HomeMy WebLinkAboutSPRING HILLS ESTATES #1 BLK 1 LT 8
, Municipality of Anchorage
• Community Development Department Page 1 of 3
On-Site Water&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: OSP171123 PID Number 015-051-78 ❑ New •Upgrade
Name. ABSORPTION FIELD
ANDREA ROSENBERG
Address: ❑ Deep Trench ■ Shallow Trench 0 Bed 0 Mound
4700 GOLDEN SPRING CIRCLE*ANCHORAGE,AK 99507 0 Other
Phone: No.of Bedrooms: Sod Paung Total Depth from original grade.
522-5252 4 1.0 OPOilia FL 9.66 (MAX.) Ft
`oepintop,pe,nbn5.66 from (MAX.) R onginal grade Gravel daghbeneath ptx
LEGAL DESCRIPTION 4 &4
W Ft
Subdivision: Block Lot: Fie added above Original grade Gravel length
SPRING HILL ESTATES#1 1 8 (30& 30) 60
SEE DWG. R Ft
Township Range: Section. Gravel width- 3eds Number of Imes Distance between Ines
5 & 5 Ft - - Ft
SEPARATION DISTANCES Total absorptwn area Number of trenches Diet between trenches
To Septic Absorption Lit Holding PubadPnvate
From Tank Field Station Tank Sewer Lines 600 M.R 2 10+ Ft
I
Well 100'+ '85' 100'+ - 25+ TANK ❑ Septic ■ S.T.E.P. ❑Holding 0 Other
Manufacturer Capacity
Surface Water 100'+ 100'+ 100'+ - ANCHORAGE TANK 1500 Gal
Material Number of compartments
Lot Line 5'+ •2' 5'+ - N/A
STEEL 2
Foundation 5'+ 10'+ 5'+ LIFT STATION
Curtain Drain NONE KNOWN
r Manufacturer. Capacity
I
ANCHORAGE TANK 500 Gal
Remarks: PER CONTRACTOR.OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC. "Pump on level at 'Pump ofr level at: htgh water alarm at
44" 40" l 46"
BOTTOM OF EAST TRENCH AND TOP OF PIPE INSPECTED BY MOA ONSITE EMPLOYEE
Pump Make&Model Electrical Inspections performed by
TIM ECKLUNDONB/27/2017a6h28f2017. PF200511 MUNICIPALITY OF ANCHORAGE
'WR#OSV171044 PIPE MATERIAL D3034&
House to tank EXISTING/D3034 Tank to D1785
drainfield
Installer
WILCO EXCAVATION Drainfield 03034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
Inspection 95.50 Ft
Dates: 1st 6/27/2017 2nd 6/28/2017 Location and Descnp on
3rd 6/28/2017 4th 6/28/2017 TOP OF MANHOLE
ENGINE R'S SEAL
Community Development Department Approval ��."',",,ii++
Conditional approval: Date: _ If.%
4: i,
LJA. ness• •,w
>11 � •31 r, 54779,3
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Approved: `^^- Dater ��-17 LICEN9+,1A`*"S;, +.�•
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#AECCSB4
Inspection Report_t-1-12.doc
'r PERMIT NUMBER: PARCEL ID NUMBER
0gP171123 RECORD DRAWING 015-051-78
I /
r
A B C 1
FCO 60.6 26.5 3.7 ` - I �r
ST1 58.1 21.5 9.7 I
I
MH 57.0 18.4 19.1 ----,���� I
CO1 68.7 67.3 97.8 I
MT1 70.2 68.5 94.7 1, `�`. 1p0•wELLRA01us
CO2 52.5 39.4 64.7 ��� 1 \
MT2 54.3 40.2 64.9 __ _ i, �\ I
CO3 75.6 64.0 86.4 % �\ 1
7 MT3 73.7 62.4 85.1 GOLDEN SPRING CIRCLE`, `i
C04 65.8 40.4 57.5 `% ti%
%` %1 1• NEW DRAINFIELDS
MT4 94.9 41.3 59.7
CO5 53.7 15.1 21.8 `> \ �
-----).------ Tr: ..
'12(Y SLO' E/�5EMENT�
I MT1 4.. ��
c 1 I cow _.,
r 1
ALL WELL RADII SHOWN B 4-
f,
y i i IMT3 --"•‘-,..---`
EAST LOT LINE SURVEYED ��_ 1 TH#1 �`
BY SHANE HOLT,PLS 1.
-9 s' 01785 CONVERTED TO r D3034 A -------
FS
PRIOR TO CONSTRUCTION .!, FS
G'• MINIMUM OF 10 FEET PRIOR TO THE FS
c 9 ,:,•' :`1 _ C(�2 TZ PER CONTRACTOR
g ,P !DRIVEWAY l'1..- /
�C04 EXISTINGORAINFIELD
iu
3 •r•~•-,• _-�•.�! ••••• NEW 1500 GALLON STEEL STEP TANK PLUMBED
!-•1- ,-a•/ _•' SO THAT FLOW MAY BE DIVERTED BETWEEN
/:-: ..h' -•-a- ...,:4, THE EXISTING AND NEW DRAINFIELD
• A •
`•\ / ' ' f B . / 0 MH SPRING HILL ESTATES#1 BLOCK 1,LOT 9
,, i ST1
• `, •
/'y _. FCO -- _
•
EXISTING 4 / C �` Y ------------------------
---
---- -- _ --
BEDROOM HOME ;/' ��• - �`•
Ill ,SPRING HILL ESTATES#1:BLOCK 1.LOT 7 i !i N
i S ALE: !
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GREE ^ - ' SYSTEM SEi-k
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GARNESS ENGINEERING GROUP, Ltd, ; •' • 4' •���:*
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CIVIL&ENVIRONMENTAL ENGINEERS •. • . , 1� •
3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507'PHONE(9071337-6179•FAX(907)33&3246'WEBSITE www garnessengmeenng corn ,
PREPARED FOR. PHONE NUMBER: PAGE NUMBER: 0 ' ,•i - -' ess * a
ANDREA ROSENBERG 522-5252 2 OF 3 �r�- C5-79q3 +:
PROJECT/LEGAL DESCRIPTION: DRAWN BY: ♦,. �•'•,•• J 6 i, ••V r
SPRING HILLS ESTATES#1; BLOCK 1, LOT 8 L.K.B. . p 40„„ ' • �`, .�
TYPE OF WORK: DATE: LICENSE 4st' ESS\°s'•
RECORD DRAWING 7/6/2017 #AECC884 ������
•
•
PERMIT NUMBER: PARCEL ID NUMBER.
05P171123 RECORD DRAWING 015-051-78
7 INSULATION PER CONTRACTOR FINAL GRADE•93.74-94.67
TOP OF TANK ST1 ST2 MH
AT INLET=90.57 0 0 �� TOP OF TANK
AT OUTLET=90.57
—'/
INVERT OF BUNG NEW 1500 GALLON
AT INLET=90.00 ! S.T.E.P.TANK
V V
am (WEST i
° FILTER FABRIC 1 H 91
B MT CO FINAL GRADE= ON
FINAL GRADE= 97.41-98.41
FILTER FABRIC MT CO 93.99-9552
7 INSULATION ORIGINAL GRADE 12
PER CONTRACTOR HIGHEST POINT=99.73
ORIGINAL GRT=ADE95
2"INSULATION HIGHEST PCNM .10 �1 f
PER CONTRACTOR
AK •:•:••:4.4.0:•:•:•:•:•:•:
::::::_::::::::::::!!:
T1•_••__-___:
�J�`Ir�i'rro MUNICIPALITY OF ANCHORAGE rent
On-Site Water &Wastewater Program �o �
PO Box 196650 4700 Elmore Road G */-
�}}- Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r‘
http Nwww.muni.org/onsite L
I)rTaruncnt
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On-Site Wastewater Disposal System Permit
Permit Number: OSP171123 Effective Date: 6/23/2017
Work Type: Septic Upgrade Expiration Date: 6/23/2018
Tax Code Number: 01505178000 VZ7/11 ISCA-t 3fn
Site Legal Address: SPRING HILLS ESTATES #1 BLK 1 LT 8 G:2436 VOP 4130
Site Mailing Address: 4700 GOLDEN SPRING CIR, Anchorage
Owner: ROSENBERG FRED & ANDREA L Lot Size in Sq Ft: 47293
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Date: /023 /IF
Issued By: VidbeCtS `a..X,n a Date: (0/;?3 0 1 i
Municipality of Anchorage " � S
Jy
Department
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV171044 COSA#: Permit#: OSP171123
PID#: 015-051-78
Legal Description: Spring Hills Estates#1 Block 1 Lot 8
Engineer: Garness Engineering Group
Applicant: Andrea Rosenberg
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
for this lot to the private well for Spring Hills Estates #1 B1 L7 has been approved. The
approved separation distance is 85.0 feet. In addition, your request for a waiver of the required
10 feet horizontal separation from the absorption field to a property line has been approved. The
approved separation distance is 2.0 feet. In addition, your request for a waiver of the required
distance between the proposed and existing absorption fields (16.0 feet) has been approved. The
approved separation distance is 10 feet. See engineer's design narrative for waiver requests and
justifications.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
• The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
n Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
Waiver is Granted: X Waiver is not Granted:
Date: 6/231/4017 Approved by: / t 'xi,cg r „Lt-tP
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
Spring Hills Estates #1 Block 1 Lot 8
Parcel ID: 015-051-78
Waiver for 85 feet from well to drainfield
Issued 6/23/17
General
1) 2014 water sample results for Spring Hills Estates#1 Block 1 Lot 7 show ND for nitrate and negative
for total coliform.
2) The well is higher in elevation than the proposed drainfield So, should the effluent daylight, it would
not flow towards the well.
ADEC Criteria Points
Water Table
Depth to water bearing layer 188 feet
Depth of bottom of field 10.5 feet
177.5 feet 7.4 I
Soil Sorption
Soil descriptions per well log for Spring Hills Estates#1 B1 L7
DEC PTS Depth From Depth To Thickness Calc. Pts
Silty gravel 1.5 0 188 188 1.50
0 0.00
188 1.50
1.5
Permeability
Soil descriptions per well log for Spring Hills Estates#1 B1 L7
DEC PTS Depth From Depth To Thickness Calc. Pts
Silty gravel 1 0 188 188 1.00
0 0.00
188 1.00
1.0
Water Table Gradient-
Not calculated XX
Horizontal Separation
85 2.4
Total Points 12.3
As per ADEC waiver guidelines, with a minimum point value of 12.3, no bacteriological pollution possible
but chemical pollution possible but unlikely from household chemicals. If the well was redrilled to meet
the 100' separation, the points calculation would be within the same points interval. For this reason and
mitigating factors listed above, waiver is being granted.
MUNICIPALITY OF ANCHORAGE
Community Development Department . - Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On-Site Water& Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-051-78
Property owner(s) ANDREA ROSENBERG Day phone 522-5252
Mailing address 4700 GOLDEN SPRING CIRCLE *ANCHORAGE,AK 99507
Site address 4700 GOLDEN SPRING CIRCLE'ANCHORAGE,AK 99507
Legal description (Sub'd, Block& Lot) SPRING HILL ESTATES#1:BLOCK 1, LOT 8
Legal description (Township, Section& Range)
Lot Size Sq.Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(121 all that apply) Initial
❑ Single Family(SF)
Absorption Field ®
Upgrade (w/wo ADU)
Septic Tank ® Duplex(D) ❑
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well n
Water Storage U
THIS APPLICATION INCLUDES A VARIANCE!WAIVER REQUEST FOR:
DRAINFIELD TO LOT LINE:DRAINFIELD TO WELL,DRAINFIELD TO DRAINFIELD Distance: 0.5 FEET,85 FEET,10 FEET
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5 I Waiver Fees: /12
Date of Payment: ‘/57/.?' Date of Payment: WO?
Receipt Number: 1031 Receipt Number: �t 039..0-6
Permit No. O' t ?II Waiver No. 05 tit-/Q
(Rev.01/11)
_. giamics
GARNESS ENGINEERING GROUP, Ltd '1.h.ln e. '"'"e"nt Y--tert"
CIVIL&ENVIRONMENTAL ENGINEERS Dealer
May 31, 2017
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Spring Hills Estates #1; Block 1, Lot 8
To whom it may concern:
The existing 4 bedroom house is served by a private well and septic system. The septic
system is in a state of failure and needs to be upgraded. We are proposing to install a
new 1500 gallon STEP tank and dual deep trench type drainfields. One testhole was
excavated on the property and the drainfield is designed around its 30 foot radius.
Comments regarding the design are summarized as follows:
1. SOILS: See the attached 2017 log which show the soil classifications, groundwater
monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average
topography around the proposed drainfield is 20% running west to east.
5. WAIVER: We are requesting that your department issue a variance from the required
separation distance of 10 feet from drainfield to lot line down to 0.5 feet. Additionally, we
are requesting your department issue a variance from the required separation distance
of 100 feet from well to drainfield down to 85 feet. We are also requesting a variance
from drainfield to drainfield from 14 feet down to 10 feet. Justification for granting these
waivers are as follows:
• The adjacent septic system to the east (Spring Hill Estates #1; Block 1, Lot 9) is
greater than 14 feet from the proposed drainfield.
• Per MOA records, water samples were pulled on 9/5/2014 for the neighbors well
serving Spring Hill Estates #1; Block 1, Lot 7 (attached) and the nitrates were
3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.gamessengineering.com
Page 2 of 2
non-detectable.
• The well is located at a higher elevation than the proposed drainfield. If effluent
were to overflow, it would not flow directly towards the well head.
• We are only requesting a 15% variance.
• The area between the proposed drainfield and well is vegetated.
• Only the proposed field or the existing field will be in use at a time.
We are unaware of any adverse impacts this installation or waivers would have on
adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. Thank you for your assistance.
Sincerely,
r`Jeff �. . e_ss, .E., M.S.
Presi
3701 East Tudor Road,Suite 101 'Anchorage,Alaska 99507-1259
Phone: (907) 337-6179' Fax: (907) 338-3246 Website:www.garnessengineering.com
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PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •n /� ffr G�ness : w
ANDREA ROSENBURG 522-5252 1 OF 2 •. -1%1...i C 79 3 /
PROJECT/LEGAL DESCRIPTION: DRAWN BY: v.A A..'•.•tee- 7, y.•••e-
SPRING HILL ESTATES#1; BLOCK 1, LOT 8 L.K.B. 1.FDP •M •(�P�, �♦
TYPE OF WORK: DATE: LICENSE 1ROFESS\�4♦♦
SITE PLAN 5/31/2017 #AECC884 1 1������ 1
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DESIGN CRITERIA: GEG,Ltd.HAS A 8 PAGE SPECIFICATION i NOTE:THE CONTRACTOR
NUMBER OF BEDROOMS:4 LETTER THAT PERTAINS TO THIS DESIGN.TO SHALL HAVE THE NORTH&
GALLONS PER DAY(GPD):600 OBTAIN A COPY OF THE LETTER CONTACT
GEG.BY PROCEEDING FORWARD WITH THIS EAST LOT LINES,AND ALL
PERCOLATION RATES:5.5 MINJINCH INSTALLATION,THE ENGINEER,WELL DRILLER, PERTINENT WELL RADII
PROPOSED APPLICATION RATE:1.0 -- CONTRACTOR AND PROPERTY OWNER AGREE FLAGGED BY A REGISTERED
MINIMUM DRAINFIELD SO.FT.:600 FT' THAT THEY HAVE READ THESE
SPECIFICATIONS AND AGREE TO ACCEPT THE LAND SURVEYOR PRIOR TO
DRAINFIELD DESIGN: TERMS AND CONDITIONS OUTLINED. CONSTRUCTION.
MAXIMUM DEPTH:10.5 FEET - i i
WIDTH:5.0 FEET 4
LENGTH:2 4 30 FEET EACH(60 TOTAL) % 1 100,\NELL RADIUS
EFFECTIVE:4.0 FEET i `s\I
ACTUAL SO.FT.:600 FT2 %i ���
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/` GOLDEN\ SPRING CIRCLE
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.':-::'.;'''•'.'. ,, . 0.5 FOOT LOT WAIVER REQUEST
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5% • ''20' EASEMENT `
SPLITTER TO REMAIN ABOVE
85WELL M, M!' \� FL DO NOT BURY;PRESSURE LINE TO BEDE.
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T -
, RORTO FDLOW SPLIT TO 4"D3034 ER;CONTRACTOR
r + `-JO USE A ZABEL FLOW SPLITTER
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EXISTING D'RAINFIELD TO REMAIN-
J 10-15% • ' j- al• .. 4 IN PLACE FOR FUTURE USE
••••IDRIVEWAYr,..+10'WAIV - REQUEST
1.25"PVC PRESSURE LINE
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PROPOSED 1500 GALLON STEP TANK
3 .. ./:....x.;•:r- TO BE PLUMBED INTERNALLY SO FLOW
:',4 ••a7..7.4.:4-:v•
' .',A.. ' MAY BE DIVERTED TO THE PROPOSED
'��� `' Ir`- •v TRENCH OR THE EXISTING TRENCH
,\� •• EXISTING SEPTIC TANK 7
`. TO BE DECOMMISSIONED
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,!%� PER UPC
``- INSTALL FCO IF ONE
IS NOT PRESENT -------
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BEDROOM H9MC'
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3701 E TUDOR •
ROAD SU TE 0'-ANCHORAGE.AK 99507•PHONE 19071 3376179•FAX 19071 336-3246'WEBSITE www yamesseng�r,, , . },_
PREPARED FOR. PHONE NUMBER: PAGE NUMBER: / CX •/ • ' 7- =amess : 4s•
ANDREA ROSENBERG 522-5252 2 OF 2 • 0CF-7%63 ',[[�� _�
PROJECT/LEGAL DESCRIPTION: DRAWN BY:
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SPRING HILLS ESTATES#1; BLOCK 1, LOT 8 D.J.G. f •• ••• •••••••`• ���
TYPE OF WORK: DATE: LICENSE
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�r`PROFESS 44`
SEPTIC SYSTEM DESIGN UPGRADE 6/22/2017 #AECC884 ��wa��
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SOIL LOG - PERCOLATION TEST •.�,;:: e rness•::��s
40 fj� • • CE,-7n3
LEGAL DESCRIPTION: SPRING HILL ESTATES#1.BLOCK 1,LOT 8 .. •••,... 34 .9.''<c'��
PERFORMED FOR: ANDREA ROSENBERG DATE: 5/24/2017 •4•' ESS�( 4`;LICENSE �•
DEPTH‘-- #AECC884 ,,,aafsi��•
(feet) ORG/LOAM TEST HOLE #1
1 —
._�� SOIL CLASSIFICATIONS SITE PLAN
2 — r ■ Egat GW '1:::;H: ORG
■ ■ WESGP 11 ML
3 — ■ ■ II:IINIi GM i CL
aqhf
■ ,'y, ' SW MH
5
ii ■ SP 0/.1.1' CH �
■ • NM SM .' ,' �, OH
■ ■ ``� S C ((i)
6 — r S . G
■ P
1
7 —. ■ r DEPTH TO DATE Q`
r GROUNDWATER (Ci N
■ G)
8 — ■ DRY 5/24/2017
■
O
✓ DRY 5/31/2017 SCALE.
9 ^ r
■ ■ GM 1"=1oa
✓ ■
10 — ■
le CLOCK
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
11 — r ■ TIME (MINUTES) READING (INCHES)
12 —
■ r 5/25/2017 1 3:00 6" -
■ ■ 2 3:30 30 0.5" 5.5"
■
13 — • r 3 3:30 - 6" -
O r
4 4:00 30 0.5" 5.5"
14 — I 5 4:00 - 6"
■
■ r 6 4:30 30 0.5" 5.5"
15 . I
r
II r
16 ■
I
B.O.H.
17 —
18 —
19 — PERCOLATION RATE 5,4 (MIN./INCH) PERC, HOLE DIA. 6 cINLHL'.-:
TEST RUN BETWEEN 5 FT. AND 6 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: • YES ❑NO
SOILS LOGGED BY: LANDON BRUCE PERCOLATION TEST PERFORMED BY: ERIKVMDGER
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS,CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: ,II;; I y-
`
'...; MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
! ENVIRONMENI'AL ENGINEERING
DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [~NEW
MAILING ADDRESS
LEGAL DESCRIPTION
, PER IT NO.
Well Absorption are
I s..r
'1~' '~O IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O z ~ Manufacturer Material Liquid capacity in gallons
~~ DISTANCE TO: ~ I~ ~0'0~ ~ ~ ~rench w,~, ~otal Bistanc~7~n lines
Length of ~ach llneI Total leng of,li~es
~ ~ p of tile to finish ~, Material beneath tile
Length Width ~ Depth PERMIT NO.
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~ % Depth Driller Distance to lot line PERMIT NO.
~~ ~: Building foundation Sewer line Septic tank Absorption area(si
OTHER
PIPE MATERIALS
RATING
,
APPROVED DATE LEGAL ~L ~ '
9ATi! iSSUL~): D9/t0/%:4
TOTAL DEPTH (FTc) I"~) ::,5 7.5
,ShAVEL VOkUii.~ (CU.YDS,) 3;<~, q';=2
SOIL ~tATiNG (3:~. FT~/;~) 141 14! 141
¢' ~: ! q .
OF AL:, SK;~.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -'PERCOLATION TEST
SOILS LOG
[~ PERCOLATION
TEGT
DATE PERFORMED:
I J SLOPE SITE PLAN
6
7
8
9
10
11
12
13
14-
15-
16
17-
18-
19-
20-
72-008 (6/79)
~? lO.o~
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
414~o ~ :oq o, bo
~ ~-31 ~ :r,f lo o./B O,q ~
(minutes~/~nch)
PERCOL~[TION RATE
TEST RUN BE~EEN ~0 FT AND ~,~ FT
- ~?- O~d CERTIFIED BY: ~ DATE:
M-W DRILLING, Inc.
P.O. Box 10-378 · 10300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
84-291
DRILLING LOG
Well Owner
Use of We]1
Dommstic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 8 Spring llills - AncJ~orage
161 feet Cased to 161.1 feet
(below) land surface, Finish of well (check one) open end ( X
).
Size of casing 6" Depth of Hole
Static~vater level 140 ft.
Screen ( ~,/); Perforated (
i~bne
Describe screen or perforation
Well pumping test at 9 gallons per
of drawdown from static level.
October !, 1984
Date of completion
(minute) for 1 hours with 100%
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO, 2 C~si~ sticL~up
2 .TO. 4 :Orga~ics
4 .TO 32 Silty gravel
32 .TO 35 Sand & Gravel ~O~iCmAUTY OF ANC~O~A~
_ - DEPT. OF HEALTH &
ENV[RONM~N]'AL PROIEC]'IO~
35 .TO. 100 Silty lhrdpan
~00 .TO ~14 ~,'~izlg mrapm 'JUL 9 1985
114 _TO. ~52 Sil f
152 .TO 161 Waterbearing Gravel
.TO
_TO
.TO N~A Certffi~ Con.acer
~_TO
);
3 -- CONTRACTOR
4SH!
h� ,iE9 z0 ,
e 1
•
/ PGE eu
�_ JUL 2017 3 unicipality of Anchorage `'_
1 •n-Site Water and Wastewater Program �� '
�� ti (907) 343-7904 S a F c r Y
C.. /1
h
`� 168L. gCertificate of On-Site Systems Approval
Parcel I.D. 015-051-78 Expiration Date: i 7 `--1 (-17
1. GENERAL INFORMATION:
Complete legal description Spring Hill Estates#1; Block 1, Lot 8
Location (site address) 4700 Golden Spring Circle*Anchorage,AK 99507
Current Property owner(s) Andrea Rosenberg Day phone 522-5252
Mailing address 4700 Golden Spring Circle*Anchorage,AK 99507
Real Estate Agent Shari Boyd Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
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: Distance:
Received by: Date: .1(11 /? Z
COSA to be released to the engineer, unless otherwise requested by the engineer.
Rus4
COSA Fee $ ��P.
1 to 11° Waiver Fee $
Date of Payment lb b l 11 11 II )11 Date of Payment
Receipt Number OK) 1- Gt Ofot46361 Receipt Number
COSA# CDC/11 1 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date:
4
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF / 04
in accordance with the guidelines and regulations established by the Municipality of Anchorage and � •.• '' `.- 7n
industry practices. The reported results describe the condition of the system/s on the date/s of the '
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or l'
encroachments may exist that were not identified during the evaluation. The operational life of all wells * '' �' i\ VD
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, v
groundwater levels (that may fluctuate during the year), quality of construction (materials and 4 ., VA
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and I.. ...1. -S Q
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ? -•Je/f . Gam-ss,
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of 0O 3 49513 the well or septic system. GEG makes no representation whether an alternative well or septic system 9 �, cp
can be installed on the property in the event either of the current systems fail to perform adequately in � . ••••• U �'the future. The content of this report is for the sole benefit of the person/party that retained GEG to pre s S\On o
perform the evaluation. Reliance upon the information provided in this report by any other person or 4�D000pO�o
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE p
_ System #1 Approved for `I bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the follow(nc,J`-stibuiatlons
ON SITi: lY
VVATER AND
INASTEWATER
PROGRA;v1
•
By: Original Certificate Date: I 1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12.doc
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 Hili Estates#1; Block 1, Lot 8 Parcel ID: 015-051-78
A. WELL DATA
Well type Pnvaie If A, B. or C provide PWSID# N/A Well Log (YIN) Yes
Date completed 10/1/1984 Sanitary seal (Y/N) Wires properly protected (Y/N) Yes
Total depth 161 ft. Cased to 161.1 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/1/1984 3/13/2017
Static water level 140 ft. 130.1 ft.
Well production 9 g.p.m. 5+ g.p.m.
WATER SAMPLE RESULTS.
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd.
Arsenic: ND<5 ug./L. Date of sample: 6/16/2017
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 6/27-28/2017
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) Yes Depression over tank (Y/N) No High water alarm (Y/N) Yes
Date of pumping New Pumper -
C. ABSORPTION FIELD DATA 'Below Final Grade East/West
Date installed 6/27-28/2017 Soil rating (p.d./f or ft'/bdrm) 1.0 System type Shallow Trench
Length (30&30) 60 Total ft. Width 5&5 ft. Gravel below pipe 4 &4 ft.
Total depth `7.3+ ft. Eff. absorption area 600 ft2 Monitoring tube Yes Depression over field No
Date of adequacy test New Results (Pass/Fail) - For 4 bedrooms
Fluid depth in absorption field before test - in. Water added - gal. New depth - in.
Elapsed Time. - min. Final fluid depth - in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (YIN & type) No If yes, give date
Info on 1984 trench in MOA records
"Second compartment of 1500 gallon STEP tank "Per 2017 MOA electrical inspection report
D. LIFT STATION
Date installed 6/27-28/2017 Size in gallons "500 Manhole/Access (YIN) Yes
"Pump on" level at 44 in. "Pump off" level at 40 in, High water alarm level at 46 in.
Datum Bottom of Tank Cycles tested_ New Meets alarm &circuit requirements? "Yes
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 1001+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '2' Building foundation 101+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0'
Curtain drain None Known Wells on adjacent lots '85'
F. COMMENTS
`WR#OSV171044
G. ENGINEER'S CERTIFICATION „� .... .. ..., ,48 ,,,,. ♦
li_ .-..
••
14t/ 49 -,'�4 .' •
I certify that I have determined through field inspections and o : ,
review of Municipal records that the above systems are in , ,
r �
conformance with MOA COSA guidelines in effect on this • ••'�� •l•,•
date. • i‘-'•""': :III*
ey A. Ga sEngineers Printeq Name JEFFREY A.GARNESS f�♦�+(�'• 7 53 • : ��
•
Date l /1 fir' 4♦+ p ESS\ 44
LICENSE ,II iritvtilli
MAECC884
(Rev. 10/12112)
L ULUI-IV bM-<IIVIa L;II-{t;Lt
•
4 .
[1 89 58' OE" E 52-98__
10SLOPE EASEMENT
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FSM r
c � 36 /4 G C\BC. - -
�1L�
r SP -
AS-BUILT SURVEY l°" • 30'
_ NO CORNERS SET THIS DATE
HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT S, BLOCK 1, SPRING HILLS ESTATES NO. 1 .
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS;AND IS EXIST OTHER THAN NOTED.
NOT TO BE USE))FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES.
EASEMENTS Of RECORD,OTHER THAN THOSE APPEARING ON TIE RECORD PLAT,ARE NOT SHOWN DATED AT ANCHORAGE,ALASKA THIS 30TH DAY OF
HEREON(UNLESS INDICATED) JUNE , 2017.
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 DROVER DRIVE
\\` A !LK 99507 //345-5513 l
IJ569, FB 182-47,183-40 GE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Envir0nmehtal 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.# COl S- - 0 5- I -- 7 ~ ~-~ HAA# RI~-'~C:~L~
Complete legal description Lot 8;~ Sprin~ H~ Estate, ~1
Location (site address or directions)
4700 Golden Sprin~ Circle
Anchorage, AK
Property owner
Mailing address
Lending agency
Mailing address
Bob & Kay H~.ton
4700 Golden Spring Circle
Day phone 346-1789
Anchoraq~, AK 99507
Day phone
Agent Barry Cas~aday/ Jack White Real Estate
Address
Day phone 5 63-5500
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
XXX
NOTE:
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system:
TYPE OF WASTEWATER DISPOSAL:
NOTE:
XXX
Individual on-site
Holding tank
Community On-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 & S ENGINEERING
Eagle River, Alaska 99577
Phone
DHHS SIGNATURE
~'~ APproved for
Disapproved.
__ Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
Date /~//~
reSPonsible for errors or omissions in the professional engineePs work.
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
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744
Health Authority Approval Checklist
LegalDescription: L. oT'- ~' $'?Ri~(~ /¢~L.~ ¢.$7'. ~-0~). 4¢/ ParcelI.D.: O~ ,,(- - 05~1 ~ -/ ~
A. WELL DATA
Well type /O/~
Log present CN) ~ -¢- Date completed
Total depth J (0 I / '
Cased to I ..C' f
Sanitary seal (~N) 'Y ~.- ~'
If A, B, or C, attach ADEC letter. ADEC water system number
Casing height (above ground)
Wires properly protected (~/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform O
Date of sample: C;/'/ ! 6 / ¢) (,
B. SEPTIC/HOLDING TANK DATA
Date installed /0 /J /~ ~ Tank size
Foundation cleanout I~N)
Date of Pumping ~'/ / ~/ (~
FROM WELL LOG AT INSPECTION
c~ g.p.m. '~ '
Nitrate
(2./
Collected by:
g.p.m.
Other bacteria
S & S ENGINEERING
Eagle River, Alaska ~9577
I ~.5-0 Number of Compartments 2 Cleanouts ({~)N)__
Depression (Y~) /v O High water alarm (Y~ ~' O
Pumper / ~',4A C _~
C. ABSORPTION FIELD DATA
Date installed Io / ~ ! ~'~ Soil ra~ing (g.p.d./fF or~
Length '~;' Width Iff ! Gravel thickness below pipe
Effective absorption area (~ O ~ ~7 ~Monitoring Tube present CN).
Date of adequacy test il/~'~tl ~ll't Results(Pass/Fail) ~0~£$ ~ For /'/ bedrooms
Fluid depth in absorption field before test (in.);
Fluid depth -- (ins) Minutes later: -- Absorption rate = G ~ O ")- g.p.d.
Peroxide treatment (past 12 months) (Y/N) /vo,~ K~,0~, If yes, give date
-~e f.o,..ro4,.~c ~-~¢j~ c.~,~¢~.~ ~//,(,,/~6 ~ 3'7
72-026 (Rev. 3/96)*
D, LIFT STATION
Date installed Size in gallons
ManhOle/Access (Y/N) "Pump o~at*
High Water alarm level at* *~~atum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
~holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots /oO "/-
Public sewer manhole/cleanout
Lift station tv / A
SEPARATION DISTANCES FROMLSEPTIC..~HOLDING TANK ON LOT TO:
Foundation
Property line /0 Absorption field
Water main/service line
/0 ~ Surfacewater/drainage./°0/-~- Wells on adjacent lots /dO
Property line
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO:
/ O Building foundation /o ~
. Water main/service line ~ .~~
/ o o ~'- Driveway, parking/vehicle storage area
Wells on adjacent lots
F,
ENGINEER'S CERTIFICATION
in conformance with MOA ~A~ cluideline.¢ in effect on this date.
S,gnature ~Y~. ~
Date of Payment
Receipt Number
72-026 (Rev. 3196)*
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES_
Division of Environmental Services
On-Site Services Section .
P.O. Box 196650 Anchorage,Alaska 99519-6650
343-4744
Parcel I.D. # O I
1. GENERAL INFORMATION
C,o~ple,t.e legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~,ob 8.' so~e:'~zl~''~'~es, A~a~t~on
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
4700 Golden Spring Circle
Anchorage, AK 99507
Robert & Michelle Cox Day phone
4700 Golden Spring Circle, Anchorage, AK 99507
Day phone
346-3188
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
NOTE:
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site xxx
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA#21
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 · · ~'~.~.;;.=.!Nc- Phone "- ~'"/ ~J
17034 Eagle River Loop Roa~d ~ ~ ~
Address ~._, ..... z / .... ~=~=~ -
Engineeds signature ~~ ~ Date / ~/7 [ ~¢
DHHS SIGNATURE mt
y.. Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
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 purchasem 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,
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~( (~,, ~:/.]E._ I/
Parcel I.D.
o5-/
A. Well Data
Well type
Log present (~N)
Total depth
Sanitary seal Y~_~)
Cased to
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
If A, B, or C, attach ADEC letter. ADEC water system number /'J//$
Y~% Date completed ,o/, I~'c¢ Driller ,/~ '~/(/
Casing height
Wires properly protected ~)
AT INSPECTION
r
Absorption field on lot
Public sewer main
Sewer service line
SEPARATION DISTANCES FROM WELL TO:
Septic/he]~li~Hank on lot ) I~~
WATER SAMPLE RESULTS:
Coliform
Date of sample:
.g.p.m. ~l~ .g.p.m.
; On adjacent lots. ~'9 (.. T,~N,~ ~
; On adjacent lots /00 ~
Public sewer manhole/cleanout ~/~
Petroleum tank
-,~ ~EP¢ lC TA~IC ~LoT~
Nitrate ~0~ ~~ Other bacteria Collected by:
B. SEPTIC/~TANK DATA
Date installed IO/I I~ Tank size [,P~L~ Compartments ~
Cleanouts (~N) Y~% Foundation cleanout (~YN) ~/~ Depression (Y~ .
High water alarm (Y'~,~ )..5/,/.3¢ Alarm tested (Y/~ f'J/,~
Date of pumping ~/rO~ ~/~/Z/ Pumper
SEPARATION DISTANCES FROM SEPTIC/I'~ TANK TO:
Well(s) on lot /1~ On adjacent lots I1.~ ~+
~ Foundation
To property line I f~ ~'~ Absorption field ~ ~ 'p- Water main/service line
Surface water/drainage I 00 L{-
72-026 (3/93)' Front CONTINUED ON BACK PAGE
LIFT STATION
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)_.~'~-
SEPARATION DIST~ FROM LIFT STATION TO:
Manufacturer
We,,
D. ABSORPTION FIELD DATA
Width
~.._..--~ "Pump off" Level at
Cycles tested
On adjacent lots
Date installed
Length -'-'%3 ~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/~_~
Soil rating (GPD/Ft2) /~/
Gravel thickness
Cleanout present,N)
Results (pass/fail)
System type ~)F>. P_.P
Total depth /,2 '
.Depression over field (Y/(~ /'~
for L-~ Bedrooms
After test ~ ,~- ~
If yes, give date /'J/~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
f
On adjacent lots __ /~)-~ ' ~- Property line /0
/0 '¢- To existing or abandoned system on lot
Cutbank ¢/~ Water main/service line
Driveway, parking/vehicle storage area ~ f
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA ~
Engineer's Name
Date
HA,& Fee $ t~¢:~
Date of Payment
Receipt Number
72-026 (3/93)° Back
Waiver Fee $
Date of Payment
Receipt Number
09×18×96
20:43 CT&E ESI ANCHORAGE ~ 9076941211 N0,270 Q05
CT&E Environm/~I/services Inc.
Laboratory Division ~lll~r.a,l~'~;e'.a'~r.~J.~fJ"-e;~.e'a
Drinking Water Analysis Report for Total Coliform Bacteria ~oo w. Porte, Dine
Anchorage. AK ~}9518-1605
R£AD INSTRUCTIOP~ ON REVERSE SIDE BEFOF.~ COL££C2~ING SAMPLE lei: (907} 562-2343
Fox: {907} 561.5301
MUST BE COMPLETED BY WATER SUPPLIER
FUBL,C WATER SYSTm,. . I'"1 I I I
pRIVATE WATER SYSTEM
$end l~t, glall~ ~ $end lnvoice
0 SendJ~ulta ~ Sendlnvoie¢
TO BE ~OMPLETED BY LABOKATORY
Analy*is shows this Water SAdMPLE to be:
Satisfaotocy
Unsafi~facto~
o Sample over 30 hours old, resulB may
be unreliable
Sample too ong in transit samp]e should
not ba ov,r 48 hours old at examinat
to indi~t¢ reliable resulB. Please $~nd
~ew samp]~ vlo $pecial delive~ mail
Analysis Began
Analytical M~thod: ~ Membtan*Filter
* Number ofcolonledl00'ml.
.... . R**alt· Analyst
"01~
Scat to A.D.E.C. Anch Fb~
Month Day Year
SAMPLI~ TYPE: ....
/~; Routine ,iR" Treated Water
6 Repeat Sample (for routine sample 0 Untreated Water
with lab ret'. no. )
0 Special Purpose
Time Collected
SAMPLE LOCATION Collected By
[]
Client notified of unsatisfactory results:
Phoned $poh* with
MMO.MUG Result: Total Coliform
Membrane Filter: Direct Count
Verification: LTB
Fetal Coliform Confirmation
Final Membrane Filler Result*
BACTERIOLOGICAL WATER ANALYSIS RECORD
£. Cotl
" R o03 OF
BGB ~ ~ --
· TO LOW
Colifoem/lO0 mi
09/~9/96 ~:40 CT~E ESI RNCHORRSE ~ 907694~2~ ND, 2?9 D03
CT&E Environmental Services Inc.
Laboratory Division
200 W Potter Drive
Anchorage, AK 99518-160S
Tel: (907) 562-2343
Fax: (907) 5t51-5301
CT&lg Ref.#
CEerd Name
Project Name/#
Client Sample ID
Matrix
Ordered By
PWSID
Sample Remmi~:
964630001
S & S Engi~eeriikg
Lot 8 Spr~ng Mill Est. #1
L0£8 Sprint8 Hill P~t, #1
Drinki~g water
0
Client PO//
Printed Date/Time 09/19/96 09:51
Collected l)nte/Time ' 09/16/96 09:00
Received Date/Time 09/16196 09:10
Teelmiral Director:~Stephe'n C, Ede~,
Released By ~-~' '
Atto~abLe Prop Analysis
Limits Date Date Init
09/17/96 Ese
09/17/96 TAV
Jl~s Member of the SGS Group {Social;6 G~n6mlo de Surveillanoe)
~-~-VIRON~TAL FACILITIES IN ALASKA. CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JER$~('i OH~O. WEST vIRGINIA
-~.- ~ - MUNICIPALITY OF ANCHORAGE
~"- ': n EPARTMENT OF H~LTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
' ] :] ";"]?:]::' '~'~'~ERTiFi~. ~O~'~Cth AOTHORI~t~}~h;:~] :
'- ' -. ' "~ ~ ' .: ' ':~": ? ":~PRoV~ FOR a SINGLE FAMILY DWELLING ~]/~:_]~ ~,:~
-- ' Location (site addr¢~i'd~rect~ons)- ~7~0 - ~/g~/~ C/4c~. -:' ;.
.-:."-:: -..: .__:: --:..'.'::~ >..: -.,'::_ . - .;_'... :' .:;: :-:':' ...-. ~
wner ' 7~:' ~ Day phone
Lending agency Day phone
' Mailing addres's -" .............
Agent ~o°~'~ -- ~ ~cNZOs~ Daypnone
Address ' - : '- ' "' -- -
requested~ HAA wfll beheld for pmkup:::::~;? ;.?-
Unless
othe~lse
. . _. . ~ ~--. - _ · : ;,. ~- :". ._-..---:
2, NUMBER OF BEDROOMS: ' /-- -
. . :: · . ~. .
3, TYPE OFWATERSUpp~Y:-.-: --'- ':' --
....... ~ ~-~ ........ -~"-, ~ . ~-'~-- '~ ':- ~
· :'- .- - .. --- , ..: .... t .... ..
NOTE: if comm~nitY ~°~)~stem, 'pro'vino writt~n ~on~ir~a~io~ fr°m.statO AD~C
- ingto the legality and status of system. - ..... : :
- Public sewer.;::. :,~-:-: --- ;. -,: :,?,:" .':,t :~,-,:-- ::.-' -; .':-: ~ ..... ':',~-:~"-'.':
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 #21
:suo!l. elnd!:!.s. I~U!MOIIOJ. eqJ. ql.!M 'BLUOOJD@C
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
If A, B, or C, attach ADEC letter.
A. WELL DATA
Well type ~"~--~
Log present(~N)
Total depth / ~ /
Sanitary seal ~N)
Parcel I.D.
ADEC water system number
Date completed //¢/ / ¢¢ Driller /~'~ ~'
Cased to ~/ Casing height
Wires properly protected CN)
FROM WELL LOG
Date of test /~'//~' ~/
Static water level / ¢~
Well flow ? g.p.m.
Pump level /.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~ //~'- -~
Absorption fie~ld on lot /.~ 0 ~--~
AT INSPECTION
/=?
; On adjacent Jots
; On adjacent Jots
Public sewer main' J"///~
Public sewer service line
WATER SAMPLE RESULTS:
Coliform (~ '- ~,~'/~5,¢/¢c~/Nitrate
Date of sample: ~
Public sewer manhole/cleanout
Petroleum tank
Collected bY:
Other bacteria
B. SEPTIC/HOLDING TANK__ /__DATA
Date installed /¢///~.r¢ Tank size I~'~-~c--O Compartments
Cleanouts (~IN) Foundation cleanout {~N) Depression (Ye
High water alarm (Y/N) ~/~ Alarm tested (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ,//~'l'/c On adjacent lots /~ ~ Foundation 7 /'/-
To property line ~ ~' ~ Absorption field c~ '7-¢ /¢) Water main/service line
I
Surface water/drainage
72~J26(Rev. 3/91) Front MOA21 , ''~?!(¢!', "'~, ~, t CONTINUED ON BACK PAGE,i,
C. LIFT STATION ~
Date installed Manufacturer
Size in gallons ~ Manhole/Access (Y/N)
Vent (Y/N) "Pump on" I'~ev ~ ~ , "Pump off" level at
High water alarm level / V .~ Cycles tested __ _
Meets MOA electrical codes (Y/N) __ ~~
sEPARATIoN DISTANCE FROM LIFT STATION TO: ~
Well on lot On adjacent lots Surf~
D. ABSORPTION FIELD DATA
Date installed 'm/,/.~c/ Soil rating
Length 17+ 1 ¢¢Width
'rotal absoi'ption area '~) ~. --)4--
Depression over field (Yi~
Results I~)fsil) /,2¢',-~ ~ for
Peroxide treatment (past 12 months) (Y(~
System type
Gravel thickness
Cleanouts present CN)
Date of adequacy test
Total depth
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellon lot
To building foundation
! .
On adjacent lots
Surface water
Curtain drain
E. ENGINEER'S CERTIFICATION
On adjacent lots /¢¢ Property line
~)~-//~ To existing or abandoned system on lot
Cutbank /J"//~ Water main/service line
Driveway, parking/vehicle storag ~e area
/
+
I certify that I have checked, verified, or conformed to all MOA and HAA ~
inspection.
Engineer's Name
Date
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72 026 (Rev. 3/91) Back MOA 21
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
~ DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. ' GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~'~~ Telephone: Home
Business
Applicant Address '~-/'/~',~- ?~/,,.r. C~,.~'-~~ -/~'~'e ~.~Ze
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other,~ (explain);
(c)
(d)
(e)
Lending Institution /¢ //¢ ;' /C.~ /¢'Z,./ ,~'., / ~,/~.:-~./ . Telephone
Address /"~.,~,,~,:' ~-~7¢~ ~/ ~-~'~'~'¢'~ '
Real Estate Company and Agx} 7,~
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single- Family~'M ulti- Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well~ 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.
72 025 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORM'ATION ' ' ~.. ~ .
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th~'s Hea~th
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 /"~'~:::~
Date
6. DHEPAPPROVAL
Terms of Conditional Approval
-Date
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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4728
Legal Description:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
WELL DATA
If A, B, C, D.E.C. Approved (Y/N)
Date Completed _~c'f- i) /~.~'4- ~ Yield
)'41 - I / Depth of Grouting /v'A
Pump Set At ~"~'
/ / Sanitary Seal on Casihg ~N)
Depression Around Wellhead (Y/~
Well Classification
Well Log Present~N)
!
Total Depth I Cased/to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~N)
Separation Distances from Well:'
To Septic/Holding Tank on Lot /
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water
Comments
; On Adjoining Lots
/1,~ ~.~. ; On Adjoining Lots !
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ~,4
; Date ~'~
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes ~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well //
To Properiy Line
To Water Main/Service Line
Course / 0 ~'
Air-tight Caps,~)
/o-/- 8~/ Size /2_ %~0 No. of Compartments
Foundation Cleanout~/N)
Date Last Pumped /v..4
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~5 '
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~/
Date Installed ~'o ~ ! - ~' ~
¢'
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/[~
Results of Last Adequacy Test '4/4
Separation Distance from Absorption Field:
To Water-Supply Well ! ~ ~ ' ~"° '
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field '~ ~ ~
/2?
Depth of Field
Gravel Bed Thickness '¢' '
Standpipes Presen~/N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ¢ o
To Cutbank (if present)
~ Dimensions
"Pump On" Level at ~ ~"Pum~'"~E~evel at
High Water Alarm Level at _~--~ Vent (Y/N)
Tested for ~dequacy Test. Meets MOA
Electrical Codes (Y/N) ~
* C*¢~heck Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~'~7-- ,~:~¢'~''~'¢-'-- ' Date
Company /¢¢tz¢ $ MOA No.
Receipt No. ~'~L.~f..~q !
Date of Payment & ' J '~-- ~
Amount: $ _ /~' ~
Page 2 of 2
72-026 (11/84)