Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
HAMPTON HILLS #1 BLK 3 LT 4
Hampton Hills Block 3 Lot 4 #015-134-69 Municipality of Anchorage On-Site Water and Wastewater Program a (907) 343-7904 Page 1 of 3 OM-SFE bl'JASTEWA,TER MSPECT00 I REPORT Permit Number: OSP181254 PID Number: 015-134-69 puvv-111iily: U Sinjie Fattiiiy (Jr) ❑ Duplex(D) LJ iviuiiipie (3r dtiuiui v) Piujeci. t_I ivevv LJ Uj�Yidud II,IIName: Conrad & Cheryl Perry®�► ° I®N FIEF® ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10200 Hampton Drive Anchorage, AK 99507 ❑ Other Phone Number of Bedrooms uSoil Rating Total depth from original grade Jul-/L/-/4U44 4 GPD/SFJ Ft.� LEGAL DESCRIPT1OH Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hampton Hills #1 3 4 Fill added above original grade Ft., Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I Ft.� � -Ilf-AMA T 1UN ulS T A4mloES To Septic Absorption Holding Sewer tlTotal absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Nry Ftz Ft. Well >100' N/A N/A w/A >255' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity c 1,250 Gal.j Surface Water >100' N/A N/A N/A Material lNumber of compartments 1 Steel 2 Lot Line >5' N/A N/A N/A NA (LIFT STATION Foundation >10' N/A N/A N/A Manufacturer Capacity Gal. I Curtain Drain None Noted Ramain5*Tarek ot`iiy perriiii. Existing septic Pump on level at in. jPump off level at in. High water alarm at in. tank decommissioned per MOA Code. Pump make and model Electrical Inspections performed by l PIPE PUTA T ERIAL House to tank D3034 Tank D3O34 Installer drainfielto d Denali Excavating Drainfield CO/M1113031-I Inspector MEA BENCHMARK fi'lIARK (Assumed elevation) 100 ft I Inspection5c 8-20-18 8-20-18 Location and description dates: 2 Bottom of siding on West wall. 3rd 4th COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �0F A����� Conditional Approval: Date o�Q'` . � �: 49 TH •.� V Iwo v� • '. Michael E. Anderson Approved OL �,(� 4, ea_ t Lzl Date (njd19" �'� ��c • 4381-E ••x`40 �� Fop • .. NP�� OFES�0�4,G Inspection Report_9-1-12.doc HAMPTON M LLS ?°7 l , LOCK 39 LOT 4 PERNT -,k- OSP 181254 ml m zl \CAD\Forge logo.jpg Qv �� A49 7H B��un. � .f��-x.�'•_-�'-��-�./�. ...................... Michael E. Anderson �� �F`•• 4831-E �tij��PROFESSIONP c" LOT A EXISTING ABSORPTION TRENCH 1,250 GALLON SEPTIC TANK LOT 19 POD � 015-134-69 1¢ CoRRq� \ �k } EXISTING WELL ' ............ �F DRM HOM a � j I NOTE: I EXISTING SEPTIC TANK /in nlC1pinnlf'n ncn nnnA ✓Lvv I v I I v lvv wrVl_v rug rvrvn %-.vLJL-. PLAN AS—BULT (NO SCALE) 0 50 100 L_ j— -_1--f 1 1 FEET 1"=50' A B 2CO1 29.0 11.6 SV1 28.7 17.6 SV2 21.6 23.5 2CO2 1 19.9 1 25.2 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS -FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE CV �CDTI!` 1/GAIT TH -TEST HOLE HAMPTON TON H US 4M, BLOCK 3, LOT 4 PERMI T ', OSPi OO 1254 P0® 8 ®15-134-69 vu. a ACADTorge Iogo.IPg P RO " � L E " S — B "" " L (NO SCALE) 'r MUNICIPALITY OF ANCHORAGE �N ._"_,..�� 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 to ' Department 44CM O'Nkot On-Site Wastewater Disposal System Permit Permit Number: OSP181254 Effective Date: 8/15/2018 Work Type: SepticTank Upgrade Expiration Date: 8/15/2019 Tax Code Number: 01513469000 Site Legal Address: HAMPTON HILLS #1 BLK 3 LT 4 G:2540 Site Mailing Address: 10200 HAMPTON CIR, Anchorage Owner: PERRY CONRAD & CHERYL FAMILY Lot Size in Sq Ft: 50673 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field IZI Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: V-01.71/0etellrOW-' Date: /5 6 Arg Issued By: 41-(A.), 1 / Date: MUNICIPALITY OF ANCHORAGE criQ p Community Development Department • �u <-.Dhone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program OO$ AUG 08 �Z ON-SITE SEWER/WELL PE T APPLICATI• d � Parcel I.D. 015-134-69 01 6 8 Property owner(s) Conrad & Cheryl Perry Day phone Mailing address 10200 Hampton Drive Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Hampton Hills #1 , Block 3, Lot 4 Legal description (Township, Range & Section) Lot Size 50,673 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial n Single Family (SF) ❑X (w/wo ADU) Septic Tank IXl Upgrade n Duplex (D) n Holding Tank Renewal I IMultiple Dwellings Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 0/5 Waiver Fees: Date of Payment: 2/q Date of Payment: Receipt Number: OlOY&D Receipt Number: Permit No. 0,S/oig/ 1/ Waiver No. Permit App_ : ::..c jI. ) ' GE ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) August 8,2018 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage,AK 99507 Subject: Hampton Hills#1, Block 3,Lot 4- 10200 Hampton Hills Drive Septic system design and permit application Dear On-Site Services Engineer: The septic tank on the subject lot is leaking and must be replaced prior to the issuance of a COSA for the property. The attached site plan identifies the location of the home and the existing well and septic system. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The septic tank is located under a deck approximately 6' from the foundation and 7' from the absorption trench. The new tank will be placed as far from the foundation as possible to be 5' from the trench. The anticipated location is 8' from the foundation, but outside the 1:1 line of influence. It will also be placed more than 5' from any deck or stairway supports. The existing well on the lot is shown. The placement of the new septic tank will not encroach into surrounding protective well radii. Please refer to the attached plan sheet for the septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, �of A`\��1, l'14c4-Ld, 624^12---7 S r) *�49 TH� * Michael E. Anderson, PE �k__P--di Michael E.Anderson 70 F6,•, 4381-E ��'JF • 8/8/18 .• N i 'k ' ROFESS ookzik " HAMPTON HILLS #1 , BLOCK 3, LOT 4 S5 PERMIT # OSP181254 PID # 015-134-69 3 - - - - - LOT 4 +/x v. -X�x Jo, /N\\\ / S 44 EXISTING ABSORPTION \+ 0P7 +x / TRENCH \k I \,x tix PLUG LINE EXITING EXISTING TANK TO 1 EXISTING WELL 0 PREVENT BACKFLOW 2. ,� c 1,250 GALLON ---' 2C0 - " • r SEPTIC TANK FCO ••••• •• •• / N m / ri z DECOMMISSION \ \ — — 30' i --, EXISTING SEPTIC TANK PER MOA CODE. \ , ` waURE aR i ZI 0 I— a. 5 NOTE: = VERIFY FOUNDATION CLEANOUT. PLACE NEW CLEANOUT IF NOT FOUND. NEW TANK LOCATION MUST BE MORE THAN 5'FROM ANY DECK OR STAIR SUPPORT&10'FROM THE HOUSE FOUNDATION. illeirGE NGINE[[IN4 NOTE: `���\\x\x NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND „r 1.9-t!4(4� k PROPOSED SEPTIC SYSTEM �kQ.•.• .•,f.i, CO-CLEANOUT /4b.• '•.9 11 2C0-DOUBLE CLEANOUT %*:49 TH /\ :*I� ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS FCO-FOUNDATION CLEANOUT ••• •• ••••��•••�•�./ PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC • ""`�� SYSTEMS. FS-FLOW SPLITTER VALVE . Michael E.Anderson . P- # MH-MANHOLE rA ,# �F•• •831-E �`Q% 0 50 100 MT-MONITORING TUBE ("•. --�.� eV = = FEET ,ilVPROFEss+c*ti4 1"=50' SV-SEPTIC VENT \NNS. - TH-TEST HOLE \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION �{ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW E —t ---"D 3116'_ _t611 UPGRADE MAILING ADDRESS . 13O D- 76� LEGAL DESCRIPTION !-o V PTo IN 14 ILL -S LOCATION DK D',,.e— NO. OF BEORO MS v lq� Well Absorption area Dwelling PEH§IT NOB U DISTANCE TO: NoT I I D IV ioT I u 3, Y 2 Manufacturer EEC- IQ_ Material STEEL No. of compartments TLfi to Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth FO tj Y DISTANCE TO: Well Dwelling PERMIT NO. -!a2 _ FQ- Manufacturer Material Liquid capacity in gallons o DISTANCE TO: Well No—i Foundation Nearest lot line �0 PERM T NO. G W= IM OT IM J LL 2No, of line Length of each line Total length of lines Trench wid Distance between lines r-.3 W 30 Inches F Top to finish Material beneath tile Total effective absorption area C of tile grade.r. p inches 380 Length Width Depth PERMIT NO. W 4 H Type of crib Crib diameter Crib depth Total effective absorption area W d a Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS CAsr SOIL TEST RATING _ 8 5 tr INSTALLER REMARKS I /� S S s*�M I.N iaJr �1 t. 11. •..... iiie • N 2225-E .40 t.••••G\•: ... .. z i TE LEGAL APPROVED DATE 72013 (Rev. 3/76) 6 U 0 o Z Cd w ce o LU Or- y X k:0 1 k :0 :g ,a C'i co 8i Go r4vo:! I'm z NI E § & § . y X k:0 1 k :0 :g ,a C'i co 8i Go r4vo:! I'm z NI MUN I C I iLL I TY OF Rt IGHGiFZFFGE DEPARTMENT t HEALTH AND ENVIRONMENTAL`JTECTION 825 'L' STREET. ANCHORAGE, AK. 99501 264-4720 WELL F1M[7 0r4—S I TE SEWEFZ F?EFZM I T PERMIT NO. t 820839 ) APPLICANT STEPHAN P GLOVER PO BOX 10-762 99511 LOCATION LEGAL L4B3 HAMPTON HILLS LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 185 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [7EF?TH= 1 @ FLEtJGTH= 52 GFZnVa:L_ E>EF�'TH= 1S THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). j FZEQU I F=> _—SEPTIC TFFMK S I ZE= 1250 GFtLLOFVS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C ZZ ? I "E;F}ECT I OtdS nFZE FZEQU I FZEF7 --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. i WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='EFZM I T EXP I FZES E>ECEMBEFZ M1L. 1502 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET ! FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF.THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED APPLICANT STEPHAN P GLOVER ISSUED BY V4. 0 MLIN I C I PAL' I TSt OF IFiNCF-IORAGE DEPARTMENT OF HEALTH FM ENVIRONMENTAL PROrECTION o` 625 'L' STREET* F#iCHORIRGE. AK. 99581 294-4728 x WEt_L- ANO CN --SITE SEWER fl ERM I T t PERMIT NO. ( 920839 ) TN' W'% fVIPLICMT STEP" P OLOM PO BOX 18 -Tem 99511 d LOCATION " < LEGAL L403 HAMPTON HILLS LAT SIZE 999999 SQUARE FE" N THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ca iJEPTHa fLK3 L_i=TVCYTHa Ed C3RF34-PEL C> E:f}'T'H= .S cu THE LENGTH DIMENSION IS THE LENrJrH <IN FEM OF THE TAVKH OR DRAINFIELD. THE DEPTH OF A TRCHCH OR PIT IS THE D I STANCE BETWEEN THE SURF F CE OF TW GROLAD AND THE BOTTOM OF THE EXCAVATION (IN FEET). `r THERE 15 NO SET WIDTH FOR TREN3 S. F 111E GffiY&L DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). f�E�LJ I REO SEPTIC TANK S I ZEA 1_25a3 L'3AL_L_Ohl=i PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT, DURING THE'0 INsrALLRrION INSPECrtaks OF ANY WELLS ADJtiMT-To tHtS -YRroEirY'Am THE MAIBER OF RESIDENCES THAT THE WELL WILL SERVE. ----- TWO <Z?> IRE 12E:Qu I REO 8W.XFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE suwecT TO PROSEX1rION. tKINIMAK DISTANCE BETWEEN A WELL AND ANY ON-51TE SEWAGE DISPOSAL SYSTEM IS L00 FEET FOR A PRIVRTE WELL OR 138 TO 200 FEET FROM a PUBLIC WELL D£PMjNG 'f <Lb*Ohl THE TYPE OF PUBLIC WELL ,j MINIMUM DISTANCF FROM A PRIVATE WELL TO A PRIVATE SEINER LINE IS 23 FEET AND. i! TO R, COMMUNITY SEWER LINE [S 75 FEET. WELL L435 FIRE REQUIRED AND M15T BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. ` OTHER REQUIREMENTS MAY APPLY. SPECIFICATION$ AND CONSTRU6ft.rION DIAGRAMS ARE -4 AVAILABLE TO INSURE PROPER IWTALLRTIOK PERM Z T E�{P I F�iES pECEMBER 32. 1..98+2 `.t I CERTIFY THAT is I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWER$ AM WELLS AS SET E FORTH BY THE MUNICIPALITY OF (tel 2: I WILL INSTALL THE SYSTEM IN ADM WITH THE CODES_ "F �At 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE EM.AROE?"r tF THE RESIDENCE RE?M?OELED TO INCLUDE MORE THAN 4 BEDROOM SIGNE ICAHr STEPHAN P GLOVER - • ..: I$gI"'a./ - �j{7-------'--_SATE----t--=-- = ��-' 'V4. Ci It TYPE OF SOIL F&SORPTION SYSTEM IS: TRENCH MFXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <SQ FT/BR)m 183 N THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ca iJEPTHa fLK3 L_i=TVCYTHa Ed C3RF34-PEL C> E:f}'T'H= .S cu THE LENGTH DIMENSION IS THE LENrJrH <IN FEM OF THE TAVKH OR DRAINFIELD. THE DEPTH OF A TRCHCH OR PIT IS THE D I STANCE BETWEEN THE SURF F CE OF TW GROLAD AND THE BOTTOM OF THE EXCAVATION (IN FEET). `r THERE 15 NO SET WIDTH FOR TREN3 S. F 111E GffiY&L DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). f�E�LJ I REO SEPTIC TANK S I ZEA 1_25a3 L'3AL_L_Ohl=i PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT, DURING THE'0 INsrALLRrION INSPECrtaks OF ANY WELLS ADJtiMT-To tHtS -YRroEirY'Am THE MAIBER OF RESIDENCES THAT THE WELL WILL SERVE. ----- TWO <Z?> IRE 12E:Qu I REO 8W.XFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE suwecT TO PROSEX1rION. tKINIMAK DISTANCE BETWEEN A WELL AND ANY ON-51TE SEWAGE DISPOSAL SYSTEM IS L00 FEET FOR A PRIVRTE WELL OR 138 TO 200 FEET FROM a PUBLIC WELL D£PMjNG 'f <Lb*Ohl THE TYPE OF PUBLIC WELL ,j MINIMUM DISTANCF FROM A PRIVATE WELL TO A PRIVATE SEINER LINE IS 23 FEET AND. i! TO R, COMMUNITY SEWER LINE [S 75 FEET. WELL L435 FIRE REQUIRED AND M15T BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. ` OTHER REQUIREMENTS MAY APPLY. SPECIFICATION$ AND CONSTRU6ft.rION DIAGRAMS ARE -4 AVAILABLE TO INSURE PROPER IWTALLRTIOK PERM Z T E�{P I F�iES pECEMBER 32. 1..98+2 `.t I CERTIFY THAT is I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWER$ AM WELLS AS SET E FORTH BY THE MUNICIPALITY OF (tel 2: I WILL INSTALL THE SYSTEM IN ADM WITH THE CODES_ "F �At 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE EM.AROE?"r tF THE RESIDENCE RE?M?OELED TO INCLUDE MORE THAN 4 BEDROOM SIGNE ICAHr STEPHAN P GLOVER - • ..: I$gI"'a./ - �j{7-------'--_SATE----t--=-- = ��-' 'V4. Ci It !� I,A SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 025 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: �Yt7�eS IOVl Ol-1 —PIQl',W1L7C -9�IS�ATE PERFORMED: a/ZC)Ig'- LEGAL DESCRIPTION: O 1 `'( 6 B K� 14AM-P I 6Imo' H I LLS '41 Paten SLOPE SITE PLAN e . saKo�r S��r �IrITN l-p�E2S o1 �o�rsE 2 C -L -M /4N SAN O VESS 3- TFIAN 3ItiLHE.S �'a e -INE SAND lyo 5 G o O'R-S sA N O 6- S \0 l o0 Y 4 Y $ SIL -T �i55 �. 10 Stl-I "ML 11-1111 • o CLEAN S -A -NT) 13 e o u e GMV1^L- es 14 SOT 1 0 Int O F- 15 15 tl , ,s .r PSS.::. ;.qs;, 17 * ' ,8 i..; .49?1* ��� DEPTH? �Pl.� ..... A A �E 25 19 76 _ 1971 20 L COMMENTS_ PERFORMED 72-008 (6/79) WAS GROUND WATER SLENCOVNTERED7 �� Net Time Depth to Water O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop I 8.2o•�z " — A (D to 76 0 S- 3 • 20 t� 3 d' SO 10 s 4D ID y`lL )h 6 b y to I � 10 5 .... a- -N �- PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN IFT AND FT FI ED BY: FJ DATE • Municipality of Anchorage On -Site Water and Wastewater Program h - (907) 343-7904 S F [ T Y Certificate of On -Site Systems Approval Parcel I. D.015-134-69 Expiration Date: I �Z 1. GENERAL INFORMATION: Complete legal description Hampton Hills #1; Block 3, Lot 4 Location (site address) 10200 Hampton Circle *Anchorage, AK 99507 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: _ Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $550 Waiver Fee $ Date of Payment ' 3 " 2 Date of Payment Receipt Number 0 2g5 C, Receipt Number COSA # OSC211078 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 l Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/parry that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for _1L bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followin #AECC884 �j0PAUryo, tis pf E� ulq�FR ��F p - 4-x - .);)0 By: U,., �'��'Jl l,� Original Certificate Date: J z 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: Hampton Hills #1; Block 3, Lot 4 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/4182 Total depth 184 ft Cased to LINK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/2/21 Static water level at beginning of test 176.9 ft Comments B. TANK DATA Age of tank(s) <2 years Tank type/material SEP71CJSTEE Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping Parcel ID: 015-134-69 of Structure served by this system Well production at time of test 4.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes FOR No ❑ Coliform bacteria is Negative Nitrate 6.25 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 2/2/21 C. LIFT STATION ❑ Required maintenance co Age of lift station /ye Lift station material Commen *THE SEPTIC TANK WAS PUMPED PRIOR TO INSPECTION AND A LIQUID LEVEL READING COULD NOT BE TAKEN. HOWEVER, GIVEN THE AGE OF THE TANK, IT SEEMS REASONABLE TO WAIVER THIS REQUIREMENT D. ABSORPTION FIELD DATA Which system tested (date installed) 812411982 ❑ ALL standpipes present per record drawing Total measured depth from grade 16.1 ft (max) Measured depth to pipe invert from grade 11.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Adequacy test date 2/2121 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 35 in Water added 604 gal New depth 42 in Elapsed time 120 min Final fluid depth 37 in Absorption rate tiuU+ gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' Property Line > 10' Q Yes Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' F-71 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft �✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *WELL IS APPROXIMATELY 10' FROM HORSE CORAL - NO ANIMALS AND/OR MANURE PILES PRESENT DURING GEG INSPECTION **ST CLEANOUT IS 9' FROM DECK POST - DISTANCE TO DECK POST NOT NOTED IN 2018 INSPECTION REPORT ***DRAINFIELD IS LOCATED UNDER DECK - SEPERATION FROM DRAINFIELD TO FOUNDATION COULD NOT BE VERIFIED ****THERE ARE NO PIPES TO DELINEATE THE SOUTHERN END OF THE DRAINFIELD. ASSUMED BASED ON 2018 INSPECTION REPORT *****PER CONVERSATIONS WITH THE OWNER, THE BARN HAS WATER AND SEWER SERVICES - THE LOCATION OF THE SERVICE LINES ARE UNKNOWN BY GEG oQ60pp G. ENGINEER'S CERTIFICATION o ��..•-�••r•�.-9,44 1 certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with pO o 49, • MOA COSA guidelines in effect on this date. (. �'. , . �: �:,T,-� .. • _ . ; • . • • , , ;�• COSA Checklist yellow sheet ..... ,.-ffrey A`.-GaIrness: CE; -7953 ����� Pro f e ssionoQd #AECC884 MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT � €�� � �� 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC211078 Subdivision: Hampton Hills #1, Block: 3, Lot: 4 A water sample revealed a nitrate concentration of 6.25 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. � � °� ��� Ma�lmg Address P AO�'Box�196850 anchorage, �1�aska 99519 6650 *�wwuv�nuni org � � From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. ., ���, Mailing Address P O �Box196650 �`�Anchorage; ACaska 99519 6650 *�ww muni org �` z MUMUPAUTY OF A HCHO A GE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval p Parcel I.D. 015-134-69 Expiration Date: d d r 1. GENERAL INFORMATION Complete legal description Hampton Hills #1, Block 3, Lot 4 Location (site address) 10200 Hampton Circle, Anchorage, AK 99507 Current property owner(s) Cheryl & Conrad Perry Family Trust Day phone Mailing address 10200 Hampton Circle, Anchorage, AK 99507 Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Fx_1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment n Receipt Number 6C3(�f i0 COSA # 6.5 C19 /2t / Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/18/19 Ornpn���ti ............... : 49th a 6. DSD SIGNATURE o............................................�.a System #1 Approved for 4 bedrooms °o �; : MICHAEL E. ANDERSON 0--. No. CE -4381 o System #2 Approved for bedrooms 0 ��''•• 06/18/19 ,,.•�� Q Disapproved pjtl FESS\r4cjulwa00©®4 Conditional approval for bedrooms, with the following stipulations: �1((((((((rWe" op � -14r AN p�d(, ,ATTR �, • .a .,moi �� SERVICES����`�� By: tM_ Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Hampton Hills #1 Block 3 Lot 4 Parcel ID: 015-134-69 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Al Well log is filed with Onsite (or attached) Date drilled 10/4/82 Total depth 184 ft Cased to 184 ft FOR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/14/18 Static water level at beginning of test 178 ft. Comments B. TANK DATA Age of tank(s) 8!20118 years Tank type/material Septic/Steel Measured operating fluid level in septic tank New ❑ Standpipes/foundation cleanout per record drawing Date of pumping New Construction D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 8/24/82 ❑ ALL standpipes present per record drawing Total measured depth from grade 14 ft (max) Measured depth to pipe invert from grade 9 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 5.6 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 7.27 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 6/10/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/14/18 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 38 in Water added 639 gal New depth 49 in Elapsed time 1440 min Final fluid depth 38 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) None If yes, enter date I E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q✓ Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft ✓M Yes if No ft Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' F,71 Yes if No ft Absorption Field on Lot > 100'✓Q Yes if No ft Holding Tank > 100' QQ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft Q Yes if No ft ® Yes if No ft Water Service Line > 10' Q✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q✓ Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5'✓Q Yes Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' Q Yes if No ft Private Wells > 100'✓Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' Q✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q Yes if No Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review �'.:°"°++O '-. of Municipal records that the above systems are in conformance with -°� +"-. MOA COSA guidelines in effect on this date. nth ': MICHAEL E. ANDERSON „` � No CE -4381 06/18/19 A COSA Checklist yellow sheet ++'++++'+++'+p� F Ers'S1C",. ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC191251 Subdivision: Hamption Hills #1 , Block: 3 , Lot: 4 A water sample revealed a nitrate concentration of 7.27 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 0 ��������11ia���ng dd�ress PCO Box1�6f;50 z�lnchpr�ge�ACask 99`1'6650 * uWw mun �or�='; �` ew `� Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good sepa.ration distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. W o O p W o w =¢ U > p Qwo Q j Z e��}} N N !x- LL (7 Z6 W O,0 � ZQFv Ww= D r�si 'dWsa¢ DaW Z o agt�g� wF"I 2 F- 2 o.w 0 5:0 w J W Vu_p CF 9W m�U w 2 K E Ump� U S 4 h a U n J Z a pp p Z.w z o -iS0 UU q�d= a OW H W SU'Fp Wvi 120 U?3 z", mw cn w m o =3wz � =w0 N W xa W y Za0 �= W Z wNo qua<a U z J O xw ffi o �a�w ¢� `aWp d coo? 'Z�'z \co NQ� O~ LL, co o.ii H �� N to o 0 °z'oy� p N A O Nz >�xwa LL �\ Z ` U (/J tti (/1 w W w g O� Z i (� N cwia.cxi ZU t-x _�----�_ —� ._ W 3/IIaO NOldWt1H o ==aZ px�xD(0 Q NF�w WWI-UW M �0 stii_i ,00•oos=a _ 00 010 m ®� a x a O d EM 2� 25° 9.66CP w N a w cOi r Z X t M 6 SA to .5.5Z N t- m �c w N '< '�u+F'XX O z m r N to ¢ W 51 C y Z o O NF 6 n H Y Y U N 3ry• 0 0 U> a E' o °a \ ° mm �g�m co \ T co Z co U) o'o z O J n v LU O J J o � U u (L a S ¢ m Z co m O ¢m o Zm w U U Q Z Y U) � _ o v ai 0 m m m c x � E N Q) _ �T W 1N3W3SV31JIlufl .04m p' Cl) m O ,99.062 M 00 ,t�0 o00N > Nz Z _ v c m O w w vna�aG N 0, ( 7 Z U w 60000 _p�4o �• w P : J O ooh • • �^ w 0 o P. cam° p Q: Q. N O�OD U W D / Z :Z� v� m bm te�1=7o W Re9q� w �04�000ad � 0 JAFA�Vl z /' 0 W1, z VA Municipality of Anchorage 19 .� Development Services Department Building Safety Division ❑ Onsite Water and Wastewater Program „ , , , 4700 Bragaw Street P.O. Box 196650 /) Z V �D 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. COSA # UtO Expiration Date: z —Oto 1. GENERAL INFORMATION Complete legal description Lot 4 Block 3 Hampton Hills #1 Location (site address) 10200 Hampton Drive Anchorage AK 99516 Current Property owner(s) Samuel Gaston Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 4559E Collinwood Drive Gilbert, AZ 85297 Day phone Jan Pennington/Dynamic Properties Day phone 244-3099 3111 C Street Anchorage AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 19 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Pannone Enaineerina Services, LLC Phone 272.8218 Address _P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date ('rFo eoz Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. ••• a a a • The operational life of all wells and septic systems depend on the local soil condition, ground water OF ••• as levels that may fluctuate during the year, and the water usage of the family being served by the system. �•'�P�"^�` •♦j♦♦ Thcsc conditions arc outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that% w ~' fir♦ there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 5 performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this ♦ t yp report is for the sole benefit of the owner lined ♦ Steven Pannoneil5. above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ♦i c% C� 814 confer any legal right whatsoever. ♦♦j•,.,dG-'O d:: 5. DSD SIGNATURE ♦O4aa�E55;�.•' .__Z Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Auacnments: COSA ChecMist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: is — — (Rev. 111)5) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bregaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type P Date completed 1010982 Total depth SI)_4_ft Data of test Static water level Well production If A, B, or C provide PWSID # _ Well Log (YIN) Y Sanitary seal (YIN) Y Wires property p (YIN)_ Cased to —t—ft. FROM WELL LOG WATER SAMPLE RESULTS: 10 g.p.m. Coliform coloniesl100 mL Arsenic: /l- mgR B. SEPTICIHOLDING TANK DATA Nttrats5L12mg& Date of sample: 5124@¢ Tank Type/Material Sheer Steel Tank size 1250 gat. Number of Compartments j Casing height (above ground) 12+ in. AT INSPECTION 512412008 1TO ft 5A g.p.m. Other bacteria D'– ooloniesl100 mL Collected by: Lours Pannone Date installed W411982 Cleanouts (YIN) Foundation cleanout (YIN) Y_ Depression over tank (YM) )y High water alarm (YIN) WA Date of pumping ,5124 1 2 0 0 11 Pumper A+ Home ServIc" C. ABSORPTION FIELD DATA Date installed 8[3411982 Soil rating (g.p.d.lft' or ftzlbdrm) 0— System type Deep Trench Length 38 ftgr7 Width 4 ft. Gravel below pipe 5 ft. L Total depth W ft 161 Eff. absorption area ,IRfe Monitoring lube Y Depression over field 11 Date of adequacy lest 512412008 Results (Pass/Fall) Pass For 4 bedrooms Fluid depth in absorption field before test Q in. Water addediH gal. New depthJU in. Elapsed Time:1440 min. Final fluid depth Q in. Absorption rate u 1108+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 8 type) No If yes, give date D. UFT STATION Date installed 'Pump on" level at _ in. Datum 1 Size in gJx a90 'Pump ofr level in. Cycles to Manhole/Access (YIN) High water alarm level at in. Meets slarn d dreuk requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAiR station on lot 199► On adjacent kris 100* Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 100+ Public sewer menholeldeanout 100* Sewer /septic service line 25+ Holding tank JW Animal containment areas 9.V Manuretanimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLOING TANK ON LOT TO: Building foundation T Property, line,,Q Absorption field B Water main 100+ Water service one 25+ Surface water 100+ Wells on adjacent ktb 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine 10+ Building foundation 19+ Water main 100+ Water Service fine 25+ Surface water 100+ Driveway, paktrplvehide storage 30+ Curtain drain None Observed Wells on adjacent lots 1100+ F. COMMENTS G. ENGINEER'S CERTIFICATION ` ��� �_.. ;ee♦. I car* that I have determined through field inspections and o review of Munkoal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. i �. a Steven R. ?pnr pner Engineer's Printed Name Steven R Pannone. RE • 1� n No. CE E149 v i Date COSA Fee S pper/� Data of Payment Receipt Number 9139q (Rev. 11105) Waiver Fee S _ Date of Payment Receipt Number Municipality of Anchorage • '� Development Services Department / Building Safety Division s• <r• On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 060228 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 4 of Hampton Hills #1 subdivision. This inspection revealed a nitrate concentration of 5.72 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. COPY 3 E%CLUSiO4.N NOTES: Il Is iha owners respenfloil', to ddiVt.ion plot.etermine "-R9 WIt OROEwEO •v: the Pit ten.e OI Ony eOfemenls. COvenanb. W fHU¢tipn! 3.25- AL.MON• V MONUMENT BONNIE M E H N E R Under no c. rcumetoncea should anyorddata hereon Oa d Sub used for Nue a TACK with JACK WHITE COMPANY construction or for aslOoliahlnp property linea. FENCE- —K—• K — SURVEY CERTIFICATION: LANTECN has conduclsd a OVERHANG- survey of this property 03 shown On this WOOD DECKS- physical D D Y drow:ng and that the inprovemenla situated there EDNERETE- on are within the properly linea and no encroach- AS HALT O AN menta eMlal other IhOn noted. SEPRC STANDPiES� P.S BUILT OF: LEGAL OESCRIPTON: WATER 'WELL_ LAND & CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS 440 WEST BENSON BLVD. N 103 LOT 49 BLOCK 3 562-5291 ANCHORAGE. ALASKA 99503 i907 ) WORK ORDER NUMBER: JULY 16, 1992 1"-40 crDx, 561-6626 HAMPTON HILLS UNIT NO.1 92 -L -396A MA. Dr..chcaw er - MYarw. OLID. f. 2540 N\A !\ r/ MUNICIPALITY ANCHORAGE • `� DEPARTMENT OF HEALTH &HUMAN SERVICES �1F Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #�C !J — 13`"1— (O y 1. GENERAL INFORMATION Complete legal description HAA # VA R9 Q,C L-1 1.75 Location (site address or directions) Lei :4 -c' 14 OA--t� { FN7 Property owner Mailing address l Day phone 3VG 1194, r � Lending agency Day phone Mailing address Agent P1 Day phone Address X Lt, Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 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. 72-025)R".1,91) From MOA.21 w von viae (tivi — 1 oM ')IJom sjaaui6ua IeuolssaloJd etll u! SUOIssIWO Jo siolia,ol elq!suodsai IOU sl e6e,oyouV 10 Al!ledlo!unyy ey1 'ponssi sl eleoll!yao a e,olaq elep Wpm Jo suolloadsul lonpuoo IOU op SHHO to saaAoldwi 's3uawaJlnbaJ eleis pue le,apal ulupg:) Alsiles of Jap,o u! suo!inl!isul 6ulpual Jlay3 pue sawoy to siosego,nd of Asapnoo ase s!yl saoP SHH4 eyl'e>IselV toeiels eyl u! pa,alsi6a, Jaaul6ua leuolssalad luepuadapu! ue Aq enoge S ydeJ6eJed ul uan16 suolleluasa,dot4l uo n Aluo e6e oseq s too!) ed) IL'Aoiddv unVy ey1 plJotllnV y3leaH sonss! (SHHO) saolniaS uewnH pue y3leaH 1o 3 4 sluawwo0 leuo!1!PPV :suo!lelnd!ls 6ulmollol ayl yl!m 'swoojpaq 101 lenoJdde Ieuoli!PuoO 'panoJddssl° - �- � 1 ele° e,nleu6ls sdaaul6u3 ,TT :AS -swoo,poq JO1 panoJddy 3af11VNEJIS SHHO '9 ssaippv C7 or WbCL_ Z euOyd CIrylq1 s 2 WJI j 10 GLULN -uo!loodsul s!yl10 alep eyl uO 100110 ul suolieln6 ,a pue'saoueulp,o 'sapoo elelS pue Iedioiun" lle yl!M eouelldw00 ut sl walsAs lesodslp Jalemalsem JO/pue Alddns Jolem ells-uo ayi 'uolloadsul pue uo!ie6!isanul Aw woJ1 pus salll OBUJO40UV 1O Al!Isdlolunyy et13 woJ1 paulelgo uollew,olul e41 uo paseq leyl Al!Jan,ayl,nl I-ula,ay paleo!pu! a,nlon,ls 10 edAl pue swooJpaq 1o,agwnu eyl,ol alenbape pus Ieuollounl'ales s! walsAs Issodslp,alemalsem JO/pus Alddns,alem ei!s-uo 041 W41 smogs uolle0lldde lsnoJddV Al!,oylnd UlleaH s!yl 10 u0!le6!isanul Aw ieyl A1!JOA I 'molaq umoys alep uo!ieP!!s^ ayi 10 se pue OlaJay paxllle leas Aw Aq paylvao sV d33NION3 AS N01103dSNl d0 1N3W31V1S 'S Municipality of Anchorage AUL Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo4_ 4, BY, 3 Parcel I.D. O I. - 13Y- b9 }} A14'PT01441--c A. WELL DATA Well type R If A, B, or C, attach ADEC letter. ADEC water system number N�i4 Log present (Y/N) Date completed 1011 15Z Driller H Qhs e Total depth 1 8 %4Cased to 181 1 Casing height o214II Sanitary seal (Y/N) — Wires properly protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG t°l4lez NO -L n,'Vt N 10 g.p.m. $ ef%e wt SEPARATION DISTANCES FROM WELL TO: SepticA w0ding tank on lot Ila AT INSPECTION G -7/0, Q Z MUNICIPALITY OF ANCHORAGE 1 NMENTAL SERVICES DIVISION 1'7 I' JUL - E 1992 % t• /%7 g. .m. RECEIVED ;On adjacent lots. Absorption field on lot I 1 ; On adjacent lots » O -O Public sewer main A Public sewer manhole/cleanout Sewer service line ��� Petroleum tank N WATER SAMPLE RESULTS: Coliform Nitrate 3 Cl Other bacteria Date of sample: ��/9Z Collected by: r S B. SEPTIC/HOLDING TANK DATA Date installed g/�`� �B %- Tank size %9 �iO Compartments 'Z Cleanouts (Y/N)_ �//Foundation cleanout (Y/N) N Depression (Y/N) High water alarm (Y/N)WIA Alarm tested (Y/N) Date of pumpingoG Z Z Pumper De MIaLL SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I On adjacent lots -Foundation- To property line a' Absorption I ield g Water main/service line 42b Surface water/drainage N D NC -7 72026 (Rev. 7/91) From I CONTINUED ON BACK PAGE C. LIFT STATION Date Installed . Size In gallons Vent(Y/N) _ NONE High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed - gl2y IQ Z Soil rating b System type 2ENUk Length 3 �_ Width I Gravel thickness '2 I Total depth 1 4 + Total absorption area Cleanouts present (Y/N) Depression over field (Y/N) _- N Date of adequacy te'st/ O 7 1 9 Results (pass/fail) for 7 bedrooms Peroxide treatment (past 12 months) (Y/N) -N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot On adjacent lots � IOro Property line- To building foundation 30 ± To existing or abandoned system on lot N 017 L On adjacent lots NO Y) L Cutbank No ki e Water main/service line O Surface water i'V o 0 e- Driveway, parking/vehicle storage area �0 Y Curtain drain NoNe- 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. Signature77 9 C r� Engineer's Name ( e' d v V��q k e • ' "+, ; Date q L �: . V HAA Fee $ l %d a� Date of Payment 7 - Receipt Receipt Number 72-M (A". ypt) 8�k MOA 21 Waiver Fee: $ Date of Payment Receipt Number APPLIC'`W FILLS OUT UPPER HAI—''ONLY Property Owner ii eERT �iC A y —" Phone Date Date YS -6838 Malting Address y Zip Code Buyer & Address/,9,2,,;,0 zip Code Lending Institution M9 T/OVAL B2i/k O� 419 S K A Phone /y Address p zip code Realty Co. 6 Agent /4 Phone Address zip Code x-)4 33 APY9. OL'l Legal Description LAT y poG/l 3 f/lOmP7D N t%ic & s vq�w Street Locallon 4rS-&S"d DEPS` lei!' Type of Residence V,Single Family ❑ Multiple Family No. of Bedroom !!V ( -APPROVED BEDROOMS *CONDITIONS OF APPROVAL ❑ Other Water Supply Y{Indlvldual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log It available). ❑ Public Utility Solisting Date Sewer Installed Sewer Disposal Well Log Received S- 5Z Individual Year Individual Installed: /9 rF2 ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time T' Date Date Date Da Inspector Inspector Inspector Inspector M IC1P�t AGE Field Notes: x-)4 33 APY9. ENVIRO.:M:NTAL PROTECTION 4rS-&S"d DEPS` lei!' AUG 23193 RECEIVED ( -APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED T ( ) CONDITIONAL APPR AL' / GATE BY: Solisting Date Sewer Installed Well To Absorption Area Well Log Received S- Z qr, 8 Y Well to Tank Septic Tank Size SO rzox3 rxn f I ALASKA bUIROWnTAL COnTROL SMUS, InC. Engincering & Enuironmenial Studies August 27, 1983 Department of Health and Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Jim Roberts Dear Jim: On August 27, 1983 I collected a water sample from the well located on Lot 4 Block 3, Hampton Hills Subdivision for Mr. Steven Glover. The water was delivered to Chemical and Geological Laboratories for Bacteriological Analysis. The results were satisfactory. A copy of the test results are enclosed. The low areas you saw around the well have been filled . The well now has a proper ground slope so that surface water will test to run away from the well casing. 4 OF q��L Leroy C. Re Jr. No. 275 1 1200 latest 33rd Avenue, Suite 6 • Anchorage, Alaska 99503 • (907) 2161361