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Home My WebLink AboutSPRING HILLS ESTATES #1 BLK 1 LT 7MUNICIPALITY OF ANCHORAGE enI- 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 H, w Department On -Site Wastewater Disposal System Permit Permit Number: OSP231316 Effective Date: 10/11/2023 Work Type: SepticTank Upgrade Expiration Date: 10/10/2024 Tax Code Number: 01505177000 Site Legal Address: SPRING HILLS ESTATES #1 BLK 1 LT 7 G:2436 Site Mailing Address: 4620 GOLDEN SPRING CIR, Anchorage Owner: BOND CHRISTOPHER Lot Size in Sq Ft: 49558 Design Engineer: FORGE ENGINEERING Total Bedrooms: 5 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ( ` o rL-6 Issued By: =� Date: Date: r 2-1— ROUNICIPALITY OF ANCHORAGE R� Community Development Departmentt y` , Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 015-051-77 Property owner(s) Chris Bond Day phone (907) 360-2318 Mailing address 4620 Golden Spring Circle, Anchorage, AK 99507 Site address 4620 Golden Spring Circle, Anchorage, AK 99507 Legal description (Sub'd., Block & Lot) Spring Hills Est #1 B1 L7 Legal description (Township, Range & Section) Lot Size 49,558 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field IN Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 19Upgrade ❑x (D) E]❑ Holding Tank ❑ RenewalDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 Z � Waiver Fees: Date of Payment: r$/y -)-3 Receipt Number: / �R Z.3 J Permit No. V S P 2 I .� 16 Permit App_::- : - Date of Payment: Receipt Number: Waiver No. September 14, 2023 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Spring Hills Estates #1, Block 1 Lot 7 - Golden Spring Circle Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. The homeowner would also like to upgrade the capacity of his septic system, so we are replacing the septic tank with a Category III Advantex system with a 5-bedroom capacity. This new advanced system will tie into the same trench that the old tank was using. The existing trench used a standard septic tank and a soil rating of 275 SF/bdrm, or 0.54 GPD/SF. The effective absorption area is 1120 SF for a 4-bedroom system. The Advantex system for equivalent soils would use a soil rating of 2 GPD/SF. With the same absorption area, this will easily allow for 5 bedrooms. The new septic system will be a minimum of 50’ from all wells and surface water. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231316, Curtis Townsend, 10/11/23 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' 5-BDRM ADVANTEX SYSTEM 1500-GAL POLY TANK w/ BAFFLE REMOVED, 1000-GAL POLY TANK CONFIGURED FOR RECIRCULATION w/ 2x AX20 PODS CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MT TH#1 SPRING HILLS ESTATES #1, BLOCK 1 LOT 7 FEET 0 50 100 5-BDRM HOME 350 SEPTIC PLAN 10/5/23 CO GOLDEN SPRINGS CIRCLE 5' GAS EASEMENT T&E EASEMENT 25' CREEK MAINTENANCE EASEMENT CENTERED ON THREAD OF CREEK 100' CREEK SEPTIC SYSTEM SETBACK LINE REMOVE EXISTING TANK AND DISPOSE OF PER UPC 5' GAS EASEMENT 20' SLOPE EASEMENT SILVER SPRINGS CIRCLE EXISTING TRENCH TO REMAIN IN SERVICE INSTALL NEW 2CO AND DV AFTER TANK ENSURE 5' SEPARATION FROM DECK SUPPORTS NEW 25' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCH W/ 2' SAND FILTER CO MT 360 340 320 330 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231316, Curtis Townsend, 10/11/23 SPRING HILLS ESTATES #1, BLOCK 1 LOT 7 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 3' DESIGN FACTORS:SYSTEM REQUIREMENTS: 750 GPD PEAK FLOW PERK RATE: <1 MIN/IN APPLICATION RATE: 6 GPD/SF 5' WIDE TRENCH SYSTEM 5 BEDROOM ADVANTEX SYSTEM 1500-GAL POLY TANK w/ BAFFLE REMOVED PLUS 1000-GAL POLY TANK w/ 2x AX20 PODS BOTTOM OF TRENCH: 4' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE 750 GPD / 6 GPD/SF / 5' WIDE * 1 RED FACTOR [0.5 DEEP]= 25 LF TRENCH REQUIRED (25 LF SPECIFIED) GEOTEXTILE FABRIC 6" 10/5/23 PROVIDE ADDITIONAL MIN 6" FILL TO ACCOUNT FOR SETTLEMENT 5' 6" 2' MOA APPROVED SAND Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231316, Curtis Townsend, 10/11/23 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH (feet) TEST HOLE 1 DATE READING START TIME NET TIME (minutes) DEPTH to WATER NET DROP PERCOLATION RATE: (MIN/INCH) (inches)(inches) DATE OF MONITORING WAS WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING IF YES @ WHAT DEPTH? 0.1 8/23 1 2 3 4 5 6 SILTY GM Professional Engineers Stamp: NO SPRING HILLS ESTATES #1, BLOCK 1 LOT 7 8/23/23 015-051-77 CHRIS BOND 3:52 1 1' OB 0:33 Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER PERC TEST LOCATION TECHNICIAN: M. JAKUBISIN 7 - DRY 8/31/23 COMMENTS: SITE PLAN 6 0 16 USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED 9/14/23 SILTY GM CLAY GW 1 0:38 7 6 0 16 1 0:38 7 6 0 16 1 0:37 7 6 0 16 1 0:39 7 6 0 16 1 0:38 7 6 0 16 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231316, Curtis Townsend, 10/11/23 Ml N1('l1'AJTIN()FAN( HORACE ADVAN(IM NVASI ENVATEM INK kI MENT s,ixrv,.N,t MUNI FNANCE A141' REMIR AGRIT111^:AM I \ I ?,: 11 A, ( I'ANI) R'l PAIR A&RHAIIS 1, W, "t Oh- W iRF1 NIFNI took sud l woulol 1"01 an I d I& 1 514 Ir (T)ANY 4 20 U. h"uydh,qMyjj thr ',,!I( 1PAI I I YA m ocu"Mc "Wi Awhwmn WwtA Q& In CMIATUMPM 14 OW n"11611 C"WIAMON rtMIMIWd IM&L W IMIU04 by 11u, I 11v po! mb.,iiob by Ow dav,ind,pin mi b I "nond Wyamovi I inwoo Symcin (A "AV! )'al, AdvmiWx SysWai Sphng IN l7sudon Wt Mock 1 lot 7 I h1yMj-)t(1W 101otil til thin Ajq"ho:oW Ow Micl 'JI,01 ('Wo mkyit "Cl t it',' a!'Wcojolf "kh mo A" "IN ocovac am! nmhoomm v ptinli Mlawallo Ow MH WAM to AD, MMMOM0.1 b "lwy,ow"o rn AWMdN W N—twinfort"I m a Wom A" k toldwjf copoltkc fil pip"I"huh on Wowd MO Imowny b"Wd WTKAqWWW ", occordmwc lytdt 01c r611qw"04 qywod 101 ycrokul "I The NI41O"AP1111) 7 11 A& 1w Ow " qp"&&iW,d OW (h"Wr low MY lartl Q 10 Apromwil At Ilii, h4 Al oputiq ;Wonvow n koll"10 j yr4 Did In"p"Olt'n t 11w, UK on WMWMI nhmoIra urI,W (qpk An VHM j"$WH)j WIWI 10"1 C. Tot sody momlys"m v awl nlyn I" owl qqmw& in ow NhMWYv1f" w Ww iii mod" pon;" a nrixiiw kvOl m1w owl mdo mu iwvo 'ot% 00impluuKI, f, hMt" 01 hVitoOk-d dif I,Oiotl�s by 111, in {)"1" t 1R KID Mn Iny- 11LO i= P&A 111AMOMIMA "I An ladur "I G Wp bov IM 11 , 1&160 hoc 0 inyv It" Wip M"I t "W; Uponf.'" JAM&I y"pla, cm; to NO im Am, 1010 Npu 1 10 1 Owner at:Lrio" Indga, dmi thy Idunicirmlity may reciucs wecads of inaknonancu xvi wpain nun Ow nma"wairYs uprunwain iq madmomme pmvidcr, Aft 0"m ackno" Vd.us &M In um A Immg lo moirmain and rt pAr an ATSTS n be inwcordnucc with ANIC 14,60 030 C) ur agme, to Lw dw Nhanicipdi, rusorrAN amcm w test amd mTea be AIAAV'."STh.c 'vlm3€citlalh.4 give ai least 24-luiu- ru-Aicn Owncragre':'s that any sale or IninsIr u f thin of the propm, Q H rug occur w% Ahow a wv Ccriiiicatc of0ri-SitcSystems Approval'. CO 0"mr agrees thiatflicA\VWTS insufflation and mairt,,eance nrequirenviuInov s as idn! h) Ti'. ATV":TS \wAvAnswilm and appim ed 1;y dic Nlurgciralir\ orc thc pidehms R4 dw cmwatcurm, maimamwe mW wpai"NOw OwnCs AW"14, aglez�s lo mointaill remote monitoling oCtheA\V\V I'S as rLquired b� the AWWTS a"row A, 1 Temy Tw wmin of Ohs Agreement shall Wgin on We dwnw of ztriprovd by dic NlunkipaUq to opemw An WNW onerm or qNm wwwWr a6h. mW Kull cmdmic, 'vhifc thc- 'Av.JW] S i:' opraliorial or until htlt" f, tr'lwd't�n-rcd' 'riu, womn or mc A iwwcit)abt) at ,utirnito CW':'11cc a Provi'6)II of zhis Aq,lecnaimo in no top consim a xvirwr or mc pnw6kwsAun h, mq wq mc, dw \ W&qmF to Agavernew o"my pmOwmi or Me 6014 Ow \W&WyQ to ei-d orctz CVCPY P1'0\T'ua1 hcicof. 5. Am"Wmem. Ilk Agiwrnwo Whall on, bcamended by awhan-ed rqresemmiws ot' (yAmzmSapoter. py pw ebyMr an immmW Ned iqqme;wvri,v or mmihodwed memin chall R W& 6, Juvkdrc Ani k-i\ 41'dH 'on lw;myht m lhv Sipinot (Amul Wr div I Wn! WAX 11=0 WAS SUw& Aluka flndc! On 7 allnAlWy Aq pHs Kh oV bk w Kywd in, Aid 11 A cmwi of comperem Qv WIN US) Pac 2 okl Ck ,i5 VO, 0 In (print 11"'In1c) FI NRI)JI'DT(TA!, MSTRICT MSRITIICII[ was me CA" .41hr-LS+DPh4�1-_ n Notary KELSEEEIPublic,Y GStateRofN Alaska \T� Commission # 230214023 My Commission Expires 02 February 14, 2027 TY: MUNICIPALf— Rlv: !0 7-5 v/ (rc v, 0 ,, I ,� "0, S � Pa -c 3 of'I -A; 10 ZZO.nc, Vxx eg.,V'i 395 OT Mayor 7:1 Pump Installation Log Well 14riffing Permit Number: Date ter Issue; Pat -eel Identification Number: D51 _11'1 Legal Des riptioti. P Own er gant: d d r� s Syr'kr-� IPump Installation Date: ; //,*/ z 0 Pump 1--m2ke Depth Belaw'Top ot'VVOI C-w;ing: 2—, � >L—f e e t 11 Pqinp Mapufact-arer's Nme; A I Pump Model: 7 V 1 11rump Size hp Pitless, Adapter Burial Depth: feet PUless Adapter Installer: Well Disinfected 'Upon Completion? L_k1.CS;L_: No �_ Nfethod of Disinfection: Pe Comments: I Pump Installer Ninitn Attention: "f ie pumr installei shall providz a primp installation ),,-j2 TO ,tie CISI) wi�,.qhx 10 kb-.. ('11"jurnp insLallatkm. L -d zt,zi 027ZLO5, .!es j;Rfi,,N 868.:OO P-00:0 LZ, �- L Mr Jul 30 98 09:52a JERRY LE~CH RECEIVED dUL 3 0 1998 Mur,¢~palily O[' Oept. Health & Human 8ervJo~s To: DHHS Date: July 30, 1998 We hereby notify DHHS as requh'ed by permit of the intention to terraILft the following property. Lot: 7 Block: 1 Subdivision: Springhitls; T12N; 1L3W; Section 15 Address: 4620 Golden Springs Circle Anchorage, Ak. Enghaeer Consultation: Yes_x_ 'No Engineer Consulted: Alaska Wate,~r & Wastewater Jerry Ix:ach Alaska Dra/Mield Restoration President MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl.TH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT · PNONE ] ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION Well ! AbsoJ'ption alea Brig DISTANCE TO: Material NO, OF BEDROOMS L-~ iT NO. Liquid depth DISTANCE TO: ;I~L~L:aterial Foundation~ I earest lot line Total length,of line ~ red, eh width f Depth PER IT NO, PERMIT NO, 'Type of crib D__~STA____~C__: DISTANCE TO: · PIPEMA1ERIALS Well Tota~ effective absorption area Nearest lot line 'PERMIT NO. s~,~ ~ ankl26 ,. . [~,:0al~). 1~.3~ OTHER ~^PPROVED ~- C*j G- 72-0/3 (Rf~v. 3/78) DATE LEGAL L'? /3/~1 rV~-W DRILLING, Inc. P,O. Box 10-378 · 10300 Cid Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 84-234 DRILLING LOG ' ~'~: ¢'~'~' .Use of Well Well Owner_~2~I 7. ~.,c~'l Location (address of: Township, Range, Section, if ~own; or distance main road ~t 7 Llock 1 Spr~q tills Add~t~ ~.1 - Size of casing Depth of Hole_ Static water level~.?~'- ft. (~B~7~ Screen ( ); Perforated ( 202 feet Cased to 201,30 feet (below) land surface. Finish of well (cheek one) open end ( ). Describe screen or perforation ~e Well pumping test aL 8 gallons per ~:~'r) of drawdown from static level. Date of completion_ Se?t~l)er ]L3~ 1984_ (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 · · ,3 .TO. 2 Cas~z~ stickn3p ~BN ~ ~ ~c~O~ 2 .TO S0 ~O~N~ ~o~ · ' .TO. 133 .TO.. 160 1~0 .TO. 190 197 TO 202 .TO .TO. .TO TO .TO .TO X ); .I~n silty ~ravel silty , .~r~vl~ _. Drc~,.~n silty ~rravel ..~ou, n silty ~ravel.!_(d~mq~) Uaterbearir~q graw.~l - lo',,,' he~d ~i~ !~o's. 814 & 3 -- CONTRACTOR L(if ;':.'I -.','t ;{ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:_ PP 2, 3- 4 5- 7- // DATE PERFORMED: f J S~-OPE SITE PLAN 10- 12 13 14 15 16 17 18 19 2O COMMENTS WAS GROUND WATER S ENCOUNTERED? ~[~ ~) P E IF YES, AT WHAT DEPTH? 72-006 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop I ~-~1 ,~:~ Io o,75- 015' PERCOLATION I~, I'~ I ~ ¢5' ~:~ RATE ~ 7' 7~ minutes/incE) tTEST RUN BETWEEN ~ -- FT AND ~,O FT / ~'~V'~ CERTIFIED BY:__ MUNICIPALITYOFANCHORAGE . 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Agent Day phone Address .Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BI--"DROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: lng to the legality and status of system. ,: .... 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ' ' Holding tank If community well system, provide written confirmation from State ADEC attest- Community on-site . Public sewer ',,, '/ 4?/, ~.,~,, If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. NOTE: 72-~25(Rav, 1/91) Fronl 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 -~T'~',.',~ ~ ~>-C~f~,,u,,~C~,,~/--~. ~. Phone ~=Tq-o'~ ~_~ Address ~-~>,~o>~ /~"2c~'~ A,,~c-H~.; ~,v,, ~/~ Engineer's signature-~~ -. . Date 6. ' DHHS SIGNATURE Approved for Z~ __ Disapproved. Conditional approval fo~' bedrooms. bedrooms, with the following stiPulations: Additional Comments 7-2 7- Date ~,l~p'roval C~rtificatei~.~,~a~ed only upon the representations given in paragraph 5 above by an independent Pr'of~ssJonal en ¢[i~'.~e~istered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and th, ~HeRdlng'i~st~tut~ons n order to sat sfy certan federal and state requirements, Emp oyees of DHHS do not condu~t inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors o~; omissions in the professional engineer's work. 72-O2~ (Rev. 1/91) Back MOA ~1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAl OI-IEOKLIST Legal Description: /--~ A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B. or C. attach ADEC letter. ADEC water system number '---" "¢~-~ Date completed ~'- ~-~ Driller ~- o'~ Cased to ~ o ( . ..~ Casing height Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION q //:~/,~,~ ~/~,/ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line .g.pJ E C E I V E D ,jUL 1 ? 1995 Municipality of Anchorage Dept. Health & Human Services ; On adjacent lots .; On adjacent lots Public sewer manhole/cleanout ,,t,//,'/~ Petroleum tank WATER SAMPLE RESULTS: Coliform ~ c~ ~ Date of sample: Nitrate C:~ Other bacteria -- c::, -- Collected by: .~,. B. SEPTIC/HOLDING TANK DATA Date installed /~-I - ~ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping / c~ - I~- ':?q Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Tank size ,/~,5 c~ Compartments Foundation cleanout (Y/N) ~C Depression (Y/N) --- Alarm tested (Y/N) Well(s) on lot "~/~,~-/ To property line /c~ '+ ~ Surface water/drainage On adjacent lots ~. /oo ' Foundation 1,3 Absorption field /R' ~ Water main/service line /¢'o ''f'- 72.026(~93)o Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electric~ SEPA~ANCE FROM LIFT STATION TO: ...~¥efl'on lot On adjacent lots Manufacturer Manhole/A~ "Pump on'~ ~Cycles tested"Pump off" Level at Surface water D. ABSORPTION FIELD DATA Date installed /~ - / -E~fl Length "3 l ~ ~ ~t Total absorption area Date of adequacy test '~- Soil rating (GPD/FF) -2- ~7.5~ Width ,'~ ~ Gravel thickness ! t ~ c::, Cleanout present (Y/N) '-~ ~'-//~- ~ ~ Results (pass/fail) '-'~A Water level in absorption fieldJ~l~ale~t ~)-~z¥; -~) ~,'., c.;) 3c¢' Peroxide treatment (past 12 months) (Y/N) 'lA C) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type ~..-i-'. Total depthCc.~/~.3 ' Depression over field (Y/N) for ~ Bedrooms After test yes, give date Well on lot To building foundation On adjacent tots Sudace water ~ Curtain drain On adjacent lots ~ / c~c~ ~ Property line ~/o ~ To existing or abandoned system on lot ,,"~/A Cutbank ~-.5- / Water main/service line ~ ~-.~ / Driveway, parking/vehicle storage area ,_~-c~ ' E. ENGINEER'S CERTIFICATION I certify that I ha ve checked, verified, or conformed to all MOA and HAA guidelines in effect or date of this' inspection. Signature. Engineer's Name Date '~--/L. - ~,~- CE-8149 HAA Fee $ Date of Payment Receipt Number 72-028 (3~93)' Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHOFIAGE 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 AtJTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# e1 o5 -'77 HAA# /'lt-~ ~LbO~'~--/-/' ' GENERAL INFORMATION Complete legal description Location (site address or direotJons) PrlLk [o Id. I 'T- '-7 Property owner Mailing address Lending agency Mailing address Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: __ /7/ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ?2-025(Rev. 1/91) Front MOA~21 TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank - Community on-site Public aewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. -..~' '~ .',. ~ '~' lng to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address ~-~ Engineer's signature bedrooms. 6, DHHS SIGNATURE ...... ;'- /-~ Approved for Disapproved. Phone Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto 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 AUTHORrI"Y APPROVAL CHECKLIST Legal Description: A. Well Data Well type _ Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D, O/,~- -' O ¢ / - 7'~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~//,~/~¢, 6(/ Driller Cased to f~/o ';.~ Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test ~'7/t~/ Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Sewer service line ~io~ Public sewer manhole/cleanout Petroleum tank WATER SAMPLF RESULTS: Coliform /~ Date of sample: I0/I Nitrate C~¢ / Cb Other bacteria Collected by: '~ ~"'~',.~ B. SEPTIC/HOLDING TANK DATA Date installed ~O/I/g, lll Tank size I~O Compartments Cleanouts (Y/N) ~'/ Foundation cleaneut (Y/N) . '"/ Depression (Y/N) High water alarm (Y/N) /"'///~ Alarm tested (Y/N) Date of pumping I0/1,-~/~, Pumper /-~ ¢-- 4 ~u ¢' ¢L.~,,& SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK 'FO: On adjacent lots ~ I/('p Foundation Absorption field / ~ Water main/service line Well(s) on lot /¢~"~' To property line I O Surface water/drainage 72.028 (3/93)- Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manhole/Access (Y/N) "Pump off" Level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~O/I / ~L( Length ~7 ~ Width Soil rating (GPD/FF) ¢2~'-7 Gravel thickness System type /,,¢..z....¢~ ¢_. 4 Total depth I~ '~-''' Total absorption area ~ / ;~-.O Cleanout present (Y/N) Date of adequacy test ~:¢/~f¢/~ ii/ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) for ¢ After test ~'~2 ~ If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot [ L~¢_ To building foundation On adjacent lots /% Surface water ~'~ Curtain drain ~'~ On adjacent lots I. ~ 2... Property line To existing or abandoned system on lot Cutbank ~/~ ~ '~ Water main/service line Driveway, parking/vehicle storage area ~ ~O E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guideflnes in effect on;the date of this inspection. Date }0/1~'1¢1~ .' ' % r HAA Fee $ _.,~ (//~' Date of Payment '//h /'X ~h~ ,/) Receipt Number . , 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR I-IEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date _ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _Lot 7 BLock i S]2~j~nq Hills Estates Subdivision tll Location (address or directions) Golden Spring Circle (b) Applicant Name Rick Gaston Telephone: Home Business 561-8150 Applicant Address 3605 Arctic Suite 1139 Anchorage, Alaska 99503 (c) Applicant is (check one): Lending Institution []; Owner/builder ~]; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) MailtheHAAtothefollowingaddress: Rick Gaston 3605 Arctic SuJ. te 1139 Anchorage, Alaska 99503 TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms four(4) Other WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~x Public [~] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEAFICH, DATA AN[) INFORMATION AS certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm __ Telephone Address Date Engineer's Seal DHEP APPROVAL Approved for four (4) Approved XXXXXXXXX bedrooms by ~" - Disapproved Conditional _ Date March 22, 1985 Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain fsdsral and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsiblo for errors or omissions in the professional engineer's work. Page 2 of 2 72-o25 (~ ~gJNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMEntAL I{EALTH DEPARTMENT OF HEALTH AND ENVIRON/~ENTAL PROTECTION APPLICATION FOR }~ALTI-! Ab/'HORITY APPROVAL CERTIFICATE (a) L~gal Deagript~/on (include" at, block~ subdivision, section, township, range) I,ocation (address or directions) (b) Applicants Name ~'..~ ~Wo~ Telephone - Hom~ (e) Busines__s ~6 Applicant is (check one) Lending .Institution E~ ; Owner/builder ~; Buyer ~[ ; Other ~ (explain), (d) Lending Institution Telephone____ Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the ~ to the following address: 2. T_~of Residence si gle- amil Number of Bedrooms . 3. Water Supply Individual Well E~ Multi-Family Community ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation ,attesting to the legality and status. Sewage Dis~l_ / ~ I I ) / /// ? Ousite ~I Public ~I Community [~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status [Page I of 2] \, Engineering ~irm Pro_y_i_ding !pspect~sns, Tes~p, File Search, Data and Info_r~_~at~, ~ As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation of this Health Authority Approval shows that the on-sltt, water supply and/or ~stewater disposal system is safe, function~, and ~equate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the info~ation obtained from the ~nicipality of ~chorage files and from my investigation and inspection, t~e on-site water supply and/or ~stewater disposal system is in compliance ~th ~1 Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Ftm~.__~ ~ (~,~- Telephone ~ { ~-0~0 Approved Terms of Conditional Approval CAI~ION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA° THE DHEP DOES ~tlS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK° RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (BAA) CHECKLIST - FEBRUARY 1984 IVlUNICIPALI17 OF ANCHORA~t~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECrlOIq MAR 11985 Well Classi fication _ Well Log P~.esent Total Depth. 9~O 'g- ~d to Static Wate~ ~1. I Casing ~ight Elee~ieal Wi~ing in (~nduit ~g~ation Distances ~ ~11~ To ~ptie~oldin~ Ta~ To ~a~st ~ge of ~so~tion Field on Lot To Ne~est ~blic If A, B, c~. C, D.E.C. A~p~oved(Y/N) N^ Date Completed. ~%F'~ I75/F~ . Yield_ ~ ?_o J, ~) Depth of Grouting_ Pump Set At ~m+ ~ Sanitary Seal on Casing ~./N) Depression A~ound Wellhead (Y~ . ; On Adjoining Lots_ ll--J~ ":P ; On Adjoining Lots Cleancut/Manhole Water Sample Collected By Water Sample Test Results Cc~ments ;~- To Nea~sst Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC~HOLDING TANK DATA Date Installed /o,/i// ~ Size . J 7_ ~-O NO. of Cc~pa3etmnts Standgiges _~N) Air-tight Caps ~)/N) Foundation Cleanout ~N) Dep=ession Oge'~ Tank (Y_/~ Date Last Pumped_ A//~ _ Pumping/Maintenance Contract on File (Y~ ; for /~/~ Holding Ta~k High-.Wate= Alarm (Y~,) Tempo=a~y Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Watsr-Supply Wall. / 2. 6 ' 4~ To Building Foundaticn /5 / ~/~ To P~Ol~rty Line ~ 3 ' To Water Main/Service Line /O~¢- Co~se / O() ii. . . To Disposal Field /~// 'P To Stream, Pond, Lake, c~ Major D~ainage [Page i of 2] Receipt ~ Date Paid: Amount: ~4~q~ 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Square Feet of Absorption A~ea Depression over Field Results of Last Adequacy Test Separation Distance f~cm Absorption Field: To ~later-Supply Well ~g ~7~/~-- i~Type of System Eesign Length of Field c~}-O ~ '~' Depth of Field /7. ' Gravel Bed Thickness ~' l! ~Lo l~' -~ Standpipes P~esent ~N) Date of Last Adequacy Test Ay/~ To Building Foundation Lot A;~ ; On Adjoining Lots To Water Main/Service Line To Stream/Pond/Lake/°~ Majo~ D~ainage Course /oo To D~iveway, Pa~king A~ea, Cor~ments ~ ~nl ~q~j~,~¢'/'7'a,~ To Existing or'Abandoned System cn D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Weter Alarm Level at Tested for Electrical Codes(Y/N) Dimensions ~ h Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles d~ing Adequacy Test. Meets MOA Corm~ents ** Check Permitted Bed~ocm Rating Against HAA Request I certify that I have checked, verified, or oonformed to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s Date MOA No [Page 2 of 2]