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HILLSIDE PARK PUD LT 1
Onsite File Hillside Park PUD Lot 1 #015-122-50 Municipality of Anchorage f Development Services Department Building Safety Division - On-Site Water and Wastewater Program. 4700 Elmore St. P.O. Box 196650 Anchorage. AK 99519-6650 Page I of 2 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: -TW o 9 0 0 -7A PID Number: 0 IS' —I ZZ — so Nam Pckf R ;W Wastewater System: ❑ New 1�2 Upgrade TaA k •.a wl Address 700 1 7-r-o Gomele ABSORPTION FIELD Ptarle Number ol6adroom. 2z — �Tsy 13 Deep Tw Kh O shallow Tr rkm O Bad O Mound O om LEGAL DESCRIPTION Sed Penng Total Depm from olpnst grW GPDIFj FI. Block Lo summoov Depm to PIP, bbndm kom Wglnal grade Gr.vN depth beneam pips IS I afte pet�Sir P.u. n Ft. FI Tow sivp Range swc on: FYI added above ung." grade Grewal Length Ft. Ft. Well: El New ❑Upgrade Gravel endm: Number of Ines Distance between Ines Ft Ft Clesrbuoot (Pnvate. A. B. C) Told Doom CaW to Tor absorption ares Pipe Maters, 'A •' Fl. Ft FIt O -3!!$ ve- DrYler Date Dnlsd Static Walr Levy metals. Date mstased FL /� IeGiae;ea- IEX I _r/2_q 10 ywd Pump Set at Dating lNght Above Gra TANK GPM Ft. FL SEPARATION DISTANCES IR Septic ❑ Holding ❑ S.T.E.P. Q Other. To Septic Absorption Lift Holding lublrJPrtvate W,%Aaasa, .Pauly, From Tank Field Station Tank Sewer Line A,% elno n q n 4 I Z-S'o Gat Wetl 7 ZOO Mama / I Number 0 CCompanmens. LIFT STATION ¢. nu adorer Lot tin' 19, Gal 'Pump ol'svl at 'Pump otr lev.tat at Wan "atYsrmLL Foundation in N Pop Make 6 Model Eledntll Inspections io donned by Contra Oran Renurke BENCH MARK qlreatity7t, kwee, 112e �,, Location and D.sulptian LrC0..1M .f 10 lCo�CIT&F6. ot it as Iveliho.. wnsd L10v81,on. n/ialG �✓Cl' on n 2 /o�i� FL Engineer's Stamp Inspections performed by: Ffuf,lon TezA S'—c Dates: 1" S'12-914,9 gc�tspq 1E e rad p R `t=G' Development Services Department Approval •. • `� � •y A • 00 �`�a' ` e� wi ea C,' `• Conditional Approval Date: N r ... I .......... 4' �L� 11400RI! j CF•3589 ., e3 t� a Reviewed and approved by te: >,r .,,s,-_•, l6e (Rry deod) -f�,• PERMIT NO: SW 090070 PAGE 2 OF 2 rte PID NO: 015-122-50 ri_ LOT 1, HILLSIDE PARK P.U.D. EXISTING SOIL ABS. TRENCH NEW 1250 GALLON } SEPTICCrT�ANK SWING TIES: 4-BDRM ' «F" -A- "B" HOUSE TBM "E" r FROM: COR. COR. I + r TO:~ «D. - FDN. C.O. 6.5' 5.5'«C« S.T. C.O. "C" 24' 21.5' « . S.T. C.O. "D" 32' 29.5' DBL. C.O. "E" 34' 31' ;rr TR. C.O. "F" 3T 32' PLAN VIEW SCALE: 1" = 30' FINAL GRADE ELEV. 91.9' 5'SOIL COVER 2' RIGID INSULATION INV. 250 -GALLON 85.8' INV. EPTIC TANK 85.8' PROFILE VIEW NOT TO SCALE ir• ,�! ......................... ittE THEDOWF.■OO i� s ._ CE - 3589 h LOT1, HILLSIDE PARK P.U.D. SEPTIC TANK REPLACEMENT AS -BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES SCALE AS NOTED 14530 ECHO CANYON ROAD DRAWN BY TFM ANCHORAGE. ALASKA 99516 NOVEMBER, 2009 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 22, 2009 Expiration Date: May 22, 2010 Permit Number: SWO90070 Parcel ID: 015-122-50 Legal Description: HILLSIDE PARK PUD LT 1 Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 007001 TREE TOP CIR Owner Name: PAUL REID Lot Size: 45583 SO. FT. Owner Address: 7001 TREETOP CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-6828 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 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: Date: 9f, Z / c-2 Date: �Jy �%i- Municipality of Anchorage Development Services Department Building Safety Division I On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0/5 -12:2 --SO Property owner(s) E -Z" I Roca( __ Day phone 2 29 — 7 T S -v Mailingaddress 70o1 T-rse14.42 Lcret�,, AAc6of3224 Zip Code 99X-6.7 Site address Code Legal description (Sub'd., Block & Lot) 1,c,f +, ff•tlteatt Pink P. u. n Legal description (Township, Range & Section) Lot Size y5, 583 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ER Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms Y THIS APPLICATION IS AN: Initial ❑ Upgrade N] Renewal ❑ floor[ Gc�tcCcld Aelilace.tietf of &tica"os::�p Tanlr 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 applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: S30 =` Waiver Fees: Date of Payment: s -/Z? / OQ_ Date of Payment: Receipt Number. 5 Receipt Number. (Rev. 11/05) 4 'TLATTOP TECHNICAL SERVICES _ CML & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PHJFAX:(907)345.1355 ANCHORAGE, AK 99516 E -Mail: tgmooreftci.net May 21, 2009 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to replace a collapsing septic tank on Lot 1 of Hillside Park P.U.D., located at 7001 Treetop Circle. A site plan and specifications are enclosed for your review. Due to the collapsing condition of the existing tank an expedited review and approval would be appreciated. Please give me a call at 345-1355 when the permit has been approved. Sincerely, �-�-.� %i� Ted Moore, P.E. U Z m ¢U F 0 F IQ-- w w w J Q i R=100' �L LOT 3, BLOCK 2 TA GOLDEN HILLS S/D PRIVATE WELL `, Il INSTALL NEW 1250 -GALLON DEEP BURIAL , SEPTIC TANK 4-BORM HOUSE LOT 1, HILLSIDE PARK P.U.D.` , T E� i\ r V� _RETAIN EXISTING SOIL ABSORPTION TRENCH _INSTALL SEPTIC DBL. C.O. AREA / ABANDON EXISTING 1500 -GALLON SEPTIC TANK HOUSE \ LOT 2 DRIVE HILLSIDE PARK P.U.D. , TRACT A (VACANT) \ , , , NOTE: ALL HOMES IN HILLSIDE PARK AND VALLI VUE SUBDIVISIONS SERVED BY CLASS "A" WELLS LOCATED >209 FROM THIS SEPTIC SYSTEM , , , , 49m ;* .................... THEODORE F. MOORE CE - 3589 _, LOT 1, HILLSIDE PARK P.U.D. SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECI10 CANYON ROAD DRAWN BY TFM ANCI IORAGE. ALASKA 99516 MAY, 2009 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Tfattop ?echnicalServku 14530 Echo Canyon !R9a4 Anchorage, AK 99516 Thone (907) 34S -135S Lot 1, Hillside Park P.U.D. 7001 Treetop Circle Septic Tank Replacement Specifications 1.0 General: 1.1 The scope of the project consists of abandoning a collapsing 1500 -gallon steel septic tank and replacing it with a new approved 1250 -gallon deep -burial steel septic tank located as shown on the site plan. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. 1.3 The installer shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The installer shall provide adequate cover material and rough grading over the tank to ensure that proper drainage is achieved after settlement and that there are no residual depressions. 1.5 The homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing 1500 -gallon steel septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250 -gallon steel, 2 compartment septic tank shall be fabricated from 10 -gage steel to allow burial as deep as 8 feet. It shall be Municipally approved and set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet it shall be insulated with 2 inches of rigid insulation plus 2 feet of soil cover. 2.3 A double cleanout shall be installed in the discharge line within 5 feet of the tank prior to the point of connection with the existing soil absorption trench. 3.0 Inspections: 3.1 A total of 3 engineering inspections will be required during the course of the project: (1) initial discussion with the contractor to finalize the location of the tank and construction procedures, (2) after the tank is set level and piping connected but prior to backfill, and (3) after rough backfill and grading is complete. The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE XNEW Aj f G , 6 /-.6,6 ❑ UPGRADE ADDRESS 3 rd.ST. E 14tr @ 5(3 :� -su )'tr' d3 'DESCRIPTION .3T 1.K SX 14 )1 L L,5 i'o E PAR rt 112AJ 1q -3W Sec. 14 ,ATION * NO. OF BDROOMS dQEE -%&P C,p CLL j, Well MoT Absorption are, Dwelling PE IT NO. L)Y DISTANCE TO:I 1A) 1Ci PROM -Sc 07„30 o~. ZZ Manufacturer Mater l No. of cc r rtments W� E N I-) capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ❑ Y DISTANCE TO: Well Dwelling PERMIT NO. J2 _ Manufacturer Material Liquid capacity in gallons ❑ Well AJOT' Foun tJ'� n ) t Nearestn� 0 "'M-23b w= DISTANCE TO:C5/.,o � J Z w No. of lines Length ofg�c�ine Total len9 of lines Trench w�cltIt Distance b tw n lines f.. Top of the to finish grade I Material beneath rile 8 Total effeLt _ e ab5p pti rea o- Length Width Depth PERMIT NO. W (7 <I- Type of crib Crib diameter Crib depth Total effective absorption area wa W rn Well Building foundation Nearest lot line DISTANCE TO: Class A/4017- Depth Driller Distance to lot line PERMIT NO. J J AJ W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER IN PL. PIPE MATERIALS C: 5`T IRON t) 30 3 if SOIL TEST RATING ' I INSTALLER MEW -rWU EX 9 IP REMARKS p e l VaAJe iv F i'C OWEA 'rRINC-4 a11SP= # S0 CAr6 4-c3� C p C. .(fy APPROVED DATES LEGAL A140K Tl? -Au 0?3 w Sac 14 /� ^ � ` ���I C"' :1 IF"' WC�- L...'�� 101 IP:` ir.-% P4 I[:-_: IFA 01 IFZ t�`h�E"---' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � 825 L STREET, ANCHORAGE, AK 99501, 264-472O C) !NJ _.... E'."I 1: �3 E-Zt4l V"EE- F�Z MI ~ ` PERMIT NO: 840730 ^ DATE ISSUED: 07/13/84 APPLICANT: A E C S v �� ADDRESS: 1200 W 33RD ANCHORAGE, AK 99503 CONTACT PHONE : 561-5040 LEGAL DESCRIP: SUBDIVISION. HILLSIDE PARK LOT: 1 SECTION: 14 T8WNSHIP: 121\1 RANGE: 3W LOT SIZE: (SQ°FT. OR ACRES) MAX BEDROOMS: ---- Listed below are the options available to ' you in designing system. Choose the option that best fits your site. E�'t IE-:7�� DEPTH TO PIPE BOTTOM (FT.) 3.0 2.0 +�* GRAVEL DEPTH (FT.) 0.5 1.5 TOTAL—DEPTH (FT,) 3,5 ` 3.5 GRAVELWIDTH (FT^) 24"0 5"0 LENGTH (FT. > 45"0 111"0 ** ^GRAVEL GRAVEL VOLUME (CU. YDS. 40^0 41"2 TANK SIZE (GALS> 1,250^0 ** 1�250"O ** . SOIL -RATING (SQ"FT. /BR) ` 177 177 MM BLOCK: NA Your septic , ** DEPTH TO PIPE BOTTOM < 3"5 FT" REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4"0 FT. MAY REQUIRE A LIFT STATION ** GRAVEL LEN8TH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT" EACH> ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ~~.... .-.... ~... ~_�.... �.-_.... ~.... .... ....... ... ~~_� I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of'Anchorage (MOA) and the State of' Alaska. 2 I will install th�� system in accordancewith all MOA codes and regulations, and, in compliance with the design criteria of this permit" 3" I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wa5tew�ter 5y�tem or public sewtcrage systemon this or any adjacent oP nearby `lot"- 4" I understand that this permit is valid for a maximum of 4 bedrooms and any enl�rgement will require an additional permit. ` IF A LIFT STATION IS INSTALLED IN AM AREA COVERED BY MOA BUILDING CODEF, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE SIGNED ..... .... �..... ..... .... ... .... .... �..... ... �.... ... ......... ~�... ........ _ APPLICANT: A E C S �",UNICIPALITY OF ANCHORAGE Department;' Health and Environmental otection 825 L Street, Anchorage, AK. 99501 264-4720 Permit 4 �t�o% � # # HANDWRITTEN PERMIT # # WEiA R ON-SITE SEWER PERMIT �J Applicant: /S Mailing Address: Location: ,/ Phonp Number: Legal Description: '-r1.2Z43gi6t Size: �8 Type of Soil Absorption System Is: Trench: _ Drainfield: (/ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ , Soil Rating(sq.ft/br) 1-74(7 The Required Size of the Soil Absorption System Is: DEPTH �, LENGTH __ GRAVEL DEPTH _�_t_(5 WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). REQUIRED SEPTIC(HOLDING) TANK SIZE _ ��ga GALLONS # aE 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. # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs. are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I wil install thff accordance with codes. (3) I u e stand that sewer system may require enlargement if th r sidence is include more that bedrooms. Signed:Issued by: Applicant Date. Q SWP/024 (1/81) ALASKA �i UROWnTAL COnTROL SeWUS, InC. Enyneerinq & Enuironmental Studies August 30, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99503 Attention: Keith Bandt Subject: Hillside Park Subdivision, Lot 1, Block 0 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP 5 1984 RECEIVED Dear Mr. Bandt: On August 25, 1984 a new soil test was performed on the above subject lot. The soil was better than on permit, so system was redesigned accordingly. The system was also redesigned for a four (4) bedroom house. If you have any further questions, please feel free to contact me. Approved Pres Sincerely, A -k'7 k) A John W. Gates Engineering Technician PhD, P.E. t.)nn Illo<t Q4rd Anrnno %nits R • Anrknrnne Alncka 99503 •(901) 561-5040 !^ SOILS LOG MUNICIPALITY OF ANCHORAGE <. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SSOILS LOG — PERCOLATION TEST PERFORMED FOR:_/✓ ®V L /h 161DATE PERFORMED: y LEGAL DESCRIPTION: FEP T) d vr C 3 —00 ?r 4 r r U �. -eul i 6 d r t 4et^r_- uc a r r < { e� o (✓ 8 r r 9 e i " " of a 10 r® t r K e n e WAS GROUND WATER 11 � � ENCOUNTERED? t r o. 12 r , r IF YES, AT WHAT " ` w DEPTH? 13 17 e1 18- 19- 20 8 1920 COMMENTS SITE PLAN r a Gross Time Net Time Depth to Water Net Drop 14 �P 15 d` t � n EEE P � e 'j 16�- 0 MEN 17 e1 18- 19- 20 8 1920 COMMENTS SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop MEMO MIEN EEE 'j 0 MEN Reading Date Gross Time Net Time Depth to Water Net Drop 'j PERCOLATION RATE TEST RI N/BETWEF" FT AND (minutes/inch) , FT PERFORMED BY: CERTIFIED BY:- DATE ^���/� MUNICIPALITY OF ANCHORAGE PERCOLATION ..� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST ' 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: \ ETE,a S #4 3al Ay'T" DATE PERFORMED: 30 - S3 LEGAL DESCRIPTION: L1?P\YZK SID ;t -D ?-S3!1 ,a♦---SSL-OPE SITE PLAN I -�- I `f `F'/'1 Tr 1- 3== 4- 5- S • 16�T y S A, 400 Gl'2AJx u. (A 11) ' fI .'iAJtL� �s ti1� 8 - .. 9 10-D 11 ��, ,d"' 10, OF A 1 'A A u c014'Q'/p. ;>) ISC4'/�t, cSPi 5t%ty �EFJS AL– WAS GROUND WATER •.T.ys�Y 4��£� NCOUNTERED? rte,` ` S•�T �i'�{.� IF YES, AT WHAT eea DEPTH? ywa • • •.•••• ..•..• �1 1 C. Rei Jrr y .•"•••A•yaIs a'•. % o. 2251: �! ,e'9 Net Timei\t•1.,4) Depth to Water(CF) Net Drop cr- OFESSI ..•. ......r... .. 17 t ; % rn 18 Cs -'; l C. Reid, Jr. �, Ik "-LO o. 2251-E �,I��PL1nr�ne\t1l�p 19 .?-% — I IL^—Jj PERCOLATION RATE1ZJ5� (minutes/inch) TEST RUN BETWEEN y• a FT AND FT COMMENTS i I F4 J Q�D;�r..� _��O E� a.Y -'•" C r -- Fic.0L s. PERFORMED BY:CERTIFIED BY: DATE:_ 72-008 (6/79) 1.4 Reading Date Gross Time Net Timei\t•1.,4) Depth to Water(CF) Net Drop cr- t ; % rn to 1`4 Ik "-LO y l $ a .?-% — 2 a q1 Z �� �0 4 • t5 o r -3 t B 1(j + -1 3 �, p •Za +>a,o psi a 3(21, 5 A'.0I 10 `4 tZ IL^—Jj PERCOLATION RATE1ZJ5� (minutes/inch) TEST RUN BETWEEN y• a FT AND FT COMMENTS i I F4 J Q�D;�r..� _��O E� a.Y -'•" C r -- Fic.0L s. PERFORMED BY:CERTIFIED BY: DATE:_ 72-008 (6/79) 1.4 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-122-50 1. GENERAL INFORMATION: ab Complete legal description Hillside Park, Lot 1 Location (site address) 7001 Tree Top Circle *Anchorage, AK Expiration Date: MO -0a 1 a 001 a `� Current Property owner(s) Daniel & Crystal Rogers Day phone 907-244-7548 Mailing address Real Estate Agent 7001 Tree Top Circle *Anchorage, AK 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 Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J .90 Date of Payment Receipt Numbers 75 Ci COSA# 05G2Z 12 52 Waiver Fee $ Date of Payment Receipt Number Waiver # W5 6. 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 2� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for ( bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fol #AECC884 OF f A*( ON-SITE WATER. AND zgtiBul ta���TEvVATER o �PROGRAM o\': ou ,7j))) Fl))I 1 By: i? UlYlt!4Z4� Ori inal Certificate Date:y �� Lo (� g 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. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc .1 . ...... ........... #AECC884 OF f A*( ON-SITE WATER. AND zgtiBul ta���TEvVATER o �PROGRAM o\': ou ,7j))) Fl))I 1 By: i? UlYlt!4Z4� Ori inal Certificate Date:y �� Lo (� g 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. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.doc �9 �p Legal Description: Hillside Park; Lot 1 If more than 1 septic system on tot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for C Static wate eat beginning of test ft. B. TANK DATA Age of tank(s) 13 years Tank type/material _PW1_' Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping � I i- I D. ABSORPTION FIELD DATA Parcel ID: 015-122-50 Structure served by this system Well production at time of test q Water storage tank volume gallons Well disinfectedf i orm test? El Yes ❑ No ❑ Co ' bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station year Lift station material Which system tested (date installed) 1984 1 Adequacy test date 5/21/22 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 10.5 ft (max) Fluid depth prior to test 11 in Measured depth to pipe invert from grade 5.84+ ft (min) Water added 704 gal ❑ N/A — pressurized field New depth 49 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective a.ss ❑ Code -required soil cover over field Final fluid depth 30 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test Gallons introduced n/a gallons If yes, enter date n/a Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Clea _ 00' ❑ Yes if No ft Yes if No ft Neighboring Tank > 100' r-1 F1 if No ft Private r Septic Line > 25' ❑Yes if No ft Absorption Field on Lot > 100' F1Yes if No _ Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 10 ' Animal Containment > 50' ❑ Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Commu wer Main > 75' ❑Yes if No ft El Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' Q Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑r Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS Wet-Code-att-time-ohnstaffati© — G. ENGINEER'S CERTIFICATION I certify that / 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. COSA Checklist yellow sheet 0 F A * : g H �* ffr A. Garn s: Q P,. 7. E)-fjj 793 0� s , 444�aPro fessia�°ate #AECC884 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 *4-" qu APR 161 reld'811 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-122-50 Expiration Date: 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK S/D; LOT 1 Location (site address) 7001 TREE TOP CIRCLE, ANCHORAGE, AK, 99507 Current Property owner(s) PAUL & KATHLEEN REID Day phone 229-7754 Mailing address 7001 TREE TOP CIRCLE, ANCHORAGE AK 99507 Real Estate Agent BETH WEISER W/ JACK WHITE Day phone 223-1632 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site U Public Water System ❑ Public Sewer ❑ Waiverd/ariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '52lo// Date of Payment �1�f Receipt Number ),� /�l Y COSA# t3Se 14�i Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: — 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. /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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date f6 o 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 o0 U DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation O�� • • q 4 distances measured to readily identifiable features. The operational life of all wefts and 'c' O 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 fest /Tj results do not guarantee future performance of the system, nor do they guarantee that Q.... "' _ ) ".. ""' • .. there are no hidden defects or encroachments. GEG, LTD. can therefore not provide / 1 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 O ✓ (7'.J A> the safe benefit of the owner listed above. Any reliance upon or use of this report by any .Gayness,: O A e'y other person or party is not authorized, nor will it confer any legal right whatsoevero4 g. C 7 53 ym G 4p P;e �f�iG�t�f 6. DSD SIGNATURE°Prof esslon 400�`��p00o System #1 Approved for _�` — bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Pti�ty OF A/VC"((/( ON-SITE WATER AND ...c-e�WATER By: Original Certificate Date: 7 — The M Icipality A orage Develop,emt 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 engineers work. 7. ATTCHMENTS: COSA Checklist �� Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other IRA isms 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 PARK S/D; LOT 1 1pt� 0 Parcel ID: 015-122-50 A. WELL DATA Well type COMMUNITY Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE If A, B. or C provide PWSID# 212461 Well Log (Y/N)- Sanitary seal (Y/N)_ Wires properly protected Cased to ft. Casing height (abo n FROM WELL LOG g.p.m. ATI Coliform �-� colonies/100 ml. Nitrate mg./L. Collected by: ft. in. Vinic: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/29/2009 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) T Depression over tank (Y/N) NO /High water alarm (YIN) N/A Date of pumping `"' �" Pumper a � ✓✓t /t C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 8/27/1984 Soil rating (g.p.d./ft or /bdrm 150 System type TRENCH Length 40 ft. Width 4 ft. Gravel below pipe 8 ft. Total depth *13.4 ft. Eff. absorption area 640 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 3/7/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 1 in. Water added 1170 gal. New depth 76 in. Elapsed Time: 120 min. Final fluid depth 23 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN 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 at wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service areas COMMUNITYWELL On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field *5'+ Water main 10'+ Water service line **10'+ Surface water 100'+ Wells on adjacent lots 100'+ PRIVATE/200'+ PUBLIC 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'+ PRIVATE/200'+ PUBLIC F. COMMENTS *BASED UPON 3/15/2010 AS—BUILT DRAWING BY TED F. MOORE P.E. **SEE 5/21/2009 TED F MOORE P E DRAWING ON FILE W/ MOA. G. ENGINEER'S CERTIFICATION 1 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 JEFFREY A. GARNESS Date 01 bliq (Rev. 11/05) ■ 2 )!` q� a2m E�` - 2■§ %§@Ek\ � ■ n Municipality of Anchorage Development Services Department Building Safety Division = : On -Site Water 8 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cf.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL ^ FOR A SINGLE FAMILY DWELLING Parcell.D. 615—Z.2L✓.(./ HAAft�nzz& 1. GENERAL INFORMATION Expiration Date: / 0 — * — O & Complete legal description HILLSIDE PARK PUD SUBDMSION• LOT 1 Location (site address or directions) 7001 TREETOP CIRCLE • ANCHORAGE AK 99507 Current Property owner(s) BRUCE dr SHARON GAGNON Day phone 346-2592 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 7001 TREETOP CIRCLE • ANCHORAGE AK 99507 Day phone BETH WEISER w/PRUDENTIAL J.W. Day phone 726-3111 3801 CENTERPOINT DRIVE 1200 • ANCHORAGE. AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class -A- 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 professionaf 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 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 horoto 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 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 Municipal the on-site water supply and/or wastewater disposal system is(are) in compliance with all app ' 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 Guidehnes & 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 life 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 fatuity 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 confor any legal right whatsoever. 5. DSD SIGNATURE —1Z Approved for _*; bedrooms. Phone 337-6179 Date Iy 05 Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-sTTE WA�TEWATE�R Attachments: HAA Checklist :� Maintenance Agreements Septic System Advisory Supplemental Engineer's Repot' Well Flow Advisory Other By: Original Certificate Date: / 0 — 4 _ 0S (Rw. 12101) Municipality of Anchorage Development Services Department �J Building Safety Division On -Sits Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-68W www.ci.anchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HILLSIDE PARK PUD SUBDIVISION: LOT 1 Parcel ID: A. WELL DATA COMMUNITY WELL Well type _W K A, B, or C provide PWSID# 212461 Well Log Y Date completed Sanitary seal (YT /N) fres properly protected (Y/N) Total depth ft sed to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate mgJL. co onies/100 mi. Arsenic: Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material _ STEEL/SEPTIC Date installed 8/27/1984 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/13/2005 Pumper MCDONALD'S PUMPING C. ABSORPTION FIELD DATA Date installed 8/27/1984 Soil rating (g.p.d./ft'or(l!!� 150 System type DEEP TRENCH Length 40 ft. Width 4 ft. Gravel below pipe 8 ft. Total depth 13.2 ft. Eff. absorption area 640 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/12/2005 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth In absorption field before test DRI' in. Water added 800 gal. New depth 30.5 in. Elapsed Time: 172 min. Final fluid depth 21.5 In. Absorption rate >= 600+ g,p.d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer COMMUNITY WATER On adjacent lots On Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water service line Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line •13' Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 20'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS PER 1984 INSPECTION REPORT G. ENGINEER'S CERTIFICATION Akv••r;• I certify that I have determined through field inspections and * 4 Y* review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. • . , • .. , .. , , • .. ........ . y JEFFREY A. GARNESS 79 3 mess.- ` Engineer's Printed Name +� •. y,T /5 '• ��' Date q/1 rf /ate PP. as HAA Fee $ L `y Waiver Fee $ _ Date of Payment P j �' — Date of Payment Receipt Number -7 Receipt Number (Rev. 12101) F 0 nN� f5�z d" w�f �aa SN 6� OI5 'o ygp0 / ^r Zpg•Sp a/ n / a / y n / ^ + N icl z / NV • I p' / � N � V r m ;0 m LI -4 r 0 M v Mil \0 �o O °y v 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 I.D. # n1 129 SO HAA # ►.\ "I �� �> � � `n`� 1. GENERAL INFORMATION Complete legal description Lot 1 Hillside Park PUD Section 14, _T12—N, R3W r- 1 1*e: s ,k Rrdperty owner 4 Mailing address rtding agency a, , Ii'rig address . Agent"::;a A cress or directions) . �iY'�1-e P.0% jr :a Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 1 3. TYPE OF WATER SUPPLY: Day phone 269-3546 Day phone Day phone r � Individual well Community well x Public water (1 ,,( err 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: It community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 921 5. STATEMENT OF INSPECTION BY ENGINEER 6. By: 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 Criterium Alaska Engineers Phone 349-1003 Address Engineer's signatu DHHS SIGNATURE X Approved for ';W 63 bedrooms. Disapproved. Conditional approval for Additional Comments Date 6/22/93 bedrooms, with the following stipulations: 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)RBV. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1, Block 1 Parcel I.D. 015 122 50 Hillside Park PUD A. Well Data — not applicable Well type C If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test o 0C_ Static water level TOM :ZD Well flow g.p.m. g'p'm' n ;.i N o Pump levell C c n n SEPARATION DISTANCES FROM WELL TO: N/A .Z 3� Septic/holding tank on lot ; On adjacent lots Absorption field on lot ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date install I I� �&_ Tank size 1,500 gallons Compartments Clean"• s++ " oundation cleanout (Y/N) v Depression (Y/N) ralarm (Y/N) F Alarm tested (Y/N) aping 6/18/§:3` Pumper Old McDonalds 46 w, % "s SEAI'U DISTANCE,_ EPTIC/HOLDING TANK TO: Well(smli; "' _ On adjacent lots 200+ Foundation 14 To property 16764 Absorption field 19' Water main/service line 100+ Surface water/drainage 90c) -l- 72-026 (3/93)* Front 0na-72-026(9/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION N/A 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: Well on lot D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed $/17/84 Soil rating (GPD/Ftz) 1.0 GPD/ft.2 System type Deep trench Length Width Gravel thickness Total absorption area 640 ft.2 Cleanout present (Y/N) Total depth Depression over field (Y/N) N Date of adequacy test 6/21 /93 Results (pass/fail) Pass for 't Bedrooms Water level in absorption field before test 11.4' (&{,{p,n ) After test 9.4 Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Community On adjacent lots 200+ Property line To building foundation To existing or abandoned system on lot On adjacent lots 60' Cutbank N/A Water main/service line Surface water 280+ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect Signatur Engineer's Name T eodore A. Johnson, P. E. Date _ 6/22/93 HAA Fee $ % 7 D ' D 0 Date of Payment (n — cl/� 2 Receipt Number e�� 1 70 -ADA /A/OAI' R.,4 Waiver Fee $ Date of Payment Receipt Number all CE 51 of this inspection. July 13, 1993 Municipality of Anchorage Department of Health and Human Services On -Site Services Division P.O. Box 196650 Anchorage, AK 99519-6650 Attention: Susan Oswalt P.O. BOX 111790 ANCHORAGE AK 99511-1790 TEL 907 349-1003 IN AK 800478-1003 FAX 907 344-9936 RECEIVED JUL 13 1993 Municipality of Anchorage Dept. Health & Human Services Reference: Lot 7, Hillside Park PUD, (7001 Tree Top Circle) Anchorage, AK (Job #93390, FDIC/Stout) Dear Susan: The purpose of this letter is to address your questions regarding the Health Authority Approval (HAA) for Lot 7, Hillside Park PUD. Your first question was whether the request was for a three or four bedroom system. According to the sellers, FDIC, the home has been listed and is being sold as a three bedroom house. A copy of the appraisal showing three bedrooms is attached. Your second question related to the length of time the home had been vacant prior to our test, and if that period was over three months, if the system was pre-soaked prior to the test. According to Robin Stout of FDIC, the system had not been used since March 1993. To comply with this regulation, the system was doused with 2,000 gallons of water followed by 914 gallons of water on July 12, 1993 and retested. Similar pre and post test results were obtained as on our earlier test of June 21, 1993. Please note, however, that the 11.4' pre-test reading is the bottom of the monitoring tube. We believe we have answered your questions and concerns and respectfully request HAA approval at this time. If you have further questions regarding the testing or this report, please feel free to call us for clarification. Sincerely, Theodo e A. Johnson, P.E., L.S. Princi al TAJ/jbj/Attachments REGISTERED PROFESSIONAL ENGINEERS BUILDING INSPECTIONS INVESTIGATIVE ENGINEERING LITIGATION SUPPORT CONSTRUCTION MANAGEMENT �v � g `a.4°xe 5'rar 'n wNt. e" 'R 44 £ �F Ft $ pk rZl i rx4 `} - i2 ��' ` z Ux� y x lL S K I�E1 VEER S I July 13, 1993 Municipality of Anchorage Department of Health and Human Services On -Site Services Division P.O. Box 196650 Anchorage, AK 99519-6650 Attention: Susan Oswalt P.O. BOX 111790 ANCHORAGE AK 99511-1790 TEL 907 349-1003 IN AK 800478-1003 FAX 907 344-9936 RECEIVED JUL 13 1993 Municipality of Anchorage Dept. Health & Human Services Reference: Lot 7, Hillside Park PUD, (7001 Tree Top Circle) Anchorage, AK (Job #93390, FDIC/Stout) Dear Susan: The purpose of this letter is to address your questions regarding the Health Authority Approval (HAA) for Lot 7, Hillside Park PUD. Your first question was whether the request was for a three or four bedroom system. According to the sellers, FDIC, the home has been listed and is being sold as a three bedroom house. A copy of the appraisal showing three bedrooms is attached. Your second question related to the length of time the home had been vacant prior to our test, and if that period was over three months, if the system was pre-soaked prior to the test. According to Robin Stout of FDIC, the system had not been used since March 1993. To comply with this regulation, the system was doused with 2,000 gallons of water followed by 914 gallons of water on July 12, 1993 and retested. Similar pre and post test results were obtained as on our earlier test of June 21, 1993. Please note, however, that the 11.4' pre-test reading is the bottom of the monitoring tube. We believe we have answered your questions and concerns and respectfully request HAA approval at this time. If you have further questions regarding the testing or this report, please feel free to call us for clarification. Sincerely, Theodo e A. Johnson, P.E., L.S. Princi al TAJ/jbj/Attachments REGISTERED PROFESSIONAL ENGINEERS BUILDING INSPECTIONS INVESTIGATIVE ENGINEERING LITIGATION SUPPORT CONSTRUCTION MANAGEMENT rraperrrueeonanaeeyr<aetrnrufrNarUMM a;rxre�waw a Nall AwbO ALINAU rscrurs s rile no. 97Arl5�2 4714 <3 PrFopr dress 7QQ1 Tree Top C,iri Ili Census Tract pg.01 C(nchorege Coun State LENDEADISCRETIONARYUSE Sale Price $ "„ .AKii _Cp _ode LegalDeaeriptian Lot 1. Hillside Park P.U.D. Date ' Owner/OGGUpant Leslie Pace Map Reference —. Mortgage Amount i , Mortgage Type Discount Points and Other Concessions J; 5211 Price N A Date of Sale N/A ':. Loan charges/ooncesslons to be paid by seller; PROPERTY RIGHTS APPRAISED rXI Fee Simple I Fit Taxes; 4,590.30 Tax Year 1990 HOA;/Mo, 500/yr N ❑Leasehold Paid by Salley ; N . Lender/Client F.D.I.C. Asset 27§§1151-142B ❑Condominium(HUDNA) 1990 Assessed Value $400.900 De Minimis PUD Source SM LOCATION Urban ❑X suburban =Rural NEIGHBORHOOD ANALYSIS Good Avg, Fair Poor .rH4 : BUILT UP X over 73% ❑ 29-1596 ❑Under 25% Employment Stability ❑ � ❑ ❑ .;�>rx GROWTH RATE Rapid XStable Slow Convenience to Employment❑ F1 jf $ PROPERTY VALUES ❑ increasing Q Stable ❑ Declining Convenience to Shopping ❑ T ❑ ❑ R DEMANblSUPPLY 7 Shortage In Balance Over Supply Convenience to Schools ❑ F_X� ❑ ❑ z MARKETING TIME Undar 3 Mos. R 3-6 Mos. Over 6 Mos. Adequacy of Public Transportation PRESENT LAND USE % LAND USE CHANGE PREDOMINANT SINGLE FAMILY HOUSING Recreation Facilities ❑ ❑ ❑ ❑ ❑ ❑ Single Family go Not Likely Q OCCUPANCY PAIGE AGE Adequacy of Utilities ❑ O ❑ ❑ >g 2 4 Family Likely Owner Property Compatibility ❑ ❑X ; (000) {yrs) Proper ❑X' ❑g' ❑ ❑ .�Multi -Family In process Tenant ; ❑ ❑ 150 Low _ 2 Protection from Detrimental Cond. ❑ g ❑ ❑ ❑ PS Commercial To: Vacant (0.5%) ® 4b0 High 12 Police 8 Fire Protection ❑ ❑ ❑ Industrial Vacant (over 5%) ❑ Predominant General Appearance of Properties ® ❑ ❑ ❑ fl' Vacant 1 ary 8 Appeal to Market g II -El. El Note: Race or the raclal composition of the neighborhood are not considered reliable appraisal factors. i' COMMENTS:.,The subject is located in a uooulaz hillside residential P.U.D. built-up with ggod HQuality singlegingle familyfataily regidgaces, Some sites offer good viewl;westerly, oximity streets .r r anal a eoMWunit water s stem rvi yes the nei hborhood. Average proximity to . communitv yervises Dimensions Irregular Topography Rollin - below r _ Site Area 45,58,_ Corner lot Size Typical �No Zoning Classification R -k Zoning Compliance yiNs Shape Irregular HIGHEST 8 BEST USE:Present Use Rest iden ial Other Use None Drainage Assumed adequate. z UTILITIES Public Other SITE IMPROVEMENTS Type Public Private 'S View Typical Eteetriciry 0 StreetAsohalt 0 ❑ Landscaping Typical Gas X Curb/Gutter ❑ ❑ Water Driveway Extensive/ ravel ❑ Comm well Sidewalk o-: ❑ ❑ Apparent Easements TyR UT egm nta Sanitary Sewer ❑ Ind . Sept Street Lights ❑ ❑ FEMA Flood Hazard Yes' Nµo g Storm Sewer Alley FEMA' Map/Zone COMMENTS (Apparent adverse easements, encroachments, special assessments, slide areas, etc. : P } The suj has a r�rre,rit ate and s: extensive Concrete retainin walls. 9-r_,q vel. driveway. Landscaping is partially firti ed er .` homeowner. No adveTse conditions noted. 3i GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION n �k.' units 1 Foundation Poured cc Slab Poured CC Area Sq. FL 2194 Roof ❑ h , Stories 2.5 Type (Det./Aft.) Exterior Walls _Food sh _ Root Crawl Space No % Finished 100% ,_,__ Ceiling OX D d Surface Shin/$u Basement yeg Ceiling Dr gll Walls Design (Style) Custom Gutters $ Dwnspts. Adequate Sump Pumpp N Walls Drywall Floor❑ Existing Yes Window Type WdCemt/TH Dampness NoeNoted n Floor et None None ,. -. Proposed No. Storm Sash No Settlement NoneNoted _Car Outside Entry No Adequacy„ Q .fr Under Construction No Screens YeB Infestation N9 I oted Energy Efficient Items: Age (Yrs.) 4 Manufactured House N g9 Effective Age (Yrs.) 2 x fl. ROOMS Foyer Living—Dining Kitchen Den Fami Rm. Roo. Rm. i Baths Laundry Other Area Sq. Ft Z Basement r 2..,.', _ _ . 2 Stg 2 94 P Lovell 1 2 1 1 P1Hse 4.464 4 Level 1 1 it 1,098 ". Finished area above grade contains: 9 Rooms 1 Bedrooms) 2 Bath(s) 5 562 Square Feet of Gwss living Area g SURFACES Materials/Condition HEATING KITCHEN EQUIP, ATTIC IMPROVEMENT ANALYSIS Good Avg, Fair Poor a2, „ Floors CDt Vin/Good Type FA Refrigerator ❑None Quality of Construction �J ❑ ❑ ❑ Walls Drvwn11/aeed Fuel rMa Ranenlffvon 171 Stairs n Cnndifinn of Imnrnvamonrs rvi F N MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 9/7/A& 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 4 o / 11141-Slaza– BvieK R41,, 1>,. 5413A, SEG /4 T/ZN 03 K/, 5,,RL , 4 Location (address or directions) 700 l recZ row e1ZCZ (b) Applicant Name G64 Telephone: Home N114 Business 9'�g77 Applicant Address S©O'/ C4624k 1 -MOW COME/ ANCX10eA�x4_, Xk S�`JSd7 SSG (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other,* (explain); (d) Lending Institution %/,l/a Telephone —h Address /Y�A (e) Real Estate Company and Agent Address NI Telephone NSA (f) Mail the HAA to the following address: N� 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Communityx Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-028 (11/84) �G /,� /-/Z!I/C-944 .v�.t� fl e 5. ENGINEERING FIRM PROVIDIKa INSPECTIONS, TESTS, FILE SEARCH, b...A AND INFORMATION 1.1 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 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 ASG;/ IHC. Telephone (gelV Addre Date DHEP APPROVA Approved for ..bedrooms by Approved V Disapprove Terms of Conditional Approval CAUTION s N •9* 1 AGE-2261AV Pf0(CSS�� 4� The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and §tate requirements. Employees of DHEP 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. Page 2 of 2 ,� MUNICIPALITY OF ANCHORAGE (MOA) 4i``°""P Tr = _".WEALTH AUTHORITY APPROVAL (HAA) L. CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LOT / 1.1155 UG pw& fid, slb sEe /4 TiZN W, At A. WELL DATA ',t V LL'' Well Classification e011I1_tUA/fiY Q/ If A, B, C, D.E.C. Approved ON) i Well Log Present(Y/N) — `/ ! Date Completed 14 /ViA Yield W Total Depth IVIA Cased to NIA Depth of Grouting 61A Static Water Level s Pump Set At IV A Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) — It14 Depression Around Wellhead (Y/N) IVIA Separation Distances from Well: ype- vre To Septic/Holding Tank on Lot %��®� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot � ;On Adjoining Lots To Nearest Public Sewer Line IV 'A To Nearest Public Sewer Cleanout/Manhole NIA To Nearest Sewer Service Line on Lot N�/g Water Sample Collected byAVA Date /V /,q Water Sample Test Results IV411 Comments®S��/�TTAC/iED IQ/i�C [�r7 l3GAPl3L'OiAsg2 B. SEPTIC/HOLDING TANK DATA Date Installed - Z9 4 Size /6'®d No. of Compartments Z - Standpipes ON) Air -tight Caps A) Foundation Cleanout 19N) Depression over Tank (YO Date Last Pumped ® NO Pumping/Maintenance Contract on File (Y/N) &1A ; for INIZA Holding Tank High -Water Alarm (Y/N) __ 1V.1A Temporary Holding Tank Permit (Y/N) AVA Separation Distances from Septic/Holding Tank: To Water -Supply Well >206'" To Building Foundation SFc � To Property Line ZO To Disposal Field /9 To Water Main/Service Line /00 "f Course ? Zona " Comments qHJ&567 ONZY 0CC6/P1_c--D �fit�CE To Stream, Pond, Lake, or Major Drainage M n �E ,477W ,`50 '�qaA CC -R? /iof Page 1 of 2 GOT / H/1 -40/04F 5/D SEG /,K, 77/2N, /z3 W,, 5.My,A,, C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /s0 0 f18'C Type of System Design 062�P 1X&WCN Date Installed e127-�{ 8Length of Field©L* Width of Field 4 JrDepth of Field 1Z Gravel Bed Thickness 93 i Square Feet of Absorption Area 6,400" Standpipes Present (9N) Depression over Field (Y(I Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well >Zoo" Date of Last Adequacy Test ��AQ To Property Line rd To Building Foundation 301 To Existing or Abandoned System on Lot N�ia ; On Adjoining Lots SD i 'f To Water Main/Service Line > loo, To Stream/Pond/Lake/or Major Drainage Course To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area IU Comments �L'©rVD/T//1NAL OCGG!/ WnV (oSu�� �T iii CXE?J hHO.�f CE.t�T7e�/e.4 6rC41A4--lCS/ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at Dimensions Manhole/, Level at High Water Alarm Level at Z/ Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �00 Date Company 5. ll74 MOA No. 45.5--0104 Receipt No. t 1DO 1 boat Date of Payment $/ 14 1 S L Amount:$ Lp!s�,Do Page 2 of 2 461 App(ck 72_026 (11/84) AL -,5 1 KaI f DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: August 7, 1986 PWS I.n.# 212461 A-Walvi!no 'IF I BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the HILLSIDE PARK S/D Water System is in compliance with the State Drinking Water Regulations Sincerely, l�j 41' Michael P. 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