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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 2 LT 4Spring Hill Estates Block 2 Lot 4 #015-051-67 Municimlity of Anchorage paaP I nr 3 DEPARTMENT OF HEAI_-FI-1 AND HUMAN SERVICES ENVIRONMEN-FAL SERVICES DIVISION P.O. Box 196650 olr Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: `°�W `� G' .� .L �' 7_ _..-.__ PID Number: Name EAi� Wastewater System: ❑New Y Upgrade ABSORPTION FIELD Phone Z�� 3 No. of bedrooms: No � l Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original gado: GPD/S .Ft. _ Lot ,t Block. Subdivision C�1'0.t ,�)6 iA I Depth to pipe botlorti from original grade. J 3-S' Ft. Api- Gravel depth beneath pipe r8 Ft. Township: Range: f Section: h/ F Fill added above original grade: Ft. Gravel length:, �� Ft. AC11.�1-: New Upgladr� Gravel width: Number of lines: I Distance ehceen lines: Classdicat.or ;, wale, A.B,Gj lal nnpt71 _-!)nsc, ? FI. lam% Ft. Total absorption area: Pipe material: Ff F:. Drilla ala! c' a! ,. �rL i D SO. Ft. Installer. ! F'a Date insta led: Yeld: Pump Set a! Cas nc IF ighl !. ,round: i r/� GPM 1-1 •.•��.•�- PI.- TANK -- ` SEPARATION DISTANCES septic ❑Holding ❑S.T.E.e. �..-�_neF�o I-rn,,. Sepac Tank Absorption Feld ! a. _ihnn- r -lording Tank Snvim Ames Manufacturer: 1 / XA,-t-1 Capacity in gallons: Well / 4'q�/�'- ti JIr — { t'" Material: r^ Number of Compartments: �ilca >fco' LIFT STATION V,Mter �-^----�I�<.' dat >tcc; r��/a I_otI 4") � * �J` "1"V : (I Size in gallons: cturer: Line Foundation"Pump on" level at "Pu e t: High water alarm at Curtain �I� - _ Pump Mak Adel Electrical Inspections performed by: Drain Remarks: BENCH MARK --_. /-� I� � � 1->�:A4--C'F --._ \r-ill-\�'f"_. Location and Description: �/��-t l7 _ '�]G�!-C. O!•.l IA ..•.--`._ , �- t.' -- 1 Z r1 AssumedOElleevatio Li t CE S=_i .. -,f }C IC,r )E c ... }15 ?5 �1-t (C•�'" ENGIN�E°EaA`A SEAL �_... 1\3 i) r tt...L. �—`JJ �. Lel ^� 1�:�.rD-) A (�.\4e eeese•• ,qct'�' Q@. ^� t�Y: °a m ) Alan r v U Inspections performed by: � F-{_ " ��?<"� r' _ Dates: 1st 7/t�6 e' ° "' ° 'so$ to." '•• 2nd>_/y 9� i' • e •.ee • •e��en ®m ` 4i [department of Health and um: rvices approval 9__L�- rey A. Garnesa ; d�j���,:,a, CE -7953 •e4;: �4®�����,�°� Reviewed and approved byap�-._uM'Date: --.�M i2- nt:. nw 1 911 Y,!OA 25 V AC = 14.4 BC = 28.8 AD = 91,5 BD = 85 AE = 64 BE = 43 AF = 59 BF = 33,8 60% 2/3 QpE Mp,INj �P'�• NOTE: ALL SLOPES ARE 357 APPROX. \35% NORTH END OF TRENCH 35 FT. FROM 35% SL❑ NEW TRENCH. 60 FEET LONG. OLD BED ❑ 'D' T.H. 0 PE o VIA 75- 'E' 'E' l M.T. 2� \\C/❑ 'F' 4 INCH PVC 03034) VALVE �D❑UBLE C/❑ DOUBLE CIIA!�W�: NEW 1250 GALL❑N C. SEPTIC TANK, �'B' AS -BUILT DRAWING SEPTIC UPGRADE, LOT 4, BK 2, SPRING HILL ESTATES I PREPARED F❑Ri RON & LINDA DAVIS PREPARED BY ALASKA WATER & WASTEWATER SERVICES DATE; 7/20/96 DRAWN; GARNESS SCALE; 1' = 30' o �t ,.eooev. i ea+ u e90 a oppOSD OerzYea o o y p eo vo�epo eosa ov eos A of reY A. Gtr4ss �ppe CE -7953 �C` �opv oen `C AS -BUILT DRAWING NEW 1250 GALLON SEPTIC TANK. ANCHORAGE TANK. INLET INV. = 92,87. OUTLET INVERT = 92.57 TANK SET LEVEL WITHIN .06 FEET. 4 INCH DTA. PVC LINE FROM HOUSE, 1/4 INCH PER FOOT MIN, GROUND ELEV, AT TANK VARIES (96.0 TO 96.75) MINIMUM COVER = 2.7 FEET. TANK IS INSULATED. 2 INCHES OF BOARD INSULATION OVER THE SEPTIC TANK. GROUND ELEV. OVER FOR LOCATION OF MJ SEE PLAN DRAWING TRENCH IS 07.4 OR HIGHER. MINIMUM COVER FILTER FABRIC OVER DRAINROCK = 3.4 FEET.—` —4 INCH DIA., ASTM F810, PERFORATED PIPE ,'- TOP OF PIPE AT ELEVATION = 04.00 A, INVERT OF DRAINPIPE = 83.73 'e O B. BOTTOM OF TRENCH = 75.15 C. NO GROUNDWATER TO DEPTH OF 18 FEET. �•" D. TRENCH LENGTH = 60 FEET E. TOTAL ABSORPTION AREA = 1030 SO. FT. F. 2 INCHES OF INSULATION OVER THE N NORTH 36 FEET OF THE TRENCH. e • (D BENCHMARK IS PATIO DOOR (BACK DECK) THRESHOLD. ASSUMED ELEVATION = 100.00 SEPTIC UPGRADE) LOT 4, BK 2, SPRING HILL ESTATES PREPARED F❑Rl R❑N & LINDA DAVIS (ALASKA WATER & WASTEWATER. DATE: 7/20/96 DWN1 GARNESS I SCALE: NTS del aA ff by A, Game ° l7p ° CE -7953 mop y;'z•.' ROFfic�+"`".caw /�v /+ 617 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 12 C) n 41 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT - t'l PERMIT NUMBER:SW960207 DATE ISSUED: 7/18/96 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES EXPIRATION DATE: 7/18/97 OWNER NAME:DAVIS RONALD L & LINDA G OWNER ADDRESS:9300 SPRING HILL DR ANCHORAGE, AK 99507 PARCEL ID:01505167 LEGAL DESCRIPTION: SPRING HILLS ESTATES BLK 2 LT 4 LOT SIZE: 37099 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: BASED ON 8.5 FT. MUST NOT BE LESS RECEIVED BY: ISSUED BY: GRAVEL, THE TRENCH LENGTH DATE: DATE• l Alaska Water & Wastewater 8471 Brookridge Drive — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers July 13, 1996 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: Sewer Permit for Lot 4, Bk 2, Spring Hill Estates. To whom it may concern: f eyA.Ga'ness �- ee CE -7953 t The subject property is served by a private well and septic system. The existing septic system has failed, and needs to be upgraded prior to the sale of the house. Comments regarding the upgrade are summarized as follows: 1. Soils & Groundwater: Soils testing was done on 7/5/96. An 18 foot deep test hole was dug. The insitu soil was visually classified as a GM, and it was overlain with approximately 3 feet of a GM fill. The soil perked at 27 min/inch at a depth of 8 to 8.5 feet. No groundwater was encountered. 2. Trench Design: a. Percolation Rate: 27 minutes/inch b. Application Rate: .6 gallons/day/ft2 !' c. Number of Bedrooms: 4 J , d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f Effective Depth: 9 feet g. Width: 2 feet minimum c� h. Length: 56 feet,2 i. Effective absorption area = 1008 ft 3. Surface Waters: There are no known surface waters within 100 feet of the proposed septic upgrade. 4. Slopes: In the area of the septic upgrade, the lot slopes downhill from west to east at approximately 25-30% grade. The slopes immediately below the proposed trench were shot with a clinometer and found to be approximately 26-27%. The invert of the new drainpipe will be at a depth of 2 feet (minimum) below the original grade. The slope from the new pipe invert, to the base of the hill, will be less than 25%. To the north of the new trench is a steeper cutbank, which varies from 35-60 percent. The trench will be approximately 40 feet from the 35% slope area. The slope from the invert of the new drainpipe, to the base of the subject cutbank, is less than 25%. Alternating flow periodically between the new trench and the old bed (valve to be installed) will also help to minimize the potential for the trench system to daylight. Given the aforementioned facts, and my evaluation of the soils and the site, it is highly unlikely that the new trench will daylight. If you would like to have a site visit, please contact me. 5. Closing: 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 on my digital pager at 1-800-481-1162. Thank you for your assistance. Ron Davis M.O.A. design package.wps WELL LOCATED AT NORTHEAST END OF LOT • LOT 1, BK 2, SPRING LOT 1, BK 1, SPR G HILL ESTATES, PVT, HILL ESTATES, VT. WELL & SEPTIC. WELL & SEPTIC SYSTEM )SPRINGHILL ST. SEPTIC SEPTIC AREA SEPTIC AREA SPRING N114 SEPTIC AREA LOT 3, BK 2, SPRING HILL ESTATES. EXISTING —NEW TRENCH PVT. WELL, BUT LOT P--, IS UNDEVELOPED, LOT 2, DK 1, SPRING Z HILL ESTATES. PVT. EXISTING a2, WELL & SEPTIC SYSTEM. BED �� b, NEW 250 GALLO TANK SEPTIC AREA LOT 5, BK 2, SPRING HILL ESTATES. PVT. WELL & SEPTIC SYSTEM. • e 1, SPRING - HILL ES ATES. PVT. • WELL & SEPTIC SYSTEM. e LOT 4, BK 1, SPRING HILL E ATES. PVT. WELL & TIC SEPTIC UPGRADE, LOT 4, BK 2, SPRING HILL ESTATES PREPARED F❑Ri R❑N & LINDA DAVIS PREPARED BY, ALASKA WATER & WASTEWATER SERVICES DATE; 7/13/96 DRAWNt GARNESS SCALEi V = 100' Y� o. is'a uo ao o�euo. ec°�•• si f rey A. a� G . v r e ` CE -7953 � ,J BENCHMARK IS PATIO D❑❑R THRESHOLD, ASSUMED ELEV IS 100,00 i 60Y MAZN�' �P'4 so?� - NOTE: ALL SLOPES ARE 35% APPROX. L❑CATI❑N OF 35% NORTH E:ND OF ALL. ELEV, TRENCH 40 FT, SHOTS ARE FROM 35% SLOPE o APPROX, r GROUND = 88,7 C/❑ ELEV, = 90,8 NEW TRENCH, GROUND AT OLD 56 FEET LONG, BED M,T = 92 4 HE APPROX. GROUND AT T,H, TH = 87,5 M.T. OLD BED cn GROUND = 71,8 26�' Cn ) i� C/❑ " ✓ `— 4 INCH PVC AT A/4 INCH ALTERNATOR DOUBLE DOUBLE C/❑ PER FOOT <M J. VALVE, BULL � NEW 1250 GALLON ELEV, = 98,4 RUN,--�� ® SEPTIC TANK, AT EDGE OFEX /ISTING —ELEV, = 98,3 THE DECK `� \ �P / C/❑ CONTRACTOR SHALL REGRADE, PLACE T❑PS❑IL, AND RESEED I I��df.®�'%%` ALL AREAS AFFECTED BY THE CONSTRUCTION, 4 A4. SEPTIC UPGRADE, LOT 4, BI< 2, SPRING HILL ESTATES � °a : ...®.,. ."oat PREPARED FORT RON & LINDA DAVIS � Je•eyA.Ga 9 <�Q4 CE -7953 000 PREPARED BYi ALASKA WATER & WASTEWATER SERVICES a+sTF"°.°°'kaA DATEi 7/13/96 DRAWN, GARNESS SCALEi V = 30' Pp, FESS0\ ttL_4)_ MUnlclpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —• PERCOLATION TEST PERFORMED FOR: 'P,0 t--, �: L1Ht�A T)PVts DATE PERK L_C'T- 4--.) lel", LEGAL DESCRIPTION:_ sPP_1 .3 I}t L.L. Township, Range, Section: 1,11A CDEPTH b�6 G SLOPE SITE PLAN 1 2 3 4 5 7 8 9 10 11 - 12 13 14 15 16 17 18 19 A4I S p�.P � i -a Va1a.I C.S 6011.. Nog- 6'jej -( uQDC✓-/ �05i 5 WAS GROUND WATER NO ENCOUNTEREOI _ S 0)4 L - -- - D, P --- E p IF YES, AT WHAT DEPTH? cepill to waler Aller 111onilorinp7 _14 -IN G Reading Dato Gross. Time Not Depth to Time Water Net Drop PPr 0 3o Al A - / Ci -- �r 9d 60 N Z Y rr —�! r i' 3o rNId 20 1I PERCOLATION RATE 'L7 (minutes/inch) PERC HOLE DIAMETER r' l._ TEST RUN 13FTWEEN (3'0 FT AND e'S FT %OMMENTS �St✓ `L�1 _P �I�- A1C I-4 �C SI�IJ . _ PERFORMED eY:�� `�-�''�'�'S� .—__._ I �V�'� CERTIFY THAT THIS�TE­T+ WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MWJ CIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 74-41 72.000 (Any. 4/05) M -W DRILLING, Inc, Box 10.378 9 10300 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 i DRILLING LOG Nell Owner Sam hill _Use of Welt Domestic Location (address of: Township, Range, Section, if known; or distance main road_ _ I.ot 4 Block 2 Spring Bills , Size of casing 6„ Depth of Hole 256 feet Cased to 255.£0 feet Static water level /-it. (above) (below) land surface. Finish of well (check one) open end ( Y -XX ) Screen ( ); Perforated ( ). I Describe screen or perforation_ done _ Well pumping test at 5 gallons per (MM) (minute) for 1 hours with_ 100% -f1, of drawdown from static level. Date of completion December 1G, 1483 MUNICIPALITY OF ANCHORABF HEALTHDEPT, OF WELL LOG ENVIRONMENTAL PROTECTION Depth in feet from fpp ground surface Give details of formations penetrated, size ofapa'terial,,WAr and hardness �0_TO 2 Casing stickup E C E 11/ _ 2 TO 8 YBrovn.Silty Gravel 8_T0 12 Brown Clay Gravel (damp) 1' TO so Brown Silty Sand 80 TO 11+0 _Brown Silty Gravel 140 TO 240 240 TO 252 252 TO 256 TO TO —TO _—TO _ TO _..TO `TO Brown Silty Gravel _Brown Silty Gravel Vaterbearing Gravel NwYYA e Certificate No's. 814 & 973 'fTRACTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE NEW -_-KWK4" D & S UNLIMITED ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION ' LOCATIONU PCL_ NO. OF BEDROOMS ,= Well Absorption area I wellin Dg 1 PERMIT NO. . U yi DISTANCE TO: �O. f,�, � j� I - k- Z Manufacturer C.�,. Material No, of compartments Liq. rapacity in gallons j60 0 c/ - IF HOMEMADE: Inside length Width --- Liquid depth � ' DISTANCE TO: Well Dwelling PERMIT NO. (9Z 2 z Fd- Manufacturer Material Liquid capacity in gallons O z DISTANCE TO: Well NOf-� Foundation t Nearest lot line .+- PERMIT N0. . A. D .> «e-lq u. z b, W No. of lines Length of each line Total length of lines ,r Trench widt inches Distance between Ines f Top to fi Material beneath Total -ea a I-- of tile iish grade / G/ tile effective a so t' - - inches LAA Length Width Depth PERMIT NO. W f7 Q h Type of crib Crib diameter Crib depth Total effective absorption area w Lu DISTANCE TO: Well Building foundation Nearest lot line _j Class Depth Driller Distance to lot line PERMIT N0. IL DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS Asm SOIL TEST J ,n /R)Ay�T/INGj-T INSTALLER __17• REMARKS ['C .-I� Ciia r G re en _� r • it _ s APPROVED DATE LEGAL s ////b/ rk 72-013 (Rev. 3/78) �J MUNICIPALITY OF ANCHORAGE Department E Health and Environmenta ?rotection )� 825 i Street, Anchorage, AK. 99501 264-4720 # # HANDWRITTEN PERMIT Permit # W-a+—Af4D/OR ON-SITE SEWER PERMIT Applicant: lam/ �;'r,%/Mailing Address: 2d6 l:4'6;jJ%"?0.. — Location: Phone Number: a Legal Description: Lot Type of Soil Absorption System Is: ` Trench: Drainf.ield: _ Seepage Bed: M Maximum Number of Bedrooms: *� Soil Rating(sq.f Size: Holding Tank: _ t/br) /"-/Z The Required Size of the Soil Absorption System Is: DEPTH LENGTH Z Y GRAVEL DEPTH ( _ WIDTH j The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOL-D+NG) TANK SIZE GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. #. TWO(2) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the idence is remodeled to include more at 31b lrpoms Signed: Issued by: Applicant Date: a SWP/024(1/81) t. �,: %. X SOILS LOG MUNICIPALITY OF ANCHORAGE }}�� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION J'% PERCOLATION TEST S--825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �_5 1 ;"j , j ( TP_ %I DATE PERFORMED:' LEGAL DESCRIPTION: !1 L. /TJ ! f E pE 1 2 Net Drop Reading ro tni li 3 c 5 Gam. d 6 7 y ��t 9 I 10- 11 0 11 12 ; 13 14 15 � 4 16 TY • a 17 rG A 1k 18 ow••• t WAS GROUND WATER ENCOUNTERED? 19 P,'R% .,�5oy C. Reid, Jr. sea No. 2251•E �. COMMENTS ✓ (5)% t -a j SITE PLAN 1 Yrs S S L _ O — P E IF YES, AT WHAT Gross Time DEPTH? Depth to Water Net Drop Reading 19 P,'R% .,�5oy C. Reid, Jr. sea No. 2251•E �. COMMENTS ✓ (5)% t -a j SITE PLAN 1 Yrs S S L _ O — P E PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: (1V ("z%"�';' F= _CERTIFIED BY: 72-008 ((/79) ._((minutes/inch) T AN rJ.� FT j'+ � 0 "Y I 0 vv, f t) DATE: Date Gross Time Net Time Depth to Water Net Drop c s✓• air Gam. d ��t �: s9 0, - EO a, sjY _Ry 0 PERCOLATION RATE TEST RUN BETWEEN PERFORMED BY: (1V ("z%"�';' F= _CERTIFIED BY: 72-008 ((/79) ._((minutes/inch) T AN rJ.� FT j'+ � 0 "Y I 0 vv, f t) DATE: I')-FITIc ',r5rr_rs • 1 tdy .H • ?I Y �/'J� �V. �' /� '• � Il :''• Atid, r,e F. Pelts . 1�,1 .,•• tIo. 3b14'S 11 �.�G7�, • C.�. ;sY �,; t7:100' lWe) P,o,#--fJ �)d,Y,,oas SURVEYOR IS CERTIFICATION I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DESCRIBED ON THIS PLAT AND THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT. �{ DATED THIS [/ DAY OF ��' X19” . 1 �s 10 51,6Pk MAMT E' 1'AV . LEGEND O LOT CORNERS FOUNDATION DRAINAGE ARROWS NOTES: I, IT SHALL BE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. 2. IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RFSPFCT TO Al I OTH.ATICS, 3. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECORDED PLAT ARE NOT SHOWN ON THIS PLAT. 4. THE INFORMATION ON THIS PLAT IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS , THE PLAT IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCES. �,OT y �l,OCK BESSE, EPPS 81 POTTS 2220 E. 88th. AVE ANCHORAGE, ALASKA 99507 DRAWN BYE ,:j] SCALES ISI =',.�C-C DWG NO. CHK. BY OA"FF_, FLO.OK.- • '� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-051-67 1. GENERAL INFORMATION Expiration Date: 11 , - Complete legal description SPRING HILLS ESTATES, BLOCK 2, LOT 4 Location (site address) 9300 SPRING HILL DRIVE, ANCHORAGE, AK 99507 Current Property owner(s) DARIN & CHANDA ALOYSIUS YATES Day phone Mailing address Real Estate Agent 9138 ARLON ST. STE. A3-944, ANCHORAGE AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 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: Date: l0 COSA to be released to the engineer, unless of i fequested by the engineer. COSA Fee $ 496 Waiver Fee $ Date of Payment ?L?J113 Date of Payment Receipt Number 69nw Receipt Number COSA # ds el,3 1y39 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/20/13 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations- The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseenor' `�j encroachments, deficiencies or discrepancies exist. 0, X1, � .,9TH 6. DSD SIGNATURE System #1 Approved for I bedrooms. M The System #2 Approved for bedrooms. Disapproved. P K611;ETH N. 'E V * / Air LI i fib' ``V \ f OFT.. Conditional approval for bedrooms, with the following stipulations: Original Certificate upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAN.esheei 1010-12doc If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: SPRING HILLS ESTATES, BLOCK 2, LOT 4 Parcel ID: 015-051-67 A. WELL DATA Well type PRVT If A. B, or C provide PWSID # _ Date completed 1211611983 Sanitary seal (YIN) Y Total depth 256 ft. Cased to 255.8 ft. FROM WELL LOG Date of test 12.1983 Static water level 229 ft. Well production 5 g. p. M. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1.52 mg/L Arsenic: ND ug/L Date of sample: 8113/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC i STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 811312013 Pumper A+ C. ABSORPTION FIELD DATA Well Log (YIN) Wires properly protected (YIN) Y Casing height (above ground) 24+ in. AT INSPECTION 811312013 227 ft. 6.5 g.p.m. Collected by: ARCTERRA Date installed 711911996 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 711911996 Soil rating (g.p.d./ft2 or ftZ/bdrm) 0.6 System type DEEP TRENCH Length 60 ft. Width 2 ft. Gravel below pipe 8.6 ft. Total depth 13.2 ft. (Measured 8/13/13) Eff. absorption area 1030 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8113/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 30 in. Water added 900 gal. New depth 48 in. Elapsed Time: 930 min. Final fluid depth 29 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 54 Water main 104 Water service line 104 Surface water 1004 Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main 104 Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 8120113 COSA brown sheet 10-10-12.doc -�� of AL s 1 in. FKENNETHM. £ / 7 16 Ale i tssro�''ti Municipality of Anchorage Development Services Department IS Building Safety DivisionOn-Site Water and Wastewater Program 4700 Bragaw Street A ETY P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-67 COSA* (, ,5C, 1 01-Z Expiration Date: Q l C( f bT��� 1. GENERAL INFORMATION Complete legal description SPRING HILLS ESTATES BLOCK 2 LOT 4 Location (site address) 9300 SPRING HILL DRIVE, ANCHORAGE AK 99507 Current Property owner(s) JOHN & LINDA WHITE Day phone Mailing address 9300 SPRING HILL DRIVE, ANCHORAGE AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal 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 ARCTERRA CONSULTING INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/09/10 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface condierved from the surface; tions that may not be obs changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen^' encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: OF AIV NZ � . �IAT�R ANDR pROGRAM Attachments: A�Im COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitral$Advisory Other Original Certificate Date: Municipality of Anchorage *At Development Services Departmen Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST FROM WELL LOG AT INSPECTION Date of test 12--83 11/5/2010 Static water level 229 ft. 228 ft. Well production 5 g.p.m. 6.6 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate I-Smg/L Arsenic: NJ> rng/I Date of sample: 11/05/2010 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Matedal; Septk/Steel - Date installed 719 96 Tank size 1250 gal. Number. of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 11310 Pumper Around The Clock C. ABSORPTION FIELD DATA Date installed 7-19-96 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type Deep Trench Length 60 ft. Width 2 ft. Gravel below pine 8.6 ft. Total depth 13.2 ft. (Measured 11/5/10) Eff. absorption area 1030 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11/5/2010 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 680 gal. New depth 23 in. Elapsed Time: 1130 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date -- D. LIFT STATION Date'installed "Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? On adjacent lots 1o(Y+ On adjacent', ft 1,W+' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: areas no'+ Building foundation 51+ Property line 51+ Absorption field 51+ Water main 10'+. (Nater service line 101+ Surface water 100'+ Ut o s on adjacent lots mW+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 101+ Building foundation 10'+ Water main 101+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain _ 50'+ (Nogg Known) Vuells on adjacent lots 100'+ F. COMMENTS Vacant system surcharged' prior to test G. ENGINEER'S CERTIFICATION l certify that i have determined through field inspections and review of Municipal records first the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 11/09/10 COSA Fee $49.0.00 Date of Payment.%�/r�fj Receipt Number (RW 1 f/05) Waiver Fee $ Date of Payment_ Receipt Number_ SPRING HILL CIRCLE W I— O T M Cn N , /4 \1 Sl2 5 'p0 33 5 —5900' N7 S' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SPRING HILLS ESTATES LOT 4 BLK 2 PLAT 83-382 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DAIS: SCALE: E—PAIL NOV 4, 2010 1"=30' kndeng0ok.net 10-070 DRANK BY: CHECKED BY GRID NUMBER:BOOK/PAGE: JLS 2436 100362 4 IL lu O = FND 5/8" REBAR W/ AL CAP O = FND 5/8" REBAR ./"4TH ... .... L. SCHULLER:S-10408 a�i/ �Vafession6 _v."w S ��' �o ADL JVDR��� aw x °" 0 r v a ^r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 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.d.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-051-67 HAA# HA D I o I C3 1. GENERAL INFORMATION Expiration Date: 7—A? - O 1 Complete legal description SPRING HILLS ESTATES, LOT 4, BLOCK 2 ❑ Location (site address or directions) 9300 SPRING HILL DR. ANCH AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address RICHARD & CINDY RATHBUN Day phone 346-4464 9300 SPRING HILL DR. ANCH AK 99507 Day phone Real Estate Agent CAROL BUTLER / REMAX PROPERTIES Day phone 276-2761 Mailing address 2600 CORDOVA ANCHORAGE AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2' NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well E Individual Water Storage ❑ Community Class Welt ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site E Individual Holding tank ❑ 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 5 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Waterand Wastewater Consultants, Inc. shall be paid $1,110.00 at, or prior to closing for the engineering services proNded. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I v+edfy that my Investigation, based on procedures outlined in the Health Authorit Approml Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ls(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verily 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 lime of Installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS. INC. Address 6901 DEBARR ROAD. SUITE 2B • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A.' GARNESS, P.E. Engineer's Comments: In coWucdng this evaluation, AWING, Inc. attempted to provide a thorough. consckntious erglneedrq ansysis of the system In accordance wide ADEC and MOA DSD Guidelines d Regulations. The reported rasub &= RW the performance of the system under the cnndidons encountered at the rime of the ks; and separs don d/stances measured to readAykWWffabk features. The operational Ale of all wafts and sepda systems depend on the local Bogs cmdidon, groundwater kveis drat may , fluctuate during the year, and dw water usage of Ow fem4e behV served by the system. These coed bbou are outside die control of the evaluator of fire system. Sadstactory test results do not guarantee brass performance of the system, nor do OW guarantee that tlwre are no hidden detects or encroachments. AWWC, Inc. can ewretore not provide arty warranty or tutee esdmate of how long dw system wAl contkwe to meet the operadonal requirements of the ADEC orMOA DSD. The content of this report Is for Me sok benefit of dor owner Awed &bow. Aryreilance upon or use of b* report by any other person a party Is not sut ha&ed, nor WW N confer any legal dght whatsoever. S. DSD SIGNATURE Jk�— Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date 4 ZS d fj `J�.• ON-SITE .:•�'yc^.'`. Z: WATER AND ;m^ �lath`ms:: WASTEWATER PROGRAM Manitenanoe Agreements Supplemental Engineer's Reort Other MW. 12M) Original Certificate Date: q - a -Z - C/ Municipality of Anchorage Development Services Department Bulldlnp Safety Division Onsite water & wastewater Program 4700 South Bragew SL P.O. Box 198850 Anchorage, AK 9951118850 vwrw.dmwhorage ak ue (907)943.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SPRING HILLS LOT 4. BLOCK 2 Parcel ID: 015-051-67 A. WELL DATA Wen type Pyr If A. B, or C provide PWSID# N A Date completed 12-16-83 Sarftryseal (Y/N) YES Total depth 256 fL Cased to 255.8 fL FROM WELL LOG Date of test 12-16-83 Static water level 229 fL Well production 5 g.p.m. WATER SAMPLE RESULTS: Conform —�— colonies/100 ml. NltrateD•17 mgA. Well Log (Y/N) Y Wires properly protected (Y/N) YES Casing height (above ground) 28 in. AT INSPECTION 4-16-01 228.0 fL 6.99 g.p.rn. Other bacteria 4"lonlea/100 ml. Date of sample: 4-16-01 Collected by. AWWC. INC. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Data Installed 7-19-96 Tank size 1250 gal. Number of Compartments 2 Cleanouta (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 4-16-01 Pumper NORTHLAND C. ABSORPTION FIELD DATA Data IrtatHned 7-19-95 Son rating .p.d it'/bdrm) 0_6 System type DEEP TRENCH Length 60' IL Width 2' R Gravel below pipe 8.6 fL Total depth 13.1 A. Eff. absorption area 1030 R' Monitoring tube YES Depression over Reid NO Date of adequacy test 4-16-01 Results (Pass/Fan) PASS For 4 bedrooms Fluid depth in absorption field before test 0 In. Water added 1210gal. New depth 22.5 in. Elapsed Time: 14 min. Final Auld depth 20.5 In. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN H yes, give data - *HAS DIVERTED TO OLD BED Date installed Slee in gallons 'Pump on• level at--Jn. E. SEPARATION DISTANCES High water alarm level Cycles Meets alarm & circult requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tmW station on lot 100'+ Absorption field on lot 100'+ Public sewer maln N/A On adjacent krts 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer hreptio service One 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption field 5'+ Water main N/A Water service One 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ine 10'+ Building foundation 10'+ Water maln N/A Water service ane 101+ Surface water 100'+ Driveway, parldnglvehlcle storage 10'+ Curtain draln NONE KNOWN Wells on adjacent lots 100'+ :��•ISI:Ij:ri-j G. ENGINEER'S CERTIFICATION I car* that I have determined through field Inspections and review of Munk/pal records that the above systems are in conhxmence with MOA HAA guldefines M effect on this date. Erlpineees Pied NJEFFREY A GARNESS Date A_ /2,7 4, oI HAAFee$ WQ• QO Data of Payment Receipt Number (Rw.12=) Waiver Fee $ Data 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 / Parcel I.D. # O f � � 1 _ G � , � HAA # 1. GENERAL INFORMATION Complete legal description L -c% 4 g 2 1, SPCjj6 /4t LL Location (site address or directions) C- _21)oC) SFr 4,—,c -H• (k[-, c3�--,Sc7 Property owner P� De, DA ` , S Day phone Mailing address N`Ss Lending agency _ Mailing address Agent Vi=a 271 -v' %JE Pr Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4- 3. TYPE OF WATER SUPPLY: Individual well K Community well Public water Day phone L.0 N TAt;- j A_61c_�J7_ Day phone�T6a-'76.3 oo4 9 - 99 6";- P. Cuosi,Jb 7/711/911 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 7G Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 72-025 (Rev. V91( Frani MOA 021 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 furtherverify 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. Alaska Waier & 7 Name of Firm AA7i vat96112 icas �,` Phone 3.74/ Ri4iS CcM!'.-.—.�.--er'?cif'. Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. 0 u't bedrooms. Conditional approval for Additional Comments �cr . A. Garners e d C .• `CE -7953 0 IPJ. •• •• �V � PROFESSO� bedrooms, with the following stipulations: NUTtr 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. 1791) Back MOA #21 Municipality of Anchorage .� DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MUNICIPALITY OF 0KHORA0N t:iJVIRI.,tJMi IV A,StRVICF•S DNS" Health Authority Approval Checklist 1996 Legal Description: t -ti. -T- 6r QiL 2- Parcel I.D.: b I 'r- S PtZ rl 1-E t t 4= 5 i L d. L 1 Y E D A. WELL DATA Well type _ V ->V' 1 If A, B, or C, attach ADEC letter. ADEC water system number A Log present (Y/N) Date completed t Z /i6/g3 Total depth 'ZS 6 Cased to Z 55% 8 Casing height (above ground) 2 - Sanitary Sanitary seal (YM) _%'/ e=5 Wires properly protected (Y/N) f S FROM WELL LOG Date of test /2-//6/0-3 Static water level -I?-2 ATINSPEC ON 9 ZZ8•9- Well production S_ g.p.m. 5-.03 g.p.m. f=d ' WATER SAMPLE RESULTS: 7 19 9� 7/i5/TG Coliform � / Nitrate _ . SS 2 mekll Other bacteria -7/"&7/9 Date of sample: Collected by:'SS B. SEPTIC/HOLD11NG TANK DATA N ��✓ Date installed —rL Tank size Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N _ Depression (Y/N) 100 High water alarm (Y/N) Date of Pumping _PJ IAr Pumper 'L4 C. ABSORPTION FIELD DATA til `��AJC W / Date installed _`7/11 9 - F ' 6 Soil rating (g.p.d./ft2 or felbdrm) _ • W _ System type Length Q _Width -Gravel thickness below pipe �D • (o Total depth_ Effective absorption area 10 3 © Monitoring Tube present(Y/N)_Y_ Depression over field (Y/N) NO Date of adequacy test N Five) Results (Pass/Fail) j-)k-S�S For _.4_ -bedrooms Fluid depth in absorption field before test (in.); _� Immediately after,—::7`kal. water added (in.): T Fluid depth / _(ins.) Minutes later: _/� Absorption rate == r g.p.d. s� Peroxide treatment (past 12 months) (Y/N) l If yes, give date _ D. LI TION Date installed Size in gallons Manhole/Access (Y" on" level at* dump off' level at* High water alarm level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot t Ito / -t- : On adjacent lots Abso p onfi d on lot 4 g 13G "* : On adjacent lots I C)6) Public sewer main tJ 4 Public sewer manhole/cleanout AIIA / Sewer /septic service line Lift station /,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I / 1h Building foundation (I • Property line � 3 .+ Absorption field Water main/service line ' ! O Surface water/drainage y 100 Wells on adjacent lots 0O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: t / Building foundation 9+ Water mairr/service line �0 / tk Surface water O O Driveway, parking/vehicle storage area 90 / t Curtain drain NONE IeN6w►J Wells on adjacent lots l aU Property line._ F. ENGINEER'S CERTIFICATION w Qr 1 certify that I have d Hila thru fi its ecttons and review ofAlunicipal rec �CM'fA < �rs are in con orrnance r P h A10 l gui eli s in effect as this date, p' % `m r Signature s °• • e °.. Oe w.. .. Engineer's N Q ' �452'`tf �d'Z, •, Wl� n etev,® P °s E-7953 Date �Z-94 ���F9F'•.., .••�•���� !e FEssIONP� ------------------------------------------------------------------------------- — - - - ®®`1.oAsa��� HAA Fee $ 3 d -z) , tefD Waiver Fee $ Date of Payment C Date of Payment Receipt Number o2L� b `� Receipt Number Rev. 8/95 OSS: haa.wk.doc E. 08:36 F'Tg,E E,-1 AHCHCRAGE ME Environmental Sei-vices Inc. LOoratory Division o!�vAvgv--v4&' Al . �� '&' , -0, je• CUJRet'.# 962967,962967001 Client Sample. ID 9300 Sprint Hill Dr. Matrix Dyirddlng Water 200 W. Potter Dv,,v, Anchorage, AK 9951 Tel: (007) 662-2343 Fax: (907) 561 -5X I Collects u Okite 07/1.5/96 ,rechaicai Director: &ephcri C, E& Released By Sample Remarks: 9. Parameter Results 0C PQL Units Method Allowable Prep k! t- k ,�'i Quat Limits Date Date Nitrate -N 0.552 d 0,100 it.g/L EPA 353.2 07,'!7!96 Total Coliform :/10010L SM18 92 s 46 05 W/O COLI L C U undpteclleu J Below the 13MGsMoa)bur of tho SGS QrOUP (GooiW G6n6raiv de Surveillance) MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES ARE Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION HAA #1 1 -Ni (lei ) C a. ?) 3 Complete legal description Lot 4; Btock 2; Spni.ng Wt EStatu Location (site address or directions) 9300 Sp)Ling Hitt Dkive Property owner A244ed Smith. Mailing address CIO Jack White Co. Attn: Dan2ene Day phone Lending agency Key Pacific Mohtgage Day phone Mailing address_ X32.5_Lau.ne�, Suite 100 anaae, AK Agent _ak ene/ Jack White Co.-- Day phone 563-3500 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Individual well Community well Public water XXX 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 attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA H21 3. 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 FirmS & S ENGINEERING O River La Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments 204 bedrooms. Phone 16�2%%�/ bedrooms, with the following stipulations: Date �� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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 X21 Municipality of Anchorage Department of Health & Human Services M�'+ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: z_oT 4 Parcel I.D. j l - �S� A. WELL DATA Well type � — If / A, B, or C, attach ADEC letter. ADEC water system number AZA Log present 6N) Date completed 1 z111611y7 83 Driller M^i/J U/L(L. _Ik& Total depth ZSR _—Cased to 2 SS, Casing height Sanitary seal6N) 'Z �G Wires properly protected (til) Y _ s0 O FROM WELL LOG AT INSPECTION } Date of test Static water level Z 267 Z/ Well flow 9.p -m. �n r� _ g.p.e OOH Pump level /Jct T r�_A/[>•,AJ 1�iM14 NoT" ✓,Eg CNEIi SEPARATION DISTANCES FROM WELL TO: SepticAw4 tank on lot /0U r- ; On adjacent lots .(2(-) '/- Absorption % Absorption field on lot ; On adjacent lots /G o t Public sewer main —Public sewer manhole/cleanout Ak^f6r Y25SC&7- i Sewer service line zs r Petroleum tank N6ti6 roto,)N WATER SAMPLE RESULTS: Coliform Nitrate d. ¢3' Other bacteria Date of sample: S�% - 92 r Collected by:5 A S ENGINEERING '17 age River Loop ROad NO. B. SEPTIC/HOLDING TANK rD�ATA Eagle River, Alaska 99677 Date installed U / 1-5/ d 3 Tank size /0',O Compartments Z — Cleanoutsq�)N) Foundation cleanout) %.I _ Depression (Y/OI No _ High water alarm (Yo Alarm tested (Yy/N) ' Date of pumping :5-- — 6 - -7 3 Pumper t FNMA SF�2t//cam SEPARATION DISTANCES FROM SEPTIC/H$ ORP"OCrTANK TO: Wells on lot 0L (' Ud f () � On adjacent lots � Foundation To property line_l Absorption field �� r Water main/service line Surface water/drainage - IV6,16- f 26fGrXrr 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION �lJ6 /V C Y°2 SEs D�t !d- Size in gallons Vent(Y/N) High water alarm level "Pump on Meets MOA electrical codes (Y Manufacturer Manhole/Access (Y/N) SEPARATION -DISTANCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots �--� "Pump off" level at Cycles tested Surface water _ Date installed ��/�S�d Soil rating System type 41ffU r ' Length 43r /� Width Gravel thickness d Total depth ` 16- Total absorption area Cleanouts present&l) Depression over field (Y6) /VD Date of adequacy test Results(pa /fail) / XlS for 1 Hi -E E-6— LGT ) bedrooms Peroxide treatment (past 12 months) (Y/N) No N6 ) NIJOt' N If yes, give date 44ZA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ZO (0 f On adjacent lots '(-Sri r� Property line ZEA To building foundation �� 1 f To existing or abandoned system on lot �(IN6- f'/c+r_. r&r- On adjacent lots Ky Cutbank N°ue y°��S�N1rWater main/service line /d /71- Surface water (�Uv� r Driveway, parking/vehicle storage area v � Curtain drain No�� K�✓ti� E. ENGINEER'S CERTIFICATION 1 certify that l have checked, verified, or conformed S & S ENGINEERING 17034 Eagle River Loop Signature __ _ •_-_.- __ Engineer's Name I— and HAA guidelines in effect on the date of this inspection. y..y r , rte,' Date it HAA Fee $ l /7�/ D� Waiver Fee: $ Date of Payment -5-/-12- Z-3 Date of Payment Receipt Number 7kZ/7 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 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 MUNICIPA.UTY OF ANCHORAGE ENVIRONMENTAL SERVICES DNISION 2 5 1991 CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # dl�7 r7 HAA # 1. GENERAL INFORMATION Complete legal description Lot 4; B2ociz 2; Spt.Lng HiUs 2h E3-tatu Location (site address or directions) 9300 Spn i.ng H.iU Dative Property owner A26ted T. Smith Day phone 265-8221 Mailing address 9300 Spni,ng H.iU Dni.ve Anchorage, Ata.6ka 99507 Lending agency Mailing add Day phone Agent Batbata Dwin FIRST NATIONAL BANK OF ANCHOR?§gy phone 265-3403 Address 646 Wu t 4th Avenue, Anchatage, Ata,0a 99501 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 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 furtherverify 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 Phone 5 & S ENGINEERING Address 17034 Eagle River Loop Rea N*. 204 Eagle River, Alaska 99577 Engineers signature Date 4 L I 6. DHHS SIGNATURE Approved for - Disapproved. Conditional approval for _ Additional Comments M_ bedrooms. ° • o r.• o • a c ..0.p • ROQE' -V -r- A P.E 4 v ••• o•• Zv c;Y bedrooms, with the following stipulations: Date?//.—z = 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) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _ Parcel I.D. — 4Z5--61 (` P A. WELL DATA Well type&%- ik rc If A, B, or C, attach ADE:C letter. ADEC water system number '-L 1A — Log present&N) Date completed �Z- I V -tia3 — Driller Total depth 2-5 "% Cased to _ Z-55 • e> Casing height IZj1 � Sanitary seal ON) Date of test Static water level Well flow Wires properly protected (5N) FROM WELL LOG 22"1' S,Z7 g.p.m. AT INSPECTION Pump levely`_- V K - SEPARATION DISTANCES FROM WELL TO: 4 — g.p.m. Septic/holding tank on lot — loo" ; On adjacent lots.—L�1 Absorption field on lot ��� ; On adjacent lots ityC Public sewer main —LA Public sewer manhole/cleanout rJ Sewer service line 25 ,� Petroleum tank 14- WATER SAMPLE RESULTS: Coliform OJ )� N^ L Nitrate _ 32 r`^`�/� Other bacteria h)o 14 Date of sample: _LI -7 - 1 Collected by: 5 & 5 ENGINEERING 17034r F e TFIver Loop Koad No. 204 B. SEPTIC/HOLDING TANK DATA Engle River, Alaska 99577 Date installed U - 15 - 6'5 Tank size Compartments Z Cleanouts &N) V —Foundation cleanout (Y/N) y Depression (Y& �4 High water alarm (Y DA _ Alarm tested (Y/N) ��A -- Date ofpumping —°►1 Pumper) SD.bC.S TVrIPt.SL_�) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t Uo 1x On adjacent lots �� 1 To property line 1 0 1 —Absorption field Surface water/drainage _ 10t:�' \k Foundation Water main/service line C )-+ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at i�"Pump off' level at Meets MOA electrical codes (Y/ SEPARATION ANCE FROM LIFT STATION TO: n lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water Date installed I � — 1 S— 8 5 Soil rating 14 1 � I6(z— System type &f ---Z> Length 43 Width Gravel thickness M Total depth Total absorption area aS d' Cleanouts presento/N) Depression over field (Y& YS Date of adequacy test l Results as ail) Pn<SS for TN2GF (3) bedrooms Peroxide treatment (past 12 months) (Y� / ID,� E t<nlo vin) If yes, give date 4)LA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1!22 t -�- On adjacent lots `L-,O�k Property line To building foundation \d� To existing or abandoned system on lot tk On adjacent lots 3o Cutbank ' i An Water main/service line Lo `� Surface water loot' Driveway, parking/vehicle storage area 30� Curtain drain 'SIA E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effegkdJN%his inspection. S & S ENGINEERING Signature 17034 Eagle River Loop Road N6.204 E ° �J' 11 t3 • yr 4� Eagle River, Alaska 99577 010 0 0 + • . o q ° .jf�Ti o ^ ° Q Engineer's Name 1010 °1''�•1(' / ®A ti• ROG'R J. C1iiiAFER. P.C. e Date ��� Z7 - J� `c;, a ,5 ; HAA Fee $ Waiver Fee: $ Date of Payment Date of Payment Receipt Number �� ` �aL Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date -7- 93 -,s;;7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LZo/ / 'ey"e Gam=JfJ/'i� /4� Location (address or directions) 5� o� XZIIr pi's ice' (b) Property Owner ��/� ��/�''� -Telephone:Home ",°7 9 Business %moo u-fi'.rr� ✓-��//S fir_ Q�x�or� Mailing Address (c) Lending. Institution Telephone _ Mailing Address (d) Real Estate Company /and AgentG z����on / Address Telephone (e) Mait'the HAA to the followtno address: or: Check here 0, 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 3 Individual Wel Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-0251Rev 81861 From 3 5. EN.31NEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address & / Z/,�- Date -:�Zy 3l-,� 6. DHHS APPROVAL Telephone -�r_cZ — 3 Approved for bedrooms by �A4e'`"" ,4' ' /°'''a Date Approved ��� Disapproved Conditional Terms of Conditional Approval CAUTION 3 -9 -87 - 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 courtesyto purchasers of homes and theirlending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-02e (Rev 8/86) Back v�v ofA M 1S1Ie: rN(.NCRA ll'ALITY OF ANCHORAGE (MOA) M�N,C`PEtS(P�S�Rv1G HEALTH AUTHORITY APPROVAL (HAA) v`Rpt1M CHECKLIST - FEBRUARY 1984 EN 1�a� 264-4744 MP� Legal Description:tv A. WELL DATA \' Well Classification �'/�/'—A� If A, B, C, D.E.C. Approved (Y/N)_�� Well Log Present (Y/N) Date Completed ;� Yield Total Depth G Cased to Depth of Grouting Static Water Level Pump Set At �e Casing Height Above Ground Sanitary Seal on Casing (Y/N) / Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) AJ Separation Distances from Well: To Septic/Holding Tank on Lot _�rl ; On Adjoining Lots /.S /- To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots l c r To Nearest Public Sewer Line ��� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot AVIV Water Sample Collected by Z-�e-' Z7 Date _ 17 Water Sample Test Results —rr' �����•S Comments 13. SEPTIC/HOLDING TANK DATA Date InstalSize .a 0 No. of Compartments \\// Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) /V Date Last Pumped� '—'/a g 7 Pumping/Maintenance Contract on File (Y/N) ;for Holding Tank High -Water Alarm (Y/N) - Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Building Foundation �F�• To Property Line 's, '6- To Disposal Field To Water Main/Service Line '- Course N Comments Page 1 of 2 72-026 (Rev 8/86) Front To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �'Type of System Design Date Installed Length of Field Width of Field Depth of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test �'riS�cc.i pec - Gravel Bed Thickness Standpipes Present (Y/N) A,/ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well l/o e-ec To Property Line �6 To Building Foundations '��� To Existing or Abandoned System on Lot A_� ; On Adjoining Lots <-,5� --e'C. To Water Main/Service Line tiles To Cutbank (if present)��� To Stream/Pond/Lake/or Major Drainage Course NZA To Driveway, Parking Area, or Vehicle Storage Area 4� '01- ie 5::, Comments D. LIFT STATION /NZ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I hay chec ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �� ---� �- Date_Q OF AZ��,1 �.. Company MOA No. Receipt No. D U '49Yyp Date of Payment����� 9 d% �' :' e s Seal *cam j Amount: $ �by ngine sd ,/? bf ��•,e ►tUC3tiR.SEVAN .,k?�� •CE P225 Page 2 of 2 72-026 lRev 8/861 Back P.O. Box 112852 ������Y� �Y�u��Y���������� � � ��u�"����� u~����u����u�u�u���� Anchorage, &8995ll Approved Well & Septic Engineers (907) 522-1383 (907)258-0584 `yqr March 5� 1987 Municipality of /E.CVn� Department of Health & Environmental Protection /n�/�� 825 »Lx Street 'oV/ Anchorage, Alaska Re :: Bill Allen, Health Authority Approval (HAA) Application Lot 4 Blk 2 Spring Hills Estates Gentlemen � During the period from February 24 to February 27, 1987 I performed research, site investigations, and well water sampling pursuant to updating the existing Health Authority Approval which was approved by MOA on 4/01/86" I took a water sample for Coliform analysis and the results were negative. The septic tank was pumped and the volume verified to be 1000 gallons" Both septic tank standpipes have approved caps. The well is 32n and the pump wiring is enclosed in conduitThe well has a sanitary seal^ I am submitting this data to you for your review" Please contact me if I can provide any additional information. Sincerely� Hugh R, Bevan P.E" Attachments HAA Application HAA Checklist Total Coliform Analysis Septic Tank Pumping Receipt cc Nancy Co1lins/Vi rginia Johnson @ Fortune Properties Jerry Dewhurst @ REMAX Properties Vr R `�4� ^"��,4 *4 v'* o° A C15 7226 «. 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 t' 264-4720 Application Date �� .,• 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, towns rp, range) Location (address or directions) / (b) Applicant Name:2'/z Z,SLA/� Telephone: Home 1 }ee 2 ` Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder,; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution —— Address — (e) Real Estate Company and Agent Address Telephone (f) I Telephone 2. TYPE OF RESIDENCE Single -Family Multi -Family Other Number of Bedrooms 3. WATER SUPPLY Individual Welrnity Community El Public 11Note: If commwell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ,K Public ❑ Community El Holding Tank El Note: f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11184) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ' G == i S�. Taleone Address Date - r% A ��, ie+eeeoneeye `{� roof O++K+Y d+G� a • +�+n e� •e foe .+� V©A F� �e Cary . Mey e; ® P ee (L353 etoo 0,�W gg���pROFFSSI4���`"' 6. DHEP APPROVAL 5) Approved for � Lc bedrooms by A�— '�'� ` t-<-J.Nte Approved Disapproved Conditional Terms of Condition -Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MONUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA DEPT. OF HEALTH & CHECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 Legal Description: A. WELL DATA ' Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Presenig J) Date Completed �� `� — ' Yield Total Depth _ Cased to�� Depth of Grouting Static Water Level= ' f Pump Set At Casing Height Above Ground Electrical Wiring in Condui�v/,�1) Separation Distances from Well: Sanitary Seal on Casin (�Y -N) Depression Around Wellhead (' J To Septic/Holding Tank on Lot ���� j ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot, On Adjoining Lots — To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results -- IJ S� o � — To Nearest Public Sewer To Nearest Sewer Service Line on Lot v vis Date /9 G Comments B. SEPTIC/140i6 TANK DATA Date Installed i Sizeof Compartments — Z_ Standpipel) — Air -tight Cap�l) Foundation Cleanout Yjdl) Depression over Tank ( 65 _ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for —T Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line Temporary Holding Tank Permit (Y/N) To Building Foundation J To Disposal Field — To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments ��� a;��—_ �f�/c1G� %�/5��, i1t -!:-1y7 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design � Date Installed �� %' –�—'� Length of Field Width of Field �� / Depth of Field –� Gravel Bed Thickness f 0 Square Feet of Absorption Area S Standpipes Presen (�Y J) Depression over Field (Y� Date of Last Adequacy Test /y_E Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well ��� / pp y To Property Line "� 5 To Building Foundation = To Existing or Abandoned System on Lot ��� �s�tii ; On Adjoining Lots To Water Main/Service Line N / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area�— Comments :5-�cgc,;D f ` 16(! e?_,_ ZrJt J (b-PmtI D. rrrT Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that Kave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /' `wt rDate 3�L6��a� �7 Company ��� s f `i OA No. Receipt No. L ��y� �°°eeta4 hp Date of Payment 2 r� 6 Amount: $ - UL-) Page 2 of 2 72-026 (11/84) or - 0 °p0° ° °°Beo � f .. d} 0 0 e• y oe I �Y•1 0° �� °01 so***i gpage°°ooy�aA eeoe••e: os�eeaei •• •••a•n ••oes-� 4, Car y Mey r '• 353 P •ao� a ®� Q9^O< •e•assaoe° �t�®6OFEW Seal L��-'������C.-• �j Ecac oeou 3 e`4 v� „ e�E tl ©Oetl ep00ea 'p�®Oa4oac3��-- �� pa�. adau nea .r asps .p � $o C re S. Moy r e 44`v 6353 e e � p e BESSE, EPPS & PC(ITS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date: S - tq -OG C'e Subdivision: �,2� ^G V " \ \ Lot: 4 -\- Block: -Z Client's Name: �\\ -P---4\ Address: CA\) -t o® <,7p (2.cl 4 . \ , Tester: Initial Reading on Meter: 4\c> 3 3 \ TIME GL'M GALLONS A VOLUME C Ck =Z o C)4\ G Co p�ae a 4�S 3 NOTES: Production Rate:1 , ; GPM 24 -Hour Capacity �?`� Gallons