HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 2
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171340 PID Number: 015-051-40
Dwelling: ❑t Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Dane & Alayne Larsen ABSORPTION FIELD
Address ❑ Deep Trench LI Shallow Trench 0 Bed ❑ Mound
9138 Arlon St Suite A-3 Box 700, Anch, 99507 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 0.4 GPD/SF 4.4 - 5.5 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.9 - 5.0 Ft. 0.5 Ft.
Spring Hills Estates 1 2 Fill added above original grade Gravel length
Township Range Section 0.0 - 0.7 Ft. 53 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 29 AFt. 5 6 Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 1537 Ft2 Ft.
Well 100+ 100+ TANK ■❑Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water 100+ 100+ Anchorage Tank 1000 Gal.
Material Number of compartments
Lot Line 5+ 10+ NA Steel 2
Foundation 10+ 10+ LIFT STATION
Manufacturer Capacity
Curtain Drain None i Known i Gal.
Pump on level at Pump off level at High water alarm at
Remarks Old tank abandoned in-place.
Old drainfield and contaminated soil removed in. in. in.
and rebuilt in-place. Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to D3034
Installer _ drainfield ____
ARM Services Drainfield D3034 CO/MT D3034
Inspector Crewdson Engineering LLC BENCH MARK (Assumed elevation) 100 ft
Inspection 8-3--18
15t 7-24-18 2,0 7-24-18 Location and description
dates:
3`° 7-255. _____-18 4'" 8 18. Top of garage slab (see record drawing)
Enginegr Stamp
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL `�NNANNA
S�� OF At. 1
Conditional Approval: _ Date__ ,<P•.• �� ..../.611
s',f,�l1
9 It
.. ;01 r s. /
--- - . — / �'V James ACrewdson
/ � • .11527 .•• //
Appro _ �--- (/(14Date ��� ����OFESSIONP=
AL\G� �N 279
Inspection Report_9-1-12.doc
\
\ M1 M3
ri EG 90.4' EG 895
\ a
M4 °TH3 FG 90.9 FG 90.2'
`�• \ • 2017 1S'n' SI S2 M2 M4
BENCH MARK EG 92.0' EG 91.5' EG 91.0' EG 89.7'
r`L\ CS C6 a FG 91.0' FG 89.9'
TOP OF GARAGE SLAB FG 92.2' FG 91.7'
C2- TH3
y y\M3 • C2 ASSUMED ELEV 100' FC DC C1 C6 EG 86.3'
bo v2\o :ED I-h�'J !Mil
Zil _1 29Wx 53'L x 0.5'ED _
Z\ =MEM I H2O
N y\ SEPTIC TANK BED 8.0'BGL
o.1\ ELEV: ELEV: ELEV 78.3'
ON\ TOT 87.46' TOP OF ROCK 86.55' 10-26-17
INLET INV 86.88' DRAIN PIPE INV 86.05' BOH
V-‘
OUTLET INV 86.71' BOTTOM OF ROCK 85.51' 13'BGL
FILTER SAND USED TO ELEV 73.3'
\ • a LEVEL BOTTOM OF HOLE
\ rn Cl M2
a
\ ° DC
\ M1
*S2 SEPTIC TANK
PROFILE
STEEL AT-1000
1 7p0'W S1 NOT TO SCALE
�DS
I
LOT 2
i TH2
a I (1984) N. .--
SWING TIES(FEET)
k \ A B C
0 I \ FC 24.0 1.4
N:
I
t BENCHMARK • Si 51.6 50.2
TOP OF SLAB S2 57.3 56.5
I B
j DC 60.9 60.3
Ct r Cl 68.4 67.6
Q I _--_a---, C2 109.2 115.4
a C3 109.5 115.8
r F0 •
IIIC4 112.3 115.9
/ 3 BR SFH C5 114.4 116.7
If r C6 115.3 116.2
I M1 62.3 65.6
1 • M2 74.8 69.7
WELL
/ OM/ M3 108.7 115.1
i M4 1 116.3 117.2
i
LEGEND FC-foundation CO
NOTES BGL-below ground level FG-finish grade
1. EXISTING 1984 SEPTIC TANK WAS BOH-bottom of hole GRW-groundwater
ABANDONED IN PLACE IN ACCORDANCE WITH BR-bedroom L-long
THE CODE CO-cleanout M#-monitor tube
PLAN 2. EXISTING 1984 ABSORPTION FIELD AND DC-double CO SFH-single family home
CONTAMINATED SOIL WAS REMOVED AND ED-effective depth S#-septic tank cleanout
SCALE: 1"=30' REBUILT IN-PLACE EG-existing ground W-wide
ELEV-elevation
•
Crewdson Engineering. LLC Spring Hills Estates, Block 1, Lot 2 •
Record Drawing
PLAN & PROFILE A•
••.41••James A.Crewdson .
c• C11527 �`,
Civil Environmental Engineering Prepared for: Dale.Larsen Date: 8-15-18 �1F9� 1S.i$.
c.
PO Box 671389 Chugiak AK 99567 • cellc.1(L�outIook.com
Permit: OSP171340 Page: 2 of 2 pROFESS10Np
CelllTeM:907-280-9493 • Fax:907-688.2295 ALL INFORMATION SHOWN ON THIS DOCUMENT IS THE PROPERTY OF JAMESA CREWDSON,P.E.AND SHALL NOTRE USED FOR ALLC#112279
ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM JAMES A CREWDSON.P.E.
0, AL,„. MUNICIPALITY OF ANCHORAGE
.0rcnt
7 • On-Site Water&Wastewater Program ��� Sr;
r 4.1/e\ PO Box 196650 4700 Elmore Road _ 1
t Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,-y
%' http://www.muni.org/onsite
)( partntt•ut
On-Site Wastewater Disposal System Permit
Permit Number: OSP171340 Effective Date: 11/8/2017
Work Type: Septic Upgrade Expiration Date: 11/8/2018
Tax Code Number: 01505140000
Site Legal Address: SPRING HILLS ESTATES BLK 1 LT 2 G:2436
Site Mailing Address: 9301 SPRING HILL DR, Anchorage
Owner: LARSEN DANE C & ALAYNE A Lot Size in Sq Ft: 46146
Design Engineer: CREWDSON ENGINEERING, LLC Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field Septic Tank ❑ Holding Tank ❑ Privy 0 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
Ara
I "
Received By: la Date: ! 7 f
Issued By: 0Av, -'(`--//).-
14/111
/ A i� _� _ Date: l//g / 7
r`a� s"� 1 ICIPAL DIY OF 14\ NCH • ; ,\GE
�
•
0,„ill
Community Development Department l.? Phone:„907-343r-; 904
Development Services Division F- c -3 J
On-Site Water & ti
Wastewater Program 'A
ON-SITE SEWER/WELL PERMIT APPLICATION a OCT 31 2017
Parcel I_D. �
a -US 1 Ll O h�
,,++�� 6 Q I, 9�
Property owner(s) Uo►.1.4 g C.A.eSe 1,) Day phon
Mailing addressq(39 AriS4. ST6 A-3 3ex-9d0
03).VD`aaaa
p1,
Site address ?JO"I _ pri vt : L ( .f� �� ! p J'
Legal description (Sub'd., Block Lot) sfelt % �� G`f�o►�tS Df ck 1 t Leo ,)
Legal description (Township, Range & Section)
Lot Size �� f G Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field Initial ❑ Single Family (SF) g
(w/wo A D U)
Septic Tank Upgrade
Duplex (D)
Holding Tank ❑ Renewal ❑
❑ 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
applicabl- Municipal Codes.
( ig re of property owner or authorized agent)
Permit/Rush Fees: fi��9 Waiver Fees:
Date of Payment: /5/3/ //3- Date of Payment:
Receipt Number: 61/0Receipt Number:
Permit No. 0.5Pf'-r✓b Waiver No.
Permit App_9-1-12.doc
Crewdson Enatneer1ng,
James "Jay" Crewdson, P.E.
11);411111
Email: CELLC.1@outlook.com
Cell/Text: (907) 280-9493
Fax: (907)688-2295
`moo.
avil&Environmental Engineering
November 7, 2017
Municipality of Anchorage
On-site Water& Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Attention: On-site Engineer
Reference: Spring Hills Estates, Block 1, Lot 2
Septic System Upgrade
Design Narrative
The owner of the subject property with a 3-bedroom single family home would like to upgrade the existing
1984 septic system with a new septic tank and drainfield using conventional treatment.
The existing septic tank will either be decommissioned in place or completely removed from the property
in accordance with the code. The proposed septic tank will be located near the location of the existing
septic tank.
The existing drainfield will be removed along with any contaminated soil and replaced with a new
drainfield constructed in the same location. The design requires a current assumed seasonal high
groundwater elevation reading be used to determine the total depth of the new drainfield.The proposed
drainfield is conservatively sized using the percolation rates determined in Test Hole 2 (1984) and Test
Hole 3 (2017). Although the middle of the drainfield is not within 30 feet of a percolation test, we feel it
is not necessary given the known percolation rates in the general area and the conservative proposed
design.
There are no known conflicts with any required separation distances. All known private well protection
radii within 50 feet of the septic system are shown.
Please feel free to contact me if you have any questions.
•
i
Thanks, ,
11 leii` o
Itf
Jamec7Jay" Crewdson, P.E. � / //�
PO Box 671389 • 18368 Amonson Road • Chugiak,Alaska 99567
114g,,
I PROJECT NOTES AMD REQUIREMENTS
°TH3 I 1 1. KNOWN WELL PROTECTIVE RADII WITHIN 50'OF
`,�, 1I l /
I 1 THE SEPTIC SYSTEM ARE SHOWN
1 / 2. ALL CONSTRUCTION SHALL BE JAW AMC 15.65
l �1
yI 1 3. ALL PIPE SHALL BE NEW 4"0 ASTM D3034 PVC
J N P)DRAINFIELD COI I 4. THE CONTRACTOR SHALL DISCUSS POTENTIAI.
a 1 (5 TYP) I . I DAMAGE TO TREES WITH THE HOME OWNER
` `\ I AND ENGINEER PRIOR TO CONSTRUCTION.
t I U I DRAINFIELD AND SEPTIC T : DES NCR E- •
$` E)(P)BED I U I 1. BEDROOMS 3
W 2. SOILS:TH2 13.6 MPI 1984 IR)
N1 0 l w 1 g TH3 1.5 MPI 2017) C t{
I—
bI o I N I co 3. BED APPLICATION ' ' E 66p3/SF
111 i 0 1 I w 4. BED DIMENSIONS: •3'x29'
w w 5. GROUNDWATER:8.I' TH3 17
1 P)DRAINFIELD MTI 1•111- b 7.5' 10-31- PER MOA)
(4 TYP) I'' c 6 EFFECTIVE DEPTH 0.5'
1 / \ I I 7. TOTAL DEPTH(TO):3.5'BGL(BOTTOM OF ROCK)
1 I g 8. SAND FILTER:USE TO ACHIEVE TD ELEV.
ESTIMATED TO BE APPROX 1'TO 2'.BUT WON'T
DC I 1 KNOW UNTIL ALL CONTAMINATED SOIL HAS
I ST23 ",.........-( SEPTIC TANK 1 I BEEN REMOVED
�_ (P SEPTIC TANK 1 1 9 1000 GALLON SEPTIC TANK
' 1 ST}H2 ' I I RAR BED AND CONTAMINATED SOIL
/./.
.---<_--Z1 1 1 1. EQUIPMENT SHALL NOT BE DRIVEN ON THE BOH
el :- EXCAVATION AND ANY NEW CONSTRUCTION
` I 1 2. BOH SHALL BE SCARIFIED/RAKED PRIOR TO
To `
II I ' .7%,\ 1 1 PLACEMENT OF FILTER SAND
3. ALL FILL UNDER THE DRAINFIELD SHALL BE
o -<< I FILTER SAND
n: \ PAVED iL I 4. DISTRIBUTION PIPES:EVENLY SPACE ACROSS
IVEWAY LS' I I THE BED,3'MAX FROM BED SIDEWALL,6'MAX
----_- J 1 I BETWEEN LONGITUDINAL PIPE RUNS
1 5. CONTAMINATED SOIL MAY BE USED FOR FILL
ONSITE,BUT SHALL NOT BE PLACED WITHIN 1'
\ 1 I OF FINISHED GRADE
O I
I DSR SEPTIC TANK
I 1 SEWAGE TRANSMISSION LINES SHALL BE
V I I I BEDDED ON UNDISTURBED GROUND OR
I I ` I APPROVED MATERIAL COMPACTED TO 95%
2.
`4: ! PIPE SLOPES: 2%MIN INLET,1%MIN OUTLET
V I 3. INSTALL DC 10'MAX FROM OUTLET
'V ! I
! (E)F� I INSPECTIONS
/ I 1 ENGINEER SHALL BE NOTIFIED WHEN THE
Q I CONTRACTOR IS MOBILIZING TO THE WORKSITE
f, ! I I AND AT LEAST 2 HOURS PRIOR TO EACH OF THE
' J ! 3 BR SFH I I 1 FOLLOWING REQUIRED INSPECTIONS.
! I INSPECTION 1:ENGINEER AND CONTRACTOR
ONSITE PRE-CONSTRUCTION MEETING
I INSPECTION 2:BOTTOM OF DRAINFIELD
/ 0 WELL
EXCAVATION AFTER SCARIFICATION/RAKING
/ I 1 I INSPECTION 4:SEPTIC TANK PRIOR PIPE
I I BACKFILL ABOVE THE SPRINGLINE
j
INSPECTION 5:FINAL GRADING
I I LEGEND FC foundation CO
I /I (E) existing FG-finish grade
'96a° I I (P) proposed GRW-groundwater
F / I BEG-below EG IAW-in accordance with
ts�ro I I BGL-below ground level IR-inspection report i ,,:i
1 BOH-bottom of hole MPI-minute per inch
BR-bedroom MT-monitor tube
CO-cleanout R&R-remove&replace
PLAN 1 DC double CO SF-square foot
SCALE 1"=3Q' D&R-decom.&replace SFH-single family home
EG-existing ground ST-septic tank cleanout
Crewdson Engineering, LL,C Spring Hills Estates, Block 1. Lot 2
Septic Upgrade Design *`STM ;�
••{/James A.Crewdson : 0:,
O I Prepared for: Dale Larsen Date: 11-7-17 rF'�Fo:- (7 �����
Civil&Environmental Engineering •
PO 6ox 671369 Chuglak AK 99567 • cells 1 @outlook corn
Permit: OSP171340 Page: 1 of 1 PNoFEssioN �
Cell/Text 007-280-9493 • Fax907-688-2295 4l INFORMATION SHOWN ON THIS DOCUMENT 15 THE PROPERTY OF,MMES A CREYWSON,P E IID SNAIL NOT BE USED FUR ALLC#112279I
ENGINEERING OR CONSTRUCTION PURPOSES YNTNOUT WRITTEN PERMISSION FROM IVES A CREWOSON PE _-_I
///02 $ SOILS LOG
=--.; MUNIC ' ' TY OF ANCHORAGE >1,
• (P DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
1\+c' 825 L. Street, Anchorage, Alaska 99501 264.4720
�` SOILS LOG - PERCOLATION TEST
PERFORMED FOR: b avid , cintohled DATE PERFORMED: 4 /3-90-
LEGAL
3v0-
LEGAL DESCRIPTION: 40 2 fl l3'/ kS
/ pr H SLE/ 1 115 Sid'ti;
si �
SITE PLAN
!, 11 Vrrefrbk 5'f.if ,J/04 (o )
2 - I
(&L) -- go
_
a - I S;/ 7 (mov el Y.
0
5 - II . di-7 , /,)h-- brow~
6 - i (6 tkl)
8 I —tr4F4-a____
9 - /Ord Cprar ve//r _ .5WC_'i _.
1 1 — ' I) WAS GROUND WATER J S !e
ENCOUNTERED? /y 8 L
r °D
12 - P
IF YES,AT WHAT E
I _
13 - DEPTH?
c.'il les, /o . — --
14 — - Reading Date Gross Net Depth to Net
Time Time Water Drop
15 -
4-No i 443-84 z:vS- , 0.50
-lel, 2:is , fo o.zg 4.2 I
16 - -040 1- - 2:)6 11!2-() :/0 o,,ro/o,3s ods--
,4.NO 3 2:27/2:;7 .'/CP d.s6/o,A 0.fit
17 - 2:3E? 0.5-0
11/60 4- i:48 :/o 0.349 0, /2
18 - 2.49 0,So /� y
¢ LO S Z:s-5 •/o 0,3e 0.�2..
19 '40 G 3:/ 0: /o p;p o,!/
20-
I PERCOLATION RATE /3, C (minutes/inch)
/ TEST RUNr .c� BETWEEN - FT AND _�< Z FT
.5
COMMENTS i�/S ra hd a! /U n per hedfrooN�/1 - wPek'1 3 am d
PERFORMED BY: ! OntieY / !!it CERTIFIED BY: / DATE: '
/t/a4 sr91-O z I I
72-008 (6/19)
i
ALLC #112279
E OF A4vVk
Municipality of Anchorage 'sP'' •'•• 1"
El)
Development Services Department
Building Safety Division ; 4 r ,`
On-Site Water and Wastewater Program4700 Elmore Road P.O.Box 196650 Anchorage,AK 99507 �? •
•. es A. Crewdson /
www.ci.anchoracie.ak.us
(907)343-7904 TI, • /•.C11.527
Soils Log - Percolation Test �‘ PROFESSto-
Performed For: Dane Larsen Date Performed: 10-19-17
Legal Description: Spring Hills Estates,Block 1,Lot 2 Township, Range,Section:
Slope Site Plan
TH 3
Depth
(Feet) SEE DESIGN SEE DESIGN
1-
2- OL
3-
•4-
5-
6-
7-
8- GM
WAS GROUND WATER
9- ENCOUNTERED? slight seep
10- IF YES,ATWHATDEPTH? 9' 0 SEE DESIGN
Depth to Water After
11- Monitoring? 8 E
12- Date: 10-26-17
13- BOH _ Perc hole presoaked✓
14- Reading Date Gross Time Net Time Depth to Water Net Drop
15- 10-19-17 8.4 minutes 6 inches
16- 8.8 minutes 6 inches
17- 8.9 minutes 6 inches
18-
19-
20-
PERCOLATION RATE 1.5 (minutes/inch} PERC HOLE DIAMETER 6 Inch
TEST RUN BETWEEN 6 FT AND 6.5 FT
COMMENTS Last three readings shown
PERFORMED BY: Crewdson Engineering LLC I James Crewdson CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
NAME
MAILING ADDRESS
........... '~ z., ~ ~ t ~OO
LEGAL DESCRIPTIQN
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
PHONE 7~L~'
[~ NEW
[] UPGRADE
LOCATION
Well . Absorption area Dwelling
DISTANCE TO:
~-~ Manufacturer ~/~ ~.¢~.,,~ Material
~ Liq, capac ty nga OhS Inside length Wdth
/ 0CO IF HOMEMADE:
DISTANCE TO: Well
Manufacturer
We]~ n~/- ,',~
DISTANCE TO:
No.~iines ~Length~/J°f ~each line~
Top of tile to finish grade
NO, OFBEDROQMS
/2.
No. of compartments ~.
Liquid depth
Dwelling PERMIT NO.
Material Liquid capacity in gallons
Foundation .,/~ Q~ Nearest lot line /O ?t_ PERMIT~O).~ ~.2. 1 t~
Length ' Width
Type of crib Crib diameter
DISTANCE TO:
C~ass
DISTANCE TO:
Depth,
Total length of lines
Material beneath tile
Depth
Trench width
.,.~../ inches
inches
Crib depth
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
I'w
PERMIT NO. g3 ~/0 .~/,~,
Distance between lines
Total effective absorJ~tion area
/3 '7 7- t.7'
PERMIT NO.
Total effective absorption area
Building foundation Nearest lot line
Distance to lot line PERMIT NO,
Septic tank ¢ Absorpt on area(s)
APPROVED
72-013 (Rev. 3/78)
DATE
LEGAL
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E:' ]: ~!i;TI:::INCE::!!~, F:'ROM I:::IN'~" E::',:':: I :E;"I~ :[ NEi I,.IE:I....[ .... klf::I:!~:;TEHFITEZR E:' t ~,POE;FIL ?T't~]TEP'I OR I::'UE:L I C
?,Et.,.IEFi'.F'tEiI!i!: E;'??I"E!]'I ON TI"-IIiE; OR I:::lN"r' F:IE:'JFiCFSNT O1:~'. i",IE::f::IRE',"r' L. OT.
4. :[ L.IN[)IER~!];TFIN[) ]"1 'IFFI" 'T'I'I I :]:~; I:::'ERH :r. T I E; ',,,'FI[.. :1: E:' FOR F:I MFI::':', 1' MIJM OF: 7J: E:E:[-"ROCfl"t'.E; FIN[:'
19N"r' ENL..I:::IRGE:HI!!~NT I.,.! I I....L REG!U .I: RE: FIN F:I[:'D T T Z ONI::IL F:'E]:]:M I T.
i f 19 I.... I F'T ~!;'T'f::l]" ]: ON I i~; l N:E;TF:ILL. E!:E.' i N F:IN I=Ii:?.E!:I:::i CO',,,'EI:;i'.L::I} E~'? I'"tC)F:I E:IJ I L..I} :[ NG
THiE]",! ':: ::L ::' I::IN I!!]....E:CTR I IS:FII:. F'ISI:iff"I I ]" I:::INI} I N:i~;F'E.:]]:T I Ol",l MIJ::J!;T t'3E OE:Tf:i I .~',I[Z[:'.~ ,:: ;:2.': ::, F/'.'~i;'""EflJ Z L.T~;
I'.1:1: I....L f',ICFF E:E I::IF'I::'RC)',,,'E:]} kl I THC)UT FIF,I EiL[ii:CTI:;i: I CI:::IL. I I",IE;F'E:CT t ON REPORT.~ FIN[) ':: :i: ::' 'T'HE
ISLIZCTR Z CF:IL.. 14ORK I"ILIE;]' I?,E: [:'ONEE Eft'/ 19 I... ]: CE:N'.Ei;E:]} EI....ECTR I C :[ I::11",].
. .......... ......
F:IPt::'L I CI::II',I'T': [),!i'.:S I..,t1'.,1t/~i[ 1"'1 .T TED ·
/!
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
72-008 (6/79)
DATE PERFORMED: ~/-~'%~J'~
5,'//
SLOPE ~ SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
,,~ 14.o ~ -'/w~.-t~¢ /":~'/ ~' ~-~
~.'. Oo
· ¢ flzO 3 'z ', i I o,
z~43 "lO o,4v
PERCOLATION RATE alT"" '~'~ (minutes/inch)
TEST~NSETWEEN ~'ET AND --~r---=:-- ET
-
/
¢~./~
c
PERFORMED FOR:
LEGAL DESCRIPTION;
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
WAS GROUND WATER N ~
ENCOUNTERED? O
O
P
E
IF YES, ATWHAT ~
DEPTH?
Gross Net Depth to Net
Reading Date Time 'rime Water Drop
z:/¢ o, zg
2 ,' 3 ~ 0,50
¢~zo ~ z: 48 ~/o o, 3~ O, t3
2~4q
PERCOLATION RATE
TEST RUN BETWEEN
/¢o/¢ -o ¢
/~'~ g (minutes/inch)
~ CT AND . 3~.~__ FT
-Fl." p,.-
CERTIFIED'Y: ~7 - ~ DATE:::__
Well Owner
DESIGNS IN WOOD
~I'W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349.8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Use of Well DOmestic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 2 Block i Spring ltills - Anchorage
Size of casing. 6"
Static water level 215
Screen ( ); Perforated ( ).
Describe screen or perforation,, N, one.
Well pumping test at l0 gallons per (tf~tit9
of drawdown from static level.
Date of completion August 2, 198h
.Depth of Hole 25h feet Cased to 253.h0 feet
ft. (/~B'cYg~) (below) land surface, Finish of well (check one) open end ( X );
(minute) for i hours with 1005 ~.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO. 2 Casing stickup
2 .TO. 12
12 .TO. 25
25 .TO. 35
35 .TO, 60
60 .TO. 80
80 TO l_~l~
125 TO 174
174 TO 180_
180 TO 21~
215 TO 2h0 _
_ 240 TO 254
TO
TO
Brown silty gravel
Brown sander ~;ravel
Bro~ sandy ~ravel ,
Gr~v silt w/gravel - weeping
Gray silt w/gravel ~ occasional
Bro~
Brown silty ~ravel
Waterbearing gravel - Low Head
3- CONTRACTOR
MUNICIPALITY OF ANCHOR Ar'� f ' fq�,21
/ • a- AUG 15 2018 a
Development Services Department hone: 907-34 -7:04
On-Site Water & Wastewater Section `<< ax: 907-• - 997
H� 0! 60G9o,
S Certificate of On-Site Systems Approval
pU
Parcel I.D. 015-051-40 Expiration Date: 11_ I (0.—ic�
1. GENERAL INFORMATION
Complete Jegal description Spring Hills Estates, Block 1 , Lot 2
Location (site.address) 93.01 Spring Hill Dr., Anchorage
Current property owner(s) Dane & Alayne Larsen Day phone
Mailing address .9138 Arlon St Suite A-3 Box 700, Anch.,AK, 99507
Real restate 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: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well LI Private Septic 0
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 $ 100 Waiver Fee $
Date of Payment 1'(5510 Date of Payment
Receipt Number 601346 Receipt Number
COSA# ()VI 9!Li [3 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 Crewdson Engineering, LLC Phone 907-280-9493
Address PO Box 671389, Chugiak, AK 99567
Engineer's Printed Name James Crewdson Date F5 -/ -/ /
ALC•CII�a9-Z— x�\\
OF A<\�1
4.P•
.....gs��
6. DSD SIGNATURE ' !TH
System #1 Approved for 3 bedrooms , ' ' ^ • -
.Jamey :~Crewdson ; cc j
System #2 Approved for C11527
bedrooms
Disapproved �r1 i�•-/y. � k��'���
kgROFESSION\`_
Conditional approval for bedrooms, with the following stipulatio :
'J ON-SITE C-'%
WATER AND r-
m WASTEWATER
PROGRAM \c
By: I LA- Original Certificate Date: _ 'I
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 blue sheet
COSA Checklist
Legal Description: Spring Hills Estates, Block 1, Lot 2 Parcel ID: 015-051-40
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
El Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm
Date drilled 8-2-84 Water storage tank volume 0 gallons
Total depth 254 ft Well disinfected for coliform test? El Yes ❑ No
Cased to 254 ft Colifor •- t-ra is Negative
■❑ Sanitary seal is functioning correctly Nitrate 2 t I •/ Nitrate less than MRL (ND)
❑■ Wires are properly protected Arsenic ug/L Arsenic less than MRL(ND)
Casing height(above ground) 24 in. Collected by Crewdson Engineering
Date of flow test for COSA 1010-" Date of Sample 8-7-18
Static water level at beginning of test 208 ft.
Comments Well disinfected by Sullivan Drilling, resampled for bacteria on 8-14-18
B. TANK DATA C. LIFT STATION
Age of tank(s) 0 years ❑ Required maintenance completed
Tank type/material steel Age of lift station years
• Standpipes/foundation cleanout per record drawing Lift station material
Date of pumping new tank, pumping not required Comments:
D. ABSORPTION FIELD DATA New field,test not required
Which system tested (date installed) Adequacy test date
❑■ ALL standpipes present per record drawing Results II Pass For bedrooms
Total measured depth from grade 5.5 ft(max) Fluid depth prior to test in
Measured depth to pipe invert from grade 3.9 ft(min) Water added gal
❑ N/A—pressurized field New depth in
❑� Monitor tubes go to bottom of drainfield. If not, state Elapsed time min
depth into effective
0 Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months)
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies:
New absorption field is not required to be tested.
•
COSA Checklist yellow sheet
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' Community Sewer Manhole/Cleanout> 100'
❑■ Yes if No ft 0,Yes if No ft
Neighboring Tank > 100' 21,Yes if No ft Private Sewer/Septic Line >25' 01 Yes if No ft
Absorption Field on Lot> 100' BYes if No ft Holding Tank > 100' 21:Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' , Yes if No ft
B Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main>75' IN Yes if No ft .1 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations> 10' Lsi,Yes if No ft Surface Water> 100' 'Yes if No ft
Property Line > 5' (Z�Yes if No ft Driveway/Parking > 0' I"Yes if No, comment
Absorption Field > 5' NYes if No ft Wells on Adjacent Lots:
Water Main > 10' ix Yes if No ft Private Wells > 100' ig Yes if No ft
Water Service Line > 10' ig Yes if No ft Community Wells> 200' SYes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' NI Yes if No ft Driveway/Parking > 0' Ef Yes if No, comment
Property Line > 10' XYes if No ft Wells on Adjacent Lots:
Water Main > 10' SYes if No ft Private Wells > 100' EYes if No ft
Water Service Line > 10' IX Yes if No ft Community Wells> 200' 'Yes if No ft
Surface Water> 100' (:Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION .--0 ' F„t q�tt
I certify that 1 have determined through field inspections and review C - , 'F A
of Municipal records that the above systems are in conformance with 0.�:.4•A,1r.. rc ..7 /i
MOA COSA guidelines in effect on this date. / . ' l' R'S• . /
: ` : '/ ./
j rewdson i// .
COSA Checklist yellow sheet A Glc <�ar H
i
N 12
$9
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N SHANE A.HOLT ;OO
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4a • c247
%‘‘.°,
4�Te0 SIOna50oo
ooQ000 AS-BUILT SURVEY lea 3' Y
00 COMERS SET TINS DRIE
HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY-N\\
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, BLOCK 1, SPRING HILLS ESTATES
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED.
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES• DATED AT ANCHORAGE,A LA S KA THIS 8 TH DAY OF
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN AUGUST
HEREON ( UNLESS INDICATED) , 2 O 1 8
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
HOLT LAND SURVEYING
G
9 0
93ROVER DRIVE
ANCHORAGE,AK 99507
13856 H:; 18;-58, 189-5g 345-5513
MUNICIPALITY (~F ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.
HAA #
GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner A'~.~% ~,q~-~m,1 ,
Mailing address --f, ~
Lending agency ~ ~
Day phone
Day phone
Mailing address
Agent
Day phone_
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
.X
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 It21
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.
Address
Engineer's signature
bedrooms.
DHHS SIGNATURE ~
Approved for
Phone.
Date
Disapproved.
Conditional approval for c:~
bedrooms, with the following stipulations:
Additional Comments
The Munioipality of Anchorage Department of Mealth and Human Services (DMMS) issues Mealth Authority
Approval Oertificates based only upon the representations given in paragraph ~ above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineeds work.
72-025 (Rev. 1/9~) Back MOA ~21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type '~
Log present (Y/N)
Total depth ~-~ ~
Sanitary seal (Y/N)
Parcel I.D. OIGA~O 51
Wires properly protected (Y/N) Y
AT INSPECTIONMuN~QP^LrP~ o~ ANCHORAG~
Date of test
Staticwaterlevel
Well flow
Pump level
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed °'¢'/° 2--/,~' ~ Driller
Cased to ;2-~' L~ Casing height
FROM WELL LOG
ID
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main ~%~/,'~
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/c!eanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ¢ Nitrate
/
Date of sample: ~--_~--,~; / ~ ~ ~
~]), C//~.. Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed '~// Z/~ ~/
Cleanouts (Y/N) ~
High water alarm (Y/N)
Date of pumping ~/~ ¢.~
SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO:
Tank size / (-'~:~ Compartments
Foundation cleanout (Y/N) ~/, Depression (Y/N)
~h///~- Alarm tested (Y/N) ['"~//-¥-
Iq Pumper
Well(s) on lot [ I L/ Onadjacentlots
To property line .-~ 3r- Absorption field
Surface water/drainage
Foundation
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C.' FTSTAT O"
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed 7,/~/ 2.. /cC ~
Length ~ ~ Width __¢:~
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
1377
Soil rating
Gravel thickness
CJeanouts present (Y/N)
Date of adequacy test
for -'~
System type
Total depth L//
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wel~on lot / ~ ~ ~ On adjacent lots ~ I ~ Property line
To building foundation '70 ~ To existing or abandoned system on lot
Onadjacent lots l~ '~ Cutbank ~4/01,'1 ~-- Water main/service line
Surface water ~ 01,l ~2_ Driveway, parking/vehicle storage area
Curtain drain ~']/0
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
HAA Fee $ / ,~/'~
Date of Payment /- ~ ~L~
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301
ANALYSI3 RESULTS for INVOICE # 55038
Chemlab Rel.# 92.2937 Sample ~ 1 Matrix: WATER
Client Sample ID : HAISEN
PWSID : UA
Collected : JUN i9 92 @ 16:00 hrs.
Received : JUN 1.9 92 @ 16:i5 hrs.
Preserved with : AS REQUIRED
Analysis Completed : JUN 22 92
Laboratory Supeg-visor~TEPHEN. C. EDE
Released By : ~ ~ ~
Client Name :TOBBEN SPURKLAND, P.E.
Client Acet :TOBBENS
BPO# : PO~ :NONE RECEIVED
Req# :
Ordered By :TOEBEN SPURKLAND, P.E.
Send Report~ to:
I)TOBBEN SPURKLAND, P,E.
Parameter Results Units )[ethod Allowable Limits
NITRATE-N 0.42 mR/1 EPA 353.2 iO
Sample ROUTINE SA}4PLE COLLECTED BY: T.S,
Remarks:
i Tests Performed ' See Special Instructione Above UA=Unavailable
ND~ None Detected "Sea Sample Remarks Above
NA- Not Analyzed LT=Lese Than, GT=Greater Than
~'~ SG-~ Member of the SGS Group (Soci0t6 G6n~rale de Surveillance)
iVlUNICtPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(b)
(c)
AppLication Date
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name /~/~'~ _~ Telephone: Home ~(o'-I~;Z/ Business
Applicant Address ~,~'
Applicant is (check one): Lending Institution ~; Owner/builde~; Buyer ~; Other ~ (explain);
(d) Lending Institution
Address __
Telephone _~?~? /~f'/
(e)
Real Estate Company and Agent
Address /J//'~
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Famil~ Multi-Family []
Number of Bedrooms -~
Other
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
ENGINEERING FIRM PROVIDIhu INSPECTIONS, TESTS, FILE SEARCN, DA, A 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
shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
Authority
Approval
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 ;/~"7:~:~'~l '~"~'~' -I ~'~'~' Telephone
~,~:~ ;fL/ .-'3
Address ~_-_""=,.L_'"X~- CL~ L.~_
Date /
Approved for .~'¢~'% bedrooms by_~'~' ¢¢.~.~'%¢',,-'¢~'~¢1_~- '~.~*~ Date
Approved ~v Disapproved __
Conditional
Terms of Conditional Approval
Engineer's Seal
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84)
MUNICIPALITY OF ANCHORAGr~
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: /'~ j2
OCT o1988
RECEIVED
/
WELL DATA
Well Classification '"'-~-~
Well Log Present (Y/N)
Total Depth ~%'~/ Cased to
Static Water Level ?~.,27-~ /
Casing Height Above Ground ?',
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding -rank on Lot /?'¥)Y-
To Nearest Edge of Absorption Field on Lot /,
If A, B, C, D.E.C. Approved (Y/N) .,.o/A
Date
Completed
~-~ Depth of Grouting ~/~
Pump Set At (~~
Sanitary Seal on Casing (Y/N) ~
Depression Around Wellhead (Y/N)
; On Adjoining Lots
;On Adjoining Lots /
To Nearest Public Sewer Line ~,~ To Nearest Public Sewer
Cleanout/Manhole /,~//,,¢ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ./<'/C/E¢?'E¢- ;.~, ~¢p[)~ ~.3 ' Date
/ ' / t -
Water Sample Test Results
Comments ,,.?Z=,F' ~(~O ~¢~
SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
Size /~;C~': (:'~ No. of Compartments 2~'~
Air-tight Caps (Y/N) '-..I Foundation Cleanout (Y/N)
Date Last Pumped
/,.~/~ ; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Comments
To Building Foundation ~:% r~-
To Disposal Field 17 er
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata .~.'~ ..... ~//~¢:- Type of System Design
Date Installed "7 / 8~t Length of Field
Width of Field ~---'7~ Depth of Field
Gravel Bed Thickness ,
Square Feet of Absorption Area I-~r~'-I .-~G Standpipes Present (Y/N)
Depression over Field (Y/N) /"J Date of Last Adequacy Test
Results of Last Adequacy Test ~---%-~7--~¢-,4-c-;~'~ ~--o¢~ ~ '~-.%~'~_o~^-.~
Separation Distance from Absorption Field:
To Water-Supply Well _ /f',,~'~ ,~-~"
To Building Foundation
Lot *'-)///~-
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ,,~)///z:j.
To Cutbank (if present) ,A-)m'"~------------------E~'
Comments
D. LIFT STATION
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" Leve~....~ ~
~ Pumping Cycles during Adequacy Test. Meets MOA
** C..!b.e~ted Bedroom Rating Against HAA Request **
I certify that I h, ave cheqked,~v~rifi~d, tlr conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed '~ '_~--'~,~.?,//'/¢/'~'J ,.~"/~~e /o//
Company .~_-~--'-, ~;,/,~-_-_-~-~¢z~ MOA No.
Page 2 of 2
72-026 (11;84)
¢': : Eng nee~'s' ~e~.','r'~
~///'
/,;:7
~¢~ 'r. , ' ~" ,: ,. .
Ad :_}:es s:
B:S,~[:',,
2220 EAS'P 88
(907) 349 '~6451
Lo [:.: .... _c~ ............................................................
P, lock; .....~ ........................... :_
Prcduction [(ate:,:~'. ~:, ~ GPM 24--Hour Capacit . Gallons
MUNICIPALITY OF ANCHORAG%
DIVISION OF ENVIRONMENTAL HEALTH
DEPARriR4ENT OF I-IEALTH AND ENViRON%rENTAL PROTECTION
APPLICATION FOR ~iEALTH AUTHORITY APPROVAL CERTIFICATE
,/
1. General Information Application Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name ,.j,.-'_:,~
Telephone - Home
Business
Applicants ~ldress
<c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~Si~q ;
Buyer l---'~I ; Other :~_.'[ (explain);
(d) Lending Institution ~//~: ~ Tel ~p~bone
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
~Xpe of lesidence
Single-Family ~
Number of Bedrooms
~W~a~t? r_ S u p p~lff:
Community[~.~_[ Public~
Note: If community well system, must have v~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposa~l
Onsite ::.~ Public I7:: 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]
5. Engineerin_g Firm Providing Ins ec~_~ons Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date sho~m below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or vrastewater 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 regula-
tions in effect on the date of this inspection.
Approved for -" bedrooms ByX/~~ ~.,~..~-,_~,~_. Dat~j~
App ov d :i pp=oved Co dltioh
Terns of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF t{EALTH ;aND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
iN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND S'TATE REQUIRE-
MENTS. EMPLOYEES OF DHEP 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 PROFESSIObLXL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/Di8
[Page 2 of 2]
7-19-84
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Log P~esent (Y/N)
Total Depth -~ -~- ? Cased to
Static Water Level j2~ / ..~
Casing Height Above Ground
Electrical Wiring in Conduit
Sepa=ation Distances f~om Well:
TO Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAG2
DEPT. OF I-[EALfil &
[:NVI,~ONMEN1 AL H,{C,I [:c.'rloN
JA 4 3 1985
Legal Descri,ption: ~t~fiED
If A, B, ~ C, D.E.C. ~p~o~d(Y~)
Date ~leted .~. ~//~ Yield
~ ,~ ~ ~9th of Grouting --
~ ~t At
Sanit~y ~al on ~sing ~)
~ession ~ound ~l~ead (Y~
t
; ~ ~joining Lots '+ ~00
To Nearest Edge of Absorption Field on Lot .e
To Nearest Public Sewer Line
Cle ancut/Manhole.
Water Sample Collected By
Water Sample Test Results
C~L~.ents
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewe= Service Line on Lot
,5' .~ /~ ~/,~/~ r x
B. SEPTIC/~ TANK DATA
Date Installed x)u/l /3?~/ Size .../eChO, No. of C~,~pa~tments
~ession o~r Ta~ (Y~ ~te ~st P~d ~/~-
P~ing~intenan~ ~n~a~ ~ File (Y~) '-- ; for
Holding Tank High-Wate~ ~a~ (Y~) '--- ~=a~y Holdi~ Tank Pe~t (Y~)
Sep~ation Distan~s ~ ~ptic~olding Tank:
To Water-Supply ~11 '~ {00~ ~, To ~ilding F~ndation
To ~o~rty Li~ ~0~ To Dis~sal Field
To ~ter Mai~Servi~ Li~ ~/~ To S~e~, ~nd, rake, ~ ~jor D~aina~
COUrse
Comrents
Receipt ~
Date Paid:
Amount:
[Page 1 of 2]
2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed ~.IUL~ IL; ]/~
Width of Field ~
3~.~6~/~P~1~ Type of System Design
Length of Field ~ I /
Depth of Field ~ ~'
Gravel ~d Thick,ss · ~
S~e Feet of ~sorption ~ea ~'~'~ ~(J Stan~i~s ~esent ~)
~p=ession ove= Field (Y~ ~ of ~st ~a~ Test
Results of ~st ~a~ ~st ~/~
Separation Distan~ ~ ~s~ption Field:
To ~te=-Supply ~11 .e~O0 t To ~o~rty Li~ '4 ~
To Building Foun~tion '~'~[ To Existing or ~ndo~d System
To Wate= Main/~=vi~ Line .~4~ To ~t~(if p~e~nt) ....
To St=e~ond~ke/~ ~jo= ~aina~ C~se
To ~i~way, P~king ~ea, ~ Vehicle St~a~ ~ea '~ [0 /
Co~ents
D. LIFT STATION
Date Installed
Size in Gallons
"P~k3 On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
Con~nts
**
** Check Permitted Bedrcon Rating Against HAA Request
I certify that I have checked, verified, o= conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
si ed
MOA No.
KB1/d5/s
[Page 2 of 2]
2-15-84
BESSEt EPPS & PO~S
2220 EAST 88 AVENUE
ANCHORAGE, AK 99507
(907) 349-6451
WATER w~r,L TEST
Location:
Client's Name:
Address:
Subdivision:
Lot:
Block:
Initial Reading on Meter:
GALLONS G~r,r~
TIME GPM A VOLUME TO?AL VOLUME
_×x,'a~ Y. > dz/ /dz",/
~,-..,,.-
"¥/..
Production Rate: ~/~_ GPM 24-Hour Capacity -~ C~llons