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HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 15Hidd n Hills lock I Lot I 011-121 -40 r Municipality of Anchorage Page 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 Permit Number: ~1~O~"~"~:::~1 ~:) PID Number: ~11 Name:~~l'~b, ~ ~ Wastewater System:~ ~ New ~pgrade ~1 ~u~ ~ ~-. ~q~ ABSORPTION FIELD Phone: /~) ~ ~Deep-French D Shallow Trench ~ Bed Q Mound ~ Other LEGAL DESCRIPTION SoilRating: ¢'~GPD/Sq Ft. Total Depth from original grade: -- Subdivision: ¢ Depth to pipe bottom from 0dginal grade: Gravel depth beneath pipe Ft. Ft. 7ownship: Range: [section: Fill added above original grade: . Gravel length: ¢~ /' ~t, ~ ~. WELL: ~ New ~ Upgrade Grave~width: ~ i Number of lines: Distance between lines: Classification (Private, A~.C): ~ Total Depth: Cased ~o: Total absorption area: Pipe material: ~(O Driller: Dale Drilled: Static Water Leveh Ft Installer: *~ Date installed: Yield: GPM ~ Pump Set at: Ft Casing Height Above Ground:Ft TANK SEPARATION DISTANCES ~¢io ~¢~ Holding ~ S.T.E.P. To Septic Absorpt,on Ldt Holding Public/Private Manufacturer: Capacity~o~ From Tank Field Slalion Tank Sewer Lines Material: ~ Number of Compartments: Surface /CF /¢~ ~ LIFT STATION Water / ~ LineL°t ~/ ]01 ¢ ~ ~ Size in gallons: Manufacturer: ~ Foundation ¢/ /¢l ---- ~ ¢ "Pump on" leveler" level at: [High water alarm at: Cu by: Drai~ . __ Remarks: ¢¢~¢. ~¢¢¢-¢~'~ ~~ BENCH MARK Location and Description: kAssumed Elevation: EN61NEER'S SEAL S & S ENGINEERING ':'~ "': / Inspections performed by:Bagl~17034Rl~er,B"gl~ Al.,ka ~S77 2nd ~/~ ' ......~~,: ~' Department of Heal,. and Human Services approval~~~ _ ~ , -- ~ % ~ 'r;'~:~.~ . : ~ Reviewed and approved by: _ Date: ~- ~- ~ 72 013 (Rev 9/91) MOA 25 Permit No. SW950158 _ Page a of a 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:HIDDEN HILLS SUBDIVISION, BLOCK l, LOT 15 PID No' 01 112140 / .~z~-~10' U'I'IL. ESMT. 3 BDRM MOBILE FCO WANACAN WOOD DRIVE SEPTIC TANK (INTEGRITY VERIFIED) SCALE I" = 40' C01 I FINAL GRADE ~,~-~ 89.7' 86.8'-/ I 1000 GAL ~*-- , .... IsEPTIc I "-86.6 [ TANK / 79'5'~NAL 66.5 GRADE 60.5' NO WATER FOUND SWING TIES C02 110' 112.5' C03 105' 105' MX' 106 103.5 E.N,GIN EER'S. $EA L 72-013 A {Rev 9/gl)MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930138 DESIGN ENGINEER:S ~ S ENGINEERING OWNER NAME:SMITH CATHERINE L OWNER ADDRESS:6401 QUIET CIR ANCHORAGE, ALASKA 99502 DATE ISSUED: 6/02/93 EXPIRATION DATE: 6/02/94 PARCEL ID:01112140 LEGAL DESCRIPTION: HIDDEN HILLS BLK 1 LT 15 LOT SIZE: 17431 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITN: 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 (18LAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: ,~..~ iSSUED BY: DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER. P.E. May 21, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 69441211 funicipality of Anchorage EPARTMENT OF HEALTH AND HUMAN SERVICES 25 L Street .O. Box 196650 nchorage, Alaska 99519-6650 ~EFERENCE: Hidden Hills Subdivision, Block 1, Lot 15 {equest you issue a permit to upgrade the septic system ~erving the three bedroom residence on the referenced )roperty. The existing system is currently in a state of Failure and has reportedly discharged effluent onto the ground ~arlier this spring. The owners are currently pumping the ~ystem as needed to keep the system from overflowing. test hole was excavated and percolation test performed. The ~pproximate test hole location is shown on the site plan. ~e do not anticipate any adverse effects on the neighboring ?roperties by the installation of the proposed septic upgrade. If you have any questions, or require any information for your review, please contact us. ! ames?~lliams ivi eer er, P.E. additional 17034 NORTH EAGLE RIVER LOOP , SUITE 204 o EAGLE RIVER, ALASKA 99577 =-- 40' UPGRADE SCALE 0 .-.{ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION:j,..X3'r )~-~, I.~:J~E If /L/IDPErJ ~/~.~Township, Range, Section: A4L SLOPE SITE PLAN WAS GROUND WATER ~(.~ ENCOUNTERED? S IF YES, AT WHAT ,-- OL DEPTH? p E Oeplh Io Water Alter ~/z_~,' Moniloring? Dale: _ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17. 18 19 2O Reading Date Gross Net Depth to Net Time Time Water Drop · '/3 lO EU' ~ *' PERCOLATION RATE (.~E) (mmules/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~TAND (~ t_ FT COMMENTS.U m' ~' & ~ ENGINEERING ~ L PERFORMED BY: E~Jle River, Alaska 99577 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE: 72-008 (Rev. 4/851 CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Hidden Hills Subdivision, Block 1, Lot 15 6401 Quiet Circle GENERAL: The scope of the project consists of installation of a 35.5' long soil absorbtion trench containing 8' of sewer gravel between 4' and 12' below ground level. Construction shall be in accordance with 'the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. 3 o A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. of cover shall be insulated. page 2 Hidden Hills Subdivision, Block 1, Lot 10 A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If 'the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed- up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe° This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. page 3 Hidden Hills Subdivison, Block 1, Lot 15 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. page 4 Hidden Hills Subdivision, Block 1, Lot 15 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill° The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. oGRE' R ANCHORAGE AREA BOP' "GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MA,L,NG ADDRESS .-~-. t..'6,.-~"~'~' /.S~,~~ i~ ,,O~.~'/¢-~<,¢ SEPTIC TANK: DISTANCE FROM WELL [~}~:J~ INSIDE LENGTH .,,.oo. i ,/ NUMBER OF MANUFACTURER ~'~--~ -- MATERIAL('~'(hL"~-~'%' COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /(0Oc~' GALLONS. SEEPAGE PIT: NUMBER OF PITS [-, DIAMETER__ LINING MATERIAL ~ ~.~%,¢~ CRIB SIZE: BUILDING FOUNDATiON/'>~,~/~,.,,~¢,/ ADDITIONAL ABSORPTION OR WIDTH____ DIAMETER NEAREST LOT LINE''t;-~ O LENGTH__ DEPTH ~/) i~l &J~' - /)d' DEPTH DISTANCE FROM: WELL J ':-~ ~¢~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ]-~ ? ')',--- SQ. FT. WELL: TYPE ~,x.~-~ CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE: /0 CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE__ DEPTH '~:),-O0 DISTANCE FROM: SEPTIC ]()t~i SEEPAGE j~?/ TANK ' SYSTEM REMARKS DISTANCES: INSTALLED BY: '~'~'(¢'~ ;2~--'.A,~-~ ' REMARKS: Form NO, EQ-031 DIAGRAM OF SYSTEM G,A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "CI' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT~._~,~ INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO be SERVED FINANCED THROUGH TEST RESULTS SOil COMPLETION DATE ANTICIPATED SEEPAGE PIT DRAIN FIELD OTHER ~-'-~ NOTE= THIS PERMIT IS NO~ VALID WITHOUT :SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION bY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL. [ ~ ' SEPTIC TANK ~'--I .. SEEPAGE PIT . DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK /~) G f DRAIN FIELD WATER MAIN TO SEPTIC /TANK /~' DRAIN FIELD SEPTIC TANK.-- J00' . SEEPAGE Pit TO RIVER, LAKE, STREAM. -- SEEPAGE PIT ALSO CONSIDER AREA WELLS. seEPaGE Pit 0 I . DRAIN FIELD . CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S 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. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMiliar WITH THE REQUIREMENTS Of G..~LI~AT~CR ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAiD CODE. ~ {~ / --~*~ THE ABOVE ~tTE ' ARPLICANT'S SIGNATURE g' ~~~¢/~~ Performed for GREATER ANCUORAGE AREA BOROUr Jepartment of Environmental Qu, 3330 "C" Street. Anchorage, Alaska 99503 SOILS LO(] - PEROLATION TEST Dyess & Ziegler . cy Legal Description This form reports: Soils log Yes /~,[J[:J 9 1,974 GREAIER ANCIIORAGE AREA 8OROUGFI Date Percolation test Depth Feet I 1 ~ 12- I~ ft. Was ground water encountered? No If yes, at what depth? Reading Date Gross Time Net Time _.!!_e]_)tl~_t_'?___W~at~e_r_ Net Drop Percolation rate minute. -Proposed installat~on: ~e~page Pit .... Y.e..~ ......... Drain Field :)upth of' Inlet I)epth to bottom of pit or trench Lab EQ-040 (6174) R&M Civil ENGINEERING & GEOLOGICAL CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087- ANCHORAGE, ALASKA 99503 TELEPHONE 907--279-0483 TELEX 090-35419 Geologists Land Surveyor~ JAMES W. ROONEY, P. E. MALCOLM A. MENZIES, P,E., L.S. JAMES H. WELLMAN, P.E. August 7, 1974 AJt tS 1974 i ffi ~,REAIER ANCH©RAGE AR~A BOROUGH R & M No. 462057 RALPH R. MIGLIACCIO Engineer nfl Geologist. Dyess and Zeigler 8850 Runamuk Ave. Anchorage, Alaska 99502 Re: Test Hole and Soil Log Report for Sanitary System Lot 15 Block 1 Hidden Hills Subdivision Gentlemen: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 31, 1974, and those procedures outlined in a letter dated September 13,. 1971. by Mro Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 15 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 15.0 feet below ground surface. The final 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 service to you. Should you have any questions with regard to the above~ please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. JWR:kd xc: GAAB TH-1 7-30-7~ ORGANICS ORGANIC SILT, W/COBBLES 0.0I 0.5' 2.0I SILT, TRACE SAND (ML) NO WATER TABLE NOTE: Test hole excavated with tractor-mounted backhoe. Engineering ~ Geological Consultants Inc. ANCHORAGE FAIRi~ANXS ALASKA JUNEAU DYESS - ZEIGLER CONSTRUCTION LOG OF TEST HOLE ANCHORAGE, ALASKA 7 4 9 0 77 MUNICIPALITY OF ANCHOR • °' OCT 1 0. CO18 43.) • !;"'" Development Services Department " Phone: 907 4-4-7904 On-Site Water & Wastewater Section f " • • V .'43-7997 0/ 6 8 1 Certificate of On-Site Systems Approval Parcel I.D. 011-121-40 Expiration Date: / 1°- ^( [ 1. GENERAL INFORMATION Complete legal description Hidden Hills, Block 1 , Lot 15 Location (site address) 6401 Quiet Circle, Anchorage, AK, 99520 Joan Fogel and Jo Fisher Current property owner(s) Day phone Mailing address ". Same Real estate agent Day phone 2. TYPE OF DWELLING: 0 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: Private Well Q Private Septic CI Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received b . Date: )0- /C /g COSA to be r le.s=• o the engineer, unless otherwise requested by the engineer. COSA Fee $ 520 00 Waiver Fee $ Date of Payment 10 (10 201' Date of Payment Receipt Number Oa 1$8 C1 Receipt Number COSA# WC I 0 I5*1-3 Waiver* 5. STATEMENTOF;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 Crewdson Engineering, LLC Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 1 6 _/t -1 K' •• sl1l oe • �►� •..9 / 6. DSD SIGNATURE • System #1 Approved for .3 bedrooms games Ai Cietvdson �j C11527 System #2 Approved for bedrooms 11,`%A ' ?i 9F•!••-irk•• Disapproved 11 OFEssOrss= Conditional approval for bedrooms, with the following stipulations: C. Cn_ � E�/4T O m 0Gfil Rc rSgRVCC'n\�,� �1 c� Original Certificate Date: to C 2^ �S 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 I Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Hidden Hills, Block 1, Lot 15 Parcel ID: 011-121-40 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑� Well log is filed with Onsite (or attached) Well production at time of test 3.5+* gpm Date drilled 91974 Water storage tank volume 0 gallons Total depth 185 ft Well disinfected for coliform test? ❑ Yes 0 No Cased to 40+ ft ® Coliform bacteria is Negative 0 Sanitary seal is functioning correctly Nitrate c7. Off mg/L ❑ Nitrate less than MRL (ND) 0 Wires are properly protected Arsenic yyD ug/L ❑ Arsenic less than MRL (ND) Casing height(above ground) 12+ in. Collected by Crewdson Engineering Date of flow test for COSA 10"3"'$ Date of Sample 10-3-18 Static water level at beginning of test 172 ft. Comments *full flow at faucet, static water level didn't change during the test B. TANK DATA C. LIFT STATION Age of tank(s) 44 years ❑ Required maintenance completed Tank type/material con0f81e Age of lift station years ■❑ Standpipes/foundation cleanout per record drawing Lift station material Date of pumping ci-Z 0 rl g Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 1993 Adequacy test date 10-9-18 0 ALL standpipes present per record drawing Results 0 Pass For 3 bedrooms Total measured depth from grade 12 ft(max) Fluid depth prior to test 34 in Measured depth to pipe invert from grade 4 ft(min) Water added 1100 gal ❑ N/A—pressurized field New depth 79 in 0 Monitor tubes go to bottom of drainfield. If not, state Elapsed time 480 min depth into effective 0 Code-required soil cover over field Final fluid depth 71 in Absorption rate 450+ gpd Cl System presgakecl/ (Required if variant for greatai thgn 30 days prior to Any rejuvenation treatment(past 12 months) no* date of tes 4 A "-` If yes, enter date Gallonritroduced. �� alloris Commen /Deficiencies:'per:oWner' COSA Checklist yellow sheet" ' • E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ['Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ['Yes if No 90* ft Private Sewer/Septic Line >25' 0Yes if No ft Absorption Field on Lot> 100' 0✓ Yes if No ft Holding Tank > 100' ['Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ['Yes if No ft ['Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' 0 Yes if No ft Surface Water> 100' 0Yes if No ft Property Line > 5' ['Yes if No ft Driveway/Parking > 0' 0 Yes if No, comment Absorption Field > 5' ['Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ['Yes if No ft Water Service Line > 10' [' Yes if No ft Community Wells > 200' Q Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [' Yes if No ft Driveway/Parking > 0' ['Yes if No, comment Property Line > 10' [' Yes if No ft Wells on Adjacent Lots: Water Main > 10' ['Yes if No ft Private Wells > 100' 2 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ✓0Yes if No ft Surface Water> 100' [' Yes if No ft F. ENGINEER'S COMMENTS *waiver on file G. ENGINEER'S CERTIFICATION OFA.44 ‘1 %.cP•' f I certify that I have determined through field inspections and review oj.• --.1,. ••.y I of Municipal records that the above systems are in conformance with • . . r\ MOA COSA guidelines in effect on this date. p• •••; .cNEER'S••..'•,, p,J/ame_ A.Gewdson 1( C11527 •• i 11`o ppESS\O• �P�Air COSA Checklist yellow sheet A IL r i i)) ...17 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT i i '�‘ 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # 0SC181543 Subdivision: Hidden Hills, Block: 1, Lot: 15 A water sample revealed a nitrate concentration of 5.09 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. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org Nitrate Fact Sheet 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. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org CERTIFICATE FOR A Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF ON-SITE SYSTEMS SINGL *FAMILY DWELLING APPROVAL Parcel I.D. 011-121-40 1. GENERAL INFORMATION COSA# Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HIDDEN HILLS S/D; BLOCK 1, LOT 15 6401 QUIET CIRCLE * ANCHORAGE, AK * 99502 HERMAN HUMBERT Day phone 770-1690 ANCHORAGE, AK * 99502 Day phone 6401 QUIET CIRCLE * GERI CROWLEY W/ REAL ESTATE BROKERS ,OF AK Day phone 727-7777 3300 C STREET, #200 * ANCHORAGE, AK * 9950,.5 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] ' Individual On-site [] Individual Water Storage [] I 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 On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems 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 COSAs upon request to homeowners. Certificates of On-Site Systems 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 ,-ny 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 GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 3~7-6179 Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, DSD Guidelines & Regulations. The reported results described the performance of the ~ ' ~;1~. 4~/ ~ system under the conditions encountered at the time of the test,, and """" distances measured to readily identifiable features. The operational life of all wells and T_ septic systems depend on the local soils condition, groundwater levels that may ~ ~ ..... :' )I' /'YY"'I ...... ': ' ?"~ fluctuate during the year, and the water usage of the family being served by the system These condi§ons 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 i' ~'o ~ 's .: ' 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 solebenefltof the owner lis ted abe ve..Anyre liance up on or use of this reportbyany other person or party is. not authorized, nor will it confer any legal right whatsoever. ...... *02¢ .,, ;' ON-SITE Approved for ~ bedrooms. "" WATER AND Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ~ <~^Oo. ..° .~,-~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/'05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report' Other Original Certificate Date: ... ~.~ ' / / "/0 C= Municipality of Anchorage- Development Services Department CERTIFICATE Legal Description: WELL DATA Well type PRIVATE Date completed Total depth 185 OF Building Safety Division On-Site Water & Wastewater' Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 0N-SITE SYSTEMS APPROVAL HIDDEN HI'LLS S/D; BLOCK 1, LOT 15 *PER ARROW PUMP AND WELL INSPECTION. If A, B, or C provide PWSID# N/A 10/1974 Sanitary seal (Y/N) YES ~.ff. Cased to '40'+ ff. Date of test Static water level Well production 1'5 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA FROM WELL LOG 10/1974 168 g.p.m. Nitrate 3.91 mg./L. Date-of sample: 6/1/2010 Tank Type/Material SEPTIC/CONCRETE Tank size 1000 gal. Number of Compartments 'Foundation cleanout (Y/N) YES Date of pumping (,~/! J J'O ABSORPTION FIELD DATA I'BELOW EXISTING eRADEI Date installed '6,/20-22/1993. Soil rating ~r ft2/bdrm} 0.8 Length 55.5 ft. Width 3 ft. CHECKLIST Parcel ID: O/! ' 1 2,. 1 -/'7/ (~ SEE ATI'ACHED REPORT. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/1/2OLO 171 .ft. 5.5 g.p.m. Other bacteria 0 colonies/100 mi. Collected.by: GE(; Ltd. Date installed UNKNOWN Cleanouts (Y/N) Depression over tank (Y/N) NO High water alarm (Y/N) Eft. absorption area 568 ft2 Monitoring tube YES 6/1/201.0 Results (Pass/Fail) PASS Water added 525 gal. Total depth '12.~1 ft. Date of adequacy test Fluid depth in absorption field before test 55 in. Elapsed Time: 170 min. Final fluid depth 72 Any rejuvenation treatment (past 12 mo.) (Y/N & type) 8/30/1974 YES N/A in. System type. TRENCH Gravel below pipe 8 ft. 'Depression over field NO For 3 bedrooms New depth 76 in. 450+ g.p.d. If yes, give date - Absorption rate >= NONE KNOWN D. LIFT STATION Date installed "Pump on" level at in. Datum SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access (Y/.~ "Pump off" ~ High water alarm level at Cycles tested. Meets alarm & circuit requirements? 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ ,in. On adjacent lots. '90'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION. DISTANCES FROM' SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ Absorption field Surface water. 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 1-0'+ Surface water 100'+ Curtain.drain NONE KNOWN Wells on adjacent lots 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS *SEE ATTACHED WAIVER REQUEST. 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. (:;ARNESS Date (01'01 } I0 COSAFee ~ ~ ~/'tlc~ O, oo Date of Payment '7 ' I ~'- 7,- O ~, D Recei pt Number O ( O ~ ~ ~ (Rev. 11/05) Waiver Fee $. Date of Payment Receipt Number LOT 4 POWER POI SHI LOT 1 5 WIRE FENCE ~ 17,451 s.f. / / / / LOT 5 O' UTILITY EASEMENTS: HOME FENCE LOT 16 26.0' LOT 14 PLOT PLAN __ AS BUILT X__ SCALE 1" = 40' GRID SW 2222 Project No. 08-155 La n g (907) 522-6476 Registered Land Surveyors (907) 522-4625 kglanglsOalaska.nef / ]clanglsOalaska.nef & Associates, inc. ~500 Daryl Avenue, Anchorage, Alaska g9515-5049 Phone Fax I hereby certify fhaf I have surveyed the following described properly: LOT 15, BLOCK 1, HIDDEN HILLS SUBDIVISION (PLAT No. 70-358) Anchorage Recording District, Alaska, and fhaf the impravemenfs situated thereon are wlfhln the properly lines and do not encroach onto the properly adjacent thereto, fhaf no Impravemenfa on the praperfy lying adjacent thereto encroach on the surveyed premises and fhaf there are no roadways, transmission lines or other vislble easements on said properly except as indlcafed hereon. Dated this the [~+(A Day of ~C~'~¢X~'T~. , 'Z.~.~o~ , at Anchorage, Alaska It is the responslbillfy of the owner fo determine the exl~lenoe of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. LOST CIRCLE HIDDEN HILLS S/D; BLOCK 1, LOT 4 PROPOSED WELL RADIUS \ \ WELL 94.36' HIDDEN HILLS S/D; BLOCK 1, LOT 5 100' WELL RADIUS / / / / / HIDDEN HILLS S/D; BLOCK 1, LOT 16 HIDDEN HILLS S/D; BLOCK 1, LOT 15 HIDDEN HILLS S/D; BLOCK 1, LOT 14 SCALE: 1" = 50' QUIET CIRCLE GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. 31JDOR ROAD, sur[E 101 * ANCHORAGE, AK 99507 * PHONE (907)337-6179 * FAX (907)338-3246 * WEB~ITE: vcew.garr~senglneedng.com PREPARED FOR: l PHONE NUMBER: PAGE NUMBER: PATRICK HUMBERT I 907-770-1694 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: HIDDEN HILLS S/D; BLOCK 1, LOT 15 A.J.G. ~YPE OF WORK: DATE: WAIVER DRAWING 6/2/2010 (Rev. 01/05) GARNESS ENGINEERING G'ROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 7th, 2010 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Hidden Hills S/D, Block 1, Lot 15. Waiver of Separation Distance Between Well on Property (Lot 15, Block 1) and Septic Tank on Hidden Hills S/D; Block 1, Lot 4. The existing three (3) bedroom house is served by a private well and septic system. The well was drilled in September of 1974. The septic system on Hidden Hills S/D; Block 1, Lot 4 was installed on January 24, 1986. The distance was shot with a Topcon total station and found to be 94.3', from center of the well to the center of the septic pipe. Attached is a site plan and as-built surveys of the aforementioned properties. Based upon the graphical drawing, it appears that the septic tank is as close as 90 feet from the well; therefore, we are requesting a separation distance waiver of 90 feet. Justification for the waiver is summarized as follows: · The encroachment has existed for approximately 24 years and has not caused any noticeable problem. · A water sample was taken recently (6/1/2010) and indicated no bacteria present and reasonable nitrate levels (3.91 mg/L). · Attached is a well log for the subject property. The well is 185 feet deep. The well is drilled though several layers of clay and silty material. · The well head extends at least 18 inches above grade, has a sanitary seal, and has appropriate drainage around it. · The topography in the area of the septic tank slopes away from the well. If the septic tank were to overflow, the effluent would travel away from the well head. · There is a house between the septic tank and the well, so it would be impossible for overflowing wastewater to reach the well unnoticed. Based upon the aforementioned facts, it appears that there is minimal risk associated with granting the requested 90 foot waiver between the well and the septic tank. We also request that you waive the fee for this waiver, due to the fact that the well on Lot 15 was installed before the septic tank on Lot 4. .~ehay ly, Presid~ftt[ an] 4uq~st(~ s, please i? "[ contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com JUN-10-2010 04:02A FROM: TO:lBB82806416 P.1 Aarow Pump & Well Service, LLC P.,O, Box .110496 Anchorage~ AK 99511 Office: (907) 346-9355- Fax, (907) 333-8976 Eagle River: (907) 622.9335 CUSTOMER :~,.o.,I ,%,~.. JOB SITE ' QUA'NY~Y'~ ' ' ..... DE$CRiiiTi0N ................................... PRICE AMOUNT · . ~.. ,, ..... · t ~ II1' liT i. , ..... .................................. ~~,dts.~ol~o~;,~. ,'. ..... -t'. ~.t · ' -~" ........ ~n, · ............... - ~, '~ ~ ........... [ABOR HOURS RATE AMOUNT TOTAL MATERIAL. TOTAL LABOR Pay THIs aU0'SNT ~./0 ~' ~ Thank You ........... .. SIGNATURE (I,Hereby ^cknow edge the Satisfactory Completion of theAbove Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Walt Service, 'LLC. the rlghl to remove unpaid for equipment and charge for labor a ready performed & labor to remove unpaid for equipment;) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERV CE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.