HomeMy WebLinkAboutHIDEAWAY LAKE BLK 1 LT 6H'I'deaway Lakes Block 1 Lot 6 #015-471-30 01/221'2013 02:07 5072330742 AWPS. :tic. PAGE 03/ a•'ity� N.., Wayar Well Drilling i'ermit Number: SYV Parcel identification Number: I.c�alAescr"ptinn 1 Pump Imstalbdon Date: 1-14-1^1x Puutp Intake Depth Below Tap of Well Pump'Hanufaetua'er'sName., Pump Model: �O �j// 0615 tt — Pump SfzP 0+ lip Pitless adapter Burial Dept':x: /[j feet Pitless Adapter Al;mufacturer's Name:,, � ip Installation Log Date of Issue: I�Pro ett't ' Owner Vacate & Address': O ,ak <1dgc7 : -�7 feet a ..r+el] Li;:ts''ect;• l -poo L 1'c ;Sfethoa. of DiiAn.ecticm: 4C:2, - Comments: I Pump iinstnller Name: Fax. Attention: —he pump insiab'.er shall provide a 76th Avenue Alaska 99518 37-243-0740 installation log to the DSD within 30 Jays of pump in;°al2tior,. 61r" p Municipality of Anchorage Page I of 2 - [DEPARTMENT OF HEALTH AND HUMAN SERVICES V ENVIRONMENTAL SERVICES DIVISION c P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: —_ :5;W9`1012I PID Number: O/Set7//0 Name: M 42G -ARS �T E'm E - Wastewater System: ❑ New ZUpgrade Address: //090 1�/AE"RwAy L,��E �. ABSORPTION FIELD AN�HOI�AGc� K 7 ISMO No. of Bedrooms: y ❑ Deep Trench ❑ Shallow Trench ❑ Bed ound ❑Other LEGAL DESCRIPTION Soil Rating: ff from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: _ Gravel depth beneath pipe //--,, //�/ lD / t=iiW, LF}kt= Ft. Ft. Township: Range: Section: Fill added above original de: Gravel length: Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines: I Ft. I Ft. Classification Privat A,B,C): E-X/S'7' Total Depth: Cased To: Tota sorption area: Pipe material: 2�a/VRTE- Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: X 17 — 6 -74 Date installed: Ft. C AJ (fol,)S- Yield:Pump Set at: Casing Height Above Ground: T'AN K GPM Ft. Fl. SEPARATION DISTANCES ❑ Septic AHolding v ❑ S.T.E.P. To Septic Absorption Lit Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines NC 6 1 4600 Well' ,7 Q , _ l 2S + Material: Number of Compartments: STEEL 1 SWater -- -- /DO`) LIFT STATION Lot —_ Z.5 Size in gallons: Manufacturer: Line If Foundation __ y "Pump on" level at: "Pum evel at: High water alarm at: Curtain_ —.. N Oti7 E' OWN PumpMake a Electrical Inspections performed by: Drain Remarks: P/L IJ4IVez GaRvrEt� BENCH MARK Location and Description: m - To? OP S Erb RT 1�—EFI 12 OF Liouzg- Assumed Elevation: /00.0 - ENGIt4EER' 'SQA +� a by ( � A k pr; t 1 ,' 17034 Eagle River Loop Road, No. 204 Inspections performed by, Eagle River, Alaska 99577 pates: 1 st ?_/&_99 2nd ate; 3.; Department of Health Hu rvices apyal Reviewed and approved by: Date: 3 `, 79.n13 IFev Q/011 MnG 9F Permit NO.SW940121 Page — 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 9 Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptior�IDEAWAY LAKE SUBD; BLOCK 1, LOT 6 01547110 PID No.: �Coi t SCA111; I" = 40': 72-013 A (1193) - C) LARM PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940121 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:EMPIE MARGARET J OWNER ADDRESS:11080 HIDEAWAY LAKE DR ANCHORAGE, AK 99516-1145 PARCEL ID:01547110 LEGAL DESCRIPTION: HIDEAWAY LAKE BLK 1 LT 6 LOT SIZE: 57153 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/11/94 EXPIRATION DATE: 5/11/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE: j Z j DATE:- LOT- ATE: Lor- LAVE. oj,Alllc�z_ ro �,f' (--7,elhv F�_�, 47wK�1-1111/e Muni ipality ®i .A c1.orage K Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 11, 1994 Robert Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 a Subject: Waiver Request for Lot 6 Block 1 Hideaway Lake Subdivision Waiver Request #WR94001.8, PID #015-471-10, SW940121 Dear Mr. Shafer: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 2.5 feet from the east property line to the holding tank. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Si erely, J mes Cross Civil Engineer On-site Services ljw#7 MUNICIPALI IY Of ANLHUt�At,;Id ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAG_ Department of Health and Human Services „(��Z 15 1994 On-site Services Section Waiver Review Worksheet RIVf,D WR#I_PID# 015-471-10 HA# _ Permit if LYA'kwQ\ Date Received: April 14, 1994 Legal Description: Lot 6 Block 1 Hideaway Lake Subdivision Engineer: Robert Shafer, P.E., S & S Engineerinq 17034 Eagle river Loop Road, Suite 204, Eagle River 99577 Applicant: Margaret_ J._Empie Waiver Requested: Lot line waiver of 2.5 feet from east property line to holdinq tank. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for. above: N 0 " vE._ S -E C-&iA/%7 GYA , Rec Amount: $ `�� ���� Date Paid: O � N � 0 Ln �I "t cn 0 Y U Ln z Z / LJ J � I U � I J I I _ p� x O ti / LlAwa Z o 0 W F U U)I O C W n �Lo> O x x LJ SOX a W w 0 00 Z N p y • J Q OF U U 0 J 7 Q Z ~ wa ZEaox J o omi;-o / VOw� L EXt5T1 M � \Ijr� hX U5 W 0 z 7 6 a x wcx \ 6r / � W F U U)I E' C W qOl� a u� x O x x U a W 00 z0 0 00 •f�cy oa o EH U) U wc�m a I o3s„ EXt5T1 M � \Ijr� hX U5 W 0 z 7 6 a �i� \ z N Z K o oz �o9N �iZ ~�Fo w' 2 O CY wazo O N O w 0 Elf0 U1 U N d \ v O u"�'yaR lam- U a (!l w �3 Z w wOf ~ KZ p_ •S Z Lam. J O0�- �~ Z \ \ ww La lz WN> ZW p_ V) \ 0/ afna Owp \ y w= n V) (n Z_ \ f w Q a Uj _( G w / \ wZ` >Q 2Z O(n v) Q o R \`�`��y J,0 wcx \ 6r / � W F U U)I / / W a x U W a V �i� \ z N Z K o oz �o9N �iZ ~�Fo w' 2 O CY wazo O N O w 0 Elf0 U1 U N d \ v O u"�'yaR lam- U a (!l w �3 Z w wOf ~ KZ p_ •S Z Lam. J O0�- �~ Z \ \ ww La lz WN> ZW p_ V) \ 0/ afna Owp \ y w= n V) (n Z_ \ f w Q a Uj _( G w / \ wZ` >Q 2Z O(n v) Q o R \`�`��y J,0 wcx \ 6r x \ W F U U)I / / / I 30Vdodn TIVOS '09 = „l F�'!S%A7 April 12, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-12.11 HEALTH AUTHORITY APPROVALS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. BOX 196650 SEWER &WATER MAIN EXTENSIONS Anchorage, Alaska 99519-6650 SEWER&WATER REFERENCE: Hideaway Lake Subdivision; Block 1; Lot 6 INSPECTION Request you issue a permit to install a holding tank to serve the ENGINEERING STUDIES AND REPORTS existingfour bedroom house on the referenced ceproperty. Also request you issue a 2.5' property line waiver on said property. The property is encumbered by a creek, lake, pond and the 100' well WELLINSPECTION radius. Therefore, a 4000 gallon holding tank is the only feasible &FLOW TEST option for the referenced property. A 2.5' property line waiver is requested in order to maintain pond, creek and foundation setbacks as can be seen by the attached site plan. SITE PLANS We do not anticipate any adverse effects on neighboring properties by the installation of the proposed holding tank. If you have any questions, or require additional information for your ROAD DESIGN review, � se contact us. Sincerely, SOIL TEST i 015 rt A. Shafer, P.E. PERCOLATION �- TEST S/LSU/jk V STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 ON—SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Hideaway Lake Subdivision; Block 1; Lot 6 Cq"ZL7:I�F 1. The scope of this project includes the installation of a 4000 gallon Holding Tank to serve the four bedroom dwelling located on the referenced property. The existing 1000 gallon septic tank is to be excavated, pumped, crushed and abandoned in place. The existing sump is to be abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. HOLDING TANK INSTALLATION: 1. A holding tank is to be constructed by a certified wastewater holding tank manufacturer. Construction shall include a 6" cleanout for pumping access and watertight manholes. 2. The holding tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the holding tank shall extend a minimum of 12 inches above final grade. 4. Holding tanks installed with less than 4' of cover shall be insulated. Page Two Hideaway Lake Subdivision; Block 1; Lot 6 April 12, 1994 5. The holding tank shall be equipped with a high water alarm which registers both visually and audibly inside the dwelling. The alarm shall be positioned to allow at least 450 gallons of storage after the alarm has been activated. 6. Final grading over the holding tank shall be such that a positive slope exists away from the holding tank. MINIMUM MATERIAL SPECIFICATIONS: 1. Any holding tank proposed for installation must be constructed by a Municipally approved holding tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM P810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Holding tank inlet shall be fitted with watertight couplings (Caulder, Fernco, or equal). Page Three Hideaway Lake Subdivision; Block 1; Lot 6 April 12, 1994 INSPIETIONS: Typically there will be a minimum of two (2) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the tank has been set; lines, cleanouts, standpipes, and insulation are in place and prior to backfilling. 2. The final inspection is to occur upon final grading of the property. Often there will be more than these 2 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE i DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC ON \ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE W IIiC n m�iv >b �Z!�OUPG MAILINGADDRESS ADE 10CrI Iclocl-2r� oae,f LEGAL DESCRIPTION Lot- GIG 10(k) H'. dcc.v, �t IrP Si 1 i' 'sly LOCATION lI ,I y� 7�FII '-flue lC� NO. OF BEDROOMS I lir P Well DISTANCE TO: Absorption area Dwelling PERMIT NO. U _X I- Z h Manufacturer Material No. of compartments LU y Liq. capacity m gallons— IF HOMEMADE: Inside length Width Liquid depth LW 0 z Z i ell TO: Well Dwelling PERMIT NO. 4 Q �- _ bLiquid nu Mafar: turer Material capacity in gallons 2 DISTANCE TO: Well Foundation .m Nearest lot line PERMIT NO. w No. of lines Length of each line Total length of lines Trench width -- Distance between lines _� ccH Top of file to finish grade inches Material beneath file O inches Total effective absorption area Length Depth w PERMIT NO (7 LType of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance t o lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RAT ING�jat; Q F A/�� 1d e.t INSTALLER%� •..�� � •. A REMARKS ® ' 4 (9•� •.... .. . a•.a� ':. " NO. 986-E h .C�� /_7 00' ; U 101 APPROVED ATE LEGAL 72-013 e .3[78) T d' MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROI"ECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 9950"1 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHOfVE [])W y7 ^JUPGRADE ---- r`"jI`j MAILING ADDRESS - LEGAL DESCRIPTION �1—�— LOCATION¢ �( NO. OF BEDROOMS DISTANCE TO: Well Absorption Dwelling PERMIT NO. U �t AZ F Manufacturer Material— - No. of compartments W Liq. capacity in gallons Inside length IF HOMEMADE: Width Liquid depth PERMIT NO. Y Z Z DISTANCE TO: Well Dwelling Q 7: F' Manufacturer Material Nearest lot line Liquid capacity in gallons PERMIT NO. Lu y DISTANCE TO: Well <7.f Foundation LU a Z Zw No. of lines Length of *aWline Total length of lines Trench width Distance between fines h a to Top of file finish grade Material beneath rile _inches -Total effective absorption area w Length 9 Width Depth ��' PERMIT NO. Q Q� f_ Lu Type of crib Crib diameter Crib depth Total effective absorption area wi y DISTANCE TO: WeII Building foundation Nearest lot line J J Class Depth Drifler Distance to lot line PERMIT N0. LA DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER P.KT" PIPE MATERIALS nn S01 L TEST RATING INSTALLER O — REMARKS _3 1 tom, a-t- Q, U_ 4. C'-Q.A, vita% nJ =3-- - s S14 i� 0 APPROVED LEGAL-- 1 (�{DATE y9_ntZ fRo„ vnvt — rol It-) V-4 I C', T F'-'� r- ��ft-ru f_'y PA K'-" "-. I A�r DEPHRTM�NT OF /.�HLTH H�K." E�YIRO�MENTRL P�i 825 'L' STREET, ANCHO�A��. �K nnm� U��EVLVL U�U�U0 PERMIT NO. HPPLICANT WILLIHM EMPIE LOC�TION HIDEHWO� LK LEGRL L6 B1 HIDEHWHY LAKE �.�����`����' �.�`� ~�°,� 264~47�� . . " 14�� H STREET ' '_�/ �v�o 278 1177 LOT SIZE 57499 SQURRE Ff��~�� TYPE OF SOIL ABSORBTIONSYSTEM ISTRENCH ` � MAXIMUM NUMBER OF BEDROOMS=, SOIL��TING THE RE8UIRED SIZE OF THE SOIL HBSOR .TION SYSTEN`-­: �� �� �������� ��`��� THE LF-ENG7H DIMENSION IS THE LENGTH ifOF R DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DIST\Fl�.�) BET���m URFHCE 0F THE GROUND HND THE BOTTOM OF THE EXCAY�frION PEET. THERE IS N8 SET WIDTH FQR TRENCH` THE GR�YE� DEPTH IS THE - MINIMUM �, EPNlr_ rm�� ` F GR8��/ BETWEEN THE OUTFH|L PIPE RND THE BOTTOM OF THE BXCRYHTIC` (IFT) ��V �.�V. F'" 'T�� Jr F= J -z P:,: I �IF=,l R.���� PERMIT APPLICANT HrtS THE RES ITY TO FORM TS D 11IEPHRTMENT DURING THE INSTALLRTI0N INSPECTIONS OF R WE S HDJHC T TO THIS PROFERTY HND THE NUMBE� OF HT T4ELLU'/ILL SEFw� "T 04 P-11 �-V ��� ��������� BRCKFILLING OF ANY SY�TEM WITFI., SPECTION AND RPPROVRL BY THIS MINIMUM ` AN 8NY ON-SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET.FOR H PRIVATE WELL/ Cl'K 150 TO 200 FEET FROM H PUBLIC WEI-^^ NDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE RE8UIRED HND MUST BE Rr�uRNED TO THE DEP�RTMENT WITHIN 30 DHYS OF THE WELL COMPLETION, OTHER REQuIREmENTS �FVY APPLY. SPEC: IF I CHTI(]NS O�� CONST���TI(]N [>IHGRRMS HRE �VHILHBLE TO INSURE PROPER INSTALLATION, ~ I CX.RTIFY THAT 1� I AM FAMILIAR WITH THF ��QUI��MENTS FOR 0�-SIT� SEW2RS ANF.', �ELLS RS SET FORTH BY rRE MUNICIPRLI7f OF 8NCHORRGE. 2� I WILL INSTHLL THE SYSTEM IN RCCORDHNCE WITH THE CODES ]� I UNDERE"THN f THAI THE ON-SITE S1-WER SYSTEM MRY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS [�EMO0rl-ED TO INCLUDE MORE THAN ] BEDROOMS _i - I---J------t_i WSiL OWf (B]ITICAH I hereby certify that the following described property has been surveyed by myself, or under my supervision, and the corners shown on this drawing are existing as of tile '�date of Survey / ' l (' - f l_ -7 r 0 t-- I /.1 Vv, –V l K- �'�. 0.5 -71 " 1 1 \ �Pt20Po�'c,D ou LW-- ` • LEGEND• It is the responsibility of the owner or -\ 0 B.L.M. Brass Cap Monument Fnd. builder,prior to construction,to verify proposed building grade relative to fin- , L ished grade and utility connections and Subdivision ^y, Iron Pipe Set— Fnd._ to determine the existence of any ease- AN (, s�e'�x$�n Rebar Set_Fnd.� ments,covenants, or restrictions which do not appear on the recorded svbdivi- RECORDING PRECINCT,ALASKA r3 Survey Hub &, Tack Set— Fnd._.lon �S 111-79 0' N I DE,6AN4Y k � N arm: t7-�-v15� 4-Iov� wcA�t ors . 7 12•-7 �i 1�f41 OF 44�e�� p all Is 0 ®ems r49iH 7 F: Forl D. Kwynto �e c NO. 3254-5 1 Q�O! °p•weeeji• 5 � �pfvlCScv7tY Al �4y� —LOT SURVEY CERTIFICATION— • LEGEND• It is the responsibility of the owner or Lot- Block— I 0 B.L.M. Brass Cap Monument Fnd. builder,prior to construction,to verify proposed building grade relative to fin- , Brass Cap Monument Set__Fnd.— ished grade and utility connections and Subdivision O Iron Pipe Set— Fnd._ to determine the existence of any ease- AN (, s�e'�x$�n Rebar Set_Fnd.� ments,covenants, or restrictions which do not appear on the recorded svbdivi- RECORDING PRECINCT,ALASKA I7 Survey Hub &, Tack Set— Fnd._.lon plot. FOR UNW1N*SCHEBEN*'1%%0RYN'1 'A CONSULTING ENGINEERS and SURVEYORS 2515 A St. Anchorage, Alaska 99503 DRAWN �151 SCALE I e7' DATE 7 1 Z �`� W.0.7q aj� FB47-55GRID z&,IOD G� JUILS LUG MUNICIPAI..rry OFAn�IIORAe1:_ a 4a_ , �C DEPAR"TMEN T OF I I EALTH AN4` NVIfiONMFN TAL PROTECTION EHCOLAI ION / <<S v` Pouch 61550, Anchora9a, Alask: 19,02 -,7;G 22.2` I r_.T SOILS LOG PERCOLATION T EST PI-WORNIF1)FOI: _ 11A F! rFIiPOR v(C- �- LGGAI_ PESCHIPl ION. � I ��` A \ r N FFI T� � K I 1 I i ---10 I I � l^LNS t=;IiOUNU FVA I L R LNCo F,IVTERFD' ( DEPItl 13 Real nq I ,: - ^Jct__—� I I I I u. Ir,n Incl Drop +I I I ' 7 I I I - ?0 _I PCRt Utr",': 17 (4Y _ •q- _ _- _._, __. _ ---_-_ t. I; �: I; .'v _ .___..__. '` v �_- U.1 ( \ 1 { �� - M!, n.� -. _ _ - - - _ •1 ,: l _ -'x(41 I �1. MUNI JPALITY OF.' ANCHOR, .3E 1) 1 ME I'll T OF PUBLIC WoIr:%)I<s CONSTRUCTION DIVISION TFS1- PROJECT DATE CONTRACIOR MATERIAL. LOCATION SjA tvWi- 1= D BY 4 L)-6 Lai YLi COMMENTS IV/ Li j'� REPORTED PLOTTED BY CHI:(-"KFD BY MAR V I SOR TIRIALS SUPF S4 -VE ANALY.SiS NUMBER{ SIZE OF OPENING IN INCHES Of MESH PER INCH u S. STANDARD loo f- (4-- 7 S2 60 5 0 Ld ------------- LL] 5o, A 20-- f------ 10 %L 0 0 0 C) 1r) M LO if) 11) coloZ1111in P) C\j (;RAIN SIZE IN MILLIMETERS mm FINE GRAVEL "T COBBLES 7,1E —A,-.--- SAND INSPECTORS COMMENT s 0 H jkj F- T (9 Ji 3: 40 fr W 50 U) 0 C) ME MEW GA] � 100 cr) 0 MU NkAf"A! _ IT OF-ANCH0R/-AuE_ DFIVIFNT OF PUB1_IC WORKS CONS1 =lIJC; j 10N DIVISION 7 '—Ul.� l E S I N 0. F'ROJEC r_L b1h I _ - DATE fau , /SQ/ CONTRACTOR MATERIAL. SOURCE__-_-- L.00ATION SAM-)( I'D ):-trth— _ -- -- - 13Y COMMENTS flic__4;f,r�r_urltctfictffL_is=:aL�Lt_-- REPORI I'D PLOTTED BY ('HECrE.D B\/ MATERIALS > SUPERVISOR -- 8D -- -- - -5f 1 f INSPEC- SIEVE1 ANALYSIS SIZE_ OF ORENING IN INCHES _l iUh1(lFR OF MLSH f 100 0 7 M (VV N — R)v -N _ ro i 9 (_o 77 INCH U.S. STANDARD m - 30 r - w 40 } _ m — m 50 U) — a 0 ---60 'Z - , J LA l-O 1- T r 1A r' i L n a ali yup---- Vi 0 1 2 3 4 5 6 f- 7 8 9 10 11 -12 13 14 15 16 17 18 19 20 21 22 23 24 25 - Sol ILS 5 SolILs PROJECTrLa b CLIENT Bob Sparks W. 0. 77897 SHEET 2 OF 15 TEST HOLE NO. 2 ELEV. TOP OF HOLE. --B 5 Z DATE 11/28/77 2 3 4 5 6 7 B 10 11 12 3 4 5 6 7 8 9 0 1 22 23 24 25 Peat PT rg a n- c s a n y Damp, brownish red silty gravel, GM Damp, brownish grey gravely silty sand, SM Damp, brownish grey silty sand, SM Grab sample Damp, brownish grey sandy silt, ML (traces of gravel) %11 ®POF A4 •;® Bottom of Hole J7M ® 1 �4. �oiMwss ae•u•�pase•soae o°ee • Earl D. Korynta i!� d N9. 1823•E x�T�iree'e a••, 61 1 NOTE: 1. No ground water table at time of drilling. ? 2. Field perculation test results - 6.3 min/inch. 2 3 4 5 6 7 B 10 11 12 3 4 5 6 7 8 9 0 1 22 23 24 25 yn�^-err 17 M G� Su X1:30 7'3": yo Gyt /do :C/o S" /y8" /0; 3 Olr-F 77 OF 4/ 4�, DD° n�0 �D x w u° .aaaoa °aooDoa0000 as o Far D Korynta ck; w NO. 1823•E �r �'ROFESS\ON'g4v P�QGut,,on� T -T` lefl�/° zsO,77 5Y L� �vt4L! ,�T�iL�iNG /r�sT rc�A-s Al2��l�rrt � 5 10ft -res )vs0 /0%Wwa ef t, *v&e tJ xSUNICIPALITY OF ANCHORAGE DIVISTON OF ENVIRONMENTAL HEAI'L'li DEPARTMENT OF IIEALTH AND ENVIRONMENTAL PROTECTION APPLICA'T'ION FOR HEALTH AUTHORITY APPROVAL CERTTFICA'CI i. Geaeral Information Application nate (a) Legal Descr.tption-(Include lot, bl?cIc,ubrJi v-Lsl on, section, townshl,p, range) Location (addre,ss or directions) E 1 t l (b) Applicants Name �, �'1� fl �� -(sit t Telephone Rome;;�,�.,� '- Business, Applicants Addressv (c) Applicant: is (check 'o - no) Lending Institution j Owne-/bulkier �) ; Buyer I—] ; Other G -1 (explain); (d) Lending T.nsti.tut.ion v Tcleshone Address (e) Real Estate Co, u Agent Address Telephone. (f) Mail the HAA to the following address: r" 1 2. Type of uesi.dence Single-Lami.ly Multi-•Pamjly Other (descr.ibe Number. of Bedrooms 3. (dater SunpJ.'/ Individual. Colrnix nity PubLi.c - - Notes If colmeunity we J.J. system, must have written confiriaation Lrom t-I,e skate Depart:ment o` i:nvironmenCal Conservation a ttr�sttng to rile lega i.ty 4. Sewage Disposal_ Onsite �__,.i ;?ublic. Community I Holding iala:. J 1, g Note: If COGIFIvIn I.Ly Well. 13yst.elll, must l rtllr . 4irltl' ..@111 coo irmaLion frol± '31-a Le Departwom: of :.nviroomental. Coilsorvation (1C ti''.:it i;15 to the legal'_ty BSid srh:t ls. [Pat,e J. of 2] 5. Engineering Firm Providing Inspections 'Pests, 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 tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula-• tions in effect on the date of this ipspection. Name of Firm Z; Address r` �_-t I 1-��/F'�f� fl C j Date (ENGINEER SEAL) 6. DHEP Approval Approved for 4�bedr.00ms By Approved T� Disapproved Terms of Conditional Approval CAUTION Cond:it:ional. Telephone_`, L 6_ � ,,d l� r -r.... 0 ., Date /!;. THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENV IRO LNI? ENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. 'PHE DREP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS, EMPLOYEES CF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFCCATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSI35E FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of. 2] 7-•19•-84 A. WELL RATA a UNIOWALI W O DEPI. OF HLALm t. ENVIRONMENTAL PRGTLCIION MUNICIPALITY OF ANCHORAGE (MOA)- 1964 HEALTH AUT[IORITY APPROVAL ( HAA) RECEIVED CHECKLIST - FEBRUARY 1984 Legc]l Description: Well Classification riVa4 If A, B, or C. .E.C. Approved(Y ) Well Log Present (Y/N) No Date Completed UNKNO WJS(Yield- Total Depth UN &W4 Cased to QN KNo kV�J Depth of Groutin_^ Static Water Leve]. It Pump Set At Lt/V1 Kih(�l,Yh _ 9--AVL— Casing Height 9 Above Ground Sanitary Seal on CasingYy ) l: Electrical Wiring in Conduit � N) V Depression Around wtillhead (�t2 Separation Distances from Wel To Septic/Holding Tank on Lot R©� ; On Adjoining Lots + 0o r To Nearest Edge of Absorption Field on Lot q0 -*"# ; On Adjoining Lots a-/pp� To Nearest Public Sewer Line --&/A— To Nearest Public Sewer Cleanout/Manhole Alp, To Nearest Sewer Service Line on Lot � J} Water Sample Collected By Q Date '76'd�(' m(g�/ _ Water Sample Test Results ,n lt.<Pnnr i . s.wriva�.�s B. SEPTIC/HOLDING TANK DATA Date Installed %j -']R Size 10©U (i No. of Compartments _ Standpipes Y ) Air -tight Caps ) 5 Foundation Cleanout (Y p Depression � Tank (X (i Date Last Pompe Pumping/Maintenance Contract on File (Y/N) /� A for Holding Tank High -Water Alarm (Y N) _ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wall _Q� To Building Foundation IZ.� To Property Line ©' To Disposal Field 51 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course ./ So' Comments * e(- MoA Ida-, • * -)(- 0 oori AivA 6 _Pr.,4 A - [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2? - 0 M * Type of System Design _4YR�7K Date Installed F) -2(-)-Z2 k Length of Field �10` 'K Width of Field jo ;��(�os 'K Depth of Field /O, Gravel Bed Thickness `% ` 'r Square Feet of Absorption Area Q y O Standpipes Present /N) Depression over Field (YAN) AO Date of Last Adequacy Test rl 5e Results of Last Adequacy Test, 01 l �011iQ . Separation Distance from Absorption field• To Water -Supply Wbll 4 To Property Line To Building Foundation /Z� To Existing or Abandoned System on Lot NIA J On Adjoining Lots 4- SOI To Water Main/Service Line 50 To Cutbank(if present) To Stream/Pond/Lake/cr Major Drainage Course 100 1 To Driveway, Parking Area, or Vehicle Storage Area /01 Comments -71 p.vr _ri()A J: , * * QAmv-d b�4 NFr- K. Pray 8-20M D. LIFT STATION NI J Date Installed Sizs\in Gallons "Pumj�On" Level at High Vater Alarm Level at Tested for Electrical Codes Conmients "Pump Off" Level at Ve nt Cycles during Adequacy Testt. ets MOA ** Check PermittedBedroom Rating Against HAA Request ** I certify that I have checked, verified, or confortred to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date Company Ofy(�,1tA ie 06ax'xaFtt oS MOA No. >Ta `?'-o36�' KB1 /d5/s [Page 2 of 21 ENGINEERS SEAL r 2-15-84 ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street DATE ANCHORAGE, ALASKA 99507 Phone 563.3300 TERMS PLEASE DETACH AND RETURN WITH YOUR REMITTANCE INVOICE NUMBER / DESCRIPTION I CHARGES STATEMENT CREDITS BALANCE ISAACS PUMPING SERVICE /�� D 4 /1 G7 ,� ( jury �� PAY LAST AMOUNT �VJ ,1UfllV l v � IN THIS COLUMN ,r CHEMICAL & G.f GLOGICAL LABORATORIE6 OF ALASKA, INC. uww�ro^'[e TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENT!.R w_ 5633 B Street Drinking "i Analysis Report for Total Coliform Bacteria TO BE COMPLETED PY WATER SUPPLIER WATER SYSTEM: I I I i (') See It on back I.D. NO. Water System Name Phone No. ls�(4 C TU�o� S�� boy Mailing Address City State Zip Code SAMPLE DATE: ' "fJ LF' I b_i Mo. Day Year SAMPLE TYPE: �1 Routine 17 Check Sample (for routine sample with lab ref, no. ❑ Treated Water ❑ Special Purpose 0 Untreated Water SAMPLE No. LOCATION _—� -1 Time Collected Collected By 2 1 _� J 3 4 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY /Aj�aly:;is shows this Water SAMPLE to be: L3 Satisfactory ❑ Unsatisfactory EJ San-fle too long in transit; sample should not [ie over 30 hours old at examination to indicate reliable results. Please send new sarn•)le via special delivery mail. Date Fleceived P C/ Time flecelved Ana!,ri!cal Method: Farmentatlon Tube ZZ.1"Membrane Filter Lab '-tef. No. QS// Result' Analyst � ice` -1 ED �— aT .Nt. Of colonies/ 100 ml or NO OI Paanive Do,00ns 061220(b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rey. 1063 Membrane Filler. Direct Count Verification: LTB BG 3 Coll fonnll00mI Final Membrane Filter Results 0 /Coollforml100ml Reported ByDate_ Time. �� � _ a.m. p.m. TNTC = Too Numerous To Count u DEPT. 01� ENVIRONNIENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 October 19, 1984 Mr. Stan Brust Corwin & Associates 1549 E. Tudor Road, Suite 204 Anchorage, Alaska 99507 BILL SHEFFIELD, GOVERNOR 2.74-2533 Subject: Waiver Horizontal Separation between Well and Septic Tank, and Absorption System, Lot 6, Block 1, Hideaway Lake S/D (8521 -WA -051) Dear Mr. Brust: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 80 feet and the well and soil absorption system to 90 feet on the subject property for a 2 bedroom single family residence only. Sincerely, ruce E. Erickson District Engineer BEE/msm CORWIN & ASSOCIATES, INC. CONSULTING ENGINEERS 1549 E. TUDOR RD., SUITE 204 ANCIAORAGE, ALASKA 99507 (907) 561-6151 October 17, 1984 Mr. Bruce Erickson Alaska Department of Environmental Conservation 437 E Street Anchorage, Alaska 99501 Re: Lot 6, Block 1, Hideaway Lake Subdivision Dear Mr. Erickson: This will follow up our discussion of October 15, 1984, regarding the distance of the stream to the on-site septic system on the above referenced lot. An inspection of the property was made on October 15, 1984. This revealed that the high water mark on the stream was not closer than 101 feet from the sump at the drainfield. The septic tank cleanout was 168 feet from Hideaway Lake. A copy of the October 15th inspection report and a copy of the August 20, 1979 inspection report are enclosed for your use. I trust this is the information you require. Sincerely yours, CO WIN & AS CIATES, INC. Stanl Brust, P.E. SB:kjh Attachments cc: Keith Bandt, DHP William Empie Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-471-10 Expiration Date: 1. GENERAL INFORMATION Complete legal description HIDEAWAY LAKE S/D; BLOCK 1 LOT 6 Location (site address) 11080 HIDEAWAY LAKE DRIVE, ANCHORAGE, AK, 99516 Current Property owner(s) RICK & ANN POLLOCK Day phone 243-7828 Mailing address 11080 HIDEAWAY LAKE DRIVE, ANCHORAGE, AK, 99516 Real Estate Agent VALERIE WHITMORE W/ PRUDENTIAL Day phone 562-6464 2. TYPE OF DWELLING: E 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 0 Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by:lrYc, Date: GOSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ t `10 Date of Payment 101 to lis Receipt Number b? IRli`vl COSA# 05C13153o 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD_ attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features_ The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements ofthe ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE i� System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. 337-6179 Date f a l L 113 oo6opp� ado �F........... s�0o o* 9 T ........ ... ....... .......1 l l (74.�.,i..f ....Gornes.:.. 9. CE -79 „p �4 o rofessio�oo %IY OFAAr, bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER PROGRAM Original Certificate Date: / () 1, -13 The lilrrhicf/5ali tArchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the rep tations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11105) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: HIDEAWAY LAKE S/D; BLOCK 1, LOT 6 ParcellD: 015-471-10 A. WELL DATA *PER GEG INSPECTION. **ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (YIN) NO Date completed UNKNOWN Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth *39+ ft. Cased to **40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. AT INSPECTION 10/4/2013 39 6.96+ g.p.m. WATER SAMPLE RESULTS: Coliform o colonies/100 ml. NitrateL2�mg./L. Collected by: GEG, Ltd. Arsenic: _Yag./L. Date of sample: 10/4/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING/STEEL q, Date installed 8/16-17/1994 Tank size 4000 gal. Number of Compartments i� l Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES Dateofpumping -7ig b3 Pumper A+ µ,,.rd ,Wivlcot.S C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft or ft /bdrm) _ System type Length ft. Width ft. Gravel below Total depth ft. Eff. absorption area ft2 Monitoring tube Depres Date of adequacy test Results Fluid depth in absorption field before�fluid in. Elapsed Time: n. Finaldepth rejuvenation treatment (past 12 mo.) (YIN & type) Water added _gal. 1. Absorption rate >_ ion over field For bedrooms New depth _in. If yes, give ... D. LIFT STATION Date installed "Pump on" level at in E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N)— "Pump off"level at wa er alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *4 Property line **2.5' Absorption field Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS Building foundation Water Surface water Wells on adjacent lots storage *PER 1994 INSPECTION REPORT. **WAIVED AT TIME OF CONSTRUCTION, #WR940018 G. ENGINEER'S CERTIFICATION t certify that i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (D/IA? (Rev. 11105) Municipality of Anchorage • `� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-471-10 HAA 1. GENERAL INFORMATION Expiration Date: Complete legal description _Lot 6. Block 1 Hideawav Lakes SID Location (site address or directions) 11080 Hideaway Lakes Drive Current Property owner(s) Bill Embie Day phone 244-7075 Mailing address 11080 Hideawav Lakes Drive Anchorage AK 99516 Lending agency Day phone Mailing address 22 Real Estate Agent Oi Q -p n inn; r Day phone oyq-7075 Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc Phone 272-8218 Address P.O. Box 102954 Anch AK 99510 Engineer's Printed Name Steven R. Pannone P.E. Date 6/29/2005 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DI II IS Guidelines & 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 rcsulty do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DI11IS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DHHS SIGNATURE V-'� Approved for 14 bedrooms. 4 Disapproved. Conditional approval for bedrooms, with the following stipulations: 81 0 NotW.,ThC _WFA,for-tbj"roperty meets existing State and I\Iunicipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 7.32 mg/l. EPA maximum concentration is 10.0 mg/l. 1llorc information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory By: Expiration Date: (Ft. 11/49) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 2-11-0E Reissue Date: Municipality of Anchorage ' Development Services Department Building Safety Division On -SM Water and Wastewater Program 4700 South Bragaw Street P.O. Box 198050 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 6. BLOCK 1 HIDEAWAY LAKES SID Parcel I.D.: 01547140 A. WELL DATA Well We PRIVATE Date completed =k,4.txd ✓ Total depth 40+ ft If A, B, or C provide PWSID # Sanitary seal M Cased to 4 ft FROM WELL LOG Date of test V41kN Ow,v Static water level ft Well production 9 -p.m WATER SAMPLE RESULTS: Ccttfonn 3�coloniesH 00 ml Nitrate 713R mgA Date of sample: 6/27/2005 Collected by: SRP B. SEPTICIHOLDING TANK DATA Well Log No Wires property protected= Casing height (above ground) "_in. AT INSPECTION 6/2712005 39 It 5.5 g.p.m Other bacteria =C=�---colonies/100 ml Arsenic ,QQ± MOA Tank Type/Material STEEL Date Installed 994 Tank size 4000 gal Number of Compartments Cleanout XS Foundation deanout XS Depression over tank NO High water alarm YES Date of pumping _61912005 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date Installed _ Soil rating (g.p.d./flz or fe/bdnn) _ System type Length ft Width ft Gravel below pipe ft Total depth _ It Etfective absorption area _ftp Nbnitoring tube _ Depression over fleld Date of adequacy test 6*7/2003 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test _ in Water added_ gal. New depth_ in. Elapsed Time: _ min Final fluid depth _ in Any rejuvenation treatment (past 12 moa (Y/N & type) (Rev.1 Vee) Absorption rate >= _ g.p.d. If yes, give date D. UFT STATION Date Installed Size in gallons Manhole/Access 'Pump on" level at _ In"Purnp off level at _ In High water alar level at _ In Datum Cycles tested Meets alarm 6 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankililt station on lot NIA On adjacent lots 100+ Absorption field on lot NIA On adjacent lots 100+ Public sewer main NIA Public sewer manhole/cleanout NIA Sewer /septic service line 53 Holding tank 78 SEPARATION DISTANCES FROM wl HOU)ING TANK N LOT TO: Building foundation 4 Property line 2.5 Absorption field NIA Water main NIA Water service line 55 Surface water -100+ Drainage 50+ Wells on adjacent lots0,, 0+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line N/A Building foundation Water main Water Service line Surface water Ddveway, parking/vehide storage Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION �• �\' �....w.;;ir#4 1 car* that 1 have determined through held Inspections and review of Municipal records that the above systems are in l.. conformance wffh MOA HAA guidelines In effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. �j. �i�Sleven .. nnone r �� E 149 Date g'� 05 es4C%ES9a .O• HAA Fee $ 4:3 • � Date of Payment T 1710.5 Receipt Number (Rev. 11M) Waiver Fee S _ Date of Payment Receipt Number 0 FLAT NOTE STIPULATES TKE CREEK €ASEMENT WILL BE CENTERED ON THE E70STINC CREEK LOT 7 f 1 ............ NEICHBORwG SHED Q DRIVE SHED 5O• TEMP. TURNAROUND 111 u -x� HID 1 S71'39'40'E- 18.34' Bll–L EM PIE with DYNAMIC PROPERTIES 111y r __.._.___. 440 WEST BENSON BLVD. p 103 eturHORAGE. ALASKA 99503 WORK ORDER NUMBLN: °OL. CT. 29. 1998 1 X50' 98—L— P013 •'" en cmtmo By om `4 BB KEN 2640 HIDEAWAY LAKE FLOATING DOCK N T, t1? �• NA EXISTING in n HOUSE tx `49 Tm► * qnlh L. GreyeS-8202 ;' c c In .... ayo LOT 5 ZZ ♦`♦♦♦♦ i ..aj r,♦ �i � 0o VI�+/ =L 27• /x� ,xis PSE EXCLUSION NOTIt is the owners responsibility to determine ES: the existence of any easements. covenonts. or ftslrfcUans S�e•R0 w/CAPOe a/e' aB �YONUMENT which do not appear on the recorded subdivision plot. NOTE: any data � bs used lof ]23, AL MON TACK O no a la snob, ahinq property IMes.hould construction, circumstances ,Under __ x FE OC -—X— to SURVEY CERTIFICATION: LANTECH hos conduato o SURVEY survey of this properly os shown on this OVERHANG - OVER DECKS- physitd drasica and that lM I nprovsments at lore within the Properly lines and no entlOOCh�T CONCRETE [— M are menlf exist other IhOn noted. GRAVEL - SEPTIC STANDPIPES - TANDPIPEAS—BUILT AS— UILTOF: LEGAL DESCRIPTION: WATER wELI_ NCINEERS 561-6626 LOT 69 BLOCK 1, 562-5291 �' HIDEAWAY LAKE SUBDVIS0 C7 05 C6; 12:22 Gs" SCS Rett 1053507001 CllontName Pannone Fng.Srv. 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