HomeMy WebLinkAboutLAKE O THE HILLS BLK 3 LT 1Lake O'the Hills Block 3 Lot 1 #015-331-22 tmev uoiuu ia) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211102 PID Number: 015-331-22 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name THOMAS HOLDER ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 11120 BRIGGS COURT, ANCHORAGE ❑ Other Phone71Number of Bedrooms Soil Rating depth from original grade 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot LAKE O THE HILLS 3 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area z Number of trenches Dist. between trenches From Tank Field Tank Line Ft Ft. Well 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+__ NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Repaired FCO. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer PCN drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection1s' 4/16/21 rd 4/19/21 Location and description dates:2 3`d 4'" BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date �1 '. Curtis Huffman• • •; .�' f ���1 Apptic roved ed - pp 4119619 Date 0,2 / 028991' • •.��� ' • /21 .C4 pR�FESS. ....• �ti� .- is* iONA Note: this approval does not include well permit requirements. � tmev uoiuu ia) PID: 015-331-22 PERMIT: OSP211102 E 112TH AVE N89056'25"E 10' UTILITY ESMT )9"E 150.00' A -C=20.7' B -C=52.2' A -D=23 6' B -D=52 2' A -E=25 2' B -E=52 2' 11 C EXISTING FIELDS 100' WELL RADIUS 66.1' LOT 1 B LK 3 400.16' DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1250 -GAL HDPE SEPTIC TANK WITH NEW FCO & DCO. FCO PAVED D/W 22.0' N W N 42.3' —,;Z= 2'X9' BW CANT SEPTIC SECTION SCALE1 NTS LAKE O THE HILLS BLOCK 3, LOT 1 SUPPORTs SERVICES: OF �\\ ��' PREPARED FOR: THOMAS HOLDERTH 11120 BRIGGS COURT 1c. �* 9 ANCHORAGE, AK 99516 �� FIRST WATER CONSULTING DATE: 4/19/2021/` rtis Huffman / SURVEY: JLS 1 CE 128991 13030 SUES WAY DRAWN: FWCS ANCHORAGE, AK 99516 SCALE: 1" = 30' ' 4/19/2021G� 907-350-9566 FirstWaterAK@gmail.com \\*QMSSjO'0i E 112TH AVE _ ^ Q N89'56'25"E 400.16' CD CD C3 oa 1:1' • SEPTIC Cn�? 10' L1T3LITY ESMT VENT ' M N 89'53'49"E 150.00' [til ~ "' • """ 2' CANT �0 0 7- PAVE j D/W $ cvr Z C�+f r9 FiG ?p O ss.t• s a �-s G tic 0 w T4. V CO D- ti 2.3' N _X - ! 0 2'x9' 0 49W BW CANT $ .9• O LOT 1 ■ BLK 3 WELL 0 _h G] N6812 441 W es�T ANCHORAGE RECORDING DISTRICT, ALASKA = FND 5/8" REAR AS• -BUILT OF: NOTE: Driveway locates are approximate LAKE O' THE HILLS SUBD due to deep snow and ice conditions. LOT X BLOCK 3 PLAT 72-236 -.t;` 4 SURVEY CERTIFICATE: I, John L. Schuller, Ilave conducted a s�� OF A 'A% Lp' LA]II�R� , physical survey of this property as shown on this drawing and that the ..� improvements situated hereon are within the property lines and no �l +Y enchroachments exist other than noted. Under no circumstance should * 49TH f�` apGl any information on this drawing be used for construction of fences, • • , • • • • . • • .. • �, , i �y structures, improvements, or for establishing boundary lines. ' / C J o EXCLUSION NOTES: It is the owners responsibility to determine �. ' : "" .."" • ..... ...:.. • HN L. SCHULLER: 6 / the existence of any easements, covenants, or restrictions which � �, �, w , do not appear on the recorded subdivision plat. � LS -14408 a •,��. ®„ 1 1831 Talkeetna Street woR1S ORDER NUMBER: aeie sr E-MAIL' 11 ea :....... a = Anchorage, Alaska 99508 APR21-029-2 WAVN t.Ia*=m0. 21 CRD NUMBM schulle�k.ne�t- 1': ofessiono� Lam (907) 827-1455 office JL5 SW2639 210136C �t�t����4 (907) 874-4992 fax MUNICIPALITY OP AN HORAGE On,Site Water & Wastewater Program PO box 1956,50 4704 E�irnure Raaf Anchorage, A1askatl)51943CM Phone- W 343-790A Fac (907) 343-7997 h p p! /rwww . m u n 1. -orgen :9 i ee On -Site Wastewater Disposal System« Permit Permit (+lumber 03P211102 Work Type: SepticTank Upgrade Tear Dade NUM bar: 01 � 122000 S ite to gal A d fire ss: LAKE () THE HILLS ELK 3 LT 1 0:2039 Sita Mailing Address; 11120 BRIGGS CT, Anchorage Owoer: HOLDER TI-IOMAS E Design Engineer; RR STWATEIR CON SULTINO This permit is for the construction of: Eftactive Date Expiration Date, jin _ r% ] el}a r t rrten r Lot Size In Sq Ft: Total Bedrooms: 4112D21 4112f20221 58838 ❑ Disposal Field L Septic Tarok 0 Molding Tank ❑ PrIvyr 0 Ptvate WeV 0 Water Storage All eonstruction sh-all be iri gccordanee wtth: i. The attached approved design, 2. All requiremenks specified in AncWroge Municipal code Chapters 15,55 and 15,65 and rhe Skate of Alaska Wastewater Disposal Requlations (18AAC 72) and Drinking Water Regulafions (15AAC80) 3. Tl ie wasLi! vwwl.ei carie r ey ui i &s ii rslaGr WI i% dui inU lhi!r it i glalla liui i. TI ins w i ginner shall nu lily tl i -o Delieluprnerik Serwrae5 Oepartment per AMC 15.65_ ProvMe notification by calling �ga7) 343.7904 (2417). 4. From October 15 to ApnI 16, a subsurface soil afasorption systems undef corostruction during freezing weather s hal I be either; a Opened and Closed on the sarne dad+. Or b- 0overod, sealed, and heated to prevent fimazing Received Ey_ Issued By: 4111 Cate: Dake; 4 MUNICIPALITY OF ANCHORAGE Development Services Department f j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-331-22 Property owner(s) THOMAS E. HOLDER Day phone Mailing address 11120 BRIGGS COURT, ANCHORAGE, AK 99516 Site address 11120 BRIGGS COURT, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) LAKE O THE HILLS B3, L1 Legal description (Township, Range & Section) Lot Size 58,836 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade ElDuplex (D) F-1Holding Tank ElRenewal ❑ Multiple Multiple Dwellings ❑ Privy El 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: Z Z _ Waiver Fees: Date of Payment: y i'Z U � Date of Payment: Receipt Number: 1 8/0 : Receipt Number: Permit No. 0516Z 1 1 D 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 April 8, 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 BLOCK 3, LOT 1 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 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by private wells. The design is based on MOA record documents and 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 OSP211102, Rebecca Carroll, 04/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211102, Rebecca Carroll, 04/12/21 Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND. HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISIAN P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5`y .734932'3 PICINumber: oi533iyZ Noma: Wastewater System: (9�New Upgrade Address: ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench YShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: • . Total De from original grade: .;!. GPD/Sq.Ft, Lot; Block:3 �� Subdivision: J Depth to pipe bottom from original grade: Gravel depth tbeeneath pipe 1115 Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ill • 7� Ft. / Ft. WELL: LyNew D Upgrade Gravel width: Number of lines: 7/ Distance between lines: A0 Z-/ Ft. Ft. Classification (Private, XS.C): Total Depth: I Cased To: Total absorption area: Pipe material: e}57M. rJ -303 41 r/aEUISTANCES ZO! Ft. 7.01 Ft. /33� SC. Ft. On ler:Date Drilled: 3/4194- Static Water Level: —i39VZ%vsYield:sing Installer: Date t tailed: Height Above Ground: TANKJ Ft. Z Ft. ISTANCES LM-,Lfeptic ❑ Holding ❑ S.T.E.P. To Septic#Field Litt Holtling rivate Manufacturer: Capacity in gallons: ySo From Tank Station Tank Sewer Lines ,t/ei Well �p� / Material• Sfp Number of Compartments: YWatere >/50 '/�� LIFT STATION ^/ Lot L?/ Size in gallons: Manufacturer: Line " Foundation /(o r "Pump on" level at: "Pu evel at: High water alarm at: Curtain �/� / / Pump Make'S Mo Electrical Inspections performed by: Drain Remarks: �h% /�- alcL BENCH MARK �w5u�2f/cvL IS �.t GGda O✓le /'16%.73 Gh AI G Location and Description: / 4oex +/r/it-/7 fo 1 a.f incc✓% J41011r, IA -AA. Assumed Elevation: %°°' Inspections performed by: �� Dates: 1s 2nd Department of Health and Human Services approval Reviewed and approved by: Date:4 113 (ae'/. 9/91) MOA 25 SEAL Ci- A$D C+ r.Al a�eaon req'.1.1�°i a Michael E. Anderson tj • L 4381-E •' an en weura l: as/ ,�`,• Vr l.JJ1 ��� ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 26, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Dan Roth Subject: Lot 1, Block 3, Lake O' The Hills Permit No. SW930323 Certified As-Built/Health Authority Approval Dear Dan: Harten Construction, the contractor on this project, returned to the site and removed the 2' section of the drainfield which was encroaching into the utility easement and added 2' at the other end. The effective length of the lateral remains the same. The lot line waiver, therefore, is no longer required. We hereby request the $115.00 fee previously paid for the waiver be refunded to Anderson Engineering. The site plan included with the as -built indicates sufficient area remains for the alternate site with the well in its present location. It is neither feasible nor economically justified to move the well at this time. With the pending approval of the innovative sand filter type systems this lot will have more than adequate space for another system should the present system fail. We, therefore, request the as - built be approved and the Health Authority Approval Certification be issued. Please advise if you have any questions or comments. Sincerely, Michael E. Anderson, P.E. Attachment ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 April 20, 1994 RECEIVED ApIR 21 1994 Viiunicipaiity of A OhSeage Dept. Health & Humces Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot diiBlock 1, Lake O' The Hills Subdivision Lot Line Waiver Dear On Site Services Engineer: The north leg of the drainage trench placed on the subject lot encroaches within 8' of the lot line. The trench was placed in this location to take advantage of the good soil conditions found in this area. We, therefore, request a lot line waiver be issued allowing placement of the trench at this location. The septic system on the adjacent lot is more than 50' from this trench and is unaffected by its placement. The well on the adjacent lot is more than 200' from the trench and is similarly unaffected by its placement. Sincerely, L�4d"e' Michael E. Anderson, P.E. Permit No. 5 r.J y SO 3 Z3 Page '-- —0r — Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box -196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Lo r- l $��c�c 3 La�� cl 0' i Tic f���,<s PID No.: X 1533 i 2.2_,. Legal Description: �. T _ _., U ` � Gia; r � 37 � o �f c - 1 4 O !(Inc? ! s 42.20' — :eo —f - - - - - - - 112TH AVENUE i---�_ S r► -E' 30.00 ELEV. ".a I\ ..1 1 N 89 "56'ft" 0.16' 77.6' 110115E ELEV. 41 BEq( iS� F.F. ELEV. 88.5' ' 1 42.17' Z � 2• CANT ,ry - C> I � ns CANT f 1 ELEV, 2 I — n I ELEV. 74.➢ N O 1 C> I // 8o 1 f 1 ELEV. 78.8 V��W UTILITY 1 GAY. 00.3 \ p\\\\\ N Om 4f A �ELEV. 100.0 f o \ 90 y"frt�a 'yr',Mielrael E. Anderson ..t, F sv Zs (l C. :4U' d� LOT 2 ELEV Plot Plan for:Quigley Ent 340 Pettis Rd. Anchorage, Alaska 99515 (907) 349-1488 I hereby certify that the prof- by me, or at my direction, and are within the property lines property lying adjacent theret improvements on the property 1" premises in question and that th= nor other easements on said prop It is the responsibility - ,construction, to verify proposed and utility connections and to do (covenants, or restrictions wh n t.-JENiGINEEFI' EAL) e Municipality of Anchorage P.'E� 5.;., DEPARTMENT OF HEALTH & HUMAN SERVICES ° °o 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 11 °,Michael E. Anderson jb 4381-E d°�® PERFORMED FOR: �/ -��N GD/. Gtr. /I � DATE PERFORNIi Ll;'j, LEGAL DESCRIPTION: L / 105 31 L't'k C- Township, Range, Section: to 7-Ae-- L SLOPE SITE PLAN OLT-# WAS GROUND WATER ENCOUNTERED? /11 IF YES, AT WHAT DEPTH? Depth to Water Afler��/3fl Monitoring? Date ■EREEM Wm M,....NERNE S L O P E ®®Mm so���i�� 20 -{ IL— JI PERCOLATION RATE y� (minutes/inch) PERC HOLE DIAMETER � , / '/ ��T,,//EST RUN BETWEEN � FT AND FT COMMENTS T5 !t0/L'i /5 //te- '1!4'-"Ie—tic;Z �/ [/� T3 /vu %7�✓G fh�t_• PERFORMED BY: , I ��'^^� - CER I IFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: z 4( 9 72 -DOB (Rev. 4/85) STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELL OR CH SU D VI81j� LOT aLOCK SECTION DTRs SECTION TOWNSHIP RANGE MdtIGIAH �� ❑E ON I 44 1 ra ❑S ❑W LOCATION/SKETCH.- WELL OWNER: L? �DYIJ.h DEPTHS MEASURED FROM.Ocesing top Oground surtace WELL DEPTH: DATE OF COMPLETION �- Oepth of hole: It SGREHOLE DATA: Depth Depth of casing: ft Material Type and Color From To I DEPTH TO STATIC WATER LEVEL, t below top of casing ❑ ground surface Date: METHOD OF DRILLING: air rotary D cable tool f other USE OF WELL: A domestic ❑ irrigation ❑ monitor �.••�. 11pubtic supply ❑ other ._, ^ CASINO STICK-UP: ft. Diam: in. to,#&jft Q " Casing type: in. to ga /ft WELL INTAKE OPENING TYPE: XL open end ❑ screened A rte_,,. � � l' ❑ perforated 0 open hole Depths of openings: to , ft µ SCREEN TYPE: Diam: _In. Slot/Mash Size: _Length: _ _ ____... Length: ft GRAVEL, PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from _ It to ft DEVELOPMENT METHO)): Ciel �. Duration- __. PUMPING LEVEL AND YIELD: ft after / hrs pumping =? ,,_„gpm PUMP INTAKE DEPTH: _ ft Horsepower: WELL DISINFECTED UPON COMPLETION? ❑ YES ❑ NO CONTRACTOR 'i REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: /• u�9 s c! DNR/DIVISION OF WATER ure of�i u'thU{IzedTiesprB ntatry 17atr. PO BOX 77211& EAGLE RIVER AK 99577.211$ .1 F I - o a At ow �7 Al, kIN FF Vol W--, 71 I F I - o a At 4 02 - Vol Wnew! '.4 1, ni OW P. M114 wt PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 1 a• -12-93 DEPARTMENT OF HEALTH AND HUMAN SERVICES ia,ac1- lB P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 is -3D -" ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930323 DATE ISSUED: 8/25/93 DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 8/25/94 OWNER NAME:DESIGNS IN WOOD LTD OWNER ADDRESS:7021 DRIFTWOOD PLACE ANCHORAGE, AK 99518 PARCEL ID:01533122 LEGAL DESCRIPTION: LAKE 0 THE HILLS BLK 3 LT 1 LOT SIZE: 58836 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 TRIS 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: RECEIVED BY: ISSUED BY: DATE: DATE:�-- T ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 13, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Block 3, Lake O' The Hills Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The topography of the subject lot as shown on the attached Site Plan is characterized by fairly steep slopes. The proposed septic system is located parallel to existing ground contours where ponding will not occur. Soils encountered in the testhole revealed sandy soils with no groundwater encountered. A shallow wide trench system should function adequately on this lot. 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 have 44 erse impact on drainage patterns in the area. X36' A `r oaas�c �pf tE J tp.. 61a ° o e� C Sincerely,f� ¢ ca `` ©ae P ax ez- ,n t �Fj �oaF as eac°ap eoo°o�ono oa•�°4{_�� Sfi ay Michael E. Anderson Michael E. Anderson, P.E. ®®J' °° assi C °a SO, �!I �JJ• `Zu mawmfC W- &r mm mai N ' or „ TEST HOLE I / A / 6O TEST � QOyQyo� z - � ,V .WO ,y TEST HOLE 0 � o h 7ESJ HOLE 80 8Q i S,, -F Pu+d ° ppCF C8°d° a eeoee°oo oo Goo eGOGo "� 416Anderson 4� G”.•° Michael C. amA381-� �s�E`j1�C "boa °o co©°aeh�.t pp, 6F SSc� T 0 8 KWJa2*1IMOMWA20H MMOM.TOOWFMicuae14*MM Municipality of Anchorage O '�k DEPARTMENT OF HEALTH A HUMAN SERVICES 825 W Street, Anchorage, Alaska 99502-0650 p7r'J SOILS LOG — PERCOLATION TEST �G® r PERFORMED FOR: 1�-r 7-a7� J C.bn1S-rayIa" /oiJ DATE PER LEGAL DESCRIPTION: L I $3. �`� 0' Hill Township, Range, Section: LOPE w� T 1 rr Ste- ftfb %,Ow 4 5 6 7 6 <g 10 11 12 13 14 15 16 17 1a 19 20 COMMENTS rpt Nola *I WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT f L DEPTH? P E Depth Is Wren Aha Monitor? owe ,1 PERCOLATION RATE —!4— (mmutanncnl PERC HOLE DIAMETER TEST RUN BETWEEN 2/ FT AND 5 FT PERFORMED BY: I `o T ' " 19 dWIFY T I 4-A`f THI T T WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE -- 724= (Rev. 4/85) ATE:72.00S(Rev.4/85) I 0*:� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST A' F PERFORMED FOR: /��r ` 9A!SI�UJCXJO^j DATE LEGAL DESCRIPTION: LI (�/ e0%Ulll�i Township, Range, Section: 7 ;/- 8 •• � • I r •, •D ' 12- 13- 14- 15 213 14 15 16 17- is- 19 - 20 718192D COMMENTS SM bow SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT / 0 DEPTH? P E Depth to Water Dur Mo WIQ? out X00 ^,JE-.�f�C)=cfi£3(1Ju00�-/Y E. Anderson i1' t SITE PLAN PERCOLATION RATE 52 (minutes/inch) PERC HOLE DIAMETER rEeST RUN BETWEENJ1k. FT AND y� FT PERFORMED BY: I Z44,4dul Y TMAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) LEGAL DESCRIPTION: LIci lw/ v IrIV rf 2- 3- 4 3 4 � F. / p 5 '. oma. ISI, 5� 8- fv8_ o.• At2GP/ y raJti N/co��ey % 6 9 /p. Township, Range, Section: Nbdi . M 10 300 ✓ as°QoV Municipality of Anchorage E® F �� } DEPARTMENT OF HEALTH & HUMAN SERVICES 0> °a° 1, a° �z 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 110 aa° , oav aoo 00 ©caoa aaoovo ao av�vo A.ichaeI E. Anderson tZ lz�'® PERFORMED FOR: �My lw O 438 - DATE PEQ�Fi��E1!e LEGAL DESCRIPTION: LIci lw/ v IrIV rf 2- 3- 4 3 4 � F. / p 5 '. oma. ISI, 5� 8- fv8_ o.• At2GP/ y raJti N/co��ey % 6 9 /p. Township, Range, Section: Nbdi . M 10 WAS GROUND WATER o• . ENCOUNTERED? 11 •� IF YES, AT WHAT v DEPTH? 12 0l.... Depth to water Mer 13 Manitaring7 �� Date: 14- 15- 16- 17- 19 415 1619 20 COMMENTS ==Mmm� PERCOLATION RATE _L_ (minutes/inch) PERC HOLE DIAMETER G-1 TEST RUN BETWEEN % Y FT AND FT PERFORMED BY: �f� I �� TY THAI/, TIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 911? 9J 72-008 (Rev. 4/85) PERCOLATION RATE _L_ (minutes/inch) PERC HOLE DIAMETER G-1 TEST RUN BETWEEN % Y FT AND FT PERFORMED BY: �f� I �� TY THAI/, TIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 911? 9J 72-008 (Rev. 4/85) Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-331-22 Expiration Date: 1. GENERAL INFORMATION Complete legal description LAKE 0 THE HILLS BLOCK 3, LOT 1 Location (site address) 11120 BRIGGS COURT, ANCHORAGE, AK 99516 Current property owner(s) THOMAS E HOLDER Day phone Mailing address Real estate agent 11120 BRIGGS COURT. ANCHORAGE. AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 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: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .55 Date of Payment 41 Receipt Number COSA # O S C 211 1� 5 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 4/17/2021 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 A these various and dynamic characteristics and are outside the control of the evaluator of the OF. •�"``� l well and septic system. Therefore, any estimate of how long a system will function satisfactory g��`• • • • • • �� ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting &FWGS : . TTH • • ••: �� 6. DSD SIGNATURE • :• Curtis Huffman. System #1 Approved for bedrooms CE 128991�d �Fq'•.4/17/z1•'F��� System #2 Approved for bedrooms ���F�PROFESSIONP� Disapproved Conditional approval for bedrooms, with the following stipulations: ON-SITE r,_ n By: aR_ - C�nw Original Certificate Date: 2 ,20,. 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 COSA Checklist Legal Description: LAKE O THE HILLS BLOCK 3, LOT 1 Parcel ID: 015-331-22 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 3/4/1994 Total depth 201 ft Cased to 201 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 4/7/2021 Static water level at beginning of test 149 ft. Well production at time of test 5.6 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 Date of Sample 4/5/2021 Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) NA – NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA Standpipes/foundation cleanout per record drawing Date of pumping NA C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 12/30/1993 ALL standpipes present per record drawing Total measured depth from grade 7.4 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 4/7/2021 Results Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 670 gal New depth 2 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: TESTED LOWER TRENCH – UPPER TRENCH HAD 20” OF FLUID. 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 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 From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ 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 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 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 If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No 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 with MOA COSA guidelines in effect on this date. 4/20/21 Parcel I.D. 015-331-22 g:So Municipality of AnchorageL,;-,,. 0 ; -L"V6 On -Site Water and Wastewater Progra 1 (907) 343-7904 Certificate of On -Site Systems A 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: Lake O' the Hills. Block 3, Lot 1. 11120 Briggs Court. Current Property owner(s) David & Kathleen COTe Day phone Mailing address Real Estate Agent 11120 Briggs Court. Anchorage, AK. 99516 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: 16 �Z COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 674101D Waiver Fee $ Date of Payment IZ1%4'xl (0, Date of Payment Receipt Numbert "tom Receipt Number COSA# 05GIC0IIJ71 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixdd�heretod as of the validation date shown below, I verify that my investigation, based on proceduresoutlined in the Certificate of On -Site System 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 7/29/2016 �OF aLgs:�P�4' i �.Steveri �R. � �aririti Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 12 -- 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheer ° . . If more than 1 septic system is on the lot: COSA Checklist #_of +_ Structure served by this system .,Certificate of On -Site Systems Approval Checklist Legal Description: Lake Or the Hills. Block 3, Lot 1. A. WELL DATA Well type Private If A, B, or C provide PWSID # ' Well Log (Y/N) Y Date completed 3/4/1994 Sanitary seal (Y/N) Y Wires properly. protected (Y/N) Y Total depth 201 ft. Cased to 201 ft. Casing height (above ground) .1 g+ in. AT INSPECTION 7/29/2016 Parcel ID: 015-331-22 Date of test FROM WELL LOG 3/4/1994 Static water level 139 Well production 30 ft. g. p. m. 139 5.6 ft. WATER SAMPLE RESULTS: Coliform Pct colonies/100 mL Nitrate mg/L. Arsenic ug/L Dateofsample. Z'�-1'� Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 12/30/1993` Tank size ^ 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N)/ Y " Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping FS�oi9leZo�� Pumper 1144 A/r' -f Sem✓i[cS C. ABSORPTION FIELD DATA Date installed 12/30/1993 Soil rating (g.p.d./ftz or ft2/bdrm) 0.45 g.p.d./SF System type Shallow Trenches (2) Length 134 ft. Width 5 ft., Gravel below pipe 4 ft. Total depth 7.4 ft. Eff. absorptionarea 1 334ft2. Monitoring tube Y Depression over field N Date of adequacy test 7/29/2016 _ _ Results (Pass/Fail) PASS For 4* bedrooms Fluid depth in absorption field before test 12 in. Water added 617 gal. New depth 12 in. Elapsed Time: 110 min. Final fluid depth .12 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION. Date.installedSize 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 WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ 50+ 100+ Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 1 Q+ Surface water 100+ 00+ Wells on adjacent lots.! ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 1'0+ Water main 10+ Water Service line 10+ Surface water 1.00+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 7/29/2016 COSA canary sheet_2-6-15.doc Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(aganenRak.com 8 December 2016 Subject: Lake 0' the Hills, Block 3, Lot 1 Septic Location Letter This letter is in response to the COSA comments issued by On -Site on 12/6/2016. The record drawing and swing ties approved on 8/30/1994 did not match the survey as -built dated 9/23/2016. Pannone Engineering Services (PES) performed a site investigation on 12/7/2016 to verify swing ties and the location of all the septic standpipes and the well. PES used the building location off of the survey and PES's field measurements to create the attached drawing. As you can see on the drawing, the septic system is outside of the 10' T&E easement and also outside of the 100' well radius. PES asks that this COSA be approved as is as soon as possible to accommodate the closing date. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 5A Ave 14.8 M2 C6 _ BRIGGS CT. I U I 6t L EASEM tN I t t v,— i 12 3 cs� —T2` - I ci=—�-- rs ri o �,ai Hca 1 DRIVEWAY LA �m� 4 B SWING TIES B HOUSE m E TRUE NOR iZ�SCALE � 1"= 50' m z s� 1 70.9 /36.0 I 101 t �I \- WELL (E) / 2 I A B C FC 2.8 34.3 Scale 1" = 60' T1 18.8 52.3 P.I.D. NO T2 23 o 522 SITE PLAN DC 1 24.8 52.5 DC2 28.0 523 FS 28.8 52.7 C1 80.4 70.0 mi 70.5 59.2 C2 77.1 75.4 W2 66.0 69.8 C3 23.8 34.6 C4 34.9 68.2 C5 34.7 59.8 WELL 70.9 36.0 TRUE NOR iZ�SCALE � 1"= 50' m z s� 1 70.9 /36.0 I 101 t �I \- WELL (E) / 2 I NOTES: PAMONE ENG SVC LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 p �.' .. .. .. .. ..... even .'Pcnnone' 814 Date 12/7/2016 FIELD VERIFICATION Scale 1" = 60' LAKE 0' THE HILLS, BLOCK 3, LOT 1015-331-22 KATHLEEN & DAVID COLE 11120 BRIGGS CT. ANCHORAGE, AK 99516 P.I.D. NO PERMIT NO. OSPXX%XX% DRAWN NJC SITE PLAN Sheet 1 OF 1 E llzr" A✓- h Z V 5,830 53'09" w 3 �t ® li. O®md ® WWF a ® -E KISTrnN @ .'O �?-n STRG1 cTu.�e__-�, I Lot. �G Lot. / , Block 3 Lghe 0' Thi HI°ll Su6de Anchorage Recording District, Alaska OT SURVEY CERTIFICATION I hereby osrtIfy that I have eurveysd the property shown and described hereon, and that the Improvements situated thereon ars within the prop- rty Tina and ds not overlap or oncroaoh oc udlaaent property and that ns Ingrownwrd, on adjacent property overlap or enoroo¢h on the pnemine In queetion and that then are no roadways, utility Ihws, or other visible eosaoects an said property coapt as Indicated hereon. 3 = LOT OF AC�eq` s Ecsoments of record other than those shown on the plat at record ars not shown hereon union otherviao noted. LEGEND ® Bross or Aluminum capped monument recovered o Iron pipe rmd/or rebor recovered. ❑ 2 x 2 hub & tack recovered 0 5/81. x 30.1 rabor set this survey —z— Fence Line (Approx. Location) Scale/ �^ Dote Prepared by: R. L. BUTTON W/O – / —�Gi RegisAered Land Surveyor © (907)279-6<00 5/9 W. EighfhAve. Anchorage Aixiiv Q965 / Ref. �� Q I F. B. No. err I Property of: _ _ Municipality of Anchorage r' Development Services Department Building Safety Division Onsite Water 6 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage ekus . (907) 343.7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-331-22 HAAtt__ H A D 1. GENERAL INFORMATION Expiration Date: %— 3— b / Complete legal description LAKE O' THE HILLS SUBDIVISION: LOT 1. BLOCK 3 Location (site address or directions) 11120 BRIGG COURT * ANCHORAGE. AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIM MUNGLE Day phone 762-3111 c/o BETH WEISER w/ PRUDENTIAL JACK WHITE Day phone BETH WEISER w/ PRUDENTIAL JACK WHrrE Day phone 762-3111 3201 C STREET. SURE 200 * ANCHORAGE. AK 99503 Unless otherwise requested, HAA 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 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 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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. Note: Alaska Waterand Wastewater consultants, Inc. shall be patd $1,190.00 at, or prior. 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 verily that my, investigation, based on procedures outlined In the Health,Authd*i 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 Munlclpalily of Anchorage files and from mylnvestigaflon 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 efled at the time of installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 25 " ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysts 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 soparatfon distances measured to readily identifiable features. The operational fife ofafl wells and septic systems depend on the tical softs condition, groundwater levels that may : fluctuate during the year, and the water usage of the famiy 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. AWWC, Inc. can therefore not pro'Ode any warranty w future estimate of how long the system will continue to moat the ' operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benerut of the owner listed above. Any reliance upon or use of this report by any other person or porty Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for4 _ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date v 1 Manitenance Agreements Supplemental Engineer's Reort Other rv�Q�' • • • •�;y0 ON-SITE WATER AND : WASTEWATER PROGRAM By..�� „/ 6r/. / � � Original Certificate Date: DI Q�Av. izmr Municipality of Anchorage ' Development Services Department Building safety Division J . Onsite Water & Wasrowffier Program 47W South Bragaw, St. P.O. Bar 108850 Anchorage, AK 995194XW www.cIAnchorsge.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LAKE 0' THE HILLS SUBDIVISION; LOT 1, BLOCK 3 Parcel ID: 015-331-22 A. WELL DATA Well type PRIVATE 11 A, B, or C provide PWSID# N/A Date completed 3/4/1994 Sanitary seat (YIN) YES Total depth 201 ft. Cased to 201 ft. FROM WELL LOG Date of test 3/4/1994 Static water levet 139 ft. Well production 30 — g -p.m - WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires property protected (YIN) YES Casing height (above ground) 16 in. AT INSPECTION 3/5/2001 142 ft. 5.0+ g.p.m. Coliform 0 colonies/100 ml. Nitrate 0.5 mg./L. Other bacteria 0 colonies/100 ml. Date of sample: 3/12/2001 Collected by: AWWC, INC. 8. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 12/28-30/93 Tank size 1250 gal. Number of Compartments E Cleanouts (YM) YES Foundation cleanout (YIN) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 3/5/2001 Pumper DENALI SEWER & DRAIN C. ABSORPTION FIELD DATA [MTI/MT2] Date installed 12/28-30/93 Soli rating .p.d. r ft'/bdrm)0.45 System type SHALLOW TRENCHES Length 134 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 07.6-9.9 ft. Eft. absorption area 1..334 to Monitoring tube YES Depression over field NO Date of adequacy test 3/5/2001 Results (Pass/Fall) PASS For 4 bedrooms 620/399 Fluid depth in absorption field before test!/ 18 5in. Water added 1019 gal. New depth 0/21 in. Elapsed Time: 0 min. Final fluid depth 0/21 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date - D. UFT STATION Date installed 'Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alar level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankntft station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholeldeanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Heid 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinghrehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS A FLOW SPLITTER BE INSTALLED G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and e ! 'a review of Municipal records that the above systems are in ...... " ' . "" • ""... conformance with MOA HAA guidelines in effect on this date. e A. Coyness:' Engineer's Print Na% a JEFFREY A. GARNESS 000�s -7953 Date Z0(O1 �p%1*4yp ......• a��4 —� �n �olessan�� HAA Fee $ 300-00 Date of Payment 3 009CI-6i Receipt Number a 3 5 (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 03-28-01 09:40 FR0"TE ENVIROMENTAL 'AL CUE Environmental Services Inc. CT&E RetA ed 1011275001 Client Name AK Water & Wastewater Consultants Inc. Project Name# Lake O' the lulls SID. L 1 B 3 Client Sample 10 Lake U the Hills SID, L 1 B 3 Malls O d B Drinking Water 5615301 T-869 P.02/03 F-717 Clint PON Noted Dote/rime Collected DateMme Received Date/rime Teeealeal Director 03202001 11:29 03/122001 16:00 03/132001 17:00 Stephen C. Ede r er y PWSID 0 Released By Sample Remarks: Parameter Results PQL Units Method Limits Prep Date Limits Date Due Init Waters Departatent Nitrat -N 0.500 U 0.500 mg/L EPA 300.0 10 max Microbiology Laboratory Total Coliform 0 cot/100ml. SM18922211 03/13/01 SCL 03/13/01 SKW v MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# 0199 3317-2 HAA# -0Q� SL\0aQ 1. GENERAL INFORMATION Complete legal description r /, u` ®, 7_1"}6 14 ILL S Location (site address or directions) Property owner L C1 n l L-�,L-�L3 Day phone RAn:17r. . AAr000 - Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: Individual well XX X Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site KX X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,,,j1)CR&-)ri E�J(IiAJ&�_�AG Phone 3gcl— 4PS5/ Address PQ, k,,- Zy0173 A�,jUi ASL cmS2_4 Engineer's signature ` ° I-� ��� Date 6. DHHS SIGNATURE X Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: 111Th L/ `. ..g?i,✓,'��_�.. �.'�.. iib ii �.'�.:C �'� 4.o. <.aocoYoou o••e. °e a•e •ao•o •o E. Anderson tV 4301 - E� �F�Jo60 e°'o° \(�� xsp bedrooms, with the following stipulations: Date 5-,3o 94 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA a21 Municipality of Anchorage AUL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: far/ , JAu O'ire: %�iLa Parcel I.D. 01.5 3,71 Z. Z– A. Well Data Well type PfZ lV47'C If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) r Date completed 3 4 U Driller ALP11JE D2tLLIr46 Total depth Z10 / i Cased to Zo / Casing height 2 Sanitary seal (Y/N) Wires properly protected (Y/N) y Date of test Static water level Well flow Pump levels FROM WELL LOG 94 !3? AT INSPECTION :30 g.p.m. 9 -p.m - 0 It–" 0 vu 14 SEPARATION DISTANCES FROM WELL TO: Septictholding tank on lot /0A ; On adjacent lots Absorption field on lot / 0�5 ; On adjacent lots ? ITO, Public sewer main A/ ZA Public sewer manhole/cleanout AILA Sewer service line �- ti $ !� Petroleum Yank 141A WATER SAMPLE RESULTS: Coliform 6) Nitrate • 10 9 �� Other bacteria 0 Date of sample: 4.%Z. /9� Collected by: A. PA -2A LA B. SEPTIC/HOLDING TANK DATA Date installed I Z 2f,--' Tank size 4 2-50 6h1- Compartments —r '15 D Cleanouts (Y/N) %r Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) n Alarm tested (Y/N) LA Date of pumping /(� Lv 4 SI (LU a- 10 1,4 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 06,9 On adjacent lots 7 17S Foundation To property line ti ZT t Absorption field to Water main/service line Surface water/drainage H SD 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed 141L&-30 93 Soil rating (GPD/Ft) .45 System type W ibtS, CH Length 134, Width Gravel thickness q ` Total depth Total absorption area 1. 33 `f r'r, z Cleanout present (Y/N) Y Depression over field (Y/N) Date of adequacy test /erne CO, J S% Results (pass/fail) AA SS Ca for T::9 v )t4 Bedrooms Water level in absorption field before test (gyAfter test Peroxide treatment (past 12 months) (Y/N) pp If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /d 5 1 On adjacent lots /Z i Property line To building foundation Z,6 To existing or abandoned system on lot i On adjacent lots > %©o Cutbank o el E Water main/service line_ Surface water 140tJ G Driveway, parking/vehicle storage area � �D Curtain drain 0 nt c E. ENGINEER'S CERTIFICATION /took }60' I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the c/ate of this inspection. HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number `Z ; MjsLal > Signature X � /►1 f C i44-ra Z s1 �� ►� dLSO 4% � �i Engineer's Name /-1�► „ ; ,A,<.I, Date ZZ -7/94 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Department of Health and Human Services 44 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L.0-'/ 6GoyL 3 6kvG 0'7i�w ditfsParce1 I.D. A. Well Data 0/533fzZ Well type 1"iZ A -r -C If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 3141941 Driller /4LP/N0 DRIL(-WG Total depth Z01 Cased to Z49 / Casing height 2— Sanitary seal (Y/N) Sanitary y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION test 3�`� F 4- y Date of o Static water level ` ! `° Well flow 30 g.p.m. 9 -P.M. J 9 t� N 0 Pump levell � ^I t�.l OuQ NJ n SEPARATION DISTANCES FROM WELL TO: CD N 9 P 0 Septic/holding tank on lot /0 _; On adjacent lots Absorption field on lotI � ; On adjacent lots 1A A(/A Public sewer main Public sewer manhole/cleanout Sewer service line / S A Petroleum tank !"� WATER SAMPLE RESULTS: D Nitrate ° 1 IL Other bacteria b Coliform Date of sample: ) `//j /'! q Collected by: A, )4. B. SEPTIC/HOLDING TANK DATA Date installed/Z ' q�� Tank size 1, Z S"0 6 A-(- Compartments W0 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) All Alarm tested (Y/N) j 14 /A Date of pumping /J Gz'W � � 571" �'/0 nl Pumper A ! A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r 7/ 75' Foundation Well(s) on lot /08 On adjacent lots i To property line 25 / Absorption field Water main/service line Surface water/drainage >150 r 72-026(3W)•Front CONTINUED ON BACK PAGE T STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" Meets MOA electrical codes (Y/N SEPARA' on lot yip FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access `_'Pump off" Level at Surface water Date installed f Z IL h 193 Soil rating (GPD/Ft2) �� System type F Length /341, Width 5 / Gravel thickness Lk i Total depth -rb `I Total absorption area /, 3 3 q FT z Cleanout present (Y/N) Depression over field (Y/N) Date of adequacy test /i'-`-L�r (� N ST- Results (pass/fail) PA SS for F=0 �-'JI-- Bedrooms Water level in absorption field before test 0 After test _ Peroxide treatment (past 12 months) (Y/N) /1J If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 105 On adjacent lots Property line Q /A To building foundation Z i 0 To existing or abandoned system on lot 14 /A i On adjacent lots 7 U r Cutbank -> y0 U r Water main/service line > w t7 Surface water DC7 Driveway, parking/vehicle storage area `fib Curtain drain nI t -- E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on thg• date of this. inspection. << s, A, Signature y •,,. i2�y,.., st«.s.,� Engineer's Name 114 (-4-14- G- 1--, Z-7 X-il`D i:72.S�J� -• , � X1195 �� Date HAA Fee $ �Do` P 60 Waiver Fee $ l�iJ Date of Payment 7 zi' ` �� Date of Payment Receipt Number �S ��O Receipt Number 72-026 (3/93)' Back Commercial besting & Engineering Co. L Environmental Laboratory Services SINCE 1908 LABORATORY ANALYSIS REPORT CT&ERef.# 94.1598-1 Client Sample ID Ll B3 LAIM 9 THE HALLS SUBD. Matrix WATER ClientName ANDERSON ENGINEERING RUSH Order 77414 Ordered By ALAN Printed Date 04/13/94 @16:09 his. ProjectName Collected Date 04/12/94 @16:10 hrs. Project# Received Date 04/12/94 @ 16:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By: Sample Remarks: ROUTINE SAMPLECOLLECTED BY: A.H. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate -N 0.10 U mg/L EPA 353.2/300.0 10 04/13/94 LLH * See Special Instructions Above UA=Unavailable ** See Sample Remarks Above NA=Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT= Less Than D = Secondary dilution. Gf = Greater Than a LL 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA