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Home My WebLink AboutROCKHILL BLK 2 LT 5Onsite File s OR z v Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171073 PID Number: 015-362-10 ❑ New ❑✓ Upgrade Name: Robert Ravn & Janet Gregory ABSORPTION FIELD ❑ Deep Trench El Shallow Trench El Bed El Mound Address 6501 Shale Cir ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Rockhill 2 5 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' Ft. well 100+ N/A N/A N/A N/A TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250Gal. Surface Water 100+ N/A N/A N/A Material Steel Number of compartments 2 Lot Line 10+ N/A N/A N/A NA Foundation 5+ N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. RemarksNew Tank Onl y Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Isaacs Excavating Services Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspectiones: 1st 6/8/2017 Location and description 2nd d Top of Deck 3 4 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �\0 OF Conditional Approval: Date A ........ teven �annorae� 9 /8r . A G `V.'.AW Approved �� 6 � Cy Date 11 2v 1 l�''�DH70FF� �A Inspection Report_1-1-12.doc SWING TIES DESIGN PARAMETERS z NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �� of a\� �� "'�qs 11 /�G>�P '�y,� *; * t♦� .... R. Pannone I (✓ �Fc • CE 8149 c� j (,k N,*-pFESS--* \\\ �� PRIMARY SEPTIC SYSTEM go 00 00 J) Scale 1 "=50' A B ROCKHILL, BLOCK 2, LOT .PT'S'Steven ROBERT RAVN & JANET GREGORY 6501 SHALE CIRCLE ANCHORAGE, AK 99507 NO. BEDROOM: 4 0z a a mz PERMIT NO. OSP171073 PLAN TANK SIZE: 12508 0- C) OG/FG 0 O� T1 16.40 49.70 ``" n n EL. 89.2 T2 19.80 56.50 USED: 1,250g STEEL SEPTIC TANK j u s.o ABBREVIATIONS —w—w—w WATERLINE/ TH TEST HOLEEL. 83.6-71,2508 SEPTIC EL.83.4 WELL RADIUS (P) PROPOSED TANK NEW 55 — 5s NEW SEPTIC (E) EXISTING CO CLEAN OUT NO. PROFILE MT MONITOR TUBE NO. TYP TYPICAL T&E EASEMENT t � I i / APPROXIMATE LOCATION OF f ; \ DAINFIELD (E) PER 1980 \ INSPECTION REPORT DC2 T2 REMOVED & REPLACED 1,250g TANK WITH NEW 1,250g TANK PER T1 MOA CODE - ;' q M _ DECK 4 BR C� 5 . HOUSE (E) I DRIVEWAY NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �� of a\� �� "'�qs 11 /�G>�P '�y,� *; * t♦� .... R. Pannone I (✓ �Fc • CE 8149 c� j (,k N,*-pFESS--* \\\ �� Date 11/10/2017 RECORD DRAWING Scale 1 "=50' NOTES: ROCKHILL, BLOCK 2, LOT .PT'S'Steven ROBERT RAVN & JANET GREGORY 6501 SHALE CIRCLE ANCHORAGE, AK 99507 NJC -I.D. NO 015-362-10 PERMIT NO. OSP171073 PLAN SheetOF 2 ` ""'� MUNICIPALITY OF ANCHORAGE n,enr On-Site Water&Wastewater Program Z'. %- „,, 6�r • • f�r PO Box 196650 4700 Elmore Road 1 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 w ” http://www.muni.org/onsite 116 I I l I%. UcpaI.tt>>cnt *NCH oog. On-Site Wastewater Disposal System Permit Permit Number: OSP171073 Effective Date: 5/5/2017 Work Type: Septic Upgrade Expiration Date: 5/5/2018 Tax Code Number: 01536210000 Site Legal Address: ROCKHILL BLK 2 LT 5 G:2438 Site Mailing Address: 6501 SHALE CIR, Anchorage Owner: RAVN ROBERT L & Lot Size in Sq Ft: 53446 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank El Holding Tank ❑ Privy ❑ Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: (OilyDate: ,, /(_y___ 5/5// 7- Issued By: �' �(. 10(1 y tZvte-1' Date: 5/5//7 MUNICIPALITY OF ANCHORAGE Community Development Department /, Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-362-10 Property owner(s) Robert Ravin & Janet Gregory Day phone Mailing address 6501 Shale Cir., Anchorage AK 99507 Site address 6501 Shale Circle Legal description (Sub'd., Block & Lot) Rockhill, Block 2, Lot 5 Legal description (Township, Range & Section) Lot Size 53,446 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑Q Upgrade 111Duplex (D) ❑ Holding Tank ❑ Renewal El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct, I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: , '2 tS Waiver Fees: Date of Payment: .5151l} Date of Payment: Receipt Number: Ct) < LA Receipt Number: Permit No. Waiver No. Permit App_.- • ::..,.c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak,com May 3, 2017 Subject: Rockhill, Block 2, Lot 5 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,250g septic tank to be issued for this property. The existing 1,250g is collapsing. It will be decommissioned per code and replaced. Currently the lot is developed. The proposed system will utilize a replacement 1,250g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A double clean out will be installed after the tank, and a foundation clean out installed before The tank will be located: 5'+ from any property line or building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, �p;(E .........',ur ��i F •• • '� •IP Steven R.Pannone '•. 814 Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 MUNICIPALITY OF ANCHORAGE 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 DISTANCE TO: Well /0~/ Absorpt~n ~rea ~IEW [] UPGRADE Manufacturer Liq. gallons Inside length Liquid depth IF HOMEMADE: Well Dwelling PERMIT NO. DISTANCE TO: Liquid capacity in gallons Foundation [~_~/ Total leng_th of lin~s Materia b~eneath tile We, DISTANCE TO: I Length °'~%ne( No. of lines / ~ of tile to finish grade Dwelling IWidth Material Nearest Io~n~ ~, ~ Trench wi,~ inches inches WidthY Depth Length Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line DISTANCE TO: Building foundation Sewer line PERM,TNO. 'ooo ¢ Dista nce/~/~,~i n. es TotaIPERMiT e f fe~ve NO,~ a~)sgrption area Septic tan k PERMIT NO. Absorption area(s) OTHER t" PIPE MATERIALS ¢~/'d ~-- SOIL TEST RATING INSTALLER REMARKS APPR~~ DATE LEGAL PERMIT NO. APPLICANT LOCATION LEGAL BILL BASHAW _HALE CIA ~. .~ f LOT 5 BLK ~ RO~KHILL SUB, ~-,~l_.l~'~ I i_~ I PilL I T'~' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8~5 "L" '- ~4-4~ ~ELL Rr-J[:. Or~--$ I TE ~EWER LOT :. I~.E TYPE OF SOIL AB~ORPTIUN SYSTEM I=,. TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 6~4-3181 53466 SQUARE FEET SOIL RATING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL AB~ORFTICN _~5TEM IS: [-~EPTH: '12 LEr'~L~TH= 22 GI;.'R~"E[- I}EPTH= 8 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). ~:EL~LiIRE[> SEPTIC TANK SIZE= 1250 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. 'Tb~Em (2) I ~SF'ECTI CINS IlRE REm;!UIREC. BACKFILLING Of ANY SYSTEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t00 FEET FOR A PRIVATE WELL OR t50 TO ~00 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 8ND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ER~IT E:KPIRES C,E,Z:EMBER ---~l_. iL~80 I CERTIFY THAT i: 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 THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:_ .......... ........ ...... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221~ SOILS LOG -- PERCOLATION TEST [~SOI LS LOG [] PERCOLATION TEST SLOPE ~-/ o~~/~ lO 17 18 19 2O WAS GRO,N~ WATER IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE {minutes/inch) COMMENTS TEST RUN BETWEEN FT AND , FT BOX ~69, STAR I~OI. TTE A ANCHORAGEi, ALASKA 99,~O;~ SlX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH Of 300 Drilled at the rate Of $19.00 PER FOOt. ~94-3151 flU. B,LLL Ba~/w~ 344-9051 O,,u~ecL ~ I~. ~h~ PROPERTY OWNER LOCATION OD" WELL SITE. DRILLER WELL LOG: o .... 17' szt. 77---28~ ~0~--~07~ 234--237~ ~37--25~ ~ ~. ~4--~8e 7~o t~ ~o ~e $o~ ~ S~. O~e 14o~e S~. P~ ~e ~o~ ~ ~o~. 3/4 0~. Co4Z o~ ~9:120 ~ o~ ~ $19.00 ~ ~oo~. g2280.00 100 ~ o$ ~~ ~ o~ ~ $6.00 ~ ~ooZ. $600.00 ~OST INGLUD~$ ALL LA~O~ AND MA~[~IAL ~O~ ~OMPL~ION O~ ~AID D~ILLIN~. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THru sum OF g~80. O0 THANK YOU VERY MUCH. DATE. BERNIE C~.~ OF RAMPART~ .~.~DRI'LLINGi WORKS MUNICIPAL~ITY 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 O / ~- ~ ~, 2_ --- /O HAA # ~ ~ ~ o ~b--~ ~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner S;[~;~xJ¢,~, Mailing Address (c) Lending Institutibn Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone: (home) Business Telephone 7 '5 2. 5',y' (e) Mail the HAA to the following address: (or check here"[~, if hold for pick up.) List contact person and day phone number below: __ 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms ¢ '/ 3. WATER SUPPLY Individual Well~/3~ · Community[] Public [] Note: If community(' well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. 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 IRev. 7/88) Page 1 of 2 ~ to i5 ~Sed ')JJOM s,Jeeu!§ue i~uo)sse~oJd eql u! SUO!SS!LUO JO SJOJJe JOJ elq)suodseJ )ou s! e§~Joqouv jo/,1)l~d!o)un~ eq/'penss! s! eleo),qlJeo ~ eJojeq BieP eZ~leUe Jo suo!loedsu! lonpuoo lou op SHHQ jo see~oldLU~ 'slueLueJ!nbeJ elelS pu~ I~Jepej u!m, Jeo ~s!1~s ol JepJo u! suo!inlp, SU! §u!puel J!eq), pue seuJoq jo sJes~qoJnd o~ ~se~Jnoo ~ s~ s!q~ seop SHHQ eq.L '~)tS~l¥ ~o el~lS eql u! peJe~s!§eJ Jeeu!Sue leUO!SSejoJd luepuedepu! u~/~q e^oq~ S qde~Se~ed u! UeA!I~ suop, m, ueseJdeJ eql uodn XlUO peseq peleowJeo leAoJddv Xlpoq~,nv qll~eH senss! (SHHC]) seo!^Jes ueuJnH pue qilee. H ,to lUeLUlJedeQ e§eJoqou¥ 1o/~l!led!o!unl/N eq/ IBAoJdd¥ I~UO!ilpuo0 ,to swJe/ A. WELL DATA Well ClassificatiOn MUNICIPALITY' OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 19'84 343-4744 Legal Description: Well Log Present (Y/N) ---7--- Date Completed Total Depth '-%~ ~ Cased to Static Water Level Casing Height Above Ground /~'~ Electrical Wiring in Conduit (Y/N) y SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sam pie Collected by Water Sam pie Test Results Comments If A, B, C, D.E.C. Approved (Y/N) __ Depth of Grouting Pump Set At Yield Sanitary Seal on Casing (Y/N) .~/' Depression Around Wellhead (Y/N) ~'/ ; On Adjoining Lots ~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ---'-" ;Date i~/'0 ¢ I~: /_E/fO /,~- ~*/') NO. of Compartments yFoundation Cleanout (Y/N) ?/ Date Last Pumped //,/7'-~O ; for Temporary Holding Tank Permit (Y/N) SEPTIC/HOLDING TANK DATA Date Installed ("/~O Size Standpipes (Y/N) ~'/~?- 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 Building Foundation /~Z. To Disposal Field 7' To Water-Su pply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorptio~n Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: //~ To Property Line To Water-Supply Well To Building Foundation Lot I~(~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutback (if present) 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 gu. id~,i~.esj.n effect on the date of this inspection. ~(?, .,,~ ~ .... 0 Date ~'~0 ¢' I ~ l ,,~'*'~ ..... :#,/~ .... ::) Engineer's Seal MOA NO. Receipt No. O~ ~ ~-~,0'~"~ ¢ ¢~o Receipt NO. Date of Payment //- ~ ~, ~ ~F_.9 // Waiver Fee: $ Amount: $ ?70 ~ Date of Payment 72-026 (Rev, 7/88) Back Page 2 of 2 &751W. DINDND ~LVD. ANCHORAGE,'ALASKA 9~502-3904 ~07) 2~8-50V5 RESIDENTIAL .WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: L.,,crL 5, Block 2, Roc:khill 6501 Shale:, Drive Bill & Barbra Basham WELL LOG AVAILABLE: Yes INSTALLATION REOUIREMENTS MEI': Yes WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: TEST PROCEDURE: Well Ga].lons per' Hinut:e 6 Gal ions per' Hinute November 16, 199() r' a t (~):, O'f: 6 ga].].ons per minute while the dr'awdown was monitcH'"ed with an ac:ctus'(':ic probe. Att the begif'H"t:[ng c,f t'.l'le:, test', watte~r' leve:,l was · found att /:];2 .f:eet below top o.F casing. At a pumping rat. e o'f: 6 ~;ja].lor'~s f:)E.)r H~:i.r'~tite the ~atze:,r' ].evel c:lropped t'.o 240 feet: a.ft, er' 6() minutes c:)f pt.tmpil"~g. At this level the probe hung up. Well log iFtdica'[T, ed per'.fc~r'attions at t. his lewel. A total o.f 5()C~ ga].lons wer'e pumped in 95 minutes. During t:l"He nex't,: 60 minutes the ~,~ell r'e<:::ov- ered to, 185 feet. Actual r'e)c:ov~try is estimated at 2 gallons per m:i, nute~ based ol"l a total, c~t"-awdo~l"i to 27() ~:~:~,~'~.,, TEST FOR E.COLI AND TOTAL NITROGEN: War. er was tested .for E.Coli and total nitr'c~gen on November 19, 1990 E.Coli 0. 'T'ota]. Nitrogen ().25 rog/1. Max. allowable Total N:i. trogen 10 rog/1. I'EST RESULTS: This well. meets 'l:he requiremer'rhs of the Mur'~i(:z:i. pal:i, ty o.f Anchor'age. THIS WE__EL, WILL PRODUC~' MOR__E THAN ! GALLONS PER M~NUTE THAN FOUR HOURS ~OR MORE Tl"~e Municipal rectuir'ement ~:or well ~:].ow is 15() gallons o.F water pe:,r' bedroom per" day. This ~e]. ]. e>:(::eec'l '[l"lJ.~ i,"e~qLt:i.r'~:~fDef'F[:. The sL~bsur~ac:e:, cor~c:litic)rls that. may r'~ot, be observed ~;r'om the arid changes :i.n the ].and use ar'id otl"~er factors that: may impact the aclu:[ ~;(-F~i'" ~;e:~(,:.:,~::tJ. Fig t:he:' ~.'~e:l. ]. ,, ~51 N, DINDND BLVD, ~NCHDR~GE, ALA~K~ ~502-~V0~ (907) 248-5095 LEGAL: LOCATION: OWNER: RESIDENCE: SEPTIC SYSTEM ADEQUACY TEST Lot ""' Block 9~ Rockhill ~5()1 Shale Circle Bill & Bar'bra Basham Single Family, 4 Bedr'ooms WELL: SEPTIC SYSTEM: F:'r'ivate~ On Site FROM MUNICIPAL RECORDS: 4 Bedr'oom System TANK: Greet' Steel 1250 Gal. Two []ompar'ts. ABSORPTION SYS"FEM: Trench ABSORPTION AREA: 508 Sq, Ft. SOIL RATING: 85 I NS'T'AI_.LA'F I ON DAT'E: 1980 DATE OF LAST PUMPING: Anch. [;ess Pool November' 1'7, 1~79() DATE OF TEST: Nevember" 16, 1990 TEST PROCEDURE: System was inspected arid measur'ed. ]"aF~k was .~ound with ~ive ~eet o~ cover" and with a liquid level o~ 50 inches. Tr'ench clean out was 66 inches deep and dr"y. Trench sump was 11 ~eet deep and dry. 50() gallons o~ clean water" was added to the tr'enc:h at a constant rate r.).~ 6 gall~ns per minute while the water levels in the tank and the sump wer"e monitor'ed. "Fhis caused a water' depth o~: 10 i~'~{:hes to be measured ir') the sump~ the water level in the tan~ did not c::hange. A.~ter 60 minutes the sump was dr'y, indicating that all 500 gallens o.F water had been absorbed. TEST RESULT: 'T'h:i.s system roe. ets the c:ode r'equir'ements the Heal th and Soc: :i. al Services Department o~: the I~lunicipality o'~ Anchorage,, NOTE The operatior~al li~:e o.f all septic systems depends on t. he 1 oc:al sol 1 c:cind i t J OhS ~ gl'"(]LU]CJHater' 1 evel s that may ~ 1 u(:tuate dur'ir'~g the year".~ and the water usage o.F the .family be:Lng ser'ved by the system. 'l"hese cc~l"ldition~ ar"e oL~tside the contr'ol o.F the evaluator' o-F '[:.l"~is sept,:i.c system. Ne can there.For'e not ~l~ve any estimate o.F how long this system will .Function satis~actor"y ~or cL(rr'eF~'~, (::)F" -~tl'~:l,,ire C)CC:LIpaFI'[tS,, ' 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 /?J'E I/ o Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~'~!~.%~eltphone:Home_~:~0~ Bu~ness ~2-~77e (c) Applicant is(check one):~Lending Institution ~; Owner/builder ~; Buyer D; Other ~ (explain); (d) Lending InStitution I~'-'~Jt' ¥~0~!~0~ "~/w~ 4 ~Telephone (e) Real Estate Company and Agent t,~OI C~ Address Telephone Mail the HAA to the following address: (f) TYPE OF RESIDENCE Single-Family ~ M~lti-~'~'~ly I-I~ Number of Bedrooms 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) Page 1 of 2 ' 5. ' ENGINEERING FIRM PROVIDII~. dNSPECTIONS, TESTS, FILE SEARCH, DA,,,~ 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, t 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. ~, ~5.Soc~,~..s Telephone ,._-~O IJ'~0 Name of Firm ~A.~.'~ i. . Address 104~,,I I~A~t.t~w ~)~. Date I~ - Icl Engl neer's Seat DHEP APPROVAL Approved for Approved bedrooms by 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 I11/fl4~ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: /VlUNIClPAOfy OF E E VED WELL DATA Well Classification Well Log Present (Y/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed (~ - 1 - 80 Yield ~ · Depth of Grouting ~ Total Depth ~ ~' Cased to Static Water Level l lbO Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~,~ Water Sample Test Results Comments Pump Set At ,.Jr¢~_.aa~. Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) N ; On Adjoining Lots IO~'t" t ~ ; On Adjoining Lots ~,O~4' To Nearest Public Sewer To Nearest Sewer Service Line On Lot -- ; Date i~- tcl-~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ¥ 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 t (~' '* To Property Line I~ ~' ¥ Foundation Cleanout (Y/N) Date Last Pumped · for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Ab..sorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of LaSt Adequacy Test Type of System Design -l'"~er~c..J~ ~~ ~ Length of Field ~-~--' Depth of Field Gravel Bed Thickness '1' ~ .~,~' ~ Standpipes Present (Y/N) I~ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ! I~, To Building Foundation ,ct. t Lot ~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line I~'t- To Existing or Abandoned System on ; On Adjoining Lots '"'- To Cutbank (if present) --" To Driveway, Parking Area, or Vehicle Storage Area -"-- 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 Vet)t (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have ch/~cked,, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed~_)~./~/~-,J_ ~ Date IC~-J~-~. Co ..n, Receipt No. ~/ Date of Payment, Amount: $ ~ ~ ~. ~ .~ ~ Hn~imeer% Seal ~ '~"-. f~..- ~.........~ .... Page 2 of 2 ~'. c~-~so DATE RECEIVED / ,NSPECT,ON APPO,NTMENTS , TIME TIME ~,~,~f TIME DATE DATE , . ~t~- DATE INSPECTOR INSPECTO~~IPALt~ OF MUNICIPALITY OF ANCHORAGE rurAL P~OTECTIoN DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street . Anchorage, Alaska 99501 J~ ENVIRONMENTAL SANITATION DIVISIONTelephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ PHONE MAILING ~'OPER~ RESIDENT (If different from above) PHONE 2. BUYER PHONE MA~LI ~ G &DD~ESS' ~' ' PHONE 3. 'LE~DING INSTITUT O MAILING ADDRESS 4. REALTOR/AGENT ~ ] PHONE I MAILING ADDRESS 5, ~_~GAL DESCRIPTIO~ ' SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /'~{~'0 YEAR ON-SITE sYsTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER I--]Septic Tank or [] Holding Tank Size: ! '3-3zD If Tank is homemade SOILS RATING give dimensions: <~ ...~"~' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ISewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS E~]/~'I~PROVED FOR "~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accom~ny certificate) ~. APPLI('~NT FILLS OUT UPPER HA[~'ONLY Buyer Address Zip Code Phone Lending Institution Address ~0C/4 7--~ } .~ ~ ~, ~ t~'~ ZipCode Realty Co. & A~nt Phone Address //~ Zip Code LegalOescription ~ ~ ~/~ ~ ~ /~j~ Street Locati~ ~ ~:~ [ ~ ~,Z~--' ~ ~ Type of Resi~nce Single Family Multiple Family No. of Bedrooms / ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. '~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal Year Individual Installed: ~lndividual ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspectof~ MUNICIPALITY OF ANCHORAGE Field Notes: DEPT. OF HEALTH & /'~!~_~ ~ ENVIRONMENTAL PROTECTION RECEIVED (,~.~'.--) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE :;-",/,':~/~'~ '~, Soils Rating Date Sewer Installed Well To Absorption Area /' :.~?.~ / Well Log Received /~...~,,.~ 8 5"L" S rREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN, ~ MAYOR DEPARTMENT OF HEAt. TN AND ENVIRONMENTAL PROTECTION July 17, 1980 JAK Construction Box 2511 Chilkat Court Eagle River, Alaska 99577 Subject: Lot 5 Block 2 Rockhill Subdivision Approval for your individual sewer and water facilities can not be granted until the following items have been completed: h (~)~ .A well log submitted to this department for our -~-~review. (2) The top of the well casing sealed so that it is water tight. (3) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for 3L~ our review. Please notify this department when Item 92 has been completed for a reinspectiono If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Peoples Bank and Trust Mortgage Loan Department Pouch 7-007 99510