HomeMy WebLinkAboutSKYHILLS PH 1 BLK 1 LT 12 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: SW000035 PID Number: 011-122-13
.a,.: Wastewater System: ~New r-i Upgrade
The Petersen GrouDt Inc.
Address: 3820 Lake Otis Parkway, #204ABSORPTIONFIELD
I No. O! Bedrooms:
Pbone: 562-1170 Four (4) D Deep Trench ~ Shallow Trench ~Bed f"lMound [3Other
LEGAL DESCRIPTION SoilRating: . 8 GPD/~,q Ft. ?otal Depth from original grade:l 2
Loc 12 Brock: I SkyhillS NO. I 4 F, 8
Township: I Range: I Section: Fill added above original grade: Gravel length:
I F, , 5 0
I
I
WELL: D New 1-1 Upgrade Gravelwidth: 3 Ft. Numberloflines: I
City Water F~ F,. 800 SOFt.; ASTM D3034 PVC
FL Kincaid & Son 8/8-9/00
SEPARATION DISTANCES 0 Septic a Holding r"l S.T.E.P.
~m T..~' F.~ S~ 'r,,~k Ise~u~ Anchorage Tank 1 , 5
Well' N/A N/A N/A N/A N/A Material: Number of Compartments:
:Steel Two
Su~ace
wate, )100' )100' N/A N/A N/A LIFT STATION - N/A
Lot )5' )10' "N/A N/A N/A s~e ~. ga,o.~:
Line
I
Foundation
I
Drain None Ioted 3n Lot
· BENCH MARK
Remarks: rl'h~ ~bdiv~]c)n ~
By The Nunicipal Water System. Back Deck
/ 1 0 0.0
Inspections performed by: MEA Dates: 1st 8/8/00 ~ .?~,~~~
2nd 8/9/00.
epartment of Health and Human Services approval '~. ~-.<-, ,.
and approved by: {~.,~--~~- Date~/,2 '/,,~ -~o ' %~"--~'-~-~2~"~"~'~,,,,
Reviewed
Department of Health & Human Sorvlces
8~ L S~et, ~chmage, AK ~502~0
SOILS LOG- PERCEPTION TEST
Pedo~ FOE Petemen Gmuo ·
· Date
L~al ~pfion: Lot 12. B~k 1. S~ Hi~r9. Phe~e I '
.1
.2
I
1'
OG/PT
TESTHOLE NO. 12C
Fine 'Sand ·
Some Silt
SP
· Was Groundwater ~
· Encountered?
If Yet, What Depth?
Depth to Waler
Affe~ Monitoring
Date:
SLOPE SITE PLAN
8/8/00
S
L.
0
P
E '
- 12
15
16
17
1
'Fine Sand
Clean
SP
Boffom of.
Hole
Reading Date · Gross Net Depth To Net
Time Time ~/ater Drop
· 2 9:44. 30 5.75" 5" ·
3 9:45 .625"
· '4 10:15 30 · 5.625" 5"
5 10:16 . .75'
6 10;46 : 30' 5.75' · 5" ',
I,
Perc. Rate: 6 Min./Inch Perc. Ho;e Diameier: 6"
Test Run Between S FL and 6 Ft. '..
Comment.~: Percolation C.~vity Presoaked Prior to Testing. '*':
Performed By: 'Mi~e And~r~n I, M;ch~el P Ande~ .. Certify That This ~'est Was Peffor~nad
In Accordancc With Ail State and Municipal Guidelines In Effect On Th{{ Date: 12/18100
". rldgt:~ 0007, '8['3e0
;/~ :d [19l'ot~ .. '. ' '".* '.'" ·
Munic' pality'of Anchorage .... ~age 2 of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES ~ : ' .' '. '"' -. c~'~7 ..
ENV RONMENTAL SERV CES DIVlSIO.N., . /'
P.O BOX 196650- Anchorage, AK99519~650 343~7~ ~ ~'~ .~:. '>." "..'. ....
On~ite Wastewater Disposal System or Well Inspection ,epo~
Pe~ ,Number SW000035 "' P D No.~11-122-13 ~~~ ~'' '~ :'~ ":~'? "'~. ';'
.:..q.' .. ..
A B C
S1 19.1 11.7
S2 27.2 9.5
C4 26.0 26.0
M1 75.9 72.1
C5 74.9 71.4
- ' .... :- ~' .vce' · .-Four· Bedroom ...~ ....
· · ~/:': ~.,:::'..e~e,~ -'.-: , '...,,'.~ llouse /~':. .' '.'. '"1
~Z'::.":;',~,e~..:",'~: :l '.-'...'.:'. '.':'..,:'."...~::.~ ./:'.':',: : ~:.'-: .":'/ ',
/-5/~<,:'~. "' '~. -':/.' ~ ~ '~ :"' ' ': ',': .'" ' ': ':"' ': ' I ;-.: :.....:.. "'-~-.' ':-/'
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MunicipalityofAnchorage , .., .
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 Insp~ctlon Report
Permit Number SW000035
Page 3 of 3
PID No. 011.122-13
~ 98.7 m uu
1,250
Gallon I ~ 93,7
SeD.
I 9' 3.51'' ~'1' 24.5'
.
97.5
Geotextile
Drainfield
Fabric'
Rock
78.5
50'
PROFILE AS-BUILT
92.5
~84,6
MUNICIPALITY OF ANCHORA GE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Mar 20, 2000
Expiration Date: Mar 20, 2001
Permit Number: SW000035
Legal Description: Skyhills Phase 1, Lot 12, Block 1
Design Engineer: 0014 Anderson Engineering
Owner Name: The Petersen Group, Inc.
Owner Address: 3820 Lake Otis Parkway, Suite 204
Anchorage. AK 99508-
Parcel ID: 011-122-13
Site Address: 5200 East 112th Ave.
Lot Size: 40861 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
Ail 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 caiiing
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
,~'5. *The following s~.ial provisions. ,
AT THE TIME OF CONSTRUCTION, THE ENGINEER SHALL PERFORM AN ADDITIONAL PERCOLATION TEST
"IN THE VICINITY OF THE ABSORPTION TRENCH.
Received By: "~c'~l,_z~ ~.~ ~
Date: --20--00
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Sewer/Well Permit Application
Single Family Dwelling
P.I.D. No.
Property Owner Name: The Petersen Group, Inc..
Day Phone: 562-1170
Mailing Address:
Legal Description:
Lot Size:
3820 Lake Otis Parkway, Suite 204 Anchorage, AK 99508
Lot 12, Block 1, Skyhills Subdivision Phase 1
40,861 Square Feet Inspections will be conducted by:
Number of Bedrooms: Four (4)
X Approved Engineering Firm
__ Municipality (permit fee included)
Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool, Jacuzzi,
Or Water Softener Unit? No If yes, which one?
This Application is For: Sewer Only XXX Sewer and Well Sewer Upgrade Well Only__
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and in accordance with applicable Municipal Cedes.
Engineer
ANDERSQNiENGINEERING, "
: P~O. BOX: 240'Z73'
· ~N _C:,EI~.0L~ E. ~K 99524,
$22',7.7_,7_.3~. ' -~522~6779 (FAX}?. .
March 15, 2000
Municipality of Anchorage .. · .
Department of Health and Human Services
825 %" Street
Anchorage, AK 99502-0650
Subject: Lot 12, Block 1, Skyhills Subdivision Phase I
Septic System Tank Replacement Permit Application
Impacts to Adjacent Properties
DearOnsite Services Engmeen- . .
The'owner of Lot 12, 'Block-I, Skyhills Subdivision. Please 1 intends to construct a
four
bedroom home on the lot. We are therefore applying for a permit to construct a septic
system to serve the house. The Site Plan shows the location of the new system with
the alternate site. The subdivision is currently served by the City water system and the
water service is also shown on the plan. The system will be constructed a minimum of
10' from the new water line. ·
The testholes placed on the lot revealed clean to silty sands with gravel which
percolated at 6 minutes perinch in the area of the new absorption trench..No
groundwater was encountered nor was any noted during the monitoring period, We
have therefore designed a deep absorption trench system to dispose of the septic
effluent generated in the house. The distribution pipe will be placed at 3' below the
surface with 8' of drainfield rock beneath the pipe, The total depth of the system will be
11' from odginal ground. .
The ground surface on the lot slopes from west to east at varying grades in the area of
the new trench..The new absorption trench will be constructed across' the slope in
accordance with Municipal requirements.- Surface grading wilt .be accomplished to
assure drainage is away from the finished trench surface. Efforts will 'be made to
· protect the trench from surface runoff water.
.The subdivision is currently served by the Municipal water system and. all setbacks a. re
easily achieved from the water service. In addition, the new system wdl not conflict w~th
existing systems or those to be constructed in the future. If the system is constructed in
accordance with our design the following statements apply:
t. The system, if constructed as designed, will have no adverse impact on the wells
In the area or those to be constructed inthe future. The subdivision is currently
served bythe Municipal water system. . , - ' '
.2.
The system,_if constructed as designed, will have no adverse impact on existing.
Lot 12, Block '1, Skyhills Phase I
-March 15, 2000 .
Page Two
septic 'systems in the area or those to be constructed in the future.
The system, If construe:ted 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,
SkyHills Subdivision
Test Hole Locations
T~CTA
11
10
g
THIS PROJECT. --
7
G 'n-~-~s 4 G
5
4
I
I
6
0 4
10
11
13
14°
~28
20
17
AREA MAP
SCALE 1' = 200'
PLAT NO. 98-134
SKYHIELS SUBD., PHASE
LOT .12, BLOCK 1
40,861 S.F.
· ~'. : Gal
..... ~ttc
./
'50 ' 'T.on~" X '3 '
-' X 8'.' Effecti~
Absorption Tz
__.Four ~
'"Bedroom .'j
ltome
~rl'H11 - : ..
Altefnat~'Site'
Wide
~ Depth
~nch
SITE PLAN
SCALE 1" = 40'
LOT 12, BLOCK 1, SKY HILLS NO. 1
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: 6 MinJInch
Application Rate: .8 GPD/SF
Deep Trench System
1,250 Gallon Septic Tank
8' Drainfield Rock
4 Bedrooms X 150 GPD I .8 GPDISF = 750 SF of Absorption Area
750 SF/16 SF/ LF of Trench = 46.9 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral.
25' in Length with 8' of Dralnfield Rock Beneath the Distribution Pipe.
Distribution Pipe In Trench Placed at 3' Below the Original Ground
Surface. Total Depth to be 11' From Original Ground Surface. Mound Over
Trenches to Provide a Minimum of 3' of Cover.
Natural
2.5' Backfill
Geotextile
Fabric
6"
46 Perforate~
PVC (Slots Down)
~>~.~.~', ~, " Rock
~:~'~'~7""~" ='IT"'~ ' ~
,~~~ TYPICAL DEEP TRENCH SECTION
i~~ (NO SCALE)
Drainfield
NOTE: Grade Area Over Trench to Drain Away.
Provide 3' Cover Over Trench and 4' Over Tank or Insulate.
Maintain 10' Separation From Lot Line.
Maintain 10' Separation From Water Service Line.
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG ~ PERCOLATION TEST
PERFORMED FOR. L H Construction,
'' loc--
1.
3-
4-
5-
6-
7-
8-
9-
10
12
13
14
15
16-
17-
19-
20,
Township, Range, Section:
SLOPE
COMMENTS
WA'; GROUND WATER
ENCOUNTERED?
SITE PLAN
1
Reading . Date Gross Net Del~th to Net
Time · Time Wate~ Drop
,& I~'1~ -/~ ,'" ~.~s ~
PERCOLATION RATE ~ ~:~ {mmute~mctt) PERC HOLE DIAMETER
TESTRUN BETWEEN ~'~' 'FTAND F~' ET
Perc cavity was presoaked prior to testing.
PE~*CO~MEO Bv~~F i ~u~RTIFY THAT T.HIS ~EST WAS PERFORMED IN
· ,,ichael E. Anderson
ACC~DANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT[ DATE
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
· 825 'L" Street. Anchorage. Alaska 99502-0650
SOILS LOG m PERCOLATION TEST
PERFORMED FOR:. L It Construction
LEGAL DESCRIPTION:
1
2
4
.5
6-
7
8
9-
10-
11
14-
15-
17-
18°-
19-
20-
· Township, Range, Section: .
SLOPE
H
!1
H-NH
H-NH
II I1~1
I-I Il'Fl
11111
SITE PLA
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?.
PERCOLATION RATE *~ (m,nuteshnch) PERC HOLE DIAMETER
TBST RUN BETWEEN ~" FT AND ~ FT '
COMMENTS Perc cavity was presoaked prior to ~estin~.'
PERFORMED -:---- - I IFY THAT T~IS T~ST WAS PERFORMED IN
· Michael E. Anderson ?//~../,,.~ ·
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DAT~ [~ ["
Municipality of Anchorage.
· DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
· E A, OES R,FT, ON:
L H Con~truction, Inc.
· I
DATE PERFORMED: ~-I~/~e,
Township. Range. Section:
SLOPE SITE
I
2
3
4
5
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
20
WAS GROUND WATER
ENCOUNTERED?
$
IF YES. AT WH~T /'
DEPTH?
Reading Date Gro~ Net C)e~th to Net
Time Time Wate~ Droo
. ~o~ ~ ~,~
PERCOLATION RATE 1/~:'
~'EST RUN BETWEEN ~"
cavity was presoaked prior to
__ (m,nules,'lncl~) PERC HOLE DIAMETER
FT AND ~ FT .
testing.
COMMENTS Perc
PERFORMEOB',: :,.~;~'~ 'Michael E, Anderson
7Y~J~J~ ~,F.T~.H,S T~ST W~'PEnFORMED,.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
PERFORMED FOR:.
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
L Iff .Construction
6-
7-
8-
9-
10-
1,-
12
13
14
15
18-
19-
20-
COMMENTS
III1,'
IIII.
IIJ,I
I I IIIJ,
I Illl
WA~ GROUND WATER ~J
ENCOUNTERED? ~
SITE PLAN
IJ I .11/I-'"1 I_L
ACCORD.NCEW,T. AL-~STATEANDMUN,C,P.L~U, DEUNES,ltNiE~Fh~IoN,.,SD~TEe. r~.o~ $/t~"/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 12, BLOCK 1, SKYHILLS SUBDIVISION, PHASE 1
GENERAL:
The scope of this project includes the procurement and Placement of a
new 1,250 gallon septic tank. It also includes the construction of one
new 50' long x 3' wide x 8' effective depth absorption trench at the
location shown on the attached Site Plan. The total depth from original
ground of the trenches will be 11' below ground. Mounding over the
trench may be required to provide a minimum of 3' of protective cover,
A minimum of 10' separation must be maintained from the water
service line to all components of the new septic system and the
reserve system.
o
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
1, The new 1,250 gallon septic tank must be procured from an approved
source and installed at the location shown on the plans.
A septic tank is to be constructed by a cedified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
' ' Lot 12, Block 1, Skyhills, Phase 1
March 15, 2000
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:
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.
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 in~talled at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall vedfy 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.
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.
o
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,
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).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam .HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Fernco, or equal).
· ' Lot 12, Block 1, Skyhills, Phase 1
March 15, 2000
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:
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 bacldilled.
The second inspection must be conducted after the placement of the
geotextile fabdc, 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 cedified as-built of the completed system.
Parcel I. D
011-122-23
Gt @`
Municipality of Anchorage
V .r
On -Site Water and Wastewater Program
(907) 343-7904 S n r e T Y
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION:
Expiration Date: J ZZ
Complete legal description SKYHILLS PHASE 1: BLOCK 1, LOT 12
Location (site address) 6801 Sky Circle *Anchorage
Current Property owner(s) Lance Wilber Day phone 947-1338
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class_Well
❑
Community
❑
Public Water System
®
Public Sewer
❑
WaiverNariance request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ jW
Date of Payment
Receipt Number 09 S 3 9 G
COSA # 05G 2 I I Z T6
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
C6°1
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Gayness Enqineerinq Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road. Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for 4(_ bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the foll
/1 x/4/
:Y
A G
ess
B•,
�Y CE— 95 ��
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alp
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stNA70'_ IVD m
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PRoGAAn ER o
FA.—
Original Certificate Date: `' —21
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 Nitrate Advisory
Septic -System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: SKYHILLS PHASE 1; BLOCK 1, LOT 12
Parcel ID: 011-122-23
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for
Static wat vel at beginning of test ft.
C ments
Well production at time of test'' gpm
Water storage tank vo.luriie gallons t,t
Well disinfeot,5 f� fo coliform test? ❑ Yes
form bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
AWWU WATER
B. TANK DATA
Age of tank(s) 21 years
Tank type/material
Measured operating fluid level in septic tank
50"
® Standpipes/foundation cleanout per record drawing
Date of pumping
G t
D. ABSORPTION FIELD DATA DEEP TRENCH
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Which system tested (date installed) 8/9/00 Adequacy test date 5122/21
® ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms
Total measured depth from grade 11.08 ft (max) Fluid depth prior to test 78 in
Measured depth to pipe invert from grade 3.75 ft (min) Water added `"534 gal
❑ N/A — pressurized field
New depth "84 in
❑ Monitor tubes go to bottom of effective. If not, state 120
depth into effective 7-$ Elapsed time min
ACode-required soil cover over field Final fluid depth 80 in
❑System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test) N/A
Gallons introduced N/A gallons If yes, enter date
Comments/Deficiencies:.s., BELOW INVERT "SEE ATTACHED EMAIL FROM REBECCA CARROL WITH MOA ONSITE REGARDING WATER ADDED
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
❑ Yes if No ft ❑ Yes if No
Neighboring Tank > 100' ❑ Yes if No ft
Absorption Field on Lot > 100' ❑ Yes if No ft P,NQ,O
Neighboring Absorption Fields > 100'—y'"'^�
�f ss if No ft
Com wer Main > 75' ❑ Yes if No ft
Private Sewer/Septic Lin ._-2�'
— Yes
if No
pjding' an k > 100'
F] Yes
if No
Animal Containment > 50'
❑ Yes
if No
Manure/Animal Excreta Storage > 100'
ft
Private Wells > 100' Yes if No
❑ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5 + ft Surface Water > 100'
ft
ft
ft
ft
F✓ Yes if No ft
Property Line > 5'
❑✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
❑✓
Yes
if No
ft
Private Wells > 100' Yes if No
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200' [7✓ Yes if No
Water Service Line > 10'
F✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓71
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
177�
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
*HAFT rc)nF AT TIMF OF INSTALL
DRAINFIELD WAS 88% FULL AT START OF ADEQUACY TEST. DRAINFIELD
IS APPROACHING THE END OF ITS USEFUL LIFE.
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
MECC884
ft
ft
ft
ft
Erik Widger
From: Carroll, Rebecca M. <rebecca.carroll@anchorages
Sent: Tuesday, May 25, 2021 12:58 PM
To: Erik Widger
Subject: RE: Skyhills Phase1; Block 1, Lot 12
Erik,
We will accept this. We'll want to see the summary below, along with Jeff's stamp/signature.
Becca Carroll
Onsite Water and Wastewater
iylunicipality of Anchorage c �
343-7908
From: Erik Widger <erik@garnessengineering.com>
Sent: Tuesday, May 25, 202111:21 AM
To: Carroll, Rebecca M.<rebecca.carroll@anchorageak.gov>
Subject: Skyhills Phasel; Block 1, Lot 12
tr E.T_,r`rrL EMAIL]
Becca,
As discussed today, there was an oversite during a COSA adequacy test. I had made an error reading the water meter
during the adequacy test and believed I had introduced approximately 634 gallons into the drainfield, when only 534
gallons were introduced. We are requesting that your department allow for this data to be utilized for a 4 bedroom
COSA approval. This data is summarized as follows:
C The subject lot has a 4 bedroom home.
• The MT extends approximately 90 inches below the invert of the cleanout
® Prior to the start of the test there were 78 inches of liquid in the monitoring tube.
® After the introduction of 534 gallons the liquid level in the MT was 84 inches (6 inch rise)
® After a 120 minute recover period, the liquid level in the MT was 80 inches (4 inch drop)
® The drainfield absorbed approximately 356 gallons over the 120 minute rest period (600+ GPD)
In short, while there was an oversite while reading the meter, we feel that there is minimal risk in allowing the test to be
utilized for a 4 bedroom approval. Please let me know if the department will require the system be retested, or if we
can utilize the previously mentioned data for COSA approval. Thank you
Erik D. Widger,
Consultant
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, Alaska 99507
Phone: 907-337-6179
Cell: 907-632-7479
Website:rnu�v.garnessengineering.com
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- '~..., ..... ,.~,..~-SteSewcesS~ton 825.L StreeH Room 502 .................
FOR A,SINGLE.FA ILY. DWELUNG ......... ...... -
Current Prope~ owner(s),' ~he, Petersen Group, .-I~c. -.Day phone" 562-1 ~ 70:,1
. Mmhng ad~ras~ ~ ,3820 ,Lake Otis -Parkway., Suite -204 ',..Anchorage .. hE. 99508 '
Lending agency,, ' -.,' · .:' - · - , Dayphgne"'..', - '' . '. -
Mailing add~ess
Rehl EsMte Agent .' .... 'Day phone : , -
Unless othe~ise requested, HM will be held by DHHS for pickup. H~ picked up by: -~ "'
2." NUMBER OF BEDROOMS: ...... F~ur"( 4 ) ........: ................... ~ ' ,- ~:~ "'
3[-"- ~PE OF WATER ~UPPLY:'" ~PE-OF W~STE~ATER'DJSPOSAL: ~-=
- - Individual Well ................... ~ ....... Individual On:site ......... ~'~,?-'
- ' ,5 .~-." '
Individual Water Storage ....... ~ .............. Individual Holding Tank ..........
Community Class Well ~ Community On-site . -
Publi~Water Sy~'e~'" '-' ~ ' "Public'Sewer . ~ .
The Municipality of Ar;chorage Departmeni of Hehlth and Human Services (DHHS) issues cedificates of
Health Authority Approval (HAA] based only upon the represe_ntat!ons gi~(en in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for th.e transfer of title (except between spouses) on properties served by a single..family on-site
wastewater disposal and/or water supply system. DHHSalso 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 le~ th'an :~0 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 lhe professional engineer's work.
72-025 (Rev. 01~0)'
5. STATEMENT OF INSPECTION BY ENGINEER
- ,,. ,., , .~,,~ -~:,: !,,.,: ::
As certified by my seal affixed hereto and a~'of the validation date shown below. I verify that my Investig~ti6n
· ha~e~ bn procedures outlined in the Health Authority Al~)proval Guidelines for lhe Health Authority Aopro~;al '
appl cat on show that the on-s~te water supply and/or wastewater d~sposa system s safe. funct ona and
:adequate for the number of bedrooms and type of stmctur~ indicated herein. I further verify that based on the
information obtained from the Municipality of Anchprage files and from my investigation and inspection, the on-
site water ~upply and/or wastewater disposal system is in compliance with all applicable Municipal and StAte
codes, ordinances, and regulations in effect at th~ time of installation.
Name of Firm Anderson ~Engineering , ': :. ~' o -7773
Address P.O. Box. 240773-i :,Anchorage,, AK 99524'·'
Engineer's Printed Name Michael E. Anderson, P.E. 6ate 12/14/00
6. DHHS SIGNATURE ..............................
/.''~: ~Approved ~r /'/- bedrooms.., ~ ~ ·
Disapproved. ·
' 'Conditional approval for ......... bedrooms, w~th the f611d~ng
',Additional C0:mments
Attachments:
HAA Checklist
Septic System Advisory.
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
75-025 (Rev. 01.'00)'
Legal Description:
A. WELL DATA
Well type
Date completed
Total depth
'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
., ~#w.ci.a~chorage. ak.us
(~)7) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 12, Block 1, Skyhills Subdivision Phase I
- Municipal Water System
If A, B, or C provide PWSID # __
Sanitary seal
ft ~ased to ft
FROM WELL LOG
Nitrate
Collected by:
Date of test
Static water level ff
Well production g.p.m
WATER SAMPLE RESULTS:
Coliform colonias/100 mi
Date of sample:.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed 8/8/00 Tank size
Cleanouts ¥ Foundation cteanout ¥
Dateof pumping New Const:uct:Lon
C. ABSORPTION FIELD DATA
Date installed
Length 50
Total depth 1:7
1~250
ParcelI.D.:
011-122-13
Well Log
Wires properly protected
Casing height (above ground)
AT INSPECTION
ft
g.p.m
__ mg/I Other bacteria__
colonies/100 mi
in.
gal Number of Compartments 2
Depression over tank N High water alarm
Pumper
8/9/00 Soil rating (g.p.dJft2 or ft2fodrm) .8
__ft Width 3 ft Gravel below pipe 8
· ft Effective absorption area 800 fF Monitoring t~be
Date of adequacy tastNew Const. Results (Pass/Fall)
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
M
System type Deep Trench
ft
¥ Depression over field N
For bedrooms
gal. New depth
Absorption rate >=
.If yes, give date __
in.
g.p.d.
N/A
72-0'~ (Rev.
D. MFT'STATION- N/A
Date installed
"Pump on" level at __
Datum
Size in gallons
in "Pump off' level at __ in
Cycles tested
Manhole/Access
High water alarm level at in
Meets alarm & circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on Io!
Absorption field on lot
Public sewer main
Sewer/septic service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO'
No Well On Lot
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Building foundation > 5 ' Property line > 5 '
Water main > 1 0 ' Water service line > 1 0 '
Drainage > 1 0 0 ' Wells on adjacent lots > 1 0 0 '
Absorption field > 5 '
Surface water > 1 0 0 '
>10'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation > 1 0 ' Water main
Surface water > 100 '
Property line > 1 O'
Water Service line > 10 '
Curtain drain None Noted
F. COMMENTS
Wells on adjacent lots __
Driveway, parking/vehicle storage > 50 '
>100'
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 effe' ct on th,s date.
HAA Fee $ '~1~ O . ~'
Waiver Fee $
Date of Payment 12-- ]'~/~. Date of Payment -~'
72.026 (Rev.