HomeMy WebLinkAboutHIDEAWAY LAKE BLK 2 LT 7Hid
away Lake
lock 2
Lot 7
! 5-47 !
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$UBMITTAJ
Municipality of Anchorage JULZD��f
On-Site Water and Wastewater Program • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161085 PID Number: 015-471-18
Dwelling: ❑■ Single Family(SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ■❑ Upgrade
Name:
Louis and Babette Miller ABSORPTION FIELD
Address ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
11050 Hideaway Lake circle Anch., AK 99516 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
Seven .8 GPD/SF 7.2-7.7 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.2-3.7 Ft. 4.0 Ft.
Hideaway Lake 2 7 Fill added above original grade Gravel length
Township Range Section 0-.5 Ft. 70.0 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5.0 Ft Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 700 Ft2 One Ft.
TANK ta❑ Septic 0 S.T.E.P. 0 Holding ❑Other
Well >100' >100' >100' >75' >25� Manufacturer Capacity
Surface Water >100' >100' >100' NA Anchorage Tank 2,000 Gal.
Material Number of compartments
Lot Line >5' >10' >5' NA Steel Two
NA
Foundation >5' >10' >5' NA 1 LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Gal.
Pump on level at Pump off level at High water alarm at
Remarks New Trench Connected to Existing
Trench with Flow Splitter Valve to Satisfy in. in. in.
Requirements for Seven Bedroom Home. Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034Tank to
Installer drainfietd D3034
A Plus Home Services Drainfield F810 Co/MT D3034
Inspector Wade Roberts BENCH MARK (Assumed elevation)100.0 ft
Inspection1'' 5/9/16 20° 5/10/16 Location and description
dates:
aro 41
n_- Northeast Corner of Deck.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL ♦�•Vb'`-" A�16
It
Conditional Approval: Date C,�P.• ',47.•S�.♦,
r*;' 49TH j-'. *
0V° •MICHAEL E ANDERSON .
1 J,4. CE-4381 :••
47--
11 a;p •.7-/Z at, ... ,
Approved +f 4%,:w ,..0•
PP t!i(� ��..� Date tl
Inspection Report_9-1-12.doc
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655-343-7904 PID No.: 015-471-18
Permit Number: OSP161085
y/O
L-28.4 I ��
HIDEAWAY LAKE SUBDIVISION �s��ti -.7)--
/17'n
.7rti
LOT 7, BLOCK 2
67,433 S.F. v6•��9 //p�`�
ALTERNATE SITE; ,„..)
Advantex Treatment System w/30'
Long x 5' Wide x 4' Effective Depth
A 8 Absorption System.
Si 14.7 20.7' App. Rote 4 GPD/SF
S2 27.4' 15.6' _ 1
C4 97.3' 67.3' O^V� �-c'��
111‘
C5 45.3' 44.4'
\` 2 M1 98.1' 68.4' [kt g Fsv 31.0' 1s.7 p�� �� Existing Septic Tank _ __FS 34.0' 15.7 v �hDecommissioned in
M2P� Accordance withP Municipal Code.�O<Gcyce / M2 /' s,e0-6 i' i 2C0 S1/ iFCOQ \`\-/ OTHA: / FSVS2O \
LEGEND ® Seven Bedroom \\CO - Clean Out / r TM (U •�l HOUSeW \\`
FCO - Foundation Clean Out Mt /' ; ~`°� 1 .0 I
SV - Septic Vent / 04 IiEcr, 0
MT - Monitor Tube C4
FSV - Flow Splitter Valve I 7 cd
�� _�1 II ®,
/'� '�°�oxt^�et d~`g I Exbtinq Well % cr.
�� '"'gory`` 1 ��
I
7 3b�b/� ��� .0\\ ti I
\ t
`, Cr UTILITY EASEME`d \\ w i
�***SI�II1., I0'UTILITY EASEMENT \\ i
r41.A•G VI 1�� ♦ ` \ i
•
•
/
moi_ •i LOT 3. UNDEVELOPED /
I
• 49th �` '� �� UNDEVELOPED RICHTER PARK7
m• i "�
\ 3
;si, fMIICH�AEL E. ANDERSON , . ` ` 17 � __ ___------
.c--, • i SITE PLAN �'
• No, CE-4381 �'a RI b w
.d"• ' '•� '. • SCALE 1' = 50'
'°RDFESSI 169
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655-343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP161085 PID No. 015-471-18
/ 96.5
94.5
U t7 En U U En
Existing uIui/Ground1 CV CO
P704
2,000 Gallon
Septic Tank
90.0 89.85
N�
U E I 2U
- 88.9 - 88.6 88.8 - -
/ Finished Grade
/ /
Existing Grade
Geotextile Fabric
1 - --
85.2 - Drainfield Rock 85.2
81.21 81.21
i 70.6 70'(Trench Length) l
Groundwater @
72.6 1-13-97
WEST TRENCH
NOTE: East trench is existing and was not constructed under this pemit.
s I ♦.
i 49th
`..A--
PROFILE AS-BUILT I. .MICHAEL E. ANDERSON
.`�> No, CE-4381
No Scale ♦ �•.�-I l. . ?.......'*<,„*".
•�•i M1�SrITi••�
MUNICIPALITY OF ANCHORAGE ..� e mitii�,+�
DEVELOPMENT SERVICES DEPARTMENT �.��P•:•. ..,,4/4 A
Ick
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 is : 49th T, ��
/\
SOILS LOG - PERCOLATION TEST i ••
,S ;MICHAEL E. ANDERSON/ i
�11,.;f1;•., No. CE-4381
LEGAL DESCRIPTION: LOT 7, BLOCK 2, HIDEAWAY LAKE SUBDIVISION � ~�
PERFORMED FOR: BABETTE MILLER `�+ OF'ESS0.44.
DATE: 5/9/16 PROJECT No.: llraaw+s
PARCEL ID#: TECHNICIAN: W. ROBERTS Professional Engineers Stamp:
DEPTH TEST HOLE A
(feet)
OB/OG SLOPE SITE PLAN
1
4
2
3
4
4
5 'a SILTY SAND \ SEE SITE PLAN
WITH GRAVEL
6 4 SM/GM
7 a .
• c
8
9 —4a •4
10— WAS GROUND WATER ENCOUNTERED? Na
° IF YES C.WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: NONE L2%
11 C DATE OF MONITORING: 5/16/I6
E
12 ..z
DEGROSS TIME NET TIME WATHER
To NET DROP
13— . DATE READING WATER
d (MINUTES) (MINUTES) (INCHES) (INCHES)
14 ° BOH @ 14' TEST HOLE PRESOAKED PRIOR TO TESTING:
15 10/4 1 9:42 1.13"
16 2 10:12 30 3.88" 2.75"
3 10:13 1.25"
17 4 10:43 30 4.00" 2.75"
18— 5 10:44 1.25"
19— 6 11:14 30 4.00" 2.75"
20
PERCOLATION RATE:1 0•9(MIN/INCI I) PERC.HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4.0 FT. and 5.0 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY TI IA"I'
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 6/16/2016
Municipality of Anchorage Page [ of_~
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
Name: Wastewater System: ~ New ~ Upgrade
Address:
Phone: ~ No. of Bedrooms:
~(~-- ~q~(I ~ ~ Deep Trench ~ShallowTrench ~Bed ~ Mound ~Other
Soil Rating: Total Depth from original grade:
LEGAL DESCRIPTION ¢, ¢ ~s~. ~,. ~-~'
Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township: Range: Section: Fill added above original grade: Gravel length:
WELL: D New D Upgrade Gravel width:~ ~ -- Ft. Number of lines:~ lOista~ween lines:Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: P~e mater~l:
Driller: Date Drilled: StaticWater Level: Installer: Date instatled:
Yield:~.~ GPM Pump Set at: Ft. Casing /~Heighl Above~ Ground:Ft. TANK
SEPARATION DISTANCES ~s~ptic u Holding ~ S.T.E.P.
To Septic Absorption Lift Holding ~ublic/Privat~ Manufacturer: Cap~city in gallons:
Fro~ Ta.~ Field Station Tank Sewer Lines ~0~ ~((
Su~ace/ ~
Water /~ /~ LIFT STATION
Size in gallons: Manufacturer:
Lot
FounOation I ~
Cu~ain i o~1 1 ~ctric~
Drain 1 ~ ~ ~k~ Inspections pedormed by:
Location and Description:
EN~~AL .
Department of Health and Human Services approval
Reviewed and approved by: · _ Date: ~-Z/-¢~ ~'~:~?,~"
72-013 (Rev. 9/91) MOA 25
]3ESTGN
~/ASTEWATEll ABSE1R
LOT 7, BLOCK 2 HI]
NEW §-WII]E
SYSTEM
SYSTEM
LAKE SUBD,
NEY 1~50 GAL, - ~
SEPTIC TANK ~'"~i
125,9'
............................ i b-l- b-~ 65~- -E-A S~'~'T .............. ~i ...........
/NEW
,/': WELL
LOT 3
UN]]EVELDPE])
C,\Work\7-2HWYL,I) WG
,,,.~' OF ,4/~,.
~,~,, Y,'i,~ .............
*'~$;'"' A -...o..--*'r~-,~.
,,.......'. ...... .:.:..~..:....'. ......... ~......~
a-~ ....................... :'m'~
~A~..Steven R. Pannone.F/~/~
**'~qO~ '2';..: .......
SWING TIES
cn i ~ B
]]C1 10,2' i 26,5'
T2 L ~3,y
BC2 25,8' 89,4'
C1 26,5' 46,3'
C2 ~ 34~2' 33,3'
C3 ~0'~ ' -~-9;i:Y-
LOT 6
"-.. UNDEVELOPED
SEE SECTION '' ~:..
,~,.~c ,~, ~, ~
TRENCH PROFILE
PREPARED FORm
Mr', Bill Bunbo~r
11050 Hideaway L~ke Circle
Anchoro, ge, AK 99516
(907> 349-2931
PANNDNE ENG, SVC
P, O, BOX 142025
ANCHORAGE, ALASKA 99514
874-0308, 272-8218 F~x
DATE, 6-4-97 AS-BUILT
~CALE:' 1'=60'
M-W DRILLING, Inc,
P,O. Box 110378 · 10330 Old Seward Highwey
(907) 349.8535
ANCHORAGE, ALASKA 99511
5/3
DRILLING LOG
Well Owner~.B.I~...DUNBAR ..... Use of WeltDOMESTZc
Location (address of: Township, Range, Section, t~ ~own; or distance main road
~ 7, BIlK 2, HIDEAWAY ~ SUBDIVISION: 11050 HIDEAWAY IA~ C~R,
ANCHORAGE ~ AI2%,q KA
Size of easiug__h/L.__Depth of Hole~12D~.ieet Cased toKl.QD_,_42~feet
8tati(; water level (~6.4 tt. (~1~'ta ~b*low) land surface, Finish of well (cheek one)
Screen ( ); Pe~orated
Deserlb~ ~eteen or perfo~tion~
Well pumping test at._~,~
of drawdown from static
g~o~nd s~rface
0 ...... TO.,2
2 TO.....4
4 20
~o
~f¢ormations penetrated,
open end ( X );
(minute) for-._'4'.. ..... hour~ witb..=-qO0_~_ ...... tt,
~z'~,'/¢' ~¢/.,f.~¢ ,/
size of material, color and hardness
RECEIVED
JUN 9 1997
Municipality of AnChorage
Oept Hea ~ & H m~n c~a~ "~ -
· ,,,,,I.t~ ..... ~",~as
35 .TO. 93
93 TO 120
LENSES~
,?.? To. ~'/0
*~0 ..... ~o_~°
A/&: DARK. GI'~Y.WIr2H; ICcI!T~
A/A: SOFTER, I~INE'GRAIIqED
'~ aO T0_.,250.__
250~ .... TO.
275
275 .TO_ 380
380 ~TO._.~!.20
, ,,2'0 ....
A/At WITH VERY RED, GREEN & WHITE LENSES
A/A: WITH G~N & W]~ITE L~JNSBS
A/A: WITH WHITE LENSES
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW970008
DESIGN ENGINEER:STEVEN R. PANNONE
OWNER NAME:CHEWNING JOHN R
OWNER ADDRESS:il061 HIDEAWAY LAKE DR
ANCHORAGE, ALASKA 99516
DATE ISSUED: 1/14/97
EXPIRATION DATE: 1/14/98
PARCEL ID:01547118
LEGAL DESCRIPTION:
HIDEAWAY LAKE BLK
2 LT '7
LOT SIZE: 67433 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18A3~C72) AND DRINKING WATER REGULATIONS (18AAC80).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: . '-'?)[t'~~? ......... DATE:
ISSUED BY:
Steven R. Pannone, P.E.
Consulting Engineer
(?07) 272-8218
December 30, 1996
P.O. Box 142025
Anchorage, Alaska, 99514
(907)272-8218 Fax
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Lot 7, Block 2 Hideaway Lake Subdivision
Well and Septic Permit
Gentlemen:
My firm was contacted to investigate the possibility of installing of a new system at the above referenced
property. Currently the lot is undeveloped. A single test holes was excavated on September 18, 1996. The
soil report and percolation test results are attached. Ground water was monitored to be two inches above the
bottom of the test hole, or seventeen feet, ten inches below the top of the test hole.
The lot is approximately 1.54 acres in size. It slopes to the northwest at a rate of approximately three to five
percent. The proposed installation will be located greater than 100 feet away from the proposed well serving
this property and 25 feet from the water service lines. The surrounding systems are located greater than 100
feet from the proposed installation, the lots to the south and west are undeveloped. The neighboring wells,
across Hideaway Lake Drive and Circle, are located greater than 200 feet from the proposed system. See
attached design.
If you have any questions about the proposed installation, please contact me at 272-8218
Sincerely,
Steven R. Pannone, P.E.
Attachments:
C:\WORK\7-2HWYL.001
Cfi-8149 ~ '.
]]ESIGN
WASTEWATER ABSORPTION SYSTEM
LOT 7, BLOCK 2 HIDEAWAY LAKE SUBD,
Well Is Loc~ed
on northern
portion o?
WeLL Is toc~ed
on northern
portion o¢ Io~
Exls~ln8 Septic
Existing Septic
PROPOSE9
SYSTEM
NEW 1~50
SEPTIC TANK
REPLACEMENT SYSTEM
LOT ~
UNI]EVELDPEI)
LOT 6
' UNDEVELOPED .
Wet[ Is Ioc~ed
portion of Lo~
Exlstlng Septic
Lo~s ~re undeveloped,
There ~re no wells or
septic systeMS w~hln
800' o? proposed
well or sep~lc system,
C,\Work\7-2HWYL,~wg
Soil Rating = 188 s?/br
4 Bedroom House
750 s? Rqd
Deslgn,z~' E¢¢ectlve
'~W' To~l :Depth
~Y Wide, ~5' Long
To~l ~bsorp~lon = ~ s~
PREPARED FDR~
Mr, Dunbar
PANNDNE ENG, SVC
P, 0, BOX 142025
ANCHORAGE, ALASKA 99514
274.-0308, 272-8218 F~x
~ATE, 18-88-96 ~ DESIGN
/
DESIGN DETAILS
WASTE~/ATER ABSDRPTIDN SYSTEM
LBT 1, HIGGINS ESTATES
C,\WorE\I-HIGNS,dwi~
PREPARED FOR~
lnONv390
lfl[lN¥3'13
O
U
r-
W
lflDN¥390
lnON¥313
1~0N¥3~
iflON¥390
NOIIV~NflD~
PANNONE ENG, SVC,
P, O, ])OX 142025
ANCHORAGE, ALASKA 99514
I 27L'°3°8, 272-821~
II]ATE 12-28-96
-~=fi ~ DESIGN
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
6
7
8
9
10
11
12
13-
14-
15-
16-
17-
18-
19-
~DEPTH
'-~Acl~ ~rC-C
20-
COMMENTS
(ENGiNEER's SEAL)
DATE PER FO R ~'~'D:' II '~'~''' ~' (~,.--C~ ~'
Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? -~ p
E
Depth to Water After
Monitoring? I ~ "' ,"~'"' Dote:
I
Gross · x' Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
(m~nulest~nch) PERC HOLE DIAMETER
__ FT AND 7~2 FT
PERFORMED BY: '"~' ~---' ~:;~/~ N'P~/~4 ~-. 4 ~'~"~- C~FY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~-- '/~-~-~'~
72-008 (Rev. 4/85)
0
50 I Ii $
PROJECT Hidden Lake Subd.
CLIENT Bob Sparks
W.O. 77897
TEST HOLE NO. ll
ELEV. TOP OF HOLE 8'7' c) ~
DATE 11/29/77
SHEET ll OF 15
Peat, PT
'Organic, sandy silt, OL
Damp; brownish grey silt, ML
Damp, brown, silty sand, SM
Grab sample -.
Water table
Wet, sandy silt, ML
Bottom of Hole
NOTE:
1. Ground water table at 13.0'
2. Estimated perculation rate ~ 15 min/inch.
15
16
17
18
19
2O
Mr. Bob Sparks
December 5, 1977
Page Two
SITE AND SOIL CONDITIONS
The site is a 990 foot square parcel with an additional 330 foot square parcel
in the southeast corner. Hideaway Lake occupies approximately 5.6 acres of
the northwesterly portion of the site as determined by the lake line meanders.
Drainage enters the lake along the southerly shore line through the proposed
Lot 2, Block 1. Site topography is very irregular, especially 'in the northerly
half. However, general drainage is toward the lake at an average 12% to 15%
slope. There'are no areas within the parcel which slopes in excess of 25%.
The site is primarily underlaying by sands and gravels to the depths explored
(16'). The granular material is well bedded and well graded, with fines
ranging from little or none up to approximately 15%. The surface of the site
is blanketed by an organic mat of forest duff or peat ranging in depth from 6
inches to 24 inches. Underlying the organic mat is a layer of fine organic
sandy silt or silty sand (top soil) ranging in depth of up to 3 feet..A ver~
dense sandy .~velly silt layer located a~prosimatel~ 12_~.f t
~~n~e~easterly corner o~ s~te. Apparently this
dense stata prevent~ further penetration of the surface infiltration. There-
fore, free water was encountered at the time of drilling in test holes 10
through 15 at the interface between the relatively loose surface materials and
this dehse strata.
Based on the observed field perculation rates, visual test hole logs and
laboratory test data, on-site sanitary waste disposal systems appear feasible:
Minimum perculation rates for the proposed lots are estimated as follows:
Block 1, Lot 1 - 2 min/inch ~lock 2,~Lo_~_l -~.2 min/inch (measured)
Lot 2 - 2 min/inch~(measured) Lot 2 - 8 ~ min~7~-~-~---
Lot 3 - 6 min/inch~-
Lot 3 - 15 .min/inch
Lot 4 - 2 min/inch Lot 4 -q5 min/inch (measured)
Lot 5 - 6 min/inch Lot 5 ~"lS~'-min/inch
Lot 6 - 6.3 min/inch (measured) Lot 6 ~ 15 min/inch
Lot 7 - 2 min/inch ~ _Lot 7 - 15 m~/inch
We hope this is sufficient for your present needs. If we Can offer further
clarifications, please do not hesitate to contact me.
Attachments
EDK/clr
Very truly yours,
Earl D. Korynta, P.E.
CONSULTING 3INEERS AND SURVEYORS
2515 A ST., 99503 (907) 276-4245
' ~NCHORAGE
December 5, 1977
Mr. Bob Sparks
835 "D" Street, Suite 401
Anchorage, Alaska 99501
Re: Proposed Hideaway Lake Subdivision
Sursurface Soil Investigation
Dear Mr. Sparks:
This report presents the results of our soils investigation for the proposed
subdivision of an approximate 25 acre tract located East of Hideaway Lake and
south of Upper O'Malley Road. The investigation was conducted on November 28
to December l, 1977. The results of that investigation are included in this
report as follows:
Vicinity Map
Test Hole Lodation Sketch
Test Hole Logs (Sheets 1 through 15)
Summary of Laboratory Test Data
Standard Explanatory Information
Drilling was accomplished utilizing a mobile drill B-50 mounted on a flex
track Nodwel vehicle, owned and operated by Denali Drilling, Inc. The test
holes were logged and perculation'tests conducted by our firm. Har~ing-Lawson
& Associates performed the laboratory test data on grab samples taken during
the drilling operation.
The purpose of the investigation was to provide sufficient soils data for
establishing the feasibility of on-site disposal of sanitary waste using
seepage pits. To 'accomplish this', we drilled 15 borings'distributed across
the site as shown on the test hole location sketch. The'borings were located
one on each lot at the most probable location of a future septic system.
During the drilling, our engineer was present to log the materials encountered
and to obtain grab samples of the so~l types. All soils were ~'isually classi-
fied in the field in accordance with the unified soil classification system as
described herein. The grab samples were brought back to the laboratory for
further analysis and verification of the field logs. .
In addition to the soil sampling, several perculation tests were Conducted.
Based on visual classification of the soil types during the logging of the
test holes, the areas with probable higher perculation rates were identified.
One or more perculation tests were then conducted in each of these areas.
GORDON D. UNWIN, P.E.
LEO SCHEBEN, JR.,PE.,L.S.
EARL D, KORYNTA~ P.E.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmere 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. olS-' -fl- i¢ COSA#
~, """ -, Expiration Date: / - /
GENE~L INFORMATION
Complete legal:description::,
Location (site address)
Current Property owner(s).
Mailing address
Lending agency
Mailing address
Real Estate Agent
Day phone
Day phone
Day phone /Zclq- ~00
Mailing Address
Un/ess otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: ~
TYPE OF.WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class. Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
I
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 sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for 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. 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.
Address 'l.o3 ~O, t5"tk Ave
Engineer's Printed Name
AY,, ~flSoi .
5. DSD SIGNATURE
\/ Approved for
Disapproved..-
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
.>4
Original Certificate Date: / ~- / J~- / j
(Rev, 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650 '
www. muni.org/onsite
(907) 343~7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ~,O~ AwA,/ LA,C= [~iK l. LOT 3r Parcel ID:
A. WELL DATA
Well type ~r{V~T'~ If A, B, or'C provide PWSID
. J
Date ~mpleted ~/~/0~ Sanita~ seal (WN)
Total depth ~ ff. Cas~ to ~Z ff.
FROM WELL LOG
Statia water level
Well predu~ion ,,, 5 9.P.m.
o,5- I:~1-19
7
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground).
AT INSPECTION
5~/ ft.
"~, ~.- g.p.m.
-1- I~, in.
WATER SAMPLE RESULTS:
Coliform ~/~o- colonies/100 mL Nitrate 5,q~[ mg/L
Arsenic:
Collected by: L~ .~.,'~s, 4
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material A~c~o(QI~. "FA~k ] $ ~e¢~
Tank size J~ :gal. Number of Compartments ~..
Foundation cleanout (Y/N)'." ~/
Date.of pumping' ;~lll '
C, ABSORPTION FIELD DATA
Date installed 5]l::JrJq~r Soil rating (~orft2/bdrm) 0,~
Length ~q, 5 ft.... Width 5,O ff.
Total depth [~,~. ft. Eft. absorption area 3~Zocft2 Monitoring tube
Date of adequacy test. z~/~O/il Results (Pass/Fail) ~t55
Fluid depth in absorption field before test I~ in.
Elapsed Time: I~0 min. Final fluid depth ~9
Any rejuvenation treatment (past 12 mo.) (WN & type)
Date installed 5117/
Cleanouts (Y/N)
Depression over tank (Y/N) /V
Pumper
High water alarm (Y/N) /V'
System type Sl~,[lo~o
Gravel below pipe z~,~ ft.
~ Depression over field /V'
Water added Gl0 gal.
in. Absorption rate >=
jV'o~l¢ ~vl0'~n If yes, give date
For L/ bedrooms
New depth I~ in,
g.p.d.
D. LIFT STATION
:E.
Date installed
"Pump on" I~
Datum
SEPARATION DISTANCES
Size in gallons ,..-' Manhole/Access (Y/N) ,..--
"Pump off" level a, ,. ,,,. High water alarm level at in.
· /-
Cycles tested./ ' Meets alarm & circuit re...~nts? '
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ~00'-~
Absorption field on lot
Public sewer main
Sewer/septic service line
Animal containment areas
'3.5
On adjacent lots
On adjacent lots I
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
Water main /VIA, Water service line l0 ~- Surface water
Wells on adjacent lots J 00' +
SEPARATION DISTANCE FROM ABSORPTION FIELD ON .LOT TO:
Property line ~O ~+
Water Service line 10 ~+
Curtain drain 50'-~ CN,0,'~
~F: COMMENTS
Building foundation Jo~ ~-
Surface water 10O'4 ('A/,O,~
Wells on adjacent lots ~00'-I-
· Water main
Driveway, parking/vehicle storage
,
G. ENGINEER S CERTIFICATION
I ce~i~ that I have dete~ined through field inspection
~nrorman~ with MOA COSA guidelines in effect on this date.
. n -.
Engineer's Print~ Name L~ ~'PU~
' ' 't ".
__ ~ ~O~S~ ~ '
COSA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 4/10)
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 111357
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 7 of
Hideaway Lake subdivision. This inspection revealed a nitrate concentration
of 5.49 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
1114916001
Spurkland Engineering
Hideaway Lake B2L7
Hideaway Lake B2L7
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
10/13/2011 15:15
10/06/2011 11:00
10/06/2011 13:35
Stel~hen C. Ede
Samole Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00 ugFL EP200.8 C (<10)
10/10/11 10/12/11 NRB
Waters Department
Total Nitrate/Nitrite-N
0.310 0.100 mg/L SM204500NO3-F B (<10) 10/10/11 AYC
Microbiolo~ Laboratory
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 10/06/11 DLC
Negative 1 100mL SM20 9223B A 10/06/11 DLC
30' RIGHT QF WAY
~ASEMENT
N 89 59' 24~ W 113.96
.................. L°'_ ?_~!_~_~_s_~5%~- ............. -~~,
,~WELL
ENE FITZGERALD @
UDENTIAL REAL ESTATE
30' RIGHT OF WAY EASEMENT
HIDEAWAY LAKE
CIRCLE
N 89 53' I8"W 165.11
AS-BUILT SURVEY
NO CORNERS SET THIS DATE
! HEREBY CERTIFY 3~HAT I HAVE PERFORMED A SURVEY
OF ll~E FOLLOWING DESCRIBED PROPERTY
LOT 6 ~ BLOCK 2~ HID~A~Y LAKE SUB.
SGS Ref.# 1113937001
Client Name Spurkland Engineering Printed Date/Time 08/25/2011 11:30
Project Name/# Hideaway Lake B2 L7 Collected Date/Time 08/19/2011 13:05
Client Sample ID Hideaway Lake B2 L7 Received Date/Time 08/19/2011 13:35
Matrix Drinking Water Technical Director Stei~hen C. Ede
Saml31e 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 (<10) 08/21/11 08/22/11 NRB
Waters Department
Total Nitrate/Ni~xite-N
5.49 0.100 mg/L SM20 4500NO3-F B (<I0) 08/24/11 AYC
Microbiology Laboratory
E. Coli
Total Coliform
Negative 1 100mL SM20 9223B A 08/19/11 DLC
Neeative 1 100mL SM20 9223B A 08/19/11 DLC
~ '~m'"!t#~n~!ll!l !!lll!l:lUlllllllll Ii111 Itll!lllllllllllllHI llllil fill III
~t./ WELL EASEMENT AND ~ENANCE AG~EMENT
HIS AGREE~T, .m~::an. entered into this 6th day of May, 2011, bY ~LIAM
J. DUNB~ and JACr~ Li :~BAR, husband: and ~fei Grantor and Gr~tee, whose
~ 99515, for :~emsdyeS and their heir, assigns,
and successors in interest, lh~r~inffier ~ferredto as ',Dunbars~" ~
WITNESSETH:
WHEREAS, Dunbars are the owners of two parcels, of real property more
particularly described as follows:
Lots 6 and 7, Block 2, Hideaway .~e Subdivision, according tothe official plat thereof
filed under Plat No. 78:~i11, in the records of the ~¢ho~e RecOrding District, Third
Judi¢ialDiS~ct, State of AlaSka;
and
WHEREAS, a water .well. is::.~located upon Lot 6 which supplies: water to Lot 7; and
WH:E~A$, it is ..the.. desire .of'Dunbars to memofiali:ze an ~ement over and across
Lot 6 for the purpose of!:~aimainiag.and repairing the water Well lOCated thereon.
NOW, THEREFOr, for and in consideration of the.mutual coYenants and
condiflons:.recited herein~i'~e;~ies do hereby agree as follows:
1. That a water wcllexists on Lot 6 that provides a supply of water to Lot 7.
2. Dunbars desire.to establish an easement over and: across Lot 6 for the benefit of
Lot 7 with regard to thc Water Well:0n Lot 6. Said. easement:Is:desCribed as follows:
A strip of land 10' ~de~of which the cemeflino is moro:!~ieularly described as follows:
commencing at the n0~t'::cOmer of'Lot 6, Block 2, Hideaway L~e Sub. ~lat 78-111,
Anchorage Recording: Dt~e0;.:.~ee N 86°59'24'' W 33;:5:' and:along the North line of
said Lot 6t° the point/ Of begi~ing; thence S 37°10'00'' E 97;0' ~:a point and:the end of
said 10' wide strip ofl~d:
Water Well Agreement, Page I of 2
4. D~bars grant the'fi~tofingtess aM egress over and: across Lot 6 tothe owners
of Lot 7 to insl~ct, m~ei.:~ii: an~ such other actions ~ a~.::~easonably n~essary to
assure that: the water ell:'is:prop~fiy mamtameA.
5. Sis Agreementshall ~ with the property desefibedherein and shallbe binding
upon and ~all accrue to ::the t~n~fi't of the 'Owners, their heirs, s%eessors and: ~signs of
Lot 7.
IN WITNESS WHE~OF,.~e pa.,lies have hereto set.their hands and seals.
STATE OF ALASKA )
THIRD JUDICIAL DISTRICT )
~e :foregoing ins~ent,:W~:.aeknowledged before me: this 6t~ day of May, 2011, by
wmt. 6 SAR, d mE'L, D AR.
My Co~iSSi°n expi.~ :~:S Z~; ~o~ar:V:
Plebe record in ~chomge.Recording ,. -e,~ -,,..- ..-. ~
Willi'mm & Jackie D~b~
9622 VictofRo~
~chomge AK 99515
Water Well Agreement, Page 2 of 2
201:~21100.0
M-W Drilling, nc.
eP.O. Box l10378~Anchorage, AK 99§11e
e907-34§-4000 · 907-34§-3287 Fax,
Job No. 07-146
GROUNDWATER WEL,L AS~BUILT & LOG
Well Owner: Bill Dunbar Use of Well: Domestic
Legal Description: Lot 6, Block 2, Hideaway Lake Subdivision: 11050 Hideaway Lake Circle
Anchorage, AK
CONSTRUCTION
Hole Depth: 98' Casing Size: 6" Cased To'. 72.36' Material: A 53 Steel
Drill Method: Air Rotary Wall: .025
Well Completion: Open end X Screen Perforated Perf. Method:
Perforation description: Perforations: 51"60' w/4 rows of :L"x 1/'8" Slots 5 ea/ft/row
Grout Notes: ( 3 ) Sack(s) of No. 8 BentOnite granules
Notes:
Disinfected: Yes Method: i gallon chloro~ / ~gallon bucket p~ured and recirculated
Well Development Method Air Surge
Notes:
Static water level (SWL) 51.4 below top of casing (TOC).
Well yield test at 5 gallons per minute (GPM) for 48 hour(s) with 30'
Method: Submersible'
Start Date: 09/17/07 Completion Date: 09/19/07
Pump Install Date: 09/21/07
of drawdown (DD) from static level(SWL).
WELL LOG
Depth in feet from
Details of formations penetrated, size of material, color and miscellaneous details.
top of casing.
0 TO 3 Casing StiCk Up
3 TO 13 .......(~-a-~-k~s
To ........2'0 Sand: Damp w/Grave--f----
20 TO 44 Clay: Greyish Brown, DamP
44 ~'TO 46'"' "':Boulder
46 TO 49 Clay & Gravel
49 TO 51 Gravel: Mucky
5'i TO 60.... ' Gravel: Medium;Sandy; Waterbearing
61 TO 72 Gravel: Small, Sandy/Silty
TO
TO
To
TO .
TO President, M-W Drilling, Inc,
TO NGWA Cer~ad Mast~
.......................... Con~~ No.
Susan K. Crosson IM~in File No. 00057941 Page #21
Uniform Residential Appraisal Report File//0005794
The purpose of this summary appraisal report is to provide the lender/client with an accurate, and adequately ,supported, opinion of the market value of the subject property.
~Address 11050 Hideaway Lake Circle City Anchoraqe State AK Zip Code 99516
Borrower Louis & Babette Miller Owner of Public Record William & Jackie Dunbar County Anchorage
Lots 6 & 7, Block 2, Hideaway Lake
Assessor's Parcel # 015-471-18-000 and 015-471-17-000
Tax Year 2010
R.E. Taxes $ 15,563.70
Hillside Map Reference Grid 2640 Census Tract 0028.21
3ant [] Owner [] Tenant [] Vacant Special Assessments $ 0 [] PUD HOA $ [] per year [] per month
[] Fee Simple [] Leasehold [] Other (describe)
~e [] Purchase Transaction [] Refinance Transaction [] Other (describe)
Lender/Client Wells Fargo Bank, N.A. - 0036951 Address Anchoraqe, AK 99503
offered for sale or has it been offered for sale in the twelve months prior to the effective date of this appraisal?
data source(s) used, offering price(s), and date(s). Alaska Multiple Listing Service; Listed 11/04/2010 for $850,000
[]Yes []No
[] did [] did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not
The subject's earnest money contract was reviewed with no atypical factors noted.
Contract Price $ 850,000 Date of Contract 02/27/2011 Is the property seller the owner of public record? [] Yes [] No Data Source(s) Municipal Records
Is there any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the borrower? [] Yes [] No
)ort the total dollar amount and describe the items to be paid. Not Applicable
Note: Race and the racial composition of the neighborhood are not appraisal factors.
Neighborhood Characteristics I One-Unit Housing Trends
Location [] Urban [] Suburban [] Rural I Property Values [] Increasing [] Stable [] Declining
Built-Up [] Over 75% [] 25-75% 'l--I Under 25% ] Demand/Supply [] Shortage [] In Balance [] Over Supply
Growth [] Rapid [] Stable [] Slow Marketing nme [] Under 3 rnths [] 3-6 mths [] Over 6 rnths
hborhood Boundaries Neighborhood boundaries consist of Abbott Road to the north, the Seward
the west ach State Park to the east and Turnagain Ann to the south.
iption
One-Unit Housing I Present Land Use%
PRICE AGE One-Unit 85 %
$ (000). (yrs) 2-4 Unit 1%
200 Low 0 Multi-Family 0 %
2,200 High 60 Commercial 1%
450 Pred. 25 Other 13%
This is an established residential neighborhood located about nine miles southeast of downtown Anchorage. Neighborhood
construction of; 3eal. Schools, shopping and employment centers are located
within a a 15-20 minute drive. There are no adverse influences in proximity which would diminish the marketability or appeal of the subject property.
Market Conditions (including support for the above conclusions) After four years of increasing property values (2001-2005), prices decreased somewhat
the last half of 2006 and early 2007. Since then, values have stabilized in most sectors of the market. Average marketing times increased
in 2010 for in the subject's price rankle (as compared to 2009). Sales concessions ara prevalent in lower price ranges.
Dimensions See Attached As-Built Surveys Area 119,913 Sq. Ft. Shape Irregular View Averaqe
Zoning Classification R-6 Zoning Description Large Lot Single Family Residential Use District
[] Legal [] Legal Nonconforming (Grandfathered Use) [] No Zoning [] Illegal (describe)
nest and best use of subject property as improved (or as proposed per plans and specifications) the present use? [] Yes [] No If No, describe
Utilities PublicOther (describe) Public Other (describe) off-site Improvements- Type Public Private
[] [] Water [] [] Private well Street Asphalt [] []
Gas [] [] Sanitary Sewer [] [] Private septic Alley None [] []
FEMA Map # 020005 0360 B
Flood Hazard Ama [] Yes [] No FEMA Flood Zone C
Are the utilities and off-site improvements typical for the market area? [] Yes
FEMA Map Date 9/18/87
[] No If No, descdbe
adverse site conditions or external factors (easements, encroachments, environmental conditions, land uses, etc.)? [] Yes [] No If Yes, describe
oct site consists of two adjoining lots. The improvements are located one one lot, while the operational well is located on the adjoining lot
additional well that is not being used is located on the same lot as the home). Note also that the adjoining lot is not particularly functional by itself
because it is encumbered with a utility easement, a right-of-way easement and a creek maintenance easement.
General Description
Units [] One [] One with Accessory Unit
# of Stories 2
[] Dot. [] Att. [] S-Det./End Unit
[] Under Const
2
Year Built 1997
Effective Age (Yrs) 14 Years
Attic [] None
Stair [] Stairs
Floor [] Scut'de
[] Finished [] Heated
[] Refrigerator [] Range/Oven
i Finished area above grade contains:
Foundation
Concrete Slab [] Crawl Space
Full Basement [] Partial Basement
Basement Area sq.ft.
Basement Finish %
-~ Outside Entry/Exit [] Sump Pump
Evidence of [] Infestation
'-] Dampness [] Settlement
Heating [] FWA I[~ HWBB ][~] Radiant
~ Other IFuel Gas
Cooling [] Central Air Conditioning
~ Individual I[] Other None
Exterior Description materials/condition
Foundation Walls Concrete/Avg
Exterior Walls Wood Frame/Avq
Roof Surface Asphalt Shingle/Avg
Gutters & Downspouts Aluminum/Avg
Window Type Vinyl Casemnt/Avg
Storm Sash/Insulated Insulated Glass/Avg
Screens
AmeniUes
[] Fireplace(s) #
[] Patio/Deck [] Porch
[] Pool [] Other
Metal Mesh/Av~
I--IWoodstove(s)#
1 [] Fence
Interior materials/condition
Floors CrptWoodVinyl/Avg
Walls ShtrckWdSlate/Avq
Trim/Finish Wood/Avq
Bath Floor VinylCarprtWd/Av.q
Bath Wainscot TileFiberglass/Avg
Car Storage [] None
[] Ddveway # of Cars 4-5
Driveway Sudace Asphalt
[] Garage # of Cars 3
[] Carport # of Cars
~ Att. [] Dot. [] Built-in
[] Dishwasher [] Disposal [] Microwave [] Washer/D~er [] Other (describe) Double ovens
8 Rooms 4 Bedrooms 4 Bath(s) 6,179 Square Feet of Gross Living Area Above Grade
(special energy efficient items, etc.), covered entry, decking, extra paving, fireplace, garage door openers, vaulted/tall/open ceilings, wet
.extensive wood flooring, wood wainscotting, slate accents, wet bar, built shelving/cabinets, walk-in closets, Indry sink/cabs, granite cnters, etc.
Describe the condition of the deterioration, renovations, remodeling, etc.). The subject is existing construction of above
Overall cosmetic condition is also good. The subject has an atypical floor plan. The family room is very large. Because it is
located in the center of the home and has no exterior walls, it has no windows. Functional obsolescence exists because of this factor (and is
reflected in the appraisal). The utilities were on and operational at the time of inspection.
deficiencies or adverse conditions that affect the livability, soundness, or structural integrity of the property? [] Yes [] No If Yes, describe
A home inspection report was not provided for review. The appraiser is not qualified as a buildinq/home inspector. It is therefore assumed that there
deficiencies or adverse conditions that affect the livability, soundness, or structural integrity of the property.
conform to the neiqhborhood (functional utility, style, condition, use, construction, etc.)? [] Yes [] No If No, describe
Freddie Mac Form 70 Mamh 2005
Page 1 of 6
Fannie Mae Form 1004 March 2005
Form 1004- "WinTOTAL" appraisal software by a la mode, inc.- 1-800-ALAMODE
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
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
RECEIVED
dUL 2 0 199'/
Municipality of A,,cnorage
Dept. Health & Human Services
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
· Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
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.
72-025 (ROY. 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER.
Asicertified 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 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 on the date of this inspection.
Name of Firm
Address ~--~-~
EngineeYs signatu~
Date
DHHS SIGNATURE
V/ Approved for
Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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 DH HS 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 engineer's work.
72-025 (Rev. 1/91) Back MOA f¢21
MUNICIPALITY OF ANCHOI~GE
~ ENVIRONMENTAL SERVICE$,/I~'J~J~ON
unicipality of Anchorage /~.~
DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 24
Environmental Services Division
825 L Street, Room 502. Anchorage, Alaska 99501. (907) 343-~7~.~C E i V E D
Legal Description:
A. WFLL DATA
Well type ¢~vA"~¢
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Health Authority Approval Checklist
Parcel I.D.:
Date of test
Static water level
Well production ¢ · ~-
WATER SAMPLE RESULTS:
Coliform ~ c~ -- Nitrate
B, SEPTIC/HOLDING TANK DATA
Date installed ~'/# / c~ ~ Tank size
Foundation cleanout (Y/N) h~'
Date of Pumping /IJ¢.~c) Pumper
C. ABSORPTION FIELD DATA
Date installed ,~/l'~-/q,'~-
Length ~-L~ ,~- _.Width
IfA, B, or C, attach ADEC letter. ADEC water system number
Date completed 3/Iq! ~ ~'
Cased to /C~, ~ Casing height (above ground)
't~ Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
("~' ~ )
g.p,m, l
¢ · t Other bacteria
Collected by:
J'~-'~ Number of Compadments ~._ Cleanouts (Y/N)___
Depression (Y/N) ./b/ High water alarm (Y/N) ~
Effective absorption area ~"~.~ Monitoring Tube present (Y/N).
Date of adequacy test ~'~ ~---t.z.~ Results (Pass/Fail)
Fluid depth in absorption field before test (in.); '~ -
Fluid depth (ins) Minutes later:
Soil rating (g.p.d./ft~ or fF/bdrm) O,. ~ _ System type ~--L,-~t%~
Gravel thickness below pipe ~'f. ~- _ Total depth '-;~-"~
bedrooms
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
If yes, give date
__ Depression over field (Y/N)
For ~'
Immediately after ~ gal. water added (in,):
Absorption rate = ~ .g.p.d.
D. LIFT STATION
Date installed /'/' Size in gallons
~~ "Pump off" level at*
Manhole/Access
(Y/N)
High wa~ 'l -*Datum
~ted
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
/
Public sewer main
Sewer/septic service line
On adjacent lots ~/¢-.PC.~ 4--
On adjacent lots ! C2O~
Public sewer manhole/cleanout ~4~
..-r--
Lift station / ~ c~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ¢ ~.-f ~ Property line c~'O ¢ Absorption field
Water main/service line ~-,,~ r Surface water/drainage /C'¢'~ Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation r~ ;3' ¢ Water main/service line
Driveway, parking/vehicle storage area
Wells on adjacent lots / ¢' c2'r-
Property line
Surface water
Curtain drain
EN~!NEER'S CERTIFICATION
'y that I have determined thru field inspections and review of
...... ¢'fformance with MOA HAA guidelines in effect on this date.
Signaturo.~~
Engineer's Name .._c~'-c--~.-----------------~j ~(¢~,¢ ~ ,E~¢~,/o,,~c¢,~ ~A, ¢.
Date (~ / =~/~'~
HAA Fee $
Date Payment
Receipt Number
72-026 (Rev, 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. H~'~¢Lr~lc~r}
During a recent Health Authority Approval on-site inspection
and o~-
te~,_ ef the potable water supply well on Let ~
Block ~____ of ~i~_~ ~ Subdivision, the well's
productivity was determined to be ~.$ gallons per minute.
The minimum well productivity required by this Department
(~MC ].5 ~ ~-'-' _
~o~ for a ~__ bedroom residence is ~. ~ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies Of the subject
Health Authority Approval.
tJCT&E Environmental Serv!ces Ina.
CT&IS Ref.# 973953001
Client Name P~tmong ERg Sty,
Project Name/# N/A
Client ~ample ~ Press~e Ta~
~trlx Dfi~ng Water
Orde~fl By
PWS~
Sample Renu~rks:
Client PO//
Printed Date/Time 07/25/97 08:22
Collected Date/Time 07/20/97 16:15
Received Date/Time 07/21/97 13:00
Technical Dir~cto[': Stephen C, Ede
P~rameter Results P~L gni~
Nitrate-N O.lO0 U 0.100 mg/L
Total Col(~orm TNTC OB
Method
SM18 4500'N03~
$M18 9Z~B
Allowable Prep Analysis
Limits DBte Date Init
10 max 07/2~/97 JRJ
07/2t/97 TMW
CT&E Environmental Services Inc. ''-' r r ii
Laboratory Divisiotl ~~r~rj,~,~,~r~-arJ,~r~,~,~'~'~r~r~r~,~
Drinking Water Analysis Report for Total Coliform Bacteria 2oo w, Po.or Dr~vo
Anchorage. AK 99518-1605
RE.4D IA~'TRUCTIONS ON REVERSE SIDE BEFORE COLLECThYG SAMP£E Tel: {907) 562-2343
~ PRIVATE WATER SYSTEM
.~ J'endResults .-. D Senclltl),otce
SAMPLE DATE: ~
.Month
SAMPLE TYPE:
Routine
Repeat Sample (fol' rea, tine sample
with lab ref, no, _~~
)
U Special Purpose
S~M.PLE LOCATION
Day Year
Treated Water
D Uatreated Water
Time Collected
Collected By
Fax: (907) 5~1
TO BE COMPLETED BY ~ABORATORY
d~,al)'sis shows this Water SAMPLE to be:
Satishctory
o Unsatishctory
Sample over 30 hours old, results may
be unreliable
D Sample too long in transit; sample ~hould
not be over 48 hours old at exa:ninatior~ ..~ ........ ........
~o indicate reliable resulls: PI~ase send
new sample via special delivery mail,
Date Received =-it'/
*imeRece,ved l
Analytical Method: a~ Membrane Filter
D MMO-MUG
* Number of colonies/100 mi.
............ o. Result*
01 -'-~
S~'m to A,D,E,C. Anch l:'bk~
Dale: Till] {'
Analyst
Jun []
Fax~d
Client notified or tmsatJsfactmT results:
Phoned S!aoke with
[]
Faxed
Time:
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result; Total Coliform
ComnlenB:
Verification: LTB
f~cal Coliform Confirmation
BGB.,
Final .Membrnn* Filter Re{ults.
E. Colt _
Colonies/100 mi
COLIFIRM
Culirorm/l O0 mi
Time [ ~..-, :~;:t') hfs