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HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 2 LT 13AOnsite File
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Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181047 PID Number: 015-134-95
Dwelling: 0 Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: El New ❑■ Upgrade
Name:
Walter Quigley ABSORPTION FIELD
Address El Deep Trench El Shallow Trench ❑ Bed Cl Mound
7900 Sitzmark Cir. Anchorage, AK 99507 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
(907) 229-2115 5 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
Hampton Hills #1 2 13A Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
Tot Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well >100' N/A N/A N/A >25' TANK g Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water >100' N/A N/A N/A Anchorage Tank 1,500 Gal.
Material Number of compartments
Lot Line >5' N/A N/A N/A Steel 2
NA
Foundation *7,0' N/A N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain None Noted Gal.
Pump on level at Pump off level at High water alarm at
Remarks *Septic tank is above the 1:1 influence
line from the foundation. in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034Tank to D3034
Installer drainfield
Owner Install Drainfield CO/MT D3034
Inspector J.Millette BENCH MARK (Assumed elevation) 100 ft
Inspection
15' 6/22/18 Location and description
dates: 2'd
3'd 4th Bottom of siding on North corner
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
.tet\\\ ‘
���OF ALgllll
Conditional Approval: Date �,`Q. . • •I
%*Co:49 TH /1k • • *+06
1 ett<1,-.,-t Ea:4
F Michael E.Anderson .
� .� •1<is•, 4381-E •.`�oilf
Approv j v•./1, ` Date 7-26- 1 11F,P....�O�,.
Inspection Report_9-1-12.doc
HAMPTON HILLS #1 , BLOCK 2 LOT 13A
PERMIT # OSP181047 PID # 015-134-95
DEVELOPED LOT I \N BLOCK 6, LOT 9A
\ 10'CEA EASEMENT N
1` NEW1500-GAL SEPTIC TANK_ __ ZERMATT AVE l,�
4") 1 1
---)x-74- _ (\N....,
✓/ TH#2 l j • / ---7: -T
I /� ,
II
// % EXISTING 43.5'LONG 3'WIDE X 8'
;-'0� EFF.DEPTH ABSORPTION TRENCH
// ///7 ,_ __ __
�S \ 2
I
/ / '4 \ � V2
/� I �,5, •F�• SV1
/� J f \/ O. O TH#1.
/ CO
/ ` �
i
10'712----,-
4-1.
`I BLOCK 1, LOT 1
r------- ._,.., TFCC\ EXISTING WELL
\ - FNT LOT 13A
LOT 14
N
LOT 12 � - - - J ' '� A B
_I
SV1 41.1 13.0
_ _ _ - - - � SV2 44.1 20.8
T n 2C0 45.5 23.0
.-OFA 4'k NOTE: LEGEND
l f •'• •..?�' ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH CO-CLEANOUT
j*.49. \ *t06 WELLS OR SEPTIC SYSTEMS. 2C0-DOUBLE CLEANOUT
' n AElaFCO-FOUNDATION CLEANOUT
r� FS-FLOW SPLITTER VALVE
Michael E.Anderson: j MH-MANHOLE
�f,<F`��•••»g381 i 0 50 100
lzq �•c„� EN m m mi FEET MT-MONITORING TUBE
�* PROFEsso 4.71"=50' SV-SEPTIC VENT
\NN���~ TH-TEST HOLE
J`
' GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
July 13, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: Hampton Hills#1, Block 2, Lot 13A- 7740 Zermatt Avenue
Existing Absorption Trench
Dear On-Site Services Engineer:
The existing absorption trench on the subject lot was constructed in 1975. The design of the
trench was based on a visual analysis of the subsurface soils. The test hole log completed at the
time indicated sandy soils full depth of the hole with a siltier lense from 4' to 10'. The
assumption was made at the time that the siltier lense was visually rated at 190 square feet per
bedroom while the remainder of the test hole was rated at 125 square feet per bedroom. No
mention is made in the MOA file as to where the test hole was located.
We placed two test holes on the lot to determine the consistency of the underlying soils. The
location of the test holes is shown on the attached drawing. The second location is in the middle
of the existing trench with the 30' radius covering the entire trench. In both cases clean sand
was found full depth of the test holes. Percolation tests indicated theses soils absorbed water at a
rate less than 5 minutes per inch. We are therefore requesting the application rate for the
constructed trench be 1.2 gallons per day per square feet as filed verified rather than estimated
through a visual analysis. The actual absorption area then becomes 835 square feet which is
more than acceptable for a five bedroom home.
Sincerely,71/1- -e, E A.T��°F 51,
Michael E. Anderson, PE j*: 49 TH • *r/
� 1
•. Michael E.Anderson
���6* 4381-E ••�•`� me
ik 6,9• . cc'•A
i`F0. 7/13/18PROFESS,ON9'•
HAMPTON HILLS #1 B2 L13A
PERMIT # OSP181047 PID # 015-134-95
- 7.5
0 N 0
7- 100.0 0 > > 0
LL cn Cn CV
— — f-- 99.2 — — —
I
4.0
5.6
r 93.6
.- \\_ U L____
\ 93.0
92.8
1500 GAL
SEPTIC TANK
\
\
/
''''''-- 88.7
...V.-7;9FA : k
k
i� �••001
i*49 n
*r
-B I LT � 8enja hiller j
PROFILE AS U �r�e •. CE 12592 •��.
�slF. Jui14 2712 •� i
1 4 ,il`A\\�� -'~~
MUNICIPALITY OF ANCHORAGE �P�cl........qC 41•x,
DEVELOPMENT SERVICES DEPARTMENT /N(� * � �I#
• 49 TH 0,
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 a*•• r�•••
SOILS LOG AND PERCOLATION TEST / :MICHAEL E. ANDERSON
,I s:• CE-4381 •:,. ',
LEGAL DESCRIPTION: HAMPTON HILLS #1, BLOCK 2, LOT 13A �I�f<`��•.7-9 •r� .•'��`
PERFORMED FOR: WALTER QUIGLEY '1 rRriFESS W-.00�
DATE: 6/8/18 PROJECT No.: ProMilltiklivi!� i9111P.
PARCEL ID#: 0I5-I34-95 TECHNICIAN: N. SHAFER
DEPT TEST HOLE 1
(Peet)
1' OB SLOPE SITE PLAN
1
2 !r4,rfl.,,_• ;
J: :s• :• i^
5 ..1'...=;V.:7;: SEE SITE PLAN
6 ..:A,r ,-:.;
i._;
7 '`; 'l s: ' SAND w/GRAVEL
':q.:AV...- SW/SP
10
0 ?,i:..yi? WAS GROUND WATER ENCOUNTERED? NO
r!:.:•,.4;...1!,',.;•:, IF YES @WHAT DEPTH'? -
.4•':,:•:..i• DEPTH OF WATER AFTER MONITORING: NONE
1 1 WiAi::: DATE OF MONITORING: 6/15/18
12 r w-
-; ~i GROSS TIME NET TIME DEPTH TO NET DROP
• DATE READING (MINUTES) (MINUTES) (INCHES) (INCHES)
.
14 •'1' ':::.z'••`' 6/08 TEST HOLE PRESOAKED PRIOR TO TESTING:
,J''" • '•" 1 13:17/13:27 10 9-6/16/4-12/16
15 •`:�'�;="'�� 4-10/16
4.` 2 13:30/13:40 10 8-12/16/4-8/16 4-4/16
16 + ,a
:;4';,:•:4-.4';:* ; 3 13:42/13:52 10 8-13/16/4-8/16 4-5/16
4 13:54/14:04 10 8-11/16/4-8/16 4-3/16
18 5 14:06/14:16 10 8-11/16/4-8/16 4-3/16
19 6 14:18/14:28 10 8-10/16/4-8/16 4-2/16
20
PERCOLATION RATE:2.42 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 6 FT. and 7 FT.
COMMENTS:
MUNICIPALITY OF ANCHORAGE ��P. 41,16, ii�
DEVELOPMENT SERVICES DEPARTMENT ...,42).• 4 ;9 �k
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *' �TM �\ •.*�/
SOILS LOG AND PERCOLATION TEST r/ eenja. hiller" j
#I BLOCK 2, LOT 13A ,+ii l% �CElui 24.M18 *` /7
LEGAL DESCRIPTION: HAMPTON H ILLSPROFESSION
PERFORMED FOR: WALTER QUIGLEY i\AIX.Xw���`
Professional Engineers Stamp:
DATE: 6/19/18 PROJECT No.:
PARCEL ID#: 015-134-95 TECHNICIAN: J. MILLETTE
DEPTH TEST HOLE 2
(feet)
1' OB SLOPE SITE PLAN
2 ti'.-.
.�2:1,.if.�j� '
,y
.'.
5 —'-"',f''--.- FINE SILTY SAND SEE SITE PLAN
SM
6 —%`�`s,` 'ai
7A f
":
10 '7M11•;it?:'�:: WAS GROUND WATER ENCOUNTERED? NO S
•`' ••��• IF YES L WHAT DEPTH? -
t:•:r:si 1'.v�i L
S. %':;_:i DEPTH OF WATER AFTER MONITORING: 0
1 1 DATE OF MONITORING:
E
12
GROSS TIME NET TIME DEPTH To NET DROP
13 DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 6/19 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 4:50/4:53 3 4-8/16/10-8/16 6
2 4:54/4:57 3 4-8/16/10-8/16 6
16 3 4:58/5:01 3 4-8/16/10-8/16 6
17 4-8/16/10 8/16
4 5:02/5:05 3 6
18 5 5:06/5:09 3 4-8/16/10-8/16 6
19 6 5:10/5:13 3 4-8/16/10-8/16 6
20
PERCOLATION RATE: 0.5 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 10 FT. and 11 FT.
COMMENTS: HOLE WAS DUG FOR PERK TEST ONLY. GROUNDWATER WAS NOT MONITORED
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: OSP181047
Work Type: SepticTank Upgrade
Tax Code Number: 01513495000
Site Legal Address: HAMPTON HILLS #1 BLK 2 LT 13A G:2540
Site Mailing Address: 7740 ZERMATT AVE, Anchorage
Owner: WRIGLEY LINDA C 50% &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
Dt'I)artnnant
4/16/2018
4/16/2019
53715
❑ 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
Received By: Date: r!
Issued By: I`�� ��JUG�3'(J' Date: �� �G7 Irk
F
3
MUNICIPALITY OF
CW;:
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
C i �a�'-\s
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-134-95
Property owner(s) Walter Quigley & Linda Wrigley Day phone 229-2115
Mailing address 7900 Sitzmark Cir, Anchorage, AK 99507
Site address 7740 Zermatt Ave
Legal description (Sub'd., Block & Lot) Hampton Hills #1, Block 2 Lot 13A
Legal description (Township, Range & Section)
Lot Size 53,715 —S q. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
❑X
(w/wo AD U)
Septic Tank
INUpgrade
❑X
Duplex
❑
(D)
Holding Tank
ElRenewal
ElMultiple
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: Jib -
Date
ib -
Date of Payment: I I I I ) �
Receipt Number: Oq99 OD
Permit No. OSV J1 $1 C`� -1
Permit App_-'-:-
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
April 16, 2018
Municipality of Anchorage
Development Services Dept- On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Hampton Hills #1, Block 2 Lot 13A – 7740 Zermatt Ave
Septic tank replacement application
Dear On-Site Services Engineer:
The owner of the above lot has a 3-bedroom home on the property, but the septic tank has failed.
We are submitting this permit application for a replacement tank. The attached site plan identifies
the location of the home, well, septic system, and existing tank. No conflicts exist between this
new tank and any well, whether on this lot or adjacent lots.
According to as-built documents on file, the existing trench is 8’ from the foundation, and the
trench is 10’ further. Our measurements indicate the field is actually closer to 6’ away. Although
the existing tank is already oversized at 1250-gallons, according to the as-built report, the owner
wants us to install a new 1500-gallon tank. The new tank will be 2’ longer, and there is not enough
room to install it 10’ away from the building without impacting the field. Therefore, we will be
installing the tank 7’ from the foundation. The bottom of the tank will be approximately 8’ deep.
We do not know how deep the footings are, but if they are assumed to be 42” below grade the line
of influence from the footings will not intersect the septic tank. There is no danger from putting
the tank this close to the building.
Please refer to the attached plan for the septic tank location. If this plan is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
4/16/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181047, Rebecca Carroll, 04/16/18
HAMPTON HILLS #1, BLOCK 2 LOT 13A
J �
10, TFC
EXISTING WELL
C
� \ FgSFMF�T
LOT 12 \ \
v
LOT 13A /
i
'2CO
On-site Water and Wastewater
REVIEWED FOR CODE COMPUA
OSP181047, Rem Carroll, 04
BLOCK 6, LOT 9A
ZERMATT AVE
------ �-
/
/
/
BLOCK 1, LOT 1
EXISTING 43.5 LF, T WIDE, 8'
EFFECTIVE DEPTH ABSORPTION
TRENCH
NOTE:
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH
WELLS OR SEPTIC SYSTEMS.
0 50 100
FEET
1"=50'
INSTALL NEW 150 0 -GALSEPTIC
TANK AND DOUBLE CLEANOUT
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTERVALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
u
1 - GREk ` -NNCHORA�-E AREA BORT- r'`..
J Q Department of Environmental Quality
��:.. 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAMETEYeCK+1 VC &W fCS MAILING ADDRESS 4s 07 P_e� �- PHONE 333- SZ%7'%
LOCATION LEGAL DESCRIPTION_Li'AiD 1-0_N Hil k I31IC 'Z
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
Tec rcxcl�
NUMBER OF
MANUFACTURER _' 1" CY/^ MATERIAL _ql2rc, t COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY L-LbGALLONS.
_ ' c TOTAL LENGTH
DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE_LJ OF LINES �j3
NUMBER OF LINES ( DISTANCE BETWEEN LINES — TRENCH WIDTH,�b IN. TOTAL EFFECTIVE
ABSORPTION AREA (r)q (40 SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE i -SI MATERIAL BENEATH TILE0. ABOVE TILE IN.
WELL:
TYPE/'Si.�D CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION , LOT LINE , SEWER LINE , TANK , SYSTEM ,
CESSPOOL
OTHER SOURCES
APPROVED vv DISAPPROVED REMARKS
DISTANCES: �L� Dlt �� l,[5 DIAGRAM OF SYSTEM
I rE1
INSTALLED BY: 344--8313 24*r Il,
�^-`I
�o
9"`Idr �n TTT �o I
SEWER LINE DEPTH:
--t) 1/Z-1 -- 5., I C. Calf%� u�okse
PIPE MATERIAL: 6154 ',roil
clk_� nra� rinc���.
LOT SLOPE: c:Uwl, Tn. _5J0 K) P'bP�ed 4'eu
REMARKS: Anwe
DATE s/r/__7SAPPROVEO
G.A.A.B.
Form EQ -032
� 7
f�GRE%�' ` ANCHORAOE EA BOF i �► 3/-�%�
i• - +'✓ ~•4 DEPARTMENT OF ENVIRONMENTAL QUALITY P Ir
j
3330"C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4581 �(ezd CC
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
EXEGU77l1L' pG!/tDF_QS 9-P7 YrtK HUE J33 %J 2�
NAME OF APPLICANT MAILING ADDRESS PHONE
INSTALLATION LOCATION A T�.L
LEGAL DESCRIPTION L CT 1-'o I
C
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PR SECUTION.
SEPTIC TANK SIZE ` Y - TYPE
MINIMUM DISTANCES. REQUIREMENTS
'e- /
SEEPAGE AREA SIZE
FOUNDATION TO SEPTIC TANK
lroc
e 77L/ X Dl'PJPA
FOUNDATION TO SEEPAGE P+P
INSTALLATION OF: SEPTIC TANK
RLT-
DRAIN
FIELD OTHER
I
.�(SEEPAGE
AOQ-. l SC)
i VAIN
SEPTIC TANK . SEEPAGE
TYPE AND SIZE OF FACILITY TO BE SERV
TO NEAREST LOT LINE.
/ /
/ �L
MOON■■■■■■■■■
WELL TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
FINANCED THROUGH
TO BE INSTALLED
BY
DRAIN FIELD
/
SEPTIC TANK,0� SEEPAGE
14T^DRAIN FIELD
TO RIVER. LAKE. STREAM,
FOIL TEST RESULTS
NOTE, THIS PERMIT
IS NOT VALID WITHOUT SOIL TEST
'
S�'-/�/ a'
COMPLETION DATE ANTICIPATED
11
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PR SECUTION.
SEPTIC TANK SIZE ` Y - TYPE
MINIMUM DISTANCES. REQUIREMENTS
'e- /
SEEPAGE AREA SIZE
FOUNDATION TO SEPTIC TANK
e 77L/ X Dl'PJPA
FOUNDATION TO SEEPAGE P+P
DRAIN FIELD
/ 1( DE�7PY
SEPTIC TANK TO SEEPAGE RCL WALL
I
5-1
i VAIN
SEPTIC TANK . SEEPAGE
PIT FIELD
TO NEAREST LOT LINE.
/ /
/ �L
MOON■■■■■■■■■
WELL TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
/
SEPTIC TANK,0� SEEPAGE
14T^DRAIN FIELD
TO RIVER. LAKE. STREAM,
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
w•�� SGL',,/�O
GRAVEL BACKFILL X2__21
/;z L/c L B//P+CF/cL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
2FQ U/2E 2 /.JSPrer/cA/S
OR
LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.66 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
7 7 -r -
DATE APPLICANT'S SIGNATURE
FORM NO. CO -014 / `J
,94-O. .5Ll/L/'n/j1-Ep P/c4A^assn puQUWfj
I
■
MOON■■■■■■■■■
■MM■MM■■■■M
■MM■MM■MM■■
■ MMEMM■M■MM
0 MINIMUM=
uM uu■■■u■MM
El
■■MM■■■MMM
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.66 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
7 7 -r -
DATE APPLICANT'S SIGNATURE
FORM NO. CO -014 / `J
,94-O. .5Ll/L/'n/j1-Ep P/c4A^assn puQUWfj
Performed for
Legal Descript on:
This form reports:
r. ►LSREATER ANCHORAGE, AREA DOROLe"'.!`1
--partment of 'Envirsnmental Qu,.i _
3330 "C" Street
Anchorage, Alaska 99503
SOILS LOG - PEROLATION TEST
Date Performed
Depth LoTi3
Feet
2-
3
4 _ / ✓ 42
5-
6_ ,
41
8- /
9
10
14 -
�Was ground water encountered?
5el
If yes, at what depth?
A)
Reading Date Gross Time Net Time Depth to Water Net Drop
Percolation rate minute.
Proposed installation: S6'e age Pit Drain Field
Depth of Inlet Depth to Bottom of pit or trench
COFVIENTS:
Performed G'yc_,Iy. J' 7 I�e-�.Certified
EQ -040 (6/74)
,);1-70 0 '3!"700
y3
276
2 s -s
�3
t?r
M -W DRILLING, Inc.
P.O. Box 4.1224 • 1310C International Airport Road
(907) 274AGII
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Executive Builders Use of Well Dom
Location (address of: Township, Range, Section, if known; or distance main road—
Lot 13, Block 2 Hampton Hills
Size of casing 6" nepth of Hole 300 feet Cased to 162.2 feet
Static water level 140 ft. (llbWA) (below) land surface. Finish of well (check one) open end ( x ) ;
Screen ( ); Perforated ( x ).
Describe screen or perforation 4" PVC Liner set from 3001 to 1401 with bottom
40' perforated.
Well pumping test at 315gallons per (}siw) (minute) for—1 hours with 100/5 st,
of drawdown from static level.
Date of completion 25 Sept 1975
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
O TO 10 Silty, med.gravel
10 TO 13 Sand & Large gravel
13 TO 21 Silty, coed. gravel
—21_TO3_ Silty gravel
no TO 35 Med. gravel caving in-
.i_TO 36 Boulder
16 TO 92 small C;rayPl
79
59 TO RA Siltg, mod—gravel
79 TO 90 Shale
99
TO
105
Silty,
small gravel
105
TO
125
Sand,
fine
125
Tp
134
Silty,
med. gravel
134
TO
135
Gravel,
med.
135
TO
147
Silty,
med. gravel
1 —CUSTOMER
M -W DRILLING, Inc.
P.O. Box 4.1224 • 1310C International Airport Road
(907)274-4611
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner Use of Well
Location (address of: Township, Range, Section, if known; or distance main road_
Size of casing nepth of Hole feet Cased to feet
Static water levet I. (above) . (below) land surface. Finish of well (check one) open end ( );
Screen ( ); Perforated ( ).
Describe screen or perforation
Well pumping test at gallons per (hour) (minute) for hours with ft.
of drawdown from static level.
Date of completion
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
TO
147 TO 148
148 rn 160
Clean Gravel: dry watercourse
Siltv Small Gravel
160
TO
175
Medium Gravel
175
TO
180
AIA: silty, dirty
180
TO
200
Bedrock: gray siltstone argillite, soft
290
TO
300
A/A: black, hardier
TO
Note: Small water seaps in sporadic fractures in last
TO
50 feet of bedrock/
TO
TO
TO
TO
1 —CUSTOMER
nc&41 Munir 1pality of Ancl :gage
Department of Health and Human Services
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
July 29, 1993
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 99516
Subject: Waiver Request for Lot 13 Block 2 Hampton Hills #1
Waiver Request #WR930038, PID #015-134-64, HA930378
Dear Mr. Moore:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 0 feet.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincere
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljm
r
^ MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-site Services Section
Waiver Review Worksheet
WR# WR930038 PID# 015-134-64
Date Received: July 7, 1993
HA# HA930378 Permit #
Legal Description: Lot 13 Block 2 Hampton HIlls #1
Engineer: Ted Moore, P.E. Flattop Technical Services
14530 Echo Street, Anchorage, Alaska 99516
Applicant: paul/Beverly Proffett
Waiver Requested: Lot line - trench to lot line - 0 feet
Criteria: 1. Geology:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
TOTAL:
2. Special Conditions:
3. Other:
Points:
Waiver is Granted: _X Waiver is NOT Granted:
List Conditions or Reasons for above: SEE Eti6bvetRS AIT'9-CKf. o
LrTTF►?
Date: /--LV—
By:
ewer
Rec #: 'a4S:)S Amount: $ '10.00 Date Paid: 1 -i -CIS
FLATTOP TECHNICAL SERV CES
u e ;�.-'..��+Wa�%.L.rti-. r..- ^�. ::b :.'1 �.a:I4l$�•i'1+~+.�r�iV:�::KP'�i.
CIVn.6 ENMONMENTAL ENGNEERLVG • ENERGY CONSERVATION 6 A.WALYSS
THEODORE. F. MOORE, P.E. July 6, 1993
PH: (907) 345.1355
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
By means of this letter we are requesting issuance of a lot line waiver allowing the existing wastewater
disposal trench serving the residence on Lot 13, Block 2, Hampton Hills SID, Addn. #1 to be as close as 0
feet from the property line abutting Zermatt Avenue. Copies of the septic system as -built inspection
report and a new as -built lot survey which I have marked up to illustrate this waiver request are enclosed.
The 1975 inspection report for the on-site sewage disposal system indicates that the sump at the end of
the trench is 15 feet from the property line; it appears that the inspector was not aware that a 50 foot radius
circle for a turnaround bulb at the west end of Zermatt Avenue had been carved out of the lot at the time it
was originally platted. The 1993 as -built lot survey indicates that the sump at the end of the trench is
actually located in the platted R.O.W., approximately 14.9 feet beyond the lot line. The property owner,
Paul Proffett, has obtained the enclosed encroachment permit allowing the system to remain in the
R.O.W., and is in the process of vacating a portion of the R.O.W. circle, which will ultimately result in
the septic system being on his lot. The lot line waiver is needed because the trench presently does cross
the property line, and even after the vacation is complete, will be within approximately 2 - 3 feet of the
property line.
Issuance of the lot line waiver should not be controversial, because M.O.A. Dept. of Public Works has
already indicated their non -objection to the location of the system, and it will have no impact on the ability
of adjacent property owners to construct future water supply and wastewater disposal systems.
Please give me a call if you have any questions on this waiver request.
Sincerely,
T-4 C-
Ted Moore, P.E.
cc: Paul Proffett
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A PORTION OF ZC-R"xrr
A-OGNUIF R.o.tu. N -AS CiEE,v
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THE INFORMATION HEREON IS FOR THE USE OF LENDING
INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS EASEMENTS OF RECORD, OTHER
RETWEN EXISTING STRUCTURES AND PLATTED LOT LINES THAN THOSE SHOWN ON THE
OR EASEMENTS AND IS NOT TO RE USED FOR POSITIONING RECORDED PLAT, ARE NOT
ADDITIONAL STRUCTURES OR FENCELIMES SHOWN HEREON
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AS•RUILT SURVEY (NO CORNERS SET THIS DATE)
1 hereby certify that I have performed •
Mortgagea•s Inspection of the following
described property)
LOT 11, BLOCK 2, HAMPTON HILLS
SUR., ADDITION NO. 1
Anchorage Recording District, Alaska and
that the Improvements situated thereon
its within the property lines and do not
overlap or encroach on the property
lying adjacent thereto, that no
leprovwwts on property lying adjacent
thereto encroach on the premlass In
question and that there are no roadways,
transmission lines, or other visible
easeawnts on sold property except as
Indicated hereoVv Dated at Anchorage,
Alaska this 2_ day of U14me
19'L3 . f0/7-/
HOLT AND ASSOCIATES LAND SURVEYORS
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240 2,5-11'0
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AS•RUILT SURVEY (NO CORNERS SET THIS DATE)
1 hereby certify that I have performed •
Mortgagea•s Inspection of the following
described property)
LOT 11, BLOCK 2, HAMPTON HILLS
SUR., ADDITION NO. 1
Anchorage Recording District, Alaska and
that the Improvements situated thereon
its within the property lines and do not
overlap or encroach on the property
lying adjacent thereto, that no
leprovwwts on property lying adjacent
thereto encroach on the premlass In
question and that there are no roadways,
transmission lines, or other visible
easeawnts on sold property except as
Indicated hereoVv Dated at Anchorage,
Alaska this 2_ day of U14me
19'L3 . f0/7-/
HOLT AND ASSOCIATES LAND SURVEYORS
/yo
240 2,5-11'0
MUNICIPALITY OF ANCHORAGE
ENCROACHMENT PERMIT
THIS AGREEMENT, made this day of J ,
19, by and between Paul G. Proffe n Beverly M.
Be Proffett, and their heirs, administrators, and assigns,
hereinafter called "PERMITTEE", and the Municipality of Anchorage,
municipal corporation organized and existing under its Charter and the
laws of the State of Alaska, hereinafter called the "PERMITTER".
W I T N E S S E T H:
WHEREAS, "PERMITTEE" is the owner of the following described
property:
LOT 13, BLOCK 2, HAMPTON HILLS SUBDIVISION
ADDITION NO. 1, according to the official
plat thereof, on file in the office of
District Recorder, S.M. Alaska,
and;
WHEREAS, "PERMITTER" owns and maintains the 50 foot street
right—of—way this street right—of—way is more particularly described
as follow:
The 50 foot right-of-way at the southwest
corner of the intersection of Olympic
Street and Zermatt Avenue,
and;
WHEREAS, "PERMITTEE" has constructed a septic drain field which
encroaches upon "PERMITTER'S" right—of—way;
NOW, THEREFORE, it is mutually agreed between the parties hereto
that:
1. The "PERMITTER", acting through the Director of Public Works,
hereby grants to the "PERMITTEE" the privilege of allowing its
presently constructed septic drain field to encroach upon the
"PERMITTER'S" street right-of-way a distance of 14.9 feet as shown on
Attachment "A", included herein.
2. The "PERMITTEE" agrees forever to indemnify, defend, save and
hold harmless, the Municipality, its officers and employees, from any
and all lawsuits, claims or actions brought by any person for or on
account of damage to property or injury, disease, illness or death of
persons, including all costs and expenses incident thereto, arising
wholly or in part from or in connection with the existence of,
alterations, maintenance, repair, renewal',-Cc�co:istruction7,060etat�6ns_„
use of removal of the encroaching septic drain field situated upon
"PERMITTEE'S" property and encroaching upon "PERMITTER'S" street
right-of-way as described herein.
3. The "PERMITTEE" shall not assign or transfer any of the
rights granted herein to another individual or company without first
notifying and securing the approval of the Director of Public Works.
4. This Agreement and Permit grants "PERMITTEE" no interest in
"PERMITTER'S" real property whatsoever, except only the encroachment
rights described herein.
5. The "PERMITTER" reserves the right to revoke this permit upon
twenty days (20) written notice to the "PERMITTEE" The "PERMITTEE",
agrees upon said notice of revocation, to immediately move said
encroachment from the street right-of-way. Should the "PERMITTEE"
refuse or fail to comply with said written notice, the "PERMITTER",
may without further notice to the "PERMITTEE", remove or cause to be
removed the encroachments, and the "PERMITTEE" hereby agrees to
reimburse the "PERMITTER" for all costs incidental to the removal
thereof.
In addition to the mutual promises heretofore made, the
"PERMITTEE" hereby promises to pay the "PERMITTER" a one-time permit
fee of one hundred dollars ($100.00).
IN WITNESS WHEREOF, the parties hereto have hereunto set their
hands and seals the day and year first hereinabove written.
Grantee: Grantor: MUNICIPALITY OF ANCHORAGE
2
At -of -=way En orcemen Supervisor
07-06-93 ' 702.85 *100.00'U'
STATE OF ALASKA )
)ss
THIRD JUDICIAL DISTRICT )
HIS IS TO CERTIFY that on this day of
30 19 5 before me, the unders gne a Notary
Pu n an for }Tie Stade —of/� Alaska, duly commissioned and sworn as
such, personally appeared .fian 6J. // For' , know to me
to be the Right—of—Way Enforcement Supervisor for the Mun cipality of
Anchorage, Alaska, who executed the foregoing instrument, and
he/she/they acknowledged to me that he/she/they executed said
instrument as the free and voluntary act and deed of said corporation
for the uses and purposes therein mentioned, and that he/she/they was
authorized to execute said instrument.
WITNESS my hand and official seal on the day and year first above
written.
My Commission Expires: My CommUYonExpirh:
1pr114,1994
STATE OF ALASKA )
)ss
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this day of
19g�3 , before me, the undersigned, a Notary
Pub in an or a Sta eAlaska, duly commissioned and sworn as
such, personally appeared t / �_ know to me
to be the individual name a ein w o cu
the foregoing
instrument, and he/she/they acknowledged that he/she/they did so
freely and voluntarily for the uses and purposes therein mentioned,
and on oath stated that he/she/they was authorized to execute said
instrument.
WITNESS my hand and official seal on the day and year in this
certificate first above written.
PUBLIC in an or A as a
My Commission Expires: MYCommlutres
--ApN11,19941994
3 07-06-93 702.0 *100.006
JUN -02-93 WED 13:21 MOLT LAND SURVEY 9073433713 P.01
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�l�toc`imen�` �`�l •
THE INFORMATION HERECN IS FOR THE USE OF LENDING
INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS EASEMENTS OF RECORD, OTHER
11MEEN EXISTING STRUCTURES AND PLATTED LOT LINES THAN THOSE SHOWN ON THE
OR EASEMENTS AND IS NOT TO RE USED FOR POSITIONING RECORDED PUT, ARE NOT
ADDITIONAL STRUCTURES OR FENCELINES SHCWN HERECN
C
AS•SUILT SURVEY (No CORNERS SET THIS DATE)
I horsey certify that 1 have performen a
Mortgagoe•s Inspection of the fottoring
described prapertyt
LOT 13, BLOCS 2, HAMPTCN MILS
SUB., ADDITION NO. 1
Anchorage Recording District, Alun am
that the Improvements situated thereon
ire within the property tines and do not
overlap or encroach on the property
tying adjacent thereto, that no
Ittpreveaewtts on property lying adjacent
thereto encroach on the preetua In
question and that there are no roed.ays,
transmission tines, or other visible
easeernts on *aid property except as
Indicated hereon. Dated at Anchorage,
Alaska this 2AJ day of a^d
19n. FB/7•/
HOLT AND ASSOCIATES LAND SURVEYORS
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Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 SAF ETY
Certificate of On-Site Systems Approval
Parcel I.D. 015-134-95 Expiration Date: [ (9 `3
1. GENERAL INFORMATION
Complete legal description Hampton Hills #1 , Block 2, Lot 13
Location (site address) 7740 Zermatt Ave.
Current Property owner(s) Linda Wrigley & Walter Quigley Day phone
Mailing address
Real Estate Agent Kevin Taylor Day phone (907) 244-7437
2. TYPE OF DWELLING:
E Single Family (w/wo ADU)
111 Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: L4f d-ite ttl fl trCe Date: -1/3-0
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ a U21-5° Waiver Fee $
Date of Payment 1(l i 1 Date of Payment
Receipt Number 0 HO MO Receipt Number
COSA# 0)CA.8 (327 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, PE Date 6/06/18
p F \v�\
•
* 49 TH �� *
6. DSD SIGNATURE <� E
System #1 Approved for J bedrooms . Michael E.Anderson ."'/�-1
System #2 Approved for bedrooms r�+#�Fcsr. Y 4`81;E .�.:.c'
Disapproved �ill��\F`�IO,`'
Conditional approval for bedrooms, with the following stipulations:
\Q i,\V 1' OF 444
J` O
ON_8171 -
WATER AND m.
WASTEWATER
PROGRAM p
aN •�.
nrc-
1
By: J 1��--. Original Certificate Date:-7 E - 1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_f c
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: Hampton Hills #1 , Block 2, Lot 13 Parcel ID: 015-134-95
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 9/25/75 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 300 ft. Cased to 162.2 ft. Casing height (above ground) 38 in.
FROM WELL LOG AT INSPECTION
Date of test 9/25/75 3/27/18
Static water level 140 ft 127 ft.
Well production 3.5 gpm 4.0 g p m
WATER SAMPLE RESULTS:
Coliform N- colonies/100 mL Nitrate li) mg/L
Arsenic kl D ug/L Date of sample: ( � L I , I, Collected by: Poi'(�� t n(I���/l
J
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/22/18
Tank size 1 ,500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
Date installed 8/05/75 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF' System type Deep Trench
Length 43.5 ft. Width 3.0 ft. Gravel below pipe 8.0 ft.
Total depth 12 ft. Eff. absorption area 835* ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/22/18 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 51 in. Water added 868 gal. New depth 59 in.
Elapsed Time: 1440 min. Final fluid depth 3 in. Absorption rate >= 750 g p d
None
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 in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout X100'
Sewer/septic service line >25' Holding tank X75'
Animal containment areas >50' Manure/animal excrete storage areas X100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation **7.5� Property line >5' Absorption field >5'
Water main >10Water service line Surface water
Wells on adjacent lots X100'
ABSORPTION FIELD ON LOT TO:
Property line 10 Building foundation Water main
Water Service line >10 Surface water 100 Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Recent Test Holes and Percolation Tests indicate sand (SW) with absorption
rates <5 Min./Inch. **Bottom of tank is above 1 :1 influence line from footing.
G. ENGINEER'S CERTIFICATION �-��0F AC��`i
I certify that I have determined through field inspections and P��O.
''9S ��+
review of Municipal records that the above systems are in /rC0.. �4A •:7y +j
conformance with MOA COSA guidelines in effect on this date. *; 49 TFI /\ ••*
Engineer's Printed Name Michael E. Anderson, PE Od 111(A-ti
v1 �C';_ tl
Date 7/09/18 • Michael E.Anderson/
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1� se,�..-..7-i.3.-(.6\.• vm
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COSA brown sheet 10-10-12.doc
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0.5 LOT 13A so °° q)c. 122 SCALE: 1 "= 30'
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67°ss, \ \ 0 Staked &flagged East and North property limes 5-2418
41"IA t— RECERTIFIED 5-21-18, 6 25 1./WO
AS-BUILT NO CORNERS SETT! RATE
32,' �6' 'oI��' i. I hereby certify that I have performed a Mortgagee's inspection
ase ,, of the following described property: LOT 13A, BLOCK 2,
yF
-e,1 HAMPTON HILLS SUBDIVISION, UNIT No. 1
LOT 12
` , — anchorage Recording Precinct,Alaska, ana mat the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
-, adjacent thereto, that no improvements on the property lying
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
J visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 28th day of April ,2006
EASEMENTS OF RECORD, OTHER THAN Found 2 2/2"Aluminum 4w
Monument FRED WALATKA&ASSOCIATES, L.L.C.
THOSE SHOWN ON THE RECORDEDI Engineers and Surveyors
PLAT ARE NOT SHOWN HEREON. Fb 06-3, pg 25-26
Fb 18-3, pg 30-31 907-248-1666
Municipality of An
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-134Ag5I COSA #_ 0(p D Efl
Expiration Date: — - O Co
1. GENERAL INFORMATION
Complete legal description Let 13A, Biocc 2, Hampton Hils SubdMsion#(
Location (site address) 7740 Zermatt Drive Anchorage, AK 99516
Current Property owner(s) Ricardo Felix Day phone
Mailing address 7740 Zermatt Drive Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Jody Moses Day phone 242-3137
Mailing Address
Unless otherwise requeslod, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class _____,Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal'and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be. reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seat affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system Is (are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information
obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Englnisering
Address - P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone 522-7773
Date X006
! 49th`
6. DSD SIGNATURE jtmp!Am r- mmsom
1/ 1�f No. a-4
Disapproved.
3 bedrooms. �i�•/,,a, ��
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checidist _X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By. C7417U90r Original Certificate Date: _'6--j-06
(n«.,,os)
Municipality of Anchorage
Development Services Department
Building Safety Division
OnSRe Water & Wastewater Program •
4700 Bragaw Street
P.O. Bar 198850
Anchorage, AK 99519-850
www.muni.orp/onaRe
(907) 343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Let tali Brock 2, Hwn mo Has &bdrvwm Parcel ID: 015.1aA_9 r
A. WELL DATA
Wen type Pdvete H A, S. or C provide PWSID C _ Well Log (YIN) Y
Data completed arms Sanitary seal (YIN) Y Wires property protected (YIN) v
Total depth soo R. Cased to L52 R Casing height (above ground) >24 in.
FROM WELL. LOO AT INSPECTION
Data of test 9=75 4r25noos
Static water level 140 It. t22A fL
Wen production 35 g.p.m. 7.0 g,p.rn.
WATER SAMPLE RESULTS:
Coliform o coloniesh00 mL Nitrate No mgA. Other bacteria 0 colonies/100 mL
Arsenic: RD mg/I Date of sample: 4/17= Collected by: L Hwnwdm
B. SEPTICIHOLDING TANK DATA
Tank Type/Material aeoadsred Date installed 8WO75
Tank size 1250 gal. Number of Compartments Orw Cleanouts (YM) v
Foundation cleanout (YM) Y Depression over tank (YM) N High water alemr (YIN) N
Date of pumping 4116!2008 Pumper Ord MacD~s Pmft
C. ABSORPTION FIELD DATA
Date installed SM975 Son rating (g.p.dA? or ft2/bdrm)225 aFBDRM System type Deep Tmech
Length 4&5 R Width arewm 3 ft. Gravel below pipe 8 R
Total depth 11t13 2 Elf. absorption area A' Monitoring tube Y Depression over field N
Date of adequacy test 4MAN Results (Pasa/Fam Pan For 7N" bedrooms
Fluid depth in absorption field before test 41.2 in. Water added 80.2 gal. New depth in.
Elapsed Time:1.440 min. Final fluid depth 41.5 in. Absorption rate >c 450
g.p.d.
Any re)uvenatbn troab hent (peat 12 mo.) (YM & type) H yes, give date
D. LIFT STATION
Date installed
'Pump on' level at _ In.,
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ In.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot >tar
Absorption field on let
Public sewer main
WA
Sewer /septic service One >25'
Animal containment areas WA
Manhole/Access (YIN) _
High water mann level at
Meeh alertn & dr pdt requaemems?
On adjacent Iota >tca
On adjacent Iota >10a
Public sewer menhoWdeanout WA
Holding tank WA
Manureh]nmal exrete storage areas WA
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >s Property One>S
Water main WA
Absorption field >s
Water service One >19 Surface water >tae'
Wells on adjacent lots >tar
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One a Building foundation >ta' Water mein NfA
Water Service One >tQ Surface water >tar Driveway. pandrilksNele storage >s
Curtain drain None Noted Wells on adjacent lots >toa'
F. COMMENTS: SftLot Lim Wal artarAbserpamTrento
G. ENGINEER'S CERTIFICATION
I cer* that I have defemdned Mtmgh field krspecf = and
review Of MunibW re00nfs that the above systems are in
coNormance wJfh MOA COSA guldellnes a► effect on olds date.
Engineer's Printed Name Mwrsel E• Anderson. P.E.
Date srsnsoe
COSH Fee 8 30 Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number S Receipt Number.
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MUNICIPALANCHORAGE
• �' DEPARTMENT OF HEALTH
& HUMAN SERVICES
Division of Environmental Services
On Site Services Section to
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # I - in Ll HAA # 11
GENERAL INFORMATION
Complete legal description Loa 13, SLK 2 9AMPTON HILLS it
Location (site address or directions) _77'40 ZERMATT AV
-_ ANLHoRA E 1 AK 89516
Property owner PAUL iBEVERLY PROFFETT' Dayphone 20-95gS'
Mailing address 774o ZERMATT ANru Ak g9,5/L
Lending agency Nnrtaeyk Har-I-oay& Day phone 27G- YZro
Mailing address—_ 2SSV Oe+al; SA.,Cu Fe_ IYOd 4AMoi� Ak 99t oT
Agent KEN Mc KEAN REMAx Day phone 276' -2-767
Address 2600 Cordae -C-1. f}AcAororoe Ak 9gSa3
Unless otherwise requested, HAA will be held for pickup
2. NUMBER OF BEDROOMS: 3 V
3. TYPE OF WATER SUPPLY:
Individual well _y1*1
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.
72-025 (Rm. 1,91) pool MOA D21
5.
6.
M
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 Sfate codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm F laJLI oe T-ecti n t ecIf Se. -vita Phone ? ys--I3ss
Address /HS30 6ctio Sfftr nc� P A -h 99Sre
Engineer's signature Z4�'t� -f wle� Date 7u ty
DHHS SIGNATURE
49TH
................
THEODORE F. 400RE
CE -35£1 4
p ac
P
RfA�'.a�'�•
X_ Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Additional Comments
S 611 Pa ay
bedrooms, with the following stipulations:
Date Z -9f—.P_3
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 thei r tending 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.
rros Mw. iAn Back MOA m
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lor 13 Bk 2. HAMPTON lirccs u' parcel I.D.
A. WELL DATA
Weil type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) y Date completed 1121hr Driller_ -M -W PRILLIA16
Total depth 300
P Cased to 162 Casing height 33"
Sanitary seal (Y/N) y Wires properly protected (Y/N)y
FROM WELL LOG AT INSPECTION
Date of test 9 12575 12q MUNICIPALITY OF ANCHORAGE
..,,enNNsF_NIALSERVICES DIVISION
Static water level
Well flow
Pump level
IYD'
3.5' g.p.m.
SEPARATION DISTANCES FROM WELL TO:
12 1Y 1; 071993
civE�
> ZyN'
Septic/holding tank on lot Ito` -ro C.o . -;On adjacent lots > /oo
Absorption field on lot -- /20, to GO. : On adjacent lots > roo
Public sewer main > too, Public sewer manhole/cleanout loo'
Sewer service line loot Petroleum tank NONE OBSER✓Eb
WATER SAMPLE RESULTS:
Coliform O cot
1100Me
Nitrate 0.1 ale /.0
Other bacteria
-004d rysorhrd(
Date of sample: _411,193
Collected by: -
ELAT7aP TEcp
Svcs
B. SEPTIC/HOLDING TANK DATA
Date installed 2151/75 Tanksize 1260 6AL Compartments
Cleanouts (Y/N) - Y Foundation cleanout (Y/N) % Depression (Y/N) N
High watei alarm (Y/N) N.A. Alarm tested (Y/N) - N.A .
Date of pumping Tutt, 7� 1993 Pumper_jrLaacr
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot - 110' FRon CO. On adjacent lots > 100' Foundation Io Fk,n C.O.
To property line 30' Absorptionfieid 10 Water main/service line Soy
Surface wate r/drainage >/001
72-026 (Rev. 7191) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date Installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
—Manufacturer—
Manhole/Access
Manufacturer_Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" level at
Cycles tested
Surface water
Date Installed ' SJ'S� 7S Soil rating 215 91 /BDRM System type TRENCN
Length 4 3 Yt Width 3 7 Gravel thickness 8 Total depth It .S - 13
Total absorption area 9to O Cleanouts present (Y/N) y
Depression over field (Y/N) N Date of adequacy test 5/26l93
Results (pass/fail) Po,sd -for 3 bedrooms
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date N .A .
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 122 On adjacent lots >100' Property line
To building foundation 19' FRon Go . To existing or abandoned system on lot N.A•
Onadjacentlots > 50' Cutbank N, A. Water main/service line 50
Surface water > 1001 Driveway, parking/vehicle storage area S
Curtain drain 'NONE 085ER✓ED
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this Inspection.
A•w,.......',so
� � `.
i/ '
Signature l' TH
Engineer's Name Th",:eOrr /-tcx7.r �••••••••••••••••••••••• ..Q
t......... .....�...
Date ✓" ()C_6� N9 3 �� THEODORE F. MOORE
••� CE -3589 �•p
+14 lgly fpf1,,•�•kwta�E®��
HAA Fee $ 0 '0170 Waiver Fee: $ 7d ter' I'^ e
Date of Payment 1. 1.9-5
Receipt Number 2A 2/7-1683(
72-M (A". 3191)Beck MOA 21
Date of Payment -1 '1 -93
Receipt Number ;;LL)fi1S
MUNICIPALITY OF ANCHORAGE
• Department of Health 6 Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel l.D. # (1l'�n- j 2,L`-LLj HAA It 0 Qqa 1Q'Zn
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
.41362- /////.r -1/
Location (address or directions)
... ....; ' P.
(b) Property owneJ•^i 0 Telephone: (home) Business
Mailing•Address ' '
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
Telephone
(e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family;f Number of bedrooms_
3. WATER SUPPLY
Individual WeIl1iZ( Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status. '
4. SEWAGE DISPOSAL
On-site)4 Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025(A..mee) Page 1 of 2
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N\G�vp,� �SE0.v\`E5
E��RO�ENW', i9a9
A. WELL DVJC�'`v�o
,0r, ✓,4e
Well Classification
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Well Log Present �91N!)
Legal Description: L / 3 Q2 Na -.?i,. /,-///S-
Well
/s
If A. B, C. D.E.C. Approved (Y/N) A*
Date Completed Zr5l+PY /9'71' Yield Cc Qrfai f! tiG F.srd/�,L
Total Depth 3 00 Cased to lkZ'F Depth of Grouting uN,e4U0un
Static Water Level /1f -5- Yy! B •"^S Pump Set At -y�, ��,� N•
r
Casing Height Above Ground `3 Sanita S I C '
Electrical Wiring In Conduit�N) .
SEPARATION DISTANCES FROM WELL:
ry ea on asmg&IN)
Depression Around Wellhead (YO
To Septic/Holding Tank on Lot _ALL);? 1 ; On Adjoining Lots > /ao /
To Nearest Edge of Absorption Field on Lot -- /,7n, ; On Adjoining Lots ->/0o r
To Nearest Public Sewer Line A�llf To Nearest Public Sewer Cleanout/Manhole 'y/'R
To Nearest Sewer Service Line on Lot ? SZ'
Water Sample Collected by / • 124;j , Date iZ6ZS9
Water Sample Test Results kve4',4-
Comments At.4 1-144 V,tVCL„V
B. SEPTIC/HOLDING TANK DATA
Date Installed g' > 7 Size / Z J�D No. of Compartments
Standpipes (5N) Air -tight Caps &N) Foundation Cleanout (
Depression over Tank (Yo Date Last Pumped 7 SDI" 1
Pumping/Maintenance Contact on File (Y/N) X12 • for _- AJ/ -4
Holding Tank High-'Waferj�far5fY/N) Temporary Holding Tank Permit (Y/N) 41
SEPARATIOt4 DISI -KNEES FRCtM,�VTIC/HOLDING TANK:
To Water -Supply Weil "N~ ?CO+ To Building Foundation
To Property Line To Disposal Field /L t `
...........,..•....•,.
To Water Mlio/gAi eliner'9' >c3b/
• �•++'.iJ • F
To Stream, Porld,.Lake or, MaWr Drainage Course
Comments -
72 -026 (A".
omments
72-026(A". 7/88) F, nl Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata o7a Type of System Design Tr e e 4
Date Installed Length of Field 7`•? • S
Width of Field 76 Depth of Field
/ Gravel Bed Thickness
Square Feet of Absortion Area 6 V Statndpipes Present&VN)
Depression over Field (Y& Date of Last Adequacy Test ?L7Z�Z
Results of Last Adequacy Test �L✓'
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well /30 To Property Line 5
To Building Foundation 7s To Existing or Abandoned System on
Lot NIA : On Adjoining Lots > 30/
To Water Main/Service Line 720 To Cutback (if present) N/A
To Stream, Pond, Lake, or Major Drainage Course >/oo
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed .
Size in Gallons
"Pump On" Level at —
High Water Alarm Level at
Tested for
Meets MOA Electrical
Comments
Dimensions
Manhole/Access
Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
"Check Permitted Bedroom Rating Against HAA Request'
certify that I have checked, verified, or conformed to all MOA and HAA
inspection. / ,
Signed
i
59
,
Company
*
Date 7 162/��F
d
MOA No.
Receipt No. �2-1,�-6 �Z- r73,`3
Date of Payment
Amount: $
Receipt No. _
Waiver Fee: $
Date of Payment
72-026 (8.,,.7/88) Back Page 2 of 2
on the date of this
••
• C. ofto, ]IC.f; 1
• ••
CE -2251 ••* "A
Seal
n
_ W.
•
INSPECTION APPOINTMENTS
DATE RECEIVE
TIME
TIME
TIME /
DATE
DATE
DATE
—71c?�.Q
INSPECTOR
INSPECTOR
INSPECTOR
ro
/�
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
-\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL F: OTECTION
825 L Street - Anchorage, Alaska 88501
1
JUL 2 1981
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPS RTYOWNER t� ANA L . C( �S �� PHONE
ll i,- 34{I -(cl to
MAILING ADDRESS
53Z k -- f3o X zo ,+S • A)c--, cq -I-
PROPERTY RESIDENT (If different from above? PHONE
T. BUYER PHONE
32—.V
MAILING ADDRESSUn���^
3. LENDING INSTIT/•IT.IIOON
ZINAT'[.
PHONE
-13 Ste$
SL
MAILING ADDRESS STCG�T
4. REALTOR/AGENT
c' Sk—GL t! 0E NS
PHONE
Z7U-27( 1
MAILING ADDRESS
c.C- vl G ►a i
5. LEGAL DESCRIPTION
GUT 3,
Bt,OCtc z, �AAwiPTOA► HILLS -
STREET LOCATION
co2tjc�
�I7 p MATT co I -F
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
B -'SINGLE FAMILY
❑ One &r ---Four ❑ Other
❑ MULTIPLE FAMILY
❑ Two ❑ Five
❑ Three ❑ Six
7. WATER SU LY
L INDIVIDUAL'
a ATTACH WELL LOG. A well tog is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
G�--'INDIVIDUAVON.SITE"
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or 01-folding Tank
Size: I If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELLTO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
OY
3 '
V APPROVED FOR' BEDROOMS
❑ CONDITIONAL APPROVAL (letter mustac pany certificate)
ElDISAPPROVED
DATE 1I
BY\^/
72010 (Rev. 6/79)
moi' • n
-Municipality
d"
Anchorage
July 9, 1981
r"N,
\ 825 "L" STREET
^-R+� ANCHORAGE, ALASKA 99501
(907) 264-4111
GE GR GE M.SULLIVAN.
MAYOR
DEPARTMENT OF HCALTH AND ENVIRONMENTAL PROTECTION
Diana L. Orren
Star Route A Box 2048Q
Anchorage, Alaska 99507
Subject: Lot 13 Block 2 Hampton Hills Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1) The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
�II our review.
ct(2) The septic tank pumped with a receipt submitted to
this office.
(3) An adequacy test needs to be performed on the existing
leaching area. This test will determine if the system
4' is adequate according to National Standards. A listing
� qf rivate firms performing the test is enclosed. This
L},e rt needs to be submitted to this office for our
r4e7are any further questions, please call this office
\\ at r
�3utT�� \Sincerely,
5>
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: First National Bank of Anchorage
8 Debbie
Post Office Box 4-2090 99509
Skell Goens
% Re/Max Properties
. • (0�*\ r'`
ALASKA Cf 1110f1MRAL COIITROL SCRUICCS, Inc.
Enqinetrinq 6 Enuironmental Studies
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
JUL 171981
6/15/81 RECEIVED.
i•Tr} b •.• • s
• • •••t•Ia t
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 696 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SOUS RATING OF THE SYSTEM AT CONSTRUCTION WAS 225 AND NOP1
IS 232 SOFT/ BEDROOM.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
THE SEPTIC TANK'WA4`PLMPED ON 6/15/81 .
��'�Q:•• A ••..salt.:' ..
►�• 221.4
4 +R
1220 West 25th Auenue 9 Anchorage, Alaska 99503 0 (901) 276-1361
Time
APPLI^MT FILLS
OUT UPPER HAI -''-ONLY
Time
Time
Property Owner J4 M f r d /iyC, o f ,ti •
K kf.
Phone
i
Mailing Address
5/7A Olt zip Code '719'60?
4'r to
Buyer
/
Dale
Date
Address -
Inspector
Zip Code
Lending Institution
�1ZsCf�.h ��� ��m Mpr�,L
�T
Phone
Address
Zip Code
4
Realty Co. 6 Agent
.nGn�-c
Phone
Address
( ) APPROVED BEDROOMS
Zip Code
( ) DISAPPROVED
Legal Description
ZOt f 3 /3 /oC Z <'%+n//i /�l /1n 1./
Street Location
Type of Residence
Date Sewer Installed
Well To Absorption Area
;Single Family
Septic Tank Size
O Multiple Family
No. 01 Bedrooms
❑ Other
Water Supply
/��
)4 -Individual =
.1
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
O Community
For wells trilled prior to that date. give well depth (attach log If available).
O Public Utility
Sewer Disposal
P�Jndlvldual
L
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
4'r to
Date
Date
Dale
Date
Inspector
Inspector
Inspector
Inspector
Field es: (
MUNIC1PALITY CF ANCHORAGE
4
CE?I CF Y4!t'rl .,
ENVI.(CA:;KNrAl. P93fiCTION
APR ;& 7 EZI-,
RECEIVED
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE Ll' --7"Q)
BY:
Solis Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
72 W3 iA
0
.,tATER ANCHORAGE. ARCA BOROU,.,1
Department of Environmental Quality '
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER E WATER FACILITIES '
Type of Inspection: CMRO VA FILA CONV (/ .
2. Property Owner:
4
6.
7.
9.
Mailing Address: n„_ &P 7219 Day Phone2yVAI,
r
Name of Buyer:
Mailing .Address: r'i/;< 41.. p, &1zy Day Phone
Name of Lending Institution:
Mailing Address: Phone
,
Name of Realtor or.Agent:
Mailing Address:
Legal Description:
Location: 151r
Phone
Type of Facility to be inspected
Water Supply
I
`�� 3' iJo. Bdrms
Type of Supply: Public Utility Individual k
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility Individual (on-site)
If Individual,date of installation A 7f
r 1:30 -
rr 7-5
MUNICIPALITY
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" Street, Anchorage, Alaska 99503 — 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONV
2. Property Owner:1-,-.•.=
Mailing Address: j A Az -g:- Day Phone � S 3:6.7,,�Y
3. Name of Buyer: �JFl7rrF.t�
Mailing Address: &T /.T T!X 2��7%,t• Day Phone
4. Name of Lending Institution: F Ls1* oa:a„zt
Mailing Address: 5a dy& l -0/ Phone ,Q 21V —yZPSl
5. Name of Realtor or Agent: ASSse,
Mailing Address:
Phone
6. Legal Description: Ln% /�T 4 !� /•t' Zf��¢�yr
Location:
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply: Public Utility Individual
If Individual, number of dwellings presently served
If Individual, depth of well Z5042
9. Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation / 577S
EQ -037 (Incl
No. Bdrms.
v
Individual (on-site)
r�
F
i
Y
f'
V7'
f
e- % 4
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
"C" Street, Anchorage, Alaska 99503 274-4561
Date Received / 0— -A /- 7S
Time of Inspection 74-o 4-,n2
Date 'of Inspection 1--7.-
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by:
�-
/,dl nA7.
Mailing Address: ,-
n1&1C 7 � 7
c Phone: a 9- c/c/S1
hn�" PR
2. Property Oe ,ac_! U,(- � Phone:
Mailing Address: D
3. Legal Description: ,Bk -2 X4 -11t,
4.
Location: 14-1 E.
5.
Type of facility to be inspected
S is D No. of bedrooms 3
6.
Well Data:
o-...�
(n� .
A. Type Y� 1�-��
B. Depth
C. Constructiona4A&xnA
D. Bacterial Analysis
81/3
7.
Sewage Disposal System: 19 7.r
A. Installed Y 7,i
/�
B. Installer l -cu
C. Septic Tank: 1. Size / 2. Manufacturer
D. Seepage Pit: 1. Absorption
Area 2. Material
rc
E. Disposal Field: Total length
of lines (04 G Ai
3
ria
8. Distances:
r r
A. Well to: Septic tank %/ S Absorption area 00 -f- , Sewer Lines
Nearest lot line 10 f- Other contamination
B. Foundation to septic tank 8 / , Absorption area
n r
C. Absorption area to nearest lot line r-5
EQ -034 (1/74) Page 1 of two pages
1?
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
330 "C" Street, Anchorage, Alaska 99503 274-4561
Y�\ Date Received (1r,�. 'Q0. lgrL6
(� Time of Inspection
�0 Date of Inspection �r �r�. ig06
REQUEST FOR APPROVAL OF Us— a'.00 M
INDIVIDUAL SEWER & WATER FACILITIES
FOR tie-6a.m P Lll
1. Approval requested by:
Mailing Address: �n1 Phone:
2. Property Owner: PxrrI I% Phone: X33_Q� AL1
Mailing Address: _o ri Pr Q
3. Legal Description: _ k4 y -q 'Ont M o�c`,yL 'dale
4. Location:, -
5. Type of facility to be inspected r; No. of bedrooms a:v in
6. Well Data:
A. Type B.
C. Construction D.
7. Sewage Disposal System: pyr�Y
A. Installed 1 rlr3 B. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
Depth
Bacterial Analysis
2. Manufacturer
2. Material
A. Well to: Septic tank , Absorption area Sewer Lines
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
Page 2 of two pages - Re m^Jor Approval of Individual �,8 Water Facilities
Legal, Description �.zf3 g� .2
Comments
Approved rr. zl-d-e�44!74Disapproved Date _
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify -that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilitfis.
are operating satisfactorily.
SIGNED Date
EQ -034 (1/74)
Page'2 of two pages - Rec^'for Approval of Individual S & Water Facilities
Legal Description
Comments
Approved
Disapproved
Date 41-.x -7J'
Apoibval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
Fi1CMz7
EQ -034 (1/74)
Date