HomeMy WebLinkAboutSPRING HILLS ESTATES #1 BLK 1 LT 3Spring Hill
Estates #1
Block 1
Lot 3
#015-051-73
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Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP191436
PID Number: 015-051-73
Dwelling: X Single Family (SF)
❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade
Name
Sheldon J. Lien
ABSORPTION FIELD
❑ Deep Trench Al Wide Trench ❑ Bed ❑ Mound
Site Address
4701 Golden Spring Circle
Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
350-8905
5
1.2 GPD/SF
8.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision
Block Lot
Spring Hill Estates #1
1 3
Fill added above original grade
0.6 Ft.
Gravel length
63 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
630 Ft2
1
Ft.
Well
>100'
>1 00'
N/A
N/A
>25'
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer 1,500 Gal.
Surface Water
>1
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>1 0'
>1 0'
N/A
N/A
LIFT STATIONManufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Wilco Contractors
Drainfield D3034 CO/MT D3034
Inspector M. Jakubisin
BENCH MARK (Assumed elevation) 100 ft
Inspdiecct15` 8/11/20
8/12/20
Location and description
Sn
2nd
Threshold of sliding door near point A.
3rd
41h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
4* OF
OF
®®®
Conditional Approval:
Date
���P�""'��"'"�:Q
•49th®�®
® ` 0.
�..... s
w........ .... .... ..s.....
®............................................p
kilCHAEL E. ANDERSON ; �®
Septic System
Approved
Date oF•'••..,
®�
♦®�J,T•� No. CE-4381
9/3/20 'fit'®
..•'
®11144®OFES®\®�®®4®®
Note: this appr al does not include well permit requirements.
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SPRING HILLS ESTATES #1, BLOCK 1 LOT 3
PERMIT # OSP191436
CL SS A WELL LOCATED
PID # 015-051-73
PRO�ERTY T NORTH IS >200' FROM NORTH
,,PROPERTY LINE.
( 20' T&E EASEMENT
\ �1
LOT 4
--\-� F-- -�
i
BL CK RET. WALL
EXISTING L - / \
�\ \
\ OT 3
\ \ 63' �ONG x 5' WIDE x 4'
\ EFFECTIVE DEPTH CO2 2
\ \ ABSORPTION TRENCH.
EXItTJNG ABSORPTION ENG\HES \ \
ABA BONED PLA�E. \
TH#1 CHAIN LINK FENCE
\ \ LOT 2
RETAINING V1LL I 1 \
\I � C01
TH1
1984 TH 1 1
2C0 1
� SV 1
MH I
5 -BORN HOME _ TAN 0 GALLON SEPTIC
12
I TAN w/20" MANWAY.
\ / / DE�K
FCO
BO EXISTING$EPTIC
T N DECOMMISSIQNED
If�J PLACE PER MOA CO61€.
v
EXISTING WELL'
EXISTJNG WELL I
GOLDEN ING CIRCLE / A B
/ J
ENGINEER I N G IJ
PLAN AS -BUILT
0 50 100
FEET
1
MH
48
30.6
ST--
52.6
27.9
\2CO
54.2
26.
/C91
6.8
76/3
MT1
99,8
1 78.8
CO2
51./109.8
T2
151\1
110.1
liffelWill
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
SPRING HILLS ESTATES #1. BLOCK 1 LOT 3
PERMIT # OSP191436
MR
GE
ENGINEERING
PID # 015-051-73
O�-
U2 91.2 FINISH GRADE
DRAINFIELD ROCK
�O
90.6 ORIGINAL GRADE � U
� 82.6 82.6 �
�-� 63'
NO GROUNDWATER 7/20/20
76.6
PROFILE AS -BUILT
(NO SCALE)
:. .
N,
0
0
0
Z
N8958'08'E214.33
GOLDEN SPRING CIRCLE
OF
CO 49 THO�
1 0
wfLEGEND
U O
s SHANE A. HOLT/�O
LS -6914 ' 5J' O IANDSCAPELIGHT
4a a o
fessiona� L�� • SEWER PIPE
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT
ARE NOT SHOWN HEREON, UNLESS NOTED.
NOTE FENCELINES THAT MAYAPPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS-BUILTBURVEY I" =301
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
IOT 3, SIOCK I, SPRING HILLS ESTATESADD'N I
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 257H DAY OF
AUGUST 2020
MUNICiPAL1:TY OFANC
on-Site.0
a Program V
Water Wastew ter
PO BOK 196650 47.QQ:E1rnore.Ro$.d
...
Anchorage, Alaska 9951'9-6650 Ph�666w (907) 348-7904 Fax: {907) 343-7997
:htjpjjvmW. Muni, arg/onsite
Department
O.h�Site:wa:steW.at.er'.disposal System Permit
Effective bate: 11012/201.9
PermitNumber: OSPI91436
Work Type: Septic Upgrade Expiration Date: 10/112020
Tax Code Number: 015051.73000
Site Legal Address: SPRING HILLS ESTATES #1 BLK I LT 3 G:2436
Site Mailing. Address: 4701 GOLDEN . SPRING CIR: Anchorage
Owner, :. LI . E I N SHELDONJ 'Lot Size: in: Sq i=t: 50721
T .
btal:13edrooms.
:Design Engineer FORGE ENGINEERING
This. permit, is: for the construction of:
1Z Disposal Field 21,Septic Tank 0 Holding Tank El Privy 11 private Weil CI WaterZtorage
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.
VV.astewater Disposal Regulations (1 8.AAC72*) and Drinking Water Regulations (I 8AAC,80).
3. The wastewater code requires inspections.d
uring.the installation. . D
I The shall notify1heevelopment
S 1 0 1 rvices. I QeParftent perAM calling (907} -348-7904:.(.24/7).
C 15,65, ProVide:notificatlomby
4.. From October 15 to April15, 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 preventfreezing.
Sp :test
p Engineer needs to, do a. complete test hole 18` deep and an addirionperkprior to. th.econstruction of
:the septic field.. Construction may proceed at your own: risk before the 7 day water, monitoring ,is complete.
Please submit stamped and signed results With the, As=buflt: Inspection Report. lf:the re.sulfs' requir0a.design
change, construction of ithe system will stop pending:On-Site review: and approval.
Co
e u) je 41 , n AL&r iJ IeOcle_. 7b��*
: q
Received By: J) 0,4,vil 'trle�lah Date
u- ......
Date:
Issued By*
r,
kis
MUNICIPALITY OF ANCHORAGE arePN-r2!Iry
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-051-73
Property owner(s) Sheldon J. Lien Day phone 350-8905
Mailing address 4701 Golden Spring Circle Anchorage, AK 99507
Site address Same
Legal description (Sub'd., Block & Lot) Spring Hill Estates #1, Block 1, Lot 3
Legal description (Township, Range & Section)
Lot Size 50,721 Sq. Ft. Number of Bedrooms Five (5)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field [ Initial I I Single Family (SF) n
(w/wo ADU)
Septic Tank [ Upgrade ]X
Duplex (D) n
Holding Tank ❑ Renewal
Multiple Dwellings
Privy I-1 (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: 95a.to _ Waiver Fees:
Date of Payment: 91361iQ Date of Payment:
Receipt Number: 34 52b Receipt Number:
Permit No. r s Piq 11/ Waiver No.
Permit App_.-.. : .,.c
` E N G I NEERI NG
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
July 22, 2020
MOA Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Spring Hills Estates #1, Block 1, Lot 3 — 4701 Golden Spring Circle
Septic System Design and Permit Application
Dear On -Site Services Engineer:
The septic system on the subject lot has failed and must be replaced. We are submitting this design
and permit application for the construction of a new septic system. The attached site plan identifies
the location of the home and the existing well along with the existing and proposed septic locations.
Existing septic tanks will be decommissioned in accordance with Municipal Code. No conflicts
exist between the proposed system and any other well or septic system on this or adjacent lots.
The new system will be a minimum of 100' from all wells and surface water, and more than 5'
away from the septic tank.
The ground surface on the lot slopes to the east at grades approaching 25%. There are no slopes
greater than 25% within 50 feet downslope of the proposed site. Topographic contours are shown
on the site plan showing the grade and direction of flow. Storm water drainage will not impact this
septic system. The new trench will be constructed parallel to the slope as much as possible.
Please refer to the attached test hole logs and plan and profile pages for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
OF
Aff a 49th -
...........I ..................... e
®®� MICHAEL E. ANDERSON
J Aff
No. CE-4381.•.���®
�®1®®FeS® 0\ :410'
Michael E. Anderson, P.E.
SPRING HILLS ESTATES #1, BLOCK 1 LOT 3 CO"�cl
- - - _ LOCATE END OF Tl�fr CH PRIOF
TREtTtiERIALS, INCL-64�ING C
MUST
E REMOVED AND
I
APPROVED SA D. F LESS THA
1
E�
LOT 4 TRENCH)
l 20' T&E EASEMENT
'O CIRNSTRUCTIO�
\IN ROCK AND PIPE 63' LONG x 5' WIDE x 4'
LACE TH MOA FECTIVE DETH
DM NEW TRENCH. \ A8S�FRPTION TRENPCH.
NG 1. RPTIOl\
. \
NDON IN E. \ \ "
RETAINING VN -� \
0
CHAIN LINK FENCE
LOT 2
1984 TH I \ I t /
2C0sv T
\ 5-BDRM HOME "'"I
1,50 GALLON SEPTIC TANK
w/209' MANWAY. MIN. 5' FROM
BLOCK RET. WALL / DE K \ \ DEC�K/STAIR SUPPORT.
E OTH
ISTINNG SEPTIC �TMKS /
i \ PER MOA CODE. \
EXISTING L \ \ \
EXISTING WELL/ I \
EXISTING WELL
I ( GOLDEN ING CIRCLE
I J
% NOTE: �
\ PLACE TFge.T+tO ES PRtQR TO CONSTRU�TION.10A IMUM DEPTH \ //
/ O MONITOR GROUNQWATER FOR TO VERIFY \ \
'SUBSURFACE CONDITIONS.\
ENGINEERING (VOTE:
NO SLOPES >25% WITHIN 50' DOWNSLOPE OR SURFACE WATER LEGEND
WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
CO -CLEANOUT
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO - FOUNDATION CLEANC
SYSTEMS. FS - FLOW SPLITTER VALVE
MH - MANHOLE
WM INN 0 50 100 MT - MONITORING TUBE
FEET SV - SEPTIC VENT
1"=50' TH - TEST HOLE
SPRING HILL ESTATES #1 W "o -
DESIGN FACTORS: SYSTEM REQUIREMENTS:
750 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 1-5 MIN/IN A 1,500 -GAL SEPTIC TANK
APPLICATION RATE: 1.2 GPD/SF
750 GPD /1.2 GPD/SF /5' WIDE -.5 (RED. FACTOR) = 62.5 LF TRENCH REQUIRED (63 LF SPECIFIED)
BOTTOM OF TRENCH: 8' BELOW GRADE
FLOW LINE ELEVATION: 4' BELOW GRADE
TOP OF TRENCH:.5' ABOVE GRADE
ILE FABRIC
RATED PVC (HOLES DOWN)
_D ROCK
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
}
E N G I N E E R I N G.
SOILS LOG AND PERCOLATION TEST
E N G kEE IN G
LEGAL DESCRIPTION: SPRING HILL EST. #I,BLOCK I, LOT 3
PERFORMED FOR: SHELDON LIEN
DATE: 7/10/20 PROJECT No.:
PARCELID#: 015-051-73 TECHNICIAN: J. MILLETTE
DEPTH TEST HOLE 1
(feet)
15
READING
1' OB
1
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
2
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
4:01/4:10
10
3
y•
2
4:12/4:22
10
4
3
3
d.
10
5
15
216
6
4:34/4:44
GM
7
2is
8
f
10
6/81=6
2i6
9
4:56/5:06
10
6/81-6
2-76
11
S�
12
314 13-
14-
15
16
17
18
19
20
COMMENTS:
SLOPE
WAS GROUND WATER ENCOUNTERED? NO
IF YES n WHAT DEPTH? -
DEPTH TO WATER AFTER MONITORING: NONE 0
DATE OF MONITORING: 7/20/20 P
E
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
7/10
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
4:01/4:10
10
6/9 1 ss
316
2
4:12/4:22
10
6/9
3
3
4:23/4:33
10
6/816
15
216
4
4:34/4:44
10
6/816
2is
5
4:45/4:55
10
6/81=6
2i6
6
4:56/5:06
10
6/81-6
2-76
PERCOLATION RATE: 3.5 (MIN/INCH) PERC. HOLE DIA. -- (INCHES)
TEST RUN BETWEEN: 3 FT. and 4 FT.
N,
0
0
0
Z
N8958'08'E214.33
GOLDEN SPRING CIRCLE
OF
CO 49 T YO�
1 0
w, I%LEGEND
U O
s SHANE A. HOLT/�0
LS -6914 '5J' O IANDSCAPELIGHT
4aa o
'°fessiona% Ls�� ° STWTRPIPT
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 MAYAPPEAR 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.
AS-BUILTBURVEY I" =301
NO CORNERS SET THIS DATE
1 HEREBY CERTIFY THAT I HAVE PERA SURVEY
0 THE FOLLOWING DESCRIBED PROPERTY
LT , BLOCK 1, SPRING HILLS ESTATESADD'N 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 257H DAY OF
SEPTEMBER 2019
HOLT LAND SURVEYING
9309 GROVER DRIVE
Ax 99507
14404, F8 199-45 ANcxoRACE,
MLINICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SI{WAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE .~ []NEW
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
5~,~'j ]F/ii L=S4~$ A4d~ / L~ 3
LOCATION
D~:~.~ 'F~~ "~ DE: InsMe length
~ - ~ Manufacture,
DISTANCE TO: ,
j -- O . ' length o~l~nes
' ~ ~ - ' ' ' ~ ---- Material beneath t~__
~~ ~ Depth
Material
Nearest I o~.~r !~
Trench wi th
NO, OF BEDROOMS
PERMIT NO.
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
Total effective absorption area
PERMIT NO.
Nearest lot line
Distance to lot line
~l~ sRo rMi t~ o~'r e a ( s )
Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING
t~Oq'
NSTALLER
REMARKS
APPROVED DATE
LEGAL
72-013 (Rev, 3/78)
IAI;j 'l ' 'i lic:i': 't ]. '~' ll;~ ' ....... ;i I ' ~ ' ' ' !"?'"~ ' '
~.,~ ;i. il. ]. · '
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL. SYSTEM AND/OR WELL INSPECTION REPORT
NAILING ADDRESS
LEGAl_ DESCRIPTION
LOCATION
NO, OF BEDROOMS
PERMIT NO.~OO~. ~, ~-~
Wet] Absorption area
DISTANCE TO:
Manufacturer
capacity IF HOMEMADE: Inside length
DISTANCE TO: t~
/
Liquid depth
Well PERMIT NO.
Liquid capacity in §aliens
DISTANCE TO:
Material
Found~ion / Nearest lot line,
Total length of line~ ~ Trench width
~] NEW
[] UPGRADE
Material beneatlYtile ,~ /
Depth
Top of tile to finish grade
Length
Type of crib Crib diame[er
Crib depth
PERMIT NO.t(~ z~.O,~:~_~.~
Distance between li~//,/~
PERMIT NO.
Well Building foundation Nearest lot line
DISTANCE TO:
Depth Driller
DISTANCE TO: Building foundation Sewer line
Total effective absorption area
Near, st lot line
Distance to lot line PERMIT NO.
J ~n~r ea (S)
OTHER
PIPE MATERIALS
34 P~st ~p_o~
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
M-W DRILLING, Inc.
P,O. Box 10-378 · 10300 Old Seward Hl§hwsy
(907) 349.8535
ANCHORAGE, ALASKA 99511
84-259
DRILLING LOG
Well Owner MAIN, DOUG / Premiere Construction .Use of WelLD°rf~§tic _
Location (address of: Township, Range, Section, if known; or distance main road. Lot I3, Block 1 ~Spring Hills Addition ~1 - Anchorage
6" Depth of Hole_ 222
Size of casing_ feet
Static water level 175 ft. (~ (below) land surface.
Screen ( ); Perforated ( ).
Describe screen or perforation None
Well pumping test at~30 gallons per ~)
of drawdown from static level.
Date of completion_ September 5, 1984
Cased to 221.40 .feet
Finish of well (check one)
open end ( X );
(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 Caszng stickup
2 TO_
TO.
TO_
__TO
TO
TO
TO
TO
TO
TO
.TO
_TO
_TO
_TO
80
115
130
150
170
200
210
8O
][15
130
150
2OO
210
222
Brown 3~zlty _gravel
Gray s:Llty ~oravel
Brown silty, gravel
____ MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Gray c]Lav w/gravel
APR
Gh2~y s :L_lty,~:~avel
Br qz~n Sil~aval
'R E C EqAL-E D
Brcr~n siltJ_g~_ay~_l~ c~.
Waterbe~ring gravel ~-_lc~h~md
NWl/VA (ge~ffied Contractor
Certificate No's. 814 & 973
1 -- CUSTOMER
DEF'ARTMEN:I' OF HEAI.4TH AND ENVIRONIflE:N'I'AL F:'RO'I:ECTION
825 L STREE]', Af'.II]HORAGE~, Al'.-..' 99501
264:-4720
PERMI'T' I',IO:
DATE
840523
08/28184
APPL I CANT
ADDRErSS:
CI,SNTACT PHONE:
MAIN CORPORAT IOIq
4155 TIJDOR CENTRE DRIVE
ANC;HORAGIE.~ Al< 99508
562-4907
L..EGAI.. DIESCRiP~ SUBD]:VI~ION:-SPRIN'B HII_L.,S ESTATES LOT:: 3
SECT]OIq: 15 TC)WNSHIF': 12N IRANBE~ 5W
I_[Fr SI ZE: 1.25A (SQ. Fr. OR ACRES)
MAX BEDROOMS: 5
BLOCK: 1
L. ist~d below are the ~ptians avai].al:)le 'Lc~ yc~u in designing yaun, s~ptic .
sys+~em. C]hooee the or{ion tha'L best ¢i'Ls yaur site.
DEPTH TO PIF:'E BOTI'OH (FS'.) S.O
GRAVEL DEPTH (I='T.) :3,, 0
I'OTAI... DEF:'I'H (F'T,) ll, 0
6F(AVEL W]:D'I]"I (F"T',) 2.5
61']AVEL L.E'.'NGTI'4 (F:'T.) 7.5., 0
(i')RAVEL VOLUHE (CU, YDS,, ) 24.3
TANK S I ZEr (8ALS) 1 ~ 000,, 0 '~"~
SOIL RAJ'IN6 (SQ. FT. /BR) ~50
TANK MUST HAVE A'T' L.EAST TWO COMPAIRTIflENTS
ce~"L l £y that.:
1. I am Camilian wi'Lb t,he requipemen{s f'c)p c~n-site sewers' and w~lls as 's~et
¢ont. h by the Municipality of An(:h~r'age (~OA) and the State cfi Alaska.
~Z,, I will install the system in actor?dance with all MOA codes:and regulat:Lans~
and in compliance with 'Lhe desitin cpitel'ia of this penmit,,
5,, I will adhere to all MOA and State of Alaska r~quiremen~s far the se{ back
distances from any existin~ well, wastewa'Lep disposal system ~l" public
sewerage sys'L~m an thJ. s or an~/ ad.,,jaeent ar nearby lat,
4. I ~,~ndersta~]d that th~.s permit is valid for a maximum o¢ 3 bedp~2oms~; and
any enlargement,w:Lll require an additional perm:Lt.
IF A I...IF:T STA'TIOIXl ]:S INSTAL. I...ED ]:N AN AREA C. OVERED BY MOA B[J~L.DING CODES,
THEN (1) AN ELECTRI[',AL F:'IERM:[T AND iNSPECTION MUBT BE OBTAt. NED; (2) AS:-BUILTrS
W;I:LL. NOT BE APPROVED WITHOLJT AN EL.EISTRIC',AL. tlqSI:'IECTION IRIEF'ORT; AND C];) THE
EL. EC]TRICAL WORK IdLJE~'r BE DONE BY A LI(]ENSED EI_IEISTRIC, IAiq.
S I BNED
APPL I CANT:
]: SSI.JEI) BY
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH ANr) ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOL^T ON
TEST
PERPO MED EOR: Co p_
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
9
10
~2
~4
17
18
20
SLOPE
'l 5o
WAS GROUND WATER S
ENCOUNTERED? /~O L
O
P
E
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Readin9 Date
Time Time Water Drop
PERCOLATION RATE s/inch)
COMMENTS_
PERFORMED
TEST RUN BETWEEN
CERTIFIED E
72-008 (6/79)
MUNICPALITY OF ANCHORAGE
Development Services Department r4 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-051-73
1. GENERAL INFORMATION
Expiration Date:
(,a - 7--(
Complete legal description Spring Hill Estates #1, Block 1, Lot 3
Location (site address) 4701 Golden Spring Circle
Anchorage, AK 99507
Current property owner(s) Sheldon J. Lien Day phone 350-8905
Mailing address
Real estate agent
4701 Golden Spring Circle Anchorage, AK 99507
2. TYPE OF DWELLING:
ljm� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑e
Private Septic
❑i
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 1550
Date of Payment
Receipt Number 6 qq 7 D
COSA # U5C_21 )0 3 7
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller P.E. Date 2/9/2021
6. DSD SIGNATURE
System #1 Approved for 5 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
TH
•*r
�11 Benjam rVSchiller
CE 125922/9/21
• • �`��
i1`F9F�PROFESSkQ01
with the following stipulations:
TY OF,ri/i
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Spring Hills Estates #1, Block 1 Lot 3
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9/5/84
Total depth 222 ft
Cased to 221.4 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 9/1/20
Static water level at beginning of test 151 ft
Comments
B. TANK DATA
Age of tank(s) 8"120 years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D. ABSORPTION FIELD DATA F -WIDE Trench
Which system tested (date installed) 8/12/20
❑ ALL standpipes present per record drawing
Total measured depth from grade 8.6 ft (max)
Measured depth to pipe invert from grade 4.6 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-051-73
Structure served by this system
Well production at time of test 5.7 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate 3.70 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 01/26/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: NIA
Adequacy test date New System
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0 Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25'[E] Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' 0 Yes
if No ft
M Yes
if No
ft
if No
ft
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Mv Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'
0 Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
El Yes
if No
ft
Private Wells > 100' M Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Water Service Line > 10'
El 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'
ED
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'
0
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Fv�'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
El
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION ,dW'�,dF!.q�����
I certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with 49 TH
MOA COSA guidelines in effect on this date. ® +'
.........
• _ Benjarr Schiller
�$ ��� • CE 12592 -0,
OF�F�PROFESSION'---
COSA Checklist yellow sheet
Municipality of Anchorage a ,
• Development Services Department_
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING ////
Parcel I.D. 015-051-73 HAA# H P 0/ fl C, T
1. GENERAL INFORMATION Expiration Date: 3 — Z 2— C)
Complete legal description SPRING HILL ESTATES SUBDIVISION #1; LOT 3, BLOCK 1
Location (site address or directions) 4701 GOLDEN SPRINGS CIRCLE * ANCHORAGE, AK 99516
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KEN EAGLE & NANCY WALLIS Day phone
c/o BETH WEISER w/ PRUDENTIAL JACK WHITE
Day phone
BETH WEISER w/ PRUDENTIAL JACK WHITE Day phone
3201 C STREET SUITE 200 * ANCHORAGE, AK 99503
Unless otherwise requested, NAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
762-3111
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of
up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B
wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future perfomtance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for --4— bedrooms.
Disapproved.
337-6179
Date Z 41
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
PROGRAM ° ,
5 �
Manitenance Agreements lJ ONTSEN1`l
JJJ/).. M ,..
Supplemental Engineer's Reort
Other
By: / L Original Certificate Date: J, % — 01
(Rev. 12100)
Municipality of Anchorage
ti T6f f(4.
' Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw, St.
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anctiorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SPRING HILL ESTATE #1; LOT 3, BLOCK 1 Parcel ID: 015-051-73
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 9/5/1984 Sanitary seal (Y/N) YES
Total depth 222 ft. Cased to 221.4 ft.
Well Log (YIN) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
FROM WELL LOG
AT INSPECTION
Date of test 9/5/1984
12/11/2001
Static water level 175 ft.
152 ft,
Well production 30 g,p.m.
6.14 g,p,m•
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 1.36 mg./L.
Other bacteria 0 colonies/100 ml.
Date of sample: 12/12/2001 Collected by:
AWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL
Date installed 7/25/84 — 6/13/85
Tank size 1000/500 gal. Number of Compartments 2 1
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
High water alarm (Y/N) N/A
Date of pumping 12/11/2001 Pumper
A+ HOME/SERVICES
C. ABSORPTION FIELD DATA *TESTED 1984 TRENCH ONLY
7/25/1984
Date installed 6/1,3/1985 Soil rating (g.p.d./ft`o bdr 150
System type TRENCH
Length 77/41 ft. Width 3/2 ft.
Gravel below pipe 4/4 ft.
4
Total depth 12/10 ft. Eff. absorption area 3E62f
ft' Monitoring
tube YES Depression over field NO
Date of adequacy test 12/11/2001 Results (Pass/Fail)
PASS For 4 bedrooms
Fluid depth in absorption field before test E in. Water added*1506gal. New depth 26 in.
Elapsed Time: 1,115min. Final fluid depth 13 in.
Absorption rate >= 750+ g,p,d•
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE
KNOWN If yes, give date —
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
100'+
Absorption field on lot
100'+
Public sewer main
N/A
Sewer/septic service line
25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l have determined through field inspections and
review of Municipal records that the above systems are in •. •' • • • ' " ' ' . • • • . • •
conformance with MOA NAA guidelines in effect on this date.
Engineer's Printed Name JEFFREY A. GARNESS °Q4' I . � 07953
Date lzl4fVJ nt�
4 "�Na pfnaeedp00� oe
HAA Fee $ 3Ua ao
Date of Payment ) a- — 14-01
Receipt Number OI �-k 6 Loo
(Rev. 12100)
Waiver Fee $
Date of
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date 7/21/88
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
{a) Legal Description (include lot, block, subdivision, section, township, range)
Spring Hills~Subdivision, Lot 3, Block 1 ~.zL,~
Location (address or directions) '
4701
(b) Property/Ov~ner'~M~.r_J~__ Telephone: Home
Maili'ngAddress 4701 06'lSen Spring, Anchorage~ AK
(c) Lending Institution
Mailing Address
(d) Real~E~t~t~.Cbmpany and Agent Jack White
Address
346-3254 Business
995O7 -
Telephone
(e)
Telephone
MeiltheHAAtothefollowinaaddress:or:Checkhere~,ifholdforpickup.
Listcontactpersonand day phone numberbelow.
Hi~h~ Phukan & Sorensen Consulting Engineers, Inc.
6541DeBarr Road, Anchorage, AK 99504
TYPE OF RESIDENCE
Single-Family ~
Number of Bedrooms
5
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.
SEWAGE DISPOSAL
Onsite [] Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 fRev 8/861Fronl
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MUN[CIPALJTY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISlOi~iUNiCiPALiTY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPBOVAL (HAA)
AUG ! 1988
RECEIVED
CHECKLIST - FEBRUARY 1984
264-4744
Legal Description: Sd!ring Hills Subdivision
Golden Spring~ Lot 3~ Block 1
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth 222; ' ~(')Cased to ~221.4
Static Water Level 175 ( 1 )
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) Y (2)
Separation Distances from Well:
Private IfA, B.C,D.E.C. Approved(Y/N) __N/A
Y Date Completed ~,~/26/84 Yield_ 6.5 G.P.M.
(It'). Del)th of Grouting ~None
__ Pump Set At ~_6~ '~_(3)~
Sanitary Seal on Casi~ i~N)~P'¥ (~2)%
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot _108' (2)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~N/A __
; On Adjoining Lots
(2) ; On Adjoining Lots _
_ To Nearest Public Sewer
100' + (2.)
~OO' + (2)
Cleanout/Manhole N/A __ To Nearest Sewer Service Line on Lot N/A _/
/
Water Sample Collected by Rear~c.l( __;Date _ 7/21/88 __
Water Sample Test Results ~Satisfactory 5 Bedrooms____~ ................... ,.,, j_
Comments (i) Per Drills Recor ~~3) Assume pump is ser~'-~T.~D,~)~._~,~,,L
' ¢~ ....... .~.. ~ bottom of well as is customarJly~x
.... '....~. rCTommen~d-ed ~n ~he inzFfisnry~
(4) Per we] ] log. ~-~-,__
SEPTIC/HOLDING TANK DATA
7/25/(84) (1) 1000 (84) ('[) 2 (84) (])
Date Installed ~_,q~¢_(~__ Size fie0 (~%)~ No. of Compartments %~l~F:O-
Standpipes (Y/N) Y (?) Air-tight Caps (Y/N) .~ (~?~) Foundation Cleanout (Y/N)
Depression over Tank (Y/N) N ( 2 )
Pumping/Maintenance Contract on File (Y/N) __N
Holding Tank High-Water Alarm (Y/N) N/A
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~O8 ' ( 2 ~
To Property Line 35' (2)
To Water Main/Service Lin~ ___None
Course ~O0+ (2)
Y (?) .
Date Last Pumped 5~31/88 A+ Septic & Pumping
; for ~N/A
N/A
Temporary Holding Tank Permit (Y/N)
To Building Foundation _10' (2) __
$' (2)
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments (1) Per Dill. IS Record data
(2) Per on site meas. 7/2~/88
Page 1 of 2
72 026fRev 81861 Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 150 ¢7 /h ( 1 )
Date lnstalled 7-25-(84) & 6-13-(85) (1)
Width of Field 24' - 30'
Square Feet of Absorption Area 790
Depression over Field (Y/N) N (2)
Results of Last Adequacy Test Sar_~_s factory_
Separation Distance from Absorption Field:
To Water-Supply Well 123 ' ( 2 )
To Building Foundation 10~ + (2)
Lot N/A
To Water Main/Service Line None
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments (1) Per DHHS Record data
Type of System Design Trench (12
Length of Field (84) -77' (85) - 41' (1)
Depth of Field (84) - 12' (85) - 10' (1)
Gravel Bed Thickness 4 '
Tota 1 ( 1 ) Standpipes Present (Y/N) Y ( 2 )
Date of Last Adequacy Test 7-21-88
5 Bedrooms
To Property Line 44 (2)
To Existing or Abandoned System on
; On Adjoining Lots 30' + (1)
To Cutbank (if present) N/A _ __
100 + (2)
50 + (2)
(2) Per On site meas. 7/21/88
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
~¢nhole/Access (Y/N)
'"Rump Off" Level at
"=V...~ (Y/N)
Pumpin{)~'G~cles during Adequacy Test. Meets MOA
** Chec,~6Frr~d Bedroom Rating Against HAA Request **
I certify[thahl have ~hecke~er~'ied, ~r2oeformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~~ _ Date ~(~(~ '=' '
' t
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONIVIENTAL PROTEC'rlON
DIVISION OF ENVIRONMEN'FAL HEAL'tH
CEPtTIFIC;AI'~ OF INSPECTION FOR I-IEALTI-I AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2§4-4720
GENERAL It~FORMA'T~ON
Application Date
Lec, jaJ C~r,.cril:'?.,;J tinclude lot, block, suhdivision, section, township, range)
E~t-o¢~ ,~aCo'r,?:.e M d~reotions)
_Z~_~-L_ _.~_'¢-,:z8_~;~:~L-//~:-=¢. Telephone: Home Business _ ~.2 ~ ?0'~
Lending Institutior~; Owner/builder [~; Buyer D; Other ~ (explain); _~
Telephone
Rea E.¢.~; ..,., par. t and Agent
Ar~'~res.s
TYPE OF RESIDENCE
Sing;¢-Farril 'M'~::.~-Farml7 [] Other
WATER SUPPLY
~, ; 1,~, O'.,mrr unity Public
D
f,lote; tf oorr~rr,,¢r "), ,,, ~,; ~l"4ere, must have written confirmation from the Stats Department of Environmental Conservation
SEWAGE DISPOSAL
On;det~ Pu:., c ~ Cornrnur, ty [] Holdirlg Tank E.]
f ¢o:e If c.o;'r r- .,. t;, ,,/-' '~/;ternr mu'.t havre written confirmation from the State Department of Environmental Conservation
¢edFhed lbF ,'~yseal afl,×ed hereto and as of the validation date shown below, I verify th~zt ' ., . .
A~i~ly A;l~;o'za~ ~ows ~ '~at Ih8 on-site water supply and/or wastewater disposal system is sa~e, fu nct~e~,,,~( ~'~d
U~e ¢~r~sr o~ ~J~dfdoms and lype of structure indicated herein. I further verify thatbased on the i[~foH~k~[;o
the Mu~Jc[p¢,ly ~ ~chorage files and from my investigation and inspection, the on-site wate~ s[~,p~y and/or
w~¢ew,aler d~spGsaJ sy~te/r~ is in compliance with all Municipal and State codas, ' - .
CAUTION
7'lhe ¢'Zur. c*l~ah;t of Ar, sh¢,'age Department of Health and Environmental Protection (DHEP) issues I Ioalth Auttlority
,~provaJ ce,1~t:ca~e5 based ~]o'lely upon the representations given in paragraph 5 above by an independent professional
~-r, fJ,nc.e~ reg,;~iere¢ ~r, tJ~e S~ate of Alaska. The DI-IEP does this as a courtesy to purchasers of homes and their lending
rc,-~.f~¢ul¢or~a ~ orrJ¢;r to sa~s1/certain federal and state requirements. Employees of DHEP do not coadun[ mspoctioRs Or
Cna;yze da!a bc.:fore ~ e'.3rbficate is ~.osued. The Municipality of Anchorage is not responsible lor errors or omissions il'~ the
WEt. L DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRtJARY 1984
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Sf'J J.'7 1985:
284-4720
LegalDescription: ~'~,'~.~ J~t''l,
Well Classification
Well Log Present CN)
Total Deptn 2.~- 2~ Cased
Stabc Water Level /
Casing Height Above Ground
Electrical Wiring ~n Condu t~/N)
Separauon Distances from Welh
To Seetic/Holding Tank on Lot
To Nearest Edge of Absorption Field on LOt
TO Nearest Puo~ c Sewer Line ~ .,~
Cleanout/Man l~,ole
Water Sample Collected by
Water Sample -est Results
Comments
If A. B. C. D.E.C. Approved (Y/N)
Date Completec ~?¢,o¢' ~ J_¢_,~"¢ Yield
Depth of Grouting ~
Pump Set At ~
Sanitary Seal on Casing ~N)
Depression Around Wellhead (Y/~
; On Adjoining Lots
: On Adjoining Lots
mo Nearest Public Sewer
To Nearest Sewer Service Line on
;Date ~'- I¢- ,~ ~"
/VA_
SEPTIC/HOLDING TANK DATA
~- ~.$- ~
Date nstallea ~- I~ -8~
Standpipes~)
Depression over Tank (Y/~
. Size ~~ No. of Compartments
Air-tight Caps ~N) Foundation Cleanout~(~N)
Date Last Pumped /q,&
Pumping/Maintenance Contract on File (Y/N) /CA. ; for
Holding -rank High-Water Alarm (Y/N) /v',4 Temporary Holding Tank Permit.(Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course /~0 "/'._
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field .,2, z"/'' - 90
Square Feet of Absorption Area ~ ? OL~ '
Depression over Field (Y/t¢~2
Results of Last Adequacy Test __
Separation Distance from Absorption Field:
To Water-Supply Well / 2
To Building Foundation /o '
Lot ,,~'A
To Water Main/Service Line ~ T r o'
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field --9:' ~ ,,..~.,
Depth of Field
Gravel Bed Thickness '~ ~
¢o¢~. I Standpipes Present (~)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~ T' ~ '
TO Cutbank (if present) /,/4-
¢; 7- /~'
[3>-.--.--.--.--.-~ STATI 0 N
Date I n st ailed _~'~'""<'~. ~ Dimensions
Size in Gallons "~--~. Manhole/Access (Y/N) ~
"Pump On" Level at '~'~_~_ "Pu~~
High Water Alarr~ Level at
~ Ve,t(Y/N)
Tested for ~
Electrical Codes (~/~~
P~during Adequacy Test. Meets MOA
** Check 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 '"'~ ~ ~ Date
Company /~ _~ MOA No.
Receipt No.
Date of Payment ~ *' /'~' ~'
Amount: $ q5'- 0'¢~° ~
Page 2 of 2¢:'¢ ~ 'u~ ~' ~ °~ ¢'°' ~,,,,,, .....
72-026 (11/84)
0 0
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
I. General Information Application Date 'L `1` P5
(a) Legal Description (include lot, block, subdivision, section, township, range)
f'(l, L.�� id
—�
Location (address or directions)
(b) Applicants Name Telephone - Home Business
Applicants Address �_I i SS-icei>t,'c C C': k_0� rFk
(c) Applicant is (check one) Lending Institution ; Owner/builder ;
Buyer E:�l ; Other E7 (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. Type of Residence
Single -Family]
Number of Bedrooms
3. Water Supply
Multi -Family
13
Other (describe)
Individual Well 1= Community E=1 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 :S Public =1 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]
0 i
t�J"ri�r�z�>Pitt.�L-riaiSF+ 1-
5. Engineering Firm Providing Inspections, Tests, File Search, Data and In .arS n
As certified by my seal affixed hereto and as of the validation date shown bel "y
verify that my investigation of this Health Authority Approval shows that the on-ntt'sd
water supply and/or wastewater disposal system is safe, functional and adequate Lor
the number of bedrooms and type of structure indicated herein. I further verify tiw,
based on the information obtained from the Municipality of Anchorage files and from �-
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm TelephoneZ=/_;�yy�
Address lay' c, ",-3'"i
Date
(ENGINEER SEAL)
6. DHEP Approval a®�J
Approved for 9v bedrooms By �?�, Date
Approved 1 Disapproved, _0 Conditional s
Terms of Conditional Approval
CAUTION
6y C. Rsid, Jr.�'�
No. 2251 -L- -
THE MUNICIPALITY OF ANCIiORAGE 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 THIS 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 21 7-19-84
�NICIPALIN OF ANCHORAGE
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) APR 1985
CHECKLIST - FEBRUARY 1984
Legal Description:�c Ely%
A. VEIL DATA �. i / vi. ; / l
Well Classification (j r If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present (i LIN) S Date Colleted S n /4 z / Yield a
Total Depth 2 z z Cased to ,2 A I . `( ' Depth of Grouting
Static Water Level f-7 ' Pump Set At
Casing Height Above Ground �_ ` Sanitary Seal on Casing t/N)
Electrical Wiring in Conduit Lym) Depression Around Wellhead (Y
Separation Distances from Well:
To Septic/Holding Tank on Lot On Adjoining Lots ICI r' 7
To Nearest Edge of Absorption Field onc"
Lot %J 7) C On Adjoining Lots /C
To Nearest Public Sewer Lire LA To Nearest Public Sewer
Cleancut/Manhole �- r -t To Nearest Sewer Service Line on Lot 30
Water Sample Collected By fc� ; Date 7 ,-2/--- -:"s -�- (--
Water Sample Test Results
CCHIISL'ntS
B. SEPTIC/HOLDING TANK DiAMA
Date Installed 7 V Size /A'C'C No. of Ccmpartfrents
Standpipes U -/N-) A3'.X-tight Caps 6 ) Foundation Cleanout%(Y )
Depression over Tank ) Date Last Pumped A
Pumping/Maintenance Contract on File (YM) -; for /td
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Gell SCK " To Building Foundation /C-
To
CTo Property Line d r To Disposal Field L
To Water Main/Service Line -= To Stream, Pond, Lake, cr Major Drainage
Receipt #
Date Paid:-�-5
Amount:
(Page 1 of 2]
2-15-84
/, { /����� ���5/tri"w� •%�5 �s 4�/
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /,5—r ',�Type of System Design
Date Installed 7 , - ,q / G Length of Field 771
Width of Field -S G Depth of Field iZ C'
Gravel Bed Thickness y di
Square Feet of Absorption Area Standpipes Present /N)
Depression over Field (M) Date of Last Adequacy Test to
Results of Last Adequacy Tast A,1114
Separation Distance frau Absorption Field:
To Water -Supply Wall 1017To Property Line Z/
To Buildir_g Foundation /6 fi To Existing or Abandoned System cn
Lot y�r ; On Adjoining Lots )//-
To Water Main/Service Line I{C -(- To Cutbank(if present) /(/d
To Stream/Pord/Lake% Major Drainage Course —
To Driveway, Parking Area, or Vehicle Storage Area --
c
Comments ri,/yrs ,�-:�� �_��� A, --
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Comments
Pumping
Diirensions
.cess (Y/N)
" Level at
Vent (Y/d)
ring Adequacy Test. Lets MDA
** Check Permitted Bedroan Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
Signed / Nate
i
Company l^ MOA No.
KB1/d5/s
[Page 2 of 21
2-15-84