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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 , . '�&
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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