HomeMy WebLinkAboutLAKE HILL ACRES #5 BLK 1 LT 5Lake Hill Acres #5 Block 1 Lot 5 #051-122-15 On -Site, Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161113 Tax Code Number: 05112215000 Work Type: Well Upgrade Permit Effective Dates: May 13, 2016 to May 13, 2017 Design Engineer: Subdivision: LAKE HILL ACRES #5 Site Legal Address: LAKE HILL ACRES #5 BLK 1 LT 5 G:1562 Owner/Address: O'HARE MICHAEL & VALERIE 22424 HILLTOP CIRCLE CHUGIAK AK 995675708 Site Mailing Address: 22424 HILLTOP CIR, Chugiak Lot Size in Sq Ft: 24518 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: THE FOLLOWING ITEMS ARE REQUIRED FOR FINAL OPERATIONAL APPROVAL: 1. WELL DRILLING LOG 2. WELL PUMP INSTALLATION LOG 3. WATER QUALITY: LABORATORY RESULTS FOR NITRATE, ARSENIC AND COLIFORM BACTERIA Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907 -343 - Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015 l - — Property owner(s) Mailing address Z' Site address C de- Day phone 91%-5 a Legal description (Sub'd., Block & Lot) la, Vie UM i—ye<- #s- Legal description (Township, Range & Section) Lot Size tSR' Sq. Ft. Number of Bedrooms APPLICATION IS FOR: (ID all that apply) Initial ❑ Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) Upgrade (w/wo ADU) Renewal ❑ Duplex (D). ❑ Multiple Dwellings ❑ (SF and/or D) INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certifv that this is in accordance with Permit/Rush Fees: l = Y Waiver Fees: Date of Payment: % Date of Payment: Receipt Number: 0d;; V g Receipt Number: Permit No. 0_510/� l (/-zs Waiver No. Permit App_9-1-12.doc 91 Ito 46 w� rES4 #0 It Ise pvapo(` �a,.a�•.a iDt� Nir' t p :d IUILT-NO CORNERS SET THIS DATE. BEWARD S ASSOCIAA'ES f,AND &DR48YTNG 4-0829 :RESY CERTIFY -THAT i HAVE SURVEYED THE- SCJ�LE' LOWING DESCRIBED PROPERTY, ��' • �+►'''�pF A rrs�--rrft'p�va:sC/. '• DATE; THAT NO F -NG A HIVIENTS EXIST EXCEPT•A9 r•�a�r�t� ,vhp.•' ;`fi CATER. 1T 1S THE•RESPONSIBILITY OF THE i*��'q Ty ' • p*� !ER TO DETERMINE THE •EXIST'ENCE OF ANY GRID', �•••••• ••••••�•; •it EMENTS, COVENANTS, OR R M"ICVDNS ;11 00 NOT APPEAR ON THE REDO 00 SMB . /` • ...... •••• .• ••••• • a.,. iu.h s....d : r ON PLAT. UNDER NO CIACUMSTANCE3SHOULD F& .s � •�,= 1 '•.� LS7e018 ; • � DATA HEREON BE USED FOR CONSTRUCTION t �f' .��• ......*'*' L NESLINE% OR FOR ESTABLISHINGBDUND- DRAWN: 141��+sskrm •; /'/J-%. /003. Municipality of Anchorage< Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page t of 3 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT D Permit Number: SVl O MO (O PID Number: 061— M2_— 1 E� Name: 1 L_i_� � �/ H Wastewater stem: ❑ New U WSystem: � P9rade Address : ALlfZLI 4 1LL 1 oP C-tyZ- ABSORPTION FIELD Phone: Number of Bedrooms: (L ❑ Deep Trench ❑ Shalbw Trench ❑ Bed ❑ Mound ❑ 0 r: LEGAL DESCRIPTION Soil Rating: Total Depth from original e: cpofFt' Fl. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel tleplh b in pipe: //"� ���� 1^HF L 5 -X Ft. FL Township: Range: Section: Fill added above original grade: Gr Length: F Ft. Well: ❑ New ❑ Upgrade Gravel width: Numberoflines: Distance between lines: Ft. Ft. Classification (Private, A, B, C): Total Depth: Casedio: Total absorption area: Pipe Material t�: C{ FL FL Ft' Driller ,�� Date Drilled: Static Water Level: Installer. Date Installed: tg FL Yield-G, Pump Set Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic JAolding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding PublictPrivatE Manufacturer. Capacity: From Tank Field Station Tank Sewer Line At`1(, Ho Qmit� r '1 AHV— Ljot6�al. Material: Number of Compartments: Well q"Tj' STt.k i I 1 Sudacewater 1 p5 LIFT STATION Size: Manufacturer Lot Line 3 Gal. 'Pumpon'levelah 'Pump off' level at: High water alarm at:Foundation in. in. in. Curtain Drain Pump MakeBModel Electrical Inspections rformed by: Remarks. BENCH MARK of 4"k e-T-us Location and Description: Assumed Elevation: I v-d Engineer's Stamp.; Inspections by: performed Dates: tai 2nd Development Services Department Approval Reviewed and approved by:< Date: (Rev_ I2/00) -- - , )/ell 875.00 \ 0 � I I / I I , I L _ � � I I r // _ 1000 GAL NOLORIG T M;27 R6U01� EXJSTJNG 0 1 SANK 1 SEP TANK MEN SPURKLAND No. CE -2225 t EN RK 1- ufT srATws RM PAIFL I INSr.. D 4000Al. NOLO/ TANK SWING TILS AC 1 0 FT 6' AfPoUY�T Q 1 DC 1 AD 14• ALARM ND fLOAT I 8D 39 � I 2A 50 75 100 125 150 CALF• 1' - 0 FT iuDarm aruiTALHnu r.c. 203 W 15TH. AVENUE ` LAKE HILL ACRES 5 LOT 5 SEPTIC SYSTEM AS BUILT ANCH. AK. 99501 22414 HILLTOP CIR DATE: OCT. 30, 2001 (907) 279-3916 CHUGMK SHEET. 2/3GR/D.NW1562 PERMIT # SV 010306 PID # 051-122-15 LH45005206/6 C: 97.28 iev } 3 FEET MIN. WA RAIN CAP 6' PUMP HIGH WATER ALARM MERCURY SWITCH FL LT II 17' STANDARD 4000 GAL, HOLDING TANK 7OF I....... ���j. ANCHORAGE TANK .... ..... NV SCALE 49th )BEN SPURKLAND No. CE -2225 1' X 10' CONDUIT I' GAL VANIZED LB, DIRECT BURIAL WIRE T� V ALARM PANEL �� I' PVC CON 75.5' BENCH MAW. CONCRETE STEP NEXT TO PORCH ASSUMED ELEV. 100.00 FT. ITOBBEN SPURKLAND P,E, I I LOT 5 LAKE HILL ACRES #56 I I SEPTIC SYSTEM AS BUILT I 6751 W. DIMOND BLVD. BILLY EVANS DATE pC1 30, 2001 r9n71HPAR Sn959502-3904 22424 HILLTOP CIRCLE SHEET 3/3 GRID NW1552 5 -/�� p).1 MUNICIPALITY OF ANCHORAGE r Development Services Department On -Site Wafer &Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO10306 :.`Bleb e1 LT'`' Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Billy Evans Owner Address: 22424 Hilltop Cir Chugiak , AK 99567-5708 Date Issued: Aug 09, 2001 Expiration Date: Aug 09, 2002 Parcel ID: 051-122-15 Site Address: 022424 HILLTOP CIR Lot Size: 24518 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank 0 Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. El Private Well El Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: �T W_ Date: 0//0/0( (/YAM Data: / Municipality of Anchorage �E a • Development Services Department Building Safety Division 4.-5.. On -Site Water and Wastewater Program s A E r. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anch orage. a k. us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SWC 0 0 Parcel I.D. 051 - I a 2 - 12 Property owner(s) Day phone b661— Mailing 7661— Mailing address (1) Aa q Mailing address Legal description (Lot, Block & Sub'd.) r Zip Code 1t -L AJ2k s bb� Legal description (Section, Township & Range) Lot Size L/ 5_/ I Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only 13Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: HTub ElJacuzzi EJot Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicaab e Municipal Codes. (Signature of property owner or authorized Permit Fees: Date of Payment: Waiver Fees: Date of Payment: Receipt Number: g 1�% Receipt Number: (Rev. 12/00) T.S PURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 LAKE HILL ACRES #5 VETERAN ADMINISTARTION /JUDY LAMB Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 Aug. 6, 2001 We are submitting an application for the replacement of an existing 2000 gal holding tank for this property. Municipal records show that the 2000 gal holding tank was installed in 1980 and that at that time a 1200 gal. septic tank and a lift station existed on the lot. A HAA inspection in 1994 reported that the septic tank and the lift station were too close to the swell and a waiver was requested and granted. Except for the separation deficiency the installation was proper. An inspection by on Tune 22, 2001 found that the two "lift stations" had been installed. These lift stations consisted oftwo 50 gal drums with sump pumps. The holding tank was found to be located in a utility easement and less than 95 feet from the shore of Mirror Lake. Both the "lift stations" and the holding tank are severely corroded. We request a permit to install a 4000 gal. holding tank as shown on the attached siteplan. The tank will be more than 100 feet from the high water mark of Mirror Lake and more than 75 feet away from the well serving this lot. Access for pumping is as shown on the site plan. Yours truly, lobbe Spurkland P.E. / I I / I / 2000 CAL HOLDING T �K't ' R£MOVf�Q'ISANG / O 2000pt HOLD1, UNK / f00D T SfP rANK 2- OF STA Well 0 /NSIT 4000 GA� HOLDING DANK 1 Y 875.00 \ ®O )1 I J 1 \ \ .. 49th \ 5 10 50�75 too 125 150 • Om'. TOEN ........... .....SPU ....... .RKLAND .........= I � \ No. CE -2225 :.•stiff lUetltN -NI'URKLANU Rt.SEPTIC SYSTEM DESIGN 203 W 15TH. AV£NU£ LAKE HILL ACRES 15 LOT 5 ANCH. AK. 99501 22424 HILLTOP CIR DATE: /om) 5170-TOIR CHUGIAK I I SHED..• 2/3 GRID: I PERMIT # SW 010XXX PID # 051-122-15 LHA500520WG I RAIN CAP b' PUMP , 3 FEET MIN. HIGH WATER ALARM�I MERCURY SWITCH FL AT 18' I' X 10' CONDUIT 1' GALVANIZED LB DIRECT BURIAL WIRE TO ALARM PANEL 1' PVC CON 75.5' rrrrrr--rrr.--r-- 17' STANDARD 4000 GAL, HOLDING TANK OF 4 ANCHORAGE TANK �}# NO SCALE t h `!� k SPURKLAND CE -2225 . BENCH MARK.• TOP OF GAS METER ASSUMED REV. 100.00 FT. ITOBBEN 6751 W. DIMOND AGN E II SYSTEM 41ILACRES #56 TaA A6�ANCH AK. 99523904 8II 2LSHEET3/3GRD2736 PID 051-122-15 LHA50053.DWG 72-013 kRev. ./7S 0 MUNICIPALITY OF ANCHORAGE " DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 11NEW �L` UPGRADE MAILINGADD ESS - LEGAL DESCR PTION LOCATIONOFBEDROOMS DISTANCE TO: Well Absorption area Dwelling PERMIT NO. VY wa2 Manufacturer C l �V Material No, of compartments nJ Liq. capacity in gallon IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well "L3 f 4- `f- Dwelling .., PE 2 ZH Manufacturer /' iJ-✓e e-✓ Matgiel � / cl Liquid capaFity��gV,ll s G C. DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. w= � w z z No. of lines Length of a I n Total length of lines Trench width Distance between Tines F- ¢ inches F. Top of rile to finish grade Material beneath tile Total effective absorption area inches Length Width Depth PERMIT NO. w i H LU Type of crib Crib di er Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J LU DISTANCE TO: d d do i� Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOILTEST RATING i V� INSTALLER REMARKS 3 It T e 71v L% rT Lk Ise - APPROVED ... DATE r.,LEGAL 72-013 kRev. ./7S r-1 U r-2 I C-_ I L I T •-e 01 F= R r•J C. Fi - t=� E_ DEPARTMENT JW KING EN'•iIROtIME1ITAL EC:TIlpj 825 L STREET, ANCHORAGE, AY,. ��_ J.264-4720 AK. 0 ►' 1=er4—° . I TE .Et4E=1:;.' F'E:F rM I T PERMFT NO. 800502 A APPLICANT RAY CHURCH .TAR ROUTE �LX 9030 99567 688--9280 LOCATION MIRROR LAKE LEGAL �? Y�, _6 LOT SIZE 26000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: GRAINFIELD // MAXIMUM NUMBER OF BEDROOMS = 3 .OIL RATING (SQ FTIBR}= - L� THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LaD 1:3};�g=lti,•EL_ Cat=t='TF-1= THE LENGTH DIMENdSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINIFIELD. THE DEPTH OF A TRENCH OR PIT I_. THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATIr_N CIN FEET?. r"F= TRE=r-.t0t-% 14 I E> —r" I 0. 12-4 la FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE E;CAVATIONI (INT FEET). ocAA a_ Leo FZEe_!C_1 I F:ECs - E T ; _-rnP4t< I 2!E_ ::210C3I 13F71Lt_e= r4S; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- Tt-•-lC1 •-_ f I "-7-F'Ee_,T 10rpt t=>!RE: RE'=!U I FR. EC-- --- BACKFILLING OF ANY SYSTEM WITHOUT FINIAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIIMUM DISTANCE BETWEEN A WELL AND ANY ON -_.ITE SEWAGE DISPOSAL 'SYSTEM IS 100 FEET FOR A PR:I'VATE WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEFENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANdC:E FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER: REQUIREMENTS MAY APPLY. SPECIFICATIONS AND C:ONISTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F I=- F? I T E:4 F' I RE'•, C}EC-EMI= ER -1 ::LS=fte" I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INISTALL THE _SYSTEM INT ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER 'SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: - APPLICANT ----------- RAY ---- CHURCH ------------------------QL 02C,'Mc. ISSUED By ------------------------------DATE V4. 0 fl1-i r-4 1 + 1 r"f" t 1 + Y . --- r- r-,+...._ . - _•• _�a•�c DEPARTMENT gIgHEALTH AND ENVIRONMENTAL � ITECTION 25 "JIF TPEET. ANCHORAGE, AE:. 37' 264-4720 i3 Em i •.A F fz:- F=• E- F' r(f•1 I T PERM,IT'NO. c nn c' of C �O qq , ? o�cliN ELl nano =PLICANT {{ �F GIS S©QI {oh MH RaY (MAU& - ( Kptop (A G KAI ION _ �. =GAL jj0- 5 j �p�iG ill QepdS J L, '=IEE (�!Cc0'.!!UHFE FEET ?PE OF SOIL ABSORPTION SYSTEM IS: KHO Gja v 4 Be( pa'-�- ' 1XIMUM NUMBER OF BEDROOMS. = 15 SOIL RATING •::SII FT/BRA= SY.ef 1E REQUIRED SIZE OF THE SOIL BSORPTION SYSTEM IS: smen a6da—P E.F=•TF-1—= C L_Er-4Ci-F I:iFOFA 'EL_ C•EEF'-T-H=_ THE LENGTH DIMENSION IS THE LENGTH CIN FEET? OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DI_MANCE BETWEEN THE 'SURFACE OF THE GROUND AND THE BOTTOM OF THE E:CAVATION CIN FEET?. THERE_ IS NO SET WIDTH FOR TRENCHES THE GRAVEL DEPTH I5 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET?. �_1 I F' E= r'• _ E--_ F' T I +� T N rJ F==; ti I _RMIT APPLICANT HAS THE RESPON_•IBILITY TO INFORM THIS DEPARTMENT DURINQ THE JSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS P'ROP'ERTY AND THE 1MBER OF RESIDENCES THAT THE WELL WILL SERVE. --- T-F•1ill __' > I r!=•F F +- ( I +�rJ_• h iF'�_ RE+-I1J I F:'f_-C'• -- — ocrFILLING OF ANY SYSTEM WITHOUT FINAL_ INSPECTION AND APPROVAL BY THIS !PARTMENT WILL BE SUBJECT TO PROSECUTION. NIM!IM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I 0 FEET FOR A PRIVATE WELL OR 15X_+ TO 200 FEET FROM A PUBLIC WELL DEPENDING ON THE TYPE OF PUBLIC WELL. NIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE 'SEWER LINE IS 25 FEET AND A COMMUNITY SEWER LINE IS T5 FEET. LL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS - THE WELL COMPLETION -HER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAM- AEE +AILABLE TO IPJSURE PROPER INSTALLATION. F=-F-F'F't I T E:=_:F' I F'E E_•E-+'; F=h1t=:UF=' CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE 'SEWER- AND WELLS AS =ET 1ETH BY THE MUNIC:IPALITY OF ANCHORAGE. I WILL INSTALL THE `_SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE -EWER SYSTEM MAY REIUIRE ENLARGEMENT IF THE SIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOM= AF'F' IC:AF7T --DATE-%-- M -W DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Ray Church Use of Well Dom Location (address of: Township, Range, Section, if known; or distance main road L5, Addtion 5, Lake Hills Subdiv., Mirror Lake Size of casing --6 Depth of Hole -27 --feet Cased to 56 feet Static water level 2 ft. (dlN55 (below) land surface. Finish of well (check one) open end ( X ) ; Screen ( ); Perforated ( ). Describe screen or perforation None Well pumping test at--13—gallons per (li2iffi� (minute) for 1 hours with 100% ft. of drawdown from static level. Date of completion 9 Auauat 1974 WELL LOG I Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 Tr) 2 2 TO 4 4 Tn 10 10 TO 20 20 TOS TO 6 TO- O TO- TO TO- TO TO- TO TO- TO Gravel Gravel Fill Surface Orzanics Gravel Silty Gravel Sandy Water Gravel 1 —CUSTOMER Municipality of Anchorage Department of Health and Human Services - 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor November 16, 1994 Mr. Robert W. Cowan S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 5, Block 1, Lake Hills Acres #5 Waiver Approval: # WR940061 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: Well to Tank Well to Lift Station 91 feet 96 feet This waiver approval applies to the existing septic system to well separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Since ly, Robert W. Robinson Civil Engineer On -Site Services kb ■ Lam s �LOfGG I / mus '�el�S / �r C✓ (J 414011 / Hl�ti,� 6 A�� �O c� 1 y a�%� G6i 7/0 S -G 7Z (itV�'f��/ `J �GQILp' ./-;, r'6_y/2f/y<ya r/.Y„f Cei a l j �r i c we— e, //ve 1 / < �'�7� %/u P O ✓rye n 1� // �t✓/d"�-.`/�?(, �e ��� /FJ�N�` _�A�'u✓�.w4t� (L/:� � ��:a r� � ODv�v �p7��t c�s'iv!<-J 17, r% tPa ✓� is / 7-z.e Pn sic �1 //tom r'l'< Bald 'r � � vy r Vi A//S��. C w P/1 // (riCYt7 4, *,7�1 Mmillcipality of Anchorage Department of Health and Human Services - 825 T" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor November 16, 1994 Mr. Robert W. Cowan S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 5, Block 1, Lake Hills Acres #5 Waiver Approval: # WR940061 Dear Mr. Cowan: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: Well to Tank Well to Lift Station 91 feet 96 feet This waiver approval applies to the existing septic system to well separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincely, Robert W. Robinson Civil Engineer On -Site Services kb • MUNICIPALITY OF ANCHORAO Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# 940061 PID# 051-122-15 HA# 940606 Permit # Date Received: 11-4-94 Legal Description: Lt 5, Blk 1, Lake Hills Acres #5 Engineer: S&S Engineering 17034 Eagle River Loop Road Eagle River, AK 99577 Applicant: Waiver Requested: Well to tank - 91 feet Well to lift Station - 96 feet Criteria: 1. Geology: Points: A. Water Table ,o B. Soil Sorption �- C. Permeability 3 .� D. Water Table Gradient o?' E. Horizontal Separation TOTAL: / -7, rJ 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: �_11 Date: By: of Rev Rec #: #00469 Amount: $ 625.00 Date Paid: 11-04-94 November 2, 1994 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTHAUTHORITY 825 L Street APPROVALS P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWER&WATER REFERENCE: Lot 5 Block 1 Lake Hill Acres Subdivision #5 MAIN EXTENSIONS Request you issue a Health Authority Approval on the SEWER &WATER referenced property and grant waivers for the following INSPECTION horizontal separation distances: 1. The distance between the &optic tank and the well serving this property at 91 ft. ENGINEERING STUDIES ANDREPORTS 2. The distance between the lift station and the well serving this property at 96 ft. We feel the waivers can be granted for the following reasons: WELLINSPECTION &FLOWTEST Since the septic tank does not normally allow effluent to reach the soils prior to reaching the absorption area, the probability of contaminating the soils at less than 100 ft. SITE PLANS to the well is mitigated by the septic tank. Nitrate levels were measured at 1.03 mg/l. Since septic effluent is very high in nitrates, these low levels detected suggest there has been no influence of the septic tank and ROAD DESIGN lift station on the well even after 20 years of septic system and well use. The house is located between the septic tank and well. This SOILTEST would alleviate any surface overflow from the septic tank from reaching the well. In our opinion, the separation distance requirement PERCOLATION prescribed by 18AAC.021 is not necessary in this case. TEST If we may be of further service please contact us. STRUCTURAL& S incer 1 , MECHANICAL INSPECTIONS Robert C. Cowan, P.E. ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 40' SITE PLAN SCALE a" m } p w I> a D G7 y r z r z \� D r S ox �O. D m Z C 3 O w vso m C [l7 N (i01� DNN O N n p s �Wn OHO c z�<izm o� nm-9m m NOA cZm �N oy> m O–r-1-1- O r4 Zgm�DNND C m K:O zC ! A Z U m� N r NNW Damm N 'x Ir AV Z m -C > N 0o miEz0 D r� Z D ;a O v i X Z O D;;o/ / \ mr*1-1Awmm ! NOm O:< O D i TQP—L_ _ /)� m O COO ii^ OJ \` -1 -Dia 0� xl oo� zz a o� z0 O- �y O zN r CD o = O xy Ul v O rh 0 0 n z �,' . .� a • '•s P zAn 1 }> O (gyp a ° ^T21 - • Municipality of Anchorage p' On -Site Water and Wastewater Program GE (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-122-15-000 1. GENERAL INFORMATION Expiration Date: / m AJ `B -r Complete legal description Lake Hill Acres #5 Block 1 Lot 5 Location (site address) 22424 Hilltop Cir Current Property owner(.) Jack & Donna Demoss Day phone 334-3000 Mailing address 22424 Hilltop Cir. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: UBMITTA F-1SingleFamily (w/wo ADU) S ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) OCT t1 2014 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well it Individual ❑ Individual Water Storage ❑ Holding Tank lX Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received bylX (A lDate: COSA to be re erased to the engineer, unless otherwise requested by the engineer. COSA Fee $ �2/% c Waiver Fee $ Date of Payment ` /�y �la ` Date of Payment Receipt Number ig l5 35 Receipt Number COSA#_ p�.l y I5(" I Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Alaska Rim Engineering, Inc. Address 9131 E Frontage Rd. Palmer, AK 99645 Engineer's Printed Name Charles A. Leet, PE 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 745-0222 Date 10/1/14 bedrooms, with the following ^O' F Af +5'tff r; ° m..4l:e:.. : .,: Vim ° to (1 I zbiq : 2,; Charles A. Leet > CEtn4Eo stipulations: By: - —� Original Certificate Date: 0 The Municipa Ity of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r , If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Lake Hill Acres #5 Block 1 Lot 5 A. WELL DATA Well type Private If A, B, or C provide PWSID # N/A Date completed 8/9/74 Sanitary seal (Y/N) Y Total depth 57 ft. Cased to 56 ft Date of test Static water level FROM WELL LOG 8/9/74 2 ft. Well production 13 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 1.02 mg/L Arsenic ND ug/L Date of sample: 9/19/14 B. SEPTIC/HOLDING TANK DATA Parcel ID: 051-122-15-000 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 22 in. AT INSPECTION 9/19/14 3.1 ft. +/-0.5 g.p.m. Collected by: Brandon Jones Tank Type/Material Anchorage Tank Date installed 9/18/01 Tank size 4000 gal. Number of Compartments -1 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) Y Date of pumping 9/23/14 Pumper Denali Sewer & Drain Services C. -"SORPTION FIELD DATA Date instaile Soil rating (g.p.d./ftZ or 1?/bdrm) Length ft. Width Total deptt4t ftEff. absorption are fl? Mc 4t ' Date pf ad�equTcy test Re as I + h Elapsed Tim in. Water Final fluid depth in. 12 mo.) (YIN & type) System type ft. Gr ow pipe ft. mg-ube Depression over field For _ bedrooms ed al. New depth in. Absorption rate >= g.p.d. If yes, give date Date installed "Pump on" level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main >75 Sewer Iseptic service line >75' Animal containment areas >100' level at in. Meets alarm & circuit On adjacent lots > 150' On adjacent lots >100' Public sewer manhole/cleanout >100' Holding tank >100' Manure/animal excrete storage areas > 100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5 Absorption field N/A >10' >10' >100' Water main Water service line S rt t Wells on adjacent lots >200' FIELD ON LOTTO: Property line Water Service line F. COMMENTS G. ENGINEER'S CERTIFICATION foundation Wells on adjacent lots I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA CO�uldeli(nes in pe�ffect1on this date. Engineer's Printed flame Al/ r_ L.iiir- 2S )l n ,e -a Date 1® if Zpj COSA brown sheet -1 0-10-1 2.doc u ace wa er parking/vehicle storage MIRROR LAKE LEGEND: (C)=CALCULATED DATA (M) -MEASURED DATA (R)=RECORD DATA PER PLAT ohu—OVERHEAD UTIUTY NAT. -NATURAL PED -PEDESTAL FND.—FOUNDATION TYP.)=TYPICAL \ LOT 6 / 11 FO / F �N MEANDER SHED LINE THIS Bo z DATE 9/23/14 �y c 9P 4� STEPS (-TV T GREENHOUSE NO FND.BUILDING NO FND $nom DECK w/ RAVEL DRIVEWA\ J STEPS LOT 19,514 S.F. LIFT DWELLING NAT. GAS LOT 4 44't W PLASTICI ` Mi , RISER (TYP.) I i F 1• : �• / "jG, NO FND. COVERED) AREA �/ \ RECOVERED\ 3/4 -IRON - PIPE (TYP.) NOTE: q WELL TO IZ UFT STATION = 99.4' I S' Flo IN I I I I [UTILITY PED NOTES: •.1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY SUBSTANTIALLY COMPLIES WITH ASPLS MORTGAGE STANDARDS. 5. TIES TO PARTIALLY MONUMENTED OR UNMONUMENTED PROPERTY LINES ARE tt Fr. '6. THIS SURVEY PERFORMED FOR JACK DEMOSS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. :EXCLUSION NOTE: 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. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON ,BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. *14 9 IH dVert J. Farmer :,o 10615-5 ZZA y�FESSIDNAL L��9 AS—BU I HEREBY CERTIFY THAT A UNDER MY DIRECTION ON FIFTH ADDITION LAKE HILL' PLAT No. 67-69, ANCHORAI SURVEYED ON THE 23rd ALASKA RIM ENGINEERING, INC. 9131 E. FRONTAGE RD., SUITE 1 PALMER, ALASKA 99645 PH: (907)745-0222 : FAX: (907)746-0222 ML akrim®alaskarim.com : WEB: www.alaskarim.com WO: 14UUSU5 FB: 14-16 PAGE: 1_of 1 GRID: NW1562 SrAI F- 1 " = gin' I FII F. 14nnRn�,AC 2014. A ASK Municipality of Anchorage sL Development Services Department r.�. Building Safety Division SA ETT On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 141519 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 5 of Lake Hill Acres #5 subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 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 Certificate of On - Site Systems Approval. g on ƒ of §§ (G)\� / \!%? !; rn ;/\f 4 Eggƒ / o F. ^ ° @ I / 6 & wPi0/23/2 > ( q j \ PI) ® J / e-ue-7ec) G. _ F z § ® ® £ I CD -CD co OD { A \/( \\%D ) g °. \ S ƒ 7 �f D } % . \ w 7 2 ou 00\ } /} g on ƒ of i\K §§ (G)\� (j \!%? !; rn ;/\f 4 Eggƒ / o F. ^ 2&bbbAm§2q©»© I /2 6 & wPi0/23/2 > ( q j \ PI) ® J G. _ F z § ® . ) to co OD { A \/( °. \ �f > k w 7 2 OD 00\ k7 � » \@� > 0 §#GGGGGGGGGG\({(/ ;> ocn � 3@ �EE2 x CL E3> \j \(k) 0 \> 0 CL > }/ 3@ /{k (� rl) 00 r1a Pi m ( , CDCD i\K §§ (G)\� (j \!%? !; rn ;/\f 4 Eggƒ / o F. f ■ k I /2 & > ( q j \ E G. _ F z § ® . ) , FM - q k q Cl)ƒ ƒ f / / ( ( j CD F § ) { A °. \ w 7 2 � \ O m 0 ❑ no O O O C c c CD c c iiiiiiiiiiiiiiiimN C7�y �y C (1 OCD r/� 4Ni (I7 N fp Xk O j N cn C 6 (D N paaj n n n 9 D°o 'S O� CD 0' c n , 3 3 0 A R O a m W ❑ ❑❑ N N fD N tl� N ❑ no O O O Is -- O v m 3 o m m ❑ 7 'n O Im o N A E®E n n j 0 AL A W -7 E CL iiiiiiiiiiiiiiiimN NN■N�III� IIN■NII anti Is -- O v m 3 o m m ❑ 7 'n O Im o N A E®E n n j 0 AL A W -7 E CL .%y -,... r Municipality of Anchorage • Development Services Department Building Safety Division ao On -Site Water and Wastewater Program $ s r y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O S` - I a 1 HAA # © q O 1-7 �- Expiration Date: RE - 1. GENERAL INFORMATION Complete legal .description )-O'r 5 (31-o c kc I 1- q K i. HILL q cfe e - S #j - .S'Location Location (site address or directions) 3 a `/ q H r Lt 70,A G ra c CH ✓6-i #s< , JA - ..Current Property owner(s) 13'14-Y 014-,v4 C v4,vs Day phone % S e — 77 6 Z Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Tit vk.Ir 7-f -r-J-f Day phone Tv0V )rlgmS Day phone Sys -3600 Unless otherwise requested, HAA Wil1 be held by DSD for pickup. <� G"'�1 G_ S -/i IS /o 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well N Individual On-site ❑ 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 Health Authority Approval Guidelines for this application, shows that the On- site water supply and/or wastewater disposal system is(are) safe, funcfional 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. S & S ENGINEERING Name of Firm 17434 Eagle River Loop Road No. 204 Phone (S01 '�` `f -7 Address Eagle River, Alaska 99577 Engineer's Printed Name . R086&7- C, C© L4/ 4,11 Date Sb S/d V S. DSD SIGNATURE ROBERT C. COWAN CE -8801 I/ Approved for 4 bedrooms. Not, e" ....... Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By:4/4/o-?* Original Certificate Date: _r) -N-04 (Rev. 01102) —� Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us 43-790ak.us (907)343-7904 CFRTIFICATE OF HEAL] H AU l HORi T Y APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-122-15 1. GENERAL INFORMATION HAA # !:�O l 7 � - Expiration Date: 1; - j', - O Complete legal description Lot 5;B1ack 1; 11ake-Hi 11 Aches#5 Location (site address or directions) 22424 Hilltop Circle, Chr,E;ak, AK Current Property owner(s) Billy & Diana Evans Day phone 688-7762 Mailing address Lending agency Mailing address Real Estate Agent Day phone Judy Lamb _ _ Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. iV� 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individiial 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 Health Authority Approval Guidelines for this application,,,shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate-f¢r` 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, ord(nan"" and regulations in effect at the time of installation. Name of Firm S & S Engineering Pr,C 694-2979 Address 17034 N. Eagle River Loop RD., Eagle River, AR 99577 Engineer's Printed Name Robert C. Cowan _ Date. S 7/0 5. DSD SIGNATURE Approved for ?J Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory .P�, -;n I ROBERT C. COWAN J •� C�-8801 bedrooms. bedrooms, with the following stipulations: A •• ON-SITE ;rWATER AND WASTFWATFR ; PROGRAM X Maintenance Agreements Supplemental Engineer's Report Other By: &� Original Certificate Date: 5— — — 65�111'1� 47 (Rev01)02) Municipality of Anchorage ' Development Services Department Building Safety Division s On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY qq APPROVAL CHECKLIST Legal Description: LOT- i5 I lac t LL2&?�Oarcel ID:_ds( —12- Z - A. WELL DATA Well type�� If A, B, or C provide PWSID # Date completed/V-1- Sanitary seal (Y/N) Total depth '5 Lft. Cased to 5(o ft. FROM WELL LOG Date of test e! Static water level L ft. Well production 1 3 g.p.m. WATER SAMPLE RESULTS: // Coliform _colonies/100 ml. Nitrate ! e Z mg./l. Arsenic: mg./I. Date of sample: *6/0 ¢ B. SRPTIC/HOLDING TANK DATA l Well Log (Y/N) y Wires properly protected (Y/N) _ Casing height (above ground) —/Z in. AT INSPECTION S (' o4 2 ) o ft. W S g.p.m. Other bacteria t) colonies/100 ml. Collected by: 9j'15 6W61,JC&-2/AJ6r Tank Type/Material 40L -0I jC. I 5Tnfc— Date installed r4 Zr 1 Tank size D0 gal. Number of Compartments I Cleanouts (Y/N) Foundation cleanout (Y/N) JL Depression over tank (Y/N) /J High water alarm (Y/N) y Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed �_ Soil rating (g.p.d./ft2 or ftZ/bdrm) Length / ft. Width type ft. /Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring Date of adequ y test Results (Pass/Fail) _ Fluid depth in bsorption field before test _ in. Water ad Elapsed Tim : _min. Final fluid depth _ in. Any rejuvena n treatment (past 12 mo.) (Y/N & type) u Depression over field For _ bedrooms d_ gal. New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at/in E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level atin. High water alarm level at in. Cycles tested Meets alarm & circuit requireme ts? SEPARATION DISTANCES FROM WELL ON LOT TO: r Septie- nk/lift station on lot— ;Z5 -- Absorption field on lot Kl Public sewer main H A Sewer /septic service line -2-5- r vr On adjacent lots /co On adjacent lots /do r7 Public sewer manhole/cleanout Holding tank :7-q r A - SEPARATION DISTANCES FROM S€!PW/HOLDING TANK ON LOT TO: A/ / ✓} r l Building foundation S Property line Absorption field N 4' Water main A/ Water service line J 0 f- Surface water / ®V-> r Wells on adjacent lots P0 0 11 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parkingly icle storage IZ_ Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION Ne N .. ca; •" .... 4t i certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA NAA guidelines in effect on this date. .< p ROBERT C COWAN F!ti Engineer's Printed Name kb&A3 -- C. G'.c'- 1p%l+, CE -13801 Date HAA Fee $ 43-c--- Date T3-vDate of Payment S ! Receipt Number (Rev. 12/01) ' Fee $ Date of Payment �7 I Receipt Number 1 3 Jx ,l4 �Jfie E 44, 9° Z s r We ���f �y IS yNE4 0 r. p 1404 " 4� 80 Nd.tl JOPi-" NSC � 5 0 � •I i �y • O!� �,.Qr�.j��•9�i��v ASBUILT-NO;CORNERS SET THIS DATE. SEWARD & AS I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTY, AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATE: INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID, EASEMENTS, COVENANTS, OR RESTRICTIONS n�dz WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' ANY DATA HEREON BE USED FOR CONSTRUCTION so sz OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN, 0 V LE'✓C6" m � pF' At 40 • Duarte Mark Sawerd 0 LS -6918 �41 6 w� � Aat►a'a'4' 6'1t_� _Q 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 Parcel 1.D. # 051^ /ZZ—I J HAA # HA g40606� 1. GENERAL INFORMATION Complete legal description Lot 5; B2ock�l ; Lake H.c, tz? j.AcAe,6 Location (site address or directions) 22424 Hilltop Cikete Chuaiak. AK Property owner Pay Church Day phone 688-2803 Mailing address Box 670382 Chua.i.ak, AK 99567 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 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 XXX 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)Rov.1/91) Front MOAN21 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 - a g S ENGINEERING Phone 6q - cl 7y Address 77034 Eagle River Loo�Road No. 2N Engineer's signature Aq-f'-� !- Date ROBERT C. COWAN f `Q7 CE -8801 r 6. DHHS SIGNATURE ��`�9 u,,,,...• "`� F:F Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional . i ; i 4 J.I. - Date 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 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(Ftw.1/91) Back MOA#21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: , L n 1 , w Parcel 1.D. A. Well Data / Well type P2k\t»� If A, B, or C, attach ADEC letter. ADEC water system number \ th Log present &N) ,i Date completed Driller Total depth S 1 ' Cased to Sanitary seal 6A Casing height l2`I4- Wires properly protected &IN) V FROM WELL LOG AT INSPECTION Z L 0 Date of test 'i N Static water level z u !a1 k Well flow 13, o g.p.m. .� i g.p.m. o� > a LLJ Pump Ievell J �1� a' w P AJ SEPARATION DISTANCES FROM WELL TO: u = oil z Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots I d ~ �� Public sewer main n Public sewer manhole/cleanout Sewer sen{ice line 2S t� Petroleum tank 24 + WATER SAMPLE RESULTS: --� Corrform i> �- Nitrate Other bacteria U Date of sample: /J -a 8-9 Z 10.d5---74 Collected by: Sol SEPTIC/HOLDING TANK DATA Date installed Tank size /asb /.?ono Compartments Z Cleanouts (j�N) Foundation cleanout (Y/W Depression (Y/6 High water alarm y* Alarm tested t/ Date of pumping /o - 'A Pumper Sa �iTAtiy P✓rrPFi@S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ `t I I On adjacent lots l tiD' k Foundation S To property line 10 Absorption field a Water main/service line I o Surface water/drainage SEk `�� UIQ Y y�wY 9r 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ' / i 7 `y Manufacturer U/Z Size in gallons U{L Manhole/AccessON) Vent (VN) "Pump on" level at cJiL "Pump off" Level at Lyle— High water alarm level ^' G� Cycles tested 2 Meets MOA electrical codes (Y/N) 1%K SysrEni is Jon �o< �o�ri l5 Y✓AASES SEPARATION DISTANCE FROM LIFT STATION TO: Well on (lot °j On adjacent lots 1 a a r Surface water / o as D. ABSORPTION FIELD DATA Date installed Length Total absorption area rating (GPD/Ft) System type Width Gravel thickness Cleanout present (Y/N) Date of adequacy test Results (pass/fall) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/ SEPARATION DISTANCE FROM ABSO Well on lot n To building foundation On adjacent lots C drain E. ENGINEER'S CERTIFICATION Total depth N) If yes, give date RPTIO LD TO: adjacent lots Property line To existing or abandoned system on lot utbank Water main/service line Driveway, parkingtvehicle storage area (Y/N) Bedrooms t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature. G"L Engineer's Name �L �C.e; C . �p✓�1w` Date 1 HAAFee$ '506,00 Date of Payment <<``(_q Receipt Number 0 6 O q lW q 6q 7 72-026 (3/93)' Back n 9 ROBERT C. COWAN r V 7 g;•., CE -8801 Waiver Fee $ Date of Payment f t -H-qV 1 Receipt Number 00q0 N & Fi 1