HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 3 LT 3Rolling Hill
View Este
Block 3
Lot 3
#0§0-322-28
Municipality of Anchorage.-~,:,~,,...~,,:,,~;'~}!~
Development Services Department <~~
Building Safety Division
On-Site Water and Wastewater Program, 4700 Bragaw St. ~'~ ~
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: C'5{ii1~101020'" PID Number: 050-322-28
Nome:
JAMES GRIFFITH Wastewater System: [] New [] Upgrade
Address:
19326 MEADOW CANYON DRIVE ABSORPTION FIELD
Phone: Number of Bedrooms:
19071 694.6345 ;~ [] Deep Trench [] Shal[owTrench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION !so~ Rating: Total Depth from original grade:
1.2 ~PD/Ft' 7 Ft.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
3 3 ROLLING HILLS VIEW ESTATES 3.5 Ft. 3.5 Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
0 Ft. 43 Ft.
Well: [] New [] Upgrade Gravel width: Number of lines: J Distance between Ii
5 Ft. 1 --- Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Exist'g Private Ft, Ft. 398 Ft' 3034 PVC
Driller: Date Drilled: Static Water Level: installer: Date Installed:
Ft. JR's/Flintstone 6/812010
Yield: GPM Pump Set at: Ft. Casing Height Above Ground:
Ft. TAN K
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~To Septic Absorption Lift Holding ?ublic/Private Manufacturer: Capacity:
From~
Tank Field Station Tank Sewer Line Anchorage Tank 1000 Ga,.
Material: Number of Compartments:
We, 105.9 108.4 20 Steel 2
Su~aoeWoter 100+ 100+' ~ ~ /I LIFT STATION
Lot Line 35 20.4~ Size: Manufacturer:
Gal.
Foundation 105 108 "Pump on" level at: "Pump off" level at: High water alarm at:
in. in. in.
Curtain Drain 50+ 50+ Pump Make & Model Electrical Inspections performed by:
Remarks:
Exist'g Tank Abandoned per code BENCH MARK
Location and Description:
Door Theshold at Deck
Assumed Elevation:
100,0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 6/7/2010
2n~ 6/8/2010 ~×~ ... · .......
Development Services Department Approval ,,, ~...2.' .._/i-_. ~-,,,~. ~+
Conditional Approval Date: ~' ¢:: '-~9 TH '~ ....
~b-~breven ~. ~annone.
~..n*. ND. CE 814~
Reviewed and approved by: ,~ ~/~/~.~.~ Date: / c~ / .2 ~ ........ ,.~
/
i CO A B CO C1 I E1 CO C2 i T2
! E1 40.0 68.7 C2 34.0 i 49.8 M2 61.7 50.6
i C1 57.5 83.9 C3 54.7 i 70.9 C4 62.6 50.8
T1 55.2 71.4
T2 58.2 73.4
DC 58.3 73.1
M1 56.3 69.7
\\\ /I
\ \
~ ~ , / MSAS (Eh ABAND, QfiED '~/ // /
/ ~: / WELL
AREA UNDEVELOPED.
NO WELLS OR SEPTICS
WITHIN 200 FEET.
NO:S:
P.O. BOX 100217 ANCHORAGE, AK 99510 ~..'
RECORD DRAWING PHONE (907) 272-8218 FAX (907) 272-8211~ ~"'
1"=50'
~'~.~P.I.D. NO
Jim Oriffith ~ ~-. CE 81~9 .'~ PERMIT NO.
PLAN Eagle River, AK 99577 ll~pno;::d:~ Sheet
CO A B
E1 40.0 68.7
C1 57.5 83.9
CO C1 E1
C2 34.0 49.8
C3 54.7 70.9
T1 55.2 71.4
T2 58.2 73.4
DC 58.3 73.1
M1 56.3 69.7
CO C2 T2
M2 61.7 50.6
C4 62.6 50.8
SPECIAL PROVISIONS TO SPECiFiCATiONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SiTE WASTEWATER DISPOSAL SYSTEMS.
2. ALt_ WORK SHALL BE /N ACCORDANCE WITH THE ATTACHED SPECIFICATIONS.
5. SCOPE OF WORK: 3-BEDROOM HOUSE UPGRADE, NEW DRAIN FIELD, REUSE EXISTING FIELD.
4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE
INFORMATION ABOVE 16 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12
FEET BELOW EXISTING GRADE, STOP WORK & NOTIFY THE ENGINEER IMMEDIATELY.
5. VERIFY INTEGRITY OF EXIST'G TANK. REPLACE OUTSIDE 100' WELL RADIUS IN TANK NEEDS REPLACEMENT. ABANDON
EXISITNG TANK PER CODE, IF REQUIRED.
UPGRADE FIELD
72.3 ¢,,,,./- Filter Fabric
-0..: ~ I ~' /'/~Gravel above
~pipe inv,
~ 68.8 typical
SP l .~'"--~ 4,, diam. drain
65.3 1 ~pipe, typical
i Gravel
-8.6 ~ --5' Ty¢~.--I
GP/
SP
59.3
¢¢, ~. SECTION
~ 4 Dia Pe~ Pipe
Z~'~ 72.3 o ~ ~ 3034 PVC
72.3
70.1 ~ SEPTIC
65,3
5-WIDE TRENCH 43LFx3,5'ED
AB B ~ EVIATI 0 N % PROFILE
CU COPPER
DIP DUCTILE IRON PiPE
TH TEST HOLE DESICN PARAMETERS LECEND
FC FOUNDATION CLEAN OUT UPORADE SEPTIC SYSTEM ..... w- w .... WATER LINE/
T~ TANK CLEAN OUT NO. NO. BEDROOM: 5 (450 gpd) WELL RADIUS
Cfi CLEAN OUT NO. TANK SIZE: 1,000 g if reqd
M~ MONITOR TUBE NO. PERC. RATE: 1-5 MPI
R.I. RiGiD INSULATION SOIL RATINO: 1.2 gpd/SF ~ss ~ss ~ EXIST'G SEPTIC
DCO DOUBLE CLEAN OUT AREA RQD: 575 SF
DV DIVERTER VALVE SYS. TYPE: WIDE TRENCH, 5'ED, ss ~ ss ~ NEW SEPTIC
FS FLOW SPLITTER RF=0.54, MIN LENOTH: 40.5 LF
USE: 0 CHAINL~NK FENCE
(E) EXISTING 45LFxS'WlDE, 3.5'ED, 7.0' TD
(P) PROPOSED 70TAL AREA: 598 SF
(N) NEW
PHONE (907) 272-8218 FAX (907) 272-8211 iCa Scale
RECORD DRAWING
ROLLING HILLS VIEW EST S/D ELk 5 LT 5~- ~,~ "~'~ ~ ''*f~ N~S
Jim Oriffith ~%'~P.I.D.__ _. __ ~
NO
,)50-522-2E
........ ~9526 Meadow Co~yo, Drive ~.4~v%ER~l~2*t~ ~,~ ~o.
Eagle River, AK 99577f~/'*~ ~= -'~~ib~[~ .~ OSPlOlO2O
~i ?t~ ....... '2~ Sheet
DESIGN NOTES ~c
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP101020
Tax Code Number: 05032228000
Work Type: Septic Upgrade
Permit Effective Dates: June 02, 2010 to June 02, 2011
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: ROLLING HILLS VIEW ESTATES
Site Legal Address: ROLLING HILLS VIEW ESTATES BLK
Owner/Address: GRIFFITH JAMES R & EVELYN L
3LT 3 G:0255
I Department
REVOCABLE TRUSTS GRIFFITH J R & E L/TRUS 19326 MEADOW CANYON DRIVE EAGLE RIVER AK g
Site Mailing Address: 19326 MEADOW CANYON DR, Eagle River Lot Size In Sq Ft: 55321
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours pdor to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction dudng freezing weather must either.
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
/
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
o. SPlo~o,~o
ON-SITE SEWER/¥VELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-322.28
Property owner(s) Jim Griffith
Mailing address19326 Meadow Canyon Drive, Eaqle River
Site address 19326 Meadow Canyon Drive
Day phone
Zip Code 99577
Zip Code 99577
Legal description (Sub'd., Block & Lot) Rollinq Hills View Estates, Block 3, Lot 3
Legal description (Township, Range & Section)
Lot Size 55,32t Sq. Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR ([] all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Pannone Engineering Services, LLC
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: ,~"//IC~
Receipt Number:
(Rev, 11/05)
Waiver Fees:
Da. te of Payment:
Receipt Number:
Pannone En§ineerin§ Services LLC
Steven R. Pannone, Principal
Registered Professional En§ineer
E-maih stevet~oanen~ak.com
May23,2010
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject:
Rolling Hills View Estates S/D, Block 3 Lot 3
Septic System Permit Upgrade Request
Ladies and Gentlemen:
I am writing to request a permit to construct an upgraded septic system be issued for this property. The
proposed systems will serve an existing one-bedroom house. Currently the lot is developed. The lot is served
by a private water supply. The existing septic system shall be reused. A new drain field will be installed
south of the existing field and will be sized to handle a three bedroom waste stream. The surrounding
developed lots are served by private water systems. The private wells are located over 100 feet from the
proposed soil absorption system.
1. Soils. A single test hole was excavated by PES on May 3, 2010. See the attached soil log. Ground
water was monitored for seven days. No ground water was monitored to a depth of 13 feet below ground
level after the monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on
the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square
feet should be used, using a conventional wastewater treatment system.
Soil Absorption System Design.
a. Percolation Rate: 1 to 5 Min Per Inch
b. Application Rate: 1.2 gpd/sf
c. Design Flow: 450 gallons per day
d. Min. Absorption Area: 375 sf
e. Total Depth: 7.0 feet
L Effective Depth: 3.5 feet
g. Width: 5 feet
h. Reduction factor: 0.54
i. Minimum Length: 40.5 feet
j. Design Length: 43 If
k. Effective Absorption Area: 398 sf
1. Septic Tank Size: 1,000 g Septic if required
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 615 East 82nd Ave, Cuite B6, Anchorage, AK 99503
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the
existing drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water
and drainage ditches.
4. Topography: The average topography in the area of the proposed septic system is approximately 21
percent based on the survey information. The proposed installation will be greater than 50 feet from the
shoulder of the steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no wells or septic systems within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 615 East 82nd Ave, Cuite B6, Anchorage, AK 99503
Telephone: (907) 272-8218 FAX: (907) 272-8211
", \, /' 2
\, \'~ / FWELL (E)
i ~ ~ ~. ~~ ~ ~ / //~
~FTANKIS ~ ~ ~~
~~~,~ ~/ / /~ --
~ -
~R~ U,~LO~O.
,O W~LS OR S~T,~S -
W,T,,, ~OO rEIT.
P.O. BOX 100217 ANCHORACE, AK 99510
~SSUED FOR CONSTRUC~ON PHONE (907) 272-8218 FAX (907) 272-8211 ~'~ ~ '~ 1'=60'
~.-~~ ..... '~ ~.,.~.
ROLLING HILLS VIEW EST S/D BLk 5 LT ~ ~.~~~ ~322-2~
Jim Griffith
rl~.. CE 8149 .~ P[RUlT NO.
19~26 Meadow Canyon Drive ~j~?~... ...~
PLAN Eagle River, AK gg577 ~j ..... Sh{et
SPECIAL PROVISIONS TO SPECIFICATIONS
1, ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS.
2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATFACHED SPECIFICATIONS.
5. SCOPE OF WORK: 5-BEDROOM HOUSE UPGRADE. NEW DRAIN FIELD. REUSE EXISTING FIELD.
4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION. AS EVIDENCED BY THE SOIL TEST HOLE
INFORMATION ABOVE 16 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12
FEET BELOW EXISTING GRADE. STOP WORK & NOTIFY THE ENGINEER IMMEDIATELY.
8. VERIFY INTEGRITY OF EXIST'G TANK. REPLACE OUTSIDE 100' WELL RADIUS IN TANK NEEDS REPLACEMENT. ABANDON
EXISlTNG TANK PER CODE. IF REQUIRED.
/
SECTION
-- I
'
ABBREVIATIONS PROFILE
CU COPPER
DIP DUCTILE IRON PIPE
TH TEST HOLE DESIGN PARAMETERS LEGEND
FC FOUNDATION CLEAN OUT UPGRADE SEPTIC SYSTEM w w WATER LINE/
T~/ TANK CLEAN OUT NO. NO. BEDROOM: 3 (450 §PdT WELL RADIUS
C~ CLEAN OUT NO. TANK SIZE: 1,000 9 if reqd
M# MONITOR TUBE NO. PERC, RATE: 1-5 MPI
R.I. RIGID INSULATION SOIL RATING: 1.2 9Pd/SF I ss m~ -- EXIST'G SEPTIC
DCO DOUBLE CLEAN OUT AREA ROD: 375 SF
DV DIVERTER VALVE SYS. TYPE: WIDE TRENCH. 3'ED. ~ ~ ~ ~ NEW SEPTIC
FS FLOW SPLll-/ER RF=O.54, MIN LENGTH: 40.5 LF
USE: 0 CHAINLINK FENCE
(ET EXISTING 43LFxS'WIDE. 3.5'ED. 7.0' TD
(PT PROPOSED TOTAL AREA: .398 SF
(N) NEW
P.O. BOX 100217 ANCHORAGE, AK 99510
ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 ';*
ROLLING HILLS VIEW EST S/D BLk 5 ET
NTS
Jim Griffith
19526 Meodow Conyon Drive','~,~"~"' . CE 8149 ~..~..~ P£RM,Tsw.~x.xx.O.
Eegle River, AK 99577 ~t~"~'
Sheet
DESIGN NOTES
SOILS LOG - PERCOLATION TEST
TEST HOLE I
OR TOPSOIL SLOPE ~ ~ $~'E PLaN
3 -- poody graded
'- ',~ ~~.,7-----.._~/ ~//
'- "--V/- /
BOH WAS GROUND WATER SLOPE
14 -- ; ENCOUNTERED? N
IF YES, AT WHAT TH
DEPTH? .O.'
17 -- DEPTH TO WATER AFTER
MONITORING?
18 -- -- DATE: 5/10/10
PEROLATION RATE 2.4 (min~inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 4 FT AND 5 FT
COMMENTS: Test hole excavated by Flintstone Const. Test Ho]e was presoaked before pcrc test. Perc test ran
~'or one hour. Last three readin[ reported on this report.
PERFORMED BY: Steven R. ?annone, P.E. ! CEI~'TIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAb GUIDLINES IN EFFECT ON THE DATE OF' THIS TEST.
NOTES: PANNONE ENG SVC, 1.]C
NTS
ROLLING HILLS VIEW EST S/D BLk 3 LI3~..~-~~-'I P.Lo. ~o
,Jim Grifflth
PERMII
NO.
1~326 MeoOow Conyon Drive ~t~'-.
Eo§le River, ^K ~577 {~ '. ....... '
SOILS
LOG
~ i
i
ISSUED FOE CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211~.~~.~..~ ~-~q~t~.~,~ Sco~eETS
~OLLING HILLS ~EW EST S/D BLk 5 LT 5 ~"~~":"~ PJ.D. NO
1~32~ Meodow Conyon ~rive ~e ~[~u~* ~o.
Eagle River, AK 99577
DESIGN NOTES . -~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [~'NEW
MAILING A~;~R ESS
LEGAL DESCRIPTION
LOCATION NO, OF BEDROOMS
I ~[~ Absorption are~ Dwelling PERMIT NO.
Material ~ No, of compartments
Liq. aliens IF HOMEMADE: Inside length ~ Width Liquid depth
~ ~ DISTANCE TO: Well ~/ Dwelling PERMITNO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well /O~ /~ F°undat2~ ~ Nearest lot line , ~ PERMIT NO.
~ ~ ~ No. of lines / ~ : Length of each
~ ~ ~' Top o&tiJ~to fiSish grad~ Material beneath tile
. Lengtd Width , _. [ Depth PERMIT NO.
~ ~ Type of crib Crib diameter ' Crib depth Total effective absorption area
~ Well Building foundation 'Nearest lot line
~ DISTANCE TO:
~ Class ~- / .~--. v~t~/ ~ Driller Distance to lot line PERMITNO.
m Building foundation. Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ' N
PIPE MATERIALS
SOl L TEST RATING
,NSTA~Li7~
MUNICIPALITY OF ANCHORAGE~..~
Department,~ Health and Environmenta. i otection~q/~
~ .: ~ . 825 ~ '~ Street' Anchorage, AK. ~JE01
C * * * HANDWRITTEN PERMIT * * *
Permit # WELL AND/OR ON-SITE SEWER PERMIT
Location:
Legal Description: ~ ~/~ ~
Type of Soil Absorption System Is:
Trench: ~ ....
Drainfield:
Maximum Number of Bedrooms: ~
Mailing Address:
Phone Number: ~e~ --~
,ot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br) ~ ~_
The Required Size of the Soil Absorption System Is:
LENGTH ~,~! -'-'-
GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
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(44e'L=B~4~6) TANK SIZE = /0~ 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 comraunity 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 8 3 * * *
z certify that:
(!) 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
m~
the idence is remodeled to include more tha~ 3 bedroCm~. _
Signe~ ~ Issued by: ~r~-'~ ~'~:'~ I~
App lic a'~ ~ ..... Date: ~¢',~ ¢/t~ '
SWP/024 (1/81)
'"'"', MUNICIPALITY OF ANCHORAGE: ~
DEPAR"I:N~ENT OF HEALTH AND ENVIRONMENTAL HNOTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
__DATE PERFORMED:__ffX¢//'~
Lot
ENCOUNTERED7
IF YES, AT WHAT
DEPTH?
/-///z
Reading
l*h'zO ~
Date
Gross
Time
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/2_' .35
/2.:50
/5
Net
Time
lb/rtl'~]
t0
Depth to
Water
Net
Drop
-*//~0 ,. '¥7TT-~--
PERCOLATION RATE
TEST RUN BETWEEN
CERTIFIED
lc~. Z ~ (minutes/inch)
k~'~/2" FT AND ,, FT
'""
DATE:
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COSA Checklist
Legal Description: ROLLING HILLS VIEW ESTATES BLK 3 LT 3 Parcel ID: 05032228000
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1966 Total depth +521 ft
Cased to +40 ft
❑■ Sanitary seal is functioning correctly
❑■ Wires are properly protected
Casing height (above ground) 14 in.
Date of flow test for COSA 8/1/24
Static water level at beginning of test 103 ft
Comments Well records from MOA file, Well inside house
B. TANK DATA
Measured operating fluid level in septic tank 50
Date of pumping 9/1/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/8/10
❑■ ALL standpipes present per record drawing
Total measured depth from grade 7 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑■ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑■ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 2000 gallons 7/31/24 date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test 5 gpm
Water storage tank volume 0 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 NRim Eng.
Date 8/1/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/1/24
Results g Pass
Fluid depth prior to test
Water added 450 gal
0 in
New fluid depth 1 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 42
Effective depth used 0 in
Effective depth remaining 42 in
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
F■ Yes if No ft ❑■ Yes if No
Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' Yes if No
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑■ Yes if No
Neighboring Absorption Fields > 100' Animal Containment > 50' ■❑ Yes if No
■❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'❑ Yes if No ft ❑■ Yes if No
F-1 N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑■
Yes
if No
ft
Surface Water > 100'
❑■ Yes if No _
Tank to Property Line > 5'
■❑
Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
■❑
Yes
if No
ft
Private Wells > 100'
Yes if No _
Water Main > 10'
■❑
Yes
if No
ft
Community Wells > 200'
Yes if No _
Water Service Line > 10'
■❑
Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
ft
ft
ft
ft
ft
ft
ft
1
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Finn NorthRim Engineering Phone 694-7028
(engineer's Printed Name Steve Eng Date 8/16/24
OF
Ar
49TH.. *�
*� IA ; ... Steve Eng to
A CE -6256
`'
'\41 6/116/2Q�
COSA Checklist June 2022
/
Off/
o
c�/ LOT 2
BLOCK 3
\^� / PLAT #P-624
co N
O N /
`"/
A/
LOT 6 ^
BLOCK 3
PLAT #P-624 \
\ 64.
m /
�o
97.4'
m \
LOT 3
PA
BLOCK 3
_
E E
-
PLAT #P-624
E - E
PP
E
ppS`yv
m
�
\
> >
6;21
SEE NOTE G
G \
co `°
C0
28.1'x36.2'
O \
LOG CABIN
\
LOT 5
BLOCK 3 cJ�
129.3'
o
PLAT #P-624 00\
N
p.
100'
WELL
RADIUS
66.5'
\
(N 89°50'00" E 150.00')
TRACT D
PLAT #84-253
LOT 1 /
\ BLOCK 3
\ PLAT #71-299 /
LOT 2
BLOCK 3
Q PLAT #71-299
o \
oo,\ �O
LOT 4
BLOCK 3
PLAT #P-624
ASPLS MORTGAGE LOCATION SURVEY NOTES:
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY
EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
LEGEND
( ) RECORD DATA PER PLAT #P-624
o FOUND REBAR, NO CAP
. . . EDGE OF ASPHALT
E E OVERHEAD UTILITIES
pp POWER POLE
SEPTIC PIPE
O WELL
DECK
0 CONCRETE
NOTE: WELL LOCATION IS APPROXIMATE.
WELL IS LOCATED INA CONCRETE FOUNDATION BLOCK
VAULT (UNDERNEATH DECKINO OUTSIDE ACCESS).
0' 40' 40'
SCALE: V= 40 FEET
(11"x17")
�. OF. A�gsl
j *•••49TH ... *1
.A141 J6,�i✓ \
J ••Ryan G. Johnson;
r�+,•.No. 192159 ,•�
�� • 81129/2024•'S �
AS -BUILT OF:
\
LOT 4
BLOCK 3
PLAT #P-624
ASPLS MORTGAGE LOCATION SURVEY NOTES:
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY
EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
LEGEND
( ) RECORD DATA PER PLAT #P-624
o FOUND REBAR, NO CAP
. . . EDGE OF ASPHALT
E E OVERHEAD UTILITIES
pp POWER POLE
SEPTIC PIPE
O WELL
DECK
0 CONCRETE
NOTE: WELL LOCATION IS APPROXIMATE.
WELL IS LOCATED INA CONCRETE FOUNDATION BLOCK
VAULT (UNDERNEATH DECKINO OUTSIDE ACCESS).
0' 40' 40'
SCALE: V= 40 FEET
(11"x17")
�. OF. A�gsl
j *•••49TH ... *1
.A141 J6,�i✓ \
J ••Ryan G. Johnson;
r�+,•.No. 192159 ,•�
�� • 81129/2024•'S �
AS -BUILT OF:
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Rolling Hills View Est. Lot 3, Block 3, T14N, R1W,
Sec.6
Location (address or directions)
Meadow Canyon Drive
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
H.U.D. Telephone: (home) Business
605 w. 4th 'Ave. Suite 086 Anchoraqe, AK 99501
271-4665
Telephone
(d) Real Estate Company and Agent The Realty' Store
Address 8040 Opal Circle Anchora_~e: AK 99502
Telephone 243-1022
(e) Mail the HAA to the following address: (or check here r-l, if hold for pick up.)
List contact person and day phone number below:
Pick up by Engineer
TYPE OF RESIDENCE
Single-FamilyJ~] Number of bedrooms 3
WATER sUpPLY
Individual Well ~ Community [] Public []
Note: !f c0mmunity well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site~] 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.
72-025 (Rev. 7/88) Page 1 of 2
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 th is
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system 'is 'safe.
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name of FirmEagle River Engineering SrVS.Telephone 694-5195
Address P.O. Box 773294 Eagle River, AK 99577
Date
Lou;s A.
CE~67'36
6. DHHS APPROVAL
Approved for ,_~ bedrooms by
Approved ~ Disapproved
Terms of Conditional APproval.
,~_~_ ~/m,,~/~ Date
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
WELL D~:T,A ~"i ~, ~" ::: i~ '
Well Classff~cabon v ~.,~-'~r/
Well Log Present (Y/N) ~ Date Completed/~"~' ¢,5~,,,~,-~-~ ~-~Yield
Total Depth ~/ ' Cased to ~ / Depth of Grouting
If A. B. C, D.E.C. Approved (Y/N)
Static Water Level ~',/J' / ~'~'/.,~,,
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) /
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ,
To Neares~ Edge of Absorption FielC on Lot
To Nearest Public Sewer Line /'"//'¢
To Nearest Sewer Service Line on Lot
Water Sam pie Collected by
Water Sample Test Results ~/~-,~/'-'~""~
Comments
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
o'.,-c -~;On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
; Date
SEPTIC/HOLDING TANK DATA
Date Installed /:~/~Size
Standpipes (Y/N) /1/ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~'.~/
To Property Line ~'~ /
To Water Main/Service Line +/¢ ~
To Stream, Pond, Lake or Major Drainage Course
Comments
No. of Compartments ~
Foundation C~/,..n~g~t (Y/N)
Date Last Pumped ~?')',
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~'/?
To Disposal Field
72-026 (Rev. 7/88} Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date installed /~',,%/ ¢~_~,.~,~::2,,~.~----
Width of Field
Type of System Design 7
Length of Field Z"J""
Depth of Field 7 /
Gravel Bed Thickness ,5'"
Square Feet of Absortion Area .~J"& ¢ Statndpipes Present (Y/N)
Depression over Field (Y/N) /~/ Date of Last Adequacy Test
Results of Last Adequacy Test .¢~ .~:~ ~. ~ .~_c~. ~-~-.~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ¢7/'~'~ ? To Property Line /¢¢ /
To Building Foundation '/¢J"/ To Existing or Abandoned System on
Lot ,~e/~f ; On Adjoining Lots -/-.,~,~ '
To Water Main/Service Line ¢?¢" To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelLn~es,~f,h.: eff~,~,,~~ the date of this
inspection.
Company ~ ;:;;:,~ o~,: Seal
Date
MOA
No.
,
Receipt No.
Date of Payment
Amount: $
72-026 (Rev, 7/88) Back
t 70-
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL INFORMATION
(a)
Application Date ,~'t~n~ 9. 19RR
Legal Description (include lot, block, subdivision, section, township, range)
Lot 3, Block 3 ROLLING HTLT,$ VIEW EST. Sec. 6, %14N, R1W
Location (address or directions)
Meadow Canyon Drive
(b) Applicant Name H.U.D. Telephone: Home n/a Business 563-3333
Applicant Address c/o Associated Brokers 640 W. 36th Ave. #! Anchorage, AK 99503-5807
Attn: Eric Dvr~ud
(c) Applicant is (check one)' Lending Institutior~LI; Owner/builder ~; Buyer []; Other [] (explain);
(d) Lending Institution n/a Telephone
Address
(e) Real Estate Company and Agent ~/a
Address
Telephone
(f) Mailthe HAAtothefollowing address:
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms 3
Other
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. :
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.
~ ..... ~ ~ 72-025 (11/84)
ENGINEERING FIRM PROVIDIN' iSPECTIONS, TESTS, FILE SEARCH, DA' ~,ND 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/o~
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 Eaqle River Engineering Services Telephone 907/694-5195
Address P.O. Box 773294 Eagle River, AK 99577
Date ~ /
DHEP APPROVAL
Approved for ,~
Approved ~.
Te~ms of Conditional App'r~val
Disapproved Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 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 requirements. 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.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOL)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descriptio, n:, 2'~/'~--'~ ./ ]~/'~{' ~/ /'~/'~'~$
/~//11~ I//~,~ /~ ~ T /~/,~ /~ /,~ ~.~
Well Classification ~~E~-- If A, B, C, D.E.C. Approved (Y/N)
Well Log Present(Y/N) ~ Date Completed /'~'4'4' ~/f'~,,,~¢,~,. 4,,~¢~'~,~1d
Total Depth ¢'~',~,~.l ~ Cased to .¢-zvO ~ Depth of Grouting
Static Water Level -~"/5"/,~m,&,,/ ~-~ ~-~"/'~$ Pump Set At
Casing Height Above Ground /'F'/' Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) /P' Depression Around Wellhead
Separation Distances from Well:
To Septic/Holding Tank on Lot ~'~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /00 ~ ; On Adjoining Lots
To Nearest Public Sewer Line '~//'~ To Nearest Public Sewer
Cleanout/Manhole '~'¢"~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'~¢~-'¢-"~ ; Date
Water Sample Test Results L-'~'.¢//'~,"'~'-~. - ¢ ~ ~,-'~/~
Comments ~ t~/ ~ v,~,, s ~*~"~/~,~'~'"{ ~.v IT.P ~' /-{~ /~%
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) /1' Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~'3 ~
To Property Line ¢'1o ~
To Water Main/Service Line .e-/~ ·
Course
Size /zC~d~:2 ,.~, No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped .,1-,,.¢~
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~'/ /
To Disposal Field "~ S' ·
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /? ~ ~
Width of Field -~ ·
Square Feet of Absorption Area
Depression over Field (Y/N) /~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well '"'/~'~ '
To Building Foundation / ~,.%'" /
Lot ~/~
To Water Main/Service Line +'1~ ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ,/¢ /
To Existing or Abandoned System on
; On Adjoining Lots '/'" ~¢
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I .~.hecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed -.'~'/~ Date
Company
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~'"'-/"~/~ ~
GENERAL INFORMATION
(a)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name/~/'~Z//u¢. ~'///,/~'/~-~'~ Telephone: Home ~'/-~,.~7 ~ Business
Applicant Address DO t~o/~.. '77/~,~[;'7 _/~'_.~:~,
·
(c) Applicant is (check one): Lending Institution []; Owner/builder/~; Buyer []; Other [] (explain);
(d) Lending Institution /v,,,~ ~,. / TelePhone
(e)
Address ~'*~g' ~ ~ ,'~--
Real Estate Company and Agent
Address /~'"~ ~ /'~'
Telephone
(f)
Mail the HAA to the following address:
~ ~96~
~GLE RIVER: AK 99577
TYPE OF RESIDENCE
Single-Family/(~ Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Ind(vidual Well,~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
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.
72-025 {11/84)
ENGINEERING FIRM PROVIDII'~'-~NSPECTIONS, TESTS, FILE SEARCH, D/~'~AND INFORMATION
As'certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm S & S ENGIN_I:FRING Telephone ~'/4~7~'"" ~----~ ~' ~
Address SRB 196X
Date
FJ~GLE RIVER, AK 99577 HAY 2 4 1986
DHEP APPROVAL
Approved for "~J~"~-~
Approved
Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 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 requirements. 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.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECT/oN
RECFIVED
Well Classification
MUNICIPALITY OF ANCHORAGE (MO~-v
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y~'~)
Total Depth '~'7,~ f Cased to
Static Water Level ~ '
Casing Height Above Ground '~
Electrical Wiring in Conduit ¢~N)
Separation Distances from Well:
Date Completed ~IN,C:~C..~Y., ~¢,~ Yield
'¢¢C)~ q¢ Depth of Grouting ~
To Septic. J..Metdff~ Tank on Lot
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead (Y/~
; On Adjoining Lots
To Nearest Edge of Absorption Field og Lot ~.,,._~..~ i ; On Adjoining Lots
To Nearest Public Sewer Line
To Nearest Public Sewer
Cleanout/Manhole ~J/&' To Nearest Sewer Service Line on Lot
Water Sample Collected by '~_-~'. '~ _1¢-.~,5~..~rd~L.te,.%& ; Date
Water Sample Test Results
Comments ~ k,./_~--L ,,y,'/~-~--/'~ "-/'~¢* ._~t,'.,/'~"~:> "/-/./15
B. SEPTICP~,~L-B~IG TANK DATA
Date installed
Standpipes~N) Air-tight Caps ~/N)
Depression over Tank (Y~;~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/,btei~rrg Tank:
To Water-Supply Well (42~'¢ '
No. of Compartments
Foundation CleanoutC~J~4)
Date Last Pumped ~ ~
~ (j~,. ; for '-'---'-
.,/
Temporary Holding Tank Permit (Y/N)
To Property Line
To Water Main/Service Line
Course
I
To Building Foundation ~
To Disposal Field ~ ¢~' ~
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026il 1/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~C;::~ ~ ~
To Building Foundation
Lot ~1~ t
To Water Main/Service Line ~. =, f""("
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~'
Depth of Field
Gravel Bed Thickness
Standpipes Present 4:~i~'N)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots '"~C~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
2 !9
Signed S & S ENGINEERING Date
Company SP. R ~96X MOA No.
EAGLE RIVER,AK 99577
Receipt No. ~' .~"~' ~'~" ~
Date of Payment ~/~~
Amount: $
Page 2 of 2
72-026 (11/84)
unicip litYof
nchor ¢
P,O. BOX 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES, ,,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
June 6, 1986
Robert Shafer, P.E.
S & S Engineering
SRB 196-X
Eagle River, Alaska 99577
Subject: Lot 3 Block 3 Rolling Hills View EstAtes Subdivision
Waiver Request - WR86-063
Dear Mr. Shafer:
Your request for a waiver of the 100 foot horizontal separation
distance required between a septic tank and well has been granted
for the subject lot. This distance was waived to 63 feet.
This waiver is valid for the existing three bedroom single family
dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
ROBERTA. SHAFER
May 25, 1986
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
Municipality of Anchorage
Department of Health and Human Services
825 L Street
Anchorage, Alaska 99501
ATTENTION: Steve Morris
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOI~
MAY '2,,
RECEIVED
REFERENCE: Lot 3; Block 3; Rolling Hills View Estates
Request you issue a waiver to the horizontal separation distance of
63 feet between the septic tank and the private well located on the
referenced property. The well was constructed in approximately 1966
and at that time a log crib was constructed for on-site waste water
disposal at a distance of approximately 70 feet uphill from the well.
In 1983 a new on-site wastewater disposal system was installed and a
waiver was granted by the Municipality for the septic tank to be located
63 feet downhill from the well. The septic tank was equipped with water
tight couplings and the site chosen based upon the topography that existed.
The ground slopes away from the well at approximately 21% grade.
There is no well log available for this property, however, wells on
the surrounding property show either c~ay or bedrock protecting the
water strata from contamination above. The soil beneath the area where
the septic tank sets is GM and provides a favorable filtration and limited
percolation to the soils below.
In accordance with our risk analysis, the private well on this property
is almost sure to be free from any contamination from household sewage.
With approval of this waiver, request you approve the attached Health
Authority Approval application.
If we may~ of further service, please contact us.
V~AS/ss
SRB 196X EAGLE RIVER, ALASKA 995'~7
$ & $ ENGINEERING
SRB 196X
EAGLE RIVER, AK 99577
APPLI¢?'NT FILLS OUT UPPER HA[ ' _NLY
Propert,~Own~ [~0(~;,~ ~ j~ ~'4:% ((~;.~e~¥,?C i !~ ~x~;~'V~'~ ~T',~,~.~ Phone
Address Zip Code
Lending
Institution
Phone
Address ~) z~ {.~. ~ ~ ~ L% ~ '-
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~ f~
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A w~l Io9 is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that dat~, 9ive well depth (attach log if available).
~ Public Utility
Sewer Disposal :
~ Individual Year Individual Installed; ~ ~'.:' (::~ ~'
~ Public Utility When Connected to Public Utility:
~ Holdin9 Tank
NOTE: THE INSPECTIO~ FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
F~e~d r~ ~ ~ .~ ~.z~.~ MUN~C~P^UTY OF
( } APPROVED BEDROOM8 *CONDITIONS OF APPROVAL
( ) DISAPPROVED /'~ ~ ,~...:....~ ~
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
EXCAVATION
ROBERT A. SHAFER
WORK
December 19, 1982~
C VILENGtNEER
694~2979
Re/~ x Realty
ATTENTION: Lorraine Minor
P.O. ~ox 8Z~8
Eagle River, Alaska 99577
Dear Lorraine,
Reference: Lot 3; Block 3; Roll~nghill View Estate
We have ex~mined the septic system located on the referenced property
as you requested. As near as we could determine there is no septic
tank in existence. Located in the rear of the house is what appears,
to be a cess pool. Since this cess pool is located approximately
100 feet from the residential well, a percolation test was performed
to determine if the cess pool could be used ss a seepage pit for future
upgrade of this system.. The results of the test indicated very little
percolation.
It can be concluded that a new waste water disposal system will be
required to satisfy the reGuirements of this residence. Ex~ct
specifications for the sewer system c~n only be determined after
a soil test has been performed. It is recommended that work to
upgrade this system be deferred until after break up, 1983.
If we may be of further service, please do not hesitate to call.
Sincer.el~, / ,//
,/~,~,..'.~ '. ix ,,: ..
Municipality of Anchorage
Department of Health and Environmental Protection