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HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 7HI*dden HI'*IIs Block I Lot 7 #011�121�32 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221242 PID Number: 011-121-32 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Rachel Stephl PTION FIELD Existing r571D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 6320 Lost Cir. Other Phone Number of Bedrooms Soil Rating Total depth from original grade j D/SF Ft, LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft, Subdivision Block Lot Hidden Hills 1 7 Fill added above original grade Gr el length Ft. Ft: Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic I Absorption Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Lift Station Tank Line Ft' Well f 176' i 88' TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. f Surface Water100+ E 100+ Material Plastic Number of compartments 2 Lot Line I 5+ 10+ NA Foundation 10+* I 10+ } TATION Manufacturer Capacity Gal. Remarks *Field verified 5'+ separation from deck foundation post. Alarm location Electra tilled by PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer _ JR's Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection 1�Location dates: 8/8/22 2nd 8/8/22 and description 3,d 8/9/22 4'^ SE roof corner. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp Conditional Approval: Date ' �► 9 49IH KENNETH M. 0UF S Lc.' 4*yrs fir Septic System Approve � � Date -22-2 CE 71110 ®g ZIP s Note: this approval does not include well permit requirements. 4rAJ4 (Rev 05/02/18) AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP221242 HIDDEN HILLS BLOCK 1 LOT 7 PID# 011-121-32 mil "r:kk: I A -C=14,6' B -C=34.6' A-11=18,9' y B -D=36.9' o A -E=19.9' B-E=38.3 w A -F=19.9' A B -F=39.1' o N N as sB• sa• t E 9.00 -YELL BLOCK RET. 4 + HALL .... -' �.'�'•Y •. \ n STAIRSMACE W000 r _ BLO FENCE -' WALKWAY cu , O _ ek Ioao GAL TANK / F "SEPTIC PIPES o MO -T ---------- o uTY _ _T..ENT R=ioo• SCALD NTS OF AL Y ' fior TH 0. KENNETH M 5 CE -7 W� FESSIQ�Nti IN 000 GAL SEPTIC PREPARED FOR: RACHEL STEPHL 6320 LOST CIR, ANCHORAGE, AK FIELD BOOKS BOUNDARY: NL /A STMNG: N/A ASBUILT: — DWG. FILE: ACAD ME. FILE COMPUTE: DRAWN: KSD CHECKW: KMD. DAM 9/19 GMD: SW22,' " No' 22139 SCAt€ir-4'._= 30' SCALE: NTS BLOCK REL WOOD ILINCE- CIE r�. 0 10' UTILITY EASEMENT r`t%..� .. .• .� ��:'�.ti iii' THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES ANDIOR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON. UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPP,OXIMATE DUE TO EXCESSIVE SNOW ANDIOR ICE. ON GRACE i ooP��..�F.A<�sp� c - 49 TH fOV �N SHANE A. HOLT..' OQ4 P P LS -6914 SJR 44���°fessionak As-BUILTSURVEY f"=201 NO CORNERS SET THIS DATE i HERESY CERTIFY T HAT I HAVE PERFORMED A SURVEY OFTHEFOLLOWING DESCRIBED PROPERTY LOT 78LOCKI HIDDENHILLSSU'B.. (PLAT70-338) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT T NE VISIBLE IMPROVE)VENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATAiNCHORAGE,ALASKATHIS 25TH DAYOF AUGUST .2022 75598 ,6-71 Hol TLAND surzuEriNv 9304 GROVE.R CRIT f ANCHORAGC.4K 945127 23-8Gi5 37,566'6'f VET MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221242 Work Type: SepticTank Upgrade Tax Code Number: 01112132000 Site Legal Address: HIDDEN HILLS BLK 1 LT 7 G:2222 Site Mailing Address: 6320 LOST CIR, Anchorage Owner: STEPHL RACHEL L & Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: cnt I l) p<irtIII ell t 7/12/2022 7/12/2023 12035 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B) Issued By: Date: -7// 2Z� Date: %/I 2/z Z 3 ' 'D Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Section pent S vJ I. r1 fir, I)ep;n•tment * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221045 COSA#: Permit#:OSP221242 PID#: 011-121-32 Legal Description: HIDDEN HILLS BILK 1 LT 7 Engineer: ArcTerra Your request for a waiver of the required 100 feet horizontal separation from the absorption field and septic tank to the private well has been approved. The approved separation distance is 88 feet to the field andWfed to the tank. In addition, the field on this lot is approved to be 98 feet to the well on Block 1 Lot 13. This waiver approval applies to the existing absorption field and septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval fiom this department. Waiver is Granted: X Waiver is not Granted: Date: 711 Z/22 Approved by:k"�ey'^'d Name of Reviewer .............................. ■ .............................%................ 1 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department, Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-121-32 Property owner(s) Rachel Stephl Day phone Mailing address 6320 Lost Cir. Anchorage, AK Site address 6320 Lost Cir. Anchorage, AK Legal description (Sub'd., Block & Lot) Hidden Hills Block 1 Lot 7 Legal description (Township, Range & Section) Lot Size 12,035 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (vv/wo AD U) Septic Tank ❑X Upgrade ❑X (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Well to Tank & Well to Feild Distance: 75' & 88' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: a Date of Payment: 7�6�ZZ Receipt Number: 0-r_7ZQ46: Permit No. 0 S 10�2 _�) I -)'-I a Waiver Fees: -P / /F50 Date of Payment: Receipt Number: Waiver No. OSV 22Z 1045 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221242, Deb Wockenfuss, 07/12/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221242, Deb Wockenfuss, 07/12/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221242, Deb Wockenfuss, 07/12/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221242, Deb Wockenfuss, 07/12/22 Tom Fink, Mayor / tunicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519~6650 343-4744 September 12, 1991 Ted Moore, P. E. Flattop Technical Services 14350 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 8 Block 1 Hidden Hills S/D Waiver Request ~WR910039, PID ~011-121-33, HA910369 Dear Mr. Moore: Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 95 feetj from the well located on Lot 8 Block 1 to the leachfiled on Lot 7 Block 1, and 0 feet to the lot line on the north property line abutting Lost Circle. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: ~ ~ /~hn Smi t h,//P .~ErV.~-~ ~'¢ ~rogram Manage On-site Services ljm:~6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 1. Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ME -Scott and Catherine 1-jiston PHUNE 1:1 NEW ZI 86 U �GRADE MAILING ADDRESS '6'�20 Lost Circle Anchorage, Alaska 99502 LEGAL DESCRIPTION Lot "')even (7), Block One (1), Hlidden flills �3'ubd. LOCATION. , U'ri, 1/4 S -;',1C. 91 T.12k:.9 R-41-1.1 NO. OF BEDROOMS Well DISTANCE TO: 88 ft. Absorfa�,� airt Dwelling LJ �e -- 22 ft. PERMIT NO. -4�� -2 &2 9 1- 2 Manufacturer � < Unknown Material uJ Steel (0 1 No. of c—ompartme nts 2 Lic. cap �Miy,ftn Inside Lem ga IF HOMEMADE: Width Liquid depth V -117- -1 UZ [Te Evil— Dwelling DISTANCE TO: - - -- - - - - - - - - - - - - -- - - PERMIT NO. - - - - --- - - - - auufactur� - - -- - - - - - - - - --- - - - - - - - Material Liquid capacity in gallons— ,�u Well DISTANCE TO: 100+ ft. Foundation 19 f T Near;st —lotrine 10-F ft —.PERMIT NO. -- W -U :� LL 2 2W f 1,7 7No.of lin ('1 717Length o 6aclv�e Total length o Trenc �j�th one qf6ac t 1� —inches 84-0804 Distance bet en lines r) cc IIII Top of tile to finish grac Fe -Material —beneath tike— --- n , It 5 f . 2411 rotal eff t Lve ab tion area 5 T11 Length Width inches Depth - - - - - - - - - - - - - - - - - - - PERMI 0 < I- Lu Ty Type of critL. . . . Crib diameter b ora�t�r .L _ _ - - - - - - - - - - - - - Crib depth - ? - - - - - - - Total effective zibsor—ptiona—rei-- Lu DISTANCE TO: Well - - - - - - - - Building foundation Nearest lot line Cle ss Depth c"" Private Depth Driller ) _ a iV, t Distance to lot I in�t PERMIT No. W Building f clatio Sewer line DISTANCE TO: yi� + n/a Septic tank Abso—rption area(s) x 88 ft.*' 100+ f t. OTHER -FI-Pr �MATERIALS Upgrade with 3034 SOILTESTFIATING 85 S'F/Pfflilffi (Visual) (9/21/84) INS�TALLER REMARKS Jx �,Ilide Trench -,,' cavated 9/21/84-, Q ily I of % 1i'inal Inspection 9/22 84 'eptic tank separation waiver — ------- ------- f---T-e on -i- w-1 --H-m t " uc-C J14;x1sting appears 0 be St aly sound. Water tight couplin 1 n to Lot 6 has disconnected -been 4-; PL �I­I A I - OVED ���ll,�dl A:: :IC IF::" 11 :,'1[ "ll v` C3 P:41 U-11 C11 V.,R!������ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 DATE�� IE�E�L)E�D: {�I9/2()/[)4 APF`L.ICANT: SCOTT |. IE;l^ON C/[} lIUVY BARTER ADDRESS: 6`320 L(]ST CIRCLE ANCHORAGE, AK 99502 CONTACT PHONE: 243~3486 ~ [. LE�AL DESCRIP: SUBDIVISION: HIDDEN HILLS LOT: 7 BLOCK: J. SECTION: 9 TOWNSHIP: 12N RANGE: 4W LOT SIZE: 12035 (SQ"FT" OR ACRES) LOT LOCATION: 6320 LOST CIRCLE : MAXt�«~/ Listed below are the options available to system" Choose the option that best fits ' -1~10TIEENNICTIA DEPTH TO PIPE BOTTOM (FT.} 4.0 GRAVEL DEPTH (FT") 2"0 TOTAL DEPTH (FT.) 6,0 GRAVEL WIDTH (FT") 2.5 GRAVEL LENGTH (FT.) 64.0 GRAVEL VOLUME (COU YDS 14"9 TANK SIZE (GALS) 1/000^0 ** SOIL RATING (SQ"FT"/BR) 85 You in decigning your, site^ IDJ 1.D1 g-::;;:! 1 A 11 2.0 5.0 5^0 36.0 16"7 85 your septic ** DEPTH TO PIPE BOTTOM < 3"5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4"0 FT" MAY REQUIRE A LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS _~... ..... ..... ��~..��~����.�.._.~~�~~�-..___���_ certi[y that: 1" I am {amiliar with the requirements for on-site sewers and wells as set 1,or1...1-1 by the Municipality of Anchorage (MOA) and the State o{ Alaska. 2" I will install the system in accordance with all MOA codes and regulations, and in compliance with the 6esign criteria of this permit. 3" I will adhere to,all MOA and State oAf Alaska requireYnts for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4" I understand that this permit is valid for a maximum of 3 bedrooms and any will require an additional pormit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICI8N. SIGNED DATE: APPLICANT: SCOTT LISTONC/O TONY BARTER COD2S, AS-BUILTS (3) THE ISSUED BY DATE: �`` ..... .�����^^���^�� ` DEPT. OF ENVIROINMENTAL CONSER"TION SOUTHCENTRAL REGIONAL OFFICE 437 "Ell STREET, SUITE 200 ANCHORAGE, ALASKA 99501 September 19, 1984 Tony Barter, P.E. 5331 Tudor Road Anchorage, Alaska 99503 �C,� o 6, C (I BILL SHEFFIELD, GOVERNOR 274-2533 SUBJECT: Waiver Horizontal Separation Between a Private Well and Septic Tank, 10 Block 1 idden_Ui JJ_1 s _S.Z D—An c h o r a ge 8521 -WA -36 Dear Mr. Barter: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the private well and septic tank to 88 feet on -the subject property for a 3 bedroom single family residence only. Sincerely, Irr 4uc eet'E. Erickson District Engineer BEE/dd w P() KSOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: -­_S�-# -ob,4 Al DATEPERFORMED: LEGAL DESCRIPTION: AX7- QIOCK 1Y 6f±C1C'fe0v ?w lt�s -�tu vcf SLOPE . _ RE 6,_9CLA /cz �S/ il �5 o rn e %Sqv 1) 2 - ".6 Q. 0)v/qf-ad&d 3-'o Al)4I V 4 - 6� 5 -6 7 - .4.*040'J.. Al ls� % 8 9 Oft 1 0 04060 .0 W'�r,"A To D. Barter 10 - CE 5130 —ale �XAS GROUND WATER L 11 ENCOUNTERED? Zk P 12 IF YES, ATWHAT XIA_ E DEPTH? 13- 14 - 15- 16 - 17 - 18- 19- 20 - COMMENTS PERFORMED BY: 72-008 (6/79) SITE PLAN Reading Date Gross Time Net Time Depth to Watet Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND W e dLtL1k1 4:�-- �/_/. 54 , J)C'JZAAed L R �'M CERTIFIED 13Y (minutes/inch) — FT --DATE: i GAA9 HD I GF 'ER ANCHORAGE AREA BOROI I DL ATMENT OF ENVIRONMENTAL QUALI. TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING q.) NAME ADDRESS— P H 0 N Ed:�21- LOCATION &.C) (—,I Rc' (F JEGAL DESCRIPTICNAIt-�--)-4 SEPTIC TANK: NUMBER OF DISTANCE FROM WELL 7 --COMPARTMENTS— LIQUID LIQUID CAPACITY-ZO ----GALLONS. INSIDE LENGTH ---INSIDE WIDTH- —DEPTH -SEEPAGE SYSTEM: SEEPAGE PIT: '(,,'A x NUMBER OF PITS-- —(----OUTSIDE DIAMETER OR WIDTH-----, LENGTH--, DEPTH--, LINING MATERIALC--V-y'�vV rTj—­-­ DISTANCE FROM WELL-t-0�-:)- BUILDING FOUNDATION—, NEAREST LOT LINE -10 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)- FT. TILE DRAIN FIELD TOTAL LENGTH DISTANCE FROM WELL--­�� FOUNDATION—, NEAREST LOT LINE-- OF LINES—_ W� N Lllr4FS--TRENCVIw.lbTH— IN. TOTAL EFFECTIVE NUMBFIR OF -----DISTANCE BET FNGT A"6TION AREA ---SQ. FT. LENGT OF EACH LINE— DEPTFI: TOP OF TILE TO FINISH GRADE -------DEPTH OF FILTER MATERIAL BENEATH TILE --IN. ABOVE TILE -- WELL: DISTANCE FROM WATER DEPTH— BUILDING FOUNDATION_—— SAMPLE—- NEAREST TYPE­'�M��kl�'-t) I NEAREST SEPTIC SEEPAGE OTHER LOT LINE SEWER LINE—- TANK SYSTEM --10'-3 '—, CESSPOOL SOURCES-_ DIAGRAM OF SYSTEM DISTANCES -G G( -t-t C14 GRL�.,, ER ANCHORAGE AREA BOK-jUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT 3500 'TUDOR ROAD POUCH 6-650 NO. ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT q� NAME OF APPLICANTA� �� 117fllall�l�� M A I L I N G A D D R E S S PHONE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF- SEPTIC TANK SEEPAGE PIT. DRAIN 171ELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED, 'a"y FINANCED THROUGH TO BE INSTALLED BY e�2100zlrl 4�� �X-2 SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST �7- COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK S IZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WA SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. /I - WATER MAIN TO SEPTIC TANK SEEPAGE PIT e!!� DRAIN FIELD SEPTIC TANK GE PIT DRAIN FIELD SEEPA TO RIVER. LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL SACKFILL CONFORM To BOROUGH REGULATIONS REGARDING INSTALLATION. c- 0 HEALTH AITHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-66 AND THAT THE AL30VE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ('v DATE L� APPLICANT'S SIGNATURE Gorder Excavating ,e Otis Parkway 7929 Lal, Anchorage, Alaska 99504 RE: Test Hole and Soil Log Report for Sanitary System Lot 7, Blocl,� 1. Hidden Hills Subdivision Dear Mr. Gorder: We are submitting herewith the test boring results and Our comments regarding soil conditions encountered at the subject site. This investigation was per'formed in accordance with Your request of August 11 in a letter dated September 13, 1971 by Mr. R ) 1972 and those procedures outlined olf SbrickLuid of the Greater Anchor- age Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 7 area for the purpose of defining general subsurface S-05.1 conditions for the Proposed sanitary sy Le Was accomplished with a tractor�mounbed backhoe and the test 5 ". Excavation hole was extended -to a total depth of 14 feet below ground surface. The Einal log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole.. We appreciate being given this Opportunity to be of servic I' ny I _e to you. Should you -av3 a- quesLions wi4 b rega'd to Hie above, please do not hesitate to cont . .ac" us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS Jai -tics 1,,V. Rooney JWR:wl,) Pnclo!-�LLre xc: Greater Anchorage Area T?,orough ANCHORACE FA1PBA;'QKS C,eve'ic,mm, en -41- Servicez C)eperl-m ent Oiyisicn C r -5�`z '-I'vic-ter was,F-wa�-er Program, Gr(:gcw 5�IrSZT P.O. sox 196e::50 vark 36gi&7 Anc,�Clrcqe, AK 99519-6650 Mayor Pump Installation Log I Well DyEin<t2T Permit Number: S7V Iparcel Identi:Ec2tion Number: Date of Issue: 17-0—v?611 Lacral DescriPtiO12 Property Owuer N=e &.kddress: 13 7AVJ- A j �5�- - e; -7 �� 711P —installation Date: Pum -p J_utake Depth Below Top of WeE Casing: /'70 feet _pUjUp Manufacturer's Name: XW/ J,4ek&-1 1 &)�� puinp, Mode: 5119,512- yump Size hp PW,ess,��daptar Burial Depth: /0 feet pidesq,��dapter Manufactuxer's Naine: M;DAA�� -Pitless �4-ciaptal' 1,1stnEer'. -�jiiell -�Djsjjjfected -Upoa Cornp[etioa' Method �)CDisin:fectloci: el a- AV* Commears: a XA)P:5 pumli Tustaijer Naine: 411,,� Attentio ri: ne pump ins�Ller 3haLl j p-rovicie a. T�=p installation log to the DSD witliin'0 da7js of pum-Q imztalation- Certificate of On -Site Systems Approval Parcel I.D. 011-121-32 Legal description Hidden Hills Block 1 Lot 7 Site address 6320 Lost Cir. Anchorage, AK Current property owner(s) Rachel Stephl Expiration Date: 12-22-22 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: -/ ` Z2-2 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) islare in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 t Q . Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-121-32 Complete legal description Hidden Hills Block 1 Lot 7 Location (site address) 6320 Lost Cir. Anchorage, AK Current property owner(s) Rachel Stephl Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well 0 Private Well serving 2 dwelling units -- ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for:, Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ g�� . Waiver Fee $ Date of Payment Date of Payment COSA# 05CA"� N(A Waiver# COSA Application June 2022 C09ROWO . Legal Description: Hidden Hills Block 1 Lot 7 Parcel ID: 011-121-32 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1972* Total depth 170+* ft Cased to 40+* ft ✓❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 19 in. Date of flow test for COSA 619/22 Static water level at beginning of test 142 ft. Comments *per previous COSA B. TANK DATA Well production at time of test 4.1 gpm Water storage tank volume - gallons Well disinfected for coliform test? ❑ Yes ✓❑ No ❑✓ Coliform bacteria is Negative Nitrate 5.07 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 6/9/22 FT STATION Measured -operating fluid level in septic tank New ❑ Require�nt( Date of pumping New Tank 8/8/22 Age of lift station ❑ Required maintenance completed, if AWWTS Lift station material Comments: Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/22/84 ❑✓ ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ✓❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies; COSA Checklist June 2022 nce completed Adequacy test date 6/9/22 Results 0 Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 24 in Effective depth used 0 in Effective depth remaining 24 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' M Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 76* ft J❑ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No 88* ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft F71 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' n Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' M Yes if No ft Field to Property Line > 10' ❑✓ Yes if No ft Water Main > 10' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS *Waiver OSV221045 Approved 7/12/22 Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' Yes if No ft © Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-661111 Engineer's Printed Name Kenneth Duffus Date 0 ZZ7 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can AreTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Checklist June 2022 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221469 Subdivision: Hidden Hills Block 1 lot? A water sample revealed a nitrate concentration of 5.07 milligrams per liter (mg/L). The Environmental Protection Agency, (EPA) has established_ a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. Any future rise in Nitrates may require remediation. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. aq 2- Af Marling Address P 4 Box 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water, supplies to.10_mg/L.. The, standard_ has been. lowered --- from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MaiUng Address P O'Box 196650 *Anchorage, Alaska 99519 6650 * www muni org Parcel I.D. 011-121-32 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date, Cl Complete legal description HIDDEN HILLS BLOCK 1 LOT 7 Location (site address) 6320 LOST CIRCLE, ANCHORAGE, AK 99502 Current Property owner(s) PAULJENDRYK Mailing address Real Estate Agent 2. TYPE OF DWELLING: [�] Single Family (w/wo ADLI) F-1 Duplex El Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 306-6127 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual M Individual Water Storage Holding Tank El Community Class Well El Community F-1 u bli c 'Af a t 0 r S y s- + ern E! Public sewer Waiver/Variance request for: NONE Distance- ___ Received by:, Date: L�11 COSA to be released to the engineer, unless othenxise requested by the engineer. COSA Fee $.- 62-Cp Waiver Fee $ Date of Payment (.0 11 Date of Payment Receipt Number (yKl-')q Receipt Number, COSA # u:_,r-N 12-�--7 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 SPURKILAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved for :3bedrooms System #2 Approved for — bedrooms Disapproved Phone 279-3916 Date 6/17/2014 OF?14 TH 10 S Conditional approval for bedrooms, with the following By: Original Certificate Date: The Z,4511/0��Worlge 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - .- - If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this syJte—m 1 — Certificate of On -Site Systems Approval Checklist Legal Description: HIDDEN HILLS BLK 1 LT 7 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSI D # --- Date completed -1972 Sanitary seal (Y/N) Y Total depth 170+ ft Cased to 40+ ft. Parcel ID: 011-121-32 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/10/14 Static water level 140 ft. Well production 9 -p -m- 5.0 g.p.m. WATER SAMPLE RESULTS Coliform NEG colonies1100 mL Nitrate - 2.16 mg/L Arsenic ND ug/L Date of sample: 6110114 Collected by: ANSON MOXNESS B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1972 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of . pumping 5/2014 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA Date installed 9/22/84 Length 36 ft. Soil rating (g.p.d./fl:2 or ft/bdrm) 85 System type STRENCH Width 5 ft. Gravel below pipe 2 ft. Total depth 5 ft. Eff. absorption area 257 fe Monitoring tube Y Depression over field N Date of adequacy test 6/10114 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 1 in. Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >= 450 g.p-d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) --- If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump ofr level at -- E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested -- Septic tank/lift station on lot 801.* Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25.+ Animal containment areas 50'+ Manhole/Access (Y/N) in. High water alarm level at -- Meets alarm & circuit requirements? On adjacent lots 801.* On adjacent lots 100'+ Public sewer manholelcleanout NA Holding tank NA Manurelanimal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Water main NA Water service line 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water Service line 104 Curtain drain 50'+ (N.O.) F. COMMENTS ** WAIVER ON FILE Surface water 100'+(N.O.) Wells on adjacent lots *** WAIVER WR910039 IN LOT 8 FILE G. ENGINEER'S CERTIFICATION / 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 LARS SPURKLAND Date 6/20/14 COSA brown sheet-10-10-12.doc Absorption field 51+ Surface water 100'+ Water main NA Driveway, parkingtvehicle storage 10'+ of. At 4 -4,9 11 . .... .... . . .... R SPURK D in. 01" (AMRARD) 2014HO Deem _j LOST CIRCLE 185 .00, 66... S EIV59'30" W 9.00, WELL . . . . . 0 ..... . 6 al 10.0, .0, 8 EXISTING HOUSE 9.9" LU 0 c.0.s — — — — — — — — — — 60. -?s 10'UTILITY ESMT 7 7' S 89059'30" W 8100' UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSIRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVC'6 LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURWY SURVEY TYPE SYMBOLS FOLWA704 AS-SULT FINAL STFUCTURE AS-K&T SET REBAR DR ASPHALT AINAGE 'OT PL7 0 FOUND REBAR 0 WOW FENCE CONCRETE WXERWAMON AS�T ... M= ;;TA' Na ASSUMED ELEV *--*—* METAL FENCE WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN, FENCES, INELLS, SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOVO4 IN THEIR APPROYJMATE LOCATION. ONI.Y. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WICH DO NOT APPEAR ON THE RECOROED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CER11FICATION OF,.. Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN g# � . ......... 4 , 4V Professional Land Surveyors % 1700 Brink Drive. ANCHORAGE. ALASKA SVJ04 Air Scale: to 1 = 30' Rm Lot S.F. R� Piat Fle No. FOUINDAMON AS-0.11LIT L fl� L � Jr. ft --Ivy 11 .... ..... ....... ..... Date SiAr"yed: 06/23/14 Dram I REJ Checked bS MK ROBERT E, Date Dram: 06/25/14 Gr"" 2222 1" 14-268 en� � .1 end.��� a N FINAL STRUCTURE AS-MXT L"d Description: lift do Lot 7 Block 1 HIDDEN HILLS MUNICIPALITY OF &NCHORAGE DIVISION OF ENVTRQNtK1,?,NTA1, HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) 1 07 Location (address or directions) c lj(jLi� c Ij<ska _99.502 243-3486 (b) Applicants Name Scn)tL Liston Telephone - Home Business Applicants Address 6320 Lost Circle Anchorage, Alaska 99502 (c) Applicant is (check one) Lending Institution Owner/builder Buyer Other [TTJ Qxplain); (d) Lending Institution Frcaricier, Alaska State Cr. Ul-liOn Telephone 563-3766 Address 3500 Eide Street-., Anchorage, Alaska 99503 (a) Real Estate Co. & Agent Dynamic, lNealiLy, Inc. Doris 'Piiaperley Address 501 W. Northern Lights 13J_vd Telephone 2 7 9 -7 6 11. (f) Mail the HAA to the following address: u, ,p by agent Single -Family la:z Multi -Family I _�:j Number of Bedrooms _yLqyAL_Q1 3. Water_�Hmlzy Individual Wall 1_5�xfl Comillun t ty Anchorage, Alo-,ka 99503 Other (describe Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sywa e Disposal Holding 0 n s i t a 1___Kxj Public E--. Community 17-1 Tank[L- Note: Tf community wall system, must have written confIrmation from the State Department of Environmental Conservation attesting to the legality and status. [Page I of 2] 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 ind adequate for the number of bedrooms and type of Structure indicated herein. I further verify that, based oa the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm- - - Address Date 6. DEEP Approval Three Approved for bedrooms Telephone ORIGINAL STAMPED AND SIGNED COPY COMPLETED BY ENGINEER (ENGINEER SEAL) is (ON FILE WITH TEE DEPT. OF HEALTH & '��'NV. PROTECTION. Approved yX,,/ Disapproved Terms of Conditional Approval By o 'tJ; CAUTION Conditional P a t THE 14LTNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL 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. THE DUEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS, EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TEE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DEEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DIVISION OF RWIRONMENTAL HEALTH DEPARTMENT OF HEA1,TH AND ENVIRONMENTAL PRoTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 5. Engineerinq Firm Providinq Inspections, lbsts, Data and Information I certify that I have checked, verified, or conformd to all MOA HAA Guidelims in effect on the dat f 's inspection. Signed J11W-11 Date Name of Firm Barter And .&ssoci-ates Telephone 563--7164 Address 5�31 Tu.dor 'Top Circle Anchorage, Alaska 99507 OF Ao(- %I Signed by ku 1 AW.A� Da te ITH (ENGINEER SEAL) 6.DHEP Aooroval Approved for bedroom Approved F::T Disapproved ��- Terms of Conditional Approval — 0: % Tolvy D. Barter 11 40 CES130 BY Date Conditional The Municipality of Anchorage Departrrent of �balth and Envirormental Protection does not guarantee the continued satisfactory performance, of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms, and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: o -7 c" 6 9 A—x) Ax Tj T KB2/d5/s (Page 2 of 21 MUNICIPALITY OF ANCHOPAGR PUF. OF 11FALIH & ENV] FZONIMLN FAL Pv0fLCJ10N,' MUNICIPALITY OF ANCHORAGE (MOA) Sr -1 P HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 _V1 D, x C 1. A. MLL DATA Legal Description: Lot 7, Block 1 Hidden Bills Suba. Well Classification Private If A, B, cr C, D.E.C. Approved(Y/N) NI/A Well Log Present (YIN) No Date Completed ? Yield 1.8 gpm Total Depth Q Cased to ? Depth of Grouting. ? Static Water Level ? Pump Set At I? Casing Height Above Ground 2411 Sanitary Seal on Casing (YZN) Y Electrical Wiring in Conduit (7M) y Depression Around TAbll!�go (YM) - 1�1 Separation Distances from �%bil: 4� 40 r f _�__X_88 f t. fwcv To Septic/Holding Tank on Lot 11 ; On Adjoining Lots ;Y:f�_to lot 6 To Nearest Edge of Absorption Field on Lot 100+ f t # ; On Adjoining Lots 100+ f t. To Nearest Public Sewer Line N/A To Nearest Public Sewer W/A Cleancut/Manhole ___� �A To Nearest sewer service Line on Lot N/A Water Sample Collected By T. Barter Date— 8/14/84 Water Sample Test Results passed Camients Lot 6 had been sharing the well with owner, line disconnected 9/22/84 this will require Lot 6 to relocate tark to accom.odate new water supply. **'Separation waiver on file with 1,40A. 13. SEPTIC/HOLDING TANK DATA Date Installed. J 972 Size 1000 Gal No. of Ccrnpartments Two (2) Standpipes (YIN) y Air -tight Caps y Foundation Cleanout (YIN) J,) _apl Depression over Tank LY/N) 1\1 Date Last Pumped 2- V'84 Purrping/Maintenance Contract on File (Y/N) for _N/A Holding Tank High-water Alarm LY/N) N/A — Temporary Holding Tank Permit LY/N) N Separation Distances from Septic/Holding Tank: 'To Water -Supply �\bll 88 ft.** To Building Foundation 1 O -P To Property Lim 10+ To Disposal Field 15 ft. To Water Main/Service Line N/A To Stream, Pond, Lake, cr Major Drainage Course NT/A Comments -x-*, See note above [Page I of 2] Re C_ �) ?)�)_ C_ 2-15-84 C. ABSORPTION FIELD DATA soils Rating in Absorption Strata 85 SF/BDRM Type of System Design Id/Trench Date Installed 9/22/84 Length of Field 36 ft. Width of Field 5 ft. Depth of Field 5 ft. Gravel Bed Thickness 2 ft. Square Feet of Absorption Area 285 S -_H1 Standpipes Present (YM) Y Depression over Field (Y/N) INT Date of Last Adequacy Test 8/14/84 Results of Last Adequacy Test -Failed/ UT)grade on 9/22/84 permit'i840804 Separation Distance from Absorption Field: To Water -Supply TAbll 100+ ft. To property Lim 10+ ft. To Building Foundation 19 ft. To Existing or Abandoned System cn Lot 10-F ft. ; on Adjoining Lots 100+ To Water Main/Service Line To Cutba To Stream/Pond/Lake/or Major Drainage Course R/A To Driveway, Parking Arear or Vehicle Storage Area 30+ Comwnt1c D. LIFT STATION Date installed Size in Gallons ,,pump on" Level at n/a Diirensions ------------------ ----------- manhole/Access (YM) ------------- ----------- 11pump off" Level at ------------- High Water Alarm Level at Tested for ----------- vent (YM) ------------- pumping Cycles during Adequacy TLast- Meets MDA Electrical Code --------- ConwentIc Check Permitted Bedrocrn Rating Against HAA Request I certify that I have checkedr verifiedr or conforn-ed to all MOA HAA on the date of this inspection. ------ -a d !9� Date Signed Ut �,nd CoTrpany Bar- r And Agsocial— OA No. LT A soci Aeb 84- _08 2 KB1/d5/s (Page 2 of 21 in effect 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "Ell STREET, SUITE 200 ANCHORAGE, ALASKA 99501 September 27, 1984 Mr. Tony Barter, P. E. 5331 Tudor Road Anchorage, Alaska 99501 BILL SHEITIELD, GOVERNOR T61ephone: (907) Address: 274-2533 SUBJECT: Waiver Horizontal Separation Between Well and Septic Tank, Lot 7, Block 1, Hidden Hills S/D (8521 -WA -036) Dear Mr. Barter: The Department hereby amends the subject waiver from 88 feet to 80 feet horizontal separation between the well and septic tanks located on the subject property and on Lot 6, Block 1. Sincerely, �% ;::7� �EFrickson District Engineer BEE/dd