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HIDDEN HILLS BLK 2 LT 2
Hidden Hills Block 2 Lot 2 #011-121-68 GREE. _R ANCHORAGE AREA BOR H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_ $VC eW-tCs�if —MAILING ADDRESS�/ _ PHONE 9�J%j� y7ct LOCATION __.__ LEGAL DESCRIPTION fq(`dde� 1'`I ll/c' I __ 2- SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER �&VAt M.4, �. MATERIAL S_QN� _�E-_�I �S COMPARTMENTS �i 'I� it r �i INSIDE LENGTH to INSIDE WIDTH_5_[�LIQUID DEPTH 5 iP LIQUID CAPACITYIS,GALLONS. T-. 3k'�fFll'� !� TOTAL LENGTH DISTANCE FROM WELL FOUNDATION -� -NEAREST LOT LINE __-i - OF LINES NUMBER OF LINES_ DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE lhclti•L�f � 0i (w k- ke w l l br'e7� iH/) i DEPTH OF FILTER c DE=PTH: TOP OF TILE TO FINISH GRADE �( MATERIAL BENEATH TILE LO a1. ABOVE TILE WELL: TYPE- -_%CQ�n�r� CONSTRUCTION _. _____ _ DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION—,LOT LINE__._--, SEWER LINE TANK , SYSTEM------ CESSPOOL YSTEM _.CESSPOOL __. OTHER SOURCES APPROVED_ _- DISAPPROVED_ ____—_REMARKS DISTANCES:_ _.__�5�� — DIAGRAM OF SYSTEM I�hL INSTALLED BY: SEWER LINE DEPTH: I i PIPE MATERIAL:�S4��`�. LOT SLOPE: _Siov, "�FUkn�_Av iV REMARKS: _ V106 IV Form EQ -032 ca5 tip �1 pk I7 Y _ _ --_DATE./_ G.A.A.B. NAME OF APPLICANT _V INSTALLATION LOCATION LEGAL DESCRIPTION — 44-0- ' ^1 ' GREI R ANCHORAGE; AREA BOF Gh[ Y,I� / Y ERMIT-NO DEPARTMENT OF ENVIRONMENTAL QUALITY Rt o-0 j 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4567 Q SEWAGE DISPOSAL SYSTEM - APPLICATII�,�t}d-�,AND PERMIT j � �)j MAILING ADDRESS BX�- – Pl4c;S �?MD ` INSTALLATION OF: SEPTIC TANK OFF r_lv�114) SEEPAGE PIT DRAIN FIE D OTHER TYPE AND SIZE OF FACILITY TO BE SERVED 5- f' ' I ` / FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS ARS'"� �r+la - �a " 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 OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. o SEPTIC TANK SIZE TYPE 13�`-�� �' SEEPAGE AREA SIZE �^^'" / � 1 �� ('TY/E MINIMUM DISTANCES, REQUIREMENTS' otv, � DIAGRAM OF' S STEM GRAVEL HACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. f� DATE a • " APPLICANT'S SIGNATURE,, �--' t-_3 FORM NO. ED -016 r BOROUGH ORDINANCE NCS 2¢-6B AND THAT THE A130VE J<( \- . FOUNDATION TO SEPTIC TANK/^� �L!s FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL c ,E- �6r �_, ) SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. ' /� /�' WELL TO SEPTIC TANK , SEEPAGE PIT /� / / DRAIN FIELD pep ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK —gid –, SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT a 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 HACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. f� DATE a • " APPLICANT'S SIGNATURE,, �--' t-_3 FORM NO. ED -016 r BOROUGH ORDINANCE NCS 2¢-6B AND THAT THE A130VE J<( \- . Performed for Legal Description:__ -,/k This form reports: Soi Depth Feet 2 - GREATER ANCHORAGE AREA BOROUGr jepartment of Environmental Qui y 3330 "C" Street Anchorage, Alaska 99503 SOILS LOU - YEROLA'FION TEST _3c<� _ _ Date Performed -/ Z---- -- -- --- -- --_ -- Is s 1 og_ _ --- Percolation les i. 4 5 -- 6� 7 g -- 10 .- 13 I ')s i Was ground water encountered? 1 1v If yes, at what depth? :leading Date Gross Time Net Time Depth to Water flet Drop percolation rate rninut�. Proposed installation: Sri page Pit Drain Field Depth of Inlet Depth to bottom VC pit or trench COi11UITS: Performed Byf/`�G r f 11i'�f�Lei -Certified By: --- Ute: 111 040 (6/74) BE APPLIC NT FILLS OUT UPPED HK ONLY Properly Jwner A'' -//.•%/- Time Mailing Address 9 � 1 , r. ;,-; Zip Code Date Buyer Date _ Date Address Zip Code Lending Institution j - /-----, - ' !.,-<,_-, Phone Address 7_ip Code - - Really Co. &Agent Phone w, Address Zip Code ,r Legal Description ENVIRON"McNTAL PROTECTION Street Location Type of Residence ,0., Single Family f k lid ED Cl Multiple Family No. of Bedrooms `CONDITIONS OF APPROVAL J Other ( ) DISAPPROVED Water Supply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. T—� Community ❑ Public Utility'`_ For wells drilled prior to that date, give well depth (attach 1 g if available). 6 5 Sewer Disposal ((((1111 i Individual Year Individual Installed ,:,. Public Utility When Connected to Public Utility: ❑ Holding "rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: OF ANCHORAGE MUNICIPALITY DEPT. OF HEALTFI C ENVIRON"McNTAL PROTECTION k lid ED (�) APPROVED BEDROOMS `CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDI IONAAPPROVAL' DATE Solis Rating Date Sewer Installed Well To Absorption Area /6...9 Well Log Received Well to Tank � Septic Tank Size_ 72 023 (3102) � T File rI«I Juno q, q7§ To whom #m.ay colicorn: WBJEC Block 2, Lot 2,I dom 'tills Subdivislon This : a « has j ectionmaw ave m (G!� Awe Wlml. Rt!!RIAB 2 % A IRwith wRm.A Ovo- e0O eC.;y stern unuA be +stall . The mile should #ems tleI t , m o an On-site sew e disposal system. �k2Ry, C, SueM m6, Ra. 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MM I 3„19,Oz°£OH m bb nz w m t x..D£po°amt Mm !�/ '. sz „ o v ° \b -98laz- M-- �_ b CIC/ '� 9°. 26/ , nL / � 3.01.16 • C2, 20 ,: - lCC6 4' 3 96,60 LO!! �- B8 1(1 N q P IUa2i a 1 0^01ro y 9OD rc D O y /0° 190.'11 0� `✓ B I p ° °j b C'9'IH � _ y� D9 3 I sF fes' '� rvl ^✓: ` 3 a N r ° Y� ry � - - S 51,��m0, C2OC _ �. 91 VI ° 1 L36 W � 0 a m w ° s 7 M m a nlz°3 6 F3I x1 1az 7j d ' u o o f 3 U O\ o30oE (0 O ti 3 �' 3 0 n H1n0$ —[ 11 r _ .'`a ryO,y \P NCj ..:{� 01C 0n3in� {9 v06- � _._,:'80.881 $6'eT �' :'-_59'901 - _ ._,._ ,. _. _ L4 oaf -._ _... W _ .-'�. 1.1'B6G 1^ �:-- Q.-•�- - -- ^' U2 ot2'�..- ”. YY � d "gin - -._ I 1 r 1 r S° 2_ A OO IjcEC�S l 0 -1 W N.0 QHS 0 v z F-NZE� I _ III _ III III I I I I I I I I I I 1 1 I sL I III - 1 1 III I I I I o 1 I I 11 I a£ 89900011a Municipality of Anchorage g°<o On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 011-121-68 Expiration Date: 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: HIDDEN HILLS S/D BLOCK 2 LOT 2 6410 WEST BOTH AVENUE, ANCHORAGE, AK, 99502 KENNETH & KATHRYN FRIAR Day phone 6410 WEST 80TH AVENUE, ANCHORAGE, AK, 99502 LISA HERRINGTON W/ HERRINGTON & CO. Day phone Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 263-9333 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: n/ O Distances Received by _�% ,E {r '- Date: • r"Zt` r� > :a x COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � �i Date of Payment � 1'/J 11 LO° ` , Receipt Number COSA # 0'�C tl�!g/(_)�R 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. 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 JEFFREY A. GARNESS, P.E. Date Engineers Printed Name Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted fo 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 operationaf ffe 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 central of the evaluator of the system. satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG. LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson orparty is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _�L System #1 Approved for bedrooms. System #2 Approved for bedrooms. OF t�Ch Disapproved. W\WJERAND g SITE Conditional approval for bedrooms, with the followin stis: ON.._....TCI PROGRAM Original Certificate Date: " Th unVicipality or Anchorage 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 raau iiims Nitrate Advisory Arsenic Advisory Other If more than 7 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 2 Parcel ID: 011-121-68 A. WELL DATA *PER GEG INSPECTION. **ASSUMED BASED UPON SURROUNDING WELL LOGS. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 1975 Sanitary seal (YIN)4— Totaldepth *178+ ft. Cased to **40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform —0— colonies/100 ml. Nitrate W mg./L. Arsenic: 16-5 ug./L. Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 2/14/2014 167 ft, 6.88+ —9 P.M Date of sample: 2/14/2014 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE Tank Type/Material SEPTIC/CONCRETE Date installed 9/9/1975 Tank size 1527 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 2/18/2014 30 ft. Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA Date installed 9/9/1975 Soil rating (g.p.d./ft or /bdrm 125 Length 30 ft. Width 3 ft. System type TRENCH Gravel below pipe 10 ft. Total depth *15.8 ft. Eff. absorption area 600 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 2/14/2014 Results (Pass/Fail) PASS For 5 bedrooms ***85.5. ****96 Fluid depth in absorption field before test _ In. Water added 789 gal. New depth in. Elapsed Time: 1251 min. Final fluid depth 41.5 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **MT ONLY EXTENDS 106" BELOW INVERT OF LATERAL. ***HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED WITH 2001 GALLONS IMMEDIATELY PRIOR TO TEST. 85.5" READING WAS AT END OF PRE-SOAK READING ON 2/14/14. SYSTEM WAS DRY PRIOR TO PRE-SOAK. ****10" BELOW INVERT OF LATERAL. NOTE: DRAINFIELD SIZE OF 600 FT IS SLIGHTLY UNDERSIZED (SEE 1999 HAA). D. LIFT STATION Date installed Size.in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at wa er alarm level at in. n2t. 19 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 lots 100'+ Absorption field on tot 100'+ On adjacent lots Public sewer main Sewer /septic service line 25'+ Animal containment areas 50'+ Public sewer manhole/cleanout 100'+ Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: _ Building foundation *APPROX 1' 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 10'+ Building foundation **7'+ Water /_1 Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEE 1999 HAA & 2004 COSA. **SEE 1999 HAA. TRENCH IS 15' FROM 50%+ SLOPE. APPROVED Iiq,f6ib� G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and p 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 sf Date j . p (Rev. 11105) 9 f y A. Go ness: CE -79 3 0 .144 cG �d p`r7nre«ionoI o I Municipality of Anchorage `_ e Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval 4 OSC141058 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 2 of Hidden Hills Subdivision. This inspection revealed an arsenic concentration of 18.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http.,I/www.muni.org/0nsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP141028 PID#: 011-121-68 COSA#:OSC141068 Permit#: Legal Description: Hidden Hills, Block 2. Lot 2 Engineer: Garness Engineering Group Applicant: Kenneth & Kathryn Friar Your request for a waiver of the required 5 feet horizontal separation from the septic tank to the foundation has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Granted: Date: CQri Approved b . L• Name of Reviewer ............................................•.•..............................f GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS.:• - February 19, 2014 P 6"2 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, AK 99519-6650 (907)343-7904 Ref: Hidden Hills; Block 2, Lot 2 - Waiver Request To whom it may concern: ()Awa e This septic system on the referenced property is composed of a concrete tank, and a trench type drainfield. Per the 1975 GAAB inspection report, the tank is: q-1 Made of CMU blocks 0 ( Has an inside d� of 6'-8" (thus has a n'M. of 8') Has a liquid capacity of 1527 gallons After carefully measuring the septic tanks location in proximity to the foundation, we observed that the septic tank is sitting approximately 18" away from the foundation wall (see attached photos =WIR has been in place for 39 years. It is important to note that that a separation distance of less than 5' was noted and approved on Ted Moore's HAA in 2004, and GEG, Ltd.'s (formerly Alaska Water and Wastewater) HAA in 1999. We request that your department issue a waiver for the current separation between the tank and the foundation wall. If you have any questions, please contact us at 337-6179 r Sln`cerel3�, 'J Jeffgy A. ss, P.E., M.S. PTident Thank you for your assistance. 3701 E. Tudor Road, Suits 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com i, l Fe N There is no foundation r. G under this section of the '- house - Fireplace "chute". This section extends out 3 feet from the house foundation. r • - a� •���"�YYYY��. t X�'91.� If. WT Municipality of Anchorage Development Services Department Building Safety Division On -Site Water b Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Nww'.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Kati Parcel l.D. - o 0— I a l- "%� 1. GENERAL INFORMATION Expiration Date: tA — 2.5�— o Complete legal description HIDDEN HILLS SUBDIVISION. LOT 2 BLOCK 2 Location (site address or directions) 6410 W. 80TH AVENUE • ANCHORAGE AK 99516 Current Property owners) JOE do JAN DAVIDSON Day phone 907-770-5446 Mailing address 6410 W. 80TH AVENUE * ANCHORAGE AK 99516 Lending agency Day phone Mailing address Real Estate Agent PEGGY YOUNG W/ DYNAMIC PROpERTIESDay phone 907-261-7618 Mailing address 3111 C. STREET* ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well lit Individual On-site 0 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 Onsite 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 my seal affixed hereto and as of the validation date shown below, 1 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 (les and from my investigation and Municipal inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD. SURE 101 • ANCHORAGE, AK 99507 6 Engineer's Printed Name JEFFR Y A. GARNESS, P.E. Date I f3 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & 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 sysf ems 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, or 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 iance benefit on or is of aluthorized, nor wilt isted above. Any It ( It any legal right whatsoever. otherpeor use of this report by any 5. DSD SIGNATURE Approved for 15� bedrooms. Disapproved. Conditional approval for bedrooms, with the ftlowing stipulations: Attachments: t/ COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Manitenance Agreements Supplemental Engineer's Reort Other STEWATER 'ROG ASI c • c \ �� $1ENTSep 7//1)rlllll�l � Original Certificate Date:11 — 6 By: // / (R". 1?A1) Municipiallty of Anchorage Development Services Department �7 Building Safety Dhrialon On.S9e Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 106650 Anchorage, AK 995198850 www. ci.anchorage.ak. us (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HIDDEN HILLS SUBDIVISION: L2 B2 Parcel ID: *PER PREVIOUS HAA A. WELL DATA "WELL TEST BY TED MOORE ON 5/3/2004 Well type PRIVATE H A. B, or C provide PWSID# N/A Well Log (YM) l o_ Date completed "1975 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *^ 182 ft. Cased to 40+ ft, Casing height (above ground) 12+ In. FROM WELL LOG AT INSPECTION Date of test •*5/3/2004 Static water level O ft. 172 ft. N Well production gm. 5.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.10 mg./L. Other bacteria 8 colonies/100 ml. Arsenic: 5 mg./L. Date of aample:12/22/2005 Collected by: GEG, LTD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/ CONCRETE BLOCK Date Installed 9/4/1975 Tank size 1527 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping 9/6/2005 Pumper__ A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 914/1975 Soil rating .p.d. ft%drn) 125 System type TRENCH Length 30 ft, Width 3 A. Gravel below pipe 10 ft, Total depth 015.25 ft. Eft. absorption area600 ft' Monitoring tube YES Depression Over field NO Date of adequacy test ••5/3/2004 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test "_891n. Water added 770 gal, New depth 106 in. Elapsed Time: 118 min. Final fluid depth 100 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N d type) NONE KNOWN If yes, give date N/A "SEPTIC TEST BY TED MORE ON 5/3/2004 ***LIQUID DEPTH ON 1/ %6 WAS 86 INCHES D. UFT 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 tankllHt station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: 5'+ Pro line 5'+ Absorption field 5'+ Building foundation property 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 '+ 10Building foundation 7' Water main N/A Water service line 10'+ Surface water 100'+ Driveway. parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through held 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 ILZ A COSA Fee Date of Payment Receipt Number (Ps . 72101) Waiver Fee $ Date of Payment Receipt Number = lYlyyy full Iu;LC fu'l L1tjj Luft/JLtu1m O 0 6 z W a) RU tw R%j W. f vug:V� 1p • 'aggag'°F a4s7":� iwr SQl¢.4as fr��cs si•i it e O.0 �sSS 1 ?e�d god • 0 ,.Es r S =x 0 D N C 0 �3 D 0 r C r A / 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14 '\0 T CM IR1. JuluuLu 1 1 I c9© y Y F • ® I \°1K �1 fi 1 1 I c9© y Y F • ® I \°1K Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Braaw P.O. Box 196650 A chor age, AK 99519 61650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING S A E T Y Parcel I.D. j2 11 — 12 / — (g HAA # D `- t /Qt I. GENERAL INFORMATION Expiration Date: —g — a. Lf _ b Complete legal description G.�fi 2 /G k 2 n / S4b Location (site address or. directions) G y / a 4�. 80 '`'' i9 vQ .., .. .. A -k' 99soZ Current Property owners) van /�crce Day phone 2 yS-2�6r; Mailing address Lending agency. Mailing address Real Estate Agent Mailing Address 607 k- Day phone ;11 Cc tro crn c Pio Day phone -� 9 9SG 3 Unless otherwise requested, HAA 2. NUMBER OF BEDROOMS: will be held by DSD for pickup. p le e c , // /`lcc rj, 7.' — a t 2 `Io - 7er'$ 2 c,,Aeq eec, 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site❑ Public Sewer El 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 sample results. (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 shown below, I on As certified by my seal affixed hereto and as of the validation datdel nes for this application, shows that tthat my he'on- based on procedures outlined in the Health Authority Approval Gu) site water supply and/or wastewater disposalherein. further verify that based on the infsafe, functional and ormstem i afonfobtained from the bedrooms and type of structure indicated her on-siteI and/or Municipality of disposal system aaedinrom complianceewi investigation applicable Municipal ,eand State codes. ordinances, wastewater disposal syst is(are) and regulations in effect at the time of installation. Name of Firm �ir� l-►n� QI Serer«•� Phone 3 ys-- 17 �{n Cti o �a�P Ak 9.9 I� Address IYS & ����_� Date 5 -7 Engineer's Printed Name ti Fv M U "� I wk - 5. DSD SIGNATURE Approved for bedrooms. Disapproved. `• .',- .: �r.i*elk v ``�y • 1_,. • —12 y.••••.• • •• e •N• 16 THEODORE F. MOORE r, `t, •• CE -3589 fee Oo 14 Conditional approval for- bedrooms, with the following stipulations: Additional Comments Attachments: - HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: y 2 y —p By: (Rev. 01102) Municipality of Anchorage P ;! Develo ment ServeDepartment p Services i Building Safety Division On -Site Water & Wastewater Program 5 E T 47 " 00 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904. . HEALTH AUTHORITY APPROVAL CHECKLIST is i •: , Legal Description: Lo f Z fj /cam c k 2 parcel ID: 01, I I A. WELL DATA Well type If A, B, or C provide PWSID # Well Lo 9 (Y/N) Al Date completed = 19 7S i'Sanitary seal (Y/N) Y Wiresro erl � Total depth > ) '�S 2 ft. 'Cased totS Z ft. P' P Y Protected (Y/N) Y I Casing height (above ground) r 2 in. , FROM WELLLOG AT INSPECTION Date of test �--/ Static water level ft. Well production g.p.m. S. Z f- g.p.m. I !a WATEkSAMPLE RESULTS: I Coliform 4 colonies/100 ml. I Nitrate Other bacteria o colonies/100 ml. r (; Arsenic "-- mg,/l, Date of sample: S'13/0y Collected by c B. SEPTIC/HOLDING TANK DATA ' Date installed 9Tank aterial PS 3ac k Tank size % 527 gal. Number of Compartments / Cleanouts (Y/N); Y *Foundation cleanout (Y/N) Al Depression over tank Y/N AJ ' f ' ( ) High water alarm (Y/N) A/. ,Pum Pumper f Date of pumping -8 / I r % b3 P rye Se v cpm C. ABSORPTION FIELD DATA ! ; Date installed I -!i/ `/ / 7S Soil sating (g.p.d./ft z or f/bdrm) S � v., System type T'r�n c� Length 30 ft. Width 3 - ft. Gravel below pipe 4D ft. Total depth IS'. Zsft. Eff. absorption area6_ o0 ft2. Monitoring tube Y' Depression over field A> ' Date of ad i bacy test S`1 3 / o y Results (Pass/Fail) Parr r i For S bedrooms I; Fluid depth 16 absorption field before test 8 in. Water added 7 70 gal. New de thio in. P —� Elapsed Time: US min. Final fluid depth loo in. Absorption rate >_ � Sri g p d Any rejuve at treatment (past 12 mo.) (Y/N & type) JJomt know.,'If yes,'give date N• A i D. LIFT STATION N• I+ Date installed "Pump on" level at in. Datum F SEPARATION DISTANCES Size in gallons "Pump off" level at in. Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot x lOS On adjacent lots > ` /G.G'' Absorption field on lot 1 �5' On adjacent lots > Public sewer main AJ.'A' Public sewer manhole/cleanout 1u• . ' Sewer /septic service line Z.SHolding tank',N• �• SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line = Absorption field = S" Water main N• A. 'Water service line > iaSurface water Go ' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -- 36' Building foundation 10' Water main N• A. Water Service line > rG' Surface water. > r ao Driveway, parking/vehicle storage YG Curtain drain A1a�� se�� Wells on adjacent lots F. COMMENTS Ser fi c ¢a n tc• i1 �.G ry e lwe Gtc.{vCnola HC, � � •, t �1e `� Can 4e. cifecwneX a"I Arbr '►n fele ee•P-ICA: P!`�r+�av'•/ Q�atu� �►un �rilen`� Ce in all ror 16 ' d %Poch Sic/-fu,ar ✓. OF A4 C"4T G. ENGINEER'S CERTIFICATION ty'};f..•••1.• s`fu qp 1 certify that I have determined through field inspections and t:�;.` i�TH��' •.!, �� review of Municipal records that the above systems are in �. f f�,, f• f...f.......,.; �C conformance with MOA HAA guidelines in effect on this date. �M.ff•••• •• ., '...f ••f.fflffl Engineer's Printed Name ?A eoclare E- "&Ort �;' : rK�000re F. �:oo�E ...f CE -,3589 Date 11CAv , 4/ '•'�u ;'•...e.••' � i` c O HAA Fee $ -f Waiver Fee $ Date of Payment S/ Receipt Number (Rev. 12/01) Date of Payment Receipt Number T o � o C. ,NUI o�cc�wc Fin I'�' E 0 �� W .0 ? 3 a s: N ar .K� QN Li �i flj fA a�p E'oa,�Co' LL LU .� a 4 Ladhci�'m tai cc c,gCc uE�� vVEn v C _ •3.. � 1� � � a� 4 a � o S �' �' �v Sl a 10 CY cc �.`� Vn ' � W d rt �t. Ltt � ♦ `l p `V � ♦r� t: Q 44 ip .:..o o w�Z cr- -p0 cov w wctu a L S In Com �r4 u F-1 V) 4 v._ Opti cr w r 2' 0 d S, o� • J � 3U Q M 899 Z9 z© 3DVd I801 nadw iSSLi9ZLD6 60:91 D@DZ/hi/50 Parcel I.D. # 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 011-121-68 HAA# 1�faq`lC)Lir� 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2; Hidden Hills Subdivision Location (site address or directions) 6410 W. 80th Ave. Anchorage, AK Property.owner Ken Banzhaf Day phone 243-5454 Mailing address 6410 W. 80th Avenue Anchorage, AK Lending agency Day phone Mailing address Agent Carol Butler/Remax Properties Day phone 243-5454 Address 2600 Cordova St. Anchorage, AK 99503 - Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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 (Rev. 1/91) Front MOA #21 r(S l Municipality of Anchorage C�ECEIVE� DEP_ARTMENT_OF-HEALTH=&-HUMAN-SERVICE S 1-2 I(�99 Environmental Services Division ANCHOR 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90 RVICES [WISION CNV IRONM Health Authority Approval Checklist Legal Description: HIDDEN HILLS S/D; LOT 2, BLOCK 2 Parcel I.D.: 011-121-68 A. WELL DATA Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Total depth 210' Sanitary seal (Y/N) Date of test Static water level Well production NO Date completed per �w-:c Cased to YES FROM WELL LOG WATER SAMPLE RESULTS: 1975 40' t Casing height (above ground) 12"+ Wires properly protected (Y/N) YES AT INSPECTION 9/3/99 169' g.p.m. 7.4 g.p.m. Coliform Nitrate Other bacteria J Date of sample: 9/3/99 Collected by: A.W.W.C.. INC. B. SEPTIC/HOLDING TANK DATA i 0-b Date installed 9/9/75 Tank size 1500 Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) NO Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 9/3/99 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA NOTES: *SHORT ON AREA BY 25 FT. SQ. **MT EXTENDS 9.25' BELOW INVERT. 4" DRAINPIPE WITH PERFORATIONS FACING UP. Date installed 9/9/75 Soil rating (g.p.d./W or ft2/bdrm) 125 System type TRENCH Length 30' Width 3'+ Gravel thickness below pipe **10' Total depth 15.7' Effective absorption area *600 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 9/3/99 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test (in.); 77" Immediately after 909 gal. water added (in.): 107" Fluid depth 80.25" (ins) Minutes later: 1022 Absorption rate = 750+ a.p.d. Peroxide treatment (past 12 months) (Y/N) NO If yes, give date — 72-026 (Rev. 3/96)* �Jc�_1J-1�A7 uun lu-0 nil LillYllivn/JLIIIYI RI; n O L I -171A liv, Juluucu {p �rnR' i t�- > N' C, peoob��Q D z -J vlou z I SPY' ' : •�.7% x -4 g y W `O pm, V)_ c�D W..M I Vol N G•� 1 ti Z fo j >T9 VI I -i f�•1 1 �• r fY > I 1 � o rarff � � SME .O A 2q2 ti 40"T L< NEz N z ��lll�%lll1�.-60 c m 0 I x 1 � , � N I a I= I I Z 1 Q I D I F w I 4 1N3VQSd3 .Inu.n ,at ,6j�'OZ l M „0,00.00 N u1+77cN T OD O O D C: CA 0 0 CP a M T0'd b8ST 9LZ 406 SiN30d XHW3N 801 LS:TT 666T-2T-d3S SI � `O I Y 1 I o, I f 1 tea. I I 1 0 1 O LO I LA LnLn I 1 ; tv M A t ` a I D tp m I o .O A 2q2 ti 40"T L< NEz N z ��lll�%lll1�.-60 c m 0 I x 1 � , � N I a I= I I Z 1 Q I D I F w I 4 1N3VQSd3 .Inu.n ,at ,6j�'OZ l M „0,00.00 N u1+77cN T OD O O D C: CA 0 0 CP a M T0'd b8ST 9LZ 406 SiN30d XHW3N 801 LS:TT 666T-2T-d3S