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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 14A Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES FNVlRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Nams: . ~~ Wastewater System: D New ~pgrade Address: (~,, ~ ABSORPTION FIELD Phone: No. of BeSoms: ~2~' 5/¢F /~¢-~ .~ ~ Deep Trench,~hall°wTrench abed ~Mound UOther Tolal Depth from original grade: LEGAL DESCRIPTION Soil Rating: /¢ GPD/Sq. Ft. ? -- Lot: Block: Subdivision: Oepth lo pips bottom Irom original grads: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~ ~ ~ Gravel ~ / Number of lines: Distance belweea lines: Classification (Private, A,8,C): Total ~ ~sed To: Tolal absorption area: Pipe material; Driller:~ ~ Bate Drilled: Slalic Water Level: installer: z7 , ~ / ~ Date installed:// Yield: ~ ,.rap Set at: Casi.g .eig,l Above Grou.d: TANK ~ GPM Ft. Ft. SEPARATION DISTANCES ~p~ic ~ ,o~i~ ~ S.T.~.~. TO Sepdc Absorplion Litt Holding ~rivate Manulacturer: Oapacily in gallons: From Tank Fietd Station Tank S .... Lines ~>/~ / 5Op Well ~/~/ ~/~/ ~/~ ~/~ ~ ~ ~z Material% %~¢~ Number of Compartments: Lot Size in gallons: Manufacturer: Curtain ~[/~ , ~ Pu trical Inspections performed by: Drain Location and Description: Department of Flea~n ~ Human.~_..Services approval "~ L'~ ~ ~O~ESSt~.~ .......... ' ~?~' 72-013 (t/91) MOA 25 Permit No. SW950143 Page 2 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alasko 99519-6650 · Telephone: 543-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SPRING HILL EST #1 LOT 14A BLK 1 PID No.: 01505189 · - MONITOR TUBE o SEWER CLEANOUT + - WELL ~ NEW LEACHFIELD E_--_~_--~- EXISTING LEACHFIELD EASEMENT SWING TIES A-C = 36.9 B-C = 63.5 SCALE 1"-60' 1500 GAL. SEPTIC TANK DIVERSION \ VALVE [AL TRENCH ELEVATIBNS (NOT TEl SCALE) 7/20/95 ENGINEER'S SEAL ~'~.~,~ .......... ~ ~/ ~:.' 49TH~ '..~ ...... ~]:,:'?'~t~ ............. ....... ~....;~¢..: ...... ~ ....... ", LOUIS A. BUTERA ."~ ............ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950143 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:TURNER GLEN G OWNER ADDRESS:8027 WENTWORTH ST. ANCHORAGE, ALASKA 99508 PARCEL ID:01505189 DATE ISSUED: 7/07/95 EXPIRATION DATE: 7/07/96 LEGAL DESCRIPTION: SPRING HILLS ESTATES ELK 1 LT 14A LOT SIZE: 42335 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 (iSAACS0) . THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: I S SUED BY: Louis Butera, P.E. Registered Civil Engineer June 12, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Spring Hills Estates Lot 14A, Block 1 Narrative Dear Mr. Cross: We are applying for an upgrade permit due to a failed septic adequacy test. The owner desires to oversize the leachfield and septic tank to a five bedroom rating, althongh there are no plans to increase the number of bedrooms in the home. We will also provide a diversion valve to retain use of the existing field at a future date. Our design calls for a slightly reduced separation distance of five feet to the existing field due to the proximity to the lot lines and the area available by topographic constraints. We have excavated to within five feet of the existing leachfield with no indication of effluent travel. Due to the fine sand soil, and a gravel depth of four feet on a five wide system, we believe the reduced separation will have no affect on the system operation. The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 2. 3. 4. The surrounding lots are large, allowing sufficient room for septic sites. Immediate neighboring septic systems are all +30' distance. Reserve space is adequate, due to absorption capacity and use of a diversion valve. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. pc: Terry & Glenn Turner, Owners \G:\WPDOCS\1995\95-034B.NAR P.O. Box 773294 . Eagle River, Alaska 99577 . Telephone (907) 694-5195 · Fax (907) 694-3297 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 95-034 Calculated By: LB Date: 6/9/95 Single Family 5 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 750 Percolation rate = <1 Wastewater application rate = 1 Required absorption area = 750 Trench width 0N) = 5 Gravel depth (D) = 4 gallons minutes per inch gallons per day per square foot square feet feet feet Required length = Shallow trench factor * Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor = 0.50 Total Excavation Depth = 9 feet ~,,~ Required length = 75 feet SPECIFICATIONS FOR ON-SITE SEM'IC SYSTEM LEGAL: Spring Hills Estates #1 Lot 14A Block 1 GENERAL 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 7. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 8. The property is to he restored to original ground slope and finish graded to accept topsoil and landscaping. Wood retaining timbers are to be replaced to original condition. Asphalt drive is not to be damaged by equipment travel. SEPTIC TANK 1. The existing septic tank is to be pumped and crushed then properly disposed of off the property. 2. A new 1,500 gallon septic tank shall be installed as shown on the attached site plan. 3. A Bull Run diversion valve shall be installed after the tank, connected to both leachfields. GRAVEL TRENCH 1. The trench excavation is to be as shown on the site plan with elevations referencing the corner of the asphalt pad near the garage man door, marked "BM," elevation 100.00. 2. The bottom of the excavation or gravel layer is not to go below elevation 89.57'. Total depth will very from 10' to 7' along trench route. 3. Leachline invert is at 93.57' and level. 4. The bed gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' minimum or equivalent is to be placed over the leachfield. Mound if necessary at north end. 6. The area over the leachfield is to be finish graded to prevent ponding of surface water runoff. 7. The septic tm~k mid leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: BENCHMARK = Corner of asphalt pad near house = 100.0' GRAVEL DEPTH = 4' under pipe, 2" over pipe TRENCH LENGTH = 75' TRENCH WIDTH = 5' SOIL RATING = 1.0 GPD/ft2 BEDROOM CAPACITY = 5 SEPTIC TANK SIZE = 1,500 gallons Twenty-four (24) hours notice required for all inspections. G:\WPDOCS\1995\95-034A.SPC 3. WELL HBUSE z "~,.....,~WAPPRnXIMATE ELL NO KNOWN CURTAIN DRAINS EMBVE AND REPLACE TANK / VALVE WELL HOUSE [] - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + WELL PROPOSED LEACHFIELD /- EXISTING LEACHFfELD ~SEMENT SEPTIC SITE PLAN (v2) LEGAL: SPRING HILLS ADDN //1 OWNER: TURNER LOT 14A, BLK 1 CONTRACTOR: JOB// 95-034AI DATE: 06/16/951 SCALE 1" = 60' EAGLE RIVER ENGINEERING SERVICES A P.O. Box 773294- EAGLE RIVER, AIC 99577 (907) S94-S~gS FAX: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L." Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST .2Jz' / LEGAL DESCRIPTION:.~pt"I'r;'./~ ,.Lei'// ~"'5"~ ..//~¢.."/~// /-*] [14 I ownship, Range, Section: 1 2 3 ~-~PJ 5 6 7 8 9 10 11 1:2 13 15 ~o~/.~o~'~ ~ 17 19- 20- SLOPE WAS GROUND WATER S L IF YES, AT WHAT 0 DEPTH? p E Depth Io Water After~.~"Jr~ M0nil0ring? Data: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop / '~ J:~/ ~ '-I:~" .5,--7 ~ " / ~' -/J" ~-tT* ~', PERCOLATION RATE 0,]~ (m~nules/~nch) PERC HOLE DIAMETER ~' '/ TEST RUN BETWEEN ~4- FT AND '~ FT COMMENTS PERFORMED BY: ~ '~ ~ j I .~:_=. ~,. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH 8, HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG .- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: fL//,// ~-.~T-- ~?~,~// 2 7 8 9 10 11 12 13 DATE PERFORMED: ¢),~ / ~-lq~~ Township, Range, Section: SITE PLAN SLOPE WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? neplh to Waler/klte Monitoring? rfR/'-y Oale: I Gross Net Depth to Net Reading Date Time Time Water Drop ~ " ! .' ~ 7 ~_ '- ~-¢" ~- '- 7,~" 6'" 14 15 16 17 18 19 20 PERCOLATION RATE__' 5~ (mmules/mch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORMED BY: ~/~/~ ~ $ , ' ~'~"'~¢"¢~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W[TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) Percent Finer 0 0 0 0 0 0 0 0 0 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 NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION D, TANCETO: Liq. capacity in gallons Inside len9th ~ ,~ ~--(.~ IF HOMEMADE: Dwelling DISTANCE TO: Well Dwelllng Absorption area / o~_ Widty'/h O Material PHONE NEW Material Nearest]otline 2 y Trench width g~'~') inches NO. OF BEDROOMS PERMIT NO, Foundation Liquid depth PERMIT NO. Manufacturer Liquid capacity in gallons DISTANCE TO: Total le~h~f lines inches Material beneath tile Dept~ Nearest lot line Septic tank Distance to lot line Crib depth Building foundation No. of lines ] Length of each line PERMI NO. Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth Driller DISTANCE TO: Bm drag foundation Sewer line OTHER Total effective absorption are? Total effective absorption area PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL ? ....... :': ]: [:;S LJL-:H:) :~ I,, ]: <'-::m ~'a',.m:L J. :Lar' ]:F A L:!F:'T STAT'IL-]N ]:S INSTAL.LED IN AN ARE:iA C[]VJi:F::IE:.'f-) BY HC)A BUZJ:L.D!NG ]']'I~::N (].) AI;J EL.I:-:.C]"R]:CAL. PE:RM]:T Al\ID ]:HSF::'r::[CT:!:[]H MUST :f:.::E ~g ]: EL.. HOT ?,E: AF'J::'R[]VE:D [,g ]:'rH(:]UT AN EL.E:EXR: [:]al... :[ J\!~:::J::'l:::[]']" ,,,.:, ,.,,..... :::,.: .... ,,.:> :: ]: SSL!EH:) BY ' A-"'::' ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 826 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERCOLATION TEST PERFORMED POR: LEGAL 8 10 13 15 16 17- 18- 19- 20 WAS GROUND WATER SL ENCOUNTERED? '¢~Y¢ ' O E DATE PERFORMED: / SITE PLAN IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ~ FT AND __ FT 72-008 16/79) 85-252 M-W DRILLING, Inc. r"-~?,o. Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner ,,~.~. T'~, ~,~.L~,A Use of Well Location (address of: Township, Range, Section, if known; or distance main road I)omest ic Size of casing. 6" Depth of Hole Static water level 173 ft. (ghuNX0. Screen ( ); Perforated ( 201feet Cased to 201 feet ibelow) land surface. Finish of well (check one) open end X Describe screen or perforation :~.Hone Well pumping test at 15 gallons pe~' of drawdown from static level. Date of completion Depth in feet from ground surface r) TO__2__ __ _ ~%TO 5 ..... ~TO_ 6 .... ~+_TO_ 9---- ? TO Ig ____gqg_TO__ 59 59 TO 7q 9117185 - ,, (minute) for 1 hours with 100% WELL LOG " Give details of formations penetrated, size of mafar.~ color and hardness Cra,ge! Fill ,D an d r' Sand & Gravel Loose ); 7q TO 98 ~ilty Gravel 9,2 TO I01 weeping llard Pan 10l TO 150 150TO 151 }ql TO q~Lg_l~_ ____ICLTO 7 (11 .TO. }lard Pan Gravely Bolder Cravmly llnrd Pan NWWA Certified ContractOr Certificate No'l;. 814 & 91~ 3--CONTRACTOR BF.~SE, EPPS & 2220 EAST 88 ANC~IOi{A~, AK 99507 (907) W.~TER h~iLL TF~L' Subdivision: Lot: Address: Initial Reading on I~eter: GALLONS C~ALI~Ot~ TIME GPM 7~7 .... j NCrf F~: ' · MUN C PALTYOFANCHORAGE~{~, DEPARTMENT OF HEALTH & HUMAN sERVI 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. # 015-051-89 GENERAL INFORMATION Complete legal description Spring Hills Estates HAA # Lot 14A , B3d~ 1 Location (site address or directions) · , .., - , 4740 Silver Spring Circle, Anchroage, AK 'Property owne~*':Ter~y & Glen ~er Day phone 276-3963 -' Mailing ~ddres'~ 4740 Silver Spring Circle, Anchorage, Ak 99507 : Lending agency 'Premier Mortgage/Jeff Stanford Day phone 563-7736 Mailing add~ss~000 A Street, Suite 102, Anchora.qe, AK 99503 Agent Fortune Properties/Paul Baker - Day p_hoBe 265-0148 Address 2525 'c Street, Suite 100, ~Anchorage, AK 99503 ~th~r~i$~ ?oqu " :'., : ' .} UnleSs ested, HAA will be held for ickup. . .i .-.. ' .i',::,' . 2, NUMBER OF BEDROOMS: 5 - .-, - : .-' 3: '"TYPE oF WATER'sUpPLYi': '-'. "" -- "' "" '' ' ' "" " '"' Individual well × · 'Ooi~munity well NOTE: If community well system, provide written confirmation from State ADEC attest- ............... ~ · , -~'.1 ".'~?, ,~. in to the legality and status of system ' - ' · ,,,' - '. , g, ' ' ,~, ., :{,. ...-: .. , . ..... ' · ' ? -i~"'"" ' ~ "' :" ~,' TYPE OF WASTE, WATER DISPOSAL. ,, _.~ ,, -~ , , , ... -,.~ . -..; '._. :.'-,:. . . - . ... ....: · HOlding tank ; '..'.' '. :.:!:~. ',!..-,..:: :.-"~,;:::-:.'"...' - '.'4'-':'.:.. ' . .: . : ~.':~'~ :','".-~ :~/;/~?',¢~:-2}'.,?': ... . · . Community on-site __ - NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 inves.tLgation 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, Ak 99577 Engineer's signature ~j-~'~ Date 6. DHHS SIGNATURE -- : . ./~ :Approved for _~ ' bedrooms. ' ' '. '- - ' - :- '.:: :' ~.L. !"." - ' ':;~':;'C-,":"--< ' -' ' :'("",';- - ', Disapproved. ': .... :~:i--' - .... ' ..... .. : , ' :;:::~ :r "- ' , , . ,' , , ', ,. }'',' ':':,'' ' Conditional approval for ' ' bedrooms, with the folloWiii~stipulati°ns: - - '~,' ,:..' ~i':. ...... ~, ~ ':' ': Comments ' '" ' ' Additional ~ ,IL~ r~] '~ ~ //// By~,~_..,,,/~/.. ,.//.-/~C/~ Date (~,- /%- ¢% - ,~' ,"' t.- ",~'~ '~', . ' : ..; 'q ',,,'X; :~, ;The M~ntc~ of gn'chorage Depa~ment of Hea th and Human Se~ cas (DHHS) mssues Health Authon~ ~,~pproval C ~ificate~ased only upon the representat ons g ven n paragraph 5 above by an ~ndependent professional on~m~r roo~storod m tho 8tato of Alaska. Tho ~H HS doos th~s as a cou~osg to purchaso~ of homes and th~(~0in~i~fil~tions in or0or to ~tis~ ce~ain federal an0 stato roquirom0nts, fimplov~s of DHHS do not conduct mspoet~ons or analgxo data ~oforo a co~ificato is i~uod. ~o MunicipaH~ of Anchorage ~s not ros~onaiDlo for orro~ or omissions in tho pro~o~ional on~inoo~s wor~. 72.025(Rev. 1/91) Bac~ MOA#Q1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type ~.~1 Log present (Y/N) . Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~/~-~ Date completed ~?j/'/J¢5 Driller ~-0 / / Cased to ~-OJ / Casing height ~"~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION I~/ ¢ ' l~, ~7_ / /5 .g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/i~g tank on lot /-/~ / Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank g.p.m. WATER SAMPLE RESULTS: Coliform '~ Nitrate Date of sample: Collected by: Other bacteria B, SEPTIC/HOL-BtNG TANK DATA Date installed (2 '2/~ ¢; Cleanouts (Y/N) High water alarm (Y/N) Date of pumping .Tank size _ /5 0C) Compartments ~,_ _Foundation cleanout (Y/N) ~C',% Depression (Y/N) ./',{/,,¢ Alarm tested (Y/N) .,M J..~ ~ ./~j ~'t~-.) Pumper SEPARATION DISTANCES FROM SEPTIC/L--:IDd_-DtNG TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots. 'TLJ(,,~' Foundation ';/-/~' _Absorption field -h ~" / Water maiWservice line ,~/(_~ I 72-026 (3/93)* Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes ( Manufacturer ~ "Pump off" Level at Cycles tested SEPARATION DIST~E0"E FROM LIFT STATION TO: Well o..mtol'''''~ On adjacent lots D, ABSORPTION FIELD DATA Surface water Date installed 0 ')/(~ Length /~ ' Width Total absorption area 7/~-'' /¢ Date of adequacy test ./V//¢ '- Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) /,~ / Gravel thickness Cleanout present (Y/N) Results (pass/fail) l/iN System type Total depth ¢'-/~) / Depression over field (Y/N) for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots "//L~[) / Property tine ~'¢/(.~ / To existing or abandoned system on lot Cutbank ,/.//~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effe~t~'f~l~t~.of this inspection. Signature~~~ ~' ~'"'~%;:~ .... ' ..... ~"" ' ~ Engineer's Name ~/~ ,~{/7¢~,, /~ ;~' "~"~:*~¢~*~':~' ..... ~ ~ , Lou~s A. Butera . ~ ~ HAA Fee $ ~'-~'~, ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ... 03.5-051-89 % GENERAL INFORMATION Complete legal description Spring Hills Estates Lot 14A Block 1 Location (site address or directions) 4740 Silver Spring Circle Prope~y owner Mailing address Lending agency Gerry & Denise Arnold Day phone 474p Si~¥er Sprinq Circle, Anchorage, AK 99~07 Premier Mortgage/Jeff Stanford Day phone 346-1848 563-7736 Mailing address. 3000 A Street, Suite 102, Anchorage, AK Agent Jack White CO,/Barbar~ Ramsey Address ~9n1 (~ $~reet. a~h©ra~'~..~_w. 99503 Unless otherwise, requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ TYPE OF WATER SUPPLY: Individual wel Community well Public water 99503 Day phone 563-5500 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: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system, 72-025 (Rev. '/91) Front MOA #~1 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 Anchprage files and from my inves.ti, gation 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 Eagle River Engienering Services ~Phone Address P.O. Box 773294, Eagle River. AK 99577f Engineer's signature DHHS SIGNATURE Approved for Disapproved. Conditional approval for Irooms. 694-5195 bedrooms, with the following stipulations: Additional Comments __ By: Date The Municipality rage 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 satisf3, certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-o25(Rev. 1/91) ~ack MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:, ~?£t,W(= /-//z~.-$ £57'7'1T£5 Parcel I.D. O/~ - 0¢1 ~ ~o~ A, Well Data Well type r¢/z/v/~'~ If A, B, or C, attach ADEC letter. ADEC water system number .A/'//4 Log present (Y/N) Y¢¢5 Date completed 0~///~//~'-~ Driller -Ac/ Total depth ~,0 / / Cased to ,,~ / / Casing hI ¢'/¢-" Sanitary seal (Y/N) Yd5 wires properly protected g.p.m. Date of test Static water level Well flow Pump level1 FROM WELL LOG · SEPARATION DISTANCES FROM WELL TO: / Septic/holdi~g tank on lot AT INSPECTI Absorption field on lot Public sewer main Sewer service line ; .0.~ adjacent lots ¢/DD / ~'fl adjacent lots ~//~ P~lic sewer manhole/cleanout etroleumtank. WATER SAMPLE RESULTS: "~ Nitrate,¢;~ /' .~ ~ ~d~//L-- Other bacteria Coliform Date of sample: (2'~/a ~//~ ~ ?'~ Collected by: B. SEPTIC/H~ TANK DATA ./~ /'Tank size /~¢ '"Compartments Date installed ¢ 9//.~,,/~_5 Cleanouts (Y/N).)/~ <¢ _~),'undation cleanout (Y/N) ~/~_,5 Depression (Y/N) High water alarm (Y/N) ,~¢~//,~ Alarm tested (Y/N) Date of pumping ~/O/?/-/ Pumper .... SEPARATION DISTANC OM EPTIC/I~i.,'-:-S TANK TO: Well(s) on lot 4/00/ _On adjacent lots t/O_D / Foundation To property line /~ / Absorption field -Y /D / Water .ma~Jservice line Sudace water/drainage 72.026 (3/93), Front CONTINUED ON BACK PAGE C. LIFT STATION ,/"//~ Date installed D. ABSORPTION FIELD DATA Date installed Length ~'~' Width Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "P~~ High water alarm level ~ Meets MOA electdcal codes (Y/N) SEPARATI~O~ LIFT STATION TO: Woll~lMoi~ On adjacent lots / Sudace water Soil ratin~ (GPD~Ft~) ~Gr, I~vel thickness Total absorption area ~/?.- ~' Cleanout pres~t (Y/N) Date of adequacy test ~./~./~ Results~¢{pass/fail) /~, ~,~ Water level in absorption field before test D- / ",? Peroxide treatment (past 12 months) (Y/N) ,i" /k//,~ SEPARATION DISTANCE FROM ABSORPTIOI~'FIELD TO: Well on lot ¢/t9~9 / On adjaq~nt lots P/oO / Property line To building foundation ~ o ' /' To existing or abandoned system on lot / Ck /~///4- Water mai~service line On adjacent lots ¢ .'~('2 Cutb CurtainSUrfaCedrainWater /'//./)/t/ /.4 / Driveway, parking/vehicle storage area 7'~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or~cnformed to all MOA and HAA / 2~ 5 ¢¢/¢'/E System type 7'~E/-/C-/'/ / ~ /J Total depth Depression over field (Y/N) for After test ~ If yes, give date Bedrooms this inspection. Signature ~ Engineer's Name Date ~'~/1 ~* HAA Fee $ ~..~ D , Od) Date of Payment Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number ~lienE ~mDl~ ID Prlntad DACe ~S/~2/95 ® Colleo~ed Da~e 05/08/~5 ~ tS:16 hrs. '~0hnlcal Di~'~ohor L, BU?ERA. 200 ~t. Potte.¢ Ddv,% A,~oh,~, AK 99{~'T~'160[i Tel: (~0/} §~2~2~4~ Pax: (907] ,561 ENViAON.~tFWIAL F.,.a.:fL[~It~S IN A~ASKA, CALIFORNIA, FLO/NOA. ILLINOIS, .MARYLAND, MICHIGAN, MISSOURI. NEW' JERSEV, 0HIO, WleB~ VIRGINLA ~3~J EPP'ON L6E£ P69 L06 e ~I,I1J.SBI ]lJIDbi~Jld02} A£:EI Water ......... : - ' ..... ' ~' ~-u]a~ysls Rapo:c for ~OLaJ. Cohmrm Bacterl~ ,_MUST BE CQMJ?LE't'ED BT WA'[ER SUPPk, IEE, TO BP5 CON~LETED BY L.KBOP=ATOR.Y A-ttals'$i~ ~lt0ws rids Water S,4aMPLE toce..' ' =_~ $:ai'i~ f?ict ory Sampk ow.r ]O ho~s cia, results may new sample ,Aa specie dare,'er3, ~r~.l. A~My$is Began ~] MMO-MUG Phonrd Spok. ~Sth BA. CTEK[OLOGiCAL WATER ANAigYSIS RECORD Membl'ane Filter: Direct Verifieatiort: LTB BGB Cutoaies/101lml ff.~[fl ~PP'[3H Z,6Fg£ b'69 LI216 ~- ~4IJ. SB.L ]UIDFJ~IHI,IO3 E.~.:~I Louis Butera, P.E. Registered Civil Engineer May 10, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Spring Hills ]Estates Lot 14A, Block 1 Narrative Dear Mr. Cross: We have tested the septic system on the above referenced home with test records attached. The water level in the field was into the distribution pipe level at the start of testing. We surcharged the system and achieved m~ average 720 gpd recovery rate over three cycles in the range of 29.5" to 24.5" above bottom of monitor pipe. Normally we would not consider this to be a satisfactory test, but would like to take into consideration the hydraulic loading from recent and ongoing snow melt in this area which has supersaturated the soil, causing artificially high leachfield levels and reduced soil acceptance rate. With your concurrence, this system could be considered acceptable for Health Authority Approval. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. pc: Barbara Ramsey, Jack White Co. ~/ \C:\WPWIN60\WPDOCS\ 1995\95-034A.NAR P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 . Fax (907) 694-3297 A Eagle River Engineering Services 119¢0 Business Bird, Suite #205 P,O. Box 773294 Eagle River, Ak. 99577 69¢--5195 Fox 694.--3297 Owner: /~,~/~-P Oat. e: Type of D Well Raw Test [] Septic Test Only ~etl & Septic Test E3 Other: ¢3 r,~ Meter Monitor Well Tank GPM :1~ Remarks Time Reading Level Level Level ~' 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Address Business (b) (c) Applicant is (check onel: Lending Institution []; Owner/builded.~; Buyer []; Other (explain); (d) Lendinglnstitution ~'~L~/~xJ~¢ Ph°ne~)(7~ (e) ~eal [stato Company and Aoent AOOross Telephone TYPE OF RESIDENCE Single-Famil¢ Multi-Family,• Number of Bedrooms Other WATER SUPPLY individual Welf~ 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~i~ 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING iNSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION " A5 certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heal~ 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 irrformation obtained from the Municipality of Anchorage tiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Mgnicipal and State codes, ordinances, and regulations in effect on the date o~]~J~zsl~ction. Name of Firm ~"~'~-<~'- ~-"~'/~/'~:'~, ~' /"'~'-"~-~' Telep~ho~e Date Approved for ~/'¢~'-oc4.r4.~. bedrooms . Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protectioa (DHEP) issues Health Authority Approval certificates based so!ely upon the representations given in paragraph 5 above by an independent protessioeal 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 (~ u84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 /vtUNICIPALITY OF ANCHO,~.GE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR Leg.al Oe~.tion: -~ Well Classification ~/"'~--~ ~"~,'¢¢'~/-.-_f~ If A, B, C, D.E.C. Approved (Y/N) ~' ,~ Well Log Present(~) '~'~ Date Completed 2~i¢~/''-~'~-~'¢'''~ Yield Total Depth ~/' C~ased to .~-'~ ~' Static Water Level Casing Height Above Ground Electrical Wiring in Condu~N) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting Pump Set At Sanitary Seal on Casing~) Depression Around Wellhead To Nearest Edge of Absorption Field on Lot -PIce t To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~ '¢'/O(~) ; On Adjoining Lots ; On Adjoining Lots ~ IOO! /¢/~ To Nearest Public Sewer ~ne on Lot ,"/~1 -" To Nearest Sewer Service L' B. SEPTIC/HOLDING TANK DATA Date Installed ¢~'//~/¢'~ Size ~.~O No. of Compartments Standpipes (Y/N) ¥ ~"~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) /~O Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N'//1~ ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well "~ ~O O To Property Line To Water Main/Service Line Course Comments ~"E' ,4)~.~[;~¢__.,~f6'J~ Temporary Holding Tank Permit (Y/N) To Building Foundation "¢' ~ To Disposal Field --~ 1~2 *' To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed q Width of Field Square Feet of Absorption Area Depression over Field (Y/N) ~J O Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line -t"1oo ~)¢/~j:;~2.4~ Type of System Design Length of Field '~ ! Depth of Field ~' / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 5~'~' ,~¢t-T'r~/s~ o/~ ~ To Property Line '/" ~-' ~ / To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ~J/A Date Installed Size in Gallons "Pump 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 during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that/~ave checked, verified, Signed I. ~¢j,,,4,.¢.~ ~ Company ~;~,¢.J~. ~.,.J~' ¢~.;~0~ __ or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date Receipt No, ~'-'/7g'¢~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)