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HomeMy WebLinkAboutHIDEAWAY LAKE BLK 1 LT 3Onsite File Hideaway Lake Block 1 Lot 3 #015-471-07 UMNUMU U ULAQL FEB 9 2029 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201364 PID Number: 015-471-07 Dwelling: W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name SEAN BROSNAHAN ABSORPTION FIELD ❑Deep Trench ❑Wide Trench ❑Bed ound Site Address 10900 HIDEAWAY LAKE DRIVE *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-227-9274 4 GPD/SFJ Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeFt. Gravel depth beneath pipe Ft. Subdivision Block Lot HIDEAWAY LAKE; BLOCK 1, LOT 3 Fill added above original gr Ft. Gravel length Ft: Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orplion area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ I TANK ❑Septic ❑s S.T. E.P. El Holding El Other i Manufacturer GREER TANK Capacity 1000 Gal. Surface Water *70'+ Material Number of compartments Lot Line 15�+ i NA HDPE 2 Foundation 10, + LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC GREER TANK 500 Gal. PER CONTRACTOR "70'+ FLAGGED BY PLS DURING CONSTRUCTION Alarm location GARAGE Electrical installed by POWERLIGHTING AND CONTROL Installer PIPE MATERIAL House to tank D3034 Tank to d raO EXISTd NORTHERN EXCAVATION Draintield EXISTING co/MT/MTD3034 Inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 101.32 fl Inspectio �m 10/28/20 - Location and description 2�d TOP OF MH 3m - 4th _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp Conditional Approval: Date 0� F 7 4' H ............ .... ....... D _ i...................G Septic System '. e I ,,. ess; �p Q 9 CE— 95 Approved Date .� l i 241 i �p4 z �i a Z n ,� O P"fess-,0(10 Note: this approval does not include well permit requirements. 40�000� #AECC884 PERMIT NUMBER: RECORDGSP201364 DRAWING RAS n V�� I N G ��wEIL LOCATION AB DBL1 18.1 9.6 DBL2 18.4 10.2 MH1 17.5 11.7 / MH2 16.3 15.4 NEW 1500 GALLON HDPE GREER STEP TANK PARCEL ID NUMBER: 015-471-07 DBL / HE B EXISTING PRESSURE LINE/ GENERAL ED LOCATION PER PIPE —_ ON AS -BUILT SURVEY AND 1988 EXISTING HOUSE :° RECORD DRAWING IN MOA RECORE HIDEAWAY LAKE ° • A. ., DRIVEWAY dQ ° °d I d -°. _ I :AGR L ;' 4.lij ,- 1 . 1 1 1� I 1 d 1 � 7aD' ° ' Q • d j \ ' / e. ! • . SCALE: V=40' GROUP,GARNESS ENGINEERING ;....:::.... ..................::.....; ENGINEERING SALES CONSULTING / r 3701 E TUDOR ROAD, SUITE 101 -ANCHORAGE, AK99507• PHONE (907) 337-6179-FAX(907) 338-3246• WEBSITE: w�wgm englneenng com �. .,.ri• •. i ' ........ •••••••••••••• PREPARED FOR: PHONE NUMBER: e55PAGE NUMBER: ey A-G3R18SS � �► SEAN BROSHNAHAN 907-227-9274 2 OF 3 �j .. CE - 53 _� 7 LEGAL DESCRIPTION: DRAWN BY: , HIDEAWAY LAKE; BLOCK 1, LOT 3 D.J.G. �� �`''••• .,,..,..••('•�' •. TYPE OF WORK: DATE: LICENSE`1 Ij% ESS\"' �. SEPTIC TANK RECORD DRAWINGS 1/28/2021 #AECC884 ���Tilkswi —) PERMIT NUMF ER: PARCEL ID NUMBER: C+SP201364 RECORD DRAWING 015-471-07 TOP OF MANHOLE = 101.32 FINAL GRADE = 100.73 MH1 MH2 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 91.34 TOP OF TANK AT OUTLET = 91.35 INVERT OF BUNG AT INLET = 90.71 NEW 1500 GREER STEP TANK WITH ANCHORAGE TANK ORENCO COMPONENTS ,511 J.....:.... g ...............::..... ENGINEERING SALES CONSULTING • f' 0 3701 E TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507' PHONE )907) 337-6179' FAX (907) 336-3246' WEBSITE: �wrci.gamesse gneenng com •....• ............. ....••..• . PREPARED FOR: PHONE NUMBER: PAGE NUMBER: rey A. Garness .' 4+J Ia SEAN BROSHNAHAN 907-227-9274 3 OF 3 ��C'i�: + CE 795 ���� LEGAL DESCRIPTION: DRAWN BY: �♦ ' , Z�`a � HIDEAWAY LAKE; BLOCK 1, LOT 3 D.J.G. ��j� 1'ROFESS��P���• TYPE OF WORK: DATE: LICENSE �rrr�,►�.�.�� SEPTIC TANK PROFILE 12/10/2020 #AECC884 ,70 dock U 0) rti U*) 0 z Lot 2 S86008'5011E 293.01 Manhole Shed OXA '2 stor' �apse LOT 3 No Lot 4 795 6,p wooc, f, — 0.2' Ret. wall ewe `122. Septic vent (typ) REVISED 1-29-21&f/Z RECERTIFIED 11-30-20 8490R / 0. 10, C") J (0 L4J LIJ z R AS -BUILT NO CORNERS SEI THIS DATE OF A4 I I hereby certify that I have performed a Mortgagee's inspection - - . . . - # in accordance with ASPLS Standards of the following Aw A described property: LOT 3, BLOCK 1, 49th HIDEAWAY LAKE SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines ... and do not overlap or encroach on the property lying i z a b; �et;h L Wailatkai so adjacent thereto, that no Improvements on the property lying 9t .• 3 — LS adjacent thereto encroach on the premises in question and A0 AW that there are no roadways, transmission lines or other visible easements on said property except as Indicated SCALE: V= 40' hereod n. % Dateat Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN Z41. Zb Z4 this 14th day of AUGUST 2020. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. ARE NOT SHOWN HEREON. FB 20-4, pg 70 BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED LK FB 20-4, pg 25-27 This drawing Is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and Is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used lbr a single property transaction. Use of this drawing by the original chant or by others at a later date without the consent of Elizabeth L Walatka Is a violation of Federal Copyright taw. Unless gross negligence Is discovered, the liability extent of the preparer Is limited to the amount of less collected for services In preparation of this producL 30 R AS -BUILT NO CORNERS SEI THIS DATE OF A4 I I hereby certify that I have performed a Mortgagee's inspection - - . . . - # in accordance with ASPLS Standards of the following Aw A described property: LOT 3, BLOCK 1, 49th HIDEAWAY LAKE SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines ... and do not overlap or encroach on the property lying i z a b; �et;h L Wailatkai so adjacent thereto, that no Improvements on the property lying 9t .• 3 — LS adjacent thereto encroach on the premises in question and A0 AW that there are no roadways, transmission lines or other visible easements on said property except as Indicated SCALE: V= 40' hereod n. % Dateat Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN Z41. Zb Z4 this 14th day of AUGUST 2020. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. ARE NOT SHOWN HEREON. FB 20-4, pg 70 BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED LK FB 20-4, pg 25-27 This drawing Is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and Is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used lbr a single property transaction. Use of this drawing by the original chant or by others at a later date without the consent of Elizabeth L Walatka Is a violation of Federal Copyright taw. Unless gross negligence Is discovered, the liability extent of the preparer Is limited to the amount of less collected for services In preparation of this producL MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201364 Work Type: SepticTank Upgrade Tax Code Number: 01547107000 Site Legal Address: HIDEAWAY LAKE BLK 1 LT 3 G:2640 Site Mailing Address: 10900 HIDEAWAY LAKE DR, Anchorage Owner: BROSNAHAN SEAN P Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: Am 11 Department 9/17/2020 9/17/2021 46066 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 3 Municipality o Anchorage �. �� 1)r. parrmenr P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Divisi®n On -Site Water and Wastewater Proaram * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201053 COSA#: Permit#:OSP201364 PID#: 015-471-07 Legal Description: Hideaway Lake Blk 1 Lt 3 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the S.T.E.P. tank to the surface water has been approved. The approved separation distance is 70.0 feet. This waiver approval applies to the proposed S.T.E.P. tank only. Any fixture upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ■............................................. ■ ■ ............................. ■ 1 Waiver is Granted: X - Waiver is not Granted: Date: G I% (� Approved by: Gt/ Name of Revie r **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY -OF ANCHORAGE r 0 .*.-. Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Ethan Berkowitz On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 015-471-07 Property owner(s) SEAN BROSNAHAN Mailing address 10900 HIDEAWAY LAKE DRIVE *ANCHORAGE, AK 99507 Site address 10900 HIDEAWAY LAKE DRIVE *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot) HIDEAWAY LAKE; BLOCK 1, LOT 3 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( N all that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone 907-227-9274 Sq. Ft. Number of Bedrooms 3 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: SURFACE WATER TO PROPOSED SEPTIC TANK TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 70' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 7.5 Coy In Waiver Fees: 7S CDJo Date of Payment: 16 A20 Date of Payment: Receipt Number: 060 26 Receipt Number: Permit No. C>-`' p2013 6 t -I Waiver No. 05V2_010-53 (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201364, Deb Wockenfuss, 09/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201364, Deb Wockenfuss, 09/18/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201364, Deb Wockenfuss, 09/18/20 � 90 0" Z V �r J Lu Q SCALE: 1"= 40' Lot 2 S8600815011E 293.05 LLl F� LOT 3 u� 0 0 Z oWell Lot 4 ,34 62 .w,.►'rt \ ! t` �OF AC' �'S A '�• t j mw �'.* 49th � �•� t�I 00 / A `. izabeth L Walatka`;� s r y/ s 8036 — LS • �2 .. lr.•. • .AW EASEMENTS OF RECORD, OTHER TH Z `�o�sstosaa� .e+ THOSE SHOWN ON THE RECORDED AN p PLAT ARE NOT SHOWN HEREON. t BE UNLESS OTHERWISE NOTED LK FB 20-4, pg 25-27 0 W ooh fence �f�'a) 1 ' Z 30 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 3 BLOCK 1 HIDEAWAY LAKE SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 14th day of AUGUST 2020. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. ~UNICIPALITY OF ANCHORAGE DEPAR'~ .;NT OF HEALTH AND HUMAN SERVICE'. Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264~4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Lo[ Name Phone{s} L~)'7 ~TPe''~" No ~ _ No ~edrooms L~GAL D~SCRIPTION DISTANCES WELL 8EPTtC ^B$ORPTION TANK FIELD '~' ldo' I I O' i0~ fi- IO' TANKS SEPTIC .~\X'~.'\'~-~ ~'l HOLDING TYPE OF SYSTEM WELL LOT LINE "~0' + FOUNDATION 80: ~- ~?o: + AS-BUILT DIAGRAM (Show iocahon o1 ;';ell, $opll(; system, p[operty IiIqes. IOUl]datlon. [~ TRENCH ~ BED ,5-/' WELLS '~PRIVATg :,(~k~ ~ OTHER (Identifv) ClaSSdlCatlon (A.B.C, ,~ ~ ~otal Deplh ICaseO,o REMARKS: ~ W. DRAIN [] OTHER FT ~ ~ FT ...... L~: FT Scale: nspect OhS Pe lorn ed by - Dine ~4unicipal and State guiflelmes in ellecl on IhJs date: M U N I C I t:::' A I... :1: T ¥ 0 !:::' A N C H L') R A G E Depar'tment o~' I-lea:l.t.h & Humar~ Set'vices 825 I_ StP~:.:,~.~'l:. At, cbc)rage, hlasl<a 99',:::i()1 343....4720 0 N .... S I '1' E S E W E R F:' E R M I '1" F::'er'mit. Iqumb~.:,[': 8E1()076 )[:)at..e Issued~ 06/07/88 Enr:.l :~. m::.~er. Des i Owner' Ad(::lPes~.~: i()CK) IZAST DIM[)ND :1:I~!(:)5 PdqCI...l[)l::d)~Gliii:, Al< 99515 I:::'ar' c:e :1. I (:J ~ 0 15'""z1,'~z 1-'07 34.5 '- .,.1.440 SEi]:::'T'IC ]'ANI<: M:i. nimum tot. al septic: 'l:.ank capac::i.t¥~ 1~250 gallons, Each f'(-:~.(.:'.)t, r.(.'...!c:l(..lir'.(:~)~B :i.i'qs..",LtJ.,9, tJ.c)ri c~ver' t. anl< (s) , INFORM D ,, H. H ,, !3, l:::'F/]: 01:;i'. '1"0 1 SI' & 21xlD :1: IqSF:'IZCT ]: OI',IS BY IENG I hllili:l~!:l:~, AI::rTI~I::/ OI:::'F"']:CI!:i H[ILIRS (::;AL.I_ 343-4681 AND I....EAVE A MEEiSAGE C(:)NSTFII..!C'I" F:'l!!i:l::( EI',II'.i~IN[!!EI:~S A]'TACiHED AF'PI:ROVI::!:D DE. SI[~)Ixl '1'1-11S I:::'I~i]:RM I "1' EXP I I::/E:~i :1.2/:3 ]./88 'I"FI I !i; [::'EI:;;'M i T MAI_ l' D F:OR A S I F :1: CER I"I1: Y "I"HAI': ['c)Pt, h l:)y the IvlL~n:i.l::il:~i~l:i.t.y (:)[ (~bl'lcl"lc~r'a~jc(e (MOA) and t. he~ SCat. e c:)[' Alaska,, ;:~'~,, I ~i:l.! install the syst.(~.)m :i.n acc:oH"dar'ice wit. t') al Z I~II:]R c:c)cles arid ~ll"ld :[1"~ ~:l::ll'rl[:)][.J.~l"ll:::(~:~, ~:['['..h th6.e design (::P:i.t. eH":i.a o[ t.h:[s 3,, I ~:[:1.]. adh(~r'e) to ail MOA and Stat. e c)[ R:l. aska PeX::lU~r'emer~t.s for' 'Ll"u.~) set. bac:k (::l:[~'[..a':Xl"l(:::(.'.~ {'r'om arly exis'L:i.r'ig ~ e) :!. .[ e, ~as'Lewat. em disposal syst. em oP i:)ub:tic ~s(.~w~6H~agt.::,) ~r:/~Bt.(.~[i~ on 'l:.l'lis op al']y acl.jac:ent. (::m r'leaPby lot., 4,, :[ ur~der'.st, and t. hai. t.l'~:i.s p(~.)PfFFJ, t ~.5 valid ~'[~r' a maximum o~' 4 bex]Pooms. also url(::leH~st, arlcl t.l'~at. 'Ll']e C:al::)ac:it.y c)t' the) t.c)t, al sy~r[.6)J~) S i (:: rw.'~rl '~qi)A'T'I~: ~ ~ ....... : ................ ............................................ Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /-/~'~(C ,~./~(~ ~'~'~7'~_ t%d'~? DATE PERF( 10 ~'o'i~' ,'_'3T°wnsh~p, Range, Seclion: SLOPE WAS GROUND WATER ENCOUNTERED? ~/~.S 11 s L IF YES, AT WHAT 0 DEPTH? p Oopth t° Water After / ~r' 1 3 Monitoring? / ~! Dale: 16 SITE PLAN 18 19¸ Reading Date Gross Net DeplJl to Net Time Time Water Drop 20- PERCOLATION RATE __ (mmuteshnch) PERC HOLE DIAMETER TES1 RUN BETWEEN __ FTAND FT 72-~8 (Rev. 4/851 PERFORMED IN LEGAL [~ESCF~IPTION LOCATIOI' MUNICIPALITY OF: ANCFIORAGE DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 QN-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT T~[~IT~ N E ~U~GRADE NO. OF BEDROOMS ]tion area D,STANC TO: Manufacturer ~,~ ~_~., No. ofcom~.p~tments Liq,, I IF HOMEMADE: I Inside length Width Liquid deptl~'~ ~ DISTANCE TO: IWell I Dwelling PERMIT NO. Manufacturer Liquid capacity in gallons DISTANCE TO: Fou ndatio ~r~. Total PERM,T NO.? /O/,W No. of lines Top of tile to finish grade Length Width Type of crib Well DISTANCE TO: Class DISTANCE TO: Material beneath tile ~,~ inches Depth PERMIT NO. Crib diameter Crib depth Total effective absolption area Building foundation Nearest lot Hne Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) lines )don area OTHER -PIPE ~ATERIALS SOIL TEST RATII~G ,,ST REMARKS ~.~PROVED ~ ) DATE LEGAL L O E: FI "F I O LEGRI.. F' F: P i'.,I .. :[ E; H I E:'EFII.,.tFFr' [.Elk:E: F.':OFIC, L 2 [.:; i H.T.E. EFI..IF ' LFII<E E;,.."D LCfT '.::;IZE ,~l.,E;EhE;d; :~SC!UI:::IF;:E FEE'T' T CF'IE OF :;.:;F'~ ]: L FIBE;Ed¢.':F'T .[ O1'.,! :.'.:;"r'E;TEH 1' :5 ' TF:ENE:H TIdE F::EC!U ]: RED :5 :[ ZE OF' TFIE '.'.SE I L RE:SOI~;:F"T' I ON :'.::;"r".:4;TEH 1'::; ' THE LENGTH E:, l HEN:E; I ON .1: :.-:..; THE L. EF,tGTH ,:: 1' N FEET > OF THE 'TF.:EI',K?H OF.: I::,F.:FI :!: [',IF: ]: ELI). THE [::,EPTH OF FI TRENCH Eft;;: F'ZT :[E: THE:. D:[L=;TFINCE: BETI.4EEN 'rile '/:;UF:FFtCE QF THE C. iROUNE.', FIt'.,I[)TFIE E~OTTOPt OF THE E%CFI',,,'RT)[ON ,.':Iht F'EE:T). 'T'HEt:,?.E ]:::'!; i'.,16) SET 1.4.T. 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ON--L::,ITE 2.':Et,.IE:R'_:; Rhl[::, I.,.IEI...L..ti:.:; RtE: SET F'OFi:'rH B'T' THE HUNIC:IF'FIL.:[T'.r' OF' laNCHC~Fi:FIGE. 2: :1: I.,I:[L..L :[N?I"RI....L THE $"¢E;TEP1 ]:[',t RC.:COF.':DI::INC:E I.,.!I'TH THE 2i:: :[ LIN[>EFiYE;TFIN[::, THFIT THE: OI'.,I.~-'E;]:'I"E :'SE'I.,.IEF~: E;"¢E;'TEI'4 Hl:l"r' F.'.EC!I..I~.RE E:NLFI~:C4EP1ENT ]:F' THE:. F.~E:!~.;]:DENCE liE; I:;i~EI'"IO[::,E:LE:[::, TO ]:NCL. U[:,E HO[~'.E' THRN ,::I. E:E[:'ROCd'"IL:;. :5 1 Gt'.,IED: ............................................................................................................................ V4. 0'~ SOILS LOG DEPARTMENT OF HEALTH AND ENVI Pouch 6-660, Anchorage, Ale~(a 99602 276-2221 SOILS LOG - PERCOLATION TES/~ PERCOLATION TEST PERFORMED FOR: Francis Russo LEGAL DESCRIPTION: Lot 3, Block 1, Hide-A-Way Subdivision 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SLOPE Organics and organic silt, darkI I brown to red-brown.(Pt_0L) Sandy-silt, grading to silty- sand, tan, stiff, dry to moist, ~~_~ little to no gravel. (ML-SM) well-graded, brown, dense dry to moist, rounded gravels to cobble size, little to no fines.[___~_~ (SW-GW) ~ SITE PLAN WAS GROUND WATER No s ....... ENCOUNTERED? L ~- .... IF YES, AT WHAT E DEPTH? i PERFORMED SY: Howard Grey & Assoc., Inc. PERCOLATION RATE TEST RUN BETWEEN Reco~end using the gravelly layer for installation. 9, 1981 Reading Date Gross Net Depth to Net Time Time Water Drop • '-° Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 015-471-07 1. GENERAL INFORMATION: "E °G o .�C o S R f[ T Y Expiration Date: _ (e-" - 6' • Z Complete legal description Hideaway Lake; Block 1, Lot 3 Location (site address) 10900 Hideaway Lake Drive *Anchorage AK 99507 Current Property owner(s) Sean Brosnahan Day phone 907-227-9274 Mailing address Real Estate Agent 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: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $550 Date of Payment 242V 20,2 1 Receipt Number 6575,26 COSA # OSC211065 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information - -obtained-from the Municipality ofAnchorage 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:;1U;f% Lr 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 IGNATURE System #1 Approved for L L bedrooms System #2 Approved for Disapproved Conditional approval for By: ► v. bedrooms bedrooms, with the followi t#AECC884 �Y OFf ON-SITE WATER AND vT'' o�,u1aQPM'- 'ATER z &GFAM J ' Jj Original Certificate Date: 3- ._' `-( 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 �i Legal Description: Hideaway Lake; Block 1, Lot 3 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1981? Total depth *77.8+ ft Cased to unk ft 0 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/17120 Static water level at beginning of test 77.4 ft Comments *Per GEG well test B. TANK DATA Age of tank(s) New years Tank type/material STEPNOPE Measured operating fluid level in septic tank New 01 Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA BED Which system tested (date installed) 1988 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.0 ft (max) --- Measured depth to pipe invert from grade 3.9+ ft (min) ❑ N/A — pressurized field of Parcel ID: 015-471-07 Structure served by this system Well production at time of test 3.8+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes IN No L\J Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L A Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample '1_11 I )-, C. LIFT STATION ❑ Required maintenance completed Age of lift station New years Lift station material HDPE Comments: New Adequacy test date 7/17/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added **519 gal New depth 2 in ❑ Monitor tubes go to bottom of effective. If not, state ** depth into effective 4 INCHES Elapsed time 15 min depth 0 in d l flue FEWCode-requiredsoil cover over field Finap ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: THE EAST CLEANOUT IN THE BED IS MISSING ""ALTHOUGH 600 GALLONS WERE NOT INTRODUCED, THE MONITORING TUBE REMAINED AT 2" FOR THE FINAL 169 GALLONS AND APPEARED TO BE TAKING WATER AS IT WAS INTRODUCED. IN ADDITION, THE MONITORING TUBE WENT DRY AFTER 15 MINUTES. IT IS REASONABLE TO ASSUME THAT THE DRAINFIELD MEETS THE MOA ABSORPTION REQUIREMENTS FOR A 4 BEDROOM HOME 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' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' w ft _Yes - ---if-No---___- ft- _ -- _ _ _..---_ - _..--- - - - __ -[�✓- -Yes. _------ __tf No ----_ ft _ --- _ Neighboring Tank > 100' 7✓ Yes if No ft Private Sewer/Septic Line > 25' 7✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No *70'+ ft Property Line > 5' ✓[j Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F71 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' F✓ 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' F] Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q✓ Yes if No ft . Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' F/ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *WR#OSV201253 PORTION OF DRIVEWAY IS LOCATED UNDER "GRAVEL PAD" SEE ATTACHED AS -BUILT SURVEY FROM WALATKA G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 S8600$15011E 29Lot 2 8490R/3.05 Manhole / Shed 04 01 _...._..-_ -.__------- _ Ql� --- _ Go. so -----... _ .. _______ _-_.__.-_ -._. .-----....____ ._..___ . ___.__.__n 13 N ,C 70O 5a6 Fca0e p 0 s� 22 ouSe N 5 +� 30 °' 10$.4 w a c Cl dock 6SpraXt ' 0.2' Ret. wall '—+ 5 � PI 6�1 CD O `' rn GrdVg CV t - 122 • �.. 4LO LOT 3 Septic vent (typ) 2 Ni - Cif o Z oWell Y m cLl w S64°23, z 1 , t— S F wood fence Lot 4 794 6 2 REVISED 1-29-21 30 RECERTIFIED 11-30-20 AS -BUILT NO CORNERS SET THIS DATE ,q� � 1 hereby certify that I have performed a Mortgagee's inspection ; 9 in accordance with ASPLS Standards of the following .W ��;• • • •S� �I described property: LOT 3 BLOCK 1 �?• 49thO� HIDEAWAY LAKE SUBDIVISION - Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying izabeth L. Walatka .• a s> adjacent thereto, that no improvements on the property lying ����a-• 8036 — LS•• ��` adjacent thereto encroach on the premises in question and c� gJ AW that there are no roadways, transmission lines or other �"`o ... - ' •�o visible easements on said property except as indicated SCALE: V= 40' OFessroNAl a'4 hereon. 0 ®► Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN !.. �G, this 14th day of AUGUST 2020. THOSE SHOWN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON. FB 20-4. pg 70 Engineers and Surveyors UNLESS OTHERWISE NOTED LK FB 20-4, pg 25-27 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed, This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services In preparation of this product Teff Garness From: David Harper <dlharper2@gmail.com> _-.Sent: -------------Wednesday,-,March--3-,--2021-10:55-PM-- To: ___ ___ ___ ________._._Wednesday; March--3�202-1-10:55-PM-_To: Jeff Garness Subject: 10900 Hideaway Lake Dr. Jeff, the downhole camera was letdown to 50 feet on the well at the above property. We found no breaks, holes or entrancing water and the well casing and appurtenances appeared to be in good order. David Harper Aarow Pump & Well Service, LLC MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC211065 Subdivision: Hideaway Lake, Block: 1 , Lot: 3 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.99 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 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..# _.l~)\~- ~4'-'t~ ~'~ 1. GENERAL INFORMATION , ,Complete legal description /.-¢'¢ -~., Location (site address or directions) Property owner Ro~, /A~A~ ~'mr~' '.: Day phone Lending agency pt'.~? /~/) ,/¢ Day phone Agent ~,~, Day phone Address Unless otherwise requested, HAA will be held for pickup. 2, NUMBER OF BEDROOMS: ~ 3. TYPE OF WATER SUPPLY: Community well. Public water NOTE: If community well s, ystem, provide written confirmation from State ADEC attest- ing .to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Frol~l MOA ¢21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Iq.C-:Sd ..CZ.. Engineer's signature .~_~~ ' '~'~ ' Phone Date 6, DHHS SIGNATURE ' )/- Approved for ~ bedrooms. DisaPproved. __ ':Conditional approval for bedrooms, with the following stipulations: Additional Comments '/Il[iii'Il The Municipality of Anchorage Department of Health and HUman Se~vices (DHH$) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHH$ does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHH$ 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 (Rev. 1/91) Back MOAIY21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 3 ~ }')lb~rAk/A'( LAKE Parcel I.D. A. WELL DATA Well type PRIFhT~: If A, B, or C, attach ADEC letter, Log present (Y/N) ~ Date completed Total depth ~O¢- Cased to ~ ¥¢ ¢ Sanitary seal (Y/N) ~ ADEC water system number ~ I?~ ! Driller Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION -//i ~ Jr( I M~INtCIPALiTY OF ANCHORAgP, ENVIRONMENTAL SERVICES DIVISION g.p.m. RECE1VE SEPARATION DISTANCES I--ROM WELL TO: Septic/holding tank on lot Absorption fieldonlot ~1o' 'T~ C,O · Public sewer main ~" I Public sewer service line ; On adjacent lots ; On adjacent lots. Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (;:2//~'O ~ rn./-- Date of sample: Nitrate Collected by: Other bacteria __¢2/I¢'c~ ~ '~' B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size ~25o d;~c Compartments ~- Foundation cleanout (Y/N) Y Depression (Y/N) Alarm tested (Y/N) ~/~, N SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IH~ Topropertyline 15'~ ¢~- ¢.e. Surface water/drainage I bi 72-026 (Rev. 3/91) Front MOA 21 Onadjacentlots ';~ fYJc~' ¢~ Absorption field ~3o 1'¢ ~.T', ¢J.,.,i1¢_,/- ;,~ ~ /~ c~,~,~¢g no/ b~ Foundation ~. ~ F~r, C.c. Water main/service line > CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~,/ Size in gallons 5'oo Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer (X4 f~ Manhole/Access (Y/N) 7' Fcu~ ~?~H "Pump off" level at ~)~ ?Td Cycles tested non- corn t,)l'w~c ¢ o SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot l~'o' Fr~ NA~tl~ot. 8' On adjacent lots D. ABSORPTION FIELD DATA Date installed f~[loJ~e Soil rating Length ,5'1 Width Total absorption area ~ Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ~ ~o0' ¢' Surface water 11£~ FRo~ I$~ ~'/ttl)Rt4 System type Gravel thickness I 2" Total depth 5' Cleanouts present (Y/N) Date of adequacy test ?/1~/rt I for ~ bedrooms If yes, give date N,/L SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot Ill.! F~o~ To building foundation 112-~ On adjacent lots Surface water ~./~ t~ Curtain drain ~o~ o~,~,:~,,',~o ¢ On adjacent lots >,/oo Propertyline ~eot, ¢,o. To existing or abandoned system on lot Cutbank N.A. Water main/service line Driveway. parking/vehicle storage area ~ lo0" E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ /'7 Date of Payment ~)-- ~-- ~'~ / Receipt Number Waiver Fee: $ Date of Payment Receipt Number 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ':~/~' ~"//--z'~t~,/~-~Teleph0ne:Home Business Applicant Address / · (c) Applicant is (check one): Lending Institutign E;].; Owner/b:er D; Buye~r i-]; Othe~explain); .'~?f / (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family-'~ Multi-Family [] Other / Number of Bedrooms 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. 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 (1~,84) ENGINEERING FIRM PROVIDINL ~SPECTIONS, TESTS, FILE SEARCH, DA', .~NDINFORMATION , , 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 o.~ the date of this inspection. Address Telephone DHEP APPROVAL Approved for Approved bedrooms by >~/: ~¢~Date 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 purch~.e.,rs of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHE~=~b-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 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHC~.c.,~Ft. TH AUTHORITY APPROVAl= (HAA) ENVIRONMENTAL .SERVICEs DIVI$1q~IECKLIST - FEBRUARY 1984 ~//F 264-4744 Legal Description: ~-~ ECEi ED A. ~ELL D~T~ Well Classification '~--- I (/'~1 T~'- Well Log Present (Y/N) Total Depth /O-~- ~ ~ Cased to Static Water Level '7'~ ~ ~ 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 Field on Lot To Nearest Public Sewer Line ~k~//q. Cleanout/Manhole ~d.//~.- If A, B, C, DEC. Approved (Y/N) Date Completed _(.,),q J~-lto~.dNl Yield ~ .. J ~p ,,* -~- Jz~q_~.r~o~,,~ Depth of Grouting ~,),~ Pump Set At (.//a Sanitary Seal on Casing (Y/N)' "Y" Depression Around Wellhead (Y/N) _ ; On Adjoining Lots ;:~ ~/OO [ /O ~ ; On Adjoining Lots _ '~//CO To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Test B. SEPTIC/HOLDING TANK DATA Date Installed ~-'¢,/~0/¢( Size // Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ /C~C) To Property Line /~" / '-/- To Water Main/Service Line ~'..I/Ac Course ICC '~ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped .............. ; for Temporary Holding Tank Permit (Y/N) /k,//~ To Building Foundation ,ff '-(- To Disposal Field / / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8'861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~/]/~ ~ ~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) //¢'o~ F'"'", Type of System Design Length of Field _zS-,/ ~ Depth of Field -5~ ~ ~ Gravel Bed Thickness /~-" Standpipes Present (Y/N) Y Date of Last Adequacy Test -''kL ./'~-(x.~ Results of Last Adequacy Test '~(:~z~_ TlS F,~c.: TO4~ V"- L( _,'~- (,,_J ~' ~ ~'-7-¢:~,4/} '-~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot L~z-(['~ ¢ -/- To Water Main/Service Line ~k_[ /.]_4~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed ~ Size in Gallons ~'--(__-)O ,~o( (' "Pump On" Level at '~ l, High Water Alarm Level at Tested for / Electrical Codes (Y/N) Y Dimensions 411C/~r%~,~_~ I~¢,q ~. .,~'~( Manhole/Access (Y/N) Y "Pump Off" Level at ~.<~[.Z,5"-" h'm'Fo#-, Vent (Y/N) Y' Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Pe[m/~tted Bedrc/)m Rating Against HAA Request ** ,"A , / t I certify tha~,4,¢¢v¢ dbe, ck~/g, y6rified, or conformed to all MQA and HAA guidelines in effect on the date of this inspection. Si ned "~'"~'Y~ .'/ ~-Date ~/~ b' / ,?' Receipt No. Date of Payment Amount: $ Page 2 of 2 Cor,,vJn /M'o. CE-5283 ,ineer's Seal 72-026 fRev 8/86/ Back TIME DATE NSPECTOR "~'> RECEIVE[;) INSPECTION APPOINTMENTS TIME ', · / INSPECTOR ~ / INSPECTO~~ MUNICIPALITY OF ANCHORAGE I¢.UNICIPALrP( OF ANCHORAGE! DEPARTMENT OF HEALTH & ENVIRONMENTAL PRDTEC'rlON DEPT. OF tt~ALTH & 825 L Street - Anchorage, Alaska 99501 J~P/IRONMENTAL PROTEC]ION ENVIRONMENTAL SANITATION DIVISION &Ui; ~ 0 19!31 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERRt~I DIRECTIONS: Complete all harts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE _ ¢ -5cF:t I MAILING ADDRESS PROPE~DEN~ ~d~ ~&-above) ~ 2, BUYER PHONE MAILING ADDRESS -3. LENDING INSTITUTION IPHONE MAILING ADDRESS 4. REALTOR/AGENT / PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION ~STR E ET LOCATION -~ ~, TYPE O~ RESIDENCE SINGLE FAMILY MULTIPLE FAMILY NUMBER OF BEDROOMS ~ One ~] Four E~ Other [] Two [] Five 'r~. Three ~] Six 7, WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY INDIVIDUAL/ON-SITE'* PUBLIC UTI Lll'Y ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled ~:)rior to.that date, give wel depth (attach log if available,) /~"~/ YEAR ON-SITE SYSTEM WAS INSTALl~ED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBL,C UT, L,TY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size:_!---~ ~--(~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL / ..... 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS (~;3'~-APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) // [] DISAPPROVED DATE BY II ~ o OaAl~3a~ r Z Z O © ~ 0 0 E] ° 0 mmj o o