HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 1 LT 8Onsite File Hampton Hills #1 Block 1 Lot 8 #015-134-52 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211079 . PID Number: 015-134-52 Dwelling:❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name WILSON JOHN F EVA G ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 10400 HAMPTON DR, ANCHORAGE AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-762-3135 4 1.2 GPD/SF 18.0 / 13.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 12.0/7.0 Ft. Gravel depth beneath pipe 6.0 Ft. Subdivision Block Lot HAMPTON HILLS SUB #1 1 8 Fill added above original grade 0.0/2.9 Ft. Gravel length 42 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches From Tank Field Tank Line 504 Ft2 N/A Ft. Well >100' >100' N/A N/A >25' TANK ❑� Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water >100' > 100' N/A N/A Material PLASTIC Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >1 0' >1 0' N/A N/A LIFT STATION Manufacturer N/A Capacity N/A Gal. Remarks Alarm location N/A Electrical installed by N/A PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer GLW Enterprises Drainfield D3034 CO/MTD3034 Inspector J.MILLETTE BENCH MARK (Assumed elevation) 100 ft Inspection 15` 5/24/21 5/26/2'1 Location and description dates:2nd 3rd 5/26/21 4th CONCRETE PAD AT BOTTOM OF DECK STEPS ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date '`�• '9c4 l� CO49 * 711 •� -� / 7:�77� Septic System �^ 3��t r �•. Ben)arrr�chiller �¢ F� • CE 12592 . • �`� �sl�• Appro �n,.� Date �� 6/1/21 �klk�, PROFESS10 ? Note: this approval does not include well permit requirements. (Kev u5/ulil u) Ea , '�� Benja in Schiller 6/2121 �WJ — PLAN AS -BUILT x ��—�U� O 48 80 WE mm WE FEET A 8 MH1 42.6 51.0 SVI 47.4 54.7 2CO 48.7 55.7 DV1 50.2 56.8 C01 78.9 83.7 MT1 79.6 84.4 CO2 69.3 99.7 MT2 689 q8 4 LEGEND CO - CLEANOUT 2C0'DOUBLE CLEANOUT FCO ' FOUNDATION CLEANOUT DV'DNERTERVALVE MH - MANHOLE MT-MON|TOR|NCTUBE SV-SEPT|CVENT TH'TEST HOLE | •. 111111 �:l lljll!R�� • • PERMIT # OSP2011079 91.2 r N PID # 015-134-52 103.2 ORIGINAL AND FINAL GRADE �� 101.1 FINISH GRADE p v 98.2 ORIGINAL GRADE —�� U DRAINFIELD ROCK 91.2 �— 85.2 85.2 _ 42 NO GROUNDWATER 6/3/21 79.2 PROFILE AS -BUILT (NO SCALE) 49 7H Benja m Schiller ... . l�i�� PROFESSION�'��..�.•� DEPTH (feet) 1- 2- 3- 4- 5- 6 7 8 9 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 21- 22- 23 - SOILS LOG AND PERCOLATION TEST ENGINEERING LEGAL DESCRIPTION: —HAM PTO IN HILLS # I B I L8 PERFORMED FOR: JOHN WILSON DATE: 5/27/21 PROJECT No.: PARCELID#: 015-134-52 TECHNICIAN: L. TIDWELL TEST HOLE 2 COMMENTS: SLOPE NO 1T DEPTI I" - L \'ITORING: NONE 0 VITORING: 6/3/21 P E DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) PERCOLATION RATE: (MIN/INCH) PERC. HOLE DIA. (INCHES) TEST RUN BETWEEN: FT. and FT. 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: OSP211079 Work Type: Septic Upgrade Tax Code Number: 01513452000 Site Legal Address: HAMPTON HILLS #1 BLK 1 LT 8 G:2540 Site Mailing Address: 10400 HAMPTON DR, Anchorage Owner: WILSON JOHN F & EVA G Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ,�1'Y1CIl(' lleharemeue 3/30/2021 3/30/2022 46949 Q Disposal Field P Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Veronica Pope GE 2021.03.30 Received By: ° ° ° 13' 8:41 -08'00' Issued By: _ la;ZU Date: Date: 340� 0 4 MUNICIPALITY OF ANCHORAGE r PYA-' Community Development Department `r Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-134-52 Property owner(s) John F & Eva G Wilson Day phone (907) 762-3135 Mailing address 10400 Hampton Circle, Anchorage, AK 99507 Site address SAME Legal description (Sub'd., Block & Lot) Hampton Hills Sub #1, Block 1 Lot 8 Legal description (Township, Range & Section) Lot Size 46,949 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X (D) ❑ Holding Tank ❑ RenewalDuplex ❑ Multiple Multiple Dwellings ElPrivy El and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: A595 Date of Payment: 3 -2 3 -2- 1 Receipt Number: ICI Permit No. 0512 t07? Permit App_'-'-:. :'-.,:c; Waiver Fees: Date of Payment: Receipt Number: Waiver No. March 25, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/25/21 Subject: Hampton Hills Sub #1, Block 1 Lot 8 – Hampton Drive Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic system that has reached the end of its life, so we are submitting this permit application for the construction of a new trench and septic tank. The attached site plan identifies the location of the home as well as the existing and proposed septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The slopes on the lot are fairly mild with only a short section that is greater than 25% but less than 50%. We are proposing a new septic system that meets the steep slope provisions stated by wastewater code reference number 15.55.210.B.1.e to be located within 50’ of this slope. There are no other slopes greater than 25% within 50 feet downslope of the replacement site. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 16’ away from the existing trench. Please refer to the attached test hole logs, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211079, Rebecca Carroll, 03/30/21 1"=40' 42' LONG x 3' WIDE, 6' EFFECTIVE DEPTH ABSORPTION TRENCH MAINTAIN 20' MIN FROM SLOPE GREATER THAN 25%4-BDRM HOME1250-GAL SEPTIC TANK w/ 20" MANWAY MAINTAIN AT LEAST 5' SEPARATION FROM EXISTING FIELD NOTE: NO SLOPES >25% WITHIN 50' (EXCEPT WHERE NOTED) OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MT TH#1 HAMPTON HILLS SUB #1, BLOCK 1 LOT 8 WHIST ROAD FEET 0 40 80 3/25/21 792 800 796 78878 8 79 2 784 CO CO 2CO DV HAMPTON DRIVEEXISTING WELL 100' WELL RADII EXISTING FIELD TO REMAIN IN SERVICE EXPOSE TO VERIFY 16' SEPARATION TO NEW FIELD & LOCATE EXISTING PIPES DECOMMISSION EXISTING SEPTIC TANK PER UPC EXISTING SLOPE IN THIS LOCATION IS ABOUT OR UNDER 47%. THE CURRENT SEPTIC DESIGN MEETS THE STEEP SLOPE PROVISIONS AS STATED IN 15.55.210.B.1.E. OF THE MOA WASTEWATER CODE. VERIFY FCO 20' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211079, Rebecca Carroll, 03/30/21 HAMPTON HILLS SUB #1, BLOCK 1 LOT 8 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' 6" 6" 6.5' 6' DESIGN FACTORS:SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 2.1 MIN/IN APPLICATION RATE: 1.2 GPD/SF 6' DEEP TRENCH SYSTEM 1250-GAL SEPTIC TANK w/ 20" MANWAY BOTTOM OF TRENCH: 13' BELOW GRADE FLOW LINE ELEVATION: 7' BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 1.2 GPD/SF / 6' DEEP / 2 SIDES = 41.7 LF TRENCH REQUIRED (42 LF SPECIFIED) 3/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211079, Rebecca Carroll, 03/30/21 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) J. MILLETTE DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH?- 2.1 6 5 6 3/1/21 1 2 3 4 5 6 GM (SILTY SANDY GRAVEL 10" MINUS) Professional Engineers Stamp: NO NONE 3/12/21 HAMPTOIN HILLS #1 B1 L8 3/1/21 015-134-52 JOHN WILSON 12:31 1 2 3 4 5 6 6 0 16 / 11 0 16 12:42 12:53 1:05 1:17 1:28 1' OB 10 MIN 3/12/21 10 MIN 10 MIN 10 MIN 10 MIN 10 MIN 6 0 16 / 11 0 16 6 0 16 / 10 15 16 6 0 16 / 10 15 16 6 0 16 / 10 14 16 6 0 16 / 10 14 16 5 0 16 5 0 16 4 15 16 4 15 16 4 14 16 4 14 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211079, Rebecca Carroll, 03/30/21 LO T 22LOT 8 N89° 08' 15"W 239.45'R=400.00'L=35.06'S00° 52' 30"W 99.20'R =25.00' L =39.27'S89° 07' 30"E 5.00' R=190.83'L=92.78' R =130.83'L=65.76' N89° 56' 00"E 58.68'N00° 04' 00"W 195.59'29.8'27.5'2 .4 '24.8'32.2'52.3'EXISTING HOUSE30'30'30'30'30'25'25'LOT 7 LOT 6 LOT 21 60.2'79.9' 127.4'66.7'SHED GAS GA S G AS GAS G ASG ASGASGASGASG A S GAS GAS GAS G A S G A S G A S 30' 70.3'10' CEA EASEMENTTEST HOLE WITH PERF PIPE LOT 8, BLOCK 1, HAMPTON HILLS ADD. NO 1 AS-BUILT SEPTIC STANDPIPE WATER WELL FENCE Asphalt Concrete Overhang Wood Deck LEGEND: NOTES: 1) THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. 2) SNOW AND ICE MAY CONCEAL MINOR SURFACE FEATURES. 3) UTILITY LOCATIONS ARE APPROXIMATE. DRAWN DATE: DRAWN BY: SCALE: CHECKED BY: 03/11/2021 SC ADS 1" = 40' PLAT: WORK ORDER: 21014 76-141 FB/PG: 819/45-46 GRID: SW2540 LEGAL DESCRIPTION: ORDERED BY: JOHN WILSON 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 OTHER THAN NOTED OR SHOWN. EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTY LINES, OR FOR PLOT-PLAN PURPOSES. 250 H StreetAnchorage, Alaska 99501 Survey Department Phone 562-5291 Mainline Phone 243-8985 AECC 668 PARCEL #: 015-134-52-000 ADDRESS: 10400 HAMPTON DRIVE GAS GASGAS LINE UTILITY PEDESTAL POWER POLE MUNICIPAI_ITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L. Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WEI.L INSPECTION REPORT ]PHONE T-~-- MAILING ADDRESS LEGAL DESCRIPTION Z / LOCATION ~ Well t ~bsorption area ~g I DISTANCE TO: ] ~ ~ ~ Mm~u~c~ure~ ~ [Uiq. capacity in gallons I ~,.~ I DISTANCETO' /well Dwelhng ~ ~ ~ ~turer ~ Material Well DISTANCE TO: No. of lines ~ Length of each line ! Top of tile to finist~g~rade Length Width Type of crib Crib diameter Well DISTANCE TO: Clas~ Depth DISTANCE TO; Buildin9 foundation tDwelling lWidth NO. OF BEDROOMS PERMIT NO. Liquid depth OTHER PIPE MATERIALS p/~,~. ~ ~__ SOIL TEST RATING INSTALLER REMARKS PERMIT NO. Liquid capacity in gallons Foundation PERMIT NO. tNearest lot line Trench width Total length of lines Material beneath tile Crib depth Distance be twee ~2,~' Total effective absorption area PERMIT NO. Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption DATE / LEGAL APPROVED 72-013 (Rev. 3/78) ~ lO ~ ici' icl' t"l LI Isl ! I~Z: Z I- ,-~ L I 'J' 'T' C~ F~ ' DEPRRTMENT OF HERL. TH AND EN'¢IRCINblENTRL PROTECTII]N ,:,~._ '"L'" STREET, ttN_.HORRUE.., RK. 9950~ 264-4728 ~2 , - PERMIT NO. ( 8(~8e28 ', RPF'LICRNT SHIRLE~ Y MOORE SRR E:O,':< "~,'~ ~.4~-2,' '-'~*'~",_,L~ LOC:RTl ON HRHPTON DR ..... LEGRL LOT 8 BLK ~ HRNPTON H~LLS SUB: L_I ._I;E ~PE ..F _. IL HE,~ORPTION =,~TE["I I:,: TRENCH ¢ -~ Cs , MRXIMLIM NUMBER OF BEDROOMS = 4 SOIL RRTING THE RE6~UIRED SIZE OF THE SOIL RBSORF'TION SYSTEM I~: ~.- 61~A%-'EL [:,iF'TH= ~// THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR [:,RRINFIELD. 'THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF' THE GROUND RND THE BOTTOM OF THE E~(CRVR'TION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS 'THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E:=.(CRVRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEF:'RRTMENT DURING ]"HE INSTRLI_RTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RN[:, THE NUMBER OF RESIDENCES THRT THE WELL WILt_ SERVE. .......... 'TI~FJ ~ ~ ) I f-,ISPE6;T I ~3~45 RI;:':E I~:E(;!LI I F-::F=:[:, ........... BRCKFILLING OF RN%.' tBYSTEM HITHOU'F FINRL INSPECTION BND BPPROYRL. BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN FI HELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS 2L00 FEET FOR R PRIVRTE WELL OR 150 TO ::-)00 FEET FROM R PUBLIC WELL DEPENDING UPON THE T'¢PE OF' PUBLIC WELL. WELt_ LOGS FIRE RE~.UIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF "FHE WELL COMPLETION. OTHER REQUIREMENTS MRS' flPPL"r'. SPECIFICRTIONS FIN[:' CONSTRUCTION DIRGRFIMS RRE Rk"RILRBLE TO INSURE PROPER INSTRLLRTION. F'EI;cr,1 .~ T E>=',:P I RE'_=. [:,EI_-_:Er-IE:ER I C:ERTIFY THRT :l: I BM FRMILIRR HITH THE REOUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH E:Y THE MUNICIPRLtT9 OF RNCHORROE. 2: I WILL INSTRLL THE SS.'STEM IN RCCORDRNCE WITH THE CODES. Z;: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRROEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. ANCHORAGE, ALASKA 09503 (907) 278-1551 February 7, 1980 Shirley Moore SRA Box 75 Anchorage, Alaska 99507 Subject: Percolation Test, Lot 8, Block 1, Hampton Hills Subdivision Dear Mrs. Moore: In the spring of 1975, Alaska Testlab conducted a percolation test on the above referenced lot. Attached to this letter is a sketch showing the test hole location. Soils encountered were as follows: 1' - 7' 7' - 11' 11' - 20' Organics Silty Sandy Gravel, Silt Content 20%-25% (GM) Silty Sandy Gravel, Silt Content ±15% (GM) Silty Sandy Gravel, Silt Content ±20% (GM) The percolation rate was very fast (less than two minutes per inch). We reco~nend that'the drain field be designed to allow an absorption rate of 100 square feet per bedroom based on criteria developed by the Public Health Service. Sincerely yours, ALASKA TESTLAB James R. Finley, Jr., P.E. Geotechnical Engineer JRF/mg Attachments () Parcel I.D. 015-134-52 Certificate of On -Site Systems Approval Expiration Date: Legal description HAMPTON HILLS #1 BLK 1 LT 8 Site address 10400 HAMPTON DR Anchorage AK Current property owner(s) NEWMAN X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/11/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by. an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-134-52 Complete legal description HAMPTON HILLS #1 BLOCK 1, LOT 8 Location (site address) 10400 HAMPTON DRIVE, ANCHORAGE, AK 99507 Current property owner(s) BRIAN NEWMAN Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 2 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 550 Waiver Fee $ Date of Payment 9 / 2 Z 3 Date of Payment COSA #05 2,'Z., 1 ? 7 % Waiver # COSA Application.doc Legal Description: HAMPTON HILLS #1 BLOCK 1 LOT 8 Parcel ID: 015-134-52 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 5/12/1980 Total depth 400 ft Cased to 220 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/27/2023 Static water level at beginning of test 155 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 57" Date of pumping 9/27/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/26/2021 ® ALL standpipes present per record drawing Total measured depth from grade 17.7 ft (max) Measured depth to pipe invert from grade 8_8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ® Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Well production at time of test 1.6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) rKs Collected by - Date 9/27/2023 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/27/2023 Results N Pass Fluid depth prior to test 0 in Water added 790 gal New fluid depth 17 in Elapsed time 1140 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in (MOA WED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 72 in Comments/Deficiencies: Approximate total measured depths from existina arade ED per elevation measured shots & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® 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' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/29/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & EIdI S COSA Checklist.docx .• 7H •:� �.... .. .. ......'. j �.. Curtis Huffman F F •. CE 128991 �® PROFESS10Na �d •d®z MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section RUS ANCHORAGE ._.� •� yam;_ ._ ; Certificate of On -Site Systems Approval Parcel I.D. 015-134-52 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: q-3 -z/ 1. GENERAL INFORMATION Complete legal description Hampton Hills Sub #1, Block 1 Lot 8 Location (site address) 10400 Hampton Drive Current property owner(s) John and Eva Wilson Day phone (907) 748-3787 Mailing address 10400 Hampton Drive, Anchorage, AK 99507 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Fmil Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 168 Date of Payment 6 -3 Receipt Number. d 3 COSA # �� C 2 1130y Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/1/2021 0F'a�gs�l1 TH *. �s * r 6. DSD SIGNATURE I 1 d System #1 Approved for bedrooms �. Ben)amUry'Schiller System #2 Approved for bedrooms P� F��s , CE 12592 Disapproved 11,lk� pROFESSIO�+'!� Conditional approval for bedrooms, with the following stipulations: C)-SITE GG WATER AND Z "0 Q= Jm_ PROGRAM SE?,\J B Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: 10• Hampton Hills #1 Sub, Block 1, Lot 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 05/12/80 Total depth 400 ft Cased to 220 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 22 in. Date of flow test for COSA 2/25/21 Static water level at beginning of test 167.2 ft. Comments B. TANK DATA Age of tank(S) NEW years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank NEW © Standpipes/foundation cleanout per record drawing Date of pumping TANK INSTALLED 5/24/21 D. ABSORPTION FIELD DATA Which system tested (date installed) New ® ALL standpipes present per record drawing Total measured depth from grade 18.0 ft (max) Measured depth to pipe invert from grade 12.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015-134-52 Structure served by this system Well production at time of test 1.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 2/24/21 C. LIFT STATION uired maintenance completed Age of lift station`— tation _ years Lift station material Comments: Adequacy test date NEW Results Z Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' 0✓ Yes Community Sewer Manhole/Cleanout > 100' r✓ Yes if No ft M Yes if No Neighboring Tank > 100' F71 Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No Absorption Field on Lot > 100' F/ Yes if No ft Holding Tank > 100' p✓ Yes if No Neighboring Absorption Fields > 100' Yes if No_ Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ✓0 Yes if No ft Q Yes if No _ Water Service Line > 10' F/ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' p✓ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0✓ Yes if No ft Surface Water > 100' Yes if No Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: P(l Absorption Field > 5' if No Yes if No ft Private Wells > 100' Yes if No_ Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No _ Water Service Line > 10' F/ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓� Yes if No ft Private Wells > 100' ®✓ Yes if No Water Service Line > 10' P(l Yes if No ft Community Wells > 200' R✓ Yes if No Surface Water > 100' 7/1 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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 AMOW OF Al., Tom`° . BenjamnySchiller �� �F� •. CE 12592 • �`�,,�'� iflF • , 6/1/2021 , . '�& k® PROFESS0 ft ft ft ft ft ft ft ft ft ft M O M °000p�0°� 25' 25' o 0 m CDW N00° 04'00"W 195.59' ` op�aa < : P 7��00 10' CEA EASEMENT co o ° DAN m t0 z Z D� - i z: _ O Q o m 30 I 30 r— p o N D: ; I iu O OO Cl) �� o� �D m Z —I� o QOM _ 00 V') 0 °�-- . Dz CTI 00 Or C9 F cu 0 aso, o mc v1> 60.2' ,52.3CA) w 'I � a rl o o nz 0O �N z C: �W � N� �� � D � N m Z 00 to v mD a 0 o o N' 00 w rt o O cn o P 0) / O Ln o (D 77= m 00 24.8' � .h In m � N -I o O o w N 0 v z / r r C) p O / w / rn N n p m m m m O D D m p �n v �n C (n G -I Imn C.�% O 00 O / D m D D min z�ammc =y�< —0--i p s m vrm� -Aim�< -i p � V m Z Z' m D z m O pZ D m D C - w..\ �Q � O / 0 W rp moZ, a >z I- OZ -l> f f�//� :'5 x00 AZ �< ZOm=n n -i \ C m ( ®m p C m n 0 1-0 0< � rn m n CO Co x O my nom o 2- m O O ape V1 D In �'O�m- 0� ° X r Z -I AmO.. Z S n L00 z o ooZvi _�z� D D<m D WO � 3p C? N Z n0 C p m � z F m O Vl '� �`I No do v z��o ZZOZ Zmz N (ll V Dm toOm -1m-i D n p 0 vco r Omin O� � N A 0 I OL 6,0mman �m0 ' n "'m \ ?Dv Aoa �ZmO O � T < p�Ao fin^ DOzp .� I 0 n T W ;aD O o vZpc1W mO �m0 Fn L.) II CSO J1 IV .. 0 o v �rz(O� z�� mImn .C1j O `I F cn 0, ;rte 0=m D Z 1\ Q W S�O zD0 n l° mmn Gi n < 0m m m O � c 3 z o R=400.00' L=35.06' S00° 52'30"W 99.20' LZ, b O� 61 '' r ^� Azmzm >0An> C D N o m -oma mD� W / I A In v o �m=m �2z V1 Z O CD W C) Z o= x -zi z< m -i O n 0 6 o Z" ? D HAMPTON DRIVE -n D z n ^� 23<0m 0 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-134-52'; HAA# ~ ~q~ G ~.~ (~ GENERAl. INFORMATION Complete legal description Lot 8; Block 1; Hampton Hills #1 Location (site address or directions) 10400 Hampton Drive Anchorage, AK Property owner Mailing address _ Lending agency Mailin. g address Agent Vince Palma/ Address Robert & Suzette Willis Day phone 346-21 85 1~4~N ~nmp~n Priv~ ANchorage: AK 99516 Day phone Prudential Jack White Dayphone 563-5500 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xx 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage flies 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 effec~ ~-~¢,~ls inspection. /I Name of Firm W~ttS¢,, Co/lcA/~a/~ ~ Phone Address , /,/ / Az Engineer's signature ~.,.~/~I~ ,¢~/~~ Date. Alaska Water Wastewater Consulta~n~.~ Shall be PAID $ i cc~o., .at, or prior to, closing for the I~r~§ineeri~?4 So. ices Provide([ 6. DHHS SIGNATURE ~ Approved for /c-0 ~ Disapproved. bedrooms. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments .t'.'~Jl[~Ji The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Ray. 1/91) Back MOA#21 Municipality of Anchorage JUN 1 4 1999 DEPARTMENT OF HEALTH & HUMAN SE4~Mf~ES¥ Environmental Services Divisi~VIRONM~NT^LSERVi¢~.S 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Pv~-'~ Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist ¥[Cx,~PT~O~--~ ~-~L~ ~ J Parcel I.D.: if A, B, or C, attach ADEC letter. ADEC water?stem number k,¢ J~_._(~ Date completed ~-~/~ 7/~0 Z~O~)/' Cased to Z~.~ (+ Casing height (above ground) ~/IG~--'~'' Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTIO~ / 1-74./ /.- 2. g.p.m. 2- +/- WATER SAMPLE RESULTS: Coliform '~ Date of sample: ~/~/~ ~/ Nitrate ,, Other bacteria ~-~ - Collected by: ~r ~/~(J'(~ / /,,'.,/~:~ ' B. SEPTIC/HO L DIN G T/AN~, DATA Date installed ~//~./~O Tanksize Foundation cleanout Date of Pumping /~'~ Number of Compartments '~- Cleanouts (Y/N) . Depression (Y/N) /uo High water alarm (Y/N) Y C. ABSORPTION FIELD DATA Date installed Length ~- ~' Width Soil rating (g,t~d:fff~orfF/bdrm) JO '7-, ~ Gravel thickness below pipe Effective absorption area ~¢r-O0 Monitoring Tube present (Y/N) Date of adequacy test ~, / ~//~c~ Results(Pass/Fail) Fluid depth in absorption field before test (in.); ~O n /f Fluid depth ~-./ (ins). Minutes later: Peroxide treatment (past 12 months) (Y/N) System type I ~ Total depth /'~' . Depression over field (WN) For Immediately affe/TC~gal, water added (in.): Absorption rate = -~OO 4- g.p.d. I~-~Jlf yes, give date ~ 72-026(Rev. 3/96)* ~ /o/ ~'~ /"~0 /,~?' /q~¢'~ ~ ~u~? bedrooms Date installed '"-~'-'-'-----._~ Size in gallons Manhole/Access (Y/N) "Pump on" level at*"~'~'------~- High water alarm level at* Cycles tested *Datum "Pump off" level at* E. SEPARATION DISTANCES Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/holding tank on lot _ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line ~/¢'- Absorption field. Water main/service line J/~ t~. Surface wateddrainage /00/+' Wells on adjacent lots / /Od3 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ~ 0~ -1-- Building foundation I O /+ Property line Surface water_ Curtain drain Water main/service line ) O/~- Driveway, parking/vehicle storage area Wells on adjacent lots I=NGINEER'S CERTIFICATION I certify that I,,ha'"v~de~/rnin/ec~ field inspections and review of Municipal in conform~ce w/th~, A/~4 ~. defines in effect on this date. Signature ~.~4~, ~ 72-026 (Rev. 3/96)* Waiver Fee $ · Date of Payment. ) Receipt Number MUNICIPALITY OF ANCHORAGE ,f'~"~,, DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address I °~°° ~ ¢¢~P ~ otherwise requested, ~AA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: Day phone Day phone Day phone 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. Ugl) Front MOA N21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown betow, 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 typeofstructureindicated herein. I furtherverifythatbasedontheinformationobtained 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 ~ o~'~ ~ , I)~¢~0,-,~ ~do. %o~ ~o,s Engineer's signature Phone Date DHHS SIGNATURE Approved for /~/L, (~) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~ ~ 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 professional engineer's work. 72q)25 (Rev. 1/91) lack MOA Legal Description: A, WELL DATA Well type Log present (Y/N) 'Total depth Sanitary seal (Y/N) Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. If A. B. or C, attach ADI--C letter. ~ ~ Date cornpleted Cased to ~ ¢c)' Casing height "~ '¢,¢ S Wires properly protected (Y/N) '-d ~ ~ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on tot Public sewer main t,o/A- Sewer service line ADEC water system number I,d/Ac g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) ~J O Date of pumping q - ~ ~ ~ ~"L.-- WATER SAMPLE RESULTS: Coliform 0 - E>A.-~s~.4c-r0,a.-,( Nitrate O.[ ~'~/.¢,_ Other bacteria Date of,am , : oo, o,ed Tank size ~Z ~0 ~. Compartments Foundation cleanout (Y/N) ~ s Depression (Y/N) ~o Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I (~ '5 ' On adjacent lots ~,'2. <DO' Foundation To property line O~5. t Absorption field 'Z O .W.~aterq:mg:~/service line Surface water/drainage v~/,~ -p ~ co ~ 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level /__¢¢t~,Ae'vr~ 5,1 ~4-c¢-¢,, Manufacturer Manhole/Access (Y/N) "Pump on" level at "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Length ¢'"/ Width On adjacent lots Surface water Soil rating ~/.44. (~ r~,~,~- System type Gravel thickness '~.~¢'¢¢-~-- ~/~"~ *'¢~/-~Cleanouts present (Y/N) ~-t lb Date of adequacy test Total absorption area Depression over field (Y/N) Results (pass/fail) ~ ,~¢- s Peroxide treatment (past 12 months) (Y/N) If yes, give date Total depth 1¢- bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ To building foundation (-" '-~ On adjacent lots Surface water Curtain drain On adjacent lots '~' 'Z. c~ O ' Property line 1 t.J[A TO existing or abandoned system on lot Cutbank ~,0~¢-. AN~t~r.m~/serviceline ~ % ¢ Driveway, parking/vehicle storage area I ~' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Sig natu re C>~,,,q__...-~'~ ~-~ Engineer's Name (~ ~-.¢D'~)rsL~ ~.. ~ !.'~%~,~ Date ~¢.~ pT' HAA Fee $ /'"~ Date of Payment Receipt Number 72-026 (Rev. 3/91) 8ack MOA Waiver Fee: $ Date of Payment Receipt Number tDEQUAC¥ TEST FOR JERRY iqOORE i,OT 8, BLOCK 1~ HAHPTON fi]iLLS SUBblViSI(-1N MuF~i,',;ipahty o[ Anch0ra9~: 10,100 HAN1PTON DRIVE Oept, I toalth & kkllgall Services September 26, ] 992 i/his septic system was constructed itl Jl/l'lO o[' ] 980 and has been fttllctionil]g for the past 12 years. 'l'he system was insBalled in accordance with municipal iluidelines and properls' inspected by the municipality at the time of installation, The honleowtter has kept l~ood records of all constr~.%ction and maintenance, infornlation. The homeowner was the original installer and supplied detailed information regal?dina tho construction of the s,vstem. The septic tank was last pumped on July 1,1~ ]992 b7 Isaacs Primping Ser%ice~ records attached. Accel'ding itc the homeowner the tank has been pumped ever>; ~ ear ~:ince its installation as part of regulai~ maintenance. The system consists of a 1250 gallon Greet two con,pertinent tank. The tank located in thc front b~a~'d appt.oximately 33 feet r~-o,n the house foundation. A single leach trench is connected to the septic effluent line with a 'P~e connector and is 20 feet f~?om the effluent end of the tank. The leach trench runs parallel with the house and is a sinale trench 27 feet in length. There is a stand pipe locate(] at the gol%hel.'n end of the leach trench. A foundation cleanout ]q~esent, however' the~'e is only one acce~s tube in the septic tank and no cleanouts between the septic tank and the leach field. These c]eanouts were not ~.equired att the time oC construction. The leach trench ia constructed in silty sand5~ gt'avet (GNI) with silt content pan~in~ from 15 to 25 pel~cent, Thc original soil test infok~mation fFog'l Teatlab is attached, Alaska Teshlab recommended that a value of 100 sq~taYe fe~t per bcd:room be rased for the system design based on a percolation test. The original pelx;o!ation rate ob[ained by Alaska Testlab was less than two minutes per inch. Tho leach lines have from 4 to ? feet o~ cover material over them and from 8 to 10 feet of gravel below them. The trench was dug 4 feet wide. This gives a total absorption area in excess of 486 square feet, more than atdequtate based on the original design information. For a four beth. eom house and a design flow of 1G0 gallons per bedroom the toted dali> flow f~x>m this house is calculated to be 600 gallons per day. Using tJnl~es this amount no lnore than 900 gallons of water should be reqnired to conduct tb[~ On September 26, 1992 I at'rived at the site and began to meter water into the ~tand pipe located in the leach field. %~;ater was introduced into the sS~stem from the on-site pr[vaLe water well. A total of 935 gallons of wate~~ was introduued into the sTstem ove].' a 5 hour period at al?proximatels' 3 gallons per minute, low flow ~-ate is due to the ability of the water well. There was a rise in water level in the stand pipe of 0.40 feet after introduction of approximatel} 300 gallon:;. The ~-emaindcr of the water was introduced with no detectible rise in water level. After introdtmkion of the 935 ga]lom~ of water the drop in ~ater level was measured with ]'esl?ecL to time, These value,s are aa follows; Page 1 of 2 Scptembel: 29, 1992 '!'IbN,] IN >IiNUTES 10 2O 30 l0 60 6O ?0 DROP "- IN FEET IN' WATER LE.RL 0,06 0.02 0.02 0,02 0.01 TOTAL 0.39 Peet by Leroy C. Reid, Jr. PhD. ~nc(-~aniel L. MacFar~ane o1: Alaska ~mxiloumc .... Control Services, Inc, stale that water should be h-itroduced into the system the system is filled, the level in the access pipe raises one foot, or unG1 times tile daily design flow has been added without a significant rise in water level. The system ~ested fell into the last category, that is, 900 gaRons was introduced with no significant rise in water level. This condition is since the maximum rise in water level of 0.[ feet was reached after introduction of 300 gallons into the system a~u] maintained constant for the addition of the uemaining 600 gallons. In addition the 0.4 feet of rise tn water level dropped approximately 70 miracles which indicates that the system is capable of a,..eept]ng the daily load without a problem. The septic tank was not pumped and the honleowner was hlstructed to use water as normal after this pm, Lion of the Lest, The following morning approximately 18 hours after addition of the 900 gallons the water level in the stand pipe was again measured and found to be at level measured prior to the test. The homeowner slated that thel'e had been three showers, two loads of laundry, arid one dishwasher load used the dab in addition to incidental rurining of the kitchen sink for cookirig and esthnated that between 80 to 100 gallons had been used, I purposely requeskod th;it the tank not be pumped iii order to check the values 2-1 hottFs later with additional bad beir~g added to thc system. iu conclusion the daLa required for the graph of gallons absorbed versus time could not, be collected. The system absorbed the water so quickl> that no represeiitative value could be placed on gallons/incll rise tn the ~'ielcl, if data would be unrepresentative sine. e used =' mom this test were plotted the information this vahm can riot be calcuhited. 'Phis sy'stelll has been determined adequaLe for the I bedroom dwelling based on its acceptance of 1.5 thnes the design loading with no significant rise in water level. From the results of this investigation it can only be stated that this system performs adequately to ~erve the 4 bedroom house and that a daily absorption volume in excess ol' 1.000 gal]ous per da}~ was Page Septeniber ,- , i~!ELL FLO~,~ TEST FOR JERRY HOORE ()0'[ '~ ~ it~'~/?. LO-r 8, BL. OCK I, HAI,'iPTOI,I Hi~LLS SUBD~V~S~Oi'I DRIVE j~ig(iN;i[J?d (')' C,~ ' ' ....... ~ 10400 HAMPTON Oept. liaelt~B, liumanServices SEPTE. HBER f~7, 1992 Upon ant'ira1 ~o bhe s~Se Lhe water we~] was ~nspecbed and bested. The san~bary sea'l on She we'i'l was -in-bac'b and appea~ed 'bo be ~n good shape. The we~l casing exbended 2 fee~ abeve ground nut-face and was 'located ~n an area not sub.jec'b to 'ff-lood~ng or h~gh wa'bet Separa'b~on d~sbance bo ~che sep'b~c system was measured ~o be '105 -Feet. AIl on-~o'b d-isposa'l systems on adjacen~ pr-opert'ies are ~ocated greater Ctsan ze ~-ee~ from Chis ~eli The s'ba~c water' 1eveI was. measur'ed a'b '1~:~.6 fee% f'l~om 9round surface pr-~or to bhe -fi'iow best,. According to the well log t. he to'kal depth is ab 400 leek. Ttae dr~11 log d'id lao~ ~nd'ic;a'be 'N'~e ievel of the xel~ screens, however', from examination o'f' 'kine )og 'is assumed Nqa'c ~hey ar'e 'ioc;ated ~n 'bhe ~n~er'va~ bet~een 177 and 182 feet be'low gr'ouIqd surface, kb'is ~s Nse approx~ma%e Iota~c~on the eas'ing s~ze change. The we~l casing -is A53 grade B s~x. ~nch 'i ns ~ de d ~ nme'her p i f)e ex bencl~ 1'/9 f r'orn 2 -Fee~ above ground surfaco ~'i' 220 feeb o'f' 4 Snch ABS p~as'kic 'i'ine a dep'bh of 180 fe.~ and ex'bend~rlg t;o ~che 400 foo~ 'leve-i. -the depCln gauge was no~ able bo be extended be'low ~l'~e 180 f'oot ~eve'1, probab'iy due ~o She change c:as'i ng s4 'tho wel~ pump ~s set at 395 feeb tpe'low ground surface. The sCor'age vo ~ ul~ie ~ n %he cas'i ng -~'rom the s~a'b~ c wa~er 1 eve'i to ~he pump e'leva~on is as fol'lo,~s; Cas4tag capaci'by: 4" Casing :': 0.65 ga'llons/'l:oot; 6" Casing z 1.47 ga'lions/foot, 215 · 0.653 x 140..5 gallons (180-'153.5) s 1.471 = 39 gallons Totai St. or'age :: 179 ga'llons The v~ell gt~uge was 'lowered -bo a depth of 175 ~eet and tine we!l pumped unt~l bhe wa'bet ~evel was dr'a~n belo~ the 175 foot ~eve~. l'he x~,e'l'i pUlrlp was %hen shut off and tl-,e wa'her 'leve'i r'~se ~n the casing measur-ed, Sbopwa~ch read4ngs were Baken for every 2 feet of rise in wa~er 'level. ~,/aber 'level rise was measur-ed with a w'ir'e completing a circuik to a ohm reeker. The r'esul'bs ar'e as fo'ilows: I2, EPTN T ]' H E FiAT E FEE[ (NN:SS) GPH 175 00:00 173 0t:33 1,90 171 03:08 1,86 169 04:4.4 1,84 167 06:1S 1,!98 165 07;4.5 1,91 163 09;16 1,94. 161 10;4.9 1,90 159 12:26 1,81 The average -i:'low rabe measured 'in 'chis gallons per rnfinut, e. Th~s may seem inadequa%e f:or a 4 bed room house, however, ~here is approxima~e]Y 180 gallons of' sbor'age space in She wel"l bore and an add-i~ona'l 40 gal'Ions o'~' s~orage fin Lhe househo~ d hydropneumat~ c bank ~o mee~ peak demands. The I . 9 gallons per' IT~I1D~B 'is cons~s'ben~ wi~h ~he results that, N-~e well dr-'i]]er' obbained in 1980. The sysbem 'is capable of producing the su~ r 600 ga'l'lons per day design -~'-Io~,~ a~ ~h~s f']o~, rabe arid ~'" reserves are a. va~'~ab'le 'in bhe we'll and pressure ~ank to meeL peak demands. The day 'Fo'l'lowfing bhe we~'l test; a ~a'ber meter was used %0 ~ntroduce waR~r' in'bo the sept-lc sys'bem for an adequacy best,, A · bota~ of 935 gallons was produced ~n 5 hours, ~h~s -is -fiur%her ev'idence bo sLpport tha~ ~he required da~]y volumes (;ar~ eas~ !y be meb. P. September 29, 1992 Paze Z of '2 Seld. emhe~' 29~ i992 NORTHERN TESTING LABORATORIES, iNC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456.3116 · FAX 456.3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Shirley Moore 10400 Hampton Drive Anchorage AK 99516 Attn: - Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Report Date: 10/02/92 Date Arrived: 09/29/92 Date Sampled: 09/29/92 Time Sampled: 1358 Collected By: SM A120721 Kitchen Sink Water MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Units Result Flag MDL Analyzed Method Parameter ..... EPA 353.3 Nitrate-N rog/1 0.1 0.1 10/01/92 'Reported By:-SubJoin ~,~.~ Tifental Microbiology Supervisor -~ATE DATE %~ / DATE () MUNICIPALIIY O}' ANCIflORA~k MUNICIPALITY OF ANCHORAGE DEPT. OF H-.',Lr;~ &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ONMEN1AL /'MDJECTION 825 L 8tre~t - Anchorage, Alaska 99501 AUfi 2 8 1980 ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAI~ING ADDRESS PROPERTY RESIDENT (If different fr )m ab ) PHONE ~, BUYER .... PHONE ~AILtNG ADDRESS ~, LE~DINGINSTITUTIO~ " ~ PHONE MAILING ADDRESS ~, REALTOR/AGENT I PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION ,¢,m ? TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY ~] Three [] Six [] Other 7, WATER SUPPLY .~ INDIVIDUAL.* COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Iog if available.) 8. SEWAGE DISPOSAL SYSTEM L~ INDIVIDUAL/ON-SITE*' [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED, NOTE: THE NSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Ray. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER E~ INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER OSeptic Tank or •Holding Tank Size: I ~...~:b If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: ~ I Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR ~ BEDROOMS [][] CONDITIONALDisAPPROVED APPROVA~L (letter must ac~/~a~v certificate) DATE BY//) / 72-010 (Rev. 6/79) ® August 29, ]980 Jerry W. Moore Post Office Box 10-1928 A~%ehorage, Alaska 99511 Subject: ~Dt ~ Block 1 Hampton Mills Subdivision Approval for your individual sewer and water f;lcili~ies cannot be grante~t until the following items have be~n completed .' (I) The wa'~er analysis report be delivered to this department from Chum Lab, 5633 B Street~ for our review. The depression or pit aro~nd the well casing needs ~o be filled w£th impervious type soil so ~hat ~t slopes a~y from the w~ll casing. (3) Fill in the depression a~n~d the se~r system. Please notify thi~ ~epartmcnt for a re-insp~otion wizen the noted deso~epancies have been completed. If there are ~ny further q~lestions, please call this de]?ar~m]ent at 264-4720. Sincerely, Robe::t C. Pratt~ Associate Specialist cc: Ho~e Fed~rai Savings and Loan 535 D Street 99501