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DAFOE BLK 2 LT 1A
I At S I IL&`I�A U., IN 0 TMI Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: ��12 �j�� S — Ll q PID Number: 06 Dwelling: B ingle Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New rade Name: / Name . "20 oq tit ABSORPTION FIELD Address ri6coo_ bc` Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound El Other Phone , Number of Bedrooms Soil Rating /o Total depth from original grade GPD/SF Q, Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision ^ G Block Lot j J ' A % ' 5 Ft. 5,Ft. Fill added above original grade Gravel length Township Range Section-_ (.i. ,��� �- y� 5 Ft. v Ft. Gravel width Z Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding Sewer Total absor tion area Number of trenches Dist. between trenches Tank Field Lift Station From Tank Line 0 Fe I Ft. Well /10' ' / / TANK �,/ �� / I� septic ❑ S.T.E.P. [I Holding El Other ManufacturerCapacity 15 Surface Water .0 + 7.G0 I / g re e i-/ Z S-19 Gal. Material LL Number of compartments Lot Line / � � f / NA Foundation 307 ,) l( / / LIFT STATION Manufacturer j� ( Capacity Curtain Drain �P �l /� / r y- Gal. Remarks I / Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by nstalier � PIPE MATERIAL House to tank y Tank to � �- � 3O rlra / in£clri l� 1 > /✓ ! FJ?-)Jt) D X Drainfield � � CO/MT P vC, Inspector BENCH MARK (Assumed elevation) /0 j Sf ft Inspection 1� �� Location and description / I dates: y 2nd_ T(D �cT ?"die, C� 3"' / 4th I E COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin Stamp � Conditional Approval: Date ��P•°` / •S,<<'� ., ,.� ----- .........•. e.9 •• SUM R MAiIYOKY CE - 3467 Approved � �f�� � �o,, ° .. �,, r:•�. 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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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: NOTICE: The vicinity map and site plan do not scale properly. See the individual sheets for scaling instructions. The asbuilt drawings submitted with the final inspection report shall scale properly. Received By: Issued By Date: Date: Z Q t On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-491-06 Property owner(s) CHARLES & LINDA RONAN Day phone 250-5082 Mailing address 6501 ROCKRIDGE DRIVE ANCHORAGE,AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) BLK 2 LOT 1 A Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank MUpgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: NONE Distance: I certify that the above info ation is correct. I further certify that this is in accordance with applicable Municipal:N�� 'e� Signature of property owner or authorized agent) Permit/Rush Fees: ��/(• 4D Waiver Fees: Date of Payment: / / Z jl� Date of Payment: Receipt Number: 0-767 Receipt Number: Permit No. 0,V0102693 Waiver No. Permit App_::- :_.mac: HAAS & ASSOCIATES, INC. CIVIL ENGINEERING AND CONSTRUCTIONE-MAIL: haas@gci.net 10 tiG V�nj Tlc C P < 0 ,� ���E C° -� �t v�-i.., �C ,.2- _' j(�.�StjT �� ��� � j3-�� r..��- J') -t 3900 E.1 12TH AVENUE - ANCHORAGE, ALASKA 99516 - TEL: (907) 349-8799 - FAX (907) 349-8791 i :zC.0 .w r��i:• . 0w • O U • � rt�d , : � •S �r� l 11.x;* : �..•���� �\ m 0 J P-..pdw,.q, O Ln I 1 1 I I I 0.8z .. r 1 I a e o �" 1 •0�` Or P T — 1N3W3SV3 .inun m — r 9'66Z 3�6iLll�_00N - - 0£ I I I 0301n148nSNn Ism, ~ Y N w E. 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I I_I I I w V) III_I cn a v� Z a Y Z w Q Z Y �J V)U)W � 0 Zo �� W ZUOEQ i(W O dw� JCL NmaA cD w �� ¢ t IL w (j Z N N Q 0 o w3o N J w LLJ JNmmm p w W a Z Q 0 �W� cYi x 3v� > t a cD zZ Q � �� • o \ z V w N3A0D New N J a En w V) vot y .Z \/ 4 O 'q Zw (n o 0 � IL � Municipality of Anchorage Development Services Department ' �� •5,�, Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 -- ,-. ••^•� www.ci.anchorage.ak.us SANDOR M,qN € O€i1' ,• (907) 343-7904 1 0 kA_ _ 0111167 e � /Soils Log - Percolation Test`, Performed For: l i t •'t ` e / Zi! �a— oC� Date Performed: 7 `� Legal Description: jL j+C pCi A27- 1A Dies Township, Range, Section: TI-/ 1 ` ��Slope Site Plan 1 1 44 T-1 ® _ 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 0 -6-7-8-9- 10-11-12-13-14-15- 1617- 18- 19- 20- Depth � of "� L (CY-) (Feet) J GraLt 504ej 6-ea,-t(X1 0 is rov *-eaP e)(aKS4 Oor� 0 'q 10V ®V�! V- cj / �„� WAS GROUND WATER �® ENCOUNTERED? IF YES, AT WHAT DEPTH? L Depth to Water After P Monitoring? d E Date: 7� ® _/y COMMENTS / l it t' 7 0r1'01 0 r Reading Date Gross Time Net Time Depth to Water Net Drop 3 �44 3' s' to Z PERCOLATION RATE ' V (minuteslnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: -/ i/1 s' -pe— TO (-I 54V W&Yr ^? 4YERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7— /—)y Municipality of Anchorage � "�N°IivEER's's 1,��, Development Services Department k;7 �f"° Building Safety Division, "=! �r1 On -Site Water and Wastewater Program•°"°°°°°' 4700 Elmore Road _', ............. P.O. Box 196650 Anchorage, AK 99507 1" ° r° www.ci.anchorage.ak.us ;,�, SANDOR MANYOKY: (907) 343-7904 4, CE CE - 8,167. _� .7 Soils Log - Percolation Test I Performed For: h6Z t 4tS �i(Aaa- R(i h a ! l Date Performed: 7 I Legal Description:/ -V_ I' W - / .16� � ��%Township, Range, Section: —Th Slope Site Plan Depth OrI 01" C - (Feet) (9V,e Y l q trc(�c h 2- �-ro w tA 3 i�_t L_ 4- 5- 6- 7- 8- 9- 10- 11 -5- 6- 7-8- 13-I e 14 'POo �s Y'at ✓X, r WAS GROUND WATER ENCOUNTERED? �/✓ s IF YES, AT WHAT DEPTH? L Depth to Water After O Monitoring? E E Date: -N'// Reading Date 15- •` Net Time ti ® Net Drop 16 ' 17- 18- 1 q0 c/ - Z 'r 20- Z. 75' �r WAS GROUND WATER ENCOUNTERED? �/✓ s IF YES, AT WHAT DEPTH? L Depth to Water After O Monitoring? E E Date: -N'// Reading Date Gross Time Net Time Depth to Water Net Drop 2 q0 /,D Z S �' Z. 75' �r 10 PERCOLATION RATE -� �F' (minuteshnch) PERC HOLE DIAMETER _[ 1 - -TEST RUN BETWEEN FT AND 7 COMMENTS ��� ` `�� �-e `m.e4- & 4?- f PERFORMED BY: 4r&j'-T-S L'ys-o L I ° -('e Y j eq V ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC ON THIS DATE. DATE: 7-1-- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME----T—ZNEW C_�4—e / 11, A-, YF03 ❑UPGRADE MAILING ADDRESS 5'e /4 LEGAL DESCRIPTION 7 LOCATION r-1 dye NO. OF BEDROOMS '7 DISTANCE TO: Well z Absorption area Dwelling PERMIT NO. 1-- 2 a. < LU j,_ Manufacturer Mater No. of compartments .7 Cn Liq. 1A capacity in gallons f� IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. OZ< Manufacturer Material Liquid capacity in gallons j = Uj DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. UJ E: z Uj CC No. of lines Length of12y h line Total leng;h of lines It Trench 'dth , inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area wLength Width Depth PERMIT NO. < LU Type of crib Crib diameter Crib depth Total effective absorption area Uj (n DISTANCE TO: Well Building foundation Nearest lot line _j _j Class Depth Driller Distance to lot line PERMIT NO. LLu u DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER P Ib PIPE MATERIALS P/? 5A SOIL TEST RATING / . INSTALLER 4v C�1j 7 7 REMARKS APPROVED DATE LEGAL /2 -Li is (Nev. 'v /6) a'' i1 F,F �'-: 5 7a.. �_- �- &; =" �"3- �R t—. .y_ � ' T' ?_.0 � �=� �'-� 1�- 7'1••-`'� - _a �`_ ' =7 i�..�a �' DEPARTMEN ! HEALTH AND ENV I RONMc•NTAU OTE!" T I a_ii',} r' L" STREET, AT°,CHi_aRAGE: F•'T•":.. 99501. 264-4720 4 l E07 I.. R.. !=R C-410 1_) g'-41— ?1 .T. EF -m tom_ AJ K Fit !i ' K -' 141 1 7— PERMIT NO. ( 810721 :j APPLICANT !=:N;=:OL T i'iNDER_,a_iN SRA A B tX 411= NNCH 99502 345-4902: LOCATION ROi_ KR I D E LEGAL L.`! A 82 D FOE LOT SIZE 43500 SQUARE F EE'T TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM N iMBEF' OF BEDROOMS = _ SOIL RATING waw! FT/ BR) •_ 16S! THE REQUIRED SIZE a_aF THE SOIL ABSORPTION SYSTEM I E : En= _R -i._ x a _a i _ u c En �' i� +'=- d g—li �. - h - �� P � �"-„f 5_,i -1j f,!—!? �. s�.._ @ T L ° �'-� .; !r= %i (L•=h ,-_ .— 1,_ THE LENGTH DIMENSION I _ THE LENGTH (IN FEET) OF THE TRENCH lit;: yD :N I NF I ELD. THE DEPTH < <F N TRENCH OR FIT IS THE DISTANCE BET WEEN THE SURFACE Hi_.E OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) . THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE' MINIMUM iDEPTH i_iF GRAVEL BETWEEN THE OUTFALL ATF±=ILL F'IF'E AND THE BOTTOM M i_iF THE EXCAVATION ( I N FEET), FY E” _ 5 k.1 1 FT" R Ex in L` F T I R7-- 1-- 10 :' -tel K K=x 1 .,0. �_ : 1_ IL_ -1 LIE -9 }i -.a C_EE 0-2 ? I___. co f 1_4 PERMIT APPLICANT HAS THE RESPONSIBILITY TO i I NFOi':M THIS DEPARTMENT DURING THE INSTALLATION Ii dWPECTIa: N_ OF F-iN'T WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL , _,EF'',; E. _.__ _ - -._ -'(i- 14 C9 L,-- :_ _ 3: 1�7 F"=— H---. T 1 1—) n --AK P � - i1 v ' EE NTH 49 _ F --EH: BACKFILLING OF ANY SYSTEM 'WITHi UT FINAL iT',SPEC :TIiwN AND APPROVAL BY THIS DEPARTMENT WILL F E SUBJECT TO PROSECUTION. MINIMUM DIiTHNa E BETWEEN A f.'•IELL AND ANY ON—SITE SEi'1NimE DISPOSAL S STEi•'1 IS 100 0 FEET FOR N PRIVATE WELL OR 150 TO 200 FEET FF:i=tM A PUBLIC i_: '.TELL DEPE {'•:T►D I Y• 13 UPON THE TYPE OF PUBLIC i'.iELL . MINIMUM I STANa_ E FPi_aM t= PRIVATE WELL TO i N PRIVATE `EWER LINE IS 25 FEET AND Ti l N !=i_iC'Ti'1! ►Pd.I T'=' SEI'iTrF: LINE IS 75 FEET WELL. LOGS ARE REQUIRED AND MUST BE RETURNED T; a THE DEPARTMENT WITHIN _iia DAYS _' OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION C:'IA! ;":AMS ARE. AVAILABLE Ti i INSURE PR PER INSTALLATION. f" r-- • ra i 1 K1=7141=1 3 !rte I CERTIFY THAT 1: I 1=1M FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEi'.IERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. �E. 2: I WILL Ii' S ALL THE SYSTEM IN ACCORDANCE CE I.'•!ITH THE a=:a_`iDES. 3: i UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE i'1ORE THAN _ BEDROOMS. S I G NEC: 1.✓ __; — 1st �JQ% a fi✓ ------------- ADPL I i_ AI'•,T i=:a=fROL Nr•, DEF:::- � !N a 1 _SUED BY—_— (/�j�/—/// \_ +�`�'y �V1///J (.�" ...DATE— E f � � �___ ''i 4. 0 -[ "5Ol LS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: t'O(.-, (--r E V-, DATE PERFORMED:_ LEGAL DESCRIPTION: I�Q'C 3`0� !JE'xc'p_ DEPTH SLOPE SITE PLAN .(F� n 1 2 3 4 COMMENTS 6c 2 - PERFORMED' PERFORMED` BY: 72-008 (6/79) 1S S,LT4 nr% "e\C' WAS GROUND WATERS ENCOUNTERED?y L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Timee� Net Time Depth to Net D,rro(p / `Water 10- 0 �-3 12 12 I ill 13 �S'-. -� � I) A e ((7 14 I 51617 15- �C) 16- 17 18 19 20 COMMENTS 6c 2 - PERFORMED' PERFORMED` BY: 72-008 (6/79) 1S S,LT4 nr% "e\C' WAS GROUND WATERS ENCOUNTERED?y L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Timee� Net Time Depth to Net D,rro(p / `Water �-3 r► ll3� ill l�S� �S'-. -� � I) ' ►-icy ((7 � � � �C) PERCOLATION RATE /7 1 ?S— (minutes/inch) TEST RUN BETWEEN ___(12 FT AND FT '. ? F"Y CERTIFIED BY: DATE: ALASKA ENVIRONMENTAL CONTROL SERVICE,r'NC. 1200 West 33rd Avenue!', quite B ANCHORAGE, ALASKA 99503 Phone 276-1361 AT r4ctf m i!5w?- 0.3 JOB L(14 5Z . UAFOF- 5 SHEET NO.-,' OF CALCULATED BY D AT E__ L_ -O Ze c CHECKED BY DATE I SCALE '/-_ 30/ ALASKA ENVIRONMENTAL C0I4TROLJSERVIC�`" INC. 1200 West 33rd Avenue Suite.B ANCHORAGE, ALASKA 99503 Phone 276-1361 JOB Z146ge— L'l. 0z:_ SHEET NO. OF CALCULATED BY DATE_ CHECKED BY_'~PN— DATE �— SCALE 24:1 ( e ' Inc.. GLOM Mm. 01471. .................................................. I ....................................... Location... ........ ".. f. t..... . .. ............. Datecompleted ........... K .................................................................... Depthof well.........%.``.c'....................................................................................... Size of casing ............ ell: ........................................................ ....................................... Distance to water............ il ............................................. Distance to water while pumping ..... 7../'_._'�� of ........................... .........gallons per hour. Ci 7 Formation from to )4 X A; C Driller DELTA DRILLING COMPANY SRA BOX 394 9 ANCHORAGE. ALASKA 99507 A Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVA Parcel I.D. 015-491-06 1. GENERAL INFORMATION Complete legal description DAFOE BLOCK 2, LOT 1A Expiration Date: // - 7 / I- Location (site address) 6501 ROCKRIDGE DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) CHARLES & LINDA RONAN Day phone Mailing address Real Estate Agent 205 E DIMOND BLVD. #439, ANCHORAGE AK 99515 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage VVII IIIIUIIIIy VIQJJ YVell Public Water System Day phone AUG 5 2014 Waiver/Variance request for: _ Distance: COSA to be released to the engineer, unless F COSA Fee $ 7.5b * (�� !� Waiver Fee $ Date of Payment ��� l �� Date of Payment VReceipt Number 61591�9 OOMID Receipt Number COSA # _ ©SC /Oz39 Waiver # TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank El f'orn_l Ihl+v VIIIIIIUI Illy 1❑1 1 1 ❑ Public Sewer ❑ Waiver/Variance request for: _ Distance: COSA to be released to the engineer, unless F COSA Fee $ 7.5b * (�� !� Waiver Fee $ Date of Payment ��� l �� Date of Payment VReceipt Number 61591�9 OOMID Receipt Number COSA # _ ©SC /Oz39 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 8/6/14 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ,r OF A encroachments, deficiencies or discrepancies exist. L�g�y 1 `New tank and leach field construction inspection report completed by Haas &Assoc, Inc. 6. DSD SIGNATURE r�`,' KENNETH Dl. Dl LZ System #1 Approved for edrooms. ,116 of System #2 Approved for bedrooms. P �SS1D'-`a1 Disapproved. Conditional approval for bedrooms, with the following stipulations: OFCr(�lri J WATER AND c� WASTEo JJ {On_ BY i Original Certificate Date: — - f The nicip ' y o nc rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the repr entations 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 blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: DAME BLOCK 2, LOT 1A Parcel ID: 015-491-06 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 813011981 Sanitary seal (Y/N) Y Total depth 140 ft. Cased to 140 ft. FROM WELL LOG Date of test 8-30.1981 Static water level 116 ft. Well production 5.3 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1.65 mg/L Arsenic: ND ug/L Date of sample: 712212014 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 4130114 114 ft. 5.7 g.p.m. Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA "Per Haas & Assoc. Construction Inspection Report Tank Type/Material SEPTIC I Date installed 7/27/2014 Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping NA- NEW TANK Pumper Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA "Per Haas & Assoc. Construction Inspection Report Date installed 7/27114 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.25 System type Deep Trench Length 50 ft. Width 2 ft. Gravel below pipe 5.8 ft. Total depth 10.3 ft. Eff. absorption area 580 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA- NEW FIELD Results (Pass/Fail) PASS Forybedrooms Fluid depth in absorption field before test _ in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS New Septic tank and leach field construction inspection report by Haas & Associates Inc G. ENGINEER'S CERTIFICATION / certify that / 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. Engineer's Printed Name KENNETH M. DUFFUS Date 7130114 COSA brown sheet 10-10-12.doc 1%, OF A4 Aq'PH � KENNETH Df. FF / }s 7116 rr �w n�F',sslo- ` �/ UNSUBDIVIDED 0 c CL 0 85 N00011'29"E 299.65 30 I/ =r ? R >3. � D) O N D� ._.�. -O n >m� D N a. MMZ M z . -00 3 (D (D O I O N 1D-^oro(Q ozo (D cn 0 OZM1 fD N O 3 =r �`°mm�Fnm 2=0.< =0 O O > >p 0 0 O.O.O z D 3 a o 3nc :C3 =;a � t OM 70m R�CD O. O(70 mX R N `<G O "^ I p 0-4 = 3 n A �, � z N (D (CD O D) N T7 B O CD N -n co ID 0 N Xo=gyCL m as m O CO C) �A O U) IV o as ca=. 0 <D .�`�y5 •• :••ST �� m A 0 00 v 00 = 00 dj �tio' o • . � m D� UNSUBDIVIDED 0 c CL 0 85 N00011'29"E 299.65 30 I/ =r ? R >3. � D) O N D� ._.�. -O n 0 N a. N -00 3 (D (D O I O N 1D-^oro(Q r� (D rn fD N O 3 =r �`°mm�Fnm r O > >p 0 0 O.O.O z D 3 a o 3nc :C3 Q I 01 a) mo cn D (n - O O R O R�CD O. O(70 j 70 R N `<G O "^ I p C) 0 3 n A �, � (D (D � N (D (CD O D) N T7 B O CD N wD ID 0 N Xo=gyCL m as m _y 'D�+ �A O U) IV o as ca=. 0 <D (7i 0 N O .0 O CD 1' ?Q (D(O CD O-- A d (D v ry �o = UNSUBDIVIDED 0 c CL 0 85 N00011'29"E 299.65 30 I/ i� 00 000 'J 9 10' UTILITY EASEMENT a 14.7 c, 0 t.. moi. Q o a) �l (D A o (D 28.0 C m N00°,)5'44"E 304.41 Ma a (D a m [� c CD o CD m 0 --------_.--- Cl)-� to A m D CS I o —D ^ s 5m6, n 6 cM r� m 0o n r 0 > 30 I� Q I = O r� V N CD < C) 0 D N ? � CD z m Adm m s � i� cn rCl) o � (D O cn m ry �o = 0 O m D� m r. WU M 0 N TN CD N A O O i� 00 000 'J 9 10' UTILITY EASEMENT a 14.7 c, 0 t.. moi. Q o a) �l (D A o (D 28.0 C m N00°,)5'44"E 304.41 Ma a (D a m [� c CD o CD m 0 --------_.--- m r� I I� IC I� CD CD 0 CD IA N ico Im im Iz I I i i I I i C/) OD cfl CJi w W O m rn C z C cu m 0 MUNICIPALITY OF ANCHORAGE -- Department of Health & Human Services �y DIVISION OF ENVIRONMENTAL SERVICES – 343-4744 FHEALTH AUTHORITY L OF ITE SEWER AND WATER FACILITY FOR SINGLE I FAMILY DWELLING ON-SG ON-SITE Parcel I.D. # 01 % / u Ga HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) z_o-r 1A Location (address or*directions) , GSo y Telephone: (home) 3 2972 Business (b) Property owner Tele hone : — ------ Jew 4e �F Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE 3 Single-Family'R. Number of bedrooms 3. WATER SUPPLY Individual Well. Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-sitelg. Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z 10 Z abed NOES (981L *ABU) 9ZO-ZL -�jom s,jeeuibua leuoisseloid ayj ui suoissiwo ao saoaaa aoj ajgisuodsaj jou si abejoyouy }o AI!IedioiunW ayl •panssi si aleoijilaao a aao}aq elep azo luue ao suoiloadsui lonpuoo jou op SHHCI 10 saaAojdw3 •sluawaiinbei apels pue jejapal uie;aao llsiles of aapio ui suoilnlilsui buipual aiayj pue sawoy jo saaseyoand of Asalanoo a se siy} scop SHHQ ayl Te sexy }o aleIS ay1 ui paaalsi6aa aaauibue leuoissajoid luepuedepui ue Aq anoge g 4dea6eaed ui u9Ai6 suoijejuesaidai ayj uodn Aluo paseq paleoilpeo Jenoaddy Ajuoyjny y}leaH sanssi (SHHQ) saoinaaS uewnH pue y;leaH lo luaw}aedaa a6eaoyouy Io Ali�edioiunlnl eql !ssalOJd >� o ! • ar aiv AO • �... •ee•e•ee...• • eq vee i Ar ! �•e ••eeeo eeee® ��sty•°•...e••;� 6 Z -Z t Jenoaddy IeuoilipuoO jo swaal leuoilipuoO panoiddesi(] x I pano.iddy Aq swooape JOI panoiddy auoydalal IVAOaddV SHHQ '9 a s'_9 ale(] VI SSOJPPV S7.a-i/ wJi310 aweN •uoi}oodsui sigl jo alep eqj uo }oelle ui suoijeinbei pue 'seoueuipio 'sapoo ale3S pue ledmiunn Ile qj!m eoueildwoo ui si walsAs jesodsip aa}emalsem jo/pue Alddns jejum alis-uo ay; 'uoiloadsui PUB uoi}e6ijs9nui Aw woa} pue sag 96eaoyouy jo Aj!jedioiunW ay} woal pauiLIgo uoilewio}ui ayj uo paseq 18141 AI!JGA aay:pnj I •uiajay paleoipui ainjonals jo edAl pue swooapaq jo aagwnu ayj aol ejunbape pug leuoiloun} 'a}es si walsAs lesodsip jejumalsem ao/pue Alddns aalem el!s-uo eqj mql SMOgS JeAoaddy Aliaoy;ny glleaH siyj 10 uoi}e61Isanui Aw leyl AI!JGA 'Molaq umoys ajep uoiJep!JUA ay} jo se pue o}aaay paxi jje leas Aw Aq paipliao sy NOI1VWaOdNI ONV V1VO'HOaV3S 3'11d'S1S31'SNO11O3dSNl JNIOIAOad Wald ONIa33NION3 '9 U,,CH0PAG1- �nUN�C�PA��iY or -,Or. DNS S# 1\11CIPALITY OF ANCHORAGE (MOA) Health Authority Approval A cNv�ro� T (HAA) h5i CHECKLIST - pp HAA FEBRUARY 1984 343-4744 A. WELL DATA Well Classification P2/t1.47E Legal Description: 1- /A4 aZ �A'Go—Ic- Well Log PresentAN) Date Completed 50-30 -:5/1 Z.A/ /23zJ SEz• 2-3 If A, B, C, D.E.C. Approved (Y/N) �JA Yield ' �3 &" Total Depth Cased to __/5�0 Depth of Grouting i Static Water Level //S7 Pump Set At Casing Height Above Ground Sanitary Seal on Casing( ) Electrical Wiring in Condui(Y N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Io _5" To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line eil-14 To Nearest Sewer Service Line on Lot Depression Around Wellhead (YO I On Adjoining Lots 161r) -/- ; On Adjoining Lots /" 7 - To To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by;Date Water Sample Test Results 0�G7 7107 Comments �%G� x:2, -J B. SEPTIC/HOLDING TANK DATA Date Installed 9-ZJ- - Size /tea No. of Compartments Z-- Standpipes(Y)N) Air -tight CapsON) Foundation Cleanout&N) Depression over Tank (Y© Date Last Pumped %'zI"F% /5A►4e-,5 Pumping/Maintenance Contact on File (Y/N) ; for AilA Holding T.a► k Hid Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) A4 SEPARATION DISTAN,CI=S FROM SEPTIC/HOLDING TANK: i To Water -Supply Well ` ZO To Building Foundation zS To Property Line / i To Water Main/Service Line /d " To Stream; Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 /v' G 1,4 N- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata — Date Installed % -Z,6 -F0 Width of Field Z,S Type of System Design Length of Field Depth of Field Gravel Bed Thickness G Square Feet of Absortion Area S�z� Statndpipes Present (Y)N) Depression over Field (Y6 Date of Last Adequacy Test 7- Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply ZS Well �� i To Property Line /6 To Building Foundation Lot AJ, ; On Adjoining Lots i i To Existing or Abandoned System on 2-0 /t To Water Main/Service Line /o — To Cutback (if present) i To Stream, Pond, Lake, or Major Drainage Course 1610 71 -- To To Driveway, Parking Area, or Vehicle Storage Area /o it Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) **Check Permitted Bedroom Rating Against HAA Request** "Pump Off" Level at Vent (Y/N) i4 Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. G�'�-� . � Signed �--- �,��►�� AIR rIS OF• A4 2 Company /`�E�f �P �• ��� Ar s Date 8=�-89 0 CO • 4 T ngiri�eSeal • •.. ... . ,... . � MOA No. • ••000• so o®o•�•• o� e ROY C. REID, JR. g4� o• Receipt No. __ ���, �17 Receipt No. CE - 2251 a ¢` Ar l ••• 6..° �i(ti / •®O�°•°oJ �f profeSs'imt, � Date of Payment �1( Waiver Fee: $ Amount: $ _�/ "7 �•_ ���� Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 . ' LocuUonbaddrnusordjrochom� . `i � '� 6501 ROCKFUME 8D, ' �4 Appi N ' p (c) Applicant iu(okeokone):LonUmg|nautu�on��uwnenoux�� oer; Buyer El Other �� (explain);' ^ �^� (d) Lending Institution Address Adll , (e) Real Estate Company and Agent N/A Address Telephone tV (f) Mail the HAA to thefollowing address: fy A ` 2' TYPE OFRESIDENCE ` Number ' / 1 WATER SUPPLY VVa��� |Commun�y[] Public � Individual.Welig ~|No��|fuommunhyweUoyuU»m. must have whUenoonfir/�udonfrom the S�teDopadmnrtofEnvnunmon�U(�onuerm�on �. � e` , attesting 10the legality and status. , � ` ^ 4. SEWAGE DISPOSAL `OnuhoPublic Community Holding ' z[] dy[] [] ` Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting tothe legality and status. -` Page 1of2 .' '.� 72-025 (11/84) ` ^� T - �oos0'ai0°• a®ooso® o®oos o �� o e o s ssso� ° 1 CE 2251 ®®mss`' .7 ®sPOsam°os°®°-AP 6. DHEP APPROVZ �) Approved for —J bedrooms byJ p"i"e Date / Approved — Disapprove Conditional Terms of 0 ondition 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 federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) C. ABSORPTION FIELD DATA Soils Rating in Ahsorntinn Strata 16q Tvna of .qvstam rlacinn r(LFioCc f Date Installed Length of Field rr � Width of Field 30 Depth of Field i r Gravel Bed Thickness 6 � Square Feet of Absorption Area 52V Standpipes Present i)N) Depression over Field (Y,O Date of Last Adequacy Test Results of Last Adequacy Test SA TIS Ff}CToRZ Separation Distance from Absorption Field: To Water -Supply Well 12-5" To Property Line �� r i To Building Foundation To Existing or Abandoned System on Lot IVA ; On Adjoining Lots 550 r-1— To Water Main/Service Line `V i4 To Cutbank (if present) /V P To Stream/Pond/Lake/or Major Drainage Course j oo r To Driveway, Parking Area, or Vehicle Storage Area Comments 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 Manhole�c6ess (Y/N) ** Check Permitted Bedroom Rating Against HAA Request ** mp Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify tha I ha %Jveribfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date A�7 r Company Mcs I Ive" MOA No. C� ,yWoqu Receipt No. .3 cis �4 14 3 ,7 Date of Payment —)-I i� Amount: $ A -C -O -CHMFVT5 '*l WF -4L 1-'06 # ?.1471EP Page 2 of 2 3 s1 TE PLA/V 72-026 (11/84) g. ()F Ag k4 4 i ROY G. REID, •� B A¢ •. CE - 2251 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date "'e-cl g, (a) Legal Description (include lot, vision, section, township, range) Location (address or d'rections) .5 -0 (b) Applicants Namehone - �-417tf3 Applicants Address (c) Applicant is (check one) Lending Institution 6E/builder= Buyer � ; Other F:::j (explain); (d) Lending Institution Telephone Address (e) Peal Estate Co. & Agent Address Telephone 2. Type of R-asidenoe Single -Family P4 Multi -Family Number of Bedroom 3 3. Water Supply Individual Wbll �4 Community Other (describe) Public Note: If commnity well system, must have written confirmation from the State Departirent of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA jD2) 4. Sewage Disposal Onsite 1EJ Public Community Holding Tank Is the wastewater disposal system adequate fcr the number of bedrooms ON) [Page 1 of 21 2-15-84 5. Engineering Firm ProvidiL.9 Inspections, '.Bests, Data and Information I I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Late -'-C Name of F Telephone / Address cA LOO Zd, 33 leWlile, 13 S igmd by Date 6.DHEP Approval Approved for Approved (ENGINEER SEAL) % 000 io got a ip io-0 4c.b 0-4000 , sty 'TAI L o y c Reid* it. No. 2231-F 4V PROFESSON' 4w 3 be dr OOMS e Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Reealth and Environmental Protection does not guarantee the continued satisfactory performance of thme, water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and funs tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: I ILE U1 KB2/d5/s 3, 9 +/+02 [Pace /+02 [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHOR.NGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classification RIJ ocd ,�, If A, B, o:. C, Well Log Present (YA1 Date Total Depth s 4/ Cased to Static Water Level . - Completed Pump Set At MUNICIPALITY Of ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTIOIq MAR 2 11984 D.E.C. App4/3`'1 Yield Depth of Grouting Casing Height Above Ground /' Sanitary Seal. on Casing'/N) Electrical Wiring in Conduit aXg) Depression Around Wellhead (Y/N) Separation Distances from v _ll: To Septic/Holding Tank on Lot j'� ® on Adjoining Lots >-Ioo To Nearest Edge of Absorption Field on Lot //61 ; On Adjoining Lots :?p,;/ To Nearest Public Sewer Lire ry(A- To Nearest Public Sewer Cleancut/Manhole ry?/,4 To Nearest Sever Service Line on Lot Water Sample Collected By Lb 11 ; Date 3113/p,/ Water Sample Test Results Commre nts B. SEPTIC{ TANK DATA Date Installed 1'//; ( Size / y 0 G' No. of Carpar tments �2_ Standpipes �(Y�/N) Air -tight Caps 1�?IN) Foundation Cleanout (IV J Depression over Tank (YR Date Last Pumped Puriping/Mairterance Contract on File (Y/N)11//A_ ; for ° Holding Tank High -Water Alarm (YM-') IJ%q' Terriporary Holding Tank Per-mt (Y/N) Separation Distances from Septic/I3Q11J__J!-r-g Tank: To Water -Supply. Well /DU To Building Foundation���,S To Property Line �% ` To Di sposal Field /v / To Water 'fain/Service Lire v/,4 To Stream, Pond, ;make, or Major Drainage Course Comments [Page 1 of 21 ?mi-5ms4 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1617 Type of System Design 7 ;E.! f'ijc,% Date Installed ?/a( Length of Field " Width of Field 3 C? �Depth of Field Gravel Bed Thickness [, Z Square Feet of Absorption Area S o28 � Standpipes Present (Ym) Depression over Field (Y Date of Last Adequacy Test Results of Last Adequacy Test _�l e) Separation Distance from Absorption Field: To Water -Supply 'Abll /%D To Property Line jp To Building Foundation To Existing or Abandoned System cn Lot ;lt�On Adjoining Lots /4' j To Water Main/Service Line AJ If%- To Cutbank (if present) �L/ /�✓` To Stream/Pond/Lake/cr Major Drainage Course It/�� To Driveway, Parking Area, or Vehicle Storage Area C .OWAMUMUT D. LIFT STATION J3 0 U�� Date Installed Dimensions Size in Gallons Manhole/Access (YM) "Pum On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets POA Electrical Codes(YM) Comments Check Permitted Bedroom 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. Signed1V-41`` ;9�i�� 0�t�' Date OF Ak4 I . o,..°....° �' Company MOA No. o ENqx� . AL • KB1/d5/s °�S �° V°°.°•.. . uu. no®c •vao"oecc t*' " oy C. Reid, [Page 2 of 21 No. 2251E 0- -15-84 Time 'ime'i Date Date ` Date Inspector Inspector Inspector Comments Conditional Approval A, C � at' Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER H LF ONLY Property Owner Phone Mailing Address Buyer Address Lending Institution, Phone Address Realty Co. & Agent Phone Address Legal Description Street Location Type of Residence ingle Family ❑ Multiple Family No. of Bedrooms O Other WatepplY Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well ,depth (attach log if ❑ Public Utility available. Sewage sposal Individual LIP j Year Individual Installed: ❑ Public Utility When Connected to Public Utility: • Holding Tank NOTE: THE INSPECTION FSE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.