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HomeMy WebLinkAboutROSEBUD HILLS BLK 2 LT 2Rosebud Hills Block 2 Lot 02 #017-381-42 Municipality of .Anchorage ;•'°` '°'. Department of Health and Human Services Building Safety Division ,• Onsite Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 Pagel of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWSW030233 PID Number 017-381-42 Name: Wastewater System: ❑ New ® Upgrade Address: 5500 Ridqeview ndve� 99516 ABSORPTION FIELD Phone: Number of Bedrooms: "k4r.-JR05 It O Deep Trench O Shallow Trench ®Bed O Mound O Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: Block Lot: Subdivision: 2 2 Rosebud Hills- Depth to pipe bottom horn original grade: 3.0 Ft Gravel depth beneath pipe: Township: Range: Section: Fill added above original grade: J.0 Vt Gravel Length: 3n rt Well: ❑ New ❑ Upgrade Gravelwidltc 25 FL Number oflines: 6 Distance betweenlinsa: F1 Classification (Private, A, B. C): Existing Total Depth: Ft I Cased to: a— Total absorption area: 750 Fe Pipe Material: 30413VC/17810 HDPE Driller. Data Drilled: Static Water Level: Installer. Date Installed: TAN K Yield: P=P Set at: Casing Height Above Grand: GPM Ft. FI. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ublictPrivate Ma"aa"°r. Capecla From Tank Field Station Tank Sewer Line Existing Gal 118 161.2 ._ 101 Material: Number of Compartments: Well Surface Water 100+ 100+ LIFT STATION 67 11.5 Size: Manuracturer: Lot Line Gal. 6.7 54 'Pump on' level at: 'Poop off level at: Hph water a a m et: Foundation M M. in. 100+ 100+ Puny Make a Model Electrical Inspections performed by Curtain Drain Remarks:BENCH ExistingTank verified for Integrity. MARK Location and Description: Garage Slab Assumed Elevation: 106.0 FL Engineer's Stamp OF q� ♦♦♦ .•PSE ..•.. �•" 4. Inspections performed by: Pannone Eng. Svc Dates: 1"7/22/2003 as �`;' 49TH Jr.. ........ .... e ..... � 2"°07/23/2003 i Department of Health and Human Services approval p PP "' "' "" """""""" "'� � Steven R. F onnone; N Reviewed and approved by: Date: 9-19-0 (Rev. 11/99) 1r . ♦. J' N CE j8149 ••� ♦♦ •'•.., —V �•' �1 �c ♦♦*44''Ral55o: PERMIT NO: SW030233 DESIGN DRAWING WASTEWATER DISPOSAL SYSTEM LOT 2, BLOCK 2, ROSEBUD HILLS SUBDIVISION IN AG �-WA � ST LL 3 Y BALL VALVE S O 1 REPLACEMENT FIELD 25' x 30' x 0.5 E.D. NOTES: 1) All work sholl be performed in accordance with, and all materials shall conform to, DEC regulations. 2) Remove existing drain rock and in-situ soil contaminated with organic mott (assume 1.0' below bottom of bed). Import er materiol (sond)to--ring excavation to proper elevation. Dispose of contaminated soils. 3) Install new trench as indicated. 4) Install monitor tubes in opposite corner from clean -outs. 5) Verify integrity of the existing t$$��n Replace if holes are foundl i �?�• 49TM �°,� ,en R. Pannone i No. CE 8}49 i ,.•. TH # A B T1 8.4 47.2' T2 11.3' 55.0' C01 13.1' 57.5' CO2 19.0' 60.4' BR 19.6' 61.0' E1 34.7' 75.5' M 1 55.0' 96.2' M2 73.9' 116.5' M3 70.7' 103.8' M4 86.9' 123.7' F1 86.0' 122.2' F2 83.3' 118.8' F3 80.6' 115.5' F4 78.0' 112.2' F5 75.4' 108.8' PREPARED FOR: Wade Srock 5500 Ridgeview Dr. Anchorage, AK 99516 EXISTING WELL P.I.D. NO: 017-381-42 RADI�S 100' 118.0 3 -BR 15% JODI T2 an ; _`-VERIFj' NTEGRITY 0 EXISTING 1250 GALI TANK I r 0 12�EXISTING z DRAINFIELD "___.1 IN FAILURE H #2 5% f� m 0 2 30 NO WELLS WITHIN 100' OF EXISTING SEPTIC SYSTEM 10 DESIGN: PERC RATE: 1-5 MPI APPLICATION RATE: 0.8 3 BR HOUSE/ 450 GPD REO'D AREA: 560 SF USE BED SYSTEM 25' WIDE x 30' x 0.5 El 750 SF TOTAL / PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P. 272-8218 Fox ATE: 8-14-03 AS -BUILT SALE: 1 '=601 '=60' PERMIT NO: SWO30233 AS -BUILT DETAILS WASTEWATER ABSORPTION SYSTEM NOTES: LOT 2, BLOCK 2, ROSEBUD HILLS SUBDIVISION 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO, AMC15.65. 2) ADD A MINIMUM OF 2" OF R.I. OVER ENTIRE BED. ino Nr310 3) MAINTAIN 30' SEPARATION FROM ALL SLOPES GREATER THAN 25%. 0 !no NY313 o' u € N O c6^ 00 r0 100 NY310 ....i..... ....................I.....� r r PREPARED FOR: ♦ G� ;• ,: Aw 1� �• CE 8149 ��. �� �p•�� Wade Srock 5500 Ridgeview Dr. oo yl I�I} ` 38% LOLNOr u 3 IL o o'r) u_ v• n v V p va z _O U w V) n N NO Ntl3l: Y U o a N rn c 'o P � � 2 O M O O , Co 0 !no NY313 o' u € N O AMW 49 100 NY310 ot ••. `.�p�..............'qC Ar epo AMW 49 ....i..... ....................I.....� ' '•' .............'�" ' i ♦ � :Steven R. Pannone � PREPARED FOR: ♦ G� ;• ,: Aw 1� �• CE 8149 ��. �� �p•�� Wade Srock 5500 Ridgeview Dr. ip Anchorage, AK 99516 P.I.D. NO: 017-381-42 —U) ror.� Co00 LL. N Pannone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX 4TE: 8-14-2003 IOT TO SCALE AS—BUILT MUNICIPALITY OF ANCHORAGE Development Services Department 1 On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jul 02, 2003 Expiration Date: Jul 01, 2004 Permit Number: SW030233 Parcel ID: 017-381-42 Legal Description ADD=FIIstS Btk=2 LT.=:2 r Design Engineer: 0062 Pannone Engineering Services Site Address: 005500 RIDGEVIEW DR Owner Name: Wade & Kari A. Srock Lot Size: 51367 SQ. FT. Owner Address: 5500 RIDGEVIEW DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99516-3022 This permit is for the construction of: Q 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 catling (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: Issued By: a fmw_r� Date: ` v 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 SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING ell 1`11 ift S. ZD Parcel I.D. 017.38142 Permit Number SW 030.Z33 Property owner(s) Wade Srock i - t A- Day phone 345.1605 Mailing address (1) 550;Ridaeview Drive Mailing address (2) Anchorage, Alaska Zip Code 99516 Legal description (Lot, Block & Sub'd.) Lot 2. Block 2 Rosebud Hills Subdivision Legal description (Section, Township & Range) T12N R3W S27 Lot Size 51,367 SF Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I 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: 1400 c!U Date of Payment: o a Receipt Number: (Rev. 12/00) `7 J Waiver Fees: Date of Payment: Receipt Number: Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax June 23, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 2, Block 2, Rosebud Hills S/D Septic System Permit Request Gentlemen: My firm was asked to investigate a replacement septic system serving this lot. Two test holes were excavated on June 10, 2001 on the lot. The soils report and a percolation test result are attached. No ground water was encountered while digging the test holes. The lot is approximately 51,367 square feet in size. Lot 2 slopes to the southwest at approximately 5% percent in the area of the test holes. The proposed installation will be located on the western portion of the lot. The proposed location is greater than 100 feet away from existing & neighboring wells. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached Design and Specifications. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, •` `a"'A� "Ot• • `9 Steven R. annone, P.E. 49T4 : z} Civil Engineer Attachments: VA_lSle ^en R' Ponnon 1. .n•. Nl-� CE 8149 , Ess+6 1114YAwk •`• E:\Work\L2 B2 Rosebud Hills SD\L2 B2 Rosebud Hills.doc PERMIT NO: DESIGN DRAWING P.I.D. NO: WASTEWATER DISPOSAL SYSTEM LOT 2, BLOCK 2, ROSEBUD HILLS SUBDIVISION c \/ IES �DR. .0C 1. EXISTING WELL 1 �� a LL 3 -WAY DS BALL VALVE- TH # PROPOSED 1 REPLACEMENT FIELD 25' x 30' x 0.5 E.D.- NOTES: 1) All work shall be performed in accordance with, and all materials shall conform to, 3 DEC regulations. 0 ci 2) Remove existing drain rock N and in—situ soil contaminated with organic matt (assume 1.0' = below bottom of bed). Import filter material (sand) to bring o excavation to proper elevation. 10 Dispose of contaminated soils. m 3) Install new trench as N N indicated. J N 4) Install monitor tubes in N opposite corner from x clean—outs. 5) Verify integrity of the 0 existing tank. Replace if holes o are found. W �=Steven R. Pannone r �%. NACF.8t4s 7.0'- 1 OV .0' W11. Wade Srock 5500 Ridgeview Dr. Anchorage, AK 99516 WELL RADIUS 100' EXISTING I 5% 3—BR �,1�� I 3 8 VERIFY INTEGRITY OF I EXISTING 1250 GAL. I ANK II ' III�EXISTING DRAINFIELD z IN FAILURE M ---� 10.0' 5% r0 TH #2/ m 2 3(--) NO WELLS WITHIN 100' OF EXISTING SEPTIC SYSTEM 10 DESIGN: PERC RATE: 1-5 MPI APPLICATION RATE: 0.8 GP 3 BR HOUSE/ 450 GPD REQ'D AREA: 560 SF USE BED SYSTEM 25' WIDE x 30' x 0.5 E 750 SF TOTAL PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax ATE: 6-22-2003 DESIGN SALE: 1 "=60' PERMIT NO: DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM NOTES: LOT 2, BLOCK 2, ROSEBUD HILLS SUBDIVISION 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO, AMC15.65. 2) ADD A MINIMUM OF 2" OF R.I. OVER ENTIRE BED. Ino NV37r 3) MAINTAIN 30' SEPARATION FROM ALL SLOPES GREATER THAN 25%. M O I T 7 D N O N I 0 • E..... O F -- W m Wode Srock 5500 Ridgeview Dr. Anchorage, AK 99516 38n1 M01iN01 im Hm 1n0 NV313 ln0 NY313 P.I.D. NO: c W u$G W J_ L1_ 0 n Ponnone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE & FAX 4TE: 6-22-2003 OT TO SCALE DESIGN �� SOILS LOG - PERCOLATION TEST •" ""� . '�y1 •♦♦ PANNONE ENGINEERING SERVICES : , V .:' '; 19:10 ---- P.O. BOX 102954 T" 0 19:20 10 ■....... .. .. ..........:... 0. ; t• ANCHORAGE, AK 9951010 ---- 6• ---- (907) 272-8218 .................... ................ 10 2• 4• ♦':Steven R. Ponnone ♦�� No. CE �81r49 ♦•/ ?" 2 `����•, PERFORMED FOR: Wade Stock...... PERFORMED: 6-10-03 ••• 11,11 ��� ••• LEGAL DESCRIPTION: Lot 2, Block 2, Rosebud Bills S/D TEST }TOLE 1 SLOPE SITE PL N 1 ML Brown Silt ` \ S� 2 IEW DR. 3 RID GEV " WELLS 4 rat RADIUS loo' s 6 �0�� rH TEST HOLE a j GM Gray Silty g Sandy Gravel Cobbles and 10 Boulders 7H 12 2 13 11 3 12 0 13 WAS GROUND WATER SLOPE M 14 ENCOUNTERED? NO Y � 15 IF YES, AT WHAT W 16 DEPTH? -N/A- TEST HOLE cr 17 BOH DEPTH TO WATER AFTER N m MONITORING? VT N IS DATE: 6-•tw-2003 J (� N0 19 READING DATE GROSS NET DEPTH OF NET 20 TIME TIME WATER DROP 2 6-10-03 19:00 6• ____ v 19:10 10 2• ♦• a d N O OfN m N J Y 0 O 3 PEROLATION RATE 2.5 (min/inch) PERC HOLE DIAMETER 6 inches 4i v TEST RUN BEWTEEN 3 FT and 4 FT u 2 In COMMENTS: Test hole excavated by Dan Beeks. Test Hole was presoaked before perc test on PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE o WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST 19:10 ---- 61/8• ---- 19:20 10 2 I S• t• 19:20 ---- 6• ---- 19:30 10 2• 4• SOILS LOG - PERCOLATION TEST �.............. ��P E 19:50 10 2' 4' 19:50 PANNONE ENGINEERING SERVICES 6 1/8' •':•; 20:00 P.O. BOX 102954 2 18' TH 49— �.....:. .. .. .................• 20:00 ANCHORAGE, AK 99510 61/4' • 20:10 (907) 272 8218 2 1 4' �......:............. ... .............. . 10 �,� Steven R. Po none i No. CE 8149 .i % X1306?3.•°'� PERFORMED FOR: Wade Stock DATE PERFORMED: 6-10-03 1Q:�ea�� LEGAL DESCRIPTION: Lot 2, Block 2, Rosebud Hills SID TEST HOLE 2 SLOPE SITE P 1 ML Brown Silt Sv DR 3 p DEV IE�J EtSTN6� wELL 4 5 ^\ �� WELL RADIUS 100• 6 OSS T„ GM Gray Silty I 9 Sandy Gravel Cobbles and 10 Boulders TEST HOLE 11 TH 12 3 3 12 0 N 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? NO x 15 IF YES, AT WHAT 16 DEPTH? -N/A- TEST110LE M BOIi DEPTH TO WATER AFTER 03 17 MONITORING? Tt} D1"r 18 DATE: 6 (S -2003 N 0 19 READING DATE GROSS NET DEPTH OF NET TIME T17,1E NATER DROP " 20 6-10-03 19:40 6' ---- x v a a v 0 tyN DO N J Y 0 O 3 PEROLATION RATE 2.5 min inch PERC HOLE DIAMETER 6 inches LJ TEST RUN BEWTEEN 3 FT and 4 FT v V COMMENTS: Test hole excavated by Dan Beeks. Test Hole was presoaked before perc test. cr PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE a WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. v 19:50 10 2' 4' 19:50 10 6 1/8' "-' 20:00 10 2 18' 4' 20:00 ---- 61/4' ---- 20:10 10 2 1 4' 4' ^ Municipality of Anchorage Page --I--of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S\j 920133 PID Number: 017381yy Name: Wastewater System: ® New ❑ Upgrade 5,r O J< Address: ABSORPTION FIELD C7, Boy, ItZ3 Phone:\ 5'(9 `1- �6 3 3 CW vk 1 No. of Bedrooms: Bed Mound 1-1 Other O Deep Trench EJ Shallow Trench ❑ LEGAL DESCRIPTION Soil Rating: pO Total Dep'orede: GPD/S Ft.V,ar.^ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe �i 2 2 eUSC 6kAeA Nt iiS 3 , & Ft. CJ ; Ci Township: Range: Section: Fill added above original grade: Gravel length: t l 3 �✓ 2'� /,0 Ft. ) 8 ., Ft. Gravel width: Number of lines: Distance between lines: WELL: DQ New ❑ Upgrade Ft Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: U`^ S� _21,0 Ft. /30 Ft. SQ. Ft. .� r.. 1/,. Driller : Y: Date Drilled: Static Water Level: Installer: 5r(A Date installed oja n� JG -Nsor 6/3192 I�i Ft. Yield: --�6,:oU,4J `.� Pump Set at: I Casing Height Above Ground: TANK (/Z GPM 200 Ft. Z Fl. SEPARATION DISTANCES '.Septic [J Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Ate-. i s ti Capacity in gallons: 1z 56 From Tank Field Station Tank Sewer Lines a„kc UJ -8d 5 Material: Number of Compartments: Well I��` '��/ `� ...- r 5%L��'c�L 0- Surface Surface m LIFT STATION Water e Lot,� / /ti.. �, r y m Size in gallons: Manufacturer: Line "Pump on" level at: "Pump off" level at: High water alarm at: Foundation 12- _30' Curtain �, Pump MakeBModel Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: Set. • Of,_ CIS eC S Assumed Elevation: LL T !4 s YYd�,1 Gil ENGINEE$,FAL yy� `� ©' e•�•� �t 1 � y .e •'die � ��'.� N Inspections by: P'�r�ta�l S��Ie��l Dates: 1st S rtl9Z.•N 9 ••• .l,Up •NN.N, [.•1K1uM+ performed ' 2nd 'gh 97- SIMP n �+} Job rl Department of Health and Human Services approval p � dog1•.,, CE -666 ,.F`�� F .. ....,,,.,.�� r �� s91ed�'�;,;;;-•�'� Reviewed and approved by: �? `� Date: 3-/Z 79_n121nov 9/Q11 MOA 25 Permit No. SLJ 92 O 1 `'S3 Page 2 of a Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 11, 91,gc k 2, Aose_6uk hills, gobs, PID No.: ()1�?38/Y2- R11�GEVIGw !B wt;Ll. j 8= fZ50 G0'1, Nouse 1�5 i a' 3' i r3 0 73/ 37? (7 �SLOPF@'% X03 PE 9-T-6 ST Y7 68 v __ Gs. T 6 IOq' TEs'7' 1-/tE i y/ 120'; i 1 8AcKr11-_L Yr - NATIVE RR49th • t G2 UN I Geo rrA"BRIE F John Earl SimP�q( � 5£wsR PtacK l*e� CE -8061(/ y' P R PIPE (-rvp.) s c r)i 72-013 A (2191) MOA 25 KEN_JOHNSON_DRLG TEL No.907-243-4852 Ru9.10.92 11=29 P.03 KEN JOHNSON DRILLING CO. WATER WELL DRILLING PUMP SALES AND SERVICE 38 Years Alaska Drilling (907) 243.2281 KEN JOHNSON FAX (907) 2434M - 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 WADE L. SROCK AUGUST 3, 1992 P.O. BOX 112863 ANCHORAGE, ALASKA 99511 RE; LOT TWO BLOCK TWO ROSEBUD HILLS SUBD. WATER WELL LOG 0 FT TO 2 FT ORGANICS..BROWN Oia�l3� 2 FT TO 21 FT BROWN SILT WITH MED. GRAV 21 FT TO 41 FT MED. GRAV & GRAY SILT 41 FT TO 60 FT SILTY SAND 6 FINE GRAV 60 FT TO 81 FT SANDY BROWN SILT 81 FT TO 90 FT SAME WITH COURSER GRAV 90 FT TO 100 FT COURSE GRAV 9 GRAY SILT WITH COBBLES 100 FT TO 110 FT SAME WITH COURSER GRAV 110 FT TO 125 FT COURSE GRAV & GRAY SILT WITH COBBLES 125 FT TO 128 FT BEDROCK ( SOFT ) ( DRY ) 128 FT TO 138 FT ROCK..MED. HARD..DRY GRAY 138 FT TO 160 FT ROCK..GRAY ..HARD 160 FT TO 165 FT ROCK..GRAY ..MED. HARD 165 FT TO 168 FT ROCK..GRAY ROCK SOFT 168 FT TO 188 FT ROCK..29 FT H2O WEEPED IN OVER NIGHT 188 FT TO 190 FT ROCK ..HARD WEEPS H2O 190 FT TO 204 FT ROCK..SOFT 48 HR STATIC 116FT. H2O 1/2 GPM 204 FT TO 208 FT ROCK HARD.. GRAY 208 FT TO 250 FT ROCK..MED. HARD WEEPS STATIC WATER LEVEL, 116 FT BAILED WELL OUT 3UUGALS. IN 20 MIN. WELL RECOVERS AT 1/2 GPM WELL HAS OVER 100 GALS PERCHED WATER TOTAL CASING 130 FT RECEIVED OR 2 6 3993 Municipality of AnChDrage Imp% Hewth & Human sa aces MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 PAGE 1 OF 1 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT P' PERMIT NUMBER:SW920133 DATE ISSUED: 6/16/92 DESIGN ENGINEER:ARCTIC GEOSCIENCE EXPIRATION DATE: 6/16/93 OWNER NAME:SROCK WADE L & (yl OWNER ADDRESS:P.O. BOX 112863 n ANCHORAGE AK 99511 - 1 h - I �! L) PARCEL ID:01738142 LEGAL DESCRIPTION: ROSEBUD HILLS BLK 2 LT 2 LOT SIZE: 51367 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK /WELL SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. ADDITIONAL TEST HOLE MUST BE INSTALLED TO VERIFY SUITABL OILS AT/THE PROPOSED REPLACEMENT SITE. RECEIVED BY :r�Le�� r/1li%9�i> DATE: �- ,. ISSUED BY* _�o N-Nt S r((TH DATE: (S�myo ? - i LLJ z J w W W C d Z � I � w _ 2es o 0' I M w w J Lu Lu C W d J I W Tn'wa \ w _ Z I O 111 11� J w `j w ` Li N W T z to N W I I W j cao�5c H oz - -10 �O \� 3 W D?,AIUAGE EASENEN7 t BADE ER_CANE SEWER. SYSTEM PLOT PLAN ARCTIC GEOSCIENCE fe- J Ow AP ROY -SCALE. I I"=100'. L,0T,F 4 LOT 3 BLK2 ROSEBUD HILLS SUBR r,uFF I 2 „r 7 d W d r c W IJf= \\ O W f ¢ O w W E- CL ( a W \ d N H o � O (fin , V� �' o a 0 O 111 11� J w `j w ` Li N W T z to N W I I W j cao�5c H oz - -10 �O \� 3 W D?,AIUAGE EASENEN7 t BADE ER_CANE SEWER. SYSTEM PLOT PLAN ARCTIC GEOSCIENCE fe- J Ow AP ROY -SCALE. I I"=100'. L,0T,F 4 LOT 3 BLK2 ROSEBUD HILLS SUBR r,uFF I 2 „r 7 -:. Nj I , \ :-P ROPOSED \ WELL d 4 PIPE ASTM D3034 SO�� Sk PROF. 1�5cll P20P.--ABU 2 M TAW K—�ti 0 >6" - HOUSE 4p 0 MOAT ITOR PIPE f PROPOSED BED b C�p LOT 2 BLK 2 RDSEBUDIH ILLS 6EO FAGMC. m 06 O O O O 1271:. ISEuee 10M 4 PUF PIPE--(TYP.) CROSS SECTIONI OF BED SEWER SYSTEM DESIGN ARCTIC GEOSCIENCE r AP ROX. SCALE I"= 50' LDT_2 $LK_2 ROSEBUD HILLS SUED 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST tENGINEER'S SEAL) PERFORMED FOR: I I P LJADE Sgo(� K DATE PERFORMED: I'1AX 8,1992. LEGAL DESCRIPTION: LOTBL K 2 RrxEp-op H I LLSTownship, Range, Section: T IZ N 2-� W S 27 A,Fn�O0(.ANIGS SLOPE SITE PLAN •7'-6" ML -6M Lt, Bet-, SILT w/ -SO E GEAVEL 6M L+.13ZN SILTy6j.EAVEL MEMO ONION ■NINE Milo ■NIM■ ■Nig■ ■■M■ ■UN■ NONN WAS GROUND WATER ENCOUNTERED? YES ML Lr. BF -vv. S I LTIF YES, AT WHAT TPAcE 6,,,l IF --VGeFD. WA76K S L ti 12, 0 P E Depth to Water Alter Monitoring? ��' -3 Date: ing& Reading Date Gross Time Net Time Depth to Water Net Drop SS 2 /:Z-1 JO' 2 1:37 lorr r .46' • 04' 1:37 So' 3 / :47 /O r,; 4 .0 3, :4 7 gip, 4 : 57 10m;A G • oZ ' S 6,O' s :07 /Om;n 4 Oz' O So ' 6 Z %/7 lor';r, 48' • OL' 20 IuI PERCOLATION RATE 41•67 (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN 3.5 FT AND + FT COMMENTS M L-6 M SOI L PF RC, TEST E 3..5'- 4 O' -Tki DiCATES A SOIL PATI W(7 6NAN VSTEC) B blmM"'-- PERFORMED BY: J rP Q Y V'P F c � I dl�li A w4, n4) CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 92-0012 SHEET 1A of 3 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL DESCRIPTION: LOT 2 BLOCK 2 ROSEBUD HILLS ( see sheet 2 of 3) OWNER: MR. WADE SROCK A. GENERAL 1. The well and septic plan are for single family residence only. 2. The drawing and/or site plan shall be part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation (DEC) requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. Upon completion of the excavation, soil conditions present in the walls and floor of the absorption bed should be logged. In addition, a test pit should be dug between the permitted bed and the proposed reserve bed to a depth of 4 -ft. below the base of the absorption bed to verify consistency of onsite soil conditions. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, and State DEC requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is prudent that a surveyor locate the nearest lot line position and the location of any easements. 9. Inspection of onsite wastewater disposal system installations are required, and shall be in accordance with the Municipality of Anchorage Wastewater Disposal Regulations Section 15.65.150 92-0012 B. SEPTIC TANK SHEET 1 B of 3 1. The septic tank is to be a two compartment, steel tank approved by the Municipality of Anchorage. 2. Two standpipes are to be installed on the septic tank to provide access to each compartment. Two cleanouts are to be installed. One between the tank and the foundation clean out, and the second between the tank and the absorption bed. 3. The septic tank is to be insulated with 2" of HD Styrofoam if the soil cover over the tank is less than 4 feet. C. ABSORPTION BED 1. The bottom of the absorption bed shall be level, plus or minus 1.5". 2. The absorption bed gravel is to be covered with geofabric material. 3. Two cleanouts and one monitoring pipe are to be installed in the bed. 4. If the native fill material over the absorption bed is less than 3 feet then the bed should be insulated with 2" of HD Styrofoam. The insulation should be placed above the geofabric on a six inch layer of bedding material. 5. The fill over bed should be graded to prevent ponding of surface water. 6. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200' to any Class "A" well. D RECOMMENDED ABSORPTION BED DIMENSIONS 1. Proposed Absorption Bed : 30' wide X 58' long = 1740 sq.ft. Total depth = 3'-6" Gravel depth = 6" ( see sheet 3 of 3) 2. Percolation Rate = 41.67 min/in. ( see Municipality of Anchorage Soil Log - Percolation Test for Lot 1 Blk 2 Rosebud Hills) Q Bedroom)(150 gallonsep r day per Bedrooa = 1500 sq.ft. 0.3 gpd/sq.ft. 3. Septic tank size = 1000 gallon minimum. Municipality of Anchorage V O `•` fib,` Development Services Department Building Safety Division = On -Site Water and Wastewater Program "' 4700 South Bragaw Street 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. 017-381-42 1. GENERAL INFORMATION Complete legal description Lot 2 Bk 2 Rosebud Hills HAA # O 3 O /S Expiration Date: / / — 9 - D 3 Location (site address or directions) 5500 Ridgeview Drive, Anchorage, AK 99516 Current Property owner(s) Wade Srock Day phone 345-1605 Mailing address 5500 Ridgeview Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 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 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to home owners. 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 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. (P�. t1ss) 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eng. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 9TIr-7103 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious 0 engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The *•P reported results describe the performance of the system under the conditions encountered at the time of C the test, and separation distances measured to readily identifiable features. The operational life of all i •. wells and septic systems depend on the local soil condition, ground water levels that may fluctuate i {S during the year, and the water usage of the family being served by the system These conditions are 00,.. outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results 00. 0 / do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects ...1e ;....;Z; or encroachments. PES can therefore not provide any warranty for future performance nor give any . � Ste estimate of how long the system will continue to meet the operational requirements of the ADEC or 0, 0 MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon ## '•., or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. ,f.. 6. DSD SIGNATURE to-� Approved for 3 bedrooms. L.m..a% OF A ,en K. Hannon No. CE 8149 Disapproved. Conditional approval for bedrooms, with the following stipulations: '• i J Additional Comments WATER AND Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory WASTEWATER =� DD�DAmmAA�_ O' Jai "f/l�••• • •�\`� ��/�,.'•�CNr SES ..���� Maintenance Agreements Supplemental Engineer's Report Other By: a:: _� Iu. / Original Certificate Date: Expiration Date: Reissue Date: (Rev. 11199) Municipality of Anchorage *A9 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2 Bk 2 Rosebud Hills Parcel I.D.: 017-381-42 A WELL DATA Well type P If A, B, or C provide PWSID # Well Log Y Date completed 813/1992 Sanitary seal x Wires properly protected y Total depth _;§O ft Cased to 130 ft Casing height (above ground) 12+ In. FROM WELL LOG AT INSPECTION Date of test 8/3/1992 7/25/2003 Static water level 116 ft 116 ft Well production .5 9 -p.m 1.2" g.p.m WATER SAMPLE RESULTS: Coliform _k_colonies/100 ml Nitrat 0.1 mgll Other bacteria 0 colonies/100 ml Date of sample: 0/1 12M00 - ,olle ed by: Laura Pannone/Brian Wllev Aarow PumalWell B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 8/14/1992 Tank size 1250 gal Number of Compartments & Cleanouts Y Foundation cleanout Y Depression over tank hI High water alarm N/A Date of pumping 5119/2003 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date Installed V22/2003 Soil rating (g.p.d.lft2 or f12/bdrm) 0.8 System type ,Bed Length eft Width ,25 ft Gravel below pipe 55 ft Total depth 4 It Effective absorption area We Monitoring tube.Y Depression over field fi_ Date of adequacy test Results (Pass/Fail) as For 2 bedrooms Fluid depth In absorption field before test A m Water added gal. New depth in. Elapsed Time: Q min Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date (Rev. 11/99) D. LIFT STATION Date installed _ "Pump on" level at Datum N Size in gall o s in"Pump off" level at Cycles t ed / Manhole/Access In High water alarm level at in _ Meets alarm 8 circuit requirements?. E. SEPARATION DISTANCES " SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 118 On adjacent lots 100+ Absorption field on lot 161.2 On adjacent lots 100+ Public sewer main NIA Public sewer manhoWcfeanout NIA Sewer /septic service line 25'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 6.7 Property line 67 Absorption field 27 Water main NIA Water service line 25'+ Surface water 100'+ Drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11.5 Building foundation 54 Water main NIA Water Service line 25'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+ Curtain drain None Observed Wells on adjacent lots 00'+ F. COMMENTS G. ENGINEER'S CERTIFICATION4V-\T. •••.. AV I certify that I have determined through field inspections and : �" 49TH / V •�': review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date....;. "....... ................ �7sStcven R. onnone�0 ♦ C) Engineer's Printed Name Steven R. Pannone. P.E. �� S s , n. C A t 49.. Rate Pal x!0`3 •.� ............... 'tia :�• HAA Fee $ 15 "t '0 X V6V1 Date of Payment g Receipt Number. !V 020 R (Rev. 11/99) Waiver Fee $ _ Date of Payment Receipt Number A V G;.Q - 20 03, 02:21 AM / ?S WATERWELL -TMST PUMP REPORT Coadoct p.©1 Owaer. &Jd d 4t 5ch fine I &ddre", — Wap Location ird 2` Jt b Well information: Total Depths Depth of Cuing. Screen From To _ Culn` tiize: _ !kreta Diamt screen Slot: Remarks: Pump Information Intake Depth: Pump Sin Air Llne MOM _ Static Water Leel: _ Av. Diaekarse: GPM, Mai Dr*wdwa- _. Pump On Time: r._,_._Dote:7�� Pump Otf; Time: Date: Time water, j Flow Remarks L"el GPM Jul 11 03 Olilla SROCK 3460120 p.l w,,, aja 4[40; Aug -12.03 4:38PM; Page 111 OS -23-O7 11:13AIA FROh-UIE ENVIRONANTAL SRV 1015515301 7-878 P,02/03 F-657 SGS Rete 1032703001 Cheat Name AK Water & Wastewater Consultarnt Inc. Preject NameN 3500Rldtteview Coent Sample t0 Rt 2, S1: 2, Rosebud Hills Matrix Drinking Water AN Datcarrlmes are AlaskY Standard'nme PrintaiDstelrime 05/2=00 7:29 Collected Dste(rlme 05/1912003 8:09 Received Datamme OS/L912003 10.43 Technkal Directory Stepph/en c Ede Reteaaedl, y Sample Fonar!&: AlloweYe Pmp ArelYsis Paremew Rnulu NOL Univ Methal Lifts Dale Data Irl; Natern Department Nitrate -N 0.100U 0,100 mglL EPA300.0 (<-10) OS/19,03 JS Kicrobiology Laboratory TotalCbltfotrn 0 coMOomL SM1892228 (�1) 05/19K13 KAF Ll ;EV � BN_ DR 1YE - - - J LOT 1 t 4 N 89"59AT E 200.19 GRAPHIC SCALE t Arch " 50 fwt A 115 o 45 A 56 100 FOR: WADE SROCKLem 5-9-01 Grid 1" = 50' AS—BUILT vescri bion Lot 2 Block 2 LanMark ROSEBUD RILLS 8"""" `g& WW.Png I= 2B37 2100449 9330 Vanguard Drive, Suite 203 e, Alaska 99507 SUBDIVISIONAncho Drawn b Y Field Book (90`077) 562-6050 R.J.B. #170 I hereby certify that the property described hereon has been surveyed by me, or at my direction• and that the improvements situated thereon ��t OF A 'It AW .�`, . • • • • • . �,Q are within the prop* lines and do not overlap or encroach on the lying thereto � Q ,•' ' ,s � •.'f' property adjacent unless otherwise shown. That no Improvements on the property l�in� adjacent thereto encroach on the In that there transmission �* '• 49� */� premises question and are no roadways, / / Hass or other easements on said property except as shown.�•'�•• •••••••••••••••'•� It Is the responsibility of the owner or builder, prior to construction. .. BE W • CHN2LES E FORGES o to verify proposed building grade relative to finish grade and utility /� �.•• LS -7326 •.' a-aAW w oonaaotions and to determine the existence of any easements, covenants. or restrictions which do not appear on the recorded subdivision plat. �� 0- •,• •,• So�Aw Usted distances prevail over scaling. �d'e�u/ •••••p\\ac00 Reproduction may cause distortion. 1�\ esEloa � 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 Parcell.D.# 017-381-42 HAA# HA930238 1. GENERAL INFORMATION Complete legal description Lot 2 Block 2 Rosebud Hills Subdivision Location (site address or directions) 5500 Ridgeview Drive Property owner Wade Srock Day phone 564-7653 (w)-145-1605 Mailing address 5500 Ridgeview Drive Anchorage, Alaska 99516 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three (3) 3. TYPE OF WATER SUPPLY: Individual well XXXXX Community well Public water Day phone Day phone 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 XXXXXXXX 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 Alaska Water & Wastewater Services Phone 337-6179 Address 8471 Brookridge Drive, Anchorage, Alaska 99504 Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. 0 M�a bedrooms. Conditional approval for Date Y bedrooms, with the following stipulations: Additional Comments This is to replace the original Certificate that was lost A copy of the original with engineer's signature is on file at 343-474*2 If stions, please ca.il _ 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 orderto 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 M}i 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. # U ( % 6 1+A HAA # �) i�S 2D 2.3& 1. GENERAL INFORMATION Complete legal description W—C ZT� � (20SIE-90- Riu's 2. 3. 4. Location (site address or directions) .55Do IZtD(�Ev16�) Dom' Property owner. . i y"F Sty cid'- Day phone 13-64 -765,E 34-5 lbo�5_ A�_I- Mailing address Lending agency /A- Day phone ?v A Mailing address ^ 1A Agent /V Address Day phone Al 1A Unless otherwise requested, HAA will be held for pickup. P--- NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water X Pzea�-sC-- CA -GL prj,PJ� ovj,,j6/L F --- 2P, t0lc46P0Q 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` " W Address IiN4 _7 i Engineer's signature 6. DHHS SIGNATURE M 6 Approved for bedrooms. Disapproved. Conditional approval for Additional Comments SVC' Phone 7") Date s , 1 om:!"�o`*V OF A 44 ggr)ly A. Gurneb<1 , CE -7953 ..otoo* Soo 4%X190FESSIONP�� bedrooms, with the following stipulations: 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 orderto 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 MOA821 Municipality of Anchorage Department of Health & Human Services M� HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WT 2-,_ Z, 00S�LIP Parcel I.D. 017 3 0 1+ A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number A Logpresent(Y/N) NES Date completed � 3 572- Driller Total depth 290 Cased to i 9D Casing height Sanitary seal (Y/N) yias Wires properly protected (Y/N) ya--S CD FROM WELL LOG Date of test —0hf' Static water level Well flow _ ©�- 9•p•m• Pump level AT INSPECTION SEPARATION DISTANCES FROM WELL TO: i Septic/holding tank on lot I Z O ; On adjacent lots i Absorption field on lot 130 C ; On adjacent lots Public sewer main /q/4 3Public sewer manhole/cleanout A / . n Sewer service line r �/� Petroleum tank e4 -JA ,>i /00i WATER SAMPLE RESULTS: Coliform 56 Niitrate/ ON�� � � Other bacteria. Date of sample: �4 4h -h-3 t 1'44 `3 Collected by: nr,q O�&e 6 &,4-c_-pse_i4. B. SEPTIC/HOLDING TANK DATA Date installedLt /T 2- -Tank size III, ompartments Cleanouts (Y/N)' S. Foundation cleanout (Y/N) ti Depression (Y/N) High water alarm (Y/N) iq /� Alarm tested (Y/N) IS! Date of pumping Pumper /V .44 SEPARATION DISTANCE FROM:SEPTIC/HOLDING TANK TO- UI O- I /. -U: Well(s) on lot On adjacent lots ��U Foundation , Z To property line 60 Absorption field Water main/service line 5iD�S Ci i= Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION %,/ n(. IA Date i led Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump vel at ump off' level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION NCE FROM LIFT STATION TO: W n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA e�1 0 I Date installed ) Soil rating. FT2 System type��� o 6" Q Total depth �J Length 156°4' Width �`� ° � Gravel thickness CO Total absorption area I i40 Cleanouts present (Y/N) z Depression over field (Y/N) NO Date of adequacy test Results (pass/fail) �/ for At 1A bedrooms Peroxide treatment (Past 12 months) (Y/N) % If yes, give date _ /y 1A SEPARATION DISTAN& FROM ABSORPTION FIELD TO: 62DJ 1 / ' CwSJ=s7' Well on lot 1 3 On adjacent lots �? ��� Property line 54,6 �a'-/ !O To building foundation To existing or abandoned system on lot N / r4 On adjacent lots 026,06'1-7`1 U r- Cutbank A �' Water main/service line t J o�� H-VJ4,Sa 2� Surface water NU,`)JC-- 0eS6 &.,0 z Driveway parking/vehicle storage area AZO J Curtain drain I ° I �> r- "VIY tea 'pleit� 5;J7'-- 21 E. ENGINEER'S CERTIFICATION 3, AS �Be�tL,— SvP_v1�`J li/, tom I certify that 1 have checked, verified, or confor ed to all MOA and HAA guidelines in effect on the date of this inspection. Signature /11 Engineer's Name Date 5INA-1 3 HAA Fee $ Date of Payment Receipt Number co -1 Waiver Fee: $ Date of Payment Receipt Number ,YA.Gso CE -7953 pROFESSO,�" Alaska Water 8c Wastewater Services "Preserving the Last Frontier" S/p E t �-� ] S CAC ' 44—p—J-7C- -S Ys S ice = ()'Aj L-�e Jam-- 1� u III Wim-- !-o VV Fix W)�_puuNa pv�5 c -S)tej Caj2.F- L11 PV--- fc�,� l��HZ7 CF'C7 V" S c-) y sw q-�b -0117/ 1w� 961-- Telephone 6 Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 III Wim-- !-o VV Fix W)�_puuNa pv�5 c 5�c eoNrt�f"'776'J -S)tej Caj2.F- L11 PV--- fc�,� l��HZ7 CF'C7 V" S c-) y sw q-�b -0117/ 1w� 961-- Telephone 6 Telephone - Fax 338-3246 0 8471 Brookridge Drive 0 Anchorage, Alaska 99504 \rAoic,aT— GOT— Tu �R�� cera S//o/e13 � g gA9Is OF s WIN* / �,zoz.3s' a-1e7.40ELEV/112.5 m $1 Wim— 59.9 y FL e*. 110.0 III F. 5/0' BEOW ` ELEV. 97.0 / / g• 's N 2' EAVE ' OVEBFD POSCII C 22.00' 22.00 ' 75.7 10.0 2.0 PROPOSED 1' EAVE WISE S fol 20 F.P. CAN1 ' f' CWf F.F. ELEV. 109.5 � ,gFyy _ � �, /tel .• nn• N O 78.3 1 O In O -J LOT 1 v BLOCK 2 W w ELEV. 02.7 .i r — — --- - --- - _-- - nY EASENEN] TRACT B TUSTAMENA TERRACE 40 20 0 40 80 SCALE 1"=40' VERTICAL DATUM WAS ASSUMED. LOT 2 BLOCK 2 HAS 1.179 ACRES OF AREA. Recert Update 10221 Thimbleberry Anchorage, Alaska 99515 (907) 349-1488 late Scale 9/10/92. 111=401 rid 1plot Plan 2837 Drawn by I hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lyingadjacentthereto encroach on the premises in question and that there are no roadways, transmission -lines or other easements on said property except as shown. It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utility connections and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Listed distances prevail over scaling. Reproduction may cause distortion. t \JCC Lai LOT 3 BLOCK 2 V. 107.9 Le al Description Lot 2 Block 2 Subdivision ROSEBUD HILLS SUBDIVISION OF A444 *�?r 49tH / •• • ••-••-••N•t ••••••••� CHARLES E BES Ar �' LS - 7326"e AF