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Home My WebLink AboutSPRING HILLS ESTATES #1 BLK 1 LT 2Onsite File Spring Hills Estates #1 Block 1 Lot 2 #015-051-72 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201442 PID Number: 015-051-72 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name ALIC BOGGS ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 4721 GOLDEN SPRINGS CIRCLE *ANCHORAGE,AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating depth original grade 907-440-7944 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SPRING HILL ESTATE #1; BLOCK 1, LOT 2 Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft, SEPARATION DISTANCES To� Septic Absorption Lift Station Holding j From Sewer T otal orption area Number of trenches Dist. between trenches Tank Field Tank 1 Line Ftz Ft. well 100,+ TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface water 100,+ i Material Number of compartments Lot Line 15'+ NA HDPE 2 Foundation I 10,+ LIFT STATION -Z Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR *5'+ FROM DECK SUPPORTS Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield WILCO EXCAVATION Drainfield EXISTING CO/MT D3034 Inspector TIM ECKLUND AND ERIK WIDGER BENCH MARK (Assumed elevation) 100.79 ft Inspect ectioes: 15' 12/18/2020 - Location and description 2�a Std _ — 4°t--— TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's S amp �c6oOp Conditional Approval: Date �`1 OF /ap�� • �Qw ------ — T, D : .... Septic System(CE- Approved &tou Date3A ftf�f A,_ GorHess; 793 0l 1 Note: this does approval not include well permit requirements.�AEcca��0��ip�of 1000\ m_.. n PERMIT NUMBER: OSP201442 RECORD DRAWING PARCEL ID NUMBER: 015-051-72 TOP OF MANHOLE = 100.79 FINAL GRADE = 100.2-100.29 STI MH1 Imms TOP OF TANK AT INTLET = 94.40 TOP OF TANK AT OUTLET = 94.40 INVERT OF BUNG AT INLET = 93.78 INVERT OF BUNG 7j AT OUTLET = 93.53 NEW 1250 GALLON H.D.P.E. SEPTIC TANK A,�� .•�� OFAV �P•• • :�i "ROUPLd t 4 ' ....... .......... ..0 ENGINEERING SALES CONSULTING 0..... 3701 E TUDOR ROAD SUITE 101 'ANCHORAGE, AK 99507 'PHONE (907) 337-6179' FAX (907) 338-3246' WEBSITE: wvrvi.gameBeengineenng.com .,,,, ,,,,,,,,,, ,,,,,,, •� ' •' ,� AN PREPARED FOR: ALIC BOGGS PHONE NUMBER: 907-440-7944 PAGE NUMBER: 3 OF 3 �� . E-79 3 ess •;�: �j F '•••,•••� Z ! ,,•� • �i �j� F� p• ..,,, P� �� R�FESS1� .� LEGAL DESCRIPTION:� SPRING HIHLL ESTATES #1; BLOCK 1, LOT 2 DRAWN BY: D.J.G. TYPE OF WORK: DATE: SEPTIC TANK PROFILE 1/5/2020 LICENSE'/ #AECC884 ,rr►r Ilk* £96003V •101d UOISIAlPgns P*PuGOw 041 uo uoaddo pu OP 40140h suo;;alu{sou eo 's;uouanoo 's;uouiosoo Ruo ;o sauo;slxa 941 suluua;op o; uau*o o41 ;o 14111glsuodsw 641 11 N iQiS wisolV 'a6ouo4ouV p ' l't n;o Rop �,1 a41 -141 P -1n0 —51'' . 121 p} •uosua4 Pa;oolPul 60 ;dooxo i[luodwd pigs ua sluowosoo RB NMIalglrin uo44o .to soull uolsilwoul uo'sADmpow au 8.14) *4; 1041 PUD sosluawd F. psRonuns 841 uo 4000uous 040ua41 luaoofpo 15mlAl A1jedoud vy4 uo sluoruanwdwl ou 4041 '040.n44 ;usanfpo A4j&dad 044 a;uo 401)ououo lou op puo scull Apodoud 04; uI4NM aJo uOwOW po;oMls s}uowonwdlul 044 4041 Pug 'DOOM 1*1431(1 GuIPAvaoll o6ou04auV C (Ott–t@ 'ON 1Vld) L *ON H011100V – S31V1S3 Sll1H UNINdS 't ADOIS 'Z 10-1 L �-_' 1�V� •Jy :A4jodoud pogposap 6ulMallol o41 PsRetins wm4 1 40% RIINoo Rgouo4 TQ -I]'6; .............. �" woov[amns6uo1duo4;ouof 7 waa•Asiunseuolpua�l sj o A a na n 5 p u ❑� o u o i S S a J o.i d x03 SZ9t–LSS'L41 ■u04d 9Ct9–LLS {L06} • o u I ` 5 e+ D I o o S s V 7R Bur)] ME–SM55 WOW '■I5w04OmV 'anusnV lAjoo 0o9 L L 'ON ;os oid t 01119 L 3-1 X 11In9 SV – HVid !Old V 1 YVV3815 301 ` °a ad38H1 ❑311�d L I ` �'• •I � " 710V9 135 WILSAS 011d3S , 3133HD ,001 t I °_ Z9a 7 u � I1 I �• � � �_- ti { •3•S OG9'st 7. 1N3Y135tl3 SFI9 .5 Z 101 �3.00AGS H ' t� / I ► ' 1N3Y43SV3 I rgrJod LNY3 •Cl-x0Z ' 3:)NVN3INIVn v35o�aN3: 53 x33aa ,SZ I o r o. I► , I .I ��' .� � i�- �i�� o ri . [•r I x.0 z f / AM) 31OHM" 1 F 401 / I tV• � }ya �� to GJHS 3dld OIA43S I UI .L•tlx,g•� SH doHS ,£•OPS,91 KMA ANFI-NM43 L I r j 53dld / � f 3LLd3S �. pj � I I � / S1N3N43SV3 TTI ,01 / I 71NI1-Nms3 I ,99'96 3,90,99.69 H— • L L }off j ` I I PoplAlpgnsun II I I I 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: OSP201442 Work Type: SepticTank Upgrade Tax Code Number: 01505172000 Site Legal Address: SPRING HILLS ESTATES #1 BLK 1 LT 2 G:2436 Site Mailing Address: 4721 GOLDEN SPRING CIR, Anchorage Owner: HASTINGS JEFFREY H & LORI E Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: ,t „ellt \ S; off' n r. Deharhnent Lot Size in Sq Ft: Total Bedrooms: 10/21/2020 10/21/2021 48870 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specked 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 B Issued By: Y: Date: V / 3 ,' s " Date: MUNICIPALITY OF ANCHORAGE s � Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site SewerMell Permit Application For A Single Family Dwelling Parcel I.D. 015-051-72 Property owner(s) ALIC BOGGS Day phone 907-440-7944 Mailing address 4721 GOLDEN SPRING CIRCLE *ANCHORAGE, AK 99507 Site address 4721 GOLDEN SPRING CIRCLE *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot) SPRING HILL ESTATES #1; BLOCK 1, LOT 2 Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (Nall that apply) Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade N Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: - I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: W3,725, COL/1 f) Date of Payment: l o I 'l Da Receipt Number: d i .3 Permit No. CSP 2C) Iq42 Waiver Fees: Date of Payment: Receipt Number: Waiver No. (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201442, Deb Wockenfuss, 10/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201442, Deb Wockenfuss, 10/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201442, Deb Wockenfuss, 10/21/20 '1 v o N9958'08"E9668 20' TELE & EL EC ESM'T. PSVHAL1 STONE PATIO • DESK O N' YARD LIGHT SNED THE SURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE \ OWNER OFRECORD AS OF THEDATE OF THISSURVEY. \ ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS \ WRITTEN PERMISSION IS PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. h N 9 N8959'E 19.00 O O W � zs' W o�0000p0 N ti o OF A�o��4 49 TH OQpor SHANE A. HOLT oOO • LS -6914 y�o0 rotessiona�oo ', �DOp000� A$ -BUILT SURVEY I" =30T NO bORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY L 0T 2, BL OCK 1 SPRING HILLS ESTA TES I ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS IST DAY OF OCTOBER , 2020 HOLT LAND SURVEYING 9309 DROVER DRIVE 14809, F8208-54 ANCHORAGE,AK 99507 Municipality of Anchorage Page --)__of DEPARTMENT ()F HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 · On-Site Wastewater Disposal System and/or Well ~nspection Report ,., Permit Number: ._.~'~! ~'~ PID Number: ?l~- Name: ~,~ ~ ~[~. Wastewater System: D New ~Upgrade ~dd,~: ~q~ ~ ~n~ ~'~ ABSORPTION FIELD ' ' I ~ No~edrooms: ~hallowTre.oh []Bed ~Mound LEGAL DESCRIPTION so.....o:.~~,.,sq.~. ~.,~,...b,,o.o,~o,..,....*~.ll, Township: Range: o , Fill added shove original g¢~de: Gravo~ length: ,. , ~ ~. ..1~_ WELL: .u....o,,,..,, Yield: ~ Pump Sel al: Oasing HeighlAbOveGroun~; I ? ~ GPM U~I~U Ft ).9 .,./ TANI SEPARATION DISTANCES ~¢~c ~¢a Ho~d~.~ ~ S.~.~.~. To Septic Absorption LiFt Holding ~/Pdvate Manulacturer: Capacity in R~m.rks: BENCH MARK / Ins ections erformedb: _~~ Dates lst~J~ P P Y ~ [4_ / ]a~ ,~,~; Michael E. Anderson Department of Health and Human Services approval ' X /n . ~ / Reviewed and approved by: ~- ~w~ Date: Permit No. ~ of .~ Page Municipality of Anchorage DEPAFITMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Silte Wastewater Disposal System and/or Well Inspection Report ENG Permit No. Page '-~ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN Sl-'RVlCES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report u0'~ ~O,v' ~' 72-013 A (2/91) MOA 25 MUNICI]?ALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930150 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:MELVIN JOHN F & OWNER ADDRESS:4721 GOLDEN SPRING CIR ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/10/93 EXPIRATION DATE: 6/10/94 PARCEL ID:01505172 LEGAL DESCRIPTION: SPRING HILLS ESTATES #1 BLK i LT 2 LOT SIZE: 48870 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: EXPOSE SEPTIC TANK AND VERIFY INTEGRITY DURING CONSTRUCTION OF THE NEW ABSORPTION FIELDS. DURING CONSTRUCTION AN ADDITIONAL SOILS TEST MUST BE PERFORMED AT THE SOUTH END OF THE ABSORPTION FIELDS TO A MINIMUM DEPTH OF FOURTEEN (14) FEET AND MONITORED ]FOR GROUND WATER FOR SEVEN (7) DAYS~ THIS SOILS TEST SHOULD BE SUBMITTED WITH THE AS-BUILT/INSPECTION REPORT. RECEIVED BY:. /~.~/~I~--~ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 August 10, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Attention: Susan Oswalt Subject: Lot 2, Block 1, Spring Hills Sub., Addn. No. 1 Review Comments Dear Susan: I discussed the plugged sewer service line from the house to the septic tank with Roto-Rooter and was told the line was indeed plugged with grease, etc. restricting the flow to less than 2". This condition existed prior to their cleaning the line, however, and at the completion of their work the line was again flowing with 4" of clearance. Swing ties are shown in the table located on Page 2 of 3 of the System As-Built. Dimensions are shown in this manner to relieve the clutter on the page. In addition, the bench mark for the system elevations is noted on Page 1 of 3. Cleanouts are located on both sides of the 90 degree bend on the distribution lines. Several other cleanouts are also located in the system to expedite cleaning and removal of obstructions. Sufficient cleanouts have been placed to alleviate future problems in the system. During excavation for the new system the septic tank was exposed and inspected. No leaks were found and the integrity of the tank was verified. Final grading above the new system has been completed. The owner and constructor of the system are meeting to resolve remaining contract problems. Grading, however, is complete to the satisfaction of the owner and will not adversely affect the operation of the system. The completion of the aforementioned items should satisf, 'our comments regarding the construction of the new system. Health can now be issued. Sincerely, Michael E. Anderson, P.E. PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930150 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:MELVIN JOHN F & OWNER ADDRESS:4721 GOLDEN SPRING CIR ANCHORAGE, ALASKA 99516 DATE ISSUED: 6/10/93 EXPIRATION DATE: 6/10/94 PARCEL ID:01505172 LEGAL DESCRIPTION: SPRING HILLS ESTATES #1 BLK 1 LT 2 LOT SIZE: 48870 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. RECEIVED BY:._.. DURING CONSTRUCTIOn'AN .ADDITIQNA5 :~S0I~S TEST MUST ~UBM!TTED WITH: q?HE AS;BU!LT'~I, NSI~EC~QNjB.E-p~R~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORUED.O~:____ D ~ % LEOAL DE~CR,.T~O.:. k'r 2. i,,i3K, l 5 6 7 8 10 11 12 13 14 15 16 18 19 20. 0c44 I_ LAP.(e' COMMENTS SLOPE WAS GROUND WATER ENCOUN?ER£D? SITE PLAN [-~Tl I,. I' I'.,,l L_L_~.i:~3n~. t I I I I~ Ld~l ~/11 I_1 t 112 M~IIIIIII] ~11111 I I~ ~1111'111 II/ ~~1 t I I I I 11 ~~t I IIII E i i '1 I' '1'~ ~I'~ 1 IF YES, AT WHAT DEPTH? Grol! Net De~th to Net Reading Dale Tim Time Waler Drop ~ ~ ~ O. ~ 0 PERCOLATION RATE /~, / Iml~ula/Inchl TEST RUN BETWEEN ...~' ~ FT AND ..~(~ FT CERTIFIED RY: Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 2 4 5 6- 7 8 9 I0 11 12 13 14 15 16- 17 18 19 20 ~,^s G.OUNO WATEn ~NCOUN~E.ED~ HI2 IF YES, AT WHAT ~ SITE PLAN E PERCOLATION RATE q ~ (rmnuleUmcnl PERC HOLE DIAMETER T~ST.UN~TW~N ~/__~TA~D ~) ACOOROANO, W,,. ALL STA,E ANO .UN,O,PAL G,,OE',N.,. ,.,CT ON TH,, OA ,,. O, T~ ~ /'~ l~':~ _ 72-008 (Rev. 4/85) SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS 4 DATE PER ~' Township, Range, Section: SLOPS WAS GROUND WATER ENCOUNTE.ED? IF YES, A'T WHAT DEPTH? SITE PLAN Depth lo Wiler kller MoflilorinD? . '-~" Oill~ Reading [)ate Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN 13ETWEEN · _ (mlnutea/~nch) PI:RC HOLE DIAMETER · _FTAND_~,~ ,,_FT T. PERFORMF-O ~¥: . ~"' I '~/~d~L,.~ e~__~_..C~E~Fy THAT THIS TEST WAS PE"FORMED IN ACCORDANCE ~.'" A~L STATE AND M~.,C,PAL ~,DEL,NES,. E.~EOT ON T.,S °ATE. O^'E: , v/~'/~ 72-008 (Rev. 4185) U.~ ,.)'6/~ PI YID~D 0p3o.¥ e~l LEGEND 0 LOT CORNERS BESSE, EPPS ~ POTTS 2220 E. 881h. AVE, 349-6452 ANCHORAGE, ALASKA 99507 349-6454 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENI'AL [:NGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WE:LL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION PHONE , __ [~ UPGRADE I Well , I Absorption areaI I ¢ Dwelling DISTANCE TO: ~OT' IA.' Manufacturer ~,,~ ~ ~ ~ Material Liq, Inside length Widt~ '7 NO. OF SEDROOMS ' No, of comp 'tments I F HOMEMADE: Liquid depth Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons DISTANCE TO: Foundation Total lengtb of lin s Nearest lot lin,e~ F ~ Material beneath t, ile (,~ I Depth Well No, of lines i Lengt h~ o f eac~.jLIjge Top of tile to finish grade L~ I Width Crib depth Building foundation ;rib diameter Well PERMIT NO. Total effective absorption area Nearest lot line Depti~ Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHFR PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS _.APPROVED DATE LEGAL 72-013 (Rev. 3/78) DEF'AR"I:MENT Dl=' FIEAL/'rH AND ENVIRDNMENTAL. PF~OTECTION 82.5 L S'I"IRI~IEI', AFICHOF~GE ~ ~1'::: 9950 ;:~64-Zl. 720 I::'l~F~lq ]: 'T NO: 840704' D~'TE ISSUED." 0EI/:L7/84 APPI- :1: CANT ~:]ONTAC'I" I::'H ONIE ,~ ][) &. ~ UI',II...IMITED '7800 DEBARR :1:~206 ANCHE)I~AGE, AK 3::!,7-675:5 L. EGAL. DESCF;CI: P ." I...0'1" c,'' - ,.~ .[ Z I=.: MAX BIEDROOM~: SUBDIVI!3ION~ ~I::'RIN~ HILLS ~:1. L. OT: SECTION: 15 T[]WN~IHIP: 12N R~NGE: 2~,W 413EI70 (SD. FT,, OR ACRES) :3 BLOCK: 1 l...i!~it, ed bel<:~w are 'LI'i~} cHit. Jonas av,~ilable 'Lc) you i.n designir'~g your sep'Lic ~ysitem. Choosc~ the option tha'L best f:i. ts your sli'Le,, "IF" IF~ EE: ~'~ C: ~"~ ;ED E~E :D ~,~ .,, ]:], F:~: ,~:z~ ]:: Ih, ii DEF'TH '1"0 PIPE BOTTOM (I='T.) 4.0 4,,5 4.0 GRAVI:~:L DEF:'TH (F:'T.) 8,, 0 (). 5 3.5 TOTAL DEF'TH (FT.) 12.0 5,0 7.5 [.?RAVEL. W I DTH (F'T,,) 2,, 5 22.0 5.0 ()31:~AVEL I_I~NDTFI (Fl".) 40,, 0~.. 42.0 69,, 0 C:JRAVEL.. VC)LUME (CU.YD8.) 31.4 34.2. 51. 1 T'ANK 81ZE (GAL. S) 1 ~ 000 ,. 0 '~'* 1,0()0.0 '~"~' 1,000.0 '~"~ S[)I~_ RATING (SQ.FT. /BI:D 212 205 212 · ~'~ 'TANI< MUST HAVE Al" LEAST TWO COMI:AFCII~IEI~tt'S c:ert:i. Fy that: 1. I am {'ami], f'clr Ol'P"'~i.'L~,~ sew~,r~..~ and w~.~lls F~r'LI] by the Municipality c)F Anchorage (MOA) arid the Sta'Le oF Alaska. and :Ln ,cc~mp].ianc:e with the design c:rit~ria oF this permit,, I will adhere i:.c~ all MOA and State c~t' Alaska nequir~merrLs Fcm the r~c~t; back dist. al-iC:EH;; Ff'oln any existir~g we].1, waste~a!.ep d;i. sp~slia], sys'Le~l or pLd:~].ic sewerage syst, c~} on this or any adjaceni',. 'cra l](.~aPl:]y ~ LU]dBr~'Latld' ~[.ha'~, '[th J.~J~ permi'L is valid For a m~ximt.u~l c){' 3 bedr'ooms ar'id &~rly (~l'llal"g(~me:~rlt ~d:i,].]. rr~QLO, P~~ an addi'Lion~.~L permi'L. ,1:1= A L..,IFT ~]'AI"IOIq :KS II~LSITALI.=ED IN AN AREA COVERED BY MOA BU:[L~:O]:NE') []ODES:, ]"HEN (1) AN ELECTRICAl_ PERMIT AND ]:NSF'ECl"]:ON MUST BE OBTAINED; (2) AS'-BUIL/TS WILL,, NO]" BE AF::i='ROVED WITHOLIT AN EL. EC]]:~ICAI_ INSI='ECTiON REPORT; AND (3) THE E:LF':[7'ITilCAL WORI<~MLIST BE DONE BY A LICEiqSED ELECTRICIAN. S I GNED ,-' DATE: ;II FL..,[L,ANI '1 I} ~ ~ I.JNI_.IMI'T'E~:D ~' -~ ~c,~ ..... I)ATE: ~ .... ~ ..................................................................................................................... MUNICIPALITY OF ANCHORAGE! DEPARTMENT OF HI=ALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99!301 264-4720 SOILS LOG- PERCOLATION TEST ~ SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: /¢ /~/-¢6 ~l4 - SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O 72-008 (6~79) W^S .OU,DWA ER ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ~ ~'4z~ /0 O,ct0 ~>o~ [o / ¢455- fo O, ~ o,06 PERCOLATION RATE /~:~'/ (minutes/inch) TEST RUN BETWEEN ~/'~- . FTAND Z~,O FT CERTIFIED BY~~ ~¢1-W DRILLING, Inc. P.O. BOX 10-378 · 10300 Old Seward Highway 84-228 (907) 349-8535 ANCHORAGE, ALASKA 99511 'v~;~L/,~ .. Well Owner_ DESIGNS Z~ WOOD, Location (address of: Township, Range, Section, Lot 2 Block 1 ~ring Hills - ~chorage Size of casing. 6" Static water level--215 Screen ( ); Describe screen or perforation None Well pumping test at.~l0 gallons per of drawdown from static level. Date of completion August 2~ 1984 _ Depth of Hole__ 254 Jeer Cased to~253. 40 feet ft. (i~'//~'e~ (below) land surface. Finish of well (check one) open end ( X Perforated ( ). ); (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 Casing stickup 2 .TO. 12 12 TO 25 25 TO 35 35 TO 60 60 TO 80 8o TO_ __115 TO 12~ _ TO 17 . _32k_To 18o TO 215 __215 TO_ 240__ 24O .TO. 25~ Brown silty gravel Brown sand Brown sandy gravel Brovm sand Brown sa~ndy gravel 1N~A Certified Coutract~ Certificate No's. 814 & 973 Gray silty_~r avel Gray si_~lt w/g_rave!~-, weep_~lg Gray si_lt w/F~rave~_-~iOm~ou] der - weeping Brown clay Brown s 5 J~2f e J _j[roxrn sSJ-t4z -ggzc~x~e] -~amp Waterbearing stave! - Low .~[_e. ad I --CUSTOMER Municipality of Anchorage On -Site Water and Wastewater Program U _ (907) 343-7904 Certificate of On -Site Systems Approval 015-051-72 Parcel I.D. 0 1. GENERAL INFORMATION: r1,,1�s Complete legal description Spring Estates #1; Block 1, Lot 2 Expiration Date: J.LA'j1C_ Location (site address) 4721 Golden Spring Circle *Anchorage AK 99507 Current Property owner(s) Jeffrey Hastings Day phone 907-440-7944 Mailing address Real Estate Agent 4721 Golden Spring Circle *Anchorage, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: 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 z - 2 I Date of Payment Receipt Number VC( 03 7— C--7 Receipt Number COSA # OSC211091 Waiver # C� 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 Engineednq 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: yi In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o� 0 � in accordance with the guidelines and regulations established by the Municipality of Anchorage and A� 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 encroachments may exist that were not identified during the evaluation. The operational life of all wells Q�ik 4 9`T{ 1 �* t � and septic systems depend upon a variety of variables, including but not limited to, soil conditions, � • • � • • � ' � 'r•` '.................. groundwater levels (that may fluctuate during the year), quality of construction (materials and f workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ...r.� f .:::: .. ..t ....... are outside the control of GEG. Satisfactory test results do not guarantee future performance of the %.Je , ey A----Garness; system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QO CE -7953 the well or septic system. GEG makes no representation whether an alternative well or septic system Q 9 f'•. can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to ro f e s SW10 � perform the evaluation. Reliance upon the information provided in this report by any other person or O�p��Ocoo party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE .% System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved `��tlttttttf«�� ``� i� 44 1" \v OF ff Conditional approval for bedrooms, with the foll(Adstlpulations. ON-SITE ---- - - ti VVA I LH ANn cn By: �MIA Original Certificate Date: 311 bb 0 i 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 C COSA Checklist Legal Description: Spring Hill Estates #1; Block 1, Lot 2 Parcel ID: 015-051-72 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled $12184 Total depth 254 ft Cased to 253 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 8/28/20 Static water level at beginning of test 144.4 ft Comments B. TANK DATA Age of tank(s) New years Tank type/material s,,1i11D1E Measured operating fluid level in septic tank New ❑N Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Well production at time of test 5.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 1.50 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 8/28/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments - Which system tested (date installed) 1993 Adequacy test date "e/ze/zo ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 12.08 ft (max) Fluid depth prior to test 43 in Measured depth to pipe invert from grade 4.3+ ft (min) Water added 675 gal ❑ N/A — pressurized field New depth 43 in ■❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 0 min depth into effective ' FEWCode-requiredsoil cover over field Final fluid depth 43 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test Gallons introduced n/a gallons If yes, enter date n/a Comments/Deficiencies: *East trench MT extends 5.16' below invert "Tested east trench tested only. West trench had t inch of liquid in it and remained at that level throughout lest C/O 4 ON 1993 INSPECTION REPORT COULD NOT BE LOCATED. HOWEVER, IT APPEARS AS THOUGH A NEW CLEANOUT ON THE EAST TRENCH WAS INSTALLED AND IS SHOWN ON THE RECENT AS -BUILT SURVEY l COSA Checklist yellow sheet 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' 17✓ Yes Neighboring Tank? 100' ❑✓ Yes Absorption Field on Lot > 100' Yes Neighboring Absorption Fields > 100' E✓ Yes Community Sewer Main > 75' E✓ Yes ft ft ft ft Manure/Animal Excreta Storage > 100' if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' U Yes if No ft Property Line > 5' ❑✓ Community Sewer Manhole/Cleanout > 100' if No ft ED Yes if No if No ft Private Sewer/Septic Line > 25'E] Yes if No if No ft Holding Tank > 100' 0✓ Yes if No if No ft Animal Containment > 50' ❑✓ Yes if No if No ft if No ft ft ft ft ft Manure/Animal Excreta Storage > 100' if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' U Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' ✓❑ Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No * ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' E✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS *Septic tank is 5'+ to deck posts Portion of drainfield is located under driveway and/or shed - see as -built survey No freezing issues with septic per email from owner (attached) G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 ft ft ft ft David Garness From: Alic Boggs <alic.boggs@gmail.com> Sent: Tuesday, March 9, 2021 6:22 PM To: David Garness Subject: Re: Spring Hills Estates #1; Block 1, Lot 2 Attachments: image002.png Follow Up Flag: Flag for follow up Flag Status: Flagged We have never had freezing and the shed is not on a foundation On Tue, Mar 9, 2021, 2:52 PM David Garness <David@garnessenginee ring.com> wrote: Alic, The MOA had a few comments on the COSA submittal. I need you to please respond to this email and answer the following questions: 1. The driveway was paved over a portion of the drainfield. Have you experienced any freezing issues associated with the septic system? 2. A shed was placed near/over the drainfield. Does the larger shed in the driveway have a "foundation"? Please let me know if you have any questions. Thank you Sincerely, David Garness, P.E., M.S. Civil Engineer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 MUNICIPALITY OF ANCHORAGF- DEPARTMENT OF: HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # .~'~.~>- (-'~-/---~\ - "'1 ~. HAA# ~¢~ ¢:~ 2-~'J ~(~ 1. GENERAL INFORMATION Complete legal description L. cJT' Z~_ / Location (site address or directions) ~'TZI Property owner ~'ll~, Mailing address Day phone Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest.. lng to the legality and status of system, TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 inves_ti, gation 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. NameofFirm ,Z~,"./~$'O ,'J ~_/¢(./~J.-I.~--~_.~b Phone__ Address 1:~ O ~::) ~ 7~//¢'77,T ,Z~,~ ¢)~-¢r bce ~'/L. Engineer's signature _V~¢.~, d-~.¢:'' ~:~_ -..-~ Date SIGNATUFiE Approved for /"'d;ru~c~ (/~.~_ Disapproved. Conditional approval for 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 enly upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage ,/~..~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type Leg present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~/'t'/~' Driller -~U .Cased to '~¢ Casing height Wires properly protected (Y/N) T Date of test Static water level Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septi~-~l'tank on lot ~ ]1~~ Absorption field on lot '~ I~1~I Public sewer main Sewer service line g.p.m. AT INSPECTION > g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhoIe/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ,/O ~///- Other bacteria Collected by: _./¢./~,- B. SEPTIC-/Rlea,~__.-..~i TANK DATA Date installed Cleanouts (Y/N) Nigh water alarm (Y/N) Date of pumping Tank size --I~¢~ ~r~//¢,~ _Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) Alarm tested (Y/N) .Pumper /,%(,~,.,y_~ ~,L SEPARATION DISTANCES FROM SEPTIC~t6 TANK TO: Well(s) on lot IF' On adjacent lots > J¢/~/ Foundation ~'¢ To property line ¢..~1 Absorption field .~ '~¢/ __ Water4=a~'/service line Surface water/drainage > I~I 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION High water alarm level ~..~ O~~ __ Meets MOA electrical cedes (Y/N) ..~--"~'"~ ~ V;~erCFot On a~lacent lots Surface water '"'~. D. ABSORPTION FIELD DATA Date installed 1 l~L~"~' Length I~" Width Total absorption area J,~+ ~ Date of adequacy test ~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft Gravel thickness present (Y/N) Cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I ~/~ To building foundation On adjacent lots Surface water. Curtain drain System type "'~H"Ab '~/~(--~ Total depth ~'/~-'ll' Depression over field (Y/N) ~ Res ults (pass/fail)~?~,J' §x(~'F~ for /Jr Bedrooms ~ After test "'"" , .If yes, giv~ date ~ On adjacent lots > ~ Pmpe~y line To existing or abandoned system on lot Cutbank~ Water~/se~ice line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect of this inspection. Engineer's Name HAAFee$ / 7~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number JUL IE '93 14:54 FROI,I ROTO-ROOTER ANCHORAGE PAGE.001 MUNICIPALITY OF ANCIt0RAb~~, DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR IRIA. LTH AUTHORITY APPROVAL CERTIFICATE 1 · Ga~!~e~.al___Inf_~ormation Application Date _~- ~-' ('i~'~ (a) Legal Description (inclnde ~lot, block, s~kbdivisioe, section, tovmship, range) Loeat:ion.(address or directions) Applicants Address (¢) Applican~ is (check one) Lending Institution (e) (f) ._. Telephone ~ TM ' ~ ' Real. Estate Co. & Agent ~---~.~f~ , Address __ ....... ' ~ ........... ~--- Telephone Mail t~e.HAA to ,the following]address: ~ype o~f_R~esid ence ~umher of Bedrooms Individual Well Multi-Family_~__~ Other (describe) Community ~ Public Note: If community well system, must have written confirmation from the Stat~ Department of Environmental Conservation attesting to the legality and status° 0nsite ~ Public [_-~ Community ~ Halding Tank ~[ Note: If community well system, must have written co~tfirmation from the State Departmeat of Environmental Conse.rvation attesting to the legality and status. [Page 1 of 2] 5, ~EF~ineerinf~ Firm P].oviding Inopec!ions, Tests File Search~ Data and Infot.~ation As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Autherity Approval shows that the orr-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 ;~%chorage files and ~om my investigation and inspection, the os-site water supply and/or wastewater disposal system is in compliance ~th roll Municipal and State codas, ordinances, and regis.~ tions in effect on the date of this inspecgion~ Name of Firm /--)/~;,%~--' ~0~ l- /--~'h~'~5 Telephone ..?'/~'- (ENGINEER SEAL) DNEP ?~.j~r o__v3_l- Approved fo r' ~,oA~bed rooms Approved ~_ Disapproved Terms of ~onditiona~. Approval Conditionai CAUTION THE MUNICIPALITY OF ANCIt0RAGE DEPARTMENT OF HEALTH AND E~VIRO~fE};L~.L PROYECTIOI~ (DHEP) ISSUES HEALTH AIY~RORITY AJPPROVAL CERTiFiCATES BASED SOIJT. LY UPON THE REPRESEMT~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENI]ENT PROFESSIONAL ENGIneER REGISTERJtO IN TtlE STATE OF ALASKA~ Tt{E DUEP DOllS %~IS AS A COURTESY TO PURCHASERS OF HO}~ES AN1) THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AN~ STATE REQI]IRE-~ MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DA~ BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF JRqCHORAGE IS NOT RESPONSIBL~ FOR FJLRORS OR OMISSIONS IN T~ PROFESSIONAL ENGINEER'S WORK° RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ALK/~0RZTY APPROVAL (HAA) MUN%OPAt~TY OF ANCHORAQI] DEPT. OF HSAtTH & 5NVJRONMENTAL PROIF~CTION CHECKLIST - FEBRUARY 1984 Well Classification ~-z~//~/ If A, B, c~ C, D.E.C. ApprovedJ.Y/N) Well Log P~esent~) Date Completed~/~ ~ .'~'~"~ //~'//'field Total Depth :~ -/ Cased to . 70C3. z/o _ Depth of G~outing Static Water LeVel_ / ~.z_-~"~"'~ / Pump Set At /-' Casing Height Above Ground_ Eleei~ical Wiring in COnduit <(~N) Sepa~tation Distances f~om Well: To Septic/Holding Tank on Lot Sanita~,y Seal on Casing Y~_~N) ' Depression A~ound Wellhead (Y~ -- ~ ; On Adjoining Lots 7- 1:o Nearest Edge of Absorption Field on Lot/'i~g~ -~ _; On Adjoining Lots To Nearest Public Sewer Line. .4///~/ To Nearest Public Sewer Water Sample Test Results__ Coll~;nts B. SEPTIC/HOLDING TANK DATA Date Installed /~ .~./~/~.~/_ Size ~/r ~'O No. of Compamtm~.nts ~ Sta~dpi~s~y~) Ai~-tight Caps~) ... Fou2datio~ Clea~out~) I~p~ession o~ 'rark (Y~ Date ~st P~d ~ ~'~ - P~ing~aintenan~ Cont~a~ ~ File (Y~) ; fo~_ ~ Holding Tank High-Water Alarm (Y/N) SeDaration'DistanCOs f~'cm Se~tie/~-lolding TO ~ter Main/Se~vi~ Li~ _~ Counts Tem~orazry Holding Tank Permit (Y/N) ~f/.~ Tank: To Building Foundation /-l'~ / To Disposal ~ield . //~ / To Stream, Pond, Lake, o~ Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD ~ATA Soils Rating in Absorption Stnata Date Installed ./~, .-.~/ - c~.~/ Width of Field y^~' / / Squane Feet of Abso~ptionA~ea Depression over Field (Y~ Results of Last Adequacy Test .~/Z._ .~.~,,~- Type of System Design Length of Field Depth of Field . Gravel Bed Thickness ~. ~-~. Standpipes P~esent ~) Date of Last Adequacy Test Sepanation Distance fnc~ Abscnption Field: ~ / To Waten-Supply Well /~ .~ To ~o~nty Li~ ~D ~ To Building Fo~tion ._~ / To Existing o~ndo~d~. System Lot ~/~ ' ; ~ ~joininG ~ts ~ To Wate~ M~/~vi~ Li~e ~/~ To ~t~(if~p~e~t) ~ To Stne~ond~ke/~ ~jon ~aina~ ~ /~c / ~ / TO ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea ~' ~ C~ents D. LIFT STATION Date Installed Size in Gallons "Pump Oa" Level at High Waten Alanm Level at. Tested fo~ Eleetnical Codes(Y/N) C~,,ents Dimensions Manhole/Access (Y/N) "Primp Off" Level at Vent (Y/N) Pumping Cycles duning Adequacy Test. Meets MOA ** Cheek Permitted Bedncc~ RatinG Against HAA Request I certify that I have checked, verified, c~ oonfc~m~d to all MOA HAA on th~ date of this inspection. Signed Date Company MOA No. in effect KB1/d5/s [Page 2 of 2] 2-15-84 Location: Client's Name: Address: BESSE, EPP-q & POTTS 2220 EAST 88 AV~rJE ANCHOaAGE, AK 99507 (9O?) 3~9-6451 WA~:ER ~ELL TEST Subdivision: Lot: Block: ,/ Initial Reading ~ Meter: . ~-~.:. '~:,~ GALLONS GALL~N~ TIME GPM ~% VOLUME TOTAL VOLU~ Pr~]~ctJon Rate: GPM 2q-Hour Capacity __ C~].]c~s