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Home My WebLink AboutHAMPTON HILLS #1 BLK 3 LT 2Hampton Hill Block 3 Lot #015-134-67 �TAUV VV/VL/ 10) Municipality of Anchorage On -Site Water and Wastewater Section ^ (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number- OSP211255 PID Number: 015-134-67 — — Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑® New ❑ Upgrade Name Alexandra Caldelas ABSORPTION FIELD El Deep Trench El Wide Trench El Bed E] Mound Ad Address ddress 1te Hampton Circle ❑ Other Phone JNupmber of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF!,Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Hampton Hills Not 3 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 129.3 N/A NA NA 25'+ TANK pp Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER / Poly Capacity 1000 Gal. Surface Water 100'+ N/A NA NA Material Number of compartments Lot Line 10'+ N/A NA NA NA HDPE 2 Foundation 11.1 N/A NA NA LIFT STATION Manufacturer Capacity Remarks Tank Only Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 Tank to3034 drainfield BTH Construction Drainfield 3034 CO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 ft Inspection ist 9/7/21 Location and description 2 na 3d 4th Bottom of Siding / Nearest Corner of House ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date OF A/qs�� Steven R. Fanrome Septic System Approve 6. Date `r'O�ESS10yP - ' Note: this approval does not include well permit requirements. �TAUV VV/VL/ 10) -1 K m _1 O C7 ^ ^ -� <-iUn�00- = D� \ \ —{ z cn z0 -0 �7 0 Irl CC)�M s? mm mD \ \ co BOO O \ a \ C-) \ O m Omx mm F"m -i I mX �. fiy�zmzF o D >.m�moaOzp_I = N .0 C D \ \ m r - cEiz— m Z I N D O � D r°JnA0z0 U) rr* I N N W m D O D OC Z �� * r- -Di Cn O O m (Aa � N W L4 c0 N CDn Lo _0 m FTI 7 yDo z N N _� n m �♦ n c m [o 10 SST n 00 N" �9 c/) DOUBLE CLEAN OUT IER CLEAN OUT DOUBLE CLEAN OUT \ I I \ � I \ ' c(oo , \ r \ X \ W D D rri \ Ox \ CO ;0 — o O m O �O O �. OZ—� O 0 m N m C: �� om�rn Co zcorm \ \ U)r9 . C-9 ;0 • -007 O s? mm Ln 9 \ \ MoD Z \ a \ �D�' \ O m ! \ �. N B D \ \ P D0 �O rr* I Z D \ 7 � z fC) m >\ LTJ \ 7 D �♦ �o [o 10 SST n 00 �9 D 0 O Om \ P Lp9 Ctr \ zcorm \ \ U)r9 . C-9 ;0 • -007 O s? mm r- )S �. MoD Z \ a \ �D�' N B �-'' co - \ — 8001 y O_ m �z m oP_ �-= O \ \—0u) NOTES: PANNONE ENG SVC LLC (C.I. 1088) _�\\\\� REVISIONS DATE RECORD DRAWING PHONE P.O. B) 1807 PALMER, XAKFAX 99645 � �OFk.4\'tk+ 12/22/2021 P9�r SCALE HAMPTON HILLS #1 BLOCK 3 LOT 2 j * I P.I.D. NO 50' DRAWN LJC/DRM ALEXANDRA CALDELAS 'Steven'Ff. onnone j 015-134-67 SITE: 10080 HAMPTON CIRCLE rj g. CE alae , PERMIT SITE PLAN ANCHORAGE, AK 99507 t,�t��;�' SHEET 2OF2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211255 Work Type: SepticTank Upgrade Tax Code Number: 01513467000 Site Legal Address: HAMPTON HILLS #1 BLK 3 LT 2 G:2540 Site Mailing Address: 10080 HAMPTON CIR, Anchorage Owner: CALDELAS FEDERICO & LIOUBOV Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date t r1 r v DeI)artinell t Lot Size in Sq Ft Total Bedrooms: 7/7/2021 7/7/2022 77044 ❑ Disposal Field R Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 3 1AUNICIPALITY OF ANCHORAGE Community Development Department % Phone. 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-134-67 Property owner(s) Alexandra Caldelas Mailing address Site address 10080 Hampton Drive Legal description (Sub'd., Block.& Lot) Hamp, Legal description (Township, Range & Section) Day phone n Hills #1 Block 3 Lot 2 Lot Size 77,044 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) x❑ Septic Tank 0 Upgrade Q (w/wo ADU) (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: -#2-2-1;— Waiver Fees: Date of Payment: 7�/A I Date of Payment: Receipt Number: 016fCG (r Receipt Number: Permit No. 05/OZ.1 12-5 5 Waiver No. Permit App__- : ,_.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211255, Deb Wockenfuss, 07/07/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211255, Deb Wockenfuss, 07/07/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211255, Deb Wockenfuss, 07/07/21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \� 825 I_ Street - Anchorage, Alaska 99501 Telephone 264-4720 --� ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT --- - -- -- - - - -- -- - -- ---- -- --- --- V__�__ W� NAME ---- ----- D & B General, inc./Otis D. Carter PI�mN6965 �TNEW 3`� L] UPGRADE MAILING A1YMEhbX 10--1349, ANCHORAGE, ALASKA 99511 LEGAL DESCRIPTION Lt.2 Blk. 3 Hampton Hills Subdivision LOCATION NO. OF BEDROOMS 11MIFTON DRIVE 3 U Y 1-2 ___e_ Well Absorption area Dwelling DISTANCE TO: 126�j - . ] 0 , [Manufacturer Material PERMIT NO. - 110-92 No. of compartments W a GREER TANK STI. 2 _ co _ Liq. rapacity in gallons IF HOMEMADE Inside length Width Liquid depth m DISTANCE Well Dwelling PERMIT NO. -aU� — -- _---------- -- Manufacturer Material - Liquid capacity in gallons — -- — Wei! foundation DISTANCE TO: I , � 10 PERMIT NO 811092-- O -t X W Nearest lot line , nj -a u. U. Distance between lines — Total of lines - Length of each line � — - I otal length of lines -- — --- -- Trench width I nc . _Ihes Top of tile to finish QAaterial beeath the 90 I_ grade 4 , n effective also 0i n area V inches y 1 s . t Length Width Depth PERMIT NO. W C7 Q f- n. _ Type of crib Crib diameter Crib depth Total effective absorption area � Nearest lot line DISTANCE TO: Well Building foundation e __1 w $ Class _ DISTANCE TO: Depth Building foundation Driller Sewer I.ne Distance to lot line Septic tank PERMIT NO. Absorption areas) OTHER PIPE MATERIALPVC/CAS`.0 — SOIL TEST RATING 170 sq. ft./bdrm. INSTALLER ------- -- — - D & B GENERAL, INC. �- REMARKS _ � '✓ O. AN CJF Al � IV 7W, . . . 1 .... . ..�. a.�{I/{/.�/. D t°. No. 2100 V.- -f^"tia�--AIA K0 - ILRZ. OCT. 24, 1970 --- �Kos-- — — APPROVED DATE LEGAL 61/7' icy/3C/ar ?gLs 72-013 (Rev. 3/78) ��AW I��L��-� 13 1H. 11 too M Q 0_6 1 -1 10 fit NO V11 DEPHRTMENT HEHLill HND ENVIRONMENTPA. JOTIN TIMI! O25 'L STREET, HNCHORHGE, HK. I. 61 264�4720 �4 E.E I., h N 13, Q 0 1 --- YN 1: _y_ NEE AN K I -A THE W? F" Q N 11 X -r PERMIT NO ( 811092 ) HPPLICHNT OTIS U NOR TON! ]]15 FHlRBIll NKS ST 274-56]6 LOCHTIOM LEGHL L2 B] HHMPTON HILLS LOT SIZE 77008 SQUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS1RENCH MHXINUM NUMBER OF SOIL RHTING (SQ FT/BR)- 170 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� �� :.JL K NJ oil M 1-1 — W 02': �F -.1 1-�.Il [!�.11..E L �� !Qf THE LENGTH DIMENSION IS THE LENGTH (IN FEET) QF THE TRENCH OR DRHINFIELD. THE DEPTH QF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFRCE OF THE GROUND AND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETNEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTI1.11,%! (IN FEET) �Rhin �1-1 1 111-CmI: IEE' �J[_ rc*�-.- -Y lot 044 K ��F.,_: :11_ 19�) !12'J, �IfFl."11 11�� PERMIT HPPLICHNT HRS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTRLLHTION INSPECTIONS OF FINN WELLS HDJHCENT TO THl� PROPERTY HND THE NUMBER UF RESIDENCES THAT THE WELL WILL SERVE. ~�~ �NAB cy 1 IN n5v lo'lII IEEE If - :1 r. -A �� 1114l?', IL 1 .1�� 8HCKFIL1_ING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL. BE SUBJECT TO PROSECUTION MlNIMUM DISTHNCE BETW10N H WELL HND PONY ONWBITE SEWHGE SYSTEM �S 1G0 FEET FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPOH THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVHTE WELL TO A PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET. HE..[ L LOGS PARE: REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN 20 DWS: OF THE NELL COMPLETION. OTHER REQUIREMENTS MAY HPPM SPECIFICHTIONS HND CONSTRUCTIOM DIHGRHMS FIRE: HVHILHBLE TO INSURE PRQPER INSTHLLHTIOPA. 1W M too 141 1: "Y Q 1-0 K 1 ll ��[E."HE 11�;;`:! �1_, �1!E-]t� JL I CERTIFY THHT 1 I HM FHMILIHR WITH THE REQUIREMENTS FOR ONNSITE SEWERS HND WELLS H!_-: SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE. 2 I WlLL INSTHLL THE IN HCITORDRNCE WITH THE CODES, ]� I UNDERSTHND THHT THE ON�SITE SENER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ] BEDROOM Ph" PLICHNT KEN'S COMPANY WATER WELL DRILLING PUMP SALES & SERVICE (907) 243-7893 3163 LINDEN DRIVE KEN JOHNSON ANCHORAGE, ALASKA 99502 October 30, 1981 Otis D. Carter• 3315 Fairbanks St. Anchorage, Alaska 99503 333--0378 H 271+5636 w RE: Lot 2 Blk. 3 Hampton Hills Subd. 0 ft. -to 2 ft. 2 ft. to 6 ft. 6 f -t. to 19 ft. 19 ft. to 35 ft. 35 ft. to 60 ft. 6o ft. 'to 77 ft. 77 ft. to 85 ft. 85 ft, to 135 f -t. 1-35 f to 153 ft 153 ft to 159 ft 159 ft to 175 ft 175 ft to 182 ft 1.82 ft to 190 ft 1.90 ft to 197 ft. 197 ft to 204. ft 204 ft to 205 ft 205 ft to 233 ft WATER WELL LOG Fill Brown silt Gravel & brown silt Gravel & sand with fray silt Same but 'tighter ..0" drives Same with courser gravel. Sand & brown silt .. some Med. grav mixed Gravel & sand with gray silt Hardpan.. course gravel & gray silt ( tight ) Nied. sand with some fine grav ( loose ) Wet sand ( dirty ) weeps... Brown silt ..trace of gray.. open 4 ft. Med. gravel & brown silt Course gravel & light brown silt ( compact Same but weeps water.. Low head ( 193' ) 11. ft of water at 204 but bails down .. car. perforate.. Gravel & brown silt ( dry ) Bedrock ( dry ) Perforated casing 198' to 204 ' Sample per.f. on top of casing Surged and bailed approx 6 gals. material thru perforations Static water level 188 ft. Test bailed at 5 GPM + Drawdown 6 ft. to 194 ft. .. good recovery Total depth 233 ft. Set pump at 210 ft to 215 ft. DOWL Engineers 4040 "B" Street Anchorage, AK 99503 Attn: Mr. Al Lahnum Subject: Hampton Hills, Soils Gentlemen: 0 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PRONE: 907-279-2581 June 11, 1975 W.O. 8059 In response to your request we have placed test holes at the requested locations on the several lots. The purpose of the study was to predict the soil characteristics relative to on-site sewage disposal in accordance with current Greater Anchorage Area Borough Department of Environmental Quality guidelines. The data is summarized on Table A (attachment 1) in terms of soil textural classifications, Unified classification, estimated portions of soil less than #200 screen size, and in some instances the rate acceptance of water. The per- colation rate as described is for a filled hole with a 3/4" plastic supply pipe. The "percolation zone" is that depth interval as determined from the samples to be most permeable. In several instances the free water level in the low portion of the specific lot was encountered at depths of less than 5°, as expected from the terrain. Ir. those cases, new holes were placed in ares reasonable to the development .in higher ground (see Ilol.es 4A, 4A -X and 5A, 5A -x) . The topography in the site area is broken and often includes substantial grade changes within the lot bounds. Thus, more than average opportunity exists to provide fall for the individual sewerage systems. The seepage area requirements per. the Greater Anchorage Area Borough correlation of Unified cl.assifi.cation and seepage rates are as follows: Unified Class Seepage Area Required in Square foot/Bedroom /VI J GW --GP 85 GM 225 SW 125 SP 150 SM "2.50 � Mr,* 275 . CL --Cr}* 350 j ce j \9540 DOWL Engineers, A - Al Lahnum June 11, 1975, page two, cont. * Rates in excess of 250 square feet/bedroom are not allowed. soils of the * classes may be utilized if satisfactory percolation rates develop. In this case soils in the GM and sM classifications were examined by gradation and falling head percolation as described in Table A. The free water levels,where encountered, were generally believed to be a result of: the spring thaw and not indi- cative of steady state seepage except in the low bowl areas described by test holes O and 5A. The exploration was accomplished with a track mounted B-50 drill fitted with solid and hollow -stem auger. The drill was provided by Denali Drilling, Inc. The exploration was supervised and logged by O.M. Hatch, senior technician of our staff. The work was accomplished at the tail end of the spring snow thaw and should reflect the worst conditions for shallow ground water. We trust the foregoing is sufficient and complete to your immediate needs, though not necessarily exhaustive of the possibilities. Very truly yours, AXILAL SKA TESTLAB Barry R. Lee, P.E. Laboratory Manager IIRL:pf 04. 6 `� Al b44 r COo q0 a� Y.YY°If IPOs ee .e een e. oe.�� M L Melvin R. Nichols ss °e No. 4113•h n 1 i v •S C ^ 1� v ` _ v < p ^I n ,�_ . - ``� 4� V Cry '' �'l � �n' �n � cr `f � � � • . � - � � S. �} � � � `� � ` 1 .._, ,v '^ �� ', 1 ��,� �� \ �i `\ l� 1 � ) � �., irk v \; �� O � •:, R � _ 'n 4 � �i USC 1: "1 II L �i- V I _ G I T USC II L O G I T USC II G I t.f> -S � I � � T U� � --ice �•1 -}- �> t ( � USC I i I 1 t t l I t t -t II t.f> � T U� � --ice �•1 -}- �> t ( � I i I 1 t t l I t t -t - - - - - - - - - - LA h I� I 1/0 I� IT SHALL . rHE RESPONSIBILITY OF THE OWNER OR BUILDER TO PROVICC EASEMENT DEscRIPTIONS, COVENANTS AND RESTRIC- TIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT AND TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISH GRADE AND UTILITY CONNECTIONS. / / / / ORTAAV, 46E WELL �� ic.4 sEn� 'V7 - as zre7N .vTasse7N y<' n r s r /-iJT/C. /TY _ gfg-iGYJSE �l n /6 EASF.M'%� ARAIt1F1E S �5 � sePTlc S/DEYfFF�p . Q4F .4 MAURIC£ P. CISWALD 613•S -d ,r- or tam �` w •t°Ow' o p�oFsS�os��"� LOT SURVEY CERTIFICATION Lot � , Block Area Sq. Ft. Plot File No. fv=fs Zoning District= Anchorage Recording District, Alaska SFD z5z1-'=v ,3,5A,777 /CG, 09X0 11-1141AI 290,.0 61�01q'519'FG. 25,910 LEGEND: ®Brass cap Monument O Iron Pipe • Steel Pin U Survey Hub a Tack l�I� KII111�)Uj''UWALU• WhL(..H' l_t—t--I Residence of:4040 0 STREET ANCHORAGE.,. ALASKA Dole: /0/7Z _ - = �r ' wo. At FD �IF - — Gr/d:-- MUNICIPALITY OF ANCHORAGE o Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-134-67 1. GENERAL INFORMATION Expiration Date: f f- t / - z- 2 Complete legal description HAMPTON HILLS #1 BLOCK 3 LOT 2 Location (site address) 10080 HAMPTON HILLS CIRCLE, ANCHORAGE AK 99516 Current property owner(s) FEDERICO & LIOUBOV CALDELAS Day phone Mailing address Real estate agent 10080 HAMPTON HILLS CIRCLE, ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ _ Date of Payment 7 /25b02 2 Date of Payment Receipt Number l 5 �`� `� Receipt Number COSA# 05Ca21375 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/22/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluatorof the i well and septic system. Therefore, any estimate of how long a system will function satisfactory low •' • . for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting &FWCS *' 7H •'* / . .. ......... 6. DSD SIGNATURE % " . ur " Curtis Huffman System #1 Approved for bedrooms �t1��Fc� . CE 128991 ��i sTF�•.,7/2?/2z.•�� System #2 Approved for bedrooms�\ ESSO� Disapproved Conditional approval for bedrooms, with the following stipulations: BY: Original Certificate Date: ��12z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: HAMPTON HILLS #1 BLOCK 3 LOT 2 Parcel ID: 015-134-67 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled 10/31/81 Water storage tank volume NA gallons Total depth 233 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 204 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 4.81 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 24+ in. FSS Date of flow test for COSA 7/21/22 Collected by Static water level at beginning of test 193 ft. Date of Sample 7/21/22 Comments SGS PIWA WATER SAMPLE TAKEN. Absorption rate 450 gpd B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping 7/21/22 D. ABSORPTION FIELD DATA C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: PES PERMIT NEW TANK — SEE MOA IR Which system tested (date installed) 10/30/1981 Adequacy test date 7/21/22 ® ALL standpipes present per record drawing Results M Pass For 3 bedrooms Total measured depth from grade 7_6 ft (max) Fluid depth prior to test 2 in Measured depth to pipe invert from grade *5.7 ft (min) Water added 800 gal ❑ N/A — pressurized field New depth 9 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective MOA IR OF WED. 1.9'ED MEASURED Elapsed time 60 min ®Code -required soil cover over field Final fluid -depth- -2-in - - - - - -- ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: *SUMP/PERF MEASURED AT GRADE. RECOMMEND PUMPING OUT SUMP SLUDGE / HEAVY WATER.... FLUID LEVEL ROSE IMMEDIATELY IN SUMP AND REBOUNDED IN AN HOUR ALL SEPTIC PIPES APPEAR TO BE SEEN PER NOTED ABOVE, PER RECORD DRAWING & INSPECTION/TEST WES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *4 Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes _ if No ft ®Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *4 ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER DATED 4/21/2015. G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review �} of Municipal records that the above systems are in conformance �'' •;p' with MOA COSA guidelines in effect on this date. % : • �� ..•. ... .......... .. Curtis Huffman r✓ ��j�Fc, ,• CE 128991 •••�c��'� `} `�1�c�,' • x/26/22 . • ' A �O��pROFESSI4�P .� LOT 20A-2 Legend 20' DRAINAGE ESMT. N85°30'00 -W 403.61 W / Lot 2 Block 3 Hampton Hills Subdivision Unit No. 1 77,044 Sq. Ft. 10080 Hampton Circle 3 Story Wood Frame House / / , �� HE. 37.3 With Attached 2 Car Garage / / / / 7o, . -A as A_ / G Eso1 C0 I 20, pRpINP A / m .^ 343 0 >0' UTIL. ESMT. _ — k MULTI FLOOR / I, Electric Meter/Outside Power LTA Tel. Pedestal CO-) Telephone Pole Gas Meter ® Deck Septic Concrete Water Well rm-t Mailbox �s Fence — — DECK 00'00'E 374.48 _ M — — — — LOT — — T General Notes 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Dimensions to property lines are plus/minus 0.1ft. 2. This document is created by Frontier Surveys for the purpose of an as -built survey for Alexandra Caldelas, only. 3. This document is based on Plat No. 76-141, Anchorage Recording District. OF 4 Ill Disclaimer �qs'!,,/ 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary r 4 Cil H survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the ... •9 j ..... .. .. ...... . responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for i / construction...............t nstruclion or for establishing a boundary or fence line. / ' • ' ' • • : ' • • � ', Pier M.St gier � r // C N . LS -9 12 �= 0 15 30 60 /� �,r� 9/29/2021 r Scale in Feet jlrl�IOAROPESS10NPl M 20.7 AN AS -BUILT SURVEY OF LOT 2, BLOCK 3 HAMPTON HILLS SUBDIVISION UNIT NO.1 10080 HAMPTON CIRCLE CONTAINING: 77,034 Sq. Fl. ♦/-(RECORD) RECORD PLAT: 76-141 PREPARED BY: FRONTIER SURVEYS, LLC 650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518 907-460-1686 DRAWN BY: KC DATE: 9/29/2023 -DRAWING ID: 21.677 Parcel I.D. 015-134-67 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1 Y S� 4: 4AIFY% Expiration Date: 7' ,?' 1 J I 1. GENERAL INFORMATION Hampton Hills #1, Block 3, Lot 2 Complete legal description Location (Site address) 10080 Hampton Circle Anchorage, AK 99516 Current Property owner(s) Gunnar & Erika Kyllingstad Day phone Mailing address 10080 Hampton Circle Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADu) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariancerequest for: ----------- Date: Received by: Z( Date: `l - Z f- f S COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9' !-22(P Date of Payment 4a3 t� Receipt Number OM36 COSA# 05ajTd _ Waiver Fee $ W aiycj Date of Payment Receipt Number Waiver # Oaf/-G/02_j 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and. regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 522-7773 OF A4 to `( v 40TH 6. DSD SIGNATURE f "" A MICHA`['. "p,y�$'tp O:R50N System #1 Approved for bedrooms r6 ; GE -43£31 e �„ System #2 Approved for _bedrooms � ��, .•°• � ••` `vow Disapproved TA9® Conditional approval for bedrooms, with the following stipulations: By: ;; Original Certificate Date: � l -r2 ° The uni pa y o Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the Slate of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. . 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheel_f '- L, c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Hampton Hills #1, Block 3, Lot 2 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/30/81 Sanitary seal (YIN) Y Total depth 233 ft. Cased to >40 ft Date of test Static water level Well production FROM WELL LOG 10/30/81 WATER SAMPLE RESULTS: K. 5 Parcel ID: 015-134-67 Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) >12 in. AT INSPECTION 7/5/14 ft. 193 ft. g.p.m. 4.66 g.p.m. Coliform 0 colonies/100 mL Nitrate 5.23 mg/L Arsenic ND ug/L Date of sample: 3/27/15 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1;000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Date of pumping 4/13/15 C. ABSORPTION FIELD DATA Collected by: Anderson Engrg. Date installed 10/30/1981 Cleanouts(Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N _ Pumper Around the Clock Pumping 10/30/81 z z ft/b170 SF/BDRM Deep Trench Date installed _r Soil rating (g.p.d./ft or drm) System type Length 39 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area 624 ft2 Monitoring tube Y Depression over field N Data of adequacy test 7/5/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 64 in. Water added 450 gal. New depth 69 in. Elapsed Time: 1,440'min. Final fluid depth 64 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type.) N If yes, give date D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench. Date installed Size in gallons Manhole/Access (Y/N) _ "Pump on° level at in. "Pump off' level at in. High water alarm level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tankllift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer /septic service line >25' Animal containment areas >50' Meets alarm & circuit requirements? On adjacent lots >100, On adjacent lots >100, Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: '*** Building foundation 4Property line >10' Water main >10' Water service line >10, Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage F. COMMENTS ***See COSA issued 8/10/92 and Waiver dated 4/21/2015. G. ENGINEER'S.CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P. E. Date 4/20/2015 COSA brown sheet 10-10-12.doc in. MEL E. ANDERSON : ,,Qy i .•�4381 .' A 2�r.��1•F�Ve ? /'ROFESSiO�p��` Municipality of Anchorage Development Services Division Onsite Water and Wastewater Program menr S, �� P 2 G J � eartment **** VARIANCE/WAIVER REVIEW **** Waiver#: osn151024 COSA#: osc151135 Permit#: PID#:016434-67 Legal Description: Hampton Hills #1 B3 L-2 Engineer: Anderson Engineering Applicant: Gunner & Erika Kyliingstad Your request for a waiver of the required S feet horizontal separation from the septic -tank to foundation has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from t this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected.by this waiver, Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer P **** VARIANCE/WAIVER REVIEW **** Waiver#: osn151024 COSA#: osc151135 Permit#: PID#:016434-67 Legal Description: Hampton Hills #1 B3 L-2 Engineer: Anderson Engineering Applicant: Gunner & Erika Kyliingstad Your request for a waiver of the required S feet horizontal separation from the septic -tank to foundation has been approved. The approved separation distance is 4.0 feet. This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from t this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected.by this waiver, Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151135 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot 2 of Hampton Hills #1 subdivision. This inspection revealed a nitrate concentration of 5.23 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. Thio arlyicny� ?t?ust be attached to all enrniec of the subject Certificate of On - Site Systems Approval. April 21, 2015 Municipality of Anchorage Development Services Department Building Safety Division 4700 Bragaw Street Anchorage, AK 99507 Attention: Plan Review Engineer On -Site Water and Wastewater Subject: Lot 2, Block 3, Hampton Hills Subdivision No. 1 Foundation to Septic Tank Waiver Dear On Site Engineer: The septic tank on Lot 2, Block 3, Hampton Hills Subdivision No. 1 was placed in October of 1981 at 4' from the foundation of the house on the lot. Since that time two Certifications of On Site System Approval (COSA) have been issued allowing the tank to remain in this location which is less than 5' as required by current Municipal Code. No settlement of the tank has been noted and no depression was noted over the tank on a recent inspection. The attached drawing illustrates the septic tank and it location in relation to the house foundation. The influence line of the footing and foundation when projected down at a 1:1 slope does not encroach into the septic tank. It is unlikely that the location of the tank will have any influence on the foundation in the event a failure occurs. We hereby request a waiver be issued allowing the septic tank to be 4' from the edge of the foundation. Sincerely, Michael E. Anderson, P.E. Attachments • .ku •'LY a MICHAEL E. ANDERSON r^ . 0. CE -4381 ��o HAMPTON HILLS SUBDIVISION NO. 1 100.0 BLOCK 3, LOT 2 ml 100.0 Wo OA4J ".* I.. .7 o \ A. MICHAEL E. ANDERSON CE -4381 ;\2� IL FOUNDATION TO SEPTIC TANK WAIVER SCALE 1" = 3' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Scu!h Brog3w St. P.O, Box 196650 Anchorage, AK 99519-6650 vcxw. ci,anchorage.ak.us (907) 343-790a CERT{FICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FANllLY DWELLING ParceII.D. DIS- GENERAL INFORMATION Complete legal description 3~ Location (site addre~;s cr directions) Current Property owner(s) "~ ~t.~ Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Day phcne..._~q - Unlesso~e~e~queste~ HAAw~behe~byDSD~rp~k~. 2. NU~BEROFBEDROOMS: .~ 3. TYPE OF WATER SUPPLY: · Individual Well ~ Individual Water Storage [-I Community Class ~ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certific3tes of Health Authority Approval (HAA) based only, upon the representations given in paragraph 4 by cn independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approve! are required [or the transfer of title (except between spouses) for properties served by a single-family on.sim waste,.va.'ar disposal and/or w~ter supply system. DSD also issues HAAs upon request to homeownem. Certificates cf Nealth Authority Approwl are valid for 90 days from the date of issue for properties served by a private er Class C well and may be reissued with new water sample results. (Certificates may be reissued for 3 pedo'~ bf up to one year with valid water samples.) Certiticates are valid for one year for properties served by Class A or B we!Is or a public water system. The Municipality of Anchorage is not responsible far errors cr omissions in the professional engineer's work. 4. STATEMENT OFINSPEC~ONBYENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authonty Approval Guidelines for this app~ication~ shows that the on- site water supply and/or wastewater disposal system is(are} safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further redly that based on the information obtained fram the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(ara) in compliance with ail applicable Municipal and State codes, crdinances. and regulations in effect st the time of installatlon. DSD SIGNATURE V'/' Approved for ~)-'" bedrooms. Disapproved. Conditional apl:reval for bedrcoms, with tge following ~tipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ~: WATERAND : m-.. .~ ; WA~I'EWATER; : ~ '. PROGRAM ..-' ~ Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safet~ Division On-Site Water & Wastew~er Program 4700 Soulb 8mgaw St. P.O. Box 196~50 Anchorage, AK 99519-6650 www.ci.anchorage.ek, us (907) 343.7g04 Legal O.~p~on: t'IR~FT0~! A. WELL DATA wan type ,~ Dele completed 'o!$, 1'6, Total depm g'~ ft. HEALTH AUTHORITY APPROVAL CHECKLIST ff A, B, or C provide PVV~ID # ._~ Santta~/seal (Y/N) Cased ~ FROM WELL LOG g.p.m. Nitrate ~ mg./I. Date of sample: q._~./= ~ Date of test Statlo water level wall pnxlucflon 5,~ WATER ~,MPLE RESULTS: Collform O colonies/l{30 mL Amenic: 7mg./I. Well Log (Y/N) Wires pmpedy protected (Y/N). Casing height (atx3ve ground) AT INSPECTION Other bacteda ~10 coinnies/100 mi. Collected b/: L. 8. 8EI:rnG/NOLDING TANK DATA Tank size ~000 gal. Founclatlon cleanout (Y/N) ~ Date of pumping Ctlt..e],"~.. C. ABSORPTION FIELD DATA Numl~er of Compartments ~, Cleanoute (Y/N) 7 Depression over tank (Y/N) A~ High water alarm (Y/N) ~ Date installed 1015,1%~ ~ollratlng (g.p.d./ff~orfta/bclrm) 1'70 Totalcleplh I~. ft. ee. al~sorptlonama J*~.¥ft2 Monltodngtuloe 'f Date ofeclequacy test fl/PJOa. Results (Pass/Fall) '~ Fluid clepm in el3sorptlon field ~fore test .~. in. Water eddecl bOO gal. Elapsed TIme: ..~.min. Final fluicl depth ~0 in. At)sorpflon rate >= Any rejuvenation t~eatment (past 12 mo.) (Y/N & type) ~ ~=m type TRF.. Nc.~ Gravel I:)elow pipe ~ ff. Depression over field ~ For ;~ bedrooms New depm~ in. boo g...d. If yes, give date ~/' D. LIFT ~TATION Date installed / Size in gallons on' level at ._~ in. 'Pump off' level at 'Pump / Datum ~ Cycles tested E. SEPARATION DISTANCES in. Manhole/Acce~,/~lN) High wa,,,~,a~arm level at M~lsm~ & circuit requirements?. in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankJliff station on lot t ~.(, Absorption field on lot J~O Public sewer main ), I~O ~ Sewer/septic service line ~:~ [ ~,0~ On adjacent lots On adjacent lots Public sewer manhote/cteanout Holding tank Building foundation Water main '~ ~ 5 Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ~ Property line ) I0 Water service line ;~ 7. ~ lO0t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ) |O Water Service line ). ~. S Curtain drain COMMENTS Building foundation '~ J0 Surface water NJ0 Wells on adjacent lots YIo0 Absorption field Surface water Water main G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effecf on this date. Engineer's Printed Name HAA Fee $ Date of Payment ¢~/~"'//P Receipt Number (Rev. D~'eway. parkingNehide storage Waiver Fee $ Date of Payment Receipt Number Sen~ By: RE/BAX OF EAGLE RIVER, [NC.; 9076960214; 0ct-18.02 12:08PU; Page 212 AS B UI LT I HEREBY CERTIFY F~LOWING DESCRIB~ I~ICA~D. IT IS THE RES~SlBILI~ OF THE ~N~ ~ D~RMINE T~ EXIST~ OF ANY ~ID~ ' WHI~ ~ NOT ~R ~ THE RE~ ~DI- VIS~ON PLAT, UND~ NO ClR~MSTAN~S A~ DATA H~N ~ FENCE LIN~ OR ~R EST~LISHI~ ~ND- DRAWN~ A~ LINES. SEt~A~D & ASSOC2AT~S LA~ Sb'RVEg'I~G 69~'-O~2Ct _J ,44 #EId xxxx# MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES0* } 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. # PA6 - (i,_) HAA It � -,� R)'�) '=�( ` =\'X9, 1. GENERAL INFORMATION Complete legal description L of 2 (31 k 3 agmnq/** fit& # I Location (site address or directions) I oo 8o /4um.,2164 17t -i -e, Property owner Marti/) 1 cn r' h)`- Day phone 3 Mailing address 10080 Hf0� (�r��e mm� An e /i 99s'(� Lending agency Ala f `I GOAkC of r}-/arlTl-t Day phone 2 67 - 3300 Mailing address IS 00 W. ✓3CasooGhor-q'9 J , Ak 995-03 Agent N. A Cre.ln� Day phone J Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _ `' 3. 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. 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 x21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 F/Ram Tech Se�-v'ec,o Phone 3 Y6--- f3S5 Address MS -30 r--cAoSf. �n�horaye� 11-k 99s/,s Engineer's signature � � r' �`� Date -cL l0 199 2 DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments ill I.TIC bedrooms, with the following stipulations: Date g - 2 / - i2 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 (Rev_ 1/91) Back MOA 921 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: loT 2 SLk'3 NflMPToN HrtcS t�I Parcel LD A. WELL DATA Well type FRIVAT5 _ If A, B, or C, attach ADEC letter. ADEC water system number N A Log present (Y/N)_—Y Date completed Ib 13°'81 Driller KEN'S Co. Total depth 233 Cased to 2.05 Casing height 3 !0 rr Sanitary seal (Y/N) Wires properly protected (Y/N) Y — FROM WELL LOG AT INSPECTION Date of test Static water level 188 198 rn * Well flow g.p.m. 5.7 g.p.m. 1__r_ C s Pump level _ .210 > C) SEPARATION DISTANCES I -ROM WELL TO: i e Septic/holding tank on lot On adjacent lots /00 c�rj <, Absorption field on lot 14° ; On adjacent lots 100 t� Public sewer main /oo Public sewer manhole/cleanout >T— Sewer service line 6d 120, Petroleum tank NoNC ocsavED WATER SAMPLE RESULTS: Coliform O Ca f 160 yhf Nitrate2. J2 M. I Other bacteria O cvl /tcsar� � Date of sample: 3 Collected by: FL 7TOP TECH 5/C5, B. SEPTIC/HOLDING TANK DATA Date installed o 3o1g1 Tank size 1000 GAL Compartments Cleanouts (Y/N) I Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Alarm tested (Y/N) N -Fl Date of pumping 11 19e Pumper __7:Saat: C SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot- 12(o On adjacent lots > t00 Foundation To property line "k: 60, Absorption field Water main/service line Surface water/drainage i /00 ' 0 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed 10/30/31 Soil rating 170 SQ Fr4d 14 System type MNC// Length 39 Width Gravel thickness 8 Total depth 12 Total absorption area 6 2 q n Depression over field (Y/N) Results (pass/fail) ?A55 Cleanouts present (Y/N) Date of adequacy test 9 z for Peroxide treatment (past 12 months) (Y/N) NONC KNOvP of If yes, give date 'N. A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1401 On adjacent lots > /oo ' Property line To building foundation 10 To existing or abandoned system on lot N • A On adjacent lots > So Cutbank WA Water main/service line > 2 0 Surface water 7/09 Driveway, parking/vehicle storage area 3o Curtain drain NoNC pj3SER✓ED E. ENGINEER'S CERTIFICATION bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA 9uid�i9WWKqrt on the date of this inspection Signature ��- •+�c�r/+c 57 Engineer's Name _Theodore r Moore Date 1!! /.79 2 A��, OF A4 hr '. Tt(eocoas F. ou�e 7 CE,n s r HAA Fee $ /Zo Waiver Fee: $ Date of Payment i— / 0 —'7 'Z— Date of Payment Receipt Number __ , --� % -32- � 3 3 - � Receipt Number 72-026 (Rev. 3/91) Back MOA 21 f1g12 MUNICIPALITY OF ANC L l HOnAG 99 � 7 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SE?Vi,-E$ DI"l'ICN DEPARTMENT OF HEALTH & HUMAN SERVICES J, J DIVISION OF ENVIRONMENTAL SERVICES �_'c 1 v 187 / CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY RECEIVED 264-4744 Application Date JA, 18.8 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lolp 2, D.0 Ark Pi0M 141LLS # 1 Sffrr I3, i� -NIS3 441 Location (address or directions) odg-p 14AtPMProN 4ya%VS - �% 3�I63 I (b) Property Ownery Telephone: Home V �� Business Mailing Address— (C) ddress (c) Lending Institution L bsr-� Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (a - 3S (e) Mail the HAA to the followina address: or: Check here, if hold for pick up. List contact person and day phone number below. �J 4'19- 39tG, 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3 3. WATER SUPPLY / Individual Well Ocl Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: I community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 22-025 (Rev 61861 Fronl I 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 irsp'e'c"tion. Name of Firmy �fTelephone A7 f Address — To<<% 3 � /'`J 47 Date 6.e / I f— 7 Engineer's Seal U• 2 a 6. DHHS APPROVAL , Approved for 3 bedrooms by Date/ Z — 2 Approved X _ Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 iaev 8%861 Back MUNICIPALITY OF ANCHORAGE (MOA) pHEALTH AUTHORITY APPROVAL (HAA) p� QPRp�� CHECKLIST -FEBRUARY 1984 264-4744 J� o�Legal Description: _r__ A. WELL DATA fF Well Classification If A, B, C, D.E.C. Approved (Y/N) fir Well Log Present (Y/N) _ _ l Date Completed o Yield b Total Depth _62 3-3 Cased to Depth of Grouting _Ihl ®u �= Static Water Level _A0 Pump Set At 42 Casing Height Above Ground �j Sanitary Seal on'Casing (Y/N) Electrical Wiring in Conduit (Y/N1 Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1i9ZP ; On Adjoining Lots > /6'0 To Nearest Edge of Absorption Field on Lot _W_0; On Adjoining Lots �7 /0-0 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole _ -N®N ia- To Nearest Sewer Service Line onL t > / r,Water Sample Collected by — S ; Date / Z'/ V Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Ot i I L_ Size 1 L A4� _ No. of Compartments�� Standpipes (Y/N) �— Air -tight Caps (Y/N) — Foundation Cleanout (Y/N) Depression over Tank (Y/N) N / Date Last Pumped 1 7�/� V/�c 7 Pumping/Maintenance Contract on File (Y/N)/- ; for _11104y Holding Tank High -Water Alarm (Y/N) %/� Temporary Holding Tank Permit (Y/N) Nem Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation To Property Line el' by To Disposal Field To Water Main/Service Line ,;> / 0 To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026 (Rev 886) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption St a ! Type of System Design ��Ke14 / Date Installed D c ` ID� `, Length of Field 'a9 Width of Field v Depth of Field I Gravel Bed Thickness 8 Square Feet of Absorption Area ate` Standpipes Present (Y/N)' Depression over Field (Y/N) Date of Last Adequacy Results of Last Adequacy Test �� =m 4A4 _ AeWriy dM4A Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation To Property Line �r�J Lot No N ; On Adjoining Lots To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N ON LZ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Existing or Abandoned System on > /04P To Cutbank (if present) 4%4 &M, I f Dimensions Manhole/Access (Y/N) "Pump Off" Level at '" Check Permitted Bedroom Rating Against HAA Request '° Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, onformed to all MOA and HA�A7 guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. �r!/� 1/ (�1 /) 7 Date of Payment / . r Amount: $ Page 2 of 2 72-026 (Rev 8861 Back 3�esuo Engineer's Seal TE 203 l� 1 ) e C� �IV `'�U "I�U�1lf`1L7lNUVV� lI o�a ZOA CHORAGE,ALASKAI99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 2, Block 3, Hampton Hill #1 • 1, LOCATION: 10080 Hampton Drive y, n Vol OWNER: W. Johnson`� RESIDENCE. 16 Single Family, Three Bedrooms r1 °..222 -E: , 1u•i: 2a, l9.1. u WELL: On Site eE. SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK:Greer Steel, 1000 gal. two comp. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 824 sq. ft. SOIL RATING: 170 INSTALLATION DATE: October 1981 DATE OF LAST PUMPING: December 18, 1987. Marx DATE OF TEST: December 18, 1987 TEST PROCEDURE: System was inspected and measured. Tank was found with three feet of cover and 48 inches of liquid. Trench sump was eight feet deep and had 6 inches of liquid. 570 gallons of clean water were added to the sump Water level in tank did not change. Water level in trench rose 1.5 inches. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. V 6 T N«L; IN 18T )nMLLG�1[n1U� RESIDENTIAL WELL INSPECTION LEGAL: Lot 2, Block 3, Hampton Hills #1 LOCATION: 10080 Hampton Drive OWNER: W. Johnson TYPE OF WELL: Residential Single Family WELL LOG AVAILABLE: Yes 203 W. 15th AVE 'C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 2 2 INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 5 Gallons Per Minute PUMP YIELD FROM TEST: DATE OF INSPECTION: 5.5 Gallons Per Minute December 18, 1987 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an probe. At the beginning of the test water acoustic level was found at 201 feet below top of casing. At a pumping rate of 5,5 gallons minute the water level dropped to 205 after 35 minutes of 60 minutes. per feet aft pumping and remained at that level for the remainder othe test, A total of 470 gallons were pumped. The well recovery rate was monitored for 10 minutes. The well recover to 201 feet during this period, a 100 o recovery. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total Nitrates on December 15, 1987 E.Coli 0. Total Nitrates 2.0 mg/1. Max, allowable Total Nitrates 10 mg/l. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS — -- The Municipal requirement for well flow is 150 gallons of per bedroom per day. This water well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that aquifer feeding the well. may impact the MUNICIPALITY OF ANCHORAGE �l l DEPARTMENT OF HEALTH & HUMAN SERVICES C/ DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date N—.6—pe —_ 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT i e HANK.' 5 Location (address or di -710 (b) Property Owner Ae Mailing Address -- (c) Lending Institution Mailing AAA,,�� (d) Real Estat Address Telephone (e) Telephone: Home 2Vs '";ZdJ'E) Business Telephone Mail the HAA to the following address: or: Check here�Vif hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 From 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 inspe n Name of Firm Telephone a79" 3L, Address p2o 3 W�e la- 44 Date F - - ' bineer's Seal r o. 2225-E 1 f !'. DUNE <5, 1971 6. DHHS APPROVAL /�bedrooms Approved for %� , '. bedrooms by e Date �1�•—� `L �� A./O Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-075 (Rev 8/861 Back rG' TY OF ANCHORAGE (MOA) MUNIGME.N11�4UTHORITYAPPROVAL (HAA) �N�1RON OH KLIST - FEBRUARY 1984 819 264-4744 W��V IC Legal Description: LOT j C 4,4fK1K S — A. WELL DATA Well Classification E t'' — If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _ Y Date Completed 10 •!7' 81 Yield YZ�'_.Phl Total Depth A V Cased to Depth of Grouting 1V 0 A&ZE Static Water Level ..2.30 Pump Set At %a a� Casing Height Above Ground a I/ d — Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) >_,� — Depression Around Wellhead (Y/N) 1\4 Separation Distances from Well: 06 To Septic/Holding Tank on Lot - — On Adjoining Lots To Nearest Edge of Absorption Field on Lot /-0 0 ; On Adjoining Lots To Nearest Public Sewer Line NdNL: To Nearest Public Sewer Cleanout/Manhole __N ONE To Nearest Sewer Service Line on Lot _ rD Water Sample Collected by T 5• ; Date . 366 /s� Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size / Oltl_0 No. of Compartments —r ue1 f% Standpipes (Y/N) Air -tight Caps (Y/N) Y Foundation Cleanqut I /N) Depression over Tank (Y/N) N/ Date Last Pumped /��/�f r� x Pumping/Maintenance Contract on File (Y/N) N/,� ; for Holding Tank High -Water Alarm (Y/N) (y�/: Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well LZ o To Building Foundation 7 X To Property Line — 'T To Disposal Field �T To Water Main/Service Line f ® To Stream, Pond, Lake, or Major Drainage Course 1 N!= Comments Pagel of 2 72-0261Rnv 8'861 Froni C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 Type of System Design TCiE Date Installed A P v r / / Length of Field Not Width of Field 31 Depth of Field lot Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) T w/ D Depression over Field (Y/N) N Date of Last Adequacy Test VI LO/B $ Results of Last Adequacy Test . ��' e- 13+ WV. mo M s Separation Distance from Absorption Field: TL To Water -Supply Well JJ' J To Property Line 15,41 To Building Foundation To Existing or Abandoned System on Lot ail On Adjoining Lots To Water Main/Service Line > 0 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course N M To Driveway, Parking Area, or Vehicle Storage Area 0 Comments D. LIFT STATION N 0NG-- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all��OA d HAA guidelines in effect on the date of this inspection. Signed Date 15M Company Receipt No. Date of Payment o� Amount: $ Z 7 h Page 2 of 2 72-026 (Rev 6/861 Back MOA No. v + Engineer's Seal Jo 222°5-E 'a JUivt. 2S, 1971 ,''V• 203W 15th AVC'SUITE 203 vul ru A CHORAGEEALASKA 99501 CONSULTING ENGINEER TELEPHONE_ (907) 279-3916 D// /z/--7�r RESIDENTIAL WELL INSPECTION LEGAL: Lot 1C Hank's Subdivision LOCATION: 7903 Jodphlzr OWNER: John E. Hepler TYPE OF WELL: On Site, Single Family WELL LOG AVAILABLE. Yes '• "" ' ! INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: 40 Gallons Per Minute PUMP YIELD FROM TEST: 4 Gallons Per Minute DATE OF INSPECTION: March 17, 1988 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level was found at 230 feet below top of casing. At a pumping rate of 4 gallons per minute the water level dropped to 231 feet immediately and remained at that level for the remainder of the test, 2 hours. A total of 450 gallons were- pumped. erepumped. Total well depth is 271 feet. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrates on March 17, 1988 E.Coli 0. Total Nitrates None Detected. Max. allowable Total Nitrates 10mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal .requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. P n .IT r� . r) l' r CONSULTING ENGINEER LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: SEPTIC SYSTEM ADEQUACY T -.,T Lot 1C Hank's Subdivision 7903 Jodphur John E. Hepler Single Family, Three Bedrooms On Site, Single Family FROM MUNICIPAL RECORDS: TANK: Greer Steel. ABSORPTION SYSTEM: ABSORPTION AREA: SOIL RATING: 150 INSTALLATION DATE: DATE OF LAST PUMPING: March 18, 1988 DATE OF TEST: March 18, 1988 203 "! 15th AVE "CSUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE. (907) 279"3916 Two Comp. 1000 gal Trench 480 sq. ft. April 1981 TEST PROCEDURE: System was inspected and measured. Tank was found with seven feet of cover and a liquid depth of 51 inches. Clean ou't to trench was_7.5,_feet deepand dry. Trench sump was 11 feet deep and had a liquid depth of 53 inches. Clean water was added to the trench at a steady rate of 4 gallons per minute while the water levels in the tank and the sump were monitored. The tank level did not change while the level in the sump rose one inch per 50 gallons. A total of 4.50 gallons were added. This caused a total rise of 8 inches in the sump. The infiltration rate was monitored for 6 hours. During the first 15 minutes the water level dropped 2 inches. At the end of six. hours the water level was down to the level at the beginning of the test., indicating that all of the 450 gallons had been absorbed by the soil. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, 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 this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. APPLY ',Ni FILLS OUT UPPER HA ONLY Property Cwner r,- 7 Time rl Phone Mailing Address Zip Cod 'I 4— Buyer C-) Date Address Zip CodeC_% Inspector Inspector Lending Institution P PhoneT Address Zip Code C' 0 Realty Co. & Agent Phone Address ress Zip Code DEPT. OF Fir ENVIRON"Y-1 — Legal Description wi'p P C F Street Location 'CONDITlOI`4S OF PPRIAL Type of Residence % 2/_ Single Family 11 Multiple Family No. of Bedrooms-- ❑ Other Water Supply Date Installed I ro Absorption Area Well Log Received WeI111 /Y Individual I Well to Tank We ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Ej Community For wells drilled prior to that date, give well depth (attach log if available). Cl Public Utility Sewer Disposal fixIndividual Year Individual Installed: FI Public Utility When Connected to Public Utility: C Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,--, 71— Time Time Time rl Time Date Date Date Date Inspector Inspector Inspector Inspector � J A Field Note C' 0 MUNICIPALITY 0 CH DEPT. OF Fir ENVIRON"Y-1 — wi'p P C F 'CONDITlOI`4S OF PPRIAL APPROVED BEDROOMS DISAPPROVED % CONDITIONAL APPROVAL' DATE BY: vzz Soils Rating _7 Date Installed I ro Absorption Area Well Log Received WeI111 I Well to Tank We -Septic Tank Size 72-02313182) E�t�" 0A —0 Time luue� Date Date Date 41 _,4,(E Inspector z Inspect6r Inspector Comments Conditional Approval f . Date Sewer Installed Permit No. Septic Tank Size Com) O ( Holding Tank Size Sells Rating Well To Absorption Area ! Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner i ��" e f Phone Mailing Address ZI .5�>3 Buyer�e�_. Address Lending Institution r ` �yL Phone Address 73(er�JtJC' ly� 9�%%- Realty Co. & Agent l`3 Phone Address Legal Description CT"--") //.5 �— Street Location Type,QQf Residence 25 -Single Family ❑ Multiple Family No. of Bedrooms ❑ Other WatQr upply 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: tility:_ _❑ 17 Public Utility When Connected to Public Utility:--- []Holding Tank NOTE: THE INSPECTION FHL MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN UH INITIATED.