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HomeMy WebLinkAboutLAKE O THE HILLS BLK 1 LT 6Lake 0' he
Hills
Block 1
Lot 6
#015-331-15
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211482 PID Number: 015-331-15
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
CHRISTINA M MORONELL
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
11471 MOUNTAIN LAKE DRIVE, ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
GPD/SFJ
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
LAKE O THE HILLS 1 6
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
Ft.
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft2
Ft.
Well
100'+
__
-
25,+
TANK ® Septic ❑ STE.P❑ Hong ldiEl -
p :. .
Manufacturer
Capacity
Surface water
100'+
--
GREER
1500 Gal.
Material
Number of compartments
Lot Line
51+
__
NA
HDPE
2
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
installer DENALI EXCAVATION
PIPE MATERIAL House toan
tk 3034 Tank to 3034
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspdecctiiosn 1" 1/5/2022 2nd 1/5/22
Location and description
3`d 1/6/22 4'"
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
\I
Conditional Approval:
..5-0-0
Aso, OF t
''
Date
X9
r
• • • • • • • •.... . • .
Septic System
Approved - >� e
% '• Curtis Huffman
����'�•.•
Date �— •Zd
CE128991
�'!�•.
1/6/2022 .
�k,, OPROFESSION?�
Note: this approval does not include well permit requirements.
...,
ionc,nnia o
�
11\GV -1-110
PID: 015-331-15 PERMIT: OSP211482
o`"• 19$ 2s s,
o �
1? 0, o.
Io O 8.0'
s LOT 6 WELL
BLK 1
I 58.5' e-Q� 5.0' .� Qtv O
� o
0 29 S' irk w
No 0 72 0'
FCO
B STAKED 100'
WELL RADIUS
PRIOR TO
A DCO CONST.
C H
.._. !A!STP.LLED NEW - D. CO
DCO
1500 -GAL HDPE
SEPTIC TANK E F
WITH NEW PRE &
POST DCO.
A -C=12,5'
B -C=17.6'
A -D=14.4'
B -D=19,8'
A -E=19.5'
B -E=23,9'
A -F=21.7'
B -F=26,2'
EXISTING
FIELD
SEPTIC SECTION
SCALE, NTS
LAKE 0 THE HILLS 131, L6
PREPARED FOR:
CHRISTINA M. MORONELL
1147 MOUNTAIN LAKE DRIVE
ANCHORAGE, AK 99516
FIRST WATER CONSULTING
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 firstwaterAK@gmail.com
JVrrVt'C 1 JtKVIGtJ:
OFF5ALS
C � * TH
DATE: 1/6/2022
2022
rtis Huffman
SURVEY. KGL'4, CE 128991
DRAWN: FWCS 1 /6/22
SCALE: 1" = 30' FESSIO10
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MUNICIPALITY OF ANCHORAGE
On-SIte Water & Wastewater Program
P4 Bax 195550 4700 ElmarB Road
.Ancharags, ALmW 9951 M55G Fftmw (907) 343-7W4 Fax, S907I 343-7997
http:?1wwr.!rnunl.argh0n!j le
On -Site Wastewater Disposal System Permit
Permit Number: OSP211482
Work Typt SepticTank Upgrade
Tax Code Namber`. 0163A115W0
Site Legal AddreRs= I AKF n THF HII 1'.q AN K y I T F; 7 ❑
S lt.e Mailing Address: 11471 MOUNTAIN LAKE DIS, Anchorage
Owner. MORCNELL CHRISTINA M
Das 1-gM Engineer: FIRST WATER CONSUI_TI1,IG
This permit is for the construction of;
Effective Date
rx pi rati on Data:
Lot Size in Sq Ft;
Total Bedr*omS;
12M2g21
12{112
54470
❑ aisposar Field R1 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private well d Water Storage
A] I oe detraction s hall he i n accords n ce wrrith,
1. The attached approved design -
2. All req uirements spacitl l in lirtlChOUBIge Mun ici pal code Chapters 15.55 Sri d 15.$5 and the Stage of Alaska
Waslewater Disposal Regu lations (18AAC72) and Drin king Water R"ulatlons {1 BA_ACAOO
. The WaStewateT Wode req ui res irtspoot ns during the installation- The engin-aer shall notify the Development
SaMces .Department per AMC 15-65- Provide rn-oliticatlon by calJing (907) 343-7904 (24x7).
4, From October 15 to Aprll 15. a Subsurface soil absorption systern udder construction du ring freezing weather
shall be either:
a, Opened and Closed on the sarne day, or
- Covered, Sealed, and healed to prevent freozIng
penia I F revisions: Prior to construction, the bedroom count from M OA Pro porly Appralso I is to be ch a nged to
5 bedrooms or a Change Order is to be submitted for a $ bedroom tank design.
L
r
Rcoeived By:
Date: 12/212021
Issued Qy:�,. Date.
5
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water &Wastewater Section Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-331-15
Property owner(s) CHRISTINA M. MORONELL
Day phone
Mailing address 10688 CHESTNUT HILL LANE, DAYTON, OH 45458
Site address 11471 MOUNTAIN LAKE DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) LAKE O THE HILLS 131, L6
Legal description (Township, Range & Section)
Lot Size 54470 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
TYPE OF DWELLING:
Absorption Field ❑ Initial ❑
Single Family (SF) 0
Septic Tank 0 Upgrade rX
(w/wo ADU)
Holding Tank ❑ Renewal ❑
Duplex (D) ❑
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage . ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance: -
I certify that the above information is correct. I further certify that
this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 2 Z Waiver Fees:
Date of Payment: 1 l 2 0 21 Date of Payment:
Receipt Number: 31'4?- 5 a Receipt Number:
Permit No. O.Sp 2 1 1 1-t,3 2 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
November 24, 2021
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: LAKE O THE HILLS B1, L6
The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic
tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the
attached design to serve the existing 5-bedroom residence. The lot and area are served by private
wells. The design will not impact any of the neighboring properties. Please contact us if you
have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211482, Deb Wockenfuss, 12/01/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211482, Deb Wockenfuss, 12/01/21
Permit
Name:
Jeffrey Pi
Address:
11471 Mo
Phone:
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and W t
as ewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
:r: SW930305 PID Number: 015.331-15
Wastewater System: New
LEGAL
Block: Lot:
1 6
Township: Range:
Well: New
Bedrooms:
section:
192
Static Wates
95
U
1-2.5
.ra"W "CRh:
3.5
rota/ absorption area
960
nstallec
Harten Construction
)RPTION FIELD
Deep Trench
GPD/Fe 9.5.10
Ft.
le: Gravel depth beneath
P Pe:
Ft. 6 Ft.
Gravel Length: p
Ft. 80 Ft.
Number or lines: Distance betwean lines:
Ft. 2 >12 FI.
Pipe Material:
Fe ASTM 3034 PVC
Date Installetl:
6/17-20/94
rL
GPM
I Ft.
11
>2
Ft.
TANK
SEPARATION
DISTANCES
® Septic ❑ Holding ❑ S.T.E.P.
El Other.,
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
ublic'Private
Sewer Line
anu urr:
e
Anchorage Tank
apace, � a ons
1,500
well
>100,
>100,
NIA
NIA
>25'
ateml
Steel
um r omps
Two (2)
suaasawatar
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
Lot Line
>5'
>10,
N/A,
N/A
'w
an a are.
Gal
Foundation
>5'
>10'
N/A
N/A
ump n"Te_var7
umpo eve a:
ig eraarma:
Curtain Drain I
None
I Noted
in.
Pump Make & Model
in.
Electrical Inspections performed Is.
BENCH MARK
Garage Slab.
Inspections performed by: A. Harala Dates: 1n 6/17/94
6/20/94
Department of Health and Human Services approval
Reviewed and approved by: Date:
qRc 10/99)
100.0 Ft
Engineer's Stamp
*�wglil
�F.... ++0
to :'� i
��....
n a MICHAEL E. ANDERSON
J}':, No. CE -4381 =��
in.
Mountain Lake Drive
W
0
0
PJ
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: SW930305
PID No. 015-331-15
NOTE: TH1 Completed to 69'. No
Groundwater Or Bedrock Found.
NORTH LEG
U E 90.5
83.35 Drainfietd Rock
77,2
40' (Trench Len
SOUTH LEG
PROFILE AS -BUILT
No Scale
"ERIK:
- Municipality of Anchorage -
DcRAR T MEN? OF HEALTH $ HUMAN SERVICES
ult 320 "L" Str=et, Anchorage, Alaska 99502-0650
SOILS LOG —.PERCOLATION TEST '
6
PERFORMED FOR: %^'-/ i J dtrS'.✓ __. DATE
LEGAL DESCRIPTION: � , �'7a �-a � ILI N'1 . ownship, Range, Section. i
2
/(/
i .
Av �I �
0
n
�
WAS GROUND WATErR '
ENCOUNTERED?
11
a/O -
.lei ^vi'peiv. -
I IFYES,ATWHAT -
.i2
DEPTH?
j3
�"
Dem n Apel la. water
a� Mnoringl pate _
14-
15-
1,6
4 15js
17-
20-
L
720
L
O
P
E
t,
QOY COe eeyea
M9CNAEL $,
ct.
SITE PLAN
Reading Date Gross Net Depth to ..I ; Net
Time Time WaverDrop
,r
M� f
PERCOLATION PATE (rrinules inch) PERC HOLE DIAMETER
��! TEST, NBETWEEN FT AND FT
COMMENTS _67'�ii✓ "-.,- �` / ` .�i�'//r�'r c'�t` 7z✓ 1-�.a^vtr
PERFORMED 6Y CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCOROANCE WITH ALL. STATE AND MUNICIPAL GUI OF LINES 11 EFFECT ON THIS DATE. DATE
PAGE 1 OF 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES Lo -v
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND
` WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930305 A:L V ISEv 41�/iv DATE ISSUED: 8/16/93
DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 8/16/94
OWNER NAME:PIERCE JEFFREY & JANET
OWNER ADDRESS:11571 MOUNTAIN LAKE DR
PARCEL ID:01533115
LEGAL DESCRIPTION: LAKE 0 THE HILLS BLK 1 LT
6
LOT SIZE: 54470 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
FE
5 SHALL NOT- EXCEED 9.5
HE5 ?in[JST 'E , A I PAINED. BY
DESIGN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
DATED ALRTL 1994-,
RECEIVED E
ISSUED BY:
PAGE 2 OF 2
DATE:
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
April 5, 1994
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Attention: Robbie Robinson
RECEIVED
APR 51994
Municipality of Anchorage
D80i Hsaith & Human Services
Subject: Lot 6, Block 1, Lake O' The Hills Subdivision
Permit No. SW930305
Dear Robbie:
The owner of the subject lot has requested that the permit for the
onsite septic system be revised to reflect construction of a five
bedroom house. This will require upsizing the septic tank to 1,500
gallons and the extension of `'each drainfield lateral to a minimum of
39'. A revised site plan along with the design factors and system
requirements is included for your review. Please issue a revised
permit reflecting the construction of a five bedroom home. Thank
you for your assistance with this project.
Sincerely,
Michael E. Anderson, P.E.
Lot 6, Block 1, Lake O' The Hills
DESIGN FACTORS:
Five Bedroom Home
Perc. Rate: 9 Min./Inch
Application Rate: .8 GPD/SF
SYSTEM REQUIREMENTS:
Deep Trench System
1,500 Gal. Septic Tank
6' Gravel Below Pipe
750 GPD/.8 GPD/SF = 937.5 SF / 12 SF/LF of Trench = 78.1 LF Trench
Therefore:
Each Later
Pipe.
2
Construct a Deep Trench System with Two Laterals.
to be 40' Long with 6' Gravel Beneath the Distribution
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930305
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:PIERCE JEFFREY & JANET
OWNER ADDRESS:1651 DASHON CIRCLEE DR
ANCHORAGE, AK 99515
PARCEL ID:01533115
LEGAL DESCRIPTION: LAKE 0 THE HILLS BLK
6
LOT SIZE: 54470 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
PAGE 1 OF 1
DATE ISSUED: 8/16/93
EXPIRATION DATE: 8/16/94
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM -
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE NUNIC;1AL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA AS,TE^IA)lER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING_.,,WATER,,R8GjJLATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS {�T LEAST, 2 HOURS
PRIOR TO EACH INSPECTION. PRO WIDE NOTIFICATION BY
CALLING 343-4329 OR 343=46.81 FTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15--', S '1tSURFACE SOIL
ABSORPTION SYSTEM UNDER CQNSTRUC ON DURING FREEZING
WEATHER MUST BE EITHER
A. OPENED AND CLOSED, ON -T�E ;SAME DAY
B. COVERED,, SEALED] AND HEA�,t.p TO PREVENT FREEZING
5. THE<F.OLLOWING S,,,PECIAL PROVISIONS.
SPECIAT+.PROVISIbNS,
RECEIVED DATE:
DATE:
ISSUED BY: G' P
Ad
1 LT
t
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM -
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE NUNIC;1AL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA AS,TE^IA)lER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING_.,,WATER,,R8GjJLATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS {�T LEAST, 2 HOURS
PRIOR TO EACH INSPECTION. PRO WIDE NOTIFICATION BY
CALLING 343-4329 OR 343=46.81 FTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15--', S '1tSURFACE SOIL
ABSORPTION SYSTEM UNDER CQNSTRUC ON DURING FREEZING
WEATHER MUST BE EITHER
A. OPENED AND CLOSED, ON -T�E ;SAME DAY
B. COVERED,, SEALED] AND HEA�,t.p TO PREVENT FREEZING
5. THE<F.OLLOWING S,,,PECIAL PROVISIONS.
SPECIAT+.PROVISIbNS,
RECEIVED DATE:
DATE:
ISSUED BY: G' P
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
August 9, 1993
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 6, Block 1, Lake O' The Hills Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The topography on the subject lot is detailed on the attached site plan. The
proposed septic drainfield is located in a fairly flat area with good drainage in
all directions. Testholes excavated on the lot revealed no ground water with
soils suitable for a drainfield. We are proposing to construct a deep trench
system with 6' of drainfield rock below the pipe. This type of system should
provide adequate absorption of the septic effluent for the proposed five
bedroom home.
If the system is constructed in accordance with the attached design the
following statements can be made:
1. The system, if constructed as designed, will have no adverse impact on
the wells currently in use or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on
existing septic systems in the area or those to be constructed in the
future.
3. The system, if constructed as designed, will have no adverse impact on
reserved space, either surface or subsurface, on any lots located in the
area.
4. The system, if constructed as designed, will b y b �a t3 impact on
drainage patterns in the area.VJAn°oD`3OP,"°o' fi
Sincerely,
.0..0
� /�� � I!'4 �CM1� G� ! • c�'/�D• CO'a Q'•V an eD00 9 �..
a hhichasl E. Anderson aD `-•�
G •D 1361 • E e q,<.az
Do
Michael E. Anderson, P.E.
MAA
J013 L=14 64 J1,4 L^v %�&L:Lg gga>
SHEET NO. OF
CALCULATED BY.. DATE
CHECKED BY DATE 77
... . .... . ..
41 w
... ..... ... M . .......... .
F A
�q7
.... ........
CIO
. . .......... .. . ....
%0 ...... . ... ..... ..... ;5 ,7 oma 90
..... .... .... ..... ...... ...... ... ....... ........... .. ..........i ........... . .. .....
. .....
. ............. ........... .. ... ..... ... .. ... ..... .. .. ......
. .. ...
EY Anderson 4-
Micllcle ,4j
........ . . ............ .. ..... ..
......
............ ......... ..
. .......... . .... ........ ..........
F
JCB y. /S60 uc
SHEET NO.
CALCULATED BY MLS DATE-
CHECKED
ATE
CHECKED BY
DATE
SCALE A/D Al E
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Dhapl C. tenderson
IC,icD
4381
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION: �r %�4 I Ak l !l'� II1 Township, Range, Section:
SI (SPF SITE PLAN
1
2`
4 K
4 nG di
6
7
871/-'01'*.
9
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WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT ,� p
DEPTH? P
E
Depth to Water Ahe`� r q3
Monitoring? Date: 6 7
20 //
v PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER I¢1—
I- I_ TEST RUN BETWEEN FT AND FT
COMMENTS 'G5� r'�I� )6`y2 P�-
PERFORMED BY: o� I r"''V .L, ea_ 't'� IFY THAT THIS 71;-
72-008
/TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 917 A 1 ;-
72-008 (Rev. 4/85)
PERFORMED
LEGAL DESCRIPTION:
goz PT
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
12
13
14
151 f
16
17�
18-
19-
20-
COMMENTS
s1920COMMENTS
%Il V/AI�JI. DATE
IIIb Township, Range, Section:
SLOPE
.V&T'S SEAL)
yty���
°°'5145-
o�e�`v i
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Anderson
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
2
ai
IF YES, AT WHAT
0
DEPTH?
P
�I OcGr Q)Ibyfil
E
Depth to Water After
Monitoring?
Dale: I�
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16
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COMMENTS
s1920COMMENTS
%Il V/AI�JI. DATE
IIIb Township, Range, Section:
SLOPE
.V&T'S SEAL)
yty���
°°'5145-
o�e�`v i
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Anderson
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT
0
DEPTH?
P
E
Depth to Water After
Monitoring?
Dale: I�
PERCOLATION RATE _i1L— (minutes/inch) PERC HOLE DIAMETER �L
TEST.RUN BETWEEN FT ANDy FT
PERFORMED BY: T 1 4tdL4 - `F! &2L-MTIFY THAT THIS EST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-DO8 (Rev. 4/85)
LT1T
��it1�L��ES�1s
��■L!��■!j��177/rr``®ins
:: : ;��
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PERCOLATION RATE _i1L— (minutes/inch) PERC HOLE DIAMETER �L
TEST.RUN BETWEEN FT ANDy FT
PERFORMED BY: T 1 4tdL4 - `F! &2L-MTIFY THAT THIS EST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-DO8 (Rev. 4/85)
PERFORMED FOR:
LEGAL DESCRIPTION: !
'" tT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 " U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
SM, W/oma
�ens�
w
TeJ 44,,,
f
DATE
i, Range, Section:
SLOPE
NONE
■■UFS
■INNIM
MMON
■■(13E
■EAN.
MORE
MORE
ORION
EFINE
M111EN
NUM
-01
WAS GROUND WATER ` r
ENCOUNTERED? P
S
IF YES, AT WHAT L
0
DEPTH? P
E
Depth to Water After' �7 13
Monitoring? Date I
PERCOLATION RATE �5 (minutes/inch) PERC HOLE DIAMETER G n
TEST RUN BETWEEN FT AND _L—FT
COMMENTS r w v ry W
PERFORMED BY: I NG"f+ C' E��"''��EE3 IFY THAT J HI TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/719 r
72-008 (Rev. 4/85)
(ENGINEER'S SEAL)
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES � 1 aa� `
825 " L" Street, Anchorage, Alaska 99502-0650 c,e ao J o�oa©°o°
SOILS LOG — PERCOLATION TEST "4, �. � 1
PERFORMED FOR: i/TI DATE PEfFOD: 9�'�
lap
PROFEW
LEGAL DESCRIPTION: r Township, Range, Section:
SLOPE
SITE PLAN
1
� L
r•
N
2--
v�.
3-
4
0
/
1-47
r//I � 1N/5t7M!/bII�'� 5ovni��rB�t.�
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9
WAS GROUND WATER !1�
10 ENCOUNTERED?IF 0 V
DEPTH? WHAT P
12 c� E
Depth to Water After {{
13 Monitoring? `� Date: 7 3
14-
15-
16-
4 1516 TO -3
71a1917-
18-
19
20
PERCOLATION RATE
TEST RUN BETWEEN
COMMENTS
s id'
u
F
(minutes/inch) PERC HOLE DIAMETER
FT AND FT
PERFORMED BY: 11Vk!--- 1 �J � %� IL c TAT f f THAT THISTEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85) _
01
PERFORMED
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
LEGAL DESCRIPTION
18-
19-
20-
COMMENTS
81920COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
(ENGINEER'S SEAL)
1?e /' r,
Pj
Michael r.�
DATEtF3�/IEl�NfD':31D
0000
Range, Section: 44®OFE"
SLOPE SITE PLAN
s
L
0
P
E
Depth to Water After G
Monitoring? Date:' % 3
O� p
PERCOLATION RATE _/ (minutes/inch) PERC HOLE DIAMETER
I I
TES�T�R`{N BETWEEN � /y �TAND � 7y FT
o�lCe.� hrtor �C� +e!5+�i nol
PERFORMED BY: n T 1 M'`" "L �x AEKTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S./Z/9-T
72-008 (Rev. 4/85)
.o'
2-
3-
4-
4
5
5
8
,%�•
9
U�p
10
b '
11
12
13
; A O;
14-
4
15
15
T65 Pie
16
� ,1
(�
17
18-
19-
20-
COMMENTS
81920COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
(ENGINEER'S SEAL)
1?e /' r,
Pj
Michael r.�
DATEtF3�/IEl�NfD':31D
0000
Range, Section: 44®OFE"
SLOPE SITE PLAN
s
L
0
P
E
Depth to Water After G
Monitoring? Date:' % 3
O� p
PERCOLATION RATE _/ (minutes/inch) PERC HOLE DIAMETER
I I
TES�T�R`{N BETWEEN � /y �TAND � 7y FT
o�lCe.� hrtor �C� +e!5+�i nol
PERFORMED BY: n T 1 M'`" "L �x AEKTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S./Z/9-T
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: M. L.&Tni. DATE
LEGAL DESCRIPTION:�10, �I. I�p l4i fll7 Township, Range, Section:
1
a•
2-
ENCOUNTERED?
d
3 3
S
IF YES, AT WHAT
"moo
DEPTH?
� - a
4
0'• • o
5
, '
Monitoring? '�
Date:
8
' -.-
pRb
O� o O8
9
10
-X ;
11
on
12
o�OpO
13
q='
14
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5p w/7 ,ar.G,
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15 1wq
16-
17- TH 4
1s
19
20
COMMENTS I?
SLOPE
SEAL)
000�0r% 0,O �W .
0 0
' - W7 oAooa rg
. p� oo emmamg o:yaoo [8
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11
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"`M 4381
pi;
SITE PLAN
WAS GROUND WATER
"
ENCOUNTERED?
d
S
IF YES, AT WHAT
t
DEPTH?
P
E
Depth to Water Atter
Monitoring? '�
Date:
j,� q
PERCOLATION RATE 'Y- (minutes/inch) PERC HOLE DIAMETER E
rEST RUN BETWEEN FT AND 69 FT
PERFORMED BY: I Z 1 4U.AatL " ��C kTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Depth to
Water
j,� q
PERCOLATION RATE 'Y- (minutes/inch) PERC HOLE DIAMETER E
rEST RUN BETWEEN FT AND 69 FT
PERFORMED BY: I Z 1 4U.AatL " ��C kTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Jj J. & P. Seafaring Ventures Inc.
P.O. Box 110041 Anchorage, AK 99516 (907) 345-4756
RECEIVED
DEC 2 3 1994
'pafiiy of Anchorage
ACL ze)- OePt- Heaith & Human Services
GO C9 7�e fz. iX-
o -ice-
A Ile, 4
Q -
OL
(2
7Y,
Vj ke
F}-orn ALPINE DRILL 907 345 ©202
Dec. 14. 1994 11:34 P11 P01
,. y
STATE OP AI ASKA
DEPARTMONT OF t4ATURAL RESOUA001
DIVISION OF WATER
WATER WELL RECORD
S-'
n ufall SUBDIVISION LOT Bl.4GiC SECTIONOTRS SECTION TOWNSHIP RANGE
❑N C7E
CIS 0
ei4�NfSK 1}FL; WELL OWNER:
n
PP
f i ;I
f 6 jUGASUREU FROMOcasing top ®ground surface WELL: DFPTM. DATE OF t94h�k1 4i t`j
Depth of hole: rr�ft r....
t ifr:pth Depth of Cash r��ft /% ' �i�
1 v and Color From TO
DEPTH
O 81'baui WATER LEVEL.
---ft below top Of casing 0 prgUnd;W"Doo.,
f, r
I
METHOD OF DRILLING, air rotary
0 other
USE OF WElI.L,) domestic C) Irrigation 0 i
public supply 0 other ! i
�' .• CASING STICAC UP ft. Diem
li �.as1-1j� ),v.a.._o
5!
WILL INTAKE OP£NINO TYPE: I. open on `L I�grarbrfab �'..
parforated fr open hole
I
-:1 C ��•,::..rJ 3..... _ .�, .:'F. x./ Depths of opanmgs: r' to
SCREEN TYPE: viem: Iri.
-- — Slotftsh Size: t
--
GRAVEL SACK TYPE: i
:
- --
-- _ �- Volume used: Depth CU to tl '
t'ROUT TYPE:
Volume:
_
Depth: from ft to
DEVELOPMENT METHOD.- i
Duration:
I, t
PUMPING LEVEL AND YIELD:
It after /Is purnpirta.,
P f,�
PUMP INTAKE DEPTH:€t MorsOppwgr, ( j
WELL DISINFECTED UPON COMPI.£ilOfYii #�
y�
�STORIANPORMA'TION:
REMARKS:
z.
Hess{ am't
V er
PLEASE MAIL, WHITE CO OF Iii
+? d t tonne esprss ntative DNR/DIVISION OF WATER lT%04
(late
PO BOX 772116
- X11 /y. Iate,• • _ i..
MUNICIPALITY OF ANCHORAGE
0.14
�{
�Y.r SHa
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 015-331-15
1. GENERAL INFORMATION
Expiration Date: q — /Z —2 Z
Complete legal description LAKE 0 THE HILLS BLOCK 1, LOT 6
Location (site address) 11471 MOUNTAIN LAKE DRIVE, ANCHORAGE AK 99516
Current property owner(s) CHRISTINA M. MORONELL Day phone
Mailing address
Real estate agent
10688 CHESTNUT HILL LANE, DAYTON, OH 45458
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 950
Date of Payment /2_/3Oh-1
Receipt Number %1034'52
COSA #
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/3012021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWCS
6. DSD SIGNATURE
System #1 Approved for S bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
*: 49 TH ....�:*
...�."
• • • Curtis Huffman
��+ �'FG,/ ;• CE 128991 •.0AW�
1t ,F,�•• 1z�3o/za•���„
1 F�PROFESSIONP�
bedrooms, with the following stipulations:
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
• A
Legal Description: LAKE 0 THE HILLS BLOCK 1, LOT 6 Parcel ID: 015-331-15
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 9/6/1994
Total depth 224 ft
Cased to 192 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 11/9/2021
Static water level at beginning of test 99 ft.
Comments
B. TANK DATA
Age of tank(s) NEW TANK years
Tank type/material SEPTIC/ HDPE
Measured operating fluid level in septic tank
® Standpipes/foundation cleanout per record drawing
Date of pumping NEW TANK
Well production at time of test 3.9 gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by FES
Date of Sample 11/9/2021
C. LIFT STATION
❑ Required maintenance completed
Age of lift station __ years
Lift station material
Comments:
D. ABSORPTION FIELD DATA (UPPER / LOWER TRENCH)
Which system tested (date installed) 6/20/1994
Adequacy test date 11/9/2021
0 ALL standpipes present per record drawing
Results 0 Pass For 5 bedrooms
Total measured depth from grade *11.8 / 12.7 ft (max)
Fluid depth prior to test 0 / 0 in
Measured depth to pipe invert from grade *4.8 / 7.4 ft
Water added 1000 gal (500 / 500)
(min)
❑ N/A — pressurized field
New depth 27 / 0 in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time 1020 min
depth into effective **6.1'/ 5.6' OF THE 6'ED
Final fluid depth 0 / 0 in
® Code -required soil cover over field
Absorption rate 750 gpd
® System presoaked
Any rejuvenation treatment (past 12 months) N
(Required if vacant for greater than 30 days prior to
date of test)
If yes, enter date
Gallons introduced 2000 gallons
NES
Comments/Deficiencies: *AT MT / CO. **PER ELEVATION
SHOTS TAKEN.
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances
if
less than required)
Manure/Animal Excreta Storage > 100'
Building Foundation > 10'
Community Sewer Main > 75' ®Yes
if No
ft
® 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 if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
® Yes if No ft
Water Main > 10'
—
I� Yes .
if No
ft
Community ! > 00'
Wells _ 2.,
®Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances
if
less than required)
Building Foundation > 10'
® Yes
if No _
ft
If absorption field is under driveway comment below
Property Line >1 10'
®Yes
if No
_ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells >' 100
_
®Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and review ,� {�:''
of Municipal records that the above systems are in conformance /'�••9}�
with MOA COSA guidelines in effect on this date. &: • 7H ;* �
• Curtis Huffman
��¢ ����•.. CE 128991 ..•���/'
���O���pROFESS ON�`�'\.,,,.��
Municipality of Anchorage . °E
• Development Services Department r
C�a Building Safety Division < s• •*.
t On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci. anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING���
Parcel I.D. �1J-3.31'iJ HAA# 0s6J�
1. GENERAL INFORMATION, Expiration Date: / ;Rn ^au�ln_
Complete legal description LAKE O' THE HILLS SUBDIVISION; LOT 6, BLOCK 1,
Location (site address or directions) 11471 MOUNTAIN LAKE DRIVE * ANCHORAGE, AK. 99516
Current Property owner(s) JEFF AND JANET PIERCE Day phone 346-2356
Mailing address 11471 MOUNTAIN LAKE DRIVE * ANCHORAGE, AK. 99516
Lending agency' Day phone
Mailing address
Real Estate Agent CHARLIE WHITLOCK w/ COLDWELL BANKERDay phone 562-7653
Mailing address 2525 "C" STREET * ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name .JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, 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 systems depend on the Local soils condition, groundwater levels that may
Fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. 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
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for ` bedrooms.
Disapproved.
Conditional approval for bedrooms, with the fllowing
Phone 337-6179
Date ZQ fo G
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Attachments: J'+J�r�'
HAA Checklist_ Manitenance Agreements ////J))))))))j1
Septic System Advisory Supplemental Engineer's Reort
Well Flow Advisory Other
By: 6 6> A-►�JLIf�[3 o
(Rev. 12/01)
Original Certificate Date: Iq
Municipality of Anchorage
• Development Services Department n`
Building Safety Division !1A
On -Site Water & Wastewater Program
4700 South Bragaw St
i P.O. Box 196650 Anchorage, AK 99519-6650
+www.ci.anchorage.ak.us (907)343-7904
r
I HEALTH AUTHORITY APPROVAL CHECKLIST
x
Legal Description: LAKE 0' THE HILLS SUBDIVISION: LOT 6. BLOCK 1, Parcel ID: Aly^351'!5
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
g Date completed 5/6/1994 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
r Total depth 224 ft, Cased to 192 ft, Casing height (above ground) 12+ in.
I
FROM WELL LOG AT INSPECTION
Date of test 5/6/1994 10/4/2004
r Static water level 95 ft. 95 ft.
Well production 12 g.p.m. 5.13 g.p.m.
WATER SAMPLE RESULTS:
Coliform . colonies/100 ml. Nitrate< • 10 mg./L. Other bacteria colonies/100 mL
Arsenic: N/A mg./L: Date of sample: 10/5/2004 Collected by: GEG, UD.
B. SEPTICIHOLDING TANK DATA
Tank Type/Material STEEL Date installed 6/17-20/1994
w Tank size 1500 gal. Number of Compartments 6 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 6/11/2004 Pumper DENALI SEWER
C. ABSORPTION FIELD DATA'
1 Date Installed 6/17-20/1994 Soil rating C.p—DiDor ft'/bdrm) 0_8 System type DEEP TRENCH
Length so ft. Width 3.5 ft. Gravel below pipe 6 ft.
Total depth t1_1 —13.4 ft. Eff. absorption area 960 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/4/2004 Results (Pass/Fall) PASS For 5 bedrooms
NORTH/SOUTH
Fluid depth in absorption field before test7/00 in. Water addedln6r4lgal. New depth » §in.
h
t( Elapsed Time: 11 min. Final fluid depth 17/0 in. Absorption rate >= 750+ g.p.d.
F Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date –
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"Pump on" level at _in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 101+ Surface water 1001+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
of A nesse
Engineer's Printed Nam 1 JEFFREY A. GARNESS �Q4; E-7953` 4 `
Date
HAA Fee $ 4.3 � Waiver Fee $
Date of Payment i�� Date of Payment
Receipt Number 5 to Receipt Number
(Rev.. 12(01)
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