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Home My WebLink AboutHIDDEN HILLS BLK 1 LT 12AOnsite File WIN Ar M rr 22 �96 Pit) v LEGEND S.bj- Roundary Overhead kiirim"Utilin- Fee- u.;*-- FdgG-1 utibly P,,Ic D—age ft—uu. sepnc welt ASBUILT ASBUILT SURVEY Lot 6 Lot 8 (Zone R-5) (Zone R-5) ra - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - WWWI, E- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - Lot i2A Block i Lo11 Lo. 24,335 s f- 9 (Zone R-5) A (zone R-5) tet_ 1 Lot 15 (Zone R-5) Lot 14 (Z one P-5) 11 TrJ 15- A15- / / kiJiln>' kt,x,. �.. �,� 'moi sKA�yµ�� i f / - QUIET CIRCLE - Lot 24 (Zone R-5) 1 Lo,, 25 1 Lot 26 (Zone R-5) (Zone R- 5) N OT T S 1. Bearings shown are Alaska Slate Plane Zone 4 grid hearings orientated to Grid North. 2. Distance.. shouat,, mdumd to horizontal ground di.i-v- to I -IS Suc,,,y E -I. 3. The property owner and utilities shall not raise, I-eer, or re -grade the propert), in a manner that will alter the drainage patterns without prior approval from Municipality of Anchorage Building Safety Office, 4. property owners, and utilities shall tiol obstruct, ftnpedv or alter drainage facilities (,g, shales, ditches) in any, way that will adversely impact adjacent properties or righis-of-way. -T---- Lot 27 (Zone R-5) S5 S4 53 THIS SURVEY Wa A.44 S8 TS9' , SIO I S I G - 1 1- 1-- 1114 MILE s— ,4—s,— / —s,— I Jos T CIRCLE Lt 6 T T W 7 L- IZA QUIET CIRCLE .1 za A,bnO, Survey Lot 12A, Block I Hidden Hills Subdivision A SUHDIVIS10%, OF LOTS ),! and 13, 8 1 ()CK I„ EIR )DI --N IfIll-S SURIMISION LMATH) "TTION T"L NAN: 1 j4 Of SFC -170N 9, TOWNSHIP 12 NORTH, RANGF-, 4 WFST, SEWARD MERIDIAN, ALASKA ( 'ON, r24,335 APNING S.F. AM If0RAGf RECORDING DIST'RIC'T 49,It STAR SURVEYING ASBUILT SURVEY Lot 7 Lot 8 (Zone R-5) (Zone R-5) ra - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - WWWI, E- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - Lot i2A Block i Lo11 Lo. 24,335 s f- 9 (Zone R-5) A (zone R-5) - QUIET CIRCLE - Lot 24 (Zone R-5) 1 Lo,, 25 1 Lot 26 (Zone R-5) (Zone R- 5) N OT T S 1. Bearings shown are Alaska Slate Plane Zone 4 grid hearings orientated to Grid North. 2. Distance.. shouat,, mdumd to horizontal ground di.i-v- to I -IS Suc,,,y E -I. 3. The property owner and utilities shall not raise, I-eer, or re -grade the propert), in a manner that will alter the drainage patterns without prior approval from Municipality of Anchorage Building Safety Office, 4. property owners, and utilities shall tiol obstruct, ftnpedv or alter drainage facilities (,g, shales, ditches) in any, way that will adversely impact adjacent properties or righis-of-way. -T---- Lot 27 (Zone R-5) S5 S4 53 THIS SURVEY Wa A.44 S8 TS9' , SIO I S I G - 1 1- 1-- 1114 MILE s— ,4—s,— / —s,— I Jos T CIRCLE Lt 6 T T W 7 L- IZA QUIET CIRCLE .1 za A,bnO, Survey Lot 12A, Block I Hidden Hills Subdivision A SUHDIVIS10%, OF LOTS ),! and 13, 8 1 ()CK I„ EIR )DI --N IfIll-S SURIMISION LMATH) "TTION T"L NAN: 1 j4 Of SFC -170N 9, TOWNSHIP 12 NORTH, RANGF-, 4 WFST, SEWARD MERIDIAN, ALASKA ( 'ON, r24,335 APNING S.F. AM If0RAGf RECORDING DIST'RIC'T 49,It STAR SURVEYING 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.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW030291 PID Number: 011-121-38 Name: CLYDE R. INGALSBE Wastewater System: ❑ New ■ Upgrade Y Address: 6331 QUIET CIRCLE * ANCHORAGE, AK 99502 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 243-5451 3 ■ Deep Trench ❑ Shallow Trench O Bed ❑ Mound ❑Other LEGAL DESCRIPTION Soil Rating: 1 2 Total Depth from original 2a MAX GPD/Sq R R Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 1 13 HIDDEN HILLS 3.91 MAX R 8.09 R Township: Range: Section: nil added be. aHgincl grade: Gravel length: - - - SEE DWG Pt. 29 R WELL: ❑ New ❑ Upgrade Gravel width: 2.5 Number of lines: 1 D'ishtance between lines: — Ft, R ClauiUcotlon (Private. A,e,C): Total De Caved To: Total absorption area: Pipe material: D 3034/ F-810 Ft. Ft. 469 so. ft Driller.\ Date MIMI: Static Water Level: Installer. LITTLE BEAR Data Installed: 8/19/2003 R Yield:Pump Set At: Caving Haight Above Ground: TANK GPM R R SEPARATION DISTANCES ❑septic 13 Holding ❑S.T.E.P. Other To Septic" Lift Holding Public/Private Manufacturer. rA,11� Capa gallons: From Tank Feld Station Tank Sewer Lime Number of compormentx Well 100'+ 100'+ — — 25'+ Material: `�� Surface Water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ *1'+ — — — Size In gallon.;Manufachror. -Pump on' level ab Pump o at: High water Guamat:Foundation 5'+ 10'+ — — — Pump Maka sl: Electrical Inspections performed by: Curtain Drain NO KNOWN BENCH MARK Remarks: Loca}Ion and DeecHption: INTEGRITY OF EXISTING TANK VERIFIED ON 8/20/03. TOP OF GARAGE SLAB *WAIVER GRANTED Assumed Elevation: 1 1 .99 R ENGINEER'S AKWWC, Inspections performed by: INC. Dates: 1st 8/19/2003 �o 9 *........ �p�0 ................. 2nd 8/19/2003 3rd 8/19/2003 aQ p '. e A. or ss. Development Services Department Approval 0�9 �0 -79 Reviewed and approved by�4z Al Date: / 0-/So,03 4p a aresaw�ao� (Rev. 12/01) 4pOgOgpo PERMITNUMBER: SW030291 SWO AS — -BUILT DRAWING PARCEL ID NUMBER: 011-121-38 / \ 70• LOT 13 / / LOT 12 _ / A B ST1 42.4 20.1 DBL1 45.6 26.4 DBL2 46.2 27.4 FD 46.7 2 EXISTING 1100 GALLON CONRETE TO BE TANK.RONE C01 47.2 36.5 �Bo GOOD INTEGRITYC 8/20/20 3F MT1 57.5 39.6 �Inx N— 0O2 70.0 48.3 A g INSTALLED DOUBLE cLEANOUTS EXISTING CRIB TO BE � ALTERNATE SITE WILL USED AS A RESERVE REQUIRE THE USE OF AN SITE. EXACT PERIMETER ADVANTEX TREATMENT SYSTEM OF CRIB UNKNOWN. NEW DRAINFIELD DATE: �0 It 8/26/2003 ! �F O�Tpp DRAWN BY: 0�'•`'C� .... 'Y�1��o 11R1�1 /RW�11111�00®111111 ., ,. ALASKA WATER & WASTEWATER1 C.J.30 * :*p0a CONSULTANTS, INC. SCALE: . _ 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 99507 • PHONE (907)337-6179' FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLYDE R. INGALSBE (907) 243-5451 1 2 OF 3i Qp � ..J f Ga ess; LEGAL DESCRIPTION: VQ m E— 95 oi0O TYPE ID ENWORHILLS SUBDIVISION; LOT 13, BLOCK 1, IProfeasVol°o�'�44 AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �4ppvogoo PERMffNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SWO - SW030291 011-121-38 FINAL GRADE _ TH # 1 96.54-97.0ORIGINAL GRADE = 96.95 fl F o'IGHEST POINT -RELATIVE ELEVATION OF BOTTOM OF TEST HOLE = 78.95 (TEST HOLE DRY) ALASKA WATER & WASTEWATER CONSULTANTS, INC. 01 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 " PHONE (907)337-6179 " FAX (907)338-3241 .PARED FOR: PHONE NUMBER: CLYDE R. INGALSBE (907) 243-5451 FABRIC INVERT OF PIPE = 93.04 (AVG.) BOTTOM OF TRENCH = 84.95 (AVG.) 3 OF 3 v Uc mlrnvn: %p' -'. HIDDEN HILLS SUBDIVISION; LOT 13, BLOCK 1,E OF Q D PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 0kp fK_:l n°•oc Ooo�`� MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030291 Legal Description r=4+73ti Design Engineer: 0041 AK Water & Wastewater Consultani Owner Name: Clyde & Debra Ingalsbe Owner Address: 6331 QUIET CIRCLE ANCHORAGE , AK 99502-3937 Date Issued: Aug 04, 2003 Expiration Date: Aug 03, 2004 Parcel ID: 011-121-38 Site Address: 006331 QUIET CIR Lot Size: 11948 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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 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: Issued By: Date: 2 ?v'3 Date: �� 60 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.ei.anchorage.ak.us (907)343-7904 ON—SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. )l p Z I _ 13r Permit Number SW403029/ Property owner(s) CLYDE R. INGALSBE Day phone 243-5451 Mailing address (1) 6331 QUIET CIRCLE * ANCHORAGE. AK Mailing address (2) Zip Code 99502 Legal description (Lot, Block & Sub'd.) LOT 13. BLOCK 1. HIDDEN HILLS SUBDIVISION Legal description ((Section, Township & Range) N/A Lot Size 1 Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees::? Date of Payment: 7/2-S- 03 Receipt Number: 'yl 19 Waiver Fees: I n® 6 Date of Payment: i / 2-9 Q3 1 Receipt Number: 3 1 I y ALASKA WATER �& WASTEWATER CONSULTANTS, INC. July 25, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 13, Block 1, Hidden Hills Subdivision To whom it may concern: The existing 2 bedroom house is served by a private well and septic system. The septic system consists of a 1100 gallon concrete septic tank and a crib type drainfield. A test hole was dug on the property. The septic system will be designed around the 30 foot radius of this test hole. Per the owners request, we are designing for a 3 bedroom house. We are proposing that the integrity of inlet/outlet baffles in the existing concrete septic tank inspected. If of poor integrity, new baffles should be installed. We are also proposing that a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 1.2 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 I. Total Depth: 12 feet (max.) g. Effective Depth: 8 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 29 feet total length k. Effective absorption area = 464 ft2 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached design drawing, the topography in the area of the proposed drainfield is a 5-10 percent slope running from north to south. In short, there are no slope concerns. 5. LOT LINE WAIVER: We request a 1 foot lot line waiver to the south and cast lot lines. The homeowner owns Lot 12, Block 1; Hidden Hills Subdivision. We are unaware of any adverse impact with the granting of these waivers. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. Ifyou have any questions, please contact us at 337-6179. Thank you for your assistance. n P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com I ------------------------------ HIDDEN HILLS S/D; % j I I { LOT 3, BLOCK 1, HIDDEN HILLS 5 D; / HIDDEN HILLS S/D; ,\ LOT 2, BLOCK 1, LOT 1, BLOCK 1, I I I , IC HIDDEN HILLS 5/D;/\.` pr 4. BLOCKJT, 130\\ ,o ___ LOST- CIRCLE _—_- \ /'m1- _(JAo� moJ1' !I �\ SEP C _ L'--..�___ \/ JJ -O :SEEFTIC I \ I i l \ \ i, f \� \\ Y IP\�Ot! t Jzm My TP 1 0o _ t Jm x t{\ LOT 13 12 cYi \\ ox Nx�0 J xoF/ /LOT XITIN, Ym p5EPTIC ♦ mx\I IiI II SEPTC � \�o SYSTEM wARSARr� \ ALTERNATE SITE TH 1 SEPTI \� AREA _ EPTIC —% NY 1g z eeoRooM - �_� QUIET CIRCLE I I =m f HOUSE _ `��•\ _ PROPOSED SEPTIC SYSTEM _- I Zre /� /•' (SEE DESIGN PAGE 2 OF 2 F-- 1 NU. LLI \ IS WLI , /W'm'i \\ `o♦ I i---- / HIDDEN HILLS 5/D; / / / t �iD\i / 7 ZN \\\ �I LOT 23, BLOCK 1, / os ! o� \\ 1 1 0 1 gp If / \ r I / �_ I aid � ' a1� T\-�-''''l` _�._i '•�\--,iy1� \�.___� _�- —. —__ Il �I p I I HIDDEN HILLS S/D; \ I LOT 22, BLOCK 1, \\\\ =m 1 , !/ \� \\ I x zas in DATE: j 7/25/2003 �'C!. • ...... '� �'+M1 DRAWN BY: nllin+nmlmm, m° ALASKA WATER & WASTEWATER C.J.G./J.L.M. CONSULTANTS, INC. * / ...:....... 9 .........:.../ SCALE: 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 . PHONE (907),337-6179' FAX 907)338-3246 1" = 100' f� PREPARED FOR PHONE NUMBER: PAGE NUMBER: CLYDE R. INGALSBE 243-5451/229-1222 1 OF 2 �n Je v41 �l '., r arnes 9 m�G� LEGAL DESCRIPTION: LOTS 12 & 13, BLOCK 1; HIDDEN HILLS SUBDIVISION fe ,, p\j I,,'�e0�professio0�—a`� TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC UPGRADE I\ NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH AND EAST LOT LINES FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO / EXISTING CRIB TO BE USED AS A RESERVE SITE (EXACT PERIMETER IS UNKNOWN) - s.)iF. 1 1 I 1 e I 1 e 3. e al 0 �., , ,<, 7/25/2003 Imnmi DRAWN BY: ALASKA WATER & WASTEWATER C.J.G. CONSULTANTS, INC. SCALE' 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK 99507 `PHONE (90]$3]-61]9 •FAX (907)3385246 111 = 30' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CLYDE R. INGALSBE (907) 243-5451 2 OF 2 HIDDEN HILLS SUBDIVISION; LOT 13, BLOCK 1, OF WORK: DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE w t LOT 12 / INSTALL DOUBLE CLE ANOUTS EXISTING 1100 GALLON CONCRETE SEPTIC TANK. SEPTIC TANK TO BE EXCAVATED AND THE INTEGRITY VERIFIED. INSTALL FLOW DNERTER ALTERNATE SITE WILL REQUIRE THE USE OF AN ADVANCED TECHNOLOGY SYSTEM 1 FOOT LOT UNE WAIVER REQUESTED PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 12 FEET DEEP MAXIMUM BY 2.5 FEET WIDE BY 29 FEET LONG. ADD 8 FEET OF CLEAN, WASHED SEWER DRAINROCKy'1 v* —i e A. G nese: o C -795 m` 4 04fob �O 11. r_ ... ALASKA WATER & WASTEWATER CONSULTANTS, INC. TUDOR ROA-, SU E AK 99507 • PHONE. - ' • wcm SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HIDDEN HILLS SUBDIVISION; LOT 13, BLOCK 1, PERFORMED FOR: CLYDE R. INGALSBE DATE: 7/18/2003 DEPTH (feet) TEST HOLE 1 1 FILL 9 READING CLOCK TIME SOIL CLASSIFICATIONS 2 NET DROP (INCHES) 7/21/2003 ORGANICS 'i o` GW 6" ORG 3 •••• 2 4:02 6 ".. GP ML 3 4:03 - 6" - 12 GM 4 CL 4 0" 6- 5 GC - OL —'�•'•' SP 6 4:16 7 SW 15 MH 5 s...�• 4:16 - 6" '• •'• : SP CH 4:23 17 0" 6" SM SC l o ; OH 6 B.O.H. 10 4:31 9 READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/21/2003 •.N• 3:56 • 6" ••i 10 •••• 2 4:02 6 •i.••es 6" 3 4:03 - 6" - 12 "�'• 4 4:09 6 0" 6- 5 4:09 - 14 —'�•'•' SP 6 4:16 7 0" 15 s...�• 4:16 - 6" - 8 4:23 17 0" 6" 9 18 6- B.O.H. DEPTH TO DATE GROUNDWATER ar ess.� E 7953 `�oG Epfl i AR�Fh�.� \\ TH# 1 -` SITE PLAN 1 "=100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/21/2003 1 3:56 - 6" - 2 4:02 6 0" 6" 3 4:03 - 6" - 4 4:09 6 0" 6- 5 4:09 - 6" - 6 4:16 7 0" 6- 7 4:16 - 6" - 8 4:23 7 0" 6" 9 4:24 - 6- 10 4:31 7 0" 6" 11 4:31- 6" - 12 4.38 7 0" 6- 19 PERCOLATION RATE 1.2 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JOE MARCHETfI COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W (S P RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: % 2S� 8/4/2003 Municipality of Anchorage Mark Begich, Mayor Building Safety Division P.O. Box 196650 • 4700 Bragaw Street Anchorage, Alaska 99519-6650 • (907) 343-8301• Fax (907) 343-8200 http://w .m=i.org Jeffrey A. Garness, PE 3701 East Tudor Road, Suite 101 Anchorage, Alaska 99507 Subject: Waiver Request for Hidden Hills Subdivision Block 1 Lot 13 Waiver Request #WR030060 Parcel ID #011-121-38 Construction Permit Number SW030291 Dear Mr. Gamess: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 1.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Danrel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department • -'� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030060 PID#:011-121-38 HA#: Permit#: Date Received: 7129/03 Legal Description: Hidden Hills Block 1 Lot 13 Engineer: Alaska Water & Wastewater 3701 E. Tudor Road Suite 101 Applicant: Clyde Ingalsbe Waiver Requested: 1 Foot Lot Line Waiver to the South and East Lot Lines Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ...................................................... 0........................ Waiver is Granted: x Waiver is not Granted: List Conditions or Reasons for above: SEE Ea6:hyeag S 1-471-0,K aFR 17AeW&b AL/-& 0 7W i 2 S 2 003 Date: 84— G 3 By: PI Al Name of Reviewer ............................................................................... Rec#: 39194 Amount: $150.00 Date Paid: 7/29/2003 MImicipality of Anchorage Mark Begich, Magor Building Safety Division P.O. I3ox 196650 • 4700 Braoaw Street Anchorage, Alaska 99519-6650 • (907) 343-8301 • Fw- (907) 343-8200 hup:/N« M.muni.or", 7/21/2003 Clyde R. Ingalsbe 6331 Quiet Circle Anchorage, Alaska 99502 Subject: Waiver Request for Hidden Hills Block I Lot 13 Waiver Request #WR960030 ParcelID# 011-121-29 Dear Engineer: Your request for a waiver of the required 100 feet horizontal separation from a septic tank to private well has been approved. The approved separation distance is 80 feet from the private well on Block I Lot 13 to the septic tank on Block 1 Lot 14. This waiver approval applies to the existing septic tank to private well separation only. Any future upgrade to the private well will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, l ACU �n Daniel L Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department- 1� Building Safety Division Q Ems: • On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage. ak.us (907)343-7904 WR#: 960030 PID#:011-121-29 Date Received: 7122/03 Waiver Review Worksheet HA#: Permit#: Legal Description: Hidden Hills Block 1 Lot 13 Engineer: Tobben Sourkland 203 W. 15" Avenue #203 Applicant: Clyde R Ingalsbe 631 Quiet Circle Anchorage, AK 99502 Waiver Requested: 80 foot horizontal separation from a private well to septic tank Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: .................................................. 0............................ Waiver is Granted: X Waiver is not Granted. List Conditions or Reasons for above: FI,11 S wlq I v E i W)95- &H l9/i/'TF_ /i / N rq% 4,vn Itiw1i /Alb- pole r",E 0WA/Tl? OF Lvr 13 r P,4YI 22 03 Date: By: Name of Reviewer Rec#: 38341 Amount: $800.00 Date Paid: 7122/2003 S� Jtt L Y 7g IT GREdkR ANCHORAGE AREA BO1*GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 A INSPECTION REPORT ON-SITE SEWAGE pDISPOSAL SYSTEM iME �_=_�1L4� MAILING ADDRESS ��/� �' V T/• LOCATION PHONE .3`>/y GST LEGAL DESCRIPTION L13 Ri SEPTIC TANK: DISTANCE �i FROM WELL�L MATERIAL. MANUFACTURER yc_ NUMBER OF l �=COMPARTMENTS I INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY I() li SEEPAGE PIT: GALLONS. NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_ , DEPTH LINING MATERIAL L(',.ti i�` CRIB'SIZE DIAMETER—DEPTH – L DISTANCE FROM: WELL 'r �CU''� BUILDING FOUNDATIONTOTAL EFFECTIVE NEAREST LOT LINE L ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION _ SQ, FT. WELL: n ``i' TYPE \ CONSTRUCTION_ BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES NEAREST SEWER LINE APPROVED DISAPPROVED REMA DISTANCES: CJ K - INSTALLED BY: F �c PIPE MATERIAL: Xw LOT SLOPE: REMARKS: Form No. EQ -031 DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM- "–H./ I �n � a -;'L 4- � -e� GREATER ANCHORAGE AREA BOROUGH jid DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT No. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT OF APPLICANT /- 6 MAILING ADDRESS/ -L L- PHONE 3Se-11-0 � �TALLATION LOCATION _EGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT-_ DRAIN FIELD .OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH -- TO BE INSTALLED BY SOIL TEST RESULTS -><�� I! �,/!'a/G'-"( NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OFENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE �'t —SEEPAGE AREA SIZE �� i(- ) L.�-l� /'�'i N� j TYPE —. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ,' FOUNDATION TO SEEPAGE PIT DI RAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /',-'I SEPTIC TANK S SEEPAGE PIT "� DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK r'��Ci / SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK fL' SEEPAGE PIT DRAIN FIELD f. SEPTIC TANK,I —E--. SEEPAGE PIT DRAIN FIELD F ��- `' G4- 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 BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, G.A.A.B. OR LICENSED DESIGNBR� DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 APA FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE / Ljl l°'!, / /\ APPLICANT'S SIGNATURE/ -_ FORM NO. EO -016 � J 10 eon:'&uaRon Sre4i -Cas "One test is worth a thousand opinions" 602 TUDOR ROAD, ANCHORAG/E, ALAa KA 09507 a TSLGIHON$ 333.0472 // crformed For �� ,F 5-r6a Date Performed ca 2/ 7:caal oescrintjon: Lot t� B1 CE: Subdivision,.1,,L4,1y %/,i/ ';his Form Reports Soils Loqz9A, , Percolation Test_ J i Y tenth Feet Soil Characteristics — $ i r (f mL _ 4 I du s B rd w ti St t 4 ttt cj 9 /#Was Was Ground Water Encountered?_�/p I¢ Yes, At what Depth? Readinq i Date Gross Time I Net Time I Depth to H2O Net Dron Percolation Rate r 1inute Prnnosed Installation: Seenaae Pit `?Agp�- Drain Field Depth of Inlet Depth'T— -T o Bottom Of P't Or Trench rnwr"ENTS: a?�O s., pip 04 Grp rt? P —dE Te;: Performed B T, y-��.4r� _ Data Certified By: ON , L19 i3 /7-7 19 �C/i96pr� Date: 6t A// -7t6 • M ®W DRILLING, Ine, 0 P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 Well Owner _ __.Qjy+ : 1nf;al.sbo --- ___Use of Wel Dor.__ — Location (address of: Township, Range, Section, if known; or distance main L13, Llk 1, Hidden Hilly Sub, Sand La?ke Area R Size of casing_ 6 __Depth of Hole 195 meet Cased to 193 feet Static water level 16Q_ft. (MM) (below) land surface. Finish of well (check one) open end ( x ) ; Screen ( ); Perforated ( ). Describe screen or perforation_ Nono Well pumping test at ---18 gallons per (N_6'u'`i) (minute) for— 1 hours with_ 1 a _t, of drawdown from static level. Date of completion__ lSug 74 MUNICIPALITY OF ANCHORAGE WELL LOO DEPT. OF HEALTFJ�_,_„_.__ ., Depth in feet from ENTALRO PTECTION ground surface Give details of formations penetrated size of material, color, � d hardrn-ss 1 TO 28 —.ATO lz8 _ 48 _TO 62 _6 TO1=,f3=,R, __138TO---17-0 __ TO— 195 _TO ---- TO ----TO-- CEIV _ SanteC'ravel° Sm&il C;r•aurl e�nrly �ail�yt_ rnLnnc rt_,�_ Sandv t'jafer G.^?��1: sti*ht.] hr3,Tin_�. r_ond nntuti^mien 1 —CUSTOMER .F.:,EiF'I:':Ii:RI"HIENT HEF:ILTH FIJ'.,I[) EI',iV 825 "L' ;..2 i~..4i E""."~ IL_ IL,._ I1:::I~ Jl'"'4J E::" ~i:ii~ ~"'qi ...... .?j:T, iE 'T' EE ~:,::_,:1.,; IEiii IL...lt ~::'~ ~ IP' E?' lJ'~? Ii "-~ "ii '"'If'" ( 8 3 8 5 6 5 FI F' P i.....1' C F:I N T L.. )C FIT '[ Oi",l L. EE'iFIL ~:.l.F~::t.;2 H .T. I)DEi'.,I H ): L.I...S T"r'PIE QF' SE I L F:IBSEIFd::'T I 0t',t :?¢STiEH I :.:.'; ' E:E: E;I::IUT I Ot...t'~ O1::: i'.41~E i GHBEIB: I i'-,IG !4EL. LS L.QT 'S ! ZE: 9:.:.'9'9:3';~ S(;:!I...IFIF::E F'EET iqR;:.:;iHl..li,1 IqI. HEEF;: FIF;' EEDF..'EDHS =: 1i. SOiL F;:F:I"f'Ii'.~IG ,'SQ FT,.."E:I::::::,= tSEI TREI'.,ICH THE f'4:IEQUIF.:EF.., SIZE OF THE SOIL FIE~:B()I~:PTtOIq S'.,-'STE:iH IS: THE LIENG'FH D t HENS I O1'.,I I S THE LEI'.,IGTH ,( I N FEE'i' 1:, OF THE "['Iq:IEI'.,IE:H Iil~;;~: I)I:4:FI I i'-,ll:: I El_..[::,. TIdE DEPTH (::IF Ft TP..:IiEi'.,I(3H OR I:::'IT IS THE E:,ISTt::II",IE:E E',ETHEEN THE; SIJFi:FF:ICE OF THE GF...'OUHE:, Rt",ID THE E:QTTOM Qr::' THE E',:.:;E:F:I',,,'I::iTiOI',I ,:: tN FEE:T). THERE: Z:F.., NO SET HI E:,TH F'OIq: TI-'~'.EI'.,IE:HE:.~;. THE GI~4'.FI',,,'EL. DEF:'TH :IS THE: HINIHUH [:,EF'TH OF Gi:;.:F::t',,,'EL EdETI.,.IEE:N THE OLrTFF. IL.L I.":'tF'E RI'.4[::, THE E:OTTOH OF' THIE I:~;:.::C:i::'~',,,'R"I"ZOi'.,t ,::IN FEE"F). F'EFd','I '( 'T' I::IF:'F'I... i CFIi'.,FF HFIS 7'1.--11..-_.' I:RESF'OI'.,IS I E: I I.... ! "r'.r' -r'o 11: I'.,IFOI:;~:H TH I '!!; Ii:,EF'F:IRTHENT [:,ljl:;i: I I'.,IG THE I I'.~STF:tL.L.I~Ti ON I i'.,t:BF'EE:T i ONS OF' Rl",l"r' HEi. J._:~4; FID...'rFICEI'.,IT TO TH I :i.:; I~ I;. F E F,, I 'r FIN[:, THE I",iUi'IE',ER OF F;.':ESi:I3, E;i',iE:E:S THIq"I" THE HELl... HIL.L SEF.:',,,'E. ..................... T' It.,,-It (;Z" ,:i ;2~:: 'J::, :E ii""d :iE;; ~:;..:., EzJ ItZZ.; "'IF' % ii,.It II"*,] ":~ I]:*'~11F~: E: ~;~: lEE E;:~. EJ 31 It:q:: EiE il.3:,, BRCk:FILLZt",IG QF F:IN"r' :B:'r'STEt'I HZ'FHr3UT Fti'.,tFiL TI'.,I':;F'EF:T~FII'.,! FIND IqF'PI:;::O',/FIL :, "FI'-t];:~, B,EF'FIF.:THEJI'.4T HiLL E',E SLIEL)'E:CT TO PI:;.:OSECIjTIEfl'.,t. H I i',11 i'11...11','1 [:, :[ :};TF:Ii'.,I(]:E I~E'I'klEEI'-,I FI I.,.IEI....L t::11'.,t[:, I::lN"r' OI',I-S I TE SEHFIGIE E:, t SF'OSFIL. S'¢S"I%H ]: S 'lJ.."3EI FEET FOR Iq I::'F;.tI',,,'I::FI"E: HELL O17. :t..SE.I TO 2E~E~ I:::'EET FB.:or,1 i::1 I::'UE',L..IC HELL I)EI-::'E'I,,II3,]:I',!G UF'ON THE T'.r'F'E: (;;it:..- PUE',LtE: HEL. L.. HINII"iUH DISTF:INE:E I::'i:;::OH FI PF4:!'v'FITE I.,.iE:I...I.~ 'TEi FI PI~:t',,,'t'"4TE SEP.II~E,q'. LtI'.,tE tS 25 FEET I::Ii'.,1[:, TO i":-~ COI'IHI...IhtlT'¢ SEHEI-;: L. I I",iE IS ?'5 FEET. I.,.IEL. L. LOGS Ir:IR:E F~:Eg!Llli:~:E:Ii:, IrlN[:, HUST E',E RETUF.:I",tED TO THE E:'EF'FII:~:ThlEI",IT I.,.IITHIi'q OF' T,~"tiE 14EL. L. E:OMF'L. ETIOi',t. OTHEP:: F::EE.:!U !' I:~:E;I"IEi",tTS HFff'r' F':II::'F'L."r'. 'SPEE: I F I CRT I Ot',IS Fff',lE:' CONSTI::dJCT t ON [::' I I:::IGI:;.'.FII"IS F:IRE i::i',?l::l ][I....61E:LE TO I N:;SLit~:I:: F'RE*F'EF'. ir I'.,tSTRLLFI"I" ]: Ot'.,I. ii::::" lEE It;;.:.': ~'.'ll % "¥" E: '.':..:: F" % IF;.:: lei '.'E~; il.i::, It:~i: ,;;: E ti 'i fbi3, tEE !F;~: Z~: Ell ..... :Ii CEF::T I F"¢ THFIT :L: t FIH I'--I::tI'IlI.._II::IR H ITH THE REg!IJIt~'.EtdEt',ITS F'OI::;: OI'-,I-..SITE '_:;EI.,.IEI;:S FIND ,k. IELL. S I::1:9_; SET FORTH B"r' THE HUNIE. IF'FIL 2: I HIL. L. I?',ISTFIL. L ']"FIE: S"r'STEH I1",1 FICE:EIRDFd'qCE ,~,.tlTH ]'hi[*.".' COD!ES. 3.: I UNDERL'~;TFfi",I[) THRT THE OI',t-'L':;ITE SIEHER S"r"STIEH MFI'¢ I:REg!UIt;;:E ENI...FiF. tGEHEI',rl" I1::' THE RE':'~;IE:,ENE:E IS F.:Er,'iO[:,ELED TO Z t',!CLLI[::,E HOF..:E THFtI',! ~:'~: E:EDF..:OOMS. S & S ~INEERS, IN(;. 7125 OLD SEWARD HWY. ANCHORAGE, ALASKA 99505 549-6561 SOILS LOG PEF~C()I A'II()N I'ES1 SITE PLAN 2 10 7 8 II is ~9 2O ENCOUNTERED) IF YES. AT V,/HAT DEPTH~ Read,rig Date Ne1 OrOO CO;,4M E N TS % JO~tN E, SWANSON~ /8'.3i~-.E TEST RUN BE TW[:EN D.KTE :_ !� Municipality of Anchorage Development Services Department Building Safety Division s On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING2 r Parcell.D. 011-121-35 HAA# 03()4GO 1. GENERAL INFORMATION Expiration Date: ! " 1-6-- O Complete legal description HIDDEN HILLS SUBDIVISION; LOT 13, BLOCK 1, Individual On-site i♦ Location (site address or directions) 6331 QUIET CIRCLE * ANCHORAGE. AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CLYDE R. INGALSBE Day phone 243-5451 6331 QUIET CIRCLE * ANCHORAGE, AK 99502 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site i♦ 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date fl Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. 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 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowinq stipulations: Attachments: HAA Checklist !� Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By: �l4� / ` Original Certificate Date: (Rev. 12/01) Municipality of Anchorage fro_ 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.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HIDDEN HILLS SUBDIVISION; LOT 13, BLOCK 1, Parcel ID: 011-121-38 EIR'PI440ITA f_l Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/5/1974 Sanitary seal (Y/N) YES Total depth 195 ft. Cased to 193 ft. FROM WELL LOG Date of test 8/5/1974 Static water level 160 ft. Well production 18 g.p.m. WATER SAMPLE RESULTS Coliform 0 colonies/100 ml. Nitrate 2.99 mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/9/2003 154 ft, 6.5 g.p.m. Other bacteria D colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 7/9/2003 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA *INTEGRITY VERIFIED ON 8/20/2003 Tank Type/Material CONCRETE Date installed *7/1975 Tank size 1 100 gal. Number of Compartments 1 Cleanouts (YIN) Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 7/9/2003 Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA "ELOW FINAL GRADEI Date installed 8/19/2003 Soil rating .p.d./ft /bdrm UNIICC 1.2/ System type TRENCH/CRIB Length 29/20 ft. Width 2.5/15 ft. Gravelbelowpipe 8.09/9.0 ft. *11.69-12.14 469/ Total depth *15.9 ft. Eff. absorption area 630 ft2 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 =in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= — 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 _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 1 0u + 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 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *1'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1' Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and ";!- y i f r* v� review of Municipal records that the above systems are in " ' conformance with MOA HAA guidelines in effect on this date. Q �... .. J fr y Go ... S.... Engineer's Print d Zme JEFFREY A. GARNESS d��9s E 953 Date I�jf 3� 44�Q@a Prof "0\ HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/01) 5 S9 59'30'W42.00 QUIET CIRCLE EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. BUILT SURVEY (NO CORNERS SET THIS DATE) TALE: 1' = 20' A LOT 13, BLOCK 1, HIDDEN HILLS SUB. ENCROACHMENTS EXIST EXCEPT AS NOTED DATED AT ANCHORAGE, ALASKA THIS _22ND_ DAY OF AUGUST 2003. HOLT LAND SURVEYING 903,FB107-58 TEL. 345-5513 • MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL I ' OF ON-SITE SEWER AND WATER FACILITY -7L 264-4720 Application Date iv/Z-7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name T► -w -r > a Applicant Address Telephone: Home--yS ---�--,� Business3- (c) Applicant is (check one): Lending Institution D ; Owner/builder`; Buyer D ;Other EI (explain); (d) Lending Institution n— ' 420'1,' j22Z'�r Telephone Address J)—',-) =� p (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family D Other Number of Bedrooms 3. WATER SUPPLY Individual Well CommunityEl PublicI71 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public D Community D Holding Tank D Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/04 5. ENGINEERING FIRM PROVIDISINSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 91 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm.I`P� c .i %a i Telephone (01's I Address Date DHEP APPROVAL/ Approved for l79c bedrooms by Approved Disapprove Terms of Conditional Approval p9pEES 5101' a i Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11 184) µUNI E)EPTI of Of AN HEALTH GE UNICIPALITY OF ANCHORAGE (MOt ENY1RONµENTa' "OTECTIOFHEALTH AUTHORITY APPROVAL (HAA) UIAQ CHECKLIST - FEBRUARY 1984 264-4720 RECEIV�� Legal Description: A. WELL DATA Well Classification 'TkiV4'T'-. — If A. B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date CompletedYield Total Depth 195 C sed to /'IDepth of Grouting 'A�%iS Static Water Level /60 Pump Set At I A2k, TCasing Height Above Ground — j T Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: .1 To Septic/Holding Tank on Lot /007' Depression Around Wellhead (Y/N) On Adjoining Lots _ To Nearest Edge of Absorption Field on Lot LX)T On Adjoining Lots To Nearest Public Sewer Line NZX To Nearest Public Sewer Cleanout/ManholeL) /,4 To Nearest Sewer Service Line on Lot Water Sample Collected by �k )F=M= s t? E . S a Date /o /'=//a, - Water Sample Test Results io',� cF02 2 13i7izm) Comments Wilt i. Glow ei�!5uLT5 B. SEPTIC/HOLDING TANK DATA Date Installed T- Size y/C" (-_ No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) �J Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) >v iL Temporary Holding Tank Permit (Y/N) z"144 _ Separation Distances from Septic/Holding Tank: To Water -Supply Well ZCK, -r To Building Foundation /OtFr To Property Line S SFr To Disposal Field To Water Main/Service Line �5-c) To Stream, Pond, Lake, or Major Drainage Course Comments ��7ADd-r'/1FD ANA9 /f777kkgr) W6&L�rL 120109-1 Page 1 of 2 72-026(11/84) 0 C. ABSORPTION FIELD DATA 0 Soils Rating in Absorption Strata Type of System Design �r"r Date Installed Length of Field_ Width of Field/ r `Deep Gravel Bed Thickness Square Feet of Absorption Area /2 �-DST Standpipes Present(Y/N) 4 Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well /f-"fIcr To Property Line zc-? F-�- To Building Foundation Ja T— To Existing or Abandoned System on Lot evl On Adjoining Lots >?�� To Water Main/Service Line SO rt"r To Cutbank (if present) No NC To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area O 49nE E;I/SrN/ r- 7 - Comments rComments e�66 kHT. Aao fNSPEGkxJ gePO4 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) — 'Pump Off' Leve �. Ve t (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request *" I certify that I h vecN cke ified o conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ' ate /D/2 Company MOA No. a Ate. Receipt Date of Payment 10 Zjl e o $q Amount: $ 16--- y�j, y EOgfrae,r's Seal Page 2 of 2 72-026 (1 1184)