HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 3 LT 2Rolling Hills
View Estates
Block 3
Lot 2
#050-322-27
e
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW020479
PID Number. 050-322-27
N"n`
HELENA A BRUCE BECK
Wastewater System: R New ❑ Upgrade
19306 Meadow Canyon Drive.
E.R.. AK
ABSORPTION FIELD
Pn :
rMatmsr of aedraorm:
® Dap TtrrJt O S,Wbw Trradt O Sod O Ma+M O Omar.
LEGAL DESCRIPTION
as
Total TuDepth horn Ong" Woole.
0.6 GPDIFIr
10.0 Ft.
aloe: Lot 6iAdvlwn:
Depth b We Ewan eon orV" preoe:
Gravel depth benesm pipe:
3 2
ROLLING HILLS
1.86 - 2.0 Ft.
8.0 FL
Town.tvp: Rrge:
seceon:
Fi.dded.Eov. agew tirade:
Gravel Lergm:
1.15 - 3.38 Ft.
70 Ft.
Well: R New ❑ Upgrade
Grew with:
N• of eight:
t)tawOEee•«nallea:
2 FL
2
16 FL
f}esulbaon (Pdvata, ti a. c):
Tafel Depth:
Gaud b:
Taal abw"M area:
Pp M&anY:
Private
400
R.I
181 F,
1000+ Fr'
D3034 & F810
Drier.
Date DrAW:
slow water Loh:
ImWler:
Dale lnNeueo:
_
Sullivan
2
F,.
SOUTH FORK
6/3/2003
ne":
Pmpsra
aa"°N.pntAbd.cwana
TANK
1 GPM
unknown
FL
2 Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
Lift
Holding
Pubiwipmrat
a"a'w'•r
'
Fran
Tank
Field
Station
Tank
Semer Line
Anchorage Tank
1250 D.I.
w«
100'+
100'+
NA
NA
25'+
Mel.w.
Steel
NWnorwtanpruMna.
2
steacewatr
100'+
100'+
NA
NA
LIFT STATION
La Line
5'+
10'+
NA
NA
u r.
Fouwum
5'+
10'+
NA
NA
'"gym � aru^'P
la M at
Hgn waw aeon aL
ti.
ti
in.
c. D.NA
1-50'+
NA
NA
Pump An't'e a Model
Ebcpcel Inspw s °.domed W.
Rernrb:
*none known
BENCH MARK
Loc,aLon .Vp .
tank & field Insulated
Bottom of siding
Assumed EWelcn:
100 FL
Engineer's Stamp
+:(E OF gt•41�t
•�9 I
Engineering.
Inc.Dates:1at5/23/2003
ix f TLd
Inspections performed by: KND
eee'.�..eeie,.
n d
2 6!312003
.. �
Developmen
ervices Department Approval
t ...;...
Kennel M. f( , J.
� f., CE 711 J•��
Reviewed and approved by:
Date: ( f+�F9F'F•.,,,,,
,.••'�
AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW020479
ROLLING HILLS VIEW EST, BLOCK 3, LOT 2 PIDN050-322-27
\\ \\
BLOCK
K\ \ 2
100' WELL RADIUS EXISTING \ y�
Y
802-2 100• W LL RADIUS %ISTING
\ \ G F
\ ON 4T CO
XI \ \ SE N NKSO GAL G
\ N \ V t�OO A
BLOCK 3 \ 1 W G"`
[XIS ING EL
3000 R
L ❑ T 6 \\ \\ TH102-1
\ \ 0
SEPTIC \ \ ° • • • •SCALE 1' = 50'
\ BLOCK 3
A -C= 26.2' W 7.2
B -C=29.5'7 �' DR FINAL GRADE
A -D= 29.1' 95.18
B -D=32.7' n1?5GAL'
250
B -E=34.6' 92.16 92.1A -F=23.2' SEWER ROCKB-F= 44.3' TRENCH I
84.0 84.0
A -G=54.8' _ 35•
B -G= 34.1' 9189 FINAL GRADE X8rueE
A -H= 43.7' SCALE, NTS 899.7.7
nrt" rue I vret
B-H= 55.5'
A -I=71.0' 86.5 e6.so
B -I=53.2' SEWER ROCK
W
7851 TRENCH 2 78.5 1
35.
.�
OF A \ 72.s R>
/�tSSC� <QSL' PREPARED FOR:
�e" . ' '9 1� HORIZON VENTURES
• PO BOX 671368
CHUGIAK, AK. 99567
�..... . ......... ... . ....... 0,
(907) 250-9729 SCALE, NTS
/ KENNETH MD. S ,... _/ FIELD BOOKS 001iUTD2
CE -7116 �a / BOIMARr.ODRAM:
END ENGINEERING
sTM1N0 OXcbOb KMD 20441 PTARMIGAN BLVD.
.7.--T. DATE: EAGLE RIVER, AK 99577-6736
\ Ab' FiSS10tiAV
owc ERL Wo: NW255 if.._.. __.....
ACAO t ' 02082.DWG ''0B "" 02082 (907)696-6111/FAX (907)696-8111
01/01/1999 Oe:07 6ES2259 SLLLIVAN PAGE 01/01
Certifieb Oriliffig loo
by
DOC CO. e.08
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, AlA9KA 89567 • TELCPHONC 670.2750
f4CK J2G1� J8w'7rJ.CC$
OWNER OF LAND:
ADDRESS:
LEGAL DESCRIPTION:
r-:—(. arc 3 4 o T cwt.
DATE. __LT , L..�����G�
PERMIT NUMBER; (2�1%ate of Issue -k- - ac . i2. -ac.
TAX IDENTIFICATION NUMBER:afDo `• Q- a
Is well located at approved permit location? Fyffe 7 No
Method of Drilling•. 432r�rotary ;J cable tool
Death Of Nell: 40U � ��.',''�
Casing Type . '_ A L.Wall Thickness_'_ r}� `"� Inches
/f
Diameter inches, death /kr / feet
LinorType: _ A140114T
Casing Stickup Above Ground: r>Z feet
Static Water Level; R in J feet
Recover Rate I gpm
Method cfTesting; 4-4
Weal Inta<e Opening Type: ❑ open entlen hole
JSCreenod; Startfeet Stoppotl feet
]Perforations Start fegtStopped feet
Groutrype: 2--zzs1 rJrJ (TE Volume l'J i2on 13.S
Dopth: from n feet. to of 0 -t- feet
Well Disinfected Upon Completion? (:1�wsl :I N
Method of Disinfection: �/_'..J1g SO 7,01r,
Comments:
G•4Sr. fir. '17 eccJ'o
0 tJ c At Q aoE6.3
S1/Tl' S„t�0 E lcvCAJc
rla/:d P.4.•./•
'
LIA
.2 C jirt%AOCI Lo IEAr'I
3i0�7E0x')oG
�C �a-rrl r
S r a7.+9S � a- crl
DrilleeS Name � _
ATTENTION: It is the responsibi:ity of the property owner to submit a copy of the well log to the proper authority. Municipality
Of AnCnorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
SR -Z;' -
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Date Issued: Dec 06, 2002
Expiration Date: Dec 06, 2003
Permit Number: SW020479 Parcel ID: 050-322-27
Legal Description: -ROLLING HILLS VIEW ESTATES BLK.3 LT --'2 '
Design Engineer. 0070 KND Engineering Site Address: 019306 MEADOW CANYON DR
Owner Name: HELENA A. & BRUCE W. BECK Lot Size: 42253 SQ. FT.
Owner Address: 19306 MEADOW CANYON DRIVE Total Bedrooms: 4 Permit Bedrooms: 4
CHUGIAK , AK 99567 -
This permit is for the construction of.
Q Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Date: 2 2
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
ge.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.' DED — 322 — 2 % Permit Number SW02C4 79
Property owner(s) Horizon Ventures Day phone 250.9729
Mailing address (1) PO Box 671368 Chugiak, AK 99567
51 rF_
-Mailif� address (2)1 7306 hZ/100a. CRA -17'04y
R0R Zip Code
Legal description (Lot, Block & Sub d.) Rolling
Hills View Estates. Block 3. Lot 2
Legal description (Section, Township & Range)
Lot Size ¢2 S-3 Acre Sq.Ft.
Number of Bedrooms 4
THIS APPLICATION IS FOR:
Sewer Only ❑
Well Only
❑
Sewer and Well ®
Water Storage
❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑
Jacuzzi
❑
Swimming Pool ❑
Water Softening Unit
❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
of property owner or authorized agent)
Permit Fees: 4f5 5 C-1 -IF- 12411 "_iz
Date of Payment: %2 S d Z
Receipt Number: 2tfftlt 28e>53 - ,ewy
(Rev. 12/00) rrE�c/JFPIIG
Waiver Fees:
Date of Payment:
Receipt Number:
KYND ENGINEERING, INC.
20441 PTARMIGAN BLVD.
(907)696-6111/FAX (907)696-8111
December 5, 2002
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: New sewer/well permit — Rolling Hills View Estates B3, L2
Gentlemen:
The owner has requested we proceed forward to obtain a septic permit on the subject
lot. On November 13, 2002 two testholes were performed for the proposed system.
The results of these tests are attached. The general slope of this lot is from east to west
at a grade of approximately 18-23%.
We have designed our system utilizing the existing testholes that were excavated for
the 4 -bedroom house, which is proposed for this lot. The lot will be served by an
individual well, located on the eastern portion of the lot. We propose to install two 2'
wide deep trenches. Water was not encountered during excavation or monitoring.
There are no public or private wells within 200' of our proposed system location except
as noted. There is no surface water within 100' of the proposed system and there are no
known curtain drains within 50'. We do not expect there to be any adverse effect on
adjacent lots by the development of this system.
If you have any questions, please contact me at 696-6111 /FAX 696-8111.
Respectfully submitted,
Engineering, Inc.
Attachments: On -Site Well and Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
ROLLING HILLS VIEW EST, BLOCK 3, LOT 2
NO marc VEILS VITTOM ear 6
PROPOSED SYSTEM.
NO PRIVATE VELLS VITHDN eW 6
PNS SYSTEM EXCEPT AS IQTM
NO SEPTIC SYSTEMS V[TION ear 6
PROPOSED VELL EXCEPT AS MOTOR
Awl
CE -7116
' .....
�tasstotia' .i
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0.6 GPD PER SQ. FT. (13.7 MIN/IN.) = 1000 SO. FT
(1000/(2'(W) X 8'(D)) (8.0' GRAVEL) = 62.5 FT. TRENCH
USE 2 TRENCHES - 32' (L) X 2' (W) X 8.0'(D)
Total depth of system Is 10.0' from original grade.
Total depth of gravel below distribution pipe Is 8.0' .
NOTES,
1. USE 1250 GAL SEPTIC TANK, INSULATE IF <4' OF COVER.
2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK.
4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE
MIN. 3' COVER IF REQUIRED.
5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS.
PREPARED FOR,
HORIZON VENTURES
PO BOX 671368
CHUGIAK, AK. 99567
(907) 250-9729
FlELD BOOKS COMPUTED:
MIN7AMY. SEWARD DRAWN:
STMwNO: DNEaaa
ASOMr. DATE
M PSS., am
AUD nL* 02082.DWGI " Nm 02082
Scale, 1'= 100'
PAGE 1 OF 2
ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11
WASTEWATER DISP❑SAL SYSTEM DETAILS
ROLLING HILLS VIEW EST, BLOCK 3, LOT 2
\�\ X8,2`' o PROPOSED 1250 GAL
\ SEPTIC TANK
PR PO ED ZABEL
CN 20 0 S LITTER o FCO LE
\ o\
e'
\ \\ eq CO
\ G \ 13'
\ `\ MT
\\
Q- � SEO 16' ti rLO4
TH#02-2 A
CO NOUS
\ � o
\ \\ %
\\\ \\ TH#02-1
\ O
\
4
/v �F 1 PREPARED FOR,
. ' �('' HORIZON VENTURES
PO BOX 671368 Scale, 1'= 20'
** (907)IAK250-9729 567 PAGE 2 OF 2
K.
... A • -� n D BOOKS p]WJ7@
.. CE-71 saaortr.WARD para
1Q]bV ENGINEERING
Af 6f"1O1Q°EOE KMD 20441 PTARMIGAN BLVD.
,mir. DAM EAGLE RIVER, AK 99577-8736
02
pft'ESS100,' w- Mr. am. NW255 .
__ ..... .:-: �i:.r a.....y:a....a........:.:
` AOJD FLE' 02082.DWG '108 N- 02082
(907)696-6111/FAX (907)696-8111
ITID ENGINEERING, INC.
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SOILS PERCOLATION TEST
Performed for: Horizon Ventures - Mike Parker Date
Project: Rolling Hills View Estates, B3, L2 TEST HOLE p 02-1
Depth
ORG/OL -black/red overburden
SW — w/ minute trace of silt
GM — fight silty gravel
> 60 min / in
GM/SM - gray, mod. dense, silt
decreasing w/ depth,
occ. cobbles to 1', damp.
(Similar/better soils
as found in TH02-2 -
13.7 min/")
B.O.H.
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
Kenneth M. D
CE 7116
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Groundwater encountered? NO What depth? NA
Depth to water after monitoring? DRY Date? 11/21/02
0
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
11/14/02
1:00
-
6"
-
2
1:05
5 min
dry
6-
3
•
1:06
6"
-
4
1:11
5 min
dry
6"
5
•
1:12
-
6-
6
1:17
5 min
dry
6"
7
•
1:18
-
6"
-
8
1:23
5 min
dry"
6"
9
1:24
6"
-
10
1:29
5 min
dry"
6-
11
1:30
6"
-
12
2:35
1 5 min
dry"
6"
•
Water
Added
Percolation Rate <1(min/in) Perc Hole Diameter 6"
Test Run Between _ 3 feet and 4 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
OF
1 \M ENGINEERING, INC.
O t
Gross
Time
Net
Time
20441 PTARMIGAN BLVD.
rk
..
EAGLE RIVER, AK 99577-8736
'99
CE 7116
SOILS PERCOLATION TEST
Performed for. Horizon Ventures - Mike Parker Date Performed: 11/13%02 e^
Project: Rolling Hills View Estates, B3, L2 TEST HOLE N 02-2
Depth
(Feet) SEE ATTACHED SITE PLAN
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Org/OL-black/red overburden
SW - w/ minute trace of silt
G M/SM - med dense gray w/
cobbles to 1', moisture
increasing w/ depth
B.O.H.
HOLE PRESOAKED
PRIOR TO TEST
FOR HOLE LOCATION
Was Groundwater encountered? NO Whatdepth?NA
Depth to water after monitoring? DRY Date? 11/20/02
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Dro
1
11/14/02
1.00
6"
-
2
1:30
30 min
312/16"
2 4/16"
3
1:31
-
6"
-
4
2:01
30 min
313/16"
2 3/16"
5
'
2:02
-
6"
-
6
2:32
30 min
313/16"
2 3/16"
•
Water
Added
Percolation Rate 13.7 (min/in) Perc Hole Diameter 6"
Test Run Between 4.5 feet and 5.5 feet
1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in
effect on this date.
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904qpm°
nu, RMI
C�RTJFICXTiebF ON-SITE SYSTEMS APPROVAV '
Parcel I.D. 050-322-27 f 1 Expiration Date:Ll I
1. GENERAL INFORMATION
Complete legal description ROLLING HILLS VIEW ESTATES BLOCK 3, LOT 2
Location (site address) 19306 MEADOW CANYON DRIVE EAGLE RIVER AK 99577
Current Property owner(s) TRAVIS WILLIAMSON & KELLY POWERS Day phone
Mailing address 19306 MEADOW CANYON DRIVE EAGLE RIVER AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Communitv Class _ Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for:
Received by: -R��d 6,1&A_ Date: 5--
COSA
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Jo�%, �' t3(J �� Waiver Fee $
Date of Payment �j ]( j(rj Date of Payment
Receipt Number Receipt Number
COSA #,_ 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 3/27/2015
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 C; OF ALN
encroachments, deficiencies or discrepancies exist. Ar V �f
6. DSD SIGNATUREtilt
_ DUFF ? :.
System #1 Approved for bedrooms. KENNET 7116: G� j
System #2 Approved for bedrooms.,; 0 SA r
Ev
�• Fs tW.i
Disapproved.
Conditional approval for bedrooms, with the following stipulatiorls;kut10
Y Of
n� ON-SITE �s
WATER AND v
,,;. :,,`
By:Original Certificate Date: 3
The mcipality 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10.10.12 dw
If more than 1 septic system is on the tot:
COSA Checklist # _of
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: ROLLING HILLS VIEW ESTATES BLOCK 3 LOT 2 Parcel ID: 050-322-27
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID #
Date completed 12119/2002 Sanitary seal (Y/N) Y
Total depth 400 ft. Cased to 181 ft.
FROM WELL LOG
Date of test 12119/02
Static water level 201 ft.
Well production 1 9.p -m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 3.82 mg/L
Arsenic: ND ug/L Date of sample: 1120/2015
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
1/1912015
211 ft.
Collected by: ARCTERRA
Tank Type/Material SEPTIC 1 STEEL Date installed 5123/2003
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/)Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper JXS
C. ABSORPTION FIELD DATA
Date installed 6/3/2003 Soil rating (g.p.d./fe or e/bdrm) 0.6 System type DEEP TRENCH
Length 4* (2 x 35') 70 ft. Width 2 ft. Gravel below pipe 8 ft.
//ZO
Total depth 11.7 & 12.9 ft. (Measured 1-19-15) Eff. absorption area'Mlkft2 Monitoring tube Y Depression over field N
Date of adequacy test 111 912 0 1 5 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 4" & 5 in. Water added 880 gal. New depth 32" & 5 in.
Elapsed Time: 1440 min. Final fluid depth 6" & 3 in. Absorption rate >= 600+ g.p.d.
Any rejuvgnatipq treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
"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 1001+
Public sewer main 751+
Sewer /septic service line 251+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO:
f
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'+
Manurelanimal excrete storage areas 1001+
Building foundation 54 Property line 5'+ Absorption field 5'+
Water main 104 Water service line 104 Surface water 1004
Wells on adjacent lots 1001+
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 104 Water main 10'+
Water Service line 104 Surface water 1004 Driveway, parking/vehicle storage 10'+
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l 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,312712015
COMA canary sheet_2-6-15.doc-
+ P KENNE'18'Ck
Fy M7i�.
R`
in.
Municipality of Anchorage
• Development Services Department
Building Safety Division s r Y
On -Site Water & Wastewater Program +�
4700 Elmore Road
P.O. Box 196650 j
Anrhnrnno AK QQF10-aasn V
i
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-322-27
1. GENERAL INFORMATION
Complete legal description
Location (site address)
FOR A SINGLE FAMILY DWELLING
ROLLING HILL VIEW EST
COSA#
Expiration Date:
BLOCK 3. LOT 2
19306 MEADOW CANYON DRIVE *EAGLE RIVER. AK 99577
Current Property owner(s) DANIEL BRENNEMAN Day phone 696-2298
Mailing address
Lending agency
Mailing address
PO BOX 773526 *EAGLE RIVER. AK 99577
Day phone
Real Estate Agent SAME Day phone
Mailing address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site E
Individual Water Storage
❑
Individual Holding tank ❑
Community Class Well
❑
Community On-site ❑
Public Water System
❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems
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 samples. (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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name
JEFFREY A. GARNESS, P.E.
Date
337-6179
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the in ADEC MOA
�oo6o�O Q
Q F
system accordance with and
DSD Guidelines & Regulations. The reported results described the the
o
' ' '
performance of
the
p�'`� •
s�4
�O
system under conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
Q * •' q ;7* �O
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the and the water the family being by the
...... .... . ...............o
Q
year, usage of served system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
0
results do not guarantee future performance of the system, nor do they guarantee that
of y A. n ess., IV
QO
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
9� CE -7953 o�QO
any warranty or future estimate of how long the system will continue to meet the
4��erea
operational requirements of the ADEC or MOA DSD. The content of this report is for
the benefit
o�
QQ o f ession `�'
sole of the owner listed above. An reliance upon or use of this report b an
Y P P Y Y
,
Qp4o0o���<<<,•
I.
other person or party is not authorized, nor will it confer any legal right whatsoever.
ri�Y `,
5. DSD SIGNATURE
��'`G' • • • • • • � •'0"
Approved for bedrooms.
ON-SITE • ���-,
,
WATER AND • r"=
Disapproved.
WASTEWATER -
�, PROGRAM -
Conditional approval for bedrooms, with the following stipulations:
���h '. ••' 61
Attachments:
COSA Checklist— Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By:— Original Certificate Date: l
(Rev. 11/05)
Municipality of Anchorage
• - Development Services Department
Building Safety Division .4> .T.,..
On-Site Water & Wastewater Proaram
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ROLLING HILL VIEW ESTATES; BLOCK 3, LOT 2
Parcel I D: 050-322-27
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 12/19/02 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 400 ft. Cased to 181 ft. Casing height (above ground) 24+ in.
FROM WELL LOG AT INSPECTION
Date of test 12/19/02 10/6/11
Static water level 201 ft 209 ft
Well production 1 g.p.m. 1.97
g.p.m.
WATER SAMPLE RESULTS:
Coliform �_ colonies/100 ml. Nitrate2 mg./L. Collected by: GEG, Ltd.
Arsenic: ug./L. Date of sample: 10/6/11
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed _ 5/23-6/3/03
Tank size 1250 gal. Number of Compartments 2
p 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 _ 8/23/11 Pumper SANITARY PUMPERS
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 5/23-6/3/03 Soil rating (g.p.d./ft2or 2/bdrm 0.6 System type TRENCH
Length 70 ft. Width 2 ft. Gravel below pipe 8 ft.
Total depth *10.87 ft. Eff. absorption areal 000+ ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **10/6/1 1 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 2.5 in. Water added 599 gal. New depth 27.5 in.
Elapsed Time: 120 min. Final fluid depth 18.5 in. Absorption rate >= 600+ d
g.p.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
**WEST TRENCH WAS TESTED ONLY. EAST TRENCH HAD 29.5" OF LIQUID IN IT.
D. LIFT STATION
Date installed Size in gallons Menhole/Access,
"Pump on" level at in. "Pump ofr level el at
Cycles tested Meets alarm $ circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot
100'+
On adjacent lots 100'+
Absorption field on lot
100'+
On adjacent lots 100'+
Public sewer main
N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line
25'+
Holding tank N/A
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Property line
5'+ Absorption field 5'+
Water main 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 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION o OF A - �p
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in �' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '
conformance with MOA COSA guidelines in effect on this
date. ff A. ss.•'
Engineer's Printed Name JEFFREY A. GARNESS �Q CE -79 3 m�
O 9i v,
Date 10114 -III 11. Awa
4 f...�0roa�
COSA Fee $ g6l U f Waiver Fee $
Date of Payment I Date of Payment
Receipt Number b SS y Receipt Number
(Rev. 11/05)
A r':+lhi f i l 1!'
I HEREBY CERTIFY -THAT l HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY=
AND THAT NO ENCROACHMENTS EXI:3' EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OFFENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
azwAKV & xb_W&-Leltb LAND 6UXVhliNG 694-0829
f1'
J;
.�..... , ...�-�.
GRIDS
duan* Msrk Saward # y
FB&%
+ L5 691,{
!'+ate w;;e •..
DRAWN.
SGS Ref.#
1114939001
Client Name
Garness Engineering Group, Ltd
Project Name/#
Rolling Hills View EST B3 L2
Client Sample ID
Rolling Hills View EST B3 L2
Matrix
Drinking Water
PW SID
0
Sample Remarks:
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
10/14/2011 9:04
10/06/2011 13:00
10/07/2011 12:19
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/07/11 10/12/11 NRB
Waters Department
Total Nitrate/Nitrite-N 3.26
Microbiology Laboratory
Colony Count 0
Fecal Coliform 0
Total Coliform 0
0.100 mg/L SM20 4500NO3-F B (<10)
col/100mL SM20 9222B
col/100mL SM20 9222B
col/100mL SM20 9222B
A (<200)
A (<1)
A (<])
10/10/11 AYC
10/07/11 DLC
10/07/11 DLC
10/07/11 DLC
Municipality of Anchorage
Development Services Department
Building Safety Division
\ On -Site Water and Wastewater Program
4700 Bragaw Street •• "`
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 050-322-27 COSA# Ir
Expiration Date: 0 7
1. GENERAL INFORMATION
Complete legal description Rolling Hille_ View Estates, Block 3• Lot 2
Current Property owner(s)Helena
& Rn ire Beck
Day phone 696-
3 S
Mailing address 19306
Meadow
Canyon Drive E.R. AK 99577
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site
Systems 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. (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.
Lola Ik1&U:1q1[•]:I3/4:[el121144 7
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 Onsite 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.
Engineer's Printed Name KENNETH M- Dt1EEIIS Date 04/09/07
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
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
_L,tff" Approved for � bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: — g
(RN. I V05
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description, Rolling Hills view Estates- Block 3. Lot 2 Parcel ID: 050-322-27
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID
Date completed 12/19/02 Sanitary seal (YIN) _Y
Total depth 400 ft. Cased to 181 ft.
FROM WELL LOG
Date of test 12119/02
Static water level 201 ft.
Well production 1 g.p.m.
WATER SAMPLE RESULTS:
- Well Log (YIN) Y
Wires property protected (YIN) Y
Casing height (above ground) 24 in.
AT INSPECTION
3/22/07
rl
1.64 9 -
p.m -
Coliform _Q_oolonies/100mL Nitrate 3.81 mg/L Other bacteria _0 oolonies/100 mL
Arsenic: _(D mg/1 Date of samplq- 3/22/07 Collected by: ArcTerra
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/23/03 Tank size 1250 gal.
Number of Compartments 2 Cieanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N
High water alarm (YIN) _Date of pumping 3/21/07 Pumper J R s
C. ABSORPTION FIELD DATA
Date installed/35 /03 Soil rating (g.p.d./fe or fe/bdrm) D.6 System type Deep Trench
Length 64 f 2 x 351 ft. Width _Z ft. Gravel below pipe _Lft. Total depth 1Q ft.
Eff. absorption area 1024 fe Monitoring tube Y Depression over field N
Date of adequacy test 3/22/07 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test i s Una a in. Water added '49n/240 gal. New depth 222145 -sin.
Elapsed Time: 1260 min. Final fluid depth-61RA-6 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN 8 type)_N_If yes, give date -----
l
D. LIFT STATION
Date installed
"Pump on" level at_in
Size in gallons Manhole/Access (YIN)
"Pump off" level at_in. High water alarm level at_in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM 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'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 10 0'+
Holding tank 10 0'+
Animal containment areas 50'+ Manure/animal excrete storage areas 10 0 1 +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5 ' + Absorption field 5 '+
Water main 10'+ Water service line 10'+ Surfacewater 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surfacewater 100'+ Driveway, parking/vehide storage 10'+
Curtain drain 50'+ Wells on adjacent lots 10 0'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name _ KENNETH M. DLIFFIIS
�rL.", I.f I
COSA Fee $4,U.QQ
`
Date of Payment 131
Receipt Number 193�3a
(Rev. 11/05)
Waiver Fee $
Data of Payment
Receipt Number
SCS ReEN
1071162001
All Dates rimes are Alaska Standard Time
Client Name
ArcTerra Engineering and Surveying
Printed Date/Time
03/302007 16:18
Project name/N
Rolling Ilills View Est. B3 L2
Collected Date/Time
03222007 16:00
Client Sample ID
Rolling Ilills View Est. B3 L2
Received Date/rime
03232007 10:37
Matrix
Drinking Water
Technical Director
Stephen C. Ede
PWSID
0
Sample Remarks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitritc-N
Microbiolocv Laboratory
Total Coliform
ND
3.81
0
5.00 ug/L EP200.8
0.100 mg/L EPA 353.2
C (<10) 0327/07 03/30/07 TK
13 (<10)
coVI00mL SM20922213 A (<I)
0326/07 1DS
0323/07 DPT
- Municipality of Anchorage
- Development Services Department
Building Safety Division
On -Site Water and 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
Paroell.D. 050-322-27 HAA# Q1030I
Expiration Date: t o
1. GENERAL INFORMATION vm J
Complete legal
Location (site address or directions) 19306 MEADOW CANYON DRIVE, E R - AK 99577
Current Property owner(s) HFI FNA P. RRI IrE RFPK Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, HAA 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
❑
Day phone
Day phone
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 4 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. (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.
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 .NO ENGINEERING..(907) agg-Alin
•.. 11111111IRM-W-N
Engineer's Printed Name Kenneth M_ Duffus Date 6/27/nn
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 in
land 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, KND can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can KND guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
5. DSD SIGNATURE
✓ Approved for —1-- bedrooms.
Disapproved.
Conditional approval for bedrooms, with the
WATER AND_
..A
Hrtacnmems:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: I ri / v Original Certificate Date: 1 0
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorege.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description* ROLLIN12 HILLS VIEW ESTATES. BLOCK 3. LOT 2 Parcel 10:050-322-27
A. WELL DATA
Well type private If A, B, or C provide PWSID 9
Date completed 12/19/02 Sanitary seal (Y/N).X
Total depth 400 ft. Cased to 181 it
FROM WELL LOG
Date of test 12/19102
Static water level 201 ft.
Well production 9 -p.m
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires property protected (Y/N) Y
Casing height (above ground) 2 '
AT INSPECTION
ft.
aim
Coliform _D__polonies/100 ml. Nitrate 2.04 mg./I.Other bacteria _2—colonies/100 ml.
Arsenic: AA mg.A. Date of sample: 6/12/2003 Collected by: KND Engineering
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL Date installed 6 / 2 3 / 0 3
Tank size 1250 gal. Number of Compartment$_2— Cleanouts (Y/N).Y
Foundation cleanout (Y/N)–Y_Depression over tank (Y/NIR—High water alarm (YM) .N
Date of pumping NA - NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date Installed 6/3/03 Soil rating (g.p.d.Me or fe/bdrm) 0.6 System type DEEP TRENCH
Length 64 (2 X(5') ft. Width 2 ft. Gravel below pipe 8 ft.
Total depth 10 ft. Eff. absorption area 1QQR: ft Monitoring tube Y ' Depression over field N
Date of adequacy test NA - NEW SYSTEM Results (Pass/Fail) PASS Forte bedrooms
Fluid depth in absorption field before test in.
Elapsed Time: min. Final fluid depth _
Water added gal. New depth In.
_ In. Absorption rate >= 9.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed NA Size in gallons Manhole/Access (Y/N)
'Pump ori level al in. 'Pump ofP level al tn.High water alarm level at in.
Datum Cycles tested Meets alarm & Circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacentlots 100'+
On adjacent lots 10 0 ' +
Public sewer manhole/cleanout 100'+
Holding tank 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line -&L± + Absorption field 5 '
Water main 10'+ Water service line 10 ' + Surface water 10 0 ' +
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 ' + Water main 10'+
Water Service line 101+ Surface water 100'+ DdvmW, parking/vehicie storage 2 5 ' +
Curtain drain 50'+ Wells on adjacent lots 100'+
F. COMMENTS
OF A4Lll
S.
G. ENGINEER'S CERTIFICATION
iyy
° •
'�>�)
I certify that !have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA uidelines in effect on this date.
g
t h.
1
Engineer's Printed Name Kenneth M. Duffus
�til
ii9a�"$..
Date 06127/2003
HAA Fee S37
Date of Payment (030103
Receipt Number U37gbS
(Rev. 12/01)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT SEWARD 6 ASSOCIATES LAND SURVEYING 691
I HEREBY CERTIFY THAT 1 HAVE SURVEYED THESCALE' �
FOLLOWING DESCRIBED PROPERTY= f i �� pF A(�
QDI!/.YGII/LCS`/�Jt/E 1llfGl�loTZ C��„� DATE] ••"'
AND THAT NO F.NCROACHMENTS EXIST EXCEPT AS 6�B�cJ r �Q . '•
INDICATED. IT IS THE RESPONSIBILITY OF THE ;'=; THS
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID= ••• �• •..
EASEMENTS, COVENANTS, OR RESTRICTIONS .tiwzrs Fe .�'),Pdt,, -i
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- Dvene Mark Seward
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: 1 �'•. LS -6918 � •
ANY DATA HEREON BE USED FOR CONSTRUCTION iB �1 �' co
OF FENCE LINES, OR FOR ESTABLISHING BOUND-DRAW"Cyr-,a.!a1t
N
ARY LINES.