HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 2Hidden Hills
Block 1
Lot 2
#011 - 121 -27
Gevelo_ment Services Department
Building Safety Division
l ,
On -.S; to Water Ct Was l e'wate^ Progr _rn
4700 Bragaw 5reet
19,6650
Mark 8egich Anc•horoge, .4Y 99519-6650
Mayor wNW.IrApl ar qi On5lt,
(407;343-7904
Pump Installation Log
Well Drilling Permit Number: SW_ Date of Issue:
Parcel Identification Number:
Legal Description
14 fdet-1 N Its
Pump Installation Date: C/2 0// 3
Pump Intake Depth Below Topp of Well Casing: %?S) feet
Pump Manufacturer's Name: A� / dc—,c ootid
Pump Model: A Y A ; SOP -30 - % (J i
Pump Size 112, hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes No
Method of Disinfection:
Comments:
Property Owner Name & Address:
-)C)h 7 1V`
4u5ew J
�3j3J 1,0-54, ciy-[ i,—
Anchorage Pump & Well Service
Pump Installer Name: 330 l=ast 76th Avenue
Anchorage, Alaska 99818
Phone: 907-243-0740
Fax: 907-243-0742
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of ptunp installation.
Municipality of Anchorage ^ `
`e .r
Development Services Department `•
\�
Building Safety Division `^
-
On -Site Water and Wastewater Program, 4700 S. Bragaw SL
P.O. Box 196650 Anchorage. AK 99519 650 Page of
www.d.anchorage.ak.us (907)343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: <-C4-)
C2150,424 PID Number.
Nemo. UIMGG'
Wastewater System: New ❑ Upgrade
5��4eF1
A4ertla:
(v33/ 44 h Cirri
ABSORPTION FIELD
Pnona:
O�QDaaP
Hunca a seaome:
hsact O Shaw Tiwwh O aeP 0M. -4O Osier:
LEGAL DESCRIPTION
sod R5WV
It 2 cnwe
Tar oePa tan onvn" 9e� FI.
&ack: La:
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am:
1 A FJI /
DSM b PM Dalae tom wlg. 7aee:
7.0 FI.
GmN depth Deneam pm:
4r 0 Fl.
Tar P: Rave:
scam:
fa afdN aDow dpNl paM:
l/Q
CraM L"h;
1
FI.
l Ft.
Well: ❑ New
❑ Upgrade
Cr. argm
Z,
Ramo. rPSUnCa
Detwan sue:
FI.
FL
CUmficaam (Pnvale. A S. Cr' Tara OepR:
q:
Tal OWPaan area:
Rpe Maleea:
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a Da :
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auUen:
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GPM
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FL
SEPARATION DISTANCES
4tAl
aseptic ❑ Flolding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Litt
Holding
lubrKJPnvate
a ac.
Ar
Pauly.
/000 Gal.
From
Tank
Field
Station
Tank
Serer Lina
a
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Sunaaewala
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LIFT STATION
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9urp on N.+al
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wpn wars aYm al.
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BENCH MARK
4
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at eYr T'✓. �h
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Engineer's Stamp
OF A(,q�1tt
h � • 1,
,t /: aro
Inspections performed by: NfAcbY(A)lo eFsen Dates: 1"
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*:•49TH•• ; 1
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2na o5 H
Mf 1 fTJjj�. •.........�
Developm
nt Services Department Approval I
-va; :MICHAEL N. ANDERSON
ey C 9469 c
Reviewed and approved by:
Date:
/�pe�!^ •
(Rev Ileo)
``•�t`o�.%
���`��
Permit No. SW050424
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN 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
Legal Description: LOT 2 BLK 1 HIDDEN HILLS #2 PID No.: 011-121-27
DECK
I
SINGLE FAMILY
FRAME HOUSE o
A
GE SLAB, INCH M,&�PHILT
PARKING AREA
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NK CXUSHE
PLACE
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MARK A B V. P[P ,
C01
12.5' 19.0' 106 97.8
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31.4' 36.0 99. 95.5
/
I
TC01
31.6' 38.2' 99.
/
I
TCO2 31.0' 42.5' 99.7
/
CO3
31.5' 49.4' 100.3 95.7
C04
31.4' 49.5 100.3 95.7
/
ASBUILT1
I
b,OC
C05
12.8' 42.2' 103.3 5.9
12.9' 42.3' 103.3
/ \
SCALE: 1"=20'
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1
co6
141
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I�';MICHAEL N. ANDERSON:
No.�E
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S OYM' SECNON
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 08, 2005
Expiration Date: Nov 08, 2006
Permit Number: SWO50424 Parcel ID: 011-121-27
Legal Description: HIDDEN HILLS BLK 1 LT 2
Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 006331 LOST CIR
Owner Name: VINCENT STEVENS Lot Size: 23673 SO. FT.
Owner Address: 6331 LOST CIRCLE Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99502-3931
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 specked 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 DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 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.
Received By:
Date: d
Issued By: Date: h 2
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.sk.us
(907)343-7904
411_4eklol
�iv
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. nl �' 121- zr+ Permit Number
Property owner(s) VINC NT STEVENS Day phone 440-7140
.... - •y :� .�:
Mailing address (2)
Zip Code 99502
Legal description (Lot, Block & SuVd.) HIDDEN HILLS S/D• LOT 2 BLCOK 1 -
Legal description (Section, Township & Ran
Lot Size �� . /b' .� Acr slScl.Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit Fees: 4 G + 175 NmSn
Date of Payment: 11--I - X
Receipt Number. –7
Waiver Fees: lis —
Date of Payment:
Receipt Number: 7�,-`(I U
y
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
November 4, 2005
Municipality of Anchorage
Development Service Department
On -Site Water R Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, AK 99519-6650
(907)343-7904
Ref: Proposed Septic System Upgrade for: HIDDEN HILLS S/D; LOT 2, BLOCKI,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. We are proposing to upgrade the
septic system by installing a new 1000 gallon septic tank and a deep trench type drainfield. One test hole was
excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: The average topography around the drainfield is a 5-10 percent slope running
approximately east to west. In short, there are no slope concerns.
5. LOT LINE WAIVER: We request a 1 foot lot line waiver from the south lot line to the proposed
drainfield. We are unaware of any adverse impact with the granting of this waiver.
We are unaw9fe of any adverse impacts this installation would have on adjacent wells or septic systems. If
you have an q iestions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
N&E.�Attached is a sire plan drawing, a design drawing, one soil log, which are aU part of the design
package for this septic system. (Contact C.E.G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: garnessengineering.com
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L------
_ KINCAID ROAD _---_—_-- - --- `-
-------------------
Li.l
HIDDEN HILLS S/D;••�'� HIDDEN HI S/D;
LOT 3, BLOCK 1, , ` \ '+�- LOT 1, 8L1, N I I
�
THI �•, SAREA
I
HIDDEN MILLS 5/D;�
LOT 4, BLOCK�IS
Im \ LO` CIRCLE
// / 1„_\ �E �A
�_ /ego/ • \ SEP IC / EPn
SEPTICRD— JL
/
o f •� LOT 13 / LOT 12,\
=0
`-SEPTICEP C
ARLAD
\ \�
�\=o =s / ooQOppAp4
d
GARNESS ENGINEER INGGROUP, Ltd. pp;?: g 0
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101 c TIDM ■o,n. !Irt 101 • N,b,01VLf. wt NSDI • w1o,L (W7)M111 • F” w-3t,a • .mR1c .... ..,�ONTRACTC .•.. •. •�.............
0
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • • y• •••••• ••••••...
VINCENT STEVENS 440-7140 1 OF 3 Garners:
P 7 53 .`
LEGAL DESCRIPTION: DRAWN BY: 0��� '
HIDDEN HILLS SUBDIVISION; LOT 2, BLOCK 1, C•J•G• 0\\�'�O
TYPE OF WORK: DATE: �04OpppOQ0000
SITE PLAN FOR PROPOSED SEPTIC UPGRADE 10/26/2005
IRw:01O51
OF BEDROOMS:3
PER DAY (GPO): 450♦
NON RATE/S: (1 MIN./INCH
0 APPLK:ATION RATE: 1.2
DRAINFIELD SO.FT.: 375
DRAINFIELD DESIGN:
MAXIMUM DEPTHA2 FEET
WI T: 2-F I'LL
LENGTH:40 FEET
M.O.A. APPROVED SAND FILTER: N/A
EFFECTIVE:5 FEET
REDUCTION FACTOR: N/A
ACTUAL SO.FT.: 400
/
/
NOTE: PRIOR TO
KINCAID ROAD THE CONTRACTOR SHALL THAVEOALL
/ WELL RADII SHOWN AND THE
/ SOUTH/WEST LOT UNE FLAGGED BY
EXISTING SEPTIC SYSTEM io BE A REGISTERED LAND SURVEYOR
COMPLETELY ABANDONED -� PRIOR TO CONSTRUCTION.
LETTER THAT PERTAINS TO THIS DESIGN.
TO OBTAIN A COPY OF THE LETTER
EXISTING
CONTACT GEG. BY PROCEEDING FORWARD
FOUNDATION
WITH THIS INSTALLATION. THE ENGINEER.
CLEANOUT
WELL DRILLER. CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY
HAVE READ THESE SPECIFICATIONS AND
y
AGREE TO ACCEPT THE TERMS AND
CONDITION S INEO.
NEW
\ DRAINFIELD
(
I
/
1 \
SEPTICAR
\
I 1
1 1
m
iSED�C��
LLLON
TANK
DOUBLE I
lEANOUTS�
I
1
GARNESS ENGINEERING GROUP, Ltd. *6A le
CONSULTANTS i GENERAL CONTRACTORS . • .
1 C TILOR PAPA , 101 . MCNOKW- M N501 /.IC.[ (80I)X17-4IT • M (901)�M" �QLIL w.,�w YyN.I
:SPARED FOR: PHONE NUMBER: PACE NUMBER:
VINCENT STEVENS 440-7140 2 OF 3 A
al. DESCRIPTION:
HIDDEN HILLS S/D: LOT 2. BLOCK 1
OF WORK:
SITE PLAN FOR NEW SEPTIC SYSTEM
(Rev. 01105)
B.F.M.
1
1
I
II
AR fG
o ... 4
eyQA.. ....s.....
CX1! 7 53
—
P as• �o i
' •t: Il.
leg
iSED�C��
LLLON
TANK
DOUBLE I
lEANOUTS�
I
1
GARNESS ENGINEERING GROUP, Ltd. *6A le
CONSULTANTS i GENERAL CONTRACTORS . • .
1 C TILOR PAPA , 101 . MCNOKW- M N501 /.IC.[ (80I)X17-4IT • M (901)�M" �QLIL w.,�w YyN.I
:SPARED FOR: PHONE NUMBER: PACE NUMBER:
VINCENT STEVENS 440-7140 2 OF 3 A
al. DESCRIPTION:
HIDDEN HILLS S/D: LOT 2. BLOCK 1
OF WORK:
SITE PLAN FOR NEW SEPTIC SYSTEM
(Rev. 01105)
B.F.M.
1
1
I
II
AR fG
o ... 4
eyQA.. ....s.....
CX1! 7 53
—
P as• �o i
1110,1111
a�OF°0�p
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS b GENERAL CONTRACTORS 6 0^
01 I . VAt 101 •A"MVWl./ •FOG b 7-ln• N- (m"..OYIL p,n. M,awn •••••••• •• ••• •••
SOIL LOG — PERCOLATION TEST �. ..,......
LEGAL DESCRIPTION: HIDDEN HILLS S D: LOT 2, BLOCK 1, a 'J E �893••
9 3 e
PERFORMED FOR: VINCENT STEVENS DATE: 10/28/2005
.�I iil�• oAo
DEPTH •dPro fessioo\
(feet)=.s: TEST HOLE # 1
1 aaam ORG
== SOIL CLASSIFICATIONS
2 —_-- r GW---r ORG ----- Im�uao Irorn ------
r
3v GP ML -aux=•
GM CL
4 GC OL
°. •°° a SW MH
5 •• SP CH
SMi i OH THS
6 SM SC �.
7 DEPTH TO
8
DRY 11/3/2005
----
N
9—
SCALE:
10
I" - too'
11
12
13
SM/GM
14
15
16
17-1B.O.I1.
18
19
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 5.0 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: [3 YES N NO
SOILS LOGGED BY: BENNY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS
COMMENTS:
PERFORMED BY GEG. Ltd. I. JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: II 05'
GROUNDWATER
DATE
DRY
0/28/200
WATER LEVEL
READING
NET DROP
(INCHES)
10/28/2005
1
12:00
—
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
10/28/2005
1
12:00
—
6•
—
2
12:05
5
0•
6•
3
12:05
—
6•
—
4
12:10
5
0•
6•
5
12:10
—
6•
—
6
12:15
5
0•
6�
MUNICIPALITY OF ANCHORAGE
/' A DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
_ ENVIRONMENTAL ENGINEERING DIVISION
_ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME JJ
Q.%>4i'YtC.� Fes.-FL-".��Z�I�:J�
PHONE
,l
NEW
❑UPGRADE
MAILING ADDRESS �^
LEGAL DESCRIPTIO
LOCATION
NO. OF BEDROOMS
Well
Absorption arc
Dwelling
PERMIT NO.
a ZZ
V)
Manufacturer
Liq. capacity if gallons Inside length
- IF HOMEMADE:
Materia}
Width
No. of compartments
Liquid depth
4
JOE
DISTANCE TO:
Well
Dwelling
PERMIT NO.
_ 7 b
Manufacturer
Material
_
Liquid capacity in gallons
O
w=
DISTANCE TO
Well
Foundation
Nearest lot line
PERMIT N
'J
J LL Z
b ? w
No. of lines/
Length of each line
..'�% %(,
Total length of lines
�-� -
Trench width
inches
Distance between lines
FTop
of tile to finish grade
_ __
Material beneath the
Total effective absorption area
Lu
C7
Length
4 11r,
Width
Depth
PERMIT NO.
Q I-
wLU a
Type of crib
Crib diameter
Crib depth
Total effective absorption area
N
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
Lu
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
h�
PIPE MATERIALS
SOI L TEST RATI NG
uo
r�
m
,1
V
INSTALy_ER
Jt dry, L - L 6
REMARKS-
�1��'r�tx.�
k i ,, J� 1 A_,
-
4
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4 `
ZAPPr'�O'!t'ED r/� /�J�`/D��A"fE LEGAL
owl UN 1 U0 X 1
DEPHRTMENT Of
825 /L'
U . -A E. __1L H,.,.: -0
PERMIT NO. ( 780624 >
�
~�l["W" UK fit PA k? 1-0 f�Q 1.=
dEHLTH HND ENVIRONMENTHL PCTION
STREET/ RNCHORHGE, HK. 99501 ~
264 -4720 /'�/}�/)\
C-11 5"A' 1, 1 F;�!! ��0' F; P1�~w�'''�_/��(
HPPLICANT JHMES LEWIS 450] SP2NHRD RD #29
LOCRTION 6]]1 LOST CIRCLE
LEl, GHL L2 B1 HIDDEN HlLLS S/D LOT SIZE
TYPE OF TRENCH
MHXIMUM NUMBER OF BEDROOMSOIL RHTING (SQ FT/B�)� 85
THE REQUIRED SIZE OF THE SOIL �BSORPT�ON SYSTEM IS�
����, t- Ii = ���11"A����
THE LENGTH DIMENSION IS THEE LEENGTH uN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND RND TME BOTTOM OF THE EXCHVRTION (IN FEET).
THERE IS �O SET WI0TH FOR TRENCH�S
THE GRAVEL DEPTH IS THE MINIMUM DEPTH UF FF- HLL PlPE
HND THE BOTTOM OF THE HVHTION (IN FEET).
�IGA L -V :AE 11`1;1�'! ���::: ..�Er -11 - top 1A l< JE VE: -.-IL ���L-, f�A��
PERMIT HPPLICHHT
HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTALLATION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMGER
IDI" RESIDENCES THHT THE Wf_LL WILL SERVE.
�fAl HE:f < 21 A 1: PsHATMERAD-f- J: 0=1 lot Q Two ERE 11H 09 :1 V"` : V:
BHCKFILLING OF HNY SYSTEM WITHOUT FINAL. INSPECTION ANI) RPPROVHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PRUSECUTION
MINIMUM DISTHNCE BETWEEN H WELL AND ANY ON~SITE SEWRGE DlSPOSRL SYSTEM IS
i00 FEET FOR H PRIVHTE WELL.; OR
150 TO 200 FEET FROM R PU8LIC WELL DEPENDING UPON THE TYPE OF PUBLIC W2LL
WELL LOGS �RE REQUI[IE:D MUST 8F: RETURNED TO THE DEPORTMENT WITHIN ]0 DHYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MHY RPPLYSPECI�ICHTIONS HND CONSTRUCTION DIHGRHMS HRE
HVHILHBLE TO INSURE PROPER INSTHLLHTION.
F-111 r", H 1'. , 'T -, U, E I �. . ... _1L. ����
I CERTIFY THRT
1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS RS SET
FORTH BY THE MUNICIPHLITY OF ANCHORHGE.
2� I WILL INSTRLL THE SYSTEM IN HCCORDRNCE WITH THE COD�S
I� I UNDERSTHND THHT THE UN�SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS
SIGNED
PPLICHNT JHMES LEWIS
YSOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION
Aj
TEST
Pouch 6-650, Anchorage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST -J
PERFORMED FOR: /-/ /\s - ;JAM -Fs ( y S DATE PERFORMED: -7� A�/" /r -
LEGAL DESCRIPTION: 40- BGOV'< I HO�{„J�IV/Y
SLOPE SITE PLAN
DE TH p��
T) r
(F
2
3
4
5
6
I.
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED
Y 0
(,rg��� WAS GROUND WATER �/�'r.%/� S
���� ENCOUNTERED? _6.�_— LOI
P'
Ei
0
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE( 5/ �/�/�jfB,L__ (minutes/inch)
TEST RUN BETWEEN FT AND ✓ FT
h
CERTIFIED BY:
DATE:
I
N pGE Q4 -
• Municipality o Ancho gc p n15s a
On -Site Water and Wastewater Prog ti Y
(907) 343-7904 <y a, S A F e, V
4 r
01 6 5t
Certificate of On -Site ,Systems Approva f
Parcel I.D. 011-121-27 Expiration Date: �J f - 4
1. GENERAL INFORMATION
-Complete legal description Hidden Hills, Block 1, Lot
Location (site address) 6331, Lost Cir.
Current Property owner(s) Wendy 8c John Hansen Day phone
Mailing address, 6331 Lost Cir. Anchorage, AK 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS.
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual
Q
Individual Water Storage
❑
Holding Tank
❑
Community Class. Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for:
Distance:
Received by:�, Date: 1 (a IS
COSA to be released to the engineer, unless otherwise requested by the engineer.. -
COSA Fee $ Waiver Fee $
Date of Payment i ' ((s Date of,Payment
Receipt Number a� l°i�G Receipt Number
COSA#— 05CII J 95 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified- by my seal affixe _ s of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Siteroval- 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 regulationsin effect at
the Ume of installation. - - In conducting an adequacy test, I attempt to provide a thorough, conscientiousengineering analysis of the system in accordance with MoA COSA
guidelines and regulations:: The reported results describe. the performance of the system under the conditions encounteredatthe time of the test,
and separation distancesmeasuredto readily identifiable features. Theoperationallife of all wells and septic systems depend on the local soil
.condition,. ground water levels that. may fluctuate, during the year, and the water usage of the family being served by the system These conditions
are outside the control of the evaluator of this system. All systems_eventually fail and satisfactory, test results do not guarantee future -_
.performance of the -system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
- for future performance,. nor can we estimate remaining- life of the system. The content ofthisreport is for the sole benefit. of the owner listed
above. - - -
Name of Firm Pannone Engineering Services LLC' Phone (907) 272-8218
Address P.O: Box 100217, Anchorage Ak. 99510
Engineer's Printed Name .Steven R Pannone Date 11/30/2015
6. DSD GNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: fMA �` J! 2 Original Certificate Date: (0 —� -
The Municipality of Anchorage Development Services Division '(DSD)'issues Certificates of On -Site Systems Approval (COSA) based only'
upon the representations given in paragraph 5 by an independent professional civil engineer registered in.the State of Alaska._ The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheW E '- :, o - -
I
If more tharAptic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checkiist
Legal Description: Hidden HIIIS, Block 1, Lot 2 Parcel ID: 011-121-27
A. WELL DATA
Well .type Private If A; B, or C provide PWSID # Well Log (Y/N) N
Date completed Unknown Sanitary seal (YIN) Y Wires properly protected (YIN)
Total depth 129+ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test Unknown 11/30/2015
Static water level Unknown ft 128 ft.
Well production Unknown g.p.m. 4.4+ 9 -
p.m -WATER SAMPLE RESULTS:
Coliform ` 'colonies/100 mL Nitrate 2t4�1mg/L
Arsenic � ug/L Date of sample: 11/30/2015 Collected by: PES
B,. SEPTICIHOLDING TANK DATA
Tank Type/Matertal'Septic/Steel Date installed 11/15/2005
Tank size 1,000 gal. Number of Compartments 2— Cleanouts (Y/N)I Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 3/3/2015 Pumper isaacs Pumping
C. ABSORPTION FIELD DATA
Date installed 11/15!2005 Soil rating (g.p.d./ft2 orftz/bdrm) 1.2 GPD/SF System type Deep Trench
Length 34 ft. Width 2 ft. Gravel below pipe 66 ft.
Total depth 9 ft. Eff. absorption area 408 fe Monitoring tube Y' Depression over field `N
Date of adequacy test 11/3072015 Results (Pass/Fail)' PASS For 3 bedrooms
Fluid'depth in absorption field before test 0 in. Water added 477. gal. New depth 36 in.
Elapsed Time: 310 min. Final fluid depth 0 in. Absorption rate >= 450'1' g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pumji off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOTTO:
Septic tank/lift station on Io.t 100+ On adjacent lots 1 Q0+
Absorption field oniot 100+' On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 1 OD+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 50'1Manure/animal excrete storage areas :100+
SEPTIC/HOLDING TANK ON LOTTO:
Building foundation 5+ Property line 5+ Absorption field 5+
Watermain 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO: 1
Property line 10+ Building foundation I O F 17t7atertxln+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
Survey on File .
G. ENGINEER'S CERTIFICATION
I certify that i have determined through field inspections and
review of Municipal records that the above system's are In Ar'
conformance with MOA COSA guidelines in effect on this date.
Pannone
Engineers Printed Name Steven R. :even
Date
11 /3072015 cEg.
COSA canary sheet 2-6-15.doc
au%
K.,6?'
r^
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cf.anchorage.ak.us
. (907) 343-7904
M
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
a`;,',)
fyq
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 011— I2I t;2q HAA# 01:10D I r±r
1. GENERAL INFORMATION Expiration Date: a laal m p
Complete legal description HIDDEN HILL SUBDIVISION; LOT 2. BLOCK 1.
Location (site address or directions) 6331 LOST CIRCLE • ANCHORAGE. AK 99502
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
VINCENT STEVENS Day phone 248-8388
6331 LOST CIRCLE * ANCHORAGE. AK 99502
Day phone
MIKE LOVE w/ DYNAMIC PROPERTIES Day phone
3111 "C" STREET • ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
297-2908
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 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) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. 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 samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) 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 verily that my
investigation, based on procedures outlined in the Health Authority 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.
Address 3701
E. TUDOR
ROAD, SUrrE
101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG. Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 6 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
Attachments:
HAA Checklist_
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date It zt v
Maintenance Agreements
Supplemental Engineer's Report
Other
By:Original Certificate Date:�c—
(Rw. 17A1)
Municipality of Anchorage
Development Services Department
BUNN Safety Division
OnSke Water & Wastewater Program
4700 South emaw SL
P.O. Box 198550 Anchorage, AK 99519.8850
www.d.anchorsge.ak.ua
(907)9437904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: HIDDEN HILLS SUBDIVISION: LOT 2. BLOCK 1 Parcel ID: Ql l ^ 181 - d-)
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 1978 Sanitary seal (Y/N) YES
Total depth 129+ ft. Cased to 40+ ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenio: N/A mgA.
S. SEPTICIHOLDING TANK DATA
Nitrate 1.32 mg,/L.
Well Log (YM) NO
Wires property protected (YIN) YES
Casing height (above ground) 12+ in,
AT INSPECTION
10/24/2005
128 ft.
5.45 g.p.m.
Other bacteria 0 colonies/100 ml.
Date of sample: 10/12/2005 Collected by: GEG. LtD.
Tank Type/Material STEEL Date Installed 11/15/2005
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA
Date Installed 11/15/2005 Sok rating .p.d. r ft'/bdrn) 1_2 System type TRENCH
Length 34 ft. Width 2.0 ft. Gravel below pipe 6 ft.
Total depth '13.4 ft. Eff. absorption area 408 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) — For 3 bedrooms
Fluid depth In absorption field before test = in. Water added =gal. New depth =k1.
Elapsed Time: = min. Final fluid depth = k1. Absorption rate >= 450+
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alar level at
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot 100'+
Absorption Held on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent kits 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line *t0'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
10'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parldnglvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
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 HAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1 I Z r /D;-
HAA Fee $ 3V a
Date of Payment j 1 /9-/ OS
Receipt Number / 3
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
r A. rness:
9153
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II -01-05 05:49PM FROWCUE ESI, SGS ENV SERVICES
-W$-
SGS ReLq
1056790001
Client Name
Garness Engineering Group, Ltd.
Project Name/N
Lt 2 B1k I Hidden Ilills
Client Sample ID
Lt 2 Blk 1 hidden Hills
Matris
Drinking Water
Sample Remarks:
9075615301 T-168 P.02/07 F-684
All DatesMmes are Alaska Standard Time
Printed Datc/rlme
10/312005 16:02
Collected Date/rime
10/122005 8.33
Received Date/Time
10/122005 10:05
Technical Director
Stephen C. Ede
Metals Department
Hardness as C&CO3 .
Private Individual Analvais
Aluminum
Antimony
Arsenic
Barium
Cadmium
Col6um
Chromium
Copper
Iron
Lead
Magnesium
Manganese
Phosphorus
Chloride
Fluoride
Potassium
Selenium
Sodium
Silicon
Silver
Thallium
Sulfate
293 5.00 mg/l. SN12023400 D 10/19/05 1021/05 WAW
20.0U
20.0
Allowable • Prep Analysis
Parameter
iWults PQL Units Method
Container ID Limits !Yate Dow lair
Nitrate -N
1.32 0.100 mg/L EPA 353.2
B 10/12/05 AZS
Niuitc-N
0.100 U 0.100 mg/L EPA 353.2
B 10/12/05 AZS
Metals Department
Hardness as C&CO3 .
Private Individual Analvais
Aluminum
Antimony
Arsenic
Barium
Cadmium
Col6um
Chromium
Copper
Iron
Lead
Magnesium
Manganese
Phosphorus
Chloride
Fluoride
Potassium
Selenium
Sodium
Silicon
Silver
Thallium
Sulfate
293 5.00 mg/l. SN12023400 D 10/19/05 1021/05 WAW
20.0U
20.0
ug/L
EP200.8
D
10119/05 1021/05 WAW
1.00U
1.00
ug/L
E17200.8
D
(«6)
10/19/05 1021/05 WAW
5.00U
5.00
ug/L
EP200.8
D
(<-50)
10119/05 1021/05 WAW
34.1
3.00
ug/L
EP200.8
D
(<-2000)
10/19/05 1021/05 WAW
0.500U
0.500
ug/L
EP200.8
D
(<+=5)
10/19/05 1021/05 WAW
86600
500
ug/L
EP200.8
D
10/19/05 1021105 WAW
1.00 U
1.00
ug/L
EP200.8
D
(«100)
10/19/05 1021105 TK
101
1.00
ug/L
EP200.8
D
(x1300)
10/19/05 1021/05 WAW
334
• 250
ug/L
EP200.8
D
(<-300)
10/19/05 1021/05 WAW
0.604
0.200
ug/L
EP200.8
D
(<-15)
10/19/05 1021/05 WAW
18700
50.0
ug/L
EP200.8
D
10/19/05 1021/05 WAW
2.16
1.00
ug/L
EP200.8
D
(<.50)
10119/05 1021/05 WAW
200 U
200
ug/L
EP200.8
D
10119/05 1021/05 WAW
17.2
0.100
mg/L
EPA 300.0
B
(<-250)
10/13/05 DSH
0.127
0.100
mg/L
EPA 300.0
B
(<-2)
10/13/05 DSII
IUO
500
ug/L
EP200.8
D
10/19/05 1021/05 WAW
5.00U
5.00
ug/L
EP200.8
D
(<-50)
10/19/05 1021/05 WAW
5760
500
ug/L
EP200.8
D
(<-250000)
10/19/05 1021105 WAW
8250
200
ug/L
EP200.8
D
10/19/05 1021/05 WAW
1.00 U
1.00
ug/L
EP200.8
D
(<-100)
10/19/05 1021/05 WAW
1.00 U
1.00
ug/L
EP200.8
D
(<-2)
10/19/05 1021/05 WAW
15.2
0.100
mg/L
EPA 300.0
B
(<-250)
10/13/05 DSII
11-01-05 05:49PM FROM-CT&E ESI, SGS ENV SERVICES
SGS
SCS Rcf1
1056790001
Client Name
Garness Engineering Group. Ltd.
Project Namdq
Lt 2 Fllk I Hidden hills
Client Sample ID
Lt 2 Olk 1 Hidden Hills
Matrix
Drinking Water
9075615301 T-168 P.03/07 F-684
All Dates/flmes are Alaska Standard Time
Printed Date/time
10/312005 16:02
Collected Datdrime
10/122005 8:33
Received DaleMme
10/122005 10:05
Technical Director
Stephen C. Ede
Allowable Prep Analysis
PAr Cier Results POL Unite Method Container ID Limits Date Date Init
Private Individual
Analysis
Zinc
65.1
5.00
ug/L
EP200.8
D
(<-5000)
10/19/05 1021/05
WAW
Total Dissolved Solids
359
10.0
mgtL
S%120254DC
C
(«500)
10/18/05
ISC
Nickel
4.22
2.00
ug/L
EP2DO.8
D
(< 100)
10/19/05 1021/05
WAW
I IC03 Alkalinity
290
10.0
mg/L
SM202320B
C
1025/05
CRII
CO3 Alkalinity
10.0 U
10.0
mg/L
SM2023200
C
1025/05
CRH
011Alkalinity
10.0U
10.0
mg/L
SM202320B
C
1025/05
CRIT
Conductivity
600
LDO
umhos/cm
SM202510B
C
10/14/05
ISC
pit
727
0.100
piIunits
EPA 150.1
C
• (6.5-8.5)
10/12/05
ISC
Alkalinity
290
10.0
mg/L
SM202320D
C
10125/05
CRIT
Total Coliform
0
coVlOOmL
SN1209222D
A
(meq
10/12/05
TLF
11-01-05 05:50PM FROM-CTLE ESI, SGS ENV SERVICES 9075615301
SGS/CT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report -for Total Colifomi Bacteria
REA13 INSTRUCTKINS ON REVERSE SIDE BEFORE COLLEC71HO SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
PUBLIC WATER SYSTEM IDs _
PRIVATE WATER SYSTEM
q Sand Results Sand anvka
W r.r.mw,.a:..e.e n... I
F
cn..un...
�"
8324
_�1-.
CRY
...
d
SAMPLE COLLECTION:
T-168 P.04/07 F-684
cw n, ry r r cap vrvv c
ANCHORAGE,ALASKAU51B
Tel:907-562.2343.; •;.
Fax 007-561-5301
L4 Rat No
r1056790_..
q Said Reaves' asarslkhooe
SAMPLE TYPE:
1Routine q Treated Water
Repeat SampleUntreated Water
(rotor to lab no. 1
❑ Special Purpose
Transported
to Lab Or. 9same as collector Other.
TO BE COMPLETED BY LABORATORY
Sample Recelvina: .
Date: RUSH SAMPLE
Time: ! vo S Raw n, may a un erwala
Temp: Co~p : ❑ se Waher Phone A
Far emote Locations
Delivery Method: Fax It.
Received By. -) /1 i
Cornnwa:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; ....... a..............
Bactarloloolcal Water Analysis Record:
users
CRY
...
�..
SAMPLE TYPE:
1Routine q Treated Water
Repeat SampleUntreated Water
(rotor to lab no. 1
❑ Special Purpose
Transported
to Lab Or. 9same as collector Other.
TO BE COMPLETED BY LABORATORY
Sample Recelvina: .
Date: RUSH SAMPLE
Time: ! vo S Raw n, may a un erwala
Temp: Co~p : ❑ se Waher Phone A
Far emote Locations
Delivery Method: Fax It.
Received By. -) /1 i
Cornnwa:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; ....... a..............
Bactarloloolcal Water Analysis Record:
Sam wD ADM. '
...
MMOdaUG (PIA) RESULTS:
ANC . FBK JUN
MMyala Beean:./J �/2 /c, .ir^ /y.�
Total confarrrr
DeteRkne:
AnayaC .
E Con:
Sart b Client:
Anayecal Method:
MEMBRANE MTER RESULTS:
Phoned Q Faxed []
Direct Count C0laliesl1WmL
Date/nme:
"MembraneFlter
VeMcadm
SDnkswith
,f
MMO-MUG(P/A)
i,.o.e.;—ELTE:
OG13
Satisfactory
E
❑
Unsafisf ictory
iN/C.Yw arw.wwtr
Reported By: r %
Oatemme: /d I&I"
Form B FW- 0053 12/17103
1WseslnasolVWK_GrovpDatalPub6dD000MENT1FORMSlepprmMCcA Form 121703ids