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ROCKHILL BLK 3 LT 5
Rockhill Block Lot 5 3 #015-063-03 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW050232 PID Number. 015-063-03 Nome: FREDRERICK WILLIAMS Wastewater System: O New ■ Upgrade Mdrew: 6231 PETRIFIED TREE CIRCLE a ANCHORAG, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms. (907) 337-0071 4 ■Deep Trench OShollow Trench OBed OHound aOther LEGAL DESCRIPTION :a r 1.2 Talar 9 WPMWPM°" ;MAX �,s, n R Block: Lot: SubdWielon: 3 5 ROCKHILL oaetn b etas Mann from aglM Ooda GBM ewth twrelh AM 2.8 MAX. n 7 n Towmhip: — Range: Section: rf .deal eb . aped Voda GBM Naptic _ — SEE DWG. R 47 WELL: ❑ New p Upgrode owM .lak 2.5 ak.M.r a r,aa 1 owe» Mteaan rwa it n cbaalnwl m A9.0 Told Coale Ta0jW,,0 T.W eb.�Ve. a waled* \\ n rt 658+ so. rL D 3034/ F-810/ SCH 40 PVC Mwo wdr l WOW GEG, Ltd. pay YwbeC 7/29/ 05-8/ 8/ 05 orw.: �X\5 ado ale* R SA t:� � N>o.. Gaal TANK amR rt SEPARATION DISTANCES 0Septic 0HoWing ■S.T.LP. 0Other To rrem SepUe Tank Abee yUon Fl.ld Lift Station HOWing Ton: /P,M,a s..r unp Voiieooh' . ANCHORAGE TANK Cera'rb b eolb.s 1500 Well 100'+ 1000+ 100'+ — 25'+ STEEL Nwnbw a ..neaowwa 2 Surface water 100'+ 1006+ 100'+ — — LIFT STATION Lot tins 5'+ 10' 10'+ — —size ti "km 1500 Mae..ak"n ANCHORAGE TANK Foundation 50+ 10'+ 10'+ — — .e wa et ,...1 a: reek .aa .lean a: 42, 42' 46" Curtain Drain NONE KNOW M1aW mom t Yacht aaarlad Ywpaab,w evrarmad M• J20 OSI 05 HHF M.O.A. Remarks: BENCH MARK THE OLD TANK WAS ABANDOND PER UPC. {oaaear .w o..alyew[ TOP OF MANHOLE LID Fwd la"Gume 96.35 n 1"Goaaws UAL 0 At 7 Inspections performed by: GEG, Ltd. Dates: 1st 7/29/2005 ....... ................... 2nd 8/1/2005 3rd 8/8/2005 ..... ... ................... 13 • J f y A. arneas.: Development Services Department Approval 04e — 53 .` ii evv Reiewved and approved by: Dater pVal)�pP- PERMff SWO NUMBER: SW050232 24.73 AS -BUILT DRAWING DBL2 N PARCEL015 37.46 STI 15.82 55.25 015-063-03 0 -03C 22.85 / MH 24.67 64.97 Mil I / too' WELL PADIus 1 I \ 95.18 50.39 I I \ 1 I 11 1 ! AI J I \ NEW 1 \ DRAINFlEID / l \ \ / / II ♦ II n\\ II '?� ♦ HOUSE •� HOUSE _ -;�- / A ,� \ AA DBL1 24.73 35.83 DBL2 23.58 37.46 STI 15.82 55.25 Sit 22.85 62.89 MH 24.67 64.97 Mil 71.86 51.36 MT2 95.18 50.39 NEW 300 TANK GALLON EP. / GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 6 GENERAL CONTRACTORS am L wm inw wt yet • MPOWAL r wor • ma boryny,w • W Poy}frm.• • �w.r.�.y .. PREPARED FOR: PHONE NUMBER: PACE NUMBER: FREDERICK WILLIAMS 337-0071 2 OF 3 LEGAL DESCRIPnON: DRAWN BY: ROCKHILL SUBDIVISION; LOT 5, BLOCK 3, R.A.L. TYPE OF WORK: OATS: AS—BUILT FOR SEPTIC SYSTEM UPGRADE 8/19/20 .r.`.......... SW050232 AS-BUILT DRAWING PARCEL 063- 03 FINAL GRADE 06.20-96.47 TOP OF TANK STI ST2 MH AT INLET . 9029"1 f1 I n Ic TOP OF MANHOLE 96.35 TANK 90.33 INVERT OF BUNG / I I NEW 1500 GALLON AT INLET - 89.77 S.T.E.P. TANK ORIGINAL GRADE 100.80 - RELATIVE ELEVATION OF BOTTOM OF TEST HOLE IS 84.80 (TEST HOLE DRY) FINAL GRADE 101.07-101.60 FABRIC INVERT OF DISTRIBUTION UNE - 07.96 (AVG.) THE DISTRIBUTION UNE IS 125 NCH PVC WITH >) INCH HOLES SPACED 18 INCHES ON CENTER. (30 HODS TOTAL) W OF TRENCH 90.97 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS& GENERAL CONTRACTORS '••••• •• '•• ............ ani L a 0c *At IM • MOOMM M MW • 11aK (W*M-Nn • Mi 004AM-a" • vio w..�.• Nr+ PREPARED FOR PHONE NUMBER: PAGE NUMBER: •• •• ......•••• FREDERICK WILLIAMS 337-0071 3 OF 3t A G DRAWN BY: ness:' LEGAL DESCRIPnON: ROCKHILL SUBDIVISION; LOT 5. BLOCK 3. R.A.L.�� •.e '� LZ ��Fo4c TYPE OF WORK: ��• ODQQ4Op sIO�'-`� PROFILE AS—BUILT FOR SEPTIC SYSTEM UPGRADE 8/19/2005 From +19078308507 Thu Aug 11 06:17:27 2005 Page 1 of 1 INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW INSPECTION INFORMATION &HELP: 343-7962 INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777 www.muni.org/BSD/Inspeclons.cfm NAME KEVIN PERMIT#: 05-8805 COMPANY RISING SUN ELECTRIC INSPECT DATE: 8/11/2005 PHONE # 250-1100 PHONE # PHONE # ADDRESS 6231 PETRIFIED TREE CIR LOT 5 BLOCK 3 SUBDIVISION ROCKHILL GRID # SW2438 COMMENTS or DIRECTIONS AM / ri6 l "-Tv TYPE OF INSPECTION: Retro Electrical COMMENTS: (FOR INSPECTOR USE ONLY) L bv;pLGZ - v�<<► �� �w��E rel ��,�n��Gs PRINTED NAME af4 ! DATE: + ' MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 Permit Number: SWO50232 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 18, 2005 Expiration Date: Jul 18, 2006 Parcel ID: 015-063-03 Legal Description: ROCKHILL BLK 3 LT 5 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 006231 PETRIFIED TREE CIR Owner Name: FREDERICK WILLIAMS Lot Size: 42979 SO. FT. Owner Address: 6231 PETRIFIED TREE CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-6519 This permit is for the construction of: ❑.r Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specked 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: 7 -/P -0!5 --- Issued -/P-O!5--- Issued By: Date: 71f$740Z Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.sk.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. nim Permit Number Property owner(s) FREDERICK WILLIAMS Day phone 337-0071 Mailing address (1) 6231 PETRIFIED TREE CIRCLE • ANCHORAGE. AK Mailing address (2) Legal description (Lot, Block & Sub'd.) LOT 5. BLOCK 3: ROCKHILL SUBDIVISION Legal descri /ption (Section, Township & Range) _N/A Lot Size K0_q 7 Acr Sq.Ft Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. om Permit Fees: y0 Date of Payment: 7-6-9 Waiver Fees, Date of Payment: Receipt Number. 0-70 967 NAn Receipt Number. GA,RNESS ENGINEERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTORS July 11, 2005 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Rockhill Subdivision; Lot 5, Block 3, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is in a state of failure and needs to be upgraded. A test hole was excavated in the area of the proposed septic system. The drainfield will be designed around this test hole. We are proposing to install a new 1500 gallon S.T.E.P. tank and a deep trench type drainfield. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed drainfield. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography in the area of the proposed drainfield is relatively flat. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. .S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact C.E.C. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246Website: gamessengineering.com I I I I I I I LOT 3. BLOCK 3; ROCKHILL S/D (NO CONCERN) LOT 4. BLOCK 3; ROCKHILL S/Dy I 1 (PROPOSED SEPTIC UPGRADE I(SEE DESIGN PACE 2 OF 2) 1 LOT B, BLOCK 3; L ROCKHILL S/D I I I / \ t'I Qn. WE] LRADII IS / iiii LOT 7. BLOCK 3; ROCKHILL S/O LOT 21. BLOC ROCKHILL S, 11 L0, 22, BLOCK 2; ROCKHILL S/D \ \ I GARNESS ENGINEERING GROUP, Ltd. o;?. 4 CONSUL TANTS& GENERAL CONTRACTORS ••••••• ••• • •••• ......•••.••• 1 E /11008 VOID, AAC 101 • NIOIO IIT eswr w X," • m N eosle REPARED FOR: PHONE NUMBER: PAGE NUMBER: •• ••• •••••••••••• FREDERICK WILLIAMS (907) 337-0071 1 OF 3 P '• f y amass: CAL DESCRIPTION: DRAWN BY: oO4'o� CE -7 53 �FeO ROCKHILL SUBDIVISION; LOT 5. BLOCK 3 C.J.G./R.A.L �Q ed7�13 o\ In Im <, • / /� LOT 23, BLOCK 2; ROCKHILL S/D •"� EXISTING / \ 4 BEDROOM / \ ' HOUSE 1 LE PROPOSED SEPTIC UPGRADE (SEE DESIGN PACE 2 OF 2) /SEPTIC EXISTING ;� •`•' I SYSTEM \�G�j' `\ \ L T24. BLOCK 2; ROCKLL S/D SITE PLAN FOR SEPTIC SYSTEM UPGRADE 7/11/2005 LOT 8. BLOCK 3; \ / ROCKHILL S/D 1 1D0' WFl1 RADII is v / \ \ LOT 0, BLOCK 3; ROCKHILL S/O / (NO CONCERN) Qoo�oo000 OFMA�A°Oo� GARNESS ENGINEERING GROUP, Ltd. o;?. 4 CONSUL TANTS& GENERAL CONTRACTORS ••••••• ••• • •••• ......•••.••• 1 E /11008 VOID, AAC 101 • NIOIO IIT eswr w X," • m N eosle REPARED FOR: PHONE NUMBER: PAGE NUMBER: •• ••• •••••••••••• FREDERICK WILLIAMS (907) 337-0071 1 OF 3 P '• f y amass: CAL DESCRIPTION: DRAWN BY: oO4'o� CE -7 53 �FeO ROCKHILL SUBDIVISION; LOT 5. BLOCK 3 C.J.G./R.A.L �Q ed7�13 o\ (Rw. 01NS) In Im P LE TYPE OF WORK: RATE: °° Profes310 SITE PLAN FOR SEPTIC SYSTEM UPGRADE 7/11/2005 (Rw. 01NS) I 1oo• WELL pgplUS I\ THE DISTRIBUTION LINE IS TO 1 BE 125 INCH PVC WITH 1/4 INCH HOLES ENTER. ( (30 HOLES NCHES ONCTOTAL) V \\\�TM„\ BE NSC \ \% \ �1 t� v OF BEDROOMS:4 PER DAY (CPD): 600 TON RATE/S:1 MIN.ANCH D APPLICATION PATE. 1.0 DRAINFIELA SOTT.: 500 IM OEPTHAO FEET 2.5 FEET 1:45 FEET APPROVED SAND FILTFR:N/A TVE:7 FEET DON FACTOR: N/A . SO.FT.: 630 LEITER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT CEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION. THE ENGINEER. WELL DRILLER. CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY / HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. EXISTING SEPTIC7=N •PROPOSED 1500TANK TO BE rCALLON S.T.E.P. COMPLETELY�...TANK WITH DUAL ABANDONED OUTLETS. PLUMB SO • THAT FLAW CAN BE ALTERNATEDBETWEEN FIELDS. TO ATE ..L a••f NOTE: THE CONTRACTOR SHALL HAVE !`V/ THE NORTH AND WEST LOT LINES AND !�\ ALL 100 FOOT WELL RADII SHOWN \ --- FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. Q / 4 t+ '� n GARNESS ENGINEERING GROUP, Ltd. p;'�• 4 `�*� CONSULTANTS d GENERAL CONTRACTORS Q•••••• •• =1 L IUM M0.0. KM tot . NRIIGI L NI 90 • Rf't. [ (90W 1" 0 A (. rk=--Aw • SRO w O PREPARED FOR: PHONE NUMBER: PACE NUMBER: •••••• FREDERICK WILLIAMS 337-0071 2 OF 3 a A GAmess: 0 LEGAL DESCRIPTION: DRAWN BY: Ov CFy 79p3_ ROCKHILL SUBDIVISION; LOT 5. BLOCK 3, C.J.G./R.A.L e (vp Or3si��oQv TYPE OF WORK: ATE: ��DOO0000a DESIGN OF SEPTIC SYSTEM UPGRADE 7/11/2005 (R" 0LC5) 2.5' 1L °---------------� NOTE: THE DISTRIBUTION LINE IS TO BE 1.25 INCH PVC WITH j INCH HOLES SPACED 18 INCHES ON CENTER. (30 HOLES TOTAL) GRADE RIC FILTER ORIGINAL GRADE 10' NOTE: THE DISTRIBUTION UNE IS TO BE 1.25 INCH PVC WITH } INCH HOLES SPACED 22 INCHES ON CENTER. (30 HOLES TOTAL) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS . ]rot L TID011 NO A M 101 • MCHNA (. Mf ..4. . . O PREPARED FOR: PHONE NUMBER: PAGE NUMBER: .. •• .• .••• ......•••••• FREDERICK WILLIAMS 337-0071 3 OF 31p LEGAL DESCRIPTION: A O� e y E- arness DRAWN BY: oO�' •FO ROCKHILL SUBDIVISION. LOT 5. BLOCK 3. R.A.L. TYPE OF WORK: �Q4^salp r"FFl lt'o o\Fov 7/11/2005 4oa4O0���� DESIGN OF SEPTIC SYSTEM UPGRADE (Rev. OL05) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS Q J701 MON. WJM 101 • NIOOVGE M W 7 • F1 C W 7-.lri • FN p M • MOSIfC: pn,�r•Yrrfr•.••,n SOIL LOG — PERCOLATION TEST 0. .... . LEGAL PERFORMEDDESCRIPTION: FOR: FREDERICK WILLIAMSLIION; BLOCK 3, LOT 5, DATE. 7/7/2005 0oh01" 1 (f eij =, ORGANICS TEST HOLE 1 4�0� t 7 8 9 10 11 12 13 16 17 R;] SP, LOOSE COBBLES DEPTH TO GROUNDWATER DATE SOIL CLASSIFICATIONS 7/7/2005 DRY 2 10:21 LOAM 6' — 2 10:25 ...i;�:-. GW ---- ORG 6- 3 10:25 GP ML — 3 10:30 5 0• 6• 5 • :.•.• GM CL — 6 10:36 GC -FFM OIL 6• 4 •• ::� -1 LLIA ° •°• a SW • MH — 8 10:42 5 0• 6' 9 �•'•� �• SP CH — 5 .... •� 6 0• 6• 11 `•� �• SM i OH — 12 1 .. �.•.• Sc 0' 6• 6 .::.:. 7 8 9 10 11 12 13 16 17 R;] SP, LOOSE COBBLES DEPTH TO GROUNDWATER DATE DRY 7/7/2005 DRY 7/14/2005 10:21 - 6' — I"-100' DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/13/2005 1 10:21 - 6' — 2 10:25 4 0• 6- 3 10:25 — 6' — 4 10:30 5 0• 6• 5 10:31 — 6- — 6 10:36 5 0• 6• 7 10:37 — 6• — 8 10:42 5 0• 6' 9 10:43 — 6' — 10 10:49 6 0• 6• 11 10:49 — 6• — 12 1 10:55 6 0' 6• 19� PERCOLATION RATE 1.0 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5 FT. AND 6 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ENO SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: JORDAN TROISI COMMENTS: PERFORMED BY GEG. Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: i MUNICIPALITY OF ANCHORAGE j 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 NAME � b s PHONE p 3 - /, NEW PGRADE MAILINGrYIJD(/- e ® /'� , 9 L\X�t /6.i R LEGAL I3ESt,,R1PTION aT D f LOCATION 4 NO. OF BEDROOMS U Well �� DISTANCE TO: V V Absor�tiog area �� Dwelling a�' PER Op I Q C/ V° _Y aQ LU F Manufacturer n Mat ` No, of co artments to Liq.ca a 'ty � Ions IF HOMEMADE: Inside length Width Liquid depth �02 DISTANCE TO: Well Dwelling PERMIT NO. _ - Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well Foundation 33 Nearest lot line +/ �/ PERMIT NO. J r®` J LL Z Z w No. of lines Length Iipre CZAC!®( Total length gLli�s Trench t inches Distance b t e 'nes ¢ 1,- O Top of the to finish grade Material beneath tile inches Total effecSj'e absorption area 3 w 0 Length Width Depth PERMIT NO. oQ. F- to Type of crib Crib diameter Crib depth Total effective absorption area to DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PI,P�E MATE ALS � L SOIL TEST RS / I� INS A L RL/ &,*A _ REMARKS If APPRO E DA E LEGAL 1=1 F-� r -f C3 AE DEPHRTMENTr�- HEALTH AND ENY ECTION �] 825 '. STREET/ ANCHORAGE, HK. 9�,0l � 264-4720 �EE rl I I � v PERMIT NO ( 8101-38 ) 3-�— APPLICANT G| ENTZEL BUILDERS INC PO BOX 10238 S8 STN u ' "' 3-44-9422 LOCATION PETRIFIED TREE CIRCLE ^\),2j k] LEGAL L5 B3 R0CKHILL LOT SIZE 48000 Si�JHRE FEET � TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH ( MAXIMUM NUMBER NUMBER 8F BEBR88M,_�`- 4 SOIL RATING (S0 FT/BR)= 85 �`y\ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �����H — 1 :lL L_ EF " lZiT " = ! 5"7 C3 Fe F1'vo F=-� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEL[\ THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IM FEET). �����19 1 ���� ����I � ����K �������� �:2��� ���������� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE ` NUMBER OF RESIDENCES THAT THE WELL WILL SERVE < FZ IFE FZ CE G -A 11 1���� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY OM -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR 8 PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE: FROM f) PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL L8Q5 ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ]0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY.APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. ������� F�-- E: C -m F_- 0 ER. r-1 E:-�,`Fe =-:::L. �_5:� �13 A- I CERTIFY THAT 1: 1 HM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THECODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:����~�����-���4�~ APPLICANT GOENTZE[BUILDERS INC ISSUED BY_ gm IF THE 03� SOILS LOG a y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 825 L. Street, Anchorage, Alaska 99501 2844720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: `%DE+U/ ��G ,%�S DATE PERFORMED: 1410fre- / 1, a LEGAL DESCRIPTION: G ©C ��f ✓C DEPTH C y� (] SLOPE SITE PLAN (FEET) � � C>�pJ C -]A fw (l.. S 1 2 �'Z �r+A.) y S►�T 3- 4- 5- 6- & 4 6 8 5(Lly Cll�%�y�L 9 , 10 � 14- 15- 16- OF 415OF A t7 Vp ®oo°o®oeoo®a 0 18 �'` V 18 oe oocnn®oonm o°�moo ooas°°oe ao �' t; a, NO. 1732.E Reading Date Gross Time LL 1`-� Depth to Water Net Drop 11 WAS GROUND WATER 0 4/0 _ �Q �^ / vC L // �T ENCOUNTERED? L _lY 0 12 P E 2 IF YES, AT WHAT DEPTH? 13 c 14- 15- 16- OF 415OF A t7 Vp ®oo°o®oeoo®a 0 18 �'` V 18 oe oocnn®oonm o°�moo ooas°°oe ao �' t; a, NO. 1732.E Reading Date Gross Time Net Time Depth to Water Net Drop 20— June 22 1968 PERCOLATION RATE (minutes/inch) ki >.,¢ gRJEST RUN BETWEEN FT AND y � FT COMMENTS L EEO (2 —r& t A)LTT C PERFORMED BY: Ly�/ [i/"'�% .f// _CERTIFIEDBY: DATE: 72.008 (6/791 OF 1. For ............. 0c/)T2-i?Tt r —I�c l ................................................................................................................ ��� Location........:. 23Lk Date completed........ le,� ....................................................._............................. Depth of well.......... .`...................................................................................... Size of casing ... _ ............................................................................................ Distance to water.......:........ Distance to water while pumping ..... ......:......��- ..� . , at rate ..................... of..................t-' ..................gallons per hour. Formation I from I to Z_4i -r'241 tf9 I t C3 I c1 ' i I I I i MUNICIPALITY]OF DEPT. U� ANCHORAG -r.CTl IENVIRONM._NI;\L AUG 1981 I r I I Lo1, S` �3�I` ..........��......`/,C '���.... Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE, ALASKA 99507 Municipality of Anchorage .• , .., ' Development Services Department Building Safety Division Onsite Water& Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _101B-Uc3-153 HAA# 050tj& r- 1. GENERAL INFORMATION Expiration Date: 11 ' � � � o J Complete legal description ROCKHILL SUBDIVISION; LOT 5. BLOCK 3, Location (site address or directions) _6231 PERTRIFIED CIRCLE • ANCHORAGE, AK. 99516 Current Property owner(s) FREDERICK WILLIAMS Day phone (907) 337-0071 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 6231 PERTRInED CIRCLE • ANCHORAGE, AK. 99516 Day phone RICK JARVIS w/ REMAX PROPERTIES Day phone 276-2761 110 WEST 38TH, SUITE 100 * ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority 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 riles 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. Engineers Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD 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 readily Identifiable 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 ofthe 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 Me 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. 5. DSD SIGNATURE V Approved for 4 bedrooms. Disapproved. Phone 337-6179 Date B f/Z zbs Conditional approval for bedrooms, with the following stipulations: Note: The well for this property meets existing State and Municipal Codes There are nitrates present. It is suggested that periodic testing be performed to Insure the wells continued suitability. Current nitrate concentration is 5.30 mglI. EPA maximum concentration is 10.0 mgfl. More Information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklisty Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineers Report Other By; Original Certificate Date: S - v)_ 9 - 0.S (Rev 12/01( r. Municipality of Anchorage , • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragew St. P.O. Box 196850 Anchorage, AK 99519 -SM www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DowAptlon: ROCKHILL SUBDIVISION: LOT 5. BLOCK 3. Parcel ID: d 14-- O G 3 — 03 A. WELL DATA Well type MVA7E If A, B. or C provide PWSID# N/A Date completed 8/8/1981 Sanitaryseal (Y/N) YES Total depth 65 ft. Cased to 65 ft. FROM WELL LOO Date of test 6/8/1981 Static water level 30 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Cdifom 0 C0101`1183/1 00 mi. Nitrate 5.3 mgJL. Well Log (YM) YES Mikes properly protected (Y/N) YES Casing height (alcove around) 12+ in. AT INSPECTION 6/28/2005 47 ft. 5.58 9 -p.m - Other bacteria 1 coloties/100 m1. Arsenic: N/A mgJL. Date of sample: 6/28/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Materlal S.T.E.P. / STEEL Date installed 7/29/05-8/8/05 Tank sae 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date knatailed Soll rating .p.d ft%drm) 1_2 Length 47 ft. Width 2.5 ft. System type TRENCH Gravel below pipe 7 ft. Total depth•to.t—tanuft. Elf. absorption area628 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) Fluid depth in absorption field before test _ in. Water added Elapsed Time: _ min. (past 112 moa (Y/N &typo) For 4 bedrooms _in. Absorption rate >= g.p.d. If yes. Hive date D. UFT STATION Data installed 7/2alos-e/a/es Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at 4Y in. 'Pump off level at 42" in. High water alarm level at 46' in. Datum BOTTOM OF TANK Cycles tested NEW Meets alarm 3 circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent kNs 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 10'+ Water main N/A Water service line 10,+ Surface water 100'+ Driveway. parking/vehicle storage 50+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEERS I ced fy that I have determined through field 6upecflon3 and review of Municipal records that the above systems are in ........ . ............ conformance with MOA HAA guidelines in effect on this date. A. ess! Engineer's Printed Name JEFFREY A. GARNESS ; Date HAA Fee S �� Waiver Fee E Date of Payment Date of Payment Receipt Number 72727 —AM Receipt Number. (Rev. larotl N 84°10136"0136"- I D' YCLL. t 51~0 NE NOJ ' iµP 0CC -' DCCK 6 • LIFT STAT10H 4o J 1 � 9 ` o G o00 o0 tk r7 �: TH* ."..:...`..:.- ...........::.. {/��-� L• G 1 %.B5 V, o .SHANEA. HOLT: 0 A LS -6914 G � Opeo•LselawL Lao ./ AS -BUILT SURVEY / SCALE: V- 40' I HEREBY CERTIFY THAT I NAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT S, BLOCK 3. ROCKHILL SUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFIMLY TO SHOW ANY CONFLICTS BETMEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND M NOT TO BE USED FOR POSITKINNG ADOITKINAL STRUCTURES OR FENCELINES. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PUT, ME NOT SHOWN HEREON. "THIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. NOTE ANY FENCELINES SHONH ME LOCATED APPROXIMATELY MDME NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES DATED AT ANCHORAGE, ALASKA THIS 13TH NN ANY PAVING SHOMAY BE APPROXIMATE DUE TO SNOW CONDITIONS. DAYOF AUGUST 2005 _ HOLT LANG SURVEYING BB31. FB 110"5,66 TEL 345-0513 07-06-05;12:20 SG SCS Ref.M 1053824001 Client Name Gatrncss Engineering Group. Ltd. Project Namc/U Rockhill B3 L5 CllentSomplcTD Rockhill B3L5 Matrix Drinking Water Sample Remarks: ;907 561 5301 # 2/ 4 All DntesMmes are Alaska Standnrd Time Printed Datc/Timo 07/062005 12:08 Collected Datefrime 0628/2005 8:40 Received Date/rime 06/28/2005 15:03 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Method ContaincrlD Limier Datc Date Init Raters Departmant Nitrate -N 5.30 0.100 Microbiology Laboratory Totnl Coliform 1 OB, No Coli mg/L CPA300.0 B ("10) 012VOS JIB coVlOOmL SNUO9222B A (41) 06/28/05 TLP Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING �G J 55vjE Parcel I.D. O I,r- Q G 3- O? 1. GENERAL INFORMATION HAA# Q 30 Expiration Date: i a. — 3 0 " 3 Complete legal description Lot 5, Block 3, Rockhill Subdivision Location (site address or directions) 6231 Petrified Tree, Anchorage, Alaska Current Property owner(s) Stephen Routh Day phone 336.3377 Mailing address 12200 Lilac Drive, Anchorage, Alaska 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: In Well 0 Individual On-site B Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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 Douglas T. Kenley Phone 907-746-1076 Address 9960 E. Puffin Drive, Palmer, Alaska 99645 Engineer's Printed Name Douglas T. Kenley Date l -03 5. DSD SIGNATURE Approved for bedrooms. Disapproved. OF 00, 40 � • 49THi� DOl1 T. KEN LEY.- o00 ri} �'•, CE 8.176 Conditional approval for bedrooms, with the following stipulations: ��I OF Additional Comments `J ON-SITE •. WASTEWATER PRO lJJJ1J11)!!!��` Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 01102) .. I.................,... __111.1..._ ..................... 1111.., ......... Municipality of Anchorage b� o• • `" Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (9(Y7) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 6. Block 3. Rockhln Subdivision Parcel ID: A. WELL DATA Well type -!!!n B A. B. or C provide PWSID #, Well Log (YM) Date completed &=I Sanitary seal (Y/N) Y Total depth ft. Cased to 65 fL FROM WELL LOG Date of test 6/6/81 Static water level 30 ft. Well production 10 9— p.m-WATER SAMPLE RESULTS: Coliform o colonies/100 ml. Nitrate 4.82 mgA. Arsenic: N/A mgA. Date of sample: Qns+ B. SEPTICIHOLDING TANK DATA Tank Type/Material SeptloSteel Tank size 1— gal. Number of Compartments 2 Y Wires properly protected (YM) Y Casing height (above ground) 12 in. AT INSPEJCTION 48.2 ft. H• I- .41.0 9.p -m. Other bacteria 0 oolonies/100 ml. Collected by: Fred Kenley Date installed 8/13/81 Cleanouts (Y/N) I Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YM) N/A ,date of,pumping 10/25/02' Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed &13/81_ Sail rating (g.p.dJfte or fly lbdM 65 Length 62 ft. Width 3 ft. System type Trench Gravel below pipe 3 & Total depth 10 ft. Eft. a sorption area 340 fe Monitoring tube Y Depression over field N A 'r/Ad 0.0 Date of adequacy test nLs{(0� y i Results (Pass/Fall) Pass For 4 ab3edrpoms Fluid depth in absorption field before test !,L lin. Water added ?.?8 gat. New depth J'&in. xi•s"/iI /Y Elapsed Time: 1440 min. Final fluid depth-_ka in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mm) (Y/N & type) N If yes, give date N/A x APe- tj-5 'ed 41ger 0&411oti'17 f r,4e /hanifWt/,rI yto bes D/ff,. eil ApOrDXi/YiA�1'/y /-141 /��PS• D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump ofr level at _ in. evel at in. Datum as tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 115+' On adjacent lots 100+' Absorption field on lot 120+ On adjacent lots 100+' Public sewer main N/A Public sewer manhoWdeanout WA Sewer /septic service line 25+' Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20+' Property line 35+' Absorption field 5' Water main N/A Water service line 25+' Surface water 100+' Wells on adjacent lots 100+' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 30' Building foundation 35+' Water main WA Water Service line 25+' Surface water 100+' Driveway, parking/vehicle storage 15' Curtain drain none known Wells on adjacent lots 100+' F. COMMENTS y�►����\� G. ENGINEER'S CERTIFICATION i g� .4499TH* I certify that l have determined through field inspections and 140.. review of Municipal records that the above systems are in #• • ... ..; . conformance with MOA HAA guidelines in effect on this date. T KENLVOW Douglas T. Kenley �,� • CE 5176 Engineer's Printed Name 9 Y Date•03 `��1f-VIUX t4l HAA Fee $_ Date of Payment Receipt Number, (Rev. 12101) Waiver Fee $ _ Date of Payment Receipt Number 09-24-03 03:40PM FROWCUE ESI, SGS ENV SERVICES 9075615301 T-076 P.02/03 F-269 1 SGS ReLR 1036021001 All Dates/Pimes are Alaska Standard Time Client Name Douglas Kenley P.E. Printed Date/Time 09/23/2003 14:59 Project Name/A Prepaids + Rockhill SID Collected DaWdfime 09/15/2003 16:30 Client Sample ID Rockhill S/D LS B3 Received Date/1'ime 09/15/2003 16:57 Matrix Drinking Water Technical Director Step h . Ede PWS1D 0 Released Sample Remarks: Parameter Qualifiers Results PQL Units Method Container ID Allowable rcp y Limits Due ADate �s Init Waters Department Nitrate -N 4.82 0.100 mg/L EPA 300.0 B ("10) 09115/03 I3B Microbiology Laboratory Total Coliform 0 col/100mL SM199222B A (<-I) 09/15/03 KC Municipality of Anchorage °�°& • Development Services Department Building Safety Division e On -Site Water and Wastewater Program s. 0 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. C215"-O(o3-03 HAA # " 030 LO/ Expiration Date: .5.j1 107 1. GENERAL INFORMATION Complete legal description -1--o r- S 8<ot.'�- .20 CCN/GGJ�/dl7ill/S/O� Location (site address or directions) I.ZX44 G/4 -*'t Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Day phone /ZZ a o G /�.ye orz , 147itJdi /9irG Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site B� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 Address 9gGo P�<.0..✓Q.z .�.�<.,-F•z, A.�, 936y5— Engineer's Printed Name l7��a��s r'.��•cr��}� 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone (3p,0;,r) ?S� —""07X Date Conditional approval for ' bedrooms, with the following stipulations: By: (Rev 0' Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Jiij ���i'✓1EN7 SE���I���, Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: SIS Municipality of Anchorage Development Services Department *A1 Building Safety DivisionOn-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.enchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LQf BLOU 5.1UUILL , Q(V1jj0lA Parcel ID: A. WELL DATA Well type ;JP'(Fi Date completed ( Total depth -16—ft. Date of test Static water level If A, B, or C provide PWSID # _ Well Log (Y/N) Sanitary seat (YM) -�- Wires properly protected (YM) _ Cased to _tt FROM WELL LOG 61gi 10 ft. Casing height (above ground) 11, n. T I SPoCTION Zt 3 � 2. jflv Well production 10 g.p.m. �, o g.p.m. WATE� STLE RESULTS: �/• �/ (rf Coliform _�colonies/100 mi. Nitrate • 4 A/114 03 Other bacteria _� colonies/100 ml. Arsenio / mg./I. Date of sample: Collected by: W . Wyi B. SEPTICIHOLDING TANK DATA �t�2 �Z Tank Type/Material S6PfiGIt S1"L Date installed Tank size jj.—o gal. Number of Compartments Z Cieanouts (YM) Y Foundation cleanout (YM) Depression over tank (YM) Ij High water alarm (YIN) Date of pumping 19.1 Pumper Pumper AIPKTHLRAID RWP/n/6 C. ABSORPTION FIELD DATA Date installed 863j-81 Soil rating (g.p.d./11:2 or ft2/bdrm) 05 System type rRF�4Cfl Length G 2 ft. Width 3 ft. Gravel below pipe 3 ft. Total depth A9 ftbsorption area �ft2 Monitoring tube Depression over field 4- fv/03 Date of adequacy test Z. Io Z.Rt� ults (Pass/Fail) ASS ( For bedr B ,�� #I /Z0. Fluid depth in absorption field before test 04 in. r� �49 ter added], gal. New depth,12A in. Elapsed Time: Final fluid depth V it in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) Al If yes, give date Rrf6KCr? 0a *(RU'144 fijo Opwlfok,44 -fugES. TSE EIEd�/v�l of �i1E A7f1�`r 49 fNG HiWif'00Er94W Fy /IPPRDt'iHRfEGt/ /%//nlCff�s. D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump ofr level at Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklli€t-station on lot / 15 f A7' Absorption field on lot /to Public sewer main lJJA Sewer /septic service line ZS r fT Manhole/Access (Y/N) —H' er a arm level at in. Meets alarm & circuit requirements? On adjacent lots /00 i Ff On adjacent lots /1X1 t Ff Public sewer manhole/cleanout A/JA Holding tank AIL4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 6 Building foundation ID" Lf Property line off Absorption field S Water main 9/h Water service line Z5 t6f Surface water /DD f �f Wells on adjacent lots 100'f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 30 fTBuilding foundation 3� PGf Water main 1i/)q Water Service line L rFfrFSurface water /OD I" Jrt' Driveway, parking/vehide storage A4914 J<AIMIA/ Curtain drain f0 ai4f Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION .ilf;Q��•. ••� I certify that I have determined through field inspections and .9 review of Municipal records that the above systems are in t• "' ti conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name �DG!('a(.lk�i ��Fn1L `t� CEeY i T ' Date 5 .9 ' o HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number j (Rev. 12101) 04-25-03 04:OOPM FROM-CUE ENVIRONIENTAL SRV 9075615301 T-330 P.02/03 F-076 SCS Ret# 1032213001 All Dates/Times are Alaska Standard Time Client Name Douglas Kenley P.E. Printed Date/Time 04/25/2003 14:22 Project Name/# L5 B3 Rockhill S/D Collected Date/Time 04/22/2003 21:15 Client Sample ID L5 B3 Rockhill SID Received Date/Time 04/23/2003 10:20 Matrix Drinking Water Technical Director Stephen . Ede PWSID 0 Release y%i✓ Sample Remarks: t/ Parameter Results Allowable Prep Analysis PQL Units Method Limits Date Date Init Waters Department Nitrate-N 4.40 0.100 mg/L EPA 300.0 (<=10) 04123/03 JS Microbiology Laboratory Total Coliform 0 coVl00mL SM189222D (<=1) 04/23/03 KAP v T /e. s� E' to �6 �� t q�` \ .. 'w E a�•�� ..,Ttt.TNFlLED � r6cck X70 BUILT AS cwt,,, Liar- 1 - An(AST tlDU • .:..: �,. _ �Cy�c ; . SQL :.. : ..."+' � ., • • r ; , 03 iE / i us -i -� OF A; 130 z o n F .. O 85 3650 - PSC •'......�-9, �/ ccOf� a'zo �0 �F. '� 49t . x "Lefts m0Q3� V f s s• «. .j�, J Q � G � .','Q ? �= MAURiCE P. CIS ALp P S c��/ 40=cr 613-S 18H" REcEtz-TIFIcaTto►.t ��'.. — �' �� SSIt)�lAL �► LOT SURVEY:* CERTIFICATION LEGEND: Bros. Cap Monument Lot �, Block q, Ft. ° Ston Pipe � Area. S • st..1 Pin a Survey Hub 8 Tack Plat File No. Zoning District -Anchorage Recording District, Alaska I I REVISIONS DATE BY �����1yy� �DINNCKIh C)N-aWALD•WRLCH• E Residence of: 9/ �11 I RS ANCH • STREET ARCRDRAe[, ALASKA 3 Dote: ter—•4• w.ox� Fe.a�— 6ii0: 12-04-02 16:53 FROW-CUE ENVIROMENTAL SRV ALOCUE Environmental Services Inc. ar��rrwri��r�r�r�.rrirr� 9075615301 T-012 P.02/03 F-663 CT&E Ref.# 1028159001 All Dates/Times are Alaska Standard Time Client Name Douglas Kenley P.E. Printed Date/Time 12/04/2002 8:47 Project Name/# Rockhill S/D L5, B3 Collected Date/Time 12/02/2002 15:45 Client Sample 1D RockhilI S/D L5, B3 Received Date/Time 12/02/2002 16:10 Matrix Drinking Water Technical Director Stephc , de PWSID 0 Released By Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Dace Init Waters Department Nitrate -N 4.04 0.200 mg/L EPA 300.0 (<=10) 12/02/02 JS Microbiology Laboratory Total Coliform 0 i- col1100mL SM189222B (<=1) 12/02/02 KAP 64-0 IOAS BUILT i ���tEveK.ED ieILIJ t.IJIL � �( I •• �7111 eo cw+D0 Ol f 61r l v ; i •. �- •�� -- •• ter° �4o �r � L , " , i ' • n It C3 wt:0 moo►- (j ` i3 mu<WMeig co �JC� �iGi :�ti��'• OF . g- LAA . t � NM49t.M•N • ••,C 7viza7w �� ,C - •. R 3: W c7 Q i MAURICE P. CIS ALD S C • �a _acylcc = O�:�LS,� 613 •. ^/ram $Ec�tzTIFICA.TIor-l.._ LOT SURVEY' CERTIFICATION LEGEND: erase cop Monument Lot � Block o iron Pip. , � Area. $q, Ft. • Steel Pin G Surrey Hub 8 Tock Plat File No. Zoning District--.E46Anchorage Rec3rding District, Alaska ' REVISIONS DATE BY DICKIhSCN- WhLD•WRL H- E Residence of: EN In QS ANCHORAGE. 0 STREET 11 I, 1( ANCM011AC[, ALASKA �T Dols: aY = Scc/s. W.O.taF. B.# Grid: NN .4111st. _;NN j;; aaA I n -on 1. 14 "4t IN L 4 _NN P4 r :r 4A PON -Z P. ly'14 11 t4li IN I I k t�j ........ ... .... ... ON I UPt WDAW.3 p IN 1E]l pfM i r I L Q IN NNIN-P -qol Il PIN �Jj & I W COR 0 ! Eip - "114Y; 44 6F j NN rW :InV IN LNNd #. ON lg(j oll it WIN 41 - NO t-0 � 41 1 -r ION Nit JIN ..... . .... ...... NIJ: IN IN. NNa ; IN wa Jr ......... .......... AIA Ix i V N-'MDFn 1 _11111N. I & ql''.'rPW04- pf P* opk :I p MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M}� T Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# VAEo)a(>1fl�i 1. GENERAL INFORMATION Complete legal description Rockhill Lot 5 Blockii" Location (site address or directions) 6231 Petrified Tree Property owner Stephen Routh Day phone 258-3333 Mailing address 6231 Petrified Tree Anchorage Lending agency Day phone Mailing address Agent None __ Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site. 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 X ,1 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. 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 furtherverify 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 Mountain Engineering Phone Address Engineer's signature 6. DHHS SIGNATURE x Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: 111Th 562-1500 Date 10/10/92 l'PA�VJ. PEARSGN rte 0o CE - 7760 bedrooms, with the following stipulations: Date &/ — 2 " f2 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. 1191) Back MOA 7121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Rockhill, Lot 5, Block 3 Parcel LD. A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N),v Date completed 6/6/81 Driller Delta Drilling Total depth 65 FT Cased to 65 FT Casing height 1.1 FT Sanitary seal (Y/N) v Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test 6/6/81 T 2, 1YRZ 10/4/92 �•„ m Y Static water level 30 FT 46 FT n t, y Well flow 5 g.p.m. 7.7 g.p.mC _ y O D �k n Pump level 39 4A ^ 0 0 N SEPARATION DISTANCES FROM WELL TO: Z m Septic/holding tank on lot 11.3 FT ; On adjacent lots 160 FT Absorption field on lot 1 2-) FT ; On adjacent lots 165 FT Public sewer main NnnQ Public sewer manhole/cleanout Nona Public sewer service line Nnn, Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Nitrate 4.1 Other bacteria 0 Date of sample: 1 0/4/'a2 Collected by: Mountain Enaineering B. SEPTIC/HOLDING TANK DATA Date installed 8/13/81 Tank size 1,250 Compartments 7 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N/A Alarm tested (Y/N) N/A Date of pumping 1 0.19/92 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 113 FT On adjacent lots 200 FT + Foundation 29 FT To property line 4n FT Absorption field 5 FT Water main/service line None Surface water/drainage NnnP 72-026(Rev. 3/91) Front MOA 21 .CONTINUED ON BACK PAGE C. LIFT STATION Date installed CLQ Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested — Surface water _ Date installed 8/13/81 Soil rating 85SF/BR System type Trench Length 69 FT Width FT Gravel thickness 3 FT _Total depth 10 FT Total absorption area 340 (from as -built) Cleanouts present (Y/N) Y 558 (calculated) Depression over field (Y/N) N Date of adequacy test 10141q? Results (pass/fail) PASSED for 4 bedrooms Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 122 FT On adjacent lots 198 FT Property line 40 FT To building foundation 47 FT To existing or abandoned system on lot N/A On adjacent lots 50 FT + Cutbank None Water main/service line None Surface water None Driveway, parking/vehicle storage area 14 FT Curtain drain 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 r Engineer's Name Mark Pearson Date I n/1 0/n2 da r.,. • CE - 7/60 • 4 HAA Fee $ Waiver Fee: $ Date of Payment � � � � Z � Date of Payment Receipt Number l �� Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS fox INVOICE # 59195 Chemlab Ref.# 92:5449 Sample # 1 Matrix: WATER Client Sample ID : PETRIFIED TREE Client Name :MOUNTAIN ENGINEERING PWSID UA Client Acet :MTNENGN Collected OCT 4 92 @ 16:00 hrs. BPO# PO4 :NONE RECEIVED Received OCT 5 92 0 08:00 hrs. Req# Preserved with AS REQUIRED Ordered By :MARK Analysis Completed OCT 5 92 Send Reports to: Laboratory Supervisor STEPHEN C, EEDE`/ 1)MOUNTAIN ENGINEERING Released By : e< !� 2) . ................... It ......... ........ •.......... M1....... _.......... ,, Parameter Results Units Method Allowable Limits ---------_-----_------------ --------- ---------------- NITRATE -N 4.1 mg/1 EPA 353.2(300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: B.E. Remarks: IPO`N I QOcxlk;v 1 LSA 133 ......................... ...................... ..v ........................,....,.._, ...........,.....,.......... F... 1 Tests.. See Special Instructions Above UA -Unavailable ND- None Detected °" See Sample Remarks Abovo Nk- Not Analyzed LT -Less Than, GT -Greater Than IVNI SBS Member of the SGS Group (Societe Generale de Surveillance) 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 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L. S n s SIM 7/261 93W s-cly Location (address or directions) _61231PETRIFIED CI R (b) Applicant Name Tr f HIEN ROOT4Telephone: Home 3q_'5' -56a3 Business 276 _ S5� Applicant Address S o/ Tc- 2D1 4N"cO (4 `-5;, � (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0.; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution II Address (e) Real Estate Company and Agent Address — Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family(„ Multi -Family 11 Other Number of Bedrooms `L 3. WATER SUPPLY one /I,?& lzlorz 7 &aI?a . Individual Well a Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDW, i INSPECTIONS, TESTS, FILE SEARCH, Do- AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 Address Date Telephone 5111 REMOVE (fOlyDl7roiv�,6L I NSPECzE'D 5"-12 Ul86 By ,.)EFF XAI-rcH11c DE PRCSsloM pr800lv,D (vuL HERD FILLrJ) /IV, DHEP APPROVAL / Approved for Apaor- 41 bedrooms by _ Approve x Disapproved Terms of Conditional Approval Conditional CAUTION �,.s"%%% K :QoF�A4 � LER O C. REID, JR. 0 E-2251 AT s! WA Date ;;I /r (40 T The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRON ENTAL HEALTH CERTIFICATE OF INSPECTION FOR H AL�H AUTHORITY APPROVAL OF 1. GENERAL INFORMATION°-" (a) Legal Description (include lot, block, ATER FACILITY Ap i ti 'ate �V t w'Hghip, range) Location (address or directions) (b) Applicant Name :`°72t{44"aV Telephone: Home Business Applicant Address �f 4Z- ze 1 l7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Est. (f) Address Telephone 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. 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 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDh,, INSPECTIONS, TESTS, FILE SEARCH, D... A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I_verify that my investigation of this I iealth 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.j Name of Firm �S Telephone ��'//�� //s�Yb Address /�lyd' Gil l' /¢t� fG/r' Ala." A Date/Z Eco cgi9 si �j ury fO A14 p� e � V ie •.e9a d � e or *y: 49TH tv �® m :Lr•••�•• .•ne•m jo• roa.eee eco _ •-LER - C. REI[, JR. e - A 40• qq q e e 6. DHEP APPROVAL Approved for bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval — — CAUTION The Muncipality of Anchorage Department of -Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 '. 72-025 111/841 - - - - - MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: A. WELL DATA Well Classification �����y ��� If A, B, C, D.E.C. Approved (Y/N) Well Log Presently Date Completed �''� Yield % J✓ Total Depth �� Casedto 6� Depth of Grouting /' Static Water Level 40 '%•4"r Pump Set At Casing Height Above Ground Sanitary Seal on Casing(ON) Electrical Wiring in Conduit Y/ ) Depression Around Wellhead ON) Separation Distances from Well: i To Septic/Holding Tank on Lot 11.3 On Adjoining Lots r ' To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole %; To Nearest Sewer Service Line on Lot Water Sample Collected by /GCS ; Date Water Sample Test Results 5 �� d W Comments Cea/6oTrrAfi9L/L0 1�RC5S/� B. SEPTIC/HOLDING TANK DATA Date Installed ��y Size �,� No. of Compartments Standpipes ON) Air -tight CapsaN) Foundation Cleanout6N) Depression over Tank (Y/f�l)1 Date Last Pumped } L 46 Pumping/Maintenance Clovnnttract on File (Y/N) AA ; for .411x Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: P To Water -Supply Well o u >/ 3 Z� TBilding Foundation s To Property Line To Disposal Field r To Water Main/Service Line N�/q To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 79-n98111/841 /- S A3 P4ehw C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �J Type of System Design Date Installed 8'�3 8% Length of Field G� Width of Field Depth of Field Square Feet of Absorption Area Depression over Field (Y9_ Results of Last Adequacy Test Gravel Bed Thickness j 3%z Standpipes Present(Y ) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /y3 To Property Line �d To Building Foundation Lot To Water Main/Service Line Z5r To Stream/Pond/Lake/or Major Drainage Course _ To Existing or Abandoned System on On Adjoining Lots 3©r 1 - To Cutbank (if present) /OV fi To Driveway, Parking Area, or Vehicle Storage Area 1L Comments D. LIFT STATION Date Insta Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I hheclaed, ver fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed L - ._i,�� `. Date f-/,? Company jMOA No. Oy ♦��a��It OF .q �t Receipt No. 4� ° v a Q�v•••••••� Date of Payment d r C .0 pw •, ® Amount: $ �e .. l&n 10 I . *„0 1Wc4& 1111 A)&U, iz"✓t &&T Page 2 of 2 d<3 _ W� SifN�l� -7-5 72-026 (11/84) *y -5/To- />z/h( �IA14> too O 0R1; C. REID, .• CE • 2251 a' I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL RRALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPROVAL CERTIFICATE APPLICATION FOR HEALTH AUTHORITY 1. General Information Description (include lot _,rr_______ Addresso (c),Applicant is (check one) Lending Institution Owner/builder ; Buyer ; Other E�:j (esphain), / (d) Lending Institution°';�;y';') ,�,-jVI--/-c� Telephone Application Date 516 Ae' block, subdivision, section, township, range) ratenhone — Home Business (e) Real Estate Co. & Agent Address Single—Family Multi—Family Othe.0 describe) Number of Bedrooms 3v 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 Q Community � Holding Tank Note: If community well system, must have writtan confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Data and Information t .'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 r -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 regula- tions in effect on the date of this inspection. Name of Firm rlir-C, Telephone Address MW (A) Pr r J Date SAFAP5 ow h7 �� cz �� � (ENGINEER SEAL) 6. DHEP Approval Approved fororVU4 (44 bedrooms By-Cz,co-w Date Approved _L�_ Disapproved Ter}ps 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- MENTS. EMPLOYEES OF DEEP DO NOT CONDUCT INSPECTIO14S 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/Dl8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) I?AY 14 19851 CHECKLIST FEBRUARY 1984 RECEIVE Legal Description: &,acl1 !^oT A. WELL DATA Well Classification If. A, B, or Cr D.E.C. pr ved(Y/N) P�re Well Log Present Y ) Date Completed (0 Yield„, Total Depth (pSCased to t25 -f Depth of Grouting _J - Static Water Level C, & g -b Pump Set At Casing Height Above Ground 1.31 Sanitary Seal on Casing`( - ) Electrical Wiring in Conduit nJj) Depression Around Wellhead (Y' Separation Distances from Well: To Septic/Holding Tank on Lot_ ; On Adjoining Lots ;1 /BYE � To Nearest Edge of Absorption Field on Lot 133 ; On Adjoining Lots )t -Joy To Nearest Public Sewer Line /! To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Service Li on Lot Water Sample Collected By Date - CWater Sample Test Results-�—.a:4 Z4 55 r—A ('ra„rrnni-c °�vnol�n�hrioiVlv/4+7in ,P1�J�_ -/NY.r���Jt�i/�iL� B. SEPTIC/HOLDING TANK ARTA Date Installed Size lZs-D No. of Ccampartments ')N Standpipes ) Air -tight Caps N) Foundation Cleanout Y ) Oe"'" Depression over Tank (Y )' Date Last Pumped�i Pumping/Maintenance Contract on File (Y/N) for Al ILA - Holding Holding Tank High -Water Alarm (YM) Temporary Holding.Tank Permit (Y ) N Separation Distances fron Septic/Holding Tank: To Water -Supply WJe11 (l5'4'— To Building Foundation SS's To Property Line +/0 To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage i [Page 1 of 21 2-15-84 -83 L -S- P,6CW l C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata `� sType of System Design Date Installed Installed / Length of Field Width of Field Depth of Field 1(t / 9 Gravel Bed Thickness _ 3 Square Feet of Absorption Area 2-17 Standpipes Present ) Depression over Field ( ) _ Date of Last Adequacy Test S Results of Last Adequacy 'Inst A col IV -0 4"" Separation Distance from Absorption Field: To Water -Supply Wall /a3 '*`". To Property Line -1- 2-0 To Building Foundation 33 To Existing or Abandoned System cn LotOn Adjoining Lots t 30 To Water Main/Service Line d- '6 '0 / To Cutbank(if present) N)71� To Stream/Pond/Lake/or Major Drainage Course l DD 1 To Driveway, Parking Area, or Veh'Mpurato Storage Area p /Z/ Comments * ft9C&WLer m /J , A&1 044- D. LIFT STATION Date Installed r I Di ns Size in Gallons cess "Pump On" Level at Off" Level at High Water Alarm Level at' Vent (YIN) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Code ) Convents Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA FLAA Guidelines in effect on the date of this inspection. Date Signed MOA No ° Company • 1 Ler C. Rci ' Jr 40. (Page 2 of 21 2-15-54 ALASKA Ci ')'1R0 M6nTAL COnTROL SR� Enqineerinq & Enuironmental Studies RANIER MORTGAGE POST OFFICE BOX 10-1200 ANCHORAGE ALASKA 99510 50189 SELLER—SCHEFFER LEGAL:ROCK HILLS SUBD/BLOCK 3/LOT 5 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE—MAY 8 1985 MAY 10 1985 WILL PICK UP FROM OUR OFFICE jb"�iAW7- at-/ THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 372 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 948 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON MAY 9 1985 . FLOW TEST ON WELL WELL FLOW DATE—MAY 8 1985 A FLOW TEST WAS PERFORMED ON THE WELL. 600 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.2 GPM OVER A DURATION OF 3 HOURS. THE DRAWDOWN WAS 25 ' WITH A RECOVERY TIME OF 20 MINUTES AND THE STATIC WATER LEVEL WAS 36 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. u�) VAS O -: j •/' b:�p CG 4266E 1P �ue0 G DYOD..jr �+ n Reid, Jr. �- 1200 West 33rd Auenue, Suite E • Anc6orage, Alaska 99503• (907) 561-5040 ALASKA ENVIRONMENTAL CONTROL SERVICP') INC. 1200 West 33rd Avenin, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 Q\ PROM MlEes I... GM.. Mm 01471. joe LOT S 6"6K --5 CoCfC/1`/GL SHEET NO Of CALCULATED BY �k%E� DATE CHECKED BY BY -3o �Tlme rime Date Date Date ? �/ Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size S Holding Tank Size Soils Rating Well To Absorption Area Well Log Received S� Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner o -e LI 2 lk-' �-t ( V N(- 5 Phone Mailing Address `moi q— I, ��t C �f 1-f 1f2 Buyer /--Ci't' Address Lending Institution Phone Address Realty Co. & Agent Phone Address Legal Description Z U 1 7 .5 \ eV t/ i Street Location E� Type ,clf Residence CC55 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply k Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewgq9-Disposal 17 Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.