HomeMy WebLinkAboutROCKHILL BLK 2 LT 20
, Municipality of Anchorage Page I of 3
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 Ins, pection Report
Permit Number:. SW970~37 PIDNumber: 01536232
Name: George Jackson Wastewater System:. E] New Iz Upgrade
Ad,~ress:
6340 Limestone Circle ABSORPTION FIELD
INd. of Se,~rooms: '
,,o.e: 346-3595 ~ Three ¥~ Deep Trench i-I Shallow Trench rlBed C~Mound r'lOther
LEGAL D ESCR I PT id N soi, Rating: Total Depth from original grade:
' I r 2 GPD/Sq. Ft. I 2 '
Loc Block: Subdivision: [D~ te pil~e bottom Imm odginai gte:la: Gravel depth benaat~ pipe
20 2 Rockhill 6 m. 6 ;'-
Township: I Range: I Section: Fill aclded above original grade: Gravel length:
0 m. 42.6~
WELL: D New r-I Upgrade Gravel width: . Number of lines: Distatoel3etvi~a li~
3 ~t. I N/A Ft.'
Classification (Private. A.B.C): Total Depth: Cased To: Total abeocption area: Pipe material:
Existinq ~t. Pt. 613 se. Ft. ASTM D3034
Ddlle~. Date Drilled: Static Wat~ ~el: Installer:. Date installed:
Ff. Acreaqe Systems 10/7/97
Yield: GPM IPump Set at: Ft. Icasing Height Ab°veGmtmd:Ft. TANK
SEPARATION DISTANCES ~, Septic cl Holding I'1 S.T.E.P.
TO ~l;fl¢ Al~4~tion Lift Holding ~JbliCJ~ft~mte ManufaCture~.' Capacity in gallons:
From ?ank ,ad S,.,o, T~, S~U-. Anch, Tank I ~250 Gallon
Material: Number of Compartments:
Well >100 >100 N/A N/A >50~ Steel ~wo
s~aco LIFT STATION - N/A
Water >100 >100 N/A N/A >100'
Lot' Size in gallons: ~ Manufecture~.
Line > 5 ' .>1 0 ' N/A N/A >20 '
I
~ou.uat,on >5' >1o' N/A N/A N/A '.umpon",.e,a. 'l '.ump o'¢ ,eva' a"'l Nigh "atar ats'= a"
Curtain Pump Make & M~ I Electrical Inspections performed by:
Drain None on Lo-
1
;Remarks: Existin~ service line inter- BENCH MARK
Location and Description:
cepted 5' .from new tank. Existing Northeast Deck
tank pumped~ crushed, backfilled
I Assumed Elevation:
and abandoned on site. 100
ENGINEER'S SEAL
· Inspections performed by: Mike Anderson Dates: 1st 10/7/97 , · -- . ,
; ~". MICHAEL E. ANDERSON:
Department of Health and Human Services approval
Reviewed and approved by: . ~-/~,~'~-- /~z,,f-~ Date: [~.~-~7~
Municipality O! AnCllorage page ~ of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-47d~.'
On-Site Wast·water Disposal System and/Or Well Inspection Report
PermitNumbec SW970337 PID Numbe~ 01536.232
Existing
Well ~
Three Bedroom
Home
ST1 47.2 50.7
ST2 55.3 57.8 ~
CO4 121 119.8 ~
MT1 114 125.5 ~,~
~ STII'- 1,250 Gallon
~ ST2b Septic Tank
O1
C02 Existinq Trench
CO3~ o
Flow Diverter
' Valve
PLAN AS-BUILT
SCALE 1" = 20'
CO4~
42.6'
10' Utility Easement
MT1 ~ CO5
m
Municipality'of Anchorage Page 3 o!
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: Sw970337
PID Number:. 01536232
C04
TH No.'l
MT1
CO5
I ST1
ST2
C01
CO2
DV
C03
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUM3~N SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW970337
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:JACKSON GEORGE DALE
OWNER ADDRESS:6340 LIMESTONE CIR
ANCHORAGE, ALASKA 99516
DATE ISSUED: 9/29/97
EXPIRATION DATE: 9/29/98
PARCEL ID:01536232
LEGAL DESCRIPTION:
ROCKHILL BLK 2 LT 20
LOT SIZE: 41839 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDA/~CE 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 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 S/LME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
September 21, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
MUNICIPALITy OF ANcHOI~G~.
ENVIRONMENTAl SERVICEs DIVISION
SEP 22
RECEIVED
Subject:
Lot 20, Block 2, Rockhill Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The existing absorption trench on the subject lot has failed and must be
replaced. We are therefore requesting a permit be issued to upgrade the
system and install a new absorption trench. The attached Site Plan shows
the area of the existing trench and the location of the new trench. A
diverter valve will be installed to connect to the existing trench for
future use if the trench should rejuvenate itself over time.
The testhole placed in the area of the proposed absorption trench revealed
well graded sand with gravel with a percolation rate of 2 minutes per
inch. No groundwater was found during placement of the testhole nor
during the ensuing monitoring period. We are therefore proposing
placement of a 32' long by 3' wide by 6' effective depth absorption trench
for disposal of septic effluent. The distribution pipe will be placed at 6'
below the surface. The maximum depth of the trench will be 12' below the
ground surface.
The ground surface of the lot is relatively flat with only a minor grade
from west to east. The slope will have no impact on the placement of the
new trench. No conflicts were found between wells and septic systems in
the area and the new absorption trench.
If the system is constructed as designed the following statements apply:
Lot 20, Block 2, Rockhill Subdivision
September 21, 1997
Page Two
The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the area.
The system, if constructed as designed, will have no adverse
impact on reserved space, either surface or subsurface, on any lots
located in the area.
The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
BARRy AVENUE
VA(~ANT
~ ' LiMEsTOi~E CIRCLE
VACANT
VACANT
VACANT
AREA MAP
SCALE 1" = 100'
- ~LIMESToNE
'-CIRCLE
DRIVEWAY
WELL
3 BDRM.
HOME
EXISTING ABSORPTION
TRENCH
I
'.,VERIFY EXISTING
SEPTIC TANK
NEW ABSORPTION
TRENCH
NO. I
SITE PLAN
SCALE 1" = 40'
THREE BEDROOM -_ HOME
DIVERTER VALVE
VERIFY EXISTING
1,000 GALLON
SEPTIC TANK
EXISTING ABSORPTION
TRENCH
32' LONG X 6' EFFECTIVE
DEPTH ABSORPTION TRENCH
o 0 0
UTILITY EASEMENT
SYSTEM PLAN
SCALE 1" = 20'
LOT 20, BLOCK 2, ROCKHILL SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: 2 Min./Inch
'Application Rate: 1.2 GPD/SF
Deep Trench System
Verify Existing Septic Tank
6' Drainfield Rock
3 Bedrooms X 150 GPD / 1.2 GPD/SF = 375 SF of Absorption Area
375 SF/12 SF/LF = 31.25 LF Trench Length
Therefore: Construct a Deep Absorption Trench System With One Lateral
32' in Length with 6' of Drainfield Rock Beneath the Lateral.
Distribution Pipe in Trench Placed at 6' Below the Original Ground
Surface.
?
NOTE:
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 3' of Cover over Septic System.
Minimum 4' Separation From Groundwater.
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Stxeet~ AnchoragE, Alaska 99502~650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: Dale .Jackson
LEGAL DESCRIPTION: Lot 20, Block 2 ~
Township, Range, Section:
2,
3
4
5
6
7
8-
9
10
11
12
13
14-
15-
16-
17
18
19
20-
Rockhill Subdivision
TESTHOLE No. 1
SW
with Gravel
ttom Hole
WAS GROUND WATER
ENCOUNTERED?
SLOPE
SITE PLAN
NO
COMMENTS Testhole presoaked orior to Sest,
ACCORDANCE WITH ALL sTATE AND'MuNICIPAL GUIDELINES IN EFFECT ON THIS DATF- DATE: q]~ / Iq 7
72~08 (Rev. 4/85)
pERcOLATION RATE 2 (minutes~inch) PERC HOLE DIAMETER 6"
TEST RUN BETWEEN 8.5 FT AND 9 FT
Rea~ing Date Gr°~ Net Depth to Net
Time Time Water Dn~
Scc :its
S
IF YES, AT WHAT ~
DEPTH? p
E
aaa=m; None ' ~m: 9121 [~7
) 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
LEGAL DESCRIPTION ·
LOCATION " NO. ~EDROOMS
~ Manufacture~ ~
~ ~iq. ca~n ~allons~ ~ ~ Mat~~ ,o. o, ~rtm.nts
IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
0 Z ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO:
~ ~ ~ TopNO' of ,ineSof tile to'finish] gradeLen'~ ' T°ta~°rlineSMaterial beneath tile Trenc~h= ? incheSinchesTotaIDistance~etwe" ,ines~t~ption~/~ ' area
Length Widt~ Depth PERMIT NO.
( ~ 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 PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING ,~
REMARKS
DATE LEGAL
.... ¢/ DEF'RF.'TMENT i. HEALTH AND ENV I F.:t]NMEI'.4TRL ,= .U I'EL: F I UN
V ' ,::25 '" ~'" 'STREET., ANCHOF.:RGE., ELF:::. ~9~,0.1
~" 'l~ "- 264-4720
U ,.,-iEEE ,=,Nr:" Z -'r'E
PERMIT NO. "82:04-06 ',
MFFLI..RNT JRK F:FIN'=,,TR i-TION 8.10,:,'"4 PETERSBURG #5 ,=~,.e.. ,,.. ,.. 2.:49-~::L5.1
LOCRT I ON
L. EGRL L20 B2 RF~CI<HILL . LOT SIZE '~':.¥9'~:~ SL.'.!UARE FEET
TYF'E nF ch:IL RBSOF.:F'TIF'd"4 =,'r_,TEft [:,RRINF
MRXIHUM NUMBER OF BEDROOMS = ~: SOIL RRTING (SIT.! FT,."BR)= '125
THE REQUIRED SI~E OF THE SOIL ABSORPTION
C, EF'T'H-- 6 b. E ~""-~ "-3 T ~-t=~ 51]: i3 F~: R %-" E L Er..EF" TH=
THE LENG]"H DIMENSION IS THE LEI'4GTH (tN FEET::' OF T~HE.~~~F-iIi".tFIELD.
THE DEF'TH OF Fi TRENCH OR PIT IS TI~E DISTANCE.~..BE"q]4EEN THE SI~I~F THE
GF.:C~LtND RNE:, THE BOTTOM OF THE EXCAVATION (Ii'J/'FEET). ~
THE TE:E~-&C:I-~ #.4 I [:;'TH ][ ."_=; W.._. 5. ~;~.;~(E~ FF--E~7. ,
THE GRRVEL [:,EPTH IS ']"HE MINIMUM DEPTH OF GF.:RV~_' TWF'FN T.._~I...L_J~tIFE
AND THE BOTTOM OF THE EXCAVATION ,:: IN FEET:).
PERMIT FtPPLICFtNT HAS THE RESPONSIBILITY TO INFORM THIS [:,EPRR't"MENT DURING THE
iNSTEtLLATION INSPECTIONS OF AN'¢ WEI._LS ADJACENT TO THIS PROPERT'¢ AND 'THE
NUMBER OF RESIDENCES; THAT TFIE HELL HILL SER'v'E. -,
BACKFILLING OF ANY SYSTEM HITHOUT FINAL INSPECTION AND,APPROVAl,- BY THIS,
DEPARTMENT HILl,_ BE SI.JBJECT TO PROSECUTION.
MINIMUM DISTANCE BETHEEN Ft HELL AND RNY ON-SITE SEWAGE DISPOSAL. SYSTEM IS
· 100 FEET FOR A PRiVFITE HELL OR .150 TO 2_00 FEET FROM R PUBLIC HELL. DEPENDING
UPON 'THE TYPE OF PUBLIC HELL..
MINIMUM DISTANCE FROM FI PRIVATE HELL TO Ft PRIVATE SEWER LINE IS 25 FEET FIN[:'
TO Ft COMMUNITY SEHER LINE IS 75 FEET.
HELL LOGS ARE REC-,~LIiRED PIN[:, MUST BE RETURNED TO THE [:,EPFIRTMENT HITHIN ]:0 DI=t'¢S
OF THE HELL COMPLETION.
OTHER REG!UIREMENTS MFt"r' FtPPLY. SPECIFICATIONS FIND CONSTRUCTION DIAGRAMS ARE
A',,,'RII,_ABLE "FO INSURE PROPER INSTALLATION.
F' E] F~i.'. ~'-1 ]] T E )-:: F' ]~ F~: E: L~-; [:. FE C: E f"~ E: E F-: :_-=c ± ... ;1.."_:~-' E: ----<
I CERTIFY THAT
'1: t Fir'1 FAMILIAR HITH THE RE6!UIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET
FORTH 8Y THE MUNICtPFtLi'I"Y OF ANCHORRGE.
2: I HILL INSTALL_ THE SYSTEM IN ACCORDANCE Ht]"H THE CODES.
24: I UNDERSTAND THAT THE ON-SITE SEHER SVSTEM ["IR"," REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN Z-': BEDROOMS.
S I GNED: ....................................................
APPL ICRNT ,.IRK CONSTRUCTION
I =,_-,I_IEE. BY_--
V4. 0
r?PE: OF *_=,OIL FiG_~3iS~PTION ~t"STElt 1:-$:
-[
THE TRErdtCH Id ~ OTH I S 5. ~3~3 FEET.
PE~rl I T E;:.lp ~ ~-g DEE:EMBER ~- ~%~:~D
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVI RONIVIENTAL PROTECTION
825 L; Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LE~ALDESCR,PT'O"= Z z~ 3~
DATE PERFORMED:
1
2
3
4
5
6
7
8
9
10
11
12
13
14-
15-
16
17
18
19
20
iz- /fo
SLOPE
WAS QROU~D WATER
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Readi0g Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
~ FT
COMMENTS
CERTI : /4,1
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL JJc
ige
Expiration Date: e) �`�
Parcel I.D. 015-362-32
1. GENERAL INFORMATION
I t
Complete legal description ROCKHILL S/D; BLOCK 2, LOT 20
Location (site address) 6340 LIMESTONE CIRCLE, ANCHORAGE, AK, 99516
Current Property owner(s) JAMES FOSTER Day phone CIO AGENT
Mailing address 20723 SCENIC DRIVE, CHUGIAK, AK, 99567
Real Estate Agent JOHN OHARA W/ REMAX/DYNAMIC Day phone 242-9192
2. TYPE OF DWELLING:
▪ Single Family (w/wo ADU)
❑ Duplex
ny
❑ Multiple Dwellings (Single Family and/or Duplex)`'
r rm
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
•
3
NOV 1
14
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
•
N/A Distance: -
waiverNariance re
quest for:
Received by: . A, A
COSA to be releases he engineer, unless otherwise ::rested by the engineer.
Date:
COSA Fee $ _ 5
III lig C'
CC:it'll 61
Date of Payment
Receipt Number
COSA #
a 14Ico00
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name. of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LfD. attempted to provide a thorough
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSO Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readilyidentiiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
Phone 337-6179
Date
``4\:(OF iANCH� (r'r
bedrooms, with the following stipulatiLaa ON'S, PNTEp
kTER z
�V�"" wp,K o�
� o *5'FAM � �
pROGR off;
f
lilt ti ivaiAci1Ls
Original Certificate Date' �.
e Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
CChecklist Checcklist ,v/
Septic System Advisory
Well Flow Advisory
(Psi mn2n21
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: ROCKHILL S/D; BLOCK 2; LOT 20 Parcel ID: 015-362-32
A. WELL DATA *ASSUMED. SEE ATTACHED WELL LOG AND NOTES.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) *YES
Date completed *8/2/1983 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth *51 ft. Cased to *51 ft. Casing height (above ground)
12+ in
FROM WELL LOG AT INSPECTION
Date of test *8/211983 9/12/2014
Static water level *10 ft. 38 ft.
Well production *15 g.p,m, 4.47+ g p m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate e' 82 mg./L. Collected by: GEG, Ltd.
Arsenic `J n /' ug./L. Date of sample: 9/12/2014
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 10/7/1997
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N)
YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
�Z.l55/lit Date of pumping 11 f 1 1 F 11 Pumper /'T+'
C. ABSORPTION FIELD DATA
'BELOW EXISTING GRADE j
Date installed 10/7/1997 Soil rating.p.d./ r ft2/bdrm) 1_2 System type TRENCH
Length 42.6 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth *11.5 ft. Eff. absorption area **511 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 9/12/2014 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 26 in. Water added 605 gal
For 3 bedrooms
New depth 43 in.
Elapsed Time: 120 min. Final fluid depth 34 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
NOTE: 1983 TRENCH WAS CONNECTED AS RESERVE SITE BUT NO MONITORING TUBE COULD BE LOCATED DURING
INSPECTION **CALCULATED AREA BASED UPON LISTED TRENCH DIMENSIONS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in "Pump off' level at . wa er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+ On adjacent lots 100'+
Absorption field on lot 1001+ On adjacent lots 1001+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas *371 4-504- CYT Manure/animal excrete storage areas 1001+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 5'+
Water main N/A Water service line 101+ Surface water 1001+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 101+ Water main N/A
Water service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 1001+
F. COMMENTS
*37' TO FENCED AREA THAT CAN BE USED TO CONTAIN DOGS. 46,
G. ENGINEER'S CERTIFICATION
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.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 10/12/12)
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC141600
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 20 of
Rockhill subdivision. This inspection revealed a nitrate concentration of 8.82
milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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
01 536232 HAA#
1. GENERAL INFORMATION
Complete legal description
Lot 20, Block 2, Rockhill Subdivision
Location (site address or directions) 6340 Limestone Circle
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
G. Dale Jackson
6340 Limestone Circle
Day phone 346-3595
Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Four (4)
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
XXX
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
XXX
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.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number Of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Andar~on Enqineerinc~ Phone 563-71 55
Address P.O. Box 240773 Anchorage, AK 99524
Date 1 /16/97
DHHS SIGNATURE
~/ Approved for
Disapproved.
bedrooms.
Conditional approval for bedrooms, with the following stiRul~tions:
NOTE" The well for this property meets existing State and Municipal Coaes.
There are nitrates present. It is suggested that periodic testing be
performed to insure teh wells continued suitabilty. Current nitrate
concentration is 5.02 mg/1. EPA maximum concentration is 10.0 mg/1.
More information on nitrates is avai±aD±e ~rom the o~-site Services Program,
DHHS, 343-4744.
Additional Comments Previously a HAAwas granted for a 3 bedroom home. The
system is adequate, however for a 4 bedroom home. This certificate replaces
the HAA#970516 dated December 2, 1997.
'fA'Jl£'ii
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
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. Ct
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
01536232 NAA#
1. -' GENERAL INFORMATION
Complete legal description
Lot 20, Block 2, Rockhill Subdivision
Location (site address or directions) 6340 Limestone Circle
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Georqe Dale Jackson
6340 Limestone Circle
Day phone 346-3595
Anchorage, AK 99516
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: Three (3)
TYPE OF WATER SUPPLY:
Individual well XX
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:
XX
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
o
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of Structu re 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 Anderson Enqineerinq Phone
Address p_o. Bo× 240773 Anchorage: AK 99524
Engineer's signature ~ (::~~ Date
563-71 55
11/5/97
DHHS SIGNATURE
V'/ Approved for
Disapproved.
"7'~'~:~ bedrooms.
Conditional approval for bedrooms, with the following stipulations:
Note: The well for this property meets existing State and Mun±cipal Codes.
performed to insure the wells continued suitability. Current nitrate
g/1 .....
uuuu~ut~atlu~ i~ 5.02 m· EPA.~.~
More information on nitrates is available from the On-site Services Program,
DHHS, 343-4/44.
Additional Comments
By:
'f;','lli'li
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91 ) Back MOA #21
Legal Description: Lot
A. WELL DATA
Well type Private
Log present (Y/N)
Total depth Unknown
Sanitary seal (Y/N)
Municipality of Anchorage DE f" E
DEPARTMENT OF HEALTH & HUMAN SERVICESL % E I V E D
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907){V~-477tz~997
M un Jc~pal~ ~ ot Anchorage
Health Authority Approval Checkli~ept. Health & Human Services
20, Block 2, Rockhill Sub. Parceli.D.: 01536232
N
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0
Date of sample: 1 1 / 3 / 9 7
B. SEPTIC/HOLDING TANK DATA
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Unknown
Cased to > 4 0 ' Casing height (above ground) 2 '
¥ Wires properly protected (Y/N) ¥
FROM WELL LOG AT INSPECTION
10/18/97
43.5'
g.p.m. 6.3 g.p.m.
Nitrate 5.0 2 mq/L Other bacteria 0
Collected by: M, Anderson
Date installed 1 0 / 7 / 9 7
Foundation cleanout (Y/N)
Date of Pumping N~w
C. ABSORPTION FIELD DATA
Date installed 1 0./7/97 Soil rating (g.p.d./ft2or fF/bdrm) I _ 2
Length 4 2 _ 6 ' Width 3 ' Gravel thickness below pipe
Effective absorl~tion area 61 3 SF Monitoring Tube present (Y/N) ¥
Date of adequacy test New Const. Results (Pass/Fail) Pass
Fluid depth in absorption field before test (in.);
Fluid depth (ins) Minutes later:
Peroxide treatment (past 12 months) (Y/N)
72-026 (Rev. 3/96)*
Tank size I: 2 5 0 Number of Compartments 2, Cleanouts (Y/N) .
¥ Depression (Y/N) N High water alarm (Y/N) hi
Pumper Ccm.qt-z',]~-irm
System type r~?
6 ' Total depth 1 2 '
__ Depression over field (Y/N). hi
For Three bedrooms
__ gal. water added (in.):
g.p.d.
Immediately after
Absorption rate =
If yes, give date
D. LIFT STATION - None
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
on Lot
F.
Size in gallons
"Pump on" level at*
*Datum
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM WELL ON LOT TO:
>100'
>100'
>100'
>20'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation > 5 ' Property line > 5 '
Water main/service line > 50 ' Surface water/drainage > 1 00 '
· SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 '
Surface water > 100 '
Curtain drain None on Lot
"Pump off" level at*
On adjacent lots > 100 '
On adjacent lots > 100 '
Public sewer manhole/cleanout > 100 '
Lift station Non~ ~n Lof_
Absorption field > .5 '
Wells on adjacent lots > 1 00 '
Water main/service line
Driveway, parking/vehicle storage area > 1 0 '
Wells on adjacent lots > 1 0 0 '
>50'
ENGINEER'S CERTIFICATION
~ertifythat~ha~edet~rminedthrufie~dinspecti~nsandre~iew~fMunicipa~-~~?~ ~¥esystemsare
/'n conformance with MOA HAA guidelines in effect on this date. ~.~? ...... ~..~ l~
'
Signature
Engineer's Name N~chae~ ~. A~e~on~ P_~. ~,~~
~ ~', MICHAEL ~:~NDE~0N ~
Date 3~/~/~7 ~ 4~81-E ,,~
HAA Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
Waiver Fee $
Date of Payment
Receipt Number
