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HomeMy WebLinkAboutROLLING HILLS ESTATES BLK C LT 7Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211236 PID Number: 011-072-05 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name KRISTEN GILBERT & PAULO SIERRA ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7331 BAILEY DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROLLING HILLS EST. C 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES ToSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well *85'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks *MOA WAIVER: WR920021 85' WELL RADIUS STAKED AT CONSTRUCTION Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer ,f RS Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection 1s 8/17/21 8/17/21 Location and description 2�d 3`d 4'" WINDOW SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL , .- ®� Conditional Approval: Date �: .. .....Septic Curtis Huffman• • stem Approved Date `� % X021 •:� F •, CE 128991 `� .� ����F�,•. si2s/21 .•�� F� pROEESSOO ��N�k Note: this approval does not include well permit requirements. kmev uoiuu 10) P I D: 011-072-05 PERMIT: OSP211236 LOT 6 30'„W 175.85, SB 2 20o�W I -175 -BC)' R� 6 • SEPTIC t VENT J (tYP) 23.0' P A 48.0' DECOMMISSIONED EXISTING EXISTING S.T. & INSTALLED NEW LOT 7 CONC a 1250 -GAL HDPE SEPTIC TANK Ld DEW HOUSEm WITH NEW FCO & DCO. BLK C _0 O 24.0' O CONC ? MH CO O DFCO F EXISTING >- 00 BRICK DECK BM • FIELDS W WALK w C D E DCO JNo 12.0 � Q B X85' RADIUS SHOO M p STAKED AT p o CONST. r, 14.0' n x7 N O ® N 6.6' / CA. 00 WELL N77 03 oo,( 1g Z I LOT 8 DCO A—C=38.6' FDCOH CO CO 9851 rFINAL GRADE B—C=11.5' f A—D=40.8' 93.50 B—D=13.8' A—E=44.4' 9292 1'HDPEGANKN \,9275 EXISTING FIELD B—E=18.0' A—F=46.6' B—F=20.2' SEPTIC SECTION SCALE: NTS ROLLING HILLS ESTATES BLOCK C LOT 7 SUPPORT, SERVICES: Adw OF AL4 "11111,PREPARED FOR: `4� 1 KRISTEN GILBERT & PAULO SIERRAF cs 1 7331 BAILEY DRIVEN TH* ANCHORAGE, AK 99502 FIRST WATER CONSULTING DATE: 8/25/2021 SURVEY: JLS ` �rtis Huffman wx 13030 SUES WAY DRAWN: FWCS 1 f�'+, 8�25�2021 ��91 � A ANCHORAGE, AK 99516 SCALE: 1” = 30' 1 \ " p812512nsslo��'yi' 907-350-9566 FirstWaterAK©gmail.com PAGE: 1 of 1 �``'� LOT 6 3v C C 0 >- 0C L -Li < M C C z ANCHORAGE RECORDING DISTRICT, ALASKA IAS -BUILT OF: ROLLING HILLS ESTATES LOT 7 BLOCK C PLAT P-486 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines, EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATESCALE. E-MAIL AUG 23, 2021 1 "=30' schuller0ok.net 21-125 DRAM BY. ICHECKED BY, GRID NUMBER: BOOK/PAGE: JLS SW2124 210269 * = FND 5/8" REBAR ."641 mw104 , %k1-04.1 w""� AMr 0 F 4 NN LA 00, 4 9TH R - 'A A % �--, ......... ........ CD •J N L. SCHULLER.i . - LS -10408 ey -.0 1831 Talkeetna Street t icy ' ' zz -2-'! Anchorage, Alaska 99508 0 f �N \' 'MW (907) 227d'AW —1455 office (907) 274-4992 f ax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Sox 196650 4700 Elmore Poad Anchorage. Alaska 99579-6650 Phone: (907) 343-7904 Fax: (907) 343.7997 httpJ1www.rnuni.orgion site �CkOA"G4 On -Site Wastewater Disposal System Permit Permit Number; OSP211236 Effective Date: Work Type: SepticTank Upgrade Tax Code Number: 01107205000 Site Legal Address: ROLLING HILC.S ESTATES SLK. C LT 7 G:2124 Site Mailing Address: 7331 BAILEY DR, Anchorage Owner: GILBERT KRISTEN 50% & Design Engineer: FIRST WATER CONSULTING This permit is for the construction of. ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Expiration Date: Lot Size in Sq Ft Total Bedrooms: 71112021 71112022 14150 4 ❑ 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 15.55 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 (2417). 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 7/1/2021 Received By: Date: Issued By: Date: 7 ao-�I P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section .mcnt S ` n �iC�>�1'CCII I'IIC x x x XXT 11AR1ANk(_'T/WAIVER REVIEW X X K x Waiver#: WR920021 COSA#: Permit#:OSP211236 PID#: 011-072-05 Legal Description: Rolling Hills Estates Block C Lot 7 Engineer: First Water Consulting Applicant: Kristen Gilbert & Paulo Cesar Sierra Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 85.0 feet. This is a re - issuance of the original waiver granted in 1992. See engineer's waiver request for justifications to re -issue this waiver. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. aaaa■aeaaaaavaaaaaaasaaaaaaasaasaaoaaa.seaaaaaaaavaeaaaasaaaaaaaaaaaaaaaaaasaaaI Waiver is Granted: X Waiver is not Granted: Date: �� Approved by: ul 61-�Uu# Name of Reviewer aaaaaavaaaaaaaaaaaaaaaaaeaavaaaaaaaaaacaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaasaaaaa0a ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-072-05 Property owner(s) KRISTEN GILBERT & PAULQ CESAR SIERRA Day phone Mailing address 7331 BAILEY DRIVE, ANCHORAGE, AK 99502 Site address 7331 BAILEY DRIVE, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) ROLLING HILLS EST. BLOCK C LOT 7 Legal description (Township, Range & Section) Lot Size 14150 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Fx� Upgrade El Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: 22 Waiver Fees: Date of Payment: °f 1 ao A- 1 Date of Payment: Receipt Number: 'RVq a) O Receipt Number: Permit No. 0 S P-21 1� 6 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 30, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROLLING HILLS ESTATES BLOCK C LOT 7 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. The lot and area are served by private wells. With this upgrade, we request continuance of the existing waiver of 86’ to the well serving the subject lot. Continuance of this waiver is justifiable given the improved material of the proposed HDPE tank, the well is on the opposite of the house and up gradient from the proposed tank. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211236, Rebecca Carroll, 07/01/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211236, Rebecca Carroll, 07/01/21 C c2G -'4.5.0P Anchoi-agp',Npll & Pu,,-nj),Se!- 90724301742 P.1 Legal Description Property Owng Nam -c & Address-, rulnp Installation Date: Pump Tnt2lke ykapth ylelovv POP 0-MV11 Casing: feet ,'. , , /410 Pump I'VaruName:2cturer's Nae: I Pump.).ModeL, Pump Size t hp Fitlem Adapter Burial Dcoth: M feet kideSS Adapter N12iufactnrer'srA4,.j,-v PhICSS Adapter Installer: Well Disinfected Upon Compbe!jtiri? Y t! s _71 Ne Method of Disinfection: I COMMents: fii(,-& Pump Installer Name: ei Pump Ser"Joc-, 330 East Mth AvpnLe Anchorage,' AK 9:11518 Phone: 907-243-0740 AtteBGOH. The PUr(.'p instal F;," Shall provide a pump installation iog to the DSD,.,AtWn 30 days, of pump instaliation. N i S Ot', �we �,9,507 Pump Installation Log Well Drilling Permit Number: SIN Date of Issue: Pa reel Ideul iikation 'N am ber-- 0 2 — 0 S Legal Description Property Owng Nam -c & Address-, rulnp Installation Date: Pump Tnt2lke ykapth ylelovv POP 0-MV11 Casing: feet ,'. , , /410 Pump I'VaruName:2cturer's Nae: I Pump.).ModeL, Pump Size t hp Fitlem Adapter Burial Dcoth: M feet kideSS Adapter N12iufactnrer'srA4,.j,-v PhICSS Adapter Installer: Well Disinfected Upon Compbe!jtiri? Y t! s _71 Ne Method of Disinfection: I COMMents: fii(,-& Pump Installer Name: ei Pump Ser"Joc-, 330 East Mth AvpnLe Anchorage,' AK 9:11518 Phone: 907-243-0740 AtteBGOH. The PUr(.'p instal F;," Shall provide a pump installation iog to the DSD,.,AtWn 30 days, of pump instaliation. Municipality of Anchorage Page \ of "~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -~:>V~/c~ ~O0c/'~, PID Number: Uame~//Ur~- ~DE~ Wastewater System: ~ New ~pgrade Address: ~[ ~JC~y ~}U~ ABSORPTION FIELD Phone: ~' I~ No. of Be~ooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Soil Rating: Total Depth from original ~rade: LEGAL DESCRIPTION ¢ ~ ~, ~ ~,H~ GPD/Sq. Ft. Lot: ~ Block: ~ ~ Subdivisi~;~¢~/~ ~epth to pipe bottom from orig~a~grade: Ft. Gravel depth beneath~pip~ Ft. Township: Range: Section: Fill added above original grade: Gravel length: Grave~: WELL: ~Sts~l~ew D Upgrade ~'~ Z.~t. Numberoflines: Distance bet~een lines; ~ .. /0-+ Ft. Classifica~' (Private, A,B,C): Total Dept~: Cased To: Total absorption area: ~ipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Pump Set at: ~ Casing Height Above Ground: Yield: ~'~ GPM ~ ~ ~t. /~" ~ TANK SEPARATION DISTANCES ~s~ptic a Ho~din~ ~ S.~.E.~. TO / Septic Absorption Lift Holding =ublic/Private M~uf~turer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~ /~ ~ ~ ~ / ~ ~/~ ¢ Material: Number of Compartments: Io * Surface ~ ¢ Water I00'~ 0 ~ -- LIFT STATION Line Lot 18' ~51 j -- Si~ns~anufac ~urer:~ "Pump on" level at: / ~p off" ~gh water alarm at: Foundation ~01 ~ '~ CurtainDrain ~/~ ~/~ ~ ~ -- Pum~ Electrical Inspectionsperformedby~ Remarks: T~c~E~ ~EO ~7~ BENCH MARK Location and Description:  Assumed Elevation: ]OO~o ~, ENGINEER'S SEAL Inspections performed by: ~ ~ ~,~,~ Dates: 1st 5-~?Z ......~" ....... Department of Health and Human Services approval ~.%% Reviewed and approved by:/~ ~ Date: ~/¢/~ ~ ~o~Es~, %" 72-013 {1/91) MOA 25 Permit' NO. ,~.~e:~ 2- ~::'C~"'~ Page ~" of '~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SEFIVlCES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LoT -~-: J~LK, C- ~oLz-I~J6~/-/IL~_.~- J~'r~'~ PID No,: ~l I~~ LOT '~ LOT8 NO. 72-013 A (2/91) MOA 25 ~ ' ~: Page ~ of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description' LOT t'Jr. ~/.-~- C/ ~OI.-LING i~,LL~ J~S7/~TB-.J PID No.: , 'Fyi'. Co0- L.=HH EAL 72-013 A (2/91) MOA 25 "; June 5, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTN: Susan 0swalt 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block C; Ro~ing Hills View Estates As per the special provision of permit #SW920048 a test hole was excavated during the recent installation of septic syst~ s~rving the referenced property. We v~ified that no bedrock exists within 6 ft. of the bottom of the leachfi~ld trenches. Sincerely, ROGER J. SHA~R, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW920048 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HENDERSON LESLIE W & OWNER ADDRESS:7331 BAILEY DR ANCHORAGE, ALASKA 99502 PARCEL ID:01107205 LEGAL DESCRIPTION: ROLLING HILLS ESTATES BLK LT 7 C LOT SIZE: 13740 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 PAGE 1 OF PERMIT DATE ISSUED: 4/01/92 EXPIRATION DATE: 4/01/93 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 35.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A NEW SOILS TEST WILL BE PERFORMED AT THE TIME OF CONSTRUCT- ION TO VERIFY NO ~EDROCK IS PRESENT WITHIN 6 FEET OF THE BOTTOM OF THE PROPOSED ABSOR~,~ON ~I~$~ RECEIVED B ~y ~~/~4. ~ ~J~ DATE: ISSUED BY: . ~ Tom Fink, Mayor MunicipaJity Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 May 18, 1992 Roger A. Shafer, P. E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 7 Block C Rolling Hills View Estates Waiver Request 9WR920021, PID 9011-072-05, Permit ~SW920048 Dear Mr. Shafer: Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are: well to the septic tank 85 feet; and leachfield to the surface water - 70 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: ljm:#6 HEALTH AUTHORITY APPROVALS SEWER & WATER MA[N EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. April 28, 1992 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 7; Block "C"; Rolling Hills Vi~ Estates Subdivision; CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Request you issue a p~rmit to upgrade the septic system serving the referenced property and grant horizontal separation distance waivers between the w~ll and septic tank, and the septic leachfi~ld and a surface water source at 85 ft. and 70 ft. respectively. Also requested is a 5 ft. lot line waiver between a seepage trench and the north property line. At our request you issued a permit on April 2, 1992 for the ~mergency installation of a 1250 gallon septic tank since the existing septic tank had collapsed. As can be seen from our attached site plan the t~mporary tank is to be r~located out~ide the n~ighboring protective w~ll radius. Due to lot size restrictions, the location of the area w~lls, and the location of a small surface water source (lake) to the east of the property, there is not enough room on the property to install a septic upgrade without the above requested waivers. However, for the following reasons we fe~l th~se l~sser separation distances are acceptable: I. The alternate on-site wast~water disposal option for this property is an undesirable holding tank. Although plans are net completed, due to similar problems on adjacent properties, Municipal s~wer is anticipated to be available to the property within the next f~w years. The existing CMU seepage pit; which was presumably installed prior to the s~paratlon distance to a surfac~ water source was increased to 100 ft; has been in operation for several y~ars without any apparent adverse effects on the lake. Although th~ property slopes toward the lake, the slope is gradual. Any possible surface overflow of the proposed system will probably be noticed and remedied prior to contamination of the lak~. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 7; Block "C" Rolling Hil~ View Estates Subdivision; April 28, 1992 As ~an be seen from the soils log, the soils in the area are very silty. This silt content wou~d tend to filter septic effluent and impede its movement horizontally ~ither toward the w~ll or toward the pond. The w~ll on the lot, as with the we21s in the area, are typically deep with a static water level around 77 ft. Natura~ geologic soil layering combined with the silty soils found on the soils log would d~tour any migration of septic effluent toward, or into, the groundwater aquifer. Nitrate sample results from the w~ll on the property show no nitrates were detected. Since septic effluent is high in nitrates, and nitrates travel through soil virtually undisrupted, it appears that after several y~ars of use, the existing w~ll is sti~ unaffected by any septic effluent. 0nly the septic tank is to encroach upon the w~ll. Generally, a septic tank is not considered a continuous source of septic effluent as would a leachfi~ld. From the attached well flow data we see there is v~ry little water level drawdown when the well is used. Therefore, the hydraulic gradient for this w~ll wi~ be minimal. In other words, use of the well will not "draw" effluent toward the aquifer. Please note on the attached d~sign we have denoted a proposed seepage trench depth of only 4 ft. above the bottom of the soils test as opposed to the required 6 ft. This depth was necessary to decrease the amount of room necessary for the upgrade. We feel this is acceptable since their is no reason to expect a bedrock encroachment in ths ar~a. The absence of bedrock within 6 ft. of the proposed seepage trench can be verified during construction. Since the septic approval process for this property was initiated due to financing associated with a sale of the property, and complications which have arisen have caused time d~lays, we would appreciate the expedition of your review. If we may be of s~rvice, or if you require any additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. RJS/gm · /;'' -- $0' J SCALE JUPGRADE I00' V 40' LAKI~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION:~I)'["~! ~..Ct 2 7 8 10 12 14 17 18 19 20 COMMENTS DATE PERFORMED: ~lu.~ ~/D Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water~. , MonitorinD? ",~,~.,,-..~r...-.-.~ Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop H ~ : ~ I,o H~' PERCOLATION RATE ~,.j~l (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ FT AND "~ ET 17034 Eagle River Loop Road Eagle River, Alaska 9952'7 PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920048 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:HENDERSON LESLIE W & OWNER ADDRESS:7331 BAILEY DR ANCHORAGE AK 99502 DATE ISSUED: 4/01/92 EXPIRATION DATE: 4/01/93 PARCEL ID:01107205 LEGAL DESCRIPTION: ROLLING HILLS ESTATES BLK LT 7 LOT SIZE: 13740 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS ISSUED TO ALLOW THE EMERGENCY INSTALLATION OF A 1,250 GALLON SEPTIC TANK ONLY. THE TANK WILL BE BLIND FLANGED AT THE OUTLET AND WILL SERVE AS A TEMPORARY HOLDING TANK UNTIL THE LEACH FIELD IS UPGRADED OR UNTIL A PERMANENT HOLDING TANK IS INSTALLED. THE WASTEWATER DISPOSAL SYSTEM MUST BE UPGRADED BEFORE JUNE 15, 1992. DATE: S & S ENGINEERING 17034 Eagle River Loop Road No~ 2~ Eagle River, Alaska 99577~ t~ MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 011-072-05 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: be C o 0 � I 1. GENERAL INFORMATION Complete legal description Rolling Hills Estates Sub, Block C Lot 7 Location (Site address) 7331 Bailey Dr, Anchorage, AK 99502 Current property owner(s) Mailing address Real estate agent Kristen Kristen Gilbert & Cesar Sierra Day phone (907)229-7861 7331 Bailey Dr, Anchorage, AK 99502 2. TYPE OF DWELLING: ❑® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑� Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -5 Date of Payment I 021 Receipt Number. Q 11( 5b COSA # OsG Z 115 3 7 - Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 8/25/2021 TH 6. DSD SIGNATURE System #1 Approved for 4 bedrooms BenjarrynSchiller System #2 Approved for bedrooms �����is�F , X8/25/21 Ar� Disapproved ���® PRROOFFEESSSVO Conditional approval for bedrooms, with the following stipulations: By: 7:rn gWyn c Original Certificate Date: Y/7a02 I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet kin g WA VO �..� PROG�`A By: 7:rn gWyn c Original Certificate Date: Y/7a02 I The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Rolling Hills Estates Sub, Block C Lot 7 011-072-05 2.6 Pre 1971 79+* >40* ■ ■ 16 Forge Engineering 5/24/21 77 8/25/21 *Well measurements from 2014 COSA NEW Septic/HDPE ■ Deep Trench 5/28/92 6/2/21 ■4 11.4 0 5.2 644 17 ■ 1440 6.2 0 >600 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S 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. 8/25/21 85*80** ✔ ✔ ✔ ✔ ✔ ✔ 56**✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ 70* *WR920021 ** WR959985 ✔ 2 Z5 m 0 02— .000 0 M 0 E (D Cl) a) Cl) C� 0 0 A 14 a) ca a c 0 x w Ln C? cq r� 9 'All LO 0 LLj U) w 0 cf) U) z CD Z LLI 0 m z co 0 0 < U) 0 c LL (a z a) a) c LU -a Z W 0 0 0 L) —1 m C a) c 0 Q. 0 U) 0 F - w U) r 3: 0 a) CIL 0 P W w z 0 z LL c >1 m CL 0 0 �w E :3 z a) > 0 1 (D 1A 0 0 m (D 2 a. 2 E rr 1 cc a) U- CL Z > 0 (D 4t Lij El El M El C: 0 < af 0 0 _I_— a- L) a) 0 - Q 0 Q w C) >1 ca ca Z� :e� :3 U) U. 0 E E o —: w o -CDI m El El E] 11 E co LL CD a) 0) 0 (L c 0 0 cm Q) 0) -J (0 ui U- 0 4) LU m LU 0 L>) CD a) LL. 0 I m LL Z 7S LL E D :3 D < 0 LU 0 72 72 E o v Lu LU El El El LU CL > > E 0 (D >(L S C) F- z C -i w z 0 z LL c >1 m CL 0 0 �w E :3 z a) > 0 1 (D 1A 0 m (D 2 2 E rr 1 cc a) U- CL Z > 0 4t < 0 < af 0 0 as L) a) 0 - Q 0 Q w C) 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 7; Block C; Rollin~ Hills Estates , LoCati~3n (site address or directions) 7331 Baile~ Drive Anchorage, AK prOPerty owner ' Allan & Wend~ Rusenstrom Day phone Mailing address 7331 Baile~ Anchora,qe~ AK 99502 Lending agency . Day phone Mailing addr. esS Ag~nt '~' Day phone 248-6388 Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XXX Community well NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 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 invest_tgation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & $ ENGINEERING Phone 17034 F. agio River hoQp Road No. 204 Add ross Eagle Rl~err AI~_.~I,~ 99.577 // Engineer's signature ~'~/~// ~ Date '~/ /,!/~ T-- DHHS SIGNATURE / ~ Approved for / Disapproved. Conditional approval for bedrooms. 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. 72-4325 (Rev, 1/91 ) ~act( MOA ~1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4-ff44 Health Authority Approval Checklist LegalDescription:LOr' 7 Bt-ac C t~o~u~C tt,~S ¢~P"'arcelI.D.: 011 -- 0~12 -co $-- A. WELL DATA Well type Ia 'et ~ ~ ~'r C If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/~ t,t 0 Date completed /3 ~tc ~,~ 4~ /o/~ / Total depth '-/ q t 4~ Cased to t4 0 ~ ~'~ Casing height (above ground) I 4-- Sanitary seal (~N) FROM WELL LOG AT INSPECTION Date of test Static water level Ct Well production bi O g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate O, I Other bacteria O Date of sample: ~( / 7/ *1J"- Collected by: ~ z~: 5 B. SEPTIC/IIOL-BIN~ TANK DATA Date installed ,-C/)~ff/~/2 Tanksize ]7)..3~0 Number of Compartments ~ Cleanouts(,~q) Y~; 3 Foundation cleanout ~/N) Vt ~ Depression (Y/~ /d 0 High water alarm (Y/~ tv 0 DateofpUmping ~"/jt~.~j~ Pumper ll i ~ 4. t... i .f t ~ t,~ d~ ,O.4.4-t d C. ABSORPTiON'FIELD DATA Dateinstall~d ~-'//~/~ Soilrating~rfiZ/bdrm) 0'z'/~' Systemtype T/~t~el Length Id 0/ /4 q ~ 1[ I ;3 Wid,h ~, S- Gravel thickness below pipe Total depth Effective absorption area7' [~ ~o Yq Monitoring Tube present(l~/N),yt$ Depression over field (YIn) a/0 Dateofadequa~teSi g / ~ /~ ~' Results a~ail) f~ S J For g bedrooms Fluid depth in absorption field before test (in.); Fluid depth~- l~ Minutes later: ~' t6 Peroxide treatment (past 12 months) (Y/I~ Immediately afterTq ~ gal. water added (in. (in.) Absorption rate = '~ ~ ! 6 g.p.d. If yes, give date Do ~4UNICIPALI IY OF ~.NVIRONMENTAL .SERVICE~ DIYI~IOJ~J LIFT STATION% Date installed ~ Size ill gallons · ,.. i...~., i- i v.i., i~, Manhole/AcCess (YFN) High water alarm level at* /'/*Datum Cycles test~_~/~/ E. SEPARATION DISTANCES "Pump oiT' level at* Fo SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/ho~ tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots Public sewer manhole/clemiout Lift station SEPARATION DISTANCES FROM SEPTICglOLDiNG TANK ON LOT TO: Foundation ~-0 ! Property line I ~ Absorption field Water main/service line 4--- Wells on adjacent lots q a~t./_ Surfacewater/drainage /00 / / o~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / o rp_ Water main/service line ~o Surface water 7 0 'P Driveway, parking/vehicle storage area Curtain drain ~ ~ ~ ,L /4 ~0 w .u Wells on adjacent lots ] O O t -/" ENGINEER'S CERTIFICATION 1 certify that I have determined thrufield inspections and review of Municipal recor~e systems are in conformance with MOA b[2L4~ouidalinesJ~ effect on this date. Signature ~~-~_.--~ EugineersName ~0~ ('. ~Ow~ Date ~ ltl FW 5~ ................................................................................. ~:~: ...... ~' ~ .... Receipt Number //~~ Receipt Number Rev. 8/95 OSS: haa.wk.doc 08×10×95 16:02 COMMERCIAL TESTING ~ 90?6941211 NO. 10B Q02 ordered ~y BOB COWAN~ Printed Date 08/10/9S ® l~i~ hrs- ProJec5 Name Collected Da=e 05/07/~5 ~ 22t00 hrs. Project8 Received Date 08/08/95 ~ 12:00 h~s. PW~ID UA T~¢hni=al Dire=t~r STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: BO~ ~. QC Allowable Ext. Anal Parameter Results Q~al Unite Method Limits Dat· Date Init N&trate-N 0.10 U m~/L EPA 353.2 10. 08/09/95 CMR ~ee ~pe~al Ins=ruc~ione Above UA - U~avallable See Sampl~ Remarks Above ~A - ~ot A~lalyzed Secondary dll~lO~. GT = Greater ~an 200 ~. Po~ Dr~ve, A~ho~a~e, AK 99~ 8-~ ~O~ -- Te~ (907) 582-23~3 ~ax~ (907) 55~-5801 ENVIRONMENTAl. FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOURI. NEW JERSEY. OHIO. WEST VIRGI.N[A 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # 1, GENERAL INFORMATION Complete legal description Lot 7; Block "C"; Rolling Hills Estates Location (site address or directions) 7331 Bailey Driv~ Property owner Mailing address hon 243-1866 Wayne H~nd~rson Day p 7331 Bailey D~v~, Anchorage, Alaska 99502 Lending agency Mailing address Day phone Agent Anita DeSouza TOTEM REALTY 724 ~ast 15th Av&nu~ Address Anchora,q~, Alaska 99501 Unless otherwise requested, HAA will be held fo'r pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well XX Community well Public water 212-0511 Day phone 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: If community wastewater system, provide written confirmation from State AD£C 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 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 Address Engineer's signature 17034 Eagle River Loop Road No. 204 Ea~ie River, Alaska 99577 DHHS SIGNATURE ~'~ ~/~?~ X/~ Approved for bedrooms. Disapproved. Conditional approval for Phone Date 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 independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lendin, g institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 HEALTH AUTHORITY APPROVAL CHECKLIST ~'/~ Parcel I,D. A. WELL DATA Well type ~'~[Ol'w'~ Log present (Y/I~ Total depth Sanitary seal ~yN) If A, B, or C, attach ADEC letter. ADEC water system number .)'X~c~ru~ Date completed ~-~_,,FOi'L~ Ic~ ~( Driller --~c~ ¢ ~, Cased to /-~0 '~' Casing height F~.~5 Wires properly protected (~N) yE~S FROM WELL LOG AT INSPECTION Date of test (,~/~J (~.uFH (_ ,','~.'~_e] "L Static water level ? '~z ~ Well flow ~/ g.p.m. ~'r--oi__~ ~l '1c Pump level · ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ ¢ ; On adjacent lots Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform ~-~ Date of sample: Nitrate ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: '+ Other bacteria B. SEPTIC/HOLDING TANK DATA Date insta,ed Cleanouts (~N) High water alarm (Y/~__~ Date of pumping Tank size I _~ ,~')C~ ~ Foundation cleanout (Y/N) ~.) o . Alarm tested (Y/N) ~-~(¢' Pumper SEPARATION DISTANCES FROM SEPTIC/tlIII~II~FANK TO: ~ , Well(s) on lot ~' On adjacent lots ~00 To property line l~ ~ Absorption field lO ~ /00 % Compartments Depression (Y/~) Surface water/drainage Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE ate lied ~/~-J" Manufacturer ~'i~'i'i~ _ Manhole/Access ~~''''''''~ ---~~lat ~ "Pump off" VentHigh (Y/N)water alarm level ~><~/~ Cycles tested level at Meets MOA electrical co~ ~ ~y. et~dn lot On adjacent lots Surface waterF'"~.~ D. ABSORPTION FIELD DATA Date installed Length 8~' Width Total absorption area Depression over field (Y/~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/~) Soil rating 0,/~ Gravel thickness Cleanouts present (~N) Date of adequacy test for System type Total depth If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IOC~ On adjacent lots [00 /' Property line To building foundation ,~ 4~ To existing or abandoned system on lot ~.s~-~,~~. P~z ~ Io' On adjacent lots / --~ ~' Cutbank ~-~/A Water main/service line Surface water ~['O t ~ Driveway, parking/vehicle storage area ~/'/' Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ' 17034 Eage R~ver Loop Road No. 2~ Signature Eng nears Name Date ~ --~ ~ HAA Fee $ ~ Waiver Fee: $ Date of Payment ~/~ /~ Date of Payment Receipt Number Receipt Number PROJECT: 17034 Eagle River Loop Road ~:agle River, Alaska 99511 ROSERTA. SHAFER CIVIL ENGINEER 694 2979 DATEO TEST: WELL DEPTH; .-~,~/.~_ FT, CASING: DATE DRILLING COMPLETED: C~ K STATIC WATER LEVEL (Top of Casing):, .'~77l ~ /"~ FT. SCREEN: DRILLER: LIt t(. FT. DATE: ~-,~-~3- c~ ~ CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWN/ PUMPING TIME PUMPING STARTED/ STOPPED, MIN. WATER, FT. RECOVERY RATE, GPM REMARKS :~ 35 ~7', O 5'~% 9o ~' o ~ I :~ 120(2hours) ~ 0 : t ~,1 ~ 18013 hours) ~' ~ ~ I 5,1 ?~ 240(4hours) ~(~ ~ ~ I ~, I RECOVERY t 0 0 5 I0 15 20 25 30 35 / Comments: ~/~/t~L~ 'i~1'~P0 ~ ,~ /~/~/, OF~ ~"-, I ~FA// Flow is not Guaranteed SiJbsequent Variations Can Occur,. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 AHAL¥SIS RESULTS for INVOICE t 52139 Chemlab Ref.# 92.1140 Sample # 1 Matrix: WATER Client Sample ID = L7 SC ROLLING HILLS ESTATES S/D PWSID : UA Collected : MAR 23 92 Received : M~R 24 92 ~ 15:15 hfs, Preserved with : AS REQUIRED Client Name :S & S ENGINEERING Client Acct :SHSEHGP E?Ot : Req$ : Ordered By : PO# :HONE RECEIVED Analysis Completed : MAh 25 92 Sand Reports to: Laboratory Supervisor : STEPHEN C. EDE 1)S & S ENGINEERING Released By : /7 2) Parameter Results Units Method Allowable Limts NITRATE-N ND(O.iO) ~g/1 EPA 3S3.2 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: 1 Tests ?erformad * See Special Instructions Above UA-Unavailable ND- None Detected *' See Sample Remarks Above NA= Not Analyzed LT-Less Than, GT-Greate~ Than ~SGS Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE # 54130 Chemlab Ref.# 92,2354 Sample # 3 Matrix: WATER FAX: (907) 561-5301 Client Sample ID : L7 B C ROLLING HILLS Client Name :S & S ENGINEERING PWSID : UA Client Acct :SNSENGP Collected : FAY 27 92 @ 08:00 hrs. BPO# : Received : FAY 28 92 @ 10:45 hrs. Req# : Prose[red with : AS REQUIRED Ordered By :R. SHAFER POW :NONE RECEIVED Analysis Completed : FAY 29 92 Laboratory Superyjso, r :,JTEPHEN C. EDE Relea.ed By : ~~. ~ Send Repo[ts to: lis ~ S ENGINEERING Parameter Results Units Method Allowable Limits NITRATE-N ND(O.iOJ n~/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: 1 Tests Performed ' See Special Instructions Above UA-Unavailable ND= None Detected '* See Sample Remarks Above NA- Not Analyzed hT-Less Than, GT-G~eater Than Member of the SGS Group (Soci0tb Gbn~rale de Surveillance> '"REATER ,~NCHOR.AGE AREA BOROUGH HEALTH DF.P,aR1]~NT 327 E~GLE STREET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVED INSPECT: '~: / TIME:-~-~"> REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES FOR Approval Requested By, Address Phone :' w 41~ ' '~ ...... ~ ~, · .~/../,.~ / Property Owner Z'~/) Legal Des cript ion~,~/~? Type of Facility to be Inspected Number of Bedrooms... Well Data: D Construction_ E. Bacterial Analysis ~ Sewage Disposal System: Septic Tank (If homemade, show diagram on back) 1. Size $, ~anufacturer /~,//f/~'~., 4. Installer /5~/2~ Approval Request for S( '? ~ Water Facilities page Two Seepage Pit /c//~f Size ...... 2. Lining ' C. , Disposal Field 1. Number of Lines 2. Total Length 7. Required Measurements A. Well to Septic Tank ~3~:::~' ~ / B., Well to Seepage Pit /~ C. Well to Sewer Line ~ '::~ D. Well to Property Line E. ~ell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property 8. COMMENTS: DAT c / DATE: ~PP .... LID FOR O~E YEAR FROH DATE SIG~ED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 £ATER ANCHORAGE AREA BOROUGH ?~EAL~i DEPARU~ENT 327 EAGLE STREET ANCHORAGE, ALASKA 99501 279-2511 DATE RECEIVED INSPECT: REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE /hND WATER FACILITIES FOR 1. Approval Requested By Address_ 2. Property Owner .~ ~. Legal Oescription~/7~q 4. Type of Facility to be Inspected. Number o~ Bedrooms .... 5. Well Data: A. Type B. Depth_ C. Size D. Construction,(~/_~/~;~__~L E. Bacterial Analysis 6. Sewage Disposal System: ~" A. Septic Tank (If homemade, show diagram on back) 1. Size 2. Age 3. ,',~anu£acturer 4. installe Ap/zroval Request for S~ ~ Water Facilities Seepage Pit ~--~/~ ~' i. Size 2. Lining 1. Number of Lines 2. Total Length Required Measurements A. Well to Septic Tank B.. Well to Seepage Pit C, Well to Sewer Line D. Well to Property Line,, E. ~ell to Other Possible Contamination F. Foundation to Septic Tank G. Foundation to Seepage Pit,,,~7~ /~'~//~X- H. Seepage Pit to Property Line CO~4ENTS: APPROVED: DATE: APPROVAL VALID FOR ONE YEAR FROH DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT EDll70 26, 1971 ~s. Carolyn Ward Professional Realty 133 West Fire-ced Lane Anchorage, Alaska 99503 Well Supplying Water to Lot 7, Block ¢, Rolling Hills Subdivision. Ken Millet, ~wner. An inspection of the evb}oct lot revealed that ~ha well was For our dep~rtmnet's approval of the well the well casing will need to be extended above the ground. Temporary approval can be ~iven, pending the aecra~ of funds to upgrade the well. if you have any questions, regarding the above do not heeitate to contact this office. Sincerely. Lynn $. Coad ky cc= Mr. Ken Miller