Loading...
HomeMy WebLinkAboutHAMPTON HILLS BLK 1 LT 5 Municipality of Anchorage Page 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: ~'.b,.~'~-4:::::t:~ ~--I PID Number: __ ~ I~ N,~~ ~~ ~~ .~, Wastewater System: ~ New ~'Upgrade Address~~ ~~--0~ ~¢, ABSORPTION FIELD Phone: ~¢ .~Q~_ ______ ~eepTrench U Shallow Trench . ~Bed ~Mound bOther LEGAL DESCRIPTION SoilRating: ~,¢GPD/Sq. Ft, Total Depth from original¢~a~e: Block: Subdivision: Depth to pipe bottom Irom original~e: Gravel depth beneath pipe Township: Range: ~ection:~ Fill added above original 9ra~:l Ft. Gravel length: ~ / Ft. WELl.: Q New ~ Upgrade G~e~¢ ~1 Number of lines: Oist.ncebetw~lines: Ft. t ~[ ~t. Cl~assification (Private, A,B,C): Total Depth: Cased T~: Total absorption area: Pipe material:~ Driller: Date Drilled: Static Water Level: Yield: GPM LPump set at: Ft. ~ Casing Heighl Above Ground:Ft. f~ ~ SEPARATION DISTANCES ~tic ~ ~ Holding ~ S.T.E.P. TO Septic AbsorptioR Lilt Holding Public/Private M~nufaoturer: Capacity i~ From Tank Field Station Tank Sower Lines ~ ¢~~~, ~ .~ , ~ I ~ ~ Material: Number~partments: Surface w~t~,. I~'+ 1~¢'~ ~ ~ ~¢ LIFT STATION Lot 4~' ~t ~ Size in gall°ns: /Manufacturer: ~~ Line ~- ..... el~~o at: High I~p~tfons Curtain ~ctrJ~l performed by: Drain - Remarks: BENCH MARK Loca~n and Description: I Assumed Elevation: ENGINEER'S SEAL Department of He~dth~d Human S~vJces approval ~,,:v,.,,, ,,,,. Reviewed and approved by:- Date - 72-013 (1/91) MOA 25 Permi! No. ~[,~ ~ ~ I 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 Legal Description: ~:[¢k'~"l~kJ ~f~,~1~,¢-..~%¢__ /~ L~4::::h~ PID No.' 4~)1~l'?"""""""'~ SEAL 4 72-013A(2/91) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF I~:oL~ ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920021 DATE ISSUED: 2/28/92 DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 2/28/93 OWNER NAME:NESBITT JAMES MONROE JR OWNER ADDRESS:10460 HAMPTON DR ANCHORAGE, AK 99516 PARCEL ID:01513440 LEGAL DESCRIPTION: HAMPTON HILLS BLK 1 LT 5 LOT SIZE: 55439 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 1 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: - DATE: DATE: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELl iNSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERTSHAFER. P E ROGER SHAFER. P.E February 17, 1992 CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 REFERENCE: Lot 5, Block 1, Hampton Hills S/D Request you issue a permit to upgrade the septic system and grant the attached conditional Health Authority Approval for the referenced property. An adequacy test was performed on the existing system and the absorption capacity was sufficient for a three bedroom house. A Health Authority Approval was issued for a three bedroom house on 1/29/92. At this time we have excavated a test hole, performed a percolation test, and designed a one bedroom upgrade for the system. The septic system upgrade will be p~formed in the spring of 1992. We do not anticipate any adverse effects on the neighboring properties by the installation of the proposed upgrade. As can be seen from the attached site plan the property has enough area for another future upgrade. If you have any questions or require additional information for your review, please contact us. sincerely, Roger 3'. S~afer, P.E. RJS/lsu 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 1 2 3 4 ? 8 ~0 ~2 ~3 ~4 1 7 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOLES LOG -- PERCOI..ATION 'rEST DATE PERFORME Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S I_ IF YES, AT WHAT 0 DEPTH? p E SITE PLAN Deplh Io Water AIl_~er Monitoring? ~ Date: '~--""~,'~-,)"~"~-"' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE I.__.~___~ (mmutes¢~nch) PERC HOLE DIAMETER __ COMMENTS $ & $ ~NGINEEI~ING 17034 Eagle River Loop Ro~dNo,~ ~ _-~')~ ...., ~ A ACCORE)ANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT O~ THIS DATE. Ov ATE: (Rev. 4/85) MtJNICIPAt..ITY OF ANCHORAGE DEPARTMENT OF 14EAI.TH & ENVIRONMENTAL PROTECTION ENVIRONIVlENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT PHONE DESC DISTANCE TO: Mal/Llfacturer Liq. cai: DISTANCE TO: NAME NO, OF~DROOMS [] UPGRADE Inside length Wid t ~'~ No, of com~....ments Liquid depth IF HOMEMADE: Well Dwelling PERMIT NO, No, of lines / Top of tile to finish grade Material Foundation~..~/,.~ ~/ /" Nearest Jot line~:~/~__.).~. /.l~ Total length o~s, Trench,7 ~ ~ ~ inches Material beneath tile Width inches Depth Length Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Class Depth Driller Building foLmdation Sawer line DISTANCE TO: OTHER Liquid capacity in gallons Total eff~__~ption area PERMIT NO. area LPERMIT NO. To~ta/effec~tive a~t)s~o,'ption Jrest lot ~ine IDistance to lot line Septic tank REMARKS F'ERMIT t.iCI. F]F'PL. I C:F:It'~T LOCFI].' I ON L. EGRL FIN[:, EN',/I ROt-.IMENTF:IL F CITEI]:T I ON ~ DEF'FIR'I"t'IEt.~].' C I,-IE[~LTH C '~- .... .... 2:64-.47;::z HEF.'Z'3r~i CON':;"F. ~.4:t ..... E. 20TH '-,~.,'.~ ..... ,.~ Fl HI--~MPTOI'.4 DR I VE LOT; 5 D, LK · HFIMPTOt,I HIL. LS SUB LOT SIZE 5'1OOOF'1 S6~UFIRE FEET "F"r'F'E ElF SOIL RE,'SCIRF'TII]N S"¢STEH IS: TRENCH MR',:'::IMUM NI.JMEiER FIF BEDROOt"IS =: 2: SOIL RRTIiqG '.'.'SQ F]","BR)= :1. OO "FHE REQUIRE[:, SIZE OF THE SOIl.. PIBSORPTION S'ESTEN IS: TNE LENGTH [:, I MENS I ON IS THE L. EI",IGTI"t <IN FEET:) OF THE TRENCH OR DRRINFIELD. TFIE [:,EF'TH OF FI TRENCH OR PI]" IS ]'HE [:,I'-T, TFINCE BETHEEN ]"HE SURF'RCE OF TFIE GROI..IND FINE:, THE BOTTOH OF THE E:iCR',,,'FITION (IN FEET). THERE I2; NO SET HI[:,]"FI FOR TRENCHES. THE GRR',,,'EL DEPTIq I2; THE HINIHUM DEF'TH OF GRR',?EL BETHEEN THF OUTFRLL PIPE FIN[:, THE E:I.]T].'OM OF:' 'THE ENE:R',/I=ITION (I1'4 FEET). PERI"II].' F-IPF:'LIC:RNT HR'_-'; THE RESPONSIBILI]"'.r' TO INFORM TI-tlS [:,EPI:IRTMENT DLIRINI.'~ THE INSTFIL.LRTIC~hl INSF'EC].'IONS OF FIN'.F HELLS FIDJRCENT ]"O ]''HIS PROPERT'.r' FIND THE NUMBER OF RESI[:,ENCES THRT THE I.iELL HILL SERVE. ............... -FI..-IO < 2: > I i%I~;F"ECL~T Y. 01'-.15'; [aRE F-:EL~!LI I E:FICKF'IL. LING OF RN'T' S'¢STEN HITHOLIT FINRI. INSPECTION RND RPPRO',/RI_ 8'¢ THIS DEPRRTNENT HILL BE SUE:JECT TO PROSECUTION. MINII"IUI'd DISTANCE 8ETHEEN FI I,]ELI_ RND RN'¢ ON-SITE SEHRGE DISF'OSI::IL SYSTEM IS t00 FEET FOR R PRIVRTE 14ELL OR 150 TO 2C. IO FEET FROH R PUBLIC: HELL DEPENDING UF'Ot.i ]"HE ]""?PE OF PUBLIC HELL HINIHUtd DISTRNC:E FROM Ft PR'tVRTE HELL TO lq PRIVRTE SEHER LINE IS 25 FEET RN['.' TO FI COHHUIqIT'¢ SEHER LINE IS 7'5 FEET. HELL LOGS RRE RE6~.UIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITI"'IIN 3:0 [."R'¢S OF' ]"HE HELL COMPLETION. OTHER F.'.Eg!LIIREMENTS NFl'?' RPPL"r'. SPEC:IFICRTIOHS FIND CONSTR. UCTION [:,IRGRFIMS FIRE Ft'v'RILFIBLE "FO INSURE PROPER INSTFtLLR].'ION. I CERTIF"r' THAT :L: I BM FFIMILIFIR HITH THIS RE[.]LIIREMENTS FOR ON-SITE SEHERS FIND HELLS RS SET FOIRTH B'¢ THE MUNICIF'FILIT"r' OF RNCHORFIGE. 2: I HILL INS"rRLI.. THE S'¢'.STEM IN FtCF:OR[:,FINCE HI'tH THE CODES. 7:: I UNDERS'FRN[:, THFIT THE ON--SITE SEI.,.IER S"r'STEM MR"," REb]UIRE ENLF'IRGEMENT IF THE RESI[:,ENCE IS REMODELS[:, TO INCLUDE HORE THRN ~ BEDROOHS. S I ISNE[): ............................................................ FIPPL I C:f:tN].' HERZOCi C Oi'.iL:'; T. I SSLIE:[:, B'¢ ....................................................... [:,F~].'E ......................... Vd.. C, EPFIRTMENT O~ HEFtLTH FIN[) ENVIROHMENTFtL F'~'OTECTION 825 "[ l..-I E L l_: IR I'-.I PERMIT NO. ( ) ~ ~ S+' F'iS.:bl 1. T TYPE OF 'Sr'iIL FIBSORPTfON SYSTEM tS:~-~2~W~ LCIT SIZE -~¢lr)¢--)© S6!URRE FEET MRXIMI_IM HUME:ER OF BEDROOMS SOIL RRTING THE REL.]UIRED SIZE OF THE SOIL .i~BSORF'TIOi'.,I S'¢STEM IS: [:,EF'TH= t-Z~ LE-~-.I,-~TH=~ ,3RR'...'EL E:,EF'TH= ~ THE LENGTH E:,ZHENS~ON IS THE LENGTH (IN FEET.'.' OF THE TREHC:H OR DRRZNFZELD. THE DEPTH OF R TRENCH OR P]T ZS THE DZSTRNCE BETWEEN THE 51.1RFRCE OF THE GROUND RND THE BOTTOM OF THE EXC:RVRTZON (IN FEET). THERE ZS NO SET H[DTH FOR TRENC:HES. THE GRRVEL DEPTH ZS THE M[NZfdLIf'I DEPTH OF GRRVEL BETWEEH THE OUTFRLL PIPE RND THE BOTTOM OF THE EXC:RVRTZON (]N FEET). PERMIT RPPL~CFINT HRS THEE RESPONSZB~L]T'¢ TO INFORbl THIS DEF'RRTblENT DURING THE ~NSTRLLRT~ON INSPECTIONS OF RN'¢ HELLS RC, JRC:ENT TO THIS PROPERTY RNC, THE HIJMBER OF RESIDENCES THRT THE WELL W~LL SERVE. BRCKFILLING ~nF RN'¢ ~,-~TEM WITHOUT FINRL INSPEC:T~ON FIND RPPRCIVRL E',~" THIS O'EPRRTMENT WILL BE SUBJECT TI:) PROSECLT[:)N. MINIMUI'd DISTRNCE BETWEEN Ft WELL AND RN¥ ON-SITE SEI4FIGE C, ISPOSFIL ?¢STEM ~S 10C~ FEET FOR R F'RIVRTE HELL OR 25~ TO 2C18 FEET FROM R PUBLIC WELL DEPEN[:,ING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO ~ PRIVRTE SEWER LINE IS 25 FEET RN[:, TO R COMf'IUNIT'¢ SEWER LINE IS 75 FEET. WELL LOGS ~RE REQUIRED RND MLIST BE RETLIRNE[:, TO THE DEPRRTMEHT WITHIN 28 DR'CS OF THE WELL C:OMPLET~ON. OTHER RE~;~LIIREMENTS MRY RPF'LY. SF'ECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE F'ROPER INSTRLLBTION. PERI"1 1' T E~-::F' 1' F.:[-2S DE~SE~IE,'ER _-2...-1 .. --! '_~:.:~-3 I CERTIF'-¢ THRT 1: I RM FRMILIBR WITH THE REQUIREMENTS FOR ON-SITE 'E, EI,~ERS RND HELLS RS SET FORTH B'¢ THE r'IUNICIF'BLITY OF RHCHOR~GE. 2: I P~ILL INSTRLL THE ?¢STEM IN 8CCORDRNCE 14ITH THE CODES. 3: I UNDERSTRND THRT THE ON-SITE SEWER S'¢STEM MRY REC~UIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLLIDE MORE THAN ~ E:EDROOMS. :~] SOILS LOG MUNICIPALITY OF ANCHORAGE ~J] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST Pouch 6-650, Anchorage, Alaska 99502 27G-222l' ASI No. 01679 SOILS LOG- PERCOLATION TEST PERFORMED FOR: Mr. Bill Mazoch DATE PERFORMED: 4/16/79 LEGAL DESCRIPTION:._ I~t 5r Blcx)k 1, Hampton Hills Subdivision SLOPE (SH) 3.0I ORGANICS Silty Sand w/Tr. Grave]. Lt. Brown 8.0~ 9 10 11 12 13 Sandy Grave]. (GTq) w/some cobble Dk. Brown, S1. moist Gravelly Sand (SW) w/Ocn, cobble Dk. Brown, S1. moist 11.0' Sand (SW) w/some gravel Dk. Brown, Si. Moist 0' 5' 10' SITE PLAN 14 15 16 17¸ 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? ,F YES, ATWRAT DEPT.? Gross Net Depth to Net Reading Date Time Time Water Drop _ --4/16/79 9: 5Sam 1.0 '_ 4/16/79 9:57am 2 min. 1.4'(dryl_ 0.4' _ Slephen D. Shrador ~ , No, 4148- E RATE ( ] .0 {minutes/inch) TEST RUN BETWEEN FT AND ---- FY 2-feet snow on 9round; No ground water or_frost, observed. PERFORMED BY: 72-008 (7/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# .~"~ .~- 1. GENERAL INFORMATION Complete legal description Lot 5; Block I; Hm. pton Hills Subdivision; Location (site add'ress or directions) 10470 Hampton Drive Property owner Mailing address Lending agency Mailing address Agent Add ress James N~sbitt [)ay phone 562-2944 10470 H~pton Drive' Anchorage, Alaska 99516 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: - 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: ×X If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. Ifurtherverifythatbased 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 Address Engineer's signature REQUEST CONVERSION ISSUED JANUARY 29, S & $ ENG!NEE?ING 17034 Eagle River L6op Roaa OF HAA ~920030 1992 INTO A 4 BEDROOM CONDITIONAL APPROVAL. SEE SEPTIC UPGRADE DESIGN & PERMIT REQUEST ATTACHED. Phone Date 6. DHHS SIGNATURE Approved for bedrooms. DisaPproved. Conditional approval for ~ ~f'~/~.') bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 724)25 (Rev. 1/91) 8ac~( MOA #21 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.# --~'~LzL)" \,'~-~/ - ~(~ NAA# GENERAL INFORMATION Complete legal description Lot 5; BlocH I; Hampton Hills Subdivision; Location (site address or directions) 10470 Hampton Drive Property owner _ Jam¢--~ Mailing address 1~470 ~,mpta~ D,~Lu¢-, A~r~J-e, Lending agency Day phone ,562-2944 Day phone Mailing address_ Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State AD£C attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA~21 STATEMENT OF INSPECTION BY ENGINEER As certified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm_ $ & 5 ENGINEERING Phone Address 17034 Eagle River Loop Road NO. 204 ~a~Jn River, Alaska 99577 Engineer's signature ALL PREVIOUS HEALTH AUTHORITY APPROVAL CONDITIONS HAVE BEEN MET. Date. DHHS SIGNATURE ~/~/~_ Approved for /~//./~- y Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72425 (Rev. 1/91) Back MOAC¢21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Cf ~'~\/~-~- \,,_~L\- ~\~) HAACf 1. GENERAL. INFORMATION Complete legal description Lot 5; Block I; H~pton Hi~s Subdivision; Location (site add'ress or directions) 10470 H~pton Drive Property owner Mailing address Lending agency Mailing address J~mes Nes bitt 10470 H~pton Drive, Anchorage, Day phone 562-2944 day 346-2461 ~ Alaska 99516 Richard Mat~/la SEATTLE MORTGAGE Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Corr~munity well NOTE: XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XX Public sewer If community wastewater system, provide written confirmation from State ADEC . attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle RiYer Loop ROa~ NC. 2~ ;~...,... , - Engineer's signature · .,,,-,, ,.,v,~,.~, ur '~I"I:{JTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify t~at my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone Date bedrooms, with the following stipulations: Additional Comments Date ,///'~?//~ 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 orofessional engineer's work. 72-025 (Rev. 1/91) 0ack MOA ¢Y21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:(~%-~; ~'~ [/ ~-(/t/tA~(0,o ]~lC(_S £~ Parcel I.D. j)/,2~//~y.. A. WELL DA,~:~L)A Well type -T~i ~UccTtc~- Log present (Y/L~) Total depth Sanitary seal Y~N) Date of test Static water level Well flow Pump level FROM WELL LOG C, attach ADEC letter. Date completed l c~. ~%-~ Driller Cased to '¢¢c~'~ ~ .Casing height Wires properly protected Y~N) ADEC water system number AT INSPECTIt~K::ipALiTy OF ANCHOI~AGB g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /()(~' Absorption field on lot /86t'~L Public sewer main r~o~-[ Sewer service line __ ~)~3~. ; On adjacent lots ; On adjacent lots . Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~L ,,~.~ fh~t-/.¢._ Other bacteria __ Collected by:-~'~'-~ B. SEPTIC/HOLDING TANK DATA Date installed ~/~t-~O Tank size ~,~.~ ~ Compartments --~- Cleanouts~/N) Yf¢,--%, _Foundation cleanout (Y~ ~%(~,,~ Depression (Y/(~) /%50 High water alarm (Y/N) Ck.}/'/-'~ Alar~r-te"sted (Y/N) Date of pumping i / \ \ ~.c,t ~.~ Pumper_ ~f+ ~.~¢E..SE#~/(c~5 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /O0 ¢' .On adjacent lots Foundation To property line_ oq'0 Surface water/drainage 72-026 (Rev. 7t91) Front Absorption field Water main/service line CONTINUED ON BACK PAGE C.C.C.C.~L I FT STATION tei n-st&~d ]~J/./~ '~... Manufacturer Size in gallons '""'~. ~ Manhole/Access (Y/N) Vent (Y/N) ~;~ .... High water ale rm level m P"en~!~LaL~~' level at Meets MOA electrical codes (Y/N) _ .~--/- SEPARATION DIST .... F~¢~''''''''''"'""'~ ~FROM LIFT STATION TO: We.~l~ On adjacent lots Surface w'~ate~... D. ABSORPTION FIELD DATA Date insta,,ed. Length_ ¢Z~8~" Width Total absorption area Depression over field (Y/~-') _ Results (pass/fail) Soil rating_ /(~0 ~. - System type .. .'~ _ G ravel thickness ~ ~/z~x~_~?/~- Total depth. Cleanouts present.N) .. ~ ' Date of adequacy test_ . for. Peroxide treatment (past 12 months) (Y/~ t'kJZ, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date_ bedrooms Well on lot To building foundatign c~-L~ On adjacent lots.. Surface water¢ ~.)Oh~'~- Curtain drain On adjacent lots (00 Property line. To existing or abandoned system on lot -Cutbank /~,~. Water main/service line. · Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I/u~-'f6~a- '(i%r~21H6 B~-~./+p-~/) ~ A~I F~ "~' ~,t--~z ~uu~'7 ~0~ ~uE Luff I ceRify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ _ / Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907)562-2343 FAX:(907) 561-5301 ANALYSIS RESULTS for INVOICE ~ 50334 Chemlab Ref,~ 92.0156 Sample ~ I Natzix: WATER Client Sample ID PWSID Collected Received Preserved with DRINKING WATER L5 Bi HAMPTON HILLS S/D UA JAN 13 92 ~ 14:10 hrs. JAN 13 92 ~ 16:15 hrs. AS REQUIRED Analysis Completed : JAN 15 92 Laboratory Supervisor ~. STEPNEN C, EDE Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO~ : Roq# : Ordered By :R. SHAFER PO~ :NONE RECEIVED Send Reports to: 1)S & S ENGINEERING Results Units Method Allowable Limits Parameter ................... NITRATE-N 4.5 n~/1 EPA 353,2 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: - - 1 Tests Performed ' Soo Special Instructions Above UA~Unavailable ND- None Detected "See Sample Re,mrks Above NA~ Not Analyzed LT-Loss Than, GT-Greater Than Member of the SGS Group (Soci~tb Gbn~rale de Surveillance) ... GENERAL INFORMATION ' (a) (b) (c) MUNICIPALITY OF ANCHORAGE , . DEPARTMENT OF HEALTH AND ENVIRONMENTAL PHOTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WA'f ER FACILITY Application Date . ... ,', : Legal Description (include lot, block, subdivision s~ction, township, range) '- Location (address or directions). ~,e.J, ~,~"' Telephonei Home ~ Business ,.~'~/"//~'~ i Applicant is (check one): Lending r~stitution []; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution ~,, i'~.~;~__/Jr~t,/4 Address ~-- ~ ~, ~ ~ ' (e) Real Estate Company and Agent ~O~..-- Telephone Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY ' Individual Well,~f Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmenta[ Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL ' Onsite,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. "':' :: .' " 72-O25 {11/84)=' Page 1 of 2 ENGINEERING FIRM PROVID .~ INSPECTIONS, TESTS, FILE SEARCH, L A 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. ~ 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 "7~'~ .~~.4c~ Telephone Address/ ~> /~ Date Engineer's Seal DHEP APPROVA.L ~..,.~.~ Approved 'o~ bed too ms bY~~ ~ ,~'(~:,~,,"~/ //~/ · Approved Disapproved Conditional Ter~s of Conditional Approval CAUTION 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 thai!; . professional engineer's work. -' Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECflON .-,':.'J 0 5 1986. Legal Description: I WELL DATA Well Classification Well Log Present (Y/N) Total Depth _~' '7.~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances frorn Well: To Septic/Holding -rank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N Cleanout/Manhole ~ O J~_j~__ If A, B, C, D.E;C. Approved (Y/N) Date Completed / ~',~' E.,~ Yield Cased to '~ 7,~ Depth of Grouting N /~-,'~.~ Pump Set At j~l Sanitary Seal on Casing (Y/N) ~ /~-~?~'~" Depression Around Wellhead (Y/N) ; On Adjoining Lots ~'~¢ "~" ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by _ Water Sample Test Results Comments Y B, SEPTIC/HOLDING TANK DATA Date Installed ¢/~" ('-) Size Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Air-tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped / O/~/~,.r~' ; for ~/'//'/'~'- Temporary Holding Tank Permit (Y/N) J~/~- __ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ~ To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption St;rata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments N Date of Last Adequacy Test Type of System Design Length of Field Depth of Field /,,,~'" Gravel Bed Thickness Standpipes Present (Y/N) V' To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /'¢'O N'J~. /o D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that.~...,~ ~* ~//I have checked, verified.,~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~,*/~ ~/,~ Date Company Receipt No. Date of PaymentS" ~'~ ~ "?" /"' "." - Amount:$ ~ ¢~;t, 4.~;.]~ ¢. ' ,j Engineer's Seal Page 2 of 2 203 W~ 15:h AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-39'~ 6 RESIDENTIAL WELL INSPECTION LEGAL: LOT 5, BLOCK 1, HAMPTON HILLS LOCATION: 104'70 HAMPTON DRIVE OWNER: DR. JAMED NESBITT TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: NO. INSTALLATION REQUIREMENTS MET: NO. WELL WIRE EXPOSED. MUST BE BURRIED AND INSTALLED IN CONDUIT, WELL YIELD FROM TEST: 6 GPM AT 10 FEET DRAWDOWN PUMP YIELD: 6 GALLONS PER MINUTE DATE OF INSPECTION: FEBRUARY 3, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND TO BE 63 FEET BELOW TOP OF CASING. AFTER 30 MINUTES OF PUMPING WATER LEVEL STABILIZED AT 73 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON FEBRUARY 3, 1986. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE OPERATIONAL REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. THE WELL WIRE MUST BE PROTECTED BEFORE AN HEALTH AUTHORITY APPROVAL WILL BE ISSUED. A CONDITIONAL APPROVAL IS REQUESTED. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in ].and use and other factors that may impact the conditions of the aquJ. fer feeding the well. CONSULTING ENGINEER SEPTIC SYSTEM 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 T~L~P,.~t£~£~.IgO_7~ 279-3916 DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION 1986 RECEIVED _A D _U b. C Z T E S T LEGAL: LOCATION: OWNER: LOT 5, BLOCK 1, HAMPTON HILLS 10470 HAMPTON DRIVE JAMES NESBITT RESIDENCE: WATER SYSTEM: SINGLE FAMILY, THREE BEDROOMS ON SITE WELL SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: ~-~,'[%~'¥ ;, P~CEDURE: ~. ('F / Ld"~ ,2n25-[: TEST RESULT: FROM MUNICIPAL RECORDS: TANK: GREER TANK, STEEL, TWO COMP.1000 GAL. ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 336 SQ. FT. SOIL RATING: i00 INSTALLATION DATE: AUGUST 1980 OCT. 9, ].985 ANCHORAGE CESSPOOL PUMPING FEBRUARY 3, 1986 SYSTEM WAS INSPECTED AND WATER LEVELS MEASURED. TANK WAS BURRIED 3.5 FEET WITH 46 INCHES OF LIQUID. TANK CONTENTS WAS HEAVY WITH SOLIDS. CLEAN OUT TO TRENCH WAS 4 FEET DEEP AND DRY. SUMP WAS 10 FEET DEEP WITH 4 FEET OF LIQUID. WATER WAS ADDED TO THE TRENCH AT A STEADY RATE OF 6 GALLONS PER MINUTE. 150 GALLONS WERE ADDED. THE TIME NEEDED TO RETURN TO THE PRE TEST WATER LEVEL WAS THEN MEASURED. AFTER 45 MINUTES THE SYSTEM RETURNED TO THE PRETEST LEVEL. THIS SYSTEM MEETS TH~__CODE REQUIREMENTS OF TNE MU_~_LC~P-ALI T Y OF ANCHORAGE ~j[O R A THREE ETff R06M HOUSE_.. The operational life of al.]. septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. GARBAGE DISPOSALS SHOULD NOT BE USED. THE OPERATIONAL LIFE OF SEPTIC SYSTEMS ARE SHORTENED SUBSTANTIALY IF GREASE AND OTHER KITCHEN WASTE ARE DISPOSED OF INTO THE SYSTEM. ~. r-- ' ' DA;F~ RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR INSPECTOR MUNICIPALITY ol- MUNICIPALITY OF ANCHORAGE DEPT. OF I I~/~LI'I & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~ONMEN~AL F;.OTECTION ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREOTIONS: Complete all parts on page 1. Ineompl~to requests will not be processed, Please allow ten (10) days for processing. PHONE ~AILING ADDRESS r ~ . PROPERTY RESIDENT (If different from above) PHONE PHONE "2, 'BUYER MAILING ADDRESS ~ REALTOR/AGENT [ PHONE MAI LING ADDRESS STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~ Four ~;~,"~ SI NG LE FAMILY [] T~o [] Five [] MULTIPLE FAMILY ~'~ Three [] Six [] Other 7. WATER SUPP~I~¢' ~],/INDIVI DUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) 8, SEWAGE DIS,~3SAL SYSTEM ~' IN DIVI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE --'1~] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM -[]INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified "l~]Septic Tank or [] Holding Tank Size: ~ '~((-:'~ If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank IAbsorption Area Sewer Line JNearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79) DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR I NSP Ec'roR I NSPECTOR~.~ MUNICIPALITY OF MUNICIPALITY OF ANCHORAGE DEP1. OF H::ALTtl &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~I~C)NMEN],\L P:.C;TECTION 825 L Street - Anchorage, Alaska 99501 t~) ENVIRONMENTAL SANITATION DlVlSlONTelephone 264-4720 .! RECFIV D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIBECTIONB: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER . I PHONE PROPERTY RESIDENT (If different from ab~)ve) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION I PHONE MAILING ADDRE88 4. REALTOR/AGENT I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION ,Zo ?" 5"-/ TREET LOCATION ./- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS [] One ~- Four [] Other r~ _-~',~,~ olNGLE FAMILY E~_.-Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7. WATER (~ INDIVIDUAL~ ~ ATTACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well ~ PUBLIC UTILITY depth (attach Icg if available, I 8. SEWAGE DIS~POSAL SYSTEM [~INDIVIDUAL/ON-SITE** ~(? YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS E~/~iSi NG LE FAMi Ly [] ONE [~//THR EE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [;~NDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~-tf~lVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~;]~ Tank or [] Holding Tank Size: /'~,~ If Tank is homemade SOILS RATING i give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS ~ CONDITIONAL APPROVAL (letter must accompany certificate) [~ISAPPROVED DATE BY 72-010 (Rev. 6/79)