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HIDEAWAY LT 5B
Hl"deaway Lot 56 #050-523-02 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201054 PID Number: 050-523-02 Dwelling: IN Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name David Jones ABSORPTION FIELD Deep El Trench ❑ Dee Trench ❑ Bed ❑ Mound Site Address 25343 Black Pine Circle ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hideaway 5B Fill added above original grade Ft. Gravel length Township Range Section Eagle River Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic I Absorption Lift Station Holding ( Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100+ n/a n/a I n/a ( E TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. I Surface water 100+ n/a n/a ( n/a Material Number of compartments Lot Line 10+ I n/a n/a n/a NA Plastic 2 Foundation 10+ I n/a n/a n/a LIFT STATION Manufacturer Capacity Remarks n/a n/a Gal. Alarm location n/a Electrical installed by n/a Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield JR'S SEPTIC Drainfield CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 ft Inspection 151 20200504 20200505 da:3m Location and description 2nd 41h Bottom of house siding. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date - �_X � of At kk� 'Dtc;veri ,.. Parn�r- s �� . CE 814.9 �� Septic System Approved ��� '1Z/L�` Date �2 �1 �D,2 _ Note: this approval does not include well permit requirements.`�G���®` bd 7� F9 F - F9 > 0 4' Lo 0 M 0 r- --, > K CA - TI > 0 bzx F-(-)< m r- 0 M c (-n C) 0 M 0 > 00 >M2 'u z x 2c) 0o c: > 0 m Z Ln r- m'- cn noc)u)-u o F —5 m < M Z;O m 0 0 X D I m W -C 97 C F rr NOTES: PANNONE ENG SVC, LLC (C.l. 1088) P.O. BOX 1807 PALMER, AK 9964520201104 PHONE (907) 745-8200 FAX (907) 745-8201 497H . ....... a ' . on e CE 8149 REVISIONS DATE RECORD DRAWING REV:20210204 HIDEAWAY 1-513 DAVID JONES 25343 BLACK PINE CIRCLE EAGLE RIVER, AK 99577 SCALE 1 50' P.I.D. NO 050-523-02 DRAWN JRL SITE PLAN 1 PERMIT NO. OSP201054 SHEET 2 OF 2 \ Lot 4 0 W \ \ 00 \ �s. !T, o \ Shnd 2a,o Platform for-i�"" 1 Zip Une 11 1 J 2.50 Zip Lin Dwell encroaches 1.2't Q shed Lot 5A 23.0 N3 Story Fra �' House ma O t2o N � ccr Manhole 1 et. wall (typ) 0 Septic vent (typ ° E00PAROUTTA SCALE: V= 50' YJ \ \ �. Ronktvatl Atb. OF ter. halt 1= LOT 5B / �� • • A� ;9 49th go ".4 r Cbl oO . Elizabeth L. Walatka .'1811: 00 8036 - LS , • e� Lot 6 Rq ssloNX1 REVISED 8-20-20 �. 2� •GO RECERTIFIED 5-14-2 �� AS -BUILT NO CORN RS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 5B, HIDEAWAY SUBDIVISION ° ."<() �'�� Anchorage Recording Precinct, Alaska, and that the � V�0 improvements situated thereon are within the property lines ladormtor and do not overlap or encroach on the property lying vne �p adjacent thereto, that no improvements on the property lying Z'p O ��, adjacent thereto encroach on the premises in question and East 80.00 ¢ that there are no roadways, transmission lines or other ��� visible easements on said property except as indicated hereon. om co Dated at Anchorage, Alaska this 18th day of MAY 2005, Black Pine Circle EASEMENTS OF RECORD, OTHER THAN FRED WALATKA &ASSOCIATES, L.L.C. FB 20-4, pg 32 THOSE SHOWN ON THE RECORDED FB 20-3, pg 7 & 8 PLAT ARE NOT SHOWN HEREON. BEEngineers and Surveyors FB 05-4, 907-248-1666 pg 38 UNLESS OTHERWISE NOTED This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liabilityextent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201054 Work Type: SepticTank Upgrade Tax Code Number: 05052302000 Site Legal Address: HIDEAWAY LT 5B G:0262 Site Mailing Address: 25343 BLACK PINE CIR, Eagle River Owner: JONES DAVID T & MELISSA C Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: ^ f� t�C: 17 i11'ti17C17t Lot Size in Sq Ft: Total Bedrooms: 4/8/2020 4/8/2021 59663 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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: Adriveway/parking area appears to be over part of the 2005 disposal fields. Please confirm prior to IR approval that the system is not under the parking area or that the fields meet the Exception requirement stated in AMC 15.65.210.5.A. Received By: Date: Issued By: A2 I �A� Date: /zo 4 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/VVELL PERMIT APPLICATION Parcel I.D. 050-523-02 Property owner(s) David & Melissa Jones Mailing address 25343 Black Pine Cir Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Hideaway 1_56 Day phone Legal description (Township, Range & Section) Lot Size 59,663 Sq. Ft. Number of Bedrooms 3(e) 4(p) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: 0�25_ Waiver Fees: Date of Payment: 413 /20 �i _ Date of Payment: Receipt Number: ©9.q6( C7 Receipt Number: Permit No. 05 P 26 10W Waiver No. Permit App_-'- :- ::..,'c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201054, Deb Wockenfuss, 04/08/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201054, Deb Wockenfuss, 04/08/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201054, Deb Wockenfuss, 04/08/20 \ Municipality of Anchorage • -� Development Services Department Building Safety Division �. i 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 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW050221 PID Number. 050-523-02 Name: GARY STOKES Wastewater System: ❑ New ■ Upgrade Address: 25343 BLACK PINE CIRCLE • EAGLE RIVER, AK. 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 696-1042 3 ❑Deep Trench ■Shallow Trench Dead DMound DOther LEGAL DESCRIPTION Sol Rat's Tota ppm Mem tw" gad,: 0.8 CPO/se. n. 3.0 MAX rt Block: Lot: Subdivision: — 58 HIDEAWAY Opth W pp Wte. Ram original gree.: Cows depth beo«N pp: SEE DWG. rL 0.5+ rT Township: — Range: Section: _ — I'm added allow, Bregma grave: Gawt Ivigtn: SEE DWG. n. 114 (3 ® 38) n. WELL'Grave ❑New ❑Upgrade .wm 5 ckewlKok,n Prwale, Aa.e): Tota 0" Come r.PCpeOal TOW gkterpt� area: Pp. aterlal: m n n 570+ saw n. D 3034/ F-810 pt. Ora«: stoke Mot« uva: n,tano: mt. kutalea: Ltd. Ft.GEG, 7/11-13/2005 n1d: Pump set At: COW" Neight Akare Geared: GPM ti n TANK SEPARATION DISTANCES "- ;DSeptld ❑Holding 0Other teach'^" gaaonr. G°P«,tr r, •:!r yJ'�.E-, To Septic Absorption Lift Holdi From Tank field Station Tankg So« � `'•; I.'. Well 100'+ 100'+ — _25'+ r Surface water 100'+ too'+ — — r ., — LIFT STATION Lot Line 5'+ sn. h Boson,: Maaul«twer. Foundation 5'+ 10'+ — _ _ P'n lew4 e1i =L oL ,Iph .at« Gann at Curtain Drain NONE KNOWN Pa'"p law a: I o«wea k,pe`tiw °.na'm'e by. Remarks: BENCH MARK THE EXISTING 1000 GALLON SEPTIC TANK WAS Ipeouen ohs peedphon: TOP OF PATIO DOOR THRESHOLD. VERIFIED TO BE OF GOOD INTEGRITY ON 7/13/2005. M,wrwe El.wal,.n: 107.99 R ENGINEER'! EAL A.4 Inspections performed by: GEG, Ltd. Dates: 1st 7/11/2005 ... ............. .I 2nd 7/12/2005 3rd 7/12/2005 Q .0 e re A. amess �0 Development Services Department Approval '. CE— 3 ;' :per Reviewed and approved by: Date: ' O� �Q oprafesstanaao (R,v. 13/01) oOOOO s IIMMrr SW0 NUMBER: AS -BUILT DRAWING 50 523u 02 SW050221 A I R DBL1 41.92 183.46 DBL2 43.10 84.47 FD 43.51 84.74 C01 136.63 152.84 MT1 136.88 153.22 CO2 121.10 124.31 MT2 120.95 123.87 CO3 156.03 166.93 MT3 155.53 166.57 C04 136.41 137.22 MT4 137.02 137.65 C05 172.39 177.29 MT5 171.66 176.95 C06 151.41 147.29 MT6 149.98 145.75 DBL3 119.45 1.81 DBL4 120.1834 135.16 FSI 120.42 Fl34.91 FS2 127.04 137.31 FS3 143.50 149.19 LOT 54, HIDEAWAY S/D, 3 KISTING WELL�` WELL 1 \ %w �oN I I I � I� J t / S&S � TMj1� NEW ORNNFIE 1 1 1 1 FROM T K 50R SOR DRNNFl 37 .5R TO DRNNFlElD TO DRNNFIELD -EXISTING 1000 GALLON TANK 'OUND TO BE OF 0000 INTEGRITY ON 7/13/2005. BLACK PINE CIRCLE �<<....QF . �gs;4p GARNESS ENGINEERING GROUP, Ltd. v� CONSULTANTS d GENERAL CONTRACTORS •... .. ... ....... ......... m, c was aoro, a.rt aw • acmwaL M wear . wa[ fwrlanr�w • ra darll>•.n.a .vin w.. µms., PREPARED FOR: PHONE NUMBER: PACE NUMBER: .... GARY STOKES (907) 696-1042 2 OF 3 Q p a LEGAL DESCRIPTION: DRAWN BY: Qa�pi CE HIDEAWAY SUBDIVISION: LOT 5B. R.A.L. -711�O���gd�� SE OF WORK: DATE. AS -BUILT FOR NEW SEPTIC SYTEM 7/14/2005 04��00� stand o •G : EXISTING DRA NnELDS . •V TO BE USED AS ALTER MTE SITE BLACK PINE CIRCLE �<<....QF . �gs;4p GARNESS ENGINEERING GROUP, Ltd. v� CONSULTANTS d GENERAL CONTRACTORS •... .. ... ....... ......... m, c was aoro, a.rt aw • acmwaL M wear . wa[ fwrlanr�w • ra darll>•.n.a .vin w.. µms., PREPARED FOR: PHONE NUMBER: PACE NUMBER: .... GARY STOKES (907) 696-1042 2 OF 3 Q p a LEGAL DESCRIPTION: DRAWN BY: Qa�pi CE HIDEAWAY SUBDIVISION: LOT 5B. R.A.L. -711�O���gd�� SE OF WORK: DATE. AS -BUILT FOR NEW SEPTIC SYTEM 7/14/2005 04��00� stand o PERMITNUMBER: AS -BUILT DRAWING PARCEL NUMBER: SW0 SW050221 050-523-02 *ASSUMED ORIGINAL ORGANICS APPROXIMATELY 3 FEET OF FILL PLACED OVER DRAINFIELD. -- FINAL GRADE 91.77 +/— INSULATION LTER FABRIC 0 � • 0 1.S FEET OF' ,:• -r \\y } :;',.M.OA APPROVED'..= `� H SAND FILTER 5—� TRENCH 11 -FINAL GRADE - 86.83 +/_ FABRIC -FINAL GRADE 86.83 +/— INSULATION —FILTER FABRIC .'.1.S FEET OFA•.;>�;::. F 1. ••„M.OA APPROVED,•::.` � •" SAND PLTER / o iS I. FEET OF...` •.` ": i'M.OA APPROVED, tD' TRENCH �2 ' ` 5µD FILTER ; 5 � �--10' TRENCH #3 GARNESS ENGINEERING GROUP, Ltd.p �� 4; CONSULTANTS& GENERAL CONTRACTORS �••••. •••• •.. ...... .......... =I L TDM 110+0. WR IDI • MOIMIGL m s 7 • N (90111] jn • I1v l�Ot}lM-]SN • �OInL w..ywr.pwFyyn PREPARED FOR: PHONE NUMBER: PACE NUMBER: ..... .......... GARY STOKES) (907 696-1042 3 OF 3 Q" a ey ness: LEGAL DESCRIPTION: DRAWN BY: Q ° . CE 795 HIDEAWAY SUBDIVISION; LOT 58, R.A.L. ee' •����D���q�G TYPE OF WORK: DATE: �� dpoFesslo0\ PROFILE AS—BUILT FOR NEW SEPTIC SYSTEM 7/14/2005 ELEVATION SHOTS TRENCH it TRENCH /2 TRENCH Q3 FINAL GRADE a 91.77 +/— 86.83 +/— 83.83 +/— ORIGINAL GRADE 89.91 083.00 82.00 TOP OF SAND a 88.41 81.50 80.50 PIPE INVERT > 88.94 83.00 81.00 BOTTOM OF TRENCH e 86.91 80.00 79.00 RELATIVE ELEVATION OF GROUNDWATER IN 83.41 76.50 75.50 TEST HOLE #2 RELATIVE ELEVATION OF BOTTOM OF TEST 75.91 69.00 68.00 HOLE #2 -FINAL GRADE - 86.83 +/_ FABRIC -FINAL GRADE 86.83 +/— INSULATION —FILTER FABRIC .'.1.S FEET OFA•.;>�;::. F 1. ••„M.OA APPROVED,•::.` � •" SAND PLTER / o iS I. FEET OF...` •.` ": i'M.OA APPROVED, tD' TRENCH �2 ' ` 5µD FILTER ; 5 � �--10' TRENCH #3 GARNESS ENGINEERING GROUP, Ltd.p �� 4; CONSULTANTS& GENERAL CONTRACTORS �••••. •••• •.. ...... .......... =I L TDM 110+0. WR IDI • MOIMIGL m s 7 • N (90111] jn • I1v l�Ot}lM-]SN • �OInL w..ywr.pwFyyn PREPARED FOR: PHONE NUMBER: PACE NUMBER: ..... .......... GARY STOKES) (907 696-1042 3 OF 3 Q" a ey ness: LEGAL DESCRIPTION: DRAWN BY: Q ° . CE 795 HIDEAWAY SUBDIVISION; LOT 58, R.A.L. ee' •����D���q�G TYPE OF WORK: DATE: �� dpoFesslo0\ PROFILE AS—BUILT FOR NEW SEPTIC SYSTEM 7/14/2005 Permit Number: SW050221 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 11, 2005 Expiration Date: Jul 11, 2006 Parcel ID: 050-523-02 Legal Description: HIDEAWAY LT 56 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 025343 BLACK PINE CIR Owner Name: GARY STOKES Lot Size: 59663 SO. Ff. Owner Address: 20365 FOUNTAIN ABBY COURT Total Bedrooms: 3 Permit Bedrooms: 3 MONUMENT. CO 80132 - This permit is for the construction of: private Well E] Water Storage Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy E] 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Received By: Date: I/''Z Issued By: • \ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. /�)ff 6 Sa 3 –QL2 Permit Number Property owner(s) GARY STOKES Day phone 696-1042 Mailing address (1) 20365 FOUNTAIN y COURT * MONUMENT, hiaiing address (2) cZ5_543 Lel Rf 1L �t10E l 9 rCX> Zip Code 80132 Legal description (Lot, Block & Sub'd.) L Legal description (Section, Township & Range) Lot Size S9 &&7 — Acr to Number of Bedrooms THIS APPLICATION IS FOR: ❑ Sewer Only ❑ Well Only 13 Sewer and Well ❑ Water Storage Sewer Upgrade THIS PROPERTY CONTAINS: ❑ Hot Tub 171 ❑ Swimming Pool 171 Water Softening Unit Water ❑ Therapy Pool I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. /I//\� —�j Permit Fees: HIC7I ! I '! o) Waiver Fees Date of Payment: rJ%- 11 Date of Payment: Receipt Number. 7&LIL Receipt Number., GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS July 8, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for hideaway Subdivision; Lot 513, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing to design the drainfields around S&S engineerings test hole #2. We are proposing to excavate the existing 1000 gallon septic tank and verify the integrity. if the tank is of poor integrity we are proposing to install a new 1000 gallon septic tank and a dual 5 -wide trench type drainfield. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There is a french drain outfall towards the west property line. We are proposing to install a drywell for the outfall so as to make the drain subsurface. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the drainfield is a 1-5 percent slope running approximately north to south. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any/puestions, please contact us at 337-6179. Thank you for your assistance. M.S. NOTE: IAttached is a site plan drawing, a design drawing, one soil log, which areal! part of the design packagefor this septic system. (Contact G.E.C. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com DROLL S/0; LOT 3. BLOCK 2. DENALY S/D; TRACT Cl. \ \ DROLL S/D; 'po\.9 \` \ LOT 4. BLOCK 2. Q FA 1 I I HIDEAWAY S/0; 1 LOT SA, \ S&S ENC. \ THIItj 1 I I I S&5 ENC. I I THIz B ACK PINE__Q LE_ -__--J NO CONCERN C1/ —EXISTING 3 BEDROOM HOUSE -PROPOSED SEPTIC SYSTEM (SEE DESIGN PACE 2 OF 2) DROLL S/D; LOT 6. BLOCK 2. NO CONCERN GARNESS ENGINEERING GROUP, Ltd.?' — CONSULTANTS 30ENERAL CONTRACTORS���' 1M1 [ NIL`Ce eYO. NAF 101 . 4M:IIOPIGE. Nf eeNl) F�Cwf 1])�11a • fwV e07)]NI—])N ■ �[BSOF' w.. eat PHONE NUMBER: PAGE NUMBER: PREPARED FOR: ' GARY STOKES 696-1042 1 OF 2 Q n DRAWN BY: O�p.O; LEGAL DESCRIPTION: C.J.G. Y4� HIDEAWAY SUBDIVISION; LOT 58, oAIE. V TWE Of WORK: 7/8�2005 SITE PLAN FOR SEPTIC SYSTEM UPGRADE (Rev.0tA51 NUMBER OF BEDROOMS:3 GALLONS PER DAY (GPD): 450 PERCOLATION RATE/S:6 MIN./INCH PROPOSED APPLICATION RATE: O.D MINIMUM DRAINFIELD SO -FT.: 563 DRAINFIELD DESIGN: MAXIMUM DEPTH:3 FEET WIDTH:5 FEET LENGTH:114 FEET (2 O 57 FEET LONG) M.O.A. APPROVED SAND FILTER: 1.5 FEET EFFECTIVE:0.5 FEET REDUCTION FACTOR: N/A ACTUAL SO.FT.: 570 1 TO OBTAIN A GUPT Ur enc w� CONTACT DEG. BY PROCEEDING FORW WITH THIS INSTALLATION. THE ENGINE WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THE HAVE READ THESE SPECIFICATIONS A AGREE TO ACCEPT THE TERMS AN \ LOT 5A\ \ HIDEAWAY S/D; \ \ PROPOSED DRYWELL FOR FRENCH DRAIN OUTFALL (DRAIN MUST BE MADE SUBSURFACE; THE SOUTH LOT LINE FLAGGED. THE 10' UTILITY EASEMENT AND THE 100 WELL RADII FLAGGED: BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. � I � \ I EXISTING 1000 GALLON SEPTIC 3 X'STINC TANK TO BE EXCAVATED AND BEORqp THE INTEGRITY VERIFIED. IF OF HOUSEI M •' r''1; /fL r • , POOR INTEGRITY REPLACE WITH •'�••e!:' �•.. Nqy 1000 GALLON SEPTIC TANK ,•. ! 4.,:t,. INSTALL DOUBLE INSTALL ' FOUNDATION CLEANOUT I I c OF TOP OF / �C .OPE SLOPE /S&S ENG. FLOW TH12 PROPOSED / 1 DRAINnELDS ' �S S&S ENG. TH12 STALL FLOW DNERTER mv7.., lw. / SPUTTER 14 BLACK PINE CIR (R., 0IM5) 0 GARNESS ENGINEERING GROUP, Ltd. p'?' 1.71 ........... CONSULTANTS b GENERAL CONTRACTORS �� .......... 0 1701 L moon sdu. 9u 101 • r CHOPML FK "W7 • no•[ (007wl7 In • Ful wnva-T=N • wmm' ....,...�.�o�••�r� PREPARED FOR: PHONE NUMBER: 696-1042 PAGE NUMBER: 2 OF 2 (C A. GO CSS, GARY STOKES DRAWN BY: 0 $ LEGAL DESCRIPTION: HIDEAWAY SUBDIVISION; LOT 58, C.J.G. D O e, �l'4i ' �o �4od prd(essl*l DATE: TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE 7/8/2005 (R., 0IM5) .r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L•• Street. Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: T,A n T Cote eN! lJ0.��DATE � "L(.(,t Township LEGAL DESCRIPTION , Rangc, Section: SLOPE SITE PLAN (FEET) 0 n 2 3 G•'O 4 , O 5 t d 6 O. 9 to - 6 0 b 12- 13- 141 213 14 Ol . 15 16 17 18 19 20 COMMENTS G P�G r') Sa n ca°y ;q r -a v e l W;fh S., It 8.0.H. WAS GROUND WATER ENCOUNTERED? 7 t� 5 IF YES, AT WHAT L DEPTH? 6• S P E Depth to Water Alter Monitoring? L.s� Date.. PERCOLATION RATE &tmmutavmChh))PERC HOLE DIAMETER ..� TEST RUN BETWEEN 3J FT AND _.L/ —FT PERFORMED BY: 3d.SENGMSGRING — 1 CERTIFY THAT THIS TE T WAS PERFORMED IN 7����aQ�°A�1�9tn4RRAIAf"L%st244S IN EFFECT ON THIS DATE. DATE. //07T, ACCORDANCE WIT ag a River, Alaska 99577 72-M (Rev. 4105) NOR?= l PERCOLATION RATE &tmmutavmChh))PERC HOLE DIAMETER ..� TEST RUN BETWEEN 3J FT AND _.L/ —FT PERFORMED BY: 3d.SENGMSGRING — 1 CERTIFY THAT THIS TE T WAS PERFORMED IN 7����aQ�°A�1�9tn4RRAIAf"L%st244S IN EFFECT ON THIS DATE. DATE. //07T, ACCORDANCE WIT ag a River, Alaska 99577 72-M (Rev. 4105) C PERFO' LEGAL 1 2 3 4 5 6 20 t U PERCOLATION PATE c {nunulevmcn)L.�PERC MOLE DIAMETER TEST RUN BETWEEN 3 FT AND �q FT COMMENTS SOW e•r PERFORMED BY: S % S ENGINEERING 1 CERTIFY THAT THIS TE T WAS PERFORMED IN 17034 Ea le RlYer loo Rad NStQ, G ho �ef 3` ACCOROANCE WIT�olik 6 . KL GUI C�I [SIN EFFECT ON THIS DATE. DATE. 72.008 (Rev. 41851 Y 1— Municipality of Anchorage Page 1 of a 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: SW X5011 q PID Number: _ OSCE Sa3°a Name: /} �oNN ANO 201 -1 -CE" Wastewater System: New El Upgrade - Address: -P. ABSORPTION FIELD_ 13ok -7 709 Phone: No. of Bedrooms: 0 Deep Trench .8 Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: 0-Z Total Depth from original grade: D•15' GPD/ScI. Ft. s Lot:Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe ,g -{4 i Df= -AWA I t Ft. I •S r Ft. Township: ' _ Range: „_ Section: Fill added above g'Inal grade: Gravel length: q f t% �r - s Ft. / Ft. WELL: ❑ Upgrade Gravel width: , S Number of lines: a Distance between lines: 1 lo' _New FL Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ASTKA -PP-N-A-f 0 % r Ft. 4D t Ft. S % SQ. Ft. 'F`3f '2-D SD -5q Driller: SUIT( l t/A-,j Date Drilled: !'175 Static Vi ter Level: LS Ft. Installer: Date installed: Yield: Pump Set at: Casing Height Above Gfound: TANK O, a GPM U//-- Ft. 12-J! Ft. SEPARATION DISTANCES aseptic ❑Holding ❑S.T.E.P. Manufacturer: Capacity in gallons: -JAJK- /000 To septic Absorption Litt Holding Public/Private From Tank Field Station Tank Sewer Lines /y N!_J-IovZAbt= Well, loo'4.I0014- I a5 + Material: Number of Compartments: SWat re Ivo LIFT STATION +uo Lot , i Size in gallons: Manufacturer: Line Iv+ ID _ s -Ir "Pump on" level at: "Pump ofPI-a . High water alarm at: Foundation -- Curtain Nd �0 /v Pump Make 8 Electrical Inspections performed by: Drain BENCH MARK Remarks: 0CaIIof, J OF T /•/d i 6 s- O N ch'/t'.lNn_4 UE i /4 iV Lr •(Ulo A�;�/JC yG/M flip Location and Description: �OP O� '�UJN'DA�CI oiJ (�ALt� M /i -cC /I!474 Tks'T /fret ca rrrvl Cd O1NT Assumed Elevation: �2z SNoce/�.. ILx�.o E N ...©.... F & S ENGINEERING - S Inspections performec��y34 o4 Dates: 15t-I �' �«>, ,•.... ...•r:•,.r.o -7 -7 •- 1'j -95 Eagle River, Alaska 99.577 2nd' --1 4 ROM C. COWAN ^: Departmentof Heal and Human Services approval Reviewed and approved by: Date: Permit No, SW950119 Page — 2 -of 2 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 Legal Description: LOT 513, HIDEAWAY S/D PID No.: 05052302 72-013 A (Rev. 9/91) MOA 25 1 ST2 FINAL GR FINAL GRAD DE '1'6605 7.6 C04 M 95 98.0' NEW cG 92.8' R 1000 GAL SEPTIC 94.0' o� C S' 9 TANK 90 7' 90.9' ♦ 86.7' WELL WATER FOUND 6-7-95 13.0.11. 78. ' B SR O / C A B 51 ' ST 34' 77' " T1 / ST2 41' 82' LL d C c2 co /// �� CO CO Q•4' 45 84 85 CO3 / CO 44' 79' FICc1 // C0 53' 93' O / CO 98' 129' �� MT 89' 115' N 1q MT 98' 129' �qd I aA1 II fT. MT1p C05 ¢ / V CO6,MT / SEAL ®FAe•Q ROBERT C. COWAN P DAMMAN `\ CIRCLE ��A<A�� c� -aao� LT. SIT �Qip`�� SCALE 1" = 40' `i'i`i__ 72-013 A (Rev. 9/91) MOA 25 l3rilling lag ,. by OOC Co. aca SULLIVAN WATER WELLS P•O.BOX 670272,CHUQIAK,ALASKA 99567 • TELEPHONE665.2759 OWNER OF LAND ca 9 .-j ADDRESS lob LEGAL DESCRIPTTON_110�:(,:5_� DATE • Started Ended PERMIT NUMBER KIND,OF FORMATION: From DEPTH OF WELL 11) STATIC LEVEL of WATER FT. A,�� .,�.. OAAW DOWN FT GALS. PER HR — ago o KIND OF CASING — 6.f_ o - Ft, to—Ft. From—Ft, to/P -Ft.,.,"� ' "044421' From Ft, to-- Ft. Ftom---L?Ft. tojj_Ft• ` From Ft, to_ Ft. ' >;t. 4_0_ 4.4)/ . From o_ Ft. to--Ft— Ft— _ From_�to-12—Ft.til From_I�Ft, to Ft•�0 Fromm—_Ft, to-�--.Ft From From_ ---Ft. to Ft.� �rE/�. From Ft. to, _ Ft. ---- - From. Ft, to Ft. ---- - Front Ft. to Ft. --- From_ Ft. to—ft. From.Ft. to -_.Ft, s From Ft. to Ft Frotn Ft. to---Fl,_� From_ Ft. co Ft. From—Ft. to -Ft. -- From• Ft. to Ft, From Ft. to --Ft. From Ft. to Ft.— From Ft. to ---- Ft. � --� From.—Ft. to Ft.— From Ft. to_ FL_ From Ft. to.^ Ft._— Front From Ft. to_ Ft, Ft. t�I From—Ft. to Ft. s� - Ftom. Ft. to Ft. From—Ft, to__ �AY_ t - ��9y From FL to Ft. From Ft. to_._Fr.-,�—s Dept. Health & H11man Services MISCL. INFORMATION: DRILLER'S NAME TL-bbbbbbbbbbbb6SLZ 689 S113M N311iM NVAxi"ir1S Wd 81760 NOW 96—GO-93A HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� 7ineeninq February 23, 1996 MUNICIPALITY OF ANCHORAGE Department o4 Hea.2th and Human Se v i.Ceh P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 5B; Hideaway Subdivision ROBERT C. COWAN, P. E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 RECEIVED FEB 2 6 1996 Municipality of Anchoraue Dept. Health & Human Services The septic .in3pecti.onz Uor the reberenced property were per{yormed on 7/14/95 and 7/15/95. Prior to submitting the Onsite wastewater Visposat System and/or vett Jupect on Report we are waiting 6or the construction and 6.inat grading to be completed. 16 we may b /gk Sha6m, P. E. service ptease contact us. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW950119 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:DAMMAN JOHN DAVID & OWNER ADDRESS:P.O. BOX 772422 EAGLE RIVER, ALASKA 99577-2422 PARCEL ID:05052302 LEGAL DESCRIPTION: HIDEAWAY LT 5B LOT SIZE: 59663 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 o (Y� DATE ISSUED: 6/16/95 EXPIRATION DATE: 6/16/96 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 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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: DATE: % ISSUED BY: DATE: - %S` s&S� 7zneeRznG June 9, 1995 ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Depa)ctmen.t oU Heatth and Human Senv.ices P.O. Box 196650 SEWER&WATER Anchorage, AK 99519 FAIN EXTENSIONS REFERENCE: Lot 58; Hideaway Subd,iv" ion SEWER&WATER Request you i64&ue a penmat to d& Pt a w -ft and in6tatt a 6eptic dybten INSPECTION ,to aeue the proposed th4ee bedlLoom house on the nege✓cenced property. Test homes were excavated and pe.ncotation tests pergonmed. The approximate tocati.ons o4 the -test hotel ane .located on .the attached ENGINEERING STUDIES /site ptan. AND REPORTS At the. time ob excavation, water was encountered at 6.5 beet .in test hate #1 and 6.5 Deet .in test Note #2 and a6.ten seven day ground wa.tec WELL INSPECTION monitoiLing water was bound at 6.5 Deet and 6.5 Ue.et ne/spectc.veey. & FLOW TEST This pnope.n-ty hay enough area bon a Uuture septic upgrade which can be seen on the attached site plan. SITE PIANS We do not anticipate any adverse, e66ect6 on ne ighbon.%ng we'Us, septic systems or diLa,inage patteA/s by .the. instattation oU ,the proposed septic system. ROAD DESIGN There are no points oU contamination within .the, proposed well radius which can be seen on the attached site plan. I{ you require, addit%onat inUormati.on, ptease contact us. SOIL TEST S.incerety, PERCOLATION TEST!U-( Robert C. Cowan, P.E. RCC/gk STRUCTURAL& Enceosare MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1 = 60' SCALE DESIGN !TE—PLAN —D P _c/) 1-77> 0 / ` N CA r, ro �� ► / "-D O 0 o cil > D m � = Dop�oz=� 3 ';►fya o Z d''N /S\7 �➢<U1 DOC -izm czn p / / / n / C m A rq C q ow / -I. L — Z m O y m r'd -r-t ...� to �7 >�'ROp N _ C-) K �SE0 / p m (A in 71 Fl )> \ GRAN£( DRIVE PROPpSED / -o � oM 7j v) m z �� \\ HOUSE // o o -1W mm� 0 vA J Z ZO S \ �- / -� A' o -UM CA p i-' z C� m -%Jai r� m M0 -,7C ODOZ D-0 �m-4 p2 \/ �>➢ �z O O Z Z -i r zo ocl) O A L 4, m \ 09 tiT 0A000 ;u o AZ C)�ZD��\� SFS m -+ m oco z- z n z z m r- XOA i..� 0 O 0 \ . OOm - . T'`i ➢ DO d �'IVu >took 0 20 �m C✓, 2 r a 2 CWZJ CII-�N �� Pco(A SOW U m -0 v)(n c: \tea o �u C=J r NOC) pR"Ip ' 0011 mpr� @00 r�'i00 II p II '- cn O O N 'Tl O M' D p � O —D P _c/) 1-77> 0 / ` N CA r, ro �� ► / "-D O 0 o cil > D m � = Dop�oz=� 3 ';►fya o Z d''N /S\7 �➢<U1 DOC -izm czn p / / / n / C m A rq C q ow / -I. L — Z m O y m r'd -r-t ...� to �7 >�'ROp N _ C-) K �SE0 / p m (A in 71 Fl )> \ GRAN£( DRIVE PROPpSED / -o � oM 7j v) m z �� \\ HOUSE // o o -1W mm� 0 vA J Z ZO S \ �- / -� A' o -UM CA p i-' z C� m -%Jai r� m M0 -,7C ODOZ D-0 �m-4 p2 \/ �>➢ �z O O Z Z -i r zo ocl) O A L 4, m \ 09 tiT 0A000 ;u o AZ C)�ZD��\� SFS m -+ m oco z- z n z z m r- XOA i..� 0 O 0 \ . OOm - . T'`i ➢ DO d �'IVu >took 0 20 �m C✓, 2 r a 2 1 = 40' DETAIL SCALE `b M 7 CsJ y fp r� r ai m 7 co cn O = U _ 7 F-Cn —i Ori CD CDC G e -_ r1 a m — co I Ui ht7- y ::Ev0n N O�to0 �p�z D C7 �ZD Fri z c n i Drof\�3�t .r''.r'`! `• 7 C U ISI o ai nm ��----{{ � — ,g nwAT y rri m LJ F-� -� N P lb NLf•l � / /\ m v D O I �1 } i; � Cm P, V <�c , K Fri O kj 10, e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: TO t) T C. O//e e m pck/22,7 GL/7 DATE PER ,/ �J �/ Townshi , Range, Section: LEGAL DESCRIPTION�GJ'r' SJR ry/q�� `/7 `mac((/ P 9 DEPTH SLOPE SITE PLAN (FEET) O 2 �G, 3 6' .a 4 O 5 6 0. 7 Q " 8 Depth to Water Net Drop r� sea e er,P 9 10 11 -2 7 ,, : / �Z 12 2- '/ o 13 �, 14 ' 15 / 16 3 -s% 17 81920 18- 19- 20 COMMENTS G P1�- ry? Sa•rndl grave WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? -/--ts Depth to Water Aller Monitoring? G,s Date: S L ° E i3k1J Reading Date Gross Time Net Time Depth to Water Net Drop r� sea e er,P -2 7 ,, : / �Z o 2- '/ o / 3 -s% y �•' a / 3y 3/ ar S: 2 A/ 3/ 3/ 2 3 y �/6 a 8 1/ x:30 3'Yo.3 PERCOLATION RATE e, (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .—a— FT AND --Y-- FT PERFORMED BY: S R c ENGWEeer —p�3•—a----_-'.p,�.p.�,�-„�y`6��� I CERTIFY THAT THIS TE T WAS PERFORMED IN I17AV S�,��E! 8%rAtl7�fCJ *f1t;l6ft e206s IN EFFECT ON THIS DATE. DATE: _ �' / �1 ACCORDANCE WIT A 72-008 (Rev. 4/85) Eagle River, Alaska 99577 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES £325 "L." Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ./ O4/7 9(" �0//P, ,49a Mm a P7 DATE LEGAL DESCRIPTION:L O// /'� q'"� /ie ^ct'WOI,, Township, Range, Section. DEPTH SLOPE (FEET) o R. rT-F—r--� F- 1 2 G� 3 U 4 5 Q •, 6 7 0 9- 10- 11 1011 O 12 G d 13 0 14 " G ry? soLhc�y I -ave/ [3.O,Y. 15 16 17- 18- 19- 20- COMMENTS 71s1920COMMENTS /0 W e. Y' WAS GROUND WATER ENCOUNTERED? J— S IF YES, AT WHAT / L DEPTH? 6a 0 P E Depth to Water After q Monitoring? 4111' Date. 2! S o '1 �j„ aw►b . �:� R09ERT C. COWAN SITE PLAN 0 Reading Date Gross Time Net Time Depth to Water Net Drop Pry-soa .3 2 G,z-9s y, a _3 3 3-rlX/ 10 3 y.'v 3 v % 3 Jia is S q; 3 PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 2 TEST RUN BETWEEN J FT AND --4j—Fl PERFORMED BY: S A S ENGINEERING I CERTIFY THAT THIS TE T WAS PERFORMED IN 17034 Eagle River Low Rood No.2 (, //o �q 5— ACCORDANCE WIT6phiS.TATE,k�grj LffiffL GUIDELI S IN EFFECT ON THIS DATE. DATE. 72-008 (Rev. 4/85) 88 1C�Ye1' na �Y C.•r'`i wof X � N owa uj CD "� —1 W W �wmz Op � i` if Vl Li1__� jl "�J—v� 1 wig ggelq c"u 1♦l lil (.- '.T U clfJ Q W Z �[daz� Ckf Of zal-Ow OmrrO �— V O 1L 3;: O \ \ J N J c0 a7 W —j\ �) O z Of w O 10o oz LJ O _ O �\ N \ O V O=Z Q0 V O 'H7 00 w it O) wpm www / 6i cn m OZ Q*LqO o} Ww ti zore� d w ww>-�M 0 O / \ \ �� Z� i v < =:) w J / /, SOao� J 3nl�o 3^bhp o 0 o m i cs w-V) a �� F-- F- F"� o o \ Nd a Vl -i W O / 4 O n v CJ z LLI V p� \ > V) U VO z OV 4 ~=O V Ep ��s• n < a / \ (10 / m O Jam/ Cl-O 5/ Q 4j / H c_ O LTJ�N Q / O n_ T Cf) Q --LLJ ti � S N C / Ln 03 o = o a Ln w*-qLj_ ~ z O of 0 J Q \ E=4 a- H \ F06 C7 C/)a perco ? cq I1u `r 00 M O z y w a 11011 `riw�OJ) WIZZ W 1, H Vi w/� m C) ON O 0 LJ aLLI oaa W �7 m-j �w�oov) axw Oln N -Lomoo:D �Mo M N d' �® 31VOS ® Nd�d-311 NSISIG ,09 = „L Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water and 4700 aw Street P.O. P.O. Box 196650 Anchorage, AK 99519.6650" www.muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050-523-02 1. GENERAL INFORMATION Complete legal description Lot 5B, Hideaway Subdivision COSA# 1000901 Expiration Date: Zl 14-10 Location (site address) 25343 Black Pine Circle Eagle River, AK 99577 Current Property owner(s) Timthy and Leona Scott Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 25343 Black Pine Circle Eagle River, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual Well❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Q Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSO also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -She 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-sfte 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 Flint Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Phone 522-7773 Engineer's Printed Name Michael E. Anderson, P.E. Date w'( A���O1•�A1'1i� �, � • M100,EL E ANDERSON • v 6. DSD SIGNATURE �#j�-/L3i0•. !/ Approved for bedrooms. It o; `o"ss1t)o 4• Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: o l Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsHe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 513, Fildeaway SubdMsim Parcel ID: 050-523-02 A. WELL DATA Well type !2!11.0 If A, B, or C provide PWSID # Well Log Y Date completedE1_995 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth _L01 fl. Cased to 4 Casing height (above ground) 12 n. FROM WELL LOG AT INSPECTION Date of test 6/1995 2/1/2010 Static water level Well production 45 fl. 40 9 -p.m - WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate L1a migL Arsenic: ND ugA Date of sample: 11252010 B. SEPTICIHOLDING TANK DATA Tank Type/Material SePtIcImml 63.7 fL 9 -P.M. Other bacteria i0 colonies/100 mL Collected by: S. Gilbert Date Installed 7114-15195 Tank size 1.000 get. Number of Compartments Two Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 4/08=10 Pumper Jrs PumpIng C. ABSORPTION FIELD DATA Date installed 7/1143/05 Soil rating (g.p.d.ff2orfl?/bdrm)1_rJPD/SF System type V Wde Tmnch Length 3®38' Each fl. Width S ft. Gravel below pipe .5 fl. Total depth 5 7 ft. Eft. absorption area _�7�fe Monitoring tube Y Depression over field N Date of adequacy test 2"m10 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth In absorption field before test 0 in. Water added _600, gal. New depth 6 in. Elapsed Time: Is min. Final fluid depth 0 in. Absorption rate >* Also g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) 'Pump on' level at _ in. 'Pump off' level at _ in. High water alarm level at Datum Cycles tested Meets alar ti circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on tot >100' On adjacent lots >100` Absorption field on lot Public sewer main NIA Sewer/septic service line >25' Animal containment areas None On adjacent lots >too' Public sewer manhole/cleanout NIA Holding tank NIA Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main NIA Water service line >1a Surface water >100• Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line >17 Building foundation >10• Water main NIA Water Service line >11r Surface water >100' Driveway, parking/vehicle storage >25 Curtain drain None Noted Wells on adiacent lots >100' F. COMMENTS: G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date a1012010 COSA Fee $ l iJ Date of Payment i �/� Receipt Number. -7 O l to N (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ICa1AEl L,,ANDERSCN :, r •.iFE="d381 ; ter„ •• Ir -r0•; Va IlO;ROFESStO=�e� Ii SGS RcLM 1100258001 Client Name Anderson Enginecring ProjectName/M Lot 5B I lidcaway Subd Client Sample ID Kitchen Sink Matrix Drinking Water PrintedDate/fime 02/08/2010 15:16 Collected DateMme 01/25/2010 18:00 Received Date/Time 01/26/2010 9:30 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date lnit Metals by ICP/MS Arsenic 5.00 U 5.00 ug/L EP200.8 C (<10) 01/26/10 01/27/10 NRB Waters Department Total Nitrate/Nitrite-N 1.18 0.100 mg/L SM20 4500NO3-F B (<10) 02/03/10 RIP Microbiology Laboratory Colony Count 0 coV100mL SN1209222B A (<200) 01/26/10 SDP Total Coliform 0 col/l00mL SN1209222B A (<I) 01/26/10 SDP Fecal Coliform 0 col/100mL SN1209222B A (<I) 01/26/10 SDP I parr 04/09/2010 12:49 9073449821 eti ■ ■� ■ ■ JRs Pumping ■ PO Dox 773415 EagIcRiver,AK 99577 (907)694-6454 81111no Information Anderson Engineering Po Box 240773 ATTN: Mike Anchorage, AK 99524.0773 (907) 522-7773 Job Site Information Mike 25343 Black Pine Circle Eagle River, AK 99577 (907)522-7773 JR5 SEPTIC Job Description: 10008 P.O. Number. Terms: Net 30 PAGE 01 Service Agreement Number: 030705 Order Date: 08 -Apr -2010 Service Date: 09 -Apr -2010 12:00 Technician: Mike Tax 9c: 0 Salesrep: Kariia Job Type: Repeat Map Book: Map Grid: 131• - cross Sbeets: Deneina Drive Job Comments: " SERVICE & BILL""""' iped & Cked Tank -2X's- Lis All Good Additional Location Comments Diagram: S'%Qa=rns1171T5 bmo Mile 6.5 Eagle River Rd off -McIntyre Rd, Entry to McIntyre Rd Is Denaina tum H off from ER Rd Half log & half pinewood wy8's on da home e Septic Q front - cut low 7a7 r0 Dw Service Type Qty Price Each Tax? Septic Serv1D00K 1 $200.00 No Gallons Planned: 1000 Gal. Actual: Hose Length: Double Tank: ❑ Pump System: D Baffles Inlet: ❑ Baffles Outlet: ❑ Extension Actual $200.00 NonTasablo Total Taxable Total Tax Total Grand Total Estimated Charges, $200.00 $0.00 $0.00 $200.00 Actual Charges: Customer agrees to the terms and conditions shown. THIS 15 A BINDING AGREEMENT. As, 09 Signs 172 arid11116 of Qmiitomer Representative Date , Ort- Accepts y JRs P. PIng For your added come nce we accept; American Express, Dlcover, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. 370.00 For NSF Checks Returned. !q� Municipality of Anchorage .. ' Development Services Department Dov 1}11wr Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 00-593-61)_ HAA# SQy)I el!a= 1. GENERAL INFORMATION Expiration Date: I I — 3 " 0,� Complete legal description HIDEAWAY SUBDIVISION: LOT 58. Location (site address or directions) 25343 BLACK PINE CIRCLE • EAGLE RIVER AK 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GARY STOKES Day phone 351-8194 20365 FOUNTAIN ABBY COURT ► MONUMENT. CO 80132 Day phone SHAWN RABBIT w/ PRUDENTIAL VISTA Day phone 16635 CENTERFIELD DRIVE • EAGLE RIVER. AK 99577 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 441-2500 TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and es of the validation date shown below, I verity that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines forthis 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 Anchorago riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(aro) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiablo features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE _j% Approved for -3 -bedrooms. Disapproved. 337-6179 Date -71(545 Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: L / �YJ „� Original Certificate Date: g )Rw. 12)01) WATER AND VIA PROGRAM Municipality of Anchorage • Development Services Department Building Safety Division On-Ske Water d Wastewater Program 4700 South Bragaw St. P.O. Box 190650 Anchorage, AK 9951966W www.ct.anchorageskus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HIDEAWAY SUBDIVISION; LOT 58. Parcel ID: 050-523-02 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/1995 Sanitary seal (Y/N) YES Total depth 101 ft. Cased to 40+ ft. FROM WELL LOG Date of test 6/1995 Static water level 45 ft. Well production Q g.p.m. �M WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.76 mgJL, Well Log (YIN) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/12/05 49 ft. 7 9.p -m. Other bacteria 0 colonies/100 mi. Arsenic: N A mgJL. Date of sample: 6/29/2005 Collected by: S&S ENGINEERS B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date Installed 7/14-15/1995 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YIN) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 7/6/2005 Pumper JR'S PUMPING SERVICES C. ABSORPTION FIELD DATA Date Installed 7/11/12/2005 Soil rating .p.d. ft%drm) 0_8 System type SHALLOW TRENCHES Length 3 O 38 ft. Width 5 A. Gravel below pipe 0.5 ft. Total depth'4.as-e.e3ft. Eff. absorption area 570+ ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test _ In. Water added _ a W epth _in. Elapsed Time: —min. Fina _ In. Absorption rate >= g.p.d. (past 12 mo.) (YM 8 type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size In gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent kits 100'+ On adjacent kits 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 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, parking/vehicle, storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA IAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date-7kllells; HAA Fee $ 1 Date of Payment Receipt Number (Rev. 12M) Waiver Fee $ Date of Payment Receipt Number JLJL-11-2005 0941 SG$- sGsketv 1053888001 ClleotName S 6a S 13nemeetins PreJcctNamUN 1.4t 58, Hideaway S/D Client sample m tat 5B, Mde amy SID Matrix Dtialdng Water FWSM 0 Sa=le Remadw. S&S ENGINEERING 907 694 1211 P.03/04 AD D3ta/Imro are Alaska Standard rime PrintodDate rime 07/07/2005 14:06 CollectedDatdflmc 06/29120051330 ReecivedDnhMme 06/30120051035 Technical DJmtor stenheo C Ede AMwabk Prep Analysis Prometa Remo PQL Uab Method coataioam tdmits Date Date trait Waters Department Nitmte.N 1.76 Micmabiology Laboratory Tota[ coliform 0 0.100 mat EPA 300.0 B (�10) 07/DJro5 JEM COW00ML SM209732B A (al) 000105 TLF Lot 2 Lot 3 Lot 5A ;�Vyv� had Wakdw M 22M� Lot \ \4S0 \ \ �S, rrA \ Sra m \yFds � %J swr ".a 17.0 r. Al �w LOT 6B T— N W N a a ti • 1 40 , 9 - tc�%46t' 1 yv' ro East 80.00 L Black Pine Circle EASEM¢HTs OF RECORD. OTHERTH" TMXESMOYMoNrMCRECORDEO "a".M30 RAT ARE KT SHOwR IEREOR. SCALE: V= 5V L.2 A&&MT MO CQAIZR9 WT TW MTE 40Aw.�b lIC1W M--M� i -M PeP+tl.'- •110 b PY •-�i Y w'+o.eA P� h MOVatl MY �[MI IMIa10. •�atro hV�w�ryn. m N i�O�V MV gwwMrwo.n0ioemon ��Yw �~ Mh-wrobWr. .Y....,Ytin.M Wi.AM^,.aW-.AtsW FRW " .F' TO 30Vd OSSd B t1XiV-t1M Q38d T8OZCPZL06 LOST SOOZ/8Z/LO 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. # 050-523-02 HAA # �A a (D 1. GENERAL INFORMATION Complete legal description Lot 5B; Hideaway Subdivision Location (site address or directions) NHN Damman Circle Eagle River, AK Property owner Colleen Damman Day phone Mailing address C/0 Prudential Vista Real Estate Eagle River, AK :Lending agency Day phone Mailing address Agent Eva Loken/ Prudential Vista Day phone Address 16638 Center£iP1d Drivp Fagle River, AK 29577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well xx _ Community well Public water — NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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. 71.-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 ALASKA W. Address Engineer's signatu Alaska Water Wastewater Consultants, Inc. Shall be PAID $ t 11— K or prior to, closing for the Engineering Services Provided, 6. DHHS SIGNATURE Approved for Disapproved. r1� 4E E bedrooms. Conditional approval for Additional Comments ;f - u, ITE 28 Phone 337-0 79 Date 4TI2 OF 4%% Gomm ; CD 983 ! , Vp bedrooms, with the following stipulations: Date 5-- '?, _�—" 67C1 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 orderto 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. 1191) Back MOA 021 RECEIVED Municipality of Anchorage �qY 24 1999 0* DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OFANCHORA 825 L Street, Room 502 • Anchorage, Alaska 99501 • "4� umR vic6s DIVISION Health Authority Approval Checklist Legal Description: OiOrAvJAe S/0 1-0T 5-a Parcel I.D.:_ b 6 A. WELL DATA Well type �R A r6 If A, B, or C, attach ADEC letter. ADEC water system number ^t Log present ON) Total depth Sanitary seal (ON) Date of test Static water level Well production S Date completed /c/s' I _ Cased to 101 Casing height (above ground) YE.S FROM WELL LOG i gas Lf O Wires properly protected ON) AT INSPECTION 5/8/9°1 4F'9 g.p,m. -7-5 g.p.m, WATER SAMPLE RESULTS: o IL F o Coliform Nitrate 1 • 39 .�, Other bacteria _ S6 VN Date of sample: 5 I q q9 Collected by: A• w . vJ - G j _ N B. SEPTIC/HOLDING TANK DATA o 6 F Date installed —%/1 S Tank size 1000 Number of Compartments 2— Cleanouts ON) N 3 Foundation cleanout aN) _ Depression (Ya No Date of Pumping S 1q q-1 _ Pumper ptimp1mc C. ABSORPTION FIELD DATA Date installed Iss Soil rating .p.d./) or ft2/bdrm) High water alarm (Y49- Q0 4 o M d � n wU O • System type Length oio z®'as Width S Gravel thickness below pipe S I Total denth -3.9 5 Effective absorption area X77 Monitoring Tube present 0N)% Depression over field (YQ No Date of adequacy test _ -511 S9I Results Pass ail) _ Pass For, bedrooms 0 Fluid depth in absorption field before test (in.); y s Immediately after S98 gal. water added (in.): .20.5 I�F Fluid depth q (ins) Minutes later: J100 Absorption rate = _ � �� 4- _g.p.d. a A 03'i Peroxide treatment (past 12 months) (YQ _ h�or,a kN000 If yes, give date , /'c a 0 72-026 (Rev. 3/96)' °cam D. LIFT STATION Date installed Manhol High water alarm level at" - "Pump on" E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 10Oi--� Absorption field on lot 100 1 -1' Public sewer main tJ / (-\ Size in gallons "Pump off" level at' _ — On adjacent lots 1,00 I } On adjacent lots 100 1 t Public sewer manhole/cleanout Q�✓k_ Sewer /septic service line ZS t4 Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I I Foundation _G + Property line 5 �' Absorption field 5 Water main/service line 101+ Surface water/drainage 1 001 + Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I olt- Building foundation 10 1 Water main/service line _ Surface water I ODI -f Driveway, parking/vehicle storage area Curtain drain 0o or. ko owo F. ENGINEER'S CERTIFICATION l certify that l in conforman Signature Engineer's Name Date Date Wells on adjacent lots L I oot+ inspections and review of Municipal ?s in effect on this date. rAJ 1001+ HAA Fee $ (30 0 Waiver Fee $ Date of Payment Date of Payment Receipt Number �/ � –Z( C T��� Receipt Number 72-026 (Rev. 3/96)" are MAY -20-99 14:54 FROW-CTE ENVIRONMENTAL 8616301 CUE Environmental Services Inc, Laboratory Division CT&E Ref. V: 99.2190-1 Client NAme AK Water & Wastewater Cons. Project Name: nla Client Sample ID: Hideaway SID L58 Matrix: Drinking Water PVVSID Memarks: 200 W. Potter Dave AnCllorage, AK 99518 Tel: (907) 552.2343 Fax- (907) 5131-5301 T-982 P.01/02 F-002 Client PON: Na Printed Dateffime. 5120199 15.00 Collected Daterrime: 5119199 08:30 Received Datol—I ime: 5119/99 12-45 Technical Director: Stepnan Ede Released By Allowable Prop Analysis Faramat®r Results PQI_ units Metnoo Limits Date Date In,t Total Coliform (MF) 0 will 00 ml SM9222S 5119/99 KAP Nitrate 1 34 0.5 mgrL EPA 300 10.0 5/19199 SCI_ 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. # s0 ra 3 -.0 A- HAA #X121 (,p 0k�� s9 _1, ..-GENERAL INFORMATION . (:V --- Complete legal description Lot 5B; Hide.away:.Subdivision Location (site-addreSs;or directions) NW Damman Circle Eagle River, AK W - ti Property owner w Jol n' . . Colleen Damman Day phone Mailing address P.O.`Box 772422 Eagle River, AK 99577 Lendin "�• enc 9. a .9 Y`-- Day phone — Mailing address_— e Agent Day phone Address Unless otherwise requested, MAA will be held for pickup. - 2.''"' `NUMBER OF BEDROOMS. rs rig 3. TYPE OF WATER SUPPLY _ . _. _. _ _.._.. _ _ _ ..... Individual well - - Kix Community well Public water. NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: I Individual on-site _Xx:,: _ 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) From MOA 021 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 S & S ENGINEERING'~Phone Gq Y — 7 0/,; 17034 Eagle River Loop Road No. 204 Address295 Engineer's signature Date c\ 1t� By. �1 Date S = 29 - y6 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 orderto 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-M (Ftev- 1/91) Back MOA x21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 995019 (907) 343-4744 Health Authority Approval Checklist Legal Description: t t o Parcel LD.: aS- 0 " J`) 3 - 0 -2 A. WELL DATA Well type r t%t I<r-�_ If A, B. or C, attach ADEC letter. ADEC water system number A4 Log present &I) _+ Date completed (0 —9 ar Total � Dl depth t � p _Cased to _ `�� t k Casing height (about ground) _ J � Vt Sanitary seaiONN) Date of test FROM WELL LOG -- -lo -9 �;- Static water level Well production WATER SAMPLE RESULTS: Coliform 0 LID. b Wires property protected 6N) AT INSPECTION g.p.m. M. Nitrate D, 44r 1 Other bacteria—. a Date of sample: ��-1'� - i ( Collected bv: - S -1k S-EIdGt%I1.°@Rli�tt9 - B. SEPTIC/IIOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99'577 Date installed -7 L SsISS Tank size 100 O Number of Compartments _ 2 -_ Cleanouts QI) Foundation cleanout OIV). _ _ Depression (Y& I High water alarm (Y/N) Date of PumpingwiPumper C. ABSORPTION FIELD DATA Date installed Length R 0 r Width Soil rating (g.p.d./ft2 or ft`/bdrm) 6,9 System type %,(, L -)X""✓ Gravel thickness below pipe `a Total depth 5'--.7 Effective absorption area �/ /7 2 Monitoring Tube present4�RN) Depression over field (YQ .� Date of adequacy test _ /`/71-�/✓LcJResults (Pass/Fail) _ For ____bedrooms Fluid depth in absorption field before test 010. Inuuediately after_ gal. water added (in.): Fluid depth _(ills.) Minutes later: Absorption rate= i .p•d, Peroxide treatment (past 12 months) (Y/ b _ If yes, give date _ n/ X :fly m oz an Z D m C 7 Ste, o � u, G rr D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot J L) : On adjacent lots mo Absorption field on lot 16c> On adjacent lots Public sewer main y Public sewer manhole/cleanout Sewer /septic service line `ZSJ Lift station h SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I t Property line I b t h Absorption field 5-1 Water main/service line Lot Surface water/drainage t b o t k Wells on adjacent lots l D6 t 4 - SEPARATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation I Water main/service line lot Surface water I oo Driveway, parking/vehicle storage area /D I - Curtain drainL on . " &Jot„I t✓ Wells on adjacent lots 106' � Property line /0 � F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review af'klunicipal in conformance ivith MOA IIAA guidelines in effect on this date. Signature :�/Z 4 �V� Engineer's Name /�6,8 4,t -r C - Cdt✓�fr/ Date S— /01/ l q HAA Fee $ �' Waiver Fee $ Date of Payment `x Date of Payment Receipt Number V� S� Receipt Number Rev. 8/95 OSS: haa.wk.doc { til .e �•.. �..�} yfE: .. ,.e.: "g..e ;n ROBERT C. COWAN if CE. 8801 are 05/17/90 17:17 ME ESI ANCHORAGE 4 9076941211 NU -511U L,uc� 144'- ME Environmental Services Inc. Laboratory Division Laboratory Analysis Report C &E Ref,# 961761.961761001 Clle fl.,Sample ID L5 5B Hideaway SIDI01 Nlfa -N Drilllciug Water Vjws T) 0 Pu. Fameter »i"troYe-N NitrSte•}I Tl Coliform Collected Date 05/14/96 Technical Director; Stephen C. Ede Released By q,;„ � Results 9C POL unite Method Allowable Prep Anotysin Init ouol Limlta Date Date _ _ __ 0.467 0.100 mg/L _ EPA 353.2 05/15/96 __ E115 0.100 u 0,100 mB/L EPA 353.2 05/16/96 EMB 0 0 col/100mL 51118 92220 (OW) 05/15/96 TAV U Undoteeted LT Less than BY Greater than D - Secondary Dilution J - Below the calibration range 200 W. Potter Drive, Anchorage, AK 99518.1606 — Tel: (907) 562-2343 Fax: (907) 501 5301 3180 Peger Road, Fairbanks, AK 99709.5471 •-- Tel (907) 474.8656 Fox (907) 474-9685 It NIVIRQNM(7NTAL VACILITIE:$ IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. IAN D, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA