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Home My WebLink AboutROCKHILL BLK 2 LT 1Rockhill Block 2 Lot 1 #015-362-06 10109 r4 JL L, X r_~" I Xn�w_ K_q r- 1 -.1 N_ r-1 U-9 ff-- F-7 9-m lc�__ / / DEPARTMENT 6g-c-,HEHLTH AND ENVIRONMENTAL TECTION / r 825 /1 STREET, ANCHORAGE, 8K� 99 � ~ 264-4720 ` �-J E-:7 L_ I F -D Ir -A C� 0 r -4 1 _F FEE —S-- F—:::- UE F -e �E" F.."# --IIT APPLICANT JHK CONSTRUCTION 8100 PETERSBURG #5 99577 ]49-]151 !LOCATION LEGAL L1B2 ROCKHILL LOT SIZE 999999 SQUARE FEET / TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH ' MAXIMUM NUMBER OF BEDROOMS 3 SOIL RATING <SQ FTe-BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C -A FEE F::" -r VA :JL:2 �r=vaD-r"� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. 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). ��I FREEE-8 �E7F-'_lr 1 C., �nlr-4V_. �I E:-7= 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. �� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPHRTMENTWITHIN ]0 DA9S OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F="EE Fe r-1 I -F F=" T FR FEES—:- �EF_ ��E� lF:::"F-_" 2- -1 I CERTIFY THAT 1: I HM 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 THE CODES. ]� I UNDERSTAND THHT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: --------------------------------------------------- APPLICANT JHK CONSTRUCTION ISSUED BY DEPARMENT OF zA- rH AM ENV IPW N Tom_ iwrec r i am 264--42 .LAK CONST cf MT ION L•L62 RL-CEILT_ �3F IL t�frs+3l 'TI%W €�XIi9ti& €i+4�a t otoo #fir 3 S5 s?T r -:*IL RATING (S12 Fi'r =- 126 T s Et t3IREIN sI -E of THE :SIL As"_x wrIoN w5rim is: :IlaRami=iE'4�'L_' `! i-# u t r LEhHiT tt 4' Ito Pn I s eAE I � LimosfH � IN FEET? OF rf T f2E; � °t C3 Il9 10-0. T * : H rRE3 _#i �Q Pir I� TW DIaT'_W fi - 'tom 51-WWX e.0 174E I n4ERE 15 ro 5e r W tto fW FOR Tom: 5. THE z3RRVEL VePtH IS TW M f N I t P14 CiEP TH OF G&WEL WTHEel ME );"J rFALL PIPE AND THE 80rTQM IV THE E.`tewRTLON (IN FEED. -" L l::: -r H N K I .- j as o . t4lr Fiji i€ Y�Nr i ri-J9 RIESPJW5f8rLM To twm4 TWis # RRTj-"r QXAfNG T I?:& rRLL.R T I o:�i't Itt' � r I IW3 OF IN'f MELL;� HO,tr :'04 r To rH I*;; r'�' r ME i _tm-R oir �g IigT#mss 1'HR r r .,JELL WILL -'vv_ 1 1;z Arrj rEM Wjrj+x+T FIi It .rIr3N r� '+L 8' THIS VEPrFfiE T W I LL BE 15WJ9C;T TO PROSEC .f T I ON. tf ttdIh� ii4 L>I aTt tk SEN t1 WELL FIND f� a v)N-'5I rE � � %175F'�' 'a'r�rEm I5 jv:v PP_iEr FOR A PRIVATE 14ELL 13R '(,l;$ TO 2W FEET FROM R tl,OLIC WELL DEPe4DING QW513IN rw repE OF mute Ira IeLL. 1.147 rf-03fi4 O f S TMCE FROM A PR I YAVE WELL To A PR I'A T E SEWR L L NE I ;25 FEET At#3, s r� F: f1*2M I rY SO4ER LINE 15 75 FEET. W -ELL L� 3 s t E i °tt F t� nM Mr -ST F E I"i i�C� TO THE DEKW TMEN r WITHIN 33 rim WeLL ETI T R Ipajo4rS mw Fvavu1. SPEGIFLU T AX -6 RNV 1:.e '+iiiV�TIt DTFlrgn� FdZE )*?'APLt _£ TO IN°I PRt R rbrSTALUirlot. I C3 TIF'# rmr I RM r`=i-3d4ILIi R Wf rM r}te tec4i!Ipj: ttENTS F13R ON-SITE SEMERa F94D WELLS F'7 *_:PEr ,2; I WILL f W IL L w 3'' = r i IN _ _OI #DAM_E W I TW THE CAME S. I ic° T T} H -ru t -`t ' i �': T£i'I ?•tr`t'�' 7Ea?i.t I RERESjCYE?*_'F_ J-5 RjM3QjirXlD TO Q# JOE r jw EN(J�W_*EMENT IF T SOI LS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 p - SOILS LOG - PERCOLATION TEST PERFORMED FOR: ✓ / , CON�r DATE PERFORMED: /6 LEGAL DESCRIPTION: DEPTH ( SLOPE (FEET) D/ 0 Y� C4 -v% 2 -Z ��✓1��/ gi l 1 s Z Y p? 4 777' 1 5 6 7 8 -7_16 9 Cp?Y5�.- 10 � �I �. GCp,z�. WAS GROUND WATER an S 11 ENCOUNTERED? LO 12 E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: („(Jy� `� �7) CERTIFIED BY: DATE: ✓ _ — nAb ,;4 is 1i STANLEY BRUST & ASSOCIATES Project No. TXK F_ngineers - Planners - Surveyors Adequacy Test Log Legal Description , No of Bedrooms 3 Date Time Level Readings Remarks septic tank 1.1 , z fl a r, VrD WELL LOG - � RIC_('l l LL— Date Drilled! 11-8-8, Lot 1 B1k.2 Static Water Level 27 feet Gallons Per Minute 10 Draw Down NSA feet Total Feet of Casing 75 Material Drilled: to to 65 $ • '� Municipality of Anchorage R" On -Site Water and Wastewater Program (907)343-7904 Ba sre Certificate of On -Site Systems Approval Parcel 1. D. 015-362-06 1. GENERAL INFORMATION Expiration Date: 2 - S — 13 Complete legal description Rockhill Blk2 Lt1 Location (site address) 9201 Main Tree Dr., Anchorage Ak. 99507 Current Property owner(s) James & Sandra Gilbert Day phone Mailing address 9201 Main Tree Dr., Anchorage Ak. 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request Received by: COSA to be relea COSA Fee Date of Payment Receipt Number TYPE OF WASTEWATER DISPOSAL: I] Individual Fx1 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Date: I requested by the engineer r Waiver Fee $ _ Date of Payment Receipt Number. C0SA # !_S C 1 Z 1 �L Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE t/ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 272-8218 Date 62/10 7 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: Theunicipity f orage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other CASA blue sheet r l, c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Rockhill Blk2 Lt1 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 1118183 Sanitary seal (Y/N) Y Total depth 75 ft. Cased to 75 ft. FROM WELL LOG Date of test 11/8/83 Parcel ID: 015-362-06 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 31 in. AT INSPECTION 6/27/12 Static water level 27 ft. 27 ft. Well production 10 g.p,m, 5.1 g p in. WATER SAMPLE RESULTS Coliform Neg colonies/100 mL Nitrate 6.64 mg/L Arsenic ND ug/L Dateofsample: 11/1/12 B. SEPTIC/HOLDING TANK DATA Collected by: PES Tank Type/Material Steel Date installed 1983 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping 5/9/12 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 1983 Soil rating (g.p.d./ft2 or ftz/bdrm) 100 Sf/bd System type Trench Length 30 ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 12 ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/27/12 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 14 in. Water added 459 gal. New depth 32 in. Elapsed Time: 100 min. Final fluid depth 14 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R Pannone Date l2 /ld -7� COSA brown sheet 10-10-12.doo Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of Anchorage s P4 ,� Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 121254 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 1 of Rockhill subdivision. This inspection revealed a nitrate concentration of 6.64 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. F—mo i, IZ0 Municipality of Anchorage 1�1'��pGF' BUi • Development Services Department r Building Safety Division � -- On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORA SINGLE FAMILY DWELLING ,-,/�' Parcel I.D. oi5-362-o6 COSA # ®S 0- la `a J Expiration Date: /6 - ( - %�- 1. GENERAL INFORMATION Complete legal description Location (site address) 9201 Main Tree Dr., Anchorage Ak. 99W7 Current Property owner(s) James R & Sandra J Gilbert Day phone Mailing address 9201 Main Tree Dr., Anchorage Ak. gg5o7 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. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ 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 On -Site 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217 Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date L 20 m`7, Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water ��•� OF levels that may fluctuate during the year, and the water usage of the family being served by the system. !•�P�..........••••••.,,••• These conditions are outside the control of the evaluator of this system. All systems eventually fail and 4 �?••°• �1 satisfactory test results do not guarantee future performance of the system, nor do they guarantee that i 3 4 TH there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 0•••••+•• ••••• .• ••••• ••••• ........0 performance nor give any estimate of how long the system will continue to meet the operational 0_% .. ......... ....... .................0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ♦°;Steven R. Pannone i above. Any reliance upon or use of this report by any other person or parry is not authorized nor will it ��c� .' No. CE 8149 -0 confer any legal right whatsoever. �� .y.., o•O�'�� 5. DSD SIGNATURE yi<C�OOD,, ;: 0• Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory �� Other s By $ L Original Certificate Date: (Rev. 71/25 Municipality of Anchorage su, ' Development Services Department p °; Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Rockhill Blk z Lt 2 Parcel ID: ois-162-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 22 8 2 8 Sanitary seal (YIN) Y_ Total depth -75 ft. Cased to J5_ft. FROM WELL LOG Date of test 22/8/2983 Static water level 27 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) _32 in. AT INSPECTION 6/27/2022 ft. S.2 g.p.m. Coliform _colonies/100 mL Nitrate�_mg/L Arsenic: t ug/l Date of sample: 61Z;�iZ Collected by:�a� B. SEPTICIHOLDING TANK DATA Tank Type/Material Steel Date installed 2983 Tank size 2000 gal. Foundation cleanout (Y/N) Y Number of Compartments 2 Cleanouts (Y/N) Depression over tank (Y/N) NL1 High water alarm (Y/N) Date of pumping 51g/2o22 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 2983 Soil rating (g.p.ddff or ft2/bdrm) Zoo sf/br System type Trench Length 3o ft. Width 3 ft. Gravel below pipe 5 ft. Total depth 22 ft. Eff. absorption area 30o ft2 Monitoring tube Y Depression over field N Date of adequacy test 6127/2022 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 14 in. Water added4o gal. New depth33 in. Elapsed Time: Zoo min. Final fluid depth 2& in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Datum Size in gallons "Pump off" level at Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ioo+ Absorption field on lot ioo+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 2.00+ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots ioo+ On adjacent lots aoo+ Public sewer manhole/cleanout ioo+ Holding tank 3.00+ Manure/animal excrete storage areas ioo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line ;+ Absorption field 5+ Water main io+ Water service line 3.o+ Surface water ioo+ Wells on adjacent lots noo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io+ Building foundation io+ Water main io+ Water Service line so+ Surface water zoo+ Driveway, parking/vehicle storage io+ Curtain drain F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots zoo+ / certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 62a HOZ COSA Fee $ Waiver Fee $ _ Date of Payment�i /c3��o� Date of Payment Receipt Number a32 Receipt Number (Rev. 11/05) 0 ,en R. Ponn, No. CE 5149 a 0 Municipality of Anchorage p E s Community Development Department Development Services Division SM1 ETT On -Site Water and Wastewater Program - 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 121254 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 1 of Rockhill subdivision. This inspection revealed a nitrate concentration of 7.69 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ref.# 1122613001 Client Name Pannone Eng. Srv. Project Name/9 Rock Hill Blk2 Ltl Client Sample ID Rockhill Blk2 Ltl Matrix Water (Surface, Eff, Ground) Sample Remarks: Printed Date/Time 07/02/2012 16:55 Collected Date/Time 06/27/2012 15:24 Received Date/Time 06/27/2012 15:45 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C 06/28/12 07/02/12 NRB Waters Department Total Nitrate/Nitrite-N 7.69 0.100 mg/L SM21450ONO3-F B 06/28/12 CMA Microbiology Laboratory E. Coli Negative I 100ml, SM21 9223B A 06/27/12 MEM Total Coliform Negative 1 100mL SM21 922313 A 06/27/12 MEM MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section CEM P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# Of 5� 36)L-06 \ HAA#��i� 1. GENERAL INFORMATION Complete legal description Lot 1, Block 21 Rockhill S/D Location (site address or directions) 9201 Main Tree Drive .Property owner __ Catherine Larrea Day phone 346-2222 Mailing address Lending agency Mailing address Agent Claire Dalton/Jack White Day phone Day phone 229-1275 Address 3201 C Street, Suite 200/ Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx 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. 5. 6. By: 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 S & S ENGINEERING Phone (f- �/ y - 7 17034 Eagle River Loop Roa o. 204 Address Engineer's signature DHHS SIGNATURE Approved for T-HEE F— bedrooms. Disapproved. Date /o/iS`/ `! Y "_0 F q ti4. C ROBERT C. COWAN f,? CE - 8801 f ta'r Conditional approval for bedrooms, with the following stipulations: Additional Comments MITIC Date 10 -'Z 2- if - 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. 79m_ IAe 1/911 Back MOA M21 Municipality of Anchorage jG i j DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division )NMEN'IAL Sk VICES DIVI 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo;- 1 LOC.K 2 RO"N"' S/'Parcel I.D.: 0/5-- 3 4 2- — 0`50 A. WELL DATA Well type PR' "#' If A, B, or C, attach ADEC letter. ADEC water system number Lo resent/MN) Y 6 5 Date completed i I 18 18 3 U Total depth -7 S Cased to -7 J' r Sanitary seal ON) Date of test Es FROM WELL LOG it/ff/r3 Static water level a - / Well production 10 g.p.m. WATER SAMPLE RESULTS: 1 Casing height (above ground) It '- Wires properly protected a/N) Y I-' `J AT INSPECTION !o /ItY/9Y i a� s,� 6 t 9— p.m- Coliform O Nitrate 44-11 f o I' i °i Collected b 17034 Eagle River Loop Road No. 7' raglii-z Date of sample: Y' ,ver, AlaSKA B. SEPTICIHOLDING TANK DATA C N a + ^ s /��r' ` ��`�` �' ° v n H ti r JCIIg If Date installed I q $ 3 Tank size / a o Q Number of Compartments oZ Cleanouts ((/N) Y °Lf Foundation cleanout &N) y6 -S Date of Pumping f o i g 8 C. ABSORPTION FIELD DATA Depression (Y6 j" d High water alarm (Y/lb "' y Pumper A `I- No 14 E S'* -.A v, c,6 S Date installed 1 el 91 3 Soil rating (g.p.d./ftz or rm 10 J System type 7-1415— c 'v Length 3 c ' Width 3 Gravel thickness below pipe Total depth 1 / Effective absorption area 3 (1 o : Monitoring Tube present O/N) vis Depression over field (Y& f'' o Date of adequacy test t ° t �� ResultsFail) P `f sf For 3 bedrooms Fluid depth in absorption field before test (in.); b e2 s qi Immediately aftergal. water added (in.): cl Fluid depth c; (ins) Minutes later: Absorption rate = S 4 -/ g.p.d. Peroxide treatment (past 12 months) (Y/N) N ° ^"� �N° "� If yes, give date �F >N,yTit A530A04.4 147- S•G Gpy nr >'F,S ve4- 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* evel at* High water alarm level at* *Datum Cycles tes E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 '/,, T0 c- On adjacent lots /00 f Absorption field on lot 100 I On adjacent lots y ° 0 / Public sewer main N 14 Public sewer manhole/cleanout A i Sewer /septic service line f Lift station N /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 91 Property line / f Absorption field S /4 Water main/service line /0 o f Surface water/drainage / ° ° �t Wells on adjacent lots / a o �-4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 '` Building foundation f Water main/service line Surface water ) 0 ° Driveway, parking/vehicle storage area 3 / L Curtain drain P ° ^/'f K IV Wells on adjacent lots 1 ° 0 -.*- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance wit)i 771 7uidefines in effect on this date. Signature Engineer's Name 4 d /3 ft C CO W 4,%) Date 10 ( f Ig? f( p P? HAA Fee $ 2OC9 - Waiver Fee $ i -ih Date of Payment r D � - ) Date of Payment Receipt Number ®�/-2 �L-3 � �"z 3� J Receipt Number 72-026 (Rev. 3/96)* OF RorTge, t09YAt are n a BCT -15-1998 22:23 CT&E ESI ANCHORAGE LC7&E Environmental Services Inc. n a►is�'N'riii.�l►N��ii��Al►r CT&E Re[.f1 Client Name Project Name/# Client Sample ID Matrix Ordered By PWSw 985985002 S & S Engineering N/A Lt 1 Blk 2 Rock hill S/D Drinking Water 11 9075615301 H.W/b'! Client 1W Printed Date/Time 10/15/98 22:05 Coilected Date/Time 10/14/98 09:30 Received Date/Time 10/14198 11:20 Technical Director: Stephen C. Ede Released By AL(awabte Prop Anatysi$ Parameter Resutts ACL Units Method Limits Date Dote snit Totat Cotitorm 0 cut;lwm� SH18 92229 10/14/98 KAP Nitrate,N 4.21 0.100 mg/L EPA 300.0 10 max 10/14/98 10/14/98 GCP 01/10/1995 19:39 9076941211 U *" T S AND S ENGINEERING PAG�Ep -�01 o 0 Ak f' 1491n \ 6i?ftRR+- / 1 11&^•4 R.d Oar Ic is the responsibilitl�'of the owner' 1.s; d^'s.,rYmlr."' '�'•.'I the existence of any easements, n th*.;ati„.'`4,9`�4�rsVb- 1iti�°p°cssron►�\ strictions Hh1ch do not annear on Zh en.v NOTE division Plat. Under no circumstances, ., ;dr :.., ,,.t b- SH. j qT TME P COpOR Oeo PLAT. data hereon be used for construction pi �,'4;� `ykp $HowN NoeIEON• fence lines. The �,. lishlno boundary or` initi4l tpan5ac4 01% cr.. responsibility fop th8 - L NO Zr p� bRA11 EAI NORVMLHr ••^ L07 BLOCK �T a �noNv�rs I 6^,rIVr'10�-:...... • � Hue ., r�eR dol(, .. -ANCHOR AA RECORDING O 5_� ��,',,...... .•,. ASSOCIATES 1._....�.=— vaEr ' o- 844 EAST 15th Ave, Svi 4 \ .� -. v 10 �a)o 804 E4 AGS AkASKA -,,._,r,._.-�_..,,. F)6aDeooK; pjC e SCALE'. ci CLAIR DALTON 907 346 2187 _ �y ABCioTT ` _Ro6D 0 '•''> 5'B9'.r'9'.Zz"�' -�� J39.", I 1� w oo ,ror. DI2IUG,• N -33 E P.02 -I t - r- 4 4 f, Dl 0 Q2 It is the responsibility \of the owner to determine; ►om.,x..i the existence of any easements, covenants, or, XQJ o�n.o re- � �s'•, •,', srrictions which do not appear on the recorded sub-' Il1"Fo �.... .ash division plat, Under no cirCumstances, should any NOTE FES toxn��" data hereon be used for construction or for estab- -NO -NTS of a�cono,or�L'R�rA 'osE lishfno boundary or fence lines. The surveyor takes SHOWN ON THE RECORDED v(AT, ARE NOT responsibility for the initial transaction only. SHOWN Z1oc Kh i ll , —_.LEG HENRDE_N LOT BLOCK SAASS CAI MoMu N [KT SU JlVl O JROr Viwt �LArNo•_1 • M noa co S.r o ANCHORAGE RECORDING DISTRICT D K60 a TACK - --" REPA 1EoN ey: DOWUNG & ASSOCIATES �. _--_ 80q EAST 15fh Ave. Suite 2 ANCHORAGE ALASKA 99501 Vi H DATE: 1 B % WORRORDER: FIEIA 800K. CRIo. /SM�M ciG,_r r+7 ISCALE; �,"°60' 1"7 ?./�,a: a MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # lJ 1 �)' 3LQ--,Q - I)(D HAA # 1:A Q 0k Z$ Q )-i 1. GENERAL INFORMATION Complete legal description Block ? Rockhill -SID 4. Location (site address or directions) 9 20 f Matn Tree Dries e Property owner Cet 1%er in 4 G.a r'r eu Day phone 576h' — y6 3'y Mailing address 920f Main Tree D•^ir✓c� Ancf+o!! a" . A1c 99 SS/6_ Lending agency S ecEkIv MarfySf- Day phone .562 5626 Mailing address 5-60 iF 3y t'' 64.4 MC170 nacre A 99503 Agent N A ( Re finance) Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 3 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Fla F�� Technical Eervrcer Phone 3 q,5- i3SS Address /KS30 Ec do07-1 Sf �4ncho�a4� f}!z 945�� Engineer's signature -i -��' g 91t&ei` Date _Yj /993 p®p®r�/�"tieffaf fs�a QRS k7�jy�, 'o •f p• h,P% ♦ � S9" f�.f LI=:49f` ° 1 yd� , OFTJ'fff9fff fffff ��If�f�f/a9�eaM• �ffif a♦•,ff ea,f., a• W a THEOOOi?c K. MOORE ,^ �`"ryery, CE - 3539 "'7•• Yf i 141h pn slvo + s4; 6. SIGNATURE Approved fo3 bedrooms. 0 Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: 111717 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA N21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L•o fL, GI/< 2 Rocfzht(I E1,0 Parcel I.D. A. WELL DATA Well type Pvt. If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed II / (9/ 8 -7 Driller.HeFT Total depth Cased to 75 Casing height 30" Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test (t / 8 / 8 3 W /9 193 1;0 Static water level 2 -7 26 rn . Well flow !O L"'g.p.m. > 9 p Pump level > y 7 v _ r" SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100, %o C-0. ; On adjacent lots loo' Absorption field on lot 1/ ; On adjacent lots > foo Public sewer main N. A. Public sewer manhole/cleanout N. A. Sewer service line 90 Petroleum tank None Seen WATER SAMPLE RESULTS: Coliform Oro/ /102 r" -t Nitrate Other bacteria vane reOT rled Date of sample: y/9/9? Collected by: F/afh'P Tech Svc B. SEPTIC/HOLDING TANK DATA No as -bud F tns echae) report on S;,,e @ DHHS ketc%on kr dL S'ielr< Sniv 'Fiv. cans peri„%tom ? retroa f (tiff/ cerbh rca m.sbv. Date installed 19 S 3 Tank size /oaf aCompartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N. A Alarm tested (Y/N) N Date of pumping W/ t 2/ 9 4 Pumper O/d M c D oncrfo( SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 100' �I•om C.&- On adjacent lots ? 100' Foundation 6 Em," C c' To property line 3o Absorption field 10' Water main/service line_ > ZS Surface water/drainage > 100' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION jV, A. Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: "Pump off" level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA No aS - Lull f rns®ec><con rgor I- on .isle e DffHS. 3n -r'o :Prom CanS frucfcan per&lJ, prevcous OAM cerh.Fccccfer d• fiefo( #Asp. Date installed 1983 Soil rating loci a`/t3olnn System type TNench Length 30' Width G(n I• Gravel thickness 15 Total depth 12' Total absorption area 300 a' Cleanouts present (Y/N) Y Depression over field (Y/N) N Date of adequacy test `f Z? / 93 Results (pass/fail) __ pas{ for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) None Renown 0f If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Ito' On adjacent lots > 100' Property line_ 30' To building foundation 1:zt-s' To existing or abandoned system on lot N. A. On adjacent lots > 30' Cutbank N. A. Water main/service line > -as' Surface water > loo' Driveway, parking/vehicle storage area So' Curtain drain Non t Seen E. ENGINEER'S CERTIFICATION l certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature �� 6c•*°°p°">° ��y�.. Engineer's Name 7 eoo(0re F. i-rcpo e)e 0MTH�'= •11u8 A�6'•66 r +'� �, •6.6!61,0•••<,(b6M Date Anrif r-� (S) ♦666 • 06 f°y •" ••' :fY N[ �y �5 �; `•" C'. HAA Fee $ % 7 0 10eD Date of Payment Receipt Number ( 7 0 % Waiver Fee: $ Date of Payment Receipt Number C CHEMICAL & GEOLOGICAL LABORATORY d� A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. m• g 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 LABOPAT011V. e:alab Ref..4 :93.14$7 �. REPORT` of ANALYSIS Client Sample ID :L1 B'l ROCKHILL StD 920.1 MAIN TREE Matrix WATER Client Name :FLATTOP TECHNICAL SAV Collected :04/09/93 @ 11:45 hrs. Ordered By Received :04/09/93 @ 12:30 hrd. Protect Name WORK Order :64814 PrDiect!3 Report Completed :04/13/93 PWSID :UA Technical Director STEPH —. EDE Released By r— e!P ---- SampleROUTINE SAMPLE COLLECTED BY: T.F. MOORE. Y" S. HOSE BIBS— Rema>ks: QC Allowable Parameter Results Qual. Units Method Limits NITRATE -N 3.40 mg/l EPA 353.2/300.0 10 en n.. °mesa .SeeSpecialInstructionsAbove Aw.v•mv-.tlm- a UA - Unavailable See Sample Ramarks Above NA a Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT - Less Than D - Secondary dilution. �±�+ GT A Greater Than AZISGS Member of the SGS Group (Societe Generale de Surveillance) Extract Analysis Data Date Init. 04/09/93 LLH 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 E Application Date /�/'5 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) -R" 44 bit! .5ge— / % Location (address or directions) (b) Applicant Namewa!�a.{�� Telephone: Home 3 Business Applicant Address — (c) Applicant i;; (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); '® (e) (f) Lending Institution ��e rr-a Telephone Address _ Real Estalo Company and Ac Address Telephone x--76 –�'3 3b Mail the HAA to the following address: - Wu 1,. jo 2. TYPE OF RESIDENCE Singlo-Farnily ❑ Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well g Cornmunity ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the logality and status. 4. SEWAGE DISPOSAL Onsite A 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. Pagel of 2 72-025 (11;84) 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 than rn/ w fe-asgation c! t� 5 Haaith Authority Approval shows that the on-site waters upply and/or wastewater disposal system aP? , functi,,na' ar,c adesi;atc for the number of bedrooms and type of structure indicated herein. I further verify that baT,, rd on me ir+forrrrat.yin ot: wred from the Municipality of Anchorage files and from my investigation and inspection, the ccE-tits water supp�l/ ansi:cr wastewater disposal system is in compliance with all Municipal and State codes, ordinances and regu±ations in e `eci on the date of this ins-p'ection. n Name of Firm T®41A-4-� Telephone - Address W2 0 3 d 5 Date 6. DHEP APPROVAL i7�. Approved for. bed Approved _ C Terms of Conditional Approval Conciffional CAUTION d_ u R�r Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Anti catty Approval certificates based solely upon the representations given in paragraph S above by an independent GrotesuAwaf engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their tending 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 forc-rrors or crn&ssions iia the professional engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LOT It 13 4::� 2 :Roc. K 44 lL L SEC' i q/T 112N i 7R�m v./ A. WELL DATA Well Classification R `—+" If A, B, C, D.E.C. Approved (Y/N) /Q Well Log Present (Y/N) — Date Completed H. Yield 10!�fm Total Depth Z5 Cased to 75 Depth of Grouting IV 014 L Static Water Level A7 Pump Set At 730-1—Tn-m\ , Casing Height Above Ground 30 6Sanitary Seal on Casing (Y/N) X Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well To Septic/Holding Tank on Lot too,-'-; On Adjoining Lots > v d To Nearest Edge of Absorption Field on Lot 1 I O ; On Adjoining Lots 7 tO in To Nearest Public Sewer Line td®NE To Nearest Public Sewer Cleanout/Manhole tAOki To Nearest Sewer Service Line on Lot Water Sample Collected by �r.S ;Date 9141$ Water Sample Test Results T Q-g,�2 -- Comments B. SEPTIC/HOLDING TANK DATA Date Installed 149-3 Size i0610 No. of Compartments TwY Z) Standpipes (Y/N) �0 Air -tight Caps (Y/N) %� Foundation Cleanout (Y/N) Yr Depression over Tank (Y/N) IN Date Last Pumped WS /a.5 F Pumping/Maintenance Contract on File (Y/N) WA ; for WA Holding Tank High -Water Alarm (Y/N) NIA Temporary Holding Tank Permit (Y/N) W/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 10 a zlr To Building Foundation To Property Line To Disposal Field To Water Main/Service Line 7 O To Stream, Pond, Lake, or Major Drainage Course Comments I -It f ir.w� %� � �.Gt wul� a "�Q� t�o As .76,1-14- 4,„t Z( Ae_ Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /0 Type of System Design 'T2.RNcH Date Installed 6483 Length of Field 3 Width of Field Depth of Field 02 Gravel Bed Thickness Square Feet of Absorption Area 3y'0 Standpipes Present (Y/N) IONt= Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test raS$ Separation Distance from Absorption Field To Water -Supply Well 11 O✓ To Property Line > l D To Building Foundation To Existing or Abandoned System on Lot ly n 14 ; On Adjoining Lots 7 35 To Water Main/Service Line To Cutbank (if present) NON L To Stream/Pond/Lake/or Major Drainage Course No N E - To Driveway, Parking Area, or Vehicle Storage Area _ iwA ` _7 7 Comments f- mar /•c c�wwr�cv�s�v�� o A D. LIFTSTATION NONE^ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at — Tested for Electrical Codes (Y/N) Comments Dimensions — Manhole/Access (Y/N) "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, conformed to al) MPA and HAA guidelines in effect on the date of this inspection. Signed Date gfS/ Company MOA No. Receipt No. Date of Payment — �D`�S r ��* nF. Amount: $ `( S� ��c?P'. 3�Y�� Engineer's Seal 49TH �•• •.naso• s• • ••�' Page 2 of 2 ' JUN`_ 2b, 971 •• T`}� 72-026 (11/84) r4� •',�,c� `�0 Ga �P�iG3da�lD9 pv�o 2 ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 S E P T I C S Y S T E M A D E Q U A C Y LEGAL: LOT 1, BLOCK 2, ROCKHILL LOCATION: 9201 MAINTREE OWNER: THOMAS HASSOLD RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: • �••2225•E r NOTF.�-;:>`NO AS BUILT ON FILE WITH MUNICIPAi,ITY. 1 > 1UW: 25, 1971 FIEL 6"`MEA,SU.RE�'I -4 1983 qT •s 'yF' yea' DAT£ hQ "PING SEPTEMBER 5, 1985 DATE OF TEST: TEST RESULT: THIS SYSTEM-"""MEETS""'THE-'CCSDE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requi- rements of the Municipality and State. IN1,AICA'Z'.E-,-Fi°YSTE"1��INSTALLED IN ACCORDANCE WITH PERMIT ISSUED ON MAY 18, dTM SEPTEMBER. -4, 1985 SINGLE FAMLIY, THREE BEDROOMS ON SITE WELL T E S T FROM MUNICIPAL RECORDS: TANK: 1000 GAL, TWO COMPARTMENTS TYPE UNKNOWN ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 300 SQ. FT. SOIL RATING: 100 INSTALLATION DATE .. :1'983 """"-'__,..._ SYSTEM WAS INSPECTED AND TRENCH 1 FEET � DEEP WITH 6 INCHED OF LIQUID. 370 GALLONS WAS ADDED TO THE TRENCH CAUSING THE WATER LEVEL TO RISE 6 INCHES. BY INSPECTION THE SYSTEM WAS JUDGED TO BE OPERATIONAL. TEST PROCEDURE: 4C0 e La �p��3G3d ; aD� PAA CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 R E S I D E N T — — — — — — — — I — A L — — W — E L L I N S P E C T I O N — — — — — — — — — — — — — LEGAL: LOT 1, BLOCK 2, ROCKHILL LOCATION: 9201 MAINTREE OWNER: THOMAS HASSOLD TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 10 GPM. PUMP YIELD: 6 GPM AT 20 FEET DRAWDOWN DATE OF INSPECTION: SEPTEMBER 4, 1985 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 6 GALLONS PER MINUTE. DRAWDOWN WAS MONITORED WITH AN ACOUSTIC WELL PROBE UNTILL WATER LEVEL STABILIZED. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORMS ON SEPTEMBER 4, 1985. TEST WAS NEGATIVE. TEST RESULT: 9r• M <aI ^ P.. * y v 4 222 .5i 1E ea< �U N�' a5, 19!) �5 •• h>J c t THIS WELL MEETS THE REQUIUREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. AS- �vILZ> MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Lc/` / .�5%tee,/= <�7 'i��Ckh // 5�6W. I -- Location (address or directions) zy N p� �6J-//N !^ O T .✓>'�+��( C1�2/✓J/tom! /I %'Y U� (b) Applicants Name/,X/l_ (f Te Telephone.37`a Applicants Address 77,�eo (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer r� ; Other f:::j (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone 2. Type of Residence Single -Family F±Ej Multi -Family Number of Bedrooms 3. Water Supply Individual hb11 Community Other (describe) Public Note: If community well system, must have written confirmation frcan the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (Y/N) 4. Sewage Disposal Onsite Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (Y/N) Z_P 5 [Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MDA HAA Guidelines in effect on the date of this ins ction. Signed Date Name of Firm �'� �� i�sso c . Telephone Address Gf�Pe/act;,`�r•,,�o_ys� p' Signed by Date r� 1tc y 1n q;�a� (ENGINEER SEAL) 6.DHEP Approval Approved for V bedrooms By�9t"tk- Date D Approved � Disapproved Conditional s CO Y `chi The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date sham above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 2] 2-15-84 L�7� c o oG� �oGi /�/ fi Si/bl% L' ' 11NfCIPAC�TY of ANC�tiOR pE r7 a'f MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 APR "A ; lope A. WELL DATA RECEIVED Well Classification If A, B. cr C, D.E.C. Approved(YM) /14 Well Log Present (YM) 5 Date Completed//�_3 Yield Total Depth Cased to -7S' Depth of Grouting Static Water Level ,2, Pump Set At 11wn Casing Height Above Ground�� / / Sanitary Seal on Casing (XM) le Electrical Wiring in Conduit, QM Ay ° Depression Around rAbllhead (YM) Ala Separation Distances from Well: To Septic/Holding Tank on Lot /0/ f'o C• o. On Adjoining Lots , To Nearest Edge of Absorption Field on Lot > 1O6 On Adjoining Lots , lea To Nearest Public Sewer Line /✓A To Nearest Public Sewer i Cleanout/Manhole /✓,q To Nearest Sewer 'Service Line on Loth Water Sample Collected By Date�9r�y Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed .�/ e3 Size /G e 0 No. of Campartments Standpipes (Y//N) eS Air -tight Caps (YM) ' Foundation Cleanout (YM) o Depression over Tank (YM) ,411V Date Last Pumped it/meg - ��u✓ f� /� Pumping/Maintenance Contract on File (Y/N),4/, ; for /� Holding Tank High -Water Alarm (Y/N) ,Z / Temporary Holding Tank Permit (YM) IV;d Separation Distances from SepticMolding Tank: To Water -Supply Well 101 � �ro,ri C.O. To Building Foundation )�-vM To Property Line _1 a ' _ To Disposal Field G " e� /f, ee„ GU_ s To Water Main/Service ne fz To Stream, Pond, Lake, or Major Drainage Course /1//7 Corn -wits �,iF -7`4 frEic,,e�� 1cr �`L`d <✓�d'd/ /Cl�A9`� 1 �1f3 P G r1 C J�//C'� i ,U Lam° P i� 0A O F- 4()V g C ; k ;b (Page 1 of 2l �-► 8'q <,"Li. �,. . �� 15-84 JJ_'/ \- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata—X /o o SF/soType of System Design 7 �� Date Installed da72a/_4/:,� g3� of Field -9f 30 Width of Field Depth of Field -,f )-Z- Gravel ZGravel Bed Thickness 3>� .S Square Feet of Absorption Area usr/C„oStandpipes Present (Y/N) y Depression over Field (Y/N) Date of Last Adequacy Test/ice/fig` Results of Last Adequacy lost Separation Distance from Absorption Field: To Water -Supply M11 J o " To Property Line To Building Foundation G r,,,, 4. o. To Existing or Abandoned System on Lot is To Water Main/Service Line o Cutbank(if present) Al'iV To Stream/Pond/Lake/ar Major Drainage Course 1✓14 To Driveway, Parking Area, or Vehicle Storage Area o The sib a /d,P _ Continents X Pa.- bf1Ep 4s - AWO& 15 e,,t __. D. LIFT STATION �ayre Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) e Comments Manhole/Access (YM) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA *" Check Permitted Bedroom Rating Against HAA Request ** 3 I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date of this inspect,4cn. Signed Date C an C'o� w,� 4,44 ,<o � MOA No. STAY- 0: � Y KB1 /d5/s [Page 2 of 21 2-15-84 First Interstate bank '¢qr-CHECK DESCRIBED BELOW WHICH IS E'N' �Ol YQta Ske D(RSEO BY Y" H4 THIi DAY REE.N DEBITF,' to /"�°,. T� YOUR ACC(,11. BECAUSE OF NON P,' i.-�; �� ,'�?j•':"-_Y ' MENT FDP THE RCASOft INDICATEb HELL DATE. M A k f F —� D R A W N O N Jute. I OUNT — 89-72 r�.. o0 S 99--76 1 236.86 N;" Sc FE;❑f Ni FUNDS q EN DOV of MC NI 7 ACIOEINT CLOSED PLEASE DEDUCT THIS n,.n PA1 Mf N' j `}MEN," LOCa7E AC COUNT 5 SIGNATURE-- - 0 AMOUNTS DIf fER AMOUNT FROM YOURI$ J r>. MEN' 310Rf4D 6 DATE 9 'NECK BOOK BALANCE [1 2&Z, • �' THE ABOVE ITEMS Y.CRE CHARGED TO YOUR ACCOUNT AND D OF ARE ENCLOSED ENTERED FOR COLLECTION ��;�riORwE COL L -L --TIO% DEPT s no a31 POLi,:d 6-650 :� ?iORr�GE AK 99502 D:L2520036:1: ..moi �•=-c"__ g ...�= 1 i .a""�3�_ y M JAK CONSTRUCTION, INR 0 6 3 PH. 344.0811 a:.1'UP.N�p NVT pq� BANK OFTH�EIIORTH .ASKA NATIONAL 1601 E. 84TH COURT, SUITE '101 r 1 BANX of THE NORTH /v�K.b^.pve AX BaS(q; 4 Be_b so ANCHORAGE, AK 99507 yy9i'I" I' fiq_72 G'€o' E April b1 19 84 1252 AND N0 100"rg f" armt:;:;:a $ 45.00. FUj, S' � � 1 .` ; � s y 'l, TO THIT ORDErt E `:'UNICIPALITY OF ANCIL;ORAGOF •W 11'0070 311• 1:12520072`. 25 L8 0 578` r0 _t_ -Lt r Y u 4W2` {^ E- W KsI " sZ iidv l q � ` CiS7'I�DNtiJ z Jflis�•.TC�-}y 0 4 4t ss 9. -AA 0000045001, L` rad fr r_ -*.,,i - i r•J D T a i _tl i —r -_ k � F � ^ I� p � 4