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HomeMy WebLinkAboutHAMPTON HILLS #1 BLK 2 LT 10Hampton Hills #! Lot 10 Block 2 #015-134-58 Jul 25 22 09:45p Anchorage Well & Pump Ser 9072430742 p.1 /I MUNICIPALITY OF ANCHORAGE Development Services Department\ % Phone: 907-343-7904 On -Site Water & Wastewater Section % Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 015 134 58 Legal Description Block I Lot HAMPTON HILLS #1 2 1 10 Pump Installation Date: os - 17 - 2022 Pump Intake Depth Below Top of Well Casing: 145 Pump Manufacturer's Name: MYERS Pump Model: 3NFL52-8-P4-V2 Pump Size: .50 hp Pitless Adapter Burial Depth: 12 Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: feet Date of Issue: Property Owner Name & Address: BETHE AMBER N 50% & CRAWFORD MICHAEL S 50% 7740 MC LURE CIRCLE ANCHORAGE, AK 99507 feet ' / MARTINSON Well Disinfected Upon Completion?Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: Company: Mailing Address: ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201035 PID Number: 015-134-58 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name DENALI TRUST ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bedound ❑ Other Site Address 7740 MC LURE CIRCLE *ANCHORAGE, AK Phone Number of Bedrooms Soil Rating depth original grade 907-360-2802 77 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot HAMPTON HILLS #1; BLOCK 2, LOT 10 Fill added above original gr Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank SewerTotal Line orption area Ftz Number of trenches Dist. between trenches Ft. Well 100,+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 51+ NA HDPE 2 Foundation 10,+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. Electrical installed by PER CONTRACTOR Alarm location Installer A+ HOME SERVICES PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Drainfield o3034/EXIsTINc CO/MTD3034 Inspector TIM ECKLUND AND DAVID GARNESS, PE BENCHMARK (Assumed elevation) 99.64 ft Inspeectionction 1" 3/12/2020 2M- 3'd - 4th _ Location and description TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's stamp Conditional Approval: Date 0060 o� OF o4p o p 4 �.. ... ...................� Q /J rC •-7 53 Hess. `o�p �4v re ��-...�•' lvPp #AEccaao�0000��� Septic System `�-- DatZ.7, Approve e ® Note: this approval does not include well permit requirements. tnev U01 Uzi its/ PERMIT NUMBER: PARCEL ID NUMBER: OSP201035 RECORD DRAWING 015-134-58 �w- FCO 27.9 22.6 MH 25.2 37.7 ST1 24.0 42.5 DBL1 23.1 43.6 DBL2 22.2 43.8 CO 14.7 45.2 MT 14.5 45.8 HAMPTON HIL #1 BLOCK 2, L 16 WELL RADAR AND EASEMENT WERE \ PROFESSIONALLY SURVEYED IN PRIOR TO CONSTRUCTION 10 UTILITY EASEMEN� �� 1. •�. •j' DRIVEWAY �• 100' WELL RADIUS , \ HAMPTON HILLS #1; BLOCK 2, LOT 9 GA R NESS ENGINES NG IJP, Ltd - --= ENGINEERING* SALES 0 CONSULTING 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 - PHONE (907) 737-6179 -FAX (907) 933-9240' WEBSITE:-g....e.9meennp com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DENALI TRUST 907-360-2802 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: HAMPTON HILLS #1; BLOCK 2, LOT 10 D.J.G. TYPE OF WORK: DATE: �,_SEPTIC TANK RECORD DRAWINGS 3/17/2020 NEW 1000 GALLON HDPE SEPTIC TANK -I- -NEW C/O AND MT AT NORTH END OF TRENCH =11MATE LOCATION OF DRAINFIELD = 40' ® t®� • # Aff ,.........� 49 .. .........0 ®.�: ;rj .�.......... . d C6^ = Je.rey Garn .,se m ®� �:• CE -79 3 Z�s t•...... •{'� � ®® LICENSE�414%kili .k ® #AECC884 .n/. PERMIT NUMBER: RECORD D RAW I N O PARCEL 3 NUMBER: OSP201035 015-134-58 TOP OF MANHOLE = 99.64 FINAL GRADE = 99.55-99.57 MH ST2 2" INSULATION PER CONTRACTOR TOP OF TANK AT INTLET = 95.57 TOP OF TANK AT OUTLET = 95.57 NEW 1000 INVERT OF BUNG AT INLET = 94.91 GALLON H. D. P. E. INVERT OF BUNG AT OUTLET = 94.74 SEPTIC TANK i� 1 # _._,a GARNESS ENGIN�EjRING I.JI�, Ltd .:..... ..... ' 49 .................. = _ ENGINEERING,, SALES­ CONSULTING - - � , 3701E. TUDOR ROAD. SUITE 101' ANCHORAGE, AK 99507-PHONE (007)337-6179 -FAX (907)336-3246'WESSITE:vmw.gamn engmeeMg.— ,.,, .... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DENALI TRUST 907-360-2802 3 OF 3 ®0 e A. Carne AV LEGAL DESCRIPTION: DRAWNBY: j %, C - 9 V=Ar® HAMPTON HILLS #1; BLOCK 2, LOT 10 D.J.G. ®® . I.' �N.�® TYPE OF WORK: ®® FQ p •••• P�®®® SEPTIC TANK PROFILE DATE. LICENSE®®®q®am4ms®® 3/13/2020 #AECC884 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201035 Work Type: SepticTank Upgrade Tax Code Number: 01513458000 Site Legal Address: HAMPTON HILLS #1 BILK 2 LT 10 G:2540 Site Mailing Address: 7740 MC LURE CIR, Anchorage Owner: DENALI TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: �,,,C 11c 71 r, DeI)aI- tlllellt 3/4/2020 3/4/2021 52866 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received Bl Issued By: Date: Date: 3 y �G�� 3 MUNICIPALITY OFA �u . Qo GE Community Development Department r+rY rr ��;�;Ph : 907-343-7904 Development Services : 907- 343-7997 On -Site Water & Wastewater Program << Mayor Dan Sullivan Dy 68L95n On -Site SewerMell Permit Application For A Single Family Dwelling Parcel I.D. 015-134-58 Property owner(s) CATHLEEN LEWIS Day phone 907-360-2802 Mailing address 7740 MCLURE CIRCLE *ANCHORAGE, AK 99507 Site address 7740 MCLURE CIRCLE *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot) HAMPTON HILLS #1; BLOCK Legal description (Township, Section & Range) LOT 10 Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: ( ® all that apply) Initial ❑ Absorption Field ❑ Upgrade Septic Tank Renewal ❑ ❑ Holding Tank Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: Z -,7 s — Waiver Fees: Date of Payment: 3 2 ® 2- (5 Date of Payment: Receipt Number: Receipt Number: Permit No. —ns r' ZQ I d S Waiver No. (Rev. 01 /11) GARNESS ENGINEERING GROUP, Ltd - - = ENGINEERING SALES CONSULTING _-- -- _- February 27th, 2020 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Hampton Hills #1; Block 2, Lot 10 To whom it may concern: The subject lot is served by a private well and septic system. The existing septic tank is approximately 39 years old. Per MOA memorandum, a septic tank of this age should be physically inspected and/or replaced prior to COSA approval. We are proposing to decommission the existing septic tank per UPC and install a new 1000 -gallon HDPE Greer tank rated for 10' burial. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P. E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com HAMPTON HILLS #1of BLOCK 2, LOT 15 GARNESS ENGINEERING GROUP, Ltd APPROXIMATE X100' --_ --- ---_� WELL RADIUS I -- 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 • PHj (907) 3378179. FAX (907) 3383248' WEBSRE: www.gamessenglnoadng.com PREPARED FOR: �P OBJ o I I HAMPTON HILLS #1 BLOCK 2, LOT 16 HAMPTON HILLS #1; BLOCK 2, LOT 12 I HAMPTON HILLS BLOCIZ-2,LOT 9 / HAMPTON HILLS #1; BLOCK 2,LOT 8 H ( PTON HILL'S #1; BB(TOCK 2, LOT fM 1 I I I I I I I I I I I / I APPROXIMATE I100' WELL RADIUS WELL IS 100'+ FROM LOT LINE PROSPECT HEIGHTS #5; BLOCK1,LOT1 WELL RADIUS DOES NOT ENCHROACH ON LOT LINE PROSPECT HEIGHTS #5; BLOCK 1, LOT 5 WELL RADIUS DOES NOT ENCHROACH ON LOT LINE PROSPECT HEIGHTS #5 BLOCK 1, LOT 6 \ N / Ilmmmmd 1'=10 P�E OF . X40 TYPE OF WORK: DATE: 4 SEPTIC SYSTEM DESIGN UPGRADE 2/27/20 #AECNG8M 410 * �� 0 .......................... 0 ey A. -Gam ssAV .:i�j AT C,0 -79 3 ••.;� lkftFES's� ��•• GARNESS ENGINEERING GROUP, Ltd liff --_ --- ---_� ENGINEERINGALES -CONSULTING — ----------. 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 • PHj (907) 3378179. FAX (907) 3383248' WEBSRE: www.gamessenglnoadng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ♦♦G% CATHLEEN LEWIS 907-360-2802 1 OF 2 ♦♦♦ PROJECTILEGAL DESCRIPTION: DRAWN BY: HAMPTON HILLS #1; BLOCK 2, LOT 10 E.D.W. TYPE OF WORK: DATE: 4 SEPTIC SYSTEM DESIGN UPGRADE 2/27/20 #AECNG8M 410 * �� 0 .......................... 0 ey A. -Gam ssAV .:i�j AT C,0 -79 3 ••.;� lkftFES's� ��•• EG, Ltd. HAS AN 8 PAGE SPECIFICATION LETTER NOTE: THE CONTRACTOR SHALL HAVE THE THAT PERTAINS TO THIS DESIGN. BY PROCEEDING / FORWARD WITH THIS INSTALLATION, THE NORTH EASEMENT AND ALL WELL RADII ENGINEER, WELL DRILLER, CONTRACTOR AND SHOWN FLAGGED BY A REGISTERED LAND PROPERTY OWNER AGREE THAT THEY HAVE SURVEYOR PRIOR TO CONSTRUCTION. READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. PROPOSED 1000 GALLON HDPE SEPTIC TANK; INSTALL 10'+ F BEFORE AND AFTER; SEPTIC TANK THE FOUNDATION; EXISTING TANK INSTALL CLEANOUT AND MONITORING TUBE AT THE BEGINNING OF BE INSTALLED 10'+ F DOUBLE CLE THE EXISTING DRAINFIELD; IF DRAINFIELD ENCHROACHED ON WELL TO MAY NEED TO BE HAULED OFFSITE; IF IT IS NOT HAULED THE NORTH; A WAIVER WILL BE REQUESTED WITH THE COSA. OFFSITE, IT IS TO BE DECOMMISSIONED PER UPC CONTRACTOR SHALL HAVE THE TRENCH LOCATED SO THE ENGINEER �\ \ C VERIFY THE SEPERATION TO THE FOUNDATION AND LOT LINE \ �=UTILITYEggEMENT O - \ 10'+ 10' EXISTI G 3 BEDROOMOUSE DRIVEWAY., 700 kL VV '<< HAMPTON HILLS #1; BLOCK 2, LOT9 I`APPROXIMATE LOCATION OF EXISTING DRAINFELD PER INSPECTION REPORT IN MOA RECORDS GARNESS ENGINEERING GROUP, Ltd ENGINEERING o SALES o CONSULTING I-- - _ 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179 -FAX (907) 338-3246' WEBSITE: www.gamessengineering.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CATHLEEN LEWIS 907-360-2802 2 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: HAMPTON HILLS #1; BLOCK 2, LOT 10 D.J.G. TYPE OF WORK: DATE: DESIGN OF SEPTIC TANK UPGRADE 2/27/20 I— z w w w 0 • Municipality. of Anchorage ° On -Site Water and Wastewater Program (907) 343-7904 s r Certificate of On -Site Systems Approval 015-139- 50 Parcel I.D. i3 1. GENERAL INFORMATION: Expiration Date: (O'S d —ZQ2-0 Complete legal description HAMPTON HILLS #1: BLOCK 2, LOT 10 Location (site address) 7740 McLure Circle ;Anchorage 99507 Current Property owner(s) David & Sarah Saalfeld Day phone C/O agent Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 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: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ / Dg, -75 (� V I D Date of Payment I a �0 Receipt Number N`1536 COSA # Q5G20 11�07 Date: Waiver Fee $ Date of Payment Receipt Number 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road. Suite 101- Anchorage, Alaska 99507 , / Engineer's Printed Name: Jeffrey A. Garness Date:' Z� I In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or v.• "" �` �i;i,' encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and i >i workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ' are outside the control of GEG. Satisfactory test results do not guarantee future performance of the; .:... system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of c ncss the well or septic system. GEG makes no representation whether an alternative well or septic system �) .� "Y can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to I;,"r �{-• � �� Perform the evaluation. Reliance upon the information provided in this report by any other person or ; � party (including subsequent property purchasers) is not authorized, nor will it confer any legal right 1;� ess whatsoever. #AECC884 6. DSD SIGNATURE —7K` System #1 Approved for -3 System #2 Approved for _ Disapproved Conditional approval for bedrooms bedrooms 4,\ Y OF P,L\T 'Sores/ bedrooms, with the following 4gi lation0N-SITE _ WATER AND m r TI`_ vVATER oz Jl0 F�� 1/J ' orttv�•� JyJI!)1 ))li�l�}1 Original Certificate Date: —� 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 C Septic System Advisory Arsenic Advisory Well Flow Advisory Other 0 i I COSA Checklist Legal Description: HAMPTON HILLS #1; BLOCK 2, LOT 10 Parcel ID: 015-134-58 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA F0 Well log is filed with Onsite (or attached) Date drilled 9/11/81 Total depth 151 ft Cased to 135 ft ❑ Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2/18/20 Static water level at beginning of test 109.3 ft Comments B. TANK DATA Age of tank(S) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 6/10/81 ❑ ALL standpipes present per record drawing Total measured depth from grade *8.1 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.1' M Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: "AT SUMP COSA Checklist yellow sheet Well production at time of test 2.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? [I Yes ❑ No ❑ Coliform bacteria is Negative LNitrate 6.83 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 7/17/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments. Adequacy test date 2/18/20 Results F Pass For 3 bedrooms Fluid depth prior to test 16 in Water added 456 gal New depth 19 in Elapsed time 120 min Final fluid depth 17 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A NONE 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' El Yes if No Community Sewer Manhole/Cleanout > 100' M] Yes if No ft Q Yes if No ft Neighboring Tank > 100' P/1 Yes if No ft Private Sewer/Septic Line > 25' Fv-1 Yes if No ft Absorption Field on Lot > 100' MI Yes if No ft Holding Tank > 100' M✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 0 Yes if No ft Ml Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [D Yes if No ft [✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: M] Yes Absorption Field > 5' Q Yes if No ft Private Wells > 100' R Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' M] Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' M] Yes if No ft F. ENGINEER'S COMMENTS *UNKNOWN - BEGINNING OF DRAINFIELD WAS EXPOSED AND FOUND TO BE 10'+ FROM THE FOUNDATION - SEE ATTACHED SEPTIC TANK RECORD DRAWINGS 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 #AECC884 Nitrate Advisory Certificate of On -Site Systems Approval # OSC 201367 Subdivision: Hampton Hills #1 Blk 2 lot 10 A water sample revealed a nitrate concentration of 6.83 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. "Ma�l�ng Address P�;O � Box 196650: *Anchorage, Alaska 99519 6650 *www mum org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Maihng�Address� P O Box �96650�* Anchorage, Alaska 995196650"* www muni org � � , 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage; Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: II �Zo In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage ando��ooOp� industry practices. The reported results describe the condition of the system/s on the dateis of the`�Q©4 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 q V� workmanship), and the water usage of the family utilizing the systemis. These conditions can vary, and ""' are outside the control of GEG. Satisfactory test; results do not guarantee future performance of the j 0 system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of f r G...•.ss. . the well or septic system. GEG makes no representation whether an alternative well or septic system AA ' can be installed on the property in the event either of the current systems fail to perform adequately inV,1 9. '•. C�-7 53 the future. The content of this report is for the sole benefit of the person/party that retained GEG to VQ4 s t �2.0•' ©� perform the evaluation. Reliance upon the information provided in this report; by any other person or p fes..o�°� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right �QDofessiorQ whatsoever. #AECC884 6. D—�IGNATURE System #1 Approved for —bedrooms System #2 Approved for bedrooms t�iittit{fir"t�83§' Disapproved ���®5� f°,a,. Conditional approval for bedrooms, with thq, wind lations ;� .Z "' ON /14 NI Original Certificate Date:�'� 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 Legal Description: HAMPTON HILLS #1; BLOCK 2, LOT 10 Parcel ID: 015-134-58 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA FOR Well log is filed with Onsite (or attached) Date drilled 911'181 Total depth 151 ft Cased to 135 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 2118/20 Static water level at beginning of test 109.3 ft Comments B. TANK DATA Age of tank(s) NEW years Tank type/material HDPE Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 6/10/81 ❑ ALL standpipes present per record drawing Total measured depth from grade *8.1 ft (max) Measured depth to pipe invert from grade 5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.1' ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: *AT SUMP COSA Checklist yellow sheet Well production at time of test 2.0+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate 6.93 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 2/18120 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comment Adequacy test date 2/18/20 Results [7 Pass For 3 bedrooms Fluid depth prior to test 16 in Water added 456 gal New depth 19 in Elapsed time 120 min Final fluid depth 17 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A 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' M Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft M Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft M Yes if No ft ft If septic tank is under driveway comment below , Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 17,71 Yes if No ft F,(7I Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Q Yes if No Absorption Field > 5' [ZI Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' rVJ Yes if No ft Water Service Line > 10' 0 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' ❑ Yes if No * ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Q Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS UNKNOWN - BEGINNING OF DRAINFIELD WAS EXPOSED AND FOUND TO BE 10'+ FROM THE FOUNDATION - SEE ATTACHED SEPTIC TANK RECORD DRAWINGS G. ENGINEER'S CERTIFICATION / certify that / 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 #AECC884 ft ft ..... I ........ Gar ess.* CE -7 �4�d pro f es sio�°moo #AECC884 ft ft 26 \' �o' Utility EN82032'rpt 30„ W 263.29 61 hlanhol.. �a �6ro p �2.1OH ?2� y S House me �u q0 D Lot 11 Shed encroaches f f I a_• Septic vent (typ) f 2.3 OH f Lot 10 'Vss°s 3S Lot 9 Note: Asphalt location is approximate due to snow and ice on site. CD 6 RECERTIFIED 3-19-20 AS -BUILT NO CORNERS SET THIS DATE OF • �� 1 hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following • described property: LOT 10, BLOCK 2, 'W�'? 9th ',9 8 4g HAMPTON HILLS SUBDIVISION UNIT No. 1 Anchorage ® ✓ �Z . Recording Precinct, Alaska, and that the improvements situated thereon are within the lines 00s� 'Aizabeth L. Valatko . ,� property and do not overlap or encroach on the property lying adjacent thereto, that no improvements the lying ,o on property �sr� • 8036 – LS • Jq , ° adjacent thereto encroach on the premises in question and . , .pF , 5 .� that there are no roadways, transmission lines or other • �a • . , . • '��o SCALE: 1 "= 50' FEss1oNN1- visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN _ ,, r this 24th day of February 2020. THOSE SHOWN ON THE RECORDED' PLAT ARE NOT SHOWN HEREON. FB 20-1, pg 30 FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors UNLESS OTHERWISE NOTED FB 20-1, pg 15-16 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence, structure or other improvements. This drawing shall only be used for a single transaction. property Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L, Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the nronnrar is 11mit—q In tho ­.,.,, ..r rnnn s..- ,.,,.-,.--- t.. _e 1— ____..._. d11, .� s� �� DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section.. www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC201119 Subdivision: Hampton Hill #1, Block: 2, Lot: 10 907-343-7904 Fax: 343-7997 A water sample revealed a nitrate concentration of 6.93 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Ad�ress P O Bo�C 196650 *Anchorage, Alaska 99519 665Q * www muni org x?.v- .�.X;3:. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 4 t r Mailing Address P OBox 196650 *Anchorage, Alaska 99519 6650 * www muni org Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 015-154-58 1. GENERAL INFORMATION Complete legal description HAMPTON HILLS SUBDIVISION //1: LOT 10. BLOCK 2 Location (site address or directions) 77'~0 McCLURE CIRCLE Property owner Mailing address Lending agency Mailing address Agent JOHN BLAINE Address ANN JENKS 7740 McCLURE CIRCLE Day phone ANCHORAGE. AK 99516 Day phone (907) 545-5520 Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72-025 (Rev. 1/91 ) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at, or prior to, closing for the engineering services provided. 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 fudher 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 a~d State codes, ordinances, and regulations in effect on the date of this inspection. · ~/ /, /, /'' Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, IN(;. Phone (907) 337-6179 Address 6901 DEBARR R D, sUI 2B.. CHORAGE, ALASKA 99504 / Engineer's Signature L.___.\~,~,/I?/ "~-~ Date -] / ! / ',,, f / In conducting this evaluation, AWWC, Inc?a¢emp. ted to procide a inorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of ina family being served by ina system. These conditions are outside the control of the evaluator of the system. Satiefaetory tset reeulte do not guarantee future peffarmanos _~x ~v U...F.. ..,~. ..~ ~, of the system, nor do they guarantee that there are no hidden defects or encroachments. .~'~', ~-%..'". AWWC, Inc can therefore not protdde any warranty for future estimate ef how long the ~'~'~ ~ ~ ~/u %"~ system will continue to meet the operational requirements of the ADEC or MOA £ HHS.~,/... :.. 1...., ....... The content of this report is for the sole benefit of the owner listed above. Any ~ ~ reliance upon or use of this report by any other person or party is not auinorized,~..%,,c.;;; .';~ nor will it confer any legal right whatsoever. ~ ..SS ONATU ~1 *~. ". ....... "~,~ ~ Approved for /-~ bedrooms ~¢~p~o~'" Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHI-IS) 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, 72-025 (Rev. 1/91) Back MOA #21 Computer Version Health Authority Approval Checklist Legal Description: HAMPTON HILLS S/D #1; LOT 10, BLOCK 2 Parcel I.D.: A. WELL DATA Well Type PRIVATE Log present (Y/N) Total depth 151' Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 dUL 28 £000 IfA, B, or C~ attach ADEC letter. ADEC water system number Y Date completed Cased to 40'+ YES 015-134-58 9/41/81 Casing height (above ground) Wires propedy protected (Y/N) FROM WELL LOG 9/1 /81 AT INSPECTION 7/20/2000 100' 118' N/A 18"+ YES 2 g.p.m. 2.5 g.p.m. Nitrate Date of samplei 7/21/2000 B. SEPTIC/HOLDING TANK DATA Date installed 6/10/81 Tank size Foundation cleanout (Y/N) YES Date of Pumping 7/20/2000 C. ABSORPTION FIELD DATA Date installed 6/10/81 Length 44' Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth 24" (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev, 3/96)* Computer Version .3.35 mg/L Other bac{eda. 0 ColleCted by: A.W.W.C., INC. 1500 Number of Compartments 2 Cleanouts (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Pumper A+ HOME SERVICES I.SUMP ONLY EXTENDS 46" BELOW INVERT.I Soil rating (g.p.d./ft2 or fi2/bdrm) 130 System type TRENCH Width 3' Gravel thickness below pipe 6' Total depth 1 O' 528 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO 7/20/2000 Results (Pass/Fail) PASS _ For 4 Bedrooms *20" Immediately after 1253 gal.~w~.er added (in.): 52" 752 Absorption rate = NONE KNOWN If yes, give date D. LIFT STATION ~ Date installed ~).~ Manhole/Access (Y/N) ~evel at* ."Pump off" level at*__ High wa~ *Datum ._¢yelesTested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot. Public sewer main Sewer/septic service line 100'+ On adjacent lots 100'+ 100'+ .On adjacent lots 100'+ N/A Public sewer manhole/cleanout N/A 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line. 10'+ Surface water/drainage. 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: __ Absorption field Wells on adjacent lots 5'+ 100'+ Property line Surface water Curtain drain 10'+ Building foundation 100'+ NONE KNOWN 10'+ _Water main/service line 10'+ Driveway, parking/vehicle storage area__ 10'+ Wells on adjacent lots 100'+ F. .O .EER'S C T F £fT O2 I certify that I ~avelde~/~ni~)~d~t~l of Municipal rpco~e t~t t~fe with MOA H/~A guldE~l~e/~ in~e( Engineer's NamJ Date ?eld inspections and review systems are in conformance ~n this date, JEFFREY A. GARNESS HAA Fee $ ~ Date of Payment ~/'~/~ Receipt Number 72-026 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment. Receipt Number ,00 16:41 JACK HHITE REAL ESTATE ~7~_2_3.1.8..9/~7 · [ ~,¥' . ~ ----...-_. ~ .... .., ~,/ ,Ex ,~ , ~ I~, "' · ~ ,~. ' . ~ ~ o[ 4'% ~ " ' ~ ..... ..-.. ~.A ~. ~ - I~ ~ / ~ - ~ %~'i, ~ ~ ,~1~ I :'" ~,W.~ ~;~ ~*~ -~ -- ' g. ~ I. I-n . (/&';~ ', '"'~.:~ff .... ;~.~ ",t~;:.... '~'" ...-:~;G/ . ~ ~_~  the~istence of any eas~ents, covenants, off re- str~tons wh(ch do not appear on the recorded sub- ,. , dtv~ton Plat. Under no circumstances should a~y dat~*hereon be used for construction or fo; estab- ~OTE ~:'~A I*'* I ish'i,pg boundary., or fence lines. The surveyOr, ~aker ~owNEASE~ENTSoN THEOFRECORO'OT~ERTHRECORO~O .; resRoAsib(ltty for the initial transactior, only. sHow~ ~m~oa. ' ~N~ORAG~ R~CORDING DISTRICT ~ "~' ' : 804 EAST 15fh Ave. Built Z I ' ,', ' -~ . ~ ANCHORAGE ALASKA 995q1' ] , ~vl~;o, I ,~: . ia,: o' ~c,~:, ,,_ ~; .(~,,[~,~ .,,- I~.~ i~~ ~-r.~, 07-25'00 1~:48 FROM'¢TE E~IVIRONMENTAL Z?k C T&E Envi ,onm,nta, Services,nc. 5615301 T-094 P.OZ/03 F-SZ1 CT&E Ref.~ Client Name praject Namer5 Client SampLe ID Matrix Ordered By PWSID 1004003001 Al(. ~VaTar & W~stewaT~r Consultants Inc. Hampton Hill #1 LOT 10 Blk 2 Hamton Hill #1 Lot 10 Blk 2 Drinking Water Client PO~ Printed DateFrime 0?/26/2000 10:'{9 Collected Datetl'ime 07/21/2000 8;45 Received Date~ime 07~1/2000 Technical Director Stephen C, Ede Sample Remarks: A~ow~le ~ AnalySis Date Iui[ Parameter Resuhs PQL Units Methoa I lx-~ls 3 35 0,500 mp~- EPA 3000 10 max 07F21/00 SCL Nilr~te-N Hic=obiolog¥ Tend Coliform col/10omi- SM1S 9222B 07/21/00 KAP 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 Parcell. D.# 01'-'~ "/~"1 -- $- ~"~ 1. GENERAL INFORMATION Complete legal description Lot 10; Bloc]( 2; []ampton Hills f)l Location (s,i.t..e,addr.ess or directions) 7740 HcLure Circle Anchorage, AK ProPe'¢ty owner Hary~ ~ John r/.lheat].e¥ Mailing 'address '7?4b"~{~Lure Anchorage, Day phone AK 99516 34.6-2025 Lending agency Mailing address '" Agent ,~ob Gross/ Glacier State Realt?/ Day phone Day phone 349-9421 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ,., TYPE OF WATER SUPPLY: Individual well ~c~× Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer · NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/91) 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. Name of Firm Address Engineer's signature $ & $ ENGINEERING 17u34 I~agle River Loop Road NO. 204 Eagle P~lYer~ Alaska 99577 -Phone Date ~ /¥/¢/ 7 DHHS SIGNATURE v// Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. 72~25 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORA~ t4,,IVIRONM~NTAL SERVICE,,S DIVISIOJ~ Municipality of Anchorage AUG 04 1997//~J~'~. DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~3~4(~z~ 1 \t 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3 - Legal Description: LOg-' /o Health Authority Approval Checldist Parcel A. WFLL DATA ~ell type Log present Total depth Sanitary seal If A, B, or C, attach ADEC letter. ADEC water system number Date completed CC /h / ~ I Cased to ~ o Casing height (above ground) _.~- Wires properly protected(~N) FROM WELL LOG AT INSPECTION / dO tO '7 ~' g.p.m. / * Date of test Static water level Well production WATER SAMPLE RESULTS: O Coliform Nitrate Other bacteria g.p.m. Date of sample: '7 /, '-// ¢1 7 B. SEPTIC/HOLDING TANK DATA Tanksize I 5'00 Date installed Foundati0n'~leanout ~.N) ~, Date,6f, PfmPing .'"//~ ~-: C. ABSO'RpTflON..FiELD DATA' Collected by: S & S ENGINEERING 170:]4 I~n~_l¢, I~;¥,.. L~_ep R~"~ ."!c, 204 Eagle River, Alaska 99577 Depresmon (Y/~ /'/0 Pumper Number of Compartments -?-- Cleanouts (~'/N) ¥4 J' High water alarm (Y/~I). /~ o Date ih~talled I ¢l ~' ( ~ . i~ Soil rating (g.p.d./fF o~/ff¥/-6~ I ,,? o System type LenCh ' ~ ? r width," 3 / 6 ' ' ' ' Gravel thickness below pipe 7btal depth Effective absorption area' ~ ~ ~ ~t Monitoring Tube present~) V*J Depression over field (Y~ ,v o Date of adequacy test_ '~ / ~ o / ~ ? Results ~Fail) ~* ~ J __ For '~ bedrooms Fluid depth in absorption field before test 0n.); ~" Immediately a~er ~r~gal, water added (in.):. , ,, ~ ~ Fluld dopth ~ 7 (ins) ~inutos later:. ~ o Absorption rato = g.p.d. Poroxido lmatmant (past ~ 2 months) (Y/~) ~ ~ ~ o,~,~ ff goo, giro date _ 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" lev~at'~"'"'"'"'~Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ) 0'O Absorption field on lot / o 0 ' -/-- Public sewer main Sewer/septic service line gL .~- / .-~ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ! Foundation ~"' '~ Property line Water main/service line /0 ~-/- Surfacewateddrainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ! Property line t~ ~ Building foundation / Water main/service line Surface water /,aa r_/_ Curtain drain Driveway, parking/vehicle storage area Wells on adjacent lots / O o ENGINEER'S CERTIFICATION .,~-~~ '~'~' -'~11~~,.-~1~.~ ' I certify that I have determined thru field inspections and reviewof Muntclpal reco ' ~" he a '"' ''? are in conformance ~. ~/~ ~,,nos in effect '' ,o~.~.~e Signature ""~ K- 6-. Engineer's Name '~ ~o~ / Date ~ ¢ ~ / ~ 7 HAAFee $ ~'~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* CT&E Environmental Services Inc. Laboratory Division ~z/~/~-.~,~_~,~.~:~_.~ Laboratory Analysis Report CT&E Ref.// Client Name Project Name/// Client Sample ID Matrix Ordered By PWSID S~m~ple Remarks: 973814001 S & S Engineering N/A Lot 10 Blk 2 Hampton Hill gl Drimking Water Client PO// Printed Date/Time 07/16/97 11:23 Collected Date/Time 07/14/97 12:00 Received Date/Time 07/14/97 14:00/~ Technical Direct~ep~f C. Ede~ Released B~~._~ , Parameter Results Units Nitrate-N Tota[ Coliform 3.06 0.200 mg/L 0 col/lOOmL Allowable Prep Analysis Method L~/~its Date Date._~ ln..~ SM18 4500-~03F 10 max 07/15/97 JRJ SM18 92228 07/14/97 RAM 200 W. Potter Drive, Anchorage, Al( 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 -- Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WFS;T