Loading...
HomeMy WebLinkAboutHILLSIDE PARK PUD LT 29 ,,,,to rro, MUNICIPALITY OF ANCHORAGE ,�„e nr On-Site Water& Wastewater Program �-- S.; 1 PO Box 196650 4700 Elmore Road % Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 . r. http://www.muni.org/onsite i 11111 Di Ir,rrtin, nr On-Site Wastewater Disposal System Permit Permit Number: OSP171159 Effective Date: 7/10/2017 Work Type: Septic Upgrade Expiration Date: 7/10/2018/11 Tax Code Number: 01531232000 1/4 I I 1 .1301-'Site Legal Address: HILLSIDE PARK PUD LT 29 G:2539 I 2'P c-4-, ,xcik 44-6. Site Mailing Address: 7140 CROOKED TREE DR, Anchorage 1-1Z-1? —176P . Owner: CARTE ROBERT WILLIAM 50% & Lot Size in Sq Ft: 27808 l°"ge Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5 This permit is for the construction of: El Disposal Field El Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The extension to the field is not within a 30 foot radius of a percolation test. The Engineer is to do an additional perc test prior to construction. Submit soils log with the Inspection Report. Received By: th 4 �4 ill y -.`0. 1 . _� ,A Date: .V/n/f 7 Issued By: 0 ,,, / I Date: 7/45)4/ C11 r Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage Alaska 99519-6650 s (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV171066 COSA# PID#: 015-312-32 Legal Description: Hillside Park PUD L29 Permit#: OSP171159 Engineer: Pannone Engineering Services Applicant: Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 12.5 feet. The reserve field has approval for 0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 2- l Approved by: i k, /,I— --- __79akre of Reviewer **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phon r - 44, Development Services Division - F F. On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION a JUN21112017 46 :114 .1\c"k' Parcel I.D. 015-312-32 • c` 6 s `' Property owner(s) ROBERT CARTE & JESSICA MURPHY Day phone Mailing address 7140 CROOKED TREE DRIVE, ANCHORAGE AK 99507 Site address 7140 CROOKED TREE DRIVE Legal description (Sub'd., Block & Lot) HILLSIDE PARK PUD L29 Legal description (Township, Range & Section) Lot Size 27,808 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑Q (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Munici..I Co.- • VP AtiP (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: (, -23-11 Date of Payment: Receipt Number: 0233‘sC‘ Receipt Number: Permit No. Oe Fl 115/ Waiver No. Permit App_.- : ,c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com July 8, 2017 Subject: HILLSIDE PARK PUD L29 Septic System Permit Request Design Narrative This is a design narrative for a permit to install an upgrade septic system and well to be issued for this property. The proposed system will serve an existing four bedroom (4 BR) house which the owner intends to upgrade to a five bedroom (5 BR). Currently the lot and all surrounding lots are developed. A new 1500- gallon tank will be installed and 12.5 linear feet will be added to the absorption field. There are no wells within 100' of the proposed septic system nor will the system be within 200' of a community well. 1. Soils. Three test holes were conducted in the area by Roger Shafer in August of 1990. Test hole#3 is in the location of the existing absorption system. Bedrock was not encountered in those test holes. Ground water was not encountered to a depth of 16.5 feet in August 1990. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography on the lot generally slopes from south to north, with a slope of approximately 0% to 1% in the area of the drain field. There is a steep slope over 25%within 50' of the proposed drain field addition. See waivers. 5. Waivers: a. Steep Slope Separation: We are requesting a waiver for the drain field on the subject property for a separation distance to a steep slope. The system will consist of a 12.5LF extension to an EXISTING absorption field that has a 5' effective depth and a 10' total depth. The system will not daylight in the worst-case scenario using an infiltration line of 25%. The system was ALREADY installed in 1991 approximately 12.5' from the grade break. The reserve field if constructed will be located 0' from the grade break, where an infiltration line of 25% will not daylight. We request a waiver for the separation of the primary field to a steep slope to a distance of 12.5', and the reserve field to a distance of 0'. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, OF 1•44 • •• !!4Steven R.Pannone IP • :4�4#ESS;• •*t• Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 DESIGN PARAMrETERS ABBREVIATIONS i \ / PRIMARY/ RESERVE SEPTIC SYSTEM TH TEST HOLE • ``� NO. BEDROOM: 5(750 gpd) (P) PROPOSED \ o '51 a TANK SIZE: 1500g (E) EXISTING t- * a� PERC RATE: 3 MPI CO CLEAN OUT NO. D ori ti ++*++ i 417 SOIL RATING: 1.2 GPD/SF MT MONITOR TUBE NO. \ ** AREA RQD: 625 SF TYP TYPICAL / \ �� % A SYS. TYPE: DEEP TRENCH 5,0'ED —w w — WATER LINE / -13 MIN LENGTH: 62.5 LF WELL RADIUS (� ar.r � '�1 gp� \ Q TR OR1H _1 SCAJ.¢� / USE: L �� 62.5LFx2.5'Wx5.0' E.D., 10.0' TD ss ss NEW SEPTIC • 7.- TOTAL TOTAL AREA: 625 SF • r 30 1 03 rnJ / J / 1 gi J 1 aJ J - col / ! / 29 - \\ -kr, • r 3, \ \ RESERVE ABSORPTION FIELD(P) ` • 62.5LFx2.5'Wx5.0'E.D.,10.0'T.D. • 1 W/ MT & CO AT END I L I I / 01 I J ' 1 ) I 4!� ADD 12.5LF TO EXISTING ABSORPTION FIELD P 62.5LF 5OLF+12.5LF x2.5 Wx5.0 E.D.,10.0'T.D. i l 1 '1' W/ MT & CO AT END `�� f J 1 .T/� DRIVEWAY / 1 J 25.81 lit * ;�,f+ �_/`I - / • / ' ` _ - _ _ AND PERC TO VAUDATE RPT PROFII F/ A�� *-/ • FOR ABSORPTION RATE / — = REMOVE 1250. SEPTIC TANK E / AND INSTALL 1500g SEPTIC 4BR TANK(P) W/ DCO AFTER SFD(E) / . // 7 - � � - — I 1 / ASSUMED 25%INFILTRATION LINE HSG D - WORST CASE (PRIMARY FIELD) HSG A - 46%INFILTRATION LINE ASSUMED 25%INFILTRATION LINE (PRIMARY FIELD) HSG D - WORST CASE (RESERVE FIELD) .--- HSG A- 46%INFILTRATION LINE �� (RESERVE FIELD) r i �2b1 � 5.0 'L 5.0 / 10.0 ___r f /r J 16.3% r 35.0 -- - - - -, SECTION 1'=1O' NOTES: PANNONE ENG SVC, L •� A . , Date FOR CONSTRUCTION 07/08/2017 Scale P.D. BOX 102954 ANCHORAGE, AK 99510 '....A PHONE (907) 272-8218 FAX (907) 272-8211 '�•'�� ••••43 �• •"-•'-a• P.I.D. NO HILLSIDE PARK PUD L29 015-312-32 ROBERT CARTE & JESSICA MURPHY Z°Ven R• �OnnO•"e PERMIT NO. DRAWN JRL , CE 814 OSP171159 7140 CROOKED TREE DRIVE 1, •.REv:D7/05�ip, SITE PLAN ANCHORAGE, AK 99507 ''''fraR930 Sheet \,.. . 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION Of ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL NEW 1500g SEPTIC TANK, AND ADD 12.6LF TO SOIL ABSORPTION SYSTEM, 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16.5 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 16.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. B. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: . TITLE: DATE: NOTES: PANNONE ENG SVC, LLC Date FOR CONSTRUCTION P..O.. BOX 102954 ANCHORAGE, AK 99510 P'�G. '••., 06/22/2017 PHONE (907) 272-8218 FAX (907) 272-8211 �.• � �1 Scale • . la /\ ••* NTS ••• P.I.O. NO HILLSIDE PARK PUD L29015-312-32 DRAWN JRL ROBERT CARTE & JESSICA MURPHY , Moven"- " OR 'O " ° PERMIT NO. 7140 CROOKED TREE DRIVE �••,1:E�V 07/0417 OSP171159 DESIGN NOTES ANCHORAGE, AK 99507 • toe Sheet 2OF2 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~ ~4:~'~ ~. PID Number: 4~2{~;2 S l ~.,;::~ ~%~.~ ~ ~ ~ ~. ~~LWastewaterSystem: /New ~Upgrade Address: ~ ~~~~ ~. ABSORPTION FIELD Phone: ~. ~~ Nc. or.ems: ~DeepTrench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION so~, Rating: ~. ~PD/Sq. Ft. Lot: ~ Block: .I Subdivis~ Depth ,o pipe bottom from origin~a~e: Gravel depth beneath pipe ~j Ft. Township: Range: Section: Fill added above original grade: / Gravel length: ~t'l Ft. Ft. Number of lines: Distance between lines: WELL: ~ New ~ Upgrade erave~:~ ~ t I Classification (Private, A,B,C): ~ ~tal Depth: Cased To: Total absorption area: Pipe material: ~1~ ~ ~ ~ ~ I~/ A Ft. Ft. ~ SQ. Ft.' ~ ~~ Dr~er: Date Drilled: Static Water Level: In.lief: { ~ate in}talled:~ ~ .t. Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~eptic B Holding ~ S.T.E.P. From Tank Field Station Tank Sewer Lines' Well ~ ~ ~ Mate~~ Number of Compartments: Surface w.te, I~'+ I~ ~ -- ~ LIFT STATI~ Lot Size in gallons: Manufactu~ Line ~1~ [O~ ~ ~ Foundatio~ j~l i~/ __ -- -- "Pump on" le~Pump off" level at: CurtainDrain ~ ~ ~ ~~ ~ Pure.Model I Electrical Inspections performed by: Remarks: BENCH MARK ~~L°cati°n and Descrip~ I Assumed Elevation: ENGI~'~AL ~49~ Inspections performed b~~ ~1 ~~st~ ~] ~ ~~.~'"'~""'""~'~'~',~~ Department of Health and Human Services approval -~;~;,.,.. Reviewed and approved by: ,~ ~' Date: ~ 72-013 (1/91)MOA 25 · P~rmit No. "~:~ ~-::~-' Page '~.*-"' of ~ 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 72-013 A (2/91) MOA 25 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PE'RCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 21, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: SEPTIC INSPECTION REPORTS: RE,EiVED OCT 2 2 1991 Dept. HeaJti~ & Human Services NE ~,SW ~, SEC. 6, TI4N, RIW, S.M. Lot 3, Bear Park Subdivision; Lot 6, Block 4, South Fork West Subdivision; Lot 16A, Sec. 15, T12N, R3W, S.M. Lot 29, Hillside Park Subdivision; Lot 6, Block 8, Trails End Subdivision; Lot 3, Block I, Gateway To The Park Subdivision; Over this summer we have performed inspections on the installation of septic systems located on the above referenced propert~s. All of th~se systems were installed in a satisfactory manner and in accordance with the permits issued by your office. However, to date these remain virtually undev~oped properties without foundations installed. Once foundations are installed we will completed inspection report~ with swing ti~s tied into the corners of the ho~e. The appropriate ~evation data can then be tied ix~o a propel benchmark. Therefore, completed septic inspection report~ for these properties are forthcoming. If you have any questions or comments please contact us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm cc: REFERENCED PROPERTY OWNERS 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910232 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:COLLIANDER JOHN E & GWEN E OWNER ADDRESS:7140 CROOKED TREE DR ANCHORAGE, AK 99516 PARCEL ID:01531232 DATE ISSUED: 8/08/91 EXPIRATION DATE: 8/08/92 LEGAL DESCRIPTION: HILLSIDE PARK PUD LT 29 SEC 14, T12N, R3W, SM LOT SIZE: 27808 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS ISSUED BY: August 5, 1991 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGIN EERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 29; Hillside Park Subdivision We request you issue a permit to install a septic system to serve the referenced property. Three test holes were performed on the property in August 1990 by Flattop Technical Services. The location of these three test holes can still be seen on the property. The monitoring tube within each hole has been checked and found to be dry. We've showed the location of test hole #3, which was used in our design/site plan. Neither test hole 91 nor #2 had a percolation test performed. Since the subdivision is served by a Class 'A' water system, there are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. Sincerely, RJS/ztc tSCALE ANCH ROOFING f"~, Flattop Technlcal Servtce~ ~ . 14530 Echo Street anchorage, Alaska 99518 Muntclpatll¥ of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825"L" Street, Anchorage, Alaska {~§502-0650 ' ' SOILS LOG --- PERCOLATION TEST 4- 11 --- 12 13 14 19 20 Township, Range, Section: ~'C SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED? _. /'~ ..... IF YES. AT WHAT ~ DEPTH? p I~epth la Water Alter MonJt0rlnll? f'.~. O~v ~ 0ale: ~ Reading Date (~rogs Net Time Time ('~/;,)) Depth to Net ~, +~,~ , e:~'~ ., ,,~z,~ ,,, 3 ,=.'o~ f ,, ~/,,/~ / ?~' ON RATE ~--~ _ (minuleS/inch) PERC HOLE DIAMETER COMMENT~ . ~ /~ff~ .... ~ ~' ~ .~' ~ . c~ ~, 7' ~.,~., C~RT~y THAT TH~S ACCORDANCE WiTH ALL ~TATE AND MUNICIPAL GUIDELINES IN EFFECT ON THI~ DATK, DATE: ~ / ~ 12~8 (Rev. Parcel I. D. 015-312-32 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: Complete legal description HILLSIDE PARK PUD; LOT 29 Location (site address) 7140 Crooked Tree Drive *Anchorage Current Property owner(s) Rob Carte Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) g- 7 -zoz3 Day phone 952-2967 Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ A330 Date of Payment g�9�2Z Receipt Number 0t17G�lG COSA# 22) y 2. - 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 j Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an altemative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE i System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the foil i, ' , •. �i lil .. . ..........:.: L.. #AECC884 �0Ft(��r�(// ;50 ON-SITE WATER AND V'\EATER o G oonr'_C`AKA �J FNT SER\J���`��T ))) • J Original Certificate Date -9-2 J�2� The Municipality of Anchorage Development Services Division (DSD) issues Certiflcates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: HILLSIDE PARK PUD; LOT 29 If more than 1 septic system on lot: COSA Checklist # of COMMUNITY A. WELL DATA WELL _ j ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for C Static wate at beginning of test ft. ents B. TANK DATA Age of tank(s) 5 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 2 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/9/22 D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 'ionors, ❑ ALL standpipes present per record drawing Total measured depth from grade 12.58 ft (max) Measured depth to pipe invert from grade 7.5 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 N/A gallons Comments/Deficiencies: 'TRENCH WAS EXTENDED ON 9/6117 COSA Checklist yellow sheet Parcel ID: 015-312-32 Structure served by this system Well production at time of test _ Water storage tank volume_gallons :"91 ell disinfected �CtSliform test? ❑ Yes ❑ No Cbacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by ____ Date of Sample C. LIFT STATION ❑ Required maintenance com Age of lift station Veam Lift station materi Comme MT1/MT2 Adequacy test date 8/9/22 Results Q Pass For 5 bedrooms Fluid depth prior to test 21/0 in Water added 897 gal New depth 24/27 in Elapsed time 120 min Final fluid depth 21/15 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date - E. SEPARATION DISTANCESCOMMUNITY WELL From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > ❑ Yes if No ft es if No ft Neighboring Tank > 100' ❑ Yes if No ft Private S eptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 1 ' Animal Containment > 50' ❑ Yes if No ft :::: Yes if No ft Manure/Animal Excreta Storage > 100' Co ewer Main > 75' ❑ Yes if No ft ❑Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100' �]✓ Yes if Na ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Q Yes Absorption Field > 5' Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' [✓ Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' [j Yes if No ft Water Service Line > 10'[j✓ Yes if No ** ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *TO BUILDING FOUNDATION & APPROXIMATELY 2' FROM DECK (LESS THAN 30" HIGH) -PER 1991 INSPECTION REPORT SEE LETTER IN MOA DOCUMENTS REGARDING POSSIBLE DRAIN DATED (7/28/15). DRAINFIELD IS 5' FROM SLOPES >25% SINCE 1991. END OF DRAINFIELD MAY BE PARTIALLY UNDER DRIVEWAY. 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. COSA Checklist yellow sheet J.r y A�Gar ss. 9. CE -79 f �4Q f �e ' • -QjP ! !r3 •�•n ���A�� fessioSlndll a #AECC884 :E 10 OV O O O O to N ID ao sc D m < 2 7 (D m a N G E. to ( r 3 m n .+ D iD n 3 c O (D ov n D o Dr 3 wx l lu lD lD Ln N ao c — 7 � n. 3 .< V) Q K m c =r n m CD H o _ a D c =r 00 c N � Ol ? O N cm O a N m N m 7 m M O LA c m d m 0 3 m CL o- 3 m u 0 N /•� to W T IA 1 N l< i11 C Ln c cyQ t/N- 0 en 7 X D=j O N "w 'a = o c ? m n N m N � a ° N n7 Er c K N^ N 3mdc.R, m C a N m 3y ID os mJ, a C =O N m c °�cr (ni n c G r0 N j Q�(n d y o c Z o T00cto o g 3 m SD O m 7 K Oa y � m m O Dj 7 < N 7 <i N 7 N 7 D) o =r0. �7 m o O a (O 7 N 7 N m O»• a O' W, N C to a�UW d o d Q N .0_._ O N 2 S Q' O_ m m (DEr ° W O K 7 m Ov 77<, CCD aN. c. . N m o c m 0CDm3 my • o `D 3 0�? Ei CD N OCD d 0 O A W N 71 m �Dsmc?m w o CD LA c ? c o p C W N 7 3 N N (O •p N f7 y N CDo•a A — y 7 O m� o � •o cc m c CD d o y { Q N N 3 o. N � O o ro N Oa ,•F CD N W o- o G.,< v L Z _j O N $Wm 0 O 7 a= S• a CD N 41 �Q o m v �• m o m 'n CD a QD m y n O �CD to N N O OD O G m y m rY � A r. m r) m m m ®® o r D' nr o pr -v m m m X r >' > ID m (D S C' ' m D v m m Q a m d d rr� 1 �w V 00,00 Y ` 9500 C"Yo 0 kF� T�'F FpG,FOFAq�F F \_ NT o Cb r'?p , _•v N 'V� 1 IN3 O V Cn n o co O Q ?¢3 (Doo NCrO r Qat Q O I CD � { . ' w o 3O C / co y m / 6� 0 00 Municipality of ~.nchorage 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELrING Parcel I.D. 015-312-32 1. GENERAL INFORMATION HAA~--O .L/O / 2._ _R Expiration Date: Complete legal description Hill -~IDE Location (site address or directions) ' Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address PARK PUD SUBDIVISION; LOT 29 7140 CROOKED TREE_DRIVE_~*_ANCHORAGE~ AK * 99516 JEFF &: ¥~NE-ML ZEMAN Day phone 346-4523 7140 CROOKED TREE DRIVE * ANCHORAGE~ AK * 99516 Day phone CAROL BUTLER W/ REMAX PROPERTIES Day phone 276-2761 2600 CORDOVA STREET * ANCHORAGE, AK, 99505 Unless othen4/ise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 e TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well D Individuai On-site [] Individ~J~l Water storage D Ifidividual Holding tank D Community Class "A" .Well [] Community On-site r-] Public Water System D Public Sewer [-"] The Municipality of Anchorage DevelOpment Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may . be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A Or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. AS certified by iffy s&~l a~fixeE hereto abe ~ o'~"~he v~lid~Oh ~l~& ~hown be/ow, I ven~y'~at my investigation, based on procedures outlined in the Heal'th Authorfty Approval Guidelines for this application, shows that the on'-si!e water supply and/or w~stewatei' disposal system is(are) safe, functional and adequate 'for the number of bedrooms and type of structure indicated herein. I further veery that based on the information obtained from the Municipality of Ancho'rage fi/es ahd from my inves!igat(on and inspection, 'the on-site water supply and/or wastewater disDosal system is(are) in compliance with all applicable Municipal and State codes, o~dinance~, and regulations in effect at the time of installation. Naffle of Fir:m GARNirss ENGINE~RIN~ ~ROUP, L~d. Address 3~01 E. TubOR ROAD, SuJ')'~' lOl * ANCH0JRA{~', AK 9§~07 Eng'ine~r's Printed Name JEFFREY A. GARN~'SS, P.E. Phohe 337-6179 'Date, Eh[jiheei-'s Cb~r~ehJS: In con'duc#n'g this e~/u~tidh; G~G, Ltd. attem~'~d ~b ~[,i~i~ 'a J/~rou~h, conscientious eiiginee#ng ahalysis of the syste[n in adco'~d~n~ ~th ADE~ ahd ~)~ DSD Guidelines & Regulations. The reported results described the peiformance Of the system under,he conditions encountered at the time of the test, and Separation distances meaSUred to rea"dily identifiable features. The operational life of all weIls and septic systems depend On the local soils condition, groundwatei' levels that may 'fluctuate during the year, and the water usage of the fa~nily b~ing served by the s~/st~m. These condition's are outside the contro! of the evaluator of the system. Satisfactory test results do not guaiantee future performance of the system, noi' do they guarantee that there are no hidden defects or encroachmentS. GEG, Ltd. can therefore not provide any warranty orfuture 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 f~r the sole benefit Of the owner listed above. Any reliance upon or use of this report by ahy other person or party is not authorized, nor will it confer any legal right whatsoever. D~D sIGNATURE · Conditi0ri~! ~pjSi~oval for b~fi;00ms. ~ 'bedi'66~, with il~e fl!..owihg s{~uiati6ns: Attachmen[s: HAA Checklist Septic System Advis0fy Well Flow AdvisOry ........ , .... ..... Manitehance Agree~n~ ~~ ~h~ Sup~l~htal Engineers Reo~ /~JJ))~ Other (Rev. 12/01) O~'iginal Cei. tifi~te De~te: Leg~al Description: WELL DATA ' We'll ~ype CLASS. 'A' Date coim~pleted Total depth ' te Of test Static water level .Well production WATER, SAMPLE ColifOrm ~ 'ff. Municipality 0fAnchorage Development Services Department i., i .. Building Safe~ Division on'Site Water & Wastewater Progra ~. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho~age.ak.us (907) 343-7904 HEALTH ',AUTHORITY APPROVAL CHECKEIST HILLSIDE PARK PUD SUBDIVISION; LOT 29 .-., P, arcel ID: [WELL · If A, B, 6r C provide PWSID# 212461 : - - Sanitary seal {Y/N) ; · .. Cased to FROM wELL' LOG ./L. Nitrate :J; mg.IL. Date of sampie: 2 Depression over tank (Y/N) NO ili Pul~per I~BELOW ~ EXISTING ORADEI rating .p.~r'ffTbdrm) 1.2 . Width '3.0 ; ff.' SE~TICIHOLDING TANK DATA ' ~[ Tar~k T~,p~/Material : STEEL/SEPTIC Ta k'size :;1250 gal. .; N~mbe~rofCompartments F0~ndaiion:cleanout (y/N) ' YES Da{e'ofpumping . 3/19/2004 ABSORPTION FIELD DATA Dat~ installed' 0/10/1~g1' S6il i. Well iLog (Y/N) !Wires 15~;op~il~t protected Casing'heig 015-312-32 in, Length ;-" 50 -.fl. ft. Total depth 12.75 ft. Eft. absorption area 500 'ft Momtor, ng tube YES. ~. Depression over field NO Daie'ofadequacvtest' 3/24/2004'I~ '.~; Results (Pass/Fail) PASS =.. :I,~, ~ ~ For 4 bedrooms Fiuidd~pthinabsorpt~onfieldbeforet~st 17 in. "'. Water added1273 gaj! i;= ~ 'Newdepth 35 in. ' ' '1,330 .... '" i de th 21'in ' ' ~ Absor tion rate· 600+ d Elapsed Time: m~n. : - F~n, al flu d p .. . p = -,,.,~ . _g.p.. An~,~ejYvenationtreatmeht(Past:12AO:)(y/N&typ~) . NONE KNowN !:i!'ifyes, givedate - S~stem type. DEEP TRENCH Gravel below pipe 5.0 Other bacteria colonies/lO0 mi. Collec?d 'by: Date in§taled . ' :10/10/1991 Cleanouts {Y/N) YES High ,~ater. alarm (Y/N) N/A 'LIFT STATION' Date ir~Stall(~'d' "pdFnj3 on;' 'l~gbl at in. in. · '"--z-'Sie in-"gallons"":"" ..... ' ' . " "Pump ~Cycl~s tes~'d . E. SEP~RA;ri0h ....... ' ........ DISTANCES ' ~ M a h h 01e/A c_~.~fl,~-~ :High W~i(Ji~ al~i-i~i ie~/~l' at 'l~l'eetS ~i~i-i~ & ~:i~'cdit r~quiremeh"[s? Septic tank/lift ~tatioh On i6t :' Ab's0rp~i~)'d'~eici oh i&t : P~b'iic seWef'm~iifl - - dbg4UUi~ifY ~JELL 0'~ a~Jj~c~nt lot§ Holding tank ' 'SEPARATION DISTANCES FROM SEPTIC/HOLDING TANKON LoT TO:' Buildin[j fotJnd~(i0h : 5'+ ' W~t~r 'mhin ~ 10'-{-;" Wells 6n a~Jj;J~6'~ '10[~ ,~d~)'+ ... .. r~I~PARA~ION I~j~'I':ANCI~'~:I~OM Aj~C~j~j~j,,j Pi~L'5'Oh L~"i' ~0: .'P~op'~r~'y lihe' '~'+~ : . .Abso~{i0'n ?ieid W~{~r s~[-vide li~ '1 o'+ 'Su~f~ o~'t'~.~ :~do'+ Buildih~j':~5[~hdaii0n .' lb~'+ SU'r~e ~i~r '100'+ W~'Ii§ 6h a~Jj'a~:i~h't iSt{ ~-~)~'+ _water rhain 10'+ ~ 1'+ "review of Muhicipbl Yeco~s that the aboCb gystems a-Ye in', 'cohfor~an~e with MOA H~ guidelines iff ~ffebt bh this dJte. Engin'eb~'s Printed Na~e JEFFR~ A. GARNESS [-7953.. '." ...... ....: - "~eCej~{ Nu~be~ 0 ~ 0 ~ '~bceJPt NumbEr' 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.# 015-31232 HAA# HA 1.' GENERAL INFORMATION Complete legal description Lot 29; Hil~Zd~'~-P~rk *Subdivision Location (site address or directions) Property ow, nor S¢~,...en Robbir~ Mailihg, address. :,"~/0. PHH Hom~q~y ~e~ing agency. ' .......... .... Mailing. ad~s :: Agefi~:~ : Do~'G&nn7 VISTA'REAL ESTATE Address 4241 "g" S~ t: Anehorag~,-.~..:AK 99503 7140 Crooked Tr¢~ Drive Anchorage, AK Day phone 346-1250 2221 Camd~n Court Oakbrook, Illinois Day phone Day phone' 273-726'7 60521 ,, ..... '.,..:..L::::: ......... '~Z ..... IndividUal Well-:~;-?x, .,,:,:,,.v,~:~.,;~.,,:,::,4 : ....... : ....:,, ............................. ,, J:,':'~L:{L~,,'i[;~..,.,. :.'.:'.: ...... Public waie'i;: E}~'-f!:~,,::'... :;:}.;.....:?: '~'': ~,'" --., .,,,,~.,,, .~-.,. ,~:,~?,~ ":,,,,. ' ---- NOTE: If community well *~*t*m, ~rovi~o ~ritton ~onfirmation ~rom Stato ~fiC atte, t;. ing to the legality and stat. us of~system. .... WASTEWATER DISPOSAL Individual on:site ,. ~ Communi~ on.site 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 Be 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 S & S ENGINEERING Phone (~ 17034 Eagle River Loop Read No, 204 AH~mSS .~ .~.,~;e River~ Alas~ca 99577 / Engineer's signature '~/~ '. ~'/ '~""'~'~ Date 6. DHHS SIGNATURE ...... ~/' ApProved__for ¢ Disapproved. .:., · ~..- .-,~--- Conditional approval for ...... i~ ~.. CE- 8801./~ ~ bedrooms. - ~: bedrooms, with .~h~o~lo~ng.~tipulations~ Additional Comments \.,'~ "/,-L, The Muni(~iPality of Anchorag® 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 DHH$ does this as a courtesy to purchasers of homes ;and their lending institutions in order to satisfy certain federal and state requirements. Em ployees of DHH$ 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. 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 Parcel I,D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 29; Hillside Park Subdivi,~ion Location (site address or directions) 7140 Crooked Tree Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Steven Robbins C/0 PHH Homequity 2221 Day phone 346-1250 Ca~Tden Court, Oakbrook, Illinois Day phone 60521 Agent Donna Gunn/ VISTA REAL ESTATE Address 4241 "B" Street Anchora,ge, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 "~ / TYPE OF WATER SUPPLY: NOTE: Day phone 273-7267 Individual well Community well XXX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-025 (Rev. 1/91) Front MOA#21 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S&$ENGINEERING Phone !,U;~4 Eagle I(iver Loop Road NO. Address Eagle River, Alaska 99577 / / Engineer's signature ~%4~:.~/ { '~% ? Date C ~ ~ / DHHS SIGNATURE y- ,,,~_ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT A. Well Data Well type ~O,~,~4~Ty Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 If~, B, or C, attach ADEC letter. ADEC water system number. f J/,,& Date completed /'Jl,% Driller /J/~J- Cased ,o ~/~ Casing height M///~ /~/~ Wires properly protected (Y/N) ~:~)//~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot c~' ~ Absorption field on lot .,'~00'''J' FROM WELL LOG AT INSPECTION ~ ~ J'-J//~ ,__ g.p.m, g.p.m. ~ o ~ ~ Public sewer main /~/~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: /, B. SEPTIC/HOLDING TANK DATA Date installed ~OJ( (,.3 I~ I Cleanouts g/N) High water alarm (Y/I~ Date of )umping Tank size [~o G~,~ Compartments Foundation cleanout ~/~N) .~* Depression (Y~ /~//~ Alarm tested (Y/I~ /'~,'/~ ~/~ ~%~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot ~,J/A- To property line I 0 ' ~L Surface water/drainage On adjacent lots C~© t~ Foundation Absorption field ~ ~ Water main/service line 72026 (3~J3)* Front CONTINUED ON BACK PAGE Size in gallons ~ Manhole/Access (~ Vent (Y/N)__ __"Pump~ ~ off" Level at ...~Well o~ lot ~ ~ On adjacent lots Surface ~ D. ABSORPTION FIELD DATA Date installed lo/to/~ [ Soil rating (GPD/Ft2) I~. System type Width ~ ' Gravel thickness z~ ' Total depth Zoo SI: Cleanout present (~N) ~/F---b '~ Depression over field (Y/~.~ Length ~r-~! Total absorption area Date of adequacy test ~/~/~/C, Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~) Results (pass/fail) ?P~.5 ~ for ~ Bedrooms /'?' After test ~4,'? ~w~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /L)/~ TO building foundation I(~ ~' On adjacent lots Sudace water Curtain drain On adjacent lots ~;).~6 '-/ Property line To existing or abandoned system on lot Cutbank ~',//~- Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect'on, Engineer's Name Date HAAFee$ ~O '~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 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. # (~""J~'~'-~\~ - '%~ 1. 6ENERAL INFORMATION Complete legal description Lot 29; Hillside Park Subdivision; Location (site address or directions) Property owner Mailing address John ¢olliand~r Day phone 248-3812 8920 Greenbelt Drive, Anchorage, Alaska 99502 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: 4 XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XX Public sewer 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 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 Address 17034 Eagle River Loop Road No. 204 Engineer's signature Phone Approved for ~r~,c/ / Disapproved. Conditional approval for Date bedrooms. bedrooms, with the following stipulations: Additional Comments By: _/~'~'" ~(~¢'~'-'~"'("~ Date ¢/~-~/ 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.  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ l L--L---"~[-~'-~'~-' ~ Parcel I.D. A. WELL DATA Well type ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Date completed Driller' Total depth Cased to .Casing height. Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot g.p.m. AT INSPECTION ;On adjacentlots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: N it rate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 1~][O1~ J Cleanout~N) '~/ High water alarm (Y/N) Date of pumping Tank size I'~ 4-t~-L..---Compartments ~ Foundation cleanout~N)/ Depression (~ ,/'% , Alarm tested (Y/N) I~ · -":~ l,,~ i~_,-- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots ?.~,,'~? ~-+-' Foundation Absorption field "~ I water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electric~ SEPARATION D.?.~ANCE FROM LiFT STATION TO: Well on lot On adjacent lots Manufacturer /  ess (Y/N) "Pump on" level ~t~~ "~ump off" level at Cycles tested Surface water O. ABSORPTION FIELD DATA Date installed ~ ~ I[ ~J ~' I Soil rating Length ~'/~ Width Total absorption area ~:~'~ ,~, .'~'-'~- Depression over field (Y~ Results (pass/fail) {~'-~'~ '~---~-~-'['--'~J'-~ for Peroxide treatment (past 12 months) (Y~--'~ Gravel thickness Cleanouts presen (~) Date of adequacy test Total depth If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~' · On adjacent lots ~<~ ~ Property line To building foundation [-~d I To existing or abandoned system on lot On adjacent lots ~__~<:~ i -I-' Cutbank ~ ~ h3 ~ Water main/service line Surface water ~,~ ~ -{-' Driveway, parking/vehicle storage area Curtain drain ~1.~'~ ~--~"-~./f'~ I!-'. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & $ ENGINEERING Signature 17034 Eagle River Loop Road Ne. 204 Eagle Rive~', Alaska yy3/l Engineer's Name Date HAA Fee $ _/7D' Date of Payment R ,ce,pt Number Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 WALTER J. HICKEL, GOVERNOR (907) 349-7755 February 11, 1992 FOR: S & S Engineering PWSID Cf 212461 My review of the records on file in this office reveals that the Hillside Park Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, Byron Roys Environmental Engineer BR/cf