The URL can be used to link to this page

Home My WebLink AboutSPRING HILLS ESTATES BLK 2 LT 8Sp ing Hill Estates Block 2 Lot 8 #015-051-63 Municipality of Anchorage Page DEPARTMENT OF HEAL'I'H AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ...~/c,J'~ ~ oo~0 PID Number: O1~' Name~'~o~p. IZ."[ ~¢ Ol~ ~A~¢~ Wastewater System: ~ New ~Upgrade Phone: ~ __ ~80 IN°'°fB~°°ms: ~ Deep Trench ~hatmowTrench ~Bed UMound ~Other Total Depth from original~rade: LEGAL DESCRIPTION SoilRating: ~,~ GPD/Sq. Ft. ~. I ~ Lot; ~ Block: ~ Subdiv~ion: Depth to pipe boEom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added ~bove original grade: Gravel length: WELL: ~&wF~ New~ C Upgrade Gravelwidth: ~ Number of lines:j Disun~nlin~: Ft. r Ft. ~la~ification (Private, A,B,C): Total D~ ~;: Total absorption area;~ Pipe material: Driller: ~ Date Drilled: Static Water Level: Installer: Date~nT~led:./ M Ft. Ft, SEPARATION DISTANCES ~Septic [ ...... D Holding D S.T.E.P. TO Septic Abso~tio~ Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines J Web ~O~J~ I~l~ ~ ~ ~1.~ Material: ~ Num~r°fC°mpaRments: su,ac~ ~oo~t [~+ ~ ~ ~ LIFT STATION Wator Lot Size in Foundation Remarks: ~uN ~ I~~ BENCH ~ARK Location and Description: ~um~ Elevation: Depa~ment of Health and Human Se~ices approval -~..~ cU,,~ ...~j Reviewed and approved by: ~~ Date: 4'7'~ 72-O13 (Rev. 9.,~1) MOA25 Alaska Water & Wastewater Consultants, Inc. April 7, 1999 6901 Debarr Road, Suite 2-B - Anchorage - Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consnlting Engineers Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED Municipahty ot AnOBora~o Dept, Health & Human Services Subject: Septic System As-built Package for Lot 8, Bk 2, Spring Hills Estates To whom it may concern: Attached is the as-built package for the septic system upgrade on the subject property. The design package, which showed the location of the original bed on this lot (constructed in 1985), was based upon an as-built survey document dated 6/29/90 (Andrew F. Potts, L.S.). The accuracy of the pipe locations on the drawing is probably of limited accuracy. The position of the clean-outs in the bed was based upon the 5/31/85 MOA inspection report. Given the proximity of the bed pipes in the field, to undisturbed scrub spruce trees north of the bed, it is doubtful that the pipes could have been located at the position shown; otherwise, a portion of the bed would have been under the spruce trees. In short, the actual position of the bed is uncertain. It is clearly not 28 feet fi~om the south lot line, as shown on the 5/31/85 inspection report. In short, some liberty has been exercised, on the attached septic as-built, regarding the location of the 1985 bed. During construction, the excavator placed the trench slightly further south than originally requested by the field engineer, possibly encroaching upon the 10 foot separation distance to the old bed. The new line, from the tank to the new trench, runs between the trench and the bed. During the excavation of the trench and the line to it, no wastewater, or contaminated soils were encountered. The soils throughout the trench length were excellent, consequently, the effluent should migrate downward rapidly, minimizing any influence between the new trench and the existing bed. If you have any questions, assistance. contact me at 337-6179, or 244-9612. Thank you for your MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box '196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-81TE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar26, 1999 Expiration Date: Mar 25, 2000 Permit Number: SW990040 Legal Description: SPRING HILLS ESTATES BLK 2 LT 8 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Robed & Diane Malone Owner Address: 9500 SPRING HILLS DRIVE Total Bedrooms: 4 ANCHORAGE , AK 99507-437t Parcel ID: 015-051-63 Site Address: 009500 SPRING HILL DR Lot Size: 49282 SQ. FT. Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage AIl construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~' ~ Issued By: ~~ ~. Date: %-"~- ,~4~ - ~-~ Alaska Water & Wastewater Consultants Inc. 6901 Debarr Road, Suite 2B - Anchorage - Alaska 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers March 16, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 8, Block 2, Spring Hill Estates Subdivision To whom it may concern: The existing 4 bedroom house is served by a private septic system and a private well. The septic system will not pass an adequacy test and must be upgraded prior to the sale of the house. A test hole was excavated to the northwest of the existing bed. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is a log which shows the soil pro£de, and the percolation test result. The soils below the orgmfic layers is a reddish SM ~naterial to a depth of 3 feet and than transition to a primarily GM to GW/GM material to a depth of 7 feet. At 7 feet, the soils transition back to a SM material to a depth of 14 feet (bottom of test holes). The bottom 1 foot of soils in the test hole was hardpan and is assumed to be impermeable. No groundwater was encountered during the excavation of the test holes. A percolation test was performed between the depth of 6.25 feet to 7.25 feet and found the rate to be <1 minute/inch. It is our opinion that due to the high percentage of sand, the insitu soils will serve as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ft2 f. Total Depth: 5 t'eet (max.) g. Effective Depth: 3 feet h. Width: 5 feet minimum i. Reduction Factor: 0.58 i. Minimum Length: 58 feet long Effective absorption area = 500 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The average topography in the proposed upgrade area is mostly flat; in short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Presi~tefit [J NOTE: Attached ia' a site plan drawing, a design drawing, a soils log and a 4 page construction specification letter which are all part of the design package for this septic system upgrade. NOTE: PROPERW LINES, EASEMENT'B, HOUSE LOCA/'J(~NS, .7-~ / // 'A ~MBI~TidN CE ~QURC~ WHICH ~E ~ FO~OWS: _~ j / / .~ N].O.~ GRID ~S (PRODUOED BY GEONORD'I), / -- ~ ~ / / ,2 SUitOR'S ~-BUILTS, M.O~-D.ILH.S RECORDS, , / ~ / ' D.[.C. ~CO~S, AND/aR HEm U~U~EmS. r F ' N I ' ~ ~ INFO~ON SHOWN iS TO BE ~RIRED BY ~IE ' NI ' LOT 5, BLOCK CO~RA(TOR PRIOR TO ~ ~NSmUOllON. ; ~ ; SPRING HJI~ ~TA~S ~, . ~ EXIS~ING~ / % / /~ SPRING HILL ESTATES ~. ~ Z ~ k ~ / ~'" ~ ~ / ' LOT 9, BL.OOK 1, ' % / J' SPRING HILL. E~A-rES 100' CREEK S~K--~ LOT 10, BLOCK 2, ~ ~S~ WA~ A~) WAS~WA~ CONS~TA~S, ~C. 6001 .... PHONE: (007) 337-6179/F~: (907) 338-~246 ~'" 'n I.EOAL DESORIPTION: ,' , ' ~ '~ SPRIN~ HILL ESTATES S/D; LOT 8, BLOCK 2, '~E OF ¥~ORK~ PREPARED FOR: PItONE NU"BER: m NE ..'" ROBERT AND DATE:~/16/99 B~WN ~'. SCAL~: PAGE: J.L,M, 1 = 100' 1 OF 2 ,A~ , i 1. THE CONTRACTOR SHALL HAVE THE WE~T AND SOUTH '.., -.. PROPER'Pt LINES FLAGCIED BY A REGISTERED ~D SJJRV~OR ~....~ ~ PRIOR TO CONSR~C~ON. ~ 2. THERE ARE ~. UTILI'~ SE~ICE LJNES l~T ARE O~R ~E EXI~ING SE~IG TANK AND D~NFIEL~, THE OONT~OR ~ IS RESPONSIBLE FOR G~LING IN LOCATES. ~E CONT~OTOR IS ' ~SO REPONSIBLE FOR ~GING WIll 1HE HOMEOWNER AND ~ ] THE L.IL~ COMPANIES OF ~Y TEMPO~Y DISCONNEC~ON i ~D/OR RERO~ING OF UTILr~ SE~[CE UNES. ~~ ~ r~ ~N[) SLJ~OR PRIOR TO CONTRUGBON. ~f~ ~ i i ~-PROPOSED D~INFIELD UPG~DE, ~ J ~ ~ EXCAVATE 7 FEB" DEEP MAXIMUM // [ ~ BY 5 FE~ W?E MINIMUM BY / ~ ~ ~ ~. ~ .ONe. AB~ ;.0 ~E~' ~ ~ ~ OF CLEAN, WASHED DRAINROCK. ~ ~ i ~ INSTALL TRENCH PAI~LLEL TO / ,/ ~ , ~ ~ ~ ~ A~ SLOPE CONTOURS. / '~k~ ~ ~ ~ INSTALl. DBL CO--1 ; TH~I ¢~~ J ~ k~ ./' x..~ -i~ ~ WELL ; ~- ~ J ~ ~RI~ INEGRI~ OF' 1250 GA~O~-~ ; j j ,~ ~N 'm~ ~ ~ SHOWN O. ~ .~.N. ~ ' J ~PROPOS~ REP~CEMENT ~ , I SEPTIC TANK SITE EXISTING BED IS TO BE J ~ r ~ USED ~ A RESERVE SITE,~ ~ ': ~ / ~ / ~ j NOTE: PROPER~ UNES, ~EMEN~, HOUSE LOCATIONS, ~% / ~ SEPTIC ~MS, WE~, ~C., ~VE BEEN TAKEN FROM ~ ~ A COMBJ~ON OF SOURCES WHICH ARE AS FO~OWS: M.O~ GRID tA~S (PRODUCED BY GEONORTH), / ~ : ~U~OR'S AS-BUILTS, M,O,A.~D.H.H,S RECORDS, / '~ , D.E.C. RECORDS. ~D/OR FIELD M~SUREMENTS. / ~ ALL INFORMATION SHOWN IS TO BE VERIRE~ BY THE J [ ~ GO~P~TOR PRIOR TO ANY CONS~U~TION. J S,.~N~ .~LL ~S~T~S S/m LOT., .LOCi( ~ ........ i~ ..... I ....... 1YPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE ROBERT AND DIANE ~ALONE 546-46~0 ~-7953 ." J.L,M. I = 40' 2 OF 2 ALASKA. WATER &, WASTEWATER CONS~TA~S, ~C. 7320 E. CHEER ~S. CIRC~ ' ANCHO~GE, AR. 9950¢ ~, I SOlE LOG - PERCOLATION TESTI LEGAL DESCRIPTION: SPRING HILL ESTAES S/B; LOT 8, BLOCK 2, ,~ ,/'~ .....]~[~~: ............ ,, PERFORMED FOR: ROBERT AND DIANE MALONE (feet) :~5~¢~¢~ ORGANICS TEST HOLE ~1 ~t~ SOIL C~SSIFICATIONS ; SITE PL~,N 2--,~, SH (REDDISH) ~ ,,= 3--~; ~ ~ ~PROPOSEB ~EPTC UPO~E ~ '. GP ~. ; i~ HL ; ~%(SEE 7-- m~d,¢, ~' ~ . ~ ....... DATE ' GROUNDWATER ~ SANDY SOIL '~' ~';'~; <,~!~ WITH SILT DATE READ ~n CLOCK NET TIHE WATER LEVEL: NET DROP 11 --~,~ ;, ?~, .... TIME (MINUTES) READING (INCHES) 1 ~ ~ ~ ~T~SlTION TO 14~ B.O.H. 15~ 17--- 199 18~ ' ..... ~ ................ 19~ PERCOLATION ~TE <1 (~IN./INGH) PERt. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 6.2~ FT. AND ,~.25 FT. CO'MENTS: ]NSITU SOILS SHOULD ACT AS A SAND FIL~~,~/, ,¢* PERFOMED BY A~SKA WATE~ ~ WASTEWATER I, ( ¢~~-__,__ , CERT'~ THAT THIS WAS PERFORMED I~ ACCORDANCE WITH ALL S~¢/~I~UNICIP~GUIBELINES IN EFFECT ON THIS DATE. DATE: .' ~//~ [~' -- I / ¢ DEPTH TO DATE GROUNDWATER DRY 3/9/99 DRY 3/16/99 P,O, Box 1 ~0378 · 10330 Old SewaJd HJgI',wa¥ (gOD 3,-;9,853s DRILLIN~ LOg . j ..Use ot Well-..P.P?~e.~t, ~% ~oc~tier~ . .t,~., os ( ......e~ of: ?ownshlp, R~nge, Section, if known; or distance mai~ road__ ~?~oprlng l{i~ E~ate~, Anchorg~e water lev? _ _,167 At, (~1~8/3~, ~below) l~nd surface, Finish o~ well (cheek one) Screen ( ); Perforated ( "r)'- "'"' ~ perforatloD " of drawdown from stntle {evel, ' :'[:, ~' h:'.. "h r~ WELl. LOG Depth in fo~ from ground surf~ce __ - O_TO ...... ~,..= (minute) for-..J~ __2 TO ...... 3 .D_TO .... _ 5__TO ..... 3.1 .__ ..__.,_1 LTO_. 36__ ... s eL. TO ........ 76 .... _ 7~,5_TO_.1 L5 .... __.LI.5~TO-. ! c,,.°,.....!- _ ~ ~L'ro_ 175 181 192, .... TO .......... open end ( X ); ., _.hours wP, h:= ._[..0. gX ....... .,_.,._._/~.X Give d~tni!.~ of formations penetrated, size of materlalt~,o,~l'~..~_.~ ,' ,1,, + ; __ :Ca al~g~~ , i: _ ~ "" "" ';' ECEi VED ~_~ ~.8 _;'-" 3 ~ CONTRAC, TOR ~ 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 ~AILING ADDRESS LEGAL OESCRIPTION %o.o~ ~O~OOMS ~ Well ~ Absorption area Dwelling PERMIT NO, DISTANCE TO: ~'~ ~ ~ Manufactur.r ~,~ Material ~ ,o. ofcomoartme.ts ~ Liq. capacity in gallons Inside lenoth Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO, O ~ Manufacturer Material Liquid capacitv in gallons ~ DISTANCE TO: ~ ~ '~ uJ -- ~ ~t~ Distance botw~ linos ~ ~ ~ Top oTtilWto finish grade~ ~omgl I o Material Beneath til0~ -- ~tal effective_{o~gabsorotionw, area ~fq~a ~ V ~ inches Length Width CF"~ Depth PERMIT ~ D Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ¢ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PIPE MATERIALS ~ t~ INSTALLER I REMARKS , 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST 2 5 6 7 8 9 PERFORMED FOR: ~"'~J'~ LEGAL DESCRIPTION:_ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O IPAI,!TY OF ANCHORAOE. OEP~, OF It~ALTH & [NVI~ONMENTAL PROTECTION JUl 2 0 lg84 RECEIVED COMMENTS -~' V PERFORMED 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ~, ' '4~ Reading Cate Dross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) ':~ FT AND $~ I I.~._ FT ALASKA BIIUIBO[1F/1E ITAL COilTBOL SEIqUICES, July 31, 1985 Department of Health & Human Services 825 L. Street Anchorage, Alaska 99501 Attn: Susan Oswalt Dear Susan: InC. This is in regards to Spring Hills Block 2, Lot 8. Recently, concern has been experienced by DHHS over the fact that a permit for a bed was issued on th~s lot, since there is only 2 feet of clean soil (which the bed was built in) over a tight tan silt which failed a percolation test. The question was whether or not this silt should be treated as an impermeable material llke bedrock and thus req~ire'~ vertl~dal separation distance of 6 feet between the silt and the bed. However~ as the soil log clearly shows, this silt is not imperme~bIe. Water in a 6-inch diameter perc hole dropped a whopping one hundreth of a foot in ten minutes. If the silt were impermeable, it would not have drbp~ed at all, by definition. We shall send you the inspection report in due course. In the meantime, hopefully this letter will set your mind at rest, If you have any further questions please do not hesitate to call. Sincerely, Approvad by: Darc y~/Bew~ns Engineering Geologist 1200 LOesl 38Pd Auenu¢. $ui1¢ ~, Anch0roqe, Alaska 99503 PO ~,~,N 6 {550 ANCI JOF~AG~ , A[ Ao~ A %}95(}2 0650 (907) 26d 411 ] DEPARTMENT OF HEALTFI ANO ENVIRONMENTAL PROTECTION Permit ~: 840607 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 8 Blod{ 2 Spring L~ills ES%'. 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 Depar~aent 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 office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 DIEF'ARTMEiqT OF HEALTH Al'ID E£1qVIROIxlIglEIqTAL. I:::'ROTECTI[IIq 825 L !:TTT-,:EET, ANCHORAGE, AK 9950:1. 264-4'720 F:'ERM I T I'4[] ~: DATE ISSUEB: 84060'7 HAND WR I ]"TEN C 7/,':'.Z :5/84 APPL I CANT ADDRESS." CON]'Y-~C'f' PHONE: DESIGIq IN WOOD 70:1.2 DRIF:'TWO[ID ANCHORA(31E, AK '3. z!-~? - 801 ~1. 9<~i02 I...E:£3AL DISSCI:::~ I F': ' I...I]T SI ZIE: SIJBDIVI!3ION: SI::'RING HILLS EoT. i LOT: 8 SECTION: 15 T[IWNSHIP: 121xl RANGE." ..,W Zl.r¢22B (BQ. FT. I]R ACRES) I certify that: 1,, I am {'amiliar wi'Lh the pe[:lU~,pements 2. 3. {'CJI' eh-site sew,-~.re alnd wells as eet £opth by 'Line Munic:',[pality of Anclncmage (MOA) and t.h~ State of Alaska. I will install the ~iystetn in acccmdance with all fflOA cl~des and pegulations, and :i, rl compliance with 'Lhe de~ign c:riteria ef 'l:lni~ permit. i mill, adhere tc) aJ, l M(]A and St, at. 6} i:lf Alasl<a r'*~quir~m~nts fcH' the s~2t.back distamzes fm',om any exis'Ling well, wastemater diep~sal sys'bem ~" pub].ic ~ewePage ,~y~it. en~ er'~ tl"li~; or any a(;Jjac:g~r~t c)l" nearby ].~'L. t I:""' A 'I]4EN WILL ELECTRIC;AL WORK MIJST BE DONE BY A L. II]ENSED ELECTIRIC',IAIq. AI-'FL..[I.,AII1 . l.)E;o tN WOOD ]',SSUED BY ~.[ ) ~~~~m DATE, I,,.IF:T .,)TA1 1ON IS IN..}'[AL. LI:,I) IN AN AREA COVERED BY MOA BUILDING CODI::.nb (1) AN b. Lh:L, IIx.I. CAL PERMIT AND ].I~I-E:L,I].[]N MUST BE OBTAIIxlED~ (.~D A,~-BUILF,:~ IqgT BE AF'F:'IROVEB WITHOLFF AN ELECTIRICAL INSPECTION REPOR'I"; AND (3) THE Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 015-051-65 Pamel I.D. 1. GENERAL INFORMATION Complete legal description Location (site address or directions). 9500 SPRING HILL DRIVE, ANCHORAGE, AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE-FAMILY DWELLING HAA# Expiration Date: SPRING HILl.. ESTATES; LOT .'~'BLOCK ~ 99507 SHANE O'LEARY Day phone 677-3855 9500 SPRING HILL DRIVE~ ANCHORACE~ AK 99507 9- 6 -O.A. Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2, NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank r-] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorege is not responsible for errors or omissions in the professional engineer's work. lNote: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,310.00 at, orpdor to closing for the engineering services provided. 4. STATEMENT OFINSPECTION 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 Health Authority 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 o~f installation. Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 0EBARR ROAD, SUITE 28 ° ANCHORAGE, AK 99504 Engineer*s Printed Name JEFFREY A. CARNESS, P.E. Engineer's Comments: ---' "~ In conducting this evaluation, A WWC, Inc, attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations, The reported results desctibed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features, The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the eva/uator of the system, Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD, The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal tight whatsoever. Phone 357-6179 Date , ? DSD SIGNATURE J Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: · ..... · ON-SITE WATER AND . WASTEWATEK Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Uanitenance Agreements ~J,,. Supplemental Engineers Reo~ Other Original Certificate Date: Municipality of Anchorage Development Services Department Building sofe~ Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anctu3mge.alcus (907) ~,3-~904 Legal Description: A. WELL DATA Well typ~ PR~'VATI~ Date completed Total depth 195 HEALTH AUTHORITY APPROVAL CHECKLIST SPRING HILL FSTATI[$i LOT 8~ BLOCK 2 ParcelID: 015-051-6.3 IfA, B, orCprovtdePWSID# N/A Sanitan/seal (Y/N) YES Casedto 192.5 ft. FROM WELL LOG Date of test 9/20/1985 Static water level 167 .ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: 9/20/85 ft. Coliform ~ colonies/100 mi. Amenic: I~J !Ar mgJL SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 1250 .gal. Number of Compartments 2 Foundation deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 5/30/2002 Pumper. C. ABSORPTION FIELD DATA Date installed ~./2/t 999 Langth 59 ft. Well Log (y/N) Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION 5/3p/2002 153 .ft. 6.0 .g.p.m. YES YES 24+ in. NJ[tale ~, ~5 rog.IL Other bacteria ~ colonies/100 mi. Data of sample: 5/30/02 collected by: AKWWC, INC. Soil rating {~or fl~3drm) 1.2 Width 5 .ft. Date installed 5/31/85 Cleanoute (y/N) YES High water alarm (y/N) N/A NORTHLAND PUMPING Total depth 6.5-7.25 ft. Eft. absorption area 500 ff~ Montioring tube YES Date of adequacy test 5/30/2002 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 695 gal. System type TRENCH Gavel below pipe 2.9 ft. Depression over field NO For 4 bedrooms New depth 1.5 in. Elapsed Tim~.' I~"Omin. Final fluid depth ~ n rote >~~ ~q~~-nt (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size In gallons ~Ees~4N/~__ _ 'Pump on' level at in. "Pump off" n. High water alarm level at in. ~ Cycles tested. Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift statinn on lot100' + Absoq~tion field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line §'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS OLD DRNNFIELD WAS DRY ON 5/50/2002 On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding lank N/A Absorption field .5' + Surface water 100'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal rece~ls that the above systems ere in conformance with MOA I. fAA guidelines in effec~ on this date. Engineer's Pdnted/Na~e . JEFFREY ~ GARNE$S Water main N/A Driveway, parkingNehide storage 10'+ HAA Fee $ __ Date of Payment Receipt Number (R~v. WaNer Fee $ Date of Payment Receipt Number / / / t 4d LOT CO, NE I~ FOUNOATION DRAINAGE ARRDW~ NOT£~ A5 - ~HIL'f ..... 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01 5-051 -63 HAA # ~1 i-~-~.c~c'~ (~,i/ ~ o GENERAL INFORMATION Complete legal description Lot 8; Block 2; Spring Hills Estates Location (site address or directions) Property owner Mailing address _ Lending agency Mailin. g address Robert & Diane 9500 Sprinq Hill Drive Anchoraqe, AK Malone Day phone 9500 Sprinq Hill Dr. Anchoraqe, AK Day phone 346-4680 99516 Agent Janet Address + Gor~on/Jack White Real Estate Day phone 346-4680 Unless otherwise requested, HAA will be held for pickup. 4 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: ·NOTE: xx 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. 1/91) 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 dat~ of this inspection. Name of Fi rm ALASKA.~I~li~I i~ & WA~i ' T Address ~.¢~t ~"~, ~ Engineer's signature -.~!~ Alaska Water & Wastewater Consultants, Inc. Shall be PAID _$_~-770 ~ _at, or prior to, closing for the Engineerh~q ,'~ '. ; . .~. oeo/Ices Provided, bedrooms. Date ~/,'//~//~-'~, Sm / Approved for '~L) ~--- 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev, 1,'~1) Back MOA~21 Legal Description: L-o -r A. WELL DATA Well type '~)I~,tV/~'T~ IfA, B, crC, attach ADEC letter, ADEC water, system number /~/,~, ! Log presentl~/N) , ~P--,S Date completed ~ /,zo Total depth J ~ '~' t Cased to I~l'Z.'~ J Casing height (above ground) Sanitary seal ~N) "¢~ ~' Wires properly protected ~/N) Municipality of Anchorage i~. DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division APR 0 ~ 1999 825 L Street, Room 502 · Anchorage, Alaska 99501 · ~NVIRONMENTAL SERVICES DIVISION Health Authority Approval Checklist ~P~6 JJJl~ ~r~-r~__~/~ Parcel I.D.: FROM WELL LOG AT INSPECTION Date oftest ~,/'Z,c/~,~- . 'Z,/'Z '~j/~., I Static water level j/~'1' J,.~ /~ Well production -~ g.p.m. -7. O ':.~ g.p.m. WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~1/~'i Nitrate ~. ~ ~D/- Other bacteria Collected by: ~, ~J' ~J ' ~", j B. SEPTIC/I~ICE~tI~,TANK DATA Date installed i c~' Tank size Foundation cleanout CN) 'h/~-~ Depression of,u ,in._ C. ABSORPTION FIELD DATA Date installed '~,-'/~'l Soil rating (~¢or~) Length ~k Width ~ I Effective absorption area ~OO ~ Date of adequacy test J,~ ~ '~' Number of Compartments. ':Z._ Cleanouts~/N) High water alarm (Y/t~ J, ~- System type Gravelthickness below pipe ~-~¢i I Tetal depth Monitoring Tube present (~4N) '¢E,~. Depression over field (Y/~r~ Results (Pass/Fail) ~ For t.~ bedrooms Fluid depth in absorption field before test (in,); Immediately after '- gal. water added (in.): Fluid depth '~'-- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Absorption rate = .g.p.d. If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Dat.¢ installed Size in gallons : Ma~~p off" level at* High water alarm tevel at* ./- *Datum ~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/h,~&~g tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION blSTANCES FROM SEPTIC/li~t~ili;I~TANK ON LOTTO: Foundation [ o~ ~' Property line t O I.~ Absorption field Water main/service line ~oI'~' Surface water/drainage IOol~ Wells on adjacent lots jool..~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ ~ '~ Building foundation ~0 J'l~" Water main/service line .l~I'f'' Surface water Cu~ain drai~ : ~od~ Ice.fly that, h~et/;n~,ldinspection, and reviewof Municipa, rec r,~¢~~, are in conformance wit¢ Signature Engineer's Na~ HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 HAA# F!~°t _~ I~} L-'~L~ GENERAL INFORMATION Complete legal description Lot 8; Block 2; ,.Spring .Hill' Estates Subdivision Location (site address or directions) _ 9~oo gp~-~ n9 H'i ] '1 Dr~ve, Ar, chorage, A;].8,ska Property owner Mailing address Lending agency Mailing address_ Agent Address Tony Best [)ay phone__346-8272 950~ sprlng Hill Drive, Anchorage, Alaska 99507 [)ay phone [)ay phone 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTI-'WATER DISPOSAL: NOTE: Individual on-site xxx 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. 724)25 (Rev, l/91) Fron[ 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 flies 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 $ & S ENGINEERING . ~,-,.~"~ ~j~u ~v~r ~.oo~p~oa. Ci'No, 204 Eagle River, Alas~957~ Phone Date DHHS SIGNATURE Approved' for ~_"~'~("/~/_ Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: Additional Comments By: __~-~-~-~-~' ~ 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. 72-025 (Rev, 1/91) Bsck MOAtY21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHI"CKLIST · ~/~J,~(~ EILL E-ET/1/-E~ Parcel I.D Legal Description: A. WELL DATA If A, S. or C, attach ADEC letter. Date completed Cased to / ¢2, _~ ~ Well type ~P?lv/'tTg Log present l~/N) Total depth_ Sanitary seal ON) _ ADEC water system number ,,~"/P~ ?/~'°/~''¢ Driller ~.~' __Casing height /~' Wires properly protected~N) FROM WELL LOG Date of test ~'/~ °~'/~f- Static water level /67 Well flow Pump level g.p.m. AT INSPECTION MUUlt~"~/~ LITv ~'F ~.~/~O / ¢..? E,n,,,~,[,NT,,,.~R, ,~S ,,lVlSION SEPARATIC)N DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot "-'/00 Public sewer main Sewer service line ~:~' ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~a~JE WATER SAMPLE RESULTS: Coliform _dg~_O~ ~ Date of sample: Nitrate /~Z "~ Other bacteria Collected by: B. SEPTIC/&,t~c~I~II~I'ANK DATA Date installed _ ."5~_'J ~ Cleanouts~)'N) High water alarm (Y~J.~ Date of pumping _~/?-.5 Tank size /~.%0 Compartments __ ~'' Foundation cleanout ~N) r~J' _ Depression (Y~ /~ Pu mpe r ~_~¢~ P/~ SEPARATION DISTANCES FROM SEPTIC/FCc~EE.-~I~-TANK TO: Well(s) on lot !0~ ___On adjacent lots frO0 ~- Foundation TO propertyline Surface water/draina§e 72-026 (Rev. 7/91) Front Water main/service line CONTINUED ON BACK PAGE S~~-- ~ Manhole/Access (Y/N) _.--'"~"~ __ ~.¢J.ecr'Fot On adjacent lots Surface w~tter-.- ~ D. ABSORPTION FIELD DATA Date installed __ ~'~..~? Length '~' Width_ '/~ Total absorption area Depression over field (Y~/ Results (~/fail) J~/~J'~- Peroxide treatment (past 12 months) (Y/N) Soil rating ¢~'~" Gravel thickness ¢'~' / Cleanouts present.N) ~--~f Date o~ adequacy test for ~ ~o~ ~O~ If yes, give date System type _Totaldepth '~,~"- '¢~0' bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot .~'//~0 ¢ On adjacent lots //(..~1/_ Propertyline To building foundation On adjacent lots ~¢/'/- Surface water /?o "~//~//¢?~ ~-,¢ Curtain drain ,,¢2~/t-"C':- To existing or abandoned system on lot ,/.,,,~.,~E' Cutbank /U~''¢~ /¢~'E'J'd-/-.-.C~Water main/serviceline 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 this inspbqtion. $ & $ ENGINEERING Signature _ 17054 Ea~le Rivert.~_R,el~i]ul Eagle River, Alaska 9~577 Engineer's Name Date ~.~- / ~' Y~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION ~, FLOW TEST SITE PLANS SOIITEST PERCOLA]ION TEST STRUCTURAL& MECHANtCAL INSPECTIONS ROBERTSHAFER. PE ROGER SHAFER. PE FLOW TEST DATA CIVIL ENGINEERS (907) 694 2979 FAX 694 !2~t LOCATION OF ~ (Legal Description) t LoT ~ ~t a Sf~/~ ~/~ CLOCK DRP~H ~O DRAWDOt~I PUMPING REHI~g,S z :~o 147' I ~,q __ ..%:,~ I 47' 5:oo 147' q;oo i 47' . .... MISC. DATAI CASINO HEIOH~t 1~'"~_ S~i'ITARY SEAL?I yE? WIN~.S.ZN CO~DU[T~ y~y O~DINO O.K.?~ BACTERIA & FLOW RATE NOT OUARA~:lsED--SUBSEQUENT VARIATIONS CAN OCCURI ON S{TE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTFI AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # __~_LL~.-~- k"-~z',].~- i (~.~ HAA # , (~ 1, GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner j~p,r-'~,~. Address _ c~3-'~'O ~'/,q~_ Mailing (c) Lending Institution ~'~ Mailing Address (d) Real Estate Company and Agent Address ~0o0 Telephone %E 2 - 7~ Telephone: (home) '~ ¢¢"/¢'d'~ Business __ Telephone ~d~- ~/~/ (e) Mail the HAA to the following address: (or check here ID, if hold for pick up.) List contact person and day phone number below: 2, TYPE OF RESIDENCE Single-Family ~ Number of bedrooms__~ _ 3. WATER SUPPLY Individual Well [] Community [] Public [] Note'. If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025(Rev 7/88) Page 1 of 2 ~ ,to ~ a~d · N JaM S,J@@U!aU@ leuo!sseJoJd oq], u! suo!ssFuo Jo sJoJJa ~oJ elq!suodseJ 1au s! aaeJoqouv ,to Al!ledp!unV, l aqJ. 'penss! s! aleo!J!lJao e aJo,teq elep eZAleUe Jo suoBoadsu! ],onpuoo ~ou ap SHHQ jo sa@Aold uJ::A 's],uaLue~!nba~ ale],s pue [eJepej u¢~J@o A~s!les al mp~o u! 6u!pueI J!aq~ pue semoq jo s~aseqocnd o~ Asaimoo e s~ s!ql saop SHH(] aql 'e)tselV jo e~e]S aq~ u! pe~a)s!aaJ Jeeu~aue leUO!SSejo~d ~uapuedapuf ue ~q a^oqe ~; qdeJl~e~ed u! ua^!15 suo!le~u@sa~da~ aq~ uodn ,~luo paseq le^o~'ddv A~poq],n¥ qlfeeH senss! (SHHQ) seo!^~es UeLUnH pue q],leaH Jo ~UeLU)Jed@c] aaeJoqouv ,to A~fledp!unlq le^oJddv leuo!l!puoo jo SLUJa.L pa^oJddes!a -- /)( pa^oJddv Aq suJoo.lpeq~ JoJ pa^oJddv "l¥^Ol~ddV SHHQ '9 ama A, WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Well Classification ER \ F'ATE Well Log Present (~N) ?e'~ .Date Completed ~/2. e/~',5- __ Total Depth ~_L~L'5 Cased to 192,5 Depth of Grouting _ N,~, Static Water Level I .~',L ~ s~. ~/~/~_ _ Pump Set At Casing Height Above Ground 2 Electrical Wiring in Conduit (Y/N) ~/E~ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot. IO~, To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ )'loo~ 'To Nearest Sewer Service Line on Lot SPR~rV(, FhL~S t~,~. If A, B, C, D,E.C. Approved (Y/N) ~,~, _ .Yield ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Nb_ ; On Adjoining Lots __ 12. o ¢ ; On Adjoining Lots _~o_o ' To Nearest Public Sewer Cleanout/Manhole _)/~ o ~ gO~ Water Sample Collected by ~'ToP~ S¢C.¢ ; Date 7/5'/9o __ __ Water Sample Test Results ~("~~.y_ d-P c~h~o,-~- /~'oc,' ~ O. ¢7 ~ ~,~-~ B. SEPTiC/HOLDING TANK DATA Date Installed ~31/~' Size ~12.~'~ ~. No. of Compartments Standpipes (Y/N) ~E~__Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) 2 Foundation Cleanout (Y/N) _ Date Last Pumped 7/~'/~¢ _ ;for N,/~, ___ Holding Tank High-Water Alarm (Y/N) .__ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /0~ i To Property Line ____) 2. 5'/ To Water Main/Service Line ~ 60 ' To Stream, Pond, Lake or Major Drainage Course ~/o o ' Comments __ Temporary Holding Tank Permit (Y/N). ~,/~, I~/~ P~'o~ To Building Foundation To Disposal Field _~1 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ,.~/3~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~4-~¢¢,~x cz SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ 120 To Building Foundation _ 5'~I Lot To Water Main/Service Line _ ~ Type of System Design Length of Field Jz¢' Depth of Field ~. ~' / Gravel Bed Thickness . (¢/i Sta/(ndpipes Present (Y/N) Date of Last Adequacy Test To PropertyLine 22' ?E~' To Existing or Abandoned System on ; On Adjoining Lots ~/O0 To Cutback (if present) _ To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions __ Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and inspection. Signed ~'~~ _~. Company ~/"/~,p Date __2 MOA No, effect on the date of this Engineer's Seal Receipt No Date of Payment Amount: $ 72-028 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment / /- /, , Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name,.¢.';,'¢.j/ Telephone: Home Applicant Address /' -~-,/ ~ ~/,~7 '~'o~'"'° ,-, (c) Applicant is (check one): Lending Institution []; Owner/builder,.,i~'; Buyer []; Other [] (explain); (d) Lending Institution ~L//~¥C"~_C~~~C~:C2Z~ Telephone Address Business (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA t2 t~)e following address: TYPE OF RESIDENCE Single-Family~[~J Multi-Family [] Number of Bedrooms '~/ Other 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. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ~2-025 nuB4) ENGINEERING FIRM PROVIDINL~ INSPECTIONS, TESTS, FILI:[ SEARCH, DA IA 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 weslewater 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 ell Municipal and State codes, ordinances, and regulations in effect on the date of this ?~sp~_ti~n. ~ ---~'"b · ~¢' .~- NameofFirm /'¢~/'~--~:-.~' ~'0-% ~ ~'~'~-; Tel~epbone o'7//'~/~'- ~,d¢/~'~'*~'/ Address ~ ~ ~(~ *::¢' Date ~ ~ ~.~¢ ~ ~ Engineer's Seal Approved for z'~ .Z~ _'//_z~~ bedrooms by Approved ~..,/'~ Disapproved ____ Conditional __ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Autbority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP (Joes this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 U 1184) MUNIcIPALIty OF ANCFIo,~AG;j f'JEPT. OF H~ALT~ ENVIRONME:N~AL I ~ ' ~OTECTIoN WELL DATA UNICIPAI. ITY OF ANCHORAGE (MOAi HEAL'rH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Descri~,on: Well Classification~'~-/'/¢/,~//:' ./~//~-"//z-/-/___ if A B, C, D.E.C. Ap~pr~0 (Y/N) Well Log Presen~_....l~) ~,-~r~ '~,, Date Completed _~-,,2'~, --~'-y Yie'ld Total Depth ~ . Cased to ///-A-~ ~¢' Deoth of Grouting Static Water Level /~-~-°' Pump Set At Casing Height Above Ground ,:~ Sanitary Seal on Casino.~,l~) ~lactrical WmnO m Conduit ~) ~ ~ Doprossion Around Wollhead Soparation Distances lrom Well: To Septic/Holding Tank on LOt /~'C "~ ; On Adjoining Lots ~ Nearest Public Sewer Line ~ To Nearest Public Sewer ' Ceanout/Manhole _ ~/~ _~ To Nearest Sewer Service Line on Water Sample Collected by ~ /~¢~/1~/ Date Water Sample Test Results ~/~ ~ ~/-~ ~ Y _ , SEPTIC/HOLDING TANK DATA Date Installed, D .~/ ~ Size /~o ~' ~ No. of Compadments ~ StandpipeS) _~__ Air-tigh~ap~) ~, _ Foundation Clea~u~)~ q Depression over Tank~ ~ ~ ~ _~~. Date Last Pumped ~'~ ~.2.~/ Pumping/Maintenance Contract on File (Y/N)~// _ . ;for ~ ~//~ _,/ Holding 'rank High-Water Alarm (Y/N) ~,¢~/~_ _ T~porary Holding Tank Perm~Y/N) ~/~ Separation Distances from Septic/Ho, o,o~ing Tank: To Water-Supply Well _ ,,,'~¢"/ / To Property Line ,/~' To Water Main/Service Line _ - Course /~-~ Comments '~ _ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Rage 1 of 2 72-026(11/84) ABSORPTION FIELD DATA _ ~.~ ~.~ Soils Rating in Absorpbon Strata ~'~ ~ .'.~/_~ -~"..,¢./¢¢~/~ype of System Date Installed --~ ~ ~ ~ ' ~ _ Length of Field Width of Field ~ /~ Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~_~'~_/5,. ~ __ Standpipes Present) Field (Y,¢~. ,--~,/'~ Date of Last Adequacy Test Depression over Results of Last Adequacy Test Separation Distance from Absorption ~eld: To Water-Supply Well ./'A"~? ' To Building Foundation~n~.~___-~5 ' 7 To W~ervice Line To Stream/Pond/Lake/or Major Drainage Course __ To Driveway, Parking Area, or Vehicle,Storage Area LIFT STATION ~ / TO Property Line To Existing or ~bandoned System on ; On Adjoining Lots ~¢ ~' ~ To Cutbank (if present) ,.d~,¢-~ -~ ~ ~ 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 halve cl~,ecke¢,~,~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'//~' '~/( Date_ ~" ~'"?~? '-c¢~ Compan~.5~ ~h~A No. Receipt No, _~ ~ ~' Date of Paymen, ~/~1 ~ Amount: $ ~ 0 0 Page 2 of 2 72-026 (11/84) 2220 F2~S~' 88 AVE~"3E ANOIO~AGE, AK 99507 (907) 349-6451 WA~:ER WELL TEST LoC~ tion: Client's Nan.: Add~ess: / Initial Reading ~ Meter: --, ,-~-//, .j/.~ ~~' ~x .... GPM 24-110u~ Capacl y Cal]c~a