HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 10pring Hill
states
lock I
Lot 10
; 015-051
-48
MUNICIPALITY OF ANCHORAGE
DI:~' ,TMENT OF HEALTH AND HUMAN SERV, ,S
Environmental Health Division
825 'L' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Address
~Block Subdw~slon
Township, Range, Sechon
TANKS
DISTANCES
SEPTIC ADSORPTION
'rANK FIELD WELL
WELL ~w ~_ /~..~ /~a/t
/ /
LOT LINE ¢7'- ¢ ,(?~' /o'
FOUNDATION_ ~.l~, t /7 t
AS-BUILT DIAGRAM (Show Iocabon of well, septic system, property lines, Ioundabo¢,
driveway, water t)OdlOS, etc.)
TYPE OF SYSTEM
[] TRENCH ~ BED [] W. DRAIN [] OTHER
original grade ~,. ,~ FT ,~ O
Gravel depth berleath pipe
c~ ~,:,~) 80 FI ~
FT
FT
Installer
WELLS
PRIVATE [] OTHERfldentifv)
FT
REMARKS:
FT
.. .J
Scale:
InsF~eclions Pedormed by:
ceflily Ihat this in,s~eclion was peflormed according Ia all
ENGINEER'S SEAL
72-013 (3/85)
M-W DRILLING, Inc.
Box 110378 · 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
86~149
Well Owner
DESIGNS IN WOOD
DRILLING LOG
Use of Well Domestic
Location (address of: Township, Range, Section, it known; or distance main road
. Lot 10, Block 1 Spring Hills Subd.
Size of casing. 6" .Depth of Hole 201 feet Cased to 201.3 feet
Static water level 170 ft.--'~.,:;'~Ibelow)land surface. Finish of well (check
Screen ( ); Perforated ;(..."~ ~ )~, · .
Describe screen or perforation_ .N on.~,~ t.
.~ ~ :, -~ . .
.~.. ..~.~ ~ · r :
Well pumping test ~ 20 ~a~s':~ ~ (m~ute) fore--ours with
of drawdown from static ~elb~?l~ ~ ': ~:
Date of comp]etlon ~arch 2~4,: %~6~.~ t
Depthlnfeetfrom
ground surface
0 ~O 2
2 TO 18
18 TO 33
33 TO 51
51 ~O 75
75 TO 110
110 TO 125
125 TO 150
].50 TO. 177
177 TO 188.
one) open end ( X );
100%
Gfv~ d.d~ail~ 6f' f~rmattons penetrated, size of material, color and hardness
~.~sin g s tickup
!S.andT, 7'~ra~el & water
Silty gravel & water
]~ TO~
~O
~O
~O
~O.
_.Wa~erbearing gravel
· ~ W W.,ek (JertLtied. Contractor '
Certificate No's. 814 & 973
ft.
I -- CUSTOMER
ii!12',5 L. S'TREEYI", ANCI. li3RAGli!i/, P,K 9950
::.:l 64 .~.. 4 '72. ()
DATE
Lliii/{:;P~l... DESE;I::~' ]: F':
I...OT !E:i I ZE:
MAX BliiEDI::;:EIOM S:
I.,,OT:' :f.O EI.I)t,I-. ..... ],
I"d,~l IGb, :, 3W
Df. EI::"TI{ T(] I:::'IF'E BO'I"]"OM (F:'T,,)
Gl;RAVEL DE:F:']"H (1:::"1,,)
'r'OTAI,.. DI]ii]:::"i'T.I (I::'T.)
GRAVE]... WIDTH (l:::":f'~)
(:,D~AViEt,.. I...,E:NGTH (1:::"1" ,. )
GRAVE:I., VOL.,UME (II.J,, YDS~ )
TANI::; SI ZIE (GAL..S)
SO :[ L RA"r' I ixlS (SQ. F:"I'. /BR)
tif'y 'Lha'L:
]: ~':'idYl {' ~':Mil :i: ].' :i. ~::'LP ~'9 :i. 'l.h 't.l~(:.:.:, r' U)ClL~ :i. i' E, liie)r]t!B ~' (::)1" (:)Fm-s :i. 'L(}:: ~(}:'b~}:H" ~ ar'id ~ue ]. ]. ~i~ as !~iE~'~.
~'ol"Lh by the I'~h..u'~:i.c:J.l::~a:l.:i.'l'..y (::){ Ar'ld"~oPage (MOA) ar'id the St:.a'L(.x, (::)F Ataska,,
]: wJ.].]. :i.l'tS;'('.~';~:t.:l. th6.:, ~;y~FL(:::.)m :i. rt a:Lc:(:::(:H"d,'.':~l'lc:(.:.4, wi:Lb all MOA (:::c)d(.:::,s and
,'~.rld J.r'l ,::::(:)mj')].J.~l'it::(,~) /,,.~J.'J'..h '~:.li(:..:~ de?'.!~,:i, gn c::l'i'Ler'ia c)f' 'Lli:i.E!.
): ~,¢:i.].:t.adl~er'e 'I'..(::) ali MOA ar'id S'La'L(:.:) o{ Alaska r'-ectuil'(~.:,m6)rrt'.,s f'(::H" 't'..l'H:.:.~ set I::',ack
d :i. stal'll:::(.::.:,!;;~ ¢ r'.cim at]y (:.:i,x :i. st irlg w[.:¢]. ]., ~,,~':~s'Li;.:i, water' d :i. sposa], system of pub 1 ic
EB6:)t~E)t" ~:':l(,:l(:':) i~;~/~'~,,~:~lYl (31"] t~l :i, !~ i::)l' ~::~t'ly ~'~(:hj E~I::6,.)r'i'L C)i" li(.:.:,:'E~I"Dw ], (::)'L ,,
]: und~.::;,r, star'td that this per'nl:i.t :i.~i; va].id ¢(::)1" ~t ~a:.t:i. mLtm ~:~{' 4 I)E~dr'<]<::)ms ar'id
any. (-::H"llal'g(.~:mlen'L v~i].], i'eC:luiF'e ar'l addi'l:.:L(::,l~a], i::)~:~:.l*m:i.t.
M:l:l...I.. NEFr' BE APF:'ROVED W:I:TI..I(]UT AN EI,I:EC f'F;'. ]: CAL. IN,r.,~I::'E[:;T].[:iN REPDR]"; AND (3) THE
DEPAR]"M[i!]qT OF' HEALTH AND
825 L, S'T'REI~!!iT, AN[)HORAGE
2.64-4720
]')ATE ISSUED:
85()5'24
08 I?. :1185
CI]NTA[]'I" F:'HDNE:
I...EGAL :(}ES[?,RIF:': SI:JB][:)IVIS:t:I]N[', SF:'R]:I'4G HII...I...S LOT: 10 BI.A]CK: :[
SECT:ION: :[5 TOWNSH:[F': 12N RAN[+)E: ::T,W
I...OT SIZE: 4.9225 (SD,,F'I",, OR ACRES)
MAX BIZDF~[IOMS: 3
C:)RAVEI.... :OEiiP'TH (F']".)
T[]'I"AI.... DEI::']"H (I:=T',,)
GRAVIZI.... WID]'H (F"'T.)
GRAVEI~ I-ENG'I"H (F:'I".)
GRAVli~]_ VOLUIflE!: (CI.J,, YDS,, )
T'ANK Si ZE (I.'3AL,S)
SOIl... RA'I"ING (S(:~,, F:']",, /BR)
sys'l:em,,' CI-Ic~c)se tl"m: c~pt±on that best FiLs ycml~ site,,
1:)1~:1::"1"1"1 'TO F:'II:::'I~: B[I'T'TI]M (F'T',,) 4.0 4,,CI 4 0
:5 ,, 0 () ,, 5 ~-::'. 0
7.0 4. ,, 5 6 ()
~? ,, 5 :1. 4 ,, 0 5 0
:1., I am ['am:i.:l.:i. ap ~g:L'Lh 'Ll"w.:.:, i"equir'ements l'[:m c)n-s:i, te sewer's and wells as set
~'oc'Lh by the 1'4unicipaZi'Ly oF AnchoFage (MOA) and 'l:.he State oF Alaska.
"' ~ ...... ' . with a:l. 1 MOA codes and pc.)gu].aticw~s~,
~".'.,, :1: ~.~:i. ]. ]. zn....,~.al ]. 'l:.he svs'Lem :i.r~ac:ccH'"dal~c(.:~.)
and :i.n comp].iance wi. th ti'lc design c['i'LeP:La of Chis per'mit,,
3,, I w:i.].l adher'e 'I:.o all MOA and State oF Rlaska Pequicements fc:)l' 'Lhe set I::)ack
d~.:~L,:=uH...(=.= ~'f'om any exi%'LJ, ng well, Nast~Na'Lep disposal system op pLd:~l:i.c
sewer'aga ~ystem on this c:n, any adjac::errL
4,, :I: L.u]dePstar'~d t. ha'L 'LJ"lJ.~i~ per'mit :i.s valid FoP a max:i, mL~m oF 3 b(~4~dpooi~ &rid
any erl:l, ar'~]ement NJ.].l I',eqgJ. pe) an addJ. tiJ:~nal
]:F' A I....:I:F'T' S]'ATION' IS INS]"AL..I..ED ]:lq AN AREA C;OVI!~]RED BY HOA BUILDING (:](]DES,
"t"l"'tl~:lq (:1) AN I[~'.LE(::;TR]:[:AL.. I:::'ERMIT ANI) INSF:'I~[:TIOIxl IqLJST BE OBTAINED; (~2) AS-BU:I:I_..TS
WIL..I... NO'T' BE APF)ROVED WI'FHE)IJT AN IEI..EC'I"IRIC~L.. INSF'ECTI[]N REF'ORT~ AND (:5) TI-IE
I']..E:CTI'tICAI...' WI]RK MI]ST BE DC)NE BY A I_ICI~:IqSED I~ELI~C'TRICIAN.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
DATE PERFORMED:
(ENGINEER'S SEAL)
/l-1'2-~ '~-
1
3
4
5
6
7
8
9
10
11
12
13-
14-.
15-
16
17
18
19
2O
TEST RUN
Township, Range, Section:
SLOPE SITE CPLAN
WAS GROUND WATER
ENCOUNTERED? ~'~
IF YES, AT WHAT
DEPTH?
Depth Io Water Alter
Monitoring? Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE __ (m~nutes/mch) PERC HOLE DIAMETER
BETWEEN __ FTAND ,%~T.-~__ FT.
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
POb .,16 650
ANCI-IORAGE. Ai_ASKA 995020650
(907) 264-411
DEI~AI~'£MEN1' OF HEALI'II AND ENVIRONMENTAL PltO'i'ECTION
Permit ~: 8Lt0213
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 10 Block 1 Spring Hills Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have dril~led the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for doc%~entation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Xeith E. Sandt, SupeYvisor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/0 5 7
E:'t!]:::'I::II:ii?I'I'"IE]",IT Cfi:' !'I!iEI:::IL. TI'I I':INI]:, li!J]",Ig'II:;?.Eq',II'"IIiEI",tTF::II.~..
2 6 4- ,:1.7' ;2:0
F:'E]:~'.I"I I T NO:
DFfT'E ISSLIEE:,:
FIF:' F' L. I C Fli',l T:
CONTF;IE:T Pt.'IOI'-4E
I..I!i!X!iF:IL
I...OT ii!!; i ?.'.E~:
I'IFi'X
L,..0'T': :].0 E L. Z r/I-:' ' ::L
F;:F:IKIGliE: :]:t.,I
'?'. 0 ,::1.. 5 cJ;. 0
,q.2:. 0 ;;;i'.8. 0 ::~:d;. 0
;t.;:~:. 9 :IA.. 5 :1.6. 6
:1.., 000. 0 :+::+: ::1..., 000. 0 $:4.: ::L., 000. 0 :.i<:+:
85 85 85
I C:E~:I:;?."I" :[ F'"," THF:fT':
::L. I I:::IH F'FIf'I.1.'L.]:I:::II':;: H z"r'I.I 'Fl.lEi: Fi:tE(;:]U]:F::F3',tE:I'.,rT'.'E; F:'OF~: OF,I..-.:!i;ITE Slid.,.!E!l:;;:Ei; FIl'.,ll:::, I.,.IELL.:E; F:I'.E;
F:'O[;~:'T'H I~!!?.r' "lq"lt.':: I"ll..Ih,I):C]:F'I:::II...I'T'"r' OF:' I':'INCHOI:;i:I':I[:ii[E (["I[]F:I) I:::II",IC' THE :FJ;TFI'I"IE OF:'
;ili:.I I.,.IIL. L.. !N::T:;TFII....I.... THE: S"r':!i!;TEI'"t ]:N I:::tC:E:Or;i:I]'FIigE:[i:; HiTH FIL. I_ I"tEtFt CO[:'ES FIND
FII",!E:' I I",! [:::O1'"11:::'1_ I FII",I[:::E I.,.I :I: '1"1'I 'T'H!ii: [:'F!:S :[ ~:L"il",l C:F;'. I "1"11~::[:~'. I I::1 O1:::' TH Z S F:'EtTH I T.
:]:. I HIL..I... i::I[:'HI~:F?.IE TO ]::II....L. I'"IOFI ~'::1I",11::' :!!;'£'F:I'I"E O1:::' I:::IL.I:::I~:;I'::.'FI F~:E:(;&.III:;;:E:I'"IEI",ITi!'~; F'[]I:~:: '['1"'1[~: SET E',F:ICK
E." Z ~!;TF:ll",K][i!::i!i; I:::'I;;:OFI FIN"r' [i:::':; I '.i?l' ]: N[::i HI!EL] ...... HFI:~:!;TI.'EI.,.tF:ITE]::~: [:' I SI:::'O:~i;FIL i~.:;"r'STEI'"I O1:,?. F::'LIE',I_ I E:
:!i!;E:NEI:~:I::II2iI!E :~i;"¢:i.:;T[;H (:ll",l 'T'HI:!!; (:)B: I::ll",l"r' I:::I[).]'I::ICEi:I",IT []1:~i: I",IE:FIR[~:'T' LOT.
q.. ;!: UI",I[)[EF;i::i];TF::IN[:' ~l"l ff::l'T' TH 1:5 I::'IEI:;i:I"I i '1' ]: :!!!; ',/1:::tl..,. I [:' f::'Ol:;i: I::1 1'"11:::1::':: I i"11...1i'"1 O1::' 21: I.:.'!:EC, I:;.". O CH"] :E; FINI'.':'
l'::ll'-,!"r' ['3",ILF:I[;?.G[Ef"I['.i]",I'T I.,.1II....I.... [;:[E[;!I.J ]: I:;% F::II",I FIE:'[.:'ITIOI",IFII._
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROI'ECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAt, DESCRIPTION:
1
2
3
4
5
6
7
8
9
lO
11
12
13
14
15
16
17
18
19
20
DATE ER OR EO: -12.-84-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, ATWHAT
DEPTH?
L
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN
COMMENTS
..
PERFORMED BY:
72-008 (6/79)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O, Box 196650
Anchorage, AK 99519-6650
~rww.muni.org/Onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-051-48
1. GENERAL INFORMATION
COSA# t~) j~
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
M~il'ir~;,a. ddress
SPRING HILL ESTATES S/D; BLOCK 1, LOT 10
9621 SPRING HILL DRIVE * ANCHORAGE, AK * 99507
KATHLEEN CRONEN LIVING TRUST Day phone
Day phone
CARLA NICE W/ DYNAMIC PROPERTIES Day phone
3111 C STREET * ANCHORAGE, AK * 99505
Unle~s,o'therwi~e requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 4
229-5492
242-2427
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 afl?xed hereto and as of the vafidation date shown below, I verify' that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication,
~,,~,¢¢s ~h~, the on-site v~c,,er s,~,/:v a,,d/or wastewater disposal system is (are) safe, functiona! and adeq,ate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
informab:on obtained from the Municipality of Anchorage files and from my investigation and inspection, t,~e
on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal
and State codes, ordinances, and regulations in effect at t,~e time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
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
other person or party is not authorized, nor will it confer any legal right w,5atsoever.
DSD SIGNATURE
/ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
COSA Checklist
Septic System Advisory
Well Flow Advisory
~,4~u ~ ~uv~O~ y
(Rev. 11/05)
Arsenic Adv sory
Maintenance Agreements
Supplemental Engineer's Report
Other
,;~~__ ~, Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF
Legal Description: SPRING HILLS ESTATES S/D; BLOCK 1, LOT 10
A. WELL DATA
Well type PI~IVATE If A, B, or C provide PWSlD# N/A
Date completed 3/20/1986 Sanitary seal (Y/N) YES
Total depth 201 ft. Cased to 201.5 .ft.
ON-SITE SYSTEMS APPROVAL
mg./L.
GEG Ltd.
FROM WELL LOG
Date of test 3/20/1986
Static water level 170 ,ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 2.42
Date of sample: 5/9/2011 Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1250 gal. Number of Compartments
Foundation cleanout (Y/N) YES
Date of pumping ~,~//t / ! /
C, ABSORPTION FIELD DATA
Date installed 1 1/19/1985
Length 40 ft.
2
Depression over tank (Y/N) NO
Pumper,
I'BELOW EXISTING GRADEI
Soil rating (g.P.d./ft2o~ 150
Width 25 .ft.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
3/9/2011
153 ft.
4.6+ g.p.m.
Date installed 11/19/1985
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
ONE STOP SERVICES
YES
12+ in.
Arsenic: ND ug./L.
Total depth .6.7-6.9 .ft. Eft. absorption area 920 ft2 Monitoring tube YES
Date of adequacy test 3/9/2011 Results (Pass/Fail) PASS
Fluid depth in absorption field befOre test DRY in. Water added 600 gal.
Elapsed Time: - min. Final fluid depth DRY in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type BED
Gravel below pipe 0.5 .ft.
Depression over field NO
For 4 bedrooms
New depth DRY in.
Absorption rate >= 600+ g.p.d.
NONE KNOWN If yes, give date -
CHECKLIST
Parcel ID: ~ J,.7E' - O,~'"'/- ~-~
D. LIFT STATION
Date installed
"Pump on" level at__
in.
E. SEPARATION DISTANCES
Size in gallons
"Pump off" leve~
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 50'+
100'+
Manhole/Access (Y_..~_) ~
High water alarm level at
Meets alarm & circuit requirements?
.in.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
Building foundation
Water main
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
5'+ Property line 5'+
N/A Water service line 10'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
Curtain drain NONE
COMMENTS
*PER 1985 INSPECTION REPORT.
Absorption field 5'+
Surface water 100'+
· 10'+ Building foundation 10'+ Water main
10'+ Surface water 100'+
KNOWN Wells on adjacent lots, 100'+
G. ENGINEER'S CERTIFICATION
N/A
Driveway, parking/vehicle storage
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.
10'+
Engineer's Printed N~me
Date ~/l~/ll
JEFFREY A. GARNESS
COSA Fee $
Date of Payment.
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
84th Street Investments, LLC
19722 S. Mitkof Loop
Eagle River, AK 99577
-Invoice
Date Invoice #
5/2/2011 255
Bill To
Jusms Hinks
9621 Spring Hill
Anchorage, AK
Phone # Fax # E-mail
[9076888400 [ I jkingrea~gci.net ] P.O. No. Project
Description Est Am/ Prior Am/ Curt % Total % Amount
Electrician 142.50 100.00% 100.00% i 42.50
Labor 732.05 100.00% 100.00% 732.05
Compactor, mini 210.00 100.00% 100.00% 210.00
Sand bedding, electric wire 901.60 100.00% 100.00% 901.60
*This estimate is to replace, bed and bury the well
electrical conductor.
Total $1,986.15
~/7~fi~ ,,, Payments/Credits $o.oo
Balance Due $1,986.15
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
vwcw.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-051-48
1. GENERAL INFORMATION
COSA# L~'~ ill 0 (.~ fi
Expiration Date: '"~- (0 J' / !
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SPRING HILL ESTATES S/D; BLOCK 1~ LOT 10
9621 SPRING HILL DRIVE * ANCHORAGE, 'AK * 99507
KATHLEEN CRONEN LIVING TRUST
Day phone 229-5492
Day phone
CARLA NICE W/ DYNAMIC PROPERTIES Day phone
3111 C STREET * ANCHORAGE, AK * 99505
242-2427
Unlesso~erwiserequeste& COSA willbeheldbyDSD ~rpick~.
2. NUMBER OFBEDROOMS: 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. STATEk'!ENT OF INSPECTION BY ENGINEER
As cer~uTied 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,
s.hows that *.,he on-site water supply and/or wastewater disposal s}~tem 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 ~,om the Municipality of Anchorage Nes 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 GARNESS ENGINEERING GROUP, Ltd.
Address 5701 Eo TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 557-6179
Date
Pe
Engineer's Comments:
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
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
bedrooms, with the following stipulations:
o o 6.,/
Attachm, ents: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory,
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
~'"~,~'~ Original Certificate Date:
¥ - 6 '-//
Municipality of Anchorage
Development Services Department
CERTIFICATE OF
Legal Description: SPRING HILLS ESTATES S/D; BLOCK 1, LOT
A. WELL DATA
Well type PRIVATE: If A, B, or C provide PWSID# N/A
Date completed .3/20/1986 Sanitary seal (Y/N) YES
Total depth 201 .ft. Cased to 201 ..3 .ft.
FROM WELL LOG
Date of test 5/20/1986
Static water level 170 .ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 2.42 mg./L.
Date of sample: 3/9/2011 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tanksize 1250 gal. Number of Compartments 2
Foundation cleanout (Y/N) yES Depression over tank (Y/N) NO
Date of pumping ~,'~' / 11 / I I Pumper.
c. ABSORPTION FIELD'DATA ~*BELOW EXISTING GRADE]
Date installed 11/19/1985 Soil rating (g.p.d./ft2o~ 150
Length 40 ft. Width 25 .ft.
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
ON-SITE SYSTEMS ~,PPROVAL
CHECKLIST
Parcel ID: {~,t_~ -'O~J-
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
3/9/2011
153 ff.
4.6+ g.p.m.
YES
I',10
12+
Arsenic: ND ug./L.
in.
Date installed 11/19/1985
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
ONE STOP SERVICES
Total depth .6.7-6.9 .ft. Eft. absorption area 920 ft2 Monitoring tube YES
Date of adequacy test 3/9/2011 Results (Pa"ssJFaiI) pASS'
Fluid depth in absorption field before test DRY in. Water added 600 gal:
Elapsed Time: - min. Final fluid depth DRY in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN
Absorption rate >=
System type BED
Gravel below pipe 0.5 .ft.
Depression over field NO
For 4 bedrooms
New depth DRY in.
600+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at__in.
Datum ~ Cycles tested.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (Y__~ ~
"Pump off" leve~a.t~ High water alarm level at.
100'+
Septic tank/lift station on lot
Abs, orptionfield on lot 100'+
Public sewer main N/A
Sewer/septic service :line 25'+
Animal containment areas. 50'+
in.
Meets alarm & circuit requirements~
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Manure/animal excrete storage areas
N/A
100'+
Building foundation
Water main
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
5'+ Property line 5'+ Absorption field
N/A Water service line 10'+ Surface water.
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
5'+
100'+
'10'+
10'+
KNOWN
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main N/A
Driveway, parking/vehicle storage 10'+
Property line
Water service line
Curtain drain NONE
COMMENTS
*PER 1985 INSPECTION REPORT.
G. ENGINEER'S CERTIFICATION
! certify that I have determinedthrough 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 ,~_ ?"2_C," / I I
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
0 'Et.,
BA iU-(]
i"',_. ,9
\
m
3 ,,O0, LOoO0 S
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~Main File No. 14847H-FI Paae #71
SATISFACTORY COMPLETION CERTIFICATE
0fl March 18,
9621 Sprin,q Hill Ddve
20 11 , the pr0pcw[7 s~ated at
aka Lot 10,. Block 1 Spdn,q Hills Estates
(Borrower: Hinks & Davies)
was appraised by me or
Re appraisal report was subiect to:
satisfactory completion, X repsirs, or
I c~ify that ] bare minspected subject property, l~e requirements m' conditions set forth in the appraisal aport have b~en met, and any required
repairs Dr completior~ items have be~ done in a workmanlike mentor.
itemized below are subsla~al changes from ~he data In t~e appraisal r~po~ and t ,~.-,se changes do not adversely affect any properly ratings
final estimate of vales in 1he report.
I have reviewed an invoiee from Extreme Heating & Air, who made plumbing repa~s in the master bath. This satisfies
the cor]ditioh in my report to "repair leaking master bath je6ed tub'.
My origical inspec~on of the subject property noted 5 bedrooms. The sepf~'c system gained approval for only 4
bedrooms, however. In lieu of upgrading the septic system, the basement bedroom cieset has been modiEed. The
doors have been removed, and lhe interior has been lined with shelving such that ~t now functions as a den.
If I can be of any further assistance, please cal~ at (907) 274-8258 or ema~l to paigeh@alaska.net.
Dine
F'HLMC 442 Rev. 6/78 [Y2K]
Pa~,qe R, Hodson, SPA
Form CRT_LG -- 'VCinTOTAL' appraisal software by a ~a mode, i~c. -- 1-800-ALAMODE
ASR Electric New
10325 Thimblebe~ Dr.
Anchorage, AK 99515
Name / Address
Springhill Project
9621 Springhill
Anchorage, AK. 99507
Estimate
Date Estimate St
4/512011 20111005
Project
Description Qty' Rate Total
9621 Springhill
We propose to replace the existing surface mouated well wire with
10/3 UF wire. We will install thc wiring in a 24" deep trench with
sand bedding and refill thc trench in 6" lifts compacting each lift to
minimizc ground settlement. Wc will reconnect wiring at thc well
and thc exterior junction box. All work will comply with current
NEC and MOA codes.
rotal labor and materials for this project. 2,389.83 2,389.83
Terms: BlUing will be submitted upon completion of thc project
and due upon receipt_ Any invoice balance af~ 30 days will be
assessed 10.5% monthly interest. This cstimatc is valid for 30 days
from above date.
[yo. for'thcopp°m~ty ~ bia o. yon~p~oj~. '"
Total
$2,389.83
9076888400
84th Street Investments, LLC
19722 S. Mitkof Loop
Eagle River, AK 99577
Phone# ii! Fax#
E-mail
jking~ea(~__,gc£net
t' Estimate
Date i Estimate #
3/30/2011 i I54
Name / Address
K,EtJ31ecn
9621 Spring Hill
Anchorage, AK
P.O. No,
~ Labor
Descdption
Compactor, mini
Sand bedding, clcct~c wire
*This estimate is to replace, bed and bury the well electrical conductor.
-Estimate is good for 30 days after the above date.
~Estimate assumes normal working conditions. If new conditons arise, a change order
imay be issued.
-If estimate is over $5000.00, a 10% matedal deposit is required pdor to start of projecL
Total
Prqect
142.50
732.05
210.00
901.60
'Total
$1,986.15
Please sign here if accepted: Date:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVIOES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency Cd IA
Mailing address
Agent ,,~A-c.-tL L~J~,--~-'¢,~:
Day phone ~J IA- .~,~. ~¢'-~-~--~¢--
Address _ 32o t "¢" ¢-r-P-~-¢--*7-_,~ ~c,, .~ ~o0
Unless otherwise requested, HAA will be held for pickup.
X
Day phone
Day phone
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-
lng to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
%'.
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Fronl MOA #21
J
STATEMENT OF INSPECTION BY ENGINEER.
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Alask~Water &
84.Z-.:L,B rocCr~dge D r/"~
Address
Enginee¢s signature
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
Date
bedrooms, with the following stipulations:
Additional Comments
Date //-
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72.025 (Rev. 1/91 ) Back MOA ~1
Municipality of Anchorage MUNiCIPALiTY OF ANCHOR,/¢~
DEPARTMENT OF HEALTH & HUMA-N SERVI~:~°NMF'NTAL
Environmental Services Division I~0V 1" ~'f' ~d~F~)
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-;4.742t
Health Authority Approval Checklist R E C E I V E D
LegalDescription: L~I- lo.,, E,F-- 1.~ spC4,J~, I~-,b'-& ~D ParcelI.D.: ~16'
A, WELL DATA
Well type
Log present (Y/N)
Total depth
If A, B. or C, attach ADEC letter. ADEC water system number
\(,['~ ¢ Date completed
Cased to '~ I. $ Casing height (above ground)
Sanitary seal (Y/N)
Wires properly protected (Y/N)
Date of test
Static water level
FROM WELL LOG
!
Well production ~') g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
AT INSPECTION
!
> ~, ~,4-
g.p.m. 'N
El. SEPTIC/HOLDING TANK DATA
Date installed I~/t9/¢¢" Tanksize IZ~c~''O Number of Compartments 2.. Oleanouts (Y/N) ~E~¢
Foundation cleanout (Y/N) _ ~¢-¢> Depression (Y/N) ,.qi~ High water alarm (Y/N) ~J/¢~
Date of Pumping 1~/~'/¢2'~ Pumper ~¢/~A~ d ~
C. ABSORPTION FIELD DATA
Date installed "/'~/¢'5~
Length Width
Effective absorption area
Date of adequacy test
Soil rating (.gfl~d:~~ or fl~/bdrm)
Gravel thickness below pipe
Monitoring Tube present (Y/N)
Results (Pass/Fail)
System type
(2 ~/ Total depth
Depression over field (Y/N)
For ~' bedrooms
Fluid depth in absorption field before test (in.); :5~/~' // Immediately after~"Tgal, water added (in.):
Fluid depth (ins) Minutes later: ct~'O Absorption rate = :>6,OO _g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~,,v~ /4¢c~¢~ If yes, give date
72..026 (Rev. 3/96)* ~ ~;~ ,,~.¢~-~ ¢'~v,c--,P--
D. LIF~ ~
Date instal]ed ~ ~.--"~Size in gallons_
Manhole/Access (Y/N) ~"""'~ mp o~ "Pump off" level at*
Cycles t~c~.~F ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
,CC
Septic/holding tank on lot to I .~
Absorption field on lot t2.~.~. O~
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent 10ts
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation o/ Property line ~'O ~ Absorption field ;ZZ +
Water main/service line '> I°/ Surface water/drainage '~l~/ Wells on adjacent lots >' IOO
F.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
Property line
Surface water "> ~Oot
Curtain drain No~6.
ENGINEER'S CERTIFICATION
I certify that I have deJer/~d thru field inspections and review
in conforman/c~//,f~H~A guidelines in effect on this date.
/ / ~/1~- \
Signature (.__...~/'//?
/?
Engineers Name ~.~~..,~'~
Date
Building foundation /'7 / (~ /
Water main/service line .>1o
Driveway, parking/vehicle storage area
Wells on adjacent lots ~- ,~o'~,~
HAA Fee $ ,='~' ~
Date of Payment /////,//'~//~/~'
Receipt Number .c~,~,~.~-~//"'J-~ 7~---~--~
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
8471 Brookridge Drive ~ Anchorage ~ Alaska 99504
Phone (907) 337-6179 ~ Fax (907) 338-3246
Consulting Engineers
November 11, 1996
Municipality of Anchorage
RECEIVED
MIJnicipality of Anchora- -
Dept. Health & I-luman Ser~es
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Well & Septic System Evaluation. Lot 10, Bk 1, Spring Hill Estates.
Dear Clair:
The subject property is served by a private well & septic system. The systems were initially tested
on 11/2/96; thereafter, repairs were made and the drainfield was retested on 11/10/96. My
findings are summarized as follows:
A. WELL: On the day of the adequacy test (11/2/96) the static level was 162 feet below the
top of the casing. Water was pumped from the well at a rate of 3.64 gpm for 198 minutes (720
gallons). The water level in the casing was constant (162 feet) throughout the test. Based upon
this data it was determined that the capacity of the well exceeds 3.64 gpm, which meets the
Municipal requirements for a 4 bedroom house (600 gallons per day).
B: WATER QUALITY: Water samples were taken and analyzed for bacteria and nitrates. The
results indicated nitrate levels of 1.28 rog/l, and no bacteria. In short, the water quality is
acceptable in regards to these parameters.
C: INITIAL SEPTIC ADEQUACY TEST (11/2/96): The septic tank was pumped on
10/26/96, consequently, the drainfield had an opportunity to rest for several days. Prior to
starting the test (11/2/96) it was noted that the liquid level in the septic tank was 53 inches.
Normally, this level should be approximately 49 inches. I checked the liquid level in the clean-out
(c/o) immediately downstream from the septic tank and found it to have about 4 inches of
standing water. The liquid level in the west M.T. was 4.875 inches deep, and the east M.T. was
dry (later it was found that this M.T. was filled with over 6 inches of drainrock!). Water was
added into the east c/o at a rate of 3.67 gpm for a total of 335 minutes (1230 gallons). During the
entire filling period, the water level in the east M.T., west M.T., and the septic tank remained
unchanged. I was unable to conclude that the septic system was operating properly, and
recommended exploratory excavation to determine the cause of the excessive liquid level in the
tank, and to determine the elevation of the drainpipe, relative to the monitoring tubes.
Excavation revealed that the cast iron line from the bed to the tank had settled near the tank
(slight reverse grade), and was clogged with black sediment. This line was replaced with new
PVC (D3034), and doubled C/O's were installed. The elevation difference between the septic
tank invert and the drainfield pipe invert is only about. 12 feet (The slope is approx. 1/2 %). In
addition to this repair, the east M.T. was exposed and found to be filled with drainrock. It was
noted that the east monitoring tube extends 7.3 inches below the drainpipe invert. In short, the
liquid level in the east M.T. must be greater than 7.3 inches before the drainpipe invert is
submerged
D. SECOND ADEQUACY TEST (11/10/96): From 11/2/96 until 11/10/96 the house was
unoccupied, consequently the drainfield had another opportunity to "rest". The initial liquid level
in the east monitoring tube was 2.625 inches. Water was added to the west M.T at a rate of 3.91
gpm for a total of 180 minutes (703 gallons). The data is summarized as follows:
Time
0
30
60
71.3 estimated)
90
120
150
180
TotalFlow Level inM.T. Total Rise
0 gallons 2-5/8" 0" 3:54 PM
116 2-15/16(?) 5/16"(?)
233 3-11/16" l-1/16"
277 3-7/8" 1-2/16" 5:04 PM
350 4-3/16" 1-9/16"
468 4-11/16" 2-1/16"
586 5-1/16" 2-7/16"
704 5-4/16" 2-10/16" 6:54 PM
*704 gallons divided by 2.625": 268 gallons/inch.
The recovery of the trench was monitored 16 hours later (11:00 AM on 11/11/96) and the water
level was at 3.875 inches, a drop of 1.375 inches. This corresponds to 368 gallons in 16 hours,
or 23 gallons/hour (552 gallons per day). b~ short, using a falling head absorption test, over 16
hour& and onlyfilliltg the bed to 72% of capacity, the absorption rate is lea;~ than 25 gallons per
hour (600 gallons pet' day). However, I am confident that if a constant head condition was
maintained the absorption rate would easily exceed 600 gpd.
As can be seen from the above data, if it is assumed that the test started at t = 71.3 minutes, 427
gallons was added to the system, and absorbed completely in 16 hours (6:54 PM on 11/10/96 to
11:00 AM on 11/11/96). This corresponds to an absorption rate of 26.7 gallons per hour, or 640
gallons per day. Undoubtedly, the absorption rate could have been increased if the bed was filled
to the invert of the drainpipe (7.3 inch liquid depth). Based upon this data it can be concluded
that the drainfield is capable of absorbing at least 600 gallons per day.
MUNICIPALITY 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
Application Date '~ /-~ - 7_~ -~c~C~,
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name~.;I/-,~/s % ~5~ Telephone: Home Business
(c) Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other D (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~' Multi-Family
/
Number of Bedrooms Zi¢
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 (11/84}
ENGINE£RING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
f
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 '~--~.z'~,-~ ~ '~ ~ Telephone ~/7- ~q~/
Approved for /'~'~//~ bedroomsby ~-- '__ Date
Approved y Disapproved Gonditio
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (D~EP) 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)
WELL DATA
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
...I'3N-~CJ~R O I',[M,E N TA, L PROTECTIOI~
.U.,O,PAL,TY Or A.C.ORAGE <,.,O... -
HEALTH AUTHORITY APPROVAL (HAA) k~'~PR ~ g 1~ C H E C K LIS 2T6'4 .F4ET~ 0R U A R Y
ega, Oescri¢on' L. 0 ,,
Well Classification \~'''' ,,. ,.L o_.,J~.. H A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) "'/ Date Completed ~L¢.c~ ~.O~ [.e[ ~,¢o Yield
Total Depth ~---O~( ' Cased to 'Z_~l '
Static Water Level \ -'~ [ '
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
__ Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line JXJ ] j~
Cleanout/Manhole ~ / I~
; On Adjoining Lots
/ ';~ ~ ; On Adjoining Lots ~ t c.~ O
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
Water Sample Collected by --~..,\ ~ -J.c:~ ¢_~-~'~ ; Date -/..~- 2.z Jo -~.~ ¢.~
Comments . ¢~-~ ~'~-~' / ~ ~~ ~ ~P
13. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) k('~.~ Air-tight Caps (Y/N)
Depression over Tank (Y/N) _ /~[C:~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) IkJ J~
Separation Distances from Septic/Holding Tank:
Size ~' '~'~C:) CJ.cts. No. of Compartments 7.
?~ Foundation Cleanout (Y/N)
Date Last Pumped ~- I1~1~-~
~ lA ;for '-
Temporary Holding Tank Permit (YIN)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /'~'
To Building Foundation C~ '
To Disposal Field ~"~- !
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'P-- ~Ov-~-'
Width of Field ~
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of East Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Buildifig Foundation
Lot
To Water Main/Service Line '-~ ~-I
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments_
Type of System Design
Length of Field "'1 ~ (
Depth of Field ;~ '
Gravel Bed Thickness -7
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line z./..~
To Existing or Abandoned System on
; On Adjoining Lots
/^
TO Cutbank (if present) /k/.//-~
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~~- -
, \~ __ "Pump.Pf¢' Level at __
~ ~[X,~\ I,"~. J Vent (Y/N)
~ J _ Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroo.~ting Against HAA Request **
,n
guidelines
I certify that,L, have checJc,.e'd, verified, or conformed to all MOA. and HAA the date of this inspection.
Signed ~(,~t~zA¢,~'~,./~.../~,~· , _'. Date /-'//
Company ~::)~.U/,~,~2f~ /¢0'~_ MOA No.
Receipt No. _ ~z~ ~'3_,_ .~ ~
Date of Payment /_./v~ ~, ..
Amount: $ 4¢
Page 2 of 2
72-026 (11/84)
Loc~tion:
Client's N~me:
Add/ess:
BESSE, EPPS & POTTS
2220 EAST 88 AVENUE
ANCHORAGE, AK 99507
(9o7) 349-645~
W/LTER W~T,L TEST
Lot:
Initial Reading c~l Meter:
24-Hour CapacitySDif Callons