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HomeMy WebLinkAboutHAMPTON HILLS BLK 2 LT 2Harnpton Hills Block 2 Lot 2 #015-134-35 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Development Services Department Building Safety Division On -Site Water & Wastewater Program*S1_/ 4700 Elmore Road aP.D. Box 196650 `Mark Begich Anchorage, AK 99507 Mayor www.muni.orq/onsif - (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: Legal Description q j Property Owner Name & Address: rant Wrj ft'AiMS Pump Installation Date: _ 7 _� s Pump Intake Depth Below Top of Well Casing: 170 feet Pump Manufacturer's Name: (2 -r- p -�@ t ke, Pump Model: 8 S/6 Pump Size �Iy hp Pitless Adapter Burial Depth: / 0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: — Well Disinfected Upon Completion? 2 Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: Attention: The pump installer shall provide a pump installatiSn log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0/5/3 V35 HAA # 1110 , ��D�rS 1. GENERAL INFORMATION Complete legal description L 2 15 2 1-11G LS J/ t A/ /� 3 w S/3 Location (site address or directions) l O O d C Z- I E S %J/C, Property owner M(6ha-e/ �i� p �� V0� Snn� e`�jay phone _ Mailingaddress _/(/0() 6=LIE:5 iJ2 4ALAaD 4C� Lending agency Mailing address. Agent Address Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank _ Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Rov. 1/91) Front MOA N21 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Co L/1 5 41-VC I vl✓ E ''I� i vl,e--e-y- S Phone _ Address q bd l i3c l�c�` (tel-e.Vvk-LY- T-) nc, P Engineer's signature JA� Date 5L/�-Z000 �C ? 9-21-,y NoO�i P-?(, -4 8-z7-Fkt. de-C-Ici?_elG(e5 .10f-42__cL O P) G o 0 C4_ 1 + (000- ( ! -{- Wl `f 6 6 L) 5 Gv -2. ✓` C o v/V e- c f ` � . 6. DHHS SIGNATURE Approved for Disapproved. `� bedrooms. Conditional approval for Additional Comments bedrooms, with the following stipulations: 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 orderto 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. MUMcipality of Anchorwse Department of Health and Human Services p 825 U' Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor November 30, 1994 Henry H. Wilson, P.F. Constructing Engineers 9601 Buddy Werner Drive Anchorage, AK 99615 Re: Notice of Violation Lot 2, Block 2, Hampton Hills Subdivision On -Site Wastewater Disposal System As -built Inspection Report Dear Mr. Wilson: Following additional work on the septic system located on this property, field inspections conducted by personnel from this department, and the re -submittal of the As -built Inspection Report, all discrepancies noted in the Notice of Violation dated February 1.7, 1994 have been satisfied. Our records indicate that you are in receipt of an approved copy of the final As -built Inspection Report on this property with the approval dated 9/6/94. Our records also indicate that the Health Authority Approval Certificate was re- issued on 9/22/94. If you have any further questions regarding this matter, please contact me at 343- 4360. Sincerely, G J mes Cross, P.E. Program Manager, On -Site Services -f -t - tj Municipality of Anchorage Page , of L _ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION (/ P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S'lv 7 3 o L .3 L' PID Number:L1'1� 1,35 3S Name'4,/Cj,„,e/ 'Sc•/iaU/>y/--lo,-t-St;g Vl iQ1k1j--ctk Wastewater System: 9New El Upgrade Address: 7eyon C -//,s ��- /��(�/t�¢/L �i'9_s /k ABSORPTION FIELD Phone: No. of Bedrooms:/ fir.- W r 73v CJ�fee>9 Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: / .Z, T`pl Depth from originaal rad //� $ L' S J 0/ GPD/Sq. Ft. Lot: Block: �// //. S/}u',bdivisio//n: Z. Alefll% a///�i De th to pipe bottom from original grade: r -76 '” G! � Gravel depth beneath pipe �i.S YOJ, V(%I L1l125 r Ft. 7L' Fl. Townshi / Range: Section: J. Fill a�dded above origin I grade: 1✓(id'les /� 7 �/ Gr vel length / (9 _ 6.Ft.7 -j Ft. WELL: f,B New EJ New Upgrade Gradepth: �- U7,�4 6 Lit-�'Ft. Number of lines: Distance between lines: 7zd/') / — Ft. Classification (Private, A,B,C): P/-/ /-/ G �L(. C'_ Total Depth: 2- e� J Ft. Cased TO: / Y"/ Ft. Total absorption area: �" G Z J SO. Ft. F'i a r� terial: Ns /C./ b S 3 J Driller: • Date Drilled: Static Water Level: Ins Iter Date installed: Yield:Pump Set at Casing Height Above Ground: GPM Z C) Ft. _ Ft. TANK SEPARATION DISTANCES �® aseptic 11 Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: -7 'ti e Awc 110t, •� d� /�- Capacity in gallons: r ,� (> Well 7f/11 G f/00 c+ !-(vb Material; Number of Compartments: Surface Water i(i o i 1 t rl O L LIFT STATION -� / LotSize Line ZS� 1 LS- t ZS— in gallons: ufaccturer: Foundation "Pump on" level at: "Pym off' leve at` High water alarm at: Curtain!. 4 r� �1 _�.I Q �, Pump M odel Electrical Inspections performed by: Drain Remarks: �5 / i+t /r) i,v/c{ e '7`i r �1 c. G` r RA=NCH MARK tt / / l�I / I `YC./ C_ 11154,/I E._ Location and Description: ! / ! 1/_ �W CUx ✓14., t4sv - �2 rlu�t,1 o.� 11 VN Sick Assumed Elevation: &. 4 'n u /i e r.k v a. •5we�oa�me e Inspections performed by: Comf Gt')�1s� 8-z�,z7,3e 1 Dates: 1 st pGAN p2 y R. 1 �?r c r' t'� / Ur # GvIc,5o A-) - j r , c /d if 2nd'Y'zC, 7 2� � o-,N::ne E: necnaa.epq�aaM,n,� - ria, moi r7 a+.� n.��' Department of Health �Htu a approval �33cy s°...ti..g �A�Zp 92r tM 9 �0,4 Services Reviewed and approved by: _ �r��L ��— ®ate f� 72-013 (1/01) MOA 25 Permit No. cS ��' 73 OZ, 3 L Page Z of L Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: _L_Z /,3I_ 1-1-14-io/'1 U/U /,//&C"s F R,v1 14le�h 4 3C) _} o `C PID No.: O/•s i3 y 3S-" u �qj V)Q \e _I I ` ®� G=Li <FicJ cru j L� ti L Il11 I Fciqq i6 iD Tr�J t^z- 74 /Ci /ie/' AL / zb S8 19b�oH ti � 06 AM �f%�' /') � .� r "��` � � ���L�tf y�f'i,n6'`��•E 72-013 A (2/91) MOA 25 (46 (6 HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 Constructing Engineers Engineers, Surveyors CHARLES A. I.A\DFRS HC83 BOX 192-A, M) RI I E DR EAGLE RIVER, -%K 995: - (9071 694-9098 July 31, 1994 C.zr V, C') Z C Bell Homes 18622 Guillemot Circle Anchorage, AK 99516 Attn: Kelly Re: Lot 2, Block 2, Hampton Hills Gentlemen: Ile have played quite a bit of phone tag this past month. Ile do need to resolve and/or correct those items listed on the conditional Health Authority Ap- nroval. I urge you to make time to help resolve and con- clude this project. Very truly yours, 49 oxe'�d H. H. Wilson cc James Cross, MOA DIMS HENRY %%ILSON 9601 BUDDY 10ERNER DR.: ANCHORAGE, AK 99516 (907) 346-_'000 Constructing Engineers — Engineers, Surveyors — CHARLES A. LANDFRS HC83 BOX 192-A, \0RTLE DR. EAGLE RIVER, AK 9957.- (907) 694-9098 7-z6�7�z v /✓ s ✓� OL- M Djj- a.,S dI e_ GV C.5 a kl /e'ci r�� • �h0)'I e. 7La 9 l5 �J T Gvo✓/C,vl C fG%v5 J 7-/)/S Aj<• cJ-e. $T 0 r �2o L✓ 1� e, 74 e. lal 74, 1,,2 e 1�e q a`afD✓�}C. 2 � V)0(C' � L", a-- r /c,, 6 o u0 D VIC . AA o P� W10 / 5 o o I 4-o ee, • 4 0 70'- J' (�26 � (Pl n- / /- e, ✓wc (5 q o c� �v ✓ �i I S / U--) cJ-e. $T 0 r �2o L✓ 1� e, Ol/l•®.� - 3 3 - 07 7 2 ��ys V)0(C' � L", a-- r /c,, 6 o u0 D VIC . AA o P� W10 / 5 o o I 4-o ee, • Municipality of Anchorage, Department of Health and Human services Tom Fink, 825 "L." Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 February 17, 1994 Henry H. Wilson, P.E. Constructing Engineers 9601 Buddy Werner Drive Anchorage, Alaska 99516 Re: Notice -of Violation -AMC :15.65.150 Lot 2, Block 2 Hampton Hills Subdivision On-site Wastewater Disposal System As -built Inspection Report Dear Mr. Wilson: On January 5, 1994, this office received the subject on-site wastewater disposal system as -built inspection report that was prepared and submitted by Constructing Engineers. The report was submitted approximately four months after your final inspection of the system. Please be advised that AMC 15.65.150.E requires that as -built inspection reports be submitted to DHHS within 30 working days after the engineer's final inspection. This office conducted a random and cursory inspection of the subject on-site wastewater disposal system on January 8, 1994. Our inspection revealed several deficiencies/discrepancies between what was reported on your as -built inspection report and the wastewater system that had actually been constructed. These deficiencies/discrepancies included but may not be limited to: 1. There were no caps on the cleanout and monitor tube riser pipes in the system. 2. The effective width of the trench is in question. The permitted design required a deep trench but the as -built inspection report dated 8/30/93 appears to indicate that a 5 ft, wide drain field was installed. 3. The effective gravel depth, based on the depth of the monitoring tube, was measured to be 4.5 feet. The as -built inspection report dated 8/30/93 indicates the gravel depth to be 8.0 ft. Constructing Engineers February 17, 1994 Page 2 4. The depth of cover and relative pipe invert elevations, as measured by this office on 1/17/93, do not agree with the as - built inspection report dated 8/30/93. 5. There is only one monitoring tube installed in the system. Your as -built inspection report dated 8/30/93 indicates the presence of two monitoring tubes. Based on the above deficiencies/discrepancies it is apparent that this wastewater system was not properly inspected during or after construction. Wastewater system inspection and reporting requirements are specified in AMC 15.65.150. All as -built inspection reports received by this office must meet or exceed these requirements. The as -built inspection report for the subject property cannot be approved until all conditions of the attached conditional Health Authority Approval HA940005 have been satisfactorily completed. Please provide this office with a minimum of 24 hours notice prior to excavation of the existing system to determine its exact configuration. If you have any questions regarding this Notice -of Violation, please contact our office at 343-4744. Sincerely, } zn Smit P.E. grogram Manager, On-site Services cc: Robert Baker, Ph.D., Acting Manager, Environmental Services Robby Robinson, Civil Engineer, On-site Services 1 1 J: ill CClC!S-CJ"ll I tT9 Eri-1 r, PHONE-- 1;,_, : (K17 Ill 10: 5OPM P01 P Pogo N DEPARTMFN'r OF HiLAI-TH AN[) HUMAN SEVIVIOES I ENVIRONMENTAL SERVICES nIVISION P.U. buy, 199650 * Anch0I'lF1Cj(,�, Al,�skzlli 09-510-6650 0 Tclophono: 343-4744 On -Site Wastewater 01spostoil System and/or Well Inspection Report r) N I h 5 1 '6 4 IVa mo V Wastewater Syetil N e w LJ Upgrado ABSORPTION FIELD Phil ll U 1,)t-ep 11 ------ — - — ------ LEGAL DESCRIPTION I, L TTZ7P*a -,w �Ikvii rvigm,)i gfsa� Lr{ l J I ( �jm I I n �j P 4!.) T Fill odfi�fl Ob�l,LONQWnl OTP01' 1, r, F r ....... WELL: X N,.illl -j Upgrado, F1 IQ Cms�ific;jfion (PrivalQ. A.Ill �Totm Depo 7,x Tolai l T) 03rNS 7711 'WWVaier Le'rel ln,lal-Er: -rANK F -1 SEPAHATION [)ISTANCES F P. 7 -Tiv S Pow Inink F III ,.l briss bw of N i-irr STATIO ,l. Fir aliqrfm lil: "Pur"P ori ove; tlii w 2. ,Undla-tion ll fn -i -A,vflDy. C;L , Mal I" Dfalf FIENCH MARK -------- -- j AZY4m_At ov� t �AV Jlj V�J)j_;J- j5- �_Fa`V\ R4!�' 4 ir, t) I- kl Hf P01101"Y100 tv: 2rld ...... Assumud F At. OF At. It %* Mil 1732-1 From C: A L. rrl=r.,_:;Ccri_:rr.u_,t.irtg Errain F'HUhIE Ido. . 93-1, 694 9099 7-ar-i. 17 1994 10:51PM F'02 Perrnit No. of 7 _ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SMVICES ENVInONMEN'I AL BEFiVICF-6 DIVISION P.0, box 196050 • Anchorago, Alaska 99519-6650 e Tolephone: 343.4744 On -Site Wastewater Disposal System and/or Well Inspection Report Lopi Dosoription: Peed . {_.:-tib t r i .. .. ...... ........ � 4 nnpp d L�61' y:n-�.. •rel"�r^YI`Y __.-- t r i , RR�� nnpp d L�61' y:n-�.. •rel"�r^YI`Y r i P lt5i�' �• b' r`�• ., b �.. .4�,t•i .-� is t �:!"r.✓'c J,a;"t �v„3 l�t� ;� ,�c;v 1 �(xRt,t Nei b -4c? 9 Mt,f,, t>�. jt�(�r 'i3G r9c�tit� Pry, ('r, i aNGIN[ER'8 SFAt- Municipality of Anchorage Page ' of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5cij 93 023 Z PID Number: O�$f3435 \, sonr,w7'a Wastewater System: 9 New ❑ Upgrade Address 9951 ABSORPTION FIELD Phone: No. of Bedrooms: ...� _ � Deep Trench _Shallow Trench El Bed El Mound El Other v LEGAL DESCRIPTION Soil Rating: 1.2 Total Depth from original grade: Vfa2,1! 1 1z'4o1 ' GPD/ Sq, Ft . Lot. Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe L_ 7 I kaM ��ls �AR.,� 40 -to V a _Ft. i 9T' -- Ft. Townshi Range. Section. Fill added above original grade: Gravel length. 4� Zr f =0 1 � rt. Ft. WELL: 2T New ❑ Upgrade Gravel width: i, 5 Number of lines. I Distance between lines. NA Ft. FL Classification (Private, A,B,C). Total Depth_ -Z-03 Cased To: Total absorption -area: 'I`SC. Pipe material. Fl. 141 Ft. 6-4Z Ft. VC-) V303q Driller: A) >1��r i�\n Date Drilled: `a -Z3-93 Static Water Level. 112'?%% -FI Installer: CSS; Ia.�^'S 'Belk I Date installed: z�'z6-93 Yield: _ Pump Set a^C� Casing Height Above Ground: TANK Q•© GPM W� Ft. �'� Ft. ®e SEPARATION DISTANCES lel Septic L -Holding ElS.T.E.P. To septic Absorphon Lut bolding Public. Private Manufacturer1 Capacity in gallons: From Tank Field Station Tank Sevier Lines �/-\'1`� CNDV 29 0- --I3� I 3� Material: Number of Compartments: Well 14,7.' 168' -+Zzmr5 Surface �,�' �1� �,� LIFT STATION Water i Lot 6G -7,f Size in gallons: nufacture Mar �. Line r� 'Pump on' level aL 'Pu ' level at: High water alarm at: Foundation S '30 Curtain ' .e Pump (Jake eI Electrical Inspections performed by: Drain 10O BENCH MARK Remarks: Ir r--Lp IN5;-rAtLW17 5� W,g 'Dt=-51GN) LvAe> C¢)t2 3'. jk . Rl- Location and Description: 5w C,oYyle2 c.F Douse, 4�AZAv A_ �FFL•cTn/ti p� i`PENCrt <I 6�Z5� mea (ea e,L_ Assumed Elevation: 1� b o%NWNVAFkT SEAL � OF ALA #*4— Inspections performed by: ����--. Dates: 1st 2nd 8"Za' u, HENRY H. WILSON D - 1732-E Department of Health and Human Services approval ��P�FESSIDNA( E`!7 Opoo� Reviewed and approved by: _ Date: _ 72-013 (Rev. 9/91) MOA 25 N m U O (l) T' 0. m r d 0 Permit No. 5 U 53 0Z3Z_ Page Z" of _L Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L-7-52 AMS PID No.: 01S 134 35 FRAME � HOUSE 3 c o y CLEAN OUTS { 23� o J „ CLEAN OUT OINU TURD S'. IT 71.0 - TURA/ y y 9 pad O � � f� Y u d: U Y II I� II oQ1�.lNwti/�tu�n0� ly �n qz; -I m 1=LL,Ta2 FRBRL� �'1 PSRP z wrm n ©F 'reST 72-013 A (2/91) MOA 25 _T i bo OHENRY H. WILSON a 00 'rA\ 1732-E k p FESSIONA4E `O INS 1iS r• �� r . 4 . 1 m•- lv#i k7 r ' 10. 1 614 _ T off IT sp *�` ' ;?fit {fi �� �) i• f;- � :y-�' :. �(. _z 4i '� t•- -. J I�r� .4��41�'�:% •�� r f_ 't c EYFy r��Lt`` '"- • #r"' _ r! S k - � !Z tom` �F. •' �r i J-ft l - F / 4ir�1 1 L '`S FF c�.lt t_ 715 i •. � �I 'I i I �t«CE�• _ � 1/I F �� , • `tom :.r, r e ,. k ", r � ✓ - -; • A it syr i♦ - :i •.r� 1 �{ c F� g ABSORPTION SYSTEM DESIGN DETAIL'S --STANDARD TRENCH �0 p�vG 3' 0 cr 1Sco GA'L-c►nvx so C eLD I �___ -116' 5'I* w �— raon f1o,x r o J RO UYG _� I'NIn AIM -,I>, SCOPE OF PROJECT: New absorption field is designed for a five (5) bedroom system. Lot is to be served by a private well. The system will be a standard gravity absorption system with a deep trench. ABSORPTION -AREA CALCULATIONS: Minimum Required: 5 Bedrooms x 150gpd/bedroom = 750 gpd capacity Soils rating, proposed addition, 1.2 gpd/sf Minimum sizing: 750 gpd . 1.2 gpd/sf = 625 sf absorption area Use 31W x 401L x 8' D = 640 sf minimum for trench Trench depth: Bottom = 12' Below grade, w/ 4' cover IMPACT ON ADJACENT LOTS: There are no private wells within 100' and no public wells within 200' of this absorption system; The proposed absorption system has no impact upon any adjacent lots as shown on attached site diagram. ENGINEER'S SEAL DESIGN DETAILS PROPOSED WASTEWATER ABSORPTION SYSTEM LOT 2, BLOCK 2 HAMPTON HILLS SUBDIVISION PREPARED FOR: STEVEN BELL 345-2355 18622 GUILLEMOT CIR ANCHORAGE, AK, 9951677 NOT TO SCALE DRAWN BY CAL CONSTRUCTING ENGINEERS 346•-2000 9601 BUDDY WERNER DR 694--9098 ANCHORAGE, AK, 99516 6-28--93 DRAWING 4 93—S2-06-7 s M i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930232. DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC OWNER NAME:BAILEY MICHAEL, S & OWNER ADDRESS:10400 ELIES DR ANCHORAGE AK 99516 PARCEL ID:01513435 LEGAL DESCRIPTION: HAMPTON HILLS BILK 2 LT 2 LOT SIZE: 57948 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 7/19/93 EXPIRATION DATE: 7/19/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL, PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: -"OL4w I-"rr�4 DATE: 12,l DATE: 7 I `f Ct 3 SITE PLAN—WATER AND WASTEWATER ABSORPTION SYSTEM .A" u� I L1S / ISO �rf4L i"%�'r 9I.IeS 'bRIVE )Rn IrEST � Pt�l^^�'TE'K; I-iovSb' TS't"B�ksf w Gu_ 1c 4o„ 45/Z48 f A.ZsAt �vr4tt Ag�E 57-mr- SYSlew\ I'Z 1'7 co S F Ylto0o5¢n 5 aev leo yotlsr \ SITE PLAN DETAILS PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM LOT 2 BLOCK 2 HAMPTON HILLS SUBDIVISION PREPARED FOR: STEVEN BELL 345-2355 18622 GUILLEMOT CIR ANCHORAGE, AK, 99516 SCALE: 1" e 100' DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 6-28-92 DRAWING 4 93-S1-06-7 �J ABSORPTION SYSTEM DESIGN DETAILS --STANDARD TRENCH -r5/ pAn- TRmc" /Sr'w" 20cK J 40 I 6 li 1990 ` Acuse! NU UTC $' YY1iN 'TAN1� I` SCOPE OF PROJECT: New absorption field is designed for a five (5) bedroom system. Lot is to be served by a private well. The system will be a standard gravity absorption system with a deep trench. ABSORPTION AREA CALCULATIONS: Minimum Required: 5 Bedrooms x 150gpd/bedroom = 750 gpd capacity soils rating, proposed addition, 1.2 gpd/sf Minimum sizing: 750 gpd : 1.2 gpd/sf = 625 sf absorption area Use 31W x 401L x 8' D = 640 sf minimum for trench Trench depth: Bottom = 12' Below grade, w/ 4' cover IMPACT ON ADJACENT LOTS: There are no private wells within 100' and no public wells within 200' of this absorption system; The proposed absorption system has no impact upon any adjacent lots as shown on attached site diagram. ENGINEER'S SEAL DESIGN DETAILS PROPOSED WASTEWATER ABSORPTION SYSTEM LOT 2, BLOCK 2 HAMPTON HILLS SUBDIVISION PREPARED FOR: STEVEN BELL 345-2355 18622 GUILLEMOT CIR ANCHORAGE, AK, 9951677 NOT TO SCALE DRAWN BY CAL CONSTRUCTING ENGINEERS 346-2000 9601 BUDDY WERNER DR 694-9098 ANCHORAGE, AK, 99516 6-28-93 DRAWING 4 93-52-06--7 r, II 'IE111 EIs RSSE a Municipality of Anchorage 0 DEPARTMENT OF HEALTH & HUMAN SERVICES n'..,.. ,ins a4.Cu, of l"94B Eu •J 1'.F e� 825 "L" Street, Anchorage, Alaska 99502-0650 `.x., {. + j ,a SOILS LOG — PERCOLATION TEST J{ 1 t"w>,{u r 69414 dG'x � f i 'ep2y'3� PERFORMED FOR: Jl) DATE PERFORMED:• LEGAL DESCRIPTION: L Z L 0_5 �� Township, Range, Section: 5w'1'4 13 T) P3 LJ DEPTH 1- SLOPE SITE PLAN 1 1 IFEET) QY"S GI i'\\t) �V �NJ�f I 1 I A 2 3 4 5 6 7- 8 9- 10- 11 - 12 - 13 14- 15 16 I 17 06 'f-6�t�d�St11i p,oye kDk,�- -e�GV WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? No Depth to Water Alter mo"E- Monitoring? Date: --Z4-93 S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop 6-Zu-93 b4 Z11 _ HEI 3 I ��> !J 8' Ae, Jay 4 Zdn rn . RDp t 3 g Z` !G' S Z�rn'r� Ynh� S� Ir;' ZN 20, —1 PERCOLATION RATE Z f // L iminutesimch) PF_RC HOLE DIAMETER TEST RUN BETWEEN (a FT AND —1-- FT COMMENTS SOIL k5' - `Ve. - 0,;7- �) L -T -Tlr�) v wi U5L j����Cb4 9ii�C�+� 4s A -\J SQA -c, '�ZOC. riu. Sat L s I .-2- G7 r) kr_ PERFORMED BY: qzr'S'Tx.0 s C=S)r-4 .e I .�( Qr. CERTIFY THAT/THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 January 17, 1994 Constructing Engineers — Engineers, Surveyors Mr. John Smith, P.E. On -Site Services, DHHS PO Box 196650 Anchorage, AK, 99519 re: Lot 2 Block 2 Hampton Hills Sub Permit SW 930232 Dear Mr. Smith: CHARLES A. LANDERS HC83 BOX 192-A, MYRTI-E DR. EAGLE RIVER, AK 99577 (907) 694-9098 We are requesting a CONDITIONAL HEALTH AUTHORITY for the subject lot for the following reasons: A field inspection revealed a discrepancy between the design and the as -built measurements. We field inspected the installation on 8-26-93 and found the excavator almost completed with the trench excavation. We measured the length, width, and depth of the hole and found the measurements to be 42' Long, 5' wide, and the bottom of the trench to be from 12' to 14' deep from original ground. We authorized backfilling the trench with the sewer rock and placing the lateral pipes. We reinspected the trench on 8-27-93 and found the work to be riot ready for reinspection. We performed another inspection on 8-30-93 and found the top of the sewer rock to be at 4' below original grade (westerly end) and the trench to be level. We authorized the cover of the trench at that time. Upon field inspection Jan 17, 1994, the monitor tube on the easterly end of the trench was found to extend only 4.5' below the lateral pipe. Since this does not meet the MOA specifications or our design, we cannot say with certainty the depth of the trench. Consequently, we are requesting the CONDITIONAL HEALTH AUTHORITY based upon the following conditions: OL 1. Existing trench depth shall be confirmed by excavating the end of the trench to expose the bottom. 2. If the trench depth is as designed, the monitor tube will be extended to the bottom of the trench. 3. If the monitor tube is at the bottom of the existing trench, then the system will be extended to comply with MOA specifications for a five bedroom house. Design for a five bedroom wide -trench absorption system, 5' wide, 4' depth, is for 62.5' .length trench. The trench will be extended to 62.5' minimum at that time. 4. A new as -built and a new HAA will be submitted to MOA for approval. Since this property is located on the upper hillside area, we request a completion date of 6-30-94 to allow for sufficient time to perform the necessary repairs. Respectfully submitted, Chuck Landers Constructing Engineers NN )FI Ut IIIc , 1 31 ft 0A JZN INL t. 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ANCHORAGE., ALASKA 99503 907-277-8378 i DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA Constructing Engineers Public Water System I.D.# Satisfactory L282 Hampton Hills U = Unsatisfactory Anchorage, AK Date Received: 12/21/93 Time Received: 16:15 Date Analyzed: 12/21/93 Time Analyzed: 17:30 Collected by: Date Reported: 12/28/93 Time Reported: 14:59 Sample Type: Next Sample Due: Confluent Growth Juli chaefer En / onmental Analyst / l�- Comments: S = Satisfactory U = Unsatisfactory POS = Positive Test Result ND = None Detected Collected by: TNTC = Too Numerous To Count (>200 Colonies) Sample Type: CG = Confluent Growth Routine HSM = Heavy Sediment Masking, Results May Not Be Reliable SA = Sample Age >30 Hours But <48 Hours, Method of Analysis: Results May Not Be Reliable Membrane Filtration Old = Sample Age >48 Hours, Too Old For Analysis Comments: R = Resample Required NT = No Test * # Colonies/100 m1 ** # Colonies/m1 Sample Sample Total* Fecal* Other* HPC** Location Date Time Lab# Coliform Coliform Bacteria Result Comments ------------------------------------------------------------------------------------------------- 1 Hose Bibb 12/21/93 16:00 A82378 0 NT 0 NT S Juli chaefer En / onmental Analyst / l�- MUNICIPALITY OF ANCHORAGE ON-SITE WASTEWATER DISPOSAL SYSTEM FIELD AUDIT Date )/ c1' L/ Legal Description Document Types Site Address Engineer/FirmN ��f Excavator Inspection Findings�� ��� h4 cl /?D C Follow-up Notes /463-5-92 V, 5 111gP 4,41 — Tx� i tOkIATIGN/SK"CFS; C Of AUAASKfa c�W �13b Z3 z DIVi ;ION OF WATER WAT EI'l WELL RECORD I GF.CTION WAS SEL'Tltdle YOWNSHIP AAN01: { 9''-.11 HjV,1 CIN nE ClS 0W j WELL OWNER: i ::0'tE65 MCASUtt'.Cl ,"Ri)tvi:f_.7casing top Elground surfac0 WELL DEPTH: r DATE OF COMPLETION Depth of hole: C� ft I� bOREHOLR iJA+ At Depth Depth of casing,_ / / it l�acerini lypo 1 nd Color From To DEPTH TO STATIC WATE LEVEL: rrft below stop, of casing 0 ground surfa f Date: / ii METHOD OF DRILLING: 17 air rotary D cable tool other -z" USE OF WELL:�domestic C7 irrigation 0 rnonito, a'�•�:z� > .. ��_ _._. _ _r ® public supply 0 otheri1 07- p i CASING STICK-UP: fL Diarn i u, tr / WELL INTAKE OPENING TYPE la'epen end f I &cru: perforated Cl open hole rJr11LDepths of openings: to ig ECI �B SCREEN TYPE; Diann: If Slot/Mesh Size: length: !I JAN 51994 GRAVEL PACK TYPE -__ _ Volume used: _ Depth to 4r . P Municipelit of AnCh rage GROUT TYPE: Volume:T_ !i Dept. Health I�utnBn �c Depth: trom _ it to 1 DEVELOPMENT METHOD: ( '' Duration: PUMPING LEVEL AND YIELD: II O /� b /;f tt aftOr ,���e hrs pumping PUMP INTAKE DEPTH:. _ it Horsepoti'rtir: WELL DISINFECTED UPON r"rL4PL; TION? Yr CUN111ACTOF INFOitTfON: REMARKS: r1P,tJL�tQ .d 1311S1n ss ar'n2 111/•���� �_._ ._. fhl.`tif65L- MAIL tJtlH4"I ti t7Btr :'r3 t W a P G0� � M Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196850 Anchorage, AK 99519-850 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.-015-1 4-35 HAA #_1/&0/76 1. GENERAL INFORMATION Expiration Date: 12 - % - c9 Complete legal description ' Lot 2 Block 2 Hampton Hills SID Location (site address or directions) 10400 Eli ?s Drive Anchorage, AK 99516 Current Property owner(s) Michael & Yohana Schoeppl Von Sonnwallden Day phone 3463267 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10400 Elies Drive Anchorage. AK 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 5 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ED ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage • Development Services Department Building Safety Division On-Sfte Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.sk.us .. (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 7 Block 2 Hampton Hills 3/0 Parcel I.D.: 016-134.35 A. WELL DATA Well type P If A, B, or C provide PWSID ft _ Well Log Y Date completed $123/1993 Sanitary seal Y Total depth 203 ft Cased to 141 ft FROM WELL LOG Date of test 8/2311993 Static water level 114 ft Well production 4 g.p.m WATER SAMPLE RESULTS: Coliform :::ft colonies/100 ml Nitrate /• 83 mgA Wires properly protected Y Casing height (above ground) 12 In. AT INSPECTION 8/24/2001 91 ft 2.0 9 -p.m Other bacteria— colonies/100 ml Date of sample: 8/24/2001 Collected by: Lara Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date Installed 8126/1993 Tank size 1500 gal Number of Compartments I Cleanouts Y Foundation deanout Y Depression over tank )y High water alarm N Date of pumping 8/2112001 - Pumper Northland Pumping C. ABSORPTiO FIELD DATAgI` Date installed 16/ 191 Soil rating (g.p.d.Jf? or ft?Axdnn) jJ. System type Wide Trench Length Jff* ft Width 5 ft Gravel below pipe 4•5+ ft Total depth 12.25 It Effective absorption area 625+ ftp Monitoring tube Y Depression over field �L Date of adequacy testla 2412001 Results (Pass/Fail) Pass For.1 bedrooms Fluid depth In absorption field before lest 0 in Water addedM gal. New depth0 in. Elapsed Time: 0 min Final fluid depth Pa in Absorption rate >= 760+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No . If yes, give date (Rev. I I=) AUG -20-01 10:29 FRW-CT&E EWIROM1ENTAL SRV AL.CUR 1Erlvlronmentail BervIms Inc. arr�rr��rrr�rrrr��rv. CTiL RLN 1015621001 eclat Nems hCoone Ent. 9rv. Project Namem L2 B2 Hamptcn Hills Cheat Ompto ID 1.2 82 Hampton Hills Matrix Drinking Water Ordered by 02124101 SCL ?WSW 0 9075615301 T-593 P.02/03 F-531 Cleat POM Mand Dete?1me Coledw Detsimme PAcelvad Dawrims Te bOWDiroctar Rlsased By AwZ 02294001 17:17 0624/1001 140 02242001 14:40 Besphea C. rode Par ameter wa,Iu POL Uoim Molhw Allowable LaatU MP Aadysle Date Dau trig Warm flRRaZ9NA= Ndrate•N 1.63 0.500 mgtL EPA 300.0 (,CIO) 02124101 SCL tr3are63sleme Laabarag= Tcta: Coliforro 0 Y 0 e011100mL SM1192223 (<I) OV2VOI SKW MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 91 On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 115 1 3-4'5 - 1. GENERAL INFORMATION HAA# Complete legal description LZ. TZ, H2„`p�o� �� 1�S Location (site address or directions) 10406 CI, Property owner Mailingaddress 'I `1� ) Sc1�oe �— ✓o,-,-Sonv,w�, phone ��, _ � � (�-. J �r1,99516 1p�lob C—I �S 17Y,_rc�Ya9e1 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: S 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank — Community on-site Public sewer — NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA B21 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fir f� CADn Aly VC_i )y� Erle, (nee r5 Phon 34G -Z000 760 k 3 u `1 W a r' nA-�- Dr N -L e 3 86x Z Address Pmclw r a A\<, 9 951 (0 C- Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Date 17--30'93 Disapproved. -.L Conditional approval for _ bedrooms, with the following stipulations: ,S LISP OF "'oND1(?Qt.S Additional Comments By: —Date 1 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 orderto 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 (Rev. 1/91) Back MOA 821 ® Municipality of Anchorage ARL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data L z g z Na * „ l�,'I �s Parcel I.D. 0)5 !34 35 Well type .If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed $"z3-93 Driller �}In vie Y 11 r� Total depth C�3 Cased to _ 141 Casing height Z _ Y Sanitary seal (Y/N) _� Wires properly protected (Y/N) _ FROM WELL LOG AT INSPECTION g --z75-9-3 z Date of test C— Static water level i )� (3ZIbwG DL,n�� rrn 1� z Well flow 9 6 g.p.m. g.p.m. r) r" i s n 9 Pump levell aco it n SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I On adjacent lots Absorption field on lot 16 81 _; On adjacent lots + 106 _ Public sewer main 1.00 Public sewer manhole/cleanout _ Sewer service line +100' _Petroleum tank + 106 WATER SAMPLE RESULTS: Col'rform D Date of sample: /Z- 3/- 9 3 -- B. SEPTIC/HOLDING TANK DATA Nitrate z.4 Other bacteria n Collected by: C¢,ns ?rte cTg L=n� �n esz vs Date installed 116� S -A,-93 Tank size 15 0 o Compartments Z Cleanouts (Y/N) _ Y __Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) N A Alarm tested (Y/N) _ Date of pumping N e-> 5Y5Tm Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ) (,-- On adjacent lots 1 Foundation To property line 67' Absorption field I.Ar Water main/service line 6o Surface water/drainage 4-kU& 72-026(W93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE—FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) sted at Surface water Date installed `d -Z& 93 -_Soii rating (GPD/Ft2) ) . Z System type x,42" e$ Length Width 5 Gravel thickness $ Total depth Total absorption area T Cleanout present (Y/N) Depression over field (Y/N) �J Date of adequacy test No-^, 5Y 5 Tt_h\ Results (pass/fail) Water level in absorption field before test (1 --ft Peroxide treatment (past 12 months) (Y/N) N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: for — Bedrooms After test N fl yes, give date Well on lot j (�S On adjacent lots +� b0 Property line S) s To building foundation 3o To existing or abandoned system on lot N A On adjacent lots 4- 100' Cutbank i_ 100 1 Water main/service line + 50 Surface water 4"1 od Driveway, parking/vehicle storage area 4 Z5' Curtain drain -f- loo' E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in Signature ` �5�4G iTQ-O./FS Engineer's Name 56o Wc.,-rawo�v Anc} 99516 Date -26-33 HAA Fee$�� Date of Payment Receipt Number �2.2 f 7 72.026 (3/93)' Back this inspection. 01' AAS 111 /�, iy � hby9b11U16p� o �� ,. I;732..0 f,:. Waiver Fee $ Date of Payment Receipt Number CONDITIONS OF APPROVAL FOR HA 940005 Health Authority Approval 940005 is being approved under the following conditions: 1. The existing newly constructed on-site wastewater disposal system was not constucted in accordance with AMC 15.65 Wastewater Disposal Regulations but appears to be adequately constructed to allow for temporary use. 2. The exact configuration and dimensions of the existing system must be confirmed. The length, depth, width and relative elevations of the absorption system must confirmed. 3. All monitoring tubes and cleanouts must be installed in accordance with AMC 15.65 4. Depending on the exact configuration and dimensions of the existing system, construction of an additional estimated 25 linear feet of drain field may be required. 5. An escrow account, sufficient to cover all costs associated with the above described scope of work, must be established. The escrow account must specify that funds will not be released until DHHS has issued final approval of the wastewater system. 6. All work, including a revised as built inspection report, must be completed prior to June 30, 1994.