HomeMy WebLinkAboutLAKE O THE HILLS BLK 4 LT 1Lake O' The'
Hills
Block 4
Lot 1
#015-331-09
Inspection
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP181099
PID Number: 015-331-09
Dwelling: ■❑ Single Family (SF)
❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade
Name:
Christine Dooley
ABSORPTION FIELD
X Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
6600 Rockridge Drive
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
12.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
6.0 Ft.
Gravel depth beneath pipe
6.0 Ft.
Subdivision
Block Lot
Lake O The Hills
4 1
Fill added above original grade
0 Ft.
Gravel length
47 Ft.
Township Range Section
Gravel width
2.5 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
564 Ftz
1
N/A Ft.
Well
105.6
119.5
N/A
N/A
25+
TANK ❑■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
11250 Gal.
Surface water
100+
100+
N/A
N/A
Material
Number of compartments
Lot Line
20.0
10.0
N/A
N/A
Steel
2
NA
Foundation
10+
10+
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
50+
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 dTank to
3034
Installer
rainfield
JR's Septic
Drainfield 3034 CO/MT 3034
Inspector PES
BENCH MARK (Assumed elevation) 100 ft
Inspection15` 6/18/18
Location and description
2-,,6/19/18
3`tl 6/22/18
4th
Garage FF
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF At,9`i�
Conditional Approval:
Date
.Pow ro
• Steven .R. •PanriOFle•
CE 8149 •,���
Approved
Date
.
-.0-
Inspection Report_9-1-12.doc
SEPT[
AREA
UNDEVELOPED (PROPOSED WELL
NOT'.:W/I 200'i- ------ 1 Ox2O
L
R&R'ED ABSORPTION FIELD
'-4-47.OLFx2.5'Wx6.0'E.D.,1 2.0'T.D.
' -KR TH-I W1 MTs & COs AT ENDS, REMOVED
RIDGE RD
q' RI
TH-
'ARIFY SIDES & BOTTOM,
REPLACED BIOMAT WITH SAND (ENSURE
10.0 NW END OF FIELD MAINTAINS 10'
77F7
SEPARATION)
C
DC
M 2.�
R4R'ED 1250G SEPTIC TANK 2 C3
W-1 tO BEFORE & DCO AFTER T1
Ci
C�SEPTIC
�AREA - - -----
All
A B -119-5
C1 64.8 89.5 105.6
67.4
T1 92.1
T2 75.2 100.1
DCO 77.7 102.6 DRIVEWAY
C2 81.2 107.2 A
M1 81.5 107.3
C3 92.2 107.6 48R 8
M2 92.8 108.2 SFD
(n I WELL E
4 --
WELL (E)'-�
ti K
N F
AIN
ALiffl
fAERB-50-NV k
0 INV
z zz 2 Z
< '6 Fn z 4" 0 DRAIN PIPE z
0 OD
u m -
r FILIER FA Rt I " EG/FG-8EG/FG: 83.8
1 3.3
PROFILE 48/GM
SCALE 1'=10' 1 80.8
78.5/ 1250 g SEPTIC
78 GP
TANK (N) 77.8
DESIGN PARAMETERS
PRIMARY/RESERVE SEPTIC SYSTEM
NO. BEDROOM: 4 (600 gpd) 50.0 65.8
TANK SIZE: 1250g
PERC RATE: 2.8 MPI
SOIL RATING: 1.2 GPD/SF ABBREVIATIONS
AREA RQC: 500 SF LEGEND TH TEST HOLE
SYS. TYPE: DEEP TRENCH 6.0'ED W WATER LINE/ (P) PROPOSED
MIN LENGTH: 41.7 LF WELL RADIUS (E) EXISTING
USED: CO CLEAN OUT NO.
SS NEW SEPTIC MT MONITOR TUBE NO.
47 LFx2.5*Wx6.0' E.D., 12.0 TD TYP TYPICAL
TOTAL AREA: 564 SF
NOTES: PAMONE ENG WC, LLC
RECORD DRAWING Date
- �OFA�, 6/28/2018
P.O. BOX 100217 ANCHORAGE, AK 99510
.
Scale
PHONE (907) 272-8218 FAX (907) 272-8211 ..'9'
49-TH 1"=50'
P.I.D. NO
LAKE 0 THE HILLS, BLOCK 4, LOT 1 015-331-09
Steven R. Pannone
CHRISTINE DOOLEY PERMIT NO.
CE 8149
6600 ROCKRIDGE DRIVE ;0' OSP181099
Sheet
PLAN ANCHORAGE, AK
kk�, PROFESS100 2 OF 3
16�
TEST HOLE 2
OR ORGANICS
1
SM/ SILTY SAND
2 GM AND GRAVEL
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
SAND AND
GP GRAVEL WITH
LARGE
BOULDERS
BOH
DATE PERFORMED: 6/15/18
SOILS LOG — PERCOLATION TEST
X
TH
� J
i
TH-1
7fi8 / H-
772 772 � (• `
i
776 -
f FLAT
'�-
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH? DRY'
DEPTH TO WATER AFTER
MONITORING? —DRY'
DATE: 6/22/18
SITE PLAN
I
10x
\
Ll
�''►SEPTIC--
:AREA—
�� II
SLOPE
X
TH
READING
DATE
CLOCK NET TIME
WATERTIME
LEVEL NET DROP
READING
RECORD DRAWING
NO PERC
scale
"=50'
2
LAKE 0 THE HILLS, BLOCK 4, LOT 1
CHRISTINE DOOLEY
6600 ROCKRIDGE DRIVE
ANCHORAGE, AK
3
4
SOILS LOG
Sheet
3 OF 3
5
6
PEROLATION RATE NA (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN X FT AND X FT
COMMENTS: Test hole excavated by JR'S SEPTIC
PERFORMED BY: DAN MORAN. I CERTIFY THAT THIS TEST
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL
GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES:
ENG SVC LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
-- -
-
�� • OA F9l�,1��
r�G>�P-91"',
* */1
/ ... ... /
/015-331-09
S'te'ven 'R.'Pa'nnoriePERMIT
r �%: CE 8149
# s . �
<<��Fp' p�`��'�
PROFESS CA"
�lk\ t�0
Date
6/25/2018
RECORD DRAWING
scale
"=50'
LAKE 0 THE HILLS, BLOCK 4, LOT 1
CHRISTINE DOOLEY
6600 ROCKRIDGE DRIVE
ANCHORAGE, AK
P.I.D. NO
NO.
OSP181099
SOILS LOG
Sheet
3 OF 3
N`"PA"TY MUNICIPALITY OF ANCHORAGE mens
/ On-Site Water&Wastewater Program S;^
a,,e`, PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�
http://www.muni.orglonsite
efir
1)cpartnil•nt
4 'CHO RP°.
On-Site Wastewater Disposal System Permit
Permit Number: OSP181099 Effective Date: 6/8/2018
Work Type: Septic Initial Expiration Date: 6/8/2019
Tax Code Number: 01533109000
Site Legal Address: LAKE 0 THE HILLS BLK 4 LT 1 G:2639
Site Mailing Address: 6600 ROCKRIDGE DR, Anchorage
Owner: DOOLEY CHRISTINE Lot Size in Sq Ft: 63852
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
El Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
TSpecial Provisions:
1. The existing field may be within 10' from the property line, a property line waiver may be required.
2. Proposed system too deep for soils information submitted. The Engineer needs to do an additional test hole
prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water
monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the
results require a design change, construction of the system will stop pending On-Site review and approval.
I !
Received By: W, I .. . L - Date:
Issued By: Date: i ��
picnt
S.
Municipality of Anchorage �'�^
•
P.O. Box 196650 a 4700 Elmore Road
Anchorage, Alaska 99519-6650 e (907) 343-7904 ® Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV181027 COSA#: Permit#: OSP181099
PID#: 015-331-09
Legal Description: Lake 0 the Hills 64 L1
Engineer: Pannone Engineering Services
Applicant: Christine Dooley
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 22.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: 6/7A Approved by: /k..;-,c-,cGL L
Name of Reviewer-;:7
**** VARIANCE/WAIVER REVIEW ****
-�-
PUINS
MUNICIPALITY OF ANCHORAGE
r:j;.
Community Development Department tor Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcell.D. 015--3-3°-09
Property owner(s) CHRISTINE DOOLEY Day phone
Mailing address 6600 ROCKRIDGE DR, ANCHORAGE AK 99516
Site address 6600 ROCKRIDGE DR
Legal description (Sub'd., Block & Lot) LAKE 0 THE HILLS B4 L1
Legal description (Township, Range& Section)
Lot Size 63,852 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑X Initial ❑X Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
STEEP SLOPE SEPARATION Distance:22
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: ;J10ct Waiver Fees: f-a`5
Date of Payment: JrlufI& Date of Payment: 0/6/5
Receipt Number: 0171(7 Receipt Number: (9I
Permit No. OSP/A1049 Waiver No. 69V ( s/02.2-7
Permit App__•:•: .,.c
Munidpality of Anchorage
On-site Water and wastewater
Pannone Engineering Services tic REVIEWED FOR CODE CONPIJANCE
OSP181099,Deb 14bckenfuss,064981,
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
MAY 16, 2018
Subject: LAKE 0 THE HILLS B4 1.1
Upgrade Septic System Permit Request
Design Narrative
This is a design narrative to issue a permit to install an upgrade septic system for this property. The system
will serve an existing four (4) bedroom house. The system will utilize a new 1250g septic and a
conventional drain field. This lot is served and the surrounding lots are served by private wells. There are
no wells within 100' of the proposed septic system.
1. Soils. One test hole was performed on the property by PES in May 2018 in order to verify the soils for
the existing system. Ground water was not observed to a depth of 15.0' below the surface (3' below
the existing system). Bedrock was not encountered in the test hole to 15.0. Based on the results of the
percolation test and overall soils appearance, an application rate of 1.2 GPD/SF was used for a
conventional wastewater system in the area of the test hole. The soils for the original system was
rated at 125 SF/BR.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography on the lot generally slopes from middle to the northwest and
southeast, with a slope of approximately 1-5% in the area of the proposed drainfield. There are steep
slopes within 50' of this system. See waivers.
5. Waivers:
a. Slope Separation: We are requesting a waiver for the subject property for a separation distance
from a slope greater than 25%to twenty-two feet (22'). The combination of the depth of bury
of the system (5.5' below grade), the distance to the grade break (22.0') and the 45%
Infiltration line the effluent will not daylight within 50'. As a result we request a waiver for
steep slope separation to 22'.
6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site Department,
the note will be removed and "Issued for Construction" drawings will be issued.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
The proposed installation will not affect the future development of this or the surrounding lots.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
.•'(E 9F 4,1'4
4 `- •
` j Steven R.Pannone
• i
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Mir opality of Anchorage
On-site Water and Wastewater
NOTES & SPECIAL PROVISIONS: - — • / r "°I`�
-. \ - /REVIEVVEC ANCE
1 SCOPE AND SPECIFICATIONS: •�'r // ` \ " I /
ESXSP18'1C22._Deb_16lockenfus, WOW
1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS '1►44 \ l
(MASS)FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH �+�' / \ \ I
AMC 15.65 AND 15.55. \ *V 4 \ N I I \
1.2. SCOPE OF WORK: INSTALL NEW 1250g SEPTIC TANK,AND SOIL ABSORPTION SYSTEM. f �iF** * t \ \ I
1.3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 15 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER I 's- ** yam,_.i__ N i I \ \
TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 15 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. • N
I.4. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING:CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER;A PLOT PLAN l ._ i+ / --- I \
DEVELOPED BY RLS:OR A SURVEY AS-BUILT, ♦ APv. t ` *tirr / \ -\
2 CONSTRUCTION SPECIFICATIONS: `•"� � - - - - / / .....--
I
l I - - _/ I -
1 / - / — - _ \
2.1. ALL EXCAVATION DEPTHS ARE ADVISORY.THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM / / - - _. _I-r r - - -THOSE USED TO PREPARE THE DESIGN / / / / / / .AREA \
2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED.RECORD ELEVATIONS AT BEGINNING.MIDDLE AND END OF TRENCH � / •
1 r -01.•AREA \
BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE / / / IJ ( I N "rm1ONS
CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. I / \ I \ ROM 2441AY2018
I UND VELOPED yROPOSED WE I \ \ REV?.01JUN:U1e
7.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS.DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL � � ( � �OX2O \ \�
ROCK SURFACE TO*1"PRIOR TO INSTALLING THE PERFORATED PIPE. I I / NOO�W/I 25,0-5 -
2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM 03034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 -�)I / — - -_ _ L _ \ -
FEET OVER THE SEPTIC TANK.ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. - '(_ / / i _
2.5. ALL INSULATION SHALL BE 2"THICK DOW HI-40 INSULBOARD OR ENGINEER APPROVED EQUAL.CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. / TH-20���` -- .-------. 4 ` 1-
2.6. GEOTEXTILE SHALL BE MIRAFI 1405 OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. / / ..... r_ - - - _ -
/ VALIDATION OF SOILS AND /
_ ,
2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2"OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. / / / ABSORPTION RATE. DIG TO / / ` �
2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS,TRASH AND CONSTRUCTION DEBRIS. 18' &INSTALL MT AT TIME• / R&R ABSORPTION FIELD(P)
2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2%MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING Ai OR NEAR THE DRAIN FIELD / / / OF CONSTRUCTION /
DOES NOT OCCUR.THE FILL SHALL BE LEFT AT 6"HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT.SEED SURFACE AFTER COMPLETING INSTALLATION AS / 7` i — , / / / 47.OLFx2.5'Wx6.0'E.D.,12.0'T.D. W ii
PER MOA CODE. - -� / / / 'R 4<J [5W RD Qn / ' -- --- -W/ MTs & COs AT ENDS, REMOVE BIOMAT ,.$
2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING,MIDDLE AND END OF SYSTEM. \% / _/ l-
/ / & SCARIFY SIDES & BOTTOM, REPLACE WOY
2.11. MAINTAIN 5'SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. 7
/ / // // / o
2.12. EXPOSE,PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON LAW WITH MOA CODE. / / / / 772 / BIOMAT WITH SAND (ENSURE NW END OF oa
S. CONTRACTOR RESPONSIBILITIES: ---'1"---1
J / R&R 1250G SEPTIC TANK P 10.6 FIELD MAINTAINS 10' SEPARATION) �— . - W ��
/ 1 i/ CO BEFORE & DCO AFTER. �I- I I \ \ \ \ o zsa
3.1. THE CONTRACTOR(BOTH WELL AND SEPTIC SYSTEM CONTRACTORS)SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE / I / / I / J 1 I , \ u•OAND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE / ,/ / / // / 14;;LAT
I \ \
WORK. I f / , I —29.8 \
3.2. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W.AND OTHER REQUIRED PERMITS,OTHER THAN THE ATTACHED. J/ / I / / / / / L NO l I I I / \ \
3.3. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. / - — J ---Nn ' �, \ \
3.4. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE •
PRIOR TO NOTIFYING THE ENGINEER. _-�/ I I / �' I ISAREA M \ UJ
3.5. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS _ I/� l 7� / I
POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. /- I / j Ob , / / I / I / \\ J Lt 9 _
3.6. AT THE COMPLETION OF THE WORK.THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE ENGINEER. THE RED-LINES SHALL INCLUDE _ \/
PIPE LENGTHS.ORIGINAL GROUND ELEVATIONS,PIPE ELEVATIONS.AND TANK ELEVATIONS. / r �\ / / /
�� (( / / / �/ I// �� \ 0
to W ct
3.7. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,TOP OF PIPE WITH CLEAN-OUTS I I / / / //
AND MONITOR TUBES INSTALLED.INSTALLED TANK AND FINAL GRADING. / I �/ / / / / 118.2-/ // \ J G
4 THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT.AND ANY AND ALL - "- I I / i �� / / / // 10 .2 I �/ I / J Q
CHANCE ORDERS,AND THAi THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. I / I 1 / / / / / / // I/\ DRIVEWAY ) 17801 I r W Y
CONTRACTOR: BY: TITLE: DATE:
/ V
:). THE CONTRACTOR PROVIDED DATA(UPON WHICH THIS RECORD DRAWING IS BASED)APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA IN I I/ / /T / / / / // / // / \\ -(I 1 / I.- O (--
CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER(OR HIS DESIGNEE)AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE / / / 3'/ / ) / // / O O Q
ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. J' I I / / / 48R / I - - Y ID
--/ I 5 /
/ / SFD */ / N a - (f)
— / / / WELL (E) y / / / // / I \ ,� LL-
PRIMARY/RESERVE DESIGN SOILS LOG I /I Li/ I / / / F
/ / / /".
/ _ — — \ to
PARAMETERS TEST HOLE T N / / / / / / / / / /� WELL (E), )
OR TOPSOIL WATERI / /n /I / / / / \
PRIMARY DESIGN PARAMETERS 1 READING DATE NET TIME LEVELREADING NET DROP RATEJ I W / I / / / //// / / / / I 1il _ ` \ \
2 SM/GM dWcLCRAELL O I 09MAY16 5.900- /� /� �y I/ / I // /// / / // / I ` '� E \\ \
NO. BEDROOM: 4(600 gpd) d
TANK SIZE: 1250g 3 w/COBBLES 2 10 MIN 9.420' 3.52' 2.8 I / /I / / / / / / I I 0
PERC RATE: 2.8 MPI J s9ao' / /�I W / / i / / / -\ \ 0 u�'^m
SOIL RATING: 1.2 GPD/SF 4 4 10 Mw 9.470' 3.57' 2.8 1 / / / / I •4 I V \ u' Z u;;,,,,p.2
AREA ROD: 500 SF / �T / / / ABBREVIATIONS Z a 3
SYS.TYPE: DEEP TRENCH 6.0'ED 5— 5 s.9oo' f LLJ Q I/ / / / AI
I TH TEST HOLE o W W
MIN LENGTH: 41.7 LF 6 TO MIN 9.500' aso' 2.8 / / I If, / / / / / / / / (P) PROPOSED Z Z N
6— / I : / �( !l ' I / / / / / / I (E) EXISTING Q U' �a i x °�
EISF 7 WAS GROUND WATER SOIL TEST RESULTS/ANALYSIS I I ` ( ( / —Vr -- WAITER UNE / L RADIUS CO CLEAN OUT NO. 0- Z Laire n"9
47.OLFx2.5'Wx6.0' E.O.. 12.0'TD / `/ ``
TOTAL AREA 564 SF 8— GRAVELr ENCOUNTERED? N PERCOLATION RATE nAr1cA I'ad / ( I ( I \ I l ( / V —S'_NEI SEPTIC MTP TYPIITAL TUBE NO. w y
(Hydrologic Soils Group: HSG A) / I qk / t 1- ii N \ 1.,._ y 1 •
9 IF YES, AT WHAT • PERC HOLE DIAMETER 6' e
DEPTH? -NA-' • TEST RUN BETWEEN_5FTAND6FT. [7701 +
10— • TEST RUN FOR OVER AN HOUR.
DEPTH TO WATER AFTER LAST THREE READINGS PROVIDED. 22.3 _; 6,
II — MONITORING? - DRY - I`
O.G. 776.0± 7e 0 I
•
DATE: 15MAY2018 1 -^ - 0: X1- n
12 PROFILE L505 �`�leg'
13 SCALE:1'=10'
COMMENTS:Test hole excavated by A+HOME SERVICES [77] .-- ''14
PERFORMED BY:Joseph Lawendowski.I CERTIFY THAT THIS TEST L50% / 1 I-12.0 2$
15 WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MU_NICIPAI I OR 3 T.
-
BOH GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. 17681LO'�"� 611.0-"• - `6 S A.
L50% •6�`"'`� I 8
764 i j o .H S i ,
14
50.0 SHFFT
DATE PERFORMED: 09MAY18 760 �l C 3.O
MUNICIPALITY OF ANCHORAGE Ur C1 /CA 402f7
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
�❑ NEWS
-KJPGRADE
MAILING ADDRESS r
-9600
LEGAL DESCRI TON
LOCATION
Co
NO. OF BEDROOMS
UY
DISTANCE TO:
Well -
Abso tion area
Dwelling
PERMIT NO.
EZ
4
wF
Manufacturer
Material
No. of compartments
w
Liq. capacity in gallons
IF HOMEMADE:Inside
length
Width
Liquid depth
O z
DISTANCE TO:
Well
Dwelling —
PERMIT NO. _
Sz F
Manufacturer
Material
Liquid capacity In gallons
O
w=
DISTANCE TO:
Well /
��
Foundation
Q(J�
Nearest lot I'ne t'
PERMITNO:,?
JLL z
Z w
No. of lines
Length of each li
Total length of line
Trench widt
gel inches
Distance between lin s n
14
�—¢
H
Top of tile to finish grade
Material beneath the
inches
Total effective absorption area
w
Length
Width
Depth
PERMIT NO.
0
4 F-
w°
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
Uj
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
/
ca_- Y-
SOIL TEST RATING /
O
INSTALLER
REMARKS
y
U_
--H+
APRO E DATE LEGAL
7
72-013 (Rev. 3/78) ���
�TYPE OF SOIL HBSOR8TION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTlNG (SQ FT/BR)� 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
����E-7, FA �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SER, -/E.
�_~ ��� ��� I���������� -�� �������� ~_�
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN A WELL HND ANY ON --SITE SEWAGE DISPOSHL SYSTEM IS
100 FEET FOR R PRIVATE WELL/ OR
150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIH8RHMS FIRE
HV8ILHBLE TO INSURE PROPER INSTALLHTION.
I CERTIFY THAT
1: I HM FHMILIFIR
FORTH BY THE MU
2� I WILL
]� I UNDER
RESIDENCE i (I M
�REE lrwl E-3 A_ ca��
ITH THE REQUIREMENTS FOR ON—SITE SEWERS HNE) HS SET
IPHLITY OF HNCHQRHGE.
THESYSTEM IN ACCORDANCE WITH THE CODES.
HE ON—SITE SEWER SYS -EI MHY REQUIRE ENLHRGEMENT IF THE
E��D T[L.INCLUDE MORE THAN 4 BEDROOMS.
HP�LICHNT STEVE NOE� /
� '
DEPHRTMENT [-
HEHLTH HND EN;IRONPEN|HL ' `J|�[{1UN
'
'
S25TREET,
HNCHORAGE/
264^4720
^4L��4�
`
'
��_�����
����� ������� ������
� `,�
PERMIT
NO. (
780688 )
~��^����
HPPLICHNT
STEVE
NOEY
2600 DENALI
279 859
LOCHTION
LRKE
O THE HILLS
--~
LEGHL
L1 B4
LHKE O THE
HILLS S/� LOT S�ZE 54000
SQUHRE F
�TYPE OF SOIL HBSOR8TION SYSTEM IS: TRENCH
MHXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTlNG (SQ FT/BR)� 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
����E-7, FA �
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS HDJHCENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SER, -/E.
�_~ ��� ��� I���������� -�� �������� ~_�
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND HPPROVHL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN A WELL HND ANY ON --SITE SEWAGE DISPOSHL SYSTEM IS
100 FEET FOR R PRIVATE WELL/ OR
150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
OTHER REQUIREMENTS MAY APPLY. SPECIFICHTIONS HND CONSTRUCTION DIH8RHMS FIRE
HV8ILHBLE TO INSURE PROPER INSTALLHTION.
I CERTIFY THAT
1: I HM FHMILIFIR
FORTH BY THE MU
2� I WILL
]� I UNDER
RESIDENCE i (I M
�REE lrwl E-3 A_ ca��
ITH THE REQUIREMENTS FOR ON—SITE SEWERS HNE) HS SET
IPHLITY OF HNCHQRHGE.
THESYSTEM IN ACCORDANCE WITH THE CODES.
HE ON—SITE SEWER SYS -EI MHY REQUIRE ENLHRGEMENT IF THE
E��D T[L.INCLUDE MORE THAN 4 BEDROOMS.
HP�LICHNT STEVE NOE� /
� '
�-GRE. ER ANCHORAGE AREA BOf '1GH
r'YDepartment of Environmental Quality
U0
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE S�JEWAGE DISPOSAL SYSTEM
NAME ,VLt1 f ✓C C o�, s MAILING ADDRESS �7/Z�T �DX .3 7G 3
LOCATION LEGAL DESCRIPTION L 1 6q- 1-4e D "Vie �</Z/
SEPTIC TANK:
DISTANCE NUMBER OF /
FROM WELL MANUFACTURER —MATERIAL .S fee / COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 20062 GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER OR WIDTH 2_D LENGTH.I� DEPTH /
LINING MATERIALe, yI fP I CRIB SIZE: DIAMETER—DEPTH k' DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDA ��/ NEAREST LOT LINE 20' ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE P 1 LID f C- CONSTRUCTION
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
NEAREST
SEWER LINE
APPROVED DISAPPROVED REMARKS
DISTANCESAbb � 105 AC :712,0
INSTALLED BY: //0e q), I m;k
PIPE MATERIAL: Ca- lion en'?
Tdn015'fe
LOT SLOPE:
REMARKS- I ZS QU�CIEiY)n7e.I
Form No. EQ -031
DEPTH
SEPTIC
TANK—
10 1_
DIAGRAM OF SYSTEM
DISTANCE FROM:
SEEPAGE
SYSTEM _
DATE 5-
_L �` L4 APPROV
NAME OF APPLICANT
GREATER ANCHORAGE ARRA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
I
MAILING ADDRESS L5 g��
\�
INSTALLATION LOCATION I
1 (
LEGAL DESCRIPTION L / T
Re
/el, 777
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
J �"- "
SEEPAGE PIT ////''
YY1, '5"
5 I'LO�/
DRAIN FIELD
PERMIT NO.
OTHER
FINANCED THROUGH TO BE INSTALLED BY
% 0 �
SOIL TEST RESULTS Z>>"� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /6
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
DRAIN FIELD
Z c , DRAIN FIELD
SEEPAGE PIT J D
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEPTIC TANK,SEEPAGE PIT DRAIN FIELD O
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGU TIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
EA SIZE
TYPE
DIAGRAM OF SYSTEM
1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREAT ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
C� r
DATE —� I APPLICANT'S SIGNATURE
vr�ou un rn_n�a
for
,a l ,'Isscri pt'on
reports
Cin I-
J -
1 I -
Cif ' �R .ANUHUHAUl ARLA bUKUU1.iH
Depar,,. int of Env"i roninental Quality '-,J
1330 °C° Street
Anchorage, Alaska 99503
` 2d
s !og
Date performed
erco!a,con
,ias ground wager encountered? �l,'b. If yes, at what depth?
�
I
I
I
i r
1
fi
".._�
,ias ground wager encountered? �l,'b. If yes, at what depth?
�
I
I
I
,ias ground wager encountered? �l,'b. If yes, at what depth?
�
I
I
inS`,jl,at7arl
din !e( l
D!?J' I !�a�
.. I ri o. .. 0,
>Ie
5. LEGAL DESCRIPTION
t(/ 0/,.- zl
k&
MUNICIPALITY OF ANCHORAGES
LJ viU
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
•
6. TYPE OF RESIDENCE
ENVIRONMENTAL ENGINEERING DIVISION
SINGLE FAMILY
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10)
days for processing.
1. PR,O-PERTYOWNER l
�{^n ID L�� �I'c14t5�E'1/ �� C��rcy--iU�1a'✓ l
PHONE
MAILING ADDRESS
❑ COMMUNITY
PROPERTY RESIDENT (If different from above)
❑ PUBLIC UTILITY
PHONE
8. SEWAGE DISPOSAL SYSTEM
J INDIVIDUAL/ON-SITE**
2. BUYER
V(�VifJ;-t �C✓c f
PHONE
.aEi�i
MAILING ADDRESS
by this Department.
3. LENDING INSTITUTION
PHONE
X6,41 - )�V/ 7
MAILING ADDRESS
4. REALTOR/AGENT90C ��',,
TV�/u G. a), -els a�a C Gc , e
PHONE
a 77- <� �;--s
MAILING ADDRESS _r -
3 d ey c' S , % r"c-�dY���� .
5. LEGAL DESCRIPTION
t(/ 0/,.- zl
k&
STREET LOCATION -
LiROC-� C � /
`�
LJ viU
6. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
SINGLE FAMILY
❑ One X Four ❑ Other
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
Jul INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
J INDIVIDUAL/ON-SITE**
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
❑ PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
HIS SIDE FOR OFFICIAL USE ONLY
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL '
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
lb—�APPROVED FOR 4— BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
5' Lae o �t�ie Iii ,IS Sub., B1 k.
DATE RECEIVED
INSPECTION APPOINTMENTS
Oe - a
TIME
TIME
TIME
DATE
DATEYV
DATE
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
INSPECTOR
INSPECTOR
INSPECTOR
"�J
�F' Y C1
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(f )MONMENTAL PEOTECTION
825 L Street - Anchorage, Alaska 99501
•
MAvI 2 6 1961
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing.
1. PROPERTYOWNER4�N4�257
Anthony J. and Mary Louise Giorgione
MAI LING ADDRESS
SRA Box 25C, Anchorage, Ak. 99507
PROPERTY RESIDENT (If different from above)
PHONE
Same
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADDRESS
4. REALTOR/AGENT
Betty Halsey - Admiral Realty
PHONE
279-8586
MAILING ADDRESS -
930 W. Fifth Ave., Anchorage, Ak. 99501
5' Lae o �t�ie Iii ,IS Sub., B1 k.
4. Lot 1
sTi2ockrfdge `tri ve
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ® Four ❑ Other
® SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
KX INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) '--5
4 v
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
rn —
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size:.!:) bA If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELLTO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
V, --APPROVED FOR _ BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE rt
–
BY
72-010 (Rev. 6/79)
4i DEF/,i� HEALTH P,idi) NV I R0 PIZOTi CT
ev
S -3F�i , L7:i�.`t oraoP Al<���� i�S�.L
�zA Date Receive': December 13, 1977
i
u n
;r 1_ . 1'i n<e ��_�)��----- r 2 : "'�me _LL__;•�ZT — ,r 3 : ;' unc
Date -_6. % Date _ Jj_D_:,
I n s p --ate ��11L1r .__.__. I n s p IaLi
Date
Insp _1_ULwJ L —
R11QUEST FOR APZ';?-OVAL OF
:INDIVIDUAL Sx;:�ER
AND �A—_,ER
$�ACILI2'SE,
1.. Lending Insti-tui_ion Request:
National Bank of
Alaska
%Shirley Jones
Mailing Address: Post Office Box -3-3859 99509
Phone: 279-2606/43
2. Property ffi„ner: Stephen W./Helen H. Noey — Pl;one: 279-6947 g
-- �71-f-$S��
mailinq Address: 2600 Denali Street 99503^-
3. Legal Description: Lot 1 Block 4 Lake of the Hills Subdivision ` /
4: Single Family Residence: (x) Number of Bedrooms: Four _ �`�(
Multiple Family Residence: ( } Number of. Bedrooms: --- --
5. Well System: Individual, Well (x) Co_rsmznity/Public Svster, ( )
Permit a# - -- Depth of Well —^ Well Log on File ( )
Construction Bacterial Ana V Sls
6. . Sewage Disposal System: On-site Svstem (x) Publ-ic Utility
Permit 4 Installer 1974 1-9 Installer_
Septic Tank Size _ lX>C� — Manufacturer
Absorption Area oils Rate ��� Material
?. Distances: Well- to Septic Tank 169 tr to Absorption Area /?v`
to Sewer. Line Nearest Lot line Absorption Area
to Nearest: Lot Line
MUNICIPALITY OF ANCHORAGE MUNIDEEPT.PT. Y r
DLf t'rRI 1
DEPARTMENT OF ENVIRONMENTAL QUALITY I��)kOiJPA i P•t i"
3999�'eet, Anchorage, Eche&-99J83 - 2'4a45Q'1
825 "L" street 279 2511-
825RKrQbfSireF0R APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES ' �^
9. Type of Inspection: CMRO VA FHA CONY Xxx
2. Property Owner: Stephen W. Noey and Helen H. Noey.
Mailing Address: 2600 Denali, Anchorage 99503 Day Phone 279 6947
3. Name of Buyer: Anthony Giorgione & Mary Louise Giorgione
Mailing Address: c/o B.P. Alaska 3111- "C" St. _-Day Phone
4. Name of Lending Institution: National Bank of Alaska
Mailing Address: P.O. Box 3-3859, Anchorage, 99501 Phone 279 2506 X43 _
Shirley Jones
5. Name of Realtor or Agent: Admiral Realty - Betty Halsey
Mailing Address: Captain Cook Hotel Phone 279 8586
$. Legal Description: Lot 1 Block 4, Lake of the Hills Subd.
Location: O'Malley across from Valli Vu
e
0
Type of Facility to be inspected: SFR
Water Supply
Type of Supply: Public Utility
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation 74 or '75
EQ -037 (1174)
No. Bdrms. 4 _
Individual XX
1
Individual (on-site) XX
'Page ` Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:
Lot 1 Block 4 Lake of the Hills Subdivision
Comments:
Q� s
VV -1'-t7 �^ \Ell 1 0Vj0 'tU�, , A-
G 4
7ioD G Rz s 2 _A a t� A
2-5D a (01
Y
Affadavit Attached: ( )
Approved:
Disapproved:
Department Worksheet:
Letter Attached: (
Date:
Date:
� 4T9:NOia62 AYFA go
0
a] G
GJPFO JATUA9Y
�le
�
l I�
^'I
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received July 9, 1976
Time of Inspection '
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES �^
FOR
Conv.
1. Approval requested by:
First National Bank of Anchorage
Mailing Address: Post Box 720, 99510
Phone: 279-4481
2. Property Owner: Stephen W. Noey Phone: 274-8596
Mailing Address: Box 4-237, Anchorage
3. Legal Description: Lot 1 Block 4 Lake O the Hills Subdivision
4. Location: Rocky Ridge Road
5. Type of facility to be inspected Single Family No. of bedrooms 4
6. Well Data: Individual
A. Type
C. Construction
B. Depth
D. Bacterial Analysis
7. Sewage Disposal System: On—site system
A. Installed B. Installer,
C. Septic Tank: I. Size / 2. Manufacturer 0'&a,4,
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank , Absorption area Sewer Lines ,
Nearest lot line Other contamination
B. Foundation to septic tank Absorption area
C. Absorption area to nearest lot line
EQ -034 (1/74) Page 1 of two pages
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA
fvl;)j•J�t �
CONV_K-
2. Property Owner: %_�Y n.cn w iv
Mailing Address: &Y 4-0
3. Name of Buyer: S2fNQ�
Day Phone: d
Mailing Address:
Day Phone:
4. Name of Lending Institution:
Mailing Address: box
4- �°Z� )#nd- -
Phone: a % 9- -"k /
5. Name of Realtor or Agent: /1QAAJ
Mailing Address:
Phone:
6. Legal Description: .L /
,1
X37 Aske 0 7'Ae
6i/ZS
Location: Rack—!
R�/$y Fdaid
7. Type of Facility to be Inspected: SonQ�6 Yh`r""'y No. Bdrms.
8. Water Supply
Type of Supply: Public Utility Individual G!e-//
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site)
If Individual, date of installation
72-003(3176)
Page 2 of two pages - Re( st for Approval of Individual F -�r & Water Facilities
Legalr.Gescription Lot 1 Block 4 Lake O the Hills Subdivision
Y
Comments
Approved Disapproved Date��
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request Tor approvdi do oe d Prue and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ -034 (1/74)
u�61 8 9 707
• Municipality of Anchorage 2018
On-Site Water and Wastewater Program 2
(907) 343-7904 ,\)
w
Certificate of On-Site Systems Approval
Parcel I.D. 015-331-09 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lake 0 The Hills Block 4 Lot 1
Location (site address) 6600 Rockridge Drive
Current Property owner(s) Christine Dooley Day phone
Mailing address 6600 Rockridge Drive Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
▪ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
I.�
Received b : .;�. .`,�J�Vt� .I 1 I / Date: L2(2 SII R
COSA to be released to the engineer,unless otherwise requested by the engine 40
COSA Fee $ a.(i •5D Waiver Fee $
Date of Payment (0 l a(o'I9 Date of Payment
Receipt Number 0/(o7 -6 Receipt Number
COSA# d sLi 7124 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/25/2018
N\\l
OF A�••.s k
6. DSD SIGNATURE % . 6�
System •#1 Approved for 1( bedrooms •'.Steven R. 'annone
�,•. CE-8149.
System#2 Approved for bedrooms 9�
Disapproved �4f'.`� �O•F•
EsS40N's' '~
Conditional approval for bedrooms, with the following stipulations:
-t 0t.
Fes, 9
By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_f ,.
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Lake 0 The Hills Block 4 Lot 1 Parcel ID:015-331-09
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed UNK Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 146 ft. Cased to 40+ ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test UNK 5/9/2018
Static water level UNK ft111. ft.
Well production UNK gpm 5.3 g p m
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic NDug/L Date of sample: 5/9/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
teel Date installed 6/18/2018
Tank Type/Material Septic/S
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 6/18/2018 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Deep Trench
Length 47 ft. Width 2.5 ft. Gravel below pipe 6.0 ft.
Total depth 12.0 ft. Eff. absorption area 564 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) For 4 bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= 600+ g.p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION .a' OF i4L,4 1
I certify that I have determined through field inspections and 0*: ,.•
`1` :sr 9
review of Municipal records that the above systems are in 0*; /\ ••*
conformance with MOA COSA guidelines in effect on this date. %••••• , • •• 0
Engineer's Printed Name Steven Pannone r••:S{even 1. •annone•
CE-8149 1
Date 6/25/2018 h+#+°'• •• /
l PRoFEs90
COSA canary sheet_2-6-15.doc
Wood Rail Wood Rail
N Fence ROCKRIDGE DRIVE Fence
Wood Rail N
Fence
N89'53'09"E
220.36' A
Wood Rail • Riser \-5/8" Rebar
Fence o Pipes
MP-)
BC )<
Wood Rail
Fence — ___ rick
/ _ \ Retaining) Chain Link
o Wall Fence
SQho��
Wood Rail �- P ,' i x
FenceN441/4i = "Gravel
_ { Pad
Luminaire Post
P "<
// Wood Walk & Stairs 1I
\/'
,c
-A._
x
Wood Rail C O c0 _/
Fence 51. cS .\ .•
i
.7.6' N
Multi Level
5 9Wood FrameResidence
co z
0 rn
Xr.c9" •74 Well N M
z f�6 4' / / Wood Deck & Stairs 0.9:4.o LOT 2
' 7 `V�8
ti 1Jb.v
•Iz.
a)
E Wood Deck
0 & Stairs x
U /��,`
a)
Brick Retaining
•
c Wall & Steps
'C'
-
o e YN a)
co (0 .
a)
v
o
Yard Light w
a) (TYP') .•.,`
=
.J
0
_N LOT 1 0
v Gazebo With ^
Conc. Fireplace
in
cJ
—jr
I 220.00' 10' Utility Easement N
S89'57'25"W
SCALE : 1 " = 30'
0' 15' 30' 60'
NOTE:
Dimensions are measured to the wood trim. PREPARED FOR:
CHRISTINE DOOLEY
I hereby certify that an accurate survey of the following described
♦����itttib1 property: AS — RJILT
.:sE..F..A�y11 LAKE 0' THE HILLS SUBDIVISION (72-236)`P;•• •.J',f+�, LOT 1
i G:1 ••�•:,9 was made on June 25, 2018
and that the improvements DWN. DATE GRID %�
*.49TH '* • situated thereon are within the property lines and do not overlapor
•.� P JSP 6/27/2018 SW 2639
ncroach on the property lying adjacent thereto, that no x
%,•• '.�F. Lee Knrnbelntkof f: im rovements on the property lying adjacent thereto encroach on FILE NO. F.B. 2018 JOB NO.
### � „ the premises in question and that there are no roadways,
. No. 3143-S ; .. transmission lines or other visible easements on said property except 1805 PG. 41 1814
.1 •••'•••• '� �' as indicated hereon. Easements other than those shown on the
Lii
4itii"O��.46, record plat may not appear on this drawing. KA RA BEL N/KOF/— N ui
6/4/2oi8 Anchorage Alaska, this 27th day of June 2018. SURVEYING (907) 337-8434 W
I
0l
Municipality of Anchorage
Development Services Department
1 Building Safety Division
On -Site Water & Wastewater Program
i� 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
hh��
Parcell.D. 015-331-09 HAA#_
1. GENERAL INFORMATION Expiration Date: 7 — /.2 — D .6
Complete legal description LAKE 0'
THE HILLS SUBDIVISION: LOT 1.
BLOCK 4.
Individual Well
Location (site address or directions)
6600 ROCK RIDGE DRIVE
A I A
el9 m (o
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
VERNON JEAN AND NORMA SEALE Day phone 273-7336 (AGENT)
C/o BELINDA DAVIS w/ PRUDENTIAL JACK WHITE
Day phone
BELINDA DAVIS w/ PRUDENTIAL JACK WHITE Day phone (907) 273-7336
3801 CENTERPOINT DRIVE, SUITE) 200 * ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
E
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 ificates of Health Authority
Approval (HAA) based only upon Cert
n the representations given In paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional 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 riles and from my investigation and inspection, the
onsite 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 Finn
GARNESS
ENGINEERING
GROUP, Ltd.
Address 3701
E. TUDOR
ROAD, SUITE
101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
in conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
✓ Approved for L� bedrooms.
Disapproved.
Phone 337-6179
Date 4 k Los-
Conditional
S
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
Gtr •.• ., 10 .�
t: • c
WATER AND • 1"
:�VA3"TEVVAl ER
PROGRAM '
p7� - r
VV�i.: "ANT SE`n�
By: Original Certificate Date: `%'
(R". rmn
Municipality of Anchorage
. y f
• Development Services Department
Building Salary Division
On -Site Water 6 Wastewater Program
47011 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995196650
www.danchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LAKE O' THE HILLS SUBDIVISION: LOT 1. BLOCK 4. Parcel ID: 015-331-09
A. WELL DATA
Well type SATE If A, B, or C provide PWSID# N/A Well Log (YM) NO
Date completed 1974 Sanitary seal (YM) YES Wires property protected (YM) YES
Total depth 149 ft. Cased to 40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test ��G 3/25/2005
Static water levet_ ft. 132 ft,
Well production N� g.p.m. 3.4 g.p.m.
WATER SAMPLE RESULTS:
Collform 0 colonies/100 ml. Nitrate 0.1 mgA.. Other bacteria 0 colonies/100 ml.
Arsenic: NIA mg.IL. Date of sample: 3115/21305 Collected by: GEG. LtD.
B. SEPTIC/HOLDING TANK DATA
Tank TypelMaterial STEEL Date installed 5/22/1974
Tank sae 2000 gal. Number of Compartments 1 Cleanouts (Y/N) YES
Foundation cleanout (YM) YES Depression over tank (YIN) NO High water elann (YM) N/A
Date of pumping 3/29/2005 Purr MCDONALD'S PUMPING
C. ABSORPTION FIELD DATA EXISVING
e/4/197a
Date Installed Soil rating (g.p.dJftix� 125 System type TRENCH
Length 47 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 12 ft. Eft. absorption area 1224 fe Monitoring tube YES Depression over field NO
Date of adequacy lest ••3/25/2005 Results (Pass/Fall) PASS For 4 bedrooms
Flub depth in absorption field before test 0 In. Water added 623 gal. New depth 19 in.
Elapsed Time: 1213 min. Final Aub depth 4 in. Absorption rate >: 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date —
**ONLY THE TRENCH WAS TESTED.
D. LIFT STATION
Date installed
'Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alarm level at
Cycles tested Meets alarm & circuit requirements?,
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/desnout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 50+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 5'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I cer* that I have determined through field brspections: and * "j to I'N 0.'r*
review of Municipal records that the above systems are in 1111" 1111" 111100-1:0..
conformance wffh MOA HAA guidelines in effect on this date.
Jp A. Gemess.o
Engineer's Printed Name JEFFREY A. GARNESS CE -7 3
12h__
Date �� 2+_ o d"'Ilolo's's'tood
00
HAA Fee $ u )
/ 1
Date of Payment , �'1C-'R-c>S
Receipt Number
(RNV. 1201)
Waiver Fee $
Date of Payment
Receipt Number
N
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F/ ROCKRIDOE DRNE
.. ✓nlCo•c z'nn^c nnn ze• N �••
Ocm
N
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WELL
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LOT 1 i
1n LOT
63.891 S.F.
DECK
I
T.ag ACRES
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CRAPHIC SCALL
' 00'
I
10' U I L I --L EMFN'
S89'5 /'25"W 220.00'
RECERTIFIED AND UPDATED 12-27-77
RECERTIFIED AND UPDATED 7-20-76
RECERTIFIED AND UPDATED 3-31-05
LEGEND
9
N
G
WELL
A
o
vw;'
C)
w• I
�
LOT 1 i
1n LOT
63.891 S.F.
DECK
I
T.ag ACRES
N
o
I
10' U I L I --L EMFN'
S89'5 /'25"W 220.00'
RECERTIFIED AND UPDATED 12-27-77
RECERTIFIED AND UPDATED 7-20-76
RECERTIFIED AND UPDATED 3-31-05
LEGEND
9
SOUND I" Ht HAH
G
WELL
A
PLCCIRIC METER
a
CLEANOUT
•
SEPTIC VENT
r
CONCRLIL PAD
=
DECK
AS-BUILl. II. [RANK R. BELL. 1.11 RL.8Y CERTIFY II IAT AN
A�CURAT[ SURVF Y OF TRIC SOI ; UW!NG DcSCRlf1f I)
PREPARED FOR: BALINDA OAwS PROPERTY; LOT 1 Of I AKt 0' THE HILLS SUBDIVISION
JOU NUMBER: 2005-635
SCALtt 1"�10'
Rt CORD PLAT; /7-230
CRID NUMBER: 2639
OATC: 4-06 05
WAS M.AD-. ON: AUGUST /. 1975
AND THAT ALL IHF DIMENSIONS AND INFORMA?ION AS
SHOWN IIFRI ON ARE '•RUL AND NO ENCROACHMENTS
EXI S i UNLESS SHOWN O (FERWISF, NOH ARE THERE
ANY OTHER VIS,!3LE EASEMF'NIS ON SAID P'ROP'ERTY
CXCFP7I AS IN-DICATT'D HEREON.
U-. W. BELL & ASSOCIA TE --S
L/L 85Ld !nVZS:B SO-9-jdV !089EE9L !3OSSV 7 1139 IMIROW 4 :Ra