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HomeMy WebLinkAboutDAFOE BLK 1 LT 2Abafoe Block 1 Lot 2A #015-491-10 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221354 PID Number: 015-491-10 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Charles and Linda Ronan A ORPTION FIELD El De Trench El Wide Trench El Bed F1 Mound Site Address 6500 Rockridge Dr Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 /SF Ft. LEGAL DESCRIPTION iDepth to pipe invert from original g de F Gravel depth beneath pipe . Ft. Subdivision Block Lot Dafoe 1 2A Fill added above original grade Ft. Gr I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Line Ft2 Well >100' >100' N/A N/A >25' TANK FMI Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' >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' NIA N/A LIFT STATION Inaf urer Capacity Gal. Remarks Alarm location al installed by Installer PIPE MATERIAL House to tank D3034 drainfieldTank to D3034 Precision General Contractors Drainfield D3034 CO/MT D3034 Inspector M.Jakubisin BENCH MARK (Assumed elevation) 100 ft Inspection 151 9/12/22 9/12/22 Location and description 2nd 3r' 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 01= Conditional Approval: Date0 49 TH Septic e ° Benja%9-Schiller C9/114/222 �+ Approved '' Date 7 - �"2 ��F��srF • • •�C�zr,� . . ©p�OFESSVON� FE Note: this approval does not include well permit requirements. km( --V o) PERMIT # OSP221354 PID # 015-491-10 iA- 1 j 49 7H t .................... :.;. PROFILE AS -BUILT �# Benja 'Schiller �F • CE 12592 •��`�® (NO SCALE) t t�T'rnFOp p�<-•��`r �ENGINEE RING � �"• `�® �la_ ROFESSIOC� �. ������K�UT��M������1��� ��YFl��n1�_��1_1M PERMIT -'- . .. _- .~, ^_^_ . ~~ . PID " ~~ . ^^ _,~, . . " ------------------------------------------------- ROCK R/Fl/�� ���|V� RIDGE DRIVE " ^- ____-_—____'____-_q_______-____.____-_—_ 1,5OOGAL SEPTIC TANK wv20rM^NVvAY '----------7--- 49 T—H Ar E 2592 AW PLAN AS BU UUU T 0 50 100 kM ME kM ME FEET 111=5O A 2CO1 32.8 15.5 MH1 36.7 15.0 � 39.9 18.3 / 43.0 28.6 / / / / / / / / / ! � \ \ \ \ \ \ \ \ \ \ � | B `` | �. 2CO1 32.8 15.5 MH1 36.7 15.0 svi 39.9 18.3 2CO2 43.0 28.6 MUNICIPALITY OF ANCHORAGE „C„r On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road ° f` Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite fi , i t)C'pai-taient On -Site Wastewater Disposal System Permit Permit Number: OSP221354 Effective Date: 9/8/2022 Work Type: SepticTank Upgrade Expiration Date: 9/8/2023 Tax Code Number: 01549110000 Site Legal Address: DAFOE BLK 1 LT 2A G:2638 Site Mailing Address: 6500 ROCKRIDGE DR, Anchorage Owner: RONAN CHARLES B & LINDA D Lot Size in Sq Ft: 50547 Design Engineer: FORGE ENG Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 2Z9/_Z_ Z MUHMPAUTY OF AHC HORAGE zzam 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. 015-491-10 Property owner(s) Charles & Linda Ronan Day phone Mailing address 205 E Dimond Blvd #439, Anchorage, AK 99515 Site address 6500 Rockridge Dr Legal description (Sub'd., Block & Lot) Dafoe Block 1 Lot 2A Legal description (Township, Range & Section) Lot Size 50,547 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank Q U rade pg � (D) El Holding Tank ❑ Renewal F-1Duplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: � 3100 J Waiver Fees: Date of Payment: % 0% a Date of Payment: Receipt Number: aq(QEAD Receipt Number: Permit No. Ospa o13 SLI Waiver No. Permit App_'-'-: - September 7, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Dafoe Block 1 Lot 2A - 6500 Rockridge Dr Septic tank replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the existing concrete septic tank with a new 1,250-gallon plastic tank. The new septic tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption field. A double cleanout will be added after the tank, and either a foundation cleanout or a double cleanout before the tank will be installed. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221354, Deb Wockenfuss, 09/08/22 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' EXISTING CONCRETE TANK TO BE REMOVED OR FILLED IN CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND DAFOE, BLOCK 1 LOT 2A FEET 0 50 100 2CO NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. ROCK RIDGE DRIVE 4-BDRM HOME 9/7/22 10' UTILITY EASEMENT NEW 1,250 GAL SEPTIC TANK w/ 20" MANWAY PROVIDE FOUNDATION CO OR 2CO BEFORE THE TANK AND NEW 2CO AFTER TANK FCO EXISTING WELL EXISTING CRIB Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221354, Deb Wockenfuss, 09/08/22 P.02 ROCK R�ac:1� C1R 1 1 LOT /A m N a I. 01 . Wed_ LOT �r �B I r M. ailD II �o UDm LP IriB`9'S ' 00"W � tF .Sq Lot GA „ Block L.b fc •Suomi V;45;On Am1wrade RecardiN OWct, Ajuska 6E fUWEX c IST FICATl47�1 #wow, .N 1ln1 >M +wr...+.mr. Ntumed 1Mra M visa 10 IM- mly Km aw M ref wwwp w OWN& lil 0 adlaal m 8"p" ell no M 1 an nllwrnf pw WN �r eM IAA or 00 no! w Oft or"*" N Nw wm old a" A.7 *a w *are. mdm ONO. or Marr VNINIe edHMelda M Wid pooarA nwt a1 WON $4 Nre1e. Scale „ .are . °- /Z -Z9 93 Ref, Fa "°'93-245 a.+"WO of nae►a awR p1r•1lswr : igt •l�`i p���....m�+r Ilan or ►kaninuin eaMId manment reVrrdd Iraf1amVbr rabor rogmd. G ; s s�qu0 b took r"v"rad er • �/' a rrbor art Hda IWM fired by, RL surrON Pn;p" of: Marc, 6un-�her ** TOTAL PAGE. 02 ** �° HelMUNICIPALITY~h OF ANCHOkAGE-~ and Environmental Prot~on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 SEPTIC DISTANCE !p~p~:.~_¢~l . NUMBER OF iNS! DE LENGTH INSIDE WID] H .......... LIQUID DEPTH LIQUID CAPAC!TY TtL~ DRAIN F!ELD: DISTANCE FROM WELL ......... FOUNDATION ~ o~ ~es ............. D~STANCE BETWEEN LINES ABSORPTiO;~ AREA DEPTlt: }DP OF TtL[ TO i'~NiS~t GRADE TOTAL LENGTH NEAREST LOT LIINE ................ OF LINE TRENCH WI E)TH ..... IN. SQ. F'T. LENGTH OF EACH LINE DEPTt~ OF FILTER TOTAL EFFECTIVE MATERIAL BENEATH TILE IN. ABOVE TiL.~ IN. DI,,~,.'METER __. OR WIDTH _ , lENGTH DEPTH ___ , Log Crib Rings ~ Crib Size:, OlAMETER_~_DEPTH_~),,,, DISTANCE FROM: WELL - . ~,~ [' TOT,a.L EFFECTI\/E BUILDING FOUFJDATIO,N_,~]O_, ,NEAREST LOT LINE_~,M_~.' ABSORPTION AREA (W/ALL AREA) ~-~ .SQ. FT. we l Class:'_,~- Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materia!s: ~% ~ of Bedrooms: installer: Remarks: ~olt "On~ ~s~ i~ ~vorth a ~hou~and o~inions" 2204 CleVeland Anchorage, Alaska 99503 Lenal ~escrintion:-/Lot~.l.~Block /' Subdivision '/~-,~¢_~ .~,>~)jq~,'~,.'~,'~,~ This Korm Renorts Soils Lorl {/.~,c~ Percolation Test / .nenth Feet 4 6 , 8-- 12-- 14 16 .... 18.,, 20-- Soil Characteristics '- ~" ~"/_L.~ Was Ground Water Encountered? I~ Yes, At what Denth? i Readinq Date Gross Time Net Time i Denth to H20 Net Dron i Percolation Rate )Ii nute Proposed Installation: Seenaoe Pit Drain Field D e~th of Inlet .) Den th To Bottom Of ,P~.O5T/erich rnU~F_NTS-/(?'~,, ~'-,-- ,"~ ' ' . .- _~c~. ~F (~':]6'?~'-~ ~,v~ - / , Test Performed BV ~ Data Certified BY:__ ~ ~ Date: ALASKA ENVIRONJi~NTAL CONTROL SERVIC"~I~, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO CALCULATED BY OF DATE C.ECKED BY DATE / / t / KEN'S COMPANY WATER WELL DRILLINg PUMP SALES & SERVICE (907) 243-7893 KEN JOHNSON Dave Torgenson SRA Box 23 D Anchorage, Alaska 995~? Rel Lot 2 A Blk, ! Dafoe Sub, WATER WELL TEST DAT~ 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 DSPT. OF HEALTH & ENViRONMeNTAL P~O"f FCTIO~' Ft,-, 2 RECEIVED 0800 Tag bottom with pump.. Pump s&t 2' off bottom. Pull pump up lO ft. ~nd hook up test head etc. Static water level 63 ft. 3 in. Well depth 136 ft. Time GPM 0928 ?.5 0934 7.5 0940 7.0 0950 7.0 1000 6.0 1010 6.0 lo2o 5.0 lo3o 5 1033 1040 Drawdown Remarks 80 cloudy 89.4 cloudy..trace of grit 97.9 " " - 104.4 110 " " " 115 clearing 115 ' 15 ft. 5 min. clearing shut down to check recovery 4.0 100 Set pressure at 40 ~ Pmmp will produce 4 GPNat 40~ Leave pump run continuous from 100 ft. 1235 4.0 1247 shutdowrl olean and clear Took water sample recovers ! ft. every 20 secounds ( 4.5 GPM ) very clean and clear 1~3o Reset pitless., pump 10 ft. off bottom. Install new pressure switch 20-40# Install new pressure gauge off site,~--~: ~¢~~ Certificate of On -Site Systems Approval Parcel 1. D. 015-491-10 Legal description Dafoe, Block 1 lot 2A Site address 6500 Rockridge Dr, Anchorage, Current property owner(s) Ronan Expiration Date: 12-19-22 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: r (� By: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 O Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-491-10 Complete legal description Dafoe, Block 1 Lot 2A Location (site address) 6500 Rockridge Drive, Anchorage, AK 99516 Current property owner(s) Charles & Linda Ronan 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: A Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel A Plastic ❑ Concrete ❑ Fiberglass Age <1 yr - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ■❑ Seepage Pit Waiver request for: Expedited review requested: ❑■ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ J� -f';30 = 38-0 Date of Payment a �t 5-12,2- - d�q 2gb COSA # Q-_,p�% �✓ I�f S Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: Dafoe, Block 1 Lot 2A Parcel ID: 015-491-10 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA n Well log is filed with Onsite (or attached) Date drilled 1218177 Total depth 136 ft Cased to 136 ft 9 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 16* in. Date of flow test for COSA 9/02/22 Static water level at beginning of test 74 ft. Comments Drilled prior to 1996 B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: *New installation D. ABSORPTION FIELD DATA Which system tested (date installed) 9/23/77 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.3 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑® Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 8/23/22 date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 5.1 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ®❑ Coliform bacteria is Negative Nitrate mg/L ®❑ Nitrate less than MRL (ND) Arsenic 5.42 ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 8/23/22 C. LIFT STATION Erf' e ired maintenance completed Age of lift station years Lift station material Comments: None present Adequacy test date 8/23/22 Results ❑ Pass Fluid depth prior to test 70* in Water added 600 gal New fluid depth 70 in Elapsed time 1440 min Final fluid depth 38 in Absorption rate ' 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 96 in Effective depth used 38 in Effective depth remaining 58 in Comments/Deficiencies: *Began adequacy test directly after pre-soak COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' QYes if No ft [-U-1 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' R Yes if No ft Absorption Field on Lot > 100' Q Yes if No ft Holding Tank > 100' Fm-] Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft R] Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' R Yes if No ft Tank to Property Line > 5' Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Pn� Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Forge Engineering Engineer's Printed Name COSA Checklist—June 2022 Benjamin Schiller, P.E. Phone (907) 522-7773 Date 9/14/22 01= A]����� : 49 TH Benjam�rv5 chiller .' CE 12592 A- AW PROFESSW . m N 06'Y6Z 3..00,00 r00S \ Q O J N N N � OJ O � Z O 41 ALL► N N O CLL- J V J O vi s - L N m L M N N }I L O L L' U. 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Y j � c� DalC'st a" a�E N v U L N O m a N Y-0 L 00-1C \� S yam,, T m Cl) N ,n U O N L, Q v1 A N Ln � O `0 c n r� o =3 = N a E ---�C- r I t 0- >V2 Nw.�Y75 a m i v c C>r3 Q arc Locxc `^ O �c �rn3 IV v0i a� aw N a) a= F v ._ a) ,n Q J rn E m E- Y no N O N hk_ O U > w N• ?y w 0 Q�2m a Y Y _N t,�' I z Q L N NV. a) 2 _! rn. W N ci Ln oo p oui • a� aci y `�. Z •O WO Of L. ai U m O c ♦♦ (Y^ . • ��.Q O' Y Z o c m m V •��C�\.► al m n E -a E W U cn E L N x _ _ a V N IZ"SI �Ni C7 N ri v f 1KEN'S COMPANY ^ WATER WEU DRILLING , PUNW SALES 'SERVICE ti7tii� cyriuys 3163 LINDEN idkiVE ....r .►.+i�..�v�d ANCHORAGE, ALASKA 99502' ' }{yam �.,� m r � .g�+� a'-• + December. 1xtj 4 n7 i an $�» i�l..e•3 ..�. _`- _ .. .. �w i � e1 j ( � � �= T�i� tMi'�'u+ tl Rockrlce :give Anchorage, laska WELL LOG e �L ,' 1 �.% .sT' YA' +MM d �Wi .a ryX"'R1't• . •T �4.'�P.0 �t yi` +xfl1'kq+ ! � �` y'R'i f. .� 4 ;a 0 Ft. to 35 Ft., Course' gravel and cobble th Ta Y ilii tl 35 Ft. to 120 Ft. BROWN' SILK' with gravel >3 � �� �y-�`5 120 Ft. t0 127 Ft. Trace of waters --40 Ft. HW- --BAILS 127 Ft. to 12$ Ft, mater Bearing 'Sand and Gravel- -25: ell. ` i$ 12E Ft. to 136 Ft. GLACIAL TILT, 1 Xn��r,� s x .. ... -. L � _ .... ---". •. : �. W SSS 4'1 ''4 ..: Yl : y��rlr -�. � 136 Ft. Gleam dater Bearing Sand ;ands. 40 Ft. HEAD 'EST Mailed at 14 G. P. With 10 Ft® Drax down Goo' rerc�v 41 ♦ �'� � K �� �V .. �}-.ice 41 ._,�c. ,- .. _ - - .. <, y �� f �" • �`'`�' �. (,^� .'�"-". '.`a!F" 'lam' d-... :-' f , '`� . Y' �Y v..', ,✓" '�_�`^'•`•-'�"'�:. • •fir• _J -V4 I' STATE OF ALASKA 6917 DEPARTMENT OF NATURAL RESOURCES i DIVISION OF MINING, LAND & WATER I Alaska Hydrologic Survey cQ QW5 •RjafNi Of NJaP WATER WELL LOG Revised 08/18/2016 viunn OtdrteU. / / Uomplema: -Iz / 0 / la// _Hurnp Install: City/Borough Subdivision Block Lot Property Owner Name & Address Municipality of Anchorage DA F O E B1 L02A DAVE TO RG E N S O N, Well location: Latitude Longitude Meridian S Township 012N Range 003W Section 23 , SE 1/4 of SE 1/4 of SE 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna's hydrogeologic classification system* https://my.ngwa.org/NC Prod uct?id=a 1 85000000BYu b3AAD Depth From T Include description or buildings, etc.): n (include road names, AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.aov/welts/ OR email electronic well logs to dnr.water.reports(o)-alaska.gov "Guide for Using the Hydrogeologic Classification System for water vvell uorenoles by I homas M. Hanna NGWA Press Drilling method:Ljgir rotary,L_Pable tool,jOther Well use:OPublic supplv,[]Domestic,OReinjection,OHydrofracking El Commercial, QObservation/Monitoring, E]Test/Exploratory,0 Cooling El Irrigation/Agriculture, Grounding,®Recharge/Aquifer Storage, El Heating, ElGeothermal Exploration,QOther Fluids used: Depth of hole: 136 ft Casing stickup: ft Casing type: Casing thickness: inches Casing diameter: inches Casing depth: 136 ft Liner type: Depth: ft Diameter: inches Note: FULL CASE Well intake opening type: Open end,; Open hole, Other open end Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, PerforatedOYes 0 No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed QYesONo Gravel start: _ft, Gravel stop: ft Note: Static water (from top of casing): 96 ft on / / Artesian well ❑ Pumping level & yield: feet after hours at 14 gpm Method of testing: Development method: Duration: Recovery rate: gpm Grout type: Volume Depth: From ft, To ft Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion? Yes j : No Method of disinfection: Was water quality tested?' es No Water quality parameters tested: Well driller name: ........... ame:........... Company name:.KEN.S.C.OMPANY ..................................................................... Mailingaddress: .................................................................................... City: State: AK Zip: Phone number: ( ) Driller's signature: Date: Anchorage Municipal Code 15.55.060 (1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: Date of Issue: Parcel Identification Number: - -f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING //.C~/_ /0 ~:!;~HAA# .: ~=~r 1. GENERAL INFORMATION Complete legal description L0,~ 2A; Block I; Dafo6 Subdivision Location (site address or directions) ~,~;0o Ro~.b~'Hg~. D~'_u~. :-~p~ owner % ~ Ga~ CIO R.~.S.S. Day phone $', ' ' A~n: S~rl~y ;~ai!ing address 8200 H~boldt Ave. 5. S~e 204 Minneapo~s, 1-800-829-7377 MN 55431 [~,,l:end~ng agency '%.~,~iling. .. . address. Day phone A§ent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034 Eaa_le Rivm* Loop. Ro~,& .l~l~.. ~ Phone ¢ Eagle River, Alaska Address ~.~.J~t?~ ~ Engineer's signature ~ .... Date DHHS SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. , 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description LOt 2A; Block I; Dafo¢ 'Subdivision Location (site address or directions) 6500 Rockrid9e Drive Anchoraqe. AK Property owner Marc Gunther C/0 Real Estate SupportDay phone 1-800-829-7377 Attn:' Shirle~ Allen Mailing address 8200 Humboldt Ave. S. Suite 204 Minneapolis MN 55431 Lending agency Mailing address Day phone Agent Day phone, Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. , 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is sate, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained'from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .~--'"'-"~ Phone · . Eagle River, Alaska 995.~--"/ Engineer's s~gnazure ~~ Date DHHS SIGNATURE-- Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: /,,~ , ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only uPon the representations given in paragraph 5 above by an indepenb,~nt professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 1~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT Z,~ f~L~ t ~F~c:~- ~/L~ Parcel I.D. A. Well Data well type Log present (~) ~/~ Total depth Sanitary sealskiN) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number /t.///~ Date completed /?~/ ~/~)'~ Driller /'~/,.J',S Cased to / ,~(p f Casing height / Wires properly protecte~l) FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic~tank on lot //~7(.~ ~'-~ Absorption field on lot Public sewer main ?.~ Sewer service line g.p.mo .__ ; On adjacent lots ~_.)(..0 r _/__ ; On adjacent lots ,," (-~ © ~ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Co,form dS//o Date of sample: ~/f // / Nitrate Collected by: Other bacteria ~/fro o,/.-~ B. SEPTIC/N4;~BtN~TANK DATA Date installed ff/7_..%/~ Cleanouts ~N)~,~ High water alarm (Y~_~,") ,/'~'~ Date of pumping Tank size / '~=.~0 ~ fA C__ Compartments ~_. Foundation cleanout ~1) ~'~--'~ Depression (YN~. Alarm tested (Y~ /t.//,~ SEPARATION DISTANCES FROM SEPTIC/~TANK TO: Well(s) on lot f(__~ L_~ ~ On adjacent lots To property line /(..~ ¢''~'~ Absorption field Surface water/drainage /~L~ ~"~ Water main/service line //~ r'Z-- 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. UFT STATUe. Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DIST~FT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Date installed ~'/~.,~ / r~ ~ Length ],.~ ~X Z?_ XI ~'X ZO VV4dth- Total absorption area ~-~' Date of adequacy test //{'~ / ~/-~ Manufacturer Manhole/Access ~ ...-"~"Pump off" Level at ~~Gycles tested Surface water Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) //00 System type f Gravel thickness ~ Total depth __ Cleanout present(~) 6//~-r~.5 ~(- Depression over field (Y Results(~:fail) /Z~ ~ ,-~pl~ for 40oord-) ~/~ After test //~/'O~L~- ~_/~ O&J/(~lf yes, give date /(J/~ /O ' Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ TO building foundation On adjacent lots Surface water / ~ ~ r'~-- Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION On adjacent lots /~_~ ~ Property line To existing or abandoned system on lot Cutbank /4~o/c.~¢ P,~-water main/service line I certify that I have checked, verified, or conformed to/~tFl~ and HAA guidelines in effect~,"d~'i~"~f this inspection. Engineer's Nam~aDle ~;ver: ll~a Signature S & S ENGINEERING 17034 Eagle River 204 Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number Mui~ilCIPALITY OF ANCHORAGE P~T DEPARTM T OF HEALTH AND ENVIRONMENTAL ECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date /- ~- ] -4¢'~ ~1. '. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions)' ~ (b) Appli~,nt N~ame-/--~r'~~'/~ 5"~/J'~ Telephone: Home 3¢4' ¢?~ Business Applicant Address ......... ; - , :....-. . . .. ~' . . Owner/builder,S'; (c) Applica'ht is (c~eck one): Lendm~ Insbtubon [] ' ,,..~, Buyer [] ' Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: " £1q- TYPE OF RESIDENCE Single-Family~J~ Multi-Family [] Number of Bedrooms ¢ Other 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, i: Page 1 of 2 72-025 (11/84) 5?' ,ENGINEERING FIRM PROVIDI NSPECTIONS, TESTS, FILE SEARCH, D AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~¢--'~ Telephone ~,/-~ ~¢~ Address /,~/T /~ .~'~/~ ~)~IY/"~'~ /~ Date /-'~/~' Approved for .t~'J~-~ bedrooms by ate Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph $ 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 ~s not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HE4kL.TI-;I.~.~T.['C_Q,~ APPROVAL (HAA) MUNICIPALI I'P( DEPT. ~:.lr~ - FEBRUARY 1984 ENVIRONMENTAL PROTE,~I~I~III/'20 ,!A,~ 2 ~ ~gal Description: WELL DATA Well Classification Well Log Present'N)/ Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Condui (t~N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed /,~' - ~' ~ Y Yield /-~'/~'" Depth of Grouting '~J//~ ; Pump Set"At ,~/¢ /' ~' Sanitary Seal on Casin (~.~) Depression Around Wellhead (Y~'~'"~ Water Sample Collected by Water Sample Test Results Comments ~__~ RECEIVED Cased to To Septic/Holding Tank on Lot /O (~ On Adjoining Lots To Nearest Edge of Absorption Field on Lo ' On Adjoining Lots To Nearest Public Sewer Line ,.~,'///~' To Nearest Public Sewer Cleanout/Manhole /,-¢//¢ To Nearest Sewer Service Line on ,~;"¢ ~) t~, ~,'J'/g7,/ 'Date L~ B. SEPTIC/HOLDING TANK DATA Date Installed ~/~Z:~- 7 7 Size )Z-~'~ E?¢¢~ No. of Compartments Standpipe (~.~) Air-tight Caps~N) Foundation Cleanout (Y~,., Depression over Tank (y~,./ Date Last Pumped ,; Pumping/Maintenance Contract on File (Y/N) ~/2~ 'for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y(.?~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,~V/¢ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field /.~ ) ,~ Depth of Field _ ~' / Gravel Bed Thickness ~ Standpipes Presen~N) Date of Last Adequacy Test To Property Line io · On Adjoining Lots To Existing or Abandoned System on To Cutbank (if present) LIFT STATION Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~ Vent (Y/N) . ~cles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav, eg_.;Ihec~,ed, v~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed //'~¢ /~'"~ Date Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) · - - DATE RECEIVED I NSPECTI ON APPOI NTM ENTS ' TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE  HEALTH & ENVIRONMENTAL PROTECTION DEPARTMEN'~25 L Street-Anchorage, Alaska 99~ ~ ~/~t~.~(4,.. ~ 7¢¢~1~_~~ I~' ~OF ENVIRONMENTAL SANITATION DIVISIO'N .Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES' DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be preceded. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) ' PHONE 2, BUYER PHQNE MAILING ADDRESS 3. LENDING INSTITUTION MAILING ADDRESS 4. REALTOR/AGENT  PHONE MAILING ADDRESS 5o LEGAL DESCRIPTI ON STREET LOCATION ~1 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY /q77YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE; THE iNSFECT;ON FEE MUST ACCOMFANY EACH REQUEST BEFORE PROCE3~iNG L;AN BE INi rIAl'ED. . rh