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HomeMy WebLinkAboutROCKHILL BLK 2 LT 14 Municipality of Anchorage Page 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: .SA,' Cll Co 2. cf PID Number: 01~$~22 Name:Wastewater System: [] New ~ Upgrade J4MES + OPAl. RoBiNSoN Address: 4551 LIHESTONE cm.,~c~. ~ ABSORPTION FIELD Phone: No. of~drooms: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION so, Rating: ~, 5 GPD/Sq. Ft. Total Depth~from original grade: Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township:l~ Range: ~ ~]~Secti°n: /~ Fill added aboveo,~originalgrade: Ft. Gravel length: ~l ~ ~t Ft. WELL: EXt~T. ~ New D Upgrade Graveldepth: J Ft. Number of lines:~ Distance between lines:~ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: PRIVATE 2~ Ft. ~ Ft. 1~2~ SQ, Ft. ~C Driller: Datr~rilled:~2 StaticWaterLevel:l~8 Ft.,.~ta,,e~:c,UC~.5 ~AC~ Hog Dateinstalled: Yield: Pump Set at: Casing Height Above Ground: ~ 7.0 ~ ~. 1,1 ~. TANK SEPARATION DISTANCES ~s~pti~ ~ Ho~ding ~ S.T.E.P. TO Septic Absorption Lift Holding ~;~Private MamJfacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines G~EE~ Material: Number of Compartments: Well I 13 IOZ ~ ~ Ioo ~T~EL Surface w~t,~ >/oo >/o~ -- - >/oo LIFT STATION N,~. Lot Size in gallons: Manufacturer: Line ~O ~ ~ ~ Foundation l ~ ~ ~ ~ 0 "Pump on" revel at: [ "Pump off" level at: High water alarm at: Curtain Pump Make & Model I Electrical Inspections pedormed by: Drain ~ ~ ~ ~ I Remarks: ~~ I~ ~¢~- ~¢~c ~ BENCH MARK Location and Description: ~Z~C~ ~ ~ ~ b~ '~o ~ Fou~TIO~ ~.0, ~EKT TO I ~ss~ed filevation: Flattop Technical Se~ic( sENGINEER'S SEAL Inspections performed by: F~ATTOP mEC~ S~CS Dates:lst Department of Healt um ices approyal, ",~, ,, .,'~,,,f~,.'. .. c~- - 3o~',,~ . ,' ,~*_~' Reviewed and approved b Date: ,/ '~ ~?Pmtm~[~** '~y~ ....... 72-013 (1/91) MOA 25 Perm'it No. :51~, clJOD .~c~ Page .2 of ~ Municipality of Anchorage 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 Legal Description: L IZ-+ B2 ROCK HILL. $/D PID No.: LoT c[ i~,t Soil fiB5. 15'-oo ~L ¢.T. b R~ vE LOT 1~ House 10' C/TILIT¥ EASE. MENT' MON~¥o~, ~'uSE LOT ~c LOT l.~ LIP~E STONE I~ = tf I 5~p. TANK ¢.o. A 31° B 20' .Flatt6~ TeChniCS! S~r~ice~ 14530 Echo S~reet Anchorage, Z~ska 99~ ~ 72-013 A (2/91) MOA 25 ENGINEER'S SEAL Permit No. .~l/v' 910o 29 Page ~' of ~ Municipality of Anchorage 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 Legal Description: L I~r , 8 2. ~:ocK I/ILL S/D PID No.: lO0~ T. B. t'vt. F'Oc,~ t)AT~ O~q C.O. ELEv. = 1oO,O / 15OO 511'o ~.' INVEI~.T E. LEV: V~RT~CAI. 5cAz£: 1%-5;' No ~ORtzoHq'AL SCAL£ t4E~v SOIL AlSS. BEb FJattop Technical Services 14530 Echo Street AnChorage, AlaSka 99516 72-013 A (2/91) MOA25 DEF'Ai¥'Fi"]EN'T' i]F' HEAL. TH &i~iii)HUMAN SERVICES T'HE A"i""f'A(:;:!"'llii!;i:;.~ AI::¥:q::~'.(3VED /!~i... i... i~'. E q;! ( / l F.:'. E rd iii!:i",! r' !;i; !!ii; F:' E .'.'.'; ! i::' I E D .;f; i',.~ A N .':'.'; H E! R A G E r.'"i U hi i~ (:; l F:' ¢, L. C [::1D iii: C l-.i A F:' T E I:;'. '.i.~!. ,, !:5'.;.!, Ai".,IP :15,,¢i:,'.5 AI'"-.ID THE !i!?r'¢,,'T'E {;::ii:::' &L.ASHA MAS"I"E..',,~ATER D.'i%P(:;E;Ai .... T H E i::'(;::iL...i3 W.i; i',l G !i; i::~ E C.'i; A i... i=' Fi'. E) V ;); !ii; i (3 Iq S ,, CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 March 1, 1991 ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: By means of this letter we are requesting that you waive the 50 foot setback requirement from slopes in excess of 25% down to 20 feet for the proposed septic system upgrade for Lot 14, Block 2, Rockhill S/D. The slope in question is located to the east of the proposed bed and has a total vertical extent of approximately 15 feet and a slope of 35%. Since the proposed bed is 5' below grade there is no possibility of effluent daylighting through the toe of the slope. The slope to the north of the proposed bed, while closer, is only approximately 5' in vertical extent, so it should not be of concern either. We are also requesting a waiver of the 15' width specified for beds in the wastewater ordinance. The area of the bed is based on the measured perc rate of 8 min/inch in test hole #1 which corresponds to 0.5 gpd/sq, ft.. A 5 bedroom residence generates 750 gal/day, thus 1500 square feet of area is needed, which can most efficiently be configured as 25' by 60'. It would not be practical to construct a 15' by 100' bed in this situation. Please telephone me at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. ~ & ~Y~~ ~~ · ~¥ ~0~$~¥~0~ & ~¥S~ THEODORE F. MOORE, P.E. March 8, 1991 PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 Dan Roth M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Mr. Roth: The purpose of this letter is to address the impacts of the septic system upgrade proposed for Lot 14, Block 2, Rockhill S/D upon the surrounding properties. Please refer to the site p. lan submitted with the permit application. By abandoning the old soil absorption trench, an existing rmnor encroachment upon the 100 foot radius surrounding the well on Lot 13 will be eliminated. Due to the necessity to maintain 100 foot separations between wells and septic system components, the location of the proposed soil absorption bed will slightly constrain future well placement options on Lots 8 and 9. However, because each of the affected lots is quite large, this project will not have any significant impact on the ability to develop on-site systems on either of these lots. Please give me a call if you have any questions. cc: Mary Anne Beckwith, Fortune Properties Sincerely, Ted Moore, P.E. LoT ?AVE ..,~- BDRIq Lo-r ~ t LoT tS' C_tR¢ LE NOTES: I. No o'rHER WELLS OR SEPtiC S'/STE~$ AgE LOCATEb h/~HIN 200 OF PROJECT. 2. SITE TOPOGI~APHY IS GENERALLY LEVEL WITI~ EXPFPT iON oF SLoPeS INBICATEB TO NoRT~ ANb EAST OF PROJECT Flattop Technical Services 14aoO Echo Street LOT lur BLOCK 2 ROPKHILL SEPTIC 5Y£-~£M dPGRAD£ .SIT E PLAN SCALE' bATE: i/fi/ bWN b'/: NOT~;: ¢l~S iS NOT ~ SURVEYEb PL/JT ,~LL LoCATIoNS ARE OUTER LiMiTS OF Ex(:^ V~IT IoN PLAN VIEW I' =' ID' 1 CovE. P, C,o. T HATtvE gOIL SECTION A-A ~ ~lattop Technical Services i'= 5 14530 Echo Street Anchorage, Alaska 99516 B£L oI~' oRiG. LoT iq BLOCK 2. ROCKHiLL £/D SOiL ABSORP-[IoN BED PLAN · CRoss SECT iON Flattop Technical Services 14530' Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 14, Block 2 Rockhill S/D - 6551 Limestone Circle Wastewater Disposal System Upgrade Specifications 1.0 General: 1.1 The scope of the project consists of the construction of a new 25' wide by 60' long soil absorption bed which is to be connected up to the existing septic tank, and the abandonment in place of the existing soil absorption trench. The bed area for this 5 bedroom residence is based on a measured perc rate of 8 minutes per inch. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All constmcti0n procedures and material specifications shall conform with Municipal and State requirements. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 2.0 Septic Tank: 2.1 The existing septic tank may be retained in service if it's structural integrity has been verified, and if it has functional cleanout pipes with airtight caps, allowing pumping access to each compartment. The contractor shall expose the waterline area of the tank to allow the engineer to verify it's integrity. 2.2 A double cleanout shall be installed in the line between the septic tank and the soil absorption bed. 3.0 Soil absorption system: 3.1 The soil absorption bed shall be constructed by excavating the overlying material to create the 25' by 60' bed bottom surface as shown on the drawings. A total of 12 inches of approved sewer gravel shall be placed in the bed bottom with the horizontal distribution pipes laid level with the inverts at least 6 inches above the bottom of the gravel. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the//200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. ' 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of filter fabric, and (4) after final backfill and grading is complete. The septic tank integrity inspection should be conducted in conjunction with the second inspection. 5.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. 'FOR Municipality of Anchorage DEPARTMENT OF 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST LEGAL DESCRIPTION'. L 2 3 4 5 6 7 8 9 10 12 13 ~RAV£LLY 17 20- COMMENTS -~' ~' $/L'r',t 5,'tN b WASGROUND WATER ENCOUNTERED? N Township, Range, Section: SEC I~'~ T"12t4, ~k/ ¢ ~.~. SLOPE SITE PLAN S IF YES. AT WHAT ~L DEPTH? . p E Depth to Wale; After /~f' '7:', ~ l L T'Moniloring? Date: Reading Date Gross Net / ,, Depth to Net Time Time (.., i ,') Water Drop ~Af/~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~,~S" FTAND ~.2~' FT PERFORMED BY: FLATTOP 'TEC/~, SVCS. 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) PERFORMED FOR: LEGAL DESCRIPTION:, 0.5 2 4 7 9 10 12 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST T.N.~I PRUbF-.NT I/~, % FORT'UNE -.M,qR'/ AN~I[' Bec~Zl~ PERFORMED', Township, Range, Section: SLOPE 14- 15 16 17 18 19 20- 0 / ~/~Id~'g~I/VAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh Io Walei: Alter Monitoring? Dale: , T'I2N, R3A/ , ~,M. SITE PLAN Reading Date Gross Net \ Depth to Nat N:o I:ol 25Y; - 27 Y~ ~ I h3o:oo I0 2l ~ I Y~ ~ ~ J;~0:3o IO 22 ~ I 3~ ~ J',~l;oo Io 22 ~8 I ~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~°'~ FTAND 'ZO FT ~i~¢~c ~ . ~e~ ~/~<~z~o~ ~o~(~ ~ 8~~ x ~O' PERFORMED BY; .FLATTOP TEC~, ~VCS. 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 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 ~LOCATION NO. OF BEDROOMS 2~ DISTANCE TO: ~ Liq. c~n~llons IF HOMEMADE: Inside length Width Liquid depth T ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O z ~ Manufacturer Material Liquid capacity in gallons ~ a ~ DISTANCE TO: Well N°'°flinesl gradeLe~ [ · ~__ inches Totaleff~ion ~ ~ ~ Top of tile to finish -- Materi~l beneath tile area ~ , ~ inches Length ' Width Depth PERMIT NO. ~ ~ Type of crib Cdb diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewbr line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST "ATI D~ REMARKS PERf"!I T L E G Fd DENNIS H KEi]'.,iI'}FILL L:].4 E::~ F.:OCKHILLE; :,-. [ THE RE(;!U Z RE£> ';: T ;;:"E '" F' THE SO i L. f':IBE;ORPT ! ON .:, 'r :,, r-".i 1 i :~; ' 'THE!: L. ENGTH [> t i'"!EN:Ei; I Of',! t :.:.i; THE LENGTH -':; t N FEET ) OF THE TRENCH OR DR!::I I NFI ELD. THE E:'EPTH OF Fi TRENCH OR F'IT Z:F.:; THE DtS".rRNcE BE'f'HEE:N THE SUR.I::'FtCE OF' THE GROUND Rt'.4[::, THE BO"f'TOM OF 'THE E:4Cf~VFi]"ZON ,:.'ZN FEET). '?:HEREE l:~: NO SET N!DTH FO!:~: TRENCHE'i-:;. THE GR!::~',2EL. DEPTH I S THE M l lq l MLIM F,,:,EPTH OF' GRF!',,,'EL.. BE]"HEEN THE CiL.rTFRLL.. F:' l PE !:~!'.4D THE BOTTOM OF THE E::,4C:FI',,,'¢::I]" l Oi'.4 C I N FEE:T ). PEP:?! '.' T !::!PF'L I E:Ffi'.,FF FiFIS "FHE RE::ZF'ON?.; :[ E: I L I T'.¢ TO INFORM TH I S [:,EF'RRTMENT [:,UR I NG 'THE HIN!MLtFi E:,iS]"F;NCE E~E"f'HEE]'.,i R HELL RND FII"4"¢ ON-SiTE: :E;EI.,IF;GE :I.E'~6'~ FEE:T FOR R PRIY'F:iTE HELL. OR t'.5E~ TO 2r£~(ii~ FEET FR(]M I::I PU~::LIC': HEL. L DEPENDING UPON 'THE T'.r'PE OF PUE.:-'.L~C' MINIHUM D!S'i'FINCE FROt"t Ft F'RI'?'F:FTE HELL TO F:! PRIVRTE $[EI.,.!ER LINE t!"'; 25 FEET FIND ]"O F:! COMMUNIT'?' SEI.,.!E.~;i: LINE ]:$ 75 FEET, HELL [...,'.':)(:iS FIRE REQUIRED, R.ND h'l[..t:ST' BE RETURNED TO THE DEF'FIRTMEN]" HI'T'HtN OF THE HEL. L. COMPt...ET! O'f'HE,r.;;', RIiF.'QU ! ,q:[.::MEi",!TS h'IF:IY' FtPF'LYL SF'EC ! F I CFF'f' IONS FINE:, CONSTRUCT I ON D ! FtGRRM.?:; I:r~.RE 19qF!i.rL. RBL. E TO tNS;UF;:E PROF:'ER ]:I'-4STF~L..LRTZ .ii CER'? I F:'":' THF:!T "-~,.. SET' :1.: I !::IH FF:Ih'!!L. If:!R H!"FN.,. THE ...,.........~:'r:': .I Pi:' "'iFNT'::. ,- . _ ,ts'"'ti:.-, Ct['~-~;ITE .... ':::E'.' ;:' ] ~;'"FN E:"r' THE MUN I C i I::'F!L. ]: '!""r' OF J::!~'il:J':Hf}RF GE. ~:::' ' Z !.d 'fl i T [.~'::;'~t i '"~!!:~; ':::;'.,."::;TEVl T ~.,! RCf':I:"~RC'FiNCE 1.'.i Z TH THE .................. ('" ......... I.: ..... / '.'.,'--,UE:.L:, ....... ~ ~'~ .~: ~'":~ ~' MUNICIPALITY OF ANCHORAGE DEPARTMEN. T OF HEALTH ANIp ENVIRONMENTAl. PROTECTION 112E L, Strell, Anr~hor~JIpl, Alqlk!l 99501 ~64-4720 SOILS LOG - PERCOLATION TEST ~ smLs LO0 PERCOLATION TEST 'EO.~ OESCR,.,ON: . Lo~ /q, 1 ~iF ¥ ~anCt,/ " 4- 7 12 £~k Fh'lt~. SLOPE WAS GROUND WATER Il S L ENCOUNTERED? 0 0 P E IF YES, AT WHAT DEPTH? DATE PERFORMED: ,, SITE PLAN' 14- 15- 16- 17- 18' 19 20 COMMENTS PERFORMED BY: 72-008 (6/70) Gross Net Depth to N~t Reading Date Time Time Water Drop r�£ ys84 • Municipality of Anchorage On -Site Water and Wastewater Program 4 (907) 343-7904 s A I E T.Y , Certificate of On -Site Systems Approval Parcel I.D. 015-362-26 Expiration Date: ` qr2 Zo 2� 1. GENERAL INFORMATION: Complete legal description ROCKHILL: BLOCK 2 LOT 14 Location (site address) 6551 Limestone Circle *Anchorage 99507 Current Property owner(s) Brian Broderick Day phone 748-4900 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) - Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class—Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. . COSA Fee $ J�J� a �� Waiver Fee $ Date of Payment (o r' Date of Payment Receipt Number Q2a_2_�2 Receipt Number COSA # C "'yj 1043 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER" As certified by my seal affixed hereto -and -as of the validation date shown below, l verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems ApprovalGuidelinesfor 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: Garness Engineering Group Ltd (GEG) Address: 3701 East Tudor Road Suite 101 -Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Phone: 907-337-6179 Date: 611"47-0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation'. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. IN1 ( C 7 3 Z` o4 \_Npr e f e s slo no4 0 #AECC884 DSD SIGNATURE r System #1 Approved for _ bedrooms `���0 `(((���rr'/ System #2 Approved for bedrooms ��Q C',y� r12 Disapproved ON-SITE% Conditional approval for bedrooms, with the folk rt g st1wf wkND WASTEp. ATER : � �..- Original Certificate Date:62-23' "- The Municipality of Anchorage Development Services Division (DSD) issues Certificates _of_On-Site 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 responsiblefor errors or omissions in the professional engineer's' work. 7. ATTACHMENTS: COSA Checklist_ Nitrate Advisory Septic System Advisory Arsenic. Advisory Well Flow Advisory Other QAJ COSA Checklist Legal Description: ROCKHILL; BLOCK 2, LOT 14 Parcel ID: 015-362-26 If more than 1 septic system on lot: COSA Checklist # of 1 Structure served by this system 1 A. WELL DATA r] Well log is filed with Onsite (or attached) Well; production at time of test 6.4+ gpm Date drilled Water storage tank volume N/A gallons Total depth `240.2+ ft Well disinfected for coliform test? ❑ Yes X No Cased to UNKNOWN ft ❑ Coliformbacteria is Negative WE Sanitary seal is functioning correctly Nitrate mg/L n Nitrate less than MRL (ND) ❑Q Wires are properly protected Arsenic ug/L © Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 5/11120 Date of Sample 1122/20 Static water level at beginning of test 127.8 ft. Comments *PER GEG WELL TEST B. TANK DATA ` C. LIFT STATION Age of tank(s) 1 years ❑ Required maintenance completed Tank type/material SEPMHOPE Age of. lift station years Measured operating fluid level in septic tank **61Lift station material n Standpipes/foundation cleanout per record drawing Comments: N/A Date of pumping 6/12/20 ,. **SHOULD BE �. (Q'7 D. ABSORPTION FIELD DATA Which system tested (date installed) 6129/91 Adequacy test date 5/12/20 0 ALL standpipes present per record drawing Results 0 Pass For 5 bedrooms Total measured depth from grade 5•4i ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.8 ft (min) Water added 908' gal ❑ N/A - pressurized field New depth 2 in no Monitor tubes go to bottom of effective. If not, state" Elapsed time 120 min depth into effective W Code -required soil cover over field Final fluid depth 0 in � System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced *2001 gallons If yes, enter date N/A . Comments/Deficiencies: PRESOAK PERFORMED ON 5111/20 -TESTED 1991 BED ONLY -TRENCH WAS SURCHARGED UPON ARRIVAL COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: ,(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' �✓ Yes if No ft [7]✓ Yes if No ft Neighboring Tank > 100' P Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No ft Absorption Field on Lot> 100' F71 Yes if No ft Holding Tank > 100' R� Yes if No ft Neighboring. Absorption Fields > 100' Animal Containment > 50' P Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' F/ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enterdistances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' F Yes if No ft Property Line > 5' F✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 1771 Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' P1 Yes if No ft Community Wells > 200' ®'Yes if No ft Water Service Line > 10' ✓0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' R� Yes if No ft if absorption field is under driveway comment below Property Line? 10' FV-1 Yes if No ft Wells on Adjacent Lots: Water Main> 10' "P/1 Yes if No ft Private Wells> 100' P Yes if No ft Water Service Line> 10' P/ Yes if No ft Community Wells > 200' R✓ Yes. if No. ft Surface Water> 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL **55 FEET AWAY FROM MAN MADE FOUNTAIN ON R0CKHILL;B2, L13 o�6d4b0 q G. ENGINEER'S CERTIFICATION o� OF/.. 1 certify that I 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. �, , • , , d 1. f....................o eff��y G �rness;' 'SI f CE- c�O� COSA Checklist yellow sheetpyo f es si000a'= #AECC884 i i1 y�, f ' JV Frontier Surveys, LLC Project No: 20-206 Date: 6119J2020 6 Ordered By: Brian Broderick Plat* 1981-143 Grid: N/A Swle 1" = 50' LOTS LOT9 POND LOT 13 \ LF -gena: W; Water Well Fence Deck concrete ' z� Ery JI th yc LOT 15 / HOUSE DETAIL SCALE 1"= 30' S; Septic E. Elec. Pedestal / �- N69"50'3G"E 162.72 / p2 d.00 f0'TEL. &ELEC. EASEMENT — SV -_ �`% Lot '14, Block 2 0 1. This dowment is craalad forth. purpose of a single property transaction and u subject to Padorai Copyright Laws. Rockhill Subdivision 2. Eawpling for gross nagligonce, the liability for th's 3. Allmeas—es-ts survoy shall not e—d tho cost of preparing this survey. 52,625 Sq. Ft. +/- w -'� •� 6551 U wsfon. Circle -� - LE ib{�isr m / Story Wood Frome House o �� With Affached 2 CarGarago survey survey and is subject to any of the Owner to determine ttw ,„ . •:'9•j` fll ..istenc. of any eacemens, covenants, orrestriction which done appaaron r% r „-'•••�• 11 Il t')40 H� 'j \ As -Built Survey of 2nd STORY DECK \ i .. •, . ....... m. s u:�� .........., it •,Ile. rz"s ljl ,rT •" esynelmm r 1, Pierre Stragier, hereby certify that this Mortgage Inspection Survey under my direct supervision on June 17th, 2020. was performed by me, or ff4t�t i"`o"` Frontier Surveys, 650 W. 59th Ave. Suite E Anchorage, Alaska 99518 FRONTIER. $tu'Ve 3•., � / PROFESSIONAL SEAL y POND LOT 13 \ LF -gena: W; Water Well Fence Deck concrete ' z� Ery JI th yc LOT 15 / HOUSE DETAIL SCALE 1"= 30' S; Septic E. Elec. Pedestal .� Light Pole (2) Water Valve General Notes: 0 25 50 100 1. This dowment is craalad forth. purpose of a single property transaction and u subject to Padorai Copyright Laws. 2. Eawpling for gross nagligonce, the liability for th's 3. Allmeas—es-ts survoy shall not e—d tho cost of preparing this survey. $Cole to Feet cotback" ora to th. visua0epparant bui'.ding footprint 4. NI dimensions to pmparty Imes are plus minus 0.1 R, `"`��hthhttt This survoy compiies with th. ASPLS M.rlgnga Location Standards. Tha survoy represents s,Esibl. improvements and ccedifiens at the tin. the survey. This doent docs 1 + 0F111 1� ff of corcutua bounda s boundary wminn—..!as that a subsequent boundary survey may reveal. it is the responsibility survey survey and is subject to any of the Owner to determine ttw ,„ . •:'9•j` fll ..istenc. of any eacemens, covenants, orrestriction which done appaaron Hun record plat Unde u, clr<umsterms „-'•••�• 11 Il t')40 H� 'j should this document be used for construction or for establishing a boundary or fetus line. As -Built Survey of T y'J�� n "s Lot 13, Mock 3 Hart Lake Estates Phase 1 i .. •, . ....... m. s u:�� .........., it •,Ile. rz"s ljl ,rT •" esynelmm r 1, Pierre Stragier, hereby certify that this Mortgage Inspection Survey under my direct supervision on June 17th, 2020. was performed by me, or ff4t�t i"`o"` Frontier Surveys, 650 W. 59th Ave. Suite E Anchorage, Alaska 99518 FRONTIER. $tu'Ve 3•., 907.460.1686-info@froiitiersueys.com PROFESSIONAL SEAL w. wwfrontiersurveys.com 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O1~' ~6 22 6 NAA# ~,Oi [ I~) ~'~ ~"'~ 'L"~ GENERAL INFORMATION Complete legal description Location (site address or directions) ~EEI I.i~ES'/'ONE Ci~CLE Property owner JfiHES ~- OPAL' 1~o6t~,l SoN Mailing address 6ESl J-IHE~'/'oNE Cl['ct E Day phone Lending agency 5£~TT~-E HOeT6,~E Day phone ~..~'62-5-(=2~ Mailing address ~o ~, 3q ¢4 Agent ~LPHA REALTY ~TEYIE, J~NE~ Day phone ~2 -~2~o Address P.o, ~o~ 23o~83 ANCN ~K ~23 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 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. 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 S~UeWLUOO leUO!~!PPV :suo!Jelndp, s 6UIMOIIOJ eq~, q~!M 'SLUOOJpeq 'SLUOOJpeq JOj leAoJdde leUOR!puoo 'peAo~ddes!o '°J peA°Jddv ~t- aan.LYNglS SHHO eJn~eu§!s s,Jeeu!6u=l .5'5'£1 ~.2'~z ~' euoqct ~ P/IS '~f'~_~.[_ ciO_/ LVT~ wJ!=l jo eUUeN '9 ).4:IgNION':I AG NOIJ. OgdSNI dO J.N:ilNg.LV.LS 'g Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: £ 14 I~ 2 I~OC~K ~1£/.- Parcel I.D. A, WELL DATA Well type PRIVATE Log present (Y/N) Total depth ,2qG Sanitary seal (Y/N) Y If A, B, or C, attach ADEC letter. Date completed Cased to ~' z/O / ADEC water system number N '~ ' Driller (2NgNoA/N Casing height ] 2" Wires properly protected (Y/N) )/ Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTION '7 7. o ~ 2~9 JUL ! ? ~EC'D g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 113 t Absorption field on lot 10 2 Public sewer main ~ /OD Public sewer service line ~/oo ! ; On adjacent lots ~ leo ; On adjacent lots '~. /oo' Public sewer manhole/cleanout -~/oo Petroleum tank NoNE ~I~SE~'i/Eb WATER SAMPLE RESULTS: Coliform O Date of sample: 7/'/'1 {~( Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 7/~2 Cleanouts (Y/N) High water alarm (Y/N) Date of pumping (~/2.-///91 Tank size Foundation cleanout (Y/N) t SA~lC Compartments '2. Depression (Y/N) N Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Foundation / 7 ! Water main/service line ~ 70 Well(s) on lot /02, ' To property line ,~'0 Surface water/drainage On adjacent Pots AbsorPtion field ,.,c' Ioo 72-0~6 (Rev. 3/91)Front MOA21 ,,, : :. CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Man ufactu rer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/28 Length ~1' Width 25 Total absorption area 15'25- Depression over field (Y/N) N Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating 0,~' GP~/~' System type Gravel thickness ~ Total depth Cleanouts present (Y/N) Y Date of adequacy test N,Ai, for N If yes, give date N./~. bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots '7 /oo' Surface water Curtain drain No~IE On adjacent lots '~ /oof Property line ,,~ S' t To existing or abandoned system on lot Cutbank lq,,~. Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature ~~ Engineer's Name ....... :'$;,5' HAA Fee $ //]~' ~ Date of Payment ?"//~- ¢ / Waiver Fee: $ Date of Payment Receipt Number :-'!, MU, C PA,m' OF A.C,ORAGE --- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 / '~ DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~/~,~ - ~ ~1~.~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) , (b) Applicant Name Z-E'~l /HD,'~ ~',~7~- Telephone: Home Business Applicant Address -~"~'t';'r'D/E'-~.i C~J ' ~.O, ~"',~"~' /-~e~,,~J-~-~'y. ~,~'~L.J~"'~/~ (c) Applicant is (check one): Lending Institution~.; Owner/builder []; Buyer.[~; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Telephone Address Telephone ._~ ~/C//' _ 03~0/ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,/~ Multi-Family [] Number of Bedrooms ~'/M¢~-~'~' Other WATER SUPPLY Individual Well~lZ~' 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~L.. 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 ENGINEERING FIRM PROVIDIN(. SPECTIONS, TESTS, FILE SEARCH, DA' ~ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/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 ~/""~fL~'7',~U~'//t.~G] ~_~tL.)~?. ~, Telephone ~ ~ --~ O ~ ~ Address ~/ ~J~.~ ~~ ~/~ ~/~ ~/~ ¢~ Date //'-- ~ - ~ DHEP APPROVAL Approved for . bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ~irEqORITY APPROVAL (NAA) CHECKLIST - FEBRUARY 1984 Well Log P~esent (Y/N) Total Depth Z ?~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Legal Description: If A, B, o~ C, D.E.C. Approved(Y/N) Date C~pleted Pump Set At U~/c~/O '~ ~ Yield /~ef Depth of G~outing ~o,- Sanitary Seal on. Casing (Y/N) Depression A~ound Wellhead (Y/N) Separation Distances f~cm Well: , To Septic/Holding Tank on Lot /00 ~- ; On Adjoining Lots /oO To Nearest Edge of Absc~ption Field on Lot /~ '~ ; On Adjoining Lots To Nearest Public Se~ Line /~o ~ To Nearest Public Sewer Cleancut/Manhole ~ ~ o ~- TO Nearest Sewer Service Line on Lot Water Sample Collected By ~ ~- ; Date / ~ - / ~/- ~ 7 Water Sample Test Results ~>~/~c~/~ ~ ~/~ C~,~nts ?~L~-c~- / ~ ~_ ~-~ /$ 7- T,'q ~./~ Be 6~0o~ ~ dY ~cc~'~i'~c~ cF~P¢~i~l'3c? 15 ~-~z-' SEPTIC/HOLDING TANK DATA Date Installed ~ ~ ~ ~ Size /~-op ~. NO. of Cu,~a~tments Z-- Standpipes !Y/N) . y Air-tight Caps (Y/N) ~ .... Foundation Cleanout (Y/N) ~ Depression over Tank (Y/N) ~/ Date Last Pumped //~ ~ ~ Pumping/Maintenance Contract on File (Y/N) ~/ ; for Holding Tank High-Water Alarm (Y/N) ~ Tempora=y Holding. Tank Permit (Y/N) ~ separation Distanoe's f~c~ Septic/Holding Tank: To Water-Supply Well /~o TO P~operty Line /5 TO Water Main/service Line Course ~ /oD / To Building Foundation 2g To Disposal Field 1/~ To St~esa~, Pond, Lake, or Major D~ainage Comments [Page 1 of 2] 2-15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St=ara Date Installed ~- ~ o ~ ~ Zx Width of Field -~ / Square Feet of Absc~Dtion A~ea Dep=ession over Field (Y/N) Results of Last A~equacy Test Date of Last Adequacy Test Type of System Design Length of Field Depth of Field II Gravel Bed Thickness 5 Standpipes P=esent (Y/N) Separation Distance frc~ Absc~ption Field: To Wate=-Supply Well /~ o ~ To P=operty Line / To Building Foundation ~- z o ' To Existing c~ Abandoned System cn Lot ~//~ ; On Adjoining Lots ~7~ ' To Water Main/Service Line ~- ZS ~ To Cutbank(if present) To Stream/Pond/Lake/c= Major D~ainmge Ccu~se ~/~ o ' · To D~iveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea Cu~ments D. LIFT STATION Date Installed Size in Gallons "P~ On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Ccam~nts ** Check Permitted Bed~ocm Rating A~ainst HAA Request I certify that I have checked/verified, c~ confc~n~ed to all MOA HAA'O~u~ on the date~of th/s i. nspection. Signed ~~'~'-~ Date //- ~'-~ Company ~H3d, ~'-~5(~ ---~'~ MOA NO. C~ F?--~L3 KBi/d5/s [Pa~e 2 of 2] effect 2-15-84 TESTING LABORATORIES, INC. 907.479.3 ~ 15 907.277 8378 Quality Control Report Client: Constructing Engineers ID#: A101487-4,5 Listed below are quality control assurance reference samples with a known concentration prior to analysis. The acceptable limits represent a 95% confidence interval established by the Environmental Protection Agency or by our laboratory through repetitive analyses of the reference sample. The reference samples indicated below were analyzed at the same time as your sample, ensuring the accuracy of your results. Sample# Parameter Unit Result AcceptabLe Limit EPA WS378-6 ....... Nitrate-N mg/L 0.95 0.84 ~'''1.02 Reported By: ~ Date: 10/16/87 ~~Carol J. Garrioon, Vice-President~ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~.~LTH AND ENVIRONMENTAL PROTECTION A~PLICATION FOR m~.~J~TH AUTHORITY APPROVAL CERTIFICATE General Information Application Date April ~: ]qR~ (a) Legal Description (include lot, block, subdivision, section, township, range) L,14 Blk 2 RockHil] Sqbd Location (address or directions) 6551 Limestone Circle (b) Applicants Name ,,0ennJs,Kenda]] Applicants Address 6551Linestone Circle (c) Applicant is (check one) Lending Institution Buyer[---~ ; Other[ I (~plain); (d) Lending Institution Colonial Mo~a§e Ad~.ss Suite 107 E Tudor Rd 346-3322. Telephone - Home :'Business ~; Owner/builder~; Telephone 562-2181 (e) Real Estate Co. & Agent ,~Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Stngle-Family~--~ Number of Bedrooms 3. Water Supply Individual Well~ Multi-Family~--~ 5 Other (describe) 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 Note: If community well system, must have written confirmation from the State Department of Environmental Conse~ation attesting to the legality and status. [Page 1 of 2] En~ineerin~ Firm Providing Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date showu 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 ~ype of structure indicated herein.- I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation a~ inspection, 'the' on-site water supply and/or wastewater dis~sal system is in compliance ~zlth all Municipal and State c~es, ordinances, and reg~tla- tions in effect on the date of this inspection. Name of Firm Arctic Engineers Inc. Telephone 561-1345 Address 1506 W 36th Ave Date 4-5-85 DHEP Approval Approved for Approved bedrooms Disapproved Terms of Conditional Approval Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MEN"rS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/Di8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 8 RECEIVED L14 Blk 2 RockHill S/D Well Classification Individual Well Log P~esent (Y/N) N Total Depth 296 Static Water Level 215 Casing Height Above Ground 12" + Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot Cased to If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed Unknown Yield Unknown . Depth of Grouting. Unknown Pump Set At 223 Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) 100' + ; On Adjoining Lots 100" + 6 Bpm ~" To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line 100" + C leanout/Manhole N/A Water Sample Collected By Water Sample Test ~Results Com~nts 100' + ; On Adjoining Lots 100" + To Nea~estPublic Sewer To Nea~est Sewe~ Service Line on Lot Duane Maney ; Date 4/5/85~-~ Satisfactory ~'/' 25'+ B. SEPTIC/HOLDING T~TK DATA Date Installed 7-82 Size 1500 qal No. of Ccmpa~tments 2 Standpipes (Y/N) Y Air-tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped 7-2-84 Pumping/Maintenance Contract on File (Y/N) N ; for . Holding Tank High-Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well 100'+ To P~opertyLine To Water Main/Service Line Course None Noted To Building Foundation 29' To Disposal Field .11' 10' + To Stream, Pond, Lake, c~ Major Dzrainage Comments [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7-82 Width of Field 3' 125 Square Feet of Absorption A~ea 665 Depression over Field (Y/N) 'Y Date of Last Adequacy Test Results of Last Adequacy Test $~isfactory Separation Distance f~cm Absorption Field: To Water-Supply W~ll 100'+ To P~ope~ty Line 10'+ Type of System Design Trench Length of Field 66.5' Depth of Field 11 ' Gravel Bed Thickness 5' Standpipes P~esent (Y/N) y None 20'+ To Existing or Abandoned System ; On Adjoining Lots 30'+ None To Building Foundation Lot Nnnm To Water Main/Service Line 10'+ To Cutbank( if p~esent) To Stream/Pond/Lake/or Major D~ainage Course' None Noted To D~iveway, Parking A~ea, or Vehicle Storage A~ea 10'+ Co~mrents The ~@Dt~ ~m w~ '[n~']t~d ~n 7=R? ~nH w~c iJ~ad~d in 5-~3 (meapp~0ved). Bein~ that the s~/stem had been app~0ved in the last 2 reams ~n adeGuacy test did not have to be perfommed. ~IFT STATION Date Installed Size in Gallons "P~af~ On" Level at High Water Alarm Level at Tested fo~ Electrical Codes (Y/N) Dira~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. M~ets MOA Co~,,~ents . ** Cheek Permitted Bed~ocm Rating Against HAA Request I certify that I have checked, verified, c~ confc~med to all MOA HAA Guid~]i~m~ in effect on the date of this inspectio.~ Si Date 4-5-85 ~ ~ng~ MOA No. [Pa~ 2 of 2] 2-15-84 - APPLI/- IT FILLS OUT UPPER HA"-'"' ONLY .~roperty. Owner ~t~l~J/.~ /t/,~/ ~.~-'~\ ~L~ Phone a~ling Ad~re~ ~' ~ ~ ~? -~ ~'~J~~ Zip Code ~7 Buyer " ~ ~ ~'k~ ~ Address Zip Code Lending Institution ~y¥~_ ~ ~ ~ ~ ~ Phone ~e~ co. ~ A~.~ /~Z~ Address Zip Code Legal Description ~OT' ~ ~L~ ~ I~C~ Street Locati~ ~ / ~-.~ ~/~.-~ A~' ~{ I ~ Ty~Resi~nce ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Wa~upply ~ Individual ~ ~ ~(~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975, ~ CommunitYPublic Utility ~ ~..~ ~ ~ For wells drilled prior to that date, give well depth (attach log if available). Se~e~isposal ~ Individual ~ ~.~ Year Individual Installed: ~ ~- ~1 /~ ~ 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 .~....~ ( ~,. ~. ~'3 Date Date Inspector Insp~tor Insp~tor ~ Insp~t~ ~ Field Notes: ~ ~UNICIPALITY OF ANCHORAGE RECEIVED ~ ~APPROVED B~DROOMS *CONDITIONS OF APPROVAL ( ) CONDITIONAL APPROVAL* . Soils Rating Date ~wer installed Well To Absorption Area ~ Well Log Received "~ --~ ~' Well to Tank ,, Septic T~k Size January 3, ].983 Dennis H. and Barbara Kendall SRA Box 64-E Anchorage, AK 99507 Subject: Lot 14 Block 2 Rockhill Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The top of the well casing should be sealed so that it is water tight. The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. o A four ~4) inch cleanout needs to be installed to the sep- tic tank. ° A four (4) inch cleanout needs to be installed to the leaching area. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP1/p/EH Robert C. Pratt Associate Environmental Specislist