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LAKE HILL ACRES #3 LT 23
Lake Hill Acres #3 Lot 23 #051-122-21 _ Municipality of Anchorage Page f of 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: 5 U 9 20 3 Lt& PID Number: 0'5/ - 5/ -Name: Name: Wastewater System: ❑ New Upgrade t^_/,I SM1 tia Address: ABSORPTION FIELD Aoy 4 391 Id v 1A Phone: No. of Bedrooms: I ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mo ❑ Other 70CD Is _ DESCRIPTION Soil Rating: Total Depth fr original grade: LEGAL GPD/Sq. Ft. Lot: I Block: Subdivision: Depth to pipe bottom from original grade: Grav epth beneath pipe %i � — L KLt /f I L a It FL Ft. Township: Range: Section: > Fill added above original grade: Gravel length: Ft. 1 , w ,Y J Ft. Gravel depth: Number of lines: Distance between lines: WELL: 6vosr, ❑ New ❑Upgrade Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To• Total absorption a: Pipe material: Ft. SQ. Ft. Driller: pled: Static Water Level: Installe Date installed: Ft. Yield: Pump Set at: Casing Height Above Ground: ��/ I� TANK GPM FL Ft. SEPARATION DISTANCES ❑ Septic �i Holding ❑ S.T.E.P. To Septic Absorption Lift Holding t arivals Manufacturer: GYGGY Capacity in gallons: 3S"o0 From Tank Field Station Tank Sewer Lines Material: Number of Compartments: Well //�.�4 N�q NIA 65/ 57/ s",e—/ / Water N/4 MM MiA t�v' 90' LIFT STATION Lot/ Line A//i{ k11A IVIA- /D r f1a Size in gallons: Manufacturer: Foundation N/� NA 1v114 �"! A /� / IVI,4 'Pump on" level at: "P off' level at: High water alarm at: Curtain/ A/�. �t' A/� A )/� I / Pump Make el Electrical Inspections performed by: Drain /Y/A BENCH MARK Remarks: fl-/ 'h 7_ -; GL Location and Description: 1 /`trto lee- . 6 c1/6elh+ l Assumed Elevation: 100, D ENGINEER'S SEAL Yp, _ r �.') n. At.,,�BqQ %7J/✓. 7� P��` G / �J / lY" �7d.�^-� .;c _ U _ Inspections performed by: Dates: 1st 2nd :r... �. Department of Hea anq Human Services approval Tri-:can�n�.r inn so•r• ` ^,Nxra 04w Reviewed and approved by: Date:— 72-013 72-013 (1/91) MOA 25 .4- Permit No. SW920346 Page 2 of 2 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: Lake Hill Acres #3 Lot 23 PID No.: 051-122-21 MIRROR LAKE i S 75.53 30 I _ - SCALE 11' 50' LOT 23 z Z SWING..... TIES o £ � A - D = 16.9' WELL B - D = 211' DECK - SHE A - E = 24.9' B -E=22.0' 5 G RAGE HOUSE A y C '3 NEW 3500 GAL. '.w HOLDING TANK SMALL of A CREEK N 82.4550• E EXIST. TANKS I2790 ABANDONED o _ SEWER CLEANOUT uLVERr WELL ROSSING — — EASEMENT: I 1 AKESH❑RF DRI\' ENGINEER'S SEAL OF q<q�►� ELEVATIONS n 7UP OF SE LOT CORNER REBAR�� ASLO SUMED ELEOV = 100.00• (NOT; T❑ SCALE) AW ... .... /-GROUND �LEVEL 9 98.4' .. .. ... //////.. . m LOUIS A. BUTERA ALL SEWER LINES WITHIN ]0'I "% CE -6736 WI DRIVING SURFACE INSULATED _= TANK R\ WITH 35 PSI BURIAL FOAM `94.9 94.4' _ 1PROF, 1, \\\����''''� 72-013 A (2/91) MOA 25 10. 2G. 02 01:00 PM *NORTHSTORE OGT -26-92 MOM 12:43 M,,-Ci-1NT0CK LS—ER ENGINEER U Contractual Agreement Jr.'s CesspQ01 pumping hereby.aarmes to service the holding tank septic system looated at Lake Hill Acras #3 Lt 23 on. an as needed basis beginning Oct. 1992 at the cost of $100.00 per 3340 gallons. This contract is renegotiable May► Barbara Gibbs, Office Manager Jr.'s Cesspool pumping 1993 P 0 1 P, @1 zi:o/ �e4lr Patricia Smith, Property Owner Post -It' brand tax transmittal memo 76711 x of P&946 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, ALASKA 99577 LUR P10-01131 MUM FAR Date lel—I -:1-1e7 2 Subject��/-0f"- -2 -'? ,-'e,lee- ❑ Please reply �lo reply necessary SIGNED Municipality ®f Anchorage j Department of Health and Human Services CfhhS Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 October 20, 1992 Lou Butera, P. E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 23 Lake Hill Acres Subdivision #3 Waiver Request #WR920056, PID #051-122-21, SW920346 Dear Mr. Butera: Your request for waiver(s) of the required 75 foot horizontal separation of a holding tank to a private well has been approved. The approved separation*ance(s) are from a private well to the holding tank o feet. The request for waiver of the required 100 foot horizontal separation of a holding tank to the surface water has also been approved. The approved separation distance is 80 feet. This waiver approval applies to the existing separation distances between the holding tank and the well and surface water. Any future upgrade to the holding tank wastewater dispsoal system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Sincerely, '9 -J i"?r - tiz, Daniel J. Roth Civil Engineer On-site Services Concur: n Smit P. E. ogram Manager On-site Services 1j.:430 el e� s R MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR920056 PID# 051-122-21 HA# Permit # Date Received: September 22, 1992 Legal Description: Lot 23 Lake Hill Acres #3 Engineer: Lou Butera, P.E., Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Applicant: Patricia Smith Waiver Requested: Holding tank to private well - 68 feet. holding tank to creek 80 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: )K/,_ Waiver is NOT Granted: List Conditions or Reasons for above: SEE .9,T4 eH61' Date: /0_/4- 92- By: Rec #: 24079/4054 Amount: $ 410.00 Date Paid: Sept 22. 1992 umivER WFquEsf PoR l or 2Y L Vkf Hltl 4C� Fr 113 wlq)VER RE i?u Es r Alul6fe6R wR 92005-6 k,)91VER RwgvCrT FOR THF P/{ol°oSEd Cd+VsT,puc7/oiv OF 4 ,4ee-401 4 1;4AIk %D IFRoM TN€ o,v-LOT L,.9u APO 80 "Ff?DM 4 CAPF6K. %(E F_x/ST/N� iEPTic SYSTEM R-/?� T"F✓G C'D,ri!/?ETE j/iHkl 6�)ili PEIfF PIPS OF T/Yf fECOvO 7-.o94k, 7 -Ml- 7M&Y G,jFMf OR/6 /m I;LiLY CU,vf) /Pot erAep f4 A104,p/,16 T!4,vkf o.c. 71y,e LUT / a/ / 9 71, # s - e u / L TF o APPRe v£p B r rK E Bq/et,# q, '- TH% C U T Mar /s G Al PE/P L A/iv pY A,v /M/°F_Rli CAO` A' L sfYZjt of Cl r/yE P6ROur GnrrvFL,f £ f�aOs /3,paL, _° ti Is lku.vd1�7eD w/,—/ -r 7GIF9F IJ tiO CHfvLjaILf OR SP,4CE TKF F_,v6 >,v e5n PR03' 7-0�dirr9 LZ rl�9gqNl�l Rt% �J C/E OF SFl6 TC togRE�°L�?CF TF -e 7-j4 A,, J r 3-1-00 6,g1-ca,v HdLPlalz L C V k/a1G Ca 41.',94 7-E T UF- Tlr,sr 60af u.vffl4g I-AkES&o/pr- DR/v,E f?u0 PtoNG_ 7'/-c F wrST 1 aT L jul of r'r-(E Su o7,r c 7" L o 1' ��n I,vro NiVoA tnmF-. rl4®s f7-119,41w w)4/,4F /T is PA0P0SFi9 7-0 A,*CP?Gl9C",F kPoti MPIP/ A-6 rrnow� 5HVkL12 N67' SE /r T k r, my D I L L 0 1-: r- o u P1� R gra / E41 I- s 7'1 & 4/ sT/o.v o,A, /9_ 4 %a S� 6pF. rl,roc- 6/e 41'so SL GP S 1-a a-x3Rt1 TrY_F Llgxc 47- AJoa ?- T, /��/'%' >90iE,vilAL (%VIE IQ FLdr.� o,v TNIE G�Pou.,vn rK�P�/9C,E U,ouL/' iK9ST.5,e+Ttc� «Y rn/q vE L 04 Cp/?OSf G/PGA.,Al P 0VER lee 01 rG 4roucFwvAe4Y 7TH L f EFK I a lc v` s r/d,✓, WELL DATA— /Iv a1W E sr-iosv /f PRrPosrd 7-0 BE 6F3 FRon Tl -Gly N F w 1-104 ige.v 6 7-,9WK. TtirE w F i. L / s oou Ai 6/e A-O/E•vT Fl�ona 7-116 101WOs60 slrE FOR 7"1-eC KoL,d/NG 7"/9aIr oN xt SL0PE, rk1 f,04/37-Ia6 HCIM,r /s 10CNTF_D ',TI -Cts tv�L-L ` %%l9Lb/NG 7 A., k. rhl� 14., -'E1 -L Is ¢j DEEP hNP Cf9SEt7 To Tk4 60170M. 7'11(4 4/PL,l L0 fN-Y'S F/?oM Q -20 ' /s u✓E/?OURDE.v 7#-e FV ro 771 E 9o*qom /3 68,; ol— FR am F_ ti G /,vAE)? s �,v,ac YS/S �3TNAr 0vF!? 8E,v I a 1 H t1- LeTF /S P�*R77t14L K 0/7 CbntPZE rter r1 qb Wp OF / M Px R !tit ct h+OL ri'- r Tk I I T I M F w, ri-( )-Nr kAv aw a., %o �� L Ei9l�i�.G CONCRFAE i y04. 7-4A)kI ?.v 191-6 7-HE i N�rf?19Ta. rt(/1 /N/ rp&7-F /5 PRFaF,vT THROg61you7 TIME PERF PIPE, OF W rER T`)i 15Zr- CAS�aG DEPT/ 4S k®b0er6 TfFNk 0� Pn� v $ , 6. fo" S. L, hi , O. Po/,v rs /ly %d =, x -.7t¢ ¢. 7 SdIC Sonar/,o l2 (24- s ! 2 -r Q 3 t (37 F71 .W )ITE R Tfini- E 6RAVIENr 0 f(vr�/z oivT�-c SIFf�/Pf}Tioti ice 72 1.7 �CIJwCLuswti A5' rKIJ /J 4 AEU, Pol-PIN6 rqA.�k w,4161-1 SHOticd BE /DO% IN ATF_ l2 i/GKT A&V /i fF/�L/4CIX-6 7AI COaCf4ETE //OLt�/�vd if�ibk S��us KAl /V Ta L.f--a/z/ /,v 7 -1 -IF_ IY914,E L 0CIizTiOA/ /fAIP G"tt7-5X S,gMPLES ,TKfir ARE utF65,47-1vE AOR 8,lcrF_kiN, 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:SW920346 DATE ISSUED:10/13/92 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/13/93 OWNER NAME:SMITH PATRICIA ANN OWNER ADDRESS:HC 79 BOX 6391 CHUGIAK, ALASKA 99567 Eta PARCEL ID:05112221 LEGAL DESCRIPTION: LAKE HILL ACRES #3 LT 23 LOT SIZE: 23900 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE: /9 Z_ DATE: Zo `20 -/ 2 EmBle ever Enalm adzes Sarw'OZ Louis Butera, P.E. Registered Civil Engineer September 22, 1992 John Smith, P.E. Municipality of Anchorage Dept. of Health & Human Services 825 L Street Anchorage, AK 999502 Re: Lake Hill Acres #3, Lot 23 Dear Mr. Smith: At the request of our client, Ms. Patricia Smith, we are applying for a waiver of separation distance of surface water to septic holding tank of 801, and private well to septic holding tank of 68'. The subject lot presently has two concrete tanks that were originally installed as holding tanks, however, they were outfitted with leach pipe off of the end tank. It was felt that the tanks could not be sealed properly to prevent water intrusion through the lids and access ports as there is a high water table in this area. A steel tank with sealed lids would alleviate this concern, and allow for proper holding tank operation. The soils in the area are sandy gravel underlain by an impermeable clay and permafrost has been detected in the area. There is a high water table associated with being located next to Mirror Lake. The water table at the time of excavation was at approximately 3' below ground surface. The lot is fairly flat with a 2 % grade toward the lake to the north, and a slight grade to the west toward the creek. Wells in this area are typically shallow and this on -lot well is logged to contain 40' of casing, ending in a gravel aquifer. The static water level is at the ground surface. We are requesting a 7' waiver to 68' from the well, to allow the tank location at 80' from the creek. The tank will be a sealed tank with a high water alarm, and therefore should not be a hazard at the reduced separation distance. If the existing leaching system that has been in place since 1971 has not contaminated the well, installation of the proposed holding tank should reduce the potential health hazard. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. ml LOT 22 PRIVATE WELL SMALL CREEK CULVERT CROSSING MIRR❑R LAKE SURFACE WATER AS INDICATED NO KNOWN CURTAIN DRAINS NO WELLS +100' L T 1 'ROX WELL :ATION i' EPTIC +30' NEW 3500 GAL. HOLDING TANK 0 - SEWER CLEANOUT 4 - WELL - - - EASEMENT HOLDING TANK SITE PLAN LEGAL: LOT 23, LAKE HILL ACRES #3 OWNER: PATTI SMITH CONTRACTOR: N/A JOB # 87-345 DATE: 09/18/92 SCALE 1' = 50' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5995 FAX: (907) 694-3297 SPECIFICATIONS FOR ON-SITE HOLDING TANK SYSTEM LEGAL: LOT 23, LAKE HILL ACRES #3 A. GENERAL 1. The wastewater plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. B. EXISTING SEPTIC TANKS 1. Existing septic tanks are to be pumped dry, the tops removed, and tanks filled with compacted gravel material, or tanks completely removed and disposed of properly. 2. The existing septic tanks & area surrounding them are to be disinfected with chlorine or lime. C. NEW HOLDING TANK 1. The holding tank excavation is to be over -excavated 1' and backfilled with NFS Type II soil. 2. The tank is to be anchored by four, 2,200 lb. concrete blocks, two on each side of tank with lk" galvanized cable straps over the tank. Each pair of blocks located at % the length of tank from each end of the tank. These blocks are available at Klondike Concrete. 3. The tank is to be installed level. 4. The tank is to be a tank that is approved by the Municipality of Anchorage with corrosion prevention standard, for septic tank as per Uniform Plumbing code. 5. A holding tank must have two -six (6) inch diameter standpipes with an airtight cap to provide pumping access. The standpipe must extend at least twelve (12) inches above the surface of the ground. 6. A holding tank must have a watertight manhole to provide access to the interior of the tank. The manhole must be at least twenty (20) inches in diameter. 7. A holding tank must be equipped with a high water alarm which registers both visually and audibly inside the dwelling. The alarm must be positioned to allow at least three hundred (300) gallons per bedroom of additional storage after the alarm has been activated. 8. Alarm and wiring to be to Municipality of Anchorage code. 9. The tank is to be installed with 4' earth cover. D. EXISTING SEWER LINE 1. The existing sewer line is to be removed and replaced with 4" PVC 3034 to the house foundation with 4" cleanout and mechanical water tight connections at joints. 2. The trench for the sewer line is to be over-excavted 1', and backfilled with 1' of NFS. Type II material compacted to 95 %. 3. Sewer line is to be insulated with 2" burial foam, 2' wide centered over sewer line. BEDROOM CAPACITY = 3 HOLDING TANK SIZE = 3,500 (recommended) Twenty-four (24) hours notice required for all inspections. RETURN TO: Division of Geological and ysical Surveys (DGGSZ 3001 Porcupine Drive (Tele,..../ne: 277-6615) Anchorage, Alaska 99501 WATER WELL R•EC ORD Drilling Company Name MACMUSen bY'1.A.S.l1) i LOCATION OF WELL Please complete either la, lb, or lc. e Ia. Borough Subdivision Lot Block jib. Fraction Section No. C lei / lc. Distance andA�rtecj�n Sfrog. Road' Intersections !1 #}' Street Address and Area of Well Location WELL LOG Feet Below Surface Material Type Top Bott Over l�rdef� p 2a Grcw ea_6 11.5 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES U.S.G.S. Local No. Drilling Permit No. A.D.L. No. Township Range Meridian N/S E/W 3. OWNER OF WELL: (�r� �el`.wad We 1.sh Address: C%lUq i ok) A.kr, 4• WELL DEPTH: (completed) I Surface Elevation Date of Comple i q0 ft. i -o-1 o 0- i 5. F� Cable tool & Rotary a Driven Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: 6. USE: ® Domestic M Public Supply M Industry irrigation ❑ Recharge ❑ Commercial Test Well Other: 7. CASING: M Threaded •.ZIWelded i r/ 6 in. to q 0 ft. Depth Weight 1 ( lbs/ft- in. to ft. Depth 8. FINISH OF WELL: Type:6e era 1-1ole Diameter: u Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9. STATIC WATER LEVEL: ft. Ar4es,l a/\ Above ,19Below land surface 61C% , Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping g.p.m. ft. after hrs. pumping g.p.m. i1. WELL HEAD COMPLETION: In Approved Pit Pitless Adapter inches above grade 12. GROUTING: Well Grouted: Yes [] No Material: ❑ Neat Cement ❑�Other: 13• PUMP: (if available) HP 3 1 / Length of Drop Pipe ft. capacity g.p Type: ,M;Submersible ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS: P lAo'l, Set a '30 i'+ r 50 PlIas 50a Pew minT 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well'was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: M Lgausall .dr _l l..�aG A A53$5 Registered BusinessName Contract License Number Address: o L Signed: - i .... :_.... Date: Authorized Representative Form 02-WWR Copy -Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer ,1 RETURN TO: Division of Geological and ysical Surveys (DGGSZ 3001 Porcupine Drive (Tele--ne: 277-6615) Anchorage, Alaska 99501 Drilling Company Name LOCATION OF WELL W A T E R W E L L R E C O R D Please complete either la, lb, or Ic. U.S.G.S. Local No. Drilling Permit No. A.D.L. No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Ia. Borough Subdivision Lot Block 11b. Fraction / / / Section No. Township N/S Range E/W Meridian lc. Distance and Direction from Road Intersections Street Address and Area of Well Location 3. OWNER OF WELL: Address: 2. WELL LOG Feet Below Surface Material Type Top Bottom 4. WELL DEPTH: (completed) ft. Surface Elevation Date of Completion 5. O Cable tool [:] Rotary [] Driven 0 Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: 6. USE: FiDomestic Public Supply Industry ElIrrigation ❑ Recharge ❑ Commercial Test Well Other: 7. CASING: [] Threaded F� Welded in. to ft. Depth Weight lbs/ft. in. to ft. Depth 8. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: ft. Above Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after hrs. pumping g.p.m. ft. after hrs. pumping g.p.m. 11. WELL HEAD COMPLETION: E] In Approved Pit ❑ Pitless Adapter inches above grade 12. GROUTING: Well Grouted: El Yes [] No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (If available) HP Length of Drop Pipe ft. capacity g.p.m Type: ❑ Submersible ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS: 15. WATER 14ELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to Registered Business Name Address: the best of my knowledge and belief: Contract License Number Signed: Date: Form 02-41WR Authorized Representative Copy Distribution: WHITE - State DGGS, PINK - Driller, CANARY - Customer ,M L.0 1: 1:1 1 wmm n a. W- "v' (10 F" K PA CD W'�Fit ��� ~~ MINIMUM DISTANCE BETWEEN H WELL AND ANY SE[--1AGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM F1 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL- MINIMUM DISTANCE FROM H PRIVHTE WELL TO H PRIYHTE SEWER LIHE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FENTY WELL LOGS HRE REQUIRED HND MLGT BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENT� Mr -'11Y HPPLY. AND CON�TR�CTION DIH�R�MS �RE HYMILHBLE TO INSURE PROPER INST HLLHTMAL K 1=1 lot M 1. "7- WZ;-,--'.P" "T.' �W 10 FEE'. P-1 F2� L-=-- fl��--jL I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND AS SET FORTH BY THE MUNICIPHLITY OF 8NCHQRHGE. 2� � ��ILL INST�LL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ���L1�HNT LELHND WELSH IIS. SUED~~_~DHTE V4,0 DEPARTMENT HEALTH HND ENVIRCNMENTHL nTECTION .` ^ 2 825 'L' STREET, HNCHORHGE/ flit. S9501 ' 264~4720 ][�~ PEERMIT NO. ( 811104 ) HPPLICHNT LELMND WELSH ITAOX 136 CHUMAK 6�8 .... 2447 LCHI! TION LHKESHORE D LOT 23 LHKE�HILLSaSUB 's s � � oh � LOT SIZE 22000 SQUARE: FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY SE[--1AGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM F1 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL- MINIMUM DISTANCE FROM H PRIVHTE WELL TO H PRIYHTE SEWER LIHE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FENTY WELL LOGS HRE REQUIRED HND MLGT BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENT� Mr -'11Y HPPLY. AND CON�TR�CTION DIH�R�MS �RE HYMILHBLE TO INSURE PROPER INST HLLHTMAL K 1=1 lot M 1. "7- WZ;-,--'.P" "T.' �W 10 FEE'. P-1 F2� L-=-- fl��--jL I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND AS SET FORTH BY THE MUNICIPHLITY OF 8NCHQRHGE. 2� � ��ILL INST�LL THE SYSTEM IN HCCORDHNCE WITH THE CODES. ���L1�HNT LELHND WELSH IIS. SUED~~_~DHTE V4,0 GAAP-HD•1 'ER ANCHORAGE AREA BOROT 'I DEPARTMENT OF ENVIRONMENTAL QUALI i ti 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /� �•l, MAILING G /,(,Jj�.L�r�Ll, 1 �� PHONE NAME/ f-/_i•ii�'%� ADDRESS � l (Vl'':'J - LOCATION Pll I kCCQ'- ��% LEGAL DESCRIPTION U23, �ry- ! �'6 S TANK: •3 /�cfl�;,•�4J• NUMBER OF "5 DISTANCE FROM WELL '570r MATERIAL _���+-'�°.�z'&=L` COMPARTMENTS L Lc iaC_ 0 G•:`.0 �_� [_ ��fu)� a LIQUID ce'' LIQUID CAPACITY � °i • --j Co GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSSLRF DIAMETER OR WIDTH LENGTH DEPTH LINING MATERIAL DISTANCE FROM LLILDING FOUNDATION , NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES NUMBER OF LINES DISTANCE BETW LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF E LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL TILE IN. ABOVE TILE W ELL:' �. DISTANCE FROM WATER TYPE Do DEPTH BUILDING FOUNDATION. G -FJ P SAMPLE NEAREST NEAREST SE`i SEEPAGE OTHER LOT LINE SEWER LINE TANK C SYSTEM CESSPOOL SOURCES DIAGRAM OF SYSTEM DISTANCES r DATE d°'✓f APPROVED/_ //'��v •-� i ', Z G.A.A.B ' • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 051 - Parcel I. D122-21 Expiration Date 1. GENERAL INFORMATION: Complete legal description Lake Hill Acres #3; Lot 23 Location (site address) 22359 Mirror Lake Drive *Chugiak, AK Current Property owner(s) Mailing address Real Estate Agent Brooke 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 907-244-6742 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment 2 — V7 —2- 1 Receipt Number C,7" AGI COSA# 0-5C- -2- 1 I 112 Waiver Fee $ Date of Payment 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 Clartificate 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: Z 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 practices. The reported results describe the condition of the system/s on the date/s of the 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, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system 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 perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSDtSIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, ........... ........ A Gorn -ss:' CE— / c i ��o(ess"on�\ c c #AECC884 OF AAA�'y4 , with the folio v i�stipt�a o sT �� N1AYE� ANo r ATER n VN t-', A M pROGR 5\- Original Certificate Date: S— 2 S,-21 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 _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Others ;,,k 40( L/ � cot Legal Description: Lake Hill Acres #3; Lot 23 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA NO Well log is filed with Onsite (or attached) Date drilled 10/14/81 Total depth 45 ft Cased to 40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 1/15/2021 of Parcel ID: 051-122-21 Structure served by this system Well production at time of test **5.7+ qpm Water storage tank volume N/A gallons W II disinfected for coliform test? E] Yes RE] No Coliform bacteria is Negative Nitrate tf t mg/L ❑ trate less than MRL (ND) Arsenic ug/L rsenic less than MRL (ND) Collected by G (; Date of Sample �-U f a- 1 Static water level at beginning of test *UNK ft Comments ARTESIAN WELL -COULD NOT GET A STATIC WATER LEVEL READING "PUMPED 1,110 GALLONS IN 180 MINUTES B. TANK DATA Age of tank(s) 28 years Tank type/material HOLDING" t C. LIFT STATION 9Lj ❑ Required maintenance comp Age of lift station rs Measured operating fluid level in septic tank N/A Lift station mated ❑ Standpipes/foundation cleanout per record drawing Commen Date of pumping SEE ATTACHED PUMP RECEIPTS D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A - pressurized field ❑ Monitor tubes go to bottom of effective. If not, depth into effective ❑ Code -required soil cover over fi ❑ System presoaked (Required if vacant f eater than 30 days prior to date of test) Gallon roduced gallons Co nts/Deficiencies: COSA Checklist yellow sheet Adequacy test date Results ❑Pass or bedrooms Fluid de nor to test in er added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date , /15 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' NSA Community Sewer Manhole/Cleanout > 100' ft If absorption field is u r7 Yes if No ft Q Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'1771 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑ Yes if No *65 + ft Neighboring Absorption Fields > 100' Surface Wat _ Animal Containment > 50' 0 Yes if No ft F71 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft F-71 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes ** if No ft Surface Water > 100' ❑ Yes Ik**751+ if No ft Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No NSA ft Private Wells > 100' ❑ Yes if No *65'+ ft Water Main > 10'✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 0 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' ❑ Yes if No ft If absorption field is u veway comment below Property Line > 10' ❑ Yes if No ft Wellsen jacent Lots: Water Main > 10' ❑ Y�sii No Private Wells > 100' ❑ Yes if No ft Water Service Line > 10' No_::: ft Community Wells > 200' ❑ Yes if No ft Surface Wat _ ❑ Yes if No ft F. ENGINEER'S COMMENTS *WR# 920056 **5'+ MET CODE AT TIME OF INSTALLATION ***75' FROM TANK TO SURFACE WATERS - WE ARE REQUESTING THAT YOUR DEPARTMENT AMMEND THE EXISTING 80' WAIVER DOWN TO 75 FEET. G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet o � F i Cv�a4 4 4 T ne v � yy� I f eY��Gc�rness. 9� CE 79 3 �81 40R�p�o f e s slo��c�o #AECC884 lq,ylj MUNICIPALITY OF ANCHORAGE DEVELOPMENTSiR710ES DEPARTMENT907-343-7904 On -Site Water and Wastewater Section m Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC211112 Subdivision: Lake Hill Acres #3 Lot 23 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 to $11,000 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. MaiUng AddressP O Box 196650* Anchorage, Alaska 99519 6650 *www muni org j, OFA R Lot 21 A w rn Cn W O MIRROR LAKE S76°53'30,, \\ Wood fence (typ) LOT 23 deck Well O 49.0 24.0 2 Story Frame House 0 22.0 C> co deck m co 0CD N N /' Uy Lot 1 m Lake Hills Subd. N Addition No. 5 .P 0 l tl Ret. wall C W Gravel Septic ° rn driveway ; vent ° — I — _ -- 1 U ty i E asement till ► N 0182°45'50' 127.90 KE DRIVE CTI MIRROR 00 y c� SCALE: 1 "_ 40' OF , q4 �S d 49th00 '. 00. 700 00 &e_aj *_ -1ro 10 �9'. Elizabeth L. Walatka : a o0 , '�F • , 8036 - LS , • Je m -- � 8F0 pR�FESSIONAI-•�� ®' AM AS -BUILT NO CORNERS SET THIS DATE I hereby certify that 1 have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 23 LAKE HILL ACRES SUBD THIRD ADDITION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 25th day of JANUARY, 2021. THOSE SHOWNN ON THE RECORDED EASEMENTS RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. FB21-1, pg 5-6 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and Is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. GARNESS ENGINEERING GROULtd P, M, ENGINEERING,-, SALES b-CONSULTING March 24, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Waiver Amendment Request — Lake Hill Acres #3; Lot 23 To whom it may concern: The subject lot has an existing wavier for a reduced separation distance between the holding tank and a nearby surface water down to 80 feet (WR#920056). We are requesting that your department amend the existing waiver from 80 feet down to 75 feet. Justifications for granting this wavier are as follows: ® We are only requesting an additional 5 -foot reduction in separation. ® The encroachment has likely existed since the initial installation in 1992. ® According to the new 2021 survey (submitted with the COSA), there is a gravel driveway to the west of the existing holding tank. If effluent were to overflow, it would have to travel over the gravel .driveway to reach the surface water. It is reasonable to believe that the homeowner would notice the surfacing effluent and take corrective action. ® The holding tank has a high-water alarm. If the holding tank were to become surcharged, the owner would be notified, and corrective action could be taken. We are unaware of any adverse impacts this waiver amendment would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com Municipality of Anchorage r; �irpa•. P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: WR920056 -AMENDED COSA#: Permit#: PID#: 051-122-21 Legal Description: LAKE HILL ACRES #3 LT 23 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the holding tank to the surface water has been approved. The approved separation distance is 75.0 feet. This waiver approval applies to the existing holding 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. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 3�ZS�Z f Approved by: Name of Revie ......................................................... ■ ................. ■ 1 **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519.6650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 051-122-21 HAA # 1. GENERAL INFORMATION Complete legal description ' AKE HII ACRES ci 1RDi ISIQ i #3• 1 OT 23 Location (site address or directions) 22359 MIRROR IAKE DR CHUCIAK AK 99567 Property owner GARY & SHERRI SCHOLUEGERDES Day phone (907) 527-4497 Mailing address 22359 MIRROR LAKE DR ANCHORAGE AK 99567 Lending agency Mailing address Day phone Agent FRANK STEVENS Day phone 1907) 689-6480 Address PR iDFNTIAi YISTA• 16635 CEUTEE FIELD DRIVE EAGLE RIVER AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 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 Holding Tank XXX Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $800.00 at, or prior to, closing for the engineering services provided. 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 of this Health Authority Approval application 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 inspectio the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and. late codes, ordinances, and regulations in effect on the date of this inspection. , /, Name of Firm Phone (907) 337-6179_ In conducting this evaluation, AWWC,Tnc. ,�tt�/npY d to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and M D Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water oo�opp� usage of the family being served by the system. These conditions are outside the control of o the evaluator of the system. Satisfactory test results do not guarantee future performance o t O of the system, nor do they guarantee that there are no hidden defects or encroachments. op Q / / i •, �� AWWC, Inc. can therefore not provide any warranty for future estimate of how long the p y system will continue to meet the operational requirements of the ADEC or MOA DHHS. ,*„ ;, 4 The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. OOn J. fry A. Go ess; 6. DHHS SIGNATURE lJJJ (�E-7953 A% Ll� Approved for _ bedrooms Disapproved Conditional approval for Additional 0 ,dpi of assionoo� bedrooms, with the following stipulations: Date 7-2-0C) _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. 1191) Back MOA#21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN Environmental Services Division 825 L" Street, Rm 502 Anchorage, Alaska 99501 ,<ECEIVE.0 JUL 06 2XID SERVICESMJNIt.INALRY OF GE wIRONMENTALS - ISI— ( (907) 343-4744 Health Authority Approval Checklist Legal Description: LAKE HILL ACRES SUBDIVISION #3; LOT 23 Parcell.D.: 051-122-21 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (YIN) YES Date completed 1981 Total depth 45' Cased to 40' Casing height (above ground) 18"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM. WELL LOG Date of test 1981 Static water level ARTESIAN Well production AT INSPECTION 6/28/2000 ARTESIAN g.p.m. 6.8+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate 2.97 mo/L Other bacteria 6 O.B. Date of sample: te-29-06 '. 5 Collected by: A.W.W.C., INC. B. SEPTICO@LDING TAN DATA Date installed 10/23/92 Tank size 3500 Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) YES Date of Pumping 6/23/2000 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed _ Soil rating (g.p.d./ft2 or ft2/bdrm) System Length Width Gravel thickness below pipe Effective absorption area - Monitoring Tube Date of adequacy Fluid depth in absorption field be est (in.); depth Depression over field (Y/N) For Immediately after gal. water added (in.): Fluid dep=12 (ins) Minutes later: Absorption rate = oxide months) (Y/N) If yes, give date 72-026 (Rev. 3196r Computer Version Bedrooms D. LIFT STATION Date installed Manhole/Access (Y/N) ' mro—n" level at' "Pump off" level at* High water alarm level *Datum ested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *WAIVER GRANTED (WR920056) Septictholding tank on lot *65 On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station SEPARATION DISTANCES FROM SEPTIC OLDING TAN ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field N/A Water main/service line 10'+ Surface water/drainage **69' Wells on adjacent lots 75'+ **0 FEET WIVERAS / 69 FEET TO INBDRAN GEADITCHWON SOUTH ESIDE OF THE 6ROAD, REQUEST RAM NDMVNT 40 WAIVER (SEE ATTACHE D). SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property Surface water Curtain drain F. ENGINEER'S I certify that I of Municipal with MOA H Engineer's Date .cam HAA Fee S Q_..5>O 0 Building foundation V Inspections and review stems are In conformance this date. A. GARNESS Date of Payment 07 ©Z —o p Receipt Number � 72-026 (Rev. 3/88)* Computer Verslon Water parking/vehicle storage area Wells on a Waiver Fee Date of Payment Receipt Number 07-03-00 11:09 FROM -CTE ENVIRONMENTAL 5615301 T-924 P.01/02 F-232 CUE Environmental Services Inc. rm�www� Isos�YYd�riso CT&li Ref-# 1003389001 Client PO# Client Name A& Water & Wastewater Consultants Inc. Printed Date/Time 07/03/2000 10:42 Project Name/# Lake Hill Acres #3 Collected Date/Time 06/282000 13.50 Client Sample ID Lake Hill Acres #3 Received Datw`Ttme 06/29/2000 11:20 Matrix prinking Water Technical Director Stephen C. Ede Ordered By ,� / PWSID U Released ay vJ�(/vf+�4/J ��% ^r` Sample Remarks: Allowable Prep Analysis Parameter Resutts POL uni rs 140000 Limits Date Date Init Waters Department NiTrare-N 2.97 0.500 mg/L EPA 300.0 (c10) 06/29/00 SCL MicroDlology Laboratory Totat Cotiform 6 00, No Coli col/1D0mL SN10 92220 06/29/00 ADT ALASKA WATER & WASTEWATER ,. ;xxa.,, anzx:x. csxmcv` -r.m, = CONSULTANTS. INC. •�':• .�_s.c.,. ,.. .:. ar ='.a-- July 5, 2000 Municipality of Anchorage Department of Health and Human Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Amendment to Waiver #WR -920056 for Lot 23, Lake Hill Acres Subdivision #3 To whom it may concern: We request that your department amend waiver #WR -920056 from 80 feet to 69 feet from the existing holding tank to a surface water which is located south/southwest of the of the property. The ditch line that has the ponded water feeds a culvert which the original waiver of 80 feet was to the small creek coming from this culvert. The same justification for the original waiver should still apply. I am unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any quesAns, please contact us at 337-6179. Thank you for your assistance. M.S. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 iviunicipalit of Anchorage } i Department of Health and Human Services 825 " L' Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ei.anchorage.ak.us July 7, 2000 Jeffrey Gayness Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-13 Anchorage, AK 99504 Subject: Waiver Request for Lake Hill Acres #3, Lot 23 Waiver Request #WR920056 Parcel ID #051-122-21 RA000291 Dear Mr. Gayness: Your request for a waiver of the required 100 feet horizontal separation from the holding tank to surface water has been approved. The approved separation distance is 69.0 feet. This waiver approval applies to the existing holding tank to surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICESi 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 Parcel I.D. # 051-122-21 HAA # 0 Q1 lnrnLAC` 1. GENERAL INFORMATION Complete legal description rake Hi 1 i Amps #3. rnt 23 T15N R1W Section 3 Location (site address or directions) NHN Taka Shnrp Driv_ P Chllgiak Property owner Patricia Smith Day phone 561-0700 Mailing address HC 79 Box 6391, Chugiak, AK 99567 Lending agency Mailing address Agent Address N/A Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone 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 Holding tank X 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 921 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 of this Health Authority Approval application 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, Ak 99577 Engineer's signature Date -72 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Y: 1i 1TIr Date /) /lam //-,:Z . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. iM,25 (Rev- 1:91) Back MOA U21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1,41VE RILL_ Parcel I.D. A. WELL DATA Well type 8XIVAL6 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) YCS Date completed /9$/ Driller /t/�NUSDI/ � f Total depth 146/ Cased to -/t0 Casing height Z Sanitary seal (Y/N) YES Wires properly protected (Y/N) YGS Date of test Static water level Well flow Pump level FROM WELL LOG /(yV A4T6S t N 50-1- 9 -p.m AT INSPECTION /0/43)9 -2--- e7 I iZt 0 S g.p.m. -1 ® ti; SEPARATION DISTANCES FROM WELL TO: nom, Septic/holding tank on lot 6e5 WA/yg 4 ; On adjacent lots Absorption field on lot /W 14 ; On adjacent lots -,410()-' Public sewer main Al 1A Public sewer manhole/cleanout 141A Sewer service line 5-2 Petroleum tank NONE APPA,2CNf WATER SAMPLE RESULTS: Coliform Nitrate 3 M6 / I_ Other bacteria Date of sample: D 9V7 '; / 9 7— Collected by: �5/J6 iN C E ,e B. SEPTIC/HOLDING TANK/DATA Date installed T�9z Tank size 3/ S U d Compartments Cleanouts (Y/N) Y65 Foundation cleanout (Y/N) yC 5 Depression (Y/N) 1v!o High water alarm (Y/N) Y65 Alarm tested (Y/N) Date of pumping Pumper C l2 S SEPARATION DISTANCES FROM SEEP=HC/HOLDING TANK TO: Well(s) on lot (05, On adjacent lots f/00 Foundation 2 / 7 / To property line /U Absorption field IV,LA Water main/service line Surface water/drainage 90 -WA, / VL /e 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE �s q L �i M D ri N M OI mn to S 00 <3� NG O M Z C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at ,I � Meets MOA electrical codes (Y Manufacturer Manhole/ SEPARATION DIS -TAI -CE FROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA Date installed Length Total absorption area Width Depression over field (Y/N) Results (pass/fail) On adjacent lots Peroxide treatment (Past 12 months) (Y/N) (Y/N) "Pump off" level at Cycles tested Surface water Soil rating Gravel thickness System I depth Cleanouts presence/N) Date gf4dequacy test SEPARATION DISTANCE FROM ABSOR,P ION FIELD TO: Well on lot To building foundation On adjacent lots�� Surface Cur -tarn drain E. ENGINEER'S CERTIFICATION adjacent lots Cutbank If yes, give date Property line To existing or abandoned system on lot Water main/service line.. Driveway, parking/vehicle storage area bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signaturez'� o. Engineer's Name' Date }y < HAA Fee $ 170 Waiver Fee: $ Date of Payment —z z— Date of Payment _ Receipt Number Receipt Number _ NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 • FAX 4563125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 • FAX 2749645 Eagle River Engineering Report Date: 09/28/92 P.O. Box 773294 Eagle River AK 99577 Date Arrived: 09/23/92 Attn: Louis Butera Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: A120571 Lake Hill Acres #3,Lot 23 Water Method Parameter ------------------------------------------ EPA 353.3 Nitrate -N Reported By: Susan C. Tifental Microbiology Supervisor Date Sampled: 09/22/92 Time Sampled: 0745 Collected By: LM MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag MDL Analyzed -------------------------------------------- mg/l 3.1 0.5 09/22/92 APPLI( �.NT FILLS OUT UPPER HA: '` ONLY Property Owner -/\ O fZ Tj/-j /V /,�� F--�!`) !✓.�i =- Jv Phone Mailing Address U / . , /0 --3271 Zip Code Date Buyer jlnspectFL� Address Zip Code Lending Institution Phone Address Zip Code MUNICIPALITY OF ANCHO GE Realty Co. & Agent - Phone Address - - ��" Zip Code t Ay � Legal Description L. --t- /� sf / � / C L- d C- i 'E- .5 `� t G _ Z � L� Street Location A1141./ L e J/ -I 0 Type of Residence RECEIVED Z1, Single Family ❑ - Multiple Family No. of Bedrooms ❑ Other Water Supply E' _1, }, c% i X Individual r ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community - For wells drilled prior to that date, give well depth (attach log if available). - ❑ Public Utility ( ) CONDITIONAL APPROVAL- Sewer Disposal ❑ Individual Year Individual Installed: blic Utilit When Connected to Public Utility: Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. S //,Q -- LL1&A-4) Time Time Time Date Date Date jlnspectFL� Inspector Inspector - Inspector Field Notes: ((,, MUNICIPALITY OF ANCHO GE / �s 1 6 DEPT. OF HEALTH & ENVIRO.!MENTAtL PROTECTION t Ay � f� A� RECEIVED ( 10 APPROVED BEDROOMS - / 'CONDITIONS OF APPROVAL - (") DISAPPROVED ( ) CONDITIONAL APPROVAL- j BY, l )� Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size - Well to Tank 5. LEGAL DESCRIPTION DATER E'CE IVED INSPECTION APPOINTMENTS cfe5 SL, TIME TIME TIME rlJe 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS DATE DATE DATE 54 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six INSPECTOR INSPECTOR - INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTMIRONMENTAL P OTECTION 825 L Street - Anchorage, Alaska 99501 ,;.iii 8 981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI RECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER Le lav\ A \JekS PHONE ❑ PUBLIC UTILITY -2.�F��l MAILING ADDRESS �/tt PROPERTY RESIDENT (If different from above) PHONE 'Sexv 2a 2. BUYER - PHONE MAILING ADDRESS 3. LEND[ N INSTITUTION `0.S PHONE g�� ZC) (4 l:� G� (/�© W�wvl��C2 L Ce t1 '� !� 1 MAI LING ADDRESS G:a'letvec" 4. REALTOR/AGENT Lo PHONE 69 3�� 6 r c,tv\, \v,er MAILING ADDRESS�7 Eagle R�nniver Va Box G- k sq -77 i , 5. LEGAL DESCRIPTION Lt �2 3 Le, ke- 4 ells cfe5 SL, STREET LOCATION Lake 5ko1-e rlJe 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other 54 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY 199 INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM D< INDIVIDUAL/ON-SITE** )'11 1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MU T ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 1 s/7 \ n � �Dn� \ � _ jam, / i 0 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_LOG PERMIT NUMBER DEPTH OF WELL DATE DRILLED RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE Ll PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑ Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS -S. Z(- APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter m accompany certificate) [b�"DISAPPROVED DATE / BY i June 10, 1981 826 L St REFT (900) 264-411 1 9AYOR vt_'h.ti?:?`iii'+ � inE-A l_ali AND NV.(s0;a,%;. Mf/1LPRO Leland Welsh Lorrain-, Miner Post Off. -ice Box 677 Haglo River, Alaska 99577 Subjects Lot 23 Lake Hill Acres Subdivision i'#3 Approval for the individual SeCder and water facilities cannot be granted until the following items have been completed - (1) Hand drag wells are not acceptable within the Municipality of Anchorage as an approved water, source. Therefore, the hand du.c,, well will need to be abandoned and a neva drilled well i:lasLalled. Prior to the drilling of the well, a permit will need to be obtained from this department. (2) The cleanout to the holding tank needs to be raised above ground level and reinspected by this office. (3) A pumping contract is required on the holding tank and a copy submitted to this Office, If there are any further questions, please cdll this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw ccs Alaska Hank of Commerce Mo.rtgc° e Loaa.a Departnen+- Post . G_fice Dox 1.185 99577 ' Sanitary Pumpers , P. 0. Box 433 Eagle Riuer, Alaska 99577-0433 15 October 1981 Mr. Dean Hansen Alaska Bankof Commerce P. 0. Box 1185 Eagle River, Alaska 99577 To whom it may Concern: Sanitary Pumpers will provide a monthly pump out service at normal rate for pumping, for for. Dean Hansen, at the home on Mirror Lake. Pumping to commence on 30th. November 1981. Sincerely yours, Billy Me Gowen, owner Sanitary Pumpers BEMG/cam s L/PT $7-A rC BC /1,SaLF7�L To 42 i3F[GU"r/r5/i <k'�1 Jf h wn " io - RNP SOCy"v r�TG 8F s sFd�eO w ti ,.,Lp Q 'F L cam+ . air w �o�p _ c _Q VIJ"�- FQveZ Q k >OvJ SiELi cE G✓JH G4vC'2{ -w � � /h1101 D✓ S / �4 FJc VSTF-1&��YJrI pq� � L/PT $7-A rC BC /1,SaLF7�L To 42 i3F[GU"r/r5/i <k'�1 Jf - RNP SOCy"v r�TG 8F s Q 'F L cam+ . air w �o�p _ •. ,/ _Q VIJ"�- FQveZ Q k >OvJ SiELi cE G✓JH G4vC'2{ -w � � /h1101 D✓ S d.LP AIZf L.I L/PT $7-A rC BC /1,SaLF7�L To 42 i3F[GU"r/r5/i <k'�1 Jf L � �l � LY C/�'x :V.-_-L^=M' a _ .+v_.. �41� [n4._ cam. I_..� "GC'.�. �•(�G-..�: - a_ - RNP SOCy"v r�TG 8F s L cam+ . air w �o�p _ •. ,/ _Q VIJ"�- FQveZ Q /h1101 D✓ S d.LP AIZf L � �l � LY C/�'x :V.-_-L^=M' a _ .+v_.. �41� [n4._ cam. I_..� "GC'.�. �•(�G-..�: - a_ S -'d -[O F: ,, "y DT1000892 s . � A _ •. ,/ .rte FYl'Ar,.� Fe'�_J i S -'d -[O F: ,, "y DT1000892 s .