HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 3 LT 3L k¢ 0 The Hills East Block 3 Lot 3 #015- 333-19 MUNICIPALITY OF ANCHORAGE ~ DEPA.TUE.T Or .E^'T. ^.D .UM^. SERV,CES O/~---- Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na.~e DISTANCES 'T~/~- ~~ ~ SEPTIC ABSORPTION TANK FIELD WELL LEGAL DESCRIPTION Township. Range, Section AS-BUILT DIAGRAM (Show location of w~ll, septic system, properly lines, ~oundation, TANKS . .. _ ~_ N ' SEPTIC Manuf cturer Capacity Material NO. of Compa~ments TYPE OF SYSTEM Total depth fr original gra Fill added above original grade~ FT Gravel dep~ealh pipe / Total absorption area Distance between lines WELLS ~ PRIVATE REMARKS: , 72-013 (3/85) LEGAL oESCRleTION: 2 3 4 6 9- 10 12 14- I5- . .' Municipality of Anchorage ~.~_~7~ SER' SOLES EOG -- PEaCOEATION Township. Range. WAS GROUND WATER - ~,~ ' S DE~R?:~ YES. AT WRAT ~// ~0 c E t I Net PERCOLATION I:t~,T6 (~'te~'L~:~l PERC HOLE OIA~ETER ACCOROAt4CE ~ITM ALL STA~ ^NO ~UNIC 72-008 (Re-,,. ~'6,SI CURTAIN DRAIN EASEMENT AND MAINTENANCE AGREEMENT This document establishes a 30 foot wide curtain drain easement and sets forth a maintenance agreement pertaining to the same. The curtain drain is located on Lots 1 and 2, Block 3, Lake O' The Hills East within the Anchorage Recording District and is more specifically described as follows: Beginning at the southeast corner of Lot 1, Block 3, Lake O' The Hills East and proceeding N 00° 01' 12" E a distance of 138.70 ft., thence S 89° 58' 48" E a distance of 78.25 ft. to the~point of beginning of the curtain drain easement centerline, thence S 66° 19' 00" W a distance of 228.00 ft. to the point of the curtain drain easement centerline ending, thence S 00° 01' 47" E to the south property line of Lot 2, Block 3, Lake O' The Hills East a distance of 47.00 ft., thence N 89° 58' 13" W a distance of 333.51 ft. to the point of beginning. The curtain drain easement shall be 30 ft. wide along the above described centerline and it is hereby set aside for protection and maintenance both lot owners and their heirs, successors or agents. Neither shall damage or alter the curtain drain to prevent flow at any time and both agree to ensure the continuous maintenance of the drain to allow positive drainage. Should either property be sold, these conditions shall pass to the new owner of the property and their heirs, successors or agents. Signed %his ~/~day of September 1990 at Anchorage, Alaska in the ~c~orage~ecording District. Grantee and Gra A~¢~_c~ ~.~%fz~ Notary Acknowledgement Subscribed ~d sworn beforetime this ~/ d~ay of September, 1990 ~~~~.~ . My Commission Explres~~ s~*~ 0~ ~As~ ) '90 SEP ~1 P~ 3 50 THI~ J~ICI~ DISTRICT ) THIS IS TO CERTIFY that on this 21 day of · September , 1990 , before me, the undersigned Notary public, duly c~is~loned and sworn, personally appeared Rexfo~d ~. T~ner kno~ to me and to me kno~ to be the person, named ~ and who executed the foregoing; and ~s . acknowledged that __~e signed the same freely and voluntarily for ~he uses and purposes therein set ~orth. official seal. ~4IT~S~ my hand and . F~'c,~ : I<ENIIETH G, LAHG~ La!nd SL.-ve~jol' (907) ~, PO2 DEPt. Of HEA~TH ~ ENVI~ONMEN~A~ ' Municipality ct' Anchorage DEPARTMENT OF HEAL,TH & HUMAN SER 825 "L" SI¢~L Anchorage. Alas SOLES LOG -- PERCOLATION LEGAL OESC:~IPTION:~ 1 2 3 4 5 6 7- 8 9 10 11 12--- 13 14 I5 16 17- GP O'5'.¢,~t bL-.~_T°wnship' Range. Secdonf SLOPE ~F YES. At' WHAT DEPTH? SITE PLAN 2. I I I DEPT, ~ OF' HEALTH ENVIRONN ~NTAL RI C , ~1 v HOLE "-'T--"CERTIFY THATj/~IS TTC~LS pE.RFORMEO If',l / .... I I NOTE: / All D~ensio~ ~d Locations Must Be Field Verified Prior To Construction .:..'; /,¢~ER SYSTEM 'LOCAHON PLAN ' ~ '""' ~ ~ NORTH ~ ~_~ ~t~ ,,..* ~. ~t*~.~ ~ u~* or ~T~,¢~ ~x To~ / /~h/~ER SYSTEM LOCATION PLAN ~ ~ ~UBDIVISlON //~~ ~ ~o~ .~o. , DRAWN BY~ S~STE~S INDICATED IS NOT EXACT., ~~~:, ~~,~ ~'~... - ~',.' ~' l. ~' .. ~...,-,~.,~.~: ~ ~OT 8Y SUEVEYIN~. TECHNIQUES. DEtCARTM~NT OF 14~kTH & HUMAN SER 825 "L" St(el, Anchorage, Alas SOILS LOG ~ PERCOLATION 1 3 4 5 6- 7 8 ENCOUNTEREO? SITE PLA~ _/ / ,/II 11 12--- I3 14 15 17- 18- S IF: YES. AT Wa-aT O OEPTH? P E - ' Gro~ Net O~oth to Net 20 t:~:.RCO I.,ATIO N PATE I .- ./ ///]/'/ ACCO[~OAbiCE ~TH ALL STA~ ANO ~UNI~P~ GUIOELI FE o (m/a~ute~'i~c:h,, PERC HOLE THIS OATF-. ~C,E_RTIFYoATE: THAT.~/~j70iS T ~_~A.S pEEJEORMEID IN PERFORMED FOR:_ Municipality ol Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PE LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20 ENCOUNTERED? S DEPTH? ' P ' E t~onitoring? Date: SITE PLAN GloSs Net Depth to Net Readin9 Date Time Time Water Drop PERCOLATION RATE (minuteS/inch} PERC HOLE DIAMETER AND ~ Fl TEST WAS P R ORMEO'" Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O, Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS FOR A SINGLE APPROVAL FAMILY DWELLING Parcel I.D. 01._5- ~ ~-~ - iCl 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address LAKE O THE HILLS EAST BLOCK 5, LOT ,5 7000 LAKE 0 THE HILLS CIRCLE *ANCHORAGE, AK 99516 TYRA CHANDLER Day phone 546-1956 7000 LAKE 0 THE HILLS CIRCLE *ANCHORAGE, AK 99516 Day phone BARBARA HUNTLEY W/ PRUDENTIAL Day phone 227-5228 3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99505 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class A Well · Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems. Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea/a~T?xed hereto and as of the validation date shown below, I verify t~at my investigation, based on procedures outlined in the Certificate of Qn-Site Systems Approval Guidefines for this application, shows that the on-site water su~pfy and/or wastewater di~oosa! system is (are) safe, functiona! and adequate for the number of bedrooms and type of structure indicated herein. I furt,ffer verify t,~at based on t,~e fl~]oi'm~uuig ~,b,~fti~d .~,,, "~ ~ '~:~:~':' ' '~ .... and inspection, the L, ~ ,V/u,,,,.,/.,~,,,y o¢ ,~n~.ho, a~o files and,, ,,,,,¢-"'~ my investigation on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 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 dhow 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. DSD SIGNATURE ~ Approved for ff Disapproved. Co'nditional approval for bedrooms. bedrooms, with the following stip.u. La~ ,0.~' '.. WATER AND : ~uS,~, ~heck,s~ Septic System Advisory Well Flow Advisory (Rev, 11105) Arsenic Advisony Maintenance Agreements Supplemental Engineer's Report Original Certificate Date: ~./,~/'~/ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LAKE 0 THE HILLS BLOCK 3, LOT 3 Parcel ID: 015-333-09 A. WELL DATA Well type CLASS "A" IfA, B, or C provide PWSID# 213603 Well Log (Y/N) completed Sanitary seal (Y/N) Wires properly protected (Y/N~~ Date Total depth .ft. Cased to .ft. Casing he~ound) in. . FROM WELL LOG AT IN~SPECTION Date of test Static water level ~ ~ ~ ~ff./,,.--~ _ ft. Well production _,..--~ g.p.m. _ g.p.m. WATER SAMPLE R~~~. Coliform' ,~--'~coionies/100 mi. Nitrate mg./L. Other bacteria colonies/100 mi. Ar~.''~__ ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 10/5/90 Tank size 1250 gal. Number of Compartments 2 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 5/24/2011 Pumper. ONE STOP PUMPING ABSORPTION FIELD DATA Date installed 10/5/90 Length 58 ft. Total depth '1.5.1 6 ft. Eft. absorption area 500 ft2 Monitoring tube YES Date of adequacy test 10/12/09 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 650 gal. Elapsed Time: 10 min. Final fluid depth DRY in. Any rejuvenation treatment (Past 12 mo.) (Y/N & type) I'BELOW EXISTING GRADE] Soil rating (g.p.d./ft2o~ 125 Width 5 ft. System type TRENCH Gravel below pipe 3 .ft. NO For 4 bedrooms 1 in. g.p.d. Depression over field~ New depth Absorption rate >= 600+ NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station: on lot Size in gallons Manhole/AcceSs (Y/.~N~ -- "Pump off" leve].~~. High water alarm level at Cycles tested. Meets alarm & circuit requirements? On adjacent lots Absorption field on lot On adjacent lots Public sewer main ~anout Sewer/septic service line _-./ Holding tank ~.c~efltalh"~-ent areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: in. Building foundation 5'+ Property line 5'+ Absorption field, 5'+ Water main N/A Water service line * 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *5'+ Water service line * 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Surface water 100'+ Wells on adjacent lots' 200'+ Water main N/A Driveway, parking/vehicle storage F. COMMENTS *PER KEY BOX LOCATED **WAIVER #090065 G. ENGINEER'S CERTIFICATION ON 7/.31/90 DESIGN BY BRUCE CORWlN, P.E. ! certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this, date. Engineer's Printpd Name JEFFREY A. GARNESS Date ~]-g¥ /IJ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Parcel I.D. O t~ 3~,~ I~ 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address of Anchorage Municipality Development Services Department Building Safety Division ' On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 , cho ge, 995 9- 6s0 J I. F www.munLorglonsit~ Z'~ J/~M (907) 343-7904 ~ ~'~'~ '~ CERTIFICATE OF ON-SITE SYSTEHS /~PPROVAL FOR ~, SINGLEFAHILY DWELLING cos^. Expiration Date: LAKE O THE HILLS,~,BLOCK ,3, LOT 3 7000 LAKE O THE HILLS CIRCLE *ANCHORAGE~ AK 99516 TYRA CHANDLER Day phone 346-1956 7000 LAKE O THE HILLS CIRCLE *ANCHORAGE, AK 99516 Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank · Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon rec~est to homeowners. Certif~cetes of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on.site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date 'OIzcll~3" 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. Safisfacto~ 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 tight whatsoever. 5. DSD SIGNATURE J/ Approved for bedrooms. Disapproved. Conditional approval for ON-SITE WATER AND : ~ : WASTEWATER : _ bedrooms, with the fllowing stipulations: ' ,, ':-~ ..... - Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory , (Rev 11/0~) Arsenic Advisory Maintenance Agreem&nts Supplemental Engineer*s Report Other Original Certificate Date: Municipality ofAnchorag.e , Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munLorg/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL: CHECKLIST Legal Description: LAKE 0 THE HILLS BLOCK 3~ LOT ,3. Parcel ID: 015-333.-~ A. WELL DATA Well type CLass 'A' If A, B, or C provide PWSID# 213603 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires prope!Iy protected..~ J Total depth fl. Cased to fl. Casing hei~reund)~in. FROM WELL LOG ~ON Dateoftest __. ~ J ~ . Static water level .~.___.~_~~ ~ . fl. Well production _.~ g.p.m, g.p.m. WATER SAMPLE RE~ Coliform ,.-."~colonies/100 mi. Nitrate ' mg./L. Other bacteria colonies/100 mi. ~ Collected by: ug./L. Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tanksize 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date installed 10/5/90 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pdmping ABSORPTION FIELD DATA I'l~(~-(~w [XI~T~NG CP~D£1 Date installed lo/5/9o Soil rating (g.p.d.lft2o~ 125 Length 58 ft. Width 5 ,ft. 10/12,/2009 Pumper. AROUND THE CLOCK PUMPING System type Gravel below pipe Totaldepth .15.16 fi. Eff. absorption area 500 ft~ Monitoring tube YES Date of adequacy test 10/12/09 Re'suits (Pass/Fail) PASS Fluid depth in absorption field before test DRY, in. Water added 650 gal. Elapsed Time: 10 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN TRENCH 3 ft. Depression over field NO For 4 bedrooms New depth 1 in. 600+ g.P.d. If yes. give date - D. LIFT STATION Date installed ~ Size in gallons ~ Manhole/Access (Y/N) ~ on" level at ~el at ~ in. 'Pump ~ ~ C~ets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots nout " Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Proper~ line 5% Absorption field. Water main N/A Water service line * 10'+ Surface water. 5'-{- 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line. "`5'+ Building foundation 10'+ Water service line * 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ Water main 'N/A Driveway, parking/vehicle storage F. COMMENTS *PER KEY BOX LOCATED ON 7/,31/90 DESIGN BY BRUCE CORWIN, P.E. "'*SEE ATTACHED WAIVER LETTER. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date coSA Fee ~ Date oi Payment Recei 't Number (Rev. 11/05) :' i.. : ]. Waiver Fee $ ~ 0 0 Receipt Number .( GA'RNESS ENGINEERING GROUP, Ltd. .... . "-~ CONSULTANTS & GENERAL CONTRACTORS ~ ::~ ~:~"~-:-"- ..... ~ October 29, 2009 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Lot Line Waiver for Lake O' the llills East Subdivision; Lot 3, Block3, To whom it may concern: During our inspection, it was noted that the drainfield was less than 10 feet from the lot line. We request that your department issue a 5'+ lot line waiver from the east and north property lines to the existing drainfield. There are no septic systems within 25' of our septic system. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchoraqe, Alaska 99519-6650 · (907) 343-7904 · Fax {907) 343-7997 htr p:l/www.muni.orq/Onslte Development Services Department On-Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** WR#: (~90065 HA#: 090407 Permit~: PID#: {)15-333-19 Legal Description: ~.ake O the Hills East Block 3 Lot ~1 Engineer: Garness Engineering Group Applicant: Tyra Chandler Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line 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. Waiver is Granted: ;K Waiver is not Granted: Date: 11/10/2009 Approved by: ~'~ ~~ Name of Reviewer Recff: 003411 Amount: $200.00 Date Paid:.,1116/09 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INsPEcTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner ~-~/~¢')'~-~--~/~-~~-~, Telephone: (home) Mailing Address P~ O- /~.,~ ,~"~. //~_-//¢¢ ,'~, (c) Lending Institution _./¢~..~-_-~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone ,/~, . (e) Mail the HAA to the following address: (or check here ,l~if hol%~r pick up.) List contact person and day phone number below: 2. TYPE OFRESIDENCE ~r Single-Family/~/' Number of bedrooms. 3. WATER SUPPLY Individual Well [] Community,,,~' Public [] ' ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and Status. 4. SEWAGE DISPOSAL On-site./~ Public [] Community [] Holding Tank [] Note: If community well system, mUst have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 leAoJddV leUO!J!puoo ~o SLUJeL leUO!),!puoo peAoJddes!(] -~/ peAoJddv / - ~ j .~,~ Aq smooJpeq ~-~ JO,L pOAoJddV 'lVAOl:ldd¥ SHHa '9 leas s,JeeuCuB MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 .:a I Description: Well Classification Well Log Present (Y/N) Date Completed / Yield Total Depth Cased to Depth of Grouting Static Water Level i _ Pump Set At Casing Height Above Ground Sanity!lng (Y/N) _ _ Electrical Wiring in Conduit (Y/N) .~,gpr~s'sion Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: /.~~ ~' '_ To Septic/Holding Tank on Lot J ; On Adj_oini~g..Lots To Nearest Public s~earest Public Sewer Cleanout/Manhole To Neares~J,¥~r_Service Line on Lot ;Date Water Sampl.~ollected by Water Sample Test Results .~.~__. I~B, C, D.E.©. Approved (Y/N) ~ Comments SEPTIC/HOLDING TANK DATA Date Installed /~//f,~/~ Size /~-~.,~'0 NO. of Compartments Standpipes (Y/N) F Air-tight Caps (Y/N) ~'/ Depression Over Tank (Y/N) /(/ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Foundation Cleanout (Y/N) Date Last Pumped .,~ .,Z~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water-Supply Well To Property Line ~ ~ To Water Main/Service Line ~' f~/ To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test /~"~' Type of System Design ~-" ~.~- Length of Field ,~"'~ / Depth of Field Gravel Bed Thickness ,~ / ,~(-~ Statndpipes Present (Y/N) /(.~t Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area SEPARATION DISTANCE FROM ABSORPTION FIELD: ~:~ ~ '/ To Property Line ,/~:~2 / To Existing or Abandoned System on ; On Adjoining Lots ~,/~".D ,~/O / To Cutback (if present) Comments D. LIFT STATION ¢: Date Installed Dimensions Size in Gallons Manhole/Ac~c.~..(~) _ "Pump On" Level at . "P~r~¢~Off'' Level at _ High Water Alarm Level at //~/ ~.~.-:- Vent (Y/N) __ Tested for ~.~/'~'~ Pump ng Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N)~-~ Comments **Check Permi~Bedroom R~.~g Against HAA Request** I certify that/hCFeZcbeckedcC'eri~ed, or conformed to all MOA and HAA guidelines in effect on the date of this Signed ~~[~; &/ /~~ ~ Date - /:/::~.¢ / '~""': Engineer's Seal MOA "0. ~ ~% Receipt No. Date of Payment Amount: $ 72-028 (Rev. 7188) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHOP~GE, ALASKA 99503 October 19, 1990 563-6775 FOR: Corwin & Associates Attn: Bruce Corwin PWSID: ~213603 According to the records on file in this office, the Lake "O" The Hills East, Lot 1 - 3, Block ~3 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VEP~A E. CRAIG Environmental Specialist VEC :pf Z.~T ~r L ,~ T .5 PLOT P.LAN AS BUILT % SCALE I"=~o' KENNETH. G. LANG, L.S. 1731 GEORGE BELL CIRCLE, ANCHORAGE, ALASKA 99555 (907) 345-6476 -'~ HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED· PROPERTY: LOT ~., BLOCK ~ , b~mO'TR~tbb~ ~T ~' , /kM~o~ RECORDING DISTRICT, ALASKA, AND THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND DO NOT ENCROACH ONTO THE PROPERTY ADJACENT THERETO, THAT NO IMPROVEMENTS ON THE PRO~PERTY LYING ADJACENT THERETO ENCROACH ON THE SURVEYED PREMISES AND THAT THERE ARE NO ROADWAYS, TRANS- MISSION LINES OR OTHER'VISIBLE EASEMENTS ON SAID PROPERTY EXC~PT AS INDICATED HEREON. DATED THIS THE 7~~ DAY OF ~o~o~ , 199o, AT ANCHORAGE, ALASKA