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HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 2 LT 5S� � A _ � � � ���. �� �� �., �� n "mss �`�1 i] d r� ` S f ,} , �" ;� ;� r � f/ �. r� �y �.. tl� 7F� r,- � es -. Municipality of Anchorage • Development Services Department Building Safety Division e On -Site Water 8 Wastewater Program, 4700 South Bragaw St. , P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO30299 PID Number. 015-134-53 NOTeC JERRY MOORE Wastewater System: ❑ New ■ Upgrade Y P9 Address:0401 HAMPTON COURT * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (360) 336-2919 4 El Deep Trench ■ Shallow Trench O Bad 0 Mound 0Other LEGAL DESCRIPTION Sol Rating: 1.0 Total Depth from oe4noi grode: 8.0 MAX CPD/Sq. R R Block: Lot Subdivision: Depth to pipe bottom from orlgbrol grade: Cmel depth beneath pipe. 2 5 HAMPTON HILLS #1; 3.98 MAX R 4 in, Township: Range: Section: Fit added above original grade: Grovel length: — — — SEE DWG R 60 R WELL: ❑ New ❑ Upgrade" Gavel width: 5 Number of Knee: 1 Distance between Ines: — rt. FL Classification Private. Ae,C : Total Cased To: Total absorption area: Pipe material: D 3034/ F-810 R R 600 SO. R Driller. Date Drilled: Static water Leel: Installer. AKWWC Date X18%5-7/2003 R Yleld: Pump Set At Casing Height Above pound: TANK CPM R R SEPARATION DISTANCES ■Septic ❑Holding E1S.T.E.P. Cl Other To Septic Ab tion Uft Holding ubec/Prhate Manufac4aer: ANCHORAGE TANK Capacity In gallons: 1250 From Tank veld Station Tank Sewer un« Well 100'+ 100'+ — — 25'+ Mat": STEEL Numbef of compartments: 2 Surface Water 100'+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — Size In gala": Manufaeturer: Foundation 5'+ 10'+ — — — mp an level at: 'Pump off at Nigh water alarm at: Curtain Drain NONE KNOW Pump Mab 1: Electrical I+epectlam performed br. Remarks: BENCH MARK Location and DeeMptim OLD SEPTIC TANK WAS COMPLETELY ABANDONED BOTTOM OF SIDING ® NORTHWEST CORNER Aesvmed EWmtbm 100.00 IL ENGINEEKS S L o � AKWWC, INC. Inspections performed by: Dates: 1st 8/5/2003 �. T*�0 ........ .. ...............� 2nd 8/6/2003 3rd 8/7/2003 Q y A. ess: Development Service DepartmentApproval OD�,af'• E-7953 `e Reviewed and approved by, e Date: -2��O3 �04p°pora,gjor'0\ (Rev. 12/01) PERMrr NUMBER SWO30299 AS -BUILT DRAWING W0399 I\ -------------- ----------j i---- --`--------- r::4'•~.�a ,;. NEW DRAINFlELD FCO 31.50 13.10 STI 61.10 33.36 ST2 63.10 35.20 DBL1 65.70 37.90 DBL2 65.75 37.8 FD 65.90 40.10 C01 64.10 40.30 CO2 53.00 51.00 CO3 70.80 53.60 MTI 70.00 54.00 C04 1 70.70 77.DO M1T2 170.00 74.80 I 45x55 DRAINAIGE EASEMENT I t•: PARCEL ID NUMBER: 015-134-53 mil ALASKA WATER & NVASTENVATER CONSULTANTS, INC. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338.32f.6 'REPARED FOR: PHONE NUMBER: JERRY MOORE (360) 336-2919 EGAL DESCRIPTION: HAMPTON HILLS SUBDIVISION ,#1; LOT 5, BLOCK 2, YPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ' c A(T21 i I EXISTING DRAINFlELD •.:•. �. ' ..• It TO BE USED AS A �• :• x�• s RESERVE SITETH 1 1 CO2 1 1 1 0:1STT a 6 1 O h u EOM 1 \ FCp f t '•3 I ~� '• •�� .. mil ALASKA WATER & NVASTENVATER CONSULTANTS, INC. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338.32f.6 'REPARED FOR: PHONE NUMBER: JERRY MOORE (360) 336-2919 EGAL DESCRIPTION: HAMPTON HILLS SUBDIVISION ,#1; LOT 5, BLOCK 2, YPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE H 1250 GALLON SEPTIC TANK 8/18/2003 AWN BY: C.J.G. 1LE 1" = 40' ;E NUMBER: 2OF3 OF• M91,11 AM e A.am ss: 7 3 eG O�"Deofesslo' ' c H 1250 GALLON SEPTIC TANK 8/18/2003 AWN BY: C.J.G. 1LE 1" = 40' ;E NUMBER: 2OF3 OF• M91,11 AM e A.am ss: 7 3 eG O�"Deofesslo' PERMIT NUMBER: AS -BUILT DRAWING PARCEL NUMBER: SW030299 015-11 34-53 FINAL GRADE - 96.73 (AVG.) STI ST2 TOP OF TANKTOP OF TANK AT INLET - 90.76 S \ / AT OUTLET - 90.75 INVERT OF BUNG AT INLET - 90.27 FILTER FABRIC INSULATED PORTIONS WITH LESS THAN 3 FEET OF COVER - TH#2 / NEW 1250 GALLON SEPTIC TANK INVERT OF BUNG AT OUTLET - 90.05 FINAL GRADE 83.39-84.19 /-ORIGINAL GRADE - 84.15 O HIGH POINT NVERT OF PIPE : 101 .....0...., 1,111. ,...•.,.•.,...•.,. 1.. 000..5" 1:1:1 •.:.:1:1:1:1:1:1:1:. 1 .52 BOTTOM OF TEST HOLE #2 1 TRENCH - DEEPEND TO .. RELATIVE ELEVATION OF BOTTOM OF EST HOLE w 68.15 (TEST HOLE DRI 8/18/2003 r..._..--.__...._,._.__,.._._._._..z�_ �---"._.._...__........_._._..__ 1101... DRAWN BY: ALASKA. NATER R WASTEWATER C.J.G. Ste` CONSULTANTS, INC. 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507 • PHONE (907)337.6179 • FAX (907)338-321.6 N.T.S. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JERRY MOORE (360) 336-2919 3 OF 3 LEGAL DESCRIPTION: HAMPTON HILLS SUBDIVISION #1; BLOCK 2. LOT 5 TYPE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 4e9 H ... .:y e A. Ga ss.: —7953 �h:v. ..... COArJ MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 06, 2003 Expiration Date: Aug 05, 2004 Permit Number: SW030299 Parcel ID: 015-134-53 Legal Description:f4U F;TON HILLS #1 BLK 2 LT 5' Design Engineer: 0041 AK Water & Wastewater Consultani Site Address: 010401 HAMPTON DR Owner Name: Jerry Moore c/o Peter Dimaggio Lot Size: 48165 SQ. FT. Owner Address: 10401 HAMPTON COURT Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-1129 This permit is for the construction of: ❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: t19610-3 Municipality of Anchorage Development Services Department rf•119�1 i'1;�°: Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-134-53 Permit Number _5W0.30?.7ff Property owner(s) JERRY MOORE c/o PETER DIMAGGIO Day phone 248-3984 Mailing address (1) 1702 McKINLEY ROAD * ANCHORAGE. AK �4eUddress (2) i fi Z1 i Vl 1i. Zip Code 99517 Legal description (Lot, Block & Sub'd.) LOT 5. BLOCK 2: HAMPTON _HILLS SUBDMSION #1 Legal description (Section, Township & Range) _N/A Lot Size [D L� Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS INC. Permit Fees: N' `"t QD Date of Payment: Receipt Number: 7� c, SJ Waiver Fees - Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS, INC. July 14, 2003 Municipality of Anchorage Development Service Department Building Safety Division . On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic Upgrade for Lot 5, Lot 2, Hampton Hills Subdivision #1 To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system consists of a 1250 gallon septic tank and a deep trench type drainfield that is surcharged and must be upgraded prior to selling the house. Two test holes were excavated west of the existing drainfield. The new drainfield will be designed around the 30 foot radii of these test holes. We are proposing that a new 1250 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/ftZ c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 600 ft2 f. Total Depth: 7 feet (max.) g. Effective Depth: 4 h. Width: 5 feet i. Reduction Factor: 0.5 j. Minimum Length: 60 feet k Effective absorption area = 600 f12 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: The area for the proposed drainfields is a 20-25 percent slope running approximately east to west. All slopes that are greater than 25 percent slope to be graded less than a 25 percent slope. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. . A S i ei rruvAl. aim4s. P .. m. s. NOTE: A site plan drawing, a design drawing, two soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com I I I I I I I t I I I I I �c AD \ 1 4'1.• ' I % HAMPTON HILLS 1 ♦♦ LOT 6, BLOCK ,OI r TSN , 1 �I 1I I 'pPROX 1 WHIST O R i\ / ♦ HILLS 11 ♦♦�EEppTn�C AREAS IHAMPTON LOT 6, BLOCK 1 \\ 1 � �OQ�I 1 ♦�\` _ I / I HAMPTON HILLS 11 \/ 1 // i LOT 2, BLOCK 2 r �-- – `-SEPTIC j �—�etuuil / i r HAMPTON HILLS 11 LOT 7• BOCK 1 C ARZE: HAMPTON HILLS 11 LOT 6, BLOCK 1 1I � --- ' ♦\\� LAD HAMPTON HILLS 11 LOT 6, BLOCK 2 ( �I I i / s� r_ -- I 1 I I I j HAMPTON HILLS 11 I I LOT 1, BLOCK 2 I I I ,'—EXISTING SEPTIC SYSTEM 1 I I I EXISTING 14 BEDROOM -----•-- J L\ HOUSE / ♦ 4REA7 1 AR I aD / PROPOSED SEPTIC UPGRADE (SEE DESIGN PAGE 2 OF 2) i I HAMPTON HILLS 11 LOT 4, BLOCK 2 r App \, i ROX. LOC.11)0t4 ' ! ! r t ♦ / r HAMPTON HILLS 11 ♦� \�— — ' LOT 3, BLOCK 2 I r C �vc AREA 7/1 1. ,'R7►I �•'7�� ....... DRAWN BY: C.J.G. ALASKA WATER & «WASTER'ATER .-------------- ---• SCALE: CONSULTANTS, INC. t 3701 F TUDOR ROAD. SUITE 101 • ANCHORAGF. AK 99507 • PHONF (907),137.6179 • FAX (007)319.3260) 1 = loo, ii ... PREPARED FOR PHONE NUMBER: PAGE NUMBER: JERRY MOORE C/O PETER DIMAGGIO 248-3984 1 OF 2 ll, Je r y . ome s: LEGAL DESCR)PnON: +('y4 a, E 9 e HAMPTON HILLS SUBDIVISION #1t LOT 5, BLOCK 2 1i4��'e� .., .,..• '' �A♦' TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE \ 1 4'1.• ' I • I1 ♦\\ 1 NRI:R I I gppRO----5 AT i\ I ♦�\` _ I / I HAMPTON HILLS 11 i // i LOT 2, BLOCK 2 r �-- – `-SEPTIC j I / ♦ 4REA7 1 AR I aD / PROPOSED SEPTIC UPGRADE (SEE DESIGN PAGE 2 OF 2) i I HAMPTON HILLS 11 LOT 4, BLOCK 2 r App \, i ROX. LOC.11)0t4 ' ! ! r t ♦ / r HAMPTON HILLS 11 ♦� \�— — ' LOT 3, BLOCK 2 I r C �vc AREA 7/1 1. ,'R7►I �•'7�� ....... DRAWN BY: C.J.G. ALASKA WATER & «WASTER'ATER .-------------- ---• SCALE: CONSULTANTS, INC. t 3701 F TUDOR ROAD. SUITE 101 • ANCHORAGF. AK 99507 • PHONF (907),137.6179 • FAX (007)319.3260) 1 = loo, ii ... PREPARED FOR PHONE NUMBER: PAGE NUMBER: JERRY MOORE C/O PETER DIMAGGIO 248-3984 1 OF 2 ll, Je r y . ome s: LEGAL DESCR)PnON: +('y4 a, E 9 e HAMPTON HILLS SUBDIVISION #1t LOT 5, BLOCK 2 1i4��'e� .., .,..• '' �A♦' TYPE OF WORK: SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE -�---- r PROPOSED DRAINFlELD. EXCAVATE A TRENCH THAT IS 7 FEET DEEP MAXIMUM BY 5 FEET .` '.: :; WIDE BY 60 FEET LONG. ADD 4 FEET OF ( I ..• '..:. .:;' ^.:.,,. CLEAN, WASHED SEWER DRAINROCK. INSTALL I I \ `.; `;, •.: ;•• TRENCH PARALLEL TO SLOPE CONTOURS. .�.:. EXISTING DRAINFlELD TO BE l ^ `'•? r, USED AS A RESERVE SITE / �'•:w�•4 EXISTING SEPTIC TANK TO BE� I .••,; ,.1, COMPLETELY ABANDONED o \� I a \ \ 1 4BCD EXIy�NC Ho OOA4 45x55 DRAtNAIGE tom :•:.. I I EASEMENT INSTALL FOUNDATION ICLEANOUT PROPOSED SEPTIC TANK �ON 1 / \ INSTALL DIVERTEROW DATE: 7/14/2003 DRAWN BY. C.J.G. ALASKA `WATER & WASTE NN'ArE4 R SCALE* -•-*�--m— CONSULTANTS, INC.••-------�'••-----• c 40� 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AN 99507 • PHONE (907)337.6179 • FAX (907)339-3746 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JERRY MOORE c/o PETER DIMAGIO 248-3984 2 OF 2 LEGAL DESCRIPTION: HAMPTON HILLS SUBDIVISION #1; LOT 5, BLOCK 2, TYPE OF WORK: DESIGN DRAWING OF PROPOSED SEPTIC SYSTEM UPGRADE of a A. Ga ss; a •,. TC 7953 .• 'FFG � oma_ .. ' • � t�QplJ ALASKA WATER & WASTER'ATER �--- CONSULTANTS, INC.---- - �-�--• wwGM SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HAMPTON HILLS SUBDnnSION; LOT 5, BLOCK 2 PERFORMED FOR: JERRY MOORE DATE: 7/8/2003 ( ee!) _ -- TH ORGANICS/LOAM TEST HOLE 1 1 •Y• IGROUNDWA ERI DATE kFA ... .. ' ff A. arne 04 e C —7953 �-G u�01p fessi0n0\� 7 .Y. SOIL CLASSIFICATIONS 2— I .•. •.• SP -SM _ _ ORG 3 2 .. ft :: GP ML 3 1.12 - GM CL 4-4 SM 1:16 4 GC OL �IYO II 5 1:17 - SW MH 5 t': 1.21 4 �'• : SP CH • I SM ; OH 6 msc IGROUNDWA ERI DATE kFA ... .. ' ff A. arne 04 e C —7953 �-G u�01p fessi0n0\� 7 1 <1---��-------------- —_ -� 7/9/2003 1 1 8 2 1:12 4 0" 6' 3 1.12 - I SM 1:16 4 9 �IYO II 5 1:17 - 6" - 10 1.21 4 0" 6" I 11 12 1 13 14 1 SITE PLAN I \ 1"=100' ML 15 B.O.II. 16- 17 18 IGROUNDWA ERI DATE kFA ... .. ' ff A. arne 04 e C —7953 �-G u�01p fessi0n0\� DATE READING 1 <1---��-------------- —_ -� 7/9/2003 1 1 6" - 2 1:12 4 0" 6' 3 1.12 - I 4 1:16 4 1 0" 6- �IYO II 5 1:17 - 6" - 6 1.21 4 0" 6" 1 1 SITE PLAN / \ 1"=100' DATE READING CLOCK NET TIME TIME (MINUTES) WATER LEVEL NET DROP READING (INCHES) 7/9/2003 1 1:08 - 6" - 2 1:12 4 0" 6' 3 1.12 - 6" - 4 1:16 4 1 0" 6- 5 1:17 - 6" - 6 1.21 4 0" 6" 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.0 FT. AND 8.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: NICK HEITSTUMAN COMMENTS: THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WhS P RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: _771 2�_ AILASKA WATER & WASTEWATER CONSULTANTS. INC. S701 E. TUDOR ROAD. SOL 101 0 ANCHOWE; AIC 99507 0 PRONE - - •o.. M SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: HAMPTON HILLS SUBDIVISION; LOT 5, BLOCK 2 PERFORMED FOR: JERRY MOORE DATE: 7/8/2003 DEPTH _ (feet) ___E TEST HOLE 2 1 _ — OLD FILL/ ORGANICS 7- CLOCK TIME SOIL CLASSIFICATIONS WATER LEVEL READING NET DROP (INCHES) ORGANICS 1:01 — GW ORG SM 9 111111111ML <1 6" uilll!11 CL 10 r11111111*', �SU.2GCHNl1 • 6" — SW IIIIIIIIIMH 1:02 <1 - %//%CH 0 12 1itl1 �i�.B • — 6" — 7- CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) g 8-1 1:01 — 6. SM 9 1:01 <1 6" 0 10 1:02 — 6" — 11 1:02 <1 6. 0 12 1:03 — 6" — 13 1:03 <1 6" 0 Q.O.11. 14- 415161718 15- 16- 17- 18 DEPTH TO DATE GROUNDWATER DRY 7/8/2003 0 �r o MA�Gy�ness, —7953 lZ fessiot°o\ DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/9/2003 1 1:01 — 6. — 2 1:01 <1 6" 0 3 1:02 — 6" — 4 1:02 <1 6. 0 5 1:03 — 6" — 6 1:03 <1 6" 0 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: NICK HEITSTUMAN COMMENTS: THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WjkS RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: I WHIST HAMPTON JHAI S LOT 6. 6. 5. kotA MPTON HILLS /1 LOT 8, BLOCK I FIELD VERIFY P N I HAMPTON HILLS 11 LOT 1, 13LOCK 2 FIELD VE ',.FIELD VERIFY PTON HILLS 11 T 4, BLOCK 2 'ON J HILLS I 7. LOCK F1 LD VE DATE: I I QU) 6/W2003 DRAWN BY: M.E. 3701 F ,OR ROAD. SU ANC R rF. K 995 4 101 07 N- (907)Q?137-11�-XX (907 ?46 7��To ol PRLED FOR— P-PrINE N MBER: CE JERRY MOO�E C/o PE D�ln Io 48- q 1 OF LC04-.QESCRlPqbN:Fo-1 --Ljo SIAM N HILLS PWT 5, BLOC Li�� TYPL RK. -TOl HI CA/ DRAWING IZL IIJ 77 MUNICIPALITY 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 WELL INSPECTION REPORT C NEWNAME UPGRADE �3ry_`t /3'7 uP-TIS__7_)_-t//3'7j MAILING ADDRESS LEGAL DESCRIPTION NO. OF BEDR OMS LOCATION I / /�/y lei (/ Lirti7it Y' �'V� ✓ /LCL !%'�' _ Well / Absorption area Dwelling PERMIT NO. o O DISTANCE TO: I b C) 1 7.6 O U y h zManufacturer n. F.kE wR — - Ma Ci lI No. of comparj�m,el�ts N ILiq. _ cap�c ty Ir Ilons IF HOMEMADE: Inside length Width Liquid depth O Y DISTANCE TO: Well Dwelling PERMIT NO. p1 p _a x w -Manufacturer Material Well ^ A Foundation �� Nearest lot line DISTANCE TO: �G,. Liquid capacity in gallons PERNIJ�T1N08. � o j� 1 !S _ au. w No. of lines Length of ea h li Total length of li Trench width ©inches Distance between lines_ aTop -- of tile to finish grade Material beneath tile Total effective sorption area cc inches Length Width Depth PERMIT NO. Q F- "type of crib Crib diameter Crib depth Total effective absca p tion area a ad In ') Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. -a -J Building foundation Sewer line Septic tank Absorption area(s) -�' DISTANCE TO: OTHER PIPE MATERIALS C'a 5_ : SOIL TEST RATING INSTALLER REMARKS y„ — e�... _ u.. �` OF A1.1 m, . � i�• �,� fid. 4r�' • 9 v. 2225-E — Itl �E 25. 1911 r APPROVED DATE LEGAL_ 71 rriz In—'/"Pn t 101 L, X W "W" 11111 Fir i=loylul7l—�. pF::,1 H� , KRRE DEPHRTMENT OF HEHLTH HND ENVIRONMENTAL PROTECTION 825 'L' STREET/ HNCHORHGE/ HK99501 264-4720 L_ E H:��� ����1�� ����� ������� PERMIT NO ( 810680 ) HPPLICHNT CURTIS SHHER! HZZ 85]1 E 11CT LOCHTION HHMPTON DR LEGHL L3 B2t�ft4F_m HHMPTON ��\ LOT SIZE 54450 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS: TRENCH MAXIMUM NUMGER OF BEDROOMS ; 4 SOIL RHTING (SQ FT/BR)-: J. THE REQUOF THE SOIL ABSORPTION SYSTEM IS� �� �� ������� �� ������ ������ THE LENGTH DIMENSION IS THE LENGTH (IN FEERT) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE G�OUND HND THE BOTTOM OF THE (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL,. BETWEEN THE OUTIi- HLL PIPE HND THE BOTTOM OF THE EXCHVHTlCIN (IN FEET), IFT! Eli oil U X to! Q Ell MH Fii" 11'", 1: ICl.- 7" 1=1 N K :1., RD ...... �- PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS RDJHCENT TO THIS PROPERTY HND THE NUMBE� OF RESIDENCES THAT THE WELL WILL V 14C3 K 121 7. �N 013 F" Ell Q -V I UZI 141 0_,; iil F;", FT ERE Coo 1.1 1 Q FEE ED ��� BHCKFILLING OF HNY SYSTEM WITHOUT FINAL lNSPECTION AND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND HNYON�SITE �EWHGE DISPOSHL SYSTEM IS 100 FEET FOR H WELL OR 150 TO 200 FEE' FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVRTE WELL TO H PRIVAT SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. III ELI LOGS HRE F`!IRRQUIF!ED HND MUST IR,:E RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND IDONSTRUCTION DIAGRAM HRE RVHILRBLE TO INSURE PROPER INSTHLLHTION F=4 FRE., 0 1-1 ]:� _-F, 1, Ill"), EE 11-1 E,' IIERE �� I CERTIFY THAT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON—SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2I WILL INSTHLL THE SYSTEM IN 8Il: CORDHNCE WITH THE CODES. ]' I UNDERSTHND THAT THE ON—SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESID�NC� IS INCLUDE MORE THHN 4 BEDROOMS, SIGNED~_~��.-------~�.~�~��~~~�_���_~~��~—~~��^—~~ HPPLICHNT CURTIS SHHBHZZ ~ V4 0 ISSUED DHTE.-'.~��.~���~'�_��� � air it 1 u. HOW wal 1.15'r i_ !,wift q2 05M J" ON rpuRn _ z -:I - ASS it f -I 1 iiif N 1 v inks 1 -If ti?} j'k 10 Y rp TW py, F1 T, nT.,�n r 'Ij 1-t A f7J.47, 177 tv - - I - t IJ E F-tJ­ IRN }"Hi DEFOR If sit! 1 OR- i i I0 REL 115 T VR IN C U HIP? RXICARMS 1tF7.i 1 0 1,i; CS, Ell 01 S"M Eff, Ups rum! _ - - is - I ! i n r i in, 014-1.1 Q - Elf G H ING VH 1� yps rm M Ell 111111 0114 HIS R f Q s 01 q. .3! _ii_, IWO lots F w i.JJ'0 0 - f 1 E F QW, NEW 11 icy, i'WiY t _Y TIEV PRINT, R E t'!'-; f lot .1 Ji F f TE "Q1 . MI wo 11 a it 3 1 TF Svhgvv_� iqu_ AV 1 H 91 f C 1 FPO HII TIN 141 vil 3 THIN fit. 1 noon, i f: Q; 1 � SO] LS LOG -` MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: LR711 S g ABA` -Z DATE PERFORMED: LEGAL DESCRIPTION: ��L�_t®��14 AHP-Totl 11 L•L S �f•cl�� SLOPE SITE PLAN 1R1L,,Lcv--\w- - _- - --- - _ �- 2 i- 3�� r o vrv, L• o oo , � 11 ,, II 4 gV` ' p � � f9 d 7 i 01•we� LA, -1 wC 1 8 tv d� pA<�c a �� clew•+ 9 10 G� ' © i y (.2 'r U-, 4J+ 11 0 40 6 `J WAS GROUND WATER d ENCOUNTERED? 12 *6 it 13 S�!4le 14 / 15 Date Gross Time 16 Depth to Water w. �,, j�• ®F• Az,q `, 17 h *49TH •�. 18 '••e ••,•s•• oso• 19 No. 2225-E c� JUNE 25, 1971 20 Am fir'% •. .•••'J%��.� SAL COMMENTS PERFORMED BY: 72-008 (6/79) IF YES, AT WHAT DEPTH? S 0 L O P E adin9 Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN Z4 '/a/b . CERTIFIED BY: FT AND (minutes/inch) FT DATE: cn 00 CO fo tTi co C6 FAM 33 Vo "T I'd w 171 I-tj "il Ill Ill `11 71 71 x FQ 0 0 0 C4 qj kj j 1 X11 �fi Ill X1 1 1 1 'Tl ITi 0 O Cd O 0 0 0 -fj -I -ri 00 CO )> Municipality of Anchorage Development Services Department. Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL � FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-134-53 HAA# 030431 1. GENERAL INFORMATION Expiration Date: //T L Complete legal description HAMPTON HILLS SUBDIVISION #1: LOT 5. BLOCK 2 ❑ Public Sewer ❑ Location (site address or directions) 10401 HAMPTON DRIVE * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JERRY MOORE Day phone (360) 336-2919 10401 HAMPTON DRNE * ANCHORAGE. AK 99577 Day phone JENNIFER ZIMMERMAN w/ COLDWELL BANKER Day phone 265-9170 2525 "C" STREET * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 4 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) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certirred by my seal axed hereto and as of the validation date shown below, 1 vor Ift erify ithmy investigation, bgsed on procedures outlined in the Health Authority Approval Guidelines ford shows that the on-site water supply and/or wastewater disposal system is(are) safe, functtona for the rAAber of bedrooms and type of structure indicated herein. I further verify that bas* .. information obtained from the Municipality of Anchorage riles and from my investigation and ins oq tte water supply and/or wastewater disposal system is(are) in compliance with all applicable -;nand State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone Address 3701 E. TUDOR ROAD, SURE 101 " ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKW WC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE 337-6179 t/ Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the tllowing stipulations: o f e s s1o��°40 NOTE: THE WELL FOR THIS PROPERTY MEETS EXISTING STATE AND MUNICIPAL CODES. THERE ARE NITRATES PRESENT. IT IS SUGGESTED THAT PERIODIC TESTING BE PERFORMED TO INSURE THE WELLS CONTINUED SUITABILITY. CURRENT NITRATE LEVEL IS 5.16 MG/L. EPA MAXIMUM CONCENTRATION IS 10.0 MGL MORE INFO IS AVAILABE FROM ON-SITE AT 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 1?A1 Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: tttttt0Frrrrr,���� WASTEWATER p OGRAM �J'y�,_A 1 1))solj1�.' Municipality of Anchorage Development Services Department Building Safety Division On-8Re Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HAMPTON HILLS S/D#1: LOT 5 BLOCK 2 Parcel ID: 015-134-53 A. WELL DATA Well type PRIM if A, S, orC provide PWSID# N/A Date completed 716/1981 Sanitary seal (YM) YES Total depth 100 fL Cased to 100 ft. FROM WELL LOG Date of test 16/1981 Static water level 20 fL Well Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 6/18/2003 90 fL Welt production 8 g,p.m, 6.08 g.p.m. WATER,SAMPLE RESULTS: /'] Coliform Q colonles/100 mi. Nitrate !SJLP mgA. Other bacteria colonles/100 mi. Arsenic N A mg /L.Date of sample: 2 Collected by: AtCWWC , iNC. B. SEPTIC/HOLDING TANK DATA Tank Type/Mtaterlal STEEL Date installed 8/5-7/2003 Tank stze122.90 gal. Number of Compartments . 2 , Cleanouts (YM) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) O High water alarm (WN) NLA Date of pumping NEW Pumper — C. ABSORPTION FIELD DATA w ML TWO 8/5-7/9 Date installed 11 11981 Sollrating(Tp d r ftibdrm) 1.0-/150 System type TRENCH Length � 60/49 fL Width 5/3 _ . ft. Gravel below pipe 4.0/6.5 ft. •7.24-8.04/ Total depth _. 9s. ., ft. Eff. absorption area 600 637 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) For 4 bedrooms Fluid depth in absorption field before test in. Water added „- gal. New depth . — in. Elapsed Time: ,: min. Final fluid depth ._„ in. Absorption rate >= — g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NO If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/A "Pump on" level at in. "Pump off" , In. High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 1000+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and�� 4 - review of Municipal records that the above systems are in "" "' " "' ........ conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS E-7963— Date g? 1,21 Ins Po`� ^e ' I r kkz"f ee�� HAA Fee $ �J�S •� Waiver Fee $ Date of Payment 8 Date of Payment Receipt Number Receipt Number (Rev. 12J01) 8-21-03; 4:28PM; ;607 5815301 it A- 2 SGS SCS Ref # 1035303001 Client Name AK Water & Wastewater Consultants Inc. Project Name!# Hampton Hills #1, Lot 5, Bk 2 Client Sample ID Hampton Hills #1, Lot 5, Bk 2 Matrix Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Tlme 08/21/2003 11:20 Collected Date/Time 08/19/2003 11:35 Received Date/Time 08/19/2003 12:50 Technical Director ��� Ede Released Allowable Prep Analysis Parameter Qualifiers Results PQL Units Method Container ID Limits Date Date Inst Waters Department Nitrate -N 5.16 0.100 mg/L EPA 300.0 B (<-10) 08/20/03 JJB Microbiology Laboratory Total Coliform 0 cot/100mL SM189222D A (<-1) ❑ 3 0 0 n N N 0 N 0 In m NJ 5 B9"07'30.0"E 2 f• umm of a..f w• a 6 I s� 1 a O4V n 1 v GP ( I N B Sao a 28.320' 5.6°W 229.99 AS -BUILT SURVEY SCALE: r f as 1 HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 5. BLOCK 2, HAMPTON HILLS NO. I IFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOWANY CONFLICTS BETWEEN I ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT NO STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL THEVISIBLE IMPROVEMENTS SITUATED THEREON ARE :TURES OR FENCELINES. I WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. IENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. DATED AT ANCHORAGE, ALASKA THIS ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINE _12TH DAY OF _AUGUST 007_ 2 CATE STRUCTURES. HOLT LAND SURVEYING 9095,FB10742 4VING SHOWN MAYBE APPROXIMATE DUE TO SNOW CONDITIONS. TEL. 315-5513 Mailing address _ Lending agency _ Mailing address_ Day phone — Agent Day phone Address — - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: S. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, - Name of Firm D Engipeegng Phone ;_....... Address . . 20441 Ptarmigan. Blvd, Engineers signature Date 0 44k a ®� • '�� % o - � 3•C� oY�9ea•a a0 ee• m•� ®� - Kenna,h M. . 0 � pROFESSI� � eAoOo.®ate 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that aperiodic testing be performed to insure the wells continued siitAbiliaty. Nitrate concentration is 5.27 mg/1. EPA maximum concentrations is 10.0 mg/1. More information on nitrates is available frefa the On site gerv!Gas Program, D14HA, 343 -4744 - Additional Comments By: Date 6—"/3-9% CAUTIOW 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(Rw.1/91) Back MOAu21 -. - - - Municipality of Anchorage MUNICIPAI,tryOFANC 0* DEPARTMENT OF HEALTH & HUMAN SERVICESIRONMEALsERVIc Environmental Services Division JUf Q2 199 825 I_ Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-47 4 Health Authority Approval Checklist L ft V E D Legal Description: A',240 a6/s d1ka Lo/5 ParcelI.D.:_O/5 A. WELL DATA Well type lAa/ _ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _Y Date completed Total depth 1630 Cased to _,DD Casing height (above ground) /5 Sanitary seal (Y/N) _ Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION Date of test 7-G -,9 / 2 7- 2 7 Static water level Well production B _ g.p.m. g g.p,m. WATER SAMPLE RESULT'S: Coliform Nitrate J.2 Other bacteria UJ Date of sample: -6- - 7- 97 Collected by:ir� B. SEPTIC/HOLDING TANK DATA Date installed ,/-2-8/_ Tank size 1256 Number of Compartments 0 Cleanouts (Y/N) Foundation cleanout (Y/N) _.� Depression (Y/N) iy High water alarm (Y/N) _ NA Date of Pumping 5- Z 7__ Pumper /Var��trr� C. ABSORPTION FIELD DATA Date installed 1/— 2 --8/ _ Soil rating (g.p.d./ft2 or ft2/bdrm) 16-0 System type Length _��_Width Gravel thickness below pipe _4o •5 Total depth 91 25 Effective absorption area _ 6.37 Monitoring Tube present (Y/N) Y Depression over field (Y/N) Al Date of adequacy test _ �_ Results (Pass/Fail) /_ For _bedrooms Fluid depth in absorption field before test (in.); Immediately after,CO3 gal. water added (in.): Fluid depth X0..5 (iris) Minutes later: /`2VO Absorption rate = __4!�e9O -/- g.p.d. Peroxide treatment (past 12 months) (Y/N) _ / If yes, give date _ AV -2 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot /OD f On adjacent lots Absorption field on lot /d D f On adjacent lots Public sewer main NA Public sewer manhole/cleanout IVA r Sewer /septic service line ZS f Lift station NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation .Z Property line 30 Absorption field ZD I r Water main/service line 2.5 4 Surface water/drainage .16D* Wells on adjacent lots /DU 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line $ Surface water / Curtain drain A&I e— F. ENGINEER'S CERTIFICATION Building foundation 'VU I Water main/service line Z5 14 Driveway, parking/vehicle storage area Wells on adjacent lots l certify that l have determined thru field inspections and review of in conformance with MOA HAA guidelines in effect on this date. Signature r s Engineer's Name fj ° f� �• S 0 Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* above systems are Waiver Fee $ Date of Payment Receipt Number Ker+r�..�: r.,. �:�ir.. .• °°_ 7116 Waiver Fee $ Date of Payment Receipt Number j lime Time.ne �— Date Date Date r Inspector Inspector Inspector Comments Conditional Approval Gv Q Date Sewer Installed Permit No. Septic Tank Size J 0—� I / Holding Tank Size Soils Rating e Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Ot -4t�c.�2e,.. U�=,:.- , �.c C� d� Z Phone Mailing Address ) J _� / �, �� i�L �� �� �_ d < Buyer�i. l Address Lending Institution 724-. (,- Phone Address Realty Co. & Agent -! Phone Address Legal Description 7=71 r Street Location Type of Residence '5L�-Single Family ❑ Multiple Family No. of Bedrooms ❑ Other �ee Water Supply 4 individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility ­_____available. Sewage Disposal ,� �`_9 Individual Year Individual Installed: _ ❑ Public Utility When Connected to Public Utility:__ ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUESTBEFORE PROCESSING CAN BE INITIATED. January 25, 1982 Curtis & Jawhara 8hal:)azr £3531 r. 11t1-1 Ct. Anchorage, AK 99504 Subject. Lot 5, Block 2, Hampton Hills S/D #1 Tear Mr. & Mrs. 5habazz: Approval ,for the individual Hewer and water facilities cannot be granted until the following items have been completed: A well log :submitted to this office for our files and review. ° The top of t1le well casinci sealed with a sanitary seal so that it is water tight. The water analysis report needq to be submitted to this Office from the Chem Lab, 5633 B Street, for our review. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there aria any further questions, please call this Office at 264-4720. Sincerely, Robert C. pr.att Associate Environmental Specialist i