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HomeMy WebLinkAboutLAKE O THE HILLS BLK 1 LT 3Lake O'The Hills Block 1 Lot 3 #015-331-18 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251308 Work Type: Septic Upgrade Tax Code Number: 01533118000 Site Legal Address: LAKE O THEHILLS BLK 1 LT 3 G:2639 Site Mailing Address: 11301 MOUNTAIN LAKE DR, Anchorage Owner: BAUMAN JAMES R III & JUNE F Design Engineer: FORGE ENGINEERING This permit is for the construction of: C✓( Disposal Field Xseptic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/28/2025 8/28/2026 54789 ❑ 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 Special Provisions: Existing seepage pit to be decommissioned. Received By: t ( Date: d L_15 Issued By: Date: 2- Z X_ r 4 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-331-18 Property owner(s) James & June Bauman Day phone 907-350-2234 Mailing address 11301 Mountain Lake Dr, Anchorage, AK 99516 Site address Same Legal description Lake 0 The Hills, Block 1 Lot 3 Number of Bedrooms 4 Engineering Firm Forge Engineering Building Permit Number Not Applicable ❑ APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field El Initial ❑ Septic Tank ❑ Upgrade El Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: Permit No. 05f 251 Waiver Fees: Date of Payment: Waiver No. Distance: August 12, 2025 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Lake O The Hills Block 1 Lot 3 – 11301 Mountain Lake Dr Septic system design Dear On-Site Services Engineer: This is a request for a new septic permit at the above referenced location. The perc test hole was excavated to 18 feet with silty sand with some gravel starting at 5.0’ all the way to the bottom. A new 3’ wide trench has been designed starting at 5’ and ending at 12’ with 7.0’ effective depth. The original tank is a 1250-gallon concrete tank, this tank will be reused for this design. This is all confirmed with the attached plan. Although the home currently has 3 bedrooms, the trench will be sized for 4 bedrooms. The ground surface on the lot has some slopes, but we have found a place that is within MOA regulations to put the new trench. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. We have added contours on the site plan to show the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. We have marked all of the wells and septic system on the adjoining lots to show that there will be no impact from the new trench. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 6’ away. Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251308, Curtis Townsend, 08/28/25 LAKE O THE HILLS, BLOCK 1 LOT 3 10 EXISTING 1250-GAL CONCRETE TANK TO BE DECOMMISSIONED LOT 4 SEPTIC SYSTEM NOT IN VIEW PORT GE ENGINEERING 4^9 •TM :* • Benja i Schiller �t��c�Jl• C eiszs92 ••V���r illF9Fo PROFESSIONP'�"I 40' LONG x 3' WIDE, 7' EFFECTIVE DEPTH TRENCH LOT 4 EXISTING WELL SEPTIC PLAN (�-o P�"I LOT 2 EXISTING SEPTIC SYSTEM EXISTING SEEPAGE PIT TO BE DECOMMISSIONED LOT 2 WELL NOT IN VIEW PORT \\ NEW 1250-GAL TANK 0 50 100 FEET 1 "=50' LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH- MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LAKE O THE HILLS, BLOCK 1 LOT 3 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 3' 4'-6" 7' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 5.0 MIN/IN APPLICATION RATE: 1.2 GPD/SF 7' DEEP TRENCH SYSTEM EXISTING 1250-GAL SEPTIC TANK BOTTOM OF TRENCH: 12.0' BELOW GRADE FLOW LINE ELEVATION: 5.0' BELOW GRADE 600 GPD / 1.2 GPD/SF / 7.0' DEEP / 2 SIDES = 35.7 LF TRENCH REQUIRED (40.0 LF SPECIFIED) 6" 8/8/25 PROVIDE ADDITIONAL FILL TO ACCOUNT FOR SETTLEMENT 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK GEOTEXTILE FABRIC Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251308, Curtis Townsend, 08/28/25 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING DEPTH TO WATER AFTER MONITORING 5.0 7/21/25 1 2 3 4 5 6 GM (SILTY SAND /w SOME GRAVEL) Professional Engineers Stamp: LAKE O THE HILLS, BLOCK 1 LOT 3 7/21/25 015-331-31 A.C.E.S. 93 8 1628:00 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: JARED EARLS 99 8 16 NONE 7/28/25 COMMENTS: SITE PLAN 6 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 8/5/25 MOISTURE NOTED AT TIME OF DIGGING?NONE 93 8 1630:00 99 8 16 6 93 8 1630:00 99 8 16 6 OB Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251308, Curtis Townsend, 08/28/25 NO. 5 REBAR T HELD THIS SURVEY OF q eq�;4p 49 THE s SHANE A. HOLT < LS-6914 ���°fessiona� �Qo ASPHAL T PARKING AREA s USE \AU S LOT 2 STONE WALL LOT 4 �! `srr, ~ �� WELL F' NOTE. OO LOT 3 BOUNDARY COMPUTED FROM RETRA CEMENT OF THE 1-16 LINE ALONG THE EAST SUB. BOUNDARYAS SHOWN ON PLAT 72-236. y��0 SUPPLEMENTAL PLAT INFO. FROM 82-8 WAS ALSO UTILIZED TO COMPUTE THE \ C - E 1-16 CORNER \\\ • SEWER SYSTEM PIPE AS-BUILTSURIVEY 1 " = 40` NO CORNERS SET THIS DATE / HEREBY CERTIFY THAT / HA VE PERFORMED A SURVEY OF THE FOL L OWING DESCRIBED PROPERTY LOT3 BLOCK 1 LAKE 0' THE HILLS SUB. THE INFORMATION HEREON IS FOR THE USE OFLENDING INSTITUTIONS SPECIFICALLYTO SHOWANY CONFLICTSBETWEEN EXISTING STRUCTURESAND PLATTED LOT LINESAND/OR EASEMENTS,' AND /S NOT TO BE USED FOR POSITIONINGADD/TIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES EASEMENTS OFRECORD, OTHER THAN THOSEAPPEARING ON THE RECORD PLAT, ARENOT SHOWN HEREON ( UNLESS INDICATED) NOTE' FENCELINES THAT MAYAPPEAR ON THIS DR4 WINGARE NOT TO BE USED TO DETERMNE PROPERTYLINES OR POSITIONADD/TIONAL IMPROVEMENTS ANYPAVING SHOWN HEREON MA YBEAPPROXIMA TEDUE TO EXCESSIVE SNO WAND/OR ICE A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUA TED THEREON ARE WITHIN THEPROPERTYLINESAND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 307 DAYOF TUNE 2025 HOOT LAND SURVEYING 9309 GROVER DRIVE FWCHORAGEAK 99507 NOTE. - AN APPROX.. LOCATION OF PRIVA TE DRIVEWA YACCESS CROSSING LOTS 1- 4; APPARENTL Y INTENDED TO BENEFIT LOT 5IS NOT SHOWN HEREON. SAID DRIVEWAYAPPEARS TO HA VE NEVER BEEN UTILIZED, OR CROSSED ANY LOT . EDGE OF LAKE IN THIS VICINITY w 2 — PROPERTYLINEAS INDICATED ON THE RECORD PLAT NOTE: THE HIGH WATER MARK WAS NOT LOCATED THIS SURVEY DUE TO EXTREMEL Y LIMITED ACCESS, STEEP GRADE, AND V/SIBLITY; EXCEPTING THE AREA /N THE VICINITY OF THE NORTHEAST PROPERTY CORNER AS SHOWN HER\EO'N. `Vco �v \�VO NOTE. - THE MEANDER LINEAS SHOWN HEREON DOES NOT CONSTITUTE THE BOUNDARY OFANY LOT. ALL LOT LINES EXTEND TO THE EDGE OF THE HIGH WATER MARK 16289 242-24 n GRER ANCHORAGE AREA BOf�GH Department of Environmental Quality w 3330 C Street Anchorage, Alaska 99503 __INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 'E• T you've MAILING ADDRESS /K -/3C2 O9 PHONE Zt7!-83-2-- NUMBER OF PITS DIAMETER LOCATION 6rVA)0dACVK OAr tQW44.aEK LEGAL DESCRIPTION /-AT 3 1640"S / 11.9XE 01 Tf/r SEPTIC TANK: DISTANCE FROM WELL — MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS X51 INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY 12-5'0 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_, DEPTH LINING MATERIAL CRIB SIZE: DIAMETER _DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM $/�y sfe.n i-e.ineasu.e L A/IOW,;g M)vewmrii Oi• INSTALLED BY: y�"�h �' F- -/r-w.k. Trsf* ed -be> teo 3 �D2M So�/4Lc �+u.+d.r�o., I S Sil►r'/' due' Tru � /n O-�-t rh4/ /O CO'�t•n Pt ry 99! PIPE MATERIAL: ,,.{ SIL � � "� Pif CT�'//!OV-,,/ 17cf y¢iin � `4, �o /n5pac-ircn ups t i»e�/ j3L►F� On Su-ensC to L�{rorr O{ - LOT SLOPE: �'.o,,,t './ Yr I "sz /S ,,// REMARKS: �O�r ^�O c/-Mn/d6 '70 far- n7gpE rn S ySrrm O�iG. FidQt- 0- 19-73 W/TH+ur p,2re2 APPPodAt, DATE APPROVED r' it Prxinin I G.A.A.B. Form No. EO -031 nGRER ANCHORAGE AREA BOPGH ���✓ Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ^ c� jMAILING/� ADDRESS 1410 p pPHONE 29 C a?�3 �• LOCATIO / f. O ' c�©h.Q..Ci/LE}4'{U- LEGAL DESCRIPTION I•^ 3F O �y �.e-r•NL O �T�tL �' SEPTIC TANK: TANK: DISTANCEt . NUMBER OF 1 FROM WELL MANUFACTURER MATERIA COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I (QUID CAPACITY1 2C5 0 GALLONS. SEEPAGE PIT: ) C�tX I W r& X i VX I I 1/ NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_1 DEPTH I/ LINING MATERIALL A/1vG�Q CRIB SIZE: DIAMETER DEPTH (_!_ DISTANCE FROM: WELI_L__. BUILDING FOUNDATION ate, t NEAREST LOT LINE a. () . ABSOR TIONCA AREA (WALL AREA) O oL SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE • • CONSTRUCTION DEPTH � DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC 155 /,.SEEPAGE 1 [/ FOUNDATION LOT LINE SEWER LINE , TANK SYSTEM '7 CESSPOOL APPROVED DISTANCES: OTHER SOURCES DISAPPROVED LOT SLOPE: , // REMARKS: Ah' trCAMA CT 70'0h o "5e,_0 d��1 Form No. EQ -031 DIAGRAM OF SYSTEM n tq QX r��c A APPR G.A /L_/ �1i t. r� GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE. ALASKA 99503 TELEPHONE 274.4361 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT 77 MAILING ADDRESS . PHONE INSTALLATION LOCATION LEGAL DESCRIPTION L -E z7", INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED �j�V�IF ������J - 3 '�•�1��� ��dt� `�%/ver FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS ./.6%n �i NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION GATE ANTICIPATED .z fp' FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK TYPE $Z - � SEEPAGE AREA eoA, ✓k MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK s' FOUNDATION TO SEEPAGE PIT W -:Q2 , DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL S SEPTIC TANK -4- . SEEPAGE PIT ��� / DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ^lam /� / SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. / / WATER MAIN TO SEPTIC TANK Zl2 SEEPAGE PIT DRAIN FIELD SEPTIC TANK. ,Z442 SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE /O APPLICANT'S SIGNATURE FORM NO. CO -014 TYPE '�v DIAGRAM OF SYSTEM ORDINANCE NO. 28.60 AND THAT THE ABOVE • GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case N Performed For J-eya'd zr- T'ov,lo_Dated Performed Legal Description: Lot :_Block'_Subdivision�lal-e This'FormJReports Soils Log, Y Percolation Test - Soil Test Must Be Logged�To-4'-Below Qroposed;Seepage-.System Depth - \• , 1 -- . )e.. r > )" ,' Facet. _•t. Soil Characteristics • v —� 1 Date Gross Time Net Time,, t t Depth to H2O Net Drop t 3_ 5- -6—BF 6- 8F `. 9- 0— 2—. 3— / All 4— � Was Ground Water Encountered? eta� 111 o If Yes, At What Depth? _1 -SPF wmmsmmm� MMMMMMM0 MMMMMMM� wwwwm �m Reading Date Gross Time Net Time,, t t Depth to H2O Net Drop t Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench COMMENTS: -,0200 Test Performed BY ate Certified BY: Date: . January 14. 1574 Nr. E. J. Young P. 0. Cox 4-1202 Anchorage, Alaska 990090 Re: Lot 3, Clock 1. Lake o' the Hills Subdivision Dear hr,=Young.: This letter will confirm our conversation of January 11. 1974 in which you agreed to bring your sewer system into compliance. The foundation distance tuy be corrected ty roving the existing pit (and gravel backfill) away from the foundation. 1,11 other items are self-explanatory. Please tail for an inspection at such time as all iters are corrected. This office wilt require ail work be done by July 1, 1974. Thank you for your pronpt response. Sincerely. Susan C. Dickerson, Sanitarian SED/ko cc: Plan Review A . . 0 January t, 1974 Young P. V. h0x 4-12002 1 Anc'!oridir, Al asla T .. p 1 L "�. : { L n'' )P T Lot ., 1ioct.:1, lake"O Tho Hills Subdivision it 1 _c; r !!r. YoUn; e..•. r. . Irr 1.'ctaberof this �nrr t',is officr ar;rnvc'l't",c Ustallation of a seder systcYt cn th^ :At thf, tim4l'of -ih%r^ ctior, t!1° house I:: s not vet twilt. -':ave opnarently rot yet t:c^n cc:,-1ctc,. cre:r,7': lair requires a rcparztion of tti,erty (210) feet L^_tvc-n any four- 'aticn ant a sccrapc nit., .This officer noosure:l aprrvxir:atcly 23' frm t,'� clr:nout to Vie fcun:'atiur.: Py allovin; for tt,c distarcc fror: tt,e cl -co:: to 0C o1'a of t!t^ Iit, t!?^r•� rc:,nins only 15-1L' separation. Ttas office 1;as ask,,, that your tuil^irp rrr:,it t,, s-it':1rv1d untiI t`e frl- lr.:in- itc-s arc in cc,­li*rcr­ . 1. Distance fret fovn4at1on to ed;e of ,Nit i- 2' ft, -?t. 2 i'eth cl.anouts aro rroviucd Frit" air-tib".t c Fxrese five feet of cast iron rir on th^ irlFt-to the sc^tic tangy. 4. `%cw that thea se^tic tan!, his tccn,scalri s^ it is e0r.^let^_ly rat^r _ -.. I ^alrl su^,;c;t ttiat-Yuu ccrt?ct me rc^,,rdirn th? a:.ove. Ycu ray reach re at Z74-1561, extension Sincerely. Susan E. Cickerson, c•r.itarian SEu/ko cc: �jild{n,: )e^t. Plan Revie'.+ Certifie-! No. MOLL ' C' ( .:• ';;� sun; �, GAV' ' r,r.rl,.r.r` r -r r s..rr ..TtP It '1� RECEIPT FOR CERTIFIED MAIL -30C (plus postage) .; . SENT TO POSTMARK OR DATE If) STREET AND NO. r' -I LO P.O., STATE AND SIP CODE i - OITION_I lL f[RYI CEf EOR AOOITIO_NAL RES_ RETURN 1. Shows U rem- "If Ota dellinl0 _.. -1547 6 .t RECEIPT With debvOy to addressee only ............ 65r E• Shoo to tNi-, dab and -here Galland 35V SERVICES _ _ .. With deltvay to addressee only ............ 85 r . .. __._.__ OELIVEF TO ADDPESSEE ONLY ........... ........................................... � _ SPECIAL DELIVERY �e-ero 1w rowired)........_......_._._............ '• E'^-�•• •• - Z IRS AprFl971 3800 NO INSURANCE COVERAGE O (Se. other rid.) r - NOT FOR INTERNATIONAL MAIL • CPO: IOn Ci e4W-743 r ...'i SENDER: Be $ore /NNt o A efleea ON 0her fide PLEASE FURNISH SRRVICE(E] BY CH M BLOWS) Oro o IAddHionnf r/aftA.. :Arse rtti 1 Show to whom, dete4ffD49kFMD[>gliver ONLY 70 wherlD delivarl8d Rddvesmm n RECEIPT m ' .1' _ Rmiared. ribs _ Rew6efed efllete deaeri6d 6elew _[ `e •O i -i okn D IYRE DR IIIIrE OF weRAADDRiSEG (Mw dx'oM be ARrd is) 11 S g'Hi S � qrson } ,c4 aRTIFIED Mo.rn 1 C ^ 4 . , 741515 ko R >uoiury Axr irsutttio la. rn . - 1 DATE DLLIYt:R[D - SNDA WHERE y ' reperaad, an! irrc Code) o P Ws7rri^r: 1. GAV' ' r,r.rl,.r.r` r -r r s..rr ..TtP It '1� MUNICIPALITY OF ANCHORAGL Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# 015-331-22 HA# Permit # Date Received: April 21, 1994 Legal Description: Lot 3 Block 1 Lake 0' the Hills Subdivision Engineer: Michael E. Anderson, P.E., Anderson Engineering PO Box 240773, Anchorage, Alaska 99524 Applicant: Design In Wood Waiver Requested: Lot line trench to west property line of 8 feet. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec #: 25380/3820 Amount: $ 115.00 Date Paid: 4-21-94 ccI000S PRINTING OF ALASKA (907) 277.0446 � Municipality of Anchorage REQUEST FOR VOUCHER CHECK FROM:'D SI GN V,SVG,ons, TE (DEPARTMENT) TO: MUNICIPAL CONTROLLER DATE: 1R-30—c1LL R33157 THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY 1099 HER NO PAYMENT DT. V VENDOR NO. REFERENCE NO. INVOICE DATE INVOICE NO. DEsc (DIISPOSITION }� (1) MAIL TO PAYEE (2) D MAILTO PAYEE w/ATTACHMENT (8) D NOTIFY DEPARTMENT EMPLOYEE WHEN CHECK IS READY IN FINANCE (3) D NOTIFY PAYEE TO PICKUP IN TREASURY Nun.: Nam.: Phone No.: Ore. No.: Plwrw No.: 4. ACCOUNTS TO BE CHARGED: CHECK NO. CHECK DATE PREP APPR REOUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO: Name -M1 GttPrE'L. Ee. A -N DERSoA FIE • Address Proo Oo leficriolee2lnlcr� P,O. 12>0?d 2y -0'M, {�NG1+0Rft, Etc ) hLh ICA- CjRSZL� 2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED): Ye. uhf 'tltia LL60JQ �lSr�O i.OT Cl�)E 1JAtVE/i �EcF'T-W.0T ,( '1,0-'r L10E Wh1VZR WhS 1JO'r REOUIREA. SEC RTTACFIebD 3. OF CHECK: AUTHORIZED USE ONLY (DIISPOSITION }� (1) MAIL TO PAYEE (2) D MAILTO PAYEE w/ATTACHMENT (8) D NOTIFY DEPARTMENT EMPLOYEE WHEN CHECK IS READY IN FINANCE (3) D NOTIFY PAYEE TO PICKUP IN TREASURY Nun.: Nam.: Phone No.: Ore. No.: Plwrw No.: 4. ACCOUNTS TO BE CHARGED: ITEM I ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION Or /CC AttVlDbl I Task I t Cast Cl, WA/WO NO. DESCRIPTION AMOUNT 0/ - 13,1311 7 FUN 70 9 4W 111 111 //S 5. TOTAL AMOULjOF CHECK Of 11S— V. Approving Authority a. To be used only when payment cannot be made by purchase order. travel expense report. travel authorization or petty cash. ('1 Municipality of Anchorage • DEPARTMENT OF HEALTH AND HUMAN SERVICES �}�r Environmental Services Division Telephone: 343-4744 ON-SITE SERVICES FEE DOCUMENTATION Date Paid: 41— 2/-2(� Name pf Payer: (Name on Che Address: (Off of check) Legal Description(s): Type of Payment: (Indicate Amount Paid) z//S c,7) iealth Authority: Excavator Permit: Sewer & Well Permit: Engineer Permit: Well Permit: _ Sewer Permit: Copy Request: 72-0.11 (Rev. 10/87) Pumper Permit: _ Well Driller Permit: _ Tank Manufacturer: (Waste Treatment) DISTRIBUTION: 0 Permit Number. a: 30_0 q: WAIVERS: Lot Line: 115_,120 Well to Tank: Well to Field Field to Surface Water OS— 25830 Tank to Surface Water WHITE—MASTER FILE CANARY—PROGRAM FILE MUNICIPALANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 015-331-18 HAA# b1of 1-101nLA?n 1. GENERAL INFORMATION Complete legal description Lot 3; Block 1; Lake -'a The Hills Subdivision Location (site address or directions) 11301 Mountain Lake Drive s Anchorage, AK '='Property owner •.Donald Berwick Day phone Y Mailing address C/O Prudential Vista 4241 "B St. Anchorage, AK 99503 Lending agency Day phone Mailing address Agent Ralph Nobrega/ Prudential Vista Day phone 273-7251 Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: . Individual well xx - Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 71a25(R..1A1) From MOA021 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe 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 Municipal and State codes, ordinances, and regulations in effect AkVkadW?4pi is inspection. Name of Firm Address Engineer's signature Alaska Water & Wastewater Consultants, Mc. . Shall be PAID $ 1300 > or prior to, closing for the Englneering Services Provided. 6. DHHS SIGNATURE By: _ G Approved for' -FOU R. bedrooms. Disapproved. Conditional approval for Additional Comments Inc. Phone 337-617GJ Date bedrooms, with the following stipulations: l% A&u i //. /'n-- Date ' 3 0 - 679 �t— The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasersof homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. r2.=pW. Wt) 8. MOAm xECEIVEU Municipality of Anchorage AUG 2 7 1999 DEPARTMENT OF HEALTH & HUMAN SERVICE6UNIcipAulr OF Environmental Services Division ENVIRONMEWALSERVIO 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LAKE OF THE HILLS; LOT 3, BLOCK / Parcell.D.: 015-331-18 A. WELL DATA Well type PRIVATE It A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (YM) NO Date completed N/A Total depth 190' Cased to 40'+ Casing height (above ground) 12' Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test Static water level AT INSPECTION 8/17/99 96' Well production g.p.m. 3.7 9— p.m-WATER SAMPLE RESULTS: Conform 0 Nitrate 0.815 mg/L Other bacteria 0 Date of sample: 8/16/99 Collected by: A.W.W.C.. INC. B. SEPTICIHOLDING TANK DATA Date installed 7/30/74 Tank size 1250 Number of Compartments 1 Cleanouts (YM) YES Foundation cleanout (Y/N) YES Depression (YIN) NO High water alarm (Y/N) N/A Date of Pumping 8/17/99 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA — 0200 SOIL RATING, 702 SO FT, 4 BEDROOM. APPROVED IN 1996. — PRESOAKED WITH 1750 GALLONS ON 8/17/99 Data Installed 10/19/73 Soll rating (g.p dJfF or ft=/bdrn) 200• System type SEEPAGE PIT 19 X 14 X 6 X 18 X 11 Length Width Gravel thickness below pipe 9' Total depth 12.5' Effective absorption area 702 SO FT Monitoring Tube present (YIN) YES Depression over field (YM) NO Date of adequacy test 8/18/99 Results (Pass/Falq PASS For 4 bedrooms Fkdd depth in absorption field before test (in.); 23 Immediately after1015gal. water added (In.): 58' Fluid depth 32 (Ina) Minutes later. 1310 Absorption rate a 600+ c.p.d. Permudd , treatment (past 12 months) (YIN) NONE KNOWN if yes, ghre data 72-026 (Rev. 3/961' D. UFT STATION Date installed Manhole/Access(V/N) — High water alarm level _ ,Cyoi ested E. SEPARATION DISTANCES 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size ar Septiolholding tank on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots 'Pump oft level at' 100'+ 100'+ Public sewer main N/A Public sewer manhoie/deanout N/A Sewer /septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent kns 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine 10'+ Building foundation 10'+ Water mairdservk a line Surface water 100'4- Driveway, parkingtvehicle storage area Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. ENGINEER'S =87 HAA Fee Sy D ` Uy Date of Payment Receipt Number "j-0 72-M (Rev. 3196)• Waiver Fee $ 10'+ 25'+ �i. I I X N• Il. L Date of Payment Receipt Number are MUNICIPALITYANCHORAGE • DEPARTMENT OFFHEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # s2t.S- 331 - / P3 1. GENERAL INFORMATION HAA# VSf%C _-QQI A Complete legal description t.o-r z - Q3coo14, 1 cAt 6i o'-rpcz htrz.c.c Location (site address or directions) /1:30 / ,ww,"-rA,.,w LAyer `tutu, Propertyowner _tMR. En `t2oo.vG Day phone ZW�-zzt7 Mailing address Mct M71AVe:m2, AwCA AV- gPxz/A Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site �— Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 22-0251R" 1191, F,om MOARI 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 of this Health Authority Approval application shows 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 furtherverify 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �.j.uawc;` e'. -Ju• Sve' Phone Z�Z-�3 LLf9 Address Wo.(Bnx l4702-Sf A.OeFo AK g9Si�t-zoeS Engineer's signature j1- Date &-�F- 6. DHHS SIGNATURE X Approved for 4 bedrooms. Disapproved. Conditional approval for Additional Comments 0 • bedrooms, with the following stipulations: Date � - /0 - %." The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The D HHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72.M PW 1/91) •KK MOA $21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division brr 825"V Street, Room 502 • Anchorage, Alaska 9501 • W7) 34A49&EIVED JUN 5 1996 Health Authority Approval Checklist Mu'u =fity of Anchors9e Dept. Health & Human Services Legal DesatlNion:1oT-3 �tedGl GA1tao'-riial4�t�t Panz1I.D.: ©t.0-:�3t- (B wear A. WELL DATA Well type -MuA'r 6 If A, B, or C, anacb ADEC letter. ADEC water system number Log present (Y" 1040 Date completed My Ic clpw Tsai depth U0 k,ea,,i,✓ LIRA Cased to 40 T Casing height (above ground) I '— Sanitary seal (Y/N) YOc9 When properly protected (Y/M Ye.s FROM WELL LOG Daze of test (9r.ik.ve✓ N Static water level Well production 11— p.m-WATER SAMPLE RESULTS: AT INSPECTION s-lg C- 4 - h l 191W3. _,.m.; Coliform — in — Nitrate N.D Other bacteria ` O Date of sampleu 3/r •! vt. # 5/W 9L Collocted by: S • Ci �� a ,.N u (L. ¢. Ft Basal tv. B. SEMCMOLDING TANK DATA Date installed 1-30- fq Tank size 12,50 Number of Compartments -- Cleanauts (Y/M--Y— Foundation cleanout (Y/N) Y Depression (Y/►+i) t` _ High water alarm (Y" -- DazeofPumping S" -t9-96 pumper Cios211kAnop C. ABSORPPION FIELD DATA Date installed i o •- 19 - 7.3. Soil rating (g.p.011i or te/bdrm) System type C. 2 , B 4 1Y/V vev, X/BIwit, Length -- Width Gravel thickness below pipe qL Total depth / 2• A: r Mwirm absorption area VOL Monitoring Tube present(Y"—Y-- Depression over Sold (Y/N) AJ Date of adequacy test S-iB-trL Results (Pass/Faii) fit, c For A/ bedrooms Fluid depth in absorption Sellbefore test (in.); k3 u Immediately aftafga gat. water added (in.): 93 M Fluid depth & z„ (ins.) Mimrta I=: 7 Y N¢s Absorption ran: - ! Nko t- a.pd. Pero idde =no= (past 12 months) (Y/1) -V0 V yes, give daze D. LIFT STATION Sia in level at* "Pump air level at' High water alarm Ievnwt — / IA •Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tack on kit / SS I ; On adjacxm lots /©o Absorption field on lot 14 4 .On adjacent lots ! tJ p t Public cower main / p C7 Public sewer manhoWdeanout ! o p f Sewer /septic service lite / /y o Lift station / Ckq SEPARATION DISTANCES FROM SE mcmoLDINO TANK ON LOT TO: Building foundation / & c Property line /0+ Absorption field :301 Water maln/seMM line Mot Surfiwe water/drainage tWi Wells on adjac M lou / Op T SEPARATION DISTANCE FROM ABSORPTION FMM ON LOT TO: Building fgmdation 6 c Property Line ©* Water maintscr ice line Ser Surlhce water !ern ' Driveway, parldng/vehicle storage area J S' Curtain drain /an "t Wells on adjacent lots /oo 'C F. ENGINEER'S CERTIFICATION I certify that I have determined Nov field inspections and review ofMamicipal in conformance with MOA HAA guidelines in effect on this dote. �{ S� Engineer's Name S 60 (% v R.Q>&4*ks, , a,1� e Date HAA Fee T .�CO , (w Waiver Fee S _ Date of Payment (n- Date of Payment Receipt Number D) e-, t5 -L 3 go Receipt Number Rev. 8/95 OSS: haa.wk.doc a