HomeMy WebLinkAboutROLLING HILLS ESTATES BLK D LT 4
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Waste~wate. r Disposal System and/or Well Inspection Report
Permit Number: ,.~,-/*-~}~;~c'J'O' PID Number:
Name:~1 t114~ P, ~[~ WastewaterSystem: ~New ~Upgrade
~.d~: 53 /~ ~. ~5 ~v~ ABSORPTION FIELD
No. of BeSoms;
Phone: ~ ~ j~ ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other
BIockALlivisiONon ~ Total Depth fr~ ~riginal grade:
LEG DESCRIPTI so, Rating: · ~ GPD/Sq. Ft.
Lot: ,, DC: Subd''' ~ ~epth to pipe bottom from original grade: Gravel depth beneath pipe
Township: Range: ~ Section: Fill added above original grade: Gravel length:
I
I
I
D New ~ Upgra~~ Graveld~:~~~
WELL:
Number of lines:
Distance between fines:
Classification (Private, A,B,C): T~ Cased To: Total absorption area: Pipe material:
/ ~ Drilled: Ft. Ft. I,~ I ~ SQ. Ft. Date installed:
Driller:
Static Water Level: Installer:
~Yield~ GPM Pump Set at: Ft. Casing Height Above Ground:Ft. ' TAN K
SEPARATION DISTANCES ~septic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding 3ublic/Privete Manufacturer: Capacity in gallons:
From Tank Field Station Tank ~ewer Lines ~¢~
Material: Number of Compartments:
we,,++
Surface
, Water JOe+ IO~+ ~ ~t¢~+ LIFT STATION
Lot~ ~
Line BO4 JO* leO+ Size in gallons: Manufacturer:
"Pump on" level at: " " : water alarm at:
Foundation ~O 5~~ }~ ~ High
Curtain ~Electrical Inspections performed by:
Remarks: ~ ~mK ( ~zS~) BENCH MARK
~J ~ Fl J~/ ~ I~ ~ ~ Location and Description:
I ' Assumed Elevation:
Inspections performed by: ~ ~ ~ Dates: 1st
Department of Health and Human Services approval
72-013 (1/91) MOA 25
Permit No. 5INI~/~10
1 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:545-zW44
On-Site Wastewater Disposal System end jar Well Inspection Report
Legal Description Lot 4 Block D Rolling Hills
PID No: 01107~7..8
SEPTIC
W, 75 rd AVE
XiSTiN~XI TING
5
SEPTIC
EXISTING
WELL Q
SITE MAP
1"=100'
EXISTING
WELL Q
~LA I SW HOUSE CORNER ELEV=IO0'O I
Bbl B SE HOUSE CORNER
BM A BM B
IH
IH
ASB U LT
~/29/~
Permit_ No. ~I~I~ Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:345-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description Lot 4 Block D Rolling Hills PID No:~
~ ' DECK
PROPOSED EXISTING SURFACE~ = NOTES
~ ] ~ ELEV:92,5 1. CONT~CTOR TO VERIFY MiN. SQ. FOOTAGE
2. CAUTION SHALL BE TAKEN TO MINIMIZE
REMOVAL OF EXISTING VEG~ATION OUTSIDE
OF SEPTIC AREAS.
3, D~STURBED AR~ SHALL BE SEEDED TO
4, NO WELLS. SURFACE WATER. O~ CURTAIN
EL~=86.B B.P. DRAINS WITHIN ~00 ~ OF NEW
ELD=86,3 L ~ 5. SYSTEM TO BE INSTALLED A MINIMUM
~.~~2o ' ' , ~. ~ ~ ?'~, ~ y.. ~ '?'. '.~¢.~ OF I0 FE~ FROM PROPER~ LINE.
~. ALL CONSTRUCTION SHALL CONFORM TO M.O*A.
~ I. .I & O.H,H.S. STANDARD SPECIFICATIONS.
DONE IN THE SPRING OF 1993,
ABSORPTION SYSTEM CROSS SECTION
1"=6'
.~, ~ x ~ ... ~ ... ~,~
~ ~ .. ....~
~......... tt.e~ -~.. ......... .'
ABSORPTION SYSTEk p,n&.pH
HORIZ 1"=20' VERTICAL '~6' ~,~'
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:SW920410
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:FIELDING WILLIAM D &
OWNER ADDRESS:5316 W 73RD AVE
ANCHORAGE, ALASKA 99502
DATE ISSUED: 12/09/92
EXPIRATION DATE:12/09/93
PARCEL ID:01107228
LEGAL DESCRIPTION: ROLLING HILLS ESTATES BLK
LT 4
LOT SIZE: 50000 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD 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 (18AACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
F
ENGINEERS · ARCHITECTS · SCIENTISTS · SURVEYORS
December 2, 1992
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, AK 99501
Re:
Septic System Approval
Lot 4, Block D, Rolling Hills Est.
Attached is the permit application for a septic system upgrade on the above referenced lot.
Below is a narrative of probable impacts to adjacent properties.
1. .Wells - There are no existing wells within 100 feet of the proposed new septic system.
Wastewater System - No existing on-site wastewater systems are located within 100 feet
of the proposed well on this lot. The proposed well/septic system will not adversely
affect the development of system on the adjacent lots.
Reserved Space - Additional area is available to the north east of the proposed field.
Separation distances to adjacent wells will be maintained if the future field is developed.
Drainage - The lot gradually slopes to the south. Positive drainage away from the field
will be maintained. No concentrated surface water will be directed toward the field and
no existing streams are within 100 feet of the proposed field.
The installation of this on-site system will have no adverse impacts to adjacent well or septic
systems.
Very truly yours,
CSM:MLT: 1110-0026.048
KEVI~Llfl'iEBN ER
SEN/OR CIVIL ENGINEERING TECHNICIAN
301 ARCTIC SLOPE AVE., SUJTE 200· ANCHORAGE, AK 99518-3035
(907) 349-5148 / (907) 267-6250 · FAX (907) 349-4213
301 ARCTIC SLOPE AVENUE, SUITE 200 · ANCHORAGE, ALASKA 99518-3035
ASCG
Calculations
System Calculations for Lot 4 Block D Rolling Hills Est. 01-Dec-92
Page 1 of 1
Tank Size l Z.. 5 43 ~j a I.
Existing Tank.~o ~ ~|~-5~_'~1~d ' ~./1~ ~n
Absorption Field Sizing
Using an acceptance rate of 0.4 gal/SF/day
and a daily load for 4 bedrooms of 600 gal/day.
Req'd Absorption Area -- 600 gpd / 0.4 gpd per SF -- 1500 SF
System Dimensions
63.0' X 24.0' = 1512.0 SF
The laterals are to be spaced 6.0' apart and 3.0' from
edge of the bed.
Permit No.
1 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:345-¥744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description Lot 4 Block D Rolling Hills
PID No:
W. 75 rd AVE
XtSTiN~XI TInG
/ELL ~VEI~L ~
,
BM A BM B
SITE MAP
1"=100'
5
]SEPTIO
Permit No.
Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box lg6650 Anchorage, Alaska gg51g-6650 Telephone:S43-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal DescripUon Lot 4 Block D Rolling Hills PID No:
PROPOSED EXISTING SURFACE~ i= NOTES
F .... ~/ 1, CONT~CTOR TO VERI~ MIN, SQ. FOOTAGE
PRIOR TO P~CING TOPSOIL,
2. CAUTION SHALL BE TAKEN TO MINIMIZE
REMOVAL OF EXISTING ~G~ATION OUTSIDE
~. OF SEPTIC AREAS,
3, DISTURBED AR~ SHALL BE SEEDED TO
~, NO WELLS, SURFACE WATER, OR CURTAIN
DRAINS WITHIN 100 ~ OF NEW
~ ABSORPTION SYSTEM.
-- ~}?'~?~ X' ;;Z;Z Z Z' ZZZ'Z Z'~Z 'Z ' ~ Z~Z];.ZZaZ~Z!"'~ 5. SYSTEM TO BE INSTALLED A MINIMUM
6. ALL CONSTRUCTION SHALL CONFORM TO M.O.A,
I ..... ~ * D.H,H.S, STANDARD SPECIFICATIONS.
ABSORPTION SYSTEM CROSS SECTION
PROPOSED
ASCG
SOH$ LOG- PERCOLATION TEST
PERFO~ FOR: ACREAGE SYglEM~, INC.
LEOAL DF. SCRIP~ON: LOT 4 BLOCK D ROLLING
EST.
TWSHP, RNG, SCTN SW I/4,SEC 3,T.12N.,R.4W SM
DATE PERFORMP. lr3: 10NOV92
DEPTH
TEST HOLE 1 SLOPE
DESCRIPTION
-- BM [ HOUSE CORNERA SW
OROANICBM 8 SE HOUSE CORNER
FILL eM A BM B
TH
TN
IH
SANDY
/SILT
PERK TE3T
-- BOTTOM HOLE
WAS GROUND WATER
ENCOUN2EREU? N
IF YES, AT WHAT DEFr~
DEPTH TO WATER AFTER
MONITORING? -
SITE PLAN
DATE: 19NOV92
GROSS NET DEPTH TO NET
NO. DATE TIME TIME WATER DROP
1 I 0NE]V92 17:10 0 rain 7'-0,0' -
2 I7, 15 5 mia 7'-0.8" 0,8"
3 17:20 10 mln 7'-0,6" 0,6"
4 i7:25 15 mln 7'-0,2" 0,3"
5 17:30 20 min 7'-0,2" 0,3"
6 17:35 25 min 7 '-0,2" 0,3"
7 17,40 30 min 7'-0,2" 0,3"
10 ....
PERCOLATION RATE 20.0 (M]N/INCI-I) PERC HOLE DIAMLrrER 6.0'
TEST RUN BETWEEN 7-0.0- FT AND 7-6.0' FI'
COMMENTS: PERC HOLF~ WERE PRE-SOAKED FOR FOUR HOURS PRIOR TO TESTING
PERFO~ BY: ERIC GROPP / CAREY MEYER CERTIFY THAT THIS TEST WAS PERFO~ IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDFI.INE~ IN EFFE(Tr ON THIS DATE: 10NOV92
ASCG
SOIl51 LOG - Pi RCOIATION TEST
LEGAL DESCRIPYION: LOT 4 BLOCK D ROI.LING HIIJ
EST.
TWSHP, RNG, SCTN SW 1/4,SEC 3~T.12N. J~W SM Al(.
DATE PERFORMED: 10NOV92
0-
1--
2-
3-
DIAVI'I-I
on.r) TEST HOLE 2
DESCRIPTION
BMA ISW HOUSE CORNER
__ ORGANICBu B[SE HOUSE CORNER
BM A BM B
TH 1~-
'CH 2
-- SANDY SILT TH 3
TH 4,
-- SANDY SI~
~C
HO~
BOTTOM
WAS GROUND WATER
ENCOUNTERRr~ N
IF YES, AT WHAT DEPTH?
DEPTH TO WATER AFl'ER
MONITORING? -
SITE PLAN
GROK~ NET DEPTH TO ]qET
NO. DATE TIME TIME WATER DROP
1 i 0NDV92 I7:13 0 m;n 8'-0,0" _
2 17:18 5 mln 8'-0.3' 0.3"
3 17:23 10 mln 8'-0,3" 0,3"
4 17:88 i5 min 8'-0,2" 0.2"
5 17:33 20 min 8'-0,~" 0,2"
6 17:38 25 min 8'-0,;::>'' 0.2"
7 17~43 30 m;n 8'-0.~' 0,~"
10 ....
PERCOLATION RATE 26.7 (lVl]N/INCH) PERC HOLE DIAMETEA 6.0'
TEST RUN BETWEEN g-Off FI AND 8'--6.0" FI
COMMENTS: PERC HOI.Fg ~ PRE-SOAKED FOR FOUR HOURS PRIOR TO TESTING
PERFORMED BY: EPIC OROPP / CAREY MEYER CERTIFY THAT THIS TEST WAS PERFO~ IN
ACCORDANCE WITH Al,l, STATE AND MUNICIPAL GUIDF, IJNF_S ]lq EFFECT ON THIS DATE: 10NOV92
ASCG
SOILS LOG-
PERFORMED FOR:
LF.~AL DESCR1FrION:
TWSI-IP, RNG, SCTN
DATE PERFORMED:
PERCOLATION TEST
ACREAGE SYSTEMS, INC.
LOT 4 BLOCK D RO! JJrNG I-m .I.~
SW I/4,SEC 3,T.12N.,R~W SM AK.
10NOV92
6-
8-
9-
10-
Il-
12-
DEPTH
TEST HOLE 3
DESCRIPTION
BMAB sESW HOUSE CORNER
BM HOUSE CORNER
BM A BM B
IH
IH
TH
SLOPE
~LT
WAS GROUND WATER
ENCOUNTERED?. N
IF YES, AT WHAT DEPTH?
DEPTH TO WATER AFTER
MONITORING?
DATE: 19NOV92
SITE PL,~
14-
15-
16-
17-
18- HOLE
BOTrOM
GRO~ NET DEPTH TO NET
NO. DATE TIME TIME WATER DROP
1 1 0NE]V92 - 0 m; n -
l0 - - -
PERCOLATION RATE ERR (MIN/INCH) PERC HOLE DIAMETER
TEST RUN BETWEEN - Fr AND - Fr
COMMENTS: PERC HOLES WERE PRE-SOAKED FOR FOUR HOURS PRIOR TO TESTING
PERFORMED BY: ERIC GROPP / CAREY MEYER CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNI~ GUIDF, LINES IN E, FFF. C~ ON THIS DATE: 10NOV92
ASCG
SOILS LOG - PERCOLATION TEST
PERFOP, MI:~ FOR: ACREAGE SYSTEMS, INC.
LEGAL DESCRIFrION: LOT 4 BLOCK D ROLLING HlI.l.q
TWSHP, RNO, 8CTN SW 1/43F. C 3,T.12N. Rq'W SM AK.
DATE PERFORMED: 10NOV92
TEST HOLE 4 SLOPE
DESCRIPTION
BM A [SW HOUSE CORNER
ORGAF0~I e/SE HOUSE CORNER
BM A BM B
IH
SILT TH
TH
HOLE,
BO'rlDM
WAS GROUND WATER
ENCOUKIERED? N
IF YES, AT WHAT DEPTH?
DEPTH TO WATER AFFER
MONITORING?
SITE PLAN
DATE: 19NOV92
GROSS NET DEPTH TO NET
NO. DATE TIME TIME WATER DROP
1 10N[3VgP - 0 m ln - -
3 ....
10 - - -
PERCOLATION RATE ERR (MIN/INCH) PERC HOLE DIAIVlETER
TEST RUN B~EN - Fl' AND - FT
COMMENTS: PERC HOLES WERE PRE-SOAKED FOR FOUR HOURS PRIOR TO TES'riNG
PERFORMED BY: ERIC OROPP / CARRY MEYER CERTIFY THAT THIS TES~ WAS PERFORMF~ IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDIEIJNES IN EFFECT ON THIS DATE: 10NOV92
i~ MUNICIPALITY OF ANCHORAGE
¢ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 254-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT
NA/~E IP_H°NE / KEW
U~J 1~1 NG ADDR ES~.. -
'' DISTANCETO:~~ Materia, ~
~ Manufacturer ~~ Liquid No. of compare'ts depth
~ ~ Liq, c~t~gallons IF HOMEMADE: Inside length Widt
~ DISTANCE TO: Well ~OO f' ~ Foundation~ / ~ Nearest Iotlin~¢~ PERMITNO~
~o. of I'nes/ ken,th ~hfiine To'al le~t~l'nes Trench ~h Distance Bet~~~
--~ inchas
~ ~ Top of tile to finish ~rade __ ~ ~ Material beneath tile
~ ~ ~ lotal effectiw absorption area
~ Type of crib ~
~ ~~ Well B~l~g f~n~i~ N~r~t
~ ~lass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MA~[RIALS ~ /~
801L TEST ~ATI ~
INSTALLER i · t
A DATE LEGAL
PERMIT NO.
AF'PLI_.HNT ANNA FIELD. lNG
DEPARTMENT O~ HEALTH AND EN',,,'IRONMENT~~ 3~ECTiON 825 "L'" STREET., ANCHORAGE., AK. ~501
~,4-4, ~0
Old.
LOC:AT I ON
LEGAL
TYPE OF S ' 'cF '' ' .-.
-OIL HB-,JRFTIUN SYSTEM I=,. TRENCH
LOT SIZE
MAXIMUM NLMBER OF EEDROOM=, = 4 SOIL RATING (SQ FT,.'BR)=
M~ ~'- IS
--ABSORPTION :
THE REQI.IIRED :,I~E OF THE _,OIL z--;~ ~
[:~E~TH= ~ LE[-~GTH=
.=0000 SQLIRRE FEET
~t~ 6RR"..."EL DEPTH= 4
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND TNE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FO~ TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAYEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE E~CBVATION (IN FEET).
F-,:E~;.~LI ~r RED, SEPT ][ ,-: TRI'-.II<: S I ZE= 2L25LZ-! L3RLLC, I'4S
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL '-SERVE.
T l..-I,D ~:~-':' -':" ! I%ISP Eg-t T I ,Df-tS FIRE RE,_~LI I REI]~
BACKFILLING OF ANY
_,~_,TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE .... SI IB,IEF:T TO FRU_,ECUTION.' "---" ·
MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SENRGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIYRTE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS. ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'ER~,I I T E~-::F' I F-:E="]. [)EE:Er. IBER _---::.1..
I CERTIFY THAT
:L: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPRLIT'T' OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
R~ I CANT RNNR F I ELD I ~ ~ x
....,
I :,=,UE[. AT V4. 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6-650, Anchorage, Alaska 99502 276-2224
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PEREORUEDFOR: g(/'LL~^H 'D
LEGAL DESCRIPTION:
6
7
8
9
10
11
12
13
14-
15-
17-
18L
19"--
20'
~ L-OC.L~ D
H I-'l I:1 L.L
~o~
COMMENTS
PERFORMED BY:
SLOPE
SITE PLAN
ENCOUNTERED? J\l C)
IF YES, AT WHAT
DEPTH?
P~---'l-', .... t'-'I i i ~ t
Gross ~j,jV~ Net Depth to Net
Reading Date Time Time Water Drop
t:/¢ ~- /o i~(¢) 7~/
¢:~ ~7~- ~o /~ ~7~
PERCOLATION RATE
TEST RUN BETWEEN I-/
CERTIFIED BY:
(minutes/inch)
BOX ~3(~9~ S?AR I~lOIJ?l~ A At~CHORAOI~, /~lkLASKA 9~)~0~
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF_ ~7_0.00 PER FOOT.
PROPERTY OWNER ~-
LOCATION OF WELL SITe
DRILLEI B~J'~ ~
Coog oZ ged. L: $2470,00
CodZ o~ Ued. L Sead.: $22,50
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF//'~' ~''-- --~ ,~4*,.~2e&U '~
THANK YOU VERY MUCH.
DATE_
S¢i~c 7~o,~, 1~]80
BERN;
US"OF RAMPART DRILLING WORKS
Parcel I.D. #
1.
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
GENERAL INFORMATION
Complete legal description
/6
Location (site address or directions) .~'~ / (,. iv'.
Property owner I~v/~l(/,'~"/ ~ .
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ,-¢ .i
TYPE OF WATER SUPPLY:
Individual well
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:
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.
Name of Firm /~ .~ C ~ l~c., Phone '2.-~7 -~-z~ E)
Address ~l A~t~ ~]o~ ~¢~, ~o~+~Z~ ~, ~ ~1~
Engineer's signature ~ Date ~_5/'z~/
6. D.HI~lS SIGNATURE
/fi~'~ Approved for
Disapproved.
Gonditional approval for
bedrooms.
bedrooms, with the following stipulations:
By:
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-O25 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /---¢~'/-- z/~.~Z, /'~o//t,~J~' ~//"~5 ~----L"-~'TL..Parcel I.D. ~ j ~D ~ ~
A. WELL DATA
Well type ~¢~ d~ If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) X/ Date completed -~ ~ /~Driller ~F~
Totaldepth I ~ 4:~'
Sanitary seal (Y/N) b~),~
Casedto~ [~o~ ~,~
- ~
FROM WELL LOG
Casing height
Wires properly protected (Y/N) Y~
g.p.m.
AT INSPECTION
{~. O g.p.m. <
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
.+.
Septic/holding tank on lot
Absorption field on lot I~,~
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
/.
Coliform (,J d Nitrate ~'
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Cleanouts (Y/N) '~ Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping /",/~- ~.~ )
Compartments
Depression (Y/N)
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot I I ~ -j- Onadjacentlots
To property line ,~'0''P Absorption field
Surface water/drainage
Foundation__
Water main/service line ~ 42
72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level ~
Meets MOA electrical code~
SEPARATION DISTA~FROM LIFT STATION TO:
Well on lot ./ On adjacent lots
Date installed IS-ZZ~ I~."Z.~'~.. Soil rating
Manufacturer ~
Man.N)
"Pump off" level at
Cycles tested
Surface water
//Width
, System type ~'-D
~ ~/' ~'""-G ravel thickness
Length
Total absorption area
Depression over field (Y/N) ~'--Jo
Results (pass/fail) ~IE~
Peroxide treatment (past 12 months) (Y/N)
Cleanouts present (Y/N)
Date of adequacy test
for
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I ~ O
To building foundation
On adjacent lots I ~
Surface water /~ ~
Curtain drain [ ~
· H- -P
On adjacent lots I ~.4Z) Property line ] 1
-P' To existing or abandoned system on lot I ~"-~'
Cutbank ) ~-O Water main/service line
Driveway, parking/vehicle storage area
G o'+
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.
Engineer's Na
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
e>ARCTIC SLOPE CONSULTING GROUP, INC.
WELL LOG
DATE:
LOCATION:
Subdivision:
Client's Name:
Address:
Block:
/ v }
Initial Reading on Meter:
DRAW TIME GPM GALLONS GALLONS FIELD MONITOR METER
DOWN VOLUME TOTAL LEVEL READING
Production Rate: ~, ~ GPM 24-Hour Capacity Gallons
Arctic Slope Consulting Group
301 Danner Avenue, Suite 200
Anchorage AK 99518
Attn: Kevfn ~.
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
comments:
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456-3116 · FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378" FAX 274-9645
Report Date: 03/03/93
Date Arrived: 02/25/93
Date Sampled: 02/25/93
Time Sampled: 1604
Collected By: KL
A122445
Lot 4,Blk D,Rolling Hills
Fielding Outside Hose Bib
Water
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Date Date
Lab Units Result * MDL Prepared Analyze
Number Method Parameter
<MDL 0.1 03/02/9~
A122445 EPA 353.3 Nitrate-N mg/1
Microbiology Supervisor
DA'FL RECEIVED
'~ INSPECTION APPOINT)~ENIS' J ~I~ , ~4~L~..)~ ~.'~--y~ ~/~
TIME
TIME TIME . ~ , /I .
INSPECTO
~ffiI~IP~LITY OF ~HO~G~ ~NICIPAUIY
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT. OF I~,:',,~'1;!
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ~ L, ::TECTIOM
ENVIRONMENTAL SANITATION DIVISION J~.~
Telephone 264-4720
A...OVA. A..
: DIRECTIONS: Complete ali parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER. PHONE
P~OPE~TY ~ESlDENT (If different from ~bove) PHONE
2. BUYER PHONE
MAI LING ADD,ES8
3. LENDING INSTITUTION PHONE
MAILING ADDRESS
4. REAL~OR/AGENT ~ PHONE
I
MAILING ADDRESS
5. LEGAL DESCRIPTION ,
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
~'~'S [] One [] Four
INGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATF~R SU~.PPLY
J~ INDIVIDUAL'
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. Awell log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~IN DIVI DUAL/ON-SITE'*
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] iNDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size: )~-.~"O If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER~.// . . ~
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~'~/~PPROV ED FO R ,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY .~.~,~
' A chora e
ANCHORAGE, ALASKA 99501
(907) 264~4111
GEORGE M, SULLIVAN,
MAYOR
DEPAFITMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
December 15, 1980
William/Anna Fielding
5316 West 73rd Avenue
Anchorage, Alaska 99502
Subject: Lot 4 Block D Rolling Hills Estate Subdivision
Approval for your individual sewer and water facilities
cannot be granted until the following items have been
completed:
[ J~i ) The water analysis report needs to be delivered to
this office from the Chem Lab, 5633 B Street, for
our 'review..
) A well log submitted to this office for review.
If there are any further questions, please call this office
at 264-4720.
The well seal on the well needs to be tightened so
that it. is water tight. This will need to be reinspected
by this office.
Sincerely,
Robert C. Pratt, R.S
Associate Specialist
RCP/ljw
CC:
First National Bank of Anchorage
Mortgage Loan Division
Post Office Box 720 99510