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Home My WebLink AboutROCKHILL BLK 3 LT 9 ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAG~ DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,. NAME~ PHONE ~w LOCATION DISTANCE TO: Manufacturer Liq. ~ DISTANCE TO: DISTANCE TO: No. of lines Top of tile to finish Length Type of crib DISTANCE TO: DISTANCE TO: Class Absorption areaI iF HOMEMADE: Well Width ;rib diameter Well Depth Building foundation Dwel~ g ~ Inside length Width Dwelling Material Foundatioi<~ t' ~ Nearest/~_(Iot Ijne Trench ~.t h Total I~ ~f lines Material b~n~ath tile Depth Crib depth Building foundation Driller Sewer line inches y~ inches NO. OF BE~,~OOMS No. of com~ments Liquid depth PERMIT NO. Liquid capacity in gallons Dist a~,,C~?~e n I i n es Total eff~rption area PERM~%O. Total effective absorption area Nearest lot line Distance to lot line Septic tank JPERMITNO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL / Date completed. 4/IS] ~/ Depth of well ....4 ~ ~u~c~ ...................................................................... o~r..a ........... Size of cas~g ~ ¢/ ~v~o~,r,~ **or~cno~ ................................................ .................. ~'cr'¢'")~ ............ Distance to water ~ ~' D~t~e to w~t~ ~,~ V~p~ng. Z~ '~CEfVEb .......... - ........................................ - .............. at rate of .............. ~.~.~ .................. gallons per hour. DELTA DRILLING COMPANY ANCHORAGE, ALASKA 99507 PERM'I T NO~ FIPPLI CFINT JFIK CONST. LOCFIT ION LONE TREE LEGFIL LOT ~ BLK S< ROCK HILL SUB ,:,~.~ L ~TREET., RNCHORRGE., RK. 264-4720 LOT SIZE 4=000 SQU~RE FEET ',"~"F'E OF '-q .... ' :,[ IL FIB'~ORPTION SYSTEM IS: T~EN_.FI ,, ,,,, . _ = M~,:.:,~M_M NLMBER OF BEDREOMq 3: ~O~L R~T~NG (SQ FT,.."BR)= THE REQIJ~RED S~ZE OF THE SO~L RBSORPT~ON THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRIN~IEL[:,. THE DEPTH OF FI TRENF:H FiR PIT Iq THE [:,I'gTRNF:E BETWEEN THE SURFRCE'" ~' CIF/~,~-~]'~ uROUND FIN[:, TF.IE BOTTOM OF THE E,:sL. RVFITION <IN FEET.). / / THE uRfl,,,EL DEPTH IS THE ~,~INIMLI[I [:,E~TH OF GRfl,EL BETWEEN THE OI_ITFO~~ OND THE BOTTOM OF THE EXCOVfiTION (IN FEET). PERMIT RPPLIC:RNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTFILLFITION INSPECTIONS OF RN¥ WELLS RDJRCENT TO THIS PROPERTY FIND THE NLIMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI,.-I,] ( 2 > ~F I'-,ISF"EC:T ][ ~:~r-.IS RF?.E F."E _F.-.~LJ I F-:E[:, BFICKFILLING OF FtNY SYSTEM WITHOUT FINFIL INSPECTION RND FIPPR. O',/FIL BY THIS DEPFIRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL AND ANY ON-SITE SEt.4FIGE DISPOSRL SYSTEM IS ifs:3 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL· MINIMUM DISTRNCE FROM FI PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 2.5 FEET RND TO FI COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ~0 DFIYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS FIND CONSTRUCTION DIFIGRRMS FIRE R',/RILFIBLE TO INSURE PROPER INSTRLL. FITION. F'ERr'I I T E~-:."F' I F~E-_~--~-] E:,~-CC:E~"IE:ER ]]:1.. 19:'31 I CERTIFY THRT t: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MLINICIPRLITY OF FINCHORFIGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDFINCE WITH THE CODES. ~: I UNDERSTRND THFIT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. S I GNED: RFFLI ..RNT .. H}... I..LN_-,T I ..... LIED, BY_ .... V4. 0 - LOCRT [OI~ LOHE. Th-lEE SOl LS LOG - PERCOLATION TEST S w~ 0 ENCOUNTERED? IF YES, ATWHAT E DEPTH? 16- 16- 17- 19 ;COMMENTS PER~LATION RATE r/'?'~''"' TEST RUN BE~EEN ~ '~ FT AND DATE: 72-008 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ ''~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. :? C ,~ 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ':' =" Holding tank Community on-site NOTE: Public sewer ............ ' " , ,'~ 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 AuthorityApproval 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, Al/-. ordinances, and regulations in effect on the date of this inspection. Name of Firm ,~j)~-TZ30,J ~L'"~./,j ~-"/_~TL,~J/~ _ Phone Address r~. O. ~'(::h/. Z ~Z0 7'7 ~ ,~i4 b-I O~zAL,~ ~ Engineer's signature ~ ~ ~ Date Approved for -~ Disapproved. Conditional approval for bedroOms; bedrooms, with the following stipulations: DHHS SIGNATURE Additional Comments Note: The well for this property meets existinq State and Municipal Codes. There are nitrates present. It is continued suitability. , Nitrate concentration is 8.8 mg/1. EPA fi::!he ~u~icl;~ality of Ah~horage 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 ~ p[,bfe~s!onal engir~r registered in the State of Alaska. The DH HS 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 p.rofessional engineer's work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~,//5-/~, ! Driller 7 Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Cased to FROM WELL LOG 5/_~_ s Casing height Wires properly protected (Y/N) .g.p.m. AT INSPECTION ~/_ ,/~ , MUNICIPALrI¥ OI- J~' ~' J~'~ ~kltlJ J~r~NMENTAL SERVICES DIVISION :, 2 ~, 1994 ~. 5-- g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /Z) ~ ~ Absorption field on lot //~ ~ Public sewer main /~/J~ CC:$ Sewer service line '~ 5~ ~ ; On adjacent lots ~lt~b ~ ; On adjacent lots '~/O~ Public sewer manhole/cleanout /t~/.~$ Petroleum tank AJ¢~J6' WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: 2-/Z~5'/¢'~ ~, ~ /¢-~ / ~ Other bacteria O Collected by: ~' /'JA-'r~'¢/-'4 B. SEPTIC/HOLDING TANK DATA Date installed ?/[7 / ,,~ I Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping Z./Zz Tank size /0~0 ~..,w~L, Compartments Foundation cleanout (Y/N) V Depression (Y/N) /'~/'/~ Alarm tested (Y/N) Pumper ~C~) /V~c~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /D~; On adjacent lots To property line ~'5,--~ / Absorption field Surface water/drainage '~ / ~ ~ t Foundation Water main/service line i >5/0' CONTINUED ON BACK PAGE 72-026 (3/93)* Front · Date installed 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) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed / Length ~"' ~/ Width Total absorption area 5/-7Z Soil rating (GPD/Ft2) /5/Z ,ch z'/~'Of/./~ System type -T'7~z.~.---~' CH ~ i Gravel thickness ~ ~ ' Total depth '~ F'rT. z~ Cleanout present (Y/N) Y Depression over field (Y/N) /XJ Date of adequacy test ~/Fa- 2 3'/¢/ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Results (pass/fail) "tC>P'5-~ for ~' Bedrooms "~ /~' ~' After test / ~ ~f /~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //Z J To building foundation On adjacent lots ~J~ ~ S u trace water ;'/0 ~' On adjacent lots >/~)¢) ~ Property line ~ /0 ,~; To existing or abandoned system on lot Cutbank ,/~ ,J o-~ Water main/service line Curtain drain Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in .effect on the date of this inspection. Engineer's Name Date HAA Fee $ ~POu Date of Payment Receipt Number~-'~' Waiver Fee $ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 February 27, 1994 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 9, Block 3, Rockhill Estates Subdivision Septic System Adequacy Test Certificate of Health Authority Approval Dear Onsite Services Engineer: On February 22 and 23, 1994, an adequacy test was performed on the septic system serving the subject lot. Prior to the test 17" of standing water was measured in the absorption trench. Approximately 600 gallons of water was then injected into the system and allowed to absorb into the surrounding soil strata over a 24 hour period. The water level in the trench was then measured at 17". The system appears to be functioning in accordance with Municipal requirements. It must be noted, however, the standing water may be an indication of a system in the declining stages of effectiveness. The system was originally installed in 1981 and has been in continuous operation for nearly 13 years. Although the system is meeting the minimum requirements of operation today, the performance may begin to decline in the near future. Sincerely, Michael E. Anderson, P.E. Commercial Testing & Engineering Co. CT&E Ref.~ Client Sample ID :PRIVATE WELL WATER Matrix :WATER Environmental Laboratory Services 5633 B Street REPORT of ANALYSIS Anchorage, AK 99518-1600 : 94.0787~-1 Tel: (907) 562-2343 L9 B3 ROC~I[L S/D Fax: (907) 561-5301 Client Name =ANDERSON ENGINEERING WORt{ Order :76023 Ordered By : Printed Date :02/25/94 @ 09:22 hrso Project Name : Collected Date :02/23/94 @ 09=30 hrs. Project# ~ Received Date :02/23/94 @ 09:45 hrs. PWSID =UA Tec~%ical Director :STEPHEN C. EDE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: A. HARALA. gc ~llowable Ext. Anal Para,meter Results Qual Units Method Limits Date Date Xnit Nitrate-N 8.8 mg/L EPA 353.2/300~.0 10 02/23 CMR * See Special Instructions Above ~'~* See Sample Remarks Above U = Undetected, Re~ri;ed value is the practical quantification limit. D Secondary dilution. ~SQS Member of the SGS Group(Soci~t~ G~n~ralede Surveillance) {IA = Unavail~?2ole NA = Not Analyzed LT = Less Than GT = Greater ~£han ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA 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 FAC ILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or dbections) ~ '~ (b) ApplicantNa~b"~~': ~e:Hor. pe (c) Appl~ca~s (c~eck ~e): Lending I~st~tubon ~wner/bu~lder ~; ~yer ~, Other ~ (explain), (d) Lend,ng Insti~utio~ Address . (e) Real Estate Company and Agent Address Telephone . TYPE OF RESIDENCE Singl~-FamilyJ~ Multi-Family [] Number of Bedrooms -~' Other WATER SUPPLY Individual Well~[. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 NOI.LnYO leUO!~!puoo po^oJddBs!Q /~ pe^oJddV ~' JO; poAoJdd¥ ' 'IVAOI~ddV d3Ha ' /! 'l ~'" '9 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNiCIPALiTY OF ANC~L:H AUTHORITY APPROVAL (HAA) ENVIP, ONMEN'fAL SERVICES DIV~IiI:E, CKLIST - FEBRUARY 1984 264-4720 jUN 1 7 1987 Legal Descripti_~on' /~¢'~' ~ RECEIVED Well Classification Well Log Present(¢~, ) Total Depth ~/~"--5'~ Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed b-lC"-~1¢/ Yield /~'~ / Depth of Grouting Pump Set At ¢¢o ~ / Sanitary Seal on Casing~l) Depression Around Wellhead (Y~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date ~ '-~ ¢ To Nearest Edge of Absorption Field on Lot //~' To Nearest Public Sewer Line ~./~4 Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments _~ ¢/,/X'. /-*Jz~Z¢' B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes~N) Air-tight Caps~)N) Depression over Tank (Y{~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /o$ To Property Line /~ To Water Mai~/S...~ervice Line Course " /~¢~ Size /¢'~72 No. of Compartments Foundation Cleanou~(~N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) ? To Building FOundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '¢' I?~ ~'1 Width of Field -~ Square Feet of Absorption Area Depression over Field (Y/~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~ To Building Foundation Lot Type of System Design Length of Field ~'"'~ Depth of Field 2~ / Gravel Bed Thickness ¢ / Standpipes Presenti~N) Date of Last Adequacy Test To Property Line // To Existing or Abandoned System on ; On Adjoining Lots ~..5" /¢' To Water Main/Service Line 75' C- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) D. LIFT STATION ///'~ Dimensions Size in Gallons"'"~-~..~_ Manhole/Access (Y/N) "Pump On" Level at -"'-~ "Pump Off" Level at High Water Alarm Level at ~~ Vent (Y/N) Tested for ~'"~"""~P~L~mping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~_~.~ Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I~c~k/e_d,fszified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~-¢_-¢¢---~ - //L,//,----~- Date Company ,/¢'Er~ ~' MOA No. Receipt No. ,~-- 0(~ /~00 ~--'') / Date of Payment ~2 -~/~ Amount: $ ~,,,'/~7 ~:~ ~ c~ _ Page 2 of 2 72-026 (11/84) ~ CHEMICAL & GEOLOGICAL LABORATORIES ~F ALASKA, INC. 5633 B STREET ANCHORAGE ALASKA 99518 TELEPHONE (907)562-2343 FEDERAL TAX ID # 92-0040440 Ucdereo 8? : A~CS Ciient Accoun~ ' &L~C~ Ne!eased ~v : ~b~dT~.~. i~strucr: 5~p { e CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /~~'~ '~ 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 //-~'o~.,o;,~;%~,.~ FEDERAL T,A,X ID # 92-0040440 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 (b) (c) Legal 12¢sc¢iptlor~ (include lot, block, subdivision, section, township, range) Appl,~nt'N;~ ~~ ..... Telephone: ~ome -~-~ ~ Business ~-- Applicant is (Ch~CA ~ne): ~nding Institution ~; Owner/builder~ Buyer ~; Other ~ (explain); (d) Lending Institution C_p. L~_~.t_].~_ Address '-7{0 ~?_J~j.~j~.~ (e) Real Estate Company and Agent _ Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Number of Bedrooms .'~ Other WATER SUPPLY Individual Wel ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank Note If'comm~n~tyt well system must have written conhrmabon from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 01/84) 5 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this H, 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 obtainecl 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 /'~F~"~ f~.C_ Telephone ~'-7~/'''~,-~''-~2 Address / ~ ~ ~ ~ ~ ~~ .~ Date /~ ~? DHEP APPROVAL. Appr°veO f°r ~ bedr°°ms bY ~'~ ~onal~ 'Approved ~ Disapproverf 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION Well Classification F/~I~/~ ~ If A, B, C, D.E.C. Approved (Y/N) Well Log Presen (t~N) Date Completed A///,~,/~'/ Yield Total Depth /~',~'- ¢' Cased to Static Water Level / ~/ Casing Height Above Ground Electrical Wiring in Condui,t~N) Separation Distances from Well: Depth of Grouting Pump Set At Sanitary Seal on Casingl~N) Depression Around Wellhead ¢, To Septic/Holding Tank on Lot / O~' ! ~: ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot //,~__ i~; On Adjoining Lots To Nearest Public Sewer Eine ~ To Nearest Public Sewer Cleanout/Manhole ~ ~Nearest Sewer Service Line on Water Sam pie Collected by ~~ ;Date ~/~/~ Water Sample Test Results ~'~/~ ~ ~ ¢ Comments e~¢~¢~'- ~ ~~~ ~'~~ B. SEPTIC/HOLDING TANK DATA Date Installed ~/~ :~/~"/ Size / ~¢)'~:} No. of Compartments ~ StandpipestC~)N) Air-tight Caps ~N) Foundation Cleano~t~) Depression over Tank (Ye Date Last Pumped ~//~/~" ~' Pumping/Maintenance Contract on File (Y/N) ,~ ;for ~-/~_ ~ ~' Temporary Holding Tank Permit (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well TO Property Line ~::~/;~ To Water Main/Service Line Course Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage . Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'//':~/~2-/' Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Type of System Design Length of Field ~/ Depth of Field Gravel Bed Thickness Standpipes Present, N) Date of Last Adequacy Test Fl Separation Distance from Absorption Field: To Property Line / (/-;L/- To Existing or Abandoned System on ; On Adjoining Lots ~ 50 ! ~'- To Cutbank (if present) /L} /,/¢¢ To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments ,Ye' ~.~.~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for | Dimensions _,-.---- .~- Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA coElectriCalm m e ntsC°des (Y/N~.~'~'~ ** Check Permitted Bedroom Bating Against HAA Request ** I certify t hat(l~v~ che~,ed, verified, or conformed to all I'¢ O~A and HAA guidelines in effect on the date of this inspection. Signed ~ ~,,~ .L ~/.,~¢I.A~- Date / J)/~/'~¢ Company fl /~-~--- Receipt No.~ ~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ALASKA [ iUIROIgme[1TAL COI1TIROL ~n§in¢¢rin§ 6 Enuironmcn~ol Studies lilt. TOM LIPPITT 9800 LONETREE DRIVE ANCHORAGE ALASKA 99516 SELLER-SAME OCT 4 1985 WILL PICK UP FROM OUR OFFICE 50658 LEGAL:ROCKHILLS SUBD/BLOCK 3/LOT 9 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-SEPT 30 1985 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 472 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 640 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON SEPT 14 1985 . FLOW TEST ON WELL WELL FLOW DATE-SEPT 30 1985 THE WELL~Lf~W RATE WAS 7.1 GPM FOR 2 HOURS. ~' '?~ ~ Time e Date Date Date Inspector Inspector Inspector ~' Comments Conditional Approval Date Sewer Installed Permit No. Septic Tank Size /~ ~ O ~ ~ ~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Welt to Tank ~.~ APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~ ~'~. Phone Mailing Address ~ ~ ~ ~ ~~~ ~ ~~ Buyor ~ddross Address ~~0~ & e ~ 0 ~ Realty Co. & A~ent : ~ Phone Address Legal Description ~ jD3 ~r//fj/~C Street Location ~ ~ ~ ~ e ~ Typ~ Residence ~Single Family ~ ~ Multiplo Family ~o. of Bodrooms D Other Wat?r~Supply ~ Individual A~ACH 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 Utilit~ available.~ Sew~ Disposal / g ~ / ~lndividual Year Individual Installed: ~ Public Utility When Connected to Public Utility:. G Holdin~ Tank >~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. May 4, 1.982 JAK Construction $~A Box 2B01 Anchorage, AK Subject: Lot 9 Block 3 Rockhill ApProval for the individual sewer and water facl!ltl cannot b~-~ granted until the following items have been completed: °~well log submitted to this office for our files and review. ° The top of the well casing sealed with a sanitary seal so '~u.~"~ that it. is water tight. The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. ~'~" ~The water analysis report needs to be submitted to this ~ office from the Chem Lab, 5633 B Street, for our review. ~';~ The depression over the sewer system will need to be filled . ,~/ so that surface water drains away from the sewer Q~/Please notify this department for a reinspection when the noted discrepancies have been c°r.rected. If there are any ~\"/ further questions, please call this office at 26~-4720. / Sincerely,] .., ,- ~/ Robert C. Pratt Associate Environmental Specialist RP95fplEH