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SPRING HILLS ESTATES BLK 2 LT 16A
'0 Spring Hill Estates Block 2 Lot 16A #015-051-90 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. U-11 OWNUT- TIAL, Municipality of Anchorage 9 2021 On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211212 PID Number: 015-051-90 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑E Upgrade Name JASON BURT ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound Site Address 9900 SPRING HILLS DRIVE *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-440-9220 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeFt. Gravel depth beneath pipe Ft. Subdivision Block Lot SPRING HILL ESTATES; BLOCK 2, LOT 16A Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ TANK ❑ Septic ❑i S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1500 Gal. Surface water 100'+ Material Number of compartments Lot Line 5'+ NA HDPE 2 Foundation 110'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC GREER TANK 500 Gal. PER CONTRACTOR Alarm location Electrical installed by Installer PIPE MATERIAL House to tankD3034 Tank to D1785 drainfield A+ HOME SERVICES Drainfield D3034/EXISTINcCO/MT D3034 inspector TIM ECKLUND AND GEG BENCH MARK (Assumed elevation) 100.00 ft Inspection 1n 7/28/21 - Location and description 2n nd TOP OF MH 3b - 4th _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp oo�oop�� 0 F A Conditional Approval: Date T I 0 �.......�..... ...... ok D D t�(, O J6' k A. 'mess,• 00 Septic System y _P • O Q C 7953 Q /'•. Approved Date 1 1 5 D2 0� s (�F� 1 •' •�c�4 04Prea f Note: this approval does not include well permit requirements. 4�Pro � O000\ naEccaea�a kfCCv u0/uz/ I O) PERMITNUMBER: P015-051- ID UMBER: OSP211212 RECORD DRAWING90 TOP OF MANHOLE = 100.00 TOP OF MANHOLE = 100.14 MH1 MH2 FINAL GRADE = 99.6-99.8 TOP OF TANK AT INTLET = 96,50 INVERT OF BUNG AT INLET = 95.79 NEW 1500 GREER TANK WITH ANCHORAGE TANK 02F -N COMPONENTS TO BE USED AS STEP TANK TANK HOLE WAS DRY DURING EXCAVATION - GROUNDWATER WAS NOT ENCOUNTERED I 2" INSULATION PER CONTRACTOR OF TANK AT OUTLET = 96.50 11 Tp (3ARNESS EN(ff"INEERIN(ff", %4_3ROU Ltd ENGINEERING , SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 3376179- FAX (907)338-3246-WEBSITE:—.g...-gm..n.g...m PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JASON BURT 907-440-9220 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: SPRING HILLS ESTATES; BLOCK 2, LOT 16A D.J.G. TYPE OF WORK: DATE: � PROFILE OF NEW S.T.E.P. TANK 8/9/2021 9 WN , an I � F . . ............. rey .� # C -79 3 441P LICENSE#*.'- #AECC884 4 14 TA lk -PERMIT OSP211212 RECORD DRAWING A B t 1p0 vdE�� DBL1 34.1 52.1 DBL2 34.7 53.0 \ MH1 37.9 58.6 MH2 40.2 62.5 \ NEW 1500 GALLON HDPE GREER \ ANK WITH ANCHORAGE TANK LIFT STATION COMPONENTS - `\ EXISTING 4 BEDROOM HOUSE PARCEL ID NUMBER: 015-051-90 a N SCALE: 1"=40' IeA 101 10 ItMEAl 0 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907)3376179- FAX (907) 33&3246' Y4ESSITE: w .gamessengImeemg.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JASON BURT 907-440-9220 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SPRING HILL ESTATES; BLOCK 2, LOT 16A D.J.G. TYPE OF WORK: DATE: I, STEP TANK RECORD DRAWINGS 8/9/2021 I N SCALE: 1"=40' IeA 101 10 ItMEAl 0 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907)3376179- FAX (907) 33&3246' Y4ESSITE: w .gamessengImeemg.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JASON BURT 907-440-9220 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SPRING HILL ESTATES; BLOCK 2, LOT 16A D.J.G. TYPE OF WORK: DATE: I, STEP TANK RECORD DRAWINGS 8/9/2021 10' SLOPE MAINT. EASEMENT LOT 14A p � 0 47� nJ� 2 41.3' L Q!M0 ° x f Vr'x qg,�, I -S54° 35' 16"E LOT 13 18.55' WOOD RET �. WALL j ;IU �y N 1�v lf1 if] LOT 16A o ,^ LOT 17A r4p` Z 0 .: LIGHT 4 O POLE TYP EXISTING HOUSE 25,3' SHED 10' TELECOMM, & ELECTRIC EASEMENT N890 59'48"W 234.34' o OF* * :-• 49 ............................... . �•N CALLAGHAN ; o LS -12034 a G �Op ���•7��C��-:1ay�a roI`essiana� �"4� NOTE: THIS DRAWING SHALL NOT BE MODIFIED FDR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH, Lo ry 3 ep w 35. a� z8 .p EXISTING 96 p HOUSE ss• a �za � am HOUSE DETAIL 16z' SCALE 1" = 30' A5 -BUILT ADDRESS: 9990 SPRING HILL DRIVE PARCEL #: 015-651-90-000 SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST ORDERED BY: LINDSAY CROSS, MEHNER WEISER REAL ESTATE OTHER THAN NOTED OR SHOWN, LEGAL DESCRIPTION: n EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPO NSI BILITYTO DETEAMINETHE EXISTENCE OF LOT 16A, BLOCK Z, ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF•WAYTAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LIN ES, OR FOR SPRING HILL ESTATES PLOT -PLAN PURPOSES. 250 H Street Anchorage, Alaska 99501 LEGEND: SEPTIC STANDPIPE WATER WELL Q Overhang �... L(C GPhone FENCE—X—X— WALL WALL W��d Desk ". EXISTING HOUSE 25,3' SHED 10' TELECOMM, & ELECTRIC EASEMENT N890 59'48"W 234.34' o OF* * :-• 49 ............................... . �•N CALLAGHAN ; o LS -12034 a G �Op ���•7��C��-:1ay�a roI`essiana� �"4� NOTE: THIS DRAWING SHALL NOT BE MODIFIED FDR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH, Lo ry 3 ep w 35. a� z8 .p EXISTING 96 p HOUSE ss• a �za � am HOUSE DETAIL 16z' SCALE 1" = 30' A5 -BUILT ADDRESS: 9990 SPRING HILL DRIVE PARCEL #: 015-651-90-000 SURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST ORDERED BY: LINDSAY CROSS, MEHNER WEISER REAL ESTATE OTHER THAN NOTED OR SHOWN, LEGAL DESCRIPTION: n EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPO NSI BILITYTO DETEAMINETHE EXISTENCE OF LOT 16A, BLOCK Z, ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF•WAYTAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LIN ES, OR FOR SPRING HILL ESTATES PLOT -PLAN PURPOSES. 250 H Street Anchorage, Alaska 99501 LEGEND: SEPTIC STANDPIPE WATER WELL Q Overhang Asp halt 'Conrrefe ` L(C GPhone FENCE—X—X— W��d Desk ". `} Survey Department 562-5291 DRAWN DATE: 8/16/2021 WORK ORDER: 21111 �� Inc Mainline DRAWN BY: AP PLAT: 85-318 Phone 243-8985 CHECKED BY: SC GRID: SW2436 AECC 668 SCALE- — - 1 " = 50' FBIPG:82218 REF: 02L220A 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: OSP211212 Work Type: SepticTank Upgrade Tax Code Number: 01505190000 Site Legal Address: SPRING HILLS ESTATES BLK 2 LT 16A G:2436 Site Mailing Address: 9900 SPRING HILL DR, Anchorage Owner: BURT JASON BRYAN REVOCABLE Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date �t1��nt G � 'Z 900" v DepartIII ell t Lot Size in Sq Ft: Total Bedrooms: 6/15/2021 6/15/2022 52472 ❑ 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 Issued By: Date: Date: 4 MUNICIPAUTY OF ANCHORAGE Development Services Department n Phone: 907-34.3-7904 On-Site Water & Wastewater Section �- Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-051-90 Property owner(s) Jason Burt Mailing address 9900 Spring Hill Drive *Anchorage, AK 99507 Site address 9900 Spring Hill Drive *Anchorage, AK 99507 Day phone 907-440-9220 Legal description (Sub'd., Block & Lot) Spring Hill Estates; Block 2, Lot 16A Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade X Duplex (D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: N/A 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: A225 Date of Payment: GJ l n1 �2 O 2 Receipt Number: Q 1 G 3g"G Permit No. 06PZI 1212 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211212, Deb Wockenfuss, 06/15/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211212, Deb Wockenfuss, 06/15/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211212, Deb Wockenfuss, 06/15/21 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number:�-s ucii jJ0 t (00 PID Number:1fjU Name I 4 i{ L.o¢IPr K. LA Wastewater System: ❑ New ❑ Upgrade '�qa o ABSORPTION FIELD Phone No of Grooms . Deep Trench []ShallowTrench ❑Bed ❑Mound ❑ Other LEGAL DESCRIPTION Soil Rating '/ D•R'�GPOrS Total Depth from original gree= I Ft Lot/� elOtk a4ubdivisio Depth to pipe bottom from onginal rade / Gravel depth beneath pipe ,r /� rc�l t�l t� r• Ft Ft Township. Range. Section: Fill added above original grade' Gravel length: O Ft Ft WELL: ❑ New ❑ Upgrade Gravel width: Number tunes oistapc betweenenes 1-1/ A Ft Ft Clas dicauon (Private. CI Total Depm Cased To Total absorption area' Pipe material $ i0 Ft Ft I'/ .O Ft `t7 1'v Driller Date Drilled'. Static water Level: Installer' //����,�.. Date installed GG FI � Y�!'a�• _L Yield Pump Set at. Cas�ngHeightAboveGround TANK GPM Ft FI SEPARATION DISTANCESeptic ❑Holding ❑S.T.E.P. 14 To Septic Atnorplion L.h Noidmg 'ubwPnvate Manufacturer: // V Capacity In gallons' I�� From Tank Field Station Tank Sewer Lines TIO✓V Gr Well 1 1+0— —. — ?6 _ !f—j i Maters I Numoery�Companments1164, 1 ' Surface I6brf� ' 1ee•� LIFT STATION Water Lot /_ /A I Size in gallons: Manufacturer: Line Foundation 13 22 "Pump ori' level et. ump o1P level at High water alarm at: CurtainO —^aCi /moi Pum e d Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description. P Lo l.L— Assumed Elevation:O — 160 Ft ENGINEER'S SEAL O........ ••. L ti s; c r Lpr� Inspections performed by: s a s EIIGINEERINct1 s �j : r3 :• ..»..1 o ... 17034 Ea01e River *P d, 2nd 7 `� Eagle River, Alaska 49577 i , •' » -•••••••^••w bort A. Lhefw j; r Department of Heal d Human r ices appro al 9 ij a ►H. IA57•E •: ti ; a Reviewed and approved by: Date: _73 t l�ii`w41`µ:,ew 72-0131Rev 9t911MOA25 Permit No. SW930160 2 2 Page of — Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report SPRING HILLS ESTATES, BLOCK 2, LOT 16A 01505190 7M17 A (Rw. 9M) MOA 2S PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930160 DATE ISSUED: 6/17/93 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/17/94 OWNER NAME:LADYMAN GEORGE H & GLORIA K OWNER ADDRESS:9900 SPRING HILL DR. ANCHORAGE, AK 99516 PARCEL ID:01505190 LEGAL DESCRIPTION: SPRING HILLS ESTATES B 2 L 16A LOT SIZE: 52472 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY• y • DATE: r DATE• June 4, 1993 A A >4 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 HEALTHAUTHORITY Municipality of Anchorage APPROVALS DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L. Street Anchorage, Alaska 99501 SEWER a WATER MAIN EXTENSIONS REFERENCE: Spring Hills Estates, Block 2, Lot 16A SEWER a WATER INSPECTION Request you issue a permit to upgrade the septic system serving the four bedroom residence on the referenced property. ENGINEERING STUDIES ANDREPORTS The existing septic system was installed in October, 1984. The system was tested in October, 1991, for Health Authority Approval purposes and found to be functioning adequately for a three bedroom home. A Health Authority Approval was issued WELLINSPECTION in November, 1991. However, subsequent to that approval, it &FLOW TEST has come to our attention it appears a portion of the system is located on the adjacent property. Two test holes were excavated and percolation tests performed SITE PUNS in the area of the proposed upgrade and alternate site. The monitoring tubes within the test holes have been checked and found to be dry. Attached is the proposed upgrade design with an alternate site depicted. ROAD DESIGN We do not anticipate any adverse affects on the neighboring properties by the installation of the proposed septic upgrade. SOILTEST If you have any questions or require additional information please contact us at 694-2979. PERCOLATION Sinc , TEST MFt!uF RAIa L% / ert�hafer, P.E. MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN RAS/LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 w 0 N N to 7yry ` H � B O / i I1=: ,4A « W U rd Q O va. 0 aw^/ON/bd/H 0 a W F- 1- ww a W x 0 .�I aH U W to w 0 N N to 7yry ` H � B O / i I1=: ,4A « W U rd Q O va. 0 aw^/ON/bd/H to� f 03dOl3A30Nn W EZ Y1 Oi oc CL 3avaodn 0 a W F- 1- ww a W x aH U W to z O p o to `r > II Q„+ z II � U') E cL 00. f.� t9 co o Z5 0 Cp to \ \ 3Iyos z Qo wo �j7 6�7 \ 0 Fp a g o •'' v tW i16 .7 ..a pa`,wo� e p to� f 03dOl3A30Nn W EZ Y1 Oi oc CL 3avaodn 0 a W F- 1- ww N O W LGM COM z C� to `r > II Q„+ z II � U') E cL �II`r cx o wWZ ao0 co o Z5 A"4V)ID Cp A�(7)n 3Iyos PERFORMED LEGAL DESCRI Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST DATE PER Township, Range, Section: �C,Y V�VYLC(.J JGnIA `. Ji / •J i' P. L • to M C, j• .w .......,.,:'' a .�o'r�-.rte q �'. C�•�: e r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 S�OII-LS L/OG^- PERCOLATION TEST PERFORMED FOR: V 1.J•�M.TG L�/i'iA/� DATE LEGAL .MNGINEEWS SEAL). •4 �•yy C. Nu. IlS7.E v k,° —I c, nec e.TC ON eN TO / M lv - � IS- OSI-�/D i amu✓ ,Ll,ptit,,;.ce-eJ SUBJECT GC.C'ti I , /`�� a i'""j)' `o DATE % / 9 MESSAGE §-T- A lL�. �,{�.;.,[t ,ac.� 4..�.�-..�• cr,� �/*.c� � ..mss. �-a� /-V_.e i l-ai� 4.0 REPLY ,�`(rLYsri� ec*zC..z ""7I',l�e.�•✓ � ��G S� SIGNED DATE r' o- PEOiFORM a 4S 47iSEND PARTS I AND 7 INTACT - POLY PAIL (SO SETS) APA72 PART 7 WILL 01 RVURNRD WITH IlPtY. :i, I* MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMFNTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION j 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE VW NEW A-1-10 Al �.$�I�2 ❑UPGRADE MAILING ADDRESS _— 96a LEGAL DESCRIPTION ' L 7 it, 8K spK I�IJs,_ SLS ES`r Tifice[ 3 SEc, 1 LOCATION s NO. OF BEDROOMS - sPM is. IVt[s AD/? 3 Well Absorpu'n3n Dwelling PERT T NOb. U Y DISTANCE TO: OZINPOS - i 2 Manufacturer- Material No. of cc tments W Qr ~ r rV r ` N Uq. capacity in gallons � 000 IF HOMEMADE: Inside length Width Liquid depth G be DISTANCE T0: Well Dwelling PERMIT NO. -10Z Material in _? Manufacturer Liquid capacity gallons 0 Well Foundation Nearest lot line PERMIT NO. W = DISTANCE TO: _I M Z No. of lines Length of each line Total length of lines Trench width Distance between lines H Z W inches Top finish Malarial beneath lila Total elfenive area C F. of tile to grade absorption C) inches Length r W Width 6F Depth Lt.r PEH tlT NO. Crib diameter 410 Type of crib Crib depth Total effective absorption area 1 W W' y Well 11ijildinis foundation Nearest lot line DISTANCE T0: p OpQS ' Class Depth Driller Distance to lot line PERMIT NO. ,V u' i DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER I l �PKW& •` )'I'r -I LL, n PIPE MATERIALS SOIL TEST RATING r 2�F2" 2 INSTALLER 3�5�'IALL�SnNS—�.X-g�=O�S I I o REMARKS I I SczsAt�i�N�sLE2SA�t11t�.I[�1c�EeRt,�s� - 14J5f3CieDl�.k �� H•�J <, . _ _6 _ - cb r 7 �1 r 1 L1 r o — I .S APPROVED DATE LEGAL yL' //aQ/ 6- A%/64 I-IV aZSPXI%U&)4 2. A; '3W/SEC. IS' 72013 IRev. 3178) n tk ' MUN I C I F'AL I TY• C3F ANCHC]F1AGE V DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Iv 825 L STREET, ANCHORAGE, AK 99501 '264-4720 ON—SITE SEWEF2 S< WELL F''EF2M I T PERMIT NO: 840831 DATE ISSUED: 10/01/84 APPLICANT: MAIN CORP ADDRESS: 4155 TUDOIR CENTER DR. ANCHORAGE, AK 99508 LEGAL DESCRIP: SUBDIVISION: SPRING HILLS ESTATES LOT: 16 SECTION: 15 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 1A (SQ.FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available -to you in designing system. Choose the option that best fits your site. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BLOCK: 2 your septic DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION * TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 1.I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of AlasLa requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST 'E DONE BY A LICENSED ELECTRICIAN. .SIGNED - ---- DATE: APPLICANTVMAIINRP ISSUED B - DATE: --------�------------ �� --- I9 E ID DEPTH TO PIPE BOTTOM (FT.) 3.5 ** GRAVEL DEPTH (FT.) 0.5 TOTAL DEPTH (FT.) 4.0 GRAVEL WIDTH (FT.) 24.0 GRAVEL LENGTH (FT.) 46.0 GRAVEL VOLUME (CU.YDS.) 40.9 TANK SIZE (GALS) 10000.0 *+� SOIL RATING (SQ.FT./BR) 242 BLOCK: 2 your septic DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION * TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 1.I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of AlasLa requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST 'E DONE BY A LICENSED ELECTRICIAN. .SIGNED - ---- DATE: APPLICANTVMAIINRP ISSUED B - DATE: --------�------------ �� --- ■ SOILS LOG � --� MUNICIPALITY OF ANCHORAGE PERCOLATION r /' • ..; DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L Street, Anchorage, Alaska 89501 2644720 - ' SOILS LOG —,+PERCOLATION TEST `� PERFORMED FOR: TA -VE " " O�= /euc DATE PERFORMED: • _ � _ �� - LEGAL DESCRIPTION: L67 P2ZAJ q /II I- L5 Su �. FTLTr93P1 SLOPE SITE PLAN 1 - 2- 3- 4- 5. •3•4•5• 6. 7- 8 9 10 11 12 13 14 15 16 17 18 19 20 D I 5M- 5/ ITy, 6PA.JPs,SXI,up 5 i rr N(rxruQES• c:r4 'T $v-ou mi , w -y/ ML- 51 /T ])eN5E SOME PCgSTsG, C=4Wr Seo WA/, Df -y. A law K./A" Je: -o(-7;7_p Q•V /0 TEST RUN BETWEEN ' FT AND FT PERFORMED BY: InAQN CERTIFIED i t 72-008 (6/79) DATE: l g WASGROUND WATER M O L ENCOUNTERED) O ° P IF YES. AT WHAT E DEPTH? &// PE,z K Reading Date Gross Time Net Time Depth to Water Net Drop ° °10:44OMsu q�14: �3 - 1 I aO ° /0 5 it 0 M=u ; J 70 08 o4 103 •01 lot-UAJ . lUMzu .10q .0v TP OMs"T�/mi ERILATI NRATE //•••3Y" u*Fe0 ) {/ Q•V /0 TEST RUN BETWEEN ' FT AND FT PERFORMED BY: InAQN CERTIFIED i t 72-008 (6/79) DATE: l g MUM I C I FAIL I TY OF AM(— DEPARTMENT OF HEALTH AND ENVIRONMENT( 825 L STREETo ANCHORAGE, AK - 264 -4720 ON—S I TE SEWEF2 8c WEL—' PERMIT NO: 840522 DATE ISSUED: 06/28/84: APPLICANT: MAIN CORPORATIN ADDRESS: 4155 TUDOR CENTRE DRIVE, ANCHORAGEo All 99508 CONTACT PHONE: 562-4907 LEGAL DESCRIP: SUBDIVISION:.SPRING_HILLS_ESTATE SECTION: 15 TOWNSHIP: 12N_ LOT SIZE: 1.25A ,(SQ.FT. OR ACR S) MAX BEDROOMS: 3 /r Listed .below -are the ptic.. va�: system. Choose the optic at fits SOILS LOG - PERCOLATION TEST PERFORMED FOR: ��1//�/f2w/L /��IS [� �/D,ATE PERFORMED: 7\ LEGAL DESCRIPTION: _ S!/I�I�Y! //!I(� x r� z / A�2J 13 MD 14- 15- 16- 17- 18- 19- 20- Comm 4 151617181920 COMM Ol-- ' 6YCk51'11G Sl k�7 am - 51 I4�( l►'cxl b,eWj,), Dyl SLOPE Reading Date Gross Time Net Time Depth to Water Net Drop SOILS LOG �• MUNICIPALITY OF ANCHORAGE ,elle CTo: PERCOLATION ys DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION •73 '.("•'.r;, TEST •69 825 L. Street. Anchorage, Alaska 99501 264-4720 3 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ��1//�/f2w/L /��IS [� �/D,ATE PERFORMED: 7\ LEGAL DESCRIPTION: _ S!/I�I�Y! //!I(� x r� z / A�2J 13 MD 14- 15- 16- 17- 18- 19- 20- Comm 4 151617181920 COMM Ol-- ' 6YCk51'11G Sl k�7 am - 51 I4�( l►'cxl b,eWj,), Dyl SLOPE Reading Date Gross Time Net Time Depth to Water Net Drop ,elle CTo: ys J •73 /o •69 , 3 �a • �S . o r45 (!'f/;4L5_/6) • 70 . 0Q PERCOLATION RATE ss (minutes/inch) TEST qq�GiN B TWEEN FT AND —:fE(— FT PERFORMED BY: /iL!•Lr�7 CERTIFIED 72-008 (6/79) / SOILS LOG MUNICIPALITY OF ANCHORAGE 11 r\• � PERCOLATION o-3�.. , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 625 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:\� ,l` •e1.5 DATE PERFORMED: ine taq S LEGAL DESCRIPTION: pring N\kks Rt`k a L4 l to r7rTwT3I SLOPE SITE PLAN jkj yy. A OL- . a-�a,�, �r✓ s►�y or6ncfl Q -y CSM - SYCWr1, Dr J WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? A! / it Reading Date Gross Time Net Time MIN Depth to Water Net Drop p r . tIto •G PERCOLATION RATE oO (minutes/inch) TEST RUN BETWEEN t.-5 FT AND _40 FT r PERFORMED BY: Gy'ffPi MIA 8L1'WtYJ CERTIFIED 72-008 (6/79) _ •ar.` 1 �.aue / SOILS LOG ` MUNICIPALITY OF ANCHORAGE \ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION • v l TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Qnl ,Id .-- k , ]01''1.5 DATE PERFORMED: ,J( I1,L D9'1�w LEGAL DESCRIPTION: 'SCXl1�7C1 Qles I lncl� Q L-0�— Itn 1 - 2- 3. 4- 5. 6- 7, 8 9 10 11 12 13 14 15 16 17 18 19 20 COMME oY y u Elm - silty 9Ya;-� 13,fcwnl 10'U n r- SLOPE WAS GROUND WATER No L ENCOUNTERED? /v Depth to Water 0 ,,,, tt 4;-z-0 P x E IF YES, AT WHAT DEPTH? n--/�, 1 Reading Data Gross Time Net Time M Depth to Water Net Drop ,,,, tt 4;-z-0 x tH� 40 -T 11:01 3 �F 1i 11:17 • 7v a •2z t 11 :23 173 �PERCOLATION RATE / C� Iminutes/inch) s /TEST RUN BETWEEN L'� O- FT AND FT PERFORMED BY:�V'1 1. 1( R AU—(r@il• LL R RtA—( bs`I CERTIFIED BY 72008 (6/79( . n n - M -W DRILLING, Inc. • P.O. Box 10.378 - 10300 Old Seward Highway 84-297 • (907) 3498535 ANCHORAGE. ALASKA 99511 DRILLING LOG Well Owner DOUG MM/Premiere Construction Use of Well Domestic Location (address of: Township, Range, Section, if known; or distance main roars Lot 16 Block 2 Spring Hills Estates - Anchrn-^v Size of casing 6" ep nth of Hole 221 feet Cased to 991 4 feet Static water levet 185 ft. pt31`e) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ). Describe screen or perforation None Well pumping test at 2 rallons per (minute) for--L---hours with 100'/ Utz of drawdown from static level. Date of completion October 5. 1984 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO 2 TO 3 ---!—To 8 8 To 39 _29 -TO 62 62 TO 99 99 TO 108 108 138 TO 138 Tp 150 150 To 195 195 TO 210 _ 210 0_221- TO OF PF "q / ,CFS - 'eoya Silty gravel F� Silty gravelly hardpan Silty gravel Silty hardpan Weeping hardpan NWWA Ccrtificd Contractor Cc. i tca 61 I & n"9 1 —CUSTOMER • Municipality of Anchorage ° On -Site Water and Wastewater Program (907) 343-7904 Ell s - TfY Certificate of On -Site Systems Approval Parcel I. D.015-051-90 1. GENERAL INFORMATION: Complete legal description Spring Hill Estates; Block 2, Lot 16A Expiration Date: 7_51_Z02'1 Location (site address) 9900 Spring Hill Drive *Anchorage, AK 99507 Current Property owner(s) Jason Burt Day phone 907-440-9220 Mailing address Real Estate Agent Jake Masog Day phone 907-250-2442 2. TYPE OF DWELLING: ® 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: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55 D Date of Payment y16 .20,7,E Receipt Number 065956 COSA # D 3C)_1 1 15 1 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey. A. Garness Date: -2-1 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/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE / / K System #1 Approved for `7 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the forn V� rofessto� a #AECC884 `����1tLITYrrrrrr�ii � wAT � stl� a�ioms� T� OG ,jAR c 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory r Other _,�+eedgd,,-r,covy .Se� F ic�—avnrC W Legal Description: Spring Hills Estates; Block 2, Lot 16A If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/5/84 Total depth 221 ft Cased to 221.4 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/22/21 Static water level at beginning of test 171.3 ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material SEPTIGSTEE Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping �'I 1 1-2-1 1-' D. ABSORPTION FIELD DATA Which system tested (date installed) 7/19/93 ❑ ALL standpipes present per record drawing Total measured depth from grade 15 ft (max) Measured depth to pipe invert from grade *2.75 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 8.83 Parcel ID: 015-051-90 Structure served by this system Well production at time of test 5.9+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes WE No [2"Goliform bacteria is Negative Nitrate I �J� mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [Arsenic less than MRL (ND) Collected by GEG Date of Sample 3/26/21 C. LIFT STATION ❑ Required maintenance c Age of lift station 114 Lift station mater' Comme Adequacy test date 3/22/21 Results ❑✓ Pass For 4 Fluid depth prior to test 61 Water added 720 gal New depth 71 in Elapsed time 120 min bedrooms in ❑ Code -required soil cover over field Final fluid depth 65 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 'DRAINFIELD IS SHY ON COVER - SEE ATTACHED EMAIL COSA Checklist yellow sheet K. 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 Community Sewer Manhole/Cleanout > 100' f7v Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Q Yes if No ft . Private Sewer/Septic Line > 25' []✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' P/ Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No ft Q Yes if No ft 0 Yes if No ft Water Service Line > 10' ✓( Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Yes if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ✓V Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ✓( Yes if No ft . If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 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' U✓ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' 121 Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS *ST1 IS 3.1' FROM DECK POST G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet eeyy ., Gar ss: ��9 f CE -79 3 �c G 40��p�o f essio�°aao #AECC884 Septic Tank Advisory Certificate of On -Site Systems Approval # OSC211151 Subdivision: Spring Hill Estates Block:2, Lot: 16A The septic tank for this property is 28 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Marling Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www murn org • • '-� Municipality of Anchorage ?Gf On-Site Water and Wastewater Program cal (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 015-051-90 Expiration Date: rdo 13) 19 1. GENERAL INFORMATION: Complete legal description SPRING HILLS ESTATES; BLOCK 2, LOT 16A Location (site address) 9900 Spring Hill Dr.*Anchorage 99507 Current Property owner(s) -Grant Shearer Day phone 903-3432 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® 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: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: (i 5/(c43 COSA to be released to t e engi •-r,unless otherwise requested by the engineer. COSA Fee $ 5210-00 Waiver Fee $ _ Date of Payment 7f3/1/01 & Date of Payment Receipt Number OS Lin Receipt Number COSA# OSG(8) !O Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 mil Engineer's Printed Name: Jeffrey A. Garness Date: �„ �� oopOOQQO In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A// ,04 in accordance with the guidelines and regulations established by the Municipality of Anchorage and ��..••'•.••• T industry practices. The reported results describe the condition of the system/s on the date/s of the O -..•• / ,, / '7sU .1A+�1 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �-� v encroachments may exist that were not identified during the evaluation. The operational life of all wells �: A 9H *vD and septic systems depend upon a variety of variables, including but not limited to, soil conditions, / Q groundwater levels (that may fluctuate during the year), quality of construction (materials and D rib/ \ 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 OQ ••Je y Gorness• 13 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of VO ' 9 �3 •.1�Q� the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9 • ep can be installed on the property in the event either of the current systems fail to perform adequately in ��f •• • L Z .t 'cso_ the future. The content of this report is for the sole benefit of the person/party that retained GEG to ed�r ono� o ess perform the evaluation. Reliance upon the information provided in this report by any other person or Ur MC 0 i?"9pQppo� party (including subsequent property purchasers) is not authorized, nor will it confer any legal ri0 whatsoever. -S\ :#AECC884 ON 6. DSD SIGNATURE P-�ER o System #1 Approved for Li bedrooms \OOG System #2 Approved for bedrooms ?v x,� Disapproved '44PNT Conditional approval for bedrooms, with the following stipulations: OIRA1)0\ By: \ COUtA 1-1m Ex-,6 va Original Certificate Date: K1 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 oAk 0.9` COSA blue sheet 10.10-12.doc • If more than 1 septic system is on the lot: COSA Checklist# of_ Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: SPRING HILL ESTATES; BLOCK 2,LOT 16A Parcel ID: 015-051-90 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/5/84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 221 ft. Cased to 221.4 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/5/84 5/17/18 Static water level 185 ft. 172.8 ft. Well production 20 g.p.m. 5.8+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrates uet mg./L. Collected by: GEG, Ltd. Arsenic:/\.)C) ug./L. Date of sample: 5/17/18 B. SEPTIC/HOLDING TANK DATA 25 y 2. OLD S- y�-s',4" s y�.:�f= AP(' G/4-.,..tr e,-0rrS Tank Type/Material SEPTIC/STEEL Date installed 7/19/93 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleano(0/ t(Y/N) YES Depression over tank(Y/N) NO High water alarm (Y/N) N/A Date of pumping (:/7 ) S Pumper A4 1-6/1-2.c. . efoic c -J — C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE AT MONITORING TUBE Date installed 7/19/93 Soil rating 6y.p.d. or ft2/bdrm) 0.45 System type DEEP TRENCH Length 74 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth *14.7+ ft. Eff. absorption area 1332 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/17/18 Results(Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 56 in. Water added 874 gal. New depth 74 in. Elapsed Time: 120 min. Final fluid depth 63 in. Absorption rate>= 600+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - MONITORING TUBE EXTENDS 8.83 FEET BELOW THE INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access(Y/N) "Pump on"level at in. "Pump off'level at '• wa er alarm level at in. - Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation =5.+ Property line 5'+ Absorption field 5'+ (ASSUMED) Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ST1 IS 3.1 FEET AWAY FROM DECK POST G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and : ••••• •• review of Municipal records that the above systems are in •• conformance with MOA COSA guidelines in effect on this •.23: •• •• ••� date. • ^•• J7' r y i. Ga • Engineer's Printed Na a JEFFREY A.GARNESS •••�1. •� `• � : Date �/L�I ♦�44 RO ESS w%444 LICENSE �II Ili%%"ilt:, #AECC884 (Rev.10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT S F "• ' 907-343-7904 On-Site Water and Wastewater Section ` Fax: 343-7997 www.muni.org/onsite �.� Nitrate Advisory' Certificate of On-Site Systems Approval # 0SC181310 Subdivision: Spring Hills Estates, Block: 2, Lot: 16A A water sample revealed a nitrate concentration of 5.09 milligrams per liter (mg/L). 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. Mailing Address: P.0. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ' s '. 907-343-7904 On-Site Water and Wastewater Section `/! Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181310 Subdivision: Spring Hills Estates Block:2, Lot: 16A The septic tank for this property is 25 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. .' i'�.t 6 �f �:N }icefro ;-, 4„ v l'i" 4,,,, : „), *# "".ft. . ; '',.,,t! ' Or 4- . ,2.):"e"/ ..' .1- , 4 ' 'VbAlt,4.4''' ; ' ''.,;''--e , . , ....-,7'' s, • -, 7,'..4 ik :-tb', a . ttu h II�� ...�.•.;o a' dC e3°4e ., y. '� ,Y tip Mailing Address:P.0.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage 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/0nshe (907) 343-7904 4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-90 1. GENERAL INFORMATION Complete legal description Spring Hill Est Blk 2 Lot 16A Location (site address) 9900 Spring Hill Dr Current Property owner(s) John Powers Mailing address Lending agency Mailing address Real Estate Agent Mailing Address COSA # n04 �q Expiration Date: 40 SZ PO Box 241113 Anchorage, AK 99524 John Lopez / Prudential Real Estate Day phone Day phone Day phone 529-1679 3801 Centerpoint Dr., Suite 200 Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ 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 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 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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 Watkins Engineering, Inc Phone 349-1651 Address PO Box 110443, Anchorage, AK 99511.0443 Engineer's Printed Name Cindy W. Ellis 6. DSD SIGNATURE Approved for bedrooms. Disapproved. Date 1126107 4 �,S *; 49T-H� .. Cin y W. Ellis ;%. CE -tow Conditional approval for bedrooms, with the following Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date: (Rw. I IM) Municipality of Anchorage Development ServicesSaf* Department y OnSne Water Building Wastewater Program 4700 Bragaw Street P.O. Batt 196650 Anchorage, AK 9951M50 wwmmuni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SPft HIII Est Blk 2 Lot 14A Parcel ID: 015-051-90 A. WELL DATA Wen type EdLft If A, B. or C provide PWSID 0 Date Completed 10/5184 Sanitary said (Y" Yes Total depth 221 fl. Cased to 221.4 fl. FROM WELL LOCI Date of teat 10/5184 Static water level 185 fl. Well production 20 9 -p.m - WATER SAMPLE RESULTS: Conform 0 colonlesM00mL Nitrate 4.37 mg/L Arsenic: <0_005 m9A Date of sample: I1M4A17 S. SEPTICIHOLDINO TANK DATA Web Lop (Y/N) Yes Wires property protected (YIN) Yes Casing height (above ground) 22 in. AT INSPECTION W20/07 174 R. 6.7 9.p.m. Other bacteria 0 colonies/1 W ml. Collected by: Cindy W. Ellis Tank Type/Material Steel Septic Tank Data installed 7120/93 Tank site 1250 gat Number of Compartments ? ciewouts (YAV) Yes Foundation deanout (YRO Inslds Depression over tank (YAV) No High water alarm (YIN) NIA Date of pumping i I&= Pumper A+ Home Services C. ABSORPTION FIELD DATA Date.installed127 =3 Son rating (g.p.dAI2 or fe/bdnn)OAS Sym typo Deep Trench Length 74 ft. Width 3 fl, Gravel below pipe 9 ft. Total depth 11L --Jt Eft. absorption area 1332 ft' Monitoring tube Yes Depression over field No Date of adequacy teat 11/2= Results (Pass/Fain Pass For 4 bedrooms Fluid depth in absorption field beforetest 0 ln. Water added 7 gal. New depth 52 le, Elapsed Time: 174 min. Final fluid depth 34.75 in. Absorption nate x 400 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date inata0ed NA Site in gallons 'Pump on' leve( at —in. 'Pump ofr level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankA ft station on lot 180'+ Absorption field on lot 140'+ Public sewer main 1007+ Sewer /septic service fine 125'+ Animal containment areas 75'+ Manhole/Access (VM) High water alarm level at in. Meete alarm 6 ckouit requi emenb9 On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank WA Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7' Property fine 52_ Absorption field 5' Water main 100'+ Water service line 504 Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 42 Building foundation 15' Water main 100'+ Water Service line 70'+ Surface water 100'+ mmmw, psrktrghshkys storage 57 Curtain drain WA Wells on adjacent lots 100'+ F. COMMENTS: 2000 gallon presoak Included, due to house being vacant over one month. 0. ENGINEER'S CERTIFICATION` I certdy that / have determined M rough Yale inspections and review of Municipal records that the above systems are in -...._.•..,_ �' conformance with MOA COSA guidelAmes In effect on this date. 1 On Y W Ellis Engineer's Printed Name Cindy W FJfis CE. teen Date 12/4/07 " ................c� COSA Fee ES Waiver Fee E Date of Payment ��1�� Date of Payment Receipt Number �Q� ��/ Receipt Number (Rrrv. iM) Municipality of Anchorage • —, Deve!opment Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sit P.O. Box 196650 Anchorage, AK 99519-6550 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTi-i AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-90 1. GENERAL INFORMATION 001 HAA # 4 c+ 0ZD Zi I Expiration Date: 10 - 33 - Complete legal description Lot 16A, Block 2, Spring Hill Estates Location (site address or directions) 9900 Spring Hill Dr. Current Property owner(s) George & Kay Ladyman Mailing_address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 563-3700 9900 Soring Hill Dr., Anchorage, AK 996D7 -g3 -75_ Kathi Johnson Day phone Day phone 242-2222 Prudential/Jack 47hite, 3201 "C" Street, 4200, Anc_h. AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ❑x 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 Cert ficates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional evil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Cenificates 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 we!ls or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State cedes, ordinances, and regulations in effect at the time of installation. Name of Firm Environmental bfanagernent, Inc. Phone (907)272-9336 Address 206 East Fireweed lane, Suite 201, Anchorage, AK 99503 Engineer's Printed Name Larry A. Helgeson D 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedreoms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / /��/✓V C (�. Cricinal Certificate Date: % - > - G -2— (R" (lieu. 01,911 Municipality of Anchorage ., Development Services Department Building Safety Division OnSIDe Water & Wastewater Program - 4700 South Bragaw SL P.O. Box 198850 Anchorage, AK 99519-6650 www.ci.anchorage.akus (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Dewdpoon: Lot NPA 610C k 20SPr;dJ W1 rffqfeS Parcel ID:0lS-OSI qo A. WELL DATA Wen type ffikq+e Date completed LS _%y Total depth Zz J1 R. If A, B, or C provide PWSIID t _ Sanitary seal (YIN) Casedto22/ n FROM WELL LOG Date of test 10~ 5 ' gy Static water level / 65 R Well production Za g.p.m. WATER SAMPLE RESULTS: Coliform J—d—colontesl100 ml. Arsenlo: mg.A. Wen Log (YIN) �y{ _ Wires properly pd (YIN) J.— Casing height (above ground) 2� in. AT INSPECTION to/17/02- 17S fL 'I. ce 9— p.m- Nitrate 1'3S mgA. Other bacteria _J2_� colonies/100 ml. Date of sample 6117 02 Collected by: �� ��V e d 1F x B. SEPTICrHOLDING TANK DATA 1, II —f Q Tank Type/Material 6¢pwc_ +an k (Si er I) Date Installed Tank size gal. Number of Compartments Z Cleanouts (YIN) Foundation cleanout (YIN} _L Depression over tank (YIN) 2!� rHigh water alarm (YIN) */A Date of pumping iD/lS! /G Pumper � S g q c S f{o n P-4 C. ABSORPTION FIELO DATA Data installed 7I ZO 3 :. Sbll rating (g.p.d. or itzAxtrm) . p a r+:system type beef -�"fer' ch Length 71It. Width 2<3 tL (/Gravel below pipe �_ R Total depth . I R ER. absorption area3Lis. ft= Monitoring tube r Depression over field Al Date of adequacy test (a / 1 *7 A Results (PasafFail) PASS For A— bedrooms Fluid depth in absorption field before test%Sin. Water added 720 gal. New depth in. Elapsed Time: Z min. Final fluid depth �l Z In. Absorption rate >= 1 000 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A/ If yes. give date D. LIFT STATION Data installed — J — Size In gallons 'Pump on' level at _ in. 'Pump ofr level at _ in. E. SEPARATION DISTANCES Manhole/Access (Y/N) High water alarm level at Meets alarm 6 wcurt requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot y© On adjacent kits out Absorption field on lot ISO' On adjacent lots 60 Public sewer main Public sewer menholeldeanout IV 14 Sewer htaptle service One _��� Holding tank N14 SEPARATION DISTANCES FROM SEPTI �O�L+DIING TANK ON LOT TO: Building foundation � 13' Property line Z 1 Absorption field /Y Water main /A Water service line 40/+ Surface water 2 eO " Wells on adjacent lots 1 b0 t In. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: , Property line yU Building foundation Z i Water main Water Service line yQ Surface water t)orf Driveway. PaftVW4cIe storage Curtain drain )VIA Wells on adjacent lots JOO t F. COMMENTS G. ENGINEER'S CERTIFICATION I cer* that I have determined through field inspections and 4(��{ ` review of Munk*ai records that the above systems are in conformance w1th MOA HAA guidelines in effect on this date. Engineer's Printed Name LQ rry ICNOce - gaitsDate lZ%/0 ..,.. HAA Fee $ 4 3 = s l • Waiver Fee $ _ Date of Payment 648 Z Date of Payment Receipt Number _122, JA if 1py, Receipt Number, (Rev. 12101) UV Jun -19-02 02:58pm From -PRUDENTIAL JACK LOT 13 KATH LAND k CONSTRUCT10h 440 WEST BENSON BL +9071623199 T-945 P.002/002 F-931 S yo OR/ 10' SLOPE MaNT.-.t EASEMENT *J J S6 O LOT 14A • r wUWr sLU Ile Ss, Ir wpap r. JS• vR� vCri f w iYiont�or.� m TLL.Se � LOT 17A 0 ar •--------------------------------------------- 10' TELECCUM. k ELEC. EASEMENT 189'59'48-W 234.34' EXCLUSION NOTES: R s the owners msponubllty to determine LEGEND: SET FND N S uh o+istwnca of any eosements. corcnonts, or r"w;evons a/a'ea r/CA % 5/e• re 0 ";Chen net oppeor On the recorae0 sub3i.ision pot. NOTE: 3,25• A.uOu4bMONWMT EK WHITE Under ne eksamstenees shou00 My date mcm be Used for Nle 4 TACK' El WXWWWjJ construction or for eetebash" sraperty anew FENCE- _s_ s _ SURVEY CER71RCATiOw LANTECr hos conoueted o O"Ea hrl ■ physical survey of this properly os shown on this MOOD DECMS- drawing end Mat the YMpre.e cola situated there CONCAErE- on we within me property ihcs and no encroach- A7wALT- menlo exist other then nol@0. CmAKI �ETDRS-PLANNERS-ENGINEERS - AS—BUILT OF: IECALDESCbrna+: =�M STANDPO S- wAmtw[u- 503 (907) 562-5291 LOT 16A, BLOCK 2, "";`.50' l(fox) 551-6626 soSPRING HILLS ESTATES 2i s ssT/za r', MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 -Q Application Date S Q 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, Location (address or (b) Applicant Name VAILE 0 o✓449.6— Telephone: Home 2Caq-0/RO Business Applicant Address (c) Applicant is (check one): Lending Institution O ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) (e) (f) Lending Institution Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIII.DENCE Single -Family W Multi -Family ❑ Other Number of Bedrooms Telephone 5:_ 3. WATER SUPPLY Individual Well Community[3 Public O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11184) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this i pectio�t. tt /� Name of Firm � P Telephone � �y o Addre Date 6. DHEPAPPROYfL Approved for bedrooms Approved Disappr( Terms of Conditional Approval OF A4 C. Reid, Jr. . =I -E _: CAUTION Date Engineers Seal The Muncipality, of Anchorage Department of Health and Environmental Protection (DHEP) Issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11164) f") A. WELL DATA r) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALIP( OF ANCHORAG: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION v E P 19 1985 264-4720 alDe_scripLtcio>n• NC" �S lox 1( T/Z 0e3�s Well Classification �,/(:J4 If A. B, C. D.E.C. Approved (Y/N)'le� M Well Log Present YY N) Date '��C��omp�leted Yield l in � P ' " �� Total Depth1 1—,Cased to -J=/ Depth of Grouting Static Water Level I„ Pump Set At u(i rso z e) t ,� Casing Height Above Ground Sanitary Seal on Casing l k) Electrical Wiring in Conduit &) Depression Around Wellhead (Y& Separation Distances from Well: „t, v To Septic/Holding Tank on Lot D : On Adjoining Lots I To Nearest Edge of Absorption Field of On Adjoining Lots n To Nearest Public Sewer Line ([� To Nearest Public Sewer ^ Cleanout/Manhole ► ` To Nearest Sewer Service Line on Lot_jll Y't Water Sample Collected by C—w��� \ ;Date 6__817 � Water Sample Test Resultsaai15> -- Comments B. SEPTIC/HOLDING TANK DATA Date Installed /D Size ILM 0 z- No. of Compartments Standpipes 6)N) Depression over Tank (Y& Air -tight Caps — Foundation Cleanout'ON) . I Date Last Pumped NA Pumping/Maintenance Contract on File (Y/N) ; for 1 Holding Tank High -Water Alarm (Y/NP[ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ADO ✓ To Building Foundation To Property Line Zn + I' To Disposal Field 30 Iv To Water Main/Service Line A To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(1 V84) T10 -A-) P3w C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �.0 8� Type of System ,/Desi n Date Installed _/D-^ 6'ay Length of Field ( & ^//� y Width of Field —1 C7D ✓ � epth of Field Lf Gravel Bed Thickness 9 Square Feet of Absorption Area �� yp �✓ Standpipes Present &N) A ' Depression over Field (Y& Date of Last Adequacy Test _4Q11 11 Results of Last Adequacy Test NA A Separation Distance from Absorption Field: , n To Water -Supply Well ��va� To Property Line To Building Foundation / O To Existing or Abandoned System on Lot N ; On Adjoining Lots 11:14 To Water Main/Service Line 1V R To Cutbank (if present) PC To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area pn± Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments . Dimensions nhole/Access (Y/N) "Pump Off" Level at Vent(Y/N), •• Check Permitted Bedroom Rating Against HAA Request •• Pumping Cycles during Adequacy Test, Meets MOA Icertify thatt vecheeck verified, or conformed to all MOA and HAA guidelines ineffect onthe date ofthis inspection. SignedriiZYZ}'t�-� Date Company A = GS MOA No. 5_M57' C�0 L/ Recei t No.—`3 55c)-- 55 (� ��� Date of Payment ) - rS� s x�WW 0 9 Amount: $ y 5 /�wV��ry'y'i°grwt� oy C. Reid, Jr. No. 2251-E Page 2 of 2 72-026 11 L841 MUNICIPALITY OF ANCHORAGE • ^� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# C`i1,S—C>��1-cls 1. GENERAL INFORMATION Complete legal description HAA # "�_NQ 1C�Z)\'1 Lot 16A; Btock 2; Sp, ing H.ttta Eatattea Location (site address or directions) 9900 Sp4ing HZU Orttve Property owner Hugh 9 Nancy Mottey Day phone Mailing address Lending agency Mailing address Day phone Agent EYonito Gatt uA PHH/HOME9UiTy Day phone 510-246-6524 Address 1855 Gateway Btvd. P.O.Box 4039 Concord, Cati.S. 44524-4039 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 y 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 M". 1/91) Fool MOA m S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone 5 & 5 ENGINEERING Address 3=34 E•-1^ Rl,ar l oop frond No. 204 ;argyle River, Alaska 99577 Engineer's signature Date 6. DHHS SIGNATURE M _,Vc Approved for Disapproved. ��'•' bedrooms. Conditional approval for Additional Comments r—���vor At -11% •49TH��� �••'fr P00 .. J.E �AFEP, P.S. p S .t 11FoPROr'E:S;ONP4.. bedrooms, with the following stipulations: e.11/�/�/feAz Date / ,� 9 - utrlr The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72an1RM.1N11 8A MOA*21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L,.ffti_ArrT�rxK? `d Parcel I.D. 6Z�6f- c�'6 A. WELL DATA Well type�6tdT____ If A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) - 11 Date completed 1 D - S- R4 Drifter 10 4- W Is r; � Total depth 2 2 ( Cased to 2 2 I • 'y�r Casing height 12n '1 Sanitary seal (Y/N) U Wires properly protected (Y/N) �MUNICIPAL TY OF ANCHORAGE FROM WELL LOG AT INSPECTIOyyN IRONMENTALSERVICES DIVISION Date of test JD-S-f�� /0-29-910CT 3 1 1991 Static water level I f�i S -RECEIVED Well flow 2O g.p.m. 1'.49-P. . Pump level SEPARATION DISTANCES FROM WELL TO: r � Septic/holding tank on lot On adjacent lots Ion t Absorption field on lot f 00 ; On adjacent lots t oc0 t Public sewer mai n+ f'►� Public sewer manhole/cleanout tj.bi / Sewer service line 1r) it Petroleum tank h7nn7E kij0WtJ 1' WATER SAMPLE RESULTS: Coliform �tt A sTAGtoI � Nitrate 6 AftSfAAG:Od 14t.D � Other bacteria ?Pro Date of sample: 1 - Z'S -r► I Collected by: j S t-elc7NPrr SNS B. SEPTIC/HOLDING TANK DATA Date Installed 1 ' A4 Tank size 1 000 q n Compartments 7 Cleanouts (Y/N) 4 Foundation cleanout (Y/N) Vii -Depression (Y/N) N High water alarm (Y/N) X) !O Alarm tested (Y/NI tj to r Date of pumping to —Z5 — eF 1 Pumper*' Nome Ce _5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weli(s) on lot _J OD rt On adjacent lots J OD rt Foundation 1 To property line ? O Absorption I ield 3 O Water main/service line 119 f Surface water/drainage Inn r 72.026 (Rev. 7/91) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Manufacturer Size In gallons Manhole/Access (Y/N) " Vent (Y/N) "P p on" level at ..: • `• % 1'Pump"off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STAT N TO: Well on lot ' On adjacent s" Surface water D. ABSORPTION FIELD DATA Date installed 10- In- 84 Soil rating Z4Z*i'�_S stem a iSPcJ ---) Y tYP Length y B 7 Width Z (el Gravel thickness 1 2 JJ Total depth 7 Total absoiption area ( Z Q1 Cleanouts present (Y/N) u Depression over field (Y/N) Date of adequacy test In - Z,'7 Results (pass/fail) PA 55 for bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date t SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot (eo �1F On adjacent lots 1 00 1 t1 v 1 Property line � g To building foundation I n To existing or abandoned system on lot _IJ I); Onadjacentlots 0 Cutbank w)/A Water main/service line J n1+ Surface water ( on �+' Driveway, parking/vehicle storage area - I 0 f r Curtain drain ►) f A , I t E. ENGINEER'S CERTIFICATION l 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines In effect on date of this inspection. pry Acqki s�-11 1 Signature / hl��, %ir�•ti�iTH Engineer's Name 17034 Ea01e River Loop Road No. 204 ........ " • • "ac._ Ivcr, Alaska %. . • •• / Date - D- •jl tl/ � RJ. HAFER. P.E . Wi HAA Fee $ Waiver Fee: $ Date of Payment fid' 3�— 9 Date of Payment Receipt Number Receipt Number 72-M (R". 7191) Bxk MOA 21 ` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _2"2y S & 1. GENERAL INFORMATION (a) Legal Description (include lot block, subdivision, section, township, range) Location (address or directions) . •SDr u. E•, ..r (b) ,Applicant Name ivy Applicant Address i (c) Applicant is (check one): Lendi, (d) Lending Institution Address /t (e) Real Estate Company and Agent /� Address Telephone (f) Mail the HAA to the following 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 Telephone: Home 9," S." /Y Business > Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); Telephone 3. WATER SUPPLY Individual Well)' Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ • Holding Tank ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-02511,•8+) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by myseal affixed heretoand as of thevalidation date shown below, l verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Addre Date tri- Sova 6. DHEP APPROVAL Approved for fhrc� bedrooms by 'Q Vf' " Date 3-4— 8to Approved Disapproved Conditional Terms of Conditional Approval CAUTION S- The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Pana 9 of 9 n ^ KINICIPALM OF AN040RAGE MUNICIPALITY OF ANCHORAGE (1110..1DEPT. OF HEALTH 6 HEALTH AUTHORITY APPROVAL (HAA) 'WAOPMAENTAL PROTECTION CHECKLIST - FEBRUARY 1984 MAR 0.3 ' 284-4720 f - Legal Description:/!?r—S��sv—� r�iG t y A. WELL DATA nn rnn Well Classification Yr�t(X� t If A, B. C, D.E.C. Approved (Y/N) Ali Well Log Present®N) Date Completed 10- 5-,Rq YieldAT Total Depth 92 ( Cased to? 2 /- y r Depth of Grouting Static Water Level n7ir Pump Set At 1 Casing Height Above Ground 62 Sanitary Seal on Casing' ' N) Electrical Wiring in Conduit QN) Depression Around Wellhead (Y{�t7i Separation Distances from Well: V r To Septic/Holding Tank on Lot Iry 1 : On Adjoining Lots r loo r To Nearest Edge of Absorption Field on Lot toll ; On Adjoining Lots To Nearest Public Sewer Line 4/4 To Nearest Public Sewer 1 Cleanout/Manhole AIA To Nearest Sewer Service Line on Lot 4 Water Sample Collected by Date q Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size 4700 No. of Compartments Standpipes 67/N) Air -tight Caps�9N) Foundation Cleanou t Depression (� Depression over Tank (Y© Date Last Pumped 414 Pumping/Maintenance Contract on File (Y/N) ; for ti%r Holding Tank High -Water Alarm (Y/N) "A Temporary Holding Tank Permit (Y/N) tiG% Separation Distances from Septic/Holding Tank: r To Water -Supply Well 1PJC7 e.4 To Building Foundation JS To Property Line -1:10I To Disposal Field 30 r To Water Main/Service Line 10 To Stream, Pond, Lake, or Major Drainage Course '&7- 100 r Comments Page 1 of 2 72-0261111841 P C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata�Type of System Design Date Installed Length o1 Field Width of Field aG r Depth of Field `� 1 Gravel Bed Thickness e5 f Square Feet of Absorption Area Standpipes Present 61) Depression over Field (Y© Date of Last Adequacy Test ti(, "et. nP Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well f To Property Line To Building Foundation 14 f To Existing or Abandoned System on Lot 11A ; On Adjoining Lots 3d 4 To Water Main/Service Line 16 To Cutbank (if present) _b;17 To Stream/Pond/Lake/or Major Drainage Course (Qo !..( To Driveway, Parking Area, or Vehicle Storage Area /O Comments D. LIFT STATION Date Installed Dimensions — Size in Gallons Manhole/A s (Y/N) "Pump On" Level at p Off' Level at High Water Alarm Level at Vent(Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) " Comments •• Check Permitted Bedroom Rating Against HAA Request '• Icertify that Ihave chec verified,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed - a� Date —a-2 q -<d6 Company AECS ZIc MOA No. �S� f��c{ ������@ ++ E Of qt���1. Receipt No. 37 5i7 al 'Vol, �O Date of Payment 3'3' FL 0* } �ip� ••%�9� Amount:$ �-j l i•�r e�V '� �.. ..... l r N�. 2251E Page 2 of 2 72-046 (11,84)