HomeMy WebLinkAboutHILLSIDE NORTH #3 BLK 3 LT 2Onsite File C A new as -built survey showing the current septic system is • prior to • COSA. L Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211393 PID Number: 041-031-84 Dwelling: FO -1 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name DONALD WAGNER ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 10231 MIDDLE ROCK ROAD *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot HILLSIDE NORTH #3; BLOCK 3, LOT 2 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 - Ft. Well 100'+ A() 254- TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1000 Gal. e, r Surface Water 100'+ GfG• Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 10'x.. LIFT STATION Manufacturer Capacity Remarks Gal. THE OL T WAINU OF 2022 WE ARE REQUESTING THAT YOUR DEPARTMENIVE Alarm location Electrical installed by THE REQUIREMENT FOR AN UPDATED AS -BUILT TO APPROVE THE PIPE MATERIAL House to tank D3034 drainfieldTank to EXISTII Installer A+ HOME SERVICES Drainfield EXISTING cO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.00 ft Inspection 15i 10/13/2021 - Location and description dates: 2�a BACK DOOR THRESHOLD aro - 4'h - ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: &1Z Date 2 y ► _M_ e4j tAnk is lhe �eGpr.1�1i5ianec( oo600pO �� s4p� p°� 49 *0 p....: .. ................. i D S� ��nq ZC�22. SUrJeV re/rrn i're� �n r C.asA .................. Septic System • of r y A. ss: Q 0.� o �44 CE 793 �, Q A roved Date PP r d 4 1 `opo erL- - ... Note: this approval does not include well permit requirements. 44��OD000���o #AEcc tKev uoiuuiu/ ,PERMIT NUMBER: PARCEL ID NUMBER: OSP211393 RECORD DRAWING 041-031-84 A I B r ST 32.8 33.8 r r Q 0 j r ST37.7 38.7 DBL1 38.8 39.9 1 �OP DBL2 39.9 40.9 r OG r r r � r r r r � r r r / Ir r/ -NEW 1000 GALLON HDPE GREER TANK DBL1&�(°IMH�/ ST`1`EXISTING HOUSE 1"= 40' GROUP,GARNESS ENGINEERING ENGINEERING - SALES -�CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE. AK 99507' PHONE (907) 3376179' FAX (907) 33&3246' WEBSI7E+w�w.0ynessengineering.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DONALD WAGNER 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: HILLSIDE NORTH #3; BLOCK 3, LOT 2 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 10/26/2021 / / -NEW 1000 GALLON HDPE GREER TANK DBL1&�(°IMH�/ ST`1`EXISTING HOUSE 1"= 40' GROUP,GARNESS ENGINEERING ENGINEERING - SALES -�CONSULTING 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE. AK 99507' PHONE (907) 3376179' FAX (907) 33&3246' WEBSI7E+w�w.0ynessengineering.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DONALD WAGNER 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: HILLSIDE NORTH #3; BLOCK 3, LOT 2 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 10/26/2021 rPER,MIT.NUMBER: PARCEL ID NUMBER: OP211393 RECORD DRAWING 041 -031-84 TOP OF MANHOLE = 97.17 FINAL GRADE = 96.0-96.2 MH1 ST1 2" INSULATION PER CONTRACTOR TOP OF TANK AT I NTLET = 93.11 TOP OF TANK AT OUTLET = 93.11 INVERT OF BUNG AT INLET = 92.44 INVERT OF BUNG AT OUTLET = 92.27 NEW 1000 GALLON H. D.P. E. SEPTIC TANK OF ®®®,weave e q q :d:.:,s.>.b.R.;.......:..,.,..d,,�tw_ia,.._.,r_�.;._�...._.vw:�.-�-,.v•b..,...ac�:..�`c.�,...._....:�..�c.;.. �'r � a _ , 2 � '•®00 .� ENGINEERING,, SALES � CONSULTING � , - � 9-.x t •. �.0 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE. AK M07PHONE(907)337-6179 -FAX(907) 338-3246' WEBSITE w game gena n,= 0 ... .. .,u. t PREPARED FOR; PHONE-E NUMBER: PAGE NUMBER: DONALD WAGNER 3 OF 3 0� ; , �ef�fre,�rness ,$ i� E-7953 . .1 AV PREPARED FOR: _7�_® LEGAL DESCRIPTION: DRAWN BY: ®���F�j s.•• a U1 : �,• ���� HILLSIDE NORTH #3; BLOCK 3, LOT 2 D.J.G. TYPE OF WORK: DATE: ®® FQ �'•.........••`,�'�\`P� ®® SEPTIC TANK PROFILE 10/25/2021 #AECC88��gq MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211393 Work Type: SepticTank Upgrade Tax Code Number: 04103184000 Site Legal Address: HILLSIDE NORTH #3 BLK 3 LT 2 G:2143 Site Mailing Address: 10231 MIDDLEROCK RD, Anchorage Owner: WAGAR FAMILY TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 9/16/2021 9/16/2022 85464 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 3 Um k,� ..�.. �.� t i LI s ''.ecs" e: w � '•' �.�" � �, �"c.^� I `ea °j�' ,+m,�a 1/ Development- Services Deparl:ment \ Phone: 907-343-7904 On-Site Water & VVastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 041-031-84 Property owner(s) DONALD WAGNER Day phone Mailing address 10231 MIDLEROCK ROAD *ANCHORAGE, AK Site address 10231 MIDDLEROCK ROAD *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) HILLSIDE NORTH #3; BLOCK 3, LOT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo AD U) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5 Waiver Fees: Date of Payment:/1642021 Date of Payment: Receipt Number: 41 a S y G Receipt Number: Permit No. O SPS 113 9 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211393, Rebecca Carroll, 09/16/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211393, Rebecca Carroll, 09/16/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211393, Rebecca Carroll, 09/16/21 * Municipality of Anch 9, g 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 Permit Number: �q � o l 07 PID Number: Name: (C"�� �0�, Wastewater System: " J New "❑ Upgrade ' Address:ABSORPTi6N FIELD Phone: ?� 3 ^ [ �/} No. of Blooms: 11 Deep Trench Q Shallow Trench In Bed ❑ Mound ❑Other° LEGAL DESCRIPTION Soil Rating:/.� "GPD/ net grade: �►: z Ft .Lot: - _ Block: Subdivision: Depth to pipe bottom from odgin9l gtada -= 44-7,4'e,qtr gravel"depth beneath ipe �., t �. 4 Township: Range: Section: Fill added above original�g"rader: ' '4.o .Gravel lengthy... ` /� " �(•f'.l ' DJ .-75 To � , FLS Ft f,.� WELL: b( New ❑ Upgrade Gravel width: ! �✓ p Number of lines: Distance etweenlineS: N A . Ft. Classification (Private, A,B,C): (21Vr�`f�IG Total Depth: 3q 6 FL Cased To: /a/ Ft. Total absorption area: s q- SQ. Ft, Pipe material'. ' S"'Ae> ASS FS{D Driller. A�piN Date ril d: r3 9l0 Static Water Level: /l `l Ft. Installer: S'te—PP.S Date in talle f 6 30 96— 7 96 Yield: Pum Set at: P Casing Height Above Ground: g g TANK GPM Nbv 5M- Ft. > I Ft. SEPARATION DISTANCES ($Septic 13 Holding oS.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity galll®s: From Tank Field Station Tank Sewer Lines—wCit-� Well 10941- ts1 Material: Number RLGompartments: weier >IDd >.Imo,' tj1 Ni,4 >rom' LIFT STATION Lie 77 /a 65� ��A N�A BD /* Size in gallons: Man re❑ Foundation :2 / i` 7J JA n !a A "Pump on" level aC "Pum High water alarm at: _ Curtain N ]� N Pum odel ' Electridal Inspections performed by: Drain l� I t Remarks: 40 �p 3 �'� p�t�+;�c.�� BENCH MARK ,.r Location and Description: Assumed Elevation: 1oa.UD EN e' F A14 Sti✓ r'� Y/40/7� Ne. • . . • toff N•a�ff-,: ..T! �.:.J'._. Inspections performed by: Dates: lot 2nd 9�C ) ey A. GorneeS Department of He a hand u Services approval • j%ff,,ff Cfi 7953 faI'll. t1,1 p/ROFSSSI�'r�"'_ Reviewed and approved by: Date: 141 72-013 (Rev. 9/91) MOA 25 ora. ,e Pae t of � TOP OF CUTBANK, SLOPES DOWN TO THE ROAD AT SO2 SLOPE. PRIMARY TRENCH, 46 FEET + LONG, 3.5 FEET WIDE, 6.45 FOOT EFFECTIVE DEPTH. 593 SO, FT. + TEST HOLE #2 C/O 'D' • r' C/O 'F' MJ 'E' TEST HOLE #1 ,C, • 1000 GALLON SEPTIC TANK A. --- J DOUBLE C/O J FOUNDATION C/O FUTURE TRENCH AREA, TO BE 37.5 FEET LONG, 6 FOOT EFFECTIVE DEPTH. 450 SQ. FT. AC = 35.8 BC = 29.2 AD = 63.5 BD = 84.6 AE = 62.5 BE = 73.3 AF = 75.6 BF = 72.4 WELL TO TANK = 108 FEET WELL TO TRENCH - 150 FEET SEPTIC SYSTEM AS-BUILTi L❑T2, BK3, HILLSIDE NORTH #3 I PREPARED FOR, HOWDIE INVESTMENTS I PREPARED BY, ALASKA WATER & WASTEWATER SERVICES IDATE, JULY 21, 19961 DRAWN, GARNESS 1 SCALEi 1' = 30JULY 21, 19961 DRAWN, GARNESS f SCALEi 1' = 30' WELL 0 OF H � o •oo•s. .otos 'y A. Gar 4• CE -7953 -v..s•oasa,P� pHOFESSIO� AS -BUILT DRAWING NEW 1000 GALLON SEPTIC TANK, ANCHORAGE TANK, INLET INV, = 82.61, OUTLET INVERT = 82.08 TANK SET LEVEL WITHIN .28 FEET. 4 INCH DIA, PVC LINE FROM HOUSE, FOUNDATION C/O INVERT = 83,04. DROP FROM HOUSE TO TANK - 1.0 FEET ALONG 205 FEET OF PIPE, SLOPE = 4.9%, GROUND ELEV, OVER TRENCH IS 77.6 TO 78.6. MINIMUM COVER = 4.15 FEET 7 GROUND ELEV. AT TANK 86,85 COVER = 4 FEET. RECEIVED VERBAL APPROVAL FROM DHHS ON 7/1/96 REGARDING TANK BEING 3.4 INCHES OUT OF LEVEL. DROPS FROM INLET TO OUTLET, —" LOCATION OF M.T SEE PLAN DRAWING 'AERIC OVER BRAINROCK INCH DIA., ASTM F830, PERFORATED PIPE OP OF PIPE AT ELEVATION - 73.45 A. INVERT OF DRAINPIPE = 73.10 B. BOTTOM OF TRENCH - 66.65 C. NO GROUNDWATER TO DEPTH OF 18 FEET IN TEST HOLE, D. TRENCH LENGTH = 46 FEET + E. TOTAL ABSORPTION AREA - 593 S0. FT, + BENCHMARK IS TOP OF THE WELL CASING.. ASSUMED ELEVATION = 10040 SEPTIC SYSTEM AS -BUILT, LOT 2, BK 3, HILLSIDE NORTH #3 (PREPARED FORT HOWDIE INVESTMENTS (ALASKA WATER & WASTEWATER I DATEi 7/21/96 DWN: GARNESS ' SCALE, NTS e+ , •ee•oo S go a r • 4 94140 4444me4••s9e• • 44444 •• •••4444 °•0.11• Jeffrey A. Garness `® CE -7953 N �(C 444°4 p4•e9 �4w0 `t % pi?0EESS0��� �' SEP -29-96 TUE 10,:07 HOWDIE INV. • „ � .,,Y - ;, rte, ` t . ,. t LOCATION OF -WELT. $OkO1JGH [.-�� at4v [ON LOT BLOCK LOCATIONISKETCH., DEPTHS MEA$uREO. FKOM-,x0asing'top C7ground surface BOREHOLE DATA: Depth Material Type and Color From To _ 0 k is -IV 49 - /Ox Z /OxZ. RECM D SEP,25'fnchorag 6 MutticipalEty OfDept. Health & Hun Servi .es 4 CONTRACTOR INFORM TION: '- Reg[s ed r ._ ignature or , FAX NO. 907 373 6773 P.02 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION Of: MINING & WATER MGMT WATER WELL RECORD SECTION OURS SECTION TOWNSHIP FLANGE MEHIOIt i CIN 0 as oW WELL OWNER: ¢6 81`40 9 frV % r i i WELL DEPTH; s DATE OF COMPLETIOr: . Depth of hole; ft Depth of casing: r left_I_,IF I' i. n DEPTH Td STATIC WATER LEVEL: _q_ft below ❑ top of casing LJ ground surfa::e j Date: I METHOD OF DRILLING: 'air rotary ❑ cable toot ❑ other USE OF WELL:li Ydomestic 171 irrigation 0 monitor. CI, public supply ❑ other ) CASING STICK-UP: 40L ft. Diam: 40 in. to Casing type: _ _j(P Irl, to.2AL I WELL INTAKE OPENING TYPE: �° open end ❑ screened r (� perforated Z open hole Depths of openings: _ _ to � ft SCREEN TYPE: _ Diam• in. i; Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: _ Volume used Depth to tap: it GROUT TYPE: Volume; _ + Dep#h: from_ ft to ft I r� DEVELOPMENT METHgD: �. Duration: .:? n- o.. PUMPING LEVEL AND YIELD: b ft after "' hrs pumping �gpm .� PUMP INTAKE DEPTH: _ ft Horsepower: WELL DISINFECTED UPON COMPLETION? 91 YESr 0 No REMARKS: �.� PMASR MAIL WHITE COPY OF LOG TO: ate DNR/DIVISION OF MINING & WATER MGMT 3601 C St, suite goo ANCHORAGE AK $9503-5935 0 GRAVEL DRIVE W LLN LET- Z ) Rk- 3 Nw-1-7+ #3 `./ �.. t � t / ra� tq y / ne t / .r r00, S kF N� 4fa � l}�4y. 1. � N SY'{ Yr t smoke 1 Y Sr r `tY n C t I*u. It M L i- h� r .r AAn� M, 0 GRAVEL DRIVE W LLN LET- Z ) Rk- 3 Nw-1-7+ #3 FAX COVER SHEET Alaska Water & Wastewater Consulting Engineers 8471 Brookrige ©rive Anchorage, Alaska 99504 Country (907) 337-6179 (907) 338-3246 SEND TO Company name From ^ H.O. A� Jeffre A. Garness, P.E., M.S. Attention Date `i' S� ZAP Office location Office location Anchorage, Alaska Fax number Phone number Pager: 1-800-481-1162 Cellular: 244-9612 Urgent [ Reply ASAP Please comment E] Please review For your information Total pages, including cover. COMMENTS PAGE oI OF 1 MUNICIPALITY OF ANCHORAGE Lo `{�,{�� ` q� DEPARTMENT OF HEALTH AND HUMAN SERVICES ) `�N1l_gb P.O. BOX 196650, 825 "L" STREET, ROOM 502 �) p.m ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960107 DATE ISSUED: 6/07/96 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 6/07/97 OWNER NAME:BORG CHARLES T & NANCY P OWNER ADDRESS:4401 PALMER-WASILLA HWY. PALMER, ALASKA 99654 PARCEL ID:04103184 LEGAL DESCRIPTION: HILLSIDE NORTH #3 BLK 3 LT 2 LOT SIZE: 85464 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. 2. 3. 4. 0, 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 (18AAC72) 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 PR RECEIVED B ISSUED BY: DATE 6 i/ ,� DATE: (ncto & Alaska Water & Wast ewateir 8471 Brookridge Drive — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers June 2, 1996 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well & Sewer Permit for Lot 2, Bk 3, Hillside North #3 S/D. To whom it may concern: % 1 e ee gas b11... so 0:0 e ey A. Garnes C 5 % . AV pOFE5S10�1P\1,� The subject lot is undeveloped at this time. Howdie Investment Company has been hired by the owner to construct a 3 bedroom house on the site. It will be served by a private well and septic system. Comments regarding the proposed well and septic are summarized as follows: 1. Soils: At the proposed trench depth, the soils were a mix of SP to SP -SM. The soil had no rocks/cobbles and was very easy to dig in. The percolation rate of this soil strata was determined to be < 1 minutes/inch. Since it is a sandy soil, and underlain by a GM soil, we are not planning to install a sand filter. No groundwater or weeps were encountered. Soil samples are available if you would like to see them. 2. Trench Design: a. Percolation Rate: <1 minutes/inch b. Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. System Type: deep trench g. Effective Depth: 6 feet h. Width: 2 feet minimum i. Reduction Factor = N/A i. Length: 45 feet. j. Effective absorption area = 540 ft2 MUNICIPALITY OF ANCHUkat;r ENVIRONMENTAL SERVICES DIVISION JUN 4 1996 rR ECEIVEG 3. Surface Waters: There are no surface waters within 100 feet of the proposed septic system. 4. Slopes: See the 1" = 30' site plan for topography information. There are no slopes in excess of 25% within 50 feet of the proposed drainfields. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or on my digital pager at 1-800-481-1162. Thank you. Sincerely, Jeffrej/A//G1i less, P.E., M.S. Howdie Investmentsl.wps 0 PROPOSED WELL PRIVATE WELL LOT 9, BK. 3, HILLSIDE NORTH 43 SUBDIVISION. UNDEVELOPED. HOUSE IS LOCATED WITHING THIS WELL RADIUS, LOT 3, BLOCK 3, HILLSIDE -' NORTH #3 SUBDIVISION, OF Ae 00 SEPTIC SEPTIC SYSTEM .., LOT 2,• BK, ,B, ,HILLSIDE NORTH S/D #3 TH �>�! PREPARED FORT H❑WDIEINVESTMENTS ffrey A. Garnets } Q i i� •" CE -7953 �® PREPARED BY1 ALASKA WATER & WASTEWATER SERVICES 4 TF "•. e'°`,��`'�' ev YY 4 .YI 0FESS DATE, JUNE 2, 1996 DRAWN: GARNESS SCALES 1" = 100' LOT 1, BKI, LLSIDE NORTH 43, P IVATE WELL AND SE TIC. % -.PRIVATE % WELL % LOT 1, BK 3, HILLSIDE NORTH #3 SUBDIVISION UNDEVELOPED. BUT DESIGN SUBMITTED TO DHHS FOR PRIVATE WELL AND SEPTIC. LOT 2, BK .1, HILLSIDE Q0 % PROPOSED WELL ON THIS LOT NORTH #3 S/D. - % IS GREATER THAN 100 FEET ��. UNDEVELOPED, FROM LOT2, BK3, PROPERTY LINE. PROPOSED PRIMARY THE PROPOSED SEPTIC SYSTEM ON / RESERVE THIS LOT IS >GREATER THAN 100 % .AND TRENCHES. FEET FROM THE PROPOSED WELL % ON LOT 2, BK3. LOT 2, BK 3, HILLSIDE _ NORTH #3 S/D; SEPTIC SYSTEM AREA 0 PROPOSED WELL PRIVATE WELL LOT 9, BK. 3, HILLSIDE NORTH 43 SUBDIVISION. UNDEVELOPED. HOUSE IS LOCATED WITHING THIS WELL RADIUS, LOT 3, BLOCK 3, HILLSIDE -' NORTH #3 SUBDIVISION, OF Ae 00 SEPTIC SEPTIC SYSTEM .., LOT 2,• BK, ,B, ,HILLSIDE NORTH S/D #3 TH �>�! PREPARED FORT H❑WDIEINVESTMENTS ffrey A. Garnets } Q i i� •" CE -7953 �® PREPARED BY1 ALASKA WATER & WASTEWATER SERVICES 4 TF "•. e'°`,��`'�' ev YY 4 .YI 0FESS DATE, JUNE 2, 1996 DRAWN: GARNESS SCALES 1" = 100' TOP OF CUTBANK, SLOPES DOWN TO THE ROAD AT 50% SLOPE. THE NEW TRENCHES. SHALL BE 50' AWAY. ' sGROUND =.118,5 TEST HOLE A7 SR�99D C/0 DRAINAGE SWALE GROUND 116.7 � - 100,00 RESERVE TRENCH M.T. 45 FEET LONG. V � ELEV. = 116.7 / TEST HOLE C/O DOUBLE C/tl #1,. GROUND C/O - AT 113.97 t" 4 INCH7pV ' 1000 GALLON SEPTIC TANK C (D3034) 4 INCH PVC 03034) SLOPED T. AT' 1/4 INCH PER FOOT, - .GROUND = 109.6 C/O FOUNDATION C/O ELEV. = 112.49 PRIMARY TRENCH 45 FEET LONG 10 FOOT SEPARATION TO THE PROPERTY LINE a GROUND = 112.45 GROUND = 108.05 PROPERTY LINE !iAT—MOUSE WILL S1T .ON A iRAMAAL �U u ATr 30/ 40/, DOWN Tti� ?W DRAINAGE':' T EACH LQGAT, q AN A kS4X HT; F,LATCAU , 'THEY .WILL RUN SLIGHTLY PERPtNDICULAR TO IHE SLOPE CONTOUR&; THIS WAS TAKEN INTO CONSIDERATION :WHEry;7HE MAXIMUM_pEP7W:OFTHE:TRENCH WAS SPECIFIEZ. PHOTOGRAPMS'OF..THE ITE>WERE;5UBMITTED'WITH THE, DESIGN PACKAGE PROPOSED WELL �E OF At ,fit /i .•• 'r�9 �/ SEPTIC SYSTEM L❑T2, 13K3, HILLSIDE NORTH #3 •..:. •• 00 •••9. 0.9.09 0 PREPARED FOR+ HOWDIE INVESTMENTS :'Q4 ray A. Garne•f'; ; w • CE•7953' PREPARED BYI ALASKA WATER & WASTEWATER SERVICESF9 �'• ••''`���,; DATE. JUNE 2, 1996 DRAWN, GARNESS SCALE, 1' = 30' TOTAL TRENCH LENGTH d 45 FEET. TOTAL ABSORPTION AREA +. 540 SQUARE FEET. w LL co BACKFILL WITH NATIVE SOIL AND MOUND. TOPSOIL,A RESEEDING SHALL, BE THE REPSPONSIBILITY OF THE PROPERTY DINNER.. FILTER FABRIC S/L7 BARRIER. -PROVIDE 2 INCHES OF BOARD INSULATION IF SOIL COVER IS LESS THAN 3 FEET. INSULATION SHALL COVER THE EN7lRE'WIT f -OF THE TRENOH. 4 INCH .DIA., A8TM_F810. PERFORATED PIPE. INSTALLED WITH HOLES DOWN. PLACE 2" OF DRAINROCK OVER TOP OF PIPE, AND ACROSS THE ENTIRE WIDTH OF THE TRENCH. PIPE SHALL BE LEVEL (WITHIN .01 FEET). i i -MONITORING .TUBE (TYP). PERFORATED IN. DRAINROCK. NOTE: t TRENCHES SHALL RUN PARALLEL TO THE SLOPE CONTOURS. 2. . FOR LOCATION OF. .CLEAN -.OUTS AND MONITORING TUBES, .$&E SITE PLAN 3. CONSTRUCTION PRACTICES, AND MATERIAL SPECIFICATIONS SHALL COMPLLY WITH ANCHORAGE MUNICIPAL CODE 15.65,: "WASTE- WATER DISPOSAL REGULATIONS". 4. INSTALLATION SHALL COMPLY WITH SPECIAL PROVISIONS AS NOTED ON THE SEWER PERMIT. S. SMEARED BOTTOM AND SIDEWALLS SHALL BE RAKED. 6. DRAINROCK SHALL BE SCREENED PER M.O.A. SPECIFICATIONS. DIRTY DRAINROCK WILL BE REJECTED. TRENCH DETAIL: LOT 2, BK 3, HILLSIDE NORTH #3 P PREPARED FOR: HOWDIE INVESTMENTS 11� ALASKA WATER & WASTEWATER SERVICES � `rP•': DATE: 612196 DWN: GARNESS SCALE: NTS add 9d 0eq 09960:.0. 4....60 •96.66... ;Cc ffrey A. Garners CE -7953 AW ROFESSI�NP+~r. nr I/ 11 12- 13 2 13 ° 14 ° 15 o PtrT r% 6 ocD .Soit� 16 0 17 0 18 19 ENCOUNTERED? -- s -L IF A7 bVl-IAT ' A -. p DEPTH? N H DEPTH Depth to Water Aller 96 Monitoring? Date: 6 -- _ t �p Reading Date ross GTime Not Depth to Not im' Water Drop Te S~tpND-( G t mart hei 44 20 PERCOLATION RATE L (minute8[inch) PERC HOLE DIAMETER TEST RUN BE', WEEN —7 FT AND ? 5 F7 'OMMEN7S _ E)G _ t DT�' So t L S.. A- T L,i GA -s D �n��y`s,`i`�-f'I PERFORMED BY: JE �""_ f''�s I �( �Agwe . CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6% 9 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �0\N r> Ny�s ���' DATE,PERPORMED: L a�—z LEGAL DESCRIPTION: Ull %.SIDS ND�T3 f `� Township, Range, Section: SLOPE DEPTH (FEET) o 6 tC' F—T—T—F] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 pQeMc�z li r/ P<uz-71,4� sM /tea,, P2-0— SP TV SP-- 5"t' V Eft ,SC)pq— 5-0 DI Gr Nvr.��ou5 20c s�e-oe�t<S VtStAA-L` LOo KZ�D IPaF—T a"7 6rpo O WAS GROUND WATER w `� ENCOUNTERED? S L IF YES, AT WHAT µA. 0 DEPTH? N P E Depth to Water Alter Mnnilnrinn? Date: 6I 9 ■ 20 IL'lI PERCOLATION RATE L' ( (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 'OMMENTS g��� � So tLS PERFORMED BY: G EsS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: Z! 9th 20 IL'lI PERCOLATION RATE L' ( (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 'OMMENTS g��� � So tLS PERFORMED BY: G EsS CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: Z! 9th in accordance with tha industry practices. TT evaluation. Separatioi encroachments may e and septic systems di groundwater levels (t workmanship), and the are outside the contro system/s; therefore, G the well or -septic syst( can be installed on the the future. The contei perform the evaluation party .(including subse whatsoever. 6. DSD SIGNA i O gin;al Certificate Date: 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: HILLSIDE NORTH#3; BLOCK 3, LOT 2 Parcel ID: 041-031-84 A. WELL DATA *TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/13/96 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 346 ft. Cased to *131 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 7/13/96 7/24/18 Static water level 119 ft. 131.9 ft. Well production 4 g.p.m. 1.4+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate (°:)"mg./L. Collected by: GEG, Ltd. Arsenic: <5 _ug./L. Date of sample: 413 Jvq B. SEPTIC/HOLDING TANK DATA 22 YEAR OLD STEEL SEPTIC TANK MAY BE APPROACHING THE END OF IT'S USEFUL LIFE.51"OF LIQUID ON 7/24/18 Tank Type/Material SEPTIC/STEEL Date installed 7/1/96 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout.(Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping • 5/1/18 Pumper ALASKA SEWER AND DRAIN C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MONITORING TUBE Date installed 7/1/96 Soil rating •.p.d./''or ft2/bdrm) 1.2 System type DEEP TRENCH Length 46+ ft. Width 3.5+ ft. Gravel below pipe 6.45 ft. Total depth *12 ft. Eff. absorption area 593 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/24/18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 59 in. Water added 514 gal. New depth 62 in. Elapsed Time: 120 min. Final fluid depth 60 in. Absorption rate >= 45o+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NO If yes, give date - MONITORING TUBE EXTENDS APPROXIMATELY 75"BELOW THE INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. I - -•- Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS I ♦ 4 1 G. ENGINEER'S CERTIFICATION •�P��•O' •• '9♦♦ ♦♦ AI ' ..•71 .• ' * 4'Ili �\� • ♦♦I certifythat I have determined through field inspections and • - i review of Municipal records that the above systems are in •• • conformance with MOA COSA guidelines in effect on this • • • •• • date. ♦01.. /e fr A. Gorne s::-�= Engineer's Printed Name JEFFREY A.GARNESS ♦.S°•.• CE-79 : Ara ♦♦•'QFC'••• .C 1 F,�i Date `t 1 -LC)/�j LICENSE♦44��OFESS`��.♦♦♦ #AECC884 ���� (Rev. 10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • ;f1.4-�' 907-343-7904 On-Site Water and Wastewater Section Fax:343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval #0SC191135 Subdivision: Hillside North#3 BIk 3 Lot 3 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 22 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. L :!';94:.,[^ Vr ^ - 0Q 1 �,Y F6. - ..fa - , ^ ar'yt�C„ 9-;o., #.„ • �r+ :► i`` Def. _ ++1��� r k dr,.�° 1 o y 1 IP e, a • E . 14 : o 22 . . . k . Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650*www.muni.org HILLSIDE NORTH SUBD., ADDN. NO. 3 LOT 2, BLOCK 3 85,464 S.F. • / / / UQ / G� 4i 0 00 O. F, N1 p�O P ,�o / o (-4 -\• / C, ZY / g p / / / U / GRAVEL/RAP DRIVE SFS • • s!o !'4 9 ,9 •• .% EXISTING BUILDING .ti4 404 °wr t a• GRAVEL/RAF' DRIVE lQ 1 „_ 40 , s -+ � �;. • ik` o" 6 `a�/ WEII. 73 `V Sy �/O JVp Up, o„h ti A > • [3U 1 1 T 111E10 BY CF R IIFY MAI 1 HAVE SURVEYED 11•F GhSfhlD' IN1J) 1.'12UPLKEY RFPICJFD AROVI. ANI/ MAI NO ♦.�*RAA SURVk Y I I)! I LLQ FNCRDA(;IIMENP EXIST EXCEPT AS INDICATED. •11 15 111E RESPONSIBILITY OF THE OWNER 10 F OF . '41 1• JEFF A. GASIALDI, Ii.1.S. ��P� S 1 DETERMINE THE EXISTENCE OF ANY EASEMENTS. cs/•• ¢-�♦ 2000 L. DOWLINC RD.. SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT a �• 4911 • ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA 10 GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR ♦ g:'I'I*'r GoswW1- ` r 2143 4/18/20,2 ESTABLISHING BOUNDARY OR FENCE ONES. ♦♦• 'C, . 01' 4:1 ANCHORAGE RECORDING DISTRICT, AJASKA � �oM1alona1 0,640.• F.R. JOB NO. 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 041-031-58' COSA# as Q 1. GENERAL INFORMATION Expiration Date: O o2 do Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HILLSIDE NORTH #3 S/D; BLOCK 3 LOT2 10231 MIDDLEROCK * ANCHORAGE. AK * 99507 CHARLES & NANCY BORG Day phone 333-1146 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily identifiable features. The operational fife of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory 337-6179 Date z(a IZ _ bedrooms, with the following stipulations: Arsenic Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitr Advisory Other B. (Rev. nros Original Certificate Date: S-ltq 11,2 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: HILLSIDE NORTH #3 S/D; BLOCK 3 LOT 2 Parcel ID: A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID# N/A Date completed 7/13/96 Sanitary seal (Y/N) YES Total depth 346 ft. Cased to 131 ft. FROM WELL LOG Date of test 7/13/96 Static water level 119 ft. Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform 10� colonies/100 ml. Arsenic: N fl ug./L. B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. AT INSPECTION 10/18/11 131 ft. 1.7 g.p.m. /..a `7V Nitrate mg./L. Other bacteriaA211q colonies/100 ml. Date of sample: %Aa/La Collected by: GEG Ltd. Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping Pumper 1 :S G OL C �S C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/1/96 Soil rating ( .p.d./ r ft2/bdrm) 1_2 Length 46+ ft. Width 3.5+ ft. Date installed 7 Cleanouts (Y/N) Me High water alarm (YIN) N/A System type TRENCH Gravel below pipe 6.5+ ft. Total depth *11-12 ft. Eff. absorption area 593 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/18/11 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 38 in. Water added 810 gal. New depth 52 in. Elapsed Time: 866 min. Final fluid depth 42 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YM "Pump on" level at in. "Pump off' leve— High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer/septic service line 25'+ Public sewer rrr:anhole/cleanout N/A Holding tank . Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water n do N/A Water service line 10'+ Surface water 100'+ Driveway parking/vehicle storabe 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t 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 JEFFREY A. GARNESS Date µl26lr2 COSAFee $ `t f//Z%117 tS Date of Payment 1F 90W� 1Z Receipt Number ofLAY (Rev. 11/0.5) Waiver Fee $ Date of Receipt Number LOT 2, 3 85.4644 S.F. S.F. -ifi ETI—If H-m As w OF _ ROM RY fIR PIC D A I LNAN SIINEYNO U K G1EYIN IN ID — FlIERIMEHDf PIClEO FERC AT S tl nA F,NS HIEY WENS SIBID C%C[FI AS RV ER TOO. SUIT VE. pll.� LLL R HIE RE E EXISTENCE UE TIN OWNER EN JEEE A. CAEL.S COVENANTS THE RESTRICTIONS S ANY ,ADO III KKU f. AGE, 5 8 CNVEAR ON OR RRECOIRDED S SBAIt DU PEA BM1ti,PHONE, 50] UNDER ON RHE WSTANUED SHOULD AN PLAT. PHONE iHEREON NO CUSEUMSOR CES HROCI ANY DATA cXlo HEREON HI USED FOR Y OR FENCE U ES FOR 21U12 ESTABLISHING BOUNDARY OR FENCE L1NE5. MIDHORACE RECORDING DISTRICT. AIASNA T.B. Rfi- 11NOTE: NO CONNERS SET 7IFS DATE. Y MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES ARM Division of Environmental Services On -Site Services Section CMD P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING \ Parcel l.D.# 041 0 91-84HAA .# Ptl(A`\(,��.�Li 1. GENERAL INFORMATION Complete legal description l_o i z` gK 3 <<-� stO1 NdQ-x-13 Location (site address or directions) ?>n"g 2 0 M I M LE Property owner Day phone 333-1146 COi TA4 —Bfd1BOE Mailing address Lending agency Day phone ►J Mailing address L00% = IaVG—c--N"f Dayphone 3'76-4-7IIAgapA . l Address 1� �� —w<'s -LL �96ST4 , Unless otherwise,requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site x `.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. 72425 MAv. 1/911 Front MOA M21 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. Alaska Water & Name of Firm Wastewater Services '23-2-61-79 Address Phone — Address Engineer's signature Da4e `- OF q / •4406• ry(Q. �e 444. • (/ ` 0, 6 Jef A. Garness W ®®®� y 4• CE -7953 ,o 2�s 6. DHHS SIGNATUREFsq ••. ..•' 1., V Approved for bedrooms. -- Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: CAUTION E_ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and their lending institutions in orderto 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-=(Rev.1/91) Back MOA1121 nrv•v�.0 ruv, rav�.IlVb'1VC ENVIRONMENTAL SERVICES DIVISION DEC 101996 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES RE 1' _ Environmental Services Division 1- Y 825 L Street, Room 500*2 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L-o'r Z BK 3 +4,u S 3 Nam- rl Parcel I.D.: b4 I — O 31— S4 - A. WELL DATA N7� Well type If A, B, or C, attach ADEC letter. ADEC water system number S leted -7 j f 3 /c (6 Log present (Y/N) � / Date comp� Total depth 34" 6 Cased to 131 Casing height (above ground) 2 Sanitary seal (Y/N) N1 a( Wires properly protected (Y/N)F-5 FROM WELL LOG AT INSPECTION Date of test 7J13 J'7 i Static water level g.p.m. Well production 4- g.p.m. WATER SAMPLE RESULTS: P Nitrate �--je Other bacteria Coliform C/J Date of sample: i� � �� � �' Collected by: �S B. SEPTIC/HOLDING TANK DATA Z Cleanouts (Y/N)_ Date installed I t 6 Tank size 100a Number of Compartments -�--- Foundation cleanout (Y/N) - Depression (Y/N) tjO— High water alarm (Y/N) N�— Date of Pumping iJ 1p, Pumper tJ b, C. ABSORPTION FIELD DATA d./ft2 or ft2/bdrm) �' Z System type Date installed r 9b Soil rating (g.p• � gEl,ow Length 46 + Width 3'� + Gravel thickness below pipe 6 • g� Total depth ��- /Z F'16� �% Depression over field (Y/N) N� Effective absorption area 593 + Monitoring Tube present (Y/N) p test Fluid depth in absorption Fluid depth (ins) Mines 79-n9A (Rev. 3/96)` Results (Pass/Fail) For (in.); Immediately after. (past 12 months) (Y/N) rate = If yes, give date _g.p.d. NEti D. LIFTSTATION Date installed Manhole/Access (Y/N) High water alarm level at* "Pump *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 D a / -4- Absorption Absorption field on lot I So /+- Public sewer main IJ ! , Sewer /septic service line 8 5 Size in gallons "Pump off" level at* On adjacent lots 2:- loor On adjacent lots _ � ( no / Public sewer manhole/cleanout _ /J 6A - Lift station N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: i f=oundation Z6 •Property line "7.7 1= A Water main/service line > (0 Surface water/drainage >loo ;iEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line (� S /± Building foundation 6 I i+ i Surface water a 100 Curtain drain NoNa IWown/ F ENGINEER'S CERTIFICATION / bsorption field Wells on adjacent lots > loo/ Water main/service line > 10 Driveway, parking/vehicle storage area _ Wells on adjacent lots > 10 O l certify that l have de a mined t field inspections and review of Municipal in conforman w h A i elines in effect on this date. Signature _ Engineer's Na e A �S Date 12-/46. Z/toN76. HAA Fee $---j � Date of Payment 7 Receipt dumber z: - (J 7,s ;r , 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .110�o