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SECLUDED HILLS BLK 1 LT 6
Secluded Hills Block 1 Lot 6 #017-343-06 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191149 PID Number: 017-343-06 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name MICHELLE & BRIAN NELSON ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5300 SECLUDED CIRCLE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. SECLUDED HILLS 1 6 Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 100'+ -- 25'+ TANK ® Septic ElS.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer PCN drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection Vt 11/14/19 nd 11/15/19 Location and description dates: 3`d 4'" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL .� OF A��tll Conditional Approval: Date �!�Q.�-•' TH10 *��r ..........1 . Curtis Huffman �1,p % . CE 128991 . ..0;WK �� TFC . 3it0/202g. Septic System Approved - a02C Date �J 1 ��.� PROFESSO Note: this approval does not include well permit requirements. (Kev ub/u2/"I 6) SECLUDED HILLS BLOCK 1, LOT 6 P I D: 0 17-343-06 PERMIT: OSP191149 A -C=23 3' B -C=35 3' A -D=25.2' B -D=37.4' A -E=28.8' B -E=41.5' A -F=30.4' B -F=43.2' N89 56'06"E 269.94' SCALE: 1" = 30' SEPTIC SECTION SCALEi NTS PREPARED FOR: SUPPORT$SERVICES: \� MICHELLE & BRIAN NELSON�� OF ALA SECLUDED HILLS BLOCK 1, LOT 6F W. C. s /��� ��� 1 9 5300 SECLUDED CIR., ANCHORAGE, AK 99516 C �* TH *� FIRST WATER CONSULTING DATE: 3/14/2020 /, rtis Huffman / SURVEY: KGL CE 128991 13030 SUES WAY �' ANCHORAGE, AK 99516 DRAWN: 1'WCS 30' Ip/14/2020� j ftFESS100 907-350-9566 firstwaterAK©gmoil. com \\ t HOUSE DETAIL Scale: 1" = 30' a r 1.3'x3.3' CANT 1.0' CANT o DECK 2 SECLUDEp _ 133.76 _ N 80'00'00'E L=39.97' o R=175.00' 0 � L=36.14' R=50.00' Lot 6 L=32.92' 83,935 S.F. R=50.00' Lot 5 SEPTIC PIPES-�\1 10' UTILITY EASEMENT N / y - /-WELL I Q �sE o q \ P PO 0 _ — Lot 1 Lot 7 i / \ / 5'x90' UTILITY EASEMENTS \ Lot 8 I N 89'54'33'W _ Lot 3 III PLOT PLAN ___ AS BUILT —X— SCALE _1_=_ 6a__ GRID _ SW 2937__ Project No. —19=72O./M---- 11500 ___ 19=72O./ ----11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C. , (907) 522-6476 Phone 0000�pp (907) 522-4625 Fax o Professional Land Surveyors kenOlangsurvey.com o �F q.�q�44 jonathanOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 6, BLOCK 1, SECLUDED HILLS SUBDIVISION (PLAT No. 61-1) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the _ �— __ Day of ___--------- — at Anchorage, Alaska 49TH KENNETH G. LANGo G 4�paFo ..LS -5202.- 4�nRo�tSSION , It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program r, PO Box 196650 4700 Elmore Road ` Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Dc.partti7ent On -Site Wastewater Disposal System Permit Permit Number: OSP191149 Effective Date: 5/7/2019 Work Type: SepticTank Upgrade Expiration Date: 5/6/2020 Tax Code Number: 01734306000 Site Legal Address: SECLUDED HILLS BLK 1 LT 6 G:2937 Site Mailing Address: 5300 SECLUDED CIR, Anchorage Owner: NELSON MICHELLE T & BRIAN W Lot Size in Sq Ft: 83935 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: 120 nt q Issued By: � �iLR �11)'U'W Date: 5 ! / MMMUG'!r-,UTY OF ANCHORAGE Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 017-343-06 Property owner(s) MICHELLE & BRIAN NELSON Day phone 9072400570 Mailing address 5300 SECLUDED CIRCLE, ANCHORAGE, AK 99516 Site address 5300 SECLUDED CIRCLE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) SECLUDEDL� B1, L6 Legal description (Township, Range & Section) I L.LS Lot Size 83935 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade Pq (D) ❑ Holding Tank ElRenewal F-1Duplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS o Brent Western (Signature of property owner or authorized agent) Permit/Rush Fees: '�Zg6_ Waiver Fees: Date of Payment: q[�} /I Date of Payment: Receipt Number: 0,2a4oaD Receipt Number: Permit No. OS 01911 LIG% Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 April 29, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SECLUDED HILLS B1, L6 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by a private water and will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191149, Rebecca Carroll, 05/07/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191149, Rebecca Carroll, 05/07/19 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME%-.e_-.,.�..-..�-.,__.�___a_� PHONE QNixOG % 1.CJ ❑UPGRADE MAILING ADDRESS % LI7GAL DESC IPTION LOCATION NO. OF BEDROOMS ® �Y DISTANCE TO: Well s .— Ol / Absorlition rea L7 t Sao Dwelling pl /.ti' _ PERMIT NO, m F% NManufacturer q Mate riiy-� No, of compartments Liq. capacity in IF HOMEMADE: Inside length Width Liquid depth pUz DISTANCE T0: Well Dwelling PERMIT NO. :c FQ- Manufacturer Material Liquid capacity in gallons w y DISTANCE TO: Well IV Foundation Nearest lottt Q�� PERMIT NO. a hZ w No. of lines // /y Length of each line Total len th of lines Trench wi inches Distance between lines CC F- Top of tile to finish rade g Material beneath tile inches Total effect'' aI/�soorpti57,n area w Length Width Depth- PERMIT NO. Q F- w� Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line Class / f/,+T� Depth Driller A Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line - Septic tank Absorption area(s) OTHER LEGAL � / PIPE MATERIALS pp/ SOIL TEST RATING INSTALLER REMARKS � c APOV ED= �— DATE 7M13 (Rev. 3/78) C 1 Af`-`A L'r 1-4 ANU, E 11,1 %JI F:Or•JVIE r ITAL. F r E'C:'FIO 114 L) -04 1 8;2F�T; -"I-. .,: FREE -F., ANC'.1-10F.'Acif rl:; I.Ij 0 IZ�" reel 1, 7, PERI'll-l" NO. Fj In F:- I 6 6 J.. 0 I Fj P-4 T MICMAE'L 1,10I..-JEF.', 905 T NCRTHERN LICII-ITS 76 I-I'DC:A"f`T ("IN FT-AC:EF'l.JI- LANE' I E G Fi L I-Ol' C. I -SECVLl HII.J .5.1113 :-371;"-,iD SiDLIFIRE FEE.J L u -L clo ei I-I-rIPE OF." ABSORPTIOP-I SYSTEM 1,-.;: TRENIDIA P. 1 P-JIJMF,'f--"R CIF' BE-DROCIVIS S-0 11 - P.AFING F`T.-BR' V15f.-D THE REMIJIRED SIZE Ci F' T'Hl- SC11-AE:,-75O SY.F,T E P1 IS -If- 0--f. J- ---E P-4 IC .... .'-A_ 0-1:-- . .... Un [-:- F-:" ._fl -• gr-j::�:17:r TTIE LENGM-1 DI0lEN,-:--,IiDN IS THE LENGTH FEE -F) OF THE OR DRAINFIELD. THE DEP'TH OF A TF,,E-:r..IC:H (:.IF, PI -F IS 'FHE DT' 'TAN OE BET1,11EEPI "I-Hll' '-.;URF"AC:E' OF, -r+IE CiROUP.-ID ANC, -FFIE: BOT"I'C"IM OF THE E,-::C.F-IVFI'f'IOP-.l (IN F"EET-:1. THERE IS NO SE*T F'OR TRUIC:HES. THE GRA%-IEL DEPTH 1,-::: THE MINIMUM DEPTH FIF' G*RAVEL BETWEE:P-4 THE* OU-FFFiI-I-. PIF'E. FIND THE BF-YI-TOM OF-' 'THE EXCAVA"FION ",IN FEET'.). P -7J 31, ""IF" F --j P -j . ..... J_ #!:-a a n n=ew Ic"', n R,-.. I- 11-Y r..47" -l; PERMIT APPLIU"It-3T HAS THE: JTD INF-CIRM "I'l-41,S DF-':PFiRTMEt-,l`T DUF-.'J:NI TFIE.'. IN'.-:FlEC-FICIr-,I-l-, OF' ANY WELL -S AU'l-JAi'DEN'T 'TO 'THIS PROPERTITI FIND TI-iE hIUFlBEP'., i'JF- P.lE-,:-:fl.'.',ENC:ES rHA"r THE WELL WILL SEF",. -'E. < 1=4 LZL'" C., -T, I #D Ir. -A F7,1 F�.a EE F;r F. ICA L-1 1 IF'Ru. E:-..* E,.:,fi A CJ --:'FJ LI.- I NG, Of- ANY SITIS"I"Ell 1-41"FI-401-1-F FINAL INSPEUTICIP-4 Ii .1D AF,F',ROVAL BY TI -I 1.1n, ClEPAR-l"MEN-F WILL BE' TCI PROS:IECUT I Oti. 1-11191MUM DISTANCE E.,,E,rI.-JEE'P--I A WELL AND ANY SEWAGE 1"ITSPOSAL 1.5 F'EE-r F"OR A PRP -M -FE WELL OR 1.50 TO 200 F'E:E'T F -ROM A PUBLIC: IdELL DEPENI)ING, UPIDN THE' TYPE Of" PLIBLIC WELL. N I I'll lil DIS`FF-lNC:E 17P.,01-1 A PF.,II-.-IA'TE WELL 1*0 A PRIwA"I', SEWER LP. -IE 25 F'EE-T Ahlf') -- .1 -['IT' . .'r-, I ... INE' Ir--; 75 F'EET. 'FO A I'MIMUNI S- FJJ E WEI L ARE ANC, MUSI" BE: RE --TURNED J*Cj THE Df-7PFIRTMEN'I" I.-JITHIN DAYI--l' i'.'jF' THE IdEJ-1- CA-IMPLE'I'll"Dt-.1. OTHER MAY APF"LIT1. SPEC:IF'IC:ATION,-::" ffl-ff) C-,ON.,'-";-rRUC:TION f.)IAGRAI,IS FjRF AVAILABLE TO INSSURE PROPER INSTALLA"IrlCiN. I r - I F-.' 1-.,. 0, J—,, 1. A I CEF"TIF"Y TFI1=I7 1: 1 AM F7AM'[LIAR, 14111-1 'THE RECx.lIF-'Er-lEI`-,IT'..; FOR ON-27ITE AND E:I-il TTIE MUNIC.:11"ALIT"T' OF A11,10-10RAGE. 2i I 1,111-L. INSITALI.- -FHE SITIS"FE'r-1 IN AC:D--*i-JC:E 1-41-11-1 THE -rE SEI. JEM MAIr' REQUIRE IF 'FFIE 3: 1 IJNDER'-,3 -FAt-,ID 'THM" THE orj-sI -JER SY'— RE,.:.-",IDEt-JF,E IS RE'r-101*',ELEI'..*j TO IN[A.ICIE [ql,-If--:E 'THAN 3 BEDROOPVb. GNE'D: APF,I-I D" 'T Ml --HAE.L NOWER V.,... ' s -� r : �a w"� v>`mWswimm�� �� M ..W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE=, ALASKA 99509 DRILLING LOG Well Owner=H Ire "fn1•Io � _ Use of Well iAll'10, 3 C1.0 Location (address of: Township, Range, Section, if known; or distance main �+�-k-Ja l (li-•j;. I_ �i 0, C J_A:.lr�ri `.-I l Sl,i Size of casing_ !' Depth of Hole__'. ,t —feet Cased to --a, —feet Static water level '=, ft. (above) (below) land surface. finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation—_4_'_____ Well pumping test at 5 _gallons per ;(hijtir) (minute) for__ _hours with— of drawdown from static level. Date of completion—Li i :• _ t I << 1 <"'. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness , `1'O Certificate No's. 81,1 & Ji3 TO -- TO - 3 -- CONTRACTOR O —TO 3—CONTRACTOR Municipality of Anchorage g ' Development Services Department ='- Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.akus 1-<e _ t 5,5i Acs, i C (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Paroel I.D. 017-343-06 COSA# Lr3 1. GENERAL INFORMATION Expiration Date: r /— Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent SECLUDED HILLS S/D• BLOCK 1 LOT 6 5300 SECLUDED CIRCLE * ANCHORAGE, AK * 99516 GREG COOKE Day phone 5300 SECLUDED CIRCLE * ANCHORAGE, AK * 99516 Day phone NANCY POLLOCK W/ PRUDENTIAL Day phone 345-3176 230-0293 Mailing address 3801 CENTERPOINT DRIVE #200 * ANCHORAGE, AK * 99503 4. Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, t 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. t 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 Linde- 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. 5. DSD SIGNATURE I, Approved for bedrooms. Disapproved. Phone 337-6179 Date y) I e 1 Iz Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory (Maintenance Agreements Supplemental Engineer's Report Other ,....,� v ON-SITE WATER AND WASTE -WATER PROGRAIA By. �a/�� �• Original Certificate Date:_CJ�2 (Rev. 11105) Municipality of Anchorage • '� Development Services Department �4°= Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SECLUDED HILLS S/D; BLOCK 1, LOT 6 Parcel ID: 017-343-06 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 11 /12/1981 Sanitary seal (YIN) YES Total depth 360 ft. Cased to 359.3 ft, FROM WELL LOG Date of test 11/12/1981 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION Static water level 285 ft. Well production 5 g.p.m. _ WATER SAMPLE RESULTS: Coliform Q colonies/100 ml. Nitrate ll .91 mg./L. Arsenic: N 0 ug./L. Date of sample: 4/3/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 8/25/2011 304 3.8+ Collected by: GEG, Ltd. Date installed 6/5/1981 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N)NE High water alarm (Y/N) N/A Date of pumping 8/23/11 Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 6/5/1981 Soil rating (g.p.d./111:2o /bd 150 Length 34 ft. Width UNSPECIFIED ft, System type TRENCH Gravel below pipe 8 ft. Total depth *12.4 ft. Eff. absorption area 612 fe Monitoring tube YES Depression over field No Date of adequacy test 8/25/2011 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 44 in. Water added 8155 gal. New depth87 in. Elapsed Time: 240 min. Final fluid depth 66 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' level High -water level at Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line Animal containment areas 50'+ Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *6, Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER EXISTING WAIVER #WR900012. G. ENGINEER'S CERTIFICATION OF A� o I certify that 1 have determined through field inspections and :. 41 ... Y"�Q review of Municipal records that the above systems are in """"" ' ' ""' """""'� conformance with MOA COSA guidelines in effect on thisQ date. f r y . G rness! Engineer's Printed Name JEFFREY A. GARNESS �° CE 79 3 09 Date I` I l a I I z �� P^ o t•Z oAoo 4�Pa'Oro f esslO� �DO0000�� COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11105) SCS Ref.# 1121048001 Client Name Gatness Engineering Group, Ltd Project Name/# Secluded Hills L6Bl Client Sample 1D Secluded Hills L6Bl Matrix Drinking Water PWSID 0 Printed Date/Time 04/10/2012 8:59 Collected Date/Time 04/03/2012 15:45 Received Date/Time 04/03/2012 16:26 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (40) 04/04/12 04/05/12 ACF Waters Department Total Nitrate/Nitrite-N 1.41 0.100 mg/L SM21 4500NO3-F B (<10) 04/05/12 LCE Microbiology Laboratory E. Coli Negative 1 100ml, SM21 9223B A 04/03/12 DLC Total Coliform Negative 1 100mL SM21 9223B A 04/03/12 DLC Page 2 of 4 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-343-06 COSA# 0 1. GENERAL INFORMATION Expiration Date: I (P I 1 Complete legal description SECLUDED HILLS S/D; BLOCK 1, LOT 6 Location (site address) 5300 SECLUDED CIRCLE * ANCHORAGE AK * 99516 Current Property owner(s) GREG COOKE Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 5300 SECLUDED CIRCLE * ANCHORAGE. AK * 99516 Day phone NANCY POLLOCK W/ PRUDENTIAL Day phone 345-3176 230-0293 3801 CENTERPOINT DRIVE, #200 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UD. 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. 5. DSD SIGNATURE l _AZ Approved for _ bedrooms. Disapproved. Phone 337-6179 Date Gl If �J �o�S�Op DO T '•7, �....... ... .. .. .... ........ . ff A. r ss:� � O CE -79 3 �G Pro f e s sio�°oma Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By: (Rev. 11/05) ��tt(ltOtFrtrr,r Xoz ��Yy��' 011 ri ` O ON-SITE WATER AND wASTEWATER PROGRAM Original Certificate Date: 9 _/ 6 /I Municipality of Anchorage +....:; ...g P......... . • Development Services Department :z Building Safety Division A "' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SECLUDED HILLS S/D; BLOCK 1, LOT 6 Parcel ID: 017-343-06 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 11 /12/1981 Sanitary seal (Y/N) YES Total depth 360 ft. Cased to 359.3 ft. FROM WELL LOG Date of test 11/12/1981 Static water level 285 ft. Well production 5 g.p.m. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/25/2011 304 ft. 3.8+ g.p.m. WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrate .3 mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 8/25/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/5/1981 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping I I Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 6/5/1981 Soil rating (g.p.d./ft2o 2/bdr 150 System type TRENCH Length 34 ft. Width UNSPECIFIED ft. Gravel below pipe 8 ft. Total depth *12.4 ft. Eff. absorption area 612 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 8/25/2011 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 44 in. Water added 815 gal. New depth 87 in. Elapsed Time: 240 min. Final fluid depth 66 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at in Datum Size in gallons Manhole/Access (Y/N "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *6' Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER EXISTING WAIVER #WR900012. G. ENGINEER'S CERTIFICATION �v 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. je.f A. Garnes Engineer's Printed Name JEFFREY A. GARNESS �4�s AGE c�G Date cl /)Ili ep" _i fessioo COSA Fee $ '-A 1� h Waiver Fee $ Date of Payment C� — N ^ 11 Date of Payment Receipt Number C)Cq q -J— , Receipt Number (Rev. 11/05) SGS Ref.# Printed Date/Time 08/31/2011 16:59 Collected Date/Time 08/23/2011 11:45 Received Date/Time 08/23/2011 12:45 Technical Director Stephen C. Ede 1113990001 Client Name Garness Engineering Group, Ltd Project Name/# Water Samples Client Sample ID 5300 Secluded Dr Matrix Drinking Water Sample Remarks: Alkalinity 107 10.0 Allowable Prep Analysis SM20 2320B Parameter Results LOQ Units Method Container ID Limits Date Date ]nit Metals by ICP/MS ug/L EP200.8 C 08/24/11 08/25/11 NRB Hardness as CaCO3 123 5.00 mg/L SM20 2340B C 08/24/11 08/25/11 NRB Waters Department NRB Barium 10.5 3.00 ug/L EP200.8 Total Nitrate/Nitrite-N 1.34 0.100 mg/L SM20 450ONO3-F B 08/24/11 AYC Microbiology Laboratory EP200.8 C (<5) 08/24/11 08/25/11 NRB Calcium E. Coli Negative 1 100mL SM20 9223B A 08/23/11 DLC Total Coliform Negative I 100mL SM20 9223B A 08/23/11 DLC Private Individual Analysis Alkalinity 107 10.0 mg/L SM20 2320B D 08/24/11 ATJ Aluminum ND 20.0 ug/L EP200.8 C 08/24/11 08/25/11 NRB Antimony ND 1.00 ug/L EP200.8 C (<6) 08/24/11 08/25/11 NRB Barium 10.5 3.00 ug/L EP200.8 C (<2000) 08/24/11 08/25/11 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 08/24/11 08/25/11 NRB Calcium 31900 500 ug/L EP200.8 C 08/24/11 08/25/11 NRB Chloride 1.83 0.100 mg/L EPA 300.0 D (<250) 08/31/11 08/31/11 DSH Chromium 3.31 2.00 ug/L EP200.8 C (<100) 08/24/11 08/25/11 NRB CO3 Alkalinity ND 10.0 mg/L SM20 2320B D 08/24/11 ATJ Conductivity 252 1.00 umhos/cm SM20 2510B D 08/24/11 ATJ Copper 195 1.00 ug/L EP200.8 C (<1300) 08/24/11 08/25/11 NRB Fluoride 0.113 0.100 mg/L EPA 300.0 D (<2) 08/31/11 08/31/11 DSH HCO3 Alkalinity 107 10.0 mg/L SM20 2320B D 08/24/11 ATJ Iron 1530 * 250 ug/L EP200.8 C (<300) 08/24/11 08/25/11 NRB Lead 34.5 * 0.200 ug/L EP200.8 C (<15) 08/24/11 08/25/11 NRB SGS SGS Ref.# 1113990001 Client Name Garness Engineering Group, Ltd Project Name/# Water Samples Client Sample ID 5300 Secluded Dr Matrix Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 08/31/2011 16:59 08/23/2011 11:45 08/23/2011 12:45 Stephen C. Ede Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date ]nit Private Individual Analysis Magnesium 10500 50.0 ug/L EP200.8 C 08/24/11 08/25/11 NRB Manganese 2.38 1.00 ug/L EP200.8 C (<50) 08/24/11 08/25/11 NRB Nickel ND 2.00 ug/L EP200.8 C (<100) 08/24/11 08/25/11 NRB OH Alkalinity ND 10.0 mg/L SM20 2320B D 08/24/11 ATJ PH 7.90 0.100 pH units SM20 4500-H B D (6.5-8.5) 08/24/11 ATJ Selenium ND 5.00 ug/L EP200.8 C (<50) 08/24/11 08/25/11 NRB Silver ND 1.00 ug/L EP200.8 C (<I00) 08/24/11 08/25/11 NRB Sodium 4850 500 ug/L EP200.8 C (<250000) 08/24/11 08/25/11 NRB Sulfate 13.8 0.100 mg/L EPA 300.0 D (<250) 08/31/11 08/31/11 DSH Thallium ND 1.00 ug/L EP200.8 C (<2) 08/24/11 08/25/11 NRB Total Dissolved Solids 147 10.0 mg/L SM20 2540C D (<500) 08/26/11 ATJ Zinc 403 5.00 ug/L EP200.8 C (<5000) 08/24/11 08/25/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/24/11 08/25/11 NRB &M Nile] IQ all il JRLWKN L"I flimplu September 16, 2011 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Septic System Sized for 4 Bedroom on Secluded Hills; Block 1, Lot 6 To whom it may concern: The referenced property recently had its well and septic system tested to receive a Certificate of On -Site Systems Approval (COSA) for a four (4) bedroom house. The inspection report on record with the MOA was approved for a three (3) bedroom system, however, the soil rating for the septic system was 150 sq.ft./bedroom and the drainfield serving the property has 612 sq.ft. of effective absorption area. The septic tank serving the referenced property is a 1250 gallon steel septic tank. In short, even though the inspection report was only approved for three (3) bedrooms the septic system is sized for and is capable of serving a four (4) bedroom house. If you have any gj`u�stions, please contact us at 337-6179. Thank you for your assistance. ly P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com MUNICIPALITY OF ANCHORAGE • �� Department of Health & Human Services o DIVISION OF ENVIRONMENTAL SERVICES ~}1 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C) \ _� - tL '�-C> n HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 6(�CIr I� Seciccr ecQ !f�'llf Location (address or directions) 5-300 Se c(u-cter'( P (act (b) Property owner Ni lir d- aru Telephone: (home) 3y5 yw3/ Business 276- /6z/ Mailing Address S30o Place An chor (c) Lending Institution fl -W U "0"A �e Telephone 276-09 V 1j Mailing Address a(/o 5ecur7�r Trfl�� 3333 DC/Ja(i� ,4�ctio�cnyc, /`}� 99so3 (d) Real Estate Company and Agent Cargef 4,-)CAor R,,aJ& - G /o(/nG �ccbrrx�G Address 7S0 �, Fire wePo� Gane f}� G%OrYCyC�, i4/r 99sa3 Telephone '277 — 6`6.6� (e) Mail the HAA to the following address: (or check here M, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family f8 3. WATER SUPPLY Individual Well N Number of bedrooms 3 Community ❑ Public ❑ Ted I-10 o r'e 3 `✓s - r ass Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site K Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z to Z abed 310e9 WWI'^ed) 990-U -�aoM s,aaauibuo jeuoissaloid ayl ui suoissiwo ao saoaaa aol ajgisuodsaa lou si a6eaogouy to AlijedioiunN ayl •panssi si aleotpliao e aaolaq Map ozAjvue ao suoiloodsui lonpuoo lou op SHHO to saaAoldw3 •sluawaainbaa alels pue jeaapal uleliao flsiles of aap.)o ui suoilnlllsui buipual a1a4l pue sawoq to saasegoind of Asolinoo e se sial saop SHHO ayl •e�seIy to alelS aul ui paaalsibei aaaui6ua jeuoissaloid luopuadepui ue (q anoge 9 gdea6eaed ui U0n16 suolleluasaidaa aul uodn Aluo paseq paleoilpoo JenoaddyAliaoylny glleaH sanssi (SHHO) saoinaaS uewnH pue 0128H to lu9wlaeda0 a6eaoyouy to AliledioiunN eq j `N01I:nV0 r' 1eno.)ddy jeuoil!puo0 to swial Jeuoil!puo0 panoaddesi0 panoaddy 96 - 0-r -17 Lijd r• °'n CS pj r: r32;OCP1 '1=uOCCF!L ° A leas s,aaau1bu3;:; ry1i..... n ...... .................. .......� Y ter.± • y / � s. e•.o n Y �a° Li e �Q. Aq swooap�q>� � y.aol panoaddy Y ( IVAOaddV SHHa '9 &/ 0/ I'-4 ale0 •uoiloadsui siyl to alep 941 uo loalla ui suoilejnbw pue 'saoueuipio 'sopoo alelS pue jediownw Ile 4l!M eoueildwoo ui si walsAs jesodsip aaleMalsum ao/pue Alddns aaleM alis-uo eql 'uolloadsui Pug uoile61lsanu1 ALU woal pue s01il a6eaotlouy to AlijediolunW a4l woal pauielgo uoilewaolui a4l uo paseq leyl /%liaan aaylanl I •ulaaay paleolpui ainlonils to ad j pue swooapaq to aagwnu aul iol alenbape pue jeuoilounl 'ales si welsAs lesodslp aaleMalseM ao/pue Alddns aaleM alis-uo aUl legl smogs Jenoaddy Aluoulny u11e9H siylto uoile6llsanui Aw leul Allaan 'Molaq uMogs alep uoilepiIen ayl to se pue olaaaq paxllle leas Aw Aq paililaao sy NOIIVVYHOdNl (INV VIVO'HOHV3S 3'11d'SIS3I'SNOII03dSNl ONIOIAOad WHId ONIM33NION3 '9 0.y0� ssaapp`d %/Sbb yl� d b-jQy,-) auogdalal r��i v 0/ wa!d }o aweN ) va;;L � ra > »tea S -F E � - Sh •uoiloadsui siyl to alep 941 uo loalla ui suoilejnbw pue 'saoueuipio 'sopoo alelS pue jediownw Ile 4l!M eoueildwoo ui si walsAs jesodsip aaleMalsum ao/pue Alddns aaleM alis-uo eql 'uolloadsui Pug uoile61lsanu1 ALU woal pue s01il a6eaotlouy to AlijediolunW a4l woal pauielgo uoilewaolui a4l uo paseq leyl /%liaan aaylanl I •ulaaay paleolpui ainlonils to ad j pue swooapaq to aagwnu aul iol alenbape pue jeuoilounl 'ales si welsAs lesodslp aaleMalseM ao/pue Alddns aaleM alis-uo aUl legl smogs Jenoaddy Aluoulny u11e9H siylto uoile6llsanui Aw leul Allaan 'Molaq uMogs alep uoilepiIen ayl to se pue olaaaq paxllle leas Aw Aq paililaao sy NOIIVVYHOdNl (INV VIVO'HOHV3S 3'11d'SIS3I'SNOII03dSNl ONIOIAOad WHId ONIM33NION3 '9 e PC�c�\O p\�00",, OF MUNICIPALITY OF ANCHORAGE (MOA) �J�\G�����P4s • u Authority CHECKLIST fiFEBRUARY 1' 984 343-4744 A. WELL DATA Legal Description: Well Classification Pr,-Vct e If A. B, C, D.E.C. Approved (Y/N) N- -. Well Lo Present Y/N Y Date Completed II/Iz/ 8r 7. qa'" 2er* y/9�?O Log ( ) p _Yield �n��eP to Total Depth 360 Cased to _36'0 Depth of Grouting n(.A. Static Water Level Casing Height Above Ground 2' Pump Set At Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 1257' ; On Adjoining Lots 7 rvo To Nearest Edge of Absorption Field on Lot 1 35' ; On Adjoining Lots To Nearest Public Sewer Line _-> 100' To Nearest Public Sewer Cleanout/Manhole (c) c, To Nearest Sewer Service Line on Lot ' 26 ' Water Sample Collected by IF TS - i ,. F. lle-cre ; Date V `>' / 9U Water Sample Test Results n,>Irafa-/K / J Comments well i-(aw ct miir itv o!/� CuJrnoj yP o(ru-u» e&c4,,z 4 ' 4ul qo rfsie� B. SEPTIC/HOLDING TANK DATA Date Installed ( (57/6/ Size2_t_ 5_0 No. of Compartments 2 Standpipes (Y/N) �' Air -tight Caps (Y/N) Foundation Cleanout (Y/N) i Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) Date Last Pumped y / !a / g0by scca_cl ; for N. A-. Temporary Holding Tank Permit (Y/N) N 4. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ( 2S' To Building Foundation To Property Line I C To Disposal Field To Water Main/Service Line 7 zs ' To Stream, Pond, Lake or Major Drainage Course a 100' Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata i T-0 0 `/3c(r" Type of System Design 7"o -e,) cA Date Installed 6 (67 / 8r Length of Field .7 Y ' Width of Field tva( /n a(cca(-ed Depth of Field Gravel Bed Thickness ra N Square Feet of Absortion Area 6/ e Statndpipes Present (Y/N) I" U Depression over Field (Y/N) N Date of Last Adequacy Test ti r �( go Results of Last Adequacy Test Adeaua { fi r hedf'oo/�Is SEPARATION DISTANCE FROM ABSORPTION FIELD: ->4k- To Water -Supply Well 1.9 To Property Line .)\ / nem ac- 6u,4 Sce,o e�, To Building Foundation A 3o -To-Existing or Abandoned System on Lot To Water Main/Service Line ; On Adjoining Lots 7 30 ` To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments 574cf:fm waJ tj pr-vge Y fin -e Wbl' D. LIFT STATION Al -4 Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To Cutback (if present) (GG , r GLia cv4 Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) ",-1). ( 4 (_� /% Lt) 4?g000/:z Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelip�e�effect on the date of this inspection. c`� 4 At att� Signed Company ° I Date fi/�� l h 099 F, . .....gineer'sSeal yo -or9 � ,�°,°°• .........� MOA No. Twoo;:e r. %!0ORe ,• Q C2 - 3539 ay e7 UF,Ii.. _7vv se o°cve°°��OVf4Y Noire Receipt No. Receipt No. Date of Payment / ��� Waiver Fee: $ Amount: $ L7 (i Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 145 3, 19, 9 P aCaLWELL -=,(�OFq A A\�•..N.... 50 1 � O ?' I. Gorald V. Randall Jr. 1 NO. 4050.5 4 Q �• ROFpSSIOo `P'� Municipality of Anchorage .r I rl Department of Health and Human Services dhh5 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 April 24, 1990 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 6 Block 2 Secluded Hills S/D Waiver Request #WR900012, PID#017-343-06, HAA#HA900129 Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 6 feet to property line to Lot 5 Block 1 Secluded Hills Subdivision. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, i Susan Oswalt On-site Services ljw#7 Concur: ?bhnSth, P.E. Program Manager On-site Services CMI, & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 April 1 Vit, 1990 ANCHORAGE, ALASKA 99516 Susan Oswalt (tel 29 LSD D) a M.O. A. DHHS P.O. Box 196650 Anchorage, AK 99519 Dear Ms. Oswalt: You have indicated that you cannot process our request for Health Authority Approval of the water supply and wastewater disposal systems serving the residence on Lot 6, Block 1, Secluded Hills until a lot line waiver is paid for and approved. I find this position ironic in light of the fact that the only reason a waiver is needed is that the Municipal inspector, whose responsibility it was to ensure that the system was installed in accordance with code, failed to properly carry out his duties. Be that as it may, the as - built property survey prepared by Gerald Randall on 9/14/81 indicates that the _ standpipe at the end of the soil absorption trench is located a�� {�}� �j'l""�" - �""• ''• ' `��� ` and approximately approximately 6 �l>.�-prclp •�Fd61—r�r+t/t4l 4TL77i� Lll feet from the property bounciaeparating_thi_s_1_ot from L5, B 1, Secluded Hills. Boni ol- - -- these lots have existing septic systems which are more than 50 feet away frons this standpipe. In light of the fact that each of the other lots is approximately 1.5 acres in size, and the fact that the topography slopes downward from the subject standpipe towards each of the adjoining lots, the continued presence of the subject septic system would not appear to measurably restrict the ability to construct replacement septic systems as needed on the affected lots. Therefore, we request that you issue a lot line waiver allowing the subject system to remain as is. Sincerely, Ted Moore �e� ew'. / c vll. 5. LEGAL DESCRIPTION L / DA i E RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME ❑ One ❑ Four ❑ Other ❑/ Two ❑ Five DATE DATE DATE - * Lsd INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR INSPECTOR Pf c7A� MUNICIPALITY OF ANCHORAGE MUNICIPALITY DEPT. Or HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC FONMENTAL pi:OTECTION 825 L Street - Anchorage, Alaska 99501 3q q NOV 2, ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 R E C E R t` L- D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER /Z%/ C Gi �a v_ �7 O by �7� - - PHONE 713.3 _-D- el 3-3 M ILI GADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION �i PHONE MAILING ADDRESS S3 s- 4. REALTOR/AGENT p - PHONE MAILINGADDRESS 5. LEGAL DESCRIPTION L / ~ e_ At C/� STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS O�SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑/ Two ❑ Five ❑ MULTIPLE FAMILY 1[0 Three ❑ Six 7. WATER SU PLY * Lsd INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DIS OSAL SYSTEM Lam' INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) -4 THIS SIDE FOR OFFICIAL USE ONLY j 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED I w 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: ± iz5� If Tank is homemade give dimensions: SOILS RATING TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 0___Af_PROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE C 2— d—� BY / �._- 72-010 (Rev. 6/79)