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SPRING HILLS ESTATES BLK 2 LT 9
Spring Hill Estates Lot 9 Block 2 #015-051-62 Municipality of Anchorage Page of --3 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: 5W910322 PID Number: 01505162 Name DAVID A. MOCHIZUKI Wastewater System: ❑ New Upgrade Y � P9 Address: 9520 SPRING HILLS DRIVE ABSORPTION FIELD Phone: No. of Bedrooms: 4 ❑Deep Trench W Shallow Trench ❑Bed ❑Mound O Olher LEGAL DESCRIPTION Soil Rating: 1 2 Total Depth from original grade: GPD/Sq Ft. .0 Lot: 9 Block: 2 Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe SPRINGHILLS EST 9_1 Ft. Ff Township:1^N Range: 3W Section: 15 Fill added above original grade: Gravel length: 70 Ft. Ft WELL: IVA ❑ New ❑ Upgrade GraveLdepc tvio� Number Of Distance eh eenbnes: / Ft Ft. Classification (Private. A.B.C): Total Depth: Cased To: Total absorption are ' Pipe material: PP.IVATE 182 Ft. 181.2 Ft. Soo so Ft. PVC Driller. I1 -W DRILLING 0 to rued, �- b-84 S1au er Level: rl5 Installer. olbl ACREAGE SYSTEMS Date installed: 10-15-91' F, Yield: 10 Pump Set at: 180 Casing Height Above Ground: 2.5 TANK GPM Ff. Ft. SEPARATION DISTANCES XX Septic ❑Holding ❑S.T.E.P. To Septic Absorption uh Holding b1WPdva1a Manufacturer: Capacity In gallons: From Tank Field station Tank Sews, Lines ANCHORAGE TAN 1250 Well 118' 100'+ 100'+ N/A N/A Material. STEEL Number of Compartments: 2 SurfacWater Water NA NA NA NA NA LIFT STATION Lot Line 14' 11' 13' N/A N/A Size In gallons: Manufacturer: Foundation 21' 70' 29' N/A N/A "Pump on" level at: 24 in "Pump off' level at: 2 i n High water alarm at: 30 in Curtain Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK FOUND TO BE OK. 12" OF GRAVEL Location and Description: FINISHED FLOOR OF NAS INSTALLED AROUND THE LIFT THE SUN ROOM. STATION. Assumed Elevation: 100.00 Ft 1 OFALt Inspections performed by: SHAWN SNISARENKO Dates: 1st 30-15-91 11 ...' 2nd 10-16-91 0 0.1 E Department of HgblthkOM1d Human Services approval Reviewed and approved by Date: 9i �"`=0�' 73-013 (1/91) MOA 25 Permit No. SW910322 Page Y of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage, Alaska 99516-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Descrip.: LOT 9 BLK 2 SPRING HILLS EST. SUB. PID No.:01505162 A 6 C D E F G H I O • TH3 F TH2 • E THI • I- 0 A Pi 0 qn PTI 1 24' 130.7-140.7-166.3-1 54' 1 80' 104' 1 100' 138' PT2 129.3-128.30126.9'146.4-1 50' 1 67' 1 90' 1 78' 1 64' I' . 20' -0 - MONITOR 5' TH • I 70.00' TH4 • NEW SHALLOW TRENCH SYSTEM tea•_ ID� 147 EXISTING SYSTEM 0I I I . VSEPTIC TANK I_� L A SINGLE FAMILY EA Permit No. SW910322 Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage. Alaska 99516-6650 Telephone: 343-4744 n -Site Wastewater Disposal System and/or Well Inspection Report Lego escr p.: LOT 9 BLK 2 SPRING HILLS EST. SUB. PID No.:01505162 o� F ^' W o m � 4, C H m i ao°i+ Ozao LL u � � n 00 O0. ' f- Z W OJ anMW rW z Z in ti ai F- • m F Z .. N >Z W LL J F- W Ilia 00 a,o •��� 4z Ar Nj 49�� LL W Join f. W LL w u � ci No. 1051-E 'rl V N • F Q I� v!/ • I I I I I 1 * : A ! [ r. � • r a n H 3 b. � � .'• ► r >/ � r w A Q M O I� v!/ • I I I I I 1 n n r • s n O pa s a » » r s w -i ,•�•. .. i I I I I I I� I I I I` i Z O ' d S W 31S`J.S 41 a00a000a N wopt" M mn� X �-, Z013 �T off; a i T � � v • � � T 1 00000000 3 D H 3 L 7 H Z Z C£ T 3 f1 1 T6 -ST -^O"' � I '' 0' ..• V • or i R trt D .qi n n r • s n O pa s a » » r s w -i ,•�•. .. i I I I I I I� I I I I` i Z O ' d S W 31S`J.S 41 a00a000a N wopt" M mn� X �-, Z013 �T off; a i T � � v • � � T 1 00000000 3 D H 3 L 7 H Z Z C£ T 3 f1 1 T6 -ST -^O"' � I 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 (UPGRADE) PERMIT PERMIT NUMBER:SW910322 DESIGN ENGINEER:TRYCK, NYMAN & HAYES OWNER NAME:MOCHIZUKI DAVID A & OWNER ADDRESS:9520 SPRING HILL DR ANCHORAGE, AK 99516 PARCEL ID:01505162 LEGAL DESCRIPTION: SPRING HILLS ESTATES BK 2 LT 9 T12N, R3W, SEC 15, SM LOT SIZE: 49743 (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: DATE ISSUED:10/07/91 EXPIRATION DATE:10/07/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: NOTE: MAXIMUM HOLE SIZE IS 1/4" FOR DISTRIBUTION LINE. MAXIMUM TRE DEPTH RECEIVED BY. �'°'"- DATE: 10105191 ISSUED BY DATE: 44 zzz- i 7Fif 1:XI7TiN6" SCPT1C:7-AIU iIAC I''26bGAt- • -.. lvyLi :gc vscp IF 1T ..Is Foovn To CovO#-rtwN l\rT'crz IN•sPt=c-rfup. I' �3. 1 lily' PVC PLRWhim ,• * e 1 .-til ........ �` IES CNN. DATE F.B. $ OF JOB NO. i - - - - - ----- — - - — —- I DES1Glu FLOW: ' y .BEnV-00m .� ISo9 /ci. 600y0.1 lc(•:3 . �n 51GU INFIL"fIDA TI0ttl RAT2 ; PfRLOLATIO u PATe =- y.'Vl m:, l INcn , :osr 1.2 5 pa( i (>0 SVoPi use �� WIOTH of TRCNCN :f= fvf2 I 11 0l: -Fro Of Gclk; L. t✓t f 1Ptl _got( _ S({12 I6NGTH OF SrAUOACO TRtsic14. S -4 t 47C1 Sao ff 2._ . .51- L.. I� F F.: LtaiLrrf or STA.'Me O Tr-CuOH. _ �j.7 ✓_ 7G(of f) = 70ft USC ^ 70ff 400G 4 f f Wlvr *e6wcH ZO rr7,4 �-- 2F4 of GQJavctr BC'LQ.J, /°l Pt•. t -. i 7Fif 1:XI7TiN6" SCPT1C:7-AIU iIAC I''26bGAt- • -.. lvyLi :gc vscp IF 1T ..Is Foovn To CovO#-rtwN l\rT'crz IN•sPt=c-rfup. I' �3. 1 lily' PVC PLRWhim ,• * e 1 .-til ........ ,Q3 la/7/9l CAPACITY Ak7 •;•y 0 1051• _• , � j ilia on y�4HTiv5 �` IES CNN. DATE F.B. $ OF JOB NO. SCALECALE ,Q3 la/7/9l CAPACITY Ak7 •;•y 0 1051• _• , � j ilia on y�4HTiv5 Permit No. Page—of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage, Alaska 99516-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 9 BLK 2 SPRING HILL EST. SUB. PID No.: 3 .2 7 7 N 00.02'13- W 99.34' �• 57.51' 10' TELE. COMM. a ELEC. ESMT. . 7u6 TH3 • TH4• 1- ' 50•-0- TH2 • FT n-1—EXISTING BED to E; I IIS THI II II SEPTIC TANK w n ' o in n % m n z o C SINGLE �O n FAMILY 3 o � C O n 'C /WELL m p" WELL ����•OF •y�'ry LOCATION P�� t�.. • 4 t �•�� 5 00.01'00- E - 156.85' , 328.5 332.9 �C�J No. lost-[ 4W �� SPRING HILL DRIVE ••+ts �� • Permit No. Page _of - Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage. Alaska 99516-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Descrip.: LOT 9 BLK 2 SPRING HILLS EST. SUB. PID No.: A R C n c r n .. 0� TH3 TH2 • E THI' 0 r: 3 46 FTI 24' 30.7. 40.7 66.3' 54' 1 80' 104' 102' IVA' PT2 29.3' 28.3' 26.9' 46.4' SO' 1 67' 1 90' 1 81' 1 $01 H T* 3, - • 20.•0. 40' I 30' i TN Ai naNtToR NEW SHALLOW TRENCH SYSTEM 24_ 17D Di I I I I I I4z I I I I I I EXISTING SYSTEM I CI I I J j SEPTIC TANK C.O. C.O. B A TJ SINGLE FAMILY 4 BEDROOM UPGRADE s PAESURE DISTRIBUTION SYSTEM ACREAGE TANK LIFT STATION SPRING HILLS ESTATE LOT 9 BLOCK 2 1 NWI/4 S15 T12N R3W SM AK 9520 SPRING HILLS OWNER DAVID MOCHIZUKI FT COVER SLOPE 3 TO I 2 1 PRESSURE DISTRIBUTION MONITOR ; MONITOR t- COVER COVER FABRIC1 y� --_--- FABRIC ---------------- COVER PIPE _� o t 2" ROCK 2.0' ROCK PfPE 2' ROCK I J t SYSTEM SHALL; HAVE 3' COVER OR INSULATION OVER FIELD. ACREAGE TANK s END VIEW SIDE VIEW FIELD j okwlP� "/wZ, S712 ONE LINE OF 1 1/4" PIPE WITH HOLE SIZE 5/16" SPACED AT 48" PVC SCHEDUAL 40 I 70 , MONITOR _ -0 2.3' ? W 2.5' p E MONITOR k TUBE 1 1 4" SOLID PVC SCH 40 PIPE 1 SYSTEM DOUSES 4 TIMES PER 24 HR. TRYCK NYMAN HAYCS, INC. ENGINEERSSURVEYORSM1ANDSCAPE ARCHITECTS TRANSPORTATION @,4 COMMUNITY PUNNING September 18, 1991 Mr. Dan Roth Municipality of Anchorage 8th and I. Street AK 99501 Dear Mr. Roth 5064.0 RE: Lot 9, Block 2, Spring Hills Estates Subdivision Attached is a permit application for upgrading septic system on the above referenced lot. A narrative description of probable impacts to adjacent property is discussed below: Wells - We anticipate no impact to the wells on the lot or on adjacent lots. All wells adjacent to the new septic system are located greater than 100 feet from the new system. No groundwater was encountered and the wells all have sanitary seals in place. Wastewater Systems - The proposed deep trench system will replace the existing system. Testing of the existing system indicated it no longer accepted the amount of water it was designed r to. The new septic system will eliminate potential impacts to adjacent properties by replacing a failing undersized field with a new adequately sized field. Reserve Space - Although no formal evaluation of reserve was completed, the lot is a relatively large one and can accept future fields. Drainage - The on-site well casing and septic tank had or will have positive drainage away from the improvement. The absorption field will be constructed along a contour interval and the cross - slope drainage slopes range from 0 -0.5%. No natural or man-made ditches, swales or standing water was found on the lot. No drainage impacts to adjacent properties are expected. Please review the attached information and issue an approval to construct the new system. Yours Very Truly TR K YMAN HAYES,INC. J i i n, E. ncipal 911 West Eighth Avenue • Anchorage, Alaska 99501.3497 • (907) 279.05431FAX (907) 276-7679 SOILS LOG — PERCOLATION TEST PERFORMED FOR: or,,V'C` MOO, : 7-o k ,' T•" '�, INS DATE PE ca LEGAL DESCRIPTION: L of I , AlK 2 SnQruGlllcu Township. Range. Secton: Al DEPTH SLOPE IFEETI C46ANICS I—I = r--T- 2- 3- 4- 7- 9- 12- 13- 14- Is- Is- 17- 18- '91 --T- 2 3 4 79121314t518171819 20 COMMENTS 1'I0LC: W!1 S WAS GROUND WATER No 1N000NTEREDr IF YES. AT WHAT DEPTH? 'wakeS . _ ,'" 1 mv""°N /.a dale //y S /5 "NlNvoi�771 w .0. Raa�M an Grou Time Nat Dep* to Tuna Water Net Omo I /Ki1 %t)n.:• I UMa 'f o/J iq r> E> I lµpn i { d.. 700..♦ % �/NN PERCOLATION RATE ' y y Imu.utaa.utcrll PERC MOLE DIAMETER � TEST RUN 6"EEN� FT ANO '-/ FT PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIOEUNI 4406— CERTIFY THAT THIS TEST WAS PERFORMED IN ON TH DATE DATE r, ACREAGE 'TO.W LIFT STATION 12" gravel or crushed stone backf H.D.P.E. LIFT STATION D.H.H.S. PERMIT # MS --91-0203 'I - Sump Lid Finish Grade c Power Cable 4" i 'd styrofoam–y i o High Water Level A ar.T_box / 1 1/4" Cable to Hous 0 DischargX c � u z = m 0 F — 4" Inlet . 0 150 gal.+' .rl Reserve Capacity E w r o+ W High Water Alarm — E Pump on/off e ZD c c •rt F„ - N o ri N iJ V t CN � N N to � 0 7 CV a m N 12" gravel or crushed stone backf H.D.P.E. LIFT STATION D.H.H.S. PERMIT # MS --91-0203 'I - i i"'d'GK % SOILSLOG — PERCOLATION TEST PERFORMED FOR:_GAV'A ^OLI7tLUV' (TV -11 DATE PER LEGAL COMMENTS SAp6 /6 ¢Av£ L• I S -rnn Q So -t AK SILTY JAVV PEQCCL/ -rl." TC;.`r WAS GROUND WATER NO ENCOUNTERED? S IF YES. AT WHAT L DEPTH? 0 P E "w? r &Wnomm"/A p Rwtling Onto Grow Time Not Time Depth to Water Net Drop F, r^ nss/zi/CJI or..:n vM•-, acv a/a IVIA I/r VIA 30m:n PERCOLATION RATE IS' S Immutfs mcnl FERC HOLE DIAMETER ^ TEST RUN BETWEEN FT AND .7 S VAK@tl Fol -n?. HDbC$ CP6r- PC TN T7 UN LY NO Hwt/ITu.! IAr PERFORMED BY; CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN S I EFFECT ON1 HIS DATE. DATE l TRYCK NYMAN HAYES,w�. SOILS LOG — PERCOLATION TEST PERFORMED FOR: _QAVr6( MDG W LUK• TO DATE►ERF( LEGAL DESCRIPTION:_ 6Lk 2 50/;nvr. 11.117 C3 i • Township, Range, Seetion: )U'/-/ S I5 T*)Ip R2k-) SM A K OEPTH SLOPE SITE PLAN (FEET) it 1 —1 1 2 PEeu TCST 3 Sana AP-Avet 4 5 6 7 a g SILT r SPNb 10 it 12 13 14 eu-rTati OF "01.6 15 61719 16- 17- is 20 WAS GROUND WATER V ENCOUNTERED? 11 IF YES. AT WHAT DEPTH? I1 NO r wwr Nlr Mmlwn,7 r°Nt—D4t R�3'�4� Reading Data Grou Time Not Time Depth to Water Not Drop 0f 7219/ O V O 6 yIVA D O u 1 6• , ?�/A N/A PERCOLATION RATE 0-S-4 (minutes inch) PERC HOLE DIAMETER TEST RUN BETWEEN 9 FT AND -3 FT pp COMMENTS CCo IKI•oma Qaic o ,n -} //l,a rl �!' r.% r rrt/1 1 VrI I r,- � Prrk�c� w•'rl /1oi be v4rl• r I• PERFORMED BY: Sn c. r.un S S 0. �—(, 1 CERTIFY THAT THIS TEST WAS PERFORMED IN _ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES I EFFECT ON T IS DATE. DATE . i ' 1 Permit Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage, Alaska 99516-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 'LOT 9 OLK 2 SOLING HILLS EST .we PID No.: N 00'02'13" W 99.34' 57.51' 1(0' TELE. COMM. qa ELEC. ESMT. O r; M i TH3• 3 O O TH2 • in r 0) m - THI • m N•T. c. EPTIC T A 7 WELL gyp" prOQJJ�WELL LOCATION S 00.01'00' E - 156.85' SPRING HILL DRIVE tea, I' . 50'-0' TZ r i- Y. 11,.E t. �,J �. r .1� •:li.• rr�\i•-... ry- T 0".: Jr:-ri_._- •1, `a _ 1 I t .G. cr,.2•Z: - 3 "OC'10400 2 Ji .1 .tlr cr,.2•Z: - 3 "OC'10400 2 Permit No. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 19665 Anchorage, Alaska 99516-6650 Telephone: 343-4744 On-Ofte Wastewater Disposal System and/or WoU Inspection Report Page _of Legal Descrip.: Lora 6LK 2 SPRING•HILLS Err sue• PID No.: - A 5 C D E F G H T I: .T Io' PTI 24' 30.T 40.T 66.3'S4' 80 104' 43' 113.5' PT2 1 29.3' 26.3 26.9 1 46.4' 1 S0 Cr I 90 34.6' 92.4' r . 20'.0' NEW DEEP TRENCH SYSTEM EXISTING SYSTEM SEPTIC TANK P72 PTI FAMILY tea w 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ` ENVIRONMENTAL ENGINEERING DIVISION \ $25 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW IGJ/O/^/ eo/QPDl4f�4rl4a Y�/ :5-6Z-007 ❑UPGRADE MAILING ADDRESS �/SS ru!/�R T,�G-" 9 /YE 99SOFi LEGAL DESCRIPTION LOCATION NO.OF BEDROOMS S dF Af:BoT% XO DISTANCE TO: Well ,/ Meir /.V Absorption area S%S/ Dwelling /// PERMIT NO. B7,A/ o SZ/ O Y lovoT n Q Manufacturer ANCHaeA�E Material s�-z=z. No. of compartments Z W � rn Liq. capacityiQQ gallons l7SU IF HOMEMADE: Inside length Width Liquid depth d Y DISTANCE TO: Well Dwelling PERMIT NO. —10 2 _ _ Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well k0% /N Foundation IVnT/N Nearest lot line lD r10, PERMIT NO.B No. of linesff Len in of eac ine r Total length Sines Trench with d Distance between lines / f- Y 7 6 inches Top of tile to finish grade C" S Material beneath tile Total effective absorption area P H inches Length Width Depth PERMIT NO. W I7 i H Wd Type of crib Crib diameter Crib depth Total affective absorption area DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area OTHER PIPE MATERIALS v , !Al/G SOIL TEST RATING e �/5(� "Dk'Y 8-/2 INSTALLER / SANOE.F'S S S'woE2'S Ex84-/69 R REMARKS PEDL 5l4A/E7J eY P.4,erY To z 2X4/ 0 %9 o 0 /N /S' --V/L . V .CE/T F3P�/NO OKO 6 z � � opt ST a -oz lnSPcch1 67 APPROVED DATE LEGAL to/3n��% Si'.c'/A/l �Y/CLS ���IT�S BL/C Z LoT9 72-013 (Rev. 3/781 ' MUM I C I F'AL. I TY OF AFVCH0FiA6FEE . DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 MM—SITE SEWEF: $c WELL F'EFiM I.T PERMIT NO: 840521 DATE ISSUED: 06/28/84 APPLICANT: MAIN CORPORATION ADDRESS: 4155 TUDOF CENTRE DRIVE ANCHORAGE, AK 99508 CONTACT PHONE: 562-4907 LEGAL DESCRIP: SUBDIVISION: SPRING HILLS ESTATES LOT: 9 SECTION: 15 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 1.25A (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you system. Choose the option that best fits your BLOCK: - 2 in designing your septic site. I certify that: 1. I am familiar with the-requirements.for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of -Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit.• 3. I will adhere to all MOAandState of Alaska requirements for the setback distances from any existingwell, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED 6Gl t A, . ,A-, tj QHS i----- DATE: APPLICANT: MAIN CCOORRPPORRATIOONNL ISSUED BY f�* *.�� DATE: L-EW- I}FiA I N DEPTH TO PIPE BOTTOM (FT.) �D �RT -3:5 ** 7.5 3.0 ** GRAVEL DEPTH (FT.) 0.5 Q(yr 1.0 TOTAL DEPTH (FT.) --4cO' (� 4.0 GRAVEL WIDTH (FT.) -16:0 SIo7.0 5.0 GRAVEL LENGTH (FT.) _;X2-.fr L/f•°G5. 60.0 tl GRAVEL VOLUME (CU.YDS.) TANK SIZE (GALS) 1,250.0 18.9 16.6 ** p0K1,250.0 x* SOIL RATING (S(2. FT. /BR) -e5 Oro Yb �Ig4 85 **.DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A -LIFT STATION ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: 1. I am familiar with the-requirements.for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of -Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit.• 3. I will adhere to all MOAandState of Alaska requirements for the setback distances from any existingwell, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED 6Gl t A, . ,A-, tj QHS i----- DATE: APPLICANT: MAIN CCOORRPPORRATIOONNL ISSUED BY f�* *.�� DATE: SOILS LOG �/I/Ci l MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION t\\ TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST Z/ PERFORMED FOR: 06v? Mf11/I.- DATE PERFORMED: c7v- :2S LEGAL DESCRIPTION: spciliQ ttil ILEI-0�-) O SLOPE SITE PLAN Jr OrAaAcc So 1 1 �� C,Icav1 �ei{cL:f"�rnst l 2- 3- 4 34 O 0 5 6 a 1111 14L tit4' 511+ 7 13 SP S„Plf�TinG GkM S'" Vfl:valtLj ru414@ 1SOdA 14- 15- 16- 41516 'L v ,8 19 20 %o T WAS GROUND WATER �j, �0 ENCOUNTERED? �v IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop I 1 PERCOLATION RATE TEST RUN BETWEEN FT COMMENTS So'. i Jr rr*''I vly-a/ty B54 n,,4edyi ry--L if tV 46�0 n 'A PERFORMED BY: IDA Evv CERTIFIED BY: NJ DA- S'r84/7 72 -008 (6/79) DATE: - f -A 1:2 s 1 . n solLs Loi MUNICIPALITY OF ANCHORAGE *N1 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIONPERCOLATION TEST 825 L. Street, Anchorage, Alaska 89501 264-4720 - ' SOILS LOG - PERCOLATION TEST �%F! PERFORMED FOR: �Ovy //I4 t�//) pDATE PERFORMED: ✓ �'s F+ LEGAL DESCRIPTION: SDnn9.Z --�.�—T SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 MMPNTS <n 7rq((rIt'C 5117 Soli" fan pmt ro�ndrd ro46kj 7 S really t11tCWASGROUNDWATER S C(e4') ENCOUNTERED? tJa o CowrSC P IF YES, AT WHAT E (zsc* DEPTH? P147'. Reading Date Gross Time Net Time Depth to Water Net Drop t/>rzD t i T1 - d 9 147 - PERCOLATION RATE / V 0 (minutes/inch) TEST RUN BETWEEN FT AND —FT anC /tf O✓r 700 /H '10 0i.t „moi PERFORMED BY: Dre, Sfir✓e— CERTIFIED BY: C /-10& Tr -f? 51"'D X 72-008 (6/79) M -W DRILLING, Inc. �0. P.O. Bac 10-378 • 10300 Old Seward Highway - 64-267 (907) 349-8535 S ANCHORAGE. ALASKA 99511 DRILLING LOG Well Owner ihr,' M11:0 / illi T. Co',=1'C:ZO.l lirestic Use of Well Location (address of: Township, Range, Section, if known; or distance main road Isit 9 Elvclz 2 Snr'rr hills - tnchorn re Size of casing--L----Depth of Hole ld2 feet Cased to 151.20 feet Static water level 157 ft. Fabo ffl- (below) land surface. Finish of well (check one) open end ( R ) Screen ( ); Perforated ( ). Describe screen or perforation Ibne Well pumping test at 10 gallons per tfioni) (minute) for---I--hours with-- .lub`,•; �: of drawdown from static level. Date of completion Scnterllcr 10, 1984 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casir!;! stid= 2 TO 4^ L`=x. Siltv :-M el A�ViViQfpT. 40 TO 90 fir, silt-j,tr'N-el - sucmirv- ,,, fretC-. Ore EDROTEMCN -a a„ E0 TO 170 Emm silty mr n,t--1 ,��r3 Uq4 170 TO 182 1.aterbearirr finml - lc•. --tend 5% s- 0- r t % I r n TO TO TO TO TO TO TO TO TO TO iiSd�B 4E�R.ilid Cotstractefr c4cwWsu $Wt. 814 do M 3—CONTRACTOR 0 • E •itc. Municipality of Anchorage On-Site Water and Wastewater Program - �v 1 r (907) 343-790 CERTIFICATE OF ON- c• M ' PPR A e Parcel I.D. 015-051-62 Expiration pate: J /2-/ 7 1. GENERAL INFORMATION Complete legal description SPRING HILL ESTATES SIk 2, LOT 9 Location (site address) 9520 SPRING HILL ANCH AK Current Property owner(s) JEFF OTTEN Day phone Mailing address SAME Real Estate Agent Day phone 2. TYPE OF DWELLING: 41062q.9 p ® Single Family (w/wo ADU) �� '194". �'� ❑ Duplex a Stp _ 1`b 111 Multiple Dwellings (Single Family and/or Duplex) 0 ,2oo,, 3. NUMBER OF BEDROOMS: 4 q 1,` 68L g I 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank E Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: /7/k Date: 7/0 2 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ li ''q/, (06 Waiver Fee $ Date of Payment q/7// Date of Payment Receipt Number Com" /63Z-( Receipt Number COSA# 0 _1 t-ll3 Waiver# r 5. STATEMENT OF INSPECTION BY ENGINEER s As certifi l by my seal aid hereto and as of the validation date shown below, I verify that my investigation, Aased on,•procet fres outlinein the Certificate of On-Site Systems Approval Guidelines for this application, ',pMows tht the otl site_eater supply and rwastewater disposal system is (are) safe, functional and adequate for the nu ber bedtpoms and type of,tl ipture • dicated herein. I further verify that based on the information obtained from Se Municipalityofr nch ''age'file nd'f(om my investigation and inspection, the on-site water supply and/or wastewater dispns�stm is,(a compliance with all applicable Municipal and State codes, ordinances, and regulatibiisl effect at the .tne in allation. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON. PE Date 9/5/17 r' •.C. T�1 f. 6. DSD SIGNATURE ,W=,°;°"' L �. :iiCHAEL N. ANDC2c 7_76,System #1 Approved for bedrooms.System #2 Approved for bedrooms. e {�'��p `�''_ Disapproved. Conditional approval for bedrooms, with the following stipulations: €[011C_ fie • v-id `��attitfi,r 2_0tC Cq Q 1' OF, fr •� ON-SITE WATER AND WASTI_WATER z PROGRAM o o �- t^" `-���. � Original Certificate'DWFf1w —( The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12 doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SPRING HILL ESTATES BIk 2, LOT 9 Parcel ID: 015-051-62 A. WELL DATA Well type Private If A. B, or C provide PWSID # Well Log (YIN) Y Date completed 9.10.84 Sanitary seal (Y/N)Y Wires properly protected (YIN) Y Total depth 182 ft. Cased to 181.2 ft. Casing height (above ground) 20"+ FROM WELL LOG AT INSPECTION Date of test 9-10.84 8116/2017 Static water level 157 ft. 150 ft Well production 10 g.p m. 6+ g p.m WATER SAMPLE RESULTS Coliform NEG colonies/100 mL Nitrate 2.98 mg/L Arsenic: ND ug/L Date of sample: 8116/2017 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6-30-84 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping 8/15/2017 Pumper AROUND THE CLOCK C. ABSORPTION FIELD DATA— Date installed 10-15-91 Soil rating (GPDISF) 1.2 System type 5WIDE Length 70 ft. Width 5.0 ft Gravel below pipe 2.0 ft. Total depth 5.5 ft. Eff. absorption area 500 ft2 Monitoring tube Depression over field N Date of adequacy test 8-16-17 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600+ gal. New depth 3 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown If yes. give date , D. LIFT STATION Date installed 10-15-91 Size in gallons 500 Manhole/Access (YIN) Y "Pump on" level at 24 in. "Pump off" level at 22 in. High water alarm level at 30 in. Datum tank bottom Cycles tested 5 Meets alarm &circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20' Property line 10' Absorption field 40' Water main 100'+ Water service line 150'+ Surface water 1001+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 20'+ Building foundation 10'+ Water main 100'+ Water Service line 50'+ Surface water 100'+ Driveway, parking/vehicle storage 50'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION `kfG OF I certify that I have determined through field inspections and • '.y review of Municipal records that the above systems are in . 497 conformance with MOA COSA guidelines in effect on this date. • j + Engineer's Printed Name MIKE N. ANDERSON, PE ; MICHAEL N. ANDL$SCN ; v1 . CE 4469 '0 Date 91512017 �tt` •• /1-;1,,`�� COSA canary sheet_2-6-15.doc LOT 8 N 89'59'00" E 317.18' z �00000p04 0 0��F .•0F 'q'•!1%0P a *�' 49 T" ��(IA A rill' (� u' 4 0 nneth L. Dreyer, ��r7 03 Ln �0 ',. • LS-8202 p -.4 Qa. ..;',:o rO�SSIiOf O ' `ND0000�4 W rri' LI);40 AT /it : 0 m LOT 9 . ,4 ,, S 7 �p ' � �� \ p,,,,v(*. Z e EXISTING 101 p ' f VC- f2 HOJSE ��,r����jj�� a ry 8.0 x ,00 �. w Wim'' 'Uc0'" 0 W > ` , i�`,�:hl.b ENTRY ' 0) ENCLOSED 0 0 L.%?6," / 4 m �/,•,,�r O. 8 0 •i , Z Viiiiit .26 7 - ( 2 - i 1 i� 1nI% A n Q W UFi STI 44* ('4 S 89'59'00- W 317.12' LOT 10 AS—BUILT OF: LEGAL DESCRIPTION: 0 LOT 9, BLOCK 2, LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS -` 440 WEST BENSON BLVD. • 103 SPRING' HILL ESTATES E . ANCHORAGE, ALASKA 99503 562-5291 (fox)561-6626 ,r <nL Mc t...w r++ . rccm�. a.r.a� �+' � r WO# 2000-L-S21A) 1-=30' P AUG. 13. 2000 TAE 2436 KEN 482/1 83-3ai Municipality of Anchorage • -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-62 1. GENERAL INFORMATION Complete legal description Spring Hill Estates Bilk 2 Lot 9 Location (site address or directions) 9520 Spring Hill Dr. ��f6,2'y �r"4 HAA #_ 05.6&2 Expiration Date: 3 — a --I, — 0 � Current Property owner(s) Kathryn & Philip Aldis Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 9520 Spring Hili Dr., Anchorage, AK 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Finn Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 12120/2005 5. DSD SIGNATURE � : Ciddy W. Ellis _e�f' Approved for ___L—bedrooms. CE -10577 ".... Disapproved. ... �.........�,cN°' Conditional approval for bedrooms, with the following stipu ations: Additional Comments _.. ___ -•_ i WATER AND Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:Original Certificate Date: , 2 - ;za-- 05� (R«.olm) Municipality of Anchorage .. Development Services Department Bu ung Safety Division On -She Water & Wastewater Program 4700 South Bragaw SL P.O. Bax 196650 Anchorage, AK 99519.6650 www.muni.orglonslte (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Spring M9 Estates Slk 2 Lot 9 Parcel ID: 015-05162 A. WELL DATA Well type Pri Date completed "m Total depth 182 ft. Date of test Stalk water level If A. B, or C provide PWSID # _ Sanitary seal (YM) Y03 caw to 161.2 ft. FROM WELL LOG Sep 10, 1984 157 ft. Well production 10 9 -P.M. WATER SAMPLE RESULTS: CdMmm -1-colonies/1W ml. Nitrate 1.84 r g,A, Arsenic: NA mg.A. Date of sample: IM" B. SEPTIC/HOLDING TANK DATA Tank Typwateriat Steel Tank size /250 gal. Number of Compartments 2 Wed Log (Y/N) Yes Wires properly protected (Y/N) Yes Casing height (above ground) 20 in. AT INSPECTION Oct 6, 2005 148 ft. 6.6 9 -P.M. Other bacteria 0 colonies/100 ml. Collected by: Cindy W. Ellis. P.E. Date Installed 8130184 Cleanauts (Y/N) Yes Foundation deanout (Y/N)Y; Depression over tardc (YIN) No High water alarm (Y/N) Yss Date of pumping 8/2/05 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date filled 10n5/1991 L VM 70 ft Set rating (g.p.ddle or fe/bdrm) 1_2 System type Shallow Trench Width 5 ft. Gravel below pipe 2.0 ft. Total depth 5A R E1 absorption area 500 ftr Monitoring tube YB.S Depression over field No Data of adequacy test 10/6/2005 Results (PasalFail) Pass For 4 bedrooms Fluid depth in absorption field before test20 In. Water added 616 gal. New depth 21 in. Etapsed Time: 91 min. Final fluid depth 21 In. Absorption rete k 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. UFT STATION Data installed 1011&91 'Pump on' level at 24 in. Datum Bottom Of Tank E. SEPARATION DISTANCES Size in gallons 500 Manhole/Access (YIN) Yes 'Pump ofr level etin. High water alarm level at 30 in. Cycles tested 10+ Meals alarm & circuit requimnsrft9 Yea SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfiiR station on lot 115+ Absorption Held on lot 130+ Public sewer main 100► Sewer /septic service Ina W+ On adjacent kris 1100+ On adjacent kris 100+ Public sewer manhole/oleanout 100* Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20 Property line 15 Absorption field 40 Water main 100+ Water service One 150► Surface water 100+ Watts an adjacent kris 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ Building foundation 10+ Water main 100+ Water Service One W Surface water 100+ @iveway. parkkpArehide salrege 50+ Curtain drain none known Wells on adjacent kris 100► F. COMMENTS 1E,....Q.F...q l` New LS pump in August 2005.'' "!t9 G. ENGINEER'S CERTIFICATION *_ I certlly that 1 have determined thimCh field inspectidne and review of Municipal raomds that the above systems are In a Y W Ellis with MOA HAA guldellnes in effect on this date. Engineer's Printed Name Cindy W. Ellis CE JOEY Date 12 -ZD, 05 HAA Fee E 7 A Waiver Fee $ Date of Payment 12 2bl05 Date of Payment Receipt Number Receipt Number (Rev. 12101) O O 0 N W _� 0 M M M m 0 O Z M Om O n O N rm W Cl) M 5, z I CO w LOT 9 A .... A�gsoo T 49_ H 9%nneti;h L. Dreyer; 0 >OD f LS -8202 01 00, �G fession& yov� O Ok LOT 8 N 89'59'00" E 317.18' ^off 362 ' 95.2 / U 140 sF CV 76 Q 8 EXISTING N �T 2 ,(0 HOSE N O CY ?6 3 2.5' DIA. S O LIFT STA. 30.0 .•A • • M S 89'59'00" W 317.12' LOT 10 AS—BUILT O F: LEGAL DESCRIPTION: ORDERED 9Y: CAROL BUTLER L=wl mum LOT 9, BLOCK 2, LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS 440 WEST BENSON BLVD. # 103 SPRING- HILL ANCHORAGE, ALASKA 99503 562-5291 (fox)561-6626 '1 cut ws Draw er. rmo �a: wEotm er: eoaR+� WO# 2000—L -521A 1"=30' AUG. 13, 2000 TAE 2436 KEN 482/7 NUMMwith RE/MAX PROPERTIES, INC. KOM SURVEY CERTIFICATION: LANTECH has conducted a physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. ESTATES EXCLUSION NOTE: It is the owners' responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. NOTE: Under no circumstances should any data 83-� g hereon be used for construction or for establishing property lines. LEGEND: SET FND 5/8"RB W/CAP @) 5/8" RB O 3.25' AL.MON. MONUMENT 0 HUB & TACK ❑ FENCE— —X— X — DVERHANG— WOOD DECKS— CONCRETE— ASPHALT— GRAVEL— SEPTIC ONCRETE—ASPHALT— GRAVEL—SEPTIC STANDPIPES— t3S WATER WELL— iAl Ob MUNICIPAUTY OF ANCHORAGE • "\ DEPARTMENT OF HEALTH & HUMAN SERVICES DMsion of Environmental Services Onsite Services Seddon crm P.O. Box 198850 Andnrape,Alas a 99619-6650 (907) 3134744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMIL�L/Y DWELLING Parcel I.D. 015-051-62 HAA# 1. GENERAL INFORMATION Location (site address or directions) 9520 SPRING HII 15 DRIVE Pro' -rift, owner PAUL AND LINDY TENNETD: Mailing address 9520 SPRING H11 I S DRIVE ANCHORAGE, AK 99516 Lending agency Day phone .:.. A_qent CAROLll •:•• Day • • •• 7) 257-0116 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 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 cn-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-0.^.5 (Rev. 1/91) Frcnt MCA 921 Computer Venbn Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1100.00 at, or prior to, dosing for ttte engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity 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-ske water supply and/or wastewater disposal system Is In compliance with all Munidpal a d State codes, ordinances, and regulations In effect on the date of this inspection. �f , Name of Firm Phone (907) 337-6179 Engineer's Signature r`! Date In conducting this eive/uadon, AWwC, /nor p to a thorough, aanscdamtious ergineertn arralysls of the system In accordance with ADE C And D H , idle w a Regulations. The reportete performance of the systern under the cmeMons encountered at the ihne of the test and separation ttlrrmnoes measured to reatflytientlheble katmes. The operations) ft of ad wells and septic systems depend on the boa/ sails condition, ground water levels that may Bucfuats during the year, and M usage of the family bring served by the system. These conMons are outalde the M*ol Me evaluator of the system. SaBsYedory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or enaoechmentss. AVMC, Inc. can therefore not provide any warrant' for Muse With Ists of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is for the sole benefit of rhe owner detect abow. Any reliance upon or use of this report by any other person or party is not authorized, nor will It cnnferanylegal right whatsoew B. DHHS SIGNATURE BY V Approved for 4 bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments ., Q/. rf�o-��_ Date R - -2 9 - O D The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Aurthcrity 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 purohasers 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 Munidpality of Anchorage Is not responsible for errors or omissions In the professional engineer's worts. 72-C25 Fw. 1191) Back MCA 921 CwTpftr Version RECEIVE© Municlpan" of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESAUG 14 EnvtromneMal Services DNWon ���e� 825 OV Street. Rm 502 Anchorage, Alaska 99501(907) 34 X91 '' Irw,A OF AtdlRY Health Authority Approval Cheddist Legal Deealpycn; SPRING HILL ESTATES S/D: LOT 9. BLOCK 2 Parcel ID_' 015-051-62 A. WELL DATA Wel Type PRIVATE BA, B, or C, attach ADEC latter. ADEC water system number N/A Log present (YM) Y Data completed 9/10/84 Totel depth 182• Cased to 1 e 1.20• Cash0 height (above ground) 180+ Sanitary seal (YIN) YES Wkes properlypr Made (YM) YES Dais afteet Staticweterlevel Well production WATER SAMPLE Coltarrn FROM WELL LOO 9/10/84 10 04LM 1. 2"7 j" AT INSPECTION 8/8/2000 152' 6.25 g.P.m. Dateorsa ;1q: 8/8/2000 Coleciedby: A.W.W.C., INC. B.SEISIMMOLDOMTANK DATA DOUBLE C/O BETWEEN SEPTIC TANK k LIFT STATION WERE NOT PRESENT. Date totaled 10/16/91 Tae* sbm 1250 Number of Comparkrbrrts 2 Clasnouts (Y/N) YES Foundation clasno t (YM) YES no; reegig e (Y" NO No water at= (YM) Y Date of Pumpkp 8/8/2000 Pumper OLD MaDONALDS C. ABSORPTION FIELD DATA Date totaled 10/16/91 Sol raft (g p dJl2 or fabdrin) 1.2 System type SHALLOW TRENCH Ler101h 70' Wk1tiu 5' (gavel thickneas below pipe 20' Toted depth 5.2' Etferihre absorption area 500 SQ Fr Mom"o}g Tube pow (YRS YES- Oepressta► over Held (YM) NO Date of adeq=7 test 8/8/2000 Results (Dasa/Fel) PASS For 4 Bedrogns Fluid depth in absorption Held bebro test (kLX 12.5 ly atter 11_1150_gd. wMa added (kL. 17 Fklkt depth 16 (to) Lftfts tater: 25 Absorption rate = 600+ GPD pamMe t eeb.a.t (pest 12 months) (YIN) NONE KNOWN 9yes, give date ----- ri-M #WK 30ep Campus Vardm L.I of Q6T^/ (1u� T� �L a� -rue C-cr-r ST�� t✓�/ /{CC�fS %N/bvbrh �llr (�f'r" 57�+—i710�j 0. UFT STATION (ACERAGE SYSTEMS TYPE) Data Installed 9/10/91 8bm in gam me 500 MBnholelAocesa (YIN) Y 'pump Ori ieVai at• 2e 'Pump dr level et' 2.20 }/— Mph water alarm levet of E SEPARATION DISTANCES BOTTOM OF TANK SEPARATION DISTANCES FROM WELL ON LOT TO: Sep nO tank on lot 100'+ On a4Wmrt loft 100'+ Absorption field on lot 1006+ On loft 100'+ Public sawyer nub N/A public sewer menhdaldeenart N/A SOwedbeptlo service One 25'+ Ulf station 100'+ SEPARATION DISTANCES FROM SEPTICIHOLOING TANK ON LOT TO: Foundation 5'+ properly Ins 5'+ Absorption Held 5'+ Water malrybendce Ins 10'+ S1sfleoe waterkirelnep 100'+ Webs an adjacent loft 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT M. Property ane 10'+ Bukft foundation 10'+ Water mainfeemice In 10'+ Surface water 100'+ —Driveway, peri kVhtehide storage eros 10'+ (fin drain NONE KNOWN Wells on adjacent kMs 100'+ F. ENGINEER'S CERTIFICATION I eer{l OW I hove determined ftu fieldkWOC tons and review of U~ meocrds that Me above systema are In cm* mance with AfQA HAA Stmdetirnes In etlecton this date. Sipnatue Engineer's Name JEFFREY A. GARNESS Date HAA Fee 0 Date a Payment o /� Receipt Number noxa PW aWcMPftvW" Waiver Fee $ Date of Payment ALASKA WATER & WASTEWATER CONSULTANTS, INC. Facsimile Transmittal Date: 9 2S d4 TO: 4;z3� Number of Pages including cover FROM: ' f=' 604" s ALASKA WATER & WASTEWATER CONSULTANTS, INC. Jeffrey A. Camess, P.E., M.S. Comments: L SF --p7!, 7y� q -C CLS f60 /tel s-1-: , -0LX-15 S-1+o1jt_0 6901 Debarf Road, Suite 2-B • Anchorage, Alaska 99504 Ph: (907) 337-6179' Fax: (907) 338-3246' email: info@ak" p../0 q— S 08-11-00 10:20 FR011-CTE ENVIRONIENTAL - a,Z. ental5 � CT&E IUf # Client Name 1004385001 AK Water& Wastewater Consultants Inc. Project Name/# Spring Hills Lot 9 Bk 2 Client Sample 1D Spring Hills Lot 9 Bk 2 Matrix Drinking Water Ordered By PWSID 0 5615301 T-564 P.01/02 F-418 Client PO# Printed Daterrime Collected DOte/rimc Received Date/time Technical Director Released By A h 09/112000 10:15 08/082000 15:30 08/082000 17 00 Stephen C. Pde Parametcr RC5MIS PQL Units Method L1mhrMe Pre DauR �Wit 'Waters Department O8 IGO SCL NirmtrN 1.27 0.500 mg/L EPA 300 0 10 max 1 Mycrob3.0109Y !!h2Eat0zy 08'08/00 JDT Total Coliform 0 eoillOUmL SM18 9=13 08-11-00 10:20 FROM -CTE ENVIRONANTAL 5615301 T-564 P.02/02 F-418 ME Environmental Services Inc. Laboratory Division rev/ iv �u�iw 200 W Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Aaenenoe. AK 99518-1606 Tel, (907) 562.2343 READINSTRUCT7ONSONRPVE&WSME REFORECOILEC7INGSdMPIF Fa..4907)561.6301 0 PUBLIC WATER SY$1EMI.D.OF 0 PRIVATE WATER SYSTEM 0 SeaeRjl+rfts_ O .$fadIRWM �rr V114 RGAMM n q SeMRaalra G Sealbrew 8 r SAMPLE DATE: EHE Mosta SAMPLE TYPE: C3 Routine a Repeat Sample (for roniae sample with lab ret no. ) O Special Purpose 6M year SAMPLE LOCATION %)(I.)&Of1I- r &;I- 1,G 8�-L Comments: o Treated Water XUnrated Water Time Collated Collocted By M rw. t+r Anp)ysu shows this Water SAMPLE to b - Q/ Sausfaclory q Unsatisfactory Cl Sample over 30 hours old, results may be unreliable 13 Sample tooIong m transit; sample should not be over If is old as examination to indicate reliable «sults. Please tend new sample vta special ltvfry awl- Date Received 6f� Tlmc Received Aatlysis Da{n t-710 Aadytical Metbad: k Mtambrans Filter q MM0-MUG "Umber of calonlesJ100 ml. 1004385 It• Analyst bks Jun ❑ Faa.o Dire: Tunr. Mat oorifled of unsatisfactory results: 0 "O"d D:re: BACTERIOLOGICAL WATER ANALYSIS RECORD Spoke tvhA T#aw MMO-MUGRenlc ToWC01110M� ECJII Membnse Filter. Direct Count t % Coloabsiloo ml Verincados: LTB BGB COLIFMf Fe"I Coliform Confirmed" Final Membrass IN1/1nil Couform/100ml •-qn J —e36 Time is:C5 - tars 0EUM Mamearofa»SOSGrouptSm&4GMwnaaSurvo4wna) VVTC-Two-ww'n T•C. a -a..8. ENVIRONMENTAL FACII.RIE6 IN ALASKA. CAUFORNIA FLORIDA ILUNOIS. MARYLAND. MCNIGAN. MISSGLIRL NEW JEIMEY. ONTO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE , • DEPARTMENT OF HEALTH & HUMAN SERVICE$ Division of Environmental Services O On -Site Services Section P.O. Box 196650 ., Anchorage, Alaska . 995119-6650 343-4744. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# D/5 -OS/ -62 HAA# AA4�DSN$ 1. GENERAL INFORMATION ;ri:'.r14 kr.,Y41••+�t h: •'.. Complete legal description Lot 9; Btoc-j,"Sjo i.ng Hatts Estatea Location (site address or directions) 9520 Spningh,iU Ortive Anchoaage, AK Property owner Yameta Yanks C/O REAL ESTATE SUPPORTDay phone 1-800-829-1311 Mailing address 8200 Humbotdt Ave. S. Suite 204 M.Lnn¢apoGis, MN 55431 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise r9quested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site ,. Public sewer, NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ' 72-M MW.VFq F,m,1 MOAR21 , S. 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 furtherverify 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 = iN0UJ1FE1tING Phone R y -;k-9 7 1"34 Nis RimLeop Reid N6. Address .._, A4 �- _ Engineer 6. DH S SIGNATURE Approved for 0 Ibedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments --y^--� Date //� AZZ 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 DHHSdonot conduct Inspections or analyze data before a certificate Is Issued. The Municipality of Anchorage is not responsible for errors or omisslons in the professional engineer's work. Municipality of Anchorage AL Aicm Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lorl B(cc(< 7- SF/C/NG N/LL$ Parcel I.D. Esrwii;T v A. Well Data Well type 1 X(V A7c' If A. B, or C, attach ADEC letter. ADEC water system number ZIA Log present&N) l Date completed g 1 /0/ 84 Driller M'W MIU-PUGI , /Juc . Total depth $ Z Cased to 19/1 zo Casing height l 7- Sanitary seal (Y ) YDS Wires properly protected[f1 /N) 'tee Date of test Static water level Well flow Pump levell FROM WELL LOG 51/o//N_ 16-90 AT INSPECTION /o//i/y9- l4+01 62 9.p -m. 5.3 g.p.m. VK /UcP' RrAcif�D SEPARATION DISTANCES FROM WELL TO: Septic/belding4ank on lot /00 9- ; On adjacent lots DO r -F - Absorption field on lot ��%D r r ; On adjacent lots l 0O 1* Public sewer main %S� f- Public sewer manhole/cleanout /010 r f Sewer service line ZS r Petroleum tank mokx /(oce-+/J WATER SAMPLE RESULTS: Coliform 0/��U'`"`e� Nitrate - 9(o Otherbacteria Date of sample:/��! 5 Collected by�*��a B. SEPTICA4GL- iNOTANK DATA Date Installed 6 30/,fp Tank size /Z -YO COAL Compartments Z Cleanouts Y/) Y(fS Foundation cleanout(&N) Ye -3 Depression (YA -vO 0 LUW LU W High water alarm (Y No �-o Alarm tested (Y/N) NSG} Dateofpumping l�Ilel �� Pumper At H6meH 5c2L1/CES SEPARATION DISTANCES FROM SEPTIC/+f61:11*NG3ANK TO: I Wells) on lot /0.0 tr On adjacent lots / U O t7` Foundation S To property line /O r Absorption field S Water main/service line / O 17L - Surface water/drainage1 ljto t� 72.026(393)• Fwt CONTINUED ON BACK PAGE C. LIFT STATION Date installed I ��/� i l Manufacturer' .5YS7z—,7,7S Size in gallons .570(7 bra L Manhole/Access(ON) Y{6-3 Vent (Y&—.:: o -Pump on- level at 1 Y 41 r 'Pump off" Level at High water alarm level :5 3 �4 Cycles tested 3 Meets MOA electrical codes &N) -IFNS/EGr70�J 0<6>'z-'rU0-J r11-6 AT A4.a.si. SEPARATION DISTANCE FROM LIFT STATION TO: Well on tot * 10 0 r -,A- On adjacent lots hoo / f Surface water _ lO o f"— D. ABSORPTION FIELD DATA Date Installed ILO// G I `! / Soil rating (GPD/Ft?) _ It Z System type Sy'fuvU 7z6ut-N Length %O ' Width S Gravel thickness Z Total depth t3� Total absorption area y50CD Cleanout presen &Y ) 163 Depression over field Date of adequacy test Resulm�Pail) — 1�aia SS for Bedrooms Water level In absorption field before test U After test U Peroxide treatment (past 12 months) (Y/N) z(-.) Ljtf KiN&jo j If yes, give date _AJI& SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /VU /-,4' On adjacent lots 100 r-,- Property line /U "/- To building foundation /U /je To existing or abandoned system on lot 00", On O+- On adjacent lots ZC) r r Cutbank S O rf Water main/service line /Q rf Surface water /U0 /t Driveway, parking/vehicle storage area S r7� Curtain drain tNKNOWI-J E. ENGINEER'S CERTIFICATION I cer* that I have checked, verified, or conformed to all MOA and HAA guidelines in et/ect Qn the date o/ this inspection. Signature -24&Z Z�in� Engineer's Name R6,06t 7— C �owA,i Date /0 %ti•/ / 4 Y Ob HAA Fee $ 300 • ' / Date of Payment ( � p I— 4 7 Receipt Number 60VPS ( ��isl 72-026 M3)• Back L ROBERT C. COWAN CE -8801 41 rF,'w... 2t���O Pn��'�:"ndP�• w Waiver Fee $ Date of Payment Receipt Number, 1.7/221/94 16:17 CTwE ENJ1Ra.`k'4T;ZL LAB SERVICES + SIWG9412il NO.029 Da2 JALCommercial Testing & Engineering Co. Environmental Laboratory Services Fara AW'6W"ri wwr,e. Rr.PORT of ANALYSIS ME Ref.♦ t94.5224-3 Client Sample ID tL9 BLK2 SPRING H111A ESTATES 11atr11% tWATER Client Name :S 1, S MIh'F:FTtING Ordered By :R.J.S. Project Nerve t Project* : PWSID 1UA Remarks: ROUTINE SAMPLE COLLECTED BY: S.F. Parameter Nitrate -N 5633 B Street Anchorage, AK 99518.1600 Tel: (907) 562.2343 Fax: (907) 561.5301 WORK Order 110008 Printed Date :10/20/94 @ 16:10 hrs. Collected Date %10/12/94 @ 12:35 Ars. Received Date %10/12/94 @ 15:30 hrs. Technical Director t5�- Released By : Jl/�^�•Gll �, QC Allowable Ext. Anal Results Qual /hits Method Limits Date Date Init 0.96 ag/L EPA 353.2/300.0 10 10/12 MCF. aa........ausss.rsu. u.saw assaa ra............ s:asscaasssaasrs...sso. auo.s.eva...... sass a See Special Instructions Above UA a Unavailable •e See Sample Remarks Move NA a Not Arv3lyzed U ■ Undetected, Reported value is the practical quantification 11s1.t. LT a Less Then ID a Secordary dilution, GT a Greater Than Memberrol-the SOS GrcuplSocw6 G4n4rale de Surwmancel_- ENVIRONMENTAL FACILITIES 14 ALASKA COLORADO. FLORIDA. ILLINOIS. MARYLAND. NEW JERSEY, OHIO. UTAH, WEST VIRGINA is Commercial Testing & Engineering Co. t Environmental Laboratory Services s... a .:. 5633 B Street Anchorage, AK 99518.1600 Drinking eater Analysis Report for Total Coliform Bacteria Tel: (907) 562-2343 READ INSTRUCTIONS ON y P Fax: (907) 561-5301 REVERSE SIDEBEFORE COLLECTING SA 11PLE )IM ❑ PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM ❑ S�,�Rerult*� ❑ SmdRtsutts ❑ Sendlnvoice -..Y i. Z.P cYY. SAIMPLE DATE: EW Month SA.\L LE TYPE: P❑ Routine Repeat Sample (for routine sample with lab ref. no. ) ❑ Special Purpose SAivIPLE LOCATION Lo 7' Day Year ❑ Treated Water ❑ Untreated Water Time Collected Collected By iZ-3-C _ TO BE COMPLETED BY LABORATORY Aralys:s shows this Water SA.WLE to be: S' Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /C Time Received /J`S O Analysis Began Analytical Method: 2�Mcrnbrane Filter ❑ MMO-LMUO Number of colonies/100 ml. Lab Ref. No. Result* Analyst 44.5224 Sent to A.D.E.0 ,7((Smdlnvowe �� NCD ❑ ..,<!..-. J.. Fazed 't� Date: �IZY Time: Client notified of unsatisfactory_ results: ❑ SmdRtsutts ❑ Sendlnvoice -..Y i. Z.P cYY. SAIMPLE DATE: EW Month SA.\L LE TYPE: P❑ Routine Repeat Sample (for routine sample with lab ref. no. ) ❑ Special Purpose SAivIPLE LOCATION Lo 7' Day Year ❑ Treated Water ❑ Untreated Water Time Collected Collected By iZ-3-C _ TO BE COMPLETED BY LABORATORY Aralys:s shows this Water SA.WLE to be: S' Satisfactory ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /C Time Received /J`S O Analysis Began Analytical Method: 2�Mcrnbrane Filter ❑ MMO-LMUO Number of colonies/100 ml. Lab Ref. No. Result* Analyst 44.5224 Sent to A.D.E.0 Anch Fbks Jun ❑ Fazed 't� Date: �IZY Time: Client notified of unsatisfactory_ results: ❑ ❑ Phoned Spoke with Fazed Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD NINIO-MUG Result: Total Coliform ��"-q E CoLi Membrane Filter: Direct Count V Colonies/100 ml Verification: LTB BGB COLIFIRM t•.vrC-T«N,Y,e.Y.r.C« Fecal Coliform Confirmation oe-ouee.eer. Final Membrane FlfterA"ults Coliform/loo ml Reported By ' F' Date /1-/7-99 Time 16 eP6brs Comments: v Member of the SGS Group(Socidt6 Gdndrale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO. FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Mt 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 l.D.If 0/5oz 162 HAA# i.141�ituS?�� 1. GENERAL INFORMATION �C t C 131�C 2 $pr ^c /'1 II.S Complete legal description � 5 1 S T11/V' R3cu SM. Location (site address or directions) AK Property owner' MOCI t Z u k'1 Day phone 3Y S 21 22 Mailing address "7S),O !;pr;n,j WHIT C'S4t"k57, km'vn, e, Ift, Lending agency Day phone Mailing address I Agent Gcv-bro,Pcv� ked- C�c k lull Day phone iloZ' Address 3201 .0 Sf;,ecf Cvi"tc�w 7a- ��`• 1%S03 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: LI 3. TYPE OF WATER SUPPLY: Individual well 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 [/ 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. 72-023(R..1/91) Aunt MOA121 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 furtherverify 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 7k Y O', A) Y1` AAj HA M -S lti G Phone 22--r 27l — U 5 y3 Address 51/i tVMW\ -'111 Ac/e• Ai Engineer's signature 6. DHHS SIGNATURE / Approved for 6Z"`= `� bedrooms. Disapproved. Conditional approval for Additional Comments By: bedrooms, with the following stipulations: Date //— r 9 -9i The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-=(Aw.1/97) Br MOAI21 i, Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST MOO Legal Description: Lof q � 151K 2 , egMlnr csf. oS 16 2 r. g p Parcel I.D. O 1 S A. WELL DATA Well type Pr: ie If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) i Date completed f7 //o/ 61 Driller M-10 /fir. 11 Total depth 162' F+ Cased to I $1' 2 f i Casingheight Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG Date of test //o /81 Static water level 15-7 T INSPECTI kUNICIPAUTY OF ANCHORAGE A T 713114711 IRONMENTAL SERVICES DIVISION /I/ IV NOV 0 g }99} Well flow I O g.p.m. ..5./ R V G Pump level 1 (6o SEPARATION DISTANCES FROM WELL TO: I I Septic/holding tank on lot I I ; On adjacent lots UO f Absorption field on lot 100 ' ; On adjacent lots Public sewer main IU /A Public sewer manhole/cleanout N Sewer service line N /A Petroleum tank N /A WATER SAMPLE RESULTS: Coliform Nitrate U' q Other bacteria Date of sample: 1110q1,7 I Collected by: _ B. SEPTIC/HOLDING TANK DATA Date installed `6 /'Z Tank size 1250 Cleanouts (Y/N) High water alarm (Y/N) Foundation cleanout (Y/N) y Sq/,(�(erJ0�1 Compartments 2 Depression (Y/N) tested (Y/N% u 1A Date of pumping I O Aff 1,7 Pumper S?�AC.S - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: I Well(s) on lot .11W On adjacent lots 1001+ Foundation 2 I To property line I tl Absorption field 6Water main/service line Surface water/drainage N 72,026 (Rev. 7191) Front CONTINUED ON BACK PAGE J C. LIFT STATION Date installed is �y i Manufacturer Size in gallons $ oo Manhole/Access (Y/N) 1 Vent (Y/N) P "Pump on" level at 2y' ^ "Pump off' level at n High water alarm level '�O1 ^ Cycles tested I Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot �l)DI On adjacent lots I Uo t f Surface water NIA D. ABSORPTION FIELD DATA Date installed /O Soil rating L System type SyAuuw 7�GNclI Length 70 1 Width 51 Gravel thickness 21 Total depth 5 2-1 Total absorption area cE� �� 2 Cleanouts present (Y/N) Y Depression over field (Y/N) �`�T='f NIA Date of adequacy test NIA (RX:4JF,' X10 Results (pass/fail) N /,1 for N bedrooms Peroxide treatment (past 12 months) (Y/N) ti /A If yes, give date N /A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 10o'4 On adjacent lots 100'4 Property line /� / To building foundation �� r To existing or abandoned system on lot �� ) On adjacent lots 50,+ Cutbank IV 1A Watermain/service line AJ Surface water N %A Driveway, parking/vehicle storage area t Curtain drain E. ENGINEER'S CERTIFICATION I certify that 1 Signature Engineer's im Date checked, verified, or conformed to all MOA and HAA guidelines in effect �1 0 I HAA Fee $ _Z Date of Payment //-8-91 Receipt Number 72-026 (Aw. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Inspection. NN 06 '91 0936 N. -TEST IW: _LP.VS..I"V:(alG�+rltulGul�lAA NORTHE 7000 WOu3TnuL AVENUE 7509 FAIASANKS STREET P. 1/Z TESTING LABORATORIES, INC. FA1P8ANKS. ALASKA 99701 (00714568119 • /N( 4500125 ANOMOPAOE. ALASKA 99503 1907) 277405 • LAX 774 96+5 Acreage Systems, 1AC. 601 £. Northern Lights Blvd., aui a 343 Anchorage AX 99503-2811 i Attns - our Lab /s A116134 Location/Projects 91081772 rout Sample SDs 9520 Spring Sample Matrixl Nater Comments: Method Parameter EPA 3SJ.J Nlttate-N go�' f, kL� Reported Sys William E. Buchan Anchorage Operations Manager In Report Dater 11/06/91 Date Arrived: 11/04/91 Date sampledo 11/04/91 Time Sampled: - Collected Sys NS Definitions MDL - Method Detection Limit 8 - Below Regulatory Nin. H - Above Regulatory Max. E - Below Detection Limit Estimated Value Unite --------------mg/1----------- Rneult Flag ------------ Date HDL Analyzed 0:1 11/05/91 z0 d swa.LdAS av"m21Oti 6Z: O T nH1 7 6-9 -ICON . ♦ 1. :1.. vL .. _i 'J.. .: h. ,_-nr....r r•N P.212 - NORTHRN TESTING LABORATORIES, INC. 3n701N0USTF1 AV91% Untreated Water Check Sample Ifor original contaminated FAIAOANKS, ALASKA 69701 907 /56-0116 2506 FAIRBANKS STREET - - - - — ANCHORAGE, ALASKA 90507 907-2116371 Drinking Water Al'alysis Report for Total Coliform Bacteria TO BE COMPLETED BY C PUBLIC WATER SYSTEM I.D. OFF= {PRIVATE WATER SYSTEM ACREAGE SYSTEMS. A ... _ aiding Address TO BE COMPLETED BY LABORATORY Received at: g Anch. p Fbks. Date Received _ii.�Y1L _ Time Received_.. 122�V_ ' Stew i ZI► tole W" Q 1.151 SAMPLE DAT9: __ Phone M� e.r reg. Purchase Ordec No. q / CIO I7I.2 SAMPLE TYPE: QRoutine Q Treatod Water M11u0 leu.>♦x fy Special Purpose Untreated Water Check Sample Ifor original contaminated R sample with lab reference no. _)'j .OB :em►k Time Ne. Loucks CotlerM lI !silted by l.ewfNory del. No. 4 -' — faLW i 5 s 7 8 9 10 ,ignature of /All IAOrl"Tn" IIA* VA GIW M11u0 leu.>♦x fy y'4//�M{�fII.t110Yi YW RESAMPLE R OTHER BACTERIA .OB faLW Next Sample Due COMMENTS: SATISFACTORY UNSATISFACTORY U RESAMPLE R OTHER BACTERIA .OB TOO NUMEROUS TNTC TO COUNT DATE A7AI.YZED 11/4 17:00 mBPA a FILTSP.. Owl V w"Iks nnel �ef�). Lea doe e • o* ••e••b .6-.C—�.__6_= • . Ot Total Coliform t4parleIto p tc vp. Vats i 1� • +..£�'rr7. -� d S W 3 1�S h r�3 J !i 3 >! F1 fiI Z = fY-T nl H VLAJTj__ rT MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRON`fENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) AK " .5�P1f;Aic 14'ct5 L 5TA7E5 T/?" 8341 -ve!.15— Location (address or directions) SP�i UG di z t S OR - (b) Applicants Name MAi .0 Cne,0 Telephone - Homme/, Z.1 OWsiness Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer [-::[ ; Other [� (explain); (d) Lending Institution Telephone Address (e)*Real Estate Co. b Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence I Single -Family �Z Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well 1�9 Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 1:5;� Public Q Community Q Holding Tank Q Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 5. Engineering Firm Providing Inspections Tests, File Search, Data and Information 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 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 regula- tions in effect on the date of this inspection. Name of Firmm%r s IrIJC. Telephone .SGi-1564t, Address /2430 W 3"� 4A)c 14!Ar r5 �.S't1T_-rc 13 ^a r' Date A4 c r;a.f• :P' .•. S� (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms By ��� trt Date v Approved .1k__ Disapproved Conditional Terms of Conditional Approval CAUTION THE 14UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSION1L ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR 014ISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 (Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MCA) HEALTH ALTIMRITY APPROVAL (HAA) rrrr. c, I, a "V 15 L094 CHECKLIST — FEBRUARY 1984 RECEIVED A. WELL DATA Legal Description: fist 9 R K 2 ,�iCwc /4;11S ESrATEJ I`12AIt'.;w&Cr5' Well Classification UATE If A, B, or C, D.E.C. Approved(Y/N) ,y/111 Well Log Present ((Y�N) Date Capleted--_fZi&/jq 4 Yield io Total Depth J g 2' Cased to /8/,7o Depth o Grouting VAJKVoWN Static Water Level I,,C-) Pump Set At UAIKMOUJAJ Casing Height Above Ground 2 ,C /'� Sanitary Seal on Casing (Z N) Electrical Wiring in Conduit cbw Depression Around Wellhead (X&) Separation Distances from Well: To Septic/Holding Tank on Lot r.) (1 f3 On Adjoining Lots > /do # 1') To Nearest Edge of Absorption Field on Lot l l Z-7' ; On Adjoining Lots X16^1 ''- To Nearest Public Sewer Line &J.lAk To Nearest Public Sewer Cleanout/Manhole 4J /A To Nearest Sewer Service Line on Lot _A1/0 Water Sample Collected By aW fr Date Water Sample Test Results _SA -I i s FAc-PoR Y CUM nts ►AJ%A *Argo u (SEC tuc« eo a B. SEPTIC/HOLDING TANK DATA Date Installed Size %j --9-O No. of Compartments 2 Standpipes lbN) Air -tight Caps N) Foundation Cleanout MN)_ Depression over Tank (Ydb Date Last Pumped _4)/14 Pumping/Maintenance Contract on File -.(YIN) ; for Adki Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation. Distances from Septic/Holding Tank: To Water -Supply Well (! ;� r� To Building Foundation:.,) 2-1 1 To Property Line �� i To Disposal Field To Water Main/Service LimAA )� To Stream, Pond, Lake, or Major Drainage Course AJf ra CCMWnts IA;FbeiwPA-0Aw PeX A-5AV;ir I,�� OCP F/!LD itrtas�iten+� uT' (Page 1 of 21 Receipt # 30`b�31 Date Paid:-//- Amount: aid:II-Amount: 'e'l 2-15-84 4 3 Z ��.QiNg 14:L L5- - �' 7-121u R3KO SEr— 19' C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata gSD I Type of System Design DEQ Date Installed T/3{���t Length of Field y.2 Width of Field 'L 9M Depth of Field i yO2:�Gravel Bed Thickness Square Feet of Absorption Area Q,� ts�Standpipes Present O1) Depression over Field (YM Date of Last Adequacy Test R >/ Results of Last Adequacy Test Separation Distance from Absorption. Field: To Water -Supply Well J,) 4:� ' I Z? To Property Lire /D !f - To To Building Foundation 1.1 /6� To Existing or Abandoned System on Lot A.JM ; On Adjoining Lots >3(p I 0 To Water Main/Service Lire 44_ To Cutbark(if present) To Stream/Pond/Lake/or Major Drainage Course ,y�,{; To Driveway, Parking Area, or Vehicle Storage Area m,) 4-P" Comments 1Ak FO eA#At;c,N P" i4e At,. c r L) Pt R 2•) Ca-mnp�O E�s.e��`ye.a.LE�m,[�.+w n,.e�,.. .Q1 X i/1 ; D. LIFT STATION NAA Date Installed n Dimersi Size in Gallcr.s. Me /Access (Y/N) "Rump On" Level at Pump Off" Level at High Water Alarm Level at Vent (YIN) Tested for Pumping cles during Adequacy Test. Meets MDA Electrical Codes(Y/N) *' Cieck Permitted Bedroom Rating Against HAA Request `* I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this irspectior.. Signed _" `.( l -Ag Date I/ )/tAff Compan1A EC5 ,.ate MOA No. Sr84-o24 KB1/d5/s [Page 2 of 21 CHEMICAL & C OLOGICAL LABORATORIL OF ALASKA, INC. oX .... _ �.. TELEPHONE (907)-2784014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street a ""'•'•-�• Drinking Water Analysis Report for Total Coliform Bacteria .e TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: CS LD.NO. Water svitern Name Phone No. Mailing Address city States Zip Code SAMPLE DATE: '- /— -1 ® C 1 Y I Mo. Day ' Yea .. 60 tou E TYPE: Ctine heck Sample (for routine sample with lab ref. no. 113,Treated Water O Special Purpose Untreated Water SAMPLE NO. LOCATION L/ t ' R 570)'1111- 2 r)'imc2 3 4 I 5 I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Time Collected Collected ., B 19 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received f1— 17- — Time Received 1 6 3 O Analytical Method: O Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result* Analyst 115578-1� 1 (� I I (]] I I m U m I I m -W d cobs•✓leo M e. No If ►panne eenbm 0e-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1979 DateCoeected Source a.m. "o Broth 24 h"15 --Broth as houral MultlPle Tube Revolt: 10ml Tuber Podtive/Tuld 10ml Portlala Membrane F111e1. Direct Count Colllorm/Iooml Verlficatlon, LTB BOB Final Membrane Fater ReauBa d .-__ Repelled Date - r f' / 3 Time. P.M. M"Aicipality of Anchorage MEMORANDUM DATE: July 23, 1984 TO: Laura Crow FROM: Environmental Health Division SUBJECT: Request for Refunds - Account # 2460 Please make arrangements for the following refunds. Two(2) were MOA inspections and changed to engineer inspection. One(1) the well permit was paid for twice. One(1) the permit was revoked. Daryl E. Kollander 2910 West 80th Avenue Anchorage, Alaska 99502 Tract 1-B Peter Gate Subdivision Permit # 840035 - Well Permit (Purchased Sewer and Well Permit on Bernie Willis 10008 Marmot Circle Anchorage, Alaska 99502 Receipt # 278742 Amount $15.00 Account # 2460 Permit #840547) Receipt # 279032 Amount $145.00 Account # 2460 Lot 1 High Hopes Subdivision Permit # 840156 - Sewer/Well Permit (Purchased MOA inspection changed to engineer inspection.) Premiere Construction Receipt # 279608 4155 Tudor Road #206 Amount $145.00 Anchorage, Alaska 99503 Account # 2460 Lot 9 Block 2 Spring Hills Estates Subdivision Permit #840521 (Purchased MOA inspection changed to engineer inspection.) R.D. Neilson Star Route A Box 738011 Anchorage, Alaska 99516 Receipt # 288398 Amount $20.00 Account #2460 Lot 8 Block 2 Spendlove View Heights Subdivision Permit #840514 (Permit has been revokedbythis Division) Laura J. Ward Office Associate CC: File attachements 91 010 W76)