HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 3 LT 5Hampton Hills #1 Block 3 Lot 5 #015-134-70 Municipality of Anchorage Page of �- 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 Permit Number: SV/qct 0 1-7d- PID Number: O i S ` 13� — 7 0 Name: a Wastewater System: ❑ New Upgrade f- Address: i o 1z.-7 o "i>—o,. ABSORPTION FIELD Phone: No. of qck Deep Trench ❑ Shallow Trench ❑ Bed []Mound ❑ Other LEGAL DESCRIPTIONSoil Rating: 1d � Total Depth from original grade: 10 GPD /S . Ft. Lot: Block: Subdivisi1oDepth to pipe bottom from original grade: Gravel depth beneath pipe }f� t` 4 f -MA iotk 0i 5 Ft. J Ft. Township: Range: Section: Fill added above original grade: Gravel length: _ � Ft. � Ft. WELL: 13 New 11 upg�# Gravel width: 2 Number99oflines: Distance between lines: J Ft. N Ft. Classification (Private, A,B,C): Total Dep Cased To: Total absorption area: Pipe material: F Ft. Ft. SQ. Ft. 8/ U £ 3 r 7 l Driller: Erate Drilled: Static Water Level: Installer: L Date installed: Ft. -L1 _ -� q Yield: Pum et at: Casing Height Above Ground: TANK I GPM Ft. Ft. SE RATION DISTANCES MSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift HoldingPublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines . N& l—I N `L 10121,50 Wei 1 -Material: Material: Number of Compartments: Surfac N10 LIFT STATION Water Lot .r b 3V Size in gallons: Manufacturer: Line __-) Foundation 42 3D "Pump on" level at: "Pump off' level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Q lel Location and Description: j f W tir��vyILte Assumed Elevation: 6LO 0-0 Ft ENGIN,,EFVS SEAL . . Inspections performed by: TS Dates- i s / q y 9 2nd a3 4 :< ..........., - Department of Health and Human Services approval Reviewed and approved by: Date: . 2 2- -77 o a 72-013 (Rev. 9/91) MOA 25 Well TOE A FD cl- q IUY&LN JYUHKLANU P.L. HAMPTON HILLS SIS SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 LOT 5 BLOCK 3 DATE.- SEPT. 17, 1999 907 279-3916 11 10270 HAMPTON DRIVE SHEET: 2/3 GRID: 2540 PERMIT # EW990172 PID # 015-134-70 HTH03052.DWG B SWING TIES AC 16 FT BC 20 AD 26.4 BD 23 AE 65 BE 71 REPLACED 1250 GAL SE INSTALLED BULLRUN DIVERSION VALVE E STANDARD TRENCH �G• 50 FT LONG 10 FT DEEP 5 FT EFFECTIVE ROCK DEPTH �••�� OF �`� ♦ �1 s ♦� 49th ° J ...:� � ........� x.11 � ........ ,c TOE A FD cl- q IUY&LN JYUHKLANU P.L. HAMPTON HILLS SIS SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 LOT 5 BLOCK 3 DATE.- SEPT. 17, 1999 907 279-3916 11 10270 HAMPTON DRIVE SHEET: 2/3 GRID: 2540 PERMIT # EW990172 PID # 015-134-70 HTH03052.DWG . W 93.0 Silt Barrie? aZs 5,0 Ft of Septic Effective /VL/ 3LMLL T❑BBEN SPURKLAND P,E, HAMPTON HILLS BK 3 LOT 5 SEPTIC SYSTEM SCHEMATIC ge Ak 99501 Ave Anchorage 10270 HAMPTON DRIVE DATE; SEPT 17, 1999 Anc JERRY DEVALL SHEET1 3/3 GRID 2540 PERMIT # SW990172 PARCEL ID # 015-134-70 HTH03053.DWG I 0 O 0-0- OO 0 1250 gal Sep tic tank o C5 'v C) i 4 m a Q j � m q L2 Standard Trench- 2' Wide 50' L ong 10' Deep 5,0' Sewer rock 51 Cover AV 49th ♦�� �.....:.... ....................... .. � i....... ........ ................�.. TOB N SPURKLAND +' : _= ♦�Cf��.••♦.. O NO. CE -2225 ��- ' NO SCALE �c Ij`'•.............. ••''��:i MFESS 93.0 Silt Barrie? aZs 5,0 Ft of Septic Effective /VL/ 3LMLL T❑BBEN SPURKLAND P,E, HAMPTON HILLS BK 3 LOT 5 SEPTIC SYSTEM SCHEMATIC ge Ak 99501 Ave Anchorage 10270 HAMPTON DRIVE DATE; SEPT 17, 1999 Anc JERRY DEVALL SHEET1 3/3 GRID 2540 PERMIT # SW990172 PARCEL ID # 015-134-70 HTH03053.DWG I MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 0(,0 &a"(— w11 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW990172 Legal Description: HAMPTON HILLS #1 BLK 3 LT 5 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Jerry De Vail Owner Address: 10270 HAMPTON DRIVE ANCHORAGE, AK 99516-1128 8•t(s� •9q -- Date Issued: Jul 02, 1999 Expiration Date: Jul 01, 2000 Parcel ID: 015-134-70 Site Address: 010270 HAMPTON DR Lot Size: 48745 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: Disposal Field Z Septic Tank Holding Tank E] 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: Issued By: L Date: 7-7—le( / 5 '—� - P, -'; V Date: % , 7—?7 46, T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 BLOCK 3 HAMPTON HILLS S/D JERRY DEVALL Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 June 28, 1999 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. From Testhole 06/18/99 <1 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 15011.2 = 125 sq.ft. Total area regaired: 125 x 4 = 500 sqft Testhole depth 16 feet Bottom Rock At 10 feet Top Rock At 5 feet Rock Depth 5 feet Total Trench Length 500 / 10 = 50 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 50 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 5 FT COVER 5 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. 50 0 6 I O I I 5 I I 1ULf(1LN 31'UKALANU P.L. HAMPTON HILLS SIS SEPTIC SYSTEM DESIGN 203 1 TH. AVENUE LOT 5 BLOCK 3 DATE: JUNE 25, 1999 (NCH.. AK..99501 10270 HAMPTON DRIVE SHEET: 1 907 3 GRID: 2540 279-3916 � PERMIT # SW9900XX PID # 015-134-70 HTH03051,DWG 49th ''sem'•. ♦i FIJ I I I I I 5 hl LkILCIIVE ROCK DEPTH N i I 0 s lUtftftN JI'UKKLANU l'.L. HAMPTON HILLS SIS SEPTIC SYSTEM DES/GN 203 W 15TH. AVENUE ANCH. AK. 9950111 11 LOT 5 BLOCK 3 DATE: JUNE 25, 1999 (9071 279-3916 10270 HAMPTON DR/VE SHEET 2/3 GRID: 2540 PERMIT # EW990OXX PID # 015-134-70 HTH03052,DWG I 0 0 0 o 1250 gal Septic tank � o � L � � 0 o � � m r -,Z) �L? Standard Trench; 2' Wide 50' Long 10' Deep 5.0' Sewer rock •.��11 5 Cover q V '� �P.• ��s�r9 ♦i 0%�49t�.♦.I .......................�% /.....F.:...:. ......... ....... A # TO BEN SPURKLAND" 0. Q i 0 ♦�C���•••••. No, CE -2225 4 �_/ AV NO SCALE ♦� �pFlj`'•• •......... ••� ��•► 441, FESS Silt Barrie 5,0 Ft of Septic Effective NLl JGMLL T❑BBEN SPURKLAND P,E, HAMPTON HILLS BK 3 LOT 5 SEPTIC SYSTEM SCHEMATIC 203 Anchorage Ak 99501 Ave Anchorage 10270 HAMPTON DRIVE DATE: JUNE 28, 1999 P79 -291C, 11 JERRY DEVALL SHEET: 3/3 GRID: 2540 PERMIT # SW9900XX PARCEL ID # 015-134-70 HTH03053.DWG I r (ENGINEER'S SEAL) Muni-iraiity of Anchorage .r DEPARTMENT OF nEALTH & HUMAN SERVICES 825 "L" Street, Aw.horage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 1 7_-�� &z"J(1 PERFORMED FOR: 1_1 Yy-.A. A)14 w DATE PERFORMED: LEGAI- DESCRIPTION:�.a �'!� �+iC 3 l'}/_kj>I(.,N Township, Range, Section: SLOPE SITE PLAN 1 T) b Ni(, 2 3 u �-x racy � yr y WV 4 5 6 7 - e 8 bb 9 t 10 12 '.. �• r 13 14- 16 4 16 17 Ut- 14LLE 18- % 19 N GROUNDWAS ■■■.■■■■■■ IF YES, AT WHAT D'cPTH? Det.il, to Water Alter Mo�itoring7 C4 V% !I Dale: F'r:adin� Date Gross Net Depth to Net Time Time Water Drop c !Zvk 0' 20 PERCOLATION RATE � � (minutes/inch) PERC HOLE DIAMETER TLST RUN BETWEEN FT AND FT DISCLAIMER Grnundwatar ran_ditions j ndicated. are for the da Pe shown only. Past and future presence &,-id/or depth of gro,rndwater can not be predicted rom Lnese o sex—v ions PERFORMED BY: 1. 3 I —CERTIFY THAT TH S TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GOIL ELINES IN EFFECT ON THIS DATP.. DATE: / 72-008 (Rev. 4/85) G'� J-5 ��o o 6-2 MUNICIPALITY OF ANCHORAGE \\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ® �) ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT �P"HONE AME- �� 11 w , M - 1 3L(y---7y 76 MAILING ADDRESS ,n LEGAL DESCRIPTION-/ L_ !, LOCATION DISTANCE TO: oh. Q11 Manufacturer fly UPGRADE NO. OF BEDROOM on areae , J Dwelling PERMIT N0.«/ pUS 3 �U Materials n No. of compallments - Width CX- Liquid *Pth�.L� Yl II- "U1viuiviHUc. 1 - )�) LO �e __J_------ -0' PERMIT NO. Well Dwelling O DISTANCE -T- _ a t7 z -��- Material Liqul apap city in gatYans 0 Manyfacturer - Wella FoundationNearest lot line PERMIT NO. °y TO: DISTANCE w _I o. UZ No. of lines Length of each Me Total length of lines Trench width Distance betty en e ��/ -�' inches _ �"i� Material beneath rile Total effective absortltion area Z w ��_% __ P Q F Top of the to finish grade �- _� o f Cl -� Depth � PERMIT NO. Length Width w Q I- Type of cri Crib diameter - _ - Crib dept lbtal effectiv ,,abso prion area _ to w e��- B ding foundatio J arest lot line m DISTANCE Depth s� Driller Distance to lot line PERMIT NO./D� 5 Class -t'- < L/ w — BuildinfoundationSewer Septic tank Absorption area(s) line 3 t DISTANCE TO: - OTHER PIPE MATERIALS �) - SOI L TEST RATI INSTALLER S � _ REMARKS r k , APPROVED DATE 3/ LEGAL , /,� ,,�,M, ���dv-�� iV� Mwlla. I I Log to 4 ..... ..... ... ny ..................... ........... Miller b E kl A MA t L k. A Ml C 0 M Pr's N V A,MC.'HC'i,A0E,. ALASKA f)9r)07 ........................... D corr plete .............. "3 1. ......... ... .... .............. .......................... Depthof we. -)'U. ...... ...... .............................. ................ ....... S I z i � of casing ............ .. ..... .......... D i t in to water .j y is qt -l- ......... ............... I ... I .... (9 Dis 'U(,Aiace t o water w1alle 13urnping .................... . ....... ........ A rate x fps 01. A... I � ..... .......... 9 to 4 ..... ..... ... ny ..................... ........... Miller b E kl A MA t L k. A Ml C 0 M Pr's N V A,MC.'HC'i,A0E,. ALASKA f)9r)07 0.._.:0:: -R- FA V0X.:;:9-,. F----- E' 1111.1 L) r-•10 1, K_ J." A- 0 I 1'*11'-'F'F,IF'.-'I'tfl[et-4'1" CIF IlEFILTH AND L= " L ANF.FIFRAG3E., Al'. 99501 9-°-0 L"_ L C-11 P -A -9- E---- FEE ll.� I IE`_ F-?. 11" F-2 rl '11" PIER[el.'(T [10. is 0_0_"V�m cx(na�rAk 1'`t, c4c) "o A P Pl_ 1. C A NT E: L:' HE_RgZ(`ICi P. ANCH. L I'-) G AT I 1'-) 1`4 I':1R. LEt:*.1&11.... Lf_)T 5 HAMPTC-14 HILLS SUB LOT ::;IZE 4.,:-::000 C"'(.."WARE FEE"L" TYPI-E- Cif'==,+:+TL. ABSORPTIOP-1 S'-YSTEM IS: TRENCH 1-Iffl-'IM(All 1`11_111BER f.lF BEl'.)ROO!"I''_ = f.j. SOIL. RI-1-l"It,113 ' THE SIZE. OF' *'['HE IL ABI�-'.O SYSTEIll ISn E-,-.' L 3 HE:LENC)"T'll 1)II`-IENSiot-j ic. THE LE1`41]'i'm -:'IN FEET'., (_'F THE' TRENCH I. -IR DRAINFIELF.:l. PIT 1'-:'; THE [)ISTMICE BETWEEhl ]"HE 'SURF"Al-E OF THE' THE LIEPTI-I ("F A TRPICH (3ROUNC, AN '['HE' BOTTO" I'll"' THE e'IN FE'ET' f+IEI,-!E is NO '_;ET' WIDTH FOR TRENCHES, THE GRF"il,,JEL F.:,Ep'rH IS THE MIP.Ift-lilel (*,,.jEPTFi OF GRAVEL. BET14EEN THE ClUTFALL PIPE: AND TFir.-_­ Bur"rom OF THE -:'IhI FEET). ElE G."! 1111 1 F--" EE E-A "EH. FEE Fm" t-5 CD H ---R F -H L.- I_ 0 -11 P-4 PER1111 APPLICAr.-IT HAS THE TO INFOPlel THIS DEPARTMENT C-LIRING THE INsPEi".:TlOt-,I,_=,' OF ANY' WELLS Ar.,,.JFv--ENT TO TFlIcS.; FROPERTIrl AP. -ID THE t-IU1-lE:ER L -IF RE'S IDENCEE; THAITHE kIEj_L_ WILL SER"..'E. J_ VA ,4 r-:4 KEE, K, _r, [III r -A _,Z.- f.:u F;;! FEL 1 ^ S BAI-:KFlLLI?-lG OF FINY '::.YSTEM 14 1 TH I'_'I UT F"INAL. P-151"ECTI(=IN AND APPROVF1L. BY T I I -I' 1.)EPAF,"TMENT WIL.L. BE '.-_...L.IE:JECT TI -1 PROS'ECuTION. ' MINIMLIM CilE;TANCE. BETWEEPI F1 WELL. AND ANY OP -J -:E;1 TE S-EWAGE CI STEM IS -I.C.10 FEEl" Ff IF, A PRf%.,i:-rrE WEI ... L. CIR 1�-O TO 2(..1Cl FEET F'Rl,-.111 A PL.IBLIC WELL DEPEND' t-41" i-ecit-i THE TYPE CIF PI_JBLII_ WE'LL. MlY.,11PIUM DI,."--,TANCE FROM FI PP.'IVFITE WELL TO A PRI',MTE SEWER LINE 15 25 FEET FIND i"o Fi corimut-wri., !,-_,'.EkIER LIP -4E. IS 75 FEET. kIE'LL LO("IS ARE FeEf-A.11RED AND BE RETURI'lED "I"CI THE DEPARTMEkIT wITHit-i DAys '.F -f FIE IdELL, COI-IPLET ."N. I F I C A T 113Nd 5 '-:TRUCTII.-.1t.4 DIAGRAMS, FIRE AND OTHER I'lAY AFT -1..'r'. -PEC Fi�..'FiILFIBLE TO IhIC.:J_IRE PRFIPER IPT.:-,'TALI_ATIOt.,I. E'--.' rKEJ_ J- -1 E-3 E I CERTIP-r' THAT 1 1 AM FAMILIPIR 1 -41 -FI -I THE REQUIREMENTS F'I__IR ON—SiTE SEWERS AND WELL,.'; AS s."T F+-IP'.TI-I L:Y rFIE MUt-11CIPALITY OF' ANCHOR'FIGE. THE IN Ai .:('*ORDANCE wrrpi TFiE, CODES. T FIE: c SITE S_,EWER s,-r­sTEP1 MAY REQUIRE EP.-ILFiF.GFJlENT IF THE TFiA"r RE"SIDEhICE IS REMODL,"LED ..ro INCLUDE MORE THAhl el. E: E I'.) RO Otl c5, IED I­If._--fzc .-.i 'LIED BY' V4, 0 X SOILS LOG MUNICIPALITY OF ANCHW$9�ALITY OF ANCHORAG ' DEPARTMENT OF HEALTH AND ENVIRONMENT@FPP.ROT- ECUON, PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 �' 26R4�'.. W,11'AL F;.OTECTION SOILS LOG — PERCOLATION TEAR 1 5 1f7i PERFORMED FOR: A ��' t'-�L0 `i Ia6,T JEVF�12[ J_D: =_J •�- 'V2f'� LEGAL DESCRIPTION: �c / S 6 c -k *a'1- 10 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS /10, PERFORMED BY: 72-008 (6/79) SLOPE V '/JRJ D,e/Ve- i Date Gross Time Net Time Depth to Water Net i Drop./ 1 - 5 /U: Y7 1 +. N l WAS GROUND WATER /" ® S ENCOUNTERED? L O _ P IF YES, AT WHAT E DEPTH? Ci Jl//o/& �`a�y / t/ O~ :r4 -,.6f' el °l f •fie 6 Wff Feading Date Gross Time Net Time Depth to Water Net i Drop./ 5 /U: Y7 3w a) Lr1 9,/ fjT'Syip��/��(-" !PERCOLATION RATE / ---(minutes/inch) ��/c'c� 1Z' d �"/TEST RUN BETWEEN �FT AND �4L FT CERTIFIED BY: DATE: - 4A3, Ac) P P f \ 0 c,1 k,c m P\m Municipality of Anchorage On -Site Water and Wastewater Program 3� (907) 343-7904 Certificate of On -Site Systems Approval �7 I Parcel I.D. 015-134-70 Expiration Date: 1. GENERAL INFORMATION Complete legal description HAMPTON HILLS #1 BLK 3 LT 5 Location (site address) 10270 HAMPTON DR, ANCHORAGE AK 99516 Current Property owner(s) KATHY GILLIS Mailing address Real Estate Agent LISA CONNER 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 244-2013 4. TYPE OF WATER SUPPLY: Waiver Fee $ TYPE OF WASTEWATER DISPOSAL: Individual Well ❑x Individual x❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Pi„ihlir 1Matar Svctam _._.. IFI PttbliC Sewer F-1_ Waiver/Variance request for: NONE Distance:_ Received by: " .' sti Date: Lf COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment ��pl�l�ii Date of Payment Receipt Number U�ln��t Receipt Number COSA# 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. Name of Firm SPURKLAND ENGINEERING Phone 279-3916 Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedroomst 1 , y��y � M Disapproved EA -; + Conditional approval for bedrooms, with the following stiphm ?' Date 4/14/14 t, t By: (19 � s _Original Certificate Date: �6^ z TheIcip itt f bhorage 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 blue sheet r c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: HAMPTON HILLS #1 B3 L5 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed 3/12/1981 Sanitary seal (Y/N) Y Total depth 191 ft. Cased to >40 ft. FROM WELL LOG Date of test 3/12/91 Static water level 170 Well production 8 WATER SAMPLE RESULTS: ft. Coliform NEG colonies/100 mL Nitrate 6.95 mg/L Arsenic ND ug/L Date of sample: 4/1/14 B. SEPTIC/HOLDING TANK DATA Parcel ID: 015-134-70 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 4/9/14 174 4.75 [R g. p. m. Collected by: ANSON MOXNESS Tank Type/Material SEPTIC/STEEL Date installed 8/23/1999 Tank size 1250 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 12/18/13 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 8/23/1999 Soil rating (g.p.cldf:2 or ft2/bdrm) 1.2 System type TRENCH Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 14.1 ft. Eff. absorption area 500 ff Monitoring tube Y Depression over field N Date of adequacy test 4/9/14 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 12 in. Water added 630 gal. New depth 39 in. Elapsed Time: 1320 min. Final fluid depth 13 in. Absorption rate >= 600 9 p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access(Y/N) in. "Pump off' level at in. High water alarm level at in. E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA 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 NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 51+ Water main NA Water service line 10+ Wells on adjacent lots100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots100+ F. COMMENTS 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 COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 4/14114 COSA brown sheet 10-10-12.doc Absorption field 6+ Surface water 100'+ Water main NA Driveway, parking/vehicle storage 10' ^= ��.OFA4'11 % .- Cog T v i �j 9 . sauaxLarvD:;�-, % 11580 t`M 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 # 141128 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 5 of Hampton Hills #1 subdivision. This inspection revealed a nitrate concentration of 6.95 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. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. N11unEcipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE-` FAMILY DWELLING Parcel I.D. 015-134-70 COSA# CILS �� v' Ll ) 1. GENERAL INFORMATION Expiration Date: — Complete legal description HAMPTON HILLS #1; BLOCK 3, LOT 5 Location (site address) 10270 HAMPTON DRIVE * ANCHORAGE AK * 99507 Current Property owner(s) WILLIAM FROST Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 10270 HAMPTON DRIVE * ANCHORAGE AK * 99507 Day phone LAURA HALVERSON DUFOUR W/ DYNAMIC Day phone 3111 C STREET * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 267-2813 229-6815 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown bellow, 1 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any h 71 't f I l't ht Phone 337-6179 Date '1 �=� Ick o Y. 4,T yA. arnessi QP E-79 �Q � 0 p0� f C49 ° F other person or party not aut oozed , no, con er any ega nghw a soever. ®`�� 5. DSD SIGNATURE ON-SITE Approved for bedrooms. WATER AND ; m WASTEWATER : Disapproved. PROGRAM Conditional approval for bedrooms, with the fllowing stipulations: �-.,� ° • , ..• Attachments: COSA Checklist LZ A . - ; I _jv;, ory no�C���v �u����y Septic System Advisory Maintenance Agreements Well Flow Advisory � Supplemental Engineer's Report Nitrate Advisory (/ Other By: Original Certificate Date: - e IV (Rev. 11/05) Municipality of Anchorage y� s� Development Services Department Building Safety Division s On -Site Water & Wastewater Program 3 E r r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HAMPTON HILLS#1 S/D; BLOCK 3, LOT 5 Parcel ID: © /3-- / 3 `-J -70 A. WELL DATA *ASSUMED BASED ON SURROUNDING WELL LOGS. SEE ATTACHED. Well type PRIVATE If A, B, or C provide PWSID# N A Date completed 3/12/1981 Sanitary seal (Y/N) YES Total depth 191 ft. Date of test Static water level Cased to *40'+ ft. FROM WELL LOG 3/12/1981 170 ft. Well production 8 g.p.m. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 7/7/2010 181 ft, 2.91 9.p -m. WATER SAMPLE RESULTS: L Coliform o colonies/100 mi. Nitrate �e mg./L. Other bacteria _colonies/100 ml. Arsenic: O ug./L. Date of sample: 7/7/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA *PRE—TANK CLEANOUT. Tank Type/Material SEPTIC/STEEL Date installed 8/4-23/1999 Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 10/14/2009 Pumper NORTHLAND PUMPING 1981 TRENCH (RESERVE)/ C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE 1999 TRENCH 3/20/1981/ 115 FT2/BRDM/ TRENCH/ Date installed 8/4-23/1999 Soil rating (g.p.d./Wor ft2/bdrm) 1.2 GPD/FT2 System type TRENCH 36/ 3/ 6.5/ Length 50 ft. Width 3 ft. Gravel below pipe 5 ft. **/ 468/ z **NO/ Total depth *13.9 ft. Eff. absorption area 500 ft Monitoring tube YES Depression over field NO Date of adequacy test **7/7/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 26 in. Water added 600 gal. Elapsed Time: 120 min. Final fluid depth 28 in. Absorption rate >= For 4 bedrooms New depth 31 in. 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **NOTE: TESTED 1999 TRENCH, WHICH DOES HAVE A MT. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm&circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field *5' Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ ¢ �� g I S vND�- Curtain drain NONE KNOWN Wells on adjacent lots 100'+ '��� J pCLt�P'Fyva? F. COMMENTS *5' PER PREVIOUS C.O.S.A. NOTE: STANDPIPES FOR 1981 TRENCH COULD NOT BE FOUND. 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -7111% co p ' COSA Fee $ !V U Date. of Payment a / O Receipt Number P7r (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • "� Development Services Department t t° Building Safety Division S A E 7 Y 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 # 101141 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 5 of Hampton Hills #1 subdivision. This inspection revealed a nitrate concentration of 7.65 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. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. I LOT 21 B LOT 21 C ►: 1 I LOT 6 I I PLOT PLAN _ AS BUILT X SCALE 1" = 40' GRID SW 2540 Project No. 10-129 Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 —6476 Registered Land Surveyors (907) 522-4625 Faxne Qa�0000�o OF 0 kglanglsOalaska.net / jclanglsOalaska.net a0v,`�• •A �'>% 1 hereby certify that I have surveyed the following described property: Q: —106) 49� '•• ��00 LOT 5, BLOCK 3, HAMPTON HILLS SUBDIVISION (PLAT No. 69 ��; Anchorage Recording District, Alaska, and that the improvements situated thereon aro .......:... �D Q............ .... within the property lines and do not encroach onto the property adjacent thereto, that Q no improvements on the property lying adjacent thereto encroach on the surveyed Flo. promises and that there aro no roadways, transmission lines or other visible .' "' ; '� easements on said roe p c^ KENNETH G. LAN property rtY exce t as indicated hereon. Qp� 0 Dated this the 2� Day of u X10 v0 LS -52021 J O at Anchorage, Alaska Q 6 t 5 OG It is the responsibility of the owner to determine the existence of any easements, D��'essioNA000� covenants, or restrictions which do not appear on the recorded subdivision plat. X4000 07/06/2010 13:12 2686770 APLUS NORTHLAND PUMPING SERVICE, INC. Your Professional Septic Pumping Service Company 7501 E. 140th Avenue ANCHORAGE, ALASKA 99516 (907) 344-7146 - FAX (907) 868-6770 To Will Frost 10270 Hampton Drive Anchorage, AK 99507 TERMS: Pump Septic PAGE 01 19991 OetObor DATE P.O.# Week of Oct. 126 — slam cbecit,' rf'Vq* - if yon see anything RC�R�,' b le �i�pof-fir l,� Ob wnv- v iA 's "2009"rate in e b an Au 09 Aug. LOWS C-10D� 344.4753 04109 11 0 gallons, 2 standpipes Tank loc ded in front yard next to deck 7ftC+-(it#J0j0L) i C-fiUDA.-s i $155.00 PUMP j SS ,C;z> Wballons Septic _ Holding Tank Standpipes t ❑ ❑ 0 ❑ PROBLEM AREA -CALL FO MORE INFORMATION NEEDS TO BE DONE A IN 6 MONTHS Good Shape Sludge buildup on bottom ❑ Floater on top Jim cap missing or ❑ Cut standpipe to V above ground ❑ Needs Septictrine Leach Area LtM needs replacing Municipality of Anchorage Development Services Department ��� Building Safety Division :+ % On -Site Water and Wastewater Program _ 4700 South Bragaw St. S " P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �1 Parcel I.D. PIE- 12-1-%D % HAA �b/hq-1cx Expiration Date: l 2 - !j - O / 1. GENERAL INFORMATION Complete legal description 1.-o 1 5 BV- 3 ViAQ? To N M 1 _ S -* Location (site address or directions) I O 2-j O I+ANA i om b 12 Current Property owner(s) ! f ztr !j Ut V'tW Day phone 1 Mailing address Lending agency Mailing address Day phone Real Estate Agent V-11til; 't -v I was 1" 4 d- W'h,'kDay phone Mailing Address Unless otherwise requested, HAA will he held by DSO for pickup. 2. NUMBER OF BEDROOMS: q 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site E311, Individual Holding tank ❑ Community On-site ❑ Public Sewer IN The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or emissions in the professional engineer's work. 4. 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 Health Authority 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 211 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 10 '_ F_ Phone pq -351 & ( Address H;Lo ?, y1 D 3 t�/ �� L� Engineers Printed Name ! U �rtrtt Date 01— 5. DSD SIGNATURE -Z Approved for Disapproved. _4— bedrooms. Conditional approval for Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory bedrooms, with the following stipulations: WATER AND Maintenance Agreements Supplemental Engineer's Report Other PROGRAM •' By: 0,//^� �� O Gt.Ci_ Original Certificate Date: (Fr.. 1200) Municipality of Anchorage Development Services Department Building Safety Division On-Ske Water & Wastewater Program 4700 South Bregaw St. P.O. Box 196650 Anchorage, AK 995IM650 www.cl.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST J:IR Legal Description: LO 1 5 d k 3 la •."tp F&.1 l i lI *1 Parcel ID: 615 – 13 4— 7 D A. WELL DATA Well type a Date completed 3_11.45 1 Total depth -L'1--I ft. Date of test Static water level Well production If A, B, or C provide PWSID # NIA Well Log (Y/N) Y Sanitary seal (Y/N) Cased to 141 ft. FROM WELL LOG 3. 12.- B 1 ft. WATER SAMPLE RESULTS: Coliform -70--colonies/100 ml. Date of sample: Y1 826 B. SEPTICIHOLDING TANK DATA Nitrate 3. e T mg./1. Wires properly protected (Y/N) Casing height (above ground) 1:5 In. AT INSPECTION 8•ALl– Ol 9— p.m- Other bacteria —0— colonies/100 ml. Collected by: Tank Type/Material _ Sy,e iL S�t C� Date installed �•.2 3 • �} 9 Tank size 1 X60 gal. Number of Compartments '� Cleanouts (Y/N) i Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper Pumper A + C. ABSORPTION FIELD DATA Date installed 9*,93' 1 Soil rating (g.p.drtt2 or ft2/bdrm) 1 • A System type 74,644e N Length 50 ft. Width -:3 ft. Gravel below pipe - 13_ ft. Total depth _Q ft. Eff. absorption area Sol/ 7 ftz Monitoring tube `/ Depression over fifield N 8' Z Date of adequacy test O Results (Pass/Fail) � T — For Hbedrooms Fluid depth in absorption field before test Q in. Water addedi4-gal. New depthlte in. r3 r Elapsed Time: I'LL reia. Final fluid depth in. Absorption rate >= 6 WO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date � D. LIFT STATION Date installed pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off* Manhole/Access (YM) _ in. High water alarm level at in. SEPARATION DISTANCES FROM WELL ON LOT TO: Meets alarm & circuit requirements? Septic tankAt t station on lot i 1 6 on adjacent lots ? / (*'0 Absorption field on lot 125 On adjacent lots k/b-0 Public sewer main N/A Public sewer manhole/cleanout N�.4 Sewer /septic service line t SL�O Holding tank N�.4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation i 2 Property line 1z3— Absorption field Water main N�A Water service line SO � Surface water 1410 Wells on adjacent lots ) lb -0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 3 0 Building foundation s Water main NV,4 Water Service fine S Surface water M I o Driveway, parkurplvehide storage 3 D Curtain drain N L o Wells on adjacent lots 7/(7a F. COMMENTS Date of Payment 47MV I Date of Payment Receipt Number ( Receipt Number (Rev. 17100) G. ENGINEER'S CERTIFICATION inspections I certify that I have determined through field and t. review of Municipal records that the above systems are in ; �' conformance with MOA HAA guidelines in effect on this date. '� •• E : "` •, Engineer's Printed Name t o b b -t K D V t, ... t. •, ; . ,. Date Se L si HAA Fee $ Waiver Fee $ Date of Payment 47MV I Date of Payment Receipt Number ( Receipt Number (Rev. 17100) AUG -27-01 12W FROM-CTIE ERVIROLF11TAL SRV JAL. CUE Environmental Services Inc. 90TS615301 T-395 P.02/E3 F-272 CML Rete 1015544001 Client POtl Prc-Paid ColisMO3 ClientNme TohbenSpurklandRE PrintedDate/Tims 0826,7001 16:07 ProjectNamet" Lot 5Bik3Hampton Hills CollectedDate/t'ime 08272001 10:30 Client Sample ID Lot S Blk 3 Hompton Hills Received Dataft'Ime 08222001 10:59 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By MID 0 Releeaed Sample Remuhr. Pw&Teter RclultsPOL lJn(o Method AllowAblc Prep Ansrysis Limits Daft Dom Init Waters Denartamint Ntrrat6N 3.84 MiernhinlQu tabGratary Total Coliform 87 OB W/Coli-No FC 0.500 myL EPA 300.0 (<I0) 08/22101 SCL coVl00mL S.M189222B (<I) 08MAI SKW A6g-26-01 14:28 CT&E Anchorage/Micro 907 561-5301 _ P.02 PAID CT&E Environmen"lServiceSainj.Ur k°V6UConfirmation fi Laboratory Division rii����������iiuii�iiiiii.���ii���������������� 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage, s-23a�ta-teos READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTMO SAMPLE . Fax: (907) 561-5301 ❑ PUSUC WATER SYSTEM IDM �I PRIVATE WATER SYSTEM Send Results Send Invoice yrs M...' On•/y M�r�• p �Y SAMPLE TYPE Fe. sew ❑ Treated Water cn aM ❑ Send Resvhs Send invoice w N.•• wu... r• v oa. SAMPLE DATE: ® ® m ❑ r.•u or .r SAMPLE TYPE Fe. txRoutine ❑ Treated Water ❑ Repast SampleUntreated Water (roller to lab no. t ❑ Special Frurpose / Fax Time Collected Location Collected fi :1 S�.+►Ibi.y Wllacba: by Omtian: i+rtt5 (Ci3O 1. Analysis ohms We Water SAMPLE to be: ❑ Satisfactory $' Unsatisfactory - l� Sample over 00 hogs ok':tesub may be unrollob4. Data Received: 0AV—Ple Ttme Received: /Os -2 Arrlysis Began: 1. Analytical Meal : � Membrane FAer ❑ MMO-MUG l..... _ Lab Rol No. II p -t OC Result' O_!p Analyst 1015544 belt to AUtI:: ANC FBK AN ❑ Del Time. Fe. Client notMed of unsatisfactory results: Fra Date: •�SrO T./4�lL / Fax WOTE 161.00ICAL WATER ANAYSIS RECORD MMO-MUG Result Total Collfo E Coil �C Me, 41 "Fllban Direct Count jO. nle'eM00ml TMK.TeOa 4O ft VeMcatbn: LTD UXqnr a.rrn•'tt A0_4e BOB Focal Collform Conflr nati : � Final MemGam Filter colformirl"" GO l Dab: Time: h Reported By:�t Comnerxs: \T' "VEMSMernber of the 802 Group 4SOo11616 OMNrals de Surveltim") 2.. � a5a0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMANSERVICEQC0001_1 Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0� h %'�� 70 HAA 1. GENERAL INFORMATION Complete legal descriptionAmp, r 11s �l Location (site address or directions) f 6) 270 9"'." �' D'— V Property owner Mailing address re�LL Day phone 3V6- V'? Lending agency dow-e-eZ ui rl �, Day phone Mailing address_ r U Agent 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 Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site / Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ;2-025(How 1/91) Front MOAM21 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. � 11 1 p l Name of Firm o �b h SDIP(' � V,1CX LA �' Phone Address Engineer's signature 6. DHHS SIGNATURE Approved for�zu`' bedrooms. Disapproved. Conditional approval for Additional Comments F� ,2D % Date —11-7- 6. IZ bedrooms, with the following stipulations: By. w..� c Date is The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 021 ® Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST hs Legal Description: L 13W3m b� s Parcel I.D. OIS - 13q `70 A. WELL DATA Well type TZ" If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) -ir'1/A — Date completed ?>' 12-' 1%1 _ Driller & I p i 0 e- Casedto Iq I Casing height f-15 Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION rn c Date of test 13' 12 - r 1 1 1' 9 3 o z n Static water level % y Well flow g g.p.m. �. `� g.p.m.< _. < a �U Pump level O o I BO 4,-Im Z c4f N � o c SEPARATION DISTANCES FROM WELL TO: z Septic/holding tank on lot On adjacent lots Absorption field on lot I a0 ; On adjacent lots �o 2 D Public sewer main � Public sewer manhole/cleanout K��4 Sewer service line i 5 Petroleum tank N n WATER SAMPLE RESULTS: Coliform - 0 ._ Nitrate — 2 3•J J Other bacteria Date of sample: t �'� qas Collected by: S �ka.�4 B. SEPTIC/HOLDING TANK DATA Date installed �n��1— Tank size— Ia-g �! Compartments 1z Cleanouts (Y/N) ___ Foundation cleanout (Y/N) ( Depression (Y/N) High water alarm (Y/N) M�p� Alarm tested (Y/N) N�/a Date of pumping 7/7�7_l9 Z Pumper opo t 1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 112S On adjacent lots i d 20 Foundation To property line _ % 10 Absorption field Surface water/drainage — N 1L�, AC) Water main/service line i 50 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. DIRT 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 Date installed 312.0 Soil rating Length 34 Width "Pump off' level at Cycles tested Surface water _ 115 System type Gravel thickness (�,• _1� Total depth / !& ± Total absorption area q � CO) Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) 1\k Date of adequacy test for 47 bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wel I on lot ) a d On adjacent lots ) /2c) Property line 7 y O To building foundation o2-3 To existing or abandoned system on lot N/A On adjacent lots lS Cutbank NO " 2 Water main/service line > Surface water l d Driveway, parking/vehicle storage area V 1,40/2 ✓ Gtr i'� uj� Curtain drain E. ENGINEER'S CERTIFICATION�x� I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name (o� V1 f7 v ✓ V Date HAA Fee $ Date of Payment Receipt Number o2 V VO 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C714-)- 1?�L{ �� HAA # L- LA \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 6.a(- S 13(ac (r 3 b7am1aAw) /411(r SIL) Location (address or directions) /0 27 O /frim p fan Dr1�c (b) Property owner iZ � serf McQO{ Telephone: (home) 3gL-71VO Business S6/- l26S Mailing Address 1 G 270 �}umr� %� Dr i ie All C 4 e�e 1+6-c99s 16- (c) Lending Institution �A !`turfc/uq� Telephone SG Mailing Address 1o! T-" do Ra•J /4-hc Ao,, /�-ae 99 SG 3 (d) Real Estate Company and Agent e f`Ztix pt-o—Rve h:'tl F" - Address - Address 2600 COrr&Utlez Sf A-nC60/-eLg A('C 9 9s0-7 Telephone 2 7 6� -2 76' (e) Mail the HAA to the following address: (or check here IZ, if hold for pick up.) List contact person and day phone number below: Oris yS- l35'S" 2. TYPE OF RESIDENCE Single -Family tK 3. WATER SUPPLY Number of bedrooms `�N Individual Well 5? Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site N Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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 inspection. Name of Firm F10H01P 1 ec.6n�ca/ v✓ Telephone 3`YS- /3 Address lW,73 G Ecya 9,9,—Ind Date Ap 0 N b1 ' • a • P, 5 • �:€.� '. TH1000PE r. MOORE ;• r'.3' CE - 3539 0; /9 •.,•.•.•••,.•'�• ineer's Seal 6. DHHS APPROVAL / q Approved for bedrooms byA41, ate Approved �� Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 P,G,rO 011 50�� J A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) 0-6 Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: t0S _'� F1K3 N4MPTONYIII.s If A, B, C, D.E.C. Approved (Y/N) KA . Well Log Present (Y/N) M'� Date Completed 3 /12 Yield >S. ly GPM MC45 /o�iAo Total Depth— I 9! Cased to IDepth of Grouting t\l,A - Static Water level _1-13 ME s' lolqlqo Pump Set At - 160 Casing Height Above Ground 15 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) YES Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 130'_ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /0o' On Adjoining Lots _ 00 ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot /0 /00 ` Water Sample Collected by FL 6770(' Trc y 5✓r S ; Date zolYL90 Water Sample Test Results : cabr� 6 D co (r,><vrm /loom Q 3"3 nolle nrAPr4 k -/✓ Comments u _r,12 well J�:/&w ke./- 0-1) 101919a ��ac<< uro in oaf 6�z u/ GC Max �rtn>� u¢ u{ ©F l c✓eyp^ CGe"./e0(uidfew leve/ /nf/de tt7leiu 6 6'e eeraCV/) acrcUn 7/0 l f�O ` (a u7 ho ycer fuer B. SEPTIC/HOLDING TANK DATA Date Installed 3/2"/8' Size 1250 G No. of Compartments Standpipes (Y/N) YCS —Air -tight Caps (Y/N) YeE Foundation Cleanout (Y/N)_kNo (irlr/a/ hui Depression over Tank (Y/N) N0 Date Last Pumped 7/rll g6, ti Sh on ar-lf Pumping/Maintenance Contact on File (Y/N) N.A ; for N,A - Holding Tank High -Water Alarm (Y/N) 1,4A Temporary Holding Tank Permit (Y/N) N•A . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well — 130' FRon C•D To Building Foundation 16 TO C.D, To Property Line ;�7 70 To Disposal Field 7 (tKR As gv)r. To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments * `l" In - 1//7z 5264-0er e (2eao sctf (v eahv'l rnr_/d&- JQC440(el-011 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata j IS /(3c�k'/ ( Type of System Design "TRFt4CY Date Installed 3 1201SI Length of Field 36 Width of Field .� / Depth of Field Gravel Bed Thickness lo—s— / 6.S , Square Feet of Absortion Area q68 a Statndpipes Present (Y/N) y� S Depression over Field (Y/N) N0 Date of Last Adequacy Test Results of Last Adequacy Test Aa(e ua(-e �� H beoCrooms SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well 130-r-koM C.o. To Property Line 20 # To Building Foundation 2S ' 'FeoM C. 0. To Existing or Abandoned System on Lot On Adjoining Lots /Do To Water Main/Service Line M1 20 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course i /oo To Driveway, Parking Area, or Vehicle Storage Area T e'E CN PRssEs UNDER PeiVeWA`/ Comments APPCAR3 To BE A-OtrQvA-rE COVER To PREv&Nr FRCEzir-16 OF D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and H��11 "dstiQ effect on the date of this inspection. ///// E ''� • °.°° } �b SpA /J Signed � r�' ' (�'�• ° '� s'° J, °. Company. F(n firm %cti S�cC I_ ` ° f� �t°.......o°°. e°oeoe°o°•o°°° Date Gc{ober 1( Engineer's Seal 1940', MOA No. 90 —Old3 4 Lc - 35.�? o, ,/p Receipt No. Date of Payment ��� r/' `� D Amount: $ 170 72-026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 - i-6— - DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME - I/�) l 1C_D l- 1_' 4 DATE DATE _L'1( DATE ❑ One r:J_ Four ❑ Other_ ❑ Two ❑ Five INSPECTOR INSPECT- INSPECTOR -- INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY A ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEcffiMONMENTAL PC:OTECTION 825 1. Street - Anchorage, Alaska 99501 �J INDIVIDUAL/ON-SITE** • JUS 1 3 19€i1 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER - - PHONE(J//� J / A MAILING ADDRESS - PROPERTY RESIDENT (If different from above) - PHONE 2. BUYER _v� - PHONE. MAILING ADDRESS. - - 3. LENDING INSTITUTION f c� PHONE X-I')- MAILINGADDRESS MAILING -T—REALTOR/AGENT -- O PHONE MAILINGADDRESS - - -. - 5. LEGAL. DESCRIPTION STREET LOCATION - REE"NC� 6. TYPELJ,--'S NUMBER OFsBEDROOMVS - �F LJ, SINGLE FAMILY ❑ One r:J_ Four ❑ Other_ ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPP -- INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975, For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE�DIS !OSAL SYSTEM s �J INDIVIDUAL/ON-SITE** -YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79) - /] J 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED r3 Fj INSTALLER ❑Septi Tank or ❑ Holding Tank Size: D -V' If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE 8Y n J 72-010 (Rev. 6/79) i OCT 02 '90 13:44 REMA`{ PROPERTIES P.1 l";i I t 'mow L=3 I I ; IVTPi.9`4 i Q � •l ' sYs re". a ' LUT S Q �"2 . I I • I Lot r Flock Anchor q "r�ecordln preoinci, Alaska to f - LO SURVEY cFR IF'I(:AT(ON . Iberabyeaelifylhatlhavesurveyed the propertyshownanddascribed LEGEND �°"'" •• fMxeOn,Md that the knprpve erAa situated theroon are within the u0p- : trop Pped morwment recovered' '�' = L3fa5S Ga arty lines em on od ooafrd p encroach ad'aGeni Property and that no q Pipe and/or mbar rectrvOred a6` sti. �� 1. kf ; +7 improvamerns on odjacenl Prperly overlap or�encraarh On the WOrnisss 2x2 huh tOGk reGOverod In question fund that there or r'°•: y nO roadways, utility tinea ar Other visible a/8 x 30'rebar sal this survey BOSErt�BrYti an sold properly (except es indicated hereon. Scale �,.����►t -- - Y FtD) f fir✓-% Prepared by: R 1.! 7rTON