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HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 3 LT 1 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: "~,4~ OolS.~4 (-.10 ¢,~t~,'~ ¢&op. Wastewater System: [] New '~'Upgrade Address: ~t..J~.% ~ ABSORPTION FIELD Phone: /,,,.~, No. of Bedrooms: ~j,~,,,'~ ~tq/,m ~.,.OJ .. ~,.~j~,,,,ff ..~ ~DeepTrenoh [3 Shallow Trench ~Bed ~Mound,,, ~Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: 0.~ GPD/Sq. Ft. Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ [ Range:.~ Section: ~ Fill added~,~above orig[nal~ ~'~grade: Ft. Gravel length: ~ Ft. Gravel width: Number of lines: Distance ~hv~n lines: WELL: ~i~Ti~New D Upgrade ~ 2.~ Ft. J ~ Ft. Classification (Private, A,B,C)'. Tota~ ~ed To: Total absorption areaj~ Pipe material: Driller: ~ Date Drilled: Static Waler Level; Installer: "' - ' Pump Set at: I Casing Height Above Ground: v'~~ ~ ~. 1 . ~. TAN K _ SEPARATION DISTANCES ~Septic ~ Holding g S.T.E,P. To Septic Absorption Lift Holding' Public/Private Manufacturer: Capacityin gallons: From Tank Field Slation Tank ~wer Lines A~~ ~ Number of Compa~ments: Sudace Foundation ~1~ jo~l~ .... "Pump on" revel at: ~h water alarm at: Curtain Remarks: BENCH MARK _ Location And Description: r I I ENGINEER'S SE~L 'nspect'°ns Ped°rmed b~820 ~2~;~:~C[ ,. ~,,~ ~ ..... ....... Depa~ment of Health and Human Se~ices approval Reviewed and approved by~_~ 72-O13 {Rev. g/91) MOA 25 ...X¢\ 10' Ullli'C¥ EASEM£NI' \\ \ ASSUMED SKWCR - ' / \ ~ lINE' t.OCA'rlO N ~ ~ X SEYlIC TANK % ~- I /-'"/ FLOW DIVERTER (lCD) ~ , .X ~ -/ // Al 1ER C(X~ / C04~ ' ~ ~ I ' '' ~' I/ ' EXI~IING IREN(JI' ' i> ~ - .~ , .-" APPROXIMAI'E LO(;A?ION ' f~ . ., . ~ / ../' NO[ 'lIED IN['O NEW TANK ~ ' ' ' .~'~ FCO[ 13.II 29.8 [ :~: ' .-" / SLAB. REFERENCe. [-:~ - ~ ~3 ~' - 19 ~' ] / IC04 129.6 118.8 ~ ' r '~ ~.~ ~ SWING tIES WI(RE SCA[ ED FINAl GRAD[ (JOI DONE F~Y tANTFiCH / /. Fll 'FE[~ , ~ IHg%~U{~ :, 95.90 (IYP.) ALA,~ WA~R AND WAS~WA~R CONS~TA~',, ~C. ~~'~%%/~ PHONE: (907) 337-6179/F~: (907) ~8-3246 HAMPTON HILLS SUBDIVISION ~1, LOT 1, BLOCK ~, ~./~ AS-BUILT OF SEPTIC SYSTEM UPGRABE TINA DOBSON 346-3146/229-2924 ~¢~ ... ~ ,,. J.L.M. 1 = 40' 2 OF Z ~%~, ~Oteaato JUJ-W DRILLING, Inc. P.O. Box44224 · ]310C Intern~tionalAirport Ro~d (907) 274-461! ANCHORAGE, ALASKA 99509 DRILLING LOG Well ·Owner. P:iz'k L:me Deve]oDmen~ Corr, r)anv Use of Well I),~,:~,o..4 r- Location (address of::'Township, Range, Section, if known; or distance main rosd Size of casing A,, ' Depth of Hole ~qq feet Cased to. ~/q feet Static water level o~q ft. (ab6ve) (below) land surface. Finish of well (check one) open end ( Screen ( ); Perforated ( x;~ ). Describe screen, or perforation Well pumping test at ~ gallons per (h-our) !minute) for. 1 .hours with ~0.')'-~ of drawdown from static level. Date of completion ~"~' ! ~'%~ 1 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ); 0 TO 2 TO ~ TO 5 TO. 2~ TO 75 TO '~4.1 TO 18~ TC 210 TC Pg~ TC pd~ TC 2~ TC TC TC TO 4 Fill z~ 741. RECEIVED s~a ,.it:~ ~om(, .-.~avai SEP 2 1 1998 2,:zn~¥ ~'avel ,] i$,. /~00 Bedrock Municipality of Anchorage 3-- CONTRACTOR MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Bo>( 196850, Anchorage, AK 995'19-6850 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 29, 1998 Expiration Date: Jul 29, 1999 Permit Number: SW980267 Legal Description: HAMPTON HILLS #1 BLK 3 LT 1 Design Engineer: Alaska Water & Wastewater Services Owner Name: Tina Dobson Owner Address: 10000 Hampton Drive Anchorage , AK 99516-1126 Parcel ID: 015-134-66 Site Address: 010000 HAMPTON DR Lot Size: 90859 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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: ~.,i ,/'/ ~ I~L/~.(_,C~(,..~_~./_y, ~ Date: '~- ~ ~ Issued By: & Date: 7' g? 2~ Alaska Water & Wastewater 7320 East Chester Heights Circle - Anchorage ~ Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers July 14, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 1, Block 3, Hampton Hill Subdivision To whom it may concern: The existing 4 bedroom house is served by a private septic system and well. The existing drainfteld is surcharged mid must be upgraded prior to the sale of the house. A test hole was excavated to the north of the existing septic system. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is the soil log which shows the soil profile, and the percolation test results. The soils below the organics is a GP/SP material to a depth of 6.0 feet. At a depth of 6.0 feet the soils transition to a GM/SM material to a depth of 9.5 feet At 9.5 feet the soils transitions to a SP/SM material to a depth of 17.5 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. Two soil percolation tests were performed, one bench at 3.5 feet to 4.0 feet which perked out at a rate of 1.5 minutes/inch and one bench at 6.0 feet to 6.5 feet which perked out at a rate of 24 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 1.5 and 24 minutes/inch b. Allowable Application Rate: Average rate = 0.9 gallons/day/122. Use 0.8 gpd/sq.12. c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 750 122 f. Effective Depth: 8 feet h. Width: 2 feet i. Minimum Length: 47 feet j. Effective absorption area = 752 122 k. Maximum depth = 11 feet maximum 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: Attached is a topography site plan. In short, there are no slope concerns. The trench will be installed parallel to contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance, i' Sincerely, /' , //Ii Princt 1}~ [ ' i S I/2, SW 1/4, NW 1/4., SE(:FION 13, T12N, R3W / :4 I (SEE DESIGN, PAGE 2 OF 2,)/ O' - // ~%ET-~6- ~E~ARIC ENCROACHING THE I / / //' WASTEWATER ALASKA WATER & ~y.r',~ .... :~ HAMPTON HILLS SUBDIVISION, LOT 1, BLOCK 3 ......... )ATe7--1/4/98 D~WN ~?: ~c~E: PASE: A.C.G. 1 = 100' 1 OF 2 L ~ ~ ~ EXJ,~FING SEP~C LINE X ' ':- .:I"" :: II k/ / SEPTC T~I( TO ~E / ~OONED f 0 JPLE%ELY PREPPED HAMPTON HILLS SUBDIVISION ~ " 1Y¢E OF WORK: .~,, TINA DOBSON NUUaer: ~ .~ · f / ~[ ar ss "~ ALASKA WATFR & WASTEWATER 7,320 E. CHESTER HTS, CIRCLE '~ ANCHORAGE, Al(. 09504 PHONE (907) 337-6170 s F~ (907) 338-3246 J SOIL LEGAL DESCRIPTION: PERFORMED FOR: DATE PERFORMED: LO(; - PERCOLATION TESTI HAMPTON HILLS SUBDIVISION, LOT 1, BLOCK 3 TINA DOBSON ORGANICS GP/SP SAN DY, GRAVELLY SOIL GM/SM SILTIER SOIL I TEST HOLE #1 PAGE 1 OF 2 S~OIL CLASSIFICATIONS i GM ~;: GC ::~ SW SP ;,;l sc "DEPTH TO GROUNDWATER DATE DRY ~/30/98 ~L~ 5/~/~ ORG ML CL OL MH CH OH I ~I~T~ P£ANI ~ ~ L r'= iOO' I DATE 7/~/98 READ Nn CLOCK NET TIME WATER LEVEL NET DROP '-~ TIME (MINUTES) READING (INCHES) 1 5:06 6" __ 4 /5:24 / 5 ~ l 5:~o / 5 / ~ 5/.. ~ ~/.,, ? l 5:42 5 - ~ ~74"' -J ~ 1/~'; PERCOLATION RATE 1.5 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.0 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR UPPER BENCH PERC. HOLE ONLY. PERFOMED BY ALASKA WATER &: WASTEWATER I, , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ALASKA WATER ac WASTEWATE _ _~~~ ~. i so~ ~o~ - .~.co~o. ~s~l HAMPTON HILLS SUBDIVISION, LOT 1, BLOCK LEGAL DESCRIPTION: PERFORMED FOR:._ DATE PERFORMED: TINA DOBSON f TEST HOLE PAGE 2 OF 2 SOIL CLASSIFICATIONS GP ~ ML  SW MH ~ sc SEE PAGE 1 OF 2 DEPTH TO DATE GROUNDWATER DRY 6/3Q/gB READING CLOCK TIME NET TIME (MINUTES) 1 4-:55 2 5:25 50 4- 5:56 30 WATER LEVEL NET READING (INCHES) PERCOLATION RATE 24- (MIN./INCH) PERC. HOLE DIA. 6 (INCHES~ TEST RUN BETWEEN. 6.0 FT. AND_ 6.5 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR LOWER BENCH PERC. HOLE ONLY. CERTIFY THAT PERFOMED BY ALASKA WATER &: WASTEWATER I, THIS WAS PERFORMED IN ACCORDANCE WtTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT QN THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE DEPAR'rIVlENT OF HEAl.TH & ENVIRONMENTAl- PROTECTION ENVlRONiV~ENI'AL ENGINEERING DIVISION 825 L. Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT b PHONE ~EW · ?g, ~ ~ UP~RA~E LEGAL DESCRIPTION _ L LOCATION ~ ~' ~L~q. capa IF HOMEMADE: DISTANCE TO: Manufacturer Well DISTANCE TO: l__lOO ~ No. of 'ine2L 1Lm'gti' °'~bcJ~TM Top of tile to finist~ grade -- ~4,¢ Length Nidth of crib Crib diameter Well DISTANCE TO: Class Depth ~kling foundation DISTANCE TO: a T Dwelling -- J Material 1 Width Inside length Dwelling  aterial ~oundation J. r~eares~' lot line ~.~ Total length of Ii j Material beneatl] tile ~. OF BEDROOMS ~-E R M I T NO. Depth No. of cou.~r~n~ Liquid depth 'ERMIT NO, ..iquid capacity in gallons PERMIT NO. Distance between lines Total effective~n area ~.~ / inches P~MIT NO. l -total e f_fectiv~e ab s2rption ar Nearest lot line '~~ ~R MIT NO. Crib depth Building foundation Driller Sewer line OTHER PE MATERIALS L TEST RATING NSTALLER ~EMARKS APPROVED DATE LEGAL JVJ-W DRILLING~ Inc. D.,~,. Box 4-1224 o ]310C Intorn~tionM Airport Road (907) 274-461] ANCIIORAGE, ALASKA 99509 DRILLING LOG Use of Well_g Well Owner _: :..~ l:ne 'b..v,'.}c~ x.,.t ('o:.--ri'2' Location (address of: Township, Range, Section, if known; or distance main road , i ..... c'- e L__'-".~'~ k; '~'1L._?2_ '~"vi'_" '~-~_ - Size of casing ._-'J'- '_Depth of Hole !~)'~ feet Cased to_' 't: _feet Static water level 9ct< ft. (above) (below) land surface. Finish of well (check one) open end ( Screen ( ); Perforated ( >ri. ). Describe screen.or perforation q M,,,,,;- ..... ,}t~qt 4~, Well pumping test at_~ __gallons per (hour) !minute) for ~ hours with__ of drawdown from static level. Date of completion_" ~ ~ 93. ~. WI~LL LOG Depth in feel from ground surface Give details of formations penetrated, size of material, color and hardness TO ,? q.-. :Lr!~ :_tick __TO_. TO TO ._TO ~ TO ' '.'--T0_ "':' ' TO. "'~ ~ "-; '-PO ........ TO~ ~ _2'0_ ~TO ); , fh x : lJ.. CT ":'rlio t;l .'i;e?-;. "? ;i ) %Z N'WWA Cert'ifle0 Contmeh.~ 3 -- CONTItACTOtl ~ -(i:" [:,EF'RRTHENT OF HEFtLTH fiN[:, EN",~IRONHEI'''TFIL F'F.'.O"FECTION :,TF..EE . FII'.JCHUF..H~E FtK ...... 264-4720 F'ERHIT NO. ,' 820966 > F:IPPLIE:FINT PRF.:K L. FINE DE'¢ F:O pi3 BO, F ERI 11 '1 I 'g-,'~l IFINCE .... ) F'F.'.~FIR TO -' '" I-II-:I:IT~. ,~11"4 Ti',L-., FHLLEE ..... LL-IT STZE .... · ,-., H I LL25 LEGRL L:t E,=. HRHPTON I ::, · [)F.:I=I I ['~F I ELD :,]IL FIBC;I]IF.:PTIIZIN $,T_-,TEH T'¢F'E OF '-F ' _ ..... -, .,., , ~. - ,.- SOIL F.'FITING ,'2;Lq FT,/BF.:>= 85 P1FtXIFIUP1 NUI1E, ER I_-IF E, EE.,F..OUbl- = '4c . c :2 -I '-- ~;CI I L. HE,=,LIF..~ T I ON =, ~ - TEl I ¢: THE RE6~UIF.:ED -,~i THE 9r399'-";Lc4. 51.T.!IJRF.:E FEET .4- (IN FEET) OF THE TF..EIq_.H 13R [)F.:FtlNFIEL[). THE L_ENGTH DIP1ENL=;II3N If.:; THE LENGTH BETI4EEN THE SIJRFFICE OF THE THE EEF. rH OF FI TRENCH FiR PIT IS THE DISTRNCE GRC.ND FIN[) THE E:OTTOH OF THE E',:..',E:RVFITION <IN FEET:). 1" I.-.# E 1- R IE~ !¢-.I C:: Pt !~.-! I [:. T !-I :Z "-~ 4-. E-I Ell E'~ F E2. E "IF". ']'HE ~3F.:f¥,,,'EL. DEF'TH I$ THE PIINZPII_If'I D, EPTH OF .~RFqVEL E:ETI4EEN THE OUTFFILL F'IF'E l=lf.4E:, TFrlE E:OTl"Of'l OF THE E::.::CF¢,/FITII3N F-.ZN FEET>. PERi"I:[T FII:'F:'L'[CFtNT HFIS THE RESF:'OI'.,12';ZBILZT¥ TO :[NFOF.:H THIS DEF'RF.:THENT [)UF.::[I'.,It3 THE ,= '-F' ~'Ol',lS OF FII'.,I'¢ FIEL. LS RE:,.TRCENT TO TH]:""; PRCF'Ef~:T"r' RN[:.' THE I NSTFILLRI' ION I N::,F E..T NUHBEF.: OF RESIE)ENCES THFIT THE 1.4ELL HILL SEF.'.'¢E. "T' IL413 ,:: ;;.~" ::, Z f-Jl "~.: F" E i; -r ][ L--~ I"-,I ~.; R R E R E I;.,. IJ ][ F~-: E [-:" -- BFICKF'[LLING nF ~i"4Y S¥STEr'I 14;[THOUT FZNFIL ZNSPECTION FINB, F-IF'F'ROVFtL E;'¢ THIS E:,EF'FIF.'.I'HENT 1.4~[LL_ BE 'SUBJ'ECT TO PkU_,[_C.U~];uf.I. ,-, ,,_- . I',lINIi'lUr'l DISTFINCE BETHEEN R HELL FINL'., RN'T' ON-L-qITE SEHFIEi[.." DISPOSFtL :,~_,TEH t.00 FEET FOF.: R F,F.,.I'¢FtTE HELL OF.: :t.50 TO 200 FEET FF.:Cif'I R F'UBLIIZ: HELL [:,EPEN[:,ING FUE, LIL. HELL ~.. . , _ UF'i3N THE T'T'F'E OF ' "' " - I',lIi'.4If,'lI.Ji"l [:,t:~,TFINCE FROf'I FI F'RIVRTE k~ELL 'FEi FI pRI~,,'RTE _E.I. IEF.. L;[NE IS 2~ FEET RNE:, TO R Fi.3HI'flUI'4IT'¢ L=,ENEF.: LINE IS 75 FEET. . - ' ......... ,= CFINSTF.'.I..II:::T 1 ON [:' l RGF.'.I:ard'5 FtF.:E O'FHEF.: F,:Ei2.UIREf'IENTS P1FI¥ FIF'F'L'¢. E, FEL. IFIi...HfII-IN- FIN[) - FI',/FtII_i'TtBLE TO IN:,JF..E F'I;.':i3PEF.: INE;TRLLFITII'IN. F"EI~:F"'~ :E T' E,--,F :][ RE:S; [:,EC:Et--1BEF~: I CEF.:TIF'¢ THFFF - , ~ " - E '- ' "= :t.' I Fli"l FFII"IILIFII~: FILTH THE R[:6!UIREi"IENT=, FOR Ulq-=,IT ::,EHEF. .....81"4[) HELLS I:t:5 SET FOF.:TH E:'¢ THE hlI.Ii'.4ICIF'FILIT'¢ OF HNI_.HUF..HLiE. '-" ':;?m"l IN RCCOF..DHN-.E FILTH THE F:I-E:,ES. 2: I klILL IN:E;TFILL THE _-,~::.F~ '-- ' .:,z--,TEfl I"1~'¢ F.'EF).UIF.:E EI'.,ILFIF.:GEHENT IF' THE ~": I ijNDEi~h2,TRI,~_~R~Z-T-HE--OI'4'-':;ITE ..,EI4EF.. '-'"- --' . "~' ¢ -I ' RESI[)Ei"~/~.;' ') _E:? TO INE:LI_IDE MI_F..E THFIN -- BEE:,F.'.OI3rqS. s '" -' ............................... FIF'F L. I'F./~F'-':'F:IRK-:'EFINE [' E"/ CiE' // /~ ~ /,- [/ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST - ' SLOPE PERCOLATION TEST SITE PLAN 4 5 7 9 11 12 13 14 15 ~,~ 16 17 20 ~o L.%=_ WAS .OUNDWATE" S ~NCO~NTERED? - ~ ,~ Y~S, ~ ~,~T ~ ~~ DEPTH? Reading Gross Date Time PERCOLATION RATE . TEST RUN BETWEEN Net Time Depth to Net Water Drop COMMENTS 72-008 (6/79) SOILS LOG MUNICIPALITY OF ANCHORAGE D[~PAFtl'MENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOH: ............. ~_~ ........... 3 4 7 10 11 12 13 14 1.5 18 19 2o WAS GROLIND WATER ENCOUNTERED? IF YES, AT WHAT DEPTiI? DATE PERFORMED:. SLOPE SITE PLAN PERCOLAI ION 1-EST Net TEST ~UN~ETWEEN . · ' - - --~,5--~ --~ ...... ~ ---- _ ~ h . PERI:OR,a[D BY:___ '~, ~ CERTIFIED BY:_ 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. # 1. GENERAL INFORMATION = Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 1; Block 3; Hampton Hills #1 Property owner Mailing address Lendi'Hg agen(~y Location(siteaddressordirections) 10000 Hampton Drive Anchoraqe, AK Ke~th & T~na Dobson Dayphone C/O Clair Dalton/Dynamic Properties 229-1275 Day phone Mailin. g address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: XX 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 MOAl¢21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/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 effect on the date of this inspection. Name of Firm A[.,"~ .... ~L"--- ". '.-~'~,,--~-¢,";,,~z~;R Phone ,75~7-~'/74 CONS~T~, ~C. Address ~ ~ ~ ~ .... - / .... Engineer's signature ~CHO~O~, ~ ~ Date Alaska Water & Wastewater C~onsultan~t~, In¢, Shall be PAID ~ ~00~- or prior to, closing for the Engineering Services Provided, DHHS ~IGNATURE '~ Approved for ~-OL)~- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~/~~¢~ ~ /~~ Date ~.,~1~11 lei ¢. 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 DH HS 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-O25[Rev. 1,'91) Back MOA~'21 Legal Description: A. WELL DATA  If A, B, or C, attach ADEC letter. ADEC water system number ~'~'~/~ Log present~ ....... Date completed Total depth -'""-~'~'~- Cased to Casing height (above ground) Municipality of Anchorage E C E IV E D DEPARTMENT OF HEALTH & HUMAN SERVICESApR Environmental Services Division 1 2 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · (~Tr)ie~llC/7o4~Anchorage Dept. Health & Human 8e~ices Health Authority Approval Checklist Sanitary seal (Y/N) Date of test Static water level Well production '"~"~*'*'*'~--~, Wires properly protected (Y/N) FROM W E L L LO ~"---~._.~.~E C T I O N g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Z.~/W ~ ~ I~,~SEPTIC/HOLDING TANK DATA '~ed Tank size Number of Compartments. Cleanouts (Y/N)__ Foundation%out (Y/N) __ Depression (Y/N) ___ High water alarm (Y/N) __ Date of Pumping ~, Pumper____ C. ABSORPTION FIELD DAT~ Date installed ~ ~(g.p.d./fF or ft2/bdrm) __ __ System type __ Length ~Width __ G~ess below pipe Total depth __ · ~bses/PF%Y/N, De:ro:SSi°n °ver field (Y/N' Fluid depth in absorption field before test (in.); Immediately a~added (in.): g.p.d. Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* ~.,'?, ~ ~ n't~/Z. Other bacteria Collected by:/~l~2¢,~ (~'r' ¢05¢-¢_j. dCCEr" Absorption rate = If yes, give date bedrooms D. LIFT. ION Date insta% Size in gallons Manhole/Access'~ "Pump on" level at* "Pump off" level at* High water alarm level % _ __ *Datum ___ _ Cycle:teste! ~ - SEPAR. A~I~)N DISTANCES FROM WELL~,~0. T TO: Septic/holding tank on lot 'N, on adjacent lots Absorption field on lot '~On adjacent lots Public sewer main __ Publi~er manhole/cleanout Sewer/septic service line __ Lift ~,~ ____ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO'~ Foundation____ _ Property line ___Absorptioh~_ Water main/service line _ __ Surface water/drainage __ Wells on adjac~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Building foundatio~ ~-- ~.Water main/service line Surface water Ddveway~vehicle storage area Curtain drain Wells on adjacent lots ENGINEER'S CERTIFICATI -- ~ X in conform~ce wlt~ ~A~ ~ect on this date. ?~"~' .~~~" ' t'~'/~Y~' ~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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. # ',~oNICIPALI[',' ©,c AJ,iCH©,~AG2_ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01 5-134L66 \, HAA# Lot 1,~ Block 3; Hampton Hi].ls~''',, 1. GENERALINFORMATION Completelegaldescription Location (site address or directions) 10000 Hampton Hills Drive Anchorage, AK Property owner Ti.ns, Pob~nn Day phone Mailing address C/O Remax Properties Attn: Alan Ward Lending agency Mailin. g address 2600 Cordova St. Anchorage, AZ( 99503 Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 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: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/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 corr ordinances, and requlations in effect on the date ¢ Alaska Water & Wastewat · -, __- ---,~---.~ ~- - //~? 7 Name of Firm Address A~e~ora~,/¢~. ¢~;a ~504 signature EnQineer's AI,ASKA WA?ER & WAS.T.~ATER CONSULTAN?S~ is to be paid $ ~ at closing for all engineering services performed. DHHS SIGNATURE J,,/' Approved for bedrooms. pliance with all Municipal and State codes, his inspection. Phone Date ZNC. Disapproved. Conditional approval for bedrooms, with th-e following stipulations: Additional Comments Jf:lqlJqJ 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 DH HS 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) BaCk MOA it21 MUnicipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICEJ~'.p Environmental Services Division 825L Street, Room 502. Anchorage, Alaska Health Authority Approval Checklist LegaiDescription: LoT I t I~..~ov- ~,~ ~-\~¢~'a~ ~U-L~- ParcelI.D.: 0~5'-t~u~- /"~' A. WELL DATA Well type ~r44,J ~ If A, S, or C, attach ADEC letter. ADEC water system number Log present ~N) 7~-s Date completed ~/2_~/~ 7- Total depth ~'t COI Cased to ~ GSt Casin'g height (above ground) Sanitary seal (~N) "¢¢~, Wires properly protected FROM WELL LOG AT iNSPECTION Date of test */'~/~ ~-~ Static water level ¢_~'_6" ~ ~.G I ~ Well production I g.p.m. I. ~ I g.p.m. WATER SAMPLE RESULTS: Coliform --'(~-' Date of sample: Nitrate c~, ~/Z f)1,/~//__, Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 9/~/¢1 ~, Tank size Foundation cleanout i¢~,o Number of Compartments ,2. Cleanouts Depression (Y/~. /'4o High water alarm (Y~[:) Date of Pumping r.j'¢t,-~ Pumper C. ABSORPTION FIELD DATA Date installed Length Z/~, I Width Effective absorption area Date of adequacy test Soil rating (g.p.d./ft2 or ft2/bdrm) ~2. ~B System type '~¢4e,Jc~ Gravel thickness below pipe. ~.o ¢~ Total depth ,'--' I o. ¢ Monitoring Tube present (:~2N) "/~--~ Depression over field (Yd~) ~z) Results (Pass/Fail) ~ For /-"f bedrooms Fluid depth in absorption field before test (in.); Immediately after ~ gal. water added (in.): Fluid depth ~ (ins) Minutes later: Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/N) ---' If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manh~ "Pump on" level at* High water alarm level at* · ~----~--~ atu"~' E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Joo I_/_ Public sewer main Sewer/septic service line 'Z~' On adjacent lots )oo~ -fl On adjacent lots I oo ~ -f- Public sewer manhole/cleanout f'J/~- Lift station ~/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~& i 4- Property line "7 o ~ +__. Absorption field I Water main/service line lo -P Surface water/drainage Ioo1~ Wells on adjacent lots Io~ If. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line _.~ ~ If Building foundation ,I0 '7 l j::: Water main/service line Surface water I OO ~-~ Driveway, parking/vehicle storage area '~o 14. Curtain drain ~,.~,~J~ ~-~¢ r4 Wells on adjacent lots lo ENGINEER'S CERTIFICATION // '~ '~"~'~ inspections and review of Municipal rec~~ ~ ~s. are in c°nf°rma?¢ ~MT~Z?Z/ide Signature ~~ ~ ~ Enginoor,sName? f~ ~- ~,-~ ~~' Date ~ %~74~? ......... 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONb~iNTAL HEALTEI DEPAR%~DSNT OF . ~HEALTH AND ENVIRON~EENTAL PROTECTIOM APPLICATION FOR IR1ALTH AUTHORITY APPROVAL CERTIFICA%~ 1 General Information Applica~.ion Date ~ (a) Legal Description (include lot, block, subdivision, sect'[on~ township, range) Location (addre~,~s or directions) : Applicants Name ~ ,~h/~t~'V'~d:)c~l~ Telephone - Home Business (e) Applicant is (check one) Lending Institution (d) Lending .[nstitutionZ:z_~.¥/ Address (e) Real Estate Co~ & Agent _._ Address 0 Telephone ~pe of Residence Single-Family ~ Individm,.l Well Note: If community well system~ must have ~itten co~irmation from the State Departmen~ of Environmental Conse~ation attesting to the legality a~ status~ 40 Sewage ~ ~t" Onsite ~Public ~'~ Comm,mlty ~ Holding Tank ~] ~ote: If community well system~ must have written confirmation from the Stat~ ~epartment of Environmental Conservation attesting to the legality and status. [Page 1 of 2] ~n~gineerin~g. Fir. va Provi~ins ~I.~_s_R~c__t~ons, Te~s_t_§_~. File Searq~l~_~ta and I~fo~ation As certified bY my seal affixed hereto and as of the validation date sho~ below, Z verify that my inves~isa~ion of this He~th Authority Approval shows that the ou-si~e water supply and/or ~ms~ewater disposal system is safe~ f~cCion~ and ~equate for the number of bedrooms and type of s~rucHure indica~c~ herein~. I further verify ~ha~ based on Hhe lnforma~ion obtafn~ from Hhe ~nicipall~y of ~choraEe files a~ from my l~vestigaHion ~d inspection, the on~siHe water supply and/or %mstewater disposal system is tn compliance ~lth all Municipal and SHare codes~ ordinances~ a~ reEula~ ttons in effect on the date of Hhis inspection. ~elephone Approved ,~ Disapproved '~"., .... '--~ndi~ion~ ~ f Terms of Co~itional Approval CA~ION THE MUNICIPALITY OF A-NCHORAGE DEPAR~[MENT OF HEA~TtI AND ENVIRONMENTAL PROTECTION (DtLEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT FROFESSIONAL ENGINEER REGISTEPJ~ iN 'I5tE STATE OF ALASKA. %%IE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND %U/EIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- ME1QZfSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. %~LE. MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ~/{RORS OR OMISSIONS IN %qtE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/DI8 [Page 2 of 2] 7 ~19~84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAAi CHECKLIsT - FEBRUARY 1984 · Legal Description: ~,Q'~- / Well Classification P~[~///~-~ If A, B, c= C, D.E.C. Approved(Y/N) ~ .-~ .. Well ~ ~esent ~N) . ~ Total ~p~ HO0 G- ~d_to .. ; ~ L ~pth of G~outing Static ~ter ~1 ~~- - ~ ~.t At ~~ Casing ~ight ~ G=~nd ~, ~- Sanit~y ~al on Casing ~) Elee~ieal Wi~ing in ~n~it ~'~ ~esslon ~ound ~l]head (~' ~p~ation Distan~s ~ ~11: To ~ptic~olding Ta~ ~ ~t ~/~/ ~ ; ~ ~joining Lots To ~a~st Edge of Abso~tion Field on ~ ~/O~/~j'~ Adjoining ~ts To Newest ~blie ~ Line ~ To ~a~est Public Clean~t~a~ole ~ To ~est ~ ~vi~ Li~ on ~t~ ,~' Wate~ S~le Collected By 3~~ ~; ~te ~/~/~ Wate~ S~le Test ~sults 3~/s'/~c:~)~.~ ~'- Co~¥ent~ - i SE~IC~O~ING T~ ~TA ~te Installed ¢~~ Si~ . ,.~ NO. of C~nts Stan~ims~) Air-tight CaD ) Foundation Cleanou~) i P~ing~intenan~ ~n~a~ on Fi], (Y~),~ ; fo~ . Holding Ta~ Hign-Wate~ ala~ (Y~) ~ ~~ Holdi~3 Tank ~rmit (Y~) Sep~ation Dis tan~s ~ ~ptic~oldin~ Ta~: To Water-Supply ~11 ~/~ /~ To ~ilding Foundat~cn ~'/~d f~Z-' -' TO ~o~'ty Li~ .~ ~'~--~ ' TO Dis~sal Field _~, /~ / ~- TO ~ter ~i~=vi~ Li~ +~ ~To S~e~, ~nd, ~e, ~ Major ~aina~ co~ _~1 ~ ' ~ Date Paid: Amount: [Pa~e 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorptio~ Strata Date .Installed Width of Field ~ "~ --~/' Square Feet of Absorption A~ea Depression over Field (Y~) Results of Last AdequaCy Test ~ t .... Type of System Design Length of Field Depth of Field ~'~ Gravel Bed Thickness ~/ ~' ~ ' Star~dpipes Present ~N) Date of Last AdequaCy Test Separation Distance from Absorption Field: To Water-Supply Well 4 /~ ~ ~'~'~-' ~ To Property Line ~)/ To Building Foundation ~_/~/vf ~ To Existing or' Abandoned System cn Lot ~J ; On Adjoining Lots ~u~yfD To Water Main/Service Line -/~/~)f5~ W~ To Cutback(if present) To Stream/Pond/Lake/or Majo~ Drainage Course 7~/d~b ' To Driveway, Pa~king Area, or Vehicle Storage Area ~-~ LIFT STATION Date Installed ~Off" Level at Size in Gallons IIP~J~TU.~ onl' Level at Electrical Codes (Y/N.~ Con~nents Vent (Y/N) al!ring AdequaCy Test. Meets MOA ** Check Permitted Bedrccm Rating Against HAA Request **: I certify that I have. checked, verified, or conformed to all MOA HAA Gu on tke date Signed Company KB1/dS/s [Page 2 of 2] effect 2-15-84 ALASKA E iiUIROFlm IqTAL COIqTROL SeRuIC $, IF1C. ~nqinm'inc1 6 [~n~ironm¢.lal $~udics 3/6/85 PATRICK SHARROCK SPA BOX 2236 ANCHORAGE ~( 99516 SELLER - SAAME BUYER - SUBDIVISION - HAMPTON HILLS ADEQUACY TEST FOR SEWER SYSTEM BLOCK - 3 ? LOT - 1 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 296 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 12/1/84 . A FLOW TEST WAS PREFORMED ON THE WELL. 476 GALLONS OF WATER WAS PUMPED AT A PATE OF 1.9 GPM OVER A DURATION OF 4 HOURS. THE DPAWDOWN WAS 43' WITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL WAS 257 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOb~. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 U,Jcst 33rd Auenuc. Suilt J~ o Anchoraqe. AJosb 99503 .(907) 561-50z~0 APPLIC' "IT FILLS OUT UPPER HAL~' )NLY . Phone Address Zip Code Lending Institution /'~/z~,~? ~ ,/~,,:) :"' ~ Address Zip Code Realty Co. & Agent ~,,~//./:~ Phone -- Address Zip Code Street t.ocation Type of Residence __ ~"~'ing e Family ~, [] Multiple Famiry No. of Bedrooms ,,,.~ E} Other Water Supply _ ,,.~]*ff~dividual ATTACH WELL LOG. A well Icg is required for all wells drilled sillce June 1975. ~ Community [] Public Utility For wells drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal ,,.,.[~lndividua Year Individual Installed: [] Public Utility When Connected to Public Ulili{y: ~ Holding Tank NOTE: THE INSPECTION EEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Date Date Inspector Inspector Field Notes: APPROVED BEDROOMS Inspectol/') h -"/_LC-' --.' RECEIVi D ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: ~ 'CONDITIONS OF APPROVAL Soils Ratieg Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received · i, . Septic Tank Size * ...," MUNICIPALITY OF ANCHORAGE MEMORANDUM Date 19_ 91-015 (Rev, 1/81)