HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 3 LT 2Lake O ' The Hills East Block 3 Lot 2 #015-333-20 cr; 0 c 0 > ri) C) m 0 m M Cf) 0 m 0 m z P M N Cl) tit 0) r m M m co 0 co o m in CD P3 ---- --------- ------ ------- ----- ----- --------- -------------------- m 0 r) rn P, Name MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES 0 /� _ 3 Environmental Health Division VV 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 Material V ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT TYPE OF SYSTEM DISTANCES ❑ W. DRAIN ❑ OTHER i_ TO FROM SEPTIC TANK ABSORPTION FIELD WELL 0 Permit No. of Be�oms ePi WELL Distance between lines FT Pipe material LOT LINE /or—,I WELLS Lot Block ISu division % 'Z 4 11IL.a� Township. Range. Section ' TANKS x SEPTIC ❑ HOLDING Manufacturer An Q_ Capacity in gallons t ZS p Material V No. of Compartments TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade 46 —` FT Total depth from original grad , _�� _q FT Fill added above original grade FT Gravel depth b eath pipe FT Gravel length CO FT Gravel width FT Total absorption area 51-7 SO FT Distance between lines FT Number of lines Soil rating SO FT Pipe material p1Z5 Installs Date Instaflled WELLS ❑ PRIVATE ❑ OTHER aderHtf REMARKS: I I V JtG/V Jl— L i. Municipal and Stale guidelines in effect on Health Department Approval: 72-013 (3/85) FT Date Installed: t®1 172' 7Zal N (Show location of well, septic system, property lines, foundation, etc.) _ I". / s /O 0X7i9�mF,.= e Ins ections Performed y: Date: Ltd certify that This inspection was performed according to all + Date:,/ I•!!W." NEVI FR■■■■I■■■ 0X7i9�mF,.= e Ins ections Performed y: Date: Ltd certify that This inspection was performed according to all + Date:,/ 9 PErroRr.<Eo 'f Municipa(ity of Anchorage DEPARTMENT Of= HEAL-TH & f-lUMAN SERtIC 825 " U' Street, Anchorage, Alaska 99502-0t5 SOILS LOG - PERCOLATION TEE LEGAL OESCRIPT(ON: 1 2✓`l 3- 4- s- 6- 7 - Say. 456Sa g 10 i 11 �` 12- 13- 14 21314 1s L 16 17 < 1s 19 20 Township, Range. Section: SLOPE a ��-'4/Avzo/( ? J' 1 L • a-11- 1 WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E t1e>;th m tYztu Rtler - CY vxaaat7 Gate Rrng Oate Grote Net -TDwaw Or<�pepth to Net Time T<me PERCOLATION RATE (min(ftsfitKh1 FERC HOLE DIAMETER TESTRUN BETWEEN FT AND FT COMMENTS ,. -kCERTIFY THAT THIS TEST WAS PERFORMED IN tACAZ�OROANCE BY: t T ALL STAT AN MUN(CIPALGU(OEL(ttES tN EFFECT ON THIS GATE. GATE:&5 Signed: Issued By: ON~S]TE SEWER PERMlT P�y`mit Number: �'� 90U238 Date Issued: ()8/13/90 Engineer Designed Owner Name: BREN�A LOLlSE NEWTON (CUSTODIAN) Day Phone: gwner Address: 1400 W, 8ENSON #180 ANCHORAGE� AK 99503 Parcel Id: C15-333~20 Lot Legal: Subdivision: LAKE O THE HILLS E. Lot: 2 8lock: 3 Section: 23 Township: 1211 Range: 3W Lot Size 27639 (sq"ft, or acres> Max Bedrooms: This Permit: 4 Total Capacity: 4 total tank capacity: 1,250 gallons" Each septic SEby! IC TANK: Minimum septic tank must have at least 2 compartments` Depth to top of septic tank(s) < 4,0 {e�t requires insulation over tank(s). ENGINEERS ATTACHED DESIGN, NOTIFY DINS PRIOR TO INSTALL PER E�CK INSPEC|ION. Ti|IS PERMIT IS ISSUED FOR [HE PLANNED 4 BEDROOM SINGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/9O, Signed: Issued By: CURTAIN DRAIN EASEMENT AND MAINTENANCE AGREEMENT This document establishes a 30 foot wide curtain drain easement and sets forth a maintenance agreement pertaining to the same. The curtain drain is located on Lots 1 and 2, Block 3, Lake 0' The Hills East within the Anchorage Recording District and is more specifically described as follows: Beginning at the southeast corner of Lot 1, Block 3, Lake O' The Hills EaSt and proceeding N 00° 01' 12" E a distance of 138.70 ft., thence- S 89° 58' 48" E a distance of 78.25 ft. to the point of beginning of the curtain drain easement centerline, thence S 66° 19' 00" W a distance of 228.00 ft. to the point of the curtain drain easement centerline ending, thence S 00. Ol' 47" E to the south property line of Lot 2, Block 3, Lake O' The Hills East a distance of 47.00 ft., thence N 89` 58' 13" W a distance of 333.51 ft. to the point of beginning. The curtain drain easement shall be 30 ft. wide along the above described centerline and it is hereby set aside for protection and maintenance both lot owners and their heirs, successors or agents. Neither shall damage or alter the curtain drain to prevent flow at any time and both agree to ensure the continuous maintenance of the drain to allow positive drainage. Should either property be sold, these conditions shall pass to the new owner of the property and their heirs, successors or agents. Signed this G�sf day of September 1990 at Anchorage, Alaska in the Anc4orage Recording District. I✓ /, L�e+urn i=m; P.o.O.x 7-3oGOE Gra tee and Grantor 61tic(ticrRry IttcR`tfZ3 Notary Acknowledgement Subscribed and sworn before me this �'/ day of September, 1990 at Ancho d, Alaska. a GG%G My Commission Expires MUNI IPALITY OF ANCHORAGE 0 4 6 16 O Yz.•... _ �•'•..:,�� DEPT. OF HEALTH & ' / `° :�.' ENVIRONMENTAL PROTECTION •E' _ — j ANCHORAGE REC. E P�' �•;,. SEP 21'1990 DISTRICT REQUESTED BY RECEIVED ; STATE OF ALASKA ) '9O SEP 21 PPI 3 50 ss.: THIRD JUDICIAL DISTRICT ) THIS IS TO CERTIFY that on this 21 day of September - 199 —0' before me, the undersigned Notary Public, duly commissioned and sworn, personally known to me and to me known to appeared Rexford L. Turner acknowledged ed be the person named in and who executed the foregoing; and hi, noweg that he signed the same freely and voluntarily for the uses and purposes therein set forth. - WITNESS my hand and official seal. XV Notar Public n a "for Alaska My C9 miss io Expi es: iT/q3 �✓ `� �� Gc�iP�rc� -04re 710slip e' Lo' 4- Xoss - 58/ MUNICIPALITY OF ANCHC DEPT. OF HEALTH & ENVIRONMENTAL PROTEC SPP'!._( C C�o 5 e)I 3! IACs , �4rr C�0 Geo_"ri G 1 ZI, �Ep 2 0 I M RECEIVED ��rl.oi 3 iln �^(! loP !2 i I—Ao . / l 4r c,� /G�df 5 ftLel rs / Z a 3 �o f G(G! �G�OI llF %✓t Eli �� G/iJ /_6? ZIry ;/VER SYSTEM LOCATION PLA SUBDIVISION SECTION WNSHIP/RANGE r<`Aat)'°a1 SCALE' I NOTE, THE ACCURACY OF LOCATION OF EXISTING PROPERTY CorAERS, WELLS, AND SEPTIC .'� DRAWN BY' SYSTEMS INDICATED 13 NOT EXACT. ;;...... - DIMENSIONS INDICATED HAVE BEEN fog•°NORTH B JG DETERMINED E AND TECHNIQUES. NOTBY a a° •�'. r • e J. Corwinj{jr < V j••• �. CE -5233 �. �` 'c 53��AR PREPARED FOR, n �& �pROF' '�'��ting E�rf9i2riears,3 e/X / p DATE, l0 w// �% SHEET 2, OF 2 - I uw \ v 4 �3 k�b ,► I O .. ' ex , a -. 0 \ _ n , N V IN o Tmm n x m 3 30 0752.; d C INrr s /�L7 z -v �'� rn -n.. N"x � Zoo rl� 'i N o �>> 4. r� rn CC) � IG]d s 9Lh9-Sh£ <Lf_155-lofizn.u,g p��r'1 'LiPiy"1 '9 H13PIhl3il �'I^--�d PERFORMED FC LEGAL OESCRIf DEPTH 1 2 3 _ { 4- 6- 7- 10- 11 671011 12- 13- 14-- is- 16- 17- 18- 19- Municipality 213 141516171s19 Municipality of Anchorage DEPART&IIENT OF HEALTH & HUMAN SERVIC 825 •'L" Street. Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Iz-GN ll(/ 2 /. -DATE /-117'- 2 AwCk 3 Township. Range. Section: DN: F, Ze SLOPE WAS GROUNDWATER - ENCOUNTERED? S / L IF YES, AT WHAT O OEPTH?^ P / l �`� clU E Depth to tYzler llWs/fin ,l O Ji I L PLAN o � 1 (RAGE TION D J PERCOLATION RATE m7nutevui j PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS � CL �a / S/L( efes e t/eww ��%:�%� '40 samjr;/ 7z//7I we/�wP� �� J ��,t I�ex4 lave �/�,//'P CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: f/ 72-008 (Rev. 4185) o Municipality of Anchorage } �i T Department of Health and Human Services dhhs 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 August 15, 1990 Mr. Bruce J. Corwin, P.E. Corwin and Associates, Inc. PO Box 230608 Anchorage, AK 99523-0608 Subject: Sewer Permits for Lots 1, 2 & 3, Blk 3 Lake 0' The Hills, East Dear Mr. Corwin: As a result of our conversation yesterday, and based on our field investigation, the On-site Sewer permit for Lot 1, Blk 3, Lake 0' The Hills East has been suspended due to the presence of a stream which crosses Lots 1, 2 and 3. The stream location appears to encroach on the required 100' set back distance to the proposed wastewater system and reserve area. In addition the permit applications for Lots 2 and 3 will be held until our concerns over stream separation requirements have been satisfied. Also the proposed relocation of the curtain drain poses physical as well as legal restrictions on all three lots. This office will therefore need to have a more clearly defined drainage plan for these lots. As a minimum, this plan should address the impact of the curtain drain on groundwater for each lot and clearly document horizontal separation distances between the planned wastewater reserve areas and any existing or proposed surface water drainage courses. Please be advised that appropriate permits must be obtained from Public Works for the proposed culvert installation and stream diversion (AMC 21.60). The person to contact at Public Works is Mr. Jack Puff, in the Flood Hazard Permit Section. His telephone number is 786-8251. Please let this office know when these requirements have been met so that the permit for Lot 1 can be reinstated, and the permit applications for Lots 2 and 3 can be reconsidered. Sincerely, Daniel N. Bolles On-site Services. cc: John Smith, P.E., Program Manager, On-site Services db/125 t t SEPTIC TANK: Minzmum o a4 tank musL have at Wasirt 2 teeL requires insulatiohNo lNTALL PER ENGIN AT S EACH 1ROOM' ION. apacity: 1�250 gallons" ~ Depth to top of septic �ED DESIGN. NOTIFY DHHS PRIOR TO CURfAIN DRAIN MUST 8 N MUN1Q LlTy UF ANLHURA62 AS -BUILT FOR THE 12« {awiliar with the requirements for on�site sewers and wells P T IS Health & Human bervzces PNNED 4 BEDROOM THE LA CMP CULVERT" State oH Alaska. Department of by the Municipality SlNG!£ FAM1LY StreetAnchorage� , Alaska 9950l 343~ and in compliance with the design criteria o{ this permit" �. I will adhere to a1l MOA and State of Alaska requirements {or the SEWER PERMIT well, wastewater disposal ON-SITE public distances vrom any existing sewerage � ��������� ~~^�~^ ~`~~~ PermitNumber: 90023E! that this permit is valid {or a maximum of it bedrooms" l Date {ssued: 08/13/90 Engineer is 4 bedrooms Uesigned also understand that capacity LOUISENEWTUN MY Day Phone: Owner Name: BRENDA ' DATE: Owner Address: 1400 W. BENSON #180 ...... .... _�~~` ANC�ORAGE, AK 9�503 Parcel Id: O15~333-20 DATE: Lot Lega1: Subdivision: LAKE Q11411 HILLS E" Lot: 2 Block: 3 Section: 23 Townshi : N Range: 3W Lot Size 27639 (sq,It` or acr s) Max 8edrooms: This Permit: 41 To�al 2apat: ity: 4 t t SEPTIC TANK: Minzmum o a4 tank musL have at Wasirt 2 teeL requires insulatiohNo lNTALL PER ENGIN AT S EACH 1ROOM' ION. apacity: 1�250 gallons" ~ Depth to top of septic �ED DESIGN. NOTIFY DHHS PRIOR TO CURfAIN DRAIN MUST 8 N Each septic tank(s) < 4"0 I CERTIFY THAT: Y (jr: THE AS -BUILT FOR THE 12« {awiliar with the requirements for on�site sewers and wells P T IS ISSUED FOR PNNED 4 BEDROOM THE LA CMP CULVERT" State oH Alaska. [HlS { top th by the Municipality SlNG!£ FAM1LY DWELLINr�()NgY install the system in accordance with AND EXPIRES ON 12/31/90. Each septic tank(s) < 4"0 I CERTIFY THAT: 1. l am {awiliar with the requirements for on�site sewers and wells as set of Anchorage (MOA) and the State oH Alaska. { top th by the Municipality 2. l wil1 install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o{ this permit" �. I will adhere to a1l MOA and State of Alaska requirements {or the set back well, wastewater disposal system or public distances vrom any existing sewerage system on this or any adjacent or nearby lot" 4. l understand that this permit is valid {or a maximum of it bedrooms" l the o� the WWI system is 4 bedrooms and also understand that capacity MY enlargement will require an additional permit, ' DATE: Siqned: ------- _~~~........ .... .... ~_.~~~~_..... ...... .... _�~~` wner) BRENDA LOUISE NEWTON Issued By: DATE: f Qunicipatity of Anchorage { �_ DEPARTMENT OF HEALTH & HUMAN SERVIC€ 825-L" Street, Anchorage, Alaska 99502-0650 a 4 SOILS LOG — PERCOLATION TEST �he s"'. Xz��� ��� PEREORt .EO FOR: OATS T 2 �OC� 3 Tov+reship, Range, Section: LEGAL DESCRIPTION:/� //� ,yQ SLOPE DEPTH �f �P / �� ' (FEET _ _. 1 F � `l/ 2 3 4- 6- 7- 8- 678 G 9 , to- 12 - 13 01213 b 14 -- is - 16 41516 17- 18- 19- 20- C 7181920 Cq.A SITE PLAN VVASGROUNOWATER / IO ENCOUNTERED?/� S / L IF YES, AT WHAT O DEPTH? P E oe to K'zter A mter fdani':xinp7 bate �L Date 4jr= Net Depth to Net Reading _ TTme Time Water Drop 4 PERCOLATION RATE (rcanujesk�l PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS- ___ PERFORMED BY: .� •�1 "` CP CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OATS. DATE:72-008 (Rev. (Rev. vast -77 61e 740 P� '7S = 50 0 D 50% _ /ao C11 5Z X 5= 2 9%58 = mo o C/o C/o Sepa�c ( / a 5 I/1tH. (�irY n n _ --�' as rvGI� <v MttX II ���Eoin�nG 21' O '3 O e D P 3'ac�-(G c r / ER SYSTEM LOCATION PLAN • LOT BLOCKSUBDIVISION el SECTION/TOWNSHIP/RANGE - f q .Qx.�ayaJ_'." �6 SCALE+ NOTE B or -� ea .-) 11 THE ACCURACY OF LOCATION OF EXISTING 0 �� ^•+ PROPERTY COFrlER3, WELLS, AND SEPTIC c.l DRAWN BY, BY3TEMS INDICATED IS NOT EXACT, Q• °' '�`���� `� NORTH BJG DIMENSIONS INDICATED HAVE BEEN .. .:...: ....... -...�. E AND DETERMINED BY USE OF CLOTH TAP �^ ` NOT SY SURVEYINQ TECHNIQUES, CE -5233 �'® u(�. © �. + F = PREPARED FOR, P r'' OFCSS�ilnq Erineecs�,' / p /(0 SHEET OF 2 Lola r, r �New_2 Go �- 2 X00 n /431 r e r-777-1-1 .. SYSTEM LOCATION PLAN i LOT - BLOCK / 1,02- 3 GAk-,c- O TN6 /f/CGS EAS --57% SECTION/ TOWNSHIP/ RANGE c? SCALE,///— / HOTEL THE ACCURACY LOCATION OF EXISTING 8 u e J. Corwin �-+.i:00 p o. CE -5283 `r Vl:•P t7 SYSTEMS INDICATED IS NOT EXACT, DIMENSIONS INDICATED HAVE BEEN OCro SECTION/ TOWNSHIP/ RANGE c? SCALE,///— / HOTEL THE ACCURACY LOCATION OF EXISTING PROPERTY CORNERS, WELLS, AND SEPTIC DRAWN BY, SYSTEMS INDICATED IS NOT EXACT, DIMENSIONS INDICATED HAVE BEEN NORTH DETERMINED BY USE OF CLOTH TAP E AND :.:.,,..:.....-.:..__:.:::...:.....:....:-:._............::..:::::...:.,...::-.:.,...., NOT BY SURVEYING TECHNIQUES. PREPARED FOR, ata+ri+ifes, ' u € � -� %Ze k • a t,�Jnp gErEgineers ...: - !...S. c.v,�•^TT'. •i:?y`�y`jw- a--�-.-' OATEN // // SHEET / OF 2 i �i 17 T.:.1 T �f cd 5 t y 'r �-t 11..• �i T.:.1 �f cd ,,rte rr,07 ,�yyyppp�� H? -j--33 L --)- October 9, 2007 7050 Lake O' the Ifills Circle Anchorage, Alaska 99516-1867 Municipality of Anchorage Department of Health and Iluman Services Environmental Services Division P. O. Box 196650 Anchorage, Alaska 99519-6650 Dear Sirs: On October 8, 2007, 1 had the septic tank at my home pumped. In light of the Municipal ordinance regarding septic system pumping, I want to make sure that you have a record of this event. I would like my records made current so that the Municipality has documentation of our compliance. Please let me know if any additional information is necessary. Yours truly, Jose h Falcone Attachment: Around the Clock Pumping Service invoice, dated October 8, 2007 (photocopy) M ;rcr..d598466 C! -_k Pumping 5700 VlhisD26na Spruce nr- CUSIOLIERS ORDER NCI orag - Iu - - -- DAIE NAIAE / ACOiiESS CIIY,SIAIE, ZIP SOLD CA4f CIO CT\P44,ONACCL Lk)sERt7D FAUCET QUAHBTY W DECJN PRICE ALIOUVr z � 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 RICE EDDY J1i0J � •---�• ...w vur rvn nCrClSCIYI.0 � h.+.•••.w...�...... v.y:�.wth....n�wf+w.w.n_...:.i..a-r..+v....�.'. • Municipality ®i Anchorage INNER On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 015-333-20 1. GENERAL INFORMATION Expiration Date: 6 -go -/ Q2 Complete legal description LAKE 0 THE HILLS EAST BLOCK3, LOT 2 Location (site address) 7050 LAKE 0 THE HILLS CIRCLE ANCHORAGE AK 99516 Current Property owner(s) JOSEPH & MARY FALCONE Day phone Mailing address Real Estate Agent 7050 LAKE 0 THE HILLS CIRCLE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: y�Dater COSA to be released to the engineer, unless oth is requested by the engineer. COSA Fee $ 59(0.0O Date of Payment 2131,901V Receipt Number 63-1.1(4t�, COSA# ()SGI(01341 Waiver Fee $ Date of Payment Receipt Number 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 6/20/2016 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a ®e_� system will function satisfactory for current or future ® OF ALS 'koccupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. or p. t� A� CZ.TY�.,9_ 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. 9 KF,\NE1'H '1. D `FFllV� �. s ®� nhbFsssto^`� Conditional approval for bedrooms, with the following stipulations: Original Certificate Date:_c The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.dw 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 0 THE HILLS EAST BLOCK 3, LOT 2 Parcel ID: 015.333.20 A. WELL DATA — CLASS A Well type A If A, B, or C provide PWSID # 213603 Well Log (Y/N) Date completed Sanitary seal (Y/N) Y Total depth ft. Cased to _ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100mL Nitrate _mg/L Arsenic: _ ug/L Date of sample: B. SEPTICIHOLDING TANK DATA Tank Type/Matedal SEPTIC I STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cllanout (Y/N) Y Depression over tank (YIN) N Date of pumping 6/16/2016 Pumper ONE STOP Wires properly protected (YM) Casing height (above ground) _in. AT INSPECTION ft. Collected by: Date installed 10!3011990 Cleanouts (Y/N) High water alarm (YIN) N C. ABSORPTION FIELD DATA C Date installed 10!3011990 Soil rating (g.p.d./fe ft? 125 System type WIDE TRENCH . Length 60 ft. Width 5Gravel below pipe 3 ft. Total depth 12.5 ft. (Measured .6116/16) Eff. absorption area 517 fe Monitoring tube Y Depression over field N Date of adequacy test 6/1612016 z Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in atigprption field before test 24 in. Water added 600 gal. New depth 33 in. Elapsed Time: 1440 min. Final fluid depth 23 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on level at —in. Datum Size in gallons "Pump off" levet at _ in. Cycles tested E. SEPARATION DISTANCES PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manurelanimal excrete storage areas Building foundation 5'+ Property line 51+ Absorption field 54 Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 104 Water main 104 Water Service line 104 Surface water. 100'+ Driveway, parking/vehicle storage *0' Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 2001+ F. COMMENTS & Per previous MOA approved COSA / HAA - the field is partially below paved drive with cast iron lids over deanouts and approx. 10' of G. ENGINEER'S CERTIFICATION ' I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 6/20/2016 COSA canary sheet 2-e-15.doc MUNICIPALITY OF ANCHORAGE *Z' DEPARTMENT OF HEALTH R 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 y Parcell.D.# [71S—S7)2)-9D HAA# Wt��1�,0 l`AS 1. GENERAL INFORMATION Complete legal description Lot 2; Stock 3; Lak HiUs East Location (site address or directions) 7050 Lake o6 the HiU6 Ci,%cee Anchorage, AK Property owner Howard and Chni.ati.ne Ftaum Day phone 346-1177 (h) Mailing address 7050 Lake ob the HiUs CilLete Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Bonnie Mehner/JACK WHITE CO. ANCHORAGE Day phone 762-3110 Address 3201 "C" StAeet Suite 100 Anchorage AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well XXX 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 (Rev. 1/91) Front MOA M21 A 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 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 034 Eagle River Loop Road Address Engineer's signature 6. DHHS SIGNATURE XApproved for bedrooms. 0 Disapproved. Conditional approval for 0 Additional Comments Phone Date Z q3 /Fl` h!.>. '145; � '�:•�/ �� �r bedrooms, with the following stipulations: atITIC 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 (Rm 1/91) Back MOA 421 4 Municipality of Anchorage O Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT i ISLK3 1AKF OF -M6 &U --s E-aSTsbParcel I.D. A. Well Data Well type Coi> mut +EY If A, B, or C, attach ADEC letter. ADEC water system number 013603 Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow umo levell Date completed Cased to FROM WELL LOG Wires properly Driller Casing height AT INSPECTION O SEPARATION DISTANCES FROM WELL TO: LLASS A GOv+ MU10rTY r 7X11C - V3 CLK Z Lc4K6-oFTm6 HILLS 6_)iS7-S/ZZ5 Septic/tank on lot ; On adjacent lots r Absorption field on lot %'7 On adjacent lots � j Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform B. SEPTICA48t91146 TANK DATA Nitrate Public sewer tank Collected by: Other bacteria Date installed 10! 3C) go Tank size /Z50 (w'LLD/JS Compartments Z Cleanout(Y/) Foundation cleanou (Y ) Depression N) Yt;5:S High water alarm (YAlarm Alarm tested (Y/N) N Date of pumping Pumper A. -t HOA4 rs /2v/cES SEPARATION DISTANCES FROM SEPTIC/Hfd&TANK TO: L-LASCI Well(s) on lot No"6 CSN Loi On adjacent lots %lY Foundation 4 r r To property line 7_5 Absorption field IS 7 Water main/service line /04 Surface water/drainage SOU 'k- -k— k --k— IPSpECleL-IDOQ.T, CONTINUED ON BACK PAGE 72-026 (3/93)` Front MoA (ZELo2US. m r 1 F n rri D p�qq � 1 r K — ® m O T —g.p.m. rn ev R Z 0 S 00 — < 3� �G) — rn O SEPARATION DISTANCES FROM WELL TO: LLASS A GOv+ MU10rTY r 7X11C - V3 CLK Z Lc4K6-oFTm6 HILLS 6_)iS7-S/ZZ5 Septic/tank on lot ; On adjacent lots r Absorption field on lot %'7 On adjacent lots � j Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform B. SEPTICA48t91146 TANK DATA Nitrate Public sewer tank Collected by: Other bacteria Date installed 10! 3C) go Tank size /Z50 (w'LLD/JS Compartments Z Cleanout(Y/) Foundation cleanou (Y ) Depression N) Yt;5:S High water alarm (YAlarm Alarm tested (Y/N) N Date of pumping Pumper A. -t HOA4 rs /2v/cES SEPARATION DISTANCES FROM SEPTIC/Hfd&TANK TO: L-LASCI Well(s) on lot No"6 CSN Loi On adjacent lots %lY Foundation 4 r r To property line 7_5 Absorption field IS 7 Water main/service line /04 Surface water/drainage SOU 'k- -k— k --k— IPSpECleL-IDOQ.T, CONTINUED ON BACK PAGE 72-026 (3/93)` Front MoA (ZELo2US. C. LIFT STATION (\ 0D f ��Csl Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N SEPARATION DISTANCE FROM LIFT STATION TO: of D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access "Pump off" Level at Cycles tested Surface water Date installleed wl3y I �U Soil rating (GPD/Ft2) %zS X12 System type w/UGf (?_/AL�J Length (�� Width 5 r Gravel thickness Total depth �� / 3 / 7'7— Total absorption area S19 Cleanout present) T63 Depression over field (YL Date of adequacy test 1211,0a Results (pass/fail) el"ss for mg_) Bedrooms Water level in absorption field before test D After test CD Peroxide treatment (past 12 months) (Y/N) lUoNL A6N�,J If yes, give date IA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /U6iJE OrJ Lo% On adjacent lots G�LAcf Property line f i To building foundation Z Z To existing or abandoned system on lot On adjacent lots 2`� r� Cutbank %�/ ater main/service line lG '2�_ ' Surface water Driveway, parking/vehicle storage area d '-� Curtain drain X_f Y?- /eNltitc5/1 ✓L'LCa2DS E. ENGINEER'S CERTIFICATION Z SEDT/oNS o I= T/C�NGttZ- P�4�/� Casj /�20 AJ Lr 61je2 cmc=-)weju7S, Ar���cl��w �Y�0 ofG�✓E2 �u62T cfi. I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature S & 5 E=NGINEERING 17034 Eagle i r a Engineer's fi@ River, Alaska 95577 Date HAA Fee $ c�l 6-1) Waiver Fee $ Date of Payment l2-4-23 Date of Payment Receipt Number 9-i _!!Z 7/_7 C Receipt Number. 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services y r DIVISION OF ENVIRONMENTAL SERVICES M} 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ( )VS-- HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block,, subdivision, section, township, range) Location (address or directions) (b) Property owner ��—L vim✓ �` Telephone: (home)Business�aZ S (c) Lending Institution Telephone Mailing Address_ (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here Fl, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENC Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Communitx Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ElHolding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z to Z abed A068 (80/L'Aa8)990-ZL �JOM s,jeeuwbue !euo!sseloid ayl ui suo!ss!wo ao saoaaaaol a!q!suodsai lou si abejoyouy to (;!!ed!o!unw ayl •panssi si aleo!l!liao a aaolaq a;ep azA!eue ao suo!loadsu!Ion puoo lou op SHHQ to sWoIdw3 -sluewaa!nbai alels pue Ieaapal u!eliao As!les oliapio ui suo!lnl!;sui bu!pua! a!ayl pue sawoy to saaseyoand o; lsa;anoo a se s!yl saop SHHO aye, 'ENseIV to ale}S ayl ul paJa}s!baJ jaeu!bue !euo!ssalad luepuadepu! ue Aq anoge g gdeiBuied u1 uaA!b suo!;eluasaidaa ay} uodn /I!uo paseq paleo!lpeo !enoaddy Al!joylny yl!eaH senss! (SHHG) sao!AaaS uewnH pue y;!eaH to luawliedaa abeaoyouy to Al!!ed!o!un!N ayl NOi.Lnyo !euo!l!puoO ( !enoaddy !euo!l!puoO to swaal panoiddes!p panoaddy Aq swooapaq aol panoaddy 1VAOdddV SHHa '9 ale(] aaPPV aweN alelS pue !ed!ownW !!e y;!M eoue!!dwoo ui s! wags (s !esods!p as;eMalseM Jo/pus A!ddns aaleM al!s-uo ayl 'uo!loodsui pue uo!leb!;sanu! (w wal pue sa!!l abeaoyouy to /l!!ed!o!unN ay; woal pau!elgo uo!;ewiolui ayl uo paseq ;eyl Al!aaA aay;anl ! •u!aaay paleo!pui ainlowls to adAl pue swooapaq to aagwnu ay; aol alenbape pue !euo!lounl 'ales s! wa;sAs !esods!p Jolumalsem ao/pue A!ddns jeleM al!s-uo ayl ;ey; sMoys !enoaddy Al!aoylny y;!eaH s!y; to uo!leb!lsanu! /w;eyl Al!aaA ! 'Mo!aq uMoys alep uo!lep!!eA ay; to se pue o;ajay pax!lle leas Aw Aq pa!l!liao sy NOIIVWEIOdNI aNV b'lb(3 `HOdd3S 3-IId `S1S31 `SNO11O3dSNI JNIOIAOdd WHId E)NIa33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: A. WELL DATA Well Classification L f A, , C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Depth of Grouting SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot — To Nearest Edge of Absorption Field To Nearest Public Sewer Pump Set At Sanitary Seal o asing (Y/N) DepreA&lrdin Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sew ervice Line on Lot Water Sample ectedby l-�te Water Sa pie Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed d -Q Size ZOO No. of Compartments Standpipes (Y/N) —Air -tight Caps (Y/N) Foundation Cleanout (Y/N) 7 Depression over Tank (Y/N) AJ Date Last Pumped AA�� Pumping/Maintenance Contact on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Ae9A Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: f To Water -Supply Well ! z�Q / To Building Foundation A0 To Property Line �� � To Disposal Field J� To Water 'Mai n/Service Line To Stream, Pond, Lake or Major Drainage Course Comments >5-49 /26 111xA" 72-026 (Rev. 7/88) Front Page 1 Of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 517 Statndpipes Present (Y/N) / Depression over Field (Y/N) A-ly e�G'�� Date of Last Adequacy Test Results of Last Adequacy Test �o�,�c 4 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well % 2-®o / To Property Line To Building Foundation %Z� To Existing or Abandoned System on Lot A— ; On Adjoining Lots To Water Main/Service Line ALU / To Cutback (if present) 4:2:A To Stream, Pond, Lake, or Major Drainage Course %%ego / T To Driveway, Parking Area, or Vehicle Storage Area > Z/ Comments -> 5-6) L, -/-c nrtt", D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Comments "Check Perm I certify tha inspection./ • • Bedroom ecke!V ve Dimensions Manhole/Access Against HAA Request" Level at Vent(Y/N) or conformed to all MOA and Company (I / av -r✓G • 41V C_ Date G/=/ ry 0 MOA No. Receipt No. a 3 y 75-5 2 Receipt No Date of Payment Amount: $ L 72-026 (Rev. 7/88) Back 1 i- ya U i — Waiver Fee: $ - - Date of Payment Page 2 of 2 Pumping Cycles during Adequacy Test. effect on the date of this Engineer's Seal STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASI{A 99503 October 19, 1990 FOR: Corwin & Associates Attn: Bruce Corwin 563-6775 PWSID: #213603 According to the records on file in this office, the Lake "O" The Bills Fast Lot 1 - 3. Block #3 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG Environmental Specialist VEC:pf uNsL)6.D1v1 P6 NoT6 FOUNo,T�orf 55?Iic oNLY PLOT PLAN AS BUILT x SCALE 40 0. L� �� H Lo®a I Hereby certify that I have surveyed the. following described propert GRID Z&39 JOB No '�)o- IS3 1731 Georqe Bell Circle Anchorage, Alaska 99515 (907) 345 �7"'k ®� Ave �,;,•....... 4 �tVISIOrJ All ,• t� !wti✓Nofacca�e - Recording District Alaska and that the improvements situated thereon are 901 1 - •�• � within the property lines and do not encroach onto the property adjacent thereto,that no N improvements on the property lying adjacent thereto encroach on the surveyed premises andi" • s • ... • • • • %• • • 1 that there are no roadways, transmission lines or other visible easements on said property 10 I except as indicated hereon_ �''• ° ° • e•°f �� 5V Kenn th ..Lang Dated this the ZiDDay of OGTSLLL 19 90 , at Anchorage, Alaska �i}k�"✓ . IS -X202 It is the responsibility of the owner to determine the existence of any easements, covenants, ��'fo [0 14,35 or restrictions which do not appear on the. recorded subdivision plat_ Municipality of Anchorage Department of Health and Human Services Environmental Services Division P. O. Box 196650 Anchorage, Alaska 99519-6650 Dear Sirs: September 12, 2003 7050 Lake O' The Hills Circle Anchorage, Alaska 99516 On September 10, 2003, I had the septic tank at my home pumped. In light of the Municipal ordinance regarding septic system pumping, I want to make sure that you have a record of this event. I would like my records made current so that the Municipality has documentation of our compliance. Please let me know if any additional information is necessary. Yours truly, q4-Y� Jos ph Falcone Attachment: Around the Clock Pumping Service receipt dated September 10, 2003 Around the Clc-k Pz-,-;-- V' ^^ %A,[ 1.)/vv vvfliS>p .-rij I)p Anchors AK NAME (go 345 ADDRESS CITY, STATE, ZIP 1Z ORDER NO. SOLD BY CASH C.O.D.E ON ACCT MDSE.RETD.1 PAID OUT QUAN. DESCRIPTION PRICE AMOUNT 2 3 4 51 7 61 7 8 11 12 13 14 15 16 =17 18l 1 RECEIVED BY ITOTALI( TAX &, sda. 35805 AROUND THE CLC�a: 5700 WHISPERING SPRU,,E e 'b;Z.; ANCHORAGE, AK 99516 CITY, STATE, ZIP SOLD By Q D C. FAjDCUl v DUAN. .DESCRIPTION PRICE AMOUNT 2 3 c 7 —7— Ell RLCEIVLo 13 --- -" I nu aur rUd HLFFRrNCE Loske. O'Ae- 144,115 i5Aslf- 6'5 L -L