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Home My WebLink AboutHIDEAWAY LAKE BLK 1 LT 1LI 015 z--I-71 • MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section = Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION • Parcel I.D. d ` Of Property owner(s) P41,1CrTROVA.61 S Day phone Mailing address 10-6 / W o to vt Site address rr -- ��" Legal description (Sub'd., Block & Lot) zoce UM10"y LcL(-r I n / Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms t( APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Ej all that apply) Absorption Field Initial Single Family (SF) ]'' (w/wo ADU) Septic Tank Upgrade Duplex (D) ❑ Holding Tank Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5Lq Waiver Fees: Date of Payment: gliO(12 Date of Payment: Receipt Number: (39'4336 Receipt Number: Permit No. OSPj2t 2I Waiver No. G:IDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDR ESS~.~ LEGAL DESCRIPTION LOCATION ~ DISTANCE TO: ] ~Z [Manufacturer G / ~< /u,, ca IF HOMEMADE: Dwelling Inside length Width NO. OF BEDROO[~ Liquid depth welting Well ~ Foundation DISTANCE TO: '1-- I O0 No. of lines Length of each line Top of tile to finish grade ;~-- t Total length of lij~. Material beneath tile PERMIT NO. gallons Nearest lot line~ lO PERMIT Trench width tween lines 'f~ ~ (p inches ~ .. i~/.ees Total effective absorption area Length Width Depth Well DISTANCE TO: C%~~ Depth Driller DISTANCE TO: Building OTHER lot line SOIL TEST RATING loc) Distance to lot line Sewer line Septic tank R EMAR KS DATE LEGAL PERMIT NO. PERMIT NO, Absorption area(s) APPROVED PERMIT NG. HPF L I L. RNT LGCFIT 1 ON L. EGRL i-"i LI I'-~ I ,Z: I F' I:t I_ I T DEPRRTMENT ~' ,-'. ~.. O ' i4EL. L MICHREL R. r,IR:gHI..ELL LOT :L 8LDCK i HIi)ERWFi~ LRKE SD, HERLTH RND ENVIF:'r~NMENTRL ' OTECTION ~]/~ ' - _TREET.. RN..HURRL~E., RK. n--,l'-.l--~ I TE St=--.[LqEF~. F'EiRI""I ][ T -- ..~ ' ' " : ' '~ ?i " STRR EUJTE R BO,.s ~.0,.0rl 99507 2'.49-:L~LT:L ~ . LOT SIZE 4.50EI0 S~I.IFIRE TYPE OF SOIL HE._,OE. PTION SYSTEM IS: TRENCH " I tlM,.'~IMZ'I NLIMBER OF BEDROOMS = 3 SOIL RFITINI3 (SQ FT,."BR)= i00 ]"HE REI~IJIRED SIZE OF THE SOIL FIBSORPTION SYSTI:."M IS: IZ:. IF2' F"-[' H =: L:: LEi'-.IGTH= 3:8 G R R",.,"E [_ [>EPTH:= 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRF~INFIEL[:,. THE DEPTH OF R TRENCH OR F'IT IS THE DISTRNCE BETWEEN THE SURFFICE OF THE GROUND RN[) THE BOTTOM OF' THE EXCR'v'RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFFtLL PIPE RND ]'HE BOTTOM OF THE E',:<CFt',/RTION (IN FEET). J .E,~4LI ][ F-:EC, SEF>]'' I C TPIi'-~K S ~ ZE= t00~m K..~RLLC, I'-.Ic; PERMIT RPPLIC:RNT HRS THE RESPONSIBILITY TO INFORM THIS DEF'RRTMENT DLIRING THE [N'.STRLLRTION INSPECTIONS OF RNY NELL~ RDJRCENT TO THIS PROF'ERT'T' RND '['HE NLIMBER OF RESIDENCES THRT THE WELL WILL SERVE. TL,~O ,C 2 }, I I'-~SF'EC:T I I:IN:_~: FIR[~.Z REg!LI I RE[} E:FtCKFILLING OF RNY S?STEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS [:,EPRRTI'IENT WILL BE SUBJECT TO PROSECUTION. MINIHUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISF'OSFtL SYSTEM IS 100 FEET FOR A PRIVRTE WELL OR 150 TO 200 [ZEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM Ft PRIYRTE WEt. L TO R PRIVATE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS FIRE REf.:,'UIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS WRY APPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRAMS ARE FIVRILABLE TO INSURE PROPER INSTRLLRTION. F'EIF;:IP"II X T E~:P I RIES DE:~i]EI',,1BER 3:1.. t9E~:3 I CERTIFY THRT ±: I R['I FRMILIRR WITH TIdE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY ]'HE MUNICIPRLITY OF RNCHORRGE. L;.:: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3:: I UNDERSTRND TH8T THE ON-SITE SEWER SYSTEM i"IRY REL'4UIF,'E ENLRRGEMENT IF' THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS. S I GNED: RPPLICANT MICHREL R. MAXWELL L:,z, LIED B, .................................. V4. 0 F'ERMIT NO. DE:F'RRTMENT HEALTH FIND ENVIRONMEN'FRL "OTECTION 82..'3', "t_ STREET, RNCHORRGE, BK. 264-472~ L4EI_L R[-4E:, C,[q--~ I TE SEF. IEF~ RPPL ICRNT tIN ~WAC--L- LOCRTION ~L~~ L..~K~ T'¢F'E OF SOIL. RE:SORBTION MR',~IhlLIM NUM[:,ER OF BEDRCIOM~ ~ SOIL RRTING (SQ F%."BR)= ~o~ THE RE64LlIRED SIZE OF THE SOIL RB.~CRPTICN S¥STE~ I~: THE LENGTH DIMENSION IS THE LENGTFI .~N FEET) OF THE TRENCH OR DRRINFIEL[:,. THE DEF'TH OF R TRENCH OR PIT IS 'rile DIS'FRNCE BETWEEN THE SURFRCE OF THE GROUND RWD THE BOTTOH OF THE EXCRVRTION (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF 'FHE EXCRVRTION (IN FEET). LOT SIZE ¢-¢"J'~/'"'¢' SQLRRE FEE1'' F-:EIDIJ I [;:cEE;, -_- EF- T I E]: -F'R f'41-{ ?-=;., I ZE= 0 0 0 ,3RL-L.C~I"~I PERMIT RPF'L. IC:RNT HRS THE RESPONSIBILITY T~] INFORM THIS I}EPRRTMENT [)I_RING THE INSTRLLRI.'IOI'.~ INSPECTION.S OF RN¥ HELLS RDJFICENT TO THIS PROPERTY RND THE '.,'UMBER OF RESIDENCES THRT THE HELL WILL SERVE. TI..IC~ < 2 ) ]: I'q:SP[-]E:T I ,] ~-.! ?-;., RRE RE6-4LI ][ ~:E[: E:RC:KFILLING OF RN~ =Y~TEfl WITHOLI'F FINFIL IWSPECTION RND RFFF.'3¢RL THIS DEF'RRTMEN'r 14ILL BE SUBJECT TO PROSECUTION. MII'.4IMUI',I DISTRNCE BETHEEN R WELL RND RNY ON-SITE SENRGE DISPOSRL. SYSTEM IS 100 FEET FOR R PRI',/RTE HELL~ OR ~50 TO 280 FEET FROM R F'UP.,LIC WF]LL DEPENDING UPON THE TYF'E OF PUBLIC WELL WELL LOGS RRE RE6IUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF Tile WELL cor,IPLiETION. OTHER REQUIREMENTS MFl¥ RPPLY. SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PEF~.I',I I 'f- E.-'-::F' I F;:E_, [.',ECEPlE).,EF~.' ]~::L., 80 I CERTIFY THRT i: I RH FRMII_IRR IqITH THE REQUIREMENT5 FCIR ON-SITE SEHERS RNC, WELLS RS SET FOR-IH BY THE MUNICIPRLIT¥ OF RNCHORFIGE. 2: I WILL INSTRLL TFIE SYSTEM IN RCCOR[)RNCE WITH THE CODES. ~: I IJNDERSTRND THRT THE ON-SITE SEWER S'¢STEM MR'T' REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. S I GNE D ..... RPPL~CRNT ~ VL~,. R MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,Pouch 6-650, Ancho~'age, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAI-DESCR,PT'ON= L0T I 1 1 1.- 14 1E 1( 17 2( COMr lENTS PERF 72-00 DATE PER FORMED:..,_~ SLOPE T~ ~ 'F~T L 5W L CO/tg. SE 5}qN'O W~TH F~NE ~alO L17:~15 WAS GROUND WATER ENCOUNTERED? SILT I i SITE PLAN -'1' l,I _/! , '-- I~ ' IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) -- FT (7/76) CERTIFIED BY: DATE: ~0. June 5, 1980 R&M No. 051001-38 Roger Dalrymple Post Office Box 3-176 Anchorage, Alaska 99501 Re: Dr. Mike Maxwell Property MUNICIPALITY OF ANCHORAGE DEPT. OF I' 'LT! & [NVIRONMEF',T,qL r~ ..; i iCTION R, ECEIVF D Subject: Soil Investigation for Sanitary Sewer System, Lot 1, Block 1, Hideaway Lake Subdivision, Anchorage, Alaska Gentlemen: At your request of June 3, 1980, we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. This investigation, which was accomplished on June 3, 1980~ consisted of a test hole excavated to a depth of 14 feet below the existing ground surface. The test hole was sited according to your instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. Test Pit sidewalls were carefully inspected and visual soils classification was made by an experienced soils engineer. The topography at the excavation site is generally rolling and sloping to the west. At the time of the investigation the site had original vegetation consisting of birch and spruce trees. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was encountered in the test hole at a depth of 12.5 feet. Bedrock was not encountered. At the time the hole was excavated seasonal frost was present from the surface to a depth of three feet and permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage, a percolation test was not necessary within the test hole on the subject lot. Roger Dalrymple June 5,1980 Page -2- We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&M CONSULTANTS, INC. Richard S. Giessel Staff Engineer RS G/rm/ATS I-R h ,X £O'/- Z Anchorage Reco~lng Precinct~ Alaska LOT SURVEY CERTIFICATION I her~9' certify thC hove surveyed the property shown end described hereo~ond that the improvemerrt$ situmed thereon ore within the prop- edy lines and do not overlap or encroach o~ adjacent property end thC no irr~rovements o~ adjoceot property overlap or encroach en the premises in question and 1hot the~e are no roadways, utility lines or other visible easements on said property excepl as indicated hereon. Scele / Date Prepared by: ~90 7) 2 7 9- 62o0 R L. BUTTON Registered Land Surveyor 519 H( Eighth Ave. ,~ncha~oge, Alaska 99501 Property..of:,~ ;¢-0 ~ - - ~ ~r ~ ' IV - :/i/IICF)O 'I " /Yl yWe l/ Z Z LPS CSA • • j'� Municipality of Anchorage ° On-Site Water and Wastewater Program (907)343-7904 ��s ,t ~ Certificate of On-Site Systems Approval Parcel I.D. 015-471-05 Expiration Date: 1. GENERAL INFORMATION Complete legal description Hideaway Lake B1 L1 Location (site address) 10800 Hideaway Lake Dr. Current Property owner(s) David Thomas Day phone Mailing address 1001 Warren Avenue North Seattle, WA 98109 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 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 Q Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: , /- Received pp Received b • LJ `. . / 0 Date: 9//1/1?) COSA to be released to the engineer,un- otherwise re9 u-.ted by engineer. ineer. 9 COSA Fee $ 5210 Waiver Fee $ Date of Payment 'L `-t (g Date of Payment Receipt Number 01 WOG Receipt Number COSA# 86G (31458 Waiver# • 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe 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 soil condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Date 8/31/2018 • 4.pr.' 4• 9 TMs, :* 6. DSD SIGNATURE • •"'+ �,.�s • System#1 Approved for bedrooms ••t -•• ' '-anno! e - ;R▪. CE 8149 .;�4. . System#2 Approved for bedrooms • • .• Disapproved '.7140E53044* • 0 Conditional approval for bedrooms, with the'following stipulations: -'2- iSki-e144-e 0-6J ,A,VulAda.Q414,i'14e y (QA).P No-to = `fie Cov.elt cp ei a w cc/1,6-m t ,J vse is uo. kvv g. ON-SITE WATER AND v WASTEWATER o PROGRAM By: N V`-- ( Original Certificate Date: Z " 'T'—(e 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 1' If more than 1 septic system is on the lot: COSA Checklist# 1 of I Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Hideaway Lake B1 L1 Parcel ID:015-471-05 A. WELL DATA Well type Private If A, B,or C provide PWSID# Well Log(Y/N) Y Date completed 6/19/1980 Sanitary seal (YIN) Y Wires properly protected(Y/N) Y Total depth 448 ft. Cased to 448 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/19/1980 8/09/18 Static water level 93 ft. 119.8 ft. Well production 1.5 g.p.m. 3.7 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 1 .49 mg/L Arsenic ND ug/L Date of sample: 8/9/2018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed Unknown Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm(Y/N) N/A Date of pumping 8/31/2018 Pumper Isaacs Pumping Services C. ABSORPTION FIELD DATA Date installed Unknown Soil ratingz 2 1.2 G.P.D/SF Deep Trench (g.p.d./ft or ft/bdrm) System type Length 52.0 ft. Width 2.5 ft. Gravel below pipe 5.0 ft. Total depth 10.25 ft. Eff. absorption area 520 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/9/2018 Results(Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 12 in. Water added 600 gal. New depth 20 in. Elapsed Time: 1440 min. Final fluid depth 12 in. Absorption rate >= 600 g.p.d. Non Known Any rejuvenation treatment(past 12 mo.)(Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on"level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ 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 50+ Wells on adjacent lots 100+ F. COMMENTS Tank & Field exposed and inspected on 8/21/2018. Both appear adequate with no deterioration. G. ENGINEER'S CERTIFICATION , .� 1c. I certify that I have determined through field inspections and �• •;� review of Municipal records that the above systems are ins•�TM �• conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone •'eleven A. `ar'r e 8/31/2018 CE 8149 ....I; Date •• COSA canary sheet_2-6-15.doc 0SEA?yrvvO,2 +"irGJi. -1--C ilk le- Te...5 AGeTOeVTt7i SWtAils-•rie• —rt.)"--11 y, •YAti11<- CG 0.-NAJ---CO i s. S'S y �e'K��ap,,,,:.A.)t.‘ r S i` ASen es'A) t. C'E)I...\Nti •;tXZY .7)0,2.S. AS—", ,--1—; A.A.)L L"/CLiLR.N- I a7c `r, �y+s': AS 14 cut) J a Ss Changemarks Report i, eCrv2..7DQAwt C.4 Project Name: OSC181458 —'\(-- Workflow Started: 09/04f2016 1;00 PM 1 Report Generated: 09/14/2018 01D3 PM Cycle Complete? i Status Department ; Snapshot ; File Markup Name Changemark Subject t Changemark Details Markup Date' -r ' Updated By Applicant Response. 1 1 'True IResokred :Onsite WeM and Septic.'�"'".'-T. Hideaway Lake B1 L1 COSA I TJE f Changemark H02 Please provide a survey 18:/10/2018&29 AM Tin Eddund I Creddtatpdf I i t ._ 1 Tore ;Resolved Onsite Well and Septic.-:_..,„,., Hideaway lake Ri L1 Inspection •TJE Changemark#01 Please pay septic upgrade 0911012018 9:28 AM Tim Eddund -j Report.pol fee to generate permit# N SHEDS OVER P.L. \ // 4 82 7 AN // ^ o 111 N89°59'46-E 419.65 Scale 1"=40' 8, a , S37° 13'40"W 29.46 SECTION LINE EASEMENT a • G'Rq"FC D '— _ \ N l x no, ' Lot 1, Block 1 ) zit �;`�� .S; • 2ND —�— 62,528 Sq. Ft. +7- —• l v s / STORY p6CK 10800 Hideaway Lake Drive 1 j ��ov ' 3 Story Wood Frame House /Qy`' 74 • , • °. • •• lov / ..s......'....-......'.....: •• •::'..!-':•''. With Attached 2 Car Garage a� i n e PAVED . ' 'COvi- s'. '` k� HIDEAWAY LAKE s i LL1 •;, a• SEE HOUSE' rpJ g • °o _ °. ; : DETAIL / t+ / / vi i S'� , i CV O� 1530 \ `.. .. .. � �: , •`. / Q'' / <P' 11111111110\� ,- / �� 1 'S1 t WOODEN STA/ �'-// A9`FO '., ob 1 Rs ---os 0�� •I q 1% -- Rp.0 LF• / \�(/ i , e S87°43'18"E 377.95 E \t� m � / L ` - v PC-� 458 ` / / V / CO' 4' . . . 00741 // "9: 0 o4 Eo . '� �o 2 `Z` 54 I D LOT 2 / ' LOT I 11 .5.4 1 ' CO / , I 8.8 co 1 / o; 1 !v / / 22.6 �4►I / 0 7.5 15 30 I1" ,82 \IIAi�� IiiIi, / Scale in Feet HOUSE DETAIL - SCALE: 1"=20' ....,,,, ,, Legend General Notes Disclaimer _ .. o F q£" s4.'// -- • "9 /// A PLOT PIAN OF 1.This document is created for the purpose of a single property 1.This survey complies with the ASPLS Mortgage Location Standards.The survey represents visible • r' 1 W, Water Well a Concrete transaction and is subject to Federal Copyright Laws. improvements and conditions al the time of the survey.This document does not constitute a boundary % * TH: 49 '•* /, LOT 1 BLOCK 1 HIDEAWAY LAKE 1 surveyand is su to anyinaccuracies that a subsequent boundarysurvey tijecl may reveal.It is the i / ANCHORAGE RECORDING DISTRICT,THIRD JUDICIAL DISTRICT C t responsibility of the Owner to determine 111e existence of any easements.covenants.or restriction / • �`T i /�j'f _� STATE OF ALASKA L , Septic 2.Excepting for gross negligence,the(ability for this survey shall which do no appear on the record plat.Under no circumstances should this document be used for to Y ' A not exceed the cost of re arin this surve10800 HIDEAWAY LAKE DRIVE preparing 9 Y• construction or for establishinga boundaryor lento line. / i LTA Tel.Pedestal AnthonyH ffmian . o; o«,,,, �u„oR_,,- NO.LS 9020 .4:f....::' n / V% Wow PLAY 7!•111 AncHoaAc[RFCOROING oatiuci E Elec.Pedestal 3.All measurements/setbacks are to the visual/apparent building / • footprint. I,Frederic Wagner,hereby certify that this Mortgage Inspection Survey //'r! 9�6�2018 PREPARED eY: FRONTIER, ootp F J FRONTIER SURVEYS,EE, �;tr.” was performed by me,or under my direct supervision on August 28th 2018. ///'p� •,• •• �S` 650 W.Seth AVE.SUITE E,ANCHORAGE,AK 99518 s `; Lir i I Mailbox 4.All dimensions to property lines are plus/minus 0.1ft. 111 f!� `ESSI0MA`\�.�` DRAWN Er N6 DATE:9/4/2018 DRAWING ID:18.349 1177 -CHECKED BY:SSR KC SCALE:1'•4W1 SHEET1 c4 • NOTES Sc SPECIAL PROVISIONS: !I / i I { T / / \ ` - - - �� /` R1GDao`ortAWao 1. SCOPE AND SPECIFICATIONS: / / I I ( \ L. �� / \/ 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS /I I / / I 1 / \ '� \ (MASS)FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH J / / / \ / ' \ `\ AMC 15.65 AND 15.55. / I i \ ` ` F, `r 1 2. SCOPE OF WORK: DOCUMENT AND RECORD SYSTEM • l I J / / - - - - - / \•; yr* - ___ : 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER / / ��I • / �.I *** TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. / / // // 0)„... � d ** 4, 1.4. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING:CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER;A PLOT PLAN __. -"---'--- DEVELOPED BY RIS;OR A SURVEY AS-BUILT. / / +I�' , \ - 2. CONSTRUCTION SPECIFICATIONS: / I/ //// / / 34 / �� \ / 2.1. ALL EXCAVATION DEPTHS ARE ADVISORY.THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM / / /• I / TRUE �R : SALE \"= SU' THOSE USED TO PREPARE THE DESIGN / /t - �- I- \ / /-" 10 \' \ 2.2. EXCAVATE THE DRAIN FIELD.BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED.RECORD ELEVATIONS AT BEGINNING.MIDDLE AND END OF TRENCH I./ / / I - / \ { BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE / / ` / -- - / \\\ \ CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. / • / / / / _ _ 2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATNE MATERIAL OR SPOILS FROM EXCAVATION.LEVEL - / 1250G SEPTIC TANK (E) 20'NW Lln t form ,- F ROCK SURFACE TO±1"PRIOR TO INSTALLING THE PERFORATED PIPE. / \\ 2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM 03034 OR ENGINEER APPROVED EQUAL.MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 / W/ (2EA) COS BEFORE / LOT NOT DEVEL9R"ED \\ FEET OVER THE SEPTIC TANK.ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. / AND DCO AFTER - - - - __ - - - - - °_ 2.5. ALL INSULATION SHALL BE 2"THICK DOW HI-40 INSULBOARD OR ENGINEER APPROVED EQUAL.CENTER INSULBOARO WIDTH OVER SEPTIC TANK OR LINES. / - -- ' m 2.6. GEOTEXTILE SHALL BE MIRAFI 140S OR ENGINEER APPROVED EQUAL.LAP ALL JOINTS 2 FEET MINIMUM. // /_ _ \ APPROXIMATE LOCATION - NO INDICATION < ` 2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2"OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. // / I 1 22.4 ,'uta Dort • �5.7 - - - - � OF 1980 FIELD AND TANK VISIBLE are' 2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS,TRASH AND CONSTRUCTION DEBRIS. / 2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2%MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING Al OR NEAR THE DRAIN FIELD - - • -1- -T = ;' DOES NOT OCCUR.THE FILL SHALL BE LEFT AT 6"HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT.SEED SURFACE AFTER COMPLETING INSTALLATION AS I \ i / 00 $$` PER MOA CODE. / I \ \ 114.0 { 26.3 '�� - �- I� '-_ / m-II; 2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING.MIDDLE AND END OF SYSTEM. I 2.11. MAINTAIN 5'SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. / I \ \ ` \ 2.12. EXPOSE,PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON LAW WITH MOA CODE IF NEEDED. -1- I \ 33'5ecllon Lint.Esmt--I I = Y -- - � 3. CONTRACTOR RESPONSIBILITIES: { I \ t 1 I { I e ___� / / -7/ 2 3.1. THE CONTRACTOR(BOTH WELL AND SEPTIC SYSTEM CONTRACTORS)SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE ABSORPTION FIELD E I I �/ \ - / 0 • AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE 52LFx2.5 Wx5.0 E.D.,10.0 T.D. I ,- W ORK. W/ MTs & COs AT ENDSz 3.2. TPHE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W.AND OTHER REQUIRED PERMITS,OTHER THAN THE ATTACHED. Ail 4BR 1 74.3 i - Y 3.3. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. I I I I I + M SFD I -- �' m J Q 3.4. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE ` PRIOR TO NOTIFYING THE ENGINEER. I I I I I --------i, 1111 J I - r Y 4 a_ 3.5. TE CONTRACTOR CAUSING THE NEED TO MODIFY THE DESINGYNDISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS \I { I 1 18 3 I �,`` I I F I TPOJ Q 3.6. AT THE COMPLETION OF THE WORK,THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE ENGINEER. THE RED-LINES SHALL INCLUDE I { I I \�. `, I I�1 72.0 \ } w U PIPE LENGTHS,ORIGINAL GROUND ELEVATIONS,PIPE ELEVATIONS,AND TANK ELEVATIONS. / I \ \�''' 1\_:."-------,„_______________, N Q 0_ 3.7. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,TOP OF PIPE WITH CLEAN-OUTS I I \ \ I I = H- AND MONITOR TUBES INSTALLED.INSTALLED TANK AND FINAL GRADING. I I I - Q 4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT,AND ANY AND ALL 1 RESERVE AREA (NIC) { I I I WELL (E)....---1-i- __ -- - p co c lel CHANGE ORDERS,AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. / BASED ON AWWTS CA[III I I I I \ _ __. _ _ _ - % I c (� CONTRACTOR: BY: TITLE: DATE: 1840 20LFx5.0 WxO.S�E.D.,S.S'T.D. I I I \ - -- \ / I � � �/% /a6 ® ' 1 jil 8Fcciilts 66=boot :8721 G --/ -� N 1 N. 7 y / / �\ -.`1 �\ • / • J / / / / \ \ \ \ I I \\ / r - -- - / -/�:/ I / If / r PRIMARY/RESERVE DESIGN SOILS LOG / / \ I I \ N / \ / / 0 PARAMETERS TH-PEs A B C \\\\ N / / I \ "� Z NwNm OR TOPSOIL _ WATER RATE - I I N / N Z K 2 o PRIMARY DESIGN PARAMETERS 1 READING DATE NET TIME LEVEL NET DROP (MPI) FC 31.6 14.4 \ \ \ \ / / / /S1 0 W ,g,,,,"„ FILL READING I I / Z tJ x W N NO. BEDROOM: 4(600 qpd) 2 t 21AUGI8 5.900• Cl - 22.8 27.1 ) 77 \ 1 \ \ W -/ �/r / / Z z 5 S ri It;g \ \ 7 / QLDO ci TANK SIZE: 1250g 3 SPA 2 5.25 MIN 11.900• 6.00- 0.87 T 1 59.0 38.6 J / / / 0- Z W a. PERC RATE: 1.1 MPI 3 5.000• / \ \ / / / W > COBBLES T2 57.8 40.1 \i'2I / / / / aSOIL RATING: 1.2 CPD/SF a- s 6.50 wN n.9o0' 9.00" 1+ / / \AREA ROD:500 SF S S9�_ DCO 57.8 42.3 / / \ \ / /SYS.TYPE: DEEP TRENCH 5.0'ED s / \ / ABBREVIATIONS MIN LENGTH:50.0 6 6.57 1!1 t,.9oo 6.00 +.t C2 55.7 46.5 / / / \ ) / / / /TH TEST HOLE *+ �; LE / // / (P) PROPOSED b STING 6 C3 48.7 63.1 / \ -Y/ WATER LINE WEI& RADIUS/ CO CLEANIOUT NO. 'S + USE: 52.OLfx2.5'Wx5.0'E.D., 10.0'TO 7 GPA/SM WAS GROUND WATER SOIL TEST RESULTS/ANALYSIS M 1 47.9 62.4 / / SAND & ENCOUNTERED? N • PERCOLATION RATE 1.1 Onirdinch1 - i \ / � / // / MT MONITOR TUBE NO. � �) �St� TOTAL AREA:520 SF 8 GRAVEL (Hydrologic Soils Group: HSG A) r / / { l I SS FW sE BC` / /7YP TYPIC1/ / t ( t:.• !. 9 IF YES. AS WHAT • PERC HOLE DIAMETER 6- - W ii DEPTH', -NA-' • TEST RUN BETWEEN 5 FT AND 6 FT. 3 T z o • TEST RUN FOR OVER AN HOUR, ain;rous I0 - m DEPTH TQ WATER AFTER LAST THREE READINGS PROVIDED. �L.o' uo uoo � o FILTER FABRIC o�mn TI MONITORING? - DRY - - •- - -- - DATE; 28AUG2018 --. --_.___-.- F&•_@65.0 DRAIN ROCK 6"ABOVE PIPE INV r,l:.=86a.75 _ •,-R• ---._ .-_ _____----._._._._._.---------' -_.. -- w 12 I -4'o DRAIN PIPE ,u _- 4.0 re. w 13 COMMENTS:Test hole excavated by A+HOME SERVICES. "`• 14 PERFORMED BY:Joseph Lawendowski.I CERTIFY THAT THIS TEST - 25pg$ pTE IC o -� Y Y IS- WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL 4 16 � �� " +j $60.4 TANK 859-Q I w. -a+ o r GUIDIINES IN EFFECT ON THE DATE OF THIS TEST. SEWER DRAIN ROCK o �- g59.0 riSOH `,,,, PROFILE -- 3� -N g„ SCALE: 1"=-10. I - 52.0 --I -•1A SHELL - -µ. C3.0 DATE PERFORMED: 21AUC18 ,o„.,c,•.a:.1•,a>.nY•' 1 11, . Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650• http://www.muni.org/onsite• (907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 6. ? IV l .32 PID Number: 015-471-05 ❑ New ✓❑ Upgrade Name: DAVID THOMAS ABSORPTION FIELD Address ✓❑ Deep Trench ❑ Shallow Trench ❑ Bed 0 Mound 1001 WARREN AVE NORTH, SEATTLE WA 98109 0 Other Phone (Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Grave!depth beneath pipe Subdivision Block Lot 5.0 Ft. 5•0Ft. HIDEAWAY LAKE 1 . 1 Fill added above original grade Gravel length Township Range Section 0.0 Ft. 52.0 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 2.5 Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line 520 Ft2 1 Ft. Well 174.3 172.0 N/A { N/A 100+ TANK C]Septic 0 S.T.E.P. 0 Holding ❑Other Manufacturer (Capacity Anchorage Tank(Assumed) 1250Gal. Surface Water 122.4 114.0 N/A N/A Material Number of compartments Line 5.7 26.3 N/A N/A STEEL ` 2 Lot NA Foundation 36.1 43.6 N/A N/A LIFT STATIONManufacturer Capacity Curtain Drain f 50+ 50+ N/A N/A Gal. Pump on level at Pump off level at High water alarm at Remarks DOCUMENT EXISTING SYSTEM ONLY INSTALLATION DATE UNKNOWN in. in. in. .- Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank todrainfield 3034 Installer UNKOWN Drainfield 3034 co/MT 3034 Inspector BENCH MARK (Assumed elevation) 870ft Pannone Engineering Services Location and description Inspection 1' 21AUG18 2 dates: WEST GARAGE SLAB 3,d 4'" Stamp COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL �_`Engineer's` Conditional Approval: _ Date op co.. . `4 ":' 4 4;7*.• 49 11-I 1' .* 6 •tteveri I�. Ilan nolae VV 0 #0 T4s /0, _. ,, Approved , �'`- \ Date lt‘‘‘0FE5s* Inspection Report_1-1-12.doc MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 015-471-05 HAA# HA890094 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block 1 Hideaway Lake Subdivision (T12N R3W Section 24) Location (address or directions) 10800 Hideaway Lake Drive (b) Property owner Mike Maxwell Mailing Address 1.0800 Hideaway (c) Lending Institution (d) Lake Telephone (home)346-3369 Business Drive, Anchorage 99516 Telephone Mailing Address Real Estate Company and Agent Judy Upton % Re/Max Address Telephone 276-2761 (e) Mail the HAA to the following address: (or check here []; if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE ~'f~'~Family;~: Number of bedrooms three WATER SUPPLY Individual Well []x Community [] Public FI Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site~ 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. 72-025 (Rev. 7/88) Page 1 of 2 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm A.E.C.S0 , Inc. Telephone 279-5523 Address 1412 West 33 Avenue, Anchorage, 99503 Date Engineer's Seal DHHS APPROVAL Approved for ~ bedrooms by Date April 12, 1989 A-pp rc;'ed'- Disapproved xxxxxxxx Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)Back Page 2 of 2 Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 April 11, 1989 Mr. Michael J. Maxwell 6641 Debarr Rd. Anchorage, AK. 99504-1706 Subject: Lot 1, Blk. 1, Hideaway Lake Subdivision. Dear Mr. Maxwell; While investigating the claim made against the Municipality, it was discovered that an apartment had been constructed in the downstairs northwest corner of the residence. This finding is important in that our office may only process health authority approvals for single family residences. Whereas the apartment has a kitchen, bath, area for sleeping and has no direct connection to the any other living areas, this renders the dwelling a multifamily unit. We must therefore withdraw our previous conditional approval. Any approval would, necessarily, come from the Alaska Department of Environmental Conservation. This in no way eliminates the question of proper ground water separation to the trench bottom. ADEC will need this question clarified prior to issuing any approval. I would suggest you contact your engineer about the particular requirements for a well and septic serving a muttifamily unit. If you have any further questions please call me at 343-4744, or stop by my office at 825 L Street, Room 502. Sincerely; Daniel N. Bolles On-site services cc: Susan Oswalt, Manager, On-site Services Lee Reid, P.E., AECS Judy Upton, Remax MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ \ ~:~_- ~'~ -'/\ - ~).~.~ NAA #. ~ ~ ~c~ (...~q ,Li 1. GENERAL INFORMATION (Musl be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Locat,on (b) Property ~,___/Y/~ ~/~J~ Telephone : (home) B~-} }G~Business Mailing Ad~,.. ~.:~~ 6~ ~-, (c) Lenomg ~nstltut49~,..'~¥..;:..,.G,~-~:' Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ~; if hold for pick up.) List contact person and day phone number below: / 2. TYPE OF RESIDENCE · ' _.~ Single-Familyp Number of bedrooms 3, WATER SUPPLY Individual Well ,~' Community [] Public FI Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 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, Iverifythatmyinvestigationofthis 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 ~;~,¢--"-,~' Telephone Address IL/i/~Z' (~(-~' ~.~ ~' /~/~c, /~K, Date 6. DHHS APPROVAL ,- . /'~'~'"i-A ,1 ./~-./ Approved for ,~ bedrooms by /¢ ate At;~r-e'~c~ ~...~vv,~' ......... ~.~ Conditional / / The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraphSabovebyanindependent 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 DHHSdo 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 (Rev. 7/88) Back Page 2 of 2 .C¢ ~ MUNICIPALITY OF ANCHORAGE (MOA) At ,,ot; ~ Health Authority Approval (HAA) ,~;;O+~ ~.%.b ,~ Legal Description: ¢°Z-/ ~,c/ /~E~E~ , Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~) Sate Completed ~ ~- ~ Yield ~,~ ~I Total DepthS.Ca, ed to-~ Depth of Grout ng Static Water L~el ~. ~ - - Pump Set At Casing Height Above Ground Electrical Wiring in Conduit/('~2N) v SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Sanitary Seal on Casing~.~N) Depression Around Wellhead (Y~_ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~/~0 To Nearest Public Sewer Line J/~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ["}..5"" Water Sample Collected by ~_i'~, ~ -' '~ . Water Sample Test Results .~/¢-d-'7'-- -~- Comments /~-/-/-- /¢z_~J "F-ge~'7'- B. SFPTIC/HOLDING TANK DATA .. x,* 'lA'-6'~ ...... Date Installed /(~;O Size f)~ Standpipes~) Air-tight Caps ~N) Depression over Tank Pumping/Maintenance Contact on File (Y/N) Holding Tank High:~.ater'A'l~irm (Y/N) SEPARATION D-.le~.¢~-E$,t~2~EPTIC/HOLDING TANK: To Wate r-S u¢¢~%Wel I~I.~,'~ ¢ ..', ~- To P r o p e r t ~'l~ih*~ '~;- '~ No. of Compartments Foundation Cleanout (Y/~-'~ Date Last Pumped ~¢-~¢ ; for . .. Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field '-~ Course 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /(-? - ~:"(:P/~ --/~'~ Width of Field ---~ Type of System Design Length of Field Depth of Field .~' ~/ ' Square Feet of Absortion Area Depression over Field (Y/~_ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well //__2~ To Building Foundation ~ ' To Water Main/Service Line Gravel Bed Thickness ~¢ / ~¢" Statndpipes Present ~'~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~'~ '''/- To Cutback (if present) ./~//.~ To Stream, Pond, Lake, or Major Drainage Course To Privewa , Parkinq Area, or Vehicle Storage Area .,.. -. . ~ ,.~ ~, . , , i ~ , i , .~ D.~..~TATIO N "Pump On" Level at ~ High Water Alarm Level at ~ Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ Pumping Cycles during Adequacy Test. **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 Company Date MOA No. 0~4 Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7188) Back ,~~_ '~*~E_ n gineer's Seal Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, FEDERAL TAX ID # 92-0040440 AIIALYStS hEPORT Date [~epo~t Client Sample ID:L1 HIDEAWAY LAKE ?~$1 D :UA C>i]ected FE~ 28 ~9 ~ 14:0[ hrs. Received FEB 28 89 2 15:00 h~s. Zeq ~'. Chemlab l{ef ~: d388 Lab ~mp] ID: ! N'atrix: ;'IAIER kliow~.b! e NIT~ATE N 1.7 mg/l EPA 350 2 20 Sample ROUTINE SAMPLE }kemarks: SM,IDLE COLLECTED B'f P,,P, i Tests ?ezfon'ned See Specie, i inst~uctlone Ahoy:. UA=Un~,vaJieb]e ,u= None Detected '* See ;)ample Neir, ar~:s Ai)ove NA" Not Analyzed LT=Loss Tha~t, GT-Creatoz Thai; MUNICIPALITY OF ANCHORAGE DEPARTIVIENT OF HEALTH AND ENVIRONMENTAL PRO'rECTION DIVISION OF ENVIRONMENTAL HEALTH CI:!RTIFICATE OF iNSPECTION FOR HEAL'FH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1, Blk t Hid_ea__wa_y_ Lake Subdivision Location (address or directions) (b) Applicant Name Michael A, Maxwell-- Telephone: Home 345-1147 Business 337-1566 Applicant Address 6641 DeBarr Rd. Anchorage, AK 99504 (c) Applicant is (check one): [_ending Institution []; Owner/builder ~J; Buyer []; Other [] (explain); __ ;. (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: //,,/ TYPE OF RESIDENCE Single-Family ~ Multi~Fa~niiy [] Other ~umberof Bedrooms (~3) Three WATER SUPPLY Individual Well [] 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: It community well system, must have written confirmation lrorn the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ~2-0:,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 effeot on the date of this inspection. Name of Firm Telephone Address Date This office has done a feild inspection of the suject property and finds that it meets current MOA requirements. Therefore, this property is now fully approved. Engineer's Seal Approved %' Disapproved Conditional Terms of Conditional Approval CAUTION 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 state 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 R 0 M P 665 689 598 RECEIPT FOR CERTIFIED MAIL NO iNSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent tOMichae1 Maxwell Street and No. 6611 De Barr Road P.O., State and ZIP Code Anchoraqe, Alaska 04 Postage $ !Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered Return receipt showing to whom, Date, and Address of DellYery TOTAL Postage and Fees $ Postmark or Date _Left this office 1-22-85 - 2nd request Approv~i for the ind'j, vi. dua~ sew~r and ,.rater faci]~J.-tJ, ea cannot qra]ut, ed unt. i.]. ~hn ~fo]_].owJ. nq items well ].or1 ~,lhtq~ktied to-this o'[~fice .for o-~)7 -, ~.l(~s and rev:i (.)w. the wo]_l casing sealed wJ.i-_'h water 'tJ_ght 0 '".~ xp.o.~c.¢~'~ e]ec-kr±c:al wi}Tes to the well head o:,7 khe HmicipaJ.~t'~_. . .. o{ ~nehc)rage Codlin ..... and i.n con(-Ik!J.t. ° q?h_e waker ana].ysJ..~ report needs 'ko be submitted /-:o 'k}~J_$ office frown 'th~ C'h. em I,ah, 5633 B S't~-eet, J[or our revi. ew. o A '~our (4) :Lnch cast :Lrcm c:leanout need~'. -to i-,e {n~,'tal.!ed to 'tbn septic tank and/or leaching area. ao that surface wa'tel' drd. J.~s away from 'the sewe~' sVS'tem, 0 'lJ}(~ s*kel'ldj)l~.pe to tho :3ewer ~ys'tem need caps on -them, PLease noe. j_-gy this dep,urtmen't for a r'~2in[~pecti.on whon the Do'bed di. screpancies have been correct:nd. If i-.here are extly :{urtl}er gtlestJ_on~;, Dloasn oa].l this oFilJ, c~ at: 254-4'120. Sincere .l.y, P, oh~.r't C. PFntt P. P4 3 /p/ Time Time Date Date Date inspector Inspector Inspector I ~ate sewer mst,~ed ~;,,.~.,,.... ~,~ ..,~,,,jf Permit No. . / ~ .¢ ~:'8 ~,~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank Property Owner Mailing Address APPLICANT FILLS OUT LOWER HALF ONLY I i:); ltl<, ~ ,.,.~ ~: t1 %Phone ~i:~t i Zl ? Buyer Address Lending Institutlon///~..~/~,¢4 //~](,-.~, ,, / Realty Co. & Agent Address Legal Description Street Location Phone Phone Type.gf Residence L'~ Single Family [] Multiple Family [] Other No. of Bedrooms Water Supply ~ Individual E] Community [] Public Utilit)/ Sew§,g e Disposal L~3 Individual [] Public Utility E] Holding. Tank ATTACH WELL LOG. A well Icg ~s required for all wells drilled since June 1975. For wells drilled prior to that d~!te, give welt depth (attach Icg 'if availabte.~_ Year Individual Installed: //¢~" / When Connected to Public Utility: NOTE: THE INSPECTION FFE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.