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HomeMy WebLinkAboutHIDDEN HILLS BLK 1 LT 28Hidden Hills BIO k 1 Lot 2 8 #011- 121-53 Municipality of Anchorage Development Services Department - Building Safety Division a. On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111013 PID Number: 011-121-53 Name: Diane & Steven Ammerman Wastewater System: ❑ New N Upgrade Address: 6300 QuietCircle Anchorage, AK 99502 ABSORPTION FIELD Phone: Number of Bedrooms: ® Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other. LEGAL DESCRIPTION Soil Rating: 1.2 rprvFt2 Total Depth from original grace: 12 Ft Block: Lot: Subdivision: Depth to pipe bottom from original grade: - Gravel depth beneath pipe: 1 28 Hidden Hills Ft * See remarks 7.94 F Township: Range: Section: Fill added above original grade: Gravel Length; -0.03 Ft. 32 Ft. Well: [_1 New El Upgrade Gmvel width: Number of lines: OMance between lines: 2 Ft. 1 FL Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area:Pipe Materiat Private - ExistingFt. Ft. 384+ Ftp D3034 Driller: Date Drilled; Static Water Level: Installer: Data Installed: Ft Mike Anderson I V26/2011 Yield: Pump Setat: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Sorp Ion 1 Holding ublic/Private Manufacturer. CapacityFrom Tank Field Station Tank Sewer Line EXISTING 1250 G.I. Well 100' 1001+ 1001+ NA 25'+ Material: Number of Compartments bLdacewater loon+ 1001+ 1001+ NA LIFT STATION Lot Line 51+ 101+ 51+ NA Sze: Manufacturer: - Gat. Foundation r 5 t r 10 t 1 S t NA 'Pump on level at 'Pump off levet at: Hghvateralarm at: in. in. in. Curtain Drain NA * 501+ NA NA Pump Make a Model Electrical Inspections performed by. Remarks * None known. Existing splitter and line to crib replaced. 81 BENCH MARK of rock installed for const safety but only 61 used for calc. Location and oea Bottom of siding n: Assumed Elevation: 100 Ft Engineer's Stamp MP, .' Inspections performed by: ArcTerra Dates: IST & 2ND 02/26/11 3RD 03/03/2011 Development Services Department Appr val; 7: Reviewed and approved by: ate: �— O ` �l (Bev. 12/00) - b'31' !`: AS—BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP111013 HIDDEN HILLS S/D BLOCK 1, LOT 28 PID# 011-121-53 co QUIET CIRCLEj- 04 S890 59' 30°W 92,00 \ 92.00 EW 32'L x 2'W x VD TRENCH F CO TH11-1 SEPTIC �5 �G �•��� MT 10.9 / IVERTER 26'6 E O ING 0 1250 GA r L6 S.T. oo C 1.0 Lr) 0 3 L❑T 27 M EXIS G co 3-BR o 0o HOUSE CD m CD L❑ T 28 26,6 23,1 0 M 00 - SCA[E\= 30' A-F=36.7 a C—F=27.9' 99.4 = C-E=13,3' MONITOR TUBE �E* c CEWd FINAL GRADE 99,0 RAwarA GRA4ED u q D-E=20.3' MTER TA VARIES EXISTING 250 GA 95.03 95.05 1 S.T. SEWER ROCK rw• 0 87.11 m m I 32• x c a SCALE] NTS x a 8011 .v OF ��\ SCALE, NTS ldwv Ar �� 4's� , PREPARED FOR. gcTEkR � �f� 1� STEVEN DIANE AMMERMAN pti 6300 QUIET T CIRCLE r * H * ANCHORAGE, AK 99502 b w / / °m u KENNETH FIELD BOOKS COMPUTED. 0 x I` CE-7 w'e BOUNDART:BOUNDARY DRANK: BMW m tiQw� sruaxc: STAKING aE«m: KMD v / ASSURT: REJ DATE: 02/16/1 \ DFEof SSIOt3= DM nM MBD: 2222ULTING 9s�F ACAD NU_ ,ae Ma.: 11-110 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111013 Tax Code Number: 01112153000 Work Type: Septic Upgrade Permit Effective Dates: February 23, 2011 to February 23, 2012 Design Engineer: ARC TERRA CONSULTING INC Subdivision: HIDDEN HILLS Site Legal Address: HIDDEN HILLS BILK 1 LT 28 G:2222 Owner/Address: AMMERMAN STEVEN R & AMMERMAN DIANE J 6300 QUIET CIR ANCHORAGE AK 995023936 Site Mailing Address: 6300 QUIET CIR, Anchorage Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: 15180 Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage d- 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Engineer is to confirm if the existing system has a splitter valve or is a spill over type system. Please document. Received By: Issued By: I Date: 3 / Municipality of Anchorage s Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING psp III0W3 Parcel I. D. 011-121-53 Property owner(s)STEVEN & DIANE AMMERMAN Day phone Mailing address 6300 QUIET CIRCLE, ANCHORAGE, AK Zip Code 99502 Site address 6300 QUIET CIRCLE, ANCHORAGE, AK Zip Code 99502 Legal description (Sub'd., Block & Lot) HIDDEN HILLS, BLOCK 1, LOT 28 Legal description (Township, Range & Section) Lot Size 15,180 Sq. Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field Q Initial ❑ Septic Tank ❑ Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. ARCTERRA, (Signature of prap-ergowner or authorized agent) Permit/Rush Fees: $530.00 Waiver Fees: Date of Payment: 01211�111 Date of Payment: Receipt Number: &J Receipt Number: (Rev. 11/05) ARcTERRA CONSULTING INC 212 E. 51"Ave, Anchorage, AK. 99503 iffice (907) 868-3791, Fax (907) 868-3793 February 16, 2011 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit— Hidden Hills, Block 1, Lot 28 The owner has requested we proceed forward to obtain a septic permit to upgrade the failed leachfield on the subject lot. The general slope of this lot and adjacent property is from west to east at a grade of approximately 2-5%. On February 9, 2011 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 -bedroom house. We propose to install one 32' long deep trench. Groundwater was not encountered at excavation or monitoring. The property and adjacent lots are served by private wells. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/ Percolation Test Owner/ Contractor Specs 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 (WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA N N 92.00 V E IW 1 NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. HIDDEN HILLS S/D BLOCK 1, LOT 28 0o eo.00 / wAL 0.) L OJ _ 0 0 6 LOT 1 LOT 11 LOT r 00 �•0 BOAO � S89' 9'300-V3130.0000 r 1 C l C IT QUIET CIRCUFu MT M MN C 92.00 0 ".""'^',_„'�" or r a IT ti LOT 27 B @ m I S LOT 28\�����J 0 C/ Q titi �O 2.00 Utl1 $ p IF LOT 30 L T 29 m ^ N T M bo -4111-+�` OF ALS i �� 9� ter- 1 *4 TH *.0 00 KENNETH D I AO CE -7116 Awa Ar 3S1O�� AV \Q'14d RO 00 /�!�01 DESIGN DETAILS PAGE 1 OF 2 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SQ. FT. (2 MIN/IN.)= 375 SQ. FT (375 / 2 x (6' GRAVEL) = 32 FT. TRENCH USE 1 TRENCH - 32' (L) X 2' (W) X 6' (D) Total depth of system is 12' arae from original grade. Total depth of gravel below distribution pipe Is 6' . NOTESI 1. 1250 GAL S.T. INSTALLED IN 1998 - INSTALL DIVERTER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FORT STEVEN & DIANE AMMERMAN 6300 QUIET CIRCLE ANCHORAGE, AK 99502 FIELD BOOKS COMPUTED: BOUNDARr.BOUNDARY DRAM: BMW STAKING: STAKING CHECKED' KMD ASBUILT1 REJ DAT` 02/16/2011 DWr, RLE MD. 2222 ACRD ""FILE 'IDB N- 11-110 2 00 WASTEWATER DISP❑SAL SYSTEM DETAILS HIDDEN HILLS S/D BLOCK 1, LOT 28 N S89° 59' 30'W 92,00 \ INSTALI NEW 32'L Ix 2'W—x 6'D TRENCH o I _ I Z� CO SEPTIC LOT 27 WELL 2,00 LOT 30 S.T. w 0 co CD LOT 28 16.0 SHED 26.6 ra 10' Util Esrn N89° 59' 00'E OF AZ4s *t� IH KENNETH 7 DUFF CE -7116 11d�n�,�/„ .�AV \ "'�rE531Ot3Pt' LOT FLAG WELL PRI❑R TH 11-1 MT / 2J CO To - 0 0 N t0 3 0 0 23.1 r C n cn X m 0 0 0 29 m PROP TY LI v'NT' RADI & EAS TO C❑NSTRUCTI❑N PREPARED FOR; STEVEN & DIANE AMMERMAN 6300 QUIET CIRCLE ANCHORAGE, AK 99502 FIELD BOOKS commT : BOUND Y. BOUNDARY DRAW: BMW G MING: STAKING DNECKm: KMD A uin. REJ DATE: 02/16/11 DWG. MILE: me . 2222 ACAD FlI.E' FILE we Na' 11-110 E O U � 41 cuI Scale) 1'= 30 PAGE 2 OF 2 ARC 1 ERRA CONSULTING, INC 212 E. 51"Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Steven & Diane Ammerman Date Performed: 9 2011 Project: Hidden Hills, Block 1, Lot 28 TEST HOLE # TH 11-1 Depth (Feet) SEE ATTACHED SITE PLAN 20 - Org/OL —top 2' FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA SM SP/GP mod dense, trace of silt, sand increasing w/ depth w/ cobbles to 6" Depth to water after monitoring? NO Date? 2/16/2011 Reading Date Gross Time Net Time Depth to Water Net Drop 1 2/9/11 1:00 6" 2 1:10 10 min 9/16" 57/16" 3 * 1:11 6" 4 1:21 10 min 11/16" 55/16" 5 * 1:22 6" - 6 1:32 10 min 12/16" 5 4116" 7 * 1:33 6" 8 1:43 10 min 15/16" 5 1/16" 9 * 1:44 6" 10 1:54 1 10 min 15/16" 5 1/16" 11 * 1:55 6" - 12 2:05 10 min 1" 5" * Water Added Percolation Rate 2.0 (min/in) Pere Hole Diameter 6' Test Run Between 6 feet and 7 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Municipality of Anchorage Page ofd DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 s Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: Name: Wastewaters stern: ❑New !'Upgrade Address: P.O. Ao K 37 O$77 ABSORPTION FIELD s L K 90&7-o&9 7 Phone:'/ No. of Bedrooms: C;2 7 a -d 99 3 ❑ Deep Trench ❑ Shallow Trench ❑ BedOuncl ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: . GPD/S Ft. Lot: Block: '/I Subnddivision: /4 S �IXUJ L z Depth to pipe bottom from original grade: ravel depth beneath pipe d-^�tI L Ft. Township: Range: Section: Fill added above original gra Gravel length: Ft. Ft. WELL: ❑New ❑Upgrade ravel width: Number of lines: Distance between lines: FL Ft. Classification (Private, A,B,C): Total D Cased To: Total absor Ion area:Pipe material: Ft. I Ft. SO. Ft. Driller: Date Drilled: Static Water Level: Ins er:Data installetl: Ft. CifN o"ST /7 gra' Yieltl: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. TO Septic Absorption Lift Holding ublic/Private Man ufaClu/er:_ Capacity in gallons: From Tank Field station Tank Sewer Linea (2, 0 (� 74we /,)50 IN& loo /Ob > ,_, as Material: sTe�Z_ Number of Compartments: c,z SurfaWater 160",f /m .LIFT STATION Lot/ / Size in gallons: Manufacturer: Line 1)9 /� Foundation O "Pump on' level at: ump off" level at: High water alarm at: Curtain ./ PumpM Model Electrical Inspections performed by: Drain /+ONC ,C/NeWN Remarks: BENCH MARK Location and Description: -f-8m = a eM a A7 Po+N A Assumed Elevation: 708.LL E L C-2 w Inspections performed by: Dates: 1 st_�,6�48 ¢, ».w•.. S& s ENGINEERING 2nd 410 8 i"? aDBERT C. COWAN r� 17034 Eagle River Loop Road No '104 CE 'e4s - 8801 Department of H#M4fRitt' WlM10 fAH Services approval ft , •.. , <<� �-' Reviewed and approved by: �• Date: 3 - °) 1liwm► 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW980248 PAGE 2 OF 2 Municipalit of Anchora e DEPARTMENT OF HEALTH AND HUM9AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tele hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 28, BLOCK 1, HIDDEN HILLS P.I.D. NO. 011-121-53 -- � QUIET CIRCLE - - STI S72 FCO /loa' FINAL GRADE EXISTING CRIB ST1 ST2 — — I Lw" ow DBL1 NEW _ DBL2 98.5' 1250 GALr,Mrz 96.3' _ �; NEW 1250 GALLON MT1 S.T. SEPTIC TANK MT2 Mri EXISTING DRAINFIELD fLA E" W ?�L LOT 27 FCO N m Z) Q i LOT 26 Ld(n = E� B W 3 � WELL WELL \ I WELL LOT 30 WELL I I LOT 29 SCALE 11' - 40' NOBERT C. COWAN CE -8801 MUNICIPALITY OF ANCHORAGE 4, 9 CYA Department of Health and Human Services On -Site Services Program //�� /� 825 L Street, Room 502 t__ll� fn Car-, P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 17, 1998 Expiration Date: Jul 17, 1999 Permit Number: SW980248 Parcel ID: 011-121-53 Legal Description: HIDDEN HILLS BLK 1 LT 28 Design Engineer: S & S Engineering Site Address: 006300 QUIET CIR Owner Name: CHARLES CHRISTOFFERSEN Lot Size: 15180 SQ. FT. Owner Address: PO BOX 870877 Total Bedrooms: 3 Permit Bedrooms: 3 WASILLA , AK 99687-0877 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued Date: %— / 7 —1 9 By: Date: 7-/7- 98 July 13, 1998 HEALTH AUTHORITY APPROVALS ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907)694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER & WATER MAIN EXTENSIONS Anchorage, AK. 99519 REFERENCE: Lot 28, Block 1, Hidden Hills Subdivision SEWER & WATER INSPECTION Request you issue a permit to replace a septic tank to serve the fbv-z bedroom house on the referenced property. " r4 x! s TIHC. c410 rO 04, C-4 �Al 60769 CJOP-ENGVtRlGY COnw bc,i"/On� foR F!JJ✓i i3 Eaf&aUM /YAPRe K/jL ANDINEERING REPORTS STUDIES Please expedite this permit to allow the replacement of the existing septic tank, which has failed and is leaking at the current time. We do not anticipate any adverse effects on neighboring wells, septic systems or WELL INSPECTION &FLOW TEST drainage patterns by the replacement of the septic tank. If you require additional information, please contact us. SITE PLANS Sincerely,, ROAD DESIGN Vj/1 Robert C. Cowan, P.E. RCC/jlm SOILTEST Enclosure PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 40' SITE PLAN DESIGN C SCALE ono O^y k'" XZm 0 ��z m I OJOAy �/ ANp x ➢ < � �Y11 V' ti 20 Isno r. V �. z zI — — — — — — — — — — I I m I X I �_ 3 o of N I a a I ea Z Z w °o•r I v SGS DEM Z�m 0 Z I 00 �--i Cn 0 A OM— M — L— --- G)moo G) C) r m i �O --- LUCY STREET —vmr - - d O c7 m — — — — — — — — — — — — — — — — — — — — —Z=O— — — — — — — — — D 9ak o OC? *,00 •.., v6\ Y �, S O Ci O O yO JC A n Z ��5�� p I y O r O Ai �> •+�••��a�r +•t �� D E d -'9 nti a ym C'b9 �9C' D11 SA j�N m•n } SSSVVV.00 N �f1 ! •�� Npa�m "�z yd[�] nom c�N gro n ti >00-�5 >lc . a+ /.+. Z N ^•.•+•`. a, icy a MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -�PHONE 1:1 NEW fOlvl etrc CrSPa1 I�O(,t%N"GrSOL't -'�-YYn5S ©RADE MAILING ADDRESS J/ // / /�rLL1�FOOc-1 44clL l ve-,-C LEGAL DESCRIP110n, ze& LOCATION NO. OF BEDROOMS ;z Well A sorption area Dwelling PERMIT NO. t7- DISTANCE TO: I .Y ha Q Manufacturer Material - No. of compartments wF y. Uq. capacity in gallons DLUL DE: Inside length Width Liquid depth 1' DISTANCE TO: Well Dwelling raz X-4 Manufacturer Material Liquid capacity in gallons D. w= DISTANCE TO: Welll j Foundations Nearest to PERMIT NO. y n u.Z No. of line Length. of a ch line/ Total length of Trench �ines wi th Distanc bet an lines h ix 7 inches F- Top of the to finish grade Material beneath the Total effective absprption area D .1i inches Q j7 Length Width - Depth PERMIT NO. w a H wa Type of crib Crib diameter Cr' Total effective absorption area to DISTANCE TO: Well Building foundation Nearest lot line a Class Depth Driller D' o of line PERMIT NO. J I w :DISTANCE TO: Building foundation S Septic tank Absorption area(s) OTHER PIPE MATERIALS ft/C—+ f7/ SPOIL TE TRATING_ A f E 1 Zin! l S �s4 T L`ot y t� 1$C2 INSTBALLER( e ,, e REMARKS vK � Gl4i/5 Oma' � / !I l"c Hew SOi�s I1` ! --LkT 9 //,�• \O I F1 I I I I DWWI ..( LEGAL 1: aY�laz.tii(dCl " 1�1sL/a 3/78) ` 17Efs0f TMENT { OE A6TM. AN73 ENV.I OISIMENrA'L. RB TEi*;Tfi t r 825 L ` JR�ET - 'ANNORAR , !C 49r't r k 64 7 y 2 —4 20 fl< � �h .ate.. CT NO $ 10129 I ^LE�33' 04f29/85 l GCANT-a�, ROBERT FERQU80'N a F)S:"l.,-TOMFOWLER ANCHORAGE, AK 99504: SOT PHONES. 7)ESCRIPs SUBDIVISION.' HIDDEN HILLS LOT. 28 B!OCCgkk SECTION: 9 TOWNSHIP1 12N RANGE: 4W i:7:ZEr 15180 (SQ..FT..OR ACRES). ss�. ic1'below are the options available to you in oesigni,ng your sept3d fm. Choose the, option that beat fits your site. .! - - -- a- - - - - - - - - i 9 t lc6-i . EEvii_ `Ari TO PIPE BOTTOM (FT: } 4.0 5 0 J' DOTH (FT.) 10: 0 . 0 DEPTH : (FT.) 14.0 5.5 L 1I DTH .(FT.) 2e 5 -19.0 Wah S' L-1;XNQTH (FT. Y0 36.0 4 L •VDL,umE (CU. yI}5.) 22.4 25.4 (BALs). 1, 000; 0 # i, 600. rr RATINP MO. FT. /BR) 150' 150 1Q ;- TANK MUST MAVE AT LEAST TWO COMPARTMENTS 1`s' ' - - - _?r tify thate am familiar with the requirements for op-site sewers an¢:.w l ' Yprth by the Municipality of Anchorage CMO;,_' X will, install -and the Stag;x� f the system in accordance with; all MOF pole error €f 3 end in compliance with the design .criteria of this, permxt,t I Will adhere to all MOA and State of Alaska distances requiremQ tsr�$ trw# from any .existing well, wastewater disposal sys#e„o7� uer,age system onthisor any adjacent ornearby'1#t« •: \r� I untlOrstand that thss permit is valid for a any 'require n, , mwxIm-us of erillargement will an, additional,permit, TpT-S`rATION IS -INSTALLED 1•N AN AREA.'QQVERED'BY MDA`BUSL]�TkrIS?,�t71i4� � Y LA --"SOI LS LOG . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ TERCOLATION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: I)e DATE PERFORMED:_ Y- I51 -SS' Tia tiw LEGAL DESCRIPTIgN: L.O n�a� + SLOPE SITE -PLAN 1 2- 3- 5- 6- 7 356 7 a - 9- 10- 11 1011 12 13- 44- 15- 16- 17- 18-- 16 344•.15161718t6 19 20 Pk6o,vic A!4'T brow.,+ ?vO ztH SMA /I f ¢rope s+`(k Rena u�,sa aj� WAS GROUND WATER ENCOUNTERED? Nt7 IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop GIV t Q, q PERCOLATION RATE (minutes/inch) PERFORMED BY: 8kc-, liiing-,S -1),7 c/ CERTIFIED BY: L. r/[C .. lY DATE: 5� ✓-� --.nos (4i,'79} UP AAiT C/D TOM !rUW, Rbbs, iT `FERGUSON ' Sa 1400x. ML#LD lOI�t RtiAA ANCHORAGE Ak 59 *04 HOWEa 338-4451 � t 'DESCRIPa l fvtlolCli 4i17t 11141Lt:81 SECTION_ 9. 'TOWNSHIP. 12N RANeEa 4W, ' IZEa 15150 ($0.FT.'OR ACRES? iTLify thAta R, 'I":am fami.liar'with the requirements fog on-site sewtepw_ and :f.grt)htby+the Municipality of Anchorage (MOA) and the 8t,ato rwill install the system in_accordarrca with all MCAeod: end _in cbmpliance with the design criteria of this'permit. r,I will adhere to all MOA and State of Alaska requirements ;distances from any existing* well, wastewater disposal cyst$ 14ewerage system an this or any-adjac'nt or nearby. lot.. X,LIFT STATION IS, INSTALLED IN AN -,AREA COVERED: BY MOA aUIl brt, hl„i11AN'ELECTRICAL - PERM IT AND INSPECTION. MUST.BE.OBTAINEDa_•,.: ;APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT,,:At TRICOL WORK M T BE -DONE BY A LICENSED.ELECTRICIAN.. hJE1{ �((�� DATE; -- ----- _f -- Y 1 4 LICANTa`CY(a TOM :-ROBERT FERGUSON SY (X DATE'a � P • T2�c.�/” `mooT4fC_ Pc!)PTzl 1. r/�Y"� 3A)/ 7 1 :: 4. 3y, A..i < C{ l . ab.- � ".Fr � nvY .-• t h.-.i�:] � �� ✓c ��.-... iE xii.. G j ., t 1 ' , • • • .. SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �OeioW1'C r' jj r II // ��DATE PERFORMED: �p� 2/Q (C'ry ) LEGAL DESCRIPTION: Lb� Z"$ U j'1"1 Q tl Q/1 P-) tts Irf 1u'Q1 no= 1 'I v 2- 3 I I 4- 6 6 r 7 8 9- 10- 11 1011 d m 12 - 13- 14- 15- 16- 17 314151617 81920 181- 19- 20-1 LA '-V� G 41 cle-- 5 t l Jof 4 btj a -it& t zs Q' (ti -- soil -4et S- •iv WAS GROUND WATER S -ENCOUNTERED? i'w L Depth to Water O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN t '`\/J\Q►\'�/'PERFORMED BY: '7>,-!Zj rtok S'1 C" BYE CERTIFI \) 72-008 (6/79) (minutes/inch) r FT AND ` FT IcZi 12-s A ' /h_. BY: \ ! _ "I DATE/&// ALASKA ENVIRONTAL 4 CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561-5040 OROOLWMJ 1 ..9N ,M OWL JOB SHEET NO. CALCULATED BY CHECKED BY OF /p nGRE40R ANCHORAGE AREA BOF*GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 ' INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME R06} t'f-QLOSOh MAILING ADDRESS :16131:16131SrANC&(J � R. PHONE W- L14 d LOCATION LUC 7✓S1• - LEGAL DESCRIPTION OOn I e -7--a.8' 4100&M NfCcs SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURER ST�LZ L. MATERIAL COMPARTMENTS z' INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY fQGQ GALLONS. SEEPAGE PIT: NUMBER OF PITS I . DIAMETER OR WIDTH A, LENGTH+ , DEPTH L f LINING MATERIALa-3� CRIB SIZE: - DIAMETER—DEPTH— DISTANCE FROM: WEL ' t TOTAL EFFECTIVE �A 1_', /j 'BUILDING FOUNDATION, NEAREST LOT LINE )( ABSORPTION AREA (WALL AREA) 4/Sb SQ. FT. ADDITIONAL ABSORPTION WELL: `� TYPE - - CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC - SEEPAGE FOUNDATION—,LOT LINE SEWER LINE TANK—, -SYSTEM CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: DIAGRAM OF SYSTEM INSTALLED BA 1 111 PIPE MATERIAL: W ao1^ LOT SLOPE: REMARKS: 6 (C - Form No. EQ -031 G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY '2330 "C" STREET ANCHORAGE, ALASKA 99508 TELEPHONE 274-4561 �ee w..�9 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION PERMIT NO, MAILING ADDRESS -L(l,i 1? '5hjy Yfs' .IJ� P�'�HONE 6/�� INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD , OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED.R00dYI� FINANCED THROUGH TO BE INSTAL LED BY SOIL TEST RESULTS ���Ndj /L'./�R'0✓N sit ROS$ $%Per<� J NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE _-9a?� TYPE MINIMUM DISTANCES, FOUNDATION TO SEPTIC TANK SEEPAGE AREA SIZE 1 FOUNDATION TO SEEPAGE PIT 90 , DRAIN FIELD 49') cc SEPTIC TANK TO SEEPAGE PIT WALL / SEPTIC TANK SEEPAGE PIT 1JL_, DRAIN FIELD I� TO NEAREST LOT i l WELL TO SEPTIC TA K SE EPAG IT GRAIN FIELD ALSO CON R AREA WELLS. ,'l ' /O / WATER MAIN TO SEPTIC T�NK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD Lam. TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER DESCRIBED SYSTEM 15 IN ACCORDANCE WITH SAID CODE. DATE'41 2 APPLICANT'S FORM NO. EQ -016 DIAGRAM OF SYSTEM AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE Gfl�Q GRE4#R ANCHORAGE AREA BOP#GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM yy2 NAME f0-6 9/0 r-IOh(35 MAILING ADDRESS y%1S �o f// T Ys/-3g./3o / LOCATION &10y"910 • LEGAL LEGAL DESCRIPTION 9 PJ �P/HONE T7/ Db E& SEPTIC TANK: (J� # /B.i -7yS" DISTANCE / NUMBER OF FROM WELL /4A0 MANUFACTURER S�i�c. /i 5�ee/ MATERIAL -CJe--1 - COMPARTMENTS INSIDE LENGTH - INSIDE WIDTH LIQUID DEPTH - LIQUID CAPACITY 7So GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH s, LENGTH ' DEPTH - LINING MATERIAL 1? 1NL5 CRIB SIZE: DIAMETER —DEPTH - DISTANCE FROM: WELL I TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOTLINE�: ABSORPTION AREA (WALL AREA) SQ. FT, ADDITIONAL ABSORPTION WELL: TYPE - PRI &I-) CONSTRUCTION BUILDING FOUNDATION CESSPOOL NEAREST NEAREST LOT LINE '-, SEWER LINE OTHER SOURCES APPROVED DISAPPROVED REMA DEPTH DISTANCE FROM: SEPTIC i SEEPAGE �^7 TANK, SYSTEM z��> DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: G12S ADAI LOT SLOPE: REMARKS: AVC y � O p �AR96E 11,40k/ O SOWei/ giporjre. Own G.A.A.B. Form No. EQ -031 0 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251126 Parcel ID 011 -121-53 Expiration Date: Legal description HIDDEN HILLS BLK 1 LT 28 site address 6300 QUIET CIR Current property owner(s) DESPAIN MICHAEL J & MARY I X The On-site system(s) is/are approved for 3 bedrooms M 4/10/2026 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 4/25/2025 Th`fs ertificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject s tem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, evelopment Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory X Arsenic Advisory I I 011'-iill 10, am Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 011-121-53 Complete legal description HIDEN HILLS BLOCK 1, LOT 28 Location (site address) 6300 QUIET CIRCLE, ANCHORAGE, AK 99502 Current property owner(s) MICHAEL & MARY DESPAIN - Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well F Private Well serving 2 dwelling units 0 Private Well serving 3+ dwelling units ❑ Community Well or Public F-1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic F Private Septic serving 2 dwelling units [I Holding Tank F-1 Community Septic or Public Sewer 5. SEPTIC TANK: Z Steel E] Plastic ❑ Concrete F-1 Fiberglass Age 27 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS R Bed [Z Deep Trench R Wide Trench R Seepage Pit Waiver request for: Expedited review requested: F Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 4 Waiver Fee $ Date of Payment Z_ C)2 -S— Date of Payment COSA C_ Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: HIDDEN HILLS BLOCK 1 LOT 28 Parcel ID: 011-121-53 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled *UNKNOWN Total depth *UNKNOWN ft Cased to *UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 4/10/25 Static water level at beginning of test 119 ft. Well production at time of test 3 gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 5.85 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 4/10/25 & 4/14/25 Comments *Per previous COSA / HAA & MOA record docs the well is noted as drilled circa 1974, 127’+ deep with 40’+ casing. B. TANK DATA Measured operating fluid level in septic tank 49” Date of pumping 4/10/25 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2/26/2011 ALL standpipes present per record drawing Total measured depth from existing grade 11.7 ft (max) Measured depth to pipe invert from grade 4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 4/10/25 Results Pass Fluid depth prior to test 55 in Water added 600 gal New fluid depth 89 in Elapsed time 1440 min Final fluid depth 41 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 95 in (MOA 7.94’ ED) Effective depth used 41 in (Final Fluid Depth) Effective depth (ED) remaining 54 in Comments/Deficiencies: Total measured depths from existing grade for this 3-beroom rated septic system (2BR house). COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *3’ between tank & field per previous 1988 S&S HAA & noted on subsequent COSAs & HAAs, but do not see elsewhere. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 04/21/2025 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 or NO 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 & 04/21/25 DEVELOPMENT SERVICES DEPARTMENT i 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite—� Nitrate Advisory Certificate of On -Site Systems Approval # OSC251126 Subdivision: Hidden Hills, Block: 1, Lot: 28 A water sample revealed a nitrate concentration of 5.85 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical' methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 011-121-53 COSA# 0 S 1l I C �J Expiration Date: 0 _/Z 1. GENERAL INFORMATION Complete legal description HIDDEN HILLS LOT 28, BLOCK 1 Location (site address) 6300 QUIET CIRCLE, ANCHORAGE AK 99502 Current Property owner(s) STEVE & DIANE AMMERMAN Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address. 6300 QUIET CIRCLE, ANCHORAGE AK 99502 .Day phone LES BAILEY & ASSOC. Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage' ❑ Community Class _ Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer R 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER 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 onsite 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 onsite 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 0412o11 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future 141W. MW occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist._ . 5. DSD SIGNATURE ---Z Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date:, (Rw. 11 Municipality of Anchorage • Development Services Department Building Safety Division < On -Site Water & Wastewater Program f 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: HIDDEN HILLS LOT 28, BLOCK 1 Parcel I D: 011-121-53 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed Approx.1974 Sanitary seal (YM) Y Total depth 127+ ft. Cased to 40+ ft. Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 2/1/2011 Static water level ft. 122 ft. Well production g.p.m. 2.5 9— p.m-WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate 4.26 mg/L Arsenic: rng/1 Date of sample: 03/02/2011 Collected by: Arc'Terra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7171998 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (YIN) N Date of pumping Z11/2011 Pumper Denali C. ABSORPTION FIELD DATA Date installed 2/26L2011 Soil rating (g.p.d./ftZ or ftZ/bdrm)1.2 System type Deep Trench Length 32 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth 12 ft. Eff. absorption area 384 ft Monitoring tube Y Depression over field N Date of adequacy test NA- New System Results (Pass/Fail)— For bedrooms Fluid depth in absorption field before test in. Water added_ gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. 'Pump off' level at _in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 751+ Sewer/septic service line 251+ Animal containment areas 501+ On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 1001+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation 51+ Property line 5'+ Absorption field- Per MOA Docs Water main 101+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 501+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS *Area has been known to have high arsenic and nitrate levels A point of use water treatment could G. ENGINEER'S CERTIFICATION 25 u ti Peel rrr cY f �r►r"w''" Gam' O �/l I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in + k conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS 7. Date 03/04/2011 COSA Fee $490.00 Waiver Fee $ Date of Payment _ _� Date of Payment Receipt Number % —7 d Receipt Number (Rev. 11/05) 1 Move NKa g51NCT SEIBMA( GNQ sEreNx QUIET CIRCLE of euanNa GE I N JA Ra0a1a serol 5891 59' 30"W 92.00' C. .S x 26.6 r o n C.0.5 m 0 3 (n c EXISTING --I HOUSE 0 0 m LOT 27 26.6 231 z m VA 16.0 24.0 30• o SHED c 0 24.0 WELL u N89° 59' 00"E 92.00' HE LOT 29 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE ❑ FOUNDATION As -BUILT SYMBOLS • SET REBAR =F DRAINAGE 0 ASPHALT ❑ FNAL STRUCTURE AS -BUILT 0 FOUND REBAR 6-8 9 WOOD FENCE '..::a:.:.. CONCRETE ❑ PIAT PLAN ... AS -BUILT ... LOT SLKLVEY ... TOPOGRAPHY OO n ASSUMED ELEV. �,c METAL FENCE ® WOOD DECK AS -BUILT, T NO CORNORS SET PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by SURVEY CERTIFICATION OF ����� Robert E. Johns, Jr. & Assoc. PLOT PLAN AW ♦ �� .......... �j `y Professional Land Surveyors ww f_ ..•{ 1700 Brink Drive. ANCHORAGE, ALASKA 99504 ••P•.• , Scale: rl _ 40' Lot oRac. . ac. Plat File Nff :� 49h FOUNDATION AS -BUILT I, Rd,rr c Aam. r.. I.e+er wiKr and I �♦ { { Dote Surveyed: �`d` 02/01/11 Drawn by. Y REJ Checked cpy W L ••• ............ .......... ......Lo { J V Date Drawn: 02/01 /11 Grid• SW 2222 W.O. 11-23 awiaan, aN HRwaean a awan Mr,an w w. ma w meerAmnu vex Wr ROBE .JOHNS { : FINAL STRUCTURE AS -BUILT t2t_ ,�� �. A o '•,, ,:' r Legal Description: i.' -Br ur q:' I�. en p...............••°�ay�♦` HIDDEN HILLS .waver. a w. NT eve mor a n. °'eB81O^••` 4�, :: BLOCK 1 LOT 28 awwi eawrr.w ,t\�T►♦ Municipality of Anchorage • ''� Development Services Department Building Safety Division 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 mom CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0111-121-53 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HAA# t/ ftO D3a�9' Expiration Date: iJ feT 011 f 13 (oz- ��e5 arJ 6300 QUIET CIRCLE * ANCHORAGE, AK 99502 CHARLES CHRISTOFFERSEN Day phone 688-5212 6300 QUIET CIRCLE * ANCHORAGE, AK 99502 DEAN C'MALLEY w/ NOVA PROPERTY MANAGMENT Day phone Day phone 8340 RAINY PLACE * ANCHORAGE, AK 99518 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 HOUSE IS 2 BEDRCCMS 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 688-5212 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 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 6 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, inc. shall be paid $ cfy j at, orprior to closing for the engineering services provided. 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 Address ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 26 * ANCHORAGE, AK 99504 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, AKWWC, Inc. 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. AKWWC, Inc. 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 S bedrooms. Disapproved. Phone 337-6179 Date 4,42 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory nN-SITE WASTEWATER PROGRAM A, JJ�J��v�'RfJENT l I���. Manitenance Agreements Supplemental Engineer's Reort Other By: ✓ Original Certificate Date: R�„_,2L V Municipality of Anchorage • Development Services Department. -x Building Safety Division J10 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HIDDEN HILLS S/D; LOT 28, BLOCK 1, Parcel ID: 011-121-53 A. WELL DATA *WELL FLOW DATA FROM S&S ENGINEERING Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) NO Date completed APPROx. 1974 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 127+ ft. Cased to 40+ ft. x:101&III A40Role] Date of test G �O Static water level ��V� ft. N� Well production g.p.m. WATER SAMPLE RESULTS: Casing height (above ground) 12+ in. AT INSPECTION *5/27/2002 123 ft. 5.5 —g -p.m. Coliform 0 colonies/100 ml. Nitrate 5.10 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 5/27/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/17/1998 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 7/17/2001 Pumper DENALI SEWER & DRAIN C. ABSORPTION FIELD DATA TESTED CRIB ONLY *"SEE COMMENT ON BACK OF BROWN SHEET Date installed 1974/7985 Soil rating (g.p.ddft`or /bdrm 140 150 System type CRIB/TRENCH Length 20/17 ft. Width 18/2.5 ft. Gravel below pipe 6/10 ft. 456 Total depth9 +/ / 15.6 ft. Eff. absorption area 340 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 7/9/2002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test ? in. Water added *� 1515 gal. New depth 43 in. Elapsed Time: 1 1 13 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) SEPTICLEAR If yes, give date 6/5/2002 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Pump off" _in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot Public sewer main 100'+ On adjacent lots On adjacent lots 100'+ 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 2b + Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 3'+/— PER S&S DRAWING Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS THE M.T. ONLY EXTENDS ^- G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and a �¢ review of Municipal records that the above systems are in "" conformance with MOA NAA guidelines in effect on this date. C Engineer's Printe Name JEFFREY A. GARNESS v0-9 _ I C 953 Date 7/1S �fl� O��p'Pd yG ���'��ofes soon o HAA Fee$ Date of Paymentx..15 _020'2 Receipt Number 2-2-9 07— (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number IS THE RESPONSIBILITY OF l'HE OWNER OR GUILDER, PRIOR'I'O 'ONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE .ELATIVE TO FINI5HED GRADE AND UTILITIES CONNECTIONS, ND 70 DETERMINE THE EXISTENCE OF ANY EASEMENT, OVENANTS' OR RESTRICTIONS WIJICH DO NOT APPEAR ON TI IE .CORDED SUBDIVISION PLAT. III s r � �1 • Or � f/p,r \9 D Ge(� ZION 2 _ o .Y �_Fa FF,1a 0 OL' d2� { azo .8= LZfJT µew' °,� I z, (B' FF• IU r�V, r &e Lo¢ OF q4 c2 /O 7'/4- GSMY — -- r •'•. 9 �l f i49 ; 1)2'001....��r.*..�*.*s. • Tamer Karl Dowling o /� I r) sf •'� 15645 t Fq •. .•' JR' i t+t` ROFESSIONA� VP�o� • I! CERTIFIED PLOT PLAN I LOT: .28 BLOCK:—� f�/L�OEN Y141S --�LJQD" (PLAT NO.:D-S38 ANCHORAGE RECORDING DISTRICT ZONED: NOTE: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN DATE: BY: SCALE: WORK ORDER: FIELD BOOK: GRID: z3f 98 = 30 98-0s9 )) 11 �/ii4�y 2zz.z DOWLING & ASSOCIATES BRASS CAP MONUMENT DRAINAGE DIRECTION P.O. BOX 110029 IRON PIPE o ANCHORAGE AK 99511-0029 REBAR PROP. CORNER FND •EXISTING ELEVSi PHONE: (907) 348-0551 - FAX: (907) 348-0881 HUB & TACK ❑ PROPOSED ELEVS® Parcel I. D. # MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 011-121-53 HAA # 1. GENERAL INFORMATION Complete legal description Lot 28, Block 1, Hidden Hills Location (site address or directions) 6300 Quiet Circle, Anchorage, AK 99502 Property owner Charles Christoffersen Day phone 242-2891 Mailing address 6300 Quiet Circle, Anchorage, AK 99502 Lending agency Residential Mortgage/Yoh Yon Day phone 222-8800 Mailing address 1400 west Benson, Anchorage, AK 99503 Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025.(Bev. 1/91) Front MOA #21 5. 153 0 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. 5& 5 ENGINEERING G cl _ q 7 y Name of Firm EagleRiver ap oa o Phone Address Eagle River, Alaska 99577 /l Engineer's signature DHHS SIGNATURE Approved for T N REE bedrooms. Disapproved. Conditional approval for Additional Comments 1l ITIr Date 9 6- k� 0 b OF q4. 9d ROBERT C. COWAN ^� CE -8801 t kit 4'2 bedrooms, with the following stipulations: Date JO "5 - 9 Q 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. 72-02 (R..1/911 Back MDAN21 LVED Municipality of Anchorage SEP Z8 " DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPAL11 r or ANI.H 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90T SERVICES Health Authority Approval Checklist Legal Description: ` �' a r) �G c.K H /DD � ✓ Nr `L j Parcel I.D.: 0 I I - 1 d / S 3 A. WELL DATA Well type Pr Iyri r 6- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/O N C Date completed „ ! q 7 y r r Total depth 13'6' + Cased to 4_° Casing height (above ground) t Sanitary seal O/N) '/ / 5 Wires properly protected &N) 'Y 1 FROM WELL LOG Date of test Static water level (� Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: 10 1 1/ `I AT INSPECTION alas -/mss i i as V,e t Other bacteria O s & s ENGINEERING Collected by: 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 g.p.m. B. SEPTIC/HOLDING TANK DATA Date installed 7 /r 7 A 5' Tank size ) a 5`y Number of Compartments Cleanouts ON) YIES Foundation cleanout (9/N) !`,I- S Depression (Y/6 c High water alarm (YIQ w L� Date of Pumping/_ /A � N 4A Pumper C. ABSORPTION FIELD DATA 1 q 7 Y ma=r¢ i3 Date installed 4 01 FrS- Soil rating (g.p.d./fts ort 6frr 1 a S- System type TAA' c 1-4 Length r 7 ' Width Gravel thickness below pipe /0 Total depth k 5-f. X, z Effective absorption area 3,Y o Monitoring Tube present &N) vhI Depression over field (Yo —d O/rS(kYCr�s�L� c.ero� Prt 3 Date of adequacy test Results (Pass/Fail) S For bedrooms Fluid depth in absorption field before test (in.); ci Immediately after 6 s'6 gal. water added (in.): S S Fluid depth ''f ti , (ins) Minutes later: d -o Absorption rate = 1'f S-0 + a.p.d. Peroxide treatment (past 12 months) (YIN) .ucft Krcwa 72-026 (Rev. 3/96)` If yes, give date - D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /00 Absorption field on lot Public sewer main N 1,4 Sewer /septic service line S / f Size in gallons On adjacent lots On adjacent lots "Pump off" level at* /0o t Public sewer manhole/cleanout Ad 4 Lift station Al %g SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /O Property line /0 '/ Absorption field 3 ' Water main/service line Surface water/drainage Ido t Wells on adjacent lots / UJ -4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: i Property line 10 Building foundation / Water main/service line o -A Surface water / U o - Driveway, parking/vehicle storage area O Curtain drain N e N k K N Q✓ ^/ Wells on adjacent lots /0 il a F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records jKaY , s s are in conformance with MOA AA gusdefine in effect on this date. ; C> Signature (/ Engineer's Namecl /l Ull/zT C �aw s✓ ! ' z.. �A��ttCiBf�r yz E;�CS+AN //� Date V11 Ar 9 HAA Fee $ > (7 [� ` h Date of Payment 1-7 `i � � % Receipt Number j—�- 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number Time - APPLI NT FILLS OUT UPPER HA ' ONLY Property OwnsrPhone RDBr;KZT �> Pi5RO140ff TlWe Date - Malting Address Zip Code - - Buyer Address Zip Code Lending Institution 1]. I1a� d. AE �T Phone Address Inspector Zip Code - Inspector Realty Co. & Agent -. - - - - Phone Address Zip Code Legal Description - - Street Location an 0 Type of Residence - Single Family Multiple Family No. of Bedrooms_ - ❑ Other - - - .'CONDITIONS OF APPROVAL - Water Supply Individual ATTACH WELL LOG. A well log Js required for all wells drilled since June 1975. `'�/�- u Community ✓ ❑ Public Utllitk� For wells drilled prior to that date, give welt depth (attach log if available).. Sewer Disposal BY; XIndivldual Year Individual Installed: _. ❑ Public Utility _ - When Connected to Public Utility: ❑ Holding Tank 47 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.. Time - - Time - Time TlWe Date - Date Date - - - Date ...� Inspector Inspector Inspector Inspector Field Notes: ,tel " - - MUNICIPALITYOF ANCHORAGE - o - DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIONC)l _ JUN 231983 RECEIVED (-3;,gPPROVED BEDROOMS - - .'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( I CONDITIONAL QPP VA DATE — BY; Solis Rating Date Sewe Installed - Well To Absorption Area -401:1- - Well Log Received 47 1 Well to Tank /60 Septic Tank Size Q DO ,za��o iaraq 1