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HIDDEN HILLS BLK 2 LT 1
lk A01 4 2L LO C Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW930189 PID Number: 01112169 Name: Wastewater System® New ❑ Upgrade Address: W 80th, Ancho aqe, AK ABSORPTION FIELD _6310 Phone: 243-4650 No. of Bedrooms: 3 1:1 Deep Trench k Shallow Trench El Bed El Mound F) Other LEGAL DESCRIPTION Soil Rating: 0.6 GPD/SG. Ft. Total Depth from original grade: 9.7' Lot. Block: Subdivision: 1 2 Hidden Hills Depth to pipe bottom from original grade. 5.7' Ft Gravel depth beneath pipe 4' Ft. Township: Range: Section. Fill added above original grade 0.5 Ft Gravel len th. 7 ' total FL WELL: N/A ❑ New �❑ Upgrade Gravel w5lh Ft Num7e_, flines: Dislalo+veer lines. FL Classification (Private. ARC): Total Depth: Cased To Total absorption area. Pipe material: Ft. FL 750 So. Ft PVC Driller: Date Drilled: Static Water Level: Ft. Installer: Whitters Landscaping Dale installed: 7/8/93 Yield: GPM Pump Set a1. FL Casing Height Above Ground: Ft. TAN SEPARATION DISTANCES R, Septic 11 Holding ❑ s.T.E.P. To Septic Absorption un Holding Public/Private giai,n„ Tank Manufacturer. Anchoraqe Tank s Capacity in gallons: 1,000 Material: Number of Compartments: 1 N/A J N/A �`•� �'"t�J �� V v N/A dN/A Steel 2 LIFT STATION N/A Size in gallons: Manufacturer: "Pump on' level at: "Pump off' level al: High water alarm at: N/A N/A Pump Make & Model Electrical Inspections performed by: BENCH MARK Location and Description: SW corner of porch stoop Assu med Elevation: inn n ENGIw ow 00 •Q� o0A`.1Co� • o 7k 0 • Gee 0000 Inspections performed by: Dates: 1st 2nd Department of Health i Htama rvices approval Reviewed and approved by:Date:' • •0eo• B •�®00sOo Theo re A. Johnson •• CE5191 0 �. ��+�f���o••�oo���g•°��`':- PRO � ® �� 72-013 (Rev- 9/91) MOA 25 Permit No. SVS 93y/�'39 Page --of 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: Z r' 9::f' PID No.: f ................................................... ..................... ........... ........ ................... ........ ......b................. ........................ ................... ........... .......... .......................................... ..................................... ..... E t � 100• I � 3 1 1 01 ' ...C..R;.,..,..��... :.....d..l ,..,.."................. ..............�.... SCS b' e . 1 ........................................................ yz. old (� C .0,2 JZZZ Nlocti 1 I 's au.ce� 10 01A' 01 .........../ .......................................52' 3„ G = 3,. ill I C.O. y 415' lo'r 0• I � 1 .„. r..,.m... ,.,.. ENGIN 't.., A X11 I �I G o • •••o o•000•e• Theodore Johnson : i4t CE 5191 �JlF, F ••��\ ����A OFFM1=�.�” M Permit lo. 640 q_e-Oe" ' Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Sox 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: x2.013 A (1193) - 1 f TN bore C lev BS 0 once 3L0 si BM 100.00 . "X.A1 ......... ...... . ....,i � .a.,�c � �. ^ r ...... �, ,.., . w' ..,..1.✓... ' ! r...l......... C7 . < .............. .. ft, C V a_ C�o� �ry ✓ Ti 7h a—eme, f e� a*�i a Sr D • I Wa-s �r°a�ew % !"�phb 0 ik-,'n�I CIA � 6-9� 40 n.. �i9t�.-i P_i��C'c."fiv-� ci�ot�o✓'�J{c. Gt-V`�� EN,� (�� i I cal r d r I "w' -v WOOS**A`4`�9�� $may, Sol �g Theodo Johnson CE 5191 a tjVI0 pAOFESS10�a�;•�'� PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 r/_) ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT --)_ PERMIT NUMBER:SW930189 DATE ISSUED: 6/28/93 DESIGN ENGINEER:TED JOHNSON, P.E., L.S. EXPIRATION DATE: 6/28/94 OWNER NAME:CARR CYNTHIA JOY OWNER ADDRESS:6310 W 80TH AVE ANCHORAGE, ALASKA 99502 PARCEL ID:01112169 LEGAL DESCRIPTION: HIDDEN HILLS BLK 2 LT 1 .LOT SIZE: 19269 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 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: ENGINEER SHALL PERFORM AN ADDITIONAL SOILS TEST AND PERCOLATION TEST AT THE TIME PRIOR TO CONSTRUCTION TO VERIFY SOILS. THE TEST SHALL BE RUN IN ACCORDANCE WITH THE E.P.A. ONSITE WASTEWATER TREATMENT AND DISPOSAL SYSTEMS MANUAL. MAXIMUM DEPTH OF THE WIDE DRAINFIELD TYPE ABSORPTION FIELD ')HALL BE 5.1 FEET. RECE I VED BY: ` i t.. /fJ� r'� f - — DATE: ' 7 l j ISSUED BY : )y' ' DATE: (o ' 2 / llkly/ e c✓ 0%s;�;, (/ ;/;wI \)-. / i lv/)F <<�; I ALASKA ENGINEERS P.O. BOX 111790 ANCHORAGE AK 99511-1790 TEL 907 349-1003 IN AK 800 478-1003 FAX 907 344-9936 June 10, 1993 Municipality of Anchorage Department of Health and Human Services On -Site Program, P.O. Box 196650 Anchorage, AK 99519-6650 Reference: 6310 W 80th Avenue, Anchorage, AK, Job # 93378 Enclosed is a design for modifications to the on-site sewage disposal system of the referenced property. These modifications were deemed necessary after performing an adequacy test on the subject site. We excavated around the septic tank and found it leaking and in need of replacement. On excavation of the seepage pit, we found that it was overflowing at the top and determined that a new disposal system would be appropriate. We investigated the site in the vicinity of the existing seepage pit. The site slopes gently to the south at about 2%. We performed a soils test near the center of a likely drainfreld location and found it to be sandy material (SM). The water table was located approximately four feet below the surface. We determined the most economical system would be to install a shallow trench under four feet of native fill. This determination was based on the uniformity of the soils encountered in that location (SM) typical of the Sand Lake area. We believe this is the most desirable location for a disposal system on this parcel where it will operate most effectively and efficiently. The system as designed complies with all Municipal and State regulations in effect at this time. If you have any questions about this system, please feel free to call us for clarification We are available for further phone consultations. Should an additional visit to the site be necessgtg�vYavy11?tk4t�e that visit to meet your needs. PLC R � G�'> 'eod Johnson, P.E. e� (P, r�i�cipal IMP' 4 . �s, o , bj/Enclosures a' J REGISTERED PROFESSIONAL ENGINEERS BUILDING INSPECTIONS INVESTIGATIVE ENGINEERING LITIGATION SUPPORT CONSTRUCTION MANAGEMENT Permit No. Page of 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:����N A?A 6I.1 5Z,k Z PID No.: 72-013 A (2/81) MOA 25 Permit No. Page of 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: Aoleor !`i','!� Lo /Y S/0CPIr) Nn Permit No. ,^ Page __.ch F Municipality of Anchorage I� DEPARTMENT OF HEALTH AND HUMAN SERVICES JUN1993 ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage P.O. Box 196650 • Anchorage, Alaska 99519-6650 *Telephone MOM & Human services On -Site. Wastewater. Disposal System and/or Well Inspection Report Legal Description: Z5'lk PID No.: i W ,.....W_ .............. ._.......... ......... ,.., ..... :.....,.,...................., i i /AA o1A: Jo' r .,.......... .... ,.....,............,.,..w....,............ ............................. .................... _. . i { 5, ................. a,.. .... G� l - i /- aPno D tin°o P ' i nc�ano �9 10 5, � Roc,K. l000 �allo�. ..................................................................................................................... i ................... ................ ....... ....... .......................... ............................................ ......i . ...................................... . i i ENI i W ���� t ° eso% e- eo •eoeoae i e• so• ee ose0000. Theo re k Johnson PROF;SSI��P� Municipality of Anchorage 1 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED GINELR'S SEAL) Y , DATE PERFORMED: J.'-G.t'""tT`i�• LEGAL DESCRIPTION: /ip�(/iltit5 �(Q�O� ( Township, Range, Section CjEP'F SLOPE 1 �?� I F 2 4 7 Date Gross Time Net Time Depth to Water Net Drop Z' z` Z• e/ • Z t` Z 9 z9 Z`z� to - 3 U �.� 12 x'22 13 14- 15- 16- 17 4151617 18 19 20 COMMENTS — CSM � 14 old AS GROUND WATER /' lJ ENCOUNTERED? /yl�� (� S IF YES, AT WHAT L DEPTH? 0 P E Depth to Water After Monitoring? knk.e— Date: SITE PLAN Reading Date Gross Time Net Time Depth to Water Net Drop e/ 3 U �.� 1- � PERCOLATION RATEc(1RnUtC3/inCtrj� C,I TEST RUN BETWEEN FT AND 1' !�FT DIAMETER PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 71.-008 (Rev. 4/85) OkIll GRE „R ANCHORAGE AREA R0, 1GH or Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 SEPTIC TANK: DISTANCE((�������� QQ NUMBER OF FROM WELLMANUFACTURER MATERIAL 30yV-A 11 '' _COMPARTMENTS_' INSIDE LENGTH --INSIDE WIDTH _LIQUID DEPTH_ LIQUID CAPACITY IDa a GALLONS. SEEPAGE PIT: NUMBER OF PITS(�'y�. DIAMETER __ LINING MATERIAL ` _ CRIB SIZE: BUILDING FOUNDATION ADDITIONAL ABSORPTION OR WIDTHat LENGTH(r! DEPTH (a DIAMETER_DEPTH DISTANCE FROM: WELL _. ' C) TOTAL EFFECTIVE NEAREST LOT LINE L_ . ABSORPTION AREA (WALL AREA) _SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL_ OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: Ow1"n_ ` LOT SLOPE'.- REMARKS: LOPE: RF_MARKS: NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK �_ , SYSTEM- DIAGRAM YSTEM_ DIAGRAM OF �YSi'EM G.A.A.B. Form No. EQ -031 REPORT ON-SITE SEWAGE DISPOSAL SYSTEM �INSPECTION NAME MAILING ADDRESS 3 '3f-�'3 9-3 LOCATION Clyfl .C:1 LEGAL DESCRIPTION I �Z JPHONE � �C7�z,—` 'e}t�`�<— SEPTIC TANK: DISTANCE((�������� QQ NUMBER OF FROM WELLMANUFACTURER MATERIAL 30yV-A 11 '' _COMPARTMENTS_' INSIDE LENGTH --INSIDE WIDTH _LIQUID DEPTH_ LIQUID CAPACITY IDa a GALLONS. SEEPAGE PIT: NUMBER OF PITS(�'y�. DIAMETER __ LINING MATERIAL ` _ CRIB SIZE: BUILDING FOUNDATION ADDITIONAL ABSORPTION OR WIDTHat LENGTH(r! DEPTH (a DIAMETER_DEPTH DISTANCE FROM: WELL _. ' C) TOTAL EFFECTIVE NEAREST LOT LINE L_ . ABSORPTION AREA (WALL AREA) _SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL_ OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: PIPE MATERIAL: Ow1"n_ ` LOT SLOPE'.- REMARKS: LOPE: RF_MARKS: NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK �_ , SYSTEM- DIAGRAM YSTEM_ DIAGRAM OF �YSi'EM G.A.A.B. Form No. EQ -031 Dim GREATER ANCHORAGE; AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT 7-, 71 /1 - I ------ NAME OF APPLICANT "�✓r"''-' 1 ' A INSTALLATION LOCATION LEGAL. DESCRIPTION '1'J INSTALLATION OF: SEPTIC TANK �^- TYPE AND SIZE OF FACILITY TO BE SERVED _ FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED MAILING ADDRESS SEEPAGE PIT 1n DRAIN FIELD 7/ i.., PERMIT NO. PHONE -3 j j OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT 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. SEPTIC TANK SIZE I u of) TYPE MINIMUM DISTANCES, REQUIREMENTS I FOUNDATION TO SEPTIC TANK SEEPAGE AREA SIZE TYPE I FOUNDATION TO SEEPAGE PIT "� ` DRAIN FIELD •� 1 SEPTIC TANK TO SEEPAGE PIT WALL sl SEPTIC TANK SEEPAGE PIT L1 DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK /6 U SEEPAGE PIT �G(/ DRAIN FIELD ALSO CONSIDER AREA WELLS. / � r WATER MAIN TO SEPTIC TANK / U SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT _, DRAIN FIELD , 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 REGULATI S R GARDING INSTALLATION. ,1 OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM 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 � >L�eL/.�:.i 7// APPLICANT'S SIGNATURE I I I I I I I E I I I I I i I I , I CERTIFY THAT 1 AM 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 � >L�eL/.�:.i 7// APPLICANT'S SIGNATURE ®Municipality ®f Anchorage On -Site Water and Wastewater Program (907) 343-7904 _S _F E -1 Certificate of On -Site Systems Approval Parcel I . D. 011-121-69 1. GENERAL INFORMATION: Complete legal description HIDDEN HILLS; BLOCK 2, LOT 1 Expiration Date: t — 1710 2. Location (site address) 6310 WEST 80TH AVENUE *ANCHORAGE, AK 99502 Current Property owner(s) JASON AND CHRISTINA CARTER Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: �� 1 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry The describe the the the date/s the 0000�Op practices. reported results condition of system/s on of evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, T.. 4 tuate during te year), quality (marials and at may groundwer levels workmanship), andth(ehwater usagecof the family utilizing the system/s. oThesesconditions can vary, and ..truction • ... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of ' •' "' ..• • • • .. '• e A. Carnes the well or septic system. GEG makes no representation whether an alternative well or septic system�, . o04 can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to 9 C perform the evaluation. Reliance upon the information provided in this report by any other person or444eap party (including subsequent property purchasers) is not authorized, nor will it confer any legal right fo fe55;F�"'" ��0 whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms ���Y OF Disapproved �' Conditional approval for bedrooms, with the win 4VIp�0ns�y WATER AND m= [[]]WATER By: �_ N^- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Legal Description: HIDDEN HILLS; BLOCK 2, LOT 1 If more than 1 septic system on lot: COSA Checklist # of *PER GEG INSPECTION A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1974(?) Total depth *127.8+ ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected x - Casing height (above ground) Ir„r� 2� Date of flow test for COSA 9/16/19 Static water level at beginning of test 123.8 ft Comments Parcel ID: 011-121-69 Structure served by this system Well production at time of test 6.7+ gpm Water storage tank volume N/A gallons rinfected for coliform test? ❑ Yes FE-1No coliform bacteria is Negative Nitrate mg/L Rkitrate less than MRL (ND) Arsenic ug/L ORIArsenic less. than MRL (ND) Collected by GEG Date of Sample 9/12119 SEPTIC TANK HAS 3.5 FEET OF SOIL COVER - NOT INSULATED PER MOA RECORDS B. TANK DATA d. LIFT STATION Age of tank(s) 26 years Tank type/material sEPTGSTEE Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping C ` .?� ` I D. ABSORPTION FIELD DATA Which system tested (date installed) /8/1993 ❑ ALL standpipes present per record drawing Total measured depth from grade 7.4+ ft (max) Measured depth to pipe invert from grade 2.25 ft (min) ❑ N/A — pressurized field ❑ Required maintenance com Age of lift station ars Lift station mater' Adequacy test date 9/18/19 Results 7 Pass For 3 bedrooms Fluid depth prior to test 7.75 in Water added 893 gal New depth 26.5 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 130 min depth into effective 4.41 p ❑ Code -required soil cover over field Final fluid depth 21.75 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced 1766 gallons If yes, enter date Comments/Deficiencies. EAST TI;ENCH COVER VARIES FROM -1.9'702.5 WEST TRENCH COVER VARIES FROM 2.53.9 -(BOTH TRENCHES SHY ON COVER) -SEE ATTACHED EMAIL A PRESOAK AND ADEQUACY TEST WAS INITIALLY ATTEMPTED ON THE WEST TRENCH. IT DID NOT MEET MOA ABSORPTION REQUIREMENTS. THEREFORE, A PRE-SOAK AND ADEQUACY TEST WAS PERFORMED ON THE EAST TRENCH. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' . ❑✓ Yes if No Community Sewer Manhole/Cleanout > 100' F✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ 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' Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No **5+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓Q Yes if No _ Water Main > 10'✓❑ Yes if No ft Community Wells > 200'✓0 Yes if No _ Water Service Line > 10' ❑✓ Yes if No * ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' ❑✓ Yes if No * Water Service Line > 10' Yes if No ft Community Wells,> 200' ❑✓ Yes if No Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS *LOCATED PER PREVOUS COSA **CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 ft ilL ft u'1 DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org%onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC191478 Subdivision: Hidden Hills Block 2 Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. ONEii1 I17g/�Q(4..$S»r���J �i� OiSi�1�j rJ7fi illlll11111 Oi� a Jeff Garness From: Sonja Blewett Sent: Monday, September 30, 2019 3:45 PM To: David Garness; Jeff Garness Subject: Fwd: No freezing issues Can you print and put on my desk Sent from my iPhone Begin forwarded message: From: Christina Carter <christinamcarter85@gmail.com> Date: September 30, 2019 at 3:18:18 PM AKDT To: sola@garnessengineering.com Subject: No freezing issues Hello, Jason and I have never had any septic or well freezing issues at 6310 W 80th Ave as long as we have owned. Thank you. Christina Carter Sent from my iPhone Municipality of Anchorage 0 `= On -Site Wafer & Wastewater Program � - - 907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-121-69 Expiration Date: h ' .21 1. GENERAL INFORMATION Complete legal description HIDDEN HILLS SID; BLOCK 2, LOT 1 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 6310 W. 80TH AVENUE, ANCHORAGE, AK, 99502 ROBERT KLEMKE Day phone 6310 W. 80TH AVENUE, ANCHORAGE, AK, 99502 BRIAN TENELL W/ CENTURY 21 Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex. ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 244-4594 230-1081 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site E Inriividttal Water St_o_ race n Individual Holdinq tank ❑ Community Class J Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ waiverNariati request for: N/A Distance: Received by: C /n Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 51R60 J` Date of Payment R%a4llcd Receipt Number gQ9&0- 0&jr r— COSA# do C'[LIMa Waiver Fee $ _ Date of Paymen Receipt Number 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. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 `ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, L. D. 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 sails 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 evaluatorofthe system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. 337-6179 Date 1 f 3I lq G bedrooms, with the following stipulations: 1 a ?ROFESS�CN�4 tOF((q�C(4i `�a�V�eP tiG ON-SITE WATER AND %arocTFWATER Original Certificate Date: �� P The "Icip rty orArero-rage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory reap imwn» Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: HIDDEN HILLS S/D; BLOCK 2, LOT 1 Parcel ID: 011-121-69 A. WELL DATA "PER GEG INSPECTION. "ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) NO Date completed UNKNOWN Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth "122* ft. Cased to ""40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/15/2014 Static water level ft. 118 ft. Well production g.p.m. 8.6+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: <5 ug./L. Date of sample: 9/3/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments ? Date installed Cleanouts(Y/N) 7/8/1993 YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 9/2/2014 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 7/8/1993 Soil rating .p.d./ or ftbdrm) 0_6 System type DUAL TRENCH Length 75 TOTAL ft. Width 5/5 ft. Gravel below pipe 4/4 ft. "8.3/ Total depth '7.2+ ft. Eff. absorption area 750 ft2 Monitoring tube YES Depression over field NO Date of adequacy test ""9/15/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 35 in. Water added 600 gal. New depth 45 in. Elapsed Time: 125 min. Final fluid depth 42 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date ""NOTE: NEW MT WAS INSTALLED IN WEST TRENCH ON NORTH END. NEW MT ONLY EXTENDS 3.43' INTO4' EFFECTIVE. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED USING THE INVERT OF THE DRAINPIPE AS THE VERTICAL DATUM. ONLY WEST DRAINFIELD WAS TESTED FOR APPROVAL. EAST TRENCH WAS DRY AT TIME OF INSPECTION. NORTH 4' OF EAST TRENCH HAS 38" OF SOIL COVER OVER THE INVERT. 2oN 611 D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y/N) "Pump off"level at wa er alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lot: Absorption field on lot 1D0'+ On adjacent lots 100'+ 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 254 Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 1004 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54 Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1(7 )'+ Building foundation 104 Water main N/A Water service line *101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *HOMEOWNER HAD WATER LINE PROFESSIONALLY LOCATED. GEG CONFIRMED SEPARATION AFTERWARD. SEE ATTACHED PICTURES. 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. GARNESS Date (Rev. 10/12112) CE- -•n..........- -ROFESSt :. >ae �� cs.nar rAEA> auRpNe �A� Pi(A nnAwo sEiOMX \ 26,0'LU& \ s� 0f \ �s'V� O Fx- •h 2 O I �y I � 12.9' .O.s ter• \� \ C �+ WELL scy, Q q?• L____C__ —— _ —__ 'R. — -- tounL �sMr rs r 0 689, 150, BUT UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCT✓ON OR FOR ESTABLISHING BOUNDARY OR FENCE LINES, THE SURVEYOR TAKES RESPONSIEIUTY FOR THE "MAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY, USTEO DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT sORVEY SURVEY TWE FOUNDatf07+ AS -MILT SYMBOLS SET REBAR =F ORAINACE 0 ASPHALT ❑ RNAL SIRUCT C AS MJILT O FOUND REBAR p_ WOOD FENCE '��^I� CONCRETE AS-BUILT .w xvEY ... 1MOCIL"), [j PLOT PLAN .. - SU 00 OD ASSUMED ELEV. X- (-X METAL FENCE ® WODECK BF CE'P'ni1 g O CCR NS& PLOT PLALOT S.URVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE VALL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, Wa S, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTEO. SURVEY CERTIFICATION ++��r�M� Prepared by Robert E. Johns, Jr. &Assoc. PLOT PLAN LwL. ewwry aril �.. P•wroo•r �+>w Iw•m, i .•+E,..... ���P�•••' •' - Professional Land Surveyors nx la r°«° ^'° e..ne.A em eW AaM r..ne «-eb1r�e o « ew w mn.. m« �••�• +� 1700 Brink D19re, ANCrIORADE� ALASKA 99504 Scae: I, I 1 ^ 40 ROC. Lot S.F. Rea. Plot File No, K �+•�••° ^�• ^^a •s"•L '• .= �' 8 FOUNDATION AB-BUILT LRewetA A.F.nby..eyPNI EMa�w�,..w„Bw = • ••r••••'% r,. • i Date S�rK e: '� 09/22/14 Drawn b "REJ Checked b, MK ........... ............. r ROBE OH.- Date Drawn: 09/22/14 Grld: 2222 r a.n •nww.. L ��� a FINAL SIHUCIURE AS-BUILT � $j •• � 21 — .•` +` � • � re„ ••"•.,•.. La0a1 DescriPHM: I, Aae1 a oa.n x. L+er •evOna1l CN: �"a: �"a'aww u �1� oy •,....... .....••• y3 Lot 1 Block 2 P �e�B.�i� t���MMwnion � HIDDEN HILLS ���\\������ i"Y Date Drilledt 9-4-83 Static stater Level 125 feet Draw Down N/A feet Tyne Material Drill 0 feet to 11 Send 11 feet to 8a Gravel 95 feet to 110 Sand 110 feet to 140 Gravel 140 feet to 150 mater Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 L• I I V t F/7 RY�'tt.I/�/� �'C/ �S Gallons Per Minute in Total Peet of trising ISO STATE OF ALASKA DEPARTMENT OF NATURAL RESDURES Division of Geological ai Geophysical Surveys Drlllfng Permit No. LOCATION OF WELL (Plato complete either to. Ib or le.) A. O. L. No. Ia. Borough Anch H11MrWJ!n Hills Lot 5. slackIb. 1 {/4gi1a. —.af_of_.ef� Steffen No. TownshlpNa eo Range Erin W�u MarHlon- Ia. DISTANCE ANO DIRECTION. FROM ROAD INTERSECTIONS Street Address end Area of Wall Location S. OWNER OF WELL! Bob Albina Address: Sand Lake E. WELL LOB Typo FblowSUrtao Bottom WELLDEPTH! 4. WELEPT! (flAvi) 0. DATE OF TPLETlL � grown top sir' _ 0 - [4use, 0d4ltad ❑Bared 0Other: Gra clay Grey 'Rrnwr sand 10 T. Usa: 2 DamitsHe 0 peflffd Bueply '0 thdeetry Irrigation 0 ltseborge 0 Commerical 0 Toot Wall other: yard n 1 Brown sand & silt 157 163, S. CASIMS, 0 ThrtedoA ❑ Welded die■: A In. lo 1-a ft. Depth Weisht_17 lbs./ft. dram. In. to ft. ow" 11I41uo it. Gravel 162 184 B. FINISH OF WELL: Typo: Open clw fr, 6 inch i1el�Mgh Slag: Length: Sat between ft, god ft. 34oklllling '.Srawl peak 10. STATIC WATER LEVEL` J;0 11. . Above er 50 Below land coffees Data Equipment used; - II . PUMPINS LEVEL below I4Rd surface and YIELD 164 ft. affar__hrs, pumping_ 0 q. p. m. ft. akar. bre., pumpingg.p.m. IS. aROUTINa Well Grouted: Yee 0 No -- Materiel: Q. most Cessont a'ofier:, - 13. PUMP: (if available) No Length of Drop Pipe it, capacity g.ptm, O Subm. 0 dot 0 Ceetrlficol 0. Other 14..REMARKS: Bailed 0 10 gpm for 4 hrs IS. WATER WELL CONTRACTORS CERTIFICATION: - IB. Water Temperature _° Q R [I C This well act dril it r r pilon and this report Is true to Ihs best of m know Nd a god belief) Sommerville 1�s�y �r��i�na p A 13 ? S � g Registered. Bvatnata. Name Contract License Number address: 9 9 slgn.e: � k god Representative Form 02•WWR (ll/SI) COPY Distribution: ,. O oats:— WHITE •State palls, PINK - Driller, CANARY' Customer r, v, oox w -i zz4 • i,7ivc international Airport Road Y " (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Tom Green Use of Wel Location (address of: Township, Range, Section, if known; or distance main road L241 81K, l', Hidden }{ills Subdy, Size of casing----6---Depth of Hole -2 -2 -82 --feet Cased toM2 feet Static water level.—LO-k—'—ft, (06Vd) (below) land surface. Finish of well (check one) open end ( x ); Screen ( ); Perforated ( ), Describe screen or perforation_ MOTH, Well pumping test atm—gallons per (lfdtir) (minute) for -1 --hours with 1O0� ft, of drawdown from static leveI.. . Date of completion 7 -TO Aug. 1475 WELL LOG Depth in feet from ground surface Give details of formations.penetrated; size of material, color and hardness — —TOS- S T.I ty_ 35. TO 40 Silty ravel 5 —I-Q—TO 60 _Sa.1. —TOS Gravel. I� 79 TO l.O1. `el Los RSI 101 TO loa Sand 3 / 1.04 TO 1.11 Gravel: silty; io4se 7 i 11 TO 1.14 GrayA.1 I little _? L`LTO S_ (:rev -I' &5 viva 116 TO 179 1orwe arAyr"I 1171 TO 200 .2n:0TO TO --TO- TO TO 1VVVWA CerciHnd Contractot 2 — STATE �V! MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING'2) r� q T Parcel I.D. # 0111916g HAA # —Q C� 1 1. GENERAL INFORMATION Complete legal description Lot 1 Blk 2 Hidden Hills _ Location (site address or directions) 6310 West 80th, Anchorage, AK Property owner Mailing address Lending agency Nati.onal Bank of Alaska Day phone 766-8196 Day phone Mailing address Agent mars, Inu1'acy RF/MAX Day phone 257-01 39 Address RE/MAX, 2600 Cordova, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 V 0 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water _ NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site _x Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Ray. 1/91) Front MOA #21 ianvow aD°a (16A'A°e)szo-zL -NioM s, aau!6ua leuolssaloid agl u1 suo!sslwo jo saoaja ao1 alglsuodsai IOU sl a6eaogouy 10 AllledloluntN agl 'panssl si aleollpeo a aaolaq elep azAleue ao suolloadsul lonpuoo IOU op SHH010 saaLo!dw3 -sluawailnba.(alels pue leaapal ulepao 4s!les of aapao ui suo!lnipsui bu!pual alagl pue sawog 10 s.(asegoind of Asalinoo a se slgl saop SHHa agl'e�sely 10 alelS aql ul paaalsl6aa aaaul6ue leuo!ssalad luepuadapu! ue (q anoge g gdei6e.(ed ul uan16 suo!leluasaidaa agl uodn �(luo paseq saleoll!liao lenaddy Al!aoglny glleaH sanssl (SHHG) sao!naaS uewnH pue glleaH 10 luawlaedaa a6eaogouy 10 Al!led!o!unN agl ,h -,z l— ale(] :suollelndlls 6uimollol aql gl!M 'swooapaq .v ��••• '.°\I, - go, LUSK u:osuyo!� " aigpoayl £6 WL C� ' alea .S.,1 "21*d , sluewwo0 leuoll!ppy aol lenoidde leu0111pu00 •panoaddeslp swooapaq aol pano.iddy T- 3unIVNJIS SHHO nleubts s,aaaulf u3 ssaa ppy £00T-6fi£ auogd SzaauT c>3 exSPTK mniT@-4T1D wal3 10 aweN -uolloadsul slgl )o alep aql uo 109110 ul suo!1elnbei pue 'seoueulpio 'sapoo alelS pue ledlolunn Ile qI!m aouelidwoo ul sl walsAs lesodslp aalemalsem ao/pue /\lddns aalem alls-uo aq1 'uolloadsul pue u01le61-sanul Aw woal pue seig a6ea0gouy 10 Al!IedlolunW 0141 woal paulelgo uollewaolul aql uo paseq legl Al!aan aagpnl I -ulaaaq paleolpul ainlonals to adAl pue swooapaq 10 aagwnu aU1 aol alenbape pue leuollounl'ales sl walsAs lesodslp aalemalsum ao/pue Alddns aalum al!s-uo aql 1e41 snnogs u011e0lldde lenoiddy Al!aoglnV glleaH slgl 10 u011e61lsanu1 Aw legl Aluan I 'molaq umogs alep uo!leplleA ag110 se pue olaaaq pexllle leas Aw Aq pa1lllaao sy m .9 »33NION3 AS N01103dSNI d0 1N3W31d1S 'S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T.1 Rl k 2 Hidden Hi 1 1 t; _Parcel I.D. 011121.69_ A. Well Data Well type private If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth 247' Sanitary seal (Y/N) _ Date of test Static water level Well flow Pump levell Date completed TJnlpa�,rA Driller Unnkeon Cased to 247' Casing height _1.5' FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: _Wires properly protected (Y/N) y m _ c AT INSPECTION o 2 O 6/27/93 yam! y 117 —' g.p.m. 7 g.p.m.n .� 245' P � cf+ a c oc Septic/holding tank on lot 140' ; On adjacent lots 100+ Absorption field on lot ; On adjacent lots Public sewer main NSA Public sewer manhole/cleanout pA Sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Petroleum tank Collected by: Other bacteria Date installed 7/8/93 Tank size 1, 009 gay Compartments 2 Cleanouts (Y/N) v _Foundation cleanout (Y/N) _ y Depression (Y/N) High water alarm (Y/N) N Date of pumping tested (Y/N) Purnper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 140' On adjacent lots To property line 45 Absorption field Surface water/drainage 2nn+ 129' Foundation 7' Water main/service line _ 25 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed N/A Size in gallons N/A Vent (Y/N) N/A "Pump on" level at High water alarm level N/A Meets MOA electrical codes (Y/N) N/A Manufacturer N/A Manhole/Access (Y/N) N/A "Pump off" Level at _Cycles tested N/A SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot N/A On adjacent lots N/A D. ABSORPTION FIELD DATA Date installed 7/8/93 Soil rating (GPD/Ft2) 0.6 Length 75' Width 5' Gravel thickness Total absorption area 750 ft. 2Cleanout present (Y/N) Y Date of adequacy test New system Results (pass/fail) - Water level in absorption field before test N/A Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: S Surface water N/A _System type Shallow drainfield Total depth 5.7' Depression over field (Y/N) N for _ 3 Bedrooms After test N/A If yes, give date Well on lot 104' On adjacent lots 116' Property line To building foundation 14' To existing or abandoned system on lot On adjacent lots 100+ Cutbank N/A Water main/service line Surface water 700+ Driveway, parking/vehicle storage area 5' Curtain drain N/A E. ENGINEER'S CERTIFICATION 10' 10' I I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. _sus__ A. Johnson, P.E, L.S. HAA Fee $ / 7D`('FD Date of Payment 7--M Receipt Numberr �D u 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number 07/19/93 09:19 CTRE ENVIRONMENTAL LAB SERVICES - 9073449936 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES N0. 751 904 ,Nrr 1°^° REPORT of ANALYSIS Chemlab Ref .# # : 93. 3390-1 5833 B STREET ANCHORAGE, AK 995113 Client Sample ID :L1 132 HIDDEN HILLS TEL: (907) 562.2343 Matrix :WAVM FAX; (907) 561.5301 Client Name :CRITERIUM AK ENGR WORK Order :68285 ordered By Report Completed :07/19/93 Project Name Collected :07/14/93 @ 10:00 hrs. Project# Received :07/14/93 @ 10:25 hrs. PWSID :UA Technical Director: Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: EMJ. WITNESSED BY 8J. QC Allowable Ext, Anal Parameter Results Qual Units Method Limits Date Date Init -----------------------____-----W___------_----------... Nitzate-N 0.10 U mG/L -------------------- __- EPA 353.2/300.0 10 -__. 07/15 LLH See �Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification .limit. LT Less Than D = secondary dilution. GT Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL _' k(n OF ON-SITE SEWER AND WATER FACILITY 264-4720 I Application Date 30 1 ���r li _( n eo 1. GENERAL INFORMATION (a) Legalescription (include lot, block, Iubdivision, section, township, range)LL dLA-� LL4 I- Location (address or directions) " (b) Applicant Name RON AV_ � WC i 6 Telephone: Home 46 TO Business Applicant Address (c) Applicant is (check one): Lending Institution l❑f ;IOwner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending Institution—�f7YiCL5 N2`Yi la 1 C1� (�} Telephone _510 _3-131YD1 Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the ff owing address: P,2 0 z1 /J a .t 2. TYPE OF RESIDE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well L Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE D POSAL Onsite Public ❑ Community ❑ Holding Tank ❑ 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 i2-025(11,8111 5. ENGINEERING FIRM PROVID, a INSPECTIONS, TESTS, FILE SEARCH, l A 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 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 CnrWt� �n �'�tct�� 6L Telephone Addre Date 6. DHEP APPROVAL Approved for 3 Approved i (?�p�� •ems i0 �a = ru J. Corrin / V% A° Engineer's Seal bedrooms by k� g Date Disapproved Terms of Conditional Approval Conditional c�hep 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 12-025 (11/84) MUNICIPALFfY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (MAA) MAR 11987 CHECKLIST - FEBRUARY 1984 264-4720 C p Legal Description: ,, A }}''�aam 01 I 11 block-� A. WELL DATA Well Classification Tfs'1(A�_ If A, B, C,,D.E.C. Approved (Y/N) _L• Well Log Presentt`(�Y�/1N) U' Date Completed (A/Ahi On — Yield _ Total Depth C2L _ Cased to OV '7 ' Depth of Grouting &A Static Water Level 1a1 I Pump Set At d9_2 Casing Height Above Ground �'�� Sanitary Seal on Casing (Y/N) B 15 Electrical Wiring in Conduit (Y/N) U0-41 Depression Around Wellhead 'Y/h'% i\J Separation Distances from Well: 1 _{- To Septic/Holding Tank on Lot IOU ; On Adjoining Lots t J I. -i To Nearest Edge of Absorption Field on Lot —lam? _; On Adjoining Lots ��+� ' To Nearest Public Sewer Line N A To Nearest Public Sewer A Cleanout/Manhole N A- To Nearest Sewer Service Line on Lot I Water Sample Collected by &uX Q Docxr ; Date /-I M cve-k Water Sample Test Results Comments dlod _ c - OTIu Q ®l�iVl4� P��drYYIQYtS OC> O{ (n45�C�.��cLkOr� _a7Dom, 07g. B. SEPTIC/HOLDING TANK DATA Date Installed Size. Q�l114Y1 No. of Compartments w' Standpipes (Y/N)Q`� Air -tight Caps (Y/N) UPS5 Foundation Cleanout (Y/N) /�O Depression over Tank (Y/N) N4 Date Last Pumped _a MarA, l Pumping/Maintenance Contract on File (Y/N) N ; for Holding Tank High -Water Alarm (Y/N) IV Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/Holding Tank: To Water -Supply Well 1,30), To Building Foundation To Property Line J1 To Water Main/ServicenLine Course &L.— Comments Firom Page 1 of 2 72-026(11/84) To Disposal Field — JJ 1 To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / r V� 'nl)Type of System Design _IXZC�Q '�1 Date Installed -1- z-- r7 Length of Field /y # Width of Field Depth of Field 0 Gravel Bed Thickness �I A Square Feet of Absorption Area tt Standpipes Present (Y/N) N G Depression over Field (Y/N) Iy 0 Date of Last Adequacy Test may-0-1n,J�E5% Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well f UU To Building Foundation 51 Lot N To Water Main/Service Line N. ff To Stream/Pond/Lake/or Major Drainage Course To Property Line To Existing or Abandoned System on On Adjoining Lots f �� To Driveway, Parking Area, or Vehicle Storage Area C Comments* FfOm D 4.14 S. D. LIFT STATION,, . Date Installed I, 't Size in Gallons\ "Pump On" Level at,__ High Water Alarm Level Tested for Electrical Codes (Y/N) Comments To Cutbank (if present) Dimensions Manhole/Access (J "Pump Off" L el at V nt (Y/N) mping Cycles during Adeq ** Check Pfr(nitted BeoroW Rating Against HAA Request ** Meets MOA I certify Uthrph9<e , verified, or conformed to all OA and HAA guidelines in effect on the date of this inspection. Signed Date goCompa cif• 24MpOA No.tF' 7" Receipt No. © 0 / 0 v C� .3/ Date of Payment AIA Amount: $ O n Engineer's Seal l V L ce J corvA ll ' Page 2 of 2 72-026 (11/84) LA BATE%V KINCAID ROAD 6600 36351 CO 2 7600 /A 6530'6350 `ST 6331 -- /C/6340' CIR. 113 /.� �_� 640 /6 330 / 7 6310 -- —C/ 6341 6320 1 2n !r 7651-. P :•.6471 /3 /0 28 1 6331 6321 i 6301 N 7661TR. 1A 16421\ li CIR. 776)C -- f— \634O 00 2e 's3zo silo � z 28 l N 7Bo��ho / I F- sai0 \ s33oV>- u' 22 \ 6311 i7e00 = I 6440 64W 29 J W 3 118 O 6321 z j I z 32 0 6441 — 2 Q ! 6461• 206331; WOODED CIR 3: 63201 6310 6470 ._L_. _. 35 7903 IO 1V 4E -64\ �- L_ - 17020 U _. _____QfJ 4D 164 4/ 6411 6 3211 17900 7941 _ 7951 nl__.. Vi. 001- 63111 36 NPI° T EVENSON CT /� 410 2 6310 q`F TR n O� TR. B 8103 v T �n 8323 GR. 2222 134A 147 --<(&>- 148 Point Campbell Area Reference Map—P9 Y © COPYRIGHT 1987 JMR 161 c 1KATAHDIN KINCAID RD. so0 W GRAVEL 5 PIT r O 3 0 J 0 4 K W W 80 AVE. 6006 6220 a z GR. 2223 135 Polni Campbell Area Reference Map—P9 147 + 149 148 IG2 COPYRIGHT 1993 JMR E