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HomeMy WebLinkAboutHIDEAWAY HILLS BLK 2 LT 5HI"deway Hills Block 2 Lot 5 #006-262-27 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES ©®/ _ 26 2 —2 Environmental Health Division f� 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -- -- Name �,l-9 / y Dl 2 T/V r - - DI STANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address �CZ_ii/otil LO r(. . Amc,6 � Phone(s)-- q 7! PO P O l3 9 No of Bedrooms Z `1JI WELL LOT LINE /O .•r• S N —_ LEGAL DESCRIPTION Lot `5 Block 2 _! Sutr/��� �p ///�4 S. ` i//1! FOUNDATION % l D --- /0 14 --- /J I I ownshlp. Range. Section / C2 {f / r i i 1 [� _—_/_-_d /V� (3 i1 _ ,/ AS -BUILT UTAGRAM (Show location of well, septic system. property lines, foundation, driveway. water bodies, etc.) ---- — T __NKS__L� GST/AUG - - - - - — — - ❑ SEPTIC ❑ H©L ManWvrclw er � i . I y in gallons r �� Material No of Cornpartments Ir W f 'r�V `! p �0 d - — µ 5 — -- KL / — TYPE OF SYSTEM G/0Glff^OF, rRENCH ❑ BED ❑ W. DRAIN ❑ OTHER epth-to pipe bottom Irom total depth from o^rlgl�al grade original grace FT L v FT (i( - F — FdI added above original grade FT Gravei length-----� _-- 2 FT Gavel depth ben rash ripe S } FT Gravel width Z S FT — — I otal absorparoa 326tio � IkDO✓lJ SQFT i Distance between lines A 14 FT Number of hoes Sod rating Pipe material 1 '260 SQ FT 1- 30 3� U Installe �a Installed WELLS \ C 1 •-- ,, �, Za /6 3 �— �S o — ❑ PRIVATE OTHER (Identity) Classdiwuon (A. B.C) I To al Depth Casetl to _ F F FT �" 3 6 f S I_/ u � — � J S 2 3 l_ l� / r ri I Inslallci Date Installed 4 ^�1 — -7 REMARKS: fir )t f v�� (/�'�/ �•� ` Z. SC012: S - Inspections P rformed by. 0 xr, ENGINEER'S SEAL AV •Ne• I .. t i 1��" ir••n •�'' e f ® «,• ..;....i,.>. „a>..�d r • g ..-.•. •,..,,...•,..,...�rq: I • rol A. dill g • t_• ) 457.9 •j�,e+��+�a •��„o"L\. rA:?'� C �4 Dale. �%G /� !i ins eclion was performed according to all ri�/ o �i�� Date- —12-88 _— �Q .��� •Y �___v, S & S ENGINEERING �=I703A Sgt® River lseop i cerlily that In' kI, qqryy MunicipalanE�IQj�mtRk:Ati t15�daYe: J _ Health Department Approval L�/� ^_ O« / MUNICIPALITY OF ANCHORAG /�� DeFartment of Health to Human Services 825 L Street, Anchorage, Alaska 99501 343 472 Ci CC/ ON^SITE SEWER PERMIT / �Lob, Permit Number: 880139 Upgrade ~~~— Date Issued: 07/26/88 Engineer Designed Owner Name: ROBERT N" JESSER Day Phone: Owner Address: 2727 SECLUSION DRIVE 694~2979 ANCHORAG�, AK 99504�3620 Parcel 1: (A 006~262^27 Lot Legal: Subdivision: HIDEAWAY HILLS SUBQ. Lot: 5 Block: 2 Section: 24 Township: 131\1 Range: 3W Lot Size 12790 (sq.{t. or acres) Max Bedrooms: This Permit: 1 Total Cap�city: 3 SET, 7IC TANK: Minimum total septic tank capacity: 1,000 gallons^ [ach septic tank must have at least 2 compartments, Depth to top o< septic tart; (s) < 4.0 [eet requires insulation over, Lank (s INFORM D"H,H.S. PRIOR TO 1ST & 21\1D INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOURS, CALL 343~46B1 AND LEAVE A MESSAGE. CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN" THIS PERMIT EXPIRES 12/31/88" THIS PERM[T VALID FOR A SINGLE FAMILY RESIDENCE ONLY, I CERTIFY THAl: I. I liar with the requirements /or on-site sewers and we1ls as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accordance with all MOA codPs and regulations� and in comy,�liance with the design criteria of this permit, 3. l I'm ili adhere to a1l MOA and State of, Alaska requirements for the set back distances from any existing welwastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understa s permiL is valid for a maximum olf 1 bedrooms" I also under t t the capacity o[ the total system is 3 bedrooms and any enlal, It wJ,/l require an additional 1::)erfit it" SCALE i � J o / S Ir loon fit.-. li fF e C?<iC- -V-�1t4- �S'CIIJCa G��b l ul l Qc • 6 �4v T/ \ 10' Gro, I�-flT lv a: no A� o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 6 PERFORMED FOR: J ���5� DATEPERFORMI LEGAL DESCRIPTION: L� 'bZ %2� Township, Range, Section: -r(22rj j DEPTH I 1 < ' 2 o� 3 /oQ Lit 7 Q�' o 8 d 9 p 0 10 N 11 12 O p 13 /p' 14 15 16 17- 18 19 20 COMMENTS S & S ENGINEERING PERFORMED BY: T7vrgitwffl 0 qqqqq ACCORDANCE WIKA91QIJ% 'E-PtiViT�I K,7Pyy� AL 72-008(Rev.4/85) SLOPE SIDE PLAN �ro ••••T•nn eau •��jie. h tom, WAS GROUND WATER Date Gross Time ENCOUNTERED? l7 Net Drop S IF YES, AT WHAT L O DEPTH? P E Depthla WaterAlia Montt Jp— _ Monitoring? . Date: Reading Date Gross Time Net Time Depth to Water Net Drop 1 -IIo-F�r3 2:1� 4 z� Z `. 5 PERCOLATION RATE ? (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND '0 FT CERIIFY THAT T IS TEST W S PERFORMED IN CST ECT ON THIS DATE. DATE: � U GAAB-HD I P' - ITER ANCHORAGE AREA BOR01" f`H .,6"ARTMENT OF ENVIRONMENTAL. QUA. _ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /MAILING NAME !?, f-L�/�/��`f —ADDRESS C�� �i✓'CSE PHONE 1411 LOCATION ��= ��= G�f/C�/� J�'C��� LEGAL DESCRIPTION -:—�e�'/ '���' /,//-i %�Z✓%i //��1 CFPTIK' TANIV. DISTANCE FROM WELL G ' /;/-' lLl- LIQUID CAPACITY_ CJ U 4- GALLONS SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER _ NUMBER OF aTERIAL —COMPARTMENTS- Z-2'- INSIDE /�— COMPARTMENTS_Z: C_INSIDE LENGTH -INSIDE WIDTH DEPTH -- OR WIDTH r.LlZ- 0_, LENGTH-�, , DEPTH LINING MATERIAL C, S _— DISTANCE FROM WELL BUILDING FOUNDATION •-'��, / C< (� NEAREST LOT LINE oO ��> TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA). _SO. FT. TILE DRAIN FIELD: 1�1111;2 DISTANCE FROM WELL NUMBER OF LINES_ ABSORPTION ARE/// STANCE BETWEEN LINES FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE_ WELL: -- TYPE U%% zz-Z , DEPTH_ NEAREST LOT LINE �� _, SEWER LINE DISTANCES: S /amu l-�`i✓ �J NEARE35-LOT LIN TRENCH AIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE —_IN. ABOVE TILE DISTANCE FROM WATER ,BUILDING FOUNDATION.._ L— ._SAMPLE NEAREST SEPTIC ` SEEPAGE�� OTHER TANK SYSTEM_— — CESSPOOL_-- SOURCES_ � r DIAGRAM OF SYSTEM 1 6y TN�✓/c DATE(% . ��APPROVED 0 A A Cr GRLH fER ANCHORAGE AREA But,, -)UGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. / J/ 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT '! �7- �• /J^""'�k�LY MAILING ADDRESS 69V 6 ke2'0PHONE"?3 qgU INSTALLATION LOCATION LEGAL DESCRIPTION & INSTALLATION OF: SEPTIC TANK SEEPAGE PIT At / JDRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED I' FINANCED THROUGH • �ppV' TO BE INSTALLED BY SOIL TEST RESULTS '1a Cfi inL NOTE: THIS PERMIT IS N UT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. /� SEPTIC TANK SIZE TYPE GLs"' ^' 'Ora SEEPAGE AREA SIZE H'�(' I TYPE '� "`�"°'1e • _ _ i MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK i FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ( SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVER, LAKE, STREAM. 2 r DRAIN FIELD _. SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. t INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ['G/ HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE Z 171 APPLICANT'S SIGNATURE / I X -T 2". 'For A H & D Builders :IT c:r` l - r ,c (I 6/7/71 Lef-,91.. Ucs t,; r ::r .- 5 2 Hideaway Hills This 1!e .t!.: :et't 2 k 0-2 silty sand ~ (SM) 2 4 6 8 10 12 14 gray silty sandy gravel (GM) War Ground f Oc-�j Not Drclp 1. e r7r) 1'."IT e .., v, .-. -,�,! .e-><-.,.�� .... .. �... ,m.. ,., ...,.. .... ...�...-.4.,,�,,,�•.-.., a-.....�.,,,...._,n.,...�.a.�a.,.....n.,��..-�.m..�_ 0' 225 square feet of drainage area is require per bedroom with a bottom depth of ¢12.5 Te-zlt Performed li'y' R. E. Carlisle Data Certified -1,,- National Testing Services, Inc. Dat e 1- 7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or (b) Property Owner Telephone: Home Business Mailing Address 27'27 f[ ,<J/0�� i?12 �� !t /-fi� f�� �Pa) a (c) Lending Institution 9 Q?-�f �� Telephone Mailing Address (d) Real Estate Companyand Agent (A%22 °!= Telephone i —� (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. 5 6 5 ENGf GERM 17034 Eagle River Loop Road Na 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY S Individual Well q Community ❑ 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 72-025 (Rev 81861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 , &5 ENGINEERING Telephone Address 17034 Eagle River Loop Road No. 204 Date F 44 x �r a�•..u•w•• f e9 A. she* ;�M J'rr� J 4D 14674 (!�b 1 0-0 v1 05 6. DHHS APPROVAL Approved for bedrooms by9 Date c9—/2 —g8 Approved x Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 faev 81861 Back A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 / Legal Description: �'� �T! ���x 4<'�e';L ev XX C /-, Pa 13 � I G If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Fi don Lot To Nearest Public Sewer e Cleanout/Man Ole Water Sam Collected by Wat ample Test Results Comments B. SEPTIC/HOLDING TANK DATA Yield Depth of Grouting — Pump Set At Sanitary Seer Casing (Y/N) on Around Wellhead (Y/N) On Adjoining Lots ; On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed �< Size w�D — No. of Compartments / Standpipe(Y/ ) Air -tight Caps(Y/ ) Foundation Cleanout ((Y N fes_ Depression over Tank (Y6 Date Last Pumped c��9/ d ta S _ Pumping/Maintenance Contract on File (Y/N) /✓�)4_ ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from SepticAioidrng;Tank: To Water -Supply Well /J�l� To Building Foundation C / To Property Line S To Disposal Field �c7 t To Water Main/Service Line Z s To Stream, Pond, Lake, or Major Drainage Course ©� Comments Page 1 of 2 72-026 rape 9 es) Ronr C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata .2 i yy `/� Type of System Design Date Installed C//��%T�NG L2ngth of Field 7',4lG 3Z / Width of Field 2's Depth of Field Gravel BedThickness Square Feet of Absorption Area I `e4Gh/ " 32D Cnr✓° il�Standpipes Presen(Y/ ) Depression over Field (Y N) Date of Last Adequacy/Test Results of Last Adequacy t /�2/ SSc70 � 4 Z 6 C 1-t 4V l✓G/en/ �Z B iC - %b T�� 3/� kaI Separation Distance from AbsorptionField: / To Water -Supply Well �-,J l/� To Property Line To Building Foundation Lot /0 Z 6 r To Water Main/Service Line 6o To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION To Existing or Abandoned System on r. On Adjoining Lots To Cutbank (if present) /vim i�r Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) i "Pump On" Level at "Pump Off' Level at High Water Alarm Level at U 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, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,g R.S ENGINEERING Date Compan 7034 Eagle River Loop Road No. 224 MOA No. 9g0 V r 7) ��c�OF ``(� � 6• y Receipt No. cw (Q •J• O l 5 6 °fes �s� Date of Payment Amount: $ -7 0 Q S Wil'"�_� / / . •.J MtY.. .. \.. t\• ° A. r• V sn„t�. Page g _ �OFESS10 `? 72-026 fRev 886 Back Tom Fink, Mayor Municipality ®f Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 12, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 5 Block 2 Hideaway Hills S/D Waiver Request #WR88-046, #H88-0329 Dear Mr. Shafer: A Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet from property line adjoining Lot 4 Block 2. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Serivices DJR/ljw#7 gra HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN August 11, 1988 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 5; Block 2; Hideaway Hills Subdivision ROBERT A. SHAFER CIVIL ENGINEER 694-2979 As owners of Lot 4; Block 2; Hideaway Hills Subdivision, we have no objection to the issuance of a five foot lot line waiver for the installation of a septic system drain field on the referenced property. ROBERT A. SHAFER, P.E. RAS/ss 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 6.1 4 f e MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) *4-(b) Applicants Name Telephone - Home Business e_ Applicants Address, (c) Applicant is (check one) Lending Institution wilder ; Buyer ; Other [::] (explain); (d) Lending Institution -� Telephone_ Address (e) Real Estate Co. & Agent Address Telephone , (f) Mail the HAA to the following address: 2. ape of Residence Single -Family Multi -Family Other (describe) Number of Bedrooms 3 3. Water Sup 1_ p individual Well Community Public �p4961/ &uz1 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to Lhe legality and status. 4. Sewage Disposal Onsite Public F= Community = Holding Tank = Note: pfecommunity well syst:em, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 5. 0 F•, c Engineering Firm Providing Inspections, Tests, File Search, Data and Information 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 regula- tions in effect on the date of this inspection. / Name of Firm Telephone Address ZZk,92 O% 00tP(' ,,�pp gFrosrteaoeee 0004 �® DateYA c7 C' YY•° °O°olp��0 -4 Oaoa00 ee eeeooee egbo on Yo ° (ENGINEER SEAL) r0 e� �,°, Leroy C Reid, Jr. % CO: �J OA. No. 231-E DHEP A pry oval bag Y4 pROPES-DO Approved £or bedrooms By Approved Disapproved Conditional - Terms of Conditional :Approval _ CAUTION THE ifUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 STATE REQUIRE- MENTS. 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. 0 RR4/ej/D18 (DHEP SEAL) [Page 2 of 2] 7-19-84 A. WELL DATA ~— PUB L-1 C FA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Description: 1�4T� < MUNICIPALITY OF ANCHORAGs DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield — Total Depth Cased to Depth of Grouting Static Water Level Pump Set At — Casing Height Above Ground Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments �(L B. SEPTIC/HOLDING TANK DATA On Adjoining Lots — On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot /vrz�'4t ; Date 1 G 1985' Date Installed o:;2:195�/ Size No. of Compartments StandpipeE N) Air -tight Cap6 l) Foundation Clean (Y ) .�+ Depression over Tank (Y� Date Last Pumped Pumping/Maintenance Contract on File (Y/N)_ ; for Holding Tank High -Water Alarm (Y/N) f Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation To Property Line e�/ To Disposal Field *To Water Main/Service Line _ %L To Stream, Pond, Lake, or Major Drainage Course V160 Comments Page 1 of 2 72-026111/841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design ��� ✓ Date Installed 'G �� �� Length of Field e Width of Field Depth of Field Gravel Bed Thickness /O Square Feet of Absorption Area VOb Standpipes PresentON) Depression over Field (Y® Date of Last Adequacy Test esults of Last Adequacy Test r�5��% ,3 Fcz�wea�( �( Separation Distance from Absorption Field: To Water -Supply Well tJ/,+ To Property Line To Building Foundation 62& JK_ To Existing or Abandoned System on Lot /t%!, -I- ; On Adjoining Lots -- 3h -)(— To Water Main/Service Line f z� To Cutbank (if present) A.114,t To Stream/Pond/Lake/or Major Drainage Course - __ yO0 � _1� To Driveway, Parking Area, or Vehicle Storage Area G -,K- — Comments f < e�'� �2c 121`«OeDiOzrQ?o D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N,�/ Comments Dimensions _ hqlp/Aucess (Y/N) "Pump Off" Level at Vent(Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I av checked, ver4ied, or conformed to all MPDA an AA guidelines in Signed r Date Company MOA No. Receipt 0. o. Date of Payment 9. 2;k (9 -F66 I' Amount: $ q Page 2 of 2 72-026 (11/84) .,� a y,,•- ..,t, rete# t9spection. y P V 4 t YF :'' r e� a ,. 4 0 JIr OE r:s, N! AV �)Fj:SS1Qd �• '•fes' w 50640 ALASKA eHUIROWnTAL COnTnOL SRUS, InC. engineerinq & 6ironmental Studies COMMUNITY REALTY SELLER—DR GEIRINGER 2825 ROSE STREET SUITE 201 ANCHORAGE ALASKA 995508 LEGAL:HIDEAWAY BILLS BLOCK 2 LOT 5 ADEQUACY TEST FOR SEWER SY'S'TEM ADEQUACY 'PEST DATE -9/2.4/85 9/25/85 COMMUNITY REALTY 2825 ROSE STREET SUITE 201 ANCHORAGE ALASKA 995508 THE TYPE OF ABSORPTION SYSTEM TS A CRIB WITH AN AREA OF 800 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 9/25/85 . 1200 West 33rd Auenue, Suite B • Anchorage. Alaska 99503 a 907) 561-5040 •_XJI I IL (11 � � rtilL� �� a S. LEGAL DE CRIPTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OP HEALTH & ENVIRONMENTAL PROTECTION; 825 L Street - Anchorage, Alaska 99501 6. TYPE OF RESIDENCE ENVIRONMENTAL ENGINEERING DIVISION l Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER- - PHONE MAILING ADDRESS cam[ •l CSC / \-J��%-�l_V,J�� / r / �/L/ U.JI (��% _ r- I��-� PROPERTY RESIDENT (If different from above) PHONE 2. BUYER — PHONE MAILINGADDRESS - A®� 3. LENDING I STITUTION - - 5 l�omy ,� 'ItI6 J}F 4k' bol-I�� — PHONE �� MAI `x-0— ADDRESS(" c . La 4. REALTOR/AGENT J �) n PHONE MAILINGA KESS a S. LEGAL DE CRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS - [ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL'" ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM A®� INDIVIDUAL/ON-SITE** **If indiviclual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. /Z -U IUl3//W THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE *00,�SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE Ea� THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED _ 3. SSE AGE DISPOSAL SYSTEM IL'fINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLE 101-71 INSTALLER ei'e. , Septic Tank or ❑ Holding Tank Size: /0049 If Tank is homemade give dimensions: SOILS RATI G TYPE QF TANK, MANUFACTUREF', _` TOTAL ABSORPTION AREA 000 MATERIAL ^ Y 4. DISTANCES WELL] Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS I!< APPROVED FOR�BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE V/ /7t BY (Title) r/kn 9 L GAL DESCRIPTION 72-010 (Rev. 3/78) n GEJA9 11 _1AM 1 INC, 1a24 C.i1.0111 I 3OX 101.1 a ntlie.11111nc=_ 1i A'e�... ­),oc 1=11 1.11 „n �vcir.iF rcr�a i �n wveio; ,in ivy run-: August 28, 1978 R&M No. 851586 Target Realty 1021 W. 25th Avenue Anchorage, Alaska 99504 Attention: Charles Bannister Re: Adequacy Test on Existing Sanitary Sewer System; Lot 5, Block 2, Hideaway Hills Subdivision, Anchorage, Alaska Dear Mr. Bannister: Per your request of August 21, 1978, we conducted a test of the sanitary sewer system on the above described property. The septic tank was pumped prior to the performance of the test on the see- page pit. During the test the liquid level in the seepage pit was measured before and after the addition of 390 gallons of water. The total depth of the crib was 13.6 feet. All liquid levels were measured below the top of the standpipe and are shown in the following table: Initial Water Second 24 hour Total Reading Added Reading Reading Drop (gallons) 10.11 390 9.1' 10.3' 1.21 The meter used during the test was a Neptune 1%" standard water meter which had previously been calibrated by R&M Consultants, Inc. The water level rose 12 inches with the addition of 390 gallons of water, indicating a capacity of 32.5 gallons per inch. Twenty-four hours later the liquid level was again measured and found to be 10.3 feet. It had dropped 1.2 feet or 14.4 inches. This indicates an average effluent acceptance rate of 468 gallons per day for the surrounding soils. If the 3 bedroom residence on the property is to house 6 people, the average load on the system can be expected to be 450 gallons per day. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom residence. R14, ,1,,1q= PHI!JRJUPze .:u vI. u[ z 11,/1$1LLA August 28, 1978 Target Realty Page -2- We appreciate this opportunity to be of service to you. Please contact us if you have any questions regarding this letter or if we can be of additional service to you. Very truly yours, R&M /A� CONSULTANTS, INC. i`X64� Lynne Kosikowski Staff Geologist GS:LK/kky/12-I //� lam' -f / �%uG✓� ih (, Gary A. Smith Project Manager FI/! f7 )RI 1_111111,, R1TS, IP.I C. 5021 CONI)Ovn no;; ec_/ - AN': ONn<,I-. ., rac. r. _.t, _ �•Fi .� 01 rl.; p z; .. 'b1 GC-Ill_p CIC I_. August 28, 1978 R&M No. 851586 Target Realty 1021 West 25th Avenue Anchorage, Alaska Attention: Charles Bannister Re: Adequacy Test on Existing Sanitary Sewer System; Lot 5, Block 2, Hideaway Hills Subdivision, Anchorage, Alaska. For Professional Services Rendered August 24 and 25, 1978. Dear Mr. Bannister: The following is our invoice for professional services rendered on the above -referenced project. Invoice No. 851586-1 Professional Services Fixed Fee $155.00 Total Invoice No. 851586-1 $155.00 Please note our invoice number on your remittance. Should you have any questions concerning this invoice, please contact me or the Project Manager, Mr. Gary Smith. Thank you, R&M CONSULTANTS, INC. a M. A. Matlock Anchorage Office Manager MAM/dkd (--iOFRGP rr.I [Fn ne..� II11-1 IF I1 1///U11 1 (0,.',i,!, . .J i IoL Ac( c P(1.11L I 11+++ " f ( 1),;,! L, GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: i ( %C 7/ INSPECT: TIME: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR C. SIZE D. CONSTRUCTION E. BACTERIAL ANALYSIS 6. SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK/(IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE_ 3. MANUFACTURER 4. INSTALLER 1. APPROVAL REQUESTED BY ADDRESS: PHONE 2. PROPERTY OWNER: PHONE: 3. LEGAL DESCRIPTION: 4. TYPE FACILITY TO BE INSPECTED:„ %�j'STREET:. NUMBER OF BEDROOMS: 5. WELL DATA: A. TYPE_ B. DEPTH_ C. SIZE D. CONSTRUCTION E. BACTERIAL ANALYSIS 6. SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK/(IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE_ 3. MANUFACTURER 4. INSTALLER 7. APPROVAL REQUEST FOR SEWER & WATER FACILITIES PAGE TWO B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES 2. TOTAL LENGTH REQUIRED MEASUREMENTS f A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION F. FOUNDATION TO SEPTIC TANK G. FOUNDATION TO SEEPAGE PIT H. SEEPAGE PIT TO PROPERTY LINE COMMENTS: APPROVE DISAPPROVED: DATE: APPROV VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY Municipality of Anchorage On -Site Water & Wastewater Program ="® (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 006-262-27 1. GENERAL INFORMATION Expiration Date: 0 __!57- , 6 6 Complete legal description HIDEAWAY HILLS; BLOCK 2, LOT 5 Location (site address) 2727 SECLUSION DRIVE *ANCHORAGE, AK Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ART & JOAN WOLFF Day phone 337-228 KATHRINE KELLER Day phone 865-6406 0 Single Family (w/wo RDU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex)VAN TAL 3. NUMBER OF BEDROOMS: 3 =1UG ? 2'014 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Stora e g r� U Individual noiding tank r� LJ Community Class Well ❑ Community On-site ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: nZo ! F � 114- � Distance: l Received by: I/ '. Date: +' 3 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 Date of Payment �11511y cej)e� Receipt Number Carl G COSA# �A t`Al3 Waiver Fee $ 2-1'5-- Date lsDate of Payment 311 15 h 't Receipt Number of ri-16 Waiver # P lb -4 133y 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures putlined 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. Phone 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 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 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 right whatsoever. 6. DSD SIGNATURE System #1 Approved for -3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. 337-6179 Date '81 t Z fli_ bedrooms, with the following stipu �al:a{isi �,0 OFAyVc ©rri Ota -SITE O WATER AND WASTEWATER o. PROGRAM M Original Certificate Date: 2.,.2 �Z" B� The AA6nicipalityor AnoN2�r—age Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (R., 1 M5) 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: HIDEAWAY HILLS; BLOCK 2, LOT 5 A. WELL DATA I AWWU WATER Well type If A, B. or C provide PWSID# Date completed Total depth ft. Date of test Sanitary seal (Y/N)— Cased to ft. FROM WELL LOG Static water level Well production _ WATER SAMPLE RESUL Coliformcolonies ug./L. 9-p M. 00 ml. Nitrate mg./L. Date of sample: Parcel ID: 006-262-27 Well Log (Y/N) Wires properly protected (Y/N) Casing height (abov round) in. AT IN CTION ft. 9— p.m-Collected by: B. SEPTICIHOLDING TANK DATA *6 FEET FROM FOUNDATION Tank Type/Material SEPTIC/STEEL Date installed 1971 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES . Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 8/4/14 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE 1971225 SEEPAGE PIT Date installed 8/7/1988 Soil rating (g.p.d./ft or �/bdrm 268 System type TRENCH 20 2 10 Length 32 ft. Width 2.5 ft. Gravel below pipe 5 ft. *13 800 Total depth *12 ft. Eff. absorption area 320 fe Monitoring tube YES Depression over field NO Date of adequacy test **8/5/14 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 832 gal. Elapsed Time: 30 min. Final fluid depth 39.5 in. Absorption rate >= For 3 bedrooms New depth ***48 in. 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **TESTED 1988 TRENCH; SEEPAGE PIT DRY ON INSPECTION ***IN THE LAST 40 MIN OF TEST 234 GALLONS WERE INTRODUCED RAISING THE WATER LEVEL FROM 40" TO 48'x. D. LIFT STATION Date installed Size in gallons Manhole/Access (YM "Pump on" level at in. HPUMPOIrlevel-At High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Holding tank manhole/cleanout Animal nureas 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 N/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line **7' 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 N/A F. COMMENTS *PER AWWU RECORDS. THE SEPTIC TANK (INSTALLED IN 1971) IS APPROACHING THE END OF ITS USEFUL LIFE. **APPROXIMATE DISTANCE PER AS BUILT SURVEY 0oo60�t` G. ENGINEER'S CERTIFICATION o of / I certify that I have determined through field inspections and review of Municipal records that the above systems are in p A conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS 9, � ..VVCE 795 m� I l,� 87tz/�/Y .�o� Date ' 7,/ ��"au_ o��`o (Rev. 11/05) �oa�+ I � \ o oo��pp�' r nro-;a<v A �p� ONC11101111 HJ "MCI w NEO ir r] O� H� AS-BUILTSURVEY «Asea: 'SHANE A. HOLT ff NocaRrvERs sETTws on3E �- LS -69 1 4, I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY ��ppp0 �Fessrol o oo�o LOT 5, BLOCK 2, HIDEAWAY HILLS SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND (HAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS THE INFORMAT30N VffREON ISFOR THE USEOFLENbIN&INsmTur ONS SPECIFICALLYTOSHOWANI EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING ETRUCNRES AND PLATTED LOT SAND/OR EASEMENTS: AND IS DATED AT ANCHORAGE,ALASKA THIS DAY OF NOT TO BE USED FOR POSITIONINS ADDITIONAL STRUCTQES, IMP9 OVEMENTS, OR FENCEL - _4TH_--_ AUGUST 2014. EASEMENTS OF RECORD, OTHER THAN THOSE APWARIN60N THE RE D RAT, ARE NOTSHOWN , HEREON(VNLE55NOWATED)' NOTE FENCELINESTHATMAYAREARONTHISDRAW ARENOT SEU5EDTODETERMNF PIG1'�LAND SURVEYING PROPERN LINES OR PoSSRON ADOIRONAL IMPROVEMENTS. 6W I IIGHVWW DRIVE ANY PAVING SHOWN HEREON MAY RE APPROXIMATE WE TO E=S$ VE SNOW AND/OR ICE. AN(I IORASE,AK 99515 345-°513 12698, FB 166-14 D 6