Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutROCKHILL BLK 2 LT 7kMUV VJIU4710Ji
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP221311
PID Number: 015-362-12
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
MCCUE
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
6530 SHALE C I R
❑ other
Phone
Number
of Bedrooms
Soil Rating
depth from original grade
4
GPD/SF
JTotal
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
ROCKHILL BLK 2, LT 7
Fill added above original grade
Gravel length
Township Range
Section
Ft
Ft
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftp
Ft.
Well
100'+
50'+
TANK N Septic I] S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCH TANK
Capacity
12550 Gal.
Surface Water
100'+
Material
Number of compartments
Lot Line
10,+1
NA
PLASTIC
2
Foundation
01+
LIFT STATION
Manufacturer
Capacity
Remarks TANK DEMO PER UPC,
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
MIKE N ANDERSON, P.E.
Drainfield Co/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 100 ft
n 1n 10/14/22
Inspdeact s
Location and description
2 .a
TOP OF MANHOLE 100
3`d 4N
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval:
Date
�``` •`°
_-
�1'y ••if
I..' '�
12 K, a e.,
IA:C-i„: rL l AK ER�K; ' a
Septic Systems
Approved l�
Date ��
- �`i
No this approval does include
i•� �`-
not
well permit requiremnts.
: . , ,::,'.': v
kMUV VJIU4710Ji
w
LOT 6
LOT 3
10' UTILITY ESMT
Z__�
S89'59'22"E
ABBOTT ROAD 20.00'
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
ROCKHILL SUBDIVISION
LOT 7 BLOCK 2 PLAT 79-37
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance shoull
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK ORDER NUMBER: DATE: SCALE: E—MAIL
APR 20, 2023 1 "=50' schuller0ok.net
23-015-2 DRAWN BY: (NECKED BY GRID NUMBER: BOOK AGE
JLS SW2438 230131
LOT 3
_OT 4A
•- = FND ALUMINUM MONUMENT
O = FND 5/8" REBAR
1c��X
OF �\ ASD s V�
0 1 �-�
/ � • 49TH 1
/
/ �., 1 7GOO
. .. './
a
I
-JOHN L. SCHULLER.� o /
•. LS -10408 ; '0' ••�..,.�...,,•,.� '
1 0,, , . • ' J / 1831 Talkeetna Street
eo, "'• :. . Z d �� Anchorage, Alaska 99508
o fe a , W (907) 227-1455 office
sslo=\ , �• (907) 274-4992 fax
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP221311
Work Type: SepticTank Upgrade
Tax Code Number: 01536212000
Site Legal Address: ROCKHILL BLK 2 LT 7 G:2438
Site Mailing Address: 6530 SHALE CIR, Anchorage
Owner: MCCUE DANIEL & TRACI L
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
'rent S
No
GCA
`G
V
llepartment
8/8/2022
8/8/2023
67155
❑ Private Well ❑ 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
Special Provisions:
• The tank is to meet the required 5' separation to both trenches.
Received By:
Issued By:
Date:
Date: g Z Z
4
�S
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-362-12
Property owner(s) MCCUE
Mailing address 6530 SHALE CIRANCH AK
Site address SAME
Day phone
Legal description (Sub'd., Block & Lot) ROCKHILL BLK 2 LT 7
Legal description (Township, Range & Section)
Lot Size 67155 Sq. Ft. Number of Bedrooms `A
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo AD U)
Septic Tank
0
Upgrade El
Duplex (D) El
Holding Tank
El
Renewal El
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A 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:
Date of Payment: �/ 5 0 2
Receipt Number: (09 8D I
Permit No. OS l�o� 1 3 i
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
August 8, 2022
Municipalities of Anchorage
On-Site Water and Waste Water Section
4700 Elmore Rd
Anchorage, Alaska
Phone 343-7904
Re: New septic tank permit
Legal: ROCKHILL BLK 2 LT 7
To whom it may concern:
This is a request for a septic tank permit on the above referenced lot. This tank
replacement will not impact any of the neighbors or encroach on any wells, septic or
open water issues. The tank will be decommissioned per the Uniform Plumbing
Code (UPC).
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221311, Deb Wockenfuss, 08/08/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221311, Deb Wockenfuss, 08/08/22
' , Municipality of Anchorage Page ! of ~.~
~ DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~O~/°~ O10¢.- PID Number:
Name:Wastewater System: ~ New ~ Upgrade
Address: ABSORPTION FIELD
Phone: No. of B~rooms: ~ Deep Trer,~h ~Shallow Trench ~ Bed '~ Mound ~ Other
Total Depth from original grade:
LEGAL DESCRIPTION Soil Rating:O, 8 GPD/~
Lot: ~ BIock:~ ~o~Subdiv~ion:H t LL Depth to pipe bottom from ori~al.i grade: Ft, Gravel depth beneath pipe ~ Ft.
Township: Range: Section: Fill added above original grade: Gravel length:
Number of lines: Distance between lines:
WELL: C New ~ Upgrade Gravelwidth: ~ Ft. ~ ~ F.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Date inst~led;
Driller: Date Drilled: Static Water Level: Installer:
Yield: GPM IPump Set at: Ft. ICasing Height Ab°ye Gr°und:Ft. TANK
SEPARATION DISTANCES ~Septic ~ Ho~ing ~ S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
FrO~ Tank Field Station Tank Sewer Lines ~NC~
I I Material: Number of Compartments:
w~,- io~ i~~ ~ ~ ~5 5T~
S~fac, LIFT STATION
Water ~ O ~ ~
LineL°t ~O ~ ~O~ Size in gallons: Manufacturer:
Foundation ~01 J ~4 "Pump on" level at: "Pump off" level at: High water alarm at:
CurtainDrain ~ , · ~ ~ Pump Make & Model Electrical Inspections performed by:
Remarks: BENCH MARK
O1~ '~ ~ ~'~ Loc~tion and Description:
Inspections performed by: ~ ~ Dates: lsL
~((~D~ ate:_appr°yalo~
u~, '~ervic~s
Department
of
He~
ith
an
Reviewed
and
approved
by:
72*013(Rev 9/91) MOA 25
5-WIDE TRENCH
$ FT TOTAL DEPTH
4 FT SEWER ROCK
$! FT TOTAL LENGTH
j I
'i
25 50 75 100 125 i50
SCALE; 1~ = 55 ?F.
SWING TIES:
AB 22.25 FT
AC 81 TANK CO
BC 85
¢~"RK ~ AD 89 TANK ¢0
~ ~IN~ BO 92
ASWktED AT iO0. O0 rr Ar 96 DOU£LE CO
I
BE 99
AF i05 £ULL£UN & ~0
BF lOB
OS 190
i
~ o 49th
I
i
AG 185 CO AND MONITOR
TOBBEN SPURKLAND P.E.
205 W 15TH. AVENUE
ANCH. AK. 99501
(907) 279-S916
IILOT ?,BLOCK 2 ROCKHILL S/D
KEN RICE
6550 SHALE CIRCLE
IlSEPTIC SYSTEM AS: BUILT
DATE: JUNE 5, i997
SHEET: 2/5 GRID: 2458
PERMIT # SW970102 Piti # 015-362-i£ RflHO?O7?,gW6
IV©n/top
IE 90.
;/£f BARRIER~
87.~
Cleon ZTu
Stzonolord Trench .'
5' V/We
$1' L on9
8' Deep
#' Sewer rock
3' Cover
MD SCALE
81
9~
,J 0-0
,,., 0 0 0
~ ~ 0 0 0 0 0
'0 0 0 0 0 0 0
D 0 0 0 0 0 O O
~O~,O~O~O~O~.O,~On
ND SCALE
1BSO 9at Septic fan/<
3ULLRUN
87.0
1B3$ SEPTIC TANK
ANCHORAGE TANK
BENCH NARK. 3Z7TTZTM SIJtNG
ASSUME£ ELEV. lO0, O0
SPURKLAND P,E,
803 WlSth Ave
Anchorage Ak 99501
L 7T Z 3LMCK £ £ 7CWHILL
KEN RICE
5530 SHALE CIRCLE
SEPTIC SYSTEM AS BUILT
]]^TE: JUNE 3, i797
SHEET~ 3/3 GR[]3, B438
PERMIT SW970102 PID / 015-562-12 ROHOSO75. DWG
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970102
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:RICE KENNETH W &
OWNER ADDRESS:6530 SHALE CIR
ANCHORAGE, AK. 99516
DATE ISSUED: 5/20/97
EXPIRATION DATE: 5/20/98
PARCEL ID:01536212
LEGAL DESCRIPTION:
ROCKHILL BLK 2 LT 7
LOT SIZE: 67155 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18/LACS0).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~I~~~
ISSUED BY:
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 7 BLOCK 2 ROCKHILL S/D
KEN RICE
6530 SHALE CIRCLE
MUNICIPALITY OF ANCHORA(~E
ENVIRONMENTAL SERVICES DIVISION
MAY 05 1997
RECEIVED
Municipality of Anchorage
Department of Health and Social Services
820 1 Street
Anchorage, Alaska 99501
April 28, 1997
We are submitting an application for the upgrade of the septic system for this lot. The existing
system has failed and must be replaced. The submittal consists of three (3) drawings showing
the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed
improvements of the lot, of which only the septic system is subject to this permit application,
(sheet 2/3), and a schematic of the septic system, (sheet 3/3)~ Soil logs and percolation tests of
applicable testholes are also enclosed. The septic system design is based on the following:
No Ground Water or Impervious Layer to 14 ft.
Use 5-foot Wide Trench
Soil Rating.
Test hole #1 15 rain/in = 0.8 gal per sq.ft/day
Test hole #2 5 rain/in = 1.2 gal per sq.ft/day
Use 0.8 gal per day = 187 sq.ft per bedroom
No. of Bedrooms 4
Total area required: 187 X 4 = 748 sq. ft
Outlet Existing Tank ~ 91.3 (elevation)
Ground at testhole locations 95.5+-
Bottom Testhole 1 81.5
Bottom Rock 87.5
Invert tank out 91.5
Rock Depth 4 feet
Reduction factor for 5-foot wide trench 0.54
Total Trench Length 748 x .54/5 = 81 ft
SYSTEM CONFIGURATION
5-FOOT WIDE
TOTAL DEPTH ~ FT
ROCK DEPTH 4 FT
COVER 3.5 FT
REPLACE TANK 1250 GAL
The installation of this septic system will not prevent wells from being installed on the adjacent lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
N
V
V
VACANT
SCALE;
/ /
. % i
LDT 3
-__J 4
/
/
?OBBEN SPURKLAflD P.E.
203 W 15TH. AVENUE
ANON. AK. 99501
(907) 279-$916
KEN R/CE
6530 SHALE CIRCLE
J J SEPTIC SYSTE,~ DES/ON
DATE: APRIL 25, 1997
SHEET: 1/5 GRID: 2458
PEI~NfT # PID# 015-36~-1~ £EHO~O?i, DIV5
,,/
, *. 1250~L ~NK
INSTALL BULLRUN CONNEC TO T.
INSTALL S-W/DE
8 FT TOTAL ! I
4 FT SEWER ~ i '
81 FT TOTAL
TRENCN
205 I,V 15TH. AVENUE
?#
BLOCK 2 ROCKHILL $/D
KEN RICE
6550 SHALE CIRCLE
SEPTIC SYSTEk( DESIGN
DATE: APRIL 2,3, 1997
SHEET: 2/5 GRID: 2458
PERMIT # PID # 0i5-367-i? RL~HO£OT?,O~6
klonitor
Cleon Out
Clean ~Tu
S?ondord Trench ,'
k//de
Lan9
Deep
Sewer rock
Cover'
ND SCALE
901 Septic tank
200 FLL}~/ VALVE
Z1P DULL£UN
1LT BARN/ER
~ 0~0
,,u 0 0 0
_ ~ 0 0 0 O O
~ 0 O 0 O 0 O
D 0 0 0 0 0 0 0
mOnOnOnOrmO~OmOm
ND SCALE
~25~ SEP?ZC TANK
BENCH PIA£K. ~O??Okl SIDING
ASSUME? ELEV. /?O, OO
TBBBEN SPURKLAND P,E,
803 Wl5th Ave
Anchopcge Ak 99501
L ~ ? Z ?L ~CK £ £I~C/{HIL L
KEN f~ICE
5530 SHALE CIRCLE
SEPTIC SYSTEM DESIGN
DATE~ AP~fL ~
SHEET~ J/3 GRID,
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L' Street, Anchorage, Alaska 99502-0650
SOILS LOG -, PERCOLATION TEST
(ENGI~:ER'~ SEAL) ih
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7--
8
9
10
11
12
13
8 Io,,~14
15
16
17
18
19
2O
COMMENTS
,'7
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? N
s
L
IF YES, AT WHAT O
DEPTH? p
E
Depth to Water Aller j
Monitoring? £l~.'~1 Date:
Gross Net Depth to Net
Reading Date Time Time Water Drop
3:0 &~ I ~ oq-~/~- I"
PERCOLATION RATE ~,~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ,1~ FT AND *~? /"Z,, FT
PERFORMED BY: ~ '~ I ~"~' "~ CERTIFY THAT.,THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /"//,~ ~/~ ~'
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF H.'=ALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18~
19-
20-
COMMENTS
Township. Range, Section:
WASGROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT O
DEPTH? p
E
Depth tt~ Water After
Monit~dng? Dale:
SLOPE SITE PLAN
I Gross Net Depth to Net
~,;eading Date Time Time Water Drop
PERCOLATION RATE 5 (minutes/inch) PERC HOLE DIAMETER
TES~ RUN BETWEEN 7YZ,," FT AND $ FT
PERFORMED BY: ~ '~ ~ '~
I CERTIFY THAT THI~S TEST WAS PERFORMED IN
AOOORDANCEW,THAL. S.A.EANDM.N,O,pA. .. ,NES,NEFFECTONTH,SOATE. DA.E:
72-008 (Rev. 4/85)
NAME ,~
i O C A T I,~N-~ ~ /
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telepho~3e 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Inside length
Dwelling
Dwelling g 5 ~'
Width
NO, OF BEDROOMS
No. of~artments
Liquid depth
PERMIT NO.
IMaterial Liquid capacity in gallons
DISTANCE TO: Well
Manufacturer C~~
I IF HOMEMADE:
I DISTANCE TO, I
Manufacturer ' I
Well
STANCE TO: I
Top of tile to finish gra e
Length ~idth
Type of crib Crib diameter
Well
~ISTA~C[ TO:
IClass De~th
DISTA~C[ TO: ~uild[n~ foundation
Foundation ~, ~ Neares~(~ot~, n~/~.
TM~tttlr :[~ tehr e~[ ft !: it I Trencl~d~" inches
Depth
)istance bet we.eqUines
Total effectiCe absorption area
PERMIT NO.~ -
Sewer line
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to tot line PERMIT NO.
Septic tank
Absorption area(s)
OTHER
INSTA~.LER '~O °
REMARKS
APP~.~~ DATE LEGAL
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ GeophysicoiSurveys
Oriliing Permit No. ~,;'¢~' £~;, ~ ,r'~ O~i'~
(Please )[ete either la, ID or lc.) A.D.L. No.
T~.lsoroug, Subdi.ision Lot mock ~-~'1 '/4qtr.. Section No.TownshipNO Range EEO .er,dia.
'c.JlDISTANCE AND DIRECTION FROM ROAD INTERSECT'ONS 5. OWNER OF WELL:~;:':~.~,
Street Address and Area of Well Location
WELL LOG Feet Below 4. WELL DEPTH: (finaJ) 5. DATE OF COMPLETION
Material Type Top Bottom
~';~ ~;' ' ~ Auger Odetted 0 Bored ~ Ot~er:
.... / ~" ~ ~/ 0 Commerical
~..~. [~, .. '.. : ........ :~ 8. CASING: ~ Threaded /~ Welded
~ diem. in. fo fl. Depth Sfickup fl.
Set between fl, and ft.
Backfilling Gravel pack
~.~ Below land surface Date
Equipment used:
II. PUMPING LEVEL below lead surface and YIELD
..~ ~':__ft. offer hfs. pumping ~s~. g.p.m.
1~.5~OUTING Well ~rouled: ~ Yes ~ No
Matert~l; ~ Ne~f Cement ~ Other:
Length of Drop Pipe ~ ft.
~ Subm. m del 0 Oentrifice, 0 Other
t5. Water Temperature o ~ F ~ C
:¥::q:::~ T 7 i::lJq"."
L 0 C !:::I T ;[ 0
L E (3 !:::! L
'T'.',.~E: LEN!?]TH [.'.' i ?lENS :[ ON i S THE LENGTH ,:: i' i'.,i FEET ::, OF 'THE TR['ii:NCH CI!:;i: DRF!:[ !",IF,'[ EL.D.
THE DEF:q"H C!F F! TF;E:.'NC::H Ed;i: P]:T ]:S THE D)r. STF!I",!C:E BETHEEN THE '.:3Ut:;;:FF:ICE OF THE
i]F~:EIUN() ,':':~,i"~ID THE: ,'E~OTTC)M O!:::' THE EXCF:!VFITZOf',!
THEF:E :[::5 i",!E~ SET H]:DTH FOR
THE; GRF?¢EiL. DEPTH Z:L::; THE M ]: ?',! .'[ h'IUi"I DEPTH OF G[i:I:::I"/E:L EIETH[:"'EN THE OU'TFF:!LJ.,.. !:::','['.F'E
F!I",![.':'- THE BOTTOH OF THE EXCC:R'v','::!.TZOhi (]:!",! FEET).
F:'E!:;;:MZT ::E:'P.'I'F¢:.'TT H.~"S THE F~:E:SPCNS]:EZ!.Lr"."'.? T'" ;[Nl::'Ot:;;:h! "!"HZS t'.)::'Pi::iF,.'TI',IF'i'.,!'I" DUF;I];NG 'T'HE
]i ?.,ISTF:ILLF!T Z ON :[ NSF'ECT ]; O?.,i:i~ OF' i;l~'-,!'.? , ~::. L :.;:] F!D.TFtCEN"! .... .'~ TH ;[ S h . ..~r*',.:.~, : F!i'.,E) THE
I'.! HF I:::'F? OF F'E:":~ ]' £.? :':'.', "l:E:i:: THF:tT 'TH!E .,,(i:L..L. !4 ;~ LL :~IERVE;
i'"!iNI.hiLII"I D i.':'~;TRi'-,!CE 8E'.'"FHEi.E;N FI i,.!EL..L. F!hE.'-' FIN? (3t",!-S!TE Ei;E!.,.!F.,'(]iE D iSPO:E;F:iL. SY!S"['E?! IS
:;LC:!!E! FEET FOF'. i:::! F'F:ZVRTE HEL. L.. (;6;: ::l..:!;!i(.i~ TO ;;;i:¢13 FEET FF;O.:'"! ,':":I F'UE3L.;[C HEL. L DEF'END;r. NG
UPOH THE T'.?pI:'E !3F PUE',L. i E: HELl. ....
i"IC[ N :[ ?.iUH D ]: STi::!NC:E FFi:C!M R F:'R Ci: VF!"f'E Hr.E:L.L 'TC! Fi t:::'!::?. :[',,,'FI"FE SEI4ER L I hie i ~E: 2(;!i FEE:T F~i'.,iD
TO !:::~ COMI"iUHZ"?¢ SEHE,';;~: L. ZN!!!~' ]::.E.; ';::'~:i F:EET.
HEM.... LOGS RF;:E F;:EC!U ;[ !:;;:ED RND i'*iU:E;T' BE F;:ETURhE.:]D TO THE DEF::'FII:~:TI'"IENT I,.!]:TI.~IZN
(.'.IF' "i"HE HELL COMF'L.ETI'
O"f'HE¢~: F:EC!U Z I:;.'~EMENTS P!f::!'?' .,':::!.r.::'F'L..'T' :E;F'EE: Z !::r ;[ CF:iT !' ONS R!',![:, CONST.P. UCT ]; 01',t [):[ R(3RI:::!!'"I:E'i Fh':~:E
i:::i'¢.~:I Z i....RE~LE 'T'(:) ;!] N;E;Lii:;;:E PRCIPER ;I.;' NSTi:::iL.j....FIT I'
'[ CE,t:;.';:'T ]; F:'? 'T'HF!'T
!: :[ FI?I FFii'"!i[L.:[fgF:: HZTH THE F:EQL.!Z[';;:E?'IENT:i.(. F'O!7 ON'""S:[TE :!.:.;E.'t.,.tERS RND I.,!ECL. L..S FI:E; :.E';ET
F'C)?.TH iECT' '?".hie HUH ]: C: i PF!L.. Z 'T'h" OF F!?',iCFiOE?::IC:iE.
2: Z !qI!,,.L. ]:I".!:i?FF!L.L, THE E;"¢STE:i"I IN RCCOF:DFIi'.,!r_":E H:["FH THE
:ii:: ;[ U?-,i[)E::RS"i".FIi'.,i[) 'T'H!:::!T THE ()i'.,!-...SZTE SE:HE:F;: Sh.':['~;'T'E!"! Mi::!? I:;~:EC!LtZF;~E ENL. F:IR(;iiE:-'"tENT
i:;;: ..i:.~; E; ]; DENCE': Z $ t:;~:EMCE::,ELED 1"O ]: HCLUDE i"!ORE 'T'HF:Ii'.,I 4. E~EDROOM:E';.
.,., ~,.,¢ ..,,,~_.....~¢ ~.
S ! G N E D: .~..~~~~,,..,
i z, ::,t ,,,,:. :, E~ ............. i:;:'F:i"t"E ..... ......... ,..."~,~ :... -
ifi2!i "l." S'I REET
ANCI IO?,AGE, ALASKA 99501
(,Q01i 2(i4:1111
January 4, 1982
Carleson Const.
P.O. Box 10-905
Anchorage, AK. 99511
Permit ~ 811121
Subject: L7 B2 Rockhill
A permit issued by this department for a well and/or sewer
system has expired as of December 31, 1981.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent to
this department to document the installation date.
If an engineer inspected the installation of the on-site
sewer system, please have them send us the as-builts for our
files.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Sewer and Water Program
Enclosure: Copy of Permit
PERM:ET NO.
FIPF'L I CFINT'
L. OCFIT' I ON
LEGFlL
PC) BOX ±0-.905
CFIRLE:[-;ON CONS]".
ROCKHILL
L7 B2 ROCKHILL
'T'T'F:"E OF: SOIL. FIBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF' BEDROOMS = 4
L. OT SIZE 56000 SQL.IRRE FEET
SOIL RFITING (SQ FT/BR)= 85
THE REQLIIRED SI:ZE OF THE =,.. [_ FIES3RF'TION ~e*.,~;~:,f...M IL-'.;:
THE LENGTH DII.'IENSI(]N IS THE L. ENE:~TH <IN FEET) OF TNE TRENCH OR DRFIINFIELD.
THE DEPTH OF Ft TRENC:H OR PIT' IS THE DISTFtNCE 8Ef'WEEN 'THE SURFFiCE OF' ]'HE
GROUND FIND THE BOTTOI"! OF THE EXCFI'¢FiTION (IN FEET).
THERE IS l",IO SET' WIDTN FOR TRENCHES.
T'HE GRRVEL. DEF'T'H IS THE MINIMUM DEF"TH OF GRF¢'/EL BETt,.IEEN TNE OI...rl"F.'i.BLL. PIPE
FIND THE BOTTOM OF THE EF~:C:W,.,'RTION ,.':IN FEET).
PERMIT FIPF'LICRNT HI=IS THE RESPONSIBILITY TO INFORM 'THIS DEPFIRTMEI,',I'T' DL1RING THE
tNS'TFILLFITION II",ISPECTIONS OF F'IN'¢ I.,.tEL. LS FIDJFiCEI",IT' TO THIS PROPERT%' RND T'NE
NUI.'!BER OF' RESIDENCES THFlT THE NELL NiLE SER'¢E.
E;RCKFILLING OF RNY SYSTEM 14ITHOL.tT' FINfll_ INSPECTION F¢',fD APF:'ROYFIL. B'¢ THIS
[:,EF'FIF4'.TI.'IEI,.CI" WILL. BE SUBJECT TO F'R-EE] .]"T?'~
M!NII,'tUM [:,ISTRNC:E: BETNEEN Fl I,.IEt_.L Bf',l[~t F(F,t¥ .F.)I,.,i-SITE %EWFlGE [:,I:E, POSHL :=,'¢:=,rEl,,1
.tRR F'EF'T' P'CiF..' R F'F:'I',/FtTE 14ELI r'~[~' ':;l~R '~¢1' 2P"~¢~ FEET FROM Fl F'UBLIC NELL. [:,EF'ENDING
UPON 'THE: T"r'PE OF' PUBLIC: WELL.
MINIMUM DtSTRNCE FROM ta PRI","FITE WEL. L. 'TO Fl PR I ',,,'RTE SE[,.IER LINE iS 25 FEET FIND
'l"O R (]OMI"tUNtT~" SEI.,.!ER LINE IS '?'5 FEET.
t4ELL. LOGS FIRE REC~I. JIRED FIND MUST 8E F.'ETURNED 'TO THE DEPFFF~'.TMENT WITHIN ]:0
OF 'THE: NELE COMPL. ETIOI,,I.
OT'FIER RE(;!UIREI,'tENTS MFI'T' FtPPL"r'. SPEC:IFICF'ITIONS RND COI,',!STRUCT'ION DIflGRfll,'iS FIRE
FI"..,'FIILI::tE;LE TO INSURE PROPER INS'TFILLFITION.
I CERTIFY THFIT'
f: t FIM FF~MIL. IFIR WITFI THE REQUIREMENTS FOR ON-SITE SEI.,.IE. RS FIND t.,.IELLS RS SE:T
F'ORTH BY THE MUI,..!ICIPFILIT'¢ C;F FINCHORFIGE.
2: I NILL. INSTFlL. L ]"PIE S%".E;TEI,4 IN RCCORDRNCE W!TFI THE CODES.
2: I UNDERSTRND THFIT TNE ON-SITE SEW. ER S'¢ST'EM MR'Y REC!LIIRE ENL. FIRGE?1EI,.,tT IF THE
REStDENC:E I:_--; REMODELED 'TO INCL. UDE I,,!ORE THFlN 4 BEDROOM'::;.
V4. 0
~ ~, ,..~ }&,r~J,[. f., OF ErE [:,kEl£
zUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENV[RONMENTAL PROTECTION
, ~..~.~_ Pouch 6-650; Ancbm'age, Alaska 9~502 276-222'[
_ .... - SOILS LOG --.PERGQL~TION TEST
PERCOLATION
TEST
P_ERFORM~E,p
LEGAL DE.SC~?.IPTION:
1
2
3
4
5
6
7
8
9-
10-
11
12
13
14
15
16
17
18
19-
20-
FOR; _ ~ -_ ' ---~ ~,~ r- DATE PERFORMED-'
~oT '7 BLK 2-
~OE.K ~ZL.L
~LO~E
SITE PLAN
2 .WAS GROUND WATER
ENCOUNTERED? ~.
IF YES. AT WHAT
DEPTH?
D~TE:~
MUNICIPALITY OF ANCHORAGE
Development Services Department1. Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-362-12-000
Expiration Date: 7/21/2023
Legal description ROCKH I LL BLK 2 LT 7
Site address 6530 SHALE CIR Anchorage AK 99507
Current property owner(s) MCCUE DANIEL & TRACI LIV TRUST
X The On-site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 4/21/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory _
Absorption Field Advisory Nitrate Advisory x
Tank Age Advisory Arsenic Advisory _
Other
COSA Approva"une 2022
MUMMPA L TY OF ANCHORAGE
Development Services Department
907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION rf
Parcel I.D.
015-362-12 I
Complete legal description ROCKHILL BLK 2 LT 7
Location (site address) 6530 SHALE CIR„ ANCH AK
Current property owner(s) MCCUE
2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass
Age 1 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: 0
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $
Date of Payment
5-5-0
`i /-7-/17,0 z
COSA # c6c 2 3 05
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: ROCKHILL BLK 2 LT 7
Parcel ID: 015-362-12
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
Q Well log is filed with Onsite (or attached)
Date drilled 4/21/82 Total depth 58 ft
Cased to 58 ft
W Sanitary seal is functioning correctly
FEI Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 4/4/23
Static water level at beginning of test 33 ft.
Comments * data from MOA files
B. TANK DATA
Measured operating fluid level in septic tank 2022
Date of pumping NEW
❑0 Required maintenance completed, if AWWTS
Comments: NEW INSTALL IN 2022
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/3/82
❑81 ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 4.5 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
❑ol Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced 25009allons 4/12/23 date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Well production at time of test 3+ qpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes Q No
X Coliform bacteria is Negative
Nitrate 9.47 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L1111 Arsenic less than MRL (ND)
Collected by
Date 4/4/23
MNA
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 4/14/23
Results [j]pass
Fluid depth prior to test 0 in
Water added 600+ gal
New fluid depth 33 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate 600+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 66 in
Effective depth used 33 in
Effective depth remaining 66 in
Comments/Deficiencies: OLD 1982 TRENCH WAS PRESOAKED & TESTED, 1997 SYSTEM HAD T OF WATER
COSA Checklist June 2022
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'
Q Yes
if No _ ft
Community Sewer Manhole/Cleanout > 100'
Mi Yes
if No
_ ft
❑� Yes
if No _ ft
Neighboring Tank > 100' ❑i• Yes
if No
_ ft
Private Sewer/Septic Line > 25' Q Yes
if No ft
Absorption Field on Lot > 100' a] Yes
if No
_ ft
Holding Tank > 100' QYes
if No _ ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' Yes
if No _ It
Ri Yes
if No
ft
_
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑w Yes
if No
_ ft
❑m Yes
if No _ It
❑ 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' E Yes if No _ It Surface Water > 100' F Yes if No _ It
Tank to Property Line > 5'
Q Yes
if No _ ft
Field to Property Line > 10'
Yes
if No _ It
Water Main > 10'
❑o Yes
if No _ ft
Water Service Line > 10'
❑� Yes
if No _ It
F. ENGINEER'S COMMENTS
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
ElYes ifNo_ft
Q Yes if No _ ft
If tank or field is under driveway comment below
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 Firm Mtkr; .yylUcvive PF,
Engineer's Printed Name '-')a V,
COSA Checklist June 2022
Phone 727-8864
Date '41/241- -2:
Nitrate Advisory
Certificate of On -Site Systems Approval # osc231096
Subdivision: Rockhill, Block: 2, Lot: 7
A water sample revealed a nitrate concentration of 9.47 milligrams per liter (mg/Q.
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. Since nitrates are known to slowly increase, we recommend
you monitor the water quality. 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.
G s
Mailing Address P O Box'�96650 *Anchorage, Alaska 99519 6650 *www muni org
x
:r
~ 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
/-J ?&.-
Legal Description (include lot. block, subdivision, section, township, range)
Location (address or directions). .
(b) Applicant Name ~-~,'~.~¢.~ .¢'¢~*~_¢~o4~'¢~ Telephone: Home Business ~-~J¢--~'/i~
Applicant Address '0~0 ~, ~~0~ ~¢Z- ~ ~¢~.
(c) Applicant is (check one): Lending Institution D; Owner/builder ~; Buyer D; Other~ (explain);
(d) Lending Institution /~]t~'//I Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the H~_pto the following address:
TYPE OF RESIDENCE
Single-FamilyN Multi-Faro y[~ Other
Number of Bt~drooms
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.
Page I of 2 72-025 (11/84)
ENGINEERING FIRM PROVIDh..~ INSPECTIONS, TESTS, FILE SEARCH,. AND INFORMATION.,
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this F~alth
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 '~,~.~(- ~'~~ Telephone ~ /-- ~/~ 7
Engineer's Seal
DHEP APPROVAL
Approved for -~'-
Approved /
bedrooms by ~~-, ,X~- "~'~ Date
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 ~n 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 om~ssions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
DEPT. OF HEALTH &
="V'*O NT^L P*OTECT'ON
021986
284-4'720
Legal Description:
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ~--~ /
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
~¢.~_~ I' A, B, C, D,E.C. Approved (Y/N)
Date Completed ,,~/~--//~!~-- Yield
t'
Cased to :~-~ Depth of Grouting
y-
Pump Set At ~' 2.-
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
~:~'~ ! "~ ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot //'~'" ! ; On Adjoining Lots
To Nearest Public Sewer Line 4~III~ To Nearest public Sewer
Cleanout/Manhole /~'"'~/~".~-~ To Nearest Sewer Service Line on Lot
Water Sample Collected by IJ0~,~ <~:~¢::~..~a.~~ .'-- ;Date
Water Sample Test Results ...;> ¢'t.(-( .~ .it,,-~..c~rl~.-t~., _
B. SEPTIC/HOLDING TANK DATA
Date Installed
/ /
Standpipes (Y/N) t~ 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 '~'
To Property Line /
To Water Main/Service Line
Course ,/V*~, ~,',~:
~/~/~'~- Size ( ~?.~'~"c;;;~ No. of Compartments ~'~,---
~ Foundation Cleanout (Y/N) ~
Date Last Pumped ~'/~"~/~'~
;,or
Temporary Holding Tank Permit (Y/N) /~"///~
!
To Building Foundation !
!
To Disposal Field 7
To Stream. Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA * '
Soils
Rating in Absorption Strata ~ Type of System Design
Date Installed ~"~~ --Length of Field
Width of Field Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area ~J~ - ~ -~ ,~. Standpipes Present (Y/N) /'~
Depression over Field (Y/N) ' ~ Date of/~_a, st Adequacy Test -'~/;~-- ~,/~',~
Results of Last Adequacy Test A-c~i.~.~'"'~' ~.. ~ ~ /:=~,.~--./r'~3o~*v~, %'E~r-r,~
Separation Distance from Absorption Fiel~l: ' / .......
To Water-Supply Well / /"~ I To Property Line /{~ f'"~'
To Building Foundation ~'// /
Lot ~ ~/~'&~
TO Water Main/Service Line //'~-/"~"
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Existing or Abandoned System on
; On Adjoining Lots / OO f --1L'
To Cutbank (if present) ,/~E),~,' ~.
Comments
D, LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
/Jo ./zE
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 haye chec_.J~, v~rifi.~, or conformed to all MOA and IFIAA guidelines in effect on the date of this inspection.
Sign.~t'~'~ ...~~~--- Date ~/'~a-a~C> /~> ~
Company ~~ ~MOA No ~ -- ~ / ~
Receipt No. ~J~/
Date of Payment' /'~/~
Amount: $ ~ ~' ~
Page 2 of 2
72-026 (11/84)
Anchorage
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TONY KNOWLES.
MA ¥OR
DEPARTMENT OF HEALTH & HUMAN SERVICES
October 9, 1986
Wayne Henderson, P.E.
440 West Benson Boulevard
Anchorage, Alaska 99503
Subject: Lot 7 Block 2 Rockhill Subdivision
Waiver Request WR86-146
Dear Mr. Henderson:
Your request for a waiver of the 100 foot separation required
between the septic tank and well on the subject property has
been granted. This distance has been waived to 92 feet.
This waiver is valid for the existing four bedroom single
family dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
~0 W. Benson Blvd.
Sldte ~06
PENINSUI F GI EI iU G
Anchorage, A!~lm 99808
(907) 56X-5107
September 30, 1986
Homequity
P.O. Box 8034
Walnut Creek, California
94596
Attn: Ron Whitmill
Case %2066-935
Lot 7 block 2 Rockhill, 86-E-145
Septic System Adequacy Test & Well Analysis
Dear Mr. Whitmill:
At the owners request and per our confirmation with your office, on September
16, 1986, we have performed the Adequacy Test and Well Analysis required for
the health authority approval on the above referenced property.
The test was performed by adding water from the well to the absorption field
and monitoring the levels in the septic tank and drainfield for 3 consecutive
days. The results and test data are tabulated below:
Date Time Tank C.O. %1 C.O. %2 Rate Quantity
9/27/86
0 48 0 32 0 0
20 48 0 36 6 120
40 48 0 40 6 240
60 48 0 41 1.5 270
PmpdTnk
100 2.0 0 42.5 1.5 330
120 2.0 0 43 1.2 354
180 2.5 0 45.5 1.2 426
240 3.25 0 47.5 1.2 498
300 3.25 0 49.0 1.2 570
320 3.5 0 49.5 1.2 600
9/28/86
0 3.75 0 42 0 0
30 4.00 0 45 6 180
40 4.0 0 51 6 240
60 4.1 0 54 6 360
80 4.5 0 56.5 6 480
100 4.5 0 59 6 600
9/29/86 0 4.5 0 42 0 0
A review of the test data indicates that the absorption system functioned
adequately for a 4 bedroom home as indicated from the second day test results
considering the home has been vacant for some time prior to testing.
The well delivery varied from 6.0 to 1.2 gpm over the 5 hour test period the
first day and then fully recovered and delivered the full 600 gallon day load
in 100 minutes the second day. This was an unusual behavior for a well system
of this type but the daily delivery was met and the well appears adequate.
If I can be of any further assistance please call.
Sincerely,
Wayne ~ende'r son
Appraiser
WH:js
APPLI?"\NT FILLS OUT UPPER HA'''''~' ONLY
Buyer~-- ~__. ~
Lend~n9 Insfi~ulion . :~ ~..~ ~ ~ ~,~ ~ ~/~/~'~ ...... ¢ _ Phone
Type of Resi~nce
Single Family
Multiple Family No, of Bedrooms
~ Other
Water Supply
~ Individual A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ Individual Year Individual Installed: J
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Insp~tor Insp~tor Insp~tor Insp~tor
C.C ~,~0 Cc~ ~ MUNICIPALI~ OF ANCHO~GE
DEPT. OF HEALTH
~/ ~ . ckc)'% ~ ENViRONM5NTAL PROTECTION
~ AUG ~ 6
RECEIVED
(~] APPROVED BEDROOMS *CONDITIONS OF APPROVAL
(I ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
APPL -' NT FILLS OUT UPPER ONLY
Prop~rtyOwne~ ~.~.~.~'¢' ~ -D, Ca-~ {~_~0~ Phone
MailingAddre~ ~ ,~ ]~ ~ ~{),~ ~"~/vS.~ ZlpC°de
Buyer
Address Zip Code
:- Phone
Lending Institution ...~ .~ .,~ .. ~ ; ~.: ~ ~./ .
('~' . ~ /, ~ .... ~ ~. ~ / }. ~ip Code 6'/'~ ~"-~ / '~one,..
Address
Realty Co. & A~nt
/
Address _ ¥ //.~/- Zip Code
Legal Description ' ' / / ¢' / Z~
Street Locati~ . , / ~ , /~ ~' / ~ _- ~ , , /' ,/ ~__ ,
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~lndividual A~ACH WELL LOG. A wall log is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal ~5~ <~ ~
~ndividual Year individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
'~Z~3'~ ~Time ~/\ ~~.-/' y Time Time Time
Date Date
Inspector Inspector Inspector Inspector
( ) D S*..ROVED
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~Shem%.:~umber
, ~ .......... ~:.~ ... .,: