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HomeMy WebLinkAboutHIDEAWAY LAKE BLK 2 LT 2Hideaway Lake Lot 2 Block 2 #015-471-13 Municipality of Anchorage Page 1 of 3 —DEPART-MENT—O�HEAL—T-H AN-D—HU--MAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990414 PID Number: 015-471-13 Name: RICHARD DAY Wastewater System: ❑ New ■ Upgrade Y P9 Address: 10901 HIDEAWAY LAKE DR. ANCHORAGE, AK ABSORPTION FIELD Phone:No. of Bedrooms: (907) 346-2979/244-672777 3 ■Deep Trench ❑Shallow Trench ❑Bed ❑Mound ■Other LEGAL DESCRIPTION Soil Rating: 1.2 Total Depth from original grade: 7.65-8.32 GPD/Sq. Ft Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Grovel depth beneath pipe: 2 2 HIDEAWAY LAKE 2.46-3.13 Ft. 5.2 Ft. Township: Range: Section: Fill added above original grade: Gravel length: — — 1.0-2.0 FL 41 Ft. WELL: El New El Upgrade Gravel width: 2.5 Number of lines 1 nce between lines: — 7 Ft.Fte Classification (Private, A,B,C): Total De Cased To: Total absorption area: Pipe material: SCH 40 PVC/ Ft, 426 so. It ASTM D -3034/F-810 Static Water Level: Installer. CARL'S EXCAVATING Date installed: 12/13/99-12/15/99 Driller. G Date Drilled: Ft. Yield: Pump Set At Coling Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ■ S.T.E.P. To Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer. ANCHORAGE TANK Capacity in gallons: 1250 From Well 100'+ 100'+ 100'+ — 25'+ Material: STEEL Number of compartments: 2 Surface Water 100'+ 100'+ 100'+ - - LIFT STATION Line 10'+ 5'+ — — Size in gallons: Manufacturer. 5'+ 1250 ANCHORAGE TANK Foundation 5'+ 10'+ 5'+ — — 'Pump on' level at, 41 " 'Pump off' level at 41 ' High water alarm at: 45" Curtain NONE KNOWN Pump Make do Model: Electrical Inspections performed by: Drain 20 OSI 05 HHF M.O.A. Remarks: GROUNDWATER IN TEST HOLE WAS A 84.53 ON BENCH MARK Location and Description: 12/13/99 PRIOR TO INSTALLATION. TOP OF MANHOLE LID * THIS IS A PRESSURIZED SYSTEM. DISTRIBUTION LINE IS 1.25 INCH SCH 40 PVC WITH .25 INCH DIAMETER HOLES Assumed Elevation: 98.01 Ft. SPACED 14-15 INCHES APART (30 HOLES TOTAL). ENGINEER'SBEAL /] 0006opp0� . /' ao�� f � � r•.I� � oma. T/ o T AWWC, INC. Inspections performed by: Dates: 1st 12/13/99 �'".:..4.g� .. .... 2nd 12/15/99 a�••••• D 3rd 12/15/99 :.J ftq,, �• Garn •ss� '. Department of Health and Human Services pproval 0�9s•'� CE 17953 •.. actio ���pedpro•••"• a Reviewed and approved by: Date: i- % -da o�Foo fession o 72-013 Rev. 9/91) MOA 25 -PERMIT -NUMBER--- : 46.1 /� c [� — L -PARCEL ID—NUMBER: DRAWING SW990414 93.8 f-� J U 015-471-13 97.7 MH 85.5 99.0 MT 115.0 120.8 I o � gFpRO I LuCOCgnON Y OF I s I 2 \ TH#1 / NEW 1250 GALLON /MT S.T.E.P. TANK // I '4 / ` \ \ZP FCO NEW PRESSURIZED DRAINFIELD 02OJ5 CO \_2" \ \ OF BLUE I L / \ BOARD INSULATION w \ 4'WIDE \ A B I} J CO 46.1 66.8 ST1 78.8 93.8 ST2 84.0 97.7 MH 85.5 99.0 MT 115.0 120.8 I� I� I I I I I I I I I ALASKA WATER AND WASTEWATER CONSULTANTS INC. �o600�O o � 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 ,. •' / •.s o0 LEGAL DESCRIPTION: Oo �I ��• O HIDEAWAY LAKE SUBDIVISION, LOT 2, BLOCK 2 TYPE OF WORK: AS -BUILT OF SEPTIC SYSTEM UPGRADE,.% .... ............... �• :� . PREPARED FOR: PHONE NUMBER: � .J f r A. Grness; Q RICHARD DAY (907) 346-2979/244-6727ODO�s •., C -7953 .,•'`c�Qp ig DATE: DRAWN BY: SCALE: PAGE: O4ered pro ..... 0\ 12/21/99 A.C.G. 1= 40' 2 OF 3 l p f PERM"UMBER:PARCEL ID—NUMBER: SW990414 AS — B -U I LT -DRAWING 015-471-13 FINAL GRADE - 97.66 MANHOLE �119 -98.01 511 5f2 MH fOP OF fANKTOP OF TANK AT INLET - 91,62 \ / Af Ol1T f - 91,66 NFW 1250 GALLON INVERf OF mc 5,f .F ,p TANK Af INLET - 91,52 Mf FINAL GRiV7E - 98,9 ORIGINAL GRADE 97,02 - 97,69 INVERT OF PIPE - 94,56 (AVGJ 11/4" 5CH 40 PVC LATERAL 60ffOM OF TRcNCN J CROUNDWAI>;t; I.FVFI. - 8937 ( AVO.) ON 12/ 13/ 99 - 84,53 ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246,.•`1 LEGAL DESCRIPTION: �� • I l� O HIDEAWAY LAKE SUBDIVISION, LOT 2, BLOCK 2 ..H*QQ TYPE OF WORK: Q..•..f... .... PROFILE AS—BUILT OF SEPTIC SYSTEM UPGRADE �.....� ............:...`..� PREPARED FOR: PHONE NUMBER: QOO '. f e C' —795 K ness, RICHARD DAY (907) 346-2979/244-6727 700 3 DATE: DRAWN BY: SCALE: PAGE: 4�4P�eo, P• " • O\ 12/21/99 1 A.C.G. 1 1 = 40' 1 3 OF 3 rofessv0 Dec 21 99 10:49a Maril3n Elsenbast 3463559 UF• ;: 1 ! .+: t 1� I pa 1 f9 i s 1 L- Ut. ! FK lil i' 7 Y.:f: ':�H•7u+J 1J 1 t.4b INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD )WECTION: VOICE 563-304 INSPEQTION: FAX (907)3434235 INFO, 343-82il I 1 ^ NA;!".E. 1 1 WT ---9q . _ PEFt 1� � � �1� � .4DUkESS _� !• — J , , /�•,Y, ......' _ _� INSPECTION n LOT BLOCK. SUBDIVISION �aATE �Z�.7": COMMV-NTS or DIRECTIONS: ope? i �"-b <<k' �1 ��7tr�,r�m ii t " rx'i' Y'e � mj;• j i rruE nc I;,SpEC±1'Ji1: • J 1 �� REINSPECTION: YE.S I!O '1z140 NONCOMPLIANCE 083ERVED 1 I CORRECTIONS ESSENTIAL AS EXPI-AINED BELOW rL ) ;".ILL RE-EXAMINE AT NEXT INSPECTION I ] DO NOT CONCEAL UNTIL REINSPECTED - COMMENTS: (FOR INSPECTOR USE ONLY) 4 MPECTOR ) w ell ) �! � >'y DATE=: ty — 1 i 'WHEN COI'tRECTiON$ ARE +,j9ADE FLEASE CA_L FOR REi)aSl•Ec- i ioN a0 NOT REMOVE THIS NO T )c:>_ i P.1 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services / On -Site -Services -Program 825 L Street, Room 502Y- P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 / /A�►/ fl�ff /-9L `9 f �� V ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT (moi Upgrade Date Issued: Nov 19, 1999 Expiration Date: Nov 18, 2000 Permit Number: SW990414 Legal Description: HIDEAWAY LAKE BLK 2 LT 2 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Richard Day Owner Address: 10901 HIDEAWAY LAKE DR ANCHORAGE, AK 99516-1146 Parcel ID: 015-471-13 Site Address: 010901 HIDEAWAY LAKE DR Lot Size: 49334 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Ge-'UnCA(X)C+"0r �� tier �� cc) �Z���� x < <n WIC8 iU1C��G� C'� ���f ��c io✓I LZ�15 �� G I "7Pi Received By: Date: //— d,2 J f q Issued By:.ZC 1 Date: November 1, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Hideaway Lake Subdivision; Lot 2, Block 2 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system is in a state of failure, and must be upgraded. Comments regarding the proposed upgrade are summarized as follows: 1. SOILS: Attached are soil logs which show the soil profile, and the percolation test results. Below the organics was a SM/GM material to a depth of 6.0 to 7.0 feet and then transitions to a SW and SW/SM material to a depth of 18.5 feet (bottom of test hole). A percolation test was performed between 4.0 feet and 4.5 feet and found the rate to be less than 1 minute/inch. A second percolation test was run between 7.5 feet and 8.0 feet and found the rate to be less than 1 minute/inch. No Groundwater was encountered during the excavation of the test hole and one week later, the monitoring tube was found dry. The insitu sandy soils should act as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minute/inch b. Allowable Application Rate: 1.2 gallon/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft 2 f. Maximum depth: 12 feet g. Effective Depth: 5.5 feet h. Width: 2.5 feet i. Length: 37 feet k. Effective absorption area = 407 ft2 4. SURFACE -WATERS: As shown on the�lc esigndrawinghere is a ponded area around the -- southwest corner of the lot as well as a small ponded area on the north side of the well on lot 3. It has been an extremely rainy season. According to the property owner, this ponding has not occurred in the past and we are treating this as an anomaly. If ground water continues to appear in these areas in the future, fill will need to be brought in to cover over the subject areas. 5. TOPOGRAPHY: As can be seen on the attached topography site plan, there are no slope concerns. The proposed drainfield is to be installed parallel to the slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. .S. LOT 1, BLOCK 1 I I ff HIDEAWAY LAKE S/D LOT 2, BLOCK 1 HIDEAWAY LAKE S/D j �r / r , LOT 1, BLOCK 2 I I f \ HIDEAWAY LAKE S/D 1 \ _ TRACT A `ZCAN CZ, A LOT 3, BLOCK 1 HIDEAWAY LAKE S/D TI a \ I { ( > r \ TH#1 I wt I EXISTING\ ( I I PROPOSED SEPTIC UPGRADE (SEE DESIGN, PAGE 2 OF 2) 3 BEDROOM \ ( ( HOUSE EXISTINGSEPTIC I j I { ( APPROXIMATE t 100' WELL RADIUS ) r ( t I I I LOT 4A, BLOCK 1 HIDEAWAY LAKE S/D/ f \ LOT 3, BLOCK 2 / r / \ HIDEAWAY LAKE S/D / I _ y1 cs'EPTIc I I I ARS I { LOT 2, BLOCK 1 ARN�ETT S/D LOT 4, BLOCK 2 i I wACAN� i HIDEAWAY LAKE S/DLOT I \F { 7 { RICHTER PARK S/D i ALASKA WATER AND WASTEWATER CONSULTANTS, INC. `- OF A���� 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 + • ,l it PHONE: (907) 337-6179/FAX: (907) 338-3246 .% ✓ �•••.� ��� LEGAL DESCRIPTION: HIDEAWAY LAKE SUBDIVISION; LOT 2, BLOCK 2 +�.:.• . . �...•••• ...:� i f TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE .................� ✓� '. e r Games '• E-7953 ,•' c •.'•""'' PREPARED FOR: PHONE NUMBER: RICHARD DAY (907) 346-2976/244-6727 ••• �A-' fi1; �������"""`�`�`�`���� DATE: DRAWN BY: SCALE: PAGE: 11/1/99 J.L.M./K.D.W. 1 = 100' 1 OF 2 AppROXI 7't- EOCAT/pN OF ORJ I�WAY PROPOSED DRAINFIELD UPGRADE.— EXCAVATE A TRENCH THAT IS 12 FEET DEEP MAXIMUM BY 2.5 FEET WIDE BY 37 FEET LONG. t ADD 5.5 FEET OF CLEAN, WASHED SEWER DRAINROCK. � I EXISTING TANK TO BE ABANDONED COMPLETELY FCO / PROPOSED 1000 GALLON SEPTIC TANK q EXISTING SE TIC SYSTEM AB/'NQO OR FUTURE USESA REU RE R WILL BE FOR FUTURE NNECTION INSTALL DBL CO 1 z W 2 W I i ! ---------j---------1 1 \ NOTE: ALL LINES THAT ARE {{ UNDER ANY PORTION OF THE LOW LYING AREAS WITS SOME DRIVEWAY ARE TO BE INSULATED SLIGHT PONDING. PER H�MEOWNER WITH 2" OF BLUE BOARD INSU— of Lor 2, BLK 2; THI IS THE FIRST TIME HE HAS S EN ANY LATION BY 4 FEET WIDE. PONDING IN THESE AREAS. ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 c,CG_ O� OQQ PHONE: (907) 337-6179/FAX: (907) 338-3246 O� \`; •' 4 LEGAL DESCRIPTION: HIDEAWAY LAKE SUBDIVISION; LOT 2, BLOCK 2 TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE PREPARED FOR: PHONE NUMBER: RICHARD DAY (907) 346-2979/244-6727 DRAWN BY: SCALE: PAGE: 11/1/99 J.L.M. 1 = 40' 2 OF 2 Iff y A- rness: �•� E-7953 ����pr'o f e s sio�°.opo ALASKA WATER &=WASTEWATER COI�TSUUTAN-T-S-,WC 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HIDEAWAY LAKE SUBDIVISION, LOT 2, BLOCK 2 PERFORMED FOR: RICHARD DAY DATE PERFORMED: 10/13/99 DEPTH -" (feet) TEST H 0 LE 1 �����^I ORGANICS/LOAM 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SM/GM SW TO SW/SM SOIL CLASSIFICATIONS GWj - ORG GP(_ ML I�iI1I GM 7%/// ICL °n ate° SW �, I I I I� MH SPoP CH rl SM '/i OH SC DEPTH TO GROUNDWATER DATE DRY 10/13/99 DRY 10/14/99 DRY 10/20/99 WAS FILLED TO THE 6" IN APPROXIMATELY 7 MINUTES LEVEL 6 TIMES AND WAS EACH TIME. ILLJ rl o I I Q \ /*TH#1 I I 2 — I I EXISTING I 3 BEDROOM HOUSE SITE PLAN I" = 100' , DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 10/14/99 _PERC HOLE ABSORBED WAS FILLED TO THE 6" IN APPROXIMATELY 7 MINUTES LEVEL 6 TIMES AND WAS EACH TIME. UPPER —BENCH - 10/14/99 ,PERC HOLE WAS FILLED ABSORBED IN APPROXIMATELY TO THE 6" 2 MINUTES LEVEL 6 TIMES AND WAS EACH TIME. LOWER —BENCH— PERCOLATION RATE <1.0 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0'-4.5' FT. AND 7.5'-8.0' FT. COMMENTS: THE INSITU SOILS SHOULD ACT AS A SAND FILTER. PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFOR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: 9I cy LOT 1, LOCK 1 IDEA AY KE /D- L 2, BL K 1 HIDER Y LAK S/ k 1, BLOCK 2 ( WAY LAKE D o \� EP�TI"C T BLOCK 1 HID KEE S/ 4" T A AAD O q� �!1 OXI TE 10 ELL IU a LOT 49, K HIDER /( E S D LO 3, BLO , K HIDER AY LA E /D tion LOT B 3%D LO WAY B H LAKE S/D A ANT RI LOT 7 R PARK /D ALA, ATERANet�1( WA C N S T N T I C. 69 D R ROAD SU E ANCHORAGE, AK. 995 4 PHO E: (907) 377 7 /FAX: (907) 338-3246 LEGAL DESCRIPTIO Ck f IDBPWA LAK BDIVISION; 2, BL TYPOF OR POG AP CAL D WII�IG PREP ED�FF0 RIPf'iAR DA 7) 34 76/2 I D 10/12 9 DRAWY: D.W. SC' LE: 1 = PAGE: 1/OF 1 MUNICIPALLY'/ OF ANCI4ORAGE iDEPAP,'FEdENT OF I-IEALTFt & ENVI f{O!\IMEf,IT/\I. ENVIRONMENTAl, ENGtNEEI-tlF, tG r)IVISION 825 L Street - Annhorage, Alaska 99501 'i'e[ephone 264-4720 ON-SITE SEWAGE F)ISPOSAL SYSTEt~4 AND/OR WE!,L INSPECTION REPORT ~ A~'~ ............................................................................................. ~?HONE RICHARD DAY L344-1750 '~AILING AODRES$ ...... SRA BOX 20-32D ANCItORAGE, AK. 99503 NEW LIPGRADE ,LEGAL DESCRIPTION LOT 2 BLOCK 2 HIDEAWAY LAKE SUBDIVISION LOCATION Ne. OF BEDROOMS ANCHORAGE, AK. 99507 3 Welt Absorption area PERMIT NO. DISTANCE TO: 102 ~ I Dwel!ing Manufacture~ Material ANCHO]~AGE TANK STEEL Liq. capacity in gallons Inside length I Width L. iquid depth 1250 DISTANCE TO: Dwelling PERMIT NO. IF HOMEMADE: We~ Manufacturer ] ~aterial /wen , IF°undati°n INear~'st ~ot line DISTANCE TO: J~__. 100 .... 66 ' 72 ' No. of Ihles ]Length of each line Totifl length of lines Ftel~i~ Top of tile to finish grade 6I Matemia; beneath tile 48 inches Liquid capacity in gallons PERMIT NO. 385 §.q ft. Length Width Depth PERMIT NO, Type of crib Crib diameter Clib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE ]O: Class Depth Driller Distance to lot li.e PERMIT NO, DISTANCE TO: Building foundation Sewer line Seplic Lank Absorption area(s) OTH E R PIPE MATERIALS 4" C.I. to trench 4" perforated hancore for trench SOIL TEST RATING INSTALLER CLABO CONSTRUCTION REMARKS As-built inspection performed by R&M Consultants, Inc. on 11-19-80 by Dan J. Cooper, Staff Engineer. Layer of Mirafi filter placed over drain to backfill. APPROVED DATE LEGAL PERMIT NO. [:,E:PRR"FklENT r' HEFILTt4 RND EIq'¢IRCrlqMENTFIL ~ 3TECTION 825 "L STREET, FINCHORRGE., FIK. 264-4720 II..q E: tl._ L_ IFi I'-.~ [:, El t'-41 --- 2-; I T E :; IE": lb-lt E IF:~;: F" E I~.". f"1 :[ 'T ,:: 800:2:::L::L .'., FIPF:'L i CRNT LOCFIT I 01',1 L. EGFIL RICHRR[:, L. L2:B2 HiE:.;ERWFI,¢-LFIKE SF.'.FI BO;,.', 202:2-D LOT SIZE 344..'..:1.750 52000 S~]).LIFIRE FEET T'¢[::'E OF:' SOIL RB':;ORPTION S"r'STEM IS;: TRENCH MFtY, IMUM IqLIMBER Cfi,"" BE[:'ROOMS = SOIL RRTING (E;Q FT,.."BR)= 85 ]"HE REC!UIRED SIZE OF' Th. IE SOIL ABSORPTION SYSTEM E::, E: F' T IH == ';-' b F£ 1'-41 f.B T ~-I~ == ]: 2 C3i F..: t.=11%,' F£ L_ L'~, E F" qr' !.4 :== THE LEHGTFI [:,IMENSION IS THE LENGTt4 (IN FEET) OF TFIE TRENCH OF,,: DRFIINFIELI::,. THE [:,EPTH OF FI TF.':ENCH OR PIT IS THE DISTFINCE BETWEEN THEE SURFRCE OF THE GROUND FINE:, THE E,'OTTOM OF THE: E,'.".,'CFIVR]'ION (IH FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR",,'EL DEPTH IS; THE MINIMUM [:,EPTH OF GRFI',,,'EL. BETWEEN THE OUTFFII.J... PIPE FINE) ]"FIE B'OT]"OM OF THE EXCRVFITION (IN FEET). F:'EF..'MIT RPPLICRI".IT HFIS THE RESPONSIBILIT'¢ TO II",IFORM THIS DEPFIRTMENT [:,URINEi THE INSTFIL. LFf]"ION IN'.=.;F'EC:'TIONS OF FINY HELLS PIE:,JFICENT TO THIS F'ROPERT'¢ RN[:, THE I'.,IUMBER OF RESI[)ENCES THFIT THE WELL WILL SERVE. F:FIC:I<FILLINf3 ELF," FIN"r' E;'¢STEM !4ITHOUT FINflL INSPECTION FIND FIPF'RFCv'FIL 8¥ THIE; I}EPI:IF?.I"MIEI'.tT WILL BE SUBJECT TO PROSECUTION. HIi"~IMUM DISTRNCE BETI.,.IEEN FI WELL FINE:, RNY ON-SITE SENRGE I)ISF'OSRI... S'-r'STEI"I IS :1.00 FEE'F FOR FI PRI',,"RTE WELL OR '1.50 TO 200 FEE]' FROM Ft PUBLIC WELL DEF'EN[:,INEi UPON THE: 'f"¢PE OF PUBLIC WELL MINIMUM [)ISTRNCE Ff;..'Obl R F'RI'v'FITE HEL. L TO FI PRIVFtTE SEWER [..INE IS 25 FEE]]" FIND TO FI COMI"IUNI]"'¢ SEHER LINE IS 75 FEE]'. HELl.. LOGS RRE F..'E(.).UIRED f'::lN[:, MUST BE RETURNED TO THE [:,EPRRTI"tENT WITHIH ~:0 OF THE WELL COMPLETION. O'I"HER REC~.UIREMENTS MR'T' RPPL'T'. SF'ECIFICFITIONS RND CONSTF.:Lh]:TION DIFIGRFIMS RRE FWFtIL.RBLE TO INSURE PROPER INSTRLLFITION. F" EE Eli: IP'! Z -[" I£ :;'< I) ][ I~;;: E S; [) E m~: E !"1 E; E: [-;: .7~-': ::J_ .. ::l.. :D'.~ :E: :L: F'I.]RTH E:Y THE MUNICI PRLI T'¢ OF RNCHORFIGE. 2: I HILL II'.,ISTRLL. ]'HE S"r'S'f'El'd IN RCCORDRI",ICE HITH THE C:ODES. ]:: I LIN[)ERSTFIND THRT TWE ON-SITE SEWER S'T'STEM i"lFl'¢ REr/.!UIRE EI'.~LFIRI]iEMENT F.'.ESZE:,ENCE IS REI',IDE~LE£:, TO I~6:L. UDE MORE THRiq 2.": E~EE:,F.:OOM2.;. CERTIF"¢ THFIT I F'IM F'FIMILIRR WITH THE REC~UIREMENTS FOR ON-SITE SEWERS FINE:..', WELLS FIS E;ET I F Th'IE 7-14-80 0I ORGANIC Pt 1' ORGANIC SILT M/Pt 2' SILTY GRAVEL GM SANDY GRAVEL GW UNIFORM CLEAN SAND SP SILT LENSE / i 2" Thick / W~ FINE SAND SP SILT W/SMALL SAND LENS ML 12' 13.5' TOTAL DEPTH Groundwater Encountered (11.0') COMMENTS: BACKHOE PIT, Perched water was observed flowing into hole off thin silt layer at 11'. /)l'r L oc,~'r~ott fDW~t KMW CKD. RG . _ SCALE. 1"=3' ?5ULTANTS~ INC,11 SOILS LOG - PERC TEST L-2, B-2; HIDEAWAY LAICE ~ P~ROd. NO. A-O . July 15, 1980 R&M No. 051001-52 Dr. Richard Day 3606 Rhone Circle Anchorage, Alaska 99503 Re: Dr. Richard Day Property Subject: Soil Investigation for Sanitary Sewer System, Lot 2, Block 2, Hideway Lake Subdivision, Anchorage, Alaska Dear Dr. Day: Per Mr. Roger Dalrymple's request of July 14, 1980, we conducted a subsurface soils investigation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Environmental Protection. This investigation, which was accomplished on July 14, ]980, consisted of a test hole excavated to a depth of 1~.5 feet below the existing ground sur- face. The test hole was sited according to Mr. Dalrymple's instructions and its location is shown in attached Drawing A-01. Excavation was accomplished with a backhoe. Test Pit sidewalls were carefully inspected and visual soils classification was made by an experienced soils engineer. The topography at the excavation site is generally rolling and sloping to the west. At the time of the investigation the site had original vegetation consisting of birch and spruce trees. The top of the test hole was located at original ground surface. The soils encountered in the excavation are shown in the test hole log in Drawing A-01. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was encountered in the test hole at a depth of 11.0 feet. Bedrock was not en- countered. At the time the hole was excavated seasonal frost was not present and permafrost was not encountered. Page -2- Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage, a percolation test was not necessary within the test hole on the subject lot. We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, R&M CONSULTANTS, INC. Janii~e< Cecere Project Manager Richard S. Giessel Staff Engineer JC/RG/jh/SSI-K STATE "OF:ALASKA Iai Borough Lot Block ib. Fraction" Section No. Township Range Meridian 3't 1jSubdivision 1�/ r E/W ic. Distance and Direction from.Road Intersections 3,, OWNER OF WELL: Address: 7 ,( �y i'�!'rt j Street'Address and Arca,of Well. Locaiion 2. WELL LOG Feet Below 4• WELL DEPTH:`(comple'ted) Surface Elevation Date of , Surface Completion, Material TypeTop Bottom` ft. rJJT� l�'f 5. ®Gallie tool QRotaryDriven j Dug 3-3 ❑Auger ❑Jetted ❑ Bored ❑ Other: - p r -r b. USE: ® Domestic Q Public Supply Industry, r%t,,rr',+f Y�_V.7r r;rI/ Ale r Y rt!� ❑Irrigation ❑Recharge ❑Commercial r .f Jt,` ' Sr^si'rf % Nest Well Other 7.' CASING: Threaded Welded in. to ft. Depth Weight lbs/ft. l�i�". r✓.� 5 F . a?.C- in. to ft. Depth 8. FINISH OF WELL: TYPe: t�:?F< %r; piameter: ( Slot/Mesh Size: Length: Set between ft. and ft." Fittings: 9, STATIC WATER LEVEL: ft. Above MSelow land surface Type of Measurement: A. 10.'PUMPING 'LEVEL below land'surface ft. after hrs.,pumping g`.p.m ft. 'after hrs. pumping g. P.M. ii. WELL HEAD'COMPLETION: In Approved Pit [:]Pitless.Adapter inches above grade. 12, GROUTING: Well Grouted: Yes No Material: ❑ Neat Cement ❑ Other: - 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g'.p. Type: ❑Submersible ❑ Ree iprocating ❑jet ❑ Other: 14. REMARKS:" 15'WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled ,under my_jurisdiction and this report ie true to the best of my knowledge and belief: t ' Reg-rstered`Busine'ss;Name "Contract L"icense+Num er Address: Signedo Date: v a = "�Au'thorized-Represehta,tive r Form 02-WWR Copy- DIstrIb tion: WHITE - State OGGS, PINK - Driller, CANARY - Customer r , �l Municipality of Anchorage On -Site Water and Wastewater Program -. (907) 343-7904 S x : E T.Y c Certificate of On -Site Systems Approval Parcel I.D. 015-471-13 1. GENERAL INFORMATION: Expiration Date: _-q—t 7 -ZZ— Complete 2Z Complete legal description HIDEAWAY LAKE; BLOCK 2, LOT 2 Location (site address) 10901 Hideaway Lake *Anchorage 99507 Current Property owner(s) Kirk & Kathleen Leadbetter Day phone 244-6149 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 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 $ Waiver Fee $ Date of Payment 15 � Da a Date of Payment Receipt Number o g o y R G Receipt Number COSA # Q;S C a .9 a g Waiver # 5. .STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess 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: 6 b g I Z z 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 01- or �,,.••., 7 ' s% i�� encroachments may exist that were not identified during the evaluation. The operational life of all wells r . — ' • and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 49 , Y. �. groundwater levels (that may fluctuate during the year), quality of construction (materials and i . 1 ,• workmanship), and the water usage of the family utilizing the systems. 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 t;%I '• : 1/r Y GC, ess, 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 /II CE-: 9:D , perform the evaluation. Reliance upon the information provided in this report by any other person or �r_�; r -a _G � � .••J party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE ,^- System #1 Approved for .3 --bedrooms � System #2 Approved for Disapproved Conditional approval for bedrooms `\\\�`QP���� OF yor,� j ON-SITE _ bedrooms, with the following st t ,iorgVATER AND o WASTLv'ATER Z pROGRA ��� Lw -Lw 0 12 l / By: �- Original Certificate Date: (o ^ 17 Z? 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_ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other qq e R ow Sr`uyq Legal Description: HIDEAWAY LAKE; BLOCK 2, LOT 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled ',a,sso WViSg�9 Eli?/ZZ, qe Parcel ID: 015-471-13 Structure served by this system Well production at time of test 1.5+ gpm Water storage tank volume 300 gallons Total depth 260 ft Well disinfected for coliform test? ❑ Yes ❑ No c`'J Cased to UNKNOWN ft � ❑Coliform bacteria is Negative 1�- ® Sanitary seal is functioning correctly Nitrate 0.698 mg/L ❑ Nitrate less than MRL (ND) 4 ❑ Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 5/20/22 Date of Sample 5/20/22 Static water level at beginning of test 136.6 ft Comments *WELL LOG IS NOT LEGIBLE. DATE IS PER 2000 HAA. B. TANK DATA Age of tank(s) 23 years Tank type/material sTE"", "' Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/9/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 23 years Lift station material STEEL Comments: COSA Checklist yellow sheet D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) X84" e2%1q Adequacy test date 5/20/22 ❑ ALL standpipes present per record drawing Results QPass For 3 bedrooms Total measured depth from grade 9.08 ft (max) Fluid depth prior to test 16 in Measured depth to pipe invert from grade ft (min) Water added 615 gal ❑ N/A —pressurized field 35 ❑ Monitor tubes go to bottom of effective. If not, state New depth in 120 depth into effective sed time min Ela p ❑ Code -required soil cover over field Final fluid depth 25 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) Gallons introduced N/A gallons If yes, enter date " Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Yes if No Community Sewer Manhole/Cleanout > 100' QQ Yes if No ft El Yes if No ft Neighboring Tank > 100' 21 Yes if No ft Private Sewer/Septic Line > 25'F-11 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' Yes if No ft M Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' SYes if No ft P1 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 ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Yes Absorption Field > 5' Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10' Q✓ Yes if No ft Community Wells > 200' P1, 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' 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'✓Q Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' [D Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION l certify that l 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 /,lef ..�.—......... A.. ,Grness,: CE -79 3 •.c�G 0 Sion& #AECC884 Lift Station/Pump Vault Owner k � r k L e,,Aetf e r Street Address I N01 H t'd ea wa v Lake J)r Septic Tank: �Pc -Sludge level inches -Pumping: required es -Pumping completed Lift station: -Pump basket cleaned no -Control floats cleaned no -Operation satisfactory a no Alarm System: -Effluent filter cleaned e no -Proper float settings confirmed a no -Dedicated electrical alarm circuit J no Audible and visual alarm inside dwelling es no -Alarm system operation(§—atisfact6& not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection yes -Ground water intrusion around pipe penetrations yes v -Manhole lid: Functional no Insulated no Weep hole functional 99 no Properly Secured a no Other .All manufacturer required inspections and maintenance completed Comments: Qualified Maintenance Provider: Technician --&-/ Company _011e �f f Signature �/ Date Date of maintenance ,-©�? www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221287 Subdivision: Hideaway Lake Block 2 lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 23 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. Ma�lmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www mum org Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-471-13 HAA # 0 0 0 ~ GENERAL INFORMATION Complete legal description HIDEAWAY LAKE SUBDIVISION: LOT 2. BLOCK 2. Location (site address or directions) 10901 HIDEAWAY LAKE DRIVE ANCHORAGE. AK 99516 Property owner RICHARD AND SALLY DAY Day phone (907~ ,546-2979 Mailing address 1o9o1 HIDEAWAY LAKE DRIVE ANCHORAGE. AK 99516 Lending agency Day phone Mailing address Agent Address Day phone Un/ess otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: /f community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ¢;~21 Computer Version Note: Alaska Water and Wastewater Consultants Inc. shall be paid $550.00 at, or prior to, closing for the engineering services provided. 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 vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspgction, the on-site water supply and/or wastewater dot tPhOeS~alYe.'ot~ tr~i~ iinns~cr~iF~ina, nce with all Muni.c~p.a~and State codes, ordinances, and regulations in effect NameofFirm ALASKA)CC~"~R&/I ,/ /~/~AYER CONSULTANTS, INC. Phone (907)337-6179 · ' -- ,,'-,, , .-,, ,' Date //- .-~/- ,, conducting ,*ie evaluation, ,ted to. de a thorough, eonsclentloue engineering ana/yels of the system in accordance with ADEC and mOA Df IS Guidelines & Regulations. The reported results described the performance of the system under the condition encountered at the time of the test, and separation distances measured to readily identifiable features. The c uerational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being sen/ed 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. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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 parly is not authorized, nor will it confer any legal right whatsoever. 6, DHHS SIGNATURE P'"' Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Fmployees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineeds work. 72A)25 (Rev. 1/91) Back MOA #21 Computer Version Legal Description: A. WELL DATA Well Type. PRIVATE Log present (Y/N) Total depth 260' Sanitary seal (Y/N) RECEIVED Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVIC (~ Environmental Services Division E~p~, 2000~lf~ 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 ~ MUNICIPAUTy 07 kNCHORAGE ENVIRONMENTAL $~gVICES DtVIS[0~I Health Authority Approval Checklist HIDEAWAY LAKE S/D; LOT 2, BLOCK 2. Parcel I.D.: Date of test Static water level NOT GIVEN Well production 5,0 WATER SAMPLE RE~TS: Coliform (/-,) Nitrate / Date of sample: 9/21/00 B, SEPTIC/HOLDING TANK DATA Date installed 12/13-15/99 Tank size 1250 Foundation cleanout (Y/N) Date of Pumping NEW C. ABSORPTION FIELD DATA Date installed 12/1.3-1 Length 41' Width 015-471-13 If A, B, or C, attach ADEC letter. ADEC water system number YES Date COmpleted Cased to '103' YES *BELIEVED TO BE TO BEDROCK FROM WELL LOG 10/19/80 10/19/80 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 12/15/99 114-' g.p.m. 2.7 ~-.~'-h3r.~/~ ('/~'~),~ Otherbacteria / Collected by: A.W.W.C., INC. N/A YES Number of Compartments 2 Cleanouts (Y/N) YES Depression (y/N) NO High water alarm (Y/N) YES Pumper - *BELOW FINAL GRADE Soil rating O or ft2/bdrm) 1.2 System type 2.5' .Gravel thickness below pipe 5.2' Total depth g.p.m. YES TRENCH *9.5' +/- Effective absorption area 426 SQ. FT. Monitoring Tube present (Y/N) YES Depression overfield (Y/N) Date of adequacy test NEW Results (Pass/Fail) - . For. 3 gal. water added (in.): __ Fluid depth in absorption field before test (in.); - Immediately after - Fluid depth. - .(ins) Minutes later: - Absorption rate = Peroxide treatment (past 12 months) (y/N) - If yes, give date 72-026 (Rev. 3/96)* Computer Version NO Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) YES High water alarm level at* Cycles tested NEW 12/15-15/99 45" Size in gallons "Pump on" level at* 4-1" *Datum BoTroM OF TANK 1250 "Pump off" level at* 4-1" E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ N/A On adjacent lots 100'+ On adjacent lots 100% Public sewer manhole/cleanout N/A 100'+ 25'+ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage. 100% SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Wells on adjacent lots 100'+ _ Property line Surface water Curtain drain 10'+ Building foundation 10'+ Water main/service line 1 o'+ 100% Driveway, parking/vehicle storage area 1 o'+ ONE KNOWN F, ENGINEER'S CERTIFIC:ATIO~ of Municipal re¢ord~ Signaturo.~L/~L~ JEFFREY A, Engineer's Nam~/_J_J~ GARNESS Date-~-~~ field inspections and review systems are in conformance on this date. Wells on adjacent Iots_____~~0'+ / '~//'~ .... .~' .?~ HA&FeeS ~ ~"(~ ' ~"~ Date of Payment ~ ¢'~ 6- 6¢)~ 72426 (Rev, 3/96)* Computer Vemlon Waiver Fee $ Date of Payment Receipt Number DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME ~'~ {j' .-~-~ TIME DATE DATE DATE ¥..~ INSPECTOR INSPECTOR ~'- I NSPECTOI~""~ MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P;-;OI'ECTION /~) ENVIRONMENTAL SANITATION DlVlSlONTelephone 264-4720 IV /,Y :[ 31981 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOW~-~I I PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4, REALTOR/AGENT I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four [] Two ~] Five J~ Three ~] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled ~rior to that date, give well depth {attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUB,.IC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, 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 [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEiVI PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY 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 WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~APP ROV ED FOR __~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY