the Ce~ficate 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 typo of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspoction, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm WATKINS ENGINEERING, Inc. Address P.O. Box 110443, ANCHORAGE, AK 99511-0443 Engineer's Printed Name CINDY W. ELLIS DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. Phone 907-349-1851 Date ~ "Z -0 (~ bedrooms, with the following stipulations: Attachments: ,.~.;.xx '.. - ' · ~;~_.' ...... ':'~. ? WATER AND ~ : WASTEWAIE~; .~ ' ~,~. · .....· COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other, Original Certificate Date: ~ - "7- 0 6 Municipality of Anchorage Development Services Department 8u~IIOG 6afaty OMslan On.~te Water & Wastewater Program 4700 flmgaw Street P.O. Box 196650 Anchorage, AK 99519-e650 www.munLorg/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST: Legal DescdplJon: SKYHlU.S PH 1 ELK 3 LOT 2 I:~rcel ID: 011-262-38 A. WEt. J. DATA Well ~_~.~ IfA, B, orC provide PWSID # Well LoG (Y/N) NO Date com'~ Sanltery seal (Y/N) ~ Wires properly protected (Y/N) Total depth_ ~ Cased to _ .lt. Casing height (above ground) ~ FR~OG AT INSPECTION Date of test ~ Static water level Wetl IxTxtucaon WATER I~MPLE RESULTS: cok]nla~lO0 mL A~enic: ~ mg/t Date ofsempie: Collected by: B. 8EPTIC/NOLDING TANK DATA Tank Type/Material STEEL., TaN(size 1~500 gal. Numi:)er of competlments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Cate of pumping 7/13/2006 Pumper DENALI PUMPING C. ABSORPTION REID DATA Date instel~Ki 4/2/2000 Cteanouts (Y/N) YES High water alarm (Y/N) NO Date installed 4/2/2000 Goll rathlg (g.p.d.At2 or ~/'Ddm0 .6 System ~jpe DEEP TRENCH Length 65.6 ft. Width 3 ft. Gravel below pipe 10 ff. Total depth 21.1 It. Eft. absoq~ion area 1:310 It2 MonltodoG tube YES Depmsston over flek] NO Date of adequacy test 7/20/2006 Results (Pass/Fall) PASSS For 5 bedrooms Fiuid depth in absorptJon flek] before test 64,75 in. Wateredded1948 gal. New depU~ 91,25 in. Elapsed Time: 120 min. Final auk] de,tit 84 in. Absorption rate >- 750 : g.p.d. Any mjuvenaUon treatment (past 12 mo.) (Y/N & type) NO If yes, give date ' O. UFT STATION Date i~lallad NA Size in galinns 'Pump on' level at ~l 'Pump or IMI at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt ste~on on lot NA ~qotinn field on lot Public sewer main Sewer/septic service line Animal containment ,,mas in. Manhole/Access (Y/N) High water ainn~ level at Me, ti elam) & circuit reqLdremente? On adjacent lots On adjacem lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 8' Water main 25'+ Wens on adjacent ints >100' SEPARATION DISTANCES FROM SEPTICA-IOLDING TANK ON LOT TO: Properly line 42* Water sen~ice line 25' Water Sewice line 18' Cu~dn drain N/A SEPARATION DISTANCE FROM ABSORPTION REID ON LOT TO: Property line 25' Building foundaUon 64' Surface water >100' WeRs on adjacent lots >100' Abson~tJon field. 45' Surface water >100' Water main 25'+ Driveway, pa~kingfvehide ~torage 25' F. COMMENTS: G. ENGINEER~ mv~ew of M~ at~e ~/ste ~ ~ ~.~'..... ~,,n~y w. cms/~ ~n~ ~ MOA CO~ ~fl~~~~~ ~gin~s P~ Na~ WA~NS ~GIN~RING, I~ Date Receipl (Rev. It~) Waiver Fee $ Date of Payment Rece~ Nun'eer / / / I I / / / / / / / / I / / S 0°00'11"W 168.85' 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.ancho rage.ak.us (907} 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-262-38 1. GENERAL INFORMATION Complete legal description HAA# Expiration Date: Lot 2, Block 3, Skyhills Subdivision Phase I Inc. Dayph0ne 345-6277 AK 99511 Location (site address or directions) Current Property owner(s) Crown Pointe, Mailing address P.O, Box 112313 Anchorage, 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: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well Five (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 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. 72-025 (Rev 01 001' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name DHHS SIGNATURE Approved for Disapproved. Conditional approval for __ Michael E. Anderson, P.E. bedrooms. Date 7/19/00 *' it ' ';;~ .'," .'.~;STAMP .:, ?:¢71 ?-;. ;. '2 bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date:_ /7 - ~ ~' - c f Original Certificate Date: Reissue Date: Legal Description: A. WELL DATA Well type Date completed __ Total depth k" Municipality of Anchorage Department of Health and Human Services .~ Division of Environmental Services i~, [~ ~ E ~ V ~ ~ On-Site Services Section 825 "L"Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 JUL 19 21)1)0 www.ci.anchorage.ak.us (907) 343-4744 ~UN~iV^~-~ O1' ANCHORAGE HEALTH AUTHORITY APPROVAL CHECKLIST Lot 2, Block 3, Skyhills Phase I - Municipal Water System If A, B, or C provide PWSID # __ Sanitary seal __ ft Cased to ff FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 4 / 2 / 00 Parcel I.D.: 011-262-38 Well Log. Wires properly protected Casing height (above ground) AT INSPECTION ft g.p.m - Municipal Water System Nitrate __ mg/I Other bacteria Collected by: Cleanouts. Y Foundation cleanout Y Date of pumping New Construction C. ABSORPTION FIELD DATA Date installed 4/10/00 Soil rating (g.p.d./ft2 or ff2/bdrm) .6 Length 65.5 ft Width 3 ft Gravel below pipe 10 Total depth 1 9 ff Effective absorption areal: _31 (Ct2 Monitoring tube Y Date of adequacy test New Const · Results (Pass/Fail) in. ft g.p.m colonies/100 mi Tank size 1,500 gal Number of Compartments 2 Depression over tank N High water alarm Pumper N/A 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 N System type ft Deep Trench __ Depression over field N For bedrooms gal. New depth___ Absorption rate >= __ .If yes, give date in. g.p.d. 72 026 (Rev. 01/00)* N/A D. LIFT STATION - Date installed Size in gallons "Pump on" level at in "Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line iR Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements No Well on Lot 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 > 25 ' Water service line > 10 ' Drainage > 100 ~ Wells on adjacent I¢~ts > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line > 10 ' Water Service line > 10 ' Curtain drain None NOted COMMENTS Absorption field > 5 ' Surface water > 100 ' Building foundation > 10 ' Surface water >100 ' Wells on adjacent lots > 100 ' Water main > 25 ' Driveway, parking/vehicle storage > 10 ' G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 7/19/00 HAA Fee $ Date of Payment Receipt Number 72-028 (Rev. 0U00)* 7--/ Waiver Fee $ Date of Payment Receipt Number