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HomeMy WebLinkAboutROSEBUD HILLS BLK 1 LT 11 +o �� - SRI --=,oj.40 —filfA Municipality of Anchorage Page 1 of 3 Development Services Department Building Safety DhAsiontOn-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.akus (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO30117 PID Number: 017-381-40 H°"t° Gene and Sandra Roigere Wastewater System: Upgrade 540 5401 Rid eview Drive Anchoratic, AK 99516 ABSORPTION FIELD phone: Ntntberof aedrooms: Deep Trench 348-0058 Four 4 LEGAL DESCRIPTION Soil l Rating: ol ToDepth from ongtnal grade: ,45 GPDfF? 14 Ft. Block Lot Subdivision Dept" to pipe bottom from original grade: Gravel depth beneath pipe: 1 1 Rosebud Hills 4 Ft. 10 FL Township: Rag°: Section: Fill added above original grade: Gravel Length: 1 Ft. 74 Fl. Well: Existing GnavelwKM Ntimberoflines: Distance between lines: 3 Ft. 1 FL Classification (Private. A B. CX Total Depth: Cased to: total W30(p.on area -riPFIX575= Private Ft. Ft 1,480 Fly ASTM 03034 PVC DnW.. Date Drilled: Static water Level: tnstatl r. Date Installed: Ft Acrenile 5 eteme 6/10/2003 yield: Ptmp Set at cavo- g eight Above Ground: TANK C'pM Ff. Ff SEPARATION DISTANCES S.T.E.P. To Septic Absorption Lift Holding ublirWvate 8n 1dCA feC Capacity in Gallons. From Tank Feld Station Tank Sewer Line Anchorage Tank 1,250 Well >109 >100' >109 N/A >25' Material: Steel 1,mbw of Compartments: Two 2 &afaoewater >100' >100' >109 N/A LIFT STATION Lot Line >5' 1„• >9 N/A tee.act'Arer. Gal. >5' >10' >9 N/A 'Ptmp of level at 'Pump off' level at High water alarm at: Foundation h h In • Drain None Noted Ptmp Make b Model Electrical nspectio $ performed by. Cunam BENCH MARK Bull Run Flow Diverter Valve Placed to Allow Use of B Existing Absorption Trench in the Future. dation and Description See Lot Line Waiver For New Absorption Trench. Bottom of 5idin . Assumed Elevation: 100.0 FL Engineers Stamp ♦♦♦����t, Aa, il Inspections performed by. Alan Harala Dates: 13t 6/10/03 :. 4th 1 q 7} ��� 2"d Fi/10/03 Department HMlth�aind Human Services �J i7�% �.�w«w C MICHAEL E. ANDERSON a of approval 00.. ND. CE -4381J. • Sf f \ I Reviewed and approved by: 1A I. c Date: #���4Fp` •.. «••. P�� : Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT S89 36'38"W page 2 of 3 On-Site Wastewater Disposal System or Well Inspection Report PID No. 017-381-40 < Permit Number: SW030117 O O S1 17.0 50.0TH S2 25.0 52.5 C4 80.0 86.5 M 1 70.5 70.5 C5 64.0 34.0 rn N u7 t` M Q � Q Lr) O N O z r O C) RIDGEVIEW P................ ..... ' •. ' asw �...... ..... ........ .. s..... � PLAN AS-BUILT ,.. ......... " s urc+wEGE./Jaoeftsor+' y SCALE I"= 50' ���-��°:, No. ce-43ei ,a�r LOT 1, BLOCK 1, ROSEBUD HILLS ••����+ESSI(�i' •+ 58.30 Mt s Diverter Valve s� our BedroD '.;. Home �. 1 v .• Bam w Existing •� Well O w+ E to , • . w ' O • 0 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030117 L a x-97.5 a Vl / N UU 4 1 1,250 Septic Page 3 of 3 PID No. 017.381-40 To Existing Absorption Trench .. U F=- S S U PROFILE AS -BUILT Scale: 10 =10' 0.I 49th AEL E. ANDERSON No. CE -4381 I" MUNICIPALITY OF ANCHORAGE Development Services Department; On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 U1 hd - t LI X00 K, ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 06, 2003 Expiration Date: May 05, 2004 Permit Number: SW030117 Parcel ID: 017-381-40 Legal Description:[ROSEBUD HILLS BE Design Engineer: 0014 Anderson Engineering Site Address: 005401 RIDGEVIEW DR Owner Name: GENE & SANDRA ROGERS Lot Size: 60261 SO. FT. Owner Address: 5401 RIDGEVIEW DR Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-3023 This permit is for the construction of: ❑✓ 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 specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify 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 Issued Date: S Date: 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.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING SLD Parcel I.D. 017.381-40 Permit Number SW 030//7 Property owner(s) Sandy Rogers Day phone 348-0058 Mailing address (1) 5401 Ridgeview Drive Anchorage, AK 99516 Mailing address (2) Zip Code HALL' Legal description (Lot, Block & Sub'd.) Lot 1, Block 1, RosebudExtstax Subdivision Legal description (Section, Township & Range) Lot Size 6 0, 2 (o% Acre q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms _Four (4) Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ED 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. (Signature of property owner or authorized agent) Permit Fees: 12 Waiver Fees: Date of Payment: 8171 I,7 Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) April 29, 2003 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 1, Block 1, Rosebud Hills Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing septic system on Lot 1, Block 1, Rosebud Hills Subdivision has failed and must be upgraded to obtain a Certificate of Health Authority Approval. We are therefore requesting a permit be issued for the construction of a new septic system to serve the four-bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. Also identified on the plans are the location of the well on the lot and the test hole location. The existing septic tank will be removed and properly disposed either on site or removed from the project. Existing drainage patterns are shown and will not be altered by the development of the lot. The test hole placed near the location of the proposed absorption trench indicated silty gravel with varying amounts of sand. Percolation tests in the material resulted in rates of 56 minutes per inch. No groundwater was found during the placement of the test hole and none was noted during the monitoring period. We are therefore proposing to place a 67' long 3' wide by 10' effective depth absorption trench. The total depth of the trench will be 14'. The distribution pipe will be placed at 4' below the ground surface to provide sufficient drop from the septic tank to the absorption trench. A flow diverter valve will be placed and the existing absorption trench tied in to the system for possible future use. The ground surface on the lot slopes as shown on the attached Site Plan with very little to no slope near the proposed absorption trench. The new absorption trench will be constructed on a fairly flat surface in conformance with Municipal requirements and parallel to ground contours where possible. All components of the new septic system will be constructed a minimum of 100' from the existing well on the lot. Lot 1, Block 1, Rosebud Hills Subdivision April 29, 2002 Page Two If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if cohstructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments �d 49th • /\ . ',r viHAEL E. aNri2co4 [[-43xi ••; 0 101 x 2q sag 36-M 15130 inv Ti IS PROJECT wM �'•. nr x>vwr.a our Bed EitlffO Y -i Sam e. Weil N VACANT No Conflicts With Neighboring Systems ill -I .1, 2 7 A 211JS .ti 8 0 N n a 1 ?� 2 a� cc _^ Q g 3 r N �;.._ L # Iw. 49th AREA MAP ;. ................................. . m L MIp1AEL E. ANDERSON j SCALE 1' = 100' •�c�s No. CE4381IV i IML S89 36'38"W 158.30 Replace Existing 1,250 Gallon Septic Tank ?tea nd Diverter Valve 67' L ng X 3' Wide x 10' EHe ive Depth Our Bedr00 Absc rption Trench Home 30 w: Barn ' Existing �::• Well r` M (O o C) N O Z ih 0 0 U) W& V&SUVAtt ..... � .`P ��. RIDGEVIE fil,l, • 49th ' �I .... •� c `: Mi soN i SITE PLAN A#, -s No. CE4381 je : - SCALE 1" = 50'• per''••••.............. �. �+ rj%::S: �•. LOT 1, BLOCK 1, ROSEBUD HILLS SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House Deep Trench System Perc. Rate: 56 Min./Inch 1,250 Galion Septic Tank Application Rate: .45 GPD/SF 10' Drainfieid Rock 4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333 SF Absorption Area 1,333 SF/20 SF/LF = 66.7 LF Trench Length THEREFORE: Construct a 67' Long x 3' Wide x 10' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 14' Below Existing Ground. Maintain 100' Separation From Well on Lot. Place A Flow Diverter Valve and Tie Existing Absorption Trench In To System For Possible Future Use. 3'6" 6" Natural Backfill 3' Geotextiie Fabric 4' Perforated PVC (Holes Down) Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 1 00'Separation From Wells in the Area. Minimum 1 00'Separation From Surface Water or Streams. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Sandy Rogers DATE PERFORMED: 4/12/2003 LEGAL DESCRIPTION: Lot 1, Block 1. Rosebud Hills Subdivision �TEST HOLE # 1 SLOPE SITE PLAN Mj�j II I I I I I II OG/OLPROJECT # M0302 I . I a c Silty Gravel W/Sand Clusters GM .a d 1% WAS GROUNDWATER NO ENCOUNTERED? • d IF YES, WHAT DEPTH? DEPTH OF WATER None AFTER MONITORING: a DATE: 4/19/2003 BOH @ 20' S L 0 P E SEE SITE PLAN FOR TEST HOLE LOCATION 2% GROSS TIME -a 0% READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 4/14/03 19:21 6.75" 1 19:51 30 7.25" .5" Recharge 19:57 6.75" 2 1 20:27 30 7.31" .56" Recharge 20:41 6.5" 3 21:11 30 7.06" .56" PERC RATE: 56 MIN./INCH PERC. HOLE DIAMETER: 8" TEST RUN BETWEEN 4.5 FT. AND 5.5 T. COMMENTS: Test Hole Pre Soaked Prior to Test. TEST PERFORMED BY: ALAN HARALA I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 4/28/2003 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1, BLOCK 1, ROSEBUD HILLS SUBDIVISION GENERAL: 1. The scope of this project includes the removal and proper disposal of the existing septic tank and the procurement and placement of a new 1,250 - gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 67' long X 3' wide X 10' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 4' below the existing ground surface. Total depth of the trench will be 14' below the existing ground surface. A flow diverter valve must be placed at the location shown and the existing absorption trench tied in for future use. The new absorption trench must be placed a minimum of 100' from the well on this and adjacent lots. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Lot 1, Block 1, Rosebud Hills Subdivision April 27, 2003 Page 2 of 3 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. Lot 1, Block 1, Rosebud Hills Subdivision April 27, 2003 Page 3 of 3 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) August 15, 2003 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 1, Block 1, Rosebud Hills Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The septic system on Lot 1, Block 1, Rosebud Hills Subdivision was recently upgraded to replace the existing failed system. It was imperative to place the new absorption trench a minimum of 20' from the existing trench to meet the requirements of the Municipal ordinance. The north end of the new trench is now located 1' from the east property line. We are therefore requesting a waiver be granted allowing the trench to remain at 1' from the property line. The existing trench was left in place for possible future use. Placement of the new absorption trench at its current location does not impacted wells or adjacent septic systems. We therefore recommend a waiver be issued allowing the new trench to remain in its current location at 1' from the east property line. Sincerely, 74J,4L EA,, Michael E. Anderson, P.E. Municipality of Anchorage Development Services Department *A' Building Safety DivisionOn-Site Water and Wastewater Program4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksbeet WR#: 030074 PID#: 01738140 HAM 030414 Permit#: 030117 Date Received: 8 15-03 Legal Description: Rosebud Hills Subdivision Block 1 Lot 1 Engineer: Anderson Engineering P.O. Box 240773 Anchorene, AK, 99524 Applicant: Gene & Sandra Rogers Waiver Requested: 1 foot absorption field to property line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: !l Waiver is not Granted. List Conditions or Reasons for above: Date:— �,1 — D 3 By: _ ........................................ Rec#: X1"3 Amount: $jM Date Paid: 2003 ............................... TMunicipalify of Anchorage Mirk Begich, Alayor Building Sttfety Dixision P.O. Box 196650 • 4700 I3ragaw Strcet Anchorage, Alaska W3519.6650 • (907) 343-£3'`301 • Pax (907) 343.800 Ul�p://t�lt�canuni.or� . Anderson Engineering ATTN: Michael E. Anderson, PE PO Box 240773 Anchorage, AK 99524 - August 21, 2003 Subject: Waiver Request forROSEBUD HILLS BLK 1 LT 1 Waiver # WR030074 Lot Line Request for Parcel ID 017-381-40 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation of the on-site wastewater disposal system to the lot line has been approved. The approved separation distance is 1 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Jeff Poet Engineering Technician III On -Site Water Quality Program MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING o* DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW `t ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION y� LOCATION NO. OF BEDROOMS F_ i - Well ., Absorption area , r Dwelling PERMIT NO. v DISTANCE T0: �� .y - ` Y 1- Z 0.Liq. _ Manufacturer Material No. of co partments capacity in gallons Inside length Width_____ Liquid depth Z- c IF HOMEMADE: _ ^� Dwelling "-�` _�•--_••-•--..._,_- PERMIT NO. 0 Y DISTANCE TO: Well O z Q 2 F Manufacturer Material Liquid capacity in gallons O �_ - - DISTANCE TO: Well i Foundation +�) Nearest lot li e . / PERMIT NO --�G�c` w J E z No. of lines Length of each line Total length of lines �- Trench width � Cr Distance between lines F Z Lu z inches - Top finish Material beneath tile Total effectiv bsorption area ®p of tile to graj or `� � inches-'\. Length Width Depth PERMIT NO. W CD Q H Type of crib Crib diameter Crib depth Total effective absorption area wa y Well Building foundation Nearest lot line DISTANCE TO: Class Depth = `� icU#o-`f Driller Distance to lot line ERMI N W 3: Building foundation Sewer line Septic tank Absorption reals) DISTANCE TO: OTHER PIPE MATERIALS cf SOI L TEST RATI Zo INSTALLER REMARKS Lam' ► / ` 'r A 4o OFA f® �+ ,®�eeeeee �te eee4e�P� 4+Aj Veeeee ese°eesee seeaeeeeaeee r 3 i" 1. 311 V se THOM A. RSCH@R `d APPROVED DATE LEGAL PERMIT NO: DATE ISSUED APPLICANT: ADDRESS: '� � v �� ����a� you in designing �� �����U Z��� your site. �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DEPTH TO PIPE BOTTOM (FT.) 4.0 825 L STREET� ANCHORAGE� AK .99501 5RAVEL DEpTH (FT.) 264~4720 TOTAL DEPTH (FT.) 45 6.O 51��� 25"0 5"0 ,.jl�� 49.0 � 840957 53.8 ���r���v 11/26/84 1,250.0 ** 1,250"0 ** SOIL �ATING (SQ.FT./BR) 201 206 ' LIL C,�^' ALMOND INC CONTACT PHONE: P O BOX 112247' ANCHORAGE: AK 99511 345-3821 LEGAL DESCRIP: SUBDIVISION: ROSEBUD HILLS ` SECTION: 27 TOWNSHIP� 12N LOT SIZE: 1.�83A (SQ.FT.OR ACRES) MAX BEDROOMS: 4 ° LOT: 1 BLOCK: 1 RANGE: 3W Listed below are the options available to you in designing your septic system. Choose the option that .... ..... ... ... best fits your site. �� ..... ..... � . . ��� A-��Z ][i� DEPTH TO PIPE BOTTOM (FT.) 4.0 4"O 5RAVEL DEpTH (FT.) TOTAL DEPTH (FT.) 45 6.O � GRAVEL WIDTH (FT.) 25"0 5"0 GRAVEL LE�GTH (FT.) 49.0 GRAVEL VOLUME (CU.YDS.) 45"4 53.8 TANK SIZE<GALS) 1,250.0 ** 1,250"0 ** SOIL �ATING (SQ.FT./BR) 201 206 ' ** GRAVEL LENGTH > 75 FT^ REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT, EACH) ** TANK MUST HAV� AT LEAST TWO COMPARTMENTS I certi�y that: 1. I am {amiliar with the requirements �or on~site sewers and weIls as set �orth by the Municipality U[ Anchorage <MOA) and the State o� Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o� this permit. 3. I will adhere to all MOA and State o� Alaska requirements {or the set back distances 4'rom any existing well� wastewater disposal system or public sewerage system on this LD 1, any adjacent or nearby lot. 4. I understand thvalid �or a maximum o� 4 bedrooms and any enlargement will require an additio:al permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� THEN (1) AN N IO| MUST BE OBTAINED; (2) AS�BUILTS WILL NOT BE INSPECTION REPORT; AND <3) THE ELECTRICALN10CENSED ELECTRICIAN. SIGNED __.... ..... ......... ........ ... ..... ..... ___ APPLICANT: A � ` v / ��..... ..... ..... .... ... ..... ..... ..... ��� ~��..... ..... ��'����... .... .... -.i WHd EjW Ei SOILS LOG I 11600 CANGE RD. ANCHORAGE, AK. � TEST(907) -1145-7008 El PERCOLATION SOILS LOG — PERCOLATION TEST PERFORMED FOR: TL�YQY'�k� DATE PERFORMED: Doc- 21 j Cpl q LEGAL DESCRIPTION: ra' 1 SC I, Ni n /41 LLL SLOPE SITE PLAN 1111111illllll 0 q Kic 3 4. ' 9- 10 - WAS 10WAS GROUND WATER �'�, S 11 '. ENCOUNTERED? �� L P 12 - _ IF YES, AT WHAT E DEPTH? 13 J 14- 15- 16— 4 1516 e��... e• 17 zk�'s49TH •el�� •a •seoe ee.oe.e •eeeai s 18 ® { 19 THOM A. FISCHER CE - 6793 20 44� ®�4m0��®���® COMMENTS PERFORMED BY: 0 Date ON ONE Net Time MEi MEN ■11111 i1�.li�li1 ��1,1•�la.1�� ■,,\ Net Drop ■„�wil,.■ I MIN ONION 111111111 R9111101 ��1 MINE 11111111 1001. 1 Reading Date Gross Time Net Time Depth to - Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: DA I PERMIT NO: DATE ISSUED: ` APPLICANT: ADDRESS: CONTACT PHONE: 850128 04/29/8� ALMOND INC. P,O, BOX 112247 ANCHORAGE, AK 99�11 345~3821 LEGAL DESCRIP: SUBDIVISION: ROSEBUD HILLS LOT: 1 SLOCK: 1 ^ PH U ins 1: 1: 1 1: to, 574 It_1:~1 -%s 1:1 1=7 V; phi oil 1- 1 oil woz m qH�: 11 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION V MAX BEDROOMS: 4 825 L STREET� ANCHORAGE� AK 99501 Listed below are the options lablet to ybu in designing your 264~4720 system. Choose the option that best fits ��� :1E *ill !E.HE� � pwil :lE IF PERMIT NO: DATE ISSUED: ` APPLICANT: ADDRESS: CONTACT PHONE: 850128 04/29/8� ALMOND INC. P,O, BOX 112247 ANCHORAGE, AK 99�11 345~3821 LEGAL DESCRIP: SUBDIVISION: ROSEBUD HILLS LOT: 1 SLOCK: 1 SECTION: 27 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 1.383A (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options lablet to ybu in designing your �eptic system. Choose the option that best fits your site. Y162 W H Q C71 1- it 1E -H: 1:1 FT an! ][IN li DEPTH TO PIPE BOTTDM (FT,) 4.0 4.0 4,0 GRAVEL DEPTH (FT.) 0.5 3.5 7.0 ` TOTAL DEPTH (FT,) 11.0 4.5 7,5 GRAVEL WIDTH (FT.) 2,5 22.0 5,0 GRAVEL LENGTH(FT,) 43.0` 41.0 65.0 GRAVEL VOLUME (CU.YDS,) 29.9 33.5 48.2 TANK SIZE (GALS) 1�25C).0 ** 1�250.0 SOIL RATING (SQ"FT./BR) 150 150 150 ' ` x TANK MUST HAVE AT LEAST TWO COMPARTMENTS ..... ..... ..... ..... _-... ..... ... .... ..... ... ..... __�~ I certi{y that: 1, I am {amiliar with the requirements |or on~sit� sewers and wells as set forth by the Municipality -.vi" Anchorage (MOA) the StatS Alaska. and of 2. I will the in MOA �install syste� accordance with all codes and regulations� and in compliance with the design criteria a[ this permit. 3. I will adhere to MOA State Alaska �or the back all and o{ requirements set distancesFrom any existing well� wastewater disposs\l system or 1Aublic sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum o� 4 bedrooms and any will require an additi�nal permit. IF A LIFT STATION IS INSTALLED IN AN AREA `COVERED BY MOA BUILDING,rODES; THEN (1) AN ELECTRICS. PERMIT AND INSPECTION MUST OBTAINED; 8E (2) AS-BUILTS WILL NOT BEE WITHOUT AN ELECTRICAL INSPECT ION REPORT; AND THE �APPROVED (3) ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN, APPLICANT: ALM ISSUED BY DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION vk< PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST COMMENTS cm- :5(�Al circ bro-oI, dxj /97 "E�4007 2A" SLOPE DATE PERFORMED: C WAS GROUND WATER S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? SITE PLAN r Reading Date Gross Time Net - Time Depth to Water Net Drop ' / v-70 q i-PL.0 t �yj/j Y / c / , j$ l 1 D P / 3 s co 1'710 'q as icy PERC�ATION RATE_------ 3"'�f © (minutes/inbmp TEST RUN B,F,TWEEN __r rL__T FT AND FT PERFORMED BY: �_' !//7 7 CERTIFIED BY: V 6 TE DATE: f b } I �' POL. .ri 6-650 �`'A'zt�. ANCHORAGE, _, ALAoKA 99r02-0650 F- at r (907) 264-4111 7ONY KNOWLES. MAYOR DEPARTMENT Or HEALTH AND LNVIRONiVIENTAL PROTECTION Permit #: 840419 January 31, 1985 TO: Permit Applicant SUBJECT. Lot 1 Block 1 Rosebud Hills Subdivision A permit issued by this Department for an individual well and/or on --site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or onsite sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer_ inspected the installation of the on --site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 2.64®47200 Sincerely, �j Keith E. Bandt �` Supevisor p Environmental Engineering Program KEB/ljw enc: Copy of Permit SwP/057 M U " I RZ- I F-- F:- E_ I ?' tee-° ®_® F=- n"NZ- E { e V F4 0 E . ` F DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION i� din 825 L STREET: ANCHORAGE, AK 99501 264-4720 (� - ®_D t-4 ----:� I -IrEE !E�: E L4 E F: '. F -A E L_ 1. F=" E F-:: r_l I "'i_ PERMIT N O :4.1:341:.= DATE ISSUED: X36 '04/84 APPLICANT: ALMOND INC ADDRESS: P 0 BOX 11-2247 ANCHORAGE, AK 99511 CONTACT PHONE: 345-3821 LEGAL DESCRIP: SI_BDIVI-ION: ROSEBUD HILL= LOT: 1 SEC:TIONd: 27 TOWNSHIP: 12N RANGE: _Nd LOT SIZE: 6_1261 (SQ. FT. OR ACRE LOT LOCATION: RIDGEVIEW DRIVE MAX BEDROOMS: _ BLOCK: I LISTED BELOW ARE THE OPTIONdS AVAILABLE TO YOU IN DESIGNdING YOUR SEPTIC: YSTEM. CHOOSE THE OPTION THAT BEST FIT- YOUR SITE. E-:EEk C -J- G•FRe:V I r-4 DEPTH TO PIPE BOTTOM (FT.) �. 0 4. 0 0 W*: GRAVEL DEPTH (FT.) _:. 0 0.5 4=1 TOTAL DEPTH (FT 6.0 4.5 6.0 GRAVEL WIDTH (FT. 2. 5 21.0 O. 0 GRAVEL LENGTH {FT. :> 92.0 0 :t::+ 40.0 65.0 GRAVEL VOLUME (CU.YDS.) 29. 8 31. 1 � 42.1 TANK SIZE (GAL_) 1, ¢jCi0. is W:t: 1,000.0 :+:+: 1,000.0 SOIL RATING (SQ. FT. /BR) 183 I3 183 DEPTH TO PIPE BOTTOM < 2. 5 FT: REQUIRES INSULATION + DEPTH TO PIPE BOTTOM 4.0 FT. MAY REQUIRE A LIFT STATION :+::+: GRAVEL LEN 13TH > T•c FT. REQUIRES MULTIPLE RUNdE, (NOT EXCEEDING 75 FT. EACH) TANK MUST HAVE AT LEAST TWO COMPARTMENTS CERTIFY THAT: I. I AM FAhiIL,IAR WITH THE REQUIREMENTS FOR ON—SITESEWERS ANDWELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS.. AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS, PERMIT. _. I WILL ADHERE TO ALL MCRA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCE= FROM ANY EXITING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SE14ERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF _ BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONdAL. PERMIT. IF A LIFT STA THEN (1) AN WILL NOT BE ELECTRICAL bd-i SIGNED APPLICANT ISSUED BY Nd = I'd TA l • AREA COVERED BY MOA BUILDING CODES T.1 'ER- T INSPECTION MOST BE OBTAINED.; (2) A'—BUILTy _ C T (' AN ELECTRICAL INSPECTION REPORT: AND (_'••) THE D •d - _ ; ELECTRIC IAN. DATE: DATE: SOILS LOG / fL/ dig MUNICIPALITY OF ANCHORAGE +r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 /SOILS LOG — PERCOLATION TEST I PERFORMED FOR: �mol�(i1, ::rig (7—. DATE PERFORMED: dfido LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS S, Mow Zw/ Q ■UNN ON MEMO SEEN M■■■ ■MOO NONE WAS GROUND WATER L ENCOUNTERED? O P IF YES, AT WHAT E DEPTH? SITE PLAN ■■■■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop 0. Z17 3 : z0 /0 PERCOLATION RATE TEST RUN BETWEEN 12, i (minutes/inch) FT AND Q FT PERFORMED BY: Jjz4dzee CERTIFIED BY: DA /ii DAC Ci. nn/C' SEP -12-95 TUE 12:47 PM M—W DRILLING 907 34532.137 P.01 M -W DRILLING, Inc, P.O. Box 110378. 10330 Old Seward Highway ($07) 349-8635 ANCHORAQC-, ALASKA 98611 DRILLING; LOG Well Owner CHRIS LUNDT Use of Wellr.[3F3VE`rF'I.C— Locati (ddress of: Township, Range, Section, if known; or distance main road tbi I,BLOCK 1 ROSEBUD HILLS SUBDIVISION : 5401 RIDGEVIEW DRIVE Y LASKA --- 5„ Size of casing Depth of Hole s ----feet Cased to—feet feet Static Ovate= level... i #t.a " " { Glow) land surface, Finish of well (check one) open end ( X }; Screen { }; Perforated ( ). ^eset.sa screen or rforatio II/xxWell purnping test at112 _.gallohq per (iiotir Xj (minute) for--I,-----hours with of drawdown from static ¢vel. , .. Date of completion 31 AUGU3l' 1 WELL LOG Depth in feet from ground surface Gfv� tsils of formations penetrated, size of material, color and hardness 0260 EXSiS'i1;N(� WELL _ TO— .. - 260 TU 315 _ GREY,•._SILTSTONE ARGELII'E: SMALL SIATERTSE'ANS IN SPARADIC FRACTURES ?64TO 29Q A/ 1:; . I RACTURF S�� 279 285 ni�i•s'riinnr�:�»� 288 290�.s.-------- FRACTU{t DARK. BROPJN CHIPS TO �� Rnu„ic au y ow Anchorac{e r ^31v 018 BR, W I -Al n?jr ONE 4-nr- t"RACTURED Dept. Health & Human Services -- TO 118 4175 GREY'SIIISTGNEIirLzT.:::sot':rACT ur;l"s Tp_ TO— TO� TO�; --TO— TO —To I LOCATION OF WELL (Please complete either to, lb 'or Ic.) la. Borough Subdivision Lot Block Ib. t/4gtrs. Los eb`,u(1 1 1 I .sofsof—Of— lc�l DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS CreStView And Naknek Street Address and Area of Well Location 2. WELL LOG Material Type O rani e Gravel W4 th interspace cobbles and bou stiator from DEPT. OF 2 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Divis,.. of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. Township N 0 Range E ❑ Meridian S❑ W❑ 3. OWNER OF WELL: iond Inc. t ry 7 Address: 1.0. 22 ox 1 1 S4 1 Anchorage, Ak. 99511 4. WELL DEPTH: (final) 5. DATE OF COMPLETION E> ft. 4 � — 85 S, ❑ Coble tool i_J Rotary [:] Driven O Dug ❑ Auger p Jetted C3 Bored ❑ Other: 12 ?.USE: P9 Domestic Public Supply C1 Industry C] Irrigation Recharge El Commerical El Test Well ❑ Other: Z 8. CASING: E) Tgrpo ed ® Welded60 1 �� Glum.—In. In. tot J(� ft. Depth Weight Ibs./ diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: oj; en E'nd Diameter sat t Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Grovel pack r, r 4 10. STATIC WATER LEVEL: ' Jll ft. ✓ Date Above or .0 Below land surface Equipment used: sounder Feet Below Surface Bottom l l . PUC IPING LEVEL besurface and YIELD jVZ Cr low land >i0 ft. after 2 hrs. pumping'AQ5 9 -P.m• ft. after hrs. pumping 9 -P.M. 12.GROUTING Well Grouted: ❑ Yes R9 No Material: [] Neat Cement ❑ Other: 13. PUMP: (if available) HP 2 ! :F Length of Drop Pipe ft. capacity 9•p•m- (aSubm. ❑ Jet Centrifical Other 14. REMARKS IS. WATER WELL CONTRACTOR'S CERTIFICATION: 15, Water Temperature __° ❑ F This well was dri lied under my jurisdiction and this report Is true to the best of my knowledge and belief; lilpix)e Drilling & Mat. A14,9108 Registeru.' Business Name Contract License Number --1 _.},0 1'i ii y.l� Anchoraaa, Ak 99511 Address: © a a Signed: _�l �.sx.� rarsa Date: j1�C3'7 Authorized RAPresen4Five - C Municipality of Anchorage 6L.v •..e.L Development Services Department Building Safety Division On -Site Water and Wastewater Program $ A -. 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 �[ LA I Parcel I.D. 017-381-40 HAA #_ �� d _ -tA � ` Expiration Date: % % - /- C) 3 1. GENERAL INFORMATION Complete legal description Lot 1. Block 1. Rosebud Hills Subdivision Location (site address or directions) 5401 Ridgeview Drive Current Property owner(s) Gene and Sandra Rogers Day phone 348-0058 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 5401 Ridgeview Drive Anchorage, AK 99516 Day phone Lori Hackenberger . Day phone 261-7600 3111 C Street Anchorage. AK 99502 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Four 4 TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ 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 5 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 less than 30 days old. (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 engineers 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. -Anderson. P.E. Date $11512003 :' 49th J-V�:•MIENAEL r- ANDERSON ♦j i % No. 5. DSD SIGNATURE ♦ r % , e s Ess Approved for bedrooms. ♦♦���t.�:•' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (IN.1VM Municipality of Anchorage Development Services Department ° 4 Z I. K Building Safety Division t " On-Slte Water & Wastewater Program Is 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 i i HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1. Block 1. Rosebud Hills Subdivision Parcel ID: 017.381.40 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 413/1985 Sanitary seal (Y/N) ij Total depth 4" _fL Cased to 140 ft. FROM WELL LOG Date of test Static water level Well production g.p.m. -a1h995 WATER SAMPLE RESULTS: 385 ft. .5 Coliform 0 colonies/100 ml. Nitrate .776 mg.A. Date of sample: 613012003 Collected by: A Harala B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septlqftei Tank size 3,250_ gal. Number of Compartments a Foundation cleanout (Y/N) Y Date of pumping C. ABSORPTION FIELD DATA Depression over tank (YAC $ Pumper New Construction Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >24 in. AT INSPECTION 412412003 132 ft. .5 g.p.m. Other bacteria colonies/100 ml. Date installed 611012003 Cleanouts (Y/N) High water alarm (Y/N) N Date installed 0110/2003 Soil rating (g.p.d.M2 or ft2/bdrm)45,_GPDISF System type peep Trench Length 74 ft. Width 3 ft. Gravel below pipe _10 ft. Total depth 14 ft. Eff. absorption area 1.480 112 Monitoring tube Y Depression over field V Date of adequacy test Results (Pass/Faiq For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. Datum Size in gallons "Pump ofr level at _ in: Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main NIA Sewer /septic service line >2S Manhole/Access (Y/N) High water alarm level at in. Meets alarm 8 circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout WA Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line )f Absorption field 25' Water main 21,10' Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11 Building foundation >10' Water main MW Water Service line >10' Surface water >100' Driveway, parkingNehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and -4 review of Municipal records that the above systems are in jiN •i conformance with MOA HAA guidelines in effect on this date. i..n Engineer's Printed Name Michael E. Anderson. P.E. �j Date 811512003 CFN.... , 49th NICKAJX E. ANMSM No. ce�43M HAA Fee $ 375 Waiver Fee $ /5 0 Date of Payment r S 6 3 Date of Payment —/ 6- e3 Receipt Number `� l B 8 Receipt Number `�� j n X (Rev. 19100) Municipality of Anchorage .41 .,: xb�, �r ,t ' Development Services Department :r = A; Building Safety Division ,. ,' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 030414 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 1, Lot 1 of Rosebud Hills subdivision, the well's productivity was determined to be 0.5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 5 • IC lo' clrlc., SP -7 Y.' T ► _ _ _' _ f $fd. apes • n I' may 2.3rY a n• '. 56.1 '* FA• HSE •'/,fr _ X6.7 I 'it ' o_ 9p t ml Gorpo :.kVMENTS GF R l ._.. i k� •; ECORD, OTNER Tl•GW Ne4.59 4J', �c i8 • a o t }I+DISE SHOWN ON. 000RDE rn I' MA ARE NOt SfiQWIJ I{EREONI y R I D G Fy l e w DP 0/ n "ASAUTLT" bAar,C4 `' '" ' -No cot Hers set Book pg FrcF j...... i ),It•bf c•rllfy that I hove Ivnreyed thl following d•Icrib•d prop•rt'y, tot /' :o'� ct .;�� o .A1'• $EPdU_)il(.C4i _JU�d nor,lc recording orsrrrtr'Alalko, and thal the ow�� 'I�.r•/..••,�_r\ r' �.,�rOr•w,j..,l 111vor•d ih•r•on Or• wlthln the prapetry Unto and do nal 9yorlop ar •ncrooch I� •+. /•cV�' ' ;l ,h• pro9•rry lying odiaclnt th•r•I•+, that no Impro•em•nb on property lying adloatl nt e(eb so J0 +^c:cach on the or•m;l41 to gv/lti0n and thol there or* *no* roodwoyl, fron►mbdoll I)nts or 00 i 49i'� .::.t• 0019 •o+•m•nh on sold proDery •Rept o/ Indicated Mreen. , H � •G`7+?„ '•••• Her •••.•••1}. to fronts M,Idonto , .9 l I jf.M1Sh: t0�e, ).101110 �, (J N,Q Vr I.04 t' cr•••rHr/tj .. So 4ti t; °., �• • . .wl.. I �•wct.t GA :' J_ •,.. J O. ku ml Gorpo :.kVMENTS GF R l ._.. i k� •; ECORD, OTNER Tl•GW Ne4.59 4J', �c i8 • a o t }I+DISE SHOWN ON. 000RDE rn I' MA ARE NOt SfiQWIJ I{EREONI y R I D G Fy l e w DP 0/ n "ASAUTLT" bAar,C4 `' '" ' -No cot Hers set Book pg FrcF j...... i ),It•bf c•rllfy that I hove Ivnreyed thl following d•Icrib•d prop•rt'y, tot /' :o'� ct .;�� o .A1'• $EPdU_)il(.C4i _JU�d nor,lc recording orsrrrtr'Alalko, and thal the ow�� 'I�.r•/..••,�_r\ r' �.,�rOr•w,j..,l 111vor•d ih•r•on Or• wlthln the prapetry Unto and do nal 9yorlop ar •ncrooch I� •+. /•cV�' ' ;l ,h• pro9•rry lying odiaclnt th•r•I•+, that no Impro•em•nb on property lying adloatl nt e(eb so J0 +^c:cach on the or•m;l41 to gv/lti0n and thol there or* *no* roodwoyl, fron►mbdoll I)nts or 00 i 49i'� .::.t• 0019 •o+•m•nh on sold proDery •Rept o/ Indicated Mreen. , H � •G`7+?„ '•••• Her •••.•••1}. to fronts M,Idonto , .9 l I jf.M1Sh: t0�e, ).101110 �, (J N,Q Vr I.04 t' cr•••rHr/tj 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ©j 7 — 3 b'1 — 1/0 HAA,# A Qq�U H(„�) 1. GENERAL INFORMATION Complete legal description Lot 1; Block 1; Rosebud HiZU Location:•(site address or directions) 5401 Ridgeview Drr ive a Anchonaae, AK Property owner Chris Lundt Day phone 345-7553 Mailing address 5401 R�dleview D,%ive Anchoaaae AK 99516 •Lending"agency-' Day phone Mailing address " Day phone 72-025 (Rev.1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation 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 invest!gation 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 S & S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6... DHHS SIGNATURE Approved for <. Disapproved. Conditional approval for By: Date 71 OF �y T ROBERT C. COWAN/ r_tia`�, bedrooms. - bedrooms, with the``following stipulations: 1IITIC Date 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 (Rw. 1/91) Back MOA 421 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-474 :� l 61 C OF' yG Health Authority Approval Checklist Legal Description: Zo' / 6t-�L l Pua€B✓D iirLLS Parcel LD 0/ 7 - 3 y/ --L/o A. WELL DATA Well type fl"'v /t r 6 - Log present &/N) Yf, Total depth L/ 0 / Sanitary sealo/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number d €SEN Datecompleted of ,'k��o Y131I9!�-i r� Cased to 136 °I m'wet Casing height (above ground) J Y E S Wires properly protected ON Y' S FROM WELL LOG q/3I /a/ ST Static water level 3 S 5 i Well production WATER SAMPLE RESULTS: Coliform 0 Date of sample 0.s- WATER .S /o/ q/9S— AT INSPECTION C1 /D,6/CiF g.p.m. 41 a g.p.m. Nitrate t7 ` 'r Ll Other bacteria B. SEPTICIHOLOEW THANK DATA Date installed (� ` y Tank size / X S'O Collected by: S & S ENGINEERING I 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Number of Compartments a Cleanouts (( Y" J Foundation cleanout ((I) V,-- ) Depression (Y/TQ ✓J 0 Date of Pumping 1 ' K c Pumper ) S t} c - S C. ABSORPTION FIELD DATA High water alarm (YIA '.0 Date installed l a / / � Y Soil rating (g.p.d./ft`' o ft2/bdr� I rG System type 7R v c a r _ � Length Width r Gravel thickness below pipe �7 / Total depth ' J Effective absorption area / �I Monitoring Tube present( Vd) Depression over field (YAQ " Date of adequacy test 1� l r `I �� s Resultsass ail) PA Y S For /7I bedrooms Fluid depth in absorption field before test (in.), Immediately after - 1) gal. water added (in.): a 6 Fluid depth --1 a- (ins.) Minutes later: S 7 Absorption rate = 60,94- g.p.d. Peroxide treatment (past 12 months) (Y/N) v (K If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles to E. SEPARATION DISTANCES Size in gallons *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hekl* tank on lot /00 ; On adjacent lots Absorption field on lot t 00 r ; On adjacent lots Public sewer train N /,I "Pump off' level at* Public sewer manhole/cleanout 1 0014 - Sewer /septic service line `-0 / '- Lift station SEPARATION DISTANCES FROM SEPTIC/P+96 TANK ON LOT TO: Building foundation a 6 Property line - -) Absorption field_ a Water main/service line 30 �'` Surface water/drainage / 0 0 f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 1( Water main/service line 30 Surface water Curtain drain N D lvf Driveway, parking/vehicle storage area a X,vow.✓ Wells on adjacent lots %0o t Property line F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal in conformance wiitth�MOA lIAA guide Ines in effect on this date. Signature `) � , 17w-� Engineer's Name 1 ` d/¢ % C — Co 4,1 fir✓ Date 1 o f a 5` 0/ S` HAA Fee $ � v - 4A;) Q Waiver Fee $ _ Date of Payment /�/ Date of Payment Receipt Number � / � ���) Receipt Number Rev. 8/95 OSS: haa.wk.doc a � v OFA�`qt �tJhZ above'yj'rQ��+e T0. .kihQ89 slgCScdvaae ;v cj��.� CE - 8801 �• e (ttIi'FD/ �.........^,,e�� v WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. & During a recent Health Authority Approval on-site inspection and p well on Lot Block test,f the potable water supply —�-- -�- of d, Subdivision, the well's productivity was determined to be C),#-' gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a �L _ bedroom residence iso. gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN S&S� PneeninG CLIENT: ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS 07) WELL RECOVERY TEST DATA FAX(907)6941211 WELL LOCATION (legal): 1--o -i' t ' TEST DATE: r1- 2A.- -`t WELL DEPTH: oS� TESTED BY: a I? L, WELL DRILLER: 'til•-\ CASING DEPTH: 1 t>U I ter- M.'et DATE DRILLED: 0-31-gS OW6.lto TEST PROCEDURE: 1) Draw water down to pump. 2) Shut pump off 15-60 min. -record time -record meter reading 3) Turn pump on. Drawdown. 4) Shut pump off. -record time -record meter reading 5) Calculate gal./min. recovery. MISC DATA: Casing Height: Sanitary Seal? Wires in Conduit? Grading O.K.? Pump Depth: Samples Taken? Date: TEST DATA: START TIME: STATIC WATER LEVEL: TRIAL PUMP TIME METER GAL./MIN. 1 OFF Slolvl -5'2/- / ' ON �RjTE 7O OFF i6 s l4W a„ v Ga�Hy _ 4. 2 OFF z .Jy 52 ` 7 Z ON n L '. So okv 3 ttix�w s OFF 6'. S-) 3 OFF �401 ' �72 ON OFF -j ' l <✓ 7 yo 4 OFF - . • ON 7 S -p i OCA OFF 5 OFF 3%7 LP .b -3- I' ON ,,. c- ` til J 2 A4 J T S OFF RESULTS: WELL CURRENTLY PRODUCES: AlZ (gptiwr t) Pt:A- fLD�OW NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR. q, 5 �RjTE 7O 7 i6 s l4W a„ v Ga�Hy _ 4. 6 a 0 /t,1L_/0,1y 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 S&S HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN nG ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS ADEQUACY TEST FORM FAX(907)6941211 CLIENT: k►�-> �DATE: e—\ -qs LEGAL DESCRIPTION: �T �j1L V -0 -se a) 17 t l lis # OF BEDROOMS: 4 SEPTIC TANK/FIELD SEPERATION TO WELL: \ k TYPE OF ABSORPTION SYSTEM: SEPTIC TANK((SIZE: ABSORPTION FIELD DATA: Depression over field (Y&: J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Driveway, parking/vehicle storage area: ?-�p X Curtain drain: Foundation: ►�� SEPTIC: DATA: Date of pumping: $ "i,5- Purnper: 1 Spti(,S Foundation cleanoutWN): Depression (Y/1 h LIFT STATION: "PUMP ON" level at: "PUMP OFF" level at: High water alarm level: /k TIME METER READING GALLONS ADDED (TOTAL) LIQUID LEVEL S.T. M.T. M.T. COMMENTS (rib U 0 2► H '- o \ (0 1 o k74R L P�T6_D l5 ►S ► IZO R -(z- � Ga- ` (v t S J S JQt D 7 ,s I o a -t 'D Q P srtil� J V 4 RESULTS:AS FAIL: ?Pg -5S EXPLANATION: t\ SFS C'yoy �" TESTED BY: THIS SYSTEM IS NOT GUARANTEED AGAINST SUBSEQUENT FAILURE 17034 NORTH EAGLE RIVER LOOP • SUITE 204 0 EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE `�� • DEPARTMENT OF HEALTH & HUMAN SERVICES Mei T Division of Environmental Services dh On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # n 1 1 - alsN- Ll C) 1. GENERAL INFORMATION Complete legal description D i3 lock 1 Dose be<d 14'(111 'rA KI 4. Location (site address or directions) O1 1414 e view C)hve Property owner✓ d- Ca.r y ( Sf rom Day phone 3 'VS-- 5.6676' Mailing address S -YO( fR1e(9eyr,ew Anchcr,20 .4k 9`9.5'1 L/ Lending agency PacrLc 41w" Morf Ky Day phone 2S� --7S3y Mailing address 2600 De" tiSf ,4_ chgC4 A41 -C 99So.3 Agent Address 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- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm FluFkp 7-ec%n1cat Servtce Phone 3 yS- I3SS Address JHS 30 ;e�cAo Engineer's signature �� a �c Date ( (3 /9/ 6. DHHS SIGNATURE _ Approved for Disapproved. 4 bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments TN6 Mt IAMuwk LvEL-1Pt-apvc-zTON ReQv19..�by &NT- FoR_ (A ¢ f U2coV✓� NouSE )6�9 1-5 600 CAL_/Dfl��. 1'RS SvVSe`T WaL(- CSS 64L/DAY/ (.vim VRs»uc--na t MAY V.� e�� S�t_SON A -&L y . v)A75C eaN� vA R()N WA�l 1�-- AECQ UI PLE > By: Jot -4N St -AI -n-4 Date Juua tU. 199 I The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L 11 BI ROSE 5 v D t,c S Parcel I.D. A. WELL DATA Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number N.A. Log present (Y/N) y Date completed 4/3/$S Driller ALPINE D1PI t,t ING Total depth 2 (oO / Cased to 136 r Casing height g H Sanitary seal (Y/N) y Wires properly protected (Y/N) Y z FROM WELL LOG AT INSPECTION o / 3 Date of test 4 13 I ,99 5 b 0 /9 / o Static water level 1 3C) 124 > � LU° Well flow O s g,p.rn. 0.44 g.p.m. t µ- U Pump level 2S2 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /66 t ; On adjacent lots 2 °t Absorption field on lot 128 TO C.D. ; On adjacent lots 1-75- Public 75Public sewer main 7/00, Public sewer manhole/cleanout -7 /oo' Public sewer service line > I oo, Petroleum tank NONE OBSERVED WATER SAMPLE RESULTS: Coliform 0 co f / (00 me Nitrate O. y/ I -e Other bacteria 1 Date of sample: S"/.70 19/ Collected by: Flaffay Tech Svc B. SEPTIC/HOLDING TANK DATA Date installed IZ 1 J4 18 q Tank size 1250 6Ac Compartments 2 Cleanouts (Y/N) ! Foundation cleanout (Y/N) x Depression (Y/N) N High water alarm (Y/N) N•A. Alarm tested (Y/N) N.A. Date of pumping 5130 / 9 1 6„ 1'taacs SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /6(.' On adjacent lots > /Do Foundation To property line N5 Absorption field Surface water/drainage i 100 Water main/service line " 60' 72-026 (Rev. 3/91)Front MOA 21 - CONTINUED ON BACK PAGE C. LIFT STATION N• f}. 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) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed Length 5 "Pump off" level at Cycles tested Surface water _ 12 /,q/ sq Soil rating 2O1 8���` System type-fRENchI , / 1 Lyfire[ii1 Gravel thickness Total absorption area _ $12 a Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) PAS Total depth Date of adequacy test .5130 Al for Peroxide treatment (past 12 months) (Y/N) N If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1281 On adjacent lots 7 /°D Property line— 27 To building foundation IZ To existing or abandoned system on lot N,f} , On adjacent lots , 100' Cutbank N, . Water main/service line ti So Surface water > too' Driveway, parking/vehicle storage area 6D Curtain drain NoNe oBseRvED E. ENGINEER'S CERTIFICATION bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in eff&q{.Q,q4�e date of this inspection. AXt, �t�� Signature re.4� _ %Yla-v<– .c;' y'BDB°/�041�4Etl,,O/�°e EDCEe ° I^[JJ Engineer's Name Beee>a en• B o 1. Datelune 3. !99/ Tr+c r � 4, �'., C� 4Q �F1���()r c t c e. a �'�Y[(�E1��'✓ HAA Fee $ /f/ O- 60 Waiver Fee: $ — C Date of Payment _ Date of Payment Receipt Number 2 119S — Receipt Number 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) Location (address or directions) (b) Applicant Name�� Telephone: Home �' ��'I Business Applicant Address (c) Applicant is (check on3): �pnding Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); A (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address:// /% 2. TYPE OF RESIDENCE Single-FamilyA Multi -Family ❑ Other Number of Bedrooms d 3. 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. 4. SEWAGE DISPOSAL Onsite I; Public ❑ Community ❑ Holding Tank ❑ Note: If/f community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11184) 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 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 ����^-�•�`"� �t-6�;'�-=�A=`NA-elephone � _? Addre Date OF. A4.. M �geeor e000;qEngineer's Seal e e . ®Q * H 3 �+ �r o �Cr fSoo eo eeo eoeeer r esa.Q'e 0 a @ e TI{o;A A. FISCHER • Cr -6793 ���Q� d`.,/ ° r a o (." 6. DHEP APPROVAL Approved for bedrooms by \ Flqate Approved Disapprove Conditional Terms of Conditional Approval CAUTION MR_ 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. MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 R, 2 5 1995 264-4720 Legal Description:(�`r.�x o J"!V LV A. WELL DATA Well Classification 'eTTE- s If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N)_ Date Completed -� YieldlkI- ~> i Total Depth'Cased to Depth of Grouting Static Water Level k 3,A0 2TS Pump Set At Casing Height Above Ground i `r Sanitary Seal on Casing (Y/N) 1. Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) Separation Distances from Well: �, To Septic/Holding Tank on Lot On Adjoining Lots 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 t vy., Gscz ; Date Water Sample Test Results Comments* _F29��sa w�L B. SEPTIC/HOLDING TANK DATA Date Installed Z ,I %L Size �� �� -4 No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N)y—T Foundation Cleanout (Y/N) �t Depression over Tank (Y/N) ` Date Last Pumped Pumping/Maintenance Contract on File (Y/N) - for Holding Tank High -Water Alarm (Y/N) iND-Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well t To Building Foundation �9 To Property Line 47 To Disposal Field � f To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design tsic 44 l Date Installed ef- &- Length of Field Width of Fields Depth of Field Q fl i Gravel Bed Thickness Square Feet of Absorption Area F) Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: L / To Water -Supply Well I � '� To Property Line f� (. To Building Foundation ) To Existing or Abandoned System on ��ey /� r' Lot Yy I A7 ; On Adjoining Lots To Water Main/Service Line ��' f'`i— To Cutbank (if present) N To Stream/Pond/Lake/or Major Drainage Course N toll, To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments Dimensions Manhole/Access (Y/N) mp Off" Level at Vent(Y/N) Pumping Cycles during Adequacy TestMeets; MOA ** Check PerMitted Bedroom Rating Against HAA Request ** I certify that I have hecked verified, or nformed to all,M�OO and HAA guidelines in effect on the date of this inspection. Signed Date `-f7���'`a Company Wv1 r&-%%WrM1L- 09M_ MOA No. Receipt No. � JLo(i Date of Payment y - 2 N-ls`5_ 66 Amount: $ pis Page 2 of 2 72-026 (11/84) OF A4 TH ••rl�� Engineer's Seal a I 7HOM A. FISCHER ® p •'.• CE - 6793 Z� �✓ ffl�'r°°••......•°•��aw �Ilk V'p%a a\ .g