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SPRING HILLS ESTATES #1 BLK 1 LT 11A
Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171089 PID Number: 015-051-87 ❑ New ❑✓ Upgrade Name: ROBERT COX ABSORPTION FIELD ❑ Deep Trench F-1 Shallow Trench M Bed El Mound Address 4620 SILVER SPRING CIRCLE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.6 GPD/SF 3.0 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 0.5Ft. Subdivision Block Lot SPRING HILL ESTATES #1 1 11A Fill added above original grade ±0.5 Ft. Gravel length 72* Ft. Township Range Section Gravel width 18Ft, Beds: Number of Lines 4 Distance between lines 4Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station I Holding l Tank Sewer Line Total absorption area 1296 z Ft Number of trenches N/A Dist. between trenches NIA Ft, Well N/A 191.6 N/A N/A N/A TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water N/A 100+ N/A N/AGal. Material Number of compartments Lot Line N/A 25.8 N/A N/A NA Foundation N/A 73.8 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A 50+ N/A N/A Gal. Remarks* FIELD UPGRADE ONLY ORIGINAL FIELD Pump on level at in. Pump off level at in. High water alarm at in. 42LF ADDED 30LF Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank Tank to drainfield A+ HOME SERVICES Drainfield 3034 CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 102.Oft Inspection" dates: l' 6/26/17 2" 6/26/17 3°' 6/27/17 4'" Location and description SW BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date OF ro r��� tteven .0 nnotie' 814�� ���`�PROFE5510�A Approved _6(1Date Jr (s i 11 lz }pt:utluj 1 nu jpu( L_ I- i- I L.000 DESIGN PARAMETERS SEPTIC SYSTEM NO. BEDROOM: 5 (750 gpd) TANK SIZE: 2,000g S.T.E.P. (E) PERC RATE: 6-9 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 1250 SF SYS. TYPE: BED 18'W (E) MIN LENGTH: 69.5 LF USED:DRIVEWAY REUSE EXISTING: _ 42 LFx18.O'Wx0.5' E.D., 3.0' TD 756SF ADD 30LFx18.0'WxO.5'E.D- 3.0'TD 540SF � TOTAL AREA: 1296 S� n w 2,000g S.T.E.P. TANK (E) Y > m 6 Lu / w co /�--- v 1 TH— ROBER- ' --� SPRING CIRCLE ,S EASEMENT--�<� w f SCAHER 199 Y wl w U O a. A B AVENUE C1 96.1 100.4 M 1 97.1 101.0 C2 99.70 103.50 M2 101.30T-104.70 DCO C3 103.50 1106.80 OG 10' T&E EASEMENT l 5BR OUSE (E) ' Aq t -111/0 TH-1 ,- �j / G / 0 SEPTIC AREA (E) DRAIN FIELD E 42LF x 18'W x 05ED x INSTALLED 3OLF x 18'W x 0.5'ED x 3.OTD. REMOVE AND REPLACE FOR RESERVE LOT VACANT NO WELL OR SEPTIC N x W m t - LEGEND W WATERLINE/ 2" RIGID INSULATION �0- FILTER FABRIC z WELL RADIUS0 1.25"0 PIPE W/ 0.125" DRILLED HOLES 18" O.C. OG. FG. :2 97.0 (1 NOTES: *�7T--��T� 7� N TLC oa® nll® \ Date RECORD DRAWING P��1V1VO1�IL ENG SVC, LLC OF A� e P.O. BOX 100217 ANCHORAGE, AK 99510 '�� ''''' -.sp t2/27/i8 PHONE (907) 272-8218 FAX (907) 272-8211 ,sc.J�P �y��}} Scale DRAWN BY: 1"=50' ACP .. ... P.I.D. NO SPRING HILLS ESTATES #1, BLOCK 1, LOT 1 / 015-051-87 ROBERT COX r Steven " . "Pannone PERMIT NO. 4620 SILVER SPRING CIRCLE ��cc,. CE 8149 c�j OSP171089 PLAN ANCHORAGE, AK 99507 ���1�� oFEss�o�4 � SheetOF 2 SS NEW SEPTIC ABBREVIATIONS FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. DCO DOUBLE CLEAN OUT OG ORIGINAL GRADE E EXISTING 97.0 (1 NOTES: *�7T--��T� 7� N TLC oa® nll® \ Date RECORD DRAWING P��1V1VO1�IL ENG SVC, LLC OF A� e P.O. BOX 100217 ANCHORAGE, AK 99510 '�� ''''' -.sp t2/27/i8 PHONE (907) 272-8218 FAX (907) 272-8211 ,sc.J�P �y��}} Scale DRAWN BY: 1"=50' ACP .. ... P.I.D. NO SPRING HILLS ESTATES #1, BLOCK 1, LOT 1 / 015-051-87 ROBERT COX r Steven " . "Pannone PERMIT NO. 4620 SILVER SPRING CIRCLE ��cc,. CE 8149 c�j OSP171089 PLAN ANCHORAGE, AK 99507 ���1�� oFEss�o�4 � SheetOF 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 TEST HOLE 1 ORGANICS DATE PERFORMED: 6/26/17 SOILS LOG - PERCOLATION TEST SLOPE X TH a/ \ kIILVER SPRING CIRCLE 5" AS EASEMENT.l1 / /• �`/'-� ''CCS z' Y� Q m N u� TH- w y TH- T y SCAHER 7490 W - C - ' \\E f OOTTH. AVENUE � 1 � WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? DATE: SITF NEWAY SEIR Hous I n } (E) ) \ \7v 1 1 `✓� \yam _ 1 rLOT VACANT NO WELL OR SEPTIC l I T 1 i SLOPE TH X READING DATE CLOCK TIME NETTIME WATER LEVEL READING NETDROP 1 6/26/17 10:10 --- 5.900 --- 2 10:20 1 10 MIN 7.360 1.46 3 10:20 --- 5.900 --- 4 10:30 10 MIN 7.350 1.45 5 10:30 --- 5.900 -- 6 10:40 10 MIN 7.350 1.45 PEROLATION RATE 6.9 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: DAN MORAN. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: PAIS ONE ENG SVC, LLC '�`'OF a`�®qil Date RECORD DRAWING .� , .. /27/2018 P.O. BOX 102954 ANCHORAGE, AK 99510 v '�. qd' �$ PHONE (907) 272-8218 FAX (907) 272-8211 '�P TH '�y r�r Scale NTS P.I.D. NO SPRING HILLS ESTATES #1, BLOCK 1, LOT 11 050_-531-27 ROBERT COX r �;'Steven CE 8149 R. Pannone ®PERMIT NO. 4620 SILVER SPRING CIRCLE r•• `�/® OSP 171089 SOILS LOG ANCHORAGE, AK 99507 �iilF�Fo' a��� Sheet �, �?OFESSIO., 3 OF 3 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP171089 Work Type: Septic Upgrade Tax Code Number: 01505187000 Effective Date: Expiration Date Site Legal Address: SPRING HILLS ESTATES #1 BILK 1 LT 11A G:2436 Site Mailing Address: 4620 SILVER SPRING CIR, Anchorage Owner: COX ROBERT E Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy �,,,rnr SOX `s' ,nV � i T;. Departnient 6/2/2017 6/2/2018 Lot Size in Sq Ft: 49633 Total Bedrooms: ',4- B ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The entire proposed disposal field is not within a 30 foot radius of an existing percolation test. A percolation test hole is to be completed prior to construction of the septic field. If the results require a design change, construction of the system shall stop pending On-site review and approval. Please submit stamped and signed results with the inspection report/record drawings. 2. Engineer to confirm 2" insulation and a minimum of 2 feet of cover over bed or a minimum of 3 feet of cover. Received Issued By: 4-0 5 bedraon s��le Date: Date: 6 Z 17 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-051-87 Property owner(s) Robert Cox Day phone aa`I (o3� 5 Mailing address 4620 Silver Spring Cir, Anchorage, AK 99507 Site address 4620 Silver Spring Circle Legal description (Sub'd., Block & Lot) Spring Hills Estates #1, Block 1, Lot 11 A Legal description (Township, Range & Section) Lot Size 49,633 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ElUpgrade r_X1 Duplex (D) ❑ Holding Tank ElRenewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: N 5 (09 C- Waiver Fees: Date of Payment:� �11 Date of Payment: Receipt Number: O 3 b52 ( Receipt Number: Permit No. OSP 1 VI 1 091 I Waiver No. Permit App_:- : :'-.,:c Steven R.Pannone, Principal Registered Professional Engineer E-mail: steve(@i)anenRak.com June 9L2Ol7 Subject: Spring Hills Estates #1, Block I, Lot 11A Septic System Permit Request Design Narrative This isa design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve anexisting five (5) bedroom house. Currently the lot isdeveloped. The system will utilize onexisting 20OUg ST.E.P.tank. This lot and the surrounding lots are served by private wells. There are nowells within 100' ofthe proposed septic system. 1. Soils. One test holes was conducted in the area by Robert Schafer in 1990. Bedrock was not encountered inthose test holes. Ground water was encountered atadepth of8feet inJune of199O. The test hole for the existing system on the subject property rated the soil at 125sf/br. An additional test hole will be performed at the time of construction. The upgrade design is based upon the original design absorption rate using 0.8 pfsf/d /lQR sf/br\ 2. Soil Absorption System Design. a. See Sheet I of the design package. 3. Surface Water: There bnosurface water within 10Ufeet ofthe proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4`Topography: The existing topography onthe lot generally slopes from east tUwest, with aslope ofapproximately 1-5Y6inthe area ofthe drain field. There are nosteep slopes within 50'ofthe proposed drain field. The proposed drain field will maintain 5O'separation all steep slopes. S. Drawing Markings: The Drawings are marked "For K4oAReview Only" When written notification that the review iScomplete and that there are nofurther comments isreceived from K4oAOn-Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mmi|ing,:P.O,Box 1OOZl7,Anchorage, /\K995IO-Q21-7 Phy3icJ[332Eas',K4ano,Andhorage,/\K9`SJ5O2 SILVER SPRING CIRCLE �5'\GAS EASEMENT- DRIV 1 1 ni 2,000g S.T.E.P. TANK (E)� TH—ROBERT SCHAFER 1990., 0 I / 1 SEPTIC AREA (E) RESERVE DRAINFIELD (P) DRAIN FIELD (E) 63LF x 15'W x 0.5'ED x 3.0'TD 421-F x 18'W x 0.5'ED x 3.0'TD WITH MT AT EACH CORNER ADD 13LF x 18'W x 0.5'ED x 3.0'TD INSTALL MONITOR TUBES IN CORNERS TH—P 10' T&E EASEMENT �E 100THAVENUE -\_ '-1\1 F LOT VACANT %DESIGN PARAMETERS NO WELL OR SEPTIC SEPTIC SYSTEM DESIGN PARAMETERS N0. BEDROOM: 5 (750 gpd) W TANK SIZE: 2,000g S.T.E.P. (E) RESERVE SEPTIC SYSTEM PERC RATE: 1 —5 MPI NO. BEDROOM: 5 (750 gpd) SOIL RATING: 0.8 GPD/SF TANK SIZE: 2,000g S.T.E.P. (E) LEGEND WATER LINE/ WELL RADIUS AREA ROD: 937.5 SF PERC RATE: 1-5 MPI SS NEW SEPTIC SYS. TYPE: BED 18'W (E) SOIL RATING: 0.8 GPD/SF ABBREVIATIONS MIN LENGTH: 52.1 LF AREA ROD: 937.5 SF FC FOUNDATION CLEAN OUT SYS. TYPE: BED 15'W USE: MIN LENGTH: 62.5 LF T# TANK CLEAN OUT NO. REUSE EXISTING: C# CLEAN OUT NO. 42 LFx18.0'WxO.5' E.D., 3.0' TD USE. DCO DOUBLE CLEAN OUT ADD 13LFx18.0'Wx0.5'E.D., 3.0'TD 63 LFx15.0'WxO.5' E.D., 3.0' TD OG ORIGINAL GRADE TOTAL AREA: 990 SF �TO�T7ALL�AREEA7:: 9455SSF7 T T E EXISTING NOTES: PAMONB ENG SVC, LLC ~'QF /��\\`' Date 6/20/2017 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 r '�.. qS lo PHONE (907) 272-8218 FAX (907) 272-8211 %g�P �y�+ Scale DRAWN BY: j*; *�I 1"=50' DRM .. .... P.I.D. NO SPRING HILLS ESTATES #1, BLOCK 1, LOT 1i -A- ' • • 1.5-051-87 ROBERT COX �� Steven Fonnone PERMIT N0. 4620 SILVER SPRING CIRCLE 1��cs CE 8149 OSP171089 PLAN ANCHORAGE, AK 99507p'`� Sheet ,`Ix PROFEng ��9QO4 1 OF 2 C -C) 4t 1 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: EXPAND EXISTING SOIL ABSORPTION SYSTEM TO ACCOMMODATE 5 BEDROOMS. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 8.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 8.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: . TITLE: DATE: NOTES: PAMONE ENG SVC, LLC�`�oF A� �t D6�;2/20,7 CHANGE ORDER P.O. BOX 100217 ANCHORAGE, AK 99510 .� '�� qS ll PHONE (907) 272-8218 FAX (907) 272-8211/�aj�P �y�� Scale NTS "' " .. P.I.D. NO SPRING HILLS ESTATES #1, BLOCK 1, LOT 11A / 015-051-87 ••Steven •R. onnone ROBERT COX � PERMI 0. %,�� CE 8149��/� OSP17,089 4620 SILVER SPRING CIRCLE _ DESIGN DETAILS ANCHORAGE, AK 99507 �il��F*PRO SSIONP��` sheet 1 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES O/5~L ~.~/'~' ~,,'~') ~Z~ SEPTIC ABSORPTION WELL AddreSS TANK FIELD TANKS SEPTIC [] HOLDING TYPE OF SYSTEM [] TRENCH ~ BED [] W. DRAIN [] OTHER Depth to pipe bottom from original grade ~'- , ~ I FT ~ I Fill added above original grade Gravel depth beneath pipe Gravel length Gravel width 10' Numbe~ of lines Pipe material WELLS PRIVATE [] OTHER (Identify) C~assification (A,B,C) Total Depth FT Cased to ~'~'~le r ' ~ Date Installed: REMARKS: AS-BUILT DIAGRAM (Show location of well, sap(lc syst em//property lines, foundation, driveway, water bodies, etc.) FT Inspecti ns perlo by: ENGINEERING -' 'c ":"~" l ooD [:~.oac{ No. 2D~, ~edily that Ibis inspeai~n was ped0rmed according t0 all 72-013 (3/85) INSPECTION ,,RE~O~'~~'LZ'C~';~/' ' MUNICIPALITY OF ANCHORAGES'BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD INSPECTIONS (907) 563-3464 INFORMATION (907) 786-8211 - ~/ ....... ~ /I /~PERMIT NO. ~ '~--J- ' I ,/- ~)~,') I j/ ~', , <:~" , c:~ , -- ' ~ - ~ / PHONE _ 1 lO ,_/IA lOO , ,,.. ~,~ -~ . .... ~ ..... -) r --:... _ ~ .-~.-~.~ FOOTI,~ U ELEO. TEMP- ~ ~ PLBO UND . G~. FOUNDATION _ ~ ~LEO. 8E~VI~E ~ . ~ PLBG. ~OUGH BOND BEAM ~ ~ ELEC. ~OUGH ~t ~ ~. GA8 TEMP. ~ F~AMING ~ ELEO. FINAL ~A8 INSULATIO~ . ~ OTHE~ ~ MEOHANIOAL 8HEET~OOK ~ BEOH, FINAL ~ 8T~UOT. FINAL ~ FI~E FINAL ~ PLBG. FINAL __ OTHE~ ~ ZONIN~ ~ ~ OTHE~ ~o NONOOMPLIANOB OBSERVED ~ OO~ECTION8 ~88ENTIAL A8 EXPLAINED BELOW ~ WILL ~EEXAMI~E AT NEXT 1~SPEOTIO~ ~ DO NOT OONOEAL UNTIL ~EINSPEOTED COMMENTS_ MUNICIPALIIY OF ANCHG Orpr OF HEALTH ENVIRONMENTAL PROTECTIOI~ JUL ~- ? I.°,90 'WHEN CORREC'~ONS ARE MADE~ PLEASE CALL FOR INSPECTION DO NOT REMOVE THIS NOTICE :I. ]. fl [9 ]. c:)c: I.::: D[EV ]:Al':[ ON FIRI:)H E:NG ]:NEE:F( ' S DES:[ GN :0ATIED 5/24./90 f:;:IEDU t F~:ES DHFIS (.'~F'F)F;ff.)V¢il.. F:'i::;; ]: C)R f'i3 CCIFIS II::(UC, T' ]: (::)Ix! ~ NOT I I:::Y DF.IHS EIE:F'i31::;HE ALI... ]: I',I?,F'I:i!:CT.-.. tE[.',.!~C i'i::;: Z EhqL. ]: FISF:'E:C'[' :[ QIq., TI.! ]; S F:'I~iF~Id :[ T :[ S I:::DF~ A' 4 EIE. DFd:]!::il9 S :[ i::;~lq:(l...Y [:dESI.t:)~::~IqCE~ CiNL..Y, (:'4x!D E:XF'IFIIES DN fcir"th by 'Llu,:~ t"lu.r'~ic:Lpal:Lty (:~F ¢~['!(:::['-~c)r'~gi,,~) (]"lOG) ?.,, :[ ~,,~:i.].:l. :Lrts~t;:tll 'Lhe~ ~ysiC[.:)m iii ac:cc:)i"darH::F~ :%, :!: ~.,,:i.:l.:! ,~tdh~::)l'(.? l,.~:~ ail ]q(::)f~ ?::~I'H::! ~[~'[,a[.e ~[:~(m/~eraga~ ?.F¢~;'l:..6mi (::)rt 'LhJ.~ oP arty ad.jac:erd.. SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST L) DATE PER LEGAL DESCRIPTION: ~.~)!~¢'~[ ~-~1/',~ ~1~.fi~-~ Township, Range, Section: 1 2 3 4 5 6 7 8 9 I0 11 12 13 14- 15- 16- 17 18 19- 20- SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WHAT E Depth to Water ADer ,~.-'lb-~c~ Monitoring? ~'~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER __ dEST RUN BETWEEN AND -- FT 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 3,) 7- ~763 ~UPGRADE LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorpt area Dwelling PERMIT NO. ~, DISTANCE TO: I '*~' I g Width ~ ~ ~ Manufacturer Material No. of compartments ~o~~~ ~ Liq.DiSTANcEcapacity inl~OTO:gail°ns WelllF HOME,DE; DwellinglnSlde length PERMITLiquid depthNo. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: IWell , J ~ O Foundation ~t,~ Nearestlotline~ ~ PERMITNO. ~ m ~ No of lines Len th of each I'ne Total length of lln~ Trench -~ I ~ ~ _ [r~ ~ inches Distance between lines Total effective absorption area ~ Top of tile to finish grade/ ~ Material beneath tile ~ inches DIST~NCE TO: Absorption area(s) Class . ' Depth Driller Distance to lot ]ine PERMIT DISTANCE TO: Sugdlng foundation Sewer line ~ O Septic tank ~ ~ ~ , . OTHER PIPE MATERIALS INSTALLER REMARKS APPROVED DATE LEGAL ~ L$ ~ ~ C~ ~ ~:~ A L I -~ Y ~]D E= ¢~ ~ql E] ~ ED R A ED EE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8~5 L STREET~ ANCNORAGE, AK 99501 264-47R0 PERMIT NO: G40664 DATE ISSUED: 08/03/$4 APPLICANT: ADDRESS: CON'fACT PHONE: I)&S UNLIMITED 7800 DEBARR ~206 ANCNORAGE, AK 99504 337-6763 LEGAL DE,.~CRIF': SUBDIVISION: SPRING HILL8 EST. ~1 LOT: 11 BLOCK: SECTION: ..~ TOWNSNIP: 12N RANGE: 3W LOT SIZE: 788'72 (SO.FT. OR ACRES) Listed below ape the options available ~.o you DEPTH TO F~PE BOTTOM (Fl'.) 2.0 / / 4.0 GRAVEL DEPTH (FT.) '3-.0 [ / (). 5 ]?TAL DEPTH (FT. > 7.0 I / TANK SIZE (BALS) 1,000.0 ~.~. ~ 1~000.0 I cepti£y that: 1, I am Camiliap with .the pequi~ements t'o~ on-site se~eps and wells as set ~o~'th by the Municipality o~ Anchopage (MOA) and the 8tare ot' Alaska. 2. I ~ill install the system in acc~pdance,wi'Lh all MOA code~ and .r, egulations~ and in compliance with the design c~i'L~t~a o( this ~' ~{.aLe ~¢ Alaska i-,equi~ements fo~' the s~t back ¢..I wilI adheF.e to all MOA and c . . · distances. ¢r'om any existing ~ell, wastewaten disposal system of public sewenage syste~ on this o~- any adjacent ol* nearby lot. 4.' I under'st, and tha'L this penmit is valJ;d fop a maximum o~' .3 bednooms and any'enlargement ~J. ll ''~ ' ~.quzn,= an addi'Eienal permit. IF A LIFT STATION IS INSTAl_LED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSF'ECTION MUST BE OBTAINED; (2) AS-BUILTS WILL. NO~ BE APPROVED WITHOUT AN ELECTRICAL INSF'EC'TION REPORT;, AND (3) THE ELECFRICAL- ' ' WORK'" MUS~E~NE)~4 ' A LICENSED' ~ ELECTRICIAN.' ~P~LIC~NT~ D&S U~L~M~TZD , · 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 PERFORMED FOR: ~ ~ LEGAL DESCRIPTION: ~ 4- 5- 6- 7 WAS G ROUND WATER ENCOUNTERED? iE YES, ATWHAT DEPTH? 14 15' 16 17 18 19 20 c~t Jd7 ~7/Y COMMENTS SLOPE E SITE PLAN / / / / / Gross Net Depth to Reading Date Time Time Water PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ~ FT ?--,:~ ,-,4~,~ ,,,'~-,,,~b ~- /~,~7'~. ~'J ~~ CERTIFIED BY: Well Owner [V~ 'W DRILLING, Inc. P.O. Box 10-378 · 10300 Old Seward Highwa~ (g07) 349-8535 ANCHORAGE, ALASKA 99511 DESI~'~S 1l~ W00D/S~f HILL ' ', J i'! 'i:_ 'i985 DRILLING LOG : Location (address of: Township, Range, Section, if known; or distance main road lot 11 Block 1 Spring }~lls Additi~ #1 - And~orage Size of casing. Static water level 150 Screen ( ); Depth of Hole 182 feet Cased to 181 ~: feet ft. (~Tg~V'v~ (below) land surface. Finish of well (check one) open end ( X Perforated ( ). Describe screen or perforation ~o~_e Well pumping test at 10 ga!Ions pe~ :~qi~fr) (minute) for 1 hours with ]{'~.~ of drawdown from static lev~L Date of completion AU~L~t 21, 1984 Depth in feet from ground surface WELL LOG Give details of formations penetrated, size .of material, color, and hardness ); :0 TO 2 _TO 50 _TO 95 _TO. 150 .TO. 175 _TO. .TO. _TO. .TO. .TO. .TO .TO ,TO TO ,TO_ 2 5O 95 150 175 182 Gray silty gravel - _~'m'ip. Waterbearing gravel - lowhoad ~aterbearing ?av~l ' Certified 3--CONTRACTOR MUNICIPALITY OF ANCHORAGE 04 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-051-87-000 Expiration Date: 7/11/2024 Legal description SPRING HILLS ESTATES #1 BLK 1 LT 11A Site address 4620 SILVER SPRING CIR Anchorage AK 99507 Current property owner(s) GALLAGHER KAREN L & SCOTT E X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: go Original Certificate Date: 1/26/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approvdjune 2022 MUNICIPALITY OF ANCHORAGE iia Development Services Department -rte Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-051-87 Complete legal description Spring Hills Estates #1 Block 1 Lot 11A Location (site address) 4620 Silver Spring Cir Current property owner(s) Scott E & Karen L Gallagher Day phone 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: © Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 8 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS © Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ C2 Jy Waiver Fee $ Date of Payment / 5� 2 o Z Date of Payment COSA # V S C 2 �( t t70 S Waiver # COSA Application June 2022 Legal Description: Spring Hill Estates #1 Block 1 Lot 11A Parcel ID: 015-051-87 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 8/21/1.984 Total depth 182 ft Cased to 181.2 ft ✓❑ Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12 in. Date of flow test for COSA 1/3/24 Static water level at beginning of test 123 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 43* Date of pumping 7/11/23 ❑ Required maintenance completed, if AWWTS Comments: *STEP tank D. ABSORPTION FIELD DATA Which system tested (date installed) 6/26/90** © ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field. *** ❑✓ Per record drawings, field is insulated. ✓❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 3.8 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑✓ Nc © Coliform bacteria is Negative Nitrate 2.04 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 2] Arsenic less than MRL (ND) Collected by Areterra Consulting Date 12/20/23 C. LIFT STATION © Required maintenance completed Age of lift station 8 years Lift station material steel Comments: Adequacy test date 1/3/24 Results F-,/] Pass Fluid depth prior to test 0 in Water added 804 qal New fluid depth 0 in Elapsed time 20 min Final fluid depth 0 in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: **addition to field added 6/26/17 ***MOA Records indicate pressurized system installed. Invert measurements taken from COs 1, 2, & 3 (Pannone Asbuilt 12/27/18). COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ✓❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft ❑./ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' © Yes if No ft Q Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ,/❑ Yes if No ft Surface Water > 100' 7 Yes if No _ Tank to Property Line > 5' F,/1 Yes if No ft Wells on Adjacent Lots: R Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Yes if No _ Water Main > 10' © Yes if No ft Community Wells > 200' © Yes if No _ Water Service Line > 10' 21 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Areterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date Engineer's Comments: This investigation was completed in compliance withADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as the day tested. The+♦��, �w�..a� �� I it +�R♦ of now and absorption rates may change due to subsurface conditions that may not be observed from the w�� . +t��.••,,, ''�. �. surface, changes inland use, local soil characteristics, levels that fluctuate during the �,•' '� 1 groundwater may year the family being by ,�(�—� and water usage of the serA,ed the system. The operational life of all well and septic ar systems are subject to these various and dynamic characteristics and are outside the control of the evaluator R of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will of function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen -K •••—�•• �V2 rM encroachments, deficiencies or discrepancies exist. + KENNETH M. DUFFUS �/ CE 7116 I4+ f 40 ,�M COSA Checklist June 2022 + MUNICIPALITY OF ANCHORAGE 4 H Development Services Department \ �.._ :: % Phone: 907-343-7904 On -Site Water & Wastewater Section �`` ' Fax: 907-343-7997 Owner Septic Tank: i -Sludge level .,a inches Lift Station/Pump Vault Maintenance Street Address OLULJ -Pumping: required e - -Pumping completed yes no Lift station: -Pump basket cleaned es %nb)—-Effluent filter cleanedest `....:. -Control floats cleanedey s no -Proper float settings confirmed;�_ps-ono -Operation satisfactores no Alarm System: -Dedicated electrical alarm circuit �e no -Audible and visual alarm inside dwelling(' -V no -Alarm system operatiorf;_�satisfactor, not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection e� -Ground water intrusion around pipe penetrations yes oe,-Weep hole functionqe no -Manhole lid: Functiona a no Insulates+ 7Xgj, no Properly Secured &:--ho Other -All manufacturer required inspections and maintenance complete es no rnmmpntc- _ Qualified Maintenance Provider: Technician % Company f !fie i Date of maintenance %6 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-051-87 1. GENERAL INFORMATION Expiration Date: 9 ) - 3V Z Complete legal description Spring Hills Estates #1 Block 1 Lot 11A Location (site address) 4620 Silver Spring.Circle Current property owner(s) Robert Cox Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment �S�Zy /Z I Receipt Number 0873- COSA # () SCS If 5z) Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date GF a�q� 6. DSD SIGNATURE • • . • • • • ...... • • .... ..... ..... System #1 Approved for S bedrooms ?,seven P. Ponnor_ CE 81z_,0 r0 System #2 Approved for bedrooms` Disapproved���`'c,-_ss':o'`` Conditional approval for bedrooms, with the following stipulations: WASv�,,t�Nm Joo OGI�AM JjJJJF�T FSS\ \,��� V� Original Certificate Date:_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSH Checklist Legal Description: Spring Hills Estates #1 Block 1 Lot 11A Parcel ID: 015-051-87 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA = 0 Well log is filed with Onsite (or attached) Date drilled """9" Total depth 182 ft Cased to 181.2 ft FE -1 Sanitary seal is functioning correctly IR Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA "`°Z' Static water level at beginning of test 128.4 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material Steel Measured operating fluid level in septic tank 4911 Oil Standpipes/foundation cleanout per record drawing Date of pumping 1�1� 'f Atli Well production at time of test 2.09 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No © Coliform bacteria is Negative Nitrate 5-0mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by PES Date of Sample D. ABSORPTION FIELD DATA Bed System Which system tested (date installed)�(G�/"j 01 ALL standpipes present per record drawing Total measured depth from grade 3.0 ft (max) 1144 A Measured depth to pipe invert from grade ft (min) R N/A — pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective RE] Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet CW STATION Required maintenance completed Age of lift station !95—years Lift station material 197A- 5�e,L. Comments: Adequacy test date MO -2021 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 754 gal New depth 0 in Elapsed time 360 min Final fluid depth 0 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F-1 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Fv-1 Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft . Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Fv� Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft Z Yes if No ft F/1 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Yes if No ft 0 Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F-1 Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: [j Absorption Field > 5' Fv-1 Yes if No ft Private Wells > 100' Fv� Yes if No ft Water Main > 10' [D Yes if No ft Community Wells > 200' F/1 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Fv� Yes if No ft Wells on Adjacent Lots: Water Main > 10' [j Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' Fv-1 Yes if No ft Community Wells > 200' [] Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 43 H te: i R. Fcr-nar= TY WUNICIPAU OF ANCHORAGE Develg3 _Ment Senricl: Department:– \ On -&16e Water & Wa:> r;mwater Section Phone: 907-34 37904 IFG r)(I 0'Fax: 907.-33,,'1."::'-7997 Lift Station/Pump vault Maintenance Log Owner Street Address Phone % = -- Legal Desc. — S Q R Le PED –yam_. _. -Sludge level �puming: required es r_Q- -Pumping completed _� Q Pump basket cleane() ve o Effluent filter cleaned es a -Control floats cleaner o -Proper proper float settings: -confirmed v -Operation satisfactox- Ala- r Dedicated electrical;--- .arra circuit n-Audibid and visual alarm inside dwelling °Al2n-n system operaticin safisfaratc�p;� not sat�sfa YNI-1 _0D_ ,Ground water intrusic; at riser to tink.con,nectjQn ^Ground water intrusic .r around pipeenetratior)s ves no �- - Weep hole functional -Manhole lid: Furcal :nal � s A �� n Insulated s i Properly Secured4� r�0 -Ail manufacturer requ i qd inspections and maintenance coMpleted des no Comments, ....................... 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'.'.'.'.'.'.•.• .. • .•... ..... 1-11 ...... /..... l'00zzq3 00 09=2j .•8 °LLSv 86 Inas �3n 'HD31NV1 DDI JO 1N3SNOD N31_I.RiM G3SS1ddX3 3 H iAOHllM NVId iMd V SV ISA 2103 G3IJIGOW 38 lON ]]VHS 9NIMM2iG SIHl 310 N 31V1S31V3H 31lHM>IDV('NONNVHS N3SIGMW :A8 G3H3GdO 899 DD3V 4jfrdy-vnv .16iOYPaLObtirrd • 2+/�r�yd r� S868-EbZ auO4d oulluleW DUJ L6ZS-Z9S auOgd auawa.IedaG Aan.InS LOS66 elselV'02?eaO14auy r 1aaaIS H OSZ o a \ouolssa}o ao0 oorb Q 0NVH9Vl1V3 NIA31S />..� ..:..../J ................... . ......... I �..�oA-0-o .0£ = L 31VDS llvl3a 3sn0H rn 8. .97 Cbl � w 3snOH o E �v JNUSIX3 IV ,0•b y L q Cv .O,E -8• L O 60 0•b tiw 0 .,s�z 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. if CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-051-87' HAA # ~L&980236 1. GENERAL INFORMATION Complete legal description Lot llA Block 1 Spring Hills Estates {~1 Locatioq. (site-address or directions) Prbperty owner Mailing address 4620 Silver Springs Circle Anchorage, Alaska 99507 Jay Tenison Day phone Le~ c~i ng agency Maiiing address Day phone JRck White~% Barry Cassidy Agent Address ' 3201 C Street, Suite 200, Anchorage, Alaska Unless otherwise requested, HAA willbe held ~rpickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Four (_4) XXX Day phone 762-3168 :99503 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm s & s Ensineering Phone 694-2979 Address 17034 Eagle River .Loop~ Rao~ Suite 204, Eagle River, Alaska 99577 / / /¢ Eng neers signature '~%--[~,/7 (.. ¢' q/,¢.-.--,.-~- Date ¢i'////¢] .~ DHHS SIGNATURE ××××× Approved for Disapproved. Conditional approval for Four (4) bedrooms. 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. Parcel I.D # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-051-87 1. GENERAL INFORMATION Complete legal descriptionL°t llA, Block 1, Spring Hills Est. Location {site address or directions) ,¢ .... -~ ;. -- Jay Tenison ,~'. F~roperty owrter~. · ," Mailing address 4620 Silver Springs Circle, Anchorage, AK 99507 Day phone ' 'Len'di~g agency Jack ~¢aite ' M~ilindaddress ¢32Ol C Street, Suite 200, Anchoraoe, AK 99503 '"- :. ',~gent Barry Cassidy Day phone ~,~d~lress Day phone 762-3168 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual wei XXX ,*~, ~ ~,'~ .~,- ,~,' ~,~.:-,.: ~-,.1~- ,, Community well '-%¢'.-~-'i' ' Public water - NOTE: If community well system, provide written confirmation from Sfate'AD£C attest- ing to the legality and stat~s of system. ,- 4. TYPE OF WASTEWATER DISPOSA'L~; " Individual on-site Ho!din~ tank ' - Commun ty on-s te ' - -.' "' ' PUbi'i~seWer- ' _ - ." /'::i '".i:'i:'.'~:;/- . '.- NOTE.:, If cOmin'unit?wasteWate¢ system provide writtbn confirmafioh;.(rr~-S~te ADEc i '. ' attesffng ~0 thb legality'and~ta~u~of sy~temJ 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & 5, ENGINEERING 17034 ~,.~. ~,. E~_, ,.'"~ ..... vet Loop Roa~ No. 204 Phone Date DHHS SIGNATURE //'/ Approved for '~/-J/~ Eg bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cedificates based only upon the representations given in paragraph 5 above by an indepe,ndent 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~'25(Rev:l/91) Back MOA~21 Municipality of Anchorage AUG 1 9 'JgD8 ~ Environmental Services Division 'VIRONMENTAL SERVICES DIVISIC[~) 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Log present (~N) 'Y Total depth Health Authority Approval Checklist ~ L~ o ~' ) Parcel I.D.: ol s- - o~-/ - g7 Sanitary seal ~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed (~ [ ~ I / ~ ? Casing height (above ground) Wires properly protected (~/N) Cased to I ecl- ~2 Date of test Static water level I ~'0 FROM WELL LOG Well production ~ o WATER SAMPLE RESULTS: AT INSPECTION g.p.m. ')' ,ct ~ g.p.m. Coliform Date of sample: ' B. SEPTIC/HOLDING TANK DATA Date installed ,::~'~TrZO, _ Tank size Foundation cleanout I~N) C. ABSORPTION FIELD DATA :. - Date installed '~ / I ~/e P: Nitrate Other bacteria $ & $ ENGINEERING Eagle River, Alaska 99577 ooe E'~O Number of Compartments I: Cleanoutsl~/N). Depression (Y~) /u 0 High water alarmt~) Pumper ~ 'J- /'J' ~ ¢- f"C£W Soil rating (g.p.d./fF or~ I ~ ~-- System type ~' E- O / / (~ Gravel thickness below pipe ~ · ~ Total depth Length ' ~ ~- Width Effective absorption area "7, ~,(~ ,~¢ Monitoring Tube present ~/N) Y~--J Depression over field (Y/I~ ~ o Date of adequab~t~Sf ~ Results (Pass/Fad) ~ ~ ~ For ~ ~ bedrooms ~ 0~, Rc~ Fluid depth in absorption field before test (in.);. 0 Immediately after, al. water added (in.): 0 Fluid depth N /a (ins) Minutes later: P/~ Absorption rate J/ = g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ ~ [ ~ ~ wM If yes, give date 72-026 (Rev. 3/96)* ~g~ ..... ' ~ , D, LIFT STATION Date installed Manhole/Access ~/~N) ~/£ ~ High water alarm level at* ~7 ~ 7 Size in gallons ~" o O "Pump on" level at* '-) t /e /, "Pump off" level at* *Datum 7° ~' o ~ /~4~¢//~ Cycles tested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ,/ Absorption field on lot / o 0 Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /o ' ¢~ Property line '¢ 0 ~2-- Absorption field / o / .,L Water main/service line /o ~¢- Surface wateddrainage /oo/¢-- Wells on adjacent lots / o,o /~- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / o '¢-- Building foundation / O I.¢.- Water main/service line Surface water ) O o f.~,L Driveway, parking/vehicle storage area Curtain drain rd c,~/c .k'~c~,' Wells on adjacent lots ? ~o R ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records in conformance with MOA HAA guidelines in effect on this date. Signature ¢~--~ A E. Engineer's Name Date HAA Fee $ '~00~00 Date of Payment Receipt Number ~?O27 ~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 3201 C Street Suite 200 Anchorage, Alaska 99503-3994 Bus. (907) 563-5500 Fax (907) 762-3189 Brokerage, leasing, management and investments. Since 1953. To whom it may concern, August 26,1998 The property located at 4620 Silver Spring aka Spring Hills Estates Lot 11A BLOCK 1 was ocuppied until the start of the second week of July, 1998. Barry Cassaday ~ Jack White Real Estate 3201 C Street #200 Anchorage, Ak. 99503 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot IIA; Block I; Spring Hil~ Estates ~I (b) Property owner Mailing Address (c) Lending Institution Location (address ordirections) 4620 Silver Sprincs Circle Dave W.& Carol Donoho 4003 Carenon Lane Telephone:(home)(813)689-741BTusi VaR Rico, Fla 33594 Mailing Address . Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here (~if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle R~ver Loop Road No, 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~jX Number of bedrooms $ 3. WATER SUPPLY Individual Well [~X Community [] Public [] Note: If community well system, must have written confirmation from the State Departmer Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~]X Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Departmer Conservation attesting to the legality and status. 3ess ,(813)681~2919 of Environmental of Environmental 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, funct cna 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. Telephone Name of Firm S & S 17034 Eagle River Loop Road No. 204 Address . 6. DHHS APPROVAL Approved z"/ Disapproved Conditional Date Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 Mu n icipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 J U L 1 7 ]990 RECEIVED A. WELL DATA Well ClassificatiOn MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Z.-o'P If A, B, C, D.E.C. Approved (Y/N) /O/IA Well Log Present (Y/N) ~ Date Completed Total Depth /~- Cased to t~,//~"Depth of Grouting Static Water Lever / ~- ~ Casing Height Above Ground ( ~-- '~ Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot [ ~)d::) To Nearest Edge of Absorption Field on Lot Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) / ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ' TO Nearest Sewer Service Line on Lot ,2. ~' ~- Water Sample Collected by ~ J¢ -~, .'~-~¢d~;~e~_~£/r,J__~ ;Date Water Sample Test Results ~&~t ~'~'AC?~o¢c~ - t.t~qc_.'~'it~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed /O-/-,!¢~ Size Standpipes (Y/N) I~ Depression over Tank (Y/N) [ O~:Y2 ?~1 No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) ~/~ ;for Holding Tank High-Water Alarm (Y/N) t J/el Temporary Holding Tank Permit (Y/N) sEPARA'CloN DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ( To Property Line To Water Main/Service Line { (2 'lc To Stream, Pond, Lake or Major Drainage Course Comments To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Ln Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ¢' / ~(~:~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Building Foundation Lot / 0 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line TO Existing or Abandoned System on ; On Adjoining Lots ~O [ O To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alar,m/~evel at Tested for Meets MOA Electrical Codes (Y/N) Comments (¢-- 2-(¢- ~O Dimensions /-/'/o'~" X z/ ' ~oO ~ IA I Manhole/Access (Y/N) ~ ~ ~" "Pump Off" Level at ? ~P~' ~ ~ b" Vent (Y/N) ~ ~--~'y ~ 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 HAA guidelin,es in effect on the date of this inspection. Signed Company Date MOA No. Receipt No. Date of Payment Amount: $ 72~026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE £ox Woxk Ozder $ 21281 Date Report Pzinted: ~L%Y 4 90 @ 11:35 Client Sample ID:LllA Bi SPRING HILL EST. PWSID :UA Collected APR 23 90 @ 15:00 h~s. Received APR.24 90 @ 13:30 hxs. Presemved with :AS REQUIRED Client Name : S & S ENGR Cliant Acct: ENSENGP P.O.~ NONE RECEIVED Req $ Oxde~ed By : R. SHAFER Analysis Completed :APR 25 90 Send Repozts to: Laboratory Superviso~ :STEPHEN C. EDE l)S & S ENGR Released By : Special Instruct: Chemlab Rei$: 901044 Lab Smpl ID: 1 Nat~ix: WATER Allowable Pa~amete~ Tested Result Units ~ethod Lir~ts NITRATE-N 0.13 mE/1 EPA 353,2 10 Sample ROUTINE SA}4PLE Remaxks: SAMPLE COLLECTED BY RJS. 1 Tests Pemfozmed See Special Instructions Above UA=Unavailable ND= None Detected ** See Sample Remazks Above NAm Not Analyzed LT-Less Than, GT-Gzeater Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONM~NTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) '-Z/X,I~ '..I5. ?~? (b) Applicants a ~. X .~/.~ Telephone - Home Busines3~~-~1~ (C) Applicant is (check one) Le~ing Institution ~ ; ~er/build~r ~ (d) Lending Institution ~f~J~ ~/o~/L ~ Telephone ~/~- (e) Real Estate Co. & Agent, ~ Address Telephone (f) Mail the HAA to the following address: 2. T_~pe of Residence Single-Family~ Number of Bedrooms // ' t//I Multi-Family~ Other (describe) 3. Water Supply- Individual Well~ Community~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Couservation attesting to the legality and status. 4..~ewage Disposal Note: If community well'system, must have written confirmation from the State Department of Environmental Conservation attesting to the lega. lity and status. [Page 1 of 2] Engineering Firm Providing Inspections, Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Mmnicipality of Anchorage files and from my investigation and inspection, the on-site w~ter supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Telephone (ENGINEER SEAL) DHEP Approval Approved for ~/~edrooms Approved _~ Disapproved Terms of:Conditional Approval Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEGTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 INSTTTUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ~LL DATA Well C lass i f icat ionj~/~/~ ~-~/~ ~,~/q MUNICIPALITY OF ANCHORA(3~ DEPT. OF HEALTH & ~'NVIRONMENTAL PROTECTION 985 RECEIVED Legal Description: z~/~/~f~ If A, B, ~ C, D.E.C. Appro~d(Y~) Well ~ ~esent~) ~te ~le~d ~~ Yield Total ~p~ /~ ~d to /~ ~ ~pth of ~outing. Static Water ~t .~J~ ~ ~t At Casing ~ight ~ Gr~nd . ~ / Sanit~ ~al on ~sing Elec~ical Wiring in ~nduit~) ~ession ~nd ~l~ead ~p~ation Distan~s ~ ~11: To ~ptic~olding Ta~ ~ ~t //~ ~ , ~ ~3oznlng Lots To ~arest ~ge of ~so~tion Field ~t/~p' ~, ~ Adjoining ~ts To Newest ~blic ~ Line/ .~/// To ~est Public Clean~t/Ma~ole ~ ~ / To ~est ~ ~rVl~ Li~ on ~t Water S~le Colle~ed ~ ~/~/ ; ~te ~' ~./~ Water S~le Test ~sults ~?/ ~ C~(=~nts Be SEPTIC/HOLDING TANK DATA Date Installed /~/~//~/ Size /'~ 6~ Standpipe ~N ) / / Air-tight Capstan ) Depression ove= Tank (~ Date Last Pumped No. of Compartments ~--~ Foundation Cleanou~/N ) / Pumping/Maintenanoe Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) Separation Distanoes f~om Septic/Holding Tank: To Water-Supply Well -/~ Z TO Property Line .~// TO Water Main/Service Line Course _/j~ / ~-~ Conm~nts Temporary Holdtr~ Tank Permit (Y/N) / To Building Foundation ~ To Disposal Field ~"' To Stream, Pond, Lake, c~ Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test Type of System Design _~L__D~-/7 Length of Field . ~J Depth of Field ~l$ Gravel Bed Thickness __ _~/~, Standpipes P~esent ~/N) Date of Lest Adequacy Test Separation Distance from Absorption Field: / TO Water-Supply Well /~ / To P~operty Line To Building Foundation ~?~ / To Existing or ,Abandoned System Lot A~//~ ' ;'On Adjoinin~ Lots To Water'M/aain/Service Line ,~×/~ ' To Cutbank(if present) To Stream/Pond/Lake/or Majo~ D~ainage Course /'~'~" / '-/--~ To D~iveway, Parking A~ea, Or Vehicle Storage A~ea '~ C~,~ents D. LIFT STATION 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 du~ing Adequacy Test. Meets MOA C~,',~nts ** Check Permitted Bedroom Rating Ag_,ainst HAA Request ** certify that I have checked, verified, o= oonfcm~red to all MOA on the date of this inspection. Signed Date Company MOA No. KB1/d5/s .nes in effect [Page 2 of 2] 2-15-84 Location: Client's Name: Address: BESSE, EPPS & 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER W~.~. TEST MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & I]NVIRONMENTAL PROTECTION RECEIVED Initial Reading c~ Meter: