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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 2 LT 10Tom Fink, Mayor ] uni¢ipali y .ho. rage Department of Health and Human Serwces 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 16, 1993 B. C. Russell 9600 Spring Hill Drive Anchorage, Alaska 99516 Subject: Lot 10 Block 2 Spring Hills Estates Subdivision Permit #SW920419, PID #015.-051-16 The subject permit, issued December 15, 1992 by this office single family well and/or on-site wastewater system, has expired as of December 15, 1993. for a A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. aR If you have any questions, On-site Services please call this office at 343-4744. enc: Copy of Permit cc: Tobben Sprukland, P.E. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920419 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:KRAUSE JAMES L ~ OWNER ADDRESS:9600 SPRING HILL DR ANCHORAGE, ALASKA 99516 DATE ISSUED:12/15/92 EXPIRATION DATE:12/15/93 PARCEL ID:01505161 LEGAL DESCRIPTION: SPRING HILLS ESTATES BLK 2 L T 10 LOT SIZE: 49743 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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). THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS DATE: / 2~/l~-/~n DAT :/2 LOT 10 203 W ]StL Avenue, S~lite 206 ANCHORASE, ALABKA 99501 ~907) 279-$16 SEPTIC SYSTEH DESIGN BLOCK 2 SPE I NG H ILLS 3~HES KR~USE ES?~E Gr"ourx:~ Wa~:er' a't. :1.1 Feet El ev. 91 Rati Fig,, F:'rom 'te!~t 1 ~.125192 ~ii~ {~'~:i,n/:Ll~ ::~' ,5 (]al/rlff. n for' 150/. 'J .... J.;00 sx::l. +'L'. .... 100 ,, O0 Bed A r- <~i,a 12OO SYSTEEH CONFI 6URATION BED TBTAI_ LENGTH 50 FT. TOTAL WIDTH 24 FT,, TOTAL DEPTH 5--4 FT. RSCK DEPTH .5 FT. COVER 5 FT. SEPTIC TANK 1000 GAL. EXISTINS STEP TANK 1000 GAL ABANDON EXIS~TING SYSTEH VERIFY INTEGRITY OF EXISTING TANK 'Th~,? :i. lui~kal 1 a't:i on p.F *tihi s sept i c: ~sys't:~,'n wi 1 1 no'ti i:)revent w(~.*l 1 s LoC :I.C).~ BTl.(:'~(:::k 2 St::)r':Ltu:~ I'fi.:I.!!~,~ Es'E. PRESSURE CALCULATIONS: Hc:)lr.'~ Sl::~aci~g~ 4. x 46 x 12 / 4S := .42 I..c)'l~. :[ 0., I;ll (::~f:; k 2 SI:H* i F'H..I h :i. ] s!~i Esi: .. LO[ II I I I <. ~ L[Ir ]0 d~ .. ,'f- LOT ]I ,50 lO0 15¢ £00 SCALD l' = 100 FT, SOO TUreEN SPURKLAND P,E. 203 W 15TH. AVENUE ANCH. AK, 99501 LOT' lO BLDCK ~? SPRING HILLS ES1; SEC 15, TI2N ~3k/ 9600 SPRING HILLS ]~RIVE SEPTIC SYSTEM I]ESIGN I)^TE, ,~E:, S, 199,2 SHEET. 1/3 GRIll, £4S6 RECEIVED ~IAN 2 6 199~, Municipalay of Anchorago Oept. Health & Human Services 0 i02,3 I xl 4~ absotD"oon bed i00~ at, xtep tank TDBBEN SPURKLAND P,E, 203 ~ 15TH, AVENUE ANCH, AK, 99501 lOO, O0 Sidln9 i000 gal v N £5 0 £5 LOT I0 :~LDCK P 2P£ING HILLS E~ , SEC 15, 1-1£N R31V 9600 SPI~ING HILLS BPIVE ~0 FL P£VISEI)~ .JAM £6, 1993 SEPTIC SYSTEM DESIGN DATE, ]2£C, 3, 1992 SHEET, 2/3 GRID, 2436 xI 4~I I I I I o 009 ~al, st;ep tank i0~00 ]000 TDBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH, AK, 99501 LOT 18 ,~LO~I~ ~ SP£ING HILLS EST, SEC 1,~ TI2N I~31/ 9600 ~PRiH6 HILLS ,DRIVE ]'=SOFT, SEPTIC SYSTEM ,5O,OO 6,00 p 4.00 I-I/P PVC I000 ~4L, STEP I,~NK / ~ £XI£L 1000 GbL lANE '(i %, 7" '~':,, ',. ' TBBt~EN SPURKLAND P,E, B751 W, DIM~ND ]~LVD, ANCH, AK, 9950~-3904 LOT I0 BL£I,'K P SPRIN6 HILLS SECtiON 1,5 TIPN R3~/ 9600 SPRIIV6 HILLS £RIVE SEPTIC SYSTEM DESIGN D~T~.a .~, 2, 1992 SHEET, 3/3 GRID, ,9436 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION 'rEST PERFORMED FOR: ~ ~[~..AL) ~'~ [.~; LEGAL DESCRIPTION: 10- 11 13 14 15 16 17 18 19 20 (ENGINEER'S SEAL) DATE PERFORMED: ' Township, Range, Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplhto Walor Aflar ~'/~ Dale; /¢/9 /~oflilaring? _ I ~' ~-~ Gross Net Depth to Net Reading Date Time Time Water Drop ,.3,' I :~ -~ ~'~ 7'/~ ~;~7 :0 _7~'/~ t.7~ PERCOLATION RATE ~ _ (m:nules/mch) PERC HOLE DIAMETER ~ if TEST RUN BETWEEN 8/'- FTAND ~ FT COMMENTS PERFORMED BY; '-~"~'~--~'~V~"~ , '~ .-(~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITN ALL STATE AND MUNICIPAL GUIDELINES IN EEFECT ON THIS DATE. DATE: ~ ~! / ~ ~ ~ 72-008 (Rev. 4~85) MuRicipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'rES1" PERFORMED FOR: LEGAL DESCRIPTION: 6 7 ¢; I¢.I ENGINEER'S SEAL) Township, Range, Section: SLOPE SITE ~LAN 10- 11 13- 14- 15- 16- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHA'F DEPTH? <~'~-~ pQ E Depth to Waler Aller ~1 Y3 / cJ I'~enitoring7 __ I, ~,,~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLA'DON RATE f~.7/~ (mLnutes/inch) PERC HOLE DIAMETER __ TESTRU BETWEEN FT PERFORMED BY: _ .~'¢~-4~'~O-~'- I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON ~'HIS DATE. DATE: ~2-008 (Rev. 4/85) 20~ ~15TH, AVE, S~ITE 206 ANCHI]RABE~ ~L6SKA 99501 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT lO BLOCK 2 SEC 15 T12N R3W 1.0 GENERAL 1~ I Owner' is James Kr'ausse~ 9600 ,Spr':i. rlg Fl:i. lls l:)r'ive~ 395:3 3 4 6 - 1.2 Engineer :i.s th*.z, person of ent'.:i, ty hired by 'hh(:.~ Owner in!ird:)ec::t 'khis I:)r"o.jceck,. 'l"he Engineer must 10e re)c:oc]lli;.'.~:?cl by the:, Plur) ic:i. pality o{: Ancl)c)ragev D(i, pa~rt, ment o,(: Health and Muman Servic(~s. the Owner Heal th and :1,,,4 The Dr"awings~ sheets 1 through Z";,~ shall be part o'~ this i ,, ~,::}i Al 1 mater i al. s and wor"kmarlsh:i, p shal 1 meet t;l'~e r"ecluil'".c~ .... m(.+nts ca,: th~,~ Mun;i. cil;~alit_y o~ Anchorage~ Department (:)~: Health arid Human ,t.'ilt;?l"vt c;es ~ the c:cn"~di t i ohs o{; the perm:i, t ~ ,;il'il:;} al 1 app ]1. :i. cai:) 1 e rul es alld r"egu:l, at :i, OhS c;urrent 1 y i n (,-t:{:ec't:. I. 6 Al. 1 excava'l:ii::n'l ch;,~p'l-.hs ar'e advi sor'y ~ anti are v(,~r" i ~c :i. ed an (:1 m;.~y I::) ¢.) moo] J. -i: i la(:] i n 't:h (.=. 4: i e 1 ti b y '1'; h 6-, Egntjji neer' ,, 1.'7 It is the responsibili't;y of tine Owner or 'k['~;~ Contractor to adhere to 'k:h~.~ approved design~ t() wer:i..~y that the speci-. ~ied separ'ation distar~ces are met~ and 'khat the required 1.8 The Contra~ztor or 'l:.h6) Owner shall reFiOr'k to 'l;Ite Engi- neer arty observed c:ond:i.'kiorl wh:i,c:h would puL: the !iiiE, J]'[]ic; Eiy~t~.i,/n iii vii::i].~':t'k:i(::ll'l <:]{: Si{:i:~I;(.D car Mun:Lc;il:~al ri~gu].at;Ll:;lrls. 2.0 SEPTIC 2. 1 :(~ 'kher-~z! :i. ss afl existing !..'.-;ept. il;; 'La[d< ~ i t may I:)(),e us~n:J :i. {: i t meeks the capac :i. 'ky re;~l:.lcli r'tDllli01'lt .f o1'" thio) I"g~,~i(:J((tH'l(zt]. ']'l'l(:e tigh'kn(.;,s!s arid stl"t.tc'kt.lr'al iri'L6~gri'l'.Ly shall be verii:ied, 2.2 A nc>w fi:i~,;,ptic; t. arik shal 1 I:)e one .t:abr:i.c:a'ked by e:ither Anchorage Tank and Dlelding or by Steer Tank Sl:)r.~c i ~: i cat i ohs 't: cir" sept :i. Lot 10 Block 2 Spr:i. ng Iq:i,:l. ls Es'ka'l:.l:.~ i~g,, [':a:qlk,~ c:ollg;trL~C:~,:ed cri: :1.2 gage?,~ '~.'[:(i-'-'6~1 wit. Il Thc) tan k shal] bh:, set 1 ~awgl c,)n L,~ndi s'i:,urL)e~cl so:i. 1 ,, 'The t. anl:: shall, be covered ~J. th the (.~qL.~iva].en[: c3'~ The? [s(~.)l::)'t:::~- c: T. ar'd:: shal I be.-:, i i'ls'~:,,'~l 1 ecl a mi n:i. mum c~ .~: 2,,4 '['h~z, stay:fL:it (:al~l.:: shall be a m:i.r]:i, lflLtrll o¥ ].OC) ~:eet'. 'From any well ser'v~ng a ~:i.r'i(.j]e r-esidence~ :L00 'Fe(~'t: ~r'om any body ~:r(]m C].ass "C" wellsv and 200 ~(~et .t:r'c:~m Class~ A Class B w~'..)lls. 2.5 Ail pipe cor'~r~ec:'t:.:Lc)r~s 't:'.cl the 'l:,~::tlfl.:: ~.~ha].l be me(:::hanical ~ga't:.¢31"tigl"l~: c:ald(.:H" couplings,, Cleanc)ut.s shall bi.;, inst. alle)d out. s shall extend a minimum o~: ~2 ir'~c:l~es above .Final gr'(:)und :~. repot'tat :L o~l :L ~:; 't:(:)psc~:[ I . 2.6 ].,. :i, 'F 'L s't:al:il:~r~ sllall be as manu~Cac'l:ured by Ail£:h~rage Tank ,and Welding 3.0 ABSORPTION FIELD :];. 2 ,%alld ~ i.~!:~el::l ~or 1 eveling I:)l" ¥or' 4::i. l'Lel"in[:l ~ shal 1 have ~,t:~:e(;:'(:J. ve (:]l'-,'-~in siz(:~ I::~e't:.wei.:~rl No. 4() s:i. eve and IJrr~:L,Forfll:i.'t:y c: c)e::,~ .f :i, c: :i. ellb shall be less thar'~ 4~ No'L more I:llar'~ ',:.]% by weight: shall pass the Ixlo. 200 sieve. 3,,3 4-'inch i::ler'.Fc~rat, ed p:i. pe shall be ASTIq F810. F::'or pres .... sur'c.! d;Ls't:r':i.l:)util:]ll,~ p:i.p¢ !~3h~':~],]. be Sd'l¢~l:lLhLe 4(} F:'VC (:iv" bBS. 3,. 4 Solid ,4....:i. nc:h pil:16~: shall be Cast Irc, n or AS-I'M D:?,034,, 3.5 Moni'L(::w' s'[:ar'ldp:Ll:)es sisal. 1 tie ins't:al led as shown. 'Tha'L su~c:'L:i, cCr~ c:)-¢ 'khr.;~ pipe pene'i:ratinE~ 1:lie gravel shall. I::~(¢ per'fo- r'at:.ed~ ei't:ller 13'y dr'ill:i.r~q ().5" h(::)les on 6.-:i.l'lch cerYt:ers or' by jo:i,r~ir~g a sec:;tJon o.f [::E~:l.O pi~!r'~f0r'/~t'.(::)d p;[],e t(:] &/ !~;l:)],id sec:'l::J,c)r'l c:).F pip6). 3.6 Geotex'L:i.l~) shall be Mira.fi 140. 3. 7 InsLI1 ati(;]n shal 1 be [;~.:'t':r"uded d:i.]'-ec:t burl al. i:)olystyrerle,, l}ow Cl'll,~!lf~il:;a], ,,%"l';yr'ci4oFid]l II:[ L. oL 10 ]ECI. I::)cI.:: 2 Spr :i. pg ,. 2'. sand and mcn'"e that 20% sJ, li',,, Alii, 3~9 Grae:,s seed shall be Kf~r'rkuck¥ bluegrass. quart ~:i'~'i es ar'l:e 4.0 INS)ALLATION 4 ,, :1 I...oc:a k e al. 1 unc:l~?r gr'cx.u id ui'.i 1 i b.:i. es ,, pr'(:~l::)er i:y 1 i 'future dri vt~k, vJay!t¢ ~ (.',~x i st ing or" prcq:)osed water ~¢tl.ll~l~F~(:::~~ ,T~IliI::J ~il..~]::) ~BL.tI""F~:~C:t~ drl~'~:l;J,l'l~:~(]]~ ~:~:~(::J, lJl[:;[E)s~ f~Uld a]L1 other" 'facil. it~E)f:¢ I"(DCJLCJ. F'J. rI~.~ f{B(DID~Jr'~'~t:~ot'l diS-- 4,,2 S~:ake al. igllment o~: system ~i'kl'~ markers sllowing the pr'crkect:i, ve d:i~itances .from wells arid ~ai:'.er I::~od:ies, Zl.4 Ii,stall the i'.anl< as sl'"~ov~n c:~l'~ tl~e drawings. Recor'd :i. nl~:z.t anc:l out]et e].evatiorls o'f 'L:l~e.' ~:arll<,, Tank shall be 4,5 Excavate the al:)sc~rpt:i, cln 'FicC[d. Bottom o'F excavatic:~n sl'u:CI, I be lc, vel and scar' J-[ i('.*(::l. ][f sidewal 1 s smears ? J;hey shall also bo scarified. Record etLc, vation o,F be(;}inningv by t':h(,.e op(:~q"at~on of tJ')~,2 C:OI'I!BtV"LLC:t, ic]n eC:lLlil:)me)r'l~: 4,6 I':>:lace~ the rock to the depth spec i.fied,, Do no~: contami.-. nai:.[~z rod< wil:',h nai::ivlc~ mate!r:J, als of spoil!:~ .fromm 'L'.Iii:=) i~,xc:av,-'.~ .... t :i c:lri. Level {'.l~c:~ rc:]l::k sur'F ac:i? ("~ .... 1 ") be.For(~) i ns(':al 1 ing [:he I::)er'~ c:)rated p :i. p(,.~,, zl..'7 :t:n~i:.all the (::l:i.s'l.:r':El::)t,,l't:J.c:lr~ pipe. Reccn"d 4.8 Covc,)r" i n su ]. ai: :i. on ? 't.l"r~ d:i. si:r:[bu'f::i.c~r'i pipe with rock? arid cover the ~i th g~.~c:ll':e;-{ I: J. ]. e b(,:}'Fo]"~,' ba(:::k~: :i. 1 :[ i I"l(.:J and 4.9 R[.'cor"d the~ f:inish[.~d gr'c)unl:J elevation at the beg:i, nn:i.t~g~ mi dclle and eJld of ~:r'enc:li. Rc-;.(::ord ~:he f :i.n:L sh ground e:L eva Spec:i f i(::at J orls .f:or ~Sel:)i::i c systexn ins't:al :t. ation L.,l::rl: :10 Blol::k 2 Sprinl;i I.lills EsLate I:)g. 3 5.0 iNSPECTIONS 5,, 1 A min:~m~ul'~ r_)~ ~cJur :i.r'~spect:i.~')r'ls are I'e(::lu:i.r~:~d. The r, la?d'-kc~)d ar~cJ ~. c:Jt~Hv~:'.~. ~: :J. (i~(:J. 'l"he se(::(:~nd :i. n~pect ~. (:~ wi :1. 1 I:)e (:~'F 'L:I~(~ open ex c: av~ J:: :i c:>1'1. Al: th:[ ~T~ 'L~. I'n~ 'J:.h(:e ~c:)J. 1 c:c)~'lc:JJ. '['.:L c]l~ w:i. ]. ]he 'lsl"c[ i'"¢J i nsp~'.[~c'l: :i tin wi 11 be ~a'{:'tel" pl a(::emer'rt (:).F gravel ~;tandpipes.~ d:Ls't'.r:ibu'L:[c)n i);Lpir~g~ '[:al"d.((c~) arid other c::c:)~r~p(::) The ~l::)f'l:h inspect:i.c)n will be a~:'l:er (:c:)ml:~].e'l::Li]rl o.t: the Such de.F:Lc:~[~_,nc:Le?!!~ shaZ1 b[.~ cc:u'-rec:~:ecJ w~thin 'L:en days. ,5.2 Al. 1 el ec'l::r':Ll:::al wl::)r'k requi r'es eitl]el" ali MOA e].l,actr:i.l::a]. J. n sp(.-'.~c t :i. on (:)r (:::(.:)r t ~. '{: :i (:ati (:~n by an 1 :[ c~?nsed el ec: [':r i c:[ an. ~JL~[.)mJ.'l: I::ll"l:)o~ 0'~: :[r'is[:)[.!c:~:.:[c;l'~ Ol'~ (:(..)rti.t:il:::atic:)r] tl::] {'.hl~, ~.~.]."."~ ~ciiL.~l:)[I)it (::a~:.ai(]~:] (:lal:a c~'[: all m~e(:::hanical equipment. Engineer a'l-, ],ea!!i)'{.' 24. hours :i.n ICI Bl(:~(::l-~: 2 Sl::)rir~g I.[:L:Lls [i:staL:e NAME 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 .5' um;n~,'.~e,.L 33':7- C'f~ 3 MAILING ADDRESS LEGAL DESCRIPTION LOCATION 'lWell I Absorption areal~ DISTANCE TO: .k i,', Manufacturer · q. capacty riga o si , Insid01ength ~Lit¥ca I000 IF HOMEMADE. Dwelling DISTANCE TO: Well ~ IMaManufacturer ~- ~-~P of tile to finish grade ~ ~ ~~' ~ Depth ~ation Sewer line [] UPGRADE Material IWidth Materia~o 1 Nearest lot line ¢o Trench widt ] NO. OF BEDROOMS PERM T NO. z$ No. of compartments Liquid depth PERMIT NO, ~iq~quid capacity in gallons PERMIT NO. Distance between lines PERMIT NO. Total effective absorption area Nearest lot line Total effective absorption area :?-~o D'~/ Distance to lot line PERMIT NO, Septic tank Absorption area(s) OTHER -PI~TERIALS SOl· TEST RATING INSTALLER REMARKS "~'0PROV ED DATE LEGAL ~3-- 2('-8V' ~,-,",~, 72-013 (Rev. 3/78) / M-W DRILLING, Inc. P.O, Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLINO LOG ~' Well Owner n~.~.o T~ W~.I TTseofWelL nntm~ Location (address of: Township, Range, Section, if ~own; or distance maiff roa~ Size of casing 6" Depth of Hole .... i~L-- feet Cased to__!~l feet Static water level_ 155 ft. £'~), ~below) land surfsce. Finish of well (check one) open end Screen ( ); Perforated ~ Describe screen or perforatio~ ,.~ Well pumping test at 20 ga~0ns pe~ (~ (minute) for i hours with 100% of drawdown from static ~d~ei Date of comoletlo~ ~ ~ z, t~ ~;~ ~'' ~', : : : WELL LOG epth in feet from ; ,::. ~.~ ground surface oi~ d0~ll~ 6f f~rmations penetrated, size of material, color and hardness ~:Oravel 2 .TO 4 4 TO 18 18 .TO 21 21 TO__ 86 86 .TO. 101 f,.4UiXllCma, i lTV OF ANCHORAOE~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEC 1 01985 i01 .TO. 121 121 .TO. 143 143 .TO. 170 OraveJ.~ ~ii an 170 .TO. 181 Water Gravel .TO__ .TO. .TO. .TO .TO.__ IgWWA Certified Contractor Csrfl/ieate .No's. 814 & 973 3 -- CONTRACTOR F'I!i:RM I T DATE 85()525 08/21/EJ~5 AI:::'I:¢I.., .[ L, AN I ,, AD:DRESS: [;[;iNTACT F:I'E]NE: D&S LJNI.,. t Jvi]"lE:D 780() DEBARR RD. AI~CHORAGE ~, AK 337-6763 99504 LJEF~AL DI:ii:S[:R I F': I.J]'T SIZE: MAX BEDRf,:)DMS: SUBD I V I S I ON: F]PF:I I NG H I LI_S LOT,", 10 .f..~Ef]'I-ION: 15 'f'OWNSHIP: :L21',l RANGE: 3W 49743 (Gl].!,, FT,, OR ACRES) ~ BLOCI<: 2 T. he c:~ptic~r~s availal::,le 'Lc:l ylm..t :i.n des:i, gn:i. ng your' system,, C, hc~ose 'Lhe c:d:~t:Lon thi,~'L bes'L ¢i'Ls yc)l..u', site. DEF"I'H '1'[) I::'I F'IZ BOTT[IM (ET,,) 5,, () 6.0 5,, 0 GRAVEl.. DIe'PTI4 (F"I'.) 5,, 0 0,, 5 ::%, 0 ]'OTAL, DEF:']'H (F;"f'.) 8. () ~:~. 5 8. () GRAVEl... , W ]: DTH (FT.,) 2.5 19.0 5. () GRAVIEL I,..EN('~)TH (I:::'T'.) 7','~J. 0 ;¢6. () E~:J¢,, 0 GRAVEl..,, VOI.,.LJIdE (CU. YDS,, ) 2.4.4 25,, 4 34.4 TANK S I ZE (GAL. S ) ¢,, 000 ,, 0 '~"~' 1,000.0 '~'~' J. ~, 0()0.0 '~'~' SOIL RA'r]:NG (SC;i. F'T. /BR~ :L50 150 :1,50 TANK I"IUS]~ HAVE AT I._,EA~!]T TIAIE) C[)MPAR'f'MIENTS cci*ti fy that: :1.,, :1: am J'ami],:Li~r' w:i. th the r, efluir'ements 2. :5. fop tin-sit6) seweps and we].l~ as .set f'c31"th by the Muriic:ipaIit. y of' ¢~rc:hcmage (MOA> and the State of' Alasl.::a. :l: ~].:1, insta].:l, 'Lh(~ system in accopdartce ~it, h al:L M[IA c:~Jd6~s and r, egulat:i, ons, ~nc:l J.['l cc)mp].ianc(~) wi. th the design cr, i'l:er'ia of i'.h:L~ per'm:i.L,, ]: will. adhere 'Lo ali, MOA ~:~l]cl S'La'JLe (:;if Al,'Aska r'eEILtil*~:'lllerrl]~ J'of the set back d:i, st,m]ces J'r,c)m any e,,:i.~'t:.ir~g ~e:l,],~, ~astewaten d;i, spesal system {:m public I ur~depsJ:ar~d tha'l:, this pL~PJ~J.t :J.~} val:i.d fop a maximum DJ' ]:1::: A LIF:"I" STATION IS .[N,::~IAI.LED tN AN A~,?IEA COVERED BY MOA THEN (I) AN EI..,ECTRICAL I:~ERMI]' AND INSF'IE[;]'I[IN MUST BE OB]"A]',ItlED; WiLL NU"I' BE APPROVIED WZ]"I-~[IUT AN EI.,,ECTRICAL INSF'E[]"rION,I:~EF:'OF~T; AND (:5) THE EI.,EC'I"R~CAL WORI:~ ~It~FF BE D[INE BY A L]:CENSED EI._,ECTI~IC~AN. PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENG~SEAL) LEGAL DESCRIPTION: ~~-~.~'17 H,' ll,s B' z 1 2 3 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- Township, Range, Section: ;~,,,_ fY- T iz-I',J le-3t,,~¢ SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? Dale: SITE PLAN 1"7' - Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (m~nutes/inch) PERC HOLE DIAMETER __ TEST RUN eETWEEN .____ FT AND FT PERFORMED BY: ~r~r /.o' ,T¢~ , ¢~_~--CERTIFYTHATTHISTESTWASPERFORMEDI" ACCORDANCE WITH ALL STATE AND MUNICIPAl_ GUIDELINES IN EFF~N THIS DATE. DATE: 72-008 (Rev. 4/85) POb,JH 64¥0 ANCItOFIAG[, AI_ASKA L))o( 2 06,)0 (907) 264 ,11 i I DEPARTMENT OF HEALTH ANO ENVIRONMENTAL PROTECTION Permit II: 8402'72 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 10 Block 2 Spring Hill Estates 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 drilled 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 documentation. If there are any further questions, please call this offlce at 264-4720. Sincerely, ~,eit:h E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 :+::.l.: 'f'Ftl",ll'::i I'"ll...l~il;T IIF:I'v'IZ FIT L.IEF:IEi;T' 'THO ]: (:::jJi:~;i:'l" :[ I::li' TIIFr!T: :;I... :1: tulld F:F:Ii'I :[1.. :[ Fit:,;: t,1~:'t'1."1 TIIfi: FOR OI",I-Ei;I'TIE :~:;EI,.IE!:I=C~; I::lj",l[)I.,.IIEL. I..~; I:::1',~-~ .~.':;ET F:'OF::I'II Ii:t/ 'T'IIE 1,11..It',!IC:II:::'F&..ZT'¢ I:)l:::' F:II",iE:HOi:?.I':p::!ilE (l',lCIl=l::, F:ll'ql:) 'T'HIE: ~FI"FFI"IZ O1:::' I::lLl:::lr::;I.(l:::l. ]: H:I:I..L, IN':.:Fr::il...I.. Till;7 ~?.,'~;'IqZH il'.,t I:::IE:(~:OI:.?.I]:q:::II'.,I[3E I,.I:[TH F:ILL. I','lOl=l E:O[)I:E'.:i~ I=lNf.':, F:lhl[::, Ii'.,i E:OtqF:'L. IJ::Ih!E:Li: I,.!ITII THE I::~E:E;)h::il',,I E:I:~'.]:f'EI:;?.:I3:::I OF: 'l"l-..lillriE; I:::'EI:;;:I"IlT. i[ Iq]'l.L. t::iDIfl:i:;i:t: 'TO i::ll.l.,. I,IOl=f i:::li'.,lll) 2;'f'FFf'E 01= f::lLF:l'.r'~q'::il':i RI:~':[;!UIF?.EHEN"I"'.E: FOI:~'. 'f'HE SET [::, :[ :~FTFII'.,tE:I!i%: F:'I:?.OH FiNY tE>:', ! '.::1 i i'.,ll:3 HI!ELI ..... I,fFI:!i;TEHF/TEI:;i: [) I S;F:'OE!;Ftl.... ~'~i;"r":'~;TEf"l OR I:::'I.,IE:L :[ C E;EHF!:I:;.'.FI[:iI!i E?'r':~;"l'l:i:t'l ON "1'111[:!~ Ol:;~: t:::IN"/ I:IE:!,:I'I:II.:::EI',I-I" O1:~: I",IEF:IF.':Bh" I....O"F. :i: LII",![:.'Iii:I:'?.EFi'Ir:tlN[::' 'FI'II:::I'T 'l'l'l i[ :!; F:'t:-=iI:,;~I'I]:T :[~.{'; ',,,'FIL.I[::' F:'(.)t~'. I':1 lflFl',:',',:[l"lI.Ji"l O1=' :~: IE~EI.":'fq'.OOH:~:!; F:II",II::' F'INh" E!:l",lJ..f:fl:;U3El'lli~:i",lF I'.111..1~. I:~:1!~:1.;!1..1II;i:1!:: F:ilq I'::I[)E:CtlT.~OI'qI'::IL. PERFORMED FOR: LEGAL DESCRIPTION:_ . 1 2 3 4 5 6 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT [)1: HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchora~Je, Alaska 99501 264-4720 SOILS LOG [] PERCOLATION TEST SOILS LOG - PERCOLATION TEST 10 11 12 13 14 15 16 17 18 19 ENCOUNTERED? OL DEPTH? Gross Net Depth to Net Reading Date Time 'rime Water Drop 20 PEF~COLATION RATE__ /ll~, /~f, (minutes/inch) . / - TEST RUN BETWEEN ~L. FT AND OOMM.NTS t/i'~/ ~/"4~ ~/' /~~~ ~/~ / ~//~/ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-051-61 1. GENERAL INFORMATION Expiration Date: 12- — z q —2 -OZ -0 Complete legal description Spring Hills Estates, Block 2, Lot 10 Location (site address) 9600 Spring Hill Drive Anchorage, AK Current property owner(s) Derek & Deborah- Lovvorn Day phone Iviaiiing.adaress - - -9600 Spring -Hill -Drive- -Anchorage;--AK--99507--._ Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Q 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 $ `7 ��� co V J Q ' %) Waiver Fee $ Date of Payment `��22�Z07.0 Date of Payment Receipt Number 02-':3 9 fob Receipt Number COSA # 0 S Cot 0 f 51-3 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 9118/20 ;90, ON -SST G� SY ''�-� �r Original Certificate Date: q —2q —2-0 � 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 �0•�0`SaiAti� � O OF q a n;� 6. DSD SIGNATURE _. a 49th •.. ... v ._.... _..._.__ ..� _ System #1--Approved-for - ........ o ...................................... bedrooms _....... .._.___..__ ___ _ 4-WCHAEL E. ANDERSON S stem #2 A y Approved for �6 S•:, No. CE-43BI :�m bedrooms X410 •..,,, 9118/20 Disapproved ,..•'°c��,�® Qb0 'P'R0©SS\ %\- Conditional approval for bedrooms, with the following stipulations: ;90, ON -SST G� SY ''�-� �r Original Certificate Date: q —2q —2-0 � 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 Legal Description: Spring Hills Estates, Block 2, Lot 10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/14/85 Total depth 181 ft Cased to 181 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) >18 in. Date of flow test for COSA 8/4/20 Static water level at beginning of test 139 ft. Comments B. TANK DATA Age of tank(s) 27 years Tank type/material STEP/Steel Measured operating fluid level in septic tank FNStandpipes/foundation cleanout per record drawing Date of pumping 9/4/20 - A Plus Home Services D. ABSORPTION FIELD DATA Absorption Bed Which system tested (date installed) 6/12/93 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.5 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-051-61 Structure served by this system Well production at time of test 6.3 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.64 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 8/20/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station 27 years Lift station material Steel Comments: Adequacy test date 8/4/20 Results R✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 515 oal New depth 0 in Elapsed time 1440 min 0 ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate '450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) If yes, enter date Gallons introduced _gallons Comments/Deficiencies: 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' 0✓ Yes if No Community Sewer Manhole/Cleanout > 100' E✓ Yes if No ft 0 Yes if No Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25'M Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' 0✓ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' Yes if No ✓Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft 0 Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No I ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10'✓Q Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10'✓Q Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS Lift Station is more than 27 years old. Septic Tank was recently removed. Piping goes directly from lift station to absorption bed. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 9/18/20 ,.•'•�• �� P......... vw ilio o ESS��.•� MU�`�MPA 7 V OF Z%HCHO GAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC201513 Subdivision: Spring Hil Estates Block:2, Lot: 10 The septic tank for this property is 27 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $7,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org MI, NICIP LITY OF AMCHORAGE a e: Phon0,(.17 -3'4'3 figs rtmet t f j'1 - C' -q EJevelopmert Services 1. 'pa __= 1 Fax: 9,37-34-", l(Vater & Write%, ater Set::ian l-ift StationiPump Vault Maintenance Log Phon —:1N—i s 9 egaS �esc._ — •pumping complet _d -Sludge level �f inci ss -pumping-.required � OD -� o •Eifuentfiltercleane9 y�st o -Pump basket cleaned �_7 - .prep, -r ;ioat settings confirmed $ o •C:ontm; floats cteaoec -.)r3erjtion satisfactori �e� irc��it �4 -Audible and uisu3l alarm inside dwelling C -Dedicated eicctrical arm r .Alarm system oP-rat: sr a�isfac n4r�ati��� [�s3F1�14'� o -C_rvund water intrusi: rr at rspr to tanSc s[ennertion •W . hotfunction-31 r� •CSr6u� -d water mtsus:' n aMund pine Fc ,e`.ratiors n ;Manhole lid.. �=unr• onal. +' insulated y s�.--Q9_ Propedly Secured •A nuivduret ret; �i;ed inspec`ions and maintenance completed yA-s 1io {_nm InU ��QrgYl� iec niaian _ C C" _ —J - �z �� C CompG>>y _J Dal of snaintwanceL, 0 I=_ tASNl6kDi I K o,sltacr r oulma orfaAcu ' 9 Uzi= SENA« aucoNo ataeAcs: , S690 59, 09W 317.12' EXISTING HOUSE {/ L�-AIi�G,� z 4O N -r<r—___.____ -t 20-V V.........' 15t1 fr Septic Vent Nos. 1 & 2 have been removed along with the underlying 1,000 gallon septic tank. DRIVEWAY ESMT SEPTEMBER 23;1985 BOOK 1324 PAGE 892 m 30' UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY, LISTED DISTANCES PREVAIL OVER SCALING.. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURWY SURVEY TYPE SYMBOLS FINA1. SM AS AsL • SET REBAR <�aMop DRAINAGE ASPHALT KOT LAN ..x. AS-9tklT o FOUND REBAR tee. qy FENCE r�:-�� CONCRETE ?LOT PLAN ... AS-8iJ1LT ...LOT SRMURWY In T�OPOCXtADNYLT .. NO_CORNERS 5� Q ASSUMED ELEV. -R--j{- x METAL FENCE LG�l�+J WOOD DECK IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SU801VISION PLAT. SURVEY CER7IFICKnON PLOT PLAN of0w r���t • �.e # a�.e.a.ow+.wmwbbaaR�y Mb\40/I1 od ,D4tlr" d a..use,. bmw b„b '� FOUNDATION AS -BUILT ;•} '• ,. L Robot E. hmk .t_ 1,- obr emWr hot I ` • •• MVf C.�rM'd M N^NN why. e! i}1► ' rand.tim ow tM, kk eN tlat dt tlw .., •� .r....... ... / tiby�OW in b bort •. ROBE , J Ar FINAL STRUCilIF2E AS-BUILTL Robot I- yr4s..f#w 4%. 8� � d kit I Pe '••�+.,• •.• Jt+.�' .e„�.. ,n t>w tx sn! eat a a» P s .......... • " r 5 :b AWA ®�+Qi �otessfona\ \.s+b`®® ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BeNG SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 ,Scale: III 50' Rec. Lot S.F. Rec. Plat FNa No. Date sur"YO& 04/27/13 Drown 6y REJ Checked bbTIY1K Date Drawn: 04/29/13 Grk" 2435 W.O. 13-153 Legal Lot 10 BLOCK 2 SPRING HILL ESTATES • • !r Municipality of Anchorage a 9 70 ,, On-Site Water and Wastewater Program `' (907) 343-7904 9 ,)� *roil , ET 7 AUG 14 2017 ) Certificate of On-Site Systems Ap r.val ti �6 .4 • Parcel I.D. 015-051-61 Expiration i►.4e0 , y 1. GENERAL INFORMATION: Complete legal description Spring Hills Estates; Block 2, Lot 10 Location (site address) 9600 Spring Hill Drive `Anchorage, AK 99507 Current Property owner(s) Douglas & Kendra Clark Day phone (406)690-1182 Mailing address 9600 Spring Hill Drive `Anchorage, AK 99507 Real Estate Agent Kathleen Poulin Day phone 242-4223 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) n Duplex 1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received b : Date: ,( f �m COSA to be release• to th-7;ineer,unless otherwise requested by the engineer. COSA Fee $ G2 co Waiver Fee $ Date of Payment -l }�p i i Date of Payment Receipt Number OgOODGi Receipt Number COSA# C5C11 t 3 69 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: Garness Engineering Group, Ltd (CEO) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Q'icti/F 4QooCoOpp� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A • 'dQnn in accordance with the guidelines and regulations established by the Municipality of Anchorage and o •.•------ industry (� 1� practices. The reported results describe the condition of the system/s on the date/s of the QQ�P'�•' j v�po evaluation. Separation distances were measured to readily identifiable features. Hidden defects or T 1 . ¢VV11n encroachments may exist that were not identified during the evaluation. The operational life of all wells 9 Vu and septic systems depend upon a variety of variables, including but not limited to• soil conditions, / ' 0 groundwater levels (that may fluctuate during the year), quality of construction (materials and f/ J' / tU t O workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and t .......... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the uppA p ••J f`fr A.\Gorress system/s;therefore, GEG makes no warranty(express or implied) regarding the future performance of VA , lr CE 79 3 `Q� the well or septic system. GEG makes no representation whether an alternative well or septic system v0 ki ' . c°Q can be installed on the property in the event either of the current systems fail to perform adequately in %f@,P ' /.tf I.7' the future. The content of this report is for the sole benefit of the person/party that retained GEG to �1 a°rpfess o"o� perform the evaluation. Reliance upon the information provided in this report by any other person or �4p�40Qo� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: • (-)N-Zl Cr� \��1� j ( i ' By: 1 vti.. (` Original Certificate Date: Pig"--/ 7 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 / Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10.12.dx If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Spring Hills Estates; Block 2, Lot 10 Parcel ID: 015-051-61 A. WELL DATA Well type Private If A, B, or C provide PWSIDt N/A, Well Log (Y/N) Yes Date completed 9/14/1985 Sanitary seal (Y/N) Yes Wires properly protected (YIN) Yes Total depth 181 ft. Cased to 181 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/14/1985 7/27/2017 Static water level 155 ft. 141.4 ft. Well production 20 g.p.m. 6+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 ml. Nitrate 3.18 mg./L. Collected by: GEG. Ltd. Arsenic: <5 ug./L. Date of sample: 7/27/2017 *32 year old steel septic tank and 24 yeor old STEP tank B. SEPTIC/HOLDING TANK DATA are approaching the end of their useful life *Septic/Steel 8/26/1985 Tank Type/Material S.T.E.P./Steel Date installed 6/12-14/1993 *1000 Tank size 1500 gal. Number of Compartments 2/2 Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (Y/N) Yes Date of pumping S ) . - `1 / I 1 Pumper C. ABSORPTION FIELD DATA *Below Existing Grade Date installed 6/12-14/1993 Soil rating 4p,d. or ft/bdrm) 0.5 System type Bed Length ***50 ft. Width ***24 ft. Gravel below pipe ***0.5 ft. Total depth *4.5+ ft. Eff. absorption area 1200 ft` Monitoring tube Yes Depression over field No Date of adequacy test 7/27/2017 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test **0 in. Water added 903 gal. New depth **0 in. Elapsed Time: **0 min. Final fluid depth **0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date - **MT at west end of bed is set approximotley 0.54 feet lower than the east MT. Liquid levels were monitored through the west (lower) MT throughout test. (west MT is assumed to be set to bottom of drainrock) ***Based upon limited inspections of undocumented system by GEG in 2013. *Second compartment of 1500 gallon STEP tank **Meets electrical code per 5/15/2013 inspection by Rising Son Electric. D. LIFT STATION Date installed 6/12-14/1993 Size in gallons *500 Manhole/Access (YIN) Yes "Pump on" level at 33 in. "Pump off' level at 33 in. High water alarm level at 44 in. Datum Bottom of Tank Cycles tested 3+ Meets alarm & circuit requirements? St E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain None Known Wells on adjacent lots 100'+ F. COMMENTS 4�;ooppp G. ENGINEER'S CERTIFICATION v, OFA � 1 certify that f have determined through field inspections and 101.::)... . +,` ;* 4 review of Municipal records that the above systems are in O r7 conformance with MOA COSA guidelines in effect on this Q ) I Q date. ",Je, -y ►.rn ss 0 Engineer's Printed N me JEFFREY A. GARNESS O 2. 4E— 95 ': 009 Date 5/'W'77 IV profession o �OpOQ�� #AECC884 (Rev. 11105) MUNICIPALITY OF ANCHORAGE DEPARTME'I',T OF HEALTH & HUMAN SERVICES Division of E qvironmental Services On-Site Services Sectior- P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner _ _~.~x.4/t,t..~. J~r~,t,~ ~ ,¢'¢..tx.~.-~_ Day phone Mailing address Len cling agency Day phone Mailing address Agent ~-.~-~ _t-~ Address Day phone 2. NUMBEFI OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual wel Community well Public water If community well system, provide written confirrnation from State ADEC attest- in9 to the legality and status of system, 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/9~) Front MOA #21 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. NameofFirm ~ ~3J2,~/ ,.-~t.)'c'~.L~.J'~'~--- Phone ~"~t~o/ ~ Address ~O~ ~ /~ ~ ~ Engineer's signature ~,., ~ ~ Date ' ~/' ~[,~ ~ / / 6. DHHS SIGNATURE Approved ms. bedrooms, with the following stipulations: Additional ~ments By: 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 D H 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. 72q)25(Rev. 1/91) Back MOA#21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST '2.- Legal Description: A. WELL DATA Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) y If A, B, or C, attach ADEC letter. "/ Date completed 1¢5 I Casedto ~ ~:~ t ADEC water system number -- Casing height Wires properly protected (Y/N) __ / FROM WELL LOG Date of test Static water level Well flow Pump level I"~ g.p.m. AT INSPECTION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION I',¢'r: i ~ 1992 g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I ~ Absorption field on lot I I_~ Public sewer main I"-",//~-- Sewer service line ~ ~- ~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ¢ Nitrate _ Date of sample: J~"/~ 7/ Collected by: _ _ Other bacteria Date installed ~/~'~/'~'~- Cleanouts (Y/N) _ Tank size _ Foundation cleanout (Y/N) Compartments ~ Depression (Y/N) High water alarm (Y/N) /'¢//¥ Alarm tested (Y/N) r-///~. Date of pumping "~--,¢,D~ / SEPARATION DISTANCES FR'OM SEPTIC/HOLDING TANK TO: Well (s) on lot I ¢ ~ On adjacent lots ~ 2- ~¢~ Foundation To property line~ Absorption field ! / ~ Water main/service line Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) "Pump on" level at "Pump off" level at High water alarm level 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 ~/~(¢/g~ ~" Length '~ ~/ '~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) ~-'~'~ / Peroxide treatment (past 12 months) (Y/N) Soil rating / ~O Gravel thickness System type Total depth Cleanouts present (Y/N) y N Date of adequacy test I -~/&7/q ~-~ for ,-~ -- bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~/2. E) Propertyline ~% ~"'~" To existing or abandoned system on ~"" C) Cutbank ~'QO ~4 -e.~ Water main/service line ~ { ~ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the~ da. te of this inspection. HAA Fee $ / Date of Payment 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 A}IMA'B~ I~L'~I)I,T$ ~or IIlVOICE ~ 61370 Chela].ab ?,ell-, 92.570~ ,gain,pla ~ i l.{at~tz: WATE~ FAX: (907) 561-5301 SP~iN¢ i2/07/92 0 14:23 l~rs. BPOI~ : PO[; :[IOll~ ![~CUV~!) ~oq~ · O~dcrod By : ~ ~,~ Member of the SGS Group (Soci6t6 G~n~rale de Surveillance) · MUNICIPALITY OF ANCHORAGE.,,; ~-~). DEPARTMENT OF HEALTH & HUMAN SERVICES O~' DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (incJude lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner _ ~It~ IT'~-{,~ Telephone: Home Mailing Address __ (c) Lending Institution N.~ Telephone Mailing Address _ Business (d) Real Estate Company and Agent . ~_...,~Cl,.~ ~ ~ J 7" ~ Address Telephone (e) Mail the HAA to the followina address: or; Check here~J,, if hold for pick up. List contact person and day phone.number below. TYPE OF RESIDENCE Sing[e-Family ~ Number of Bedrooms WATER SUPPLY · Individual Well]~[ Community [] Public E] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4, SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank Not~: if (~i~mmunity Well Sy~t~i, r~us{ ha~,e Writien C~)r~firmation from the'Sidle attesting to the legality and ~tatus.. . Page 1 of 2 72-025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this ins~ ~ Name of Firm Telephone ~" Address ! -~-,.O ~ f-,~/-~' ~ Date A,/o 17, Engineer's Seal DHHS APPROVAL Approved for ~'~-~..~/L~'3~-)bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services {DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 IRev 8/86) Back MUNICIPALITY OF ANCHORAGE" (MOA) HEALTH AUTHOI:IITY APPROVAL (HAA) CHECKLIST- FEI~RUARY 1984 264-4744 Legal Description: Z'O'7~ /~.} ! ~//',. '~,~ WELL DATA Well Classification __.~,~ '~ Well Log Present (Y/N) "'/ Total Depth /'f¢~/ Cased to Static Water Level /~'?~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot If A, B, C, ~.E.C..A/,proved (Y/N) Date Completed ~/' ¢'/~'.,~ Yield /~:)/ Depth of Grouting Pump Set At /~ ¢~ Sanitary Seal on Casing ~ Depression Around Wellhead (Y/N) 1'o Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments /O '.~ ; On Adjoining Lots / ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed /t(u-~U '~ ~' Size / CoO No. of Compartments 'T l.¢/0 Standpipes (Y/N) ~'t.~O Air-tight Caps (Y/N) ~/ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~h~' Date Last Pumped II11~'/¢ ~ Pumping/Maintenance Contract on File (Y/N) _ g///:~ ; for ~¥/',,~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: 1'o Water-Supply Well To Property Line ~ __ Temporary Holding Tank Permit (Y/N) To Building Foundation ~,;~ To Disposal Field / .~ To Water Main/Service Line Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 028fRev 8/861Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed /~--tI,L-'~ r Width of Field Square Feet of Absorption Area 7~.~' Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation Lot /X/ To Water Main/Service Line .,~ /O To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N} Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots '~ To Cutbank (if present) Comments D. LIFT STATION ~N/0/'¥/.~' 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 I have checked, verified, or conformed to all MOA and Signed -~. ~/cc~--~ Date Company MOA No. Date of Payment Amount: $ ./ Page 2 of 2 72-026 (Rev 8/861 Back HAA guidelines in effect on the date of this inspection. Engineer's Seal TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: Lot 10, Block 2, Spring Hills Estate LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: INSTALLATION REQUIREMENTS WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: 9600 Spring Hill Road Dan Smith Private, Single Family Yes MET:Yes ~0 Gallons per MJ_~Qt~'~,., 6.5 Gallons per Minute DATE OF INSPECTION: November 11, 1987 TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic probe. At the beginning of the test water level waB found at 153 feet below top of casing. At a pumping rate of 6.5 gallons per minute the water level did not change. A total of 1000 gallons were pumped. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on November 13, 1987 E.Coli 0. Total Nitrogen 0.57mg/1. Max. allowable Total Nitrogen 10mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL THAN FOUR HOURS PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. CONSUL'rING ENGINEER 203 W. 15th AVE "C- SUITE 203 ANCHORAGE ALASKA 99501 TELEPHONE (907) 279-3916 - - SEPTIC SYSTEM ADEQUACY TEST " ~ - LEGAL. · Lot 10 Block'.-2, Spring Hills Estate ~ - LOCATION: 9600 Spring Eills Road ~% .~:..:.~.~.~I~.~: ~'-'-: , OWNE'R.' - Dan Smith · '.:j. ' R~IDENC]~:' Single Famil , Three Bedrooms ~..,~ '.].:" -~ "--' · ~ANK. Greet St'eel 1000 Gal. ~%~mp"arts. '-.-: (~ _: : ABSORPTION SYSTEM: Bed ABSORPTION .AREA: 760 Sq. Ft. 'DATE OF LAST PUMPING: DATE OF TEST' TEST PROCEDURE: liquid· level of SOIL RATING: INSTAL~.ATION BATE: 150 August 1985 NoVember 18, 1987. Marx Enterprises. November 11, 1987 System was inspected and measured. Tank was found 'w.ith 2.5 feet of cover and with a 51 inches. Two monitor tubes were found mn the bed. Both tubes were 'dry. Tots1 depth of tubes were 5 feet. [[000 .gallons of clean'water was added to the.bed while the water .levels -in the tank and the monitor tubes were monitored. This caused a waterldepth of 4.5 inches to be measured in the monitor tubes, the water'level in the tank did no5 change. The next day the water level in the bed was checked. Both monitor tubes were dry, indicating that"all 1000 gallons of water had been absorbed. TEST RESULT: This sysLem meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic sysnems depeads on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. ~OJNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HFiALTH DEPAR2]4ENT OF ~{EALTH AND ENVIRONM]~NTAL PROTECTION A~PLICATION FOR IIEALTH AUTHORITY APPROVAL CERTIFICATE · ]~o Ceneral Information Application Date/~', ~ -- y_ ~ - ~. (a) Legal Description (include lot, block, subdivision~ section, township~ range) Location (address or directions' (b) Applicants Name Applicants Address Telephone ~ ttome Business (c) Applicant is (check one) Lending Institution uyar2_ Other [ (explain); (d) Landing Institution Address ~ ; O9mer/builder~ ; Telep~pn__e (e) Rea]. Estate COo & Agent Address Telephone (f) Mail the HAA to the following address: 2o ~yp~ o__f~Re~sidence Single~Family.~'~ ~umber o~ Bedrooms Multi'~Family I~ Other (describe) 3o Wa~_t e r__~S,u~ p~ j.ji~ Note: If commun'lty well system, must have vr~itten confirmation from the State Department of Environmental Conservation attesting to the legality and statnso 4o Sewage Disposal Onsite ~] Public [------]i Community ~ Holding Tank ~_ Note: /If community wall system, must have written confirmation from the State Department of Environmental Conservation attesting to the iegality and status. [Page 1 of 2] 5o Engineering Firm Providing InspectionsLT_~ests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the w~lidation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater dispssal system is safe, functional am~l adequate for the m~mber of bedrooms and type of structure indicated herein~ I further verify that, based on the infomnation 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 ~rlth all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. / Address Date (ENGINEER SEAL) o DNEP ~]~ Approved fo~ ~_~[.~ ~- ; bedrooms Approved~ Disapproved Te~s of Conditional Approval By Cond it ion~ CAUTION THE MUNICIPALITY OF ~;CHORAGE DEPARTMENT OF NE~LTH ~ND ENVIRONM]ZNTAL PROTECTION (DHEP) ISSUES I~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOI~I,Y UPON THE I~PRESENT- ATIONS GIVEN IN PARAGRakPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN TtlE STATE OF ~ASKA. THE DI{EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN'ORDER TO SATISFY CERTAIN ~DERAL AND STATE REQUIRE- MENTSo 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. (DHEP SEAL) RR4/e~/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL [I'IAA) Q :J A I t 3 il CKL'%%"UARY ,08. / WELL DATA HOIID~LLO~Jd 'IVJ. N~WNO~IAN~ ~' HJ:IVJiH 40 ~'tCJV~OH~N¥ ItC Well Classification -~/.~'/~- /z-~/.?//.z._Y' if A, B. C, D.E,C, Approved (Y/N) Well Log Present Y~',I) Date Completed .~zx ~ ~-~ Yield Total Depth ,-""~'¢~' Cased to /:,'~ __ Depth of Grouting Static Water Lave /~r~'~ Casing Haight Above Grouno _/"9/ Electrical Wiring m Conduh~q) Seearaeon Distances from To Septic/Holding Tank on Lot ~/'~/' To Nearest Edge of Absorpeon Field on Lot Pump Set At Sanitary Seal on Casing~.~) Deeression Around Wellhead (v~:~. ; On Adjoining Lots / ; On Adjoining Lots To Nearest Public Sewer Line_ M:~.:~C~ TO Nearest Public Sewer Cleanout/Manhole ,'¢Y"¢'/~'¢ To Nearest Sewer Service Line on Lot . - Water Sample Collected by _/~' -'¢?--¢~¢'/ ; Date /~ ~¢¢- ~¢ Water Samole Test Resulls -¢~ ~ ./~'/:7~./ SEPTIC/HOLDING TANK DATA Standp,pe~l)~ A,r-tight Ca~N) Deeress~on over Tank (Y~¢ Pumping/Maintenance Contract on File ~Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ To Property Line To Water Main/Service Line Course Comments Size /~'~:~ No. of Compartments Foundation Cleanou~N) Date Last Pumped -'L~-=~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation __ To Disposal Field To Stream, Pond, Lake, or Major Drainage / Page 1 of 2. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation --~--~f ' Lot . .-"t~., ~¢,/~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ,. ,. ,. ,. ,. ,. ,. ,. ,. ,~, Type of System Design / Length of Field Depth of Field Gravel Bed Thickness Standpipes Present~N) Date of Last Adequacy Test / To Property Line __ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 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" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/~ 2"'~p Date Company ,~¢:~, ~f~m~/¢o~ MOA No. Receipt No. ~[~ Date of Payment Amount: $ Page 2 of 2 72-026 )11/84) BESSE, EPPS & POI~S 2220 EAST 88 AV~NvOE ANC~ICftAGE, AK 99507 (907} 349-6451 WATER ~ELL TEST Location: Subdivision: Lot: Block: Address: Initial Reading (x~ Meter: ~, ~ ~ Pro<linc. ti on Rate: ~,__~___GPM 24-Hour Ca[k%ci ty__/ C. allc~a