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ROLLING HILLS ESTATES BLK D LT 6
Rolling Hills Estates Block D Lot 6 #011-072-30 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIOI�V ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEyy� G�' RCIS � acl L PHONE �) {, �4 '7'GsIG� NEW ❑UPGRADE MAILING ADDRESS 6J5_DO 6VL4,5N St- �����.� � o Ak q7,5-02 LEGAL DESCRIPTION L®'i & GLock b 1Q0Lu,,i6_) 1,j5 S0,61jAl SEG 3; TiznJ)V� 44,kO; 56M LOCATION Sii%LEI /�if'�'/c ae f �' nl'A �k-l�sV�rJc�.�.4�� NO. OF BEDROOMS �a Well i �� Absorption areEr Dwelling — 2,S PERMIT NO, D DISTANCE TO: 1 _ _Y a~. ZQ Manufacturer E_ AG E.. f� Material � �e L No. of compartments 2— y L'q cayZa y in.gallons ') ' IF HOMEMADE: Inside t Width N�,q Liquid dept /V A , 0 Y DISTANCE TO: Well Dwelling PERMIT NO. Jt=z = z FQ- Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well �' FoundationNearest 4�j� lot line / PER IT NO. w= AAV u W LL V No. of lines Length of ea II'J'n�e� g Total len th I}'ne�s g Tren 'dth Distance �befwAAen lines P z W ` J inches 1�.. Top of tile to finish grade�g 4 Material beneath tile �y 3d Total effe tive a orp i area O Zit Vii .' � (:1'UC-, inches LLI Length Width Depth PERMIT OF A a H Type of crib Crib di ete ' �/� Crib depth Total effective absorption area �p.••..•••••..•e W d ( ® e LU DISTANCE TO: Well Building foundation Nearest lot line ® 0° o s° • J Class Depth Driller Distance to lot line J W DISTANCE T0: Buildi fon a ion Sewer line Septic tank m 1"t $INANSON : Q IL lik®•. IME • a OTHER l C d i ` F� 00'. .'0 "� PIPE MATERIALS S i I kON -4" x2,-7 Z9 PVG AKCZ iAL SOI L TEST RATING �r� �ry 20� b,, INSTALLER 6 c-6 muck c%i -Z-43-46)8 REMARKS CAST /P.Rn/ F/20M 6fRJ&'Z"AJG+ T� S� ,446&w 774w 17-.eery A6-rm 6 /A' Z_ cIL/ GrLZi1 646r 1,eOW cf.�&M ken 64 G=% 4V*!5t4 crud tie sC-9C7�i1 3 v7 ` P4& 71 2i+ L® 0 ✓G Y .CMD jVVb v i©> m-2- 116el4l./E L P, d0V. L4 e- ueZA/ V t- �" ON Zo w IGc IA)501A Tt0AJ OSP . 'TAN APPROVED DATE LEGAL yy Atli tli.nelAr.✓ M12--7 /A---� , ,Date Drilled: WELL LOG 10-1.3-83 Static Hater Level 75 ,feet Draw Down N/A feet TY22 Material Drilled: 0 feet to 80 Sandy Clay Soil 80 feet: to 1.15 Heaving Sand 115 feet Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 Lo t 6 Blk. D Rolling Hills Sub. Gallons Per Minute 20 Total Feet of O'asing 120 to 120 Gravel Sand w/water to to to � ."�I -T-g-ra CH IF �������F1 0 EE ° . DEPHRTMENT 6� HEALTH AND ENVIRONMENTHL F^JTECTION 825 'L/ STREET, ANCHORAGE., HK. 99501 264-4720 "'IFF—E PERMIT 098.1 ) ' APPLICANT GREG MUCKEy 8500 GOLDEN ST ANCHORAGE 99502 243-46i8 LOCHTION LEGHL LL -':BLOCK D ROLLING HILLS LOT SIZE 999999 SQUARE FEET TYPE OF SOIL Hf SORPTION SYSTEM IS: TREI'-JCH MHXIMUM NUMBER OF BEDROOMS ] SOIL RATING (SQ FT/BR)= 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS ��E������ � �����T++= �� ���%.-y FE�7 P F --'F:::" 7' 9-4 -4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET)°OF" ' THE TRENCH OR DRHINFIELC\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NQ SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET). F�E I C-7: ���K' 1 27 EE -II.- C-3 42-0 ED r--! F:� 0 1— 0�� PERMIT HPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLHTION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES 'THAT THE WELL WILL SERVE. 'T" 11_4 [C.h ;.2'. ��.--_ ��������FEE Co BHCI,-"FILLIl`,IG OF HNY SYSTEM WITI-K-)UT FINAL INSPECTION HND APPROVALBY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTiQN ` MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MHY APPLY. SPECIFICATIONS HND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ��Fz-'_"#-1 1, "T"' FEEXIF" I �FE". t -1 ED EE Fe J.- _�. :JL ���=-�_ I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FO�TH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTHLL THE SYSTEM IN HCC8R1.'HNCE WITH THE CODES. I UNDERSTAP-ffD THAT TH'ON-SITE SEWER SYSTEM MAY REQUIRE ENLHRGE11ENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. � = . , ^ ISSUED BY c/ V40 MUNICIPALITY OF ANCHORAGE ,I r Department iHealth and Environmentarotection Y� N J Z 825 L Street, Anchorage, AK. ,_501 • 264-4720 Permit #45 36c(�'� # # # HANDWRITTEN PERMIT # # # WELL PERMIT Applicant: ePrT�u^ ��y Mailing Address: ,etJpp GaArc S7' i Location: Phone Number: 02 V 3 - 514o 18 Legal Description: , 61k /� ILV4 y� /1S Lot Size: ��.4 ( Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) j The Required Size of the Soil Absorption System Is: DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The I depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ AYA GALLONS # # 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. # # # TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage 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 a private 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Signed:%.crt�' Issued by:, Appli an F!- � Date: 9/a'7�83 SWP/024(1/81) BXG1=9RS, INC 7125 Old Seward Hwy. Anchorage, Alaska 99502 3496561 SOILS LOG — PERCOLATION TEST -SOILS LOG' J� PERCOLATION TEST n 3 /..�e�roos•-i s PERFORMED FOR: G'\ L 1(�E� �f _DATE PERFORMED. LEGAL DESCRIPTION: ^-ter1""�` ✓ `�`-"E f�.%�J2 �AI �°J® r SLOPE SITE PLAN 1- 2- 3- w,�4 5 6 7 9 10- 11 - ,,,.. ,Z U' Q•.`a � SlL7" cJ1T�-{ SOME �� �•; ••{'• S O�7 At Oft icS� bArAP, y .y BA�wu� Deyj tDGe�, s* -,b GN c eaa), Sa 4-;0 - f2,5 Sltavl7W 7O4CF �M 12 DEPTH 13 14 15 ®��/////►mss' 16 i ®F•qs�.� i o y m 17 91h e • JOHN E. SWANSON® W t ••® 1834-E o t • •• 19- '600900 O PROFESSI(110 '®I IF YES AT WHAT DEPTH? Reading Date Gross Time - Net Time pWatertO Net Drop Q1 1 1 ��a____ Q _._.- n O _. — 1/4r I/�= 2 /:2o Zm/ 2 1 Z men s ... _�.11 -- 2 ,/ /u, , , . :S 2mvc . r 3 /la /. 10 40 L4 -MI 20 ��®��°®®�® E'p .PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND — FT COMMENT k,106H t39FL- off- Z/9 7j . n .. .A n . .. wwY•.nA - ru ro.. _. L, S. Municipality of Anchorage Development Services Department �ff•'E:;�, Building Safety Division On -Site Water and Wastewater Program s., ll. 4700 Bragaw Street P.O: Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel fb -:alF 0;2- 3o COSA # og0,RSLA ' Expiration Date: 11-a7-0 'I. 'GENERAL INFORMATION Complete legal description F,o1l'ino 11; 115 i:44Ic3 V)oGk D L+ (o Location (site address) X330 B a; w Pri✓e, Current Property btwner(s) Tarns 4 1/i ams Day phone _ Z4 3- 366 y Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 19 Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer Q The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Stri u nd £n4ine.Evfvlr Address %OS W.15fi Sic, ID3. A,0,6rAe.4_- AK 77501 Engineer's Printed Name Lstv_s .5pvrk1 AAA 5. DSD SIGNATURE V Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 239-37/f, Date zy AI 49.TH ?.•• LAPIS E. SPUR<LAND ' r It ,?� Ilk oZ o f F J Ill �'ROFESSIONP� bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: l(i �� Original Certificate Date: (Rev. I V05) Municipality of Anchorage ` Development Services Department Building Safety Division C/ On -Site Water d Wastewater Program 47W Bragew Street P.O. Box 198050 Anchorage, AK 99519.8850 www.mtmi.org/omft (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: idol lire 141 115 f s 3ths 131cwk 1) (oi 6 Parcel ID: Oil- 012- A. il-A. WELL DATA Well type _&jjiA}r, If A, B, or C provide PWSID 0 = Dete completed 10^1 - V3 Sanitary seal (YM) Total depth 120 ft. Cased to J22 ft. FROM WELL LOG Date of test lo -13-g3 Static water level i5 rt. 9 -P.M. Well Log (YM) y Wres properly protected (Y/N) y Casing height (above ground)+lin. AT INSPECTION �5 n. > 5,to 9.p.m. WATER SAMPLE RESULTS: Col term _-0—colonies/1 00 mL Nitrate NP mg& Other bacteria �_ colonies/100 mL Arserdc: 5-11 mgll Date of sample: I w1of Collected by: t4rS s�k"I S. SEPTIC/HOLDING TANK DATA ir: Se..AeA, Tank TypelMatenei Tank size — gal. Number of Compartments = Foundation cleanout (YRV) ^ Depression over tank (YM) — Date of prmtping — Pumper C. ABSORPTION FIELD DATA Ft.bI:c. Server - Date installed — Soil ratln9 (9.p.d.AY or ftr/bdrm) Length ft. Width Total depth R. Date of adequacy test = Date installed Cleanouts(Y/N) — High water alarm (Y/N) system type 9. Gravel below pipe — A. Eff. absorption area =1t' Monifonng tube = Depression over field = Result& (Pass/Fail) — For = bedrooms Fluid depth in absorption field before test — in. Water added= gal. New depth — in. Elapsed Time: — min. Final fluid depth in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YIN 8 type) — If yes, give date — D. LIFT STATION Date installed 'Pump on' level at = in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at = in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot MIA Absorption field on lot N/A Public sewer main 25 +- SS r +ea,raco Sewer /septic service line S51 t, Animal containment areas 50 t Manhole/Access (Y/N) High water alarm level at = Meets alarm 8 circuit requirements? On adjacent lots 100 ,+ On adjacent kits fad t Public sewer manhole/deanout i0o mi. Holding tank Y/ A Manureianimal excrete storage areas 1001t. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: V/A Building foundation Water main Property line — Absorption field "— Water service line — Surface water Wells on adjacent lots — SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N f A Property line Building foundation Water main Water Service line Surface water Driveway. parldrg/vehide srorage — Curtain drain — Wells on adjacent kNs F. COMMENTS: G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA. COSA gum*fines in effect on this date. Engineer's Primed Name L,(f o Jour Mix Date -4l3 J07 COSA Fee $ 4;tlo Date of Payment 4`130 lOg Receipt Number Q7493 (Rev. 11/05) Waiver Fee $ i ..t gtgs 49TH 9 �/ 10 r^ . LARS E. PURK�'% /!f v� Date of Payment Receipt Number in. SGS ReE# 1073346001 Client Name Tobben Spurkland P.E. Project Name/N Rolling [fills Estate BlkD L7 Client Sample ID Rolling Hills Estate RIkD L6 Matrix Drinking Water PHSID 0 Sample Remarks All Datea/rimes are Alaska Standard Time Printed Date/Time 07/23/2007 8:29 Collected Date/Time 07/12/2007 13:30 Received Datc/Time 07/12/2007 14:50 Technical Director Stephen C. Ede AllowaNe Prep Analysis Parameter Results PQL Units Method ContainerlD Limits Date Date Inst Metals by SCP/MS Arsenic 3.17 5.00 Waters Department Total Nivatc/Nitrite-N ND 0.100 Microbiology Laboratory Total Coliform 0 ug/L EP200.8 C (<I0) 07/16107 07/17/07 hili mg1l. SM204500NO3-F D (<10) 07/19/07 1DS col/100ml- SM209222B A (<I) 07/12/07 SDP FOR D 00STS4 RDUSi s T UNOER NO WOUMSTANCES SHOULD AN AS-VULT VE WED FOR CM3 RUCTION OR root ESTA9J9 u e MT �n .em.c w•.... TME SURVEYOR TAp= Ii90kSML TY PDR UHE KnAL, TRANSACRON ONLY ANU ASSAES MUNOAL LIARILM QKY FOR THE COST OF THE SURVEY. OSTM OISTANOES PRtiMI OVER SCAUNC. RQRODUCTIOM MAY CAUSE ERRORS 1H IS Prepared by suRWY tutTV1CATTON PLOT PLAN �.• 7E oF� '+.. Robert E. Jahns, Jr.Assoc. Lord Surveyors Professional w.r Awerrwrw.. SAI G)r•' C1tAWLO VWM w •iw'~� �« r �� x���'�'•� � r {[ OR AN ASRA H.ea $1. tee. pkrt M No. wri { 0.1^ seal: = 50' M„q; Or 'a $7' /OUNDATt011 AS-PULT t M��•w� t�wwY•��.. 1- So7 i.�rw •. Daft MY IN mod TMi����•4 �M Mw.r� � � i+•� .Mwww•M •It�� ,�. • � .t o Dap Dn+n: M.0. Iti �w wrt. Y 4 �S 1 't w� 2124 LINK S71NORAE As•tULT L Ar.lawwa == I A,.••'• a� � 9 '.'••..«.••• p wicfptbn• 6 Block DEstate ?:'� `�`� :r.:: �......� i A`qod �%�•�►'� Folling Hi11sLot LOT 9lIR TME S �"S ❑ WIKM AT••VIALT � � • SET MAR � DRARUIOC MM. oTAl• ODNOREIE O roumoAMA REAR ,p"� Tot70O CONORCI nHr=rIu-wAlrT ..for lAlHR'f ... laoaMlMY iv AS9UIEO EtF: -:'==T AL mia PLOT PLANS & LAT SURVEYS Nm. IT R THE RLR.POHSRRLTTY or THC BUILDER OR OWNER. PRIOR TO ONLY THOSE IMrROYEMEHT3 AVOK oR ANO AND VISr9LL WILL K UNOER NO WOUMSTANCES SHOULD AN AS-VULT VE WED FOR CM3 RUCTION OR root ESTA9J9 u e MT �n .em.c w•.... TME SURVEYOR TAp= Ii90kSML TY PDR UHE KnAL, TRANSACRON ONLY ANU ASSAES MUNOAL LIARILM QKY FOR THE COST OF THE SURVEY. OSTM OISTANOES PRtiMI OVER SCAUNC. RQRODUCTIOM MAY CAUSE ERRORS 1H IS FROM BLS C RSSOC! VAX MO. 907, 5i2 6.14A DEPT. ID If•' Eta Y1N0\ i1: F.riTAI. CONSTR6'ATIGN A*ICHORAGENVESTERN PUBLIC SER1r10E OFFICE 655 CORDOVA STREET ANCHORAGE, ALASKA 98503 h1r. Kenneth M. Ouffus, P.E. Y,ND Englneering 20441 Plarmigan Blvd. Eagle River, Alaska 99577.87:16 NCu J, 199• 12,45 Pit .. IORYKMAWLes, GOVERNOR Novemb!ir4,1006 FAX: (90.1) 269 1508 Subject: Roiling Hills Estates Sewr3r Line Improvement, Separation, Distance Waiver Requests; Anchorage, 0.1aska, AWPSA Project Number 9721 -WW -283-134: Review Dear Mr. Duffus: ' This totter Is In response to your submittal received In this ofrwi D on October U. 1998 In which you requested 16 different horizontal separation distance livaivers between exisiing private water system source wells and cenponeota (manholes and laterals) of (!ie proposed sower line project. The 16 separation d'' tante waivers rangy from 39 feet to 84 tent between priva!e source wells and sewer laterals and V. feet (o 90 feet between prNate source wells and sanitary sewer Manholes (SSMH). i have completed my review of the submitted information and Infor lalion in this office filet regar:ring Rolling 1-11h Estates, Based upon this review; l have the following comments: The on-site geological one hydr"eolopical information was very limited and not well presented. However, once the soils Information from the well keg's and test pile �.us to draft a profile of the tolls In the area, some trends were visible, such as tight soils (Sandy Rill to silty sands) throughout tt+A section of the subdivision Wing lr ipocled by the proposed sewer line Improvement. With the mitlgTaing construction methods being proposed as noted in your submittal, the requested waivers are reasonablo. i Therefore. In accordance with the provisions of the State Vl aslewater Diapusal and Drinking Water Regulations (18 AAC 72 015 and le AAC 80.00), the following separation distarn.es have been granted: Between the Private Water S,/stem Source Well on Lot. 3, Block A and the lateral sewer ane from 75 feet to approximately 64 feet. , BobvePn the Private Water System Sourse Well on Lot 3, Block A, and the manhole x.. ..2 3.140 ..-04 9i II.93. L: Fr02 at' Rolling Hiss Estates 2 No,rember 4,1398 (SSMHvd) from 100 feet to approxintutely e4 feet Between tho Priva'a Water System Source Wall on Lot 4, Block A and the lateral sewer line frorr. 75 foot to approrimately 39 feet. Between the Private Water System Source V!'ell on Lot 4, B:cek A, and the manhole (SSMH#7) from 100 feel to approximately 81 feet. Between the P: ivate Water System Source Well on Lot 4, Clock J, and the manhole (SSMH#4) from 100 feet to approximately 93 feet. Between Gte Privata Water System Source Well on Lot 6, Block D and the latera! sewer Mo from 75 feet to approxirratehy 51 fist. Between the Private %A.ater System Source Well an Lot 7, Block D and the lateral eewer line from 75 feet to approximately 70 feat. Between the Private Water System Sourca Well on lot 7. Block 0. and the manhole (SSMH#1) from 100 feet to approximately 65 foot. Between the Private Water Sys!em Source Wall on Lot 8, Block D and the lateral sewer tine from 75 feet to approximately 44 feet. Between tho Private Water System Source Well on Lot 4, Block B, and the manhoto (SSMH#3) from 100 fiat to approximately 88 feat. Between Lha Private Water Sy>tem Source Well on Lot 7, Block. C, and the manholo (SSMH#2) from 100 teet to approximately 90 feet. Between the Private Water System Source Well ort Lot 8, Block C end the lateral sewer line from 75 feet to approximately 62 fe4t Between the Priva!e Water System, Source Well on Lot 8, Block C, and the manhole (SSMH#2) from 100 feet to approximately 80 feet. Botwoon me rrivate Water System Source Will on l of 9, Block C and the lateral sewer line from 75 feet to approximately 50 feet. Between the Private Water System Source Well on Lot 9, Block C, and the manhole (Oo VSH#1) from 103 feet tc approximately 76 feet. PROM BLS i ASSOC. FAX .0. 907 U2 ..40 I{oV 7. 1996 12{36 PM P. 9 ' ,�{,• ,.t' !•� w. V ..�{J ,,. ,"•Y. L..V 3„{.L,V {.,..• /V, •i0 O{33 ..y. Between the Private Water System Source Wer, on Lot 11, Block re and the lateral sewer line from 75 feet to approximately 52 feet. The above noted waivers are granted with the following requirements The Interal tines as designed will have ;oints shrink wrapped and the One encased Irl a ml., polyethylene. - The manholes will need to be watortlght In accordance with Municipality of Anchorage Standard Specifications. In addition, manholes will be hot mopped and sealed In a nd., polythene. Both of which was noted in your aubmittal. For the two prival.e system source wells that have the sewer lateral within 50 feet -(Lot 4, Block A, and Lot q, Block D), the sewer line joints will need to be double shrink wrapped. Installation of all manholes and sewer lines will need to Incorporate extra precaution during Installation. Due te, the lack of water qual:,y data from the source walls in question being submitted, one set c: test results from ach well for total coliform bacteria and nitrates (as nitrogen) will need to be submitted to this office before starting InstalMon of the sewer line. 'This Department has one nitrate sample result from the source well on Lot e, Block 8 showing nitrates at 1.3 mgA. These waivers do not Imply granting of any additional authorizations, nor obligate any state, federal or Iota; regulatory body to grant requlreC authorizations. Thank you for your cooperation with this Department. If you have any questions, please do not hesitate to contact me. SiiJncerely, Keven K Kleweno. P.E. Environmental Engineer KKK/ka .... r... n.... n e ►+nn nN4C r1n.Gpw SnnAr,.e, -. u.' t:3•: .. -'•� I::;aC i�v'� MIC• Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Lars Sourkland Legal description: Rolling Hills Estates Block D Lot 6 ❑Permit SC.O.S.A. ❑Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: 1. Waiver required for well less than 75 feet from public sewer mainline. Name of reviewer. Jeff Date: August 7. 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK �JaF3 < uclr( MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 3#40& (a) Legal Description (include lot, block, subdivision, section, township, range) / rte- 6' 24ze ,D kaz l"Z''/ r r- 1 008 S[; 3 7-1ZAl - R 3 W S A4, Location (address or directions) oF"G '73"y4?-SAAJ°"'"e �7_' TO EOZ,C6` I- X7,2 14,f/�'�&� - (b) Applicants Name G'ize6 ✓!7a✓CWe §- Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer 1-1 ; Other [__� (explain); (d) Lending Institution !` T/y��i(/� aa''r.A/ Telephone Address 4- Ci- at�4I 42" (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family 11L M4 Plumber of Bedrooms 3. Water Supply - Individual WellEz Community = Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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. [Page 1 of 21 T -'s- pc., 'A 2 e 5. Engineering Firm Providing Inspections, Tests, File Search, Data 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 regula- tions in effect on the date of this inspection. Name of Firm 98 S /A)C• Telephone 3e7� 6S6/ Address Date 6. DHEP Approval Approved for 13 Approved Terms of Conditional bedrooms Disapproved Approval ° °p•° ve fs .... THOMAS R. . °• 2248-E Conditional CAUTION J� THE tNNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) AUG 31984 CHECKLIST - FEBRUARY 1984 RECEIVED A. WELL DATA Legal Description: LC 10 &A2f104-- 7 2o"(A G IIs Sum Well Classification i�lp�u�ovat_ If A, B. or C. D.E.C. Approved(YM) AJ14 Well Log Present (Y/N) Date Completed I0-(3 e3 Yield 2dGd Total Depth (Z©" Cased to 12 O, Depth of Grouting % Static Water Level Pump Set At JL 2 Casing Height Above Ground 2 Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)M Separation Distanms from Well: To Septic/Holding Tank on Lot t 0(, ; On Adjoining Lots > /00 To Nearest Edge of Absorption Field on Lot 1 1 (0 ; On Adjoining Lots ?G --o To Nearest Public Sewer Line ���p� To Nearest Public Sewer Cleanout/Manhole } too/ To Nearest Sewer Service Line on Lot N/A - water Sample Collected By A9)5 ; Date Z A-0& Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 10 12_q 183 Size I25]D CSL- No. of Cconpartments 2. Standpipes (Y/N) YC,,::, Air -tight Caps (Y/N) YO; Foundation Cleanout (Y/N)'(eS Depression over Tank (Y/N) Ngo Date Last Pumped N oUc�y') S'-IsrEm Pumping/Maintenance Contract on File (YM) IjIA ; for iU/A- Holding Tank High -Water Alarm (Y/N)AtIA Temporary Holding Tank.Permit (Y/N) N a Separation Distances from Septic/Holding Tank: To Water -Supply Well 10(01 To Building Foundation �© ` To Property Line 301 To Disposal Field (Q/ To Water Main/Service Line rJ.LA To Stream, Pond, Lake, or Major Drainage Course 0 M Comments Sp:) -Ti(' PQ2j>- rL 1 k-'?,a'y- [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z.D„Q ,,�_ Type of System Design Date Installed iQ L?- 7 Length of Field Width of Field Z h Depth of Field g Gravel Bed Thickness Square Feet of Absorption Area 688 Standpipes Present (Y/N) YES Depression over Field (Y/N) o Date of Last Adequacy Test AJA Results of Last Adequacy 'lest /V%q itJEtn/ SYS %�h1 Separation Distance from Absorption Field: To Water -Supply Wall 116 / To Property Line Z& To Building Foundation e4 S I To Existing or Abandoned System on Lot ��A On Adjoining Lots 4S To Water Main/Service Line To Cutbank(if present) Af IA - To Stream/Pcnd/Lake/or Major Drainage Course 4J1A To Driveway, Parking Area, or Vehicle Storage Area > �1 Comments D. LIFT STATION A oT Date Installed 'v "lot ic.43LC Dimensions Size in Gallons Manhole/Access (Y�) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signe L�z� n Date CompanyS� f77.LG iM t 2S /n(C . MOA No. 37- { 60-4 KBl/d5/s [Page 2 of 21