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HomeMy WebLinkAboutROCKHILL BLK 3 LT 6Rockhill Lot 6 Block 3 #015-063-04 I Municipality of Anchorage Page of 3 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 Parmit NHnnhP.r: SW 930 1$O PID Number: 01506'304 Name: Wastewater System: ElNewoNL`1 Upgrade LA RRy 4- CAROL FUL KERSON Address: ABSORPTION FIELD EXIST)NG (0201 PETRIFIED TREE DR Phone: 34(o-2470 No. of Bedrooms: 1 S O Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: Block; Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 ROCK P I L L Ft. Ft. Township: Range: Section 14' Fill added above original grade: Gravel length: � 2 N 3 W Ft. Ft. WELLFl New ❑ Upgrade WELL: Gravel depth: Number of lines: Distance between lines: EXISTINC3 Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. Ft Driller: Date Drilled: Static Water Level: Installer: TAN k ONLY' Date installed: 71 %I9 3 Ft. SMIDTcAvATING Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lin Holding Public/Privala Manufacturer: ANCHORAGE TANK Capacity in gallons: 1500 From Tank Field Station Tank Sewer Lines Well I Oar Material: STEEL Number of Compartments: 2 Surface>100 LIFT STATION WaterLotr \�� Size in gallons: Manufacturer: Line 15 ��F� r - "Pump on" level at: "Pump off' level at: High water alarm at: POunne S Curtain Rump Make 8 Model Electrical Inspections performed by: Drain BENCH MARK Remarks: New se pec �etnIT InS1,01ted Location and Description. r ca rove( e✓rn'ir '�7rt teat BOTTOM OF 51DIN6 AT NORTH SCefic kinin uA .eon ,tllrcl w. cancrtlLe _. CORNER OF GARAGE Assumed Elevation: iv/)Ir retklaF-ed w, 2° blue buar»� /00.0 Flattop Technical Services ENGINEER'S SEAL r� r rii t ns o f h�� c io treet�r Ancho:1.1�Rb�r�r. �rrpptiY�'+! '�'r^vs !�"• -TECH 5VCS._ iw ;din✓" ;, A.. — Inspections performed by: __FLAT pates: 1st___°�7/93 a !!!//!l"lint l!llYfll llf ll'v by 2nd.___ �I .� yIIYYI if Ff Of�llV 1, "t1A'. �THcODORf F, iA00RE Department of Health ncl Fit�mar ervl ¢sappy Vat ,..! CE -3589 1010 Reviewed and approved by _.._._- _-: __-._.._._ _ _ .._ .. Dat('JF_ tt `y�`�•11�11 4 72-013 (1/91) MOA 25 . Permit No. 5 W 930 190 Municipality of Anchorage Page 2 of 3 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 BLk 3, ROCK HILL L)T--•-j L IT� 65MT. I I PIDNo.: blSO(030Y �l wl DRIVE J I 192,, I-- 72-013 A (Rev. 9/91) MOA 25 Pk WELL PLAN v/.G—u- Flattop Technical Seri 14530 Echo Street Anchorage, Alaska 9 ENGINEER'S SEAL r« a • ,, . . 46d �v d i TH' D - -0r. AM ORE j 1 CE - 3539 }¢r� Iy#•# .• So I Ex15TING NOUSE CORNERS Sou Ai35 TRENC14 NEV `fa FRoM H l 1500 GAL SEPTIC fgNK TAN KN1< TA C.O. i i � 5 BDRM ! TBM -->A ---' �l wl DRIVE J I 192,, I-- 72-013 A (Rev. 9/91) MOA 25 Pk WELL PLAN v/.G—u- Flattop Technical Seri 14530 Echo Street Anchorage, Alaska 9 ENGINEER'S SEAL r« a • ,, . . 46d �v d i TH' D - -0r. AM ORE j 1 CE - 3539 }¢r� Iy#•# .• Permit No. SW 930180 Page— 3 of 3 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 Leaal Descriotion: Lo -r 6, BLK 3, ROCKH ILL PID No.: O 1506304 72-019 A (Rev. 9/91) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930180 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:FULKERSON LARRY W & CAROL J OWNER ADDRESS:6201 PETRIFIED TREE DR ANCHORAGE,AK 99516 PARCEL ID:01506304 LEGAL DESCRIPTION: ROCKHILL BLK 3 LT 6 LOT SIZE: 53003 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 6/24/93 EXPIRATION DATE: 6/24/94 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: 642 1/ 3 DATE: [- 0T 6 �XIST�N4 TRENCH I„= w I I DOuQAG' c, o EX1Sr(N6 1500 Gf}L, C,r To QE s PuryPEo !r AL ,#)1,R ED W,rtf 1 CoNCRPrE\ N E w (f00 6-A I- 5EPT(C TANIT va aC PA u r D DRI✓E .awmN�. -A%o 4 `d . TH@ODORf f• IAOORG ,• CG • 3589 3 .0- r I C)T '6-- N Orr_ S NGTEs: TANI< mopl-Acomumr- NECL?SSr}/{r 7U EG/HIAIfrL CXISTING ?-,+NiC U101CH IS ENDER GA(?AGe 1=riUNPA770K d is IN D14 -N6 -0N Oe- Caaf.APJIArc, CA RG SHA -AA rsc TAIzeN M �INSuRG Th`�T No DECfr. ScrPpo RTJ A -/i c� m,i�R NPw TAN I� No OTHER wPUIS 06 SEPreC SYST "O "r'{IN foo' of rHo & Syow N, Z Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99519 I -CT 61 61-1-v3, ROCkH /I- I- S/D SEPTIC TANK RE P�/bCE IyGNT S 17-e P6 -A -N DA-ra : 6/93 PL -N. 3f-: TP/1 NOTE: TAfs Is NOT A 5u RV C -YC -D PLAT A[.l, LOCMWALS ARF fbPP(?OKjH4TG'` MUNICIPALITY OF ANCHORAGE / ® _ 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 PH7ONE i.B NEW 3 L/7-( —5&)? ❑ UPGRADE MAILING ADD SS ft (����a� /u�Ze ��z� %967 LEGAL DESCRIPTION LOCATION r - DISTANCE TOell Absorption area Dwelling D r : 5 F-z Manufacturer �f1 n< Meted Liq. ca achy in gallonsIF HOMEMADE: Inside length Width NO. OF BEDROOMS PERMIT NO. No. of cgjnpartments Liquid depth mDISTANCE J z z Well a a Dwelling —..-__ PERMIT NO. Y —�—�'-- —F Man to rer Material — Liquid capacity in gallons 0 2 M DISTANCE TO: Well �„/� '� � Foundation —�`rD r Nearest lot line PERMIT NO. �Y �7` foz" J11.2 = Z � F. No. of lines Length of each Iii e a � (✓ _ 3 Top of tile to finish grade Total length of lin s Trench width _ inches Material beneath tile (,in es Distance between li es Q� Total effective a bsorption area 5 ( w C7 Length Width — Depth PERMIT NO. Q H w Type of crib ZCribameter __ Crib dep Ttaleffective absorptina DISTANCE TO: Building foundation a Ina J J CI ss �1J�' Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(sl OTHER LEGAL `—` PIPE, XTERIALS (-TING i 10 �t SOI LTEST /RATING INS,J, LI_ER REMAR,KS� Ccs i (J APPROVED DATE 72-013 ev.3/78) � ni i c� 7,� l'JO • �iD hiL I G.7t\Fi LVI'1 I KM`. I llYl� LV ( . � Well Log For..,.,,. ! //J' .,.,..................... ....................... .............................. Location.... 4477....?.s ... . &! ..r......cti................ Datecompleted......... ...`......................................................................... Depthof well......... .... ........... ................:............. ......................... ..................... Sizeof casing...............r....... ......... ,..............,........... .............................. Distanceto water,.,....... ....... ..:.......................... ;................. I ....... ... .................. Distance to water while pumping . ............ ...., ........... o .............at rate of........... 216.6 ...................... gallons per,, i,q RECEIVED Formation froze to � .......... .......... Driller FEB 51993 Municipality of Anchorage DELTA DRILLING COMPANY Dept. Health & Human Services SRA BOX 984 B ANCHORAGE, ALASKA 99507 I -OIL ..9 PA 1 0-,* :X 8`11L....fl 'I' 'a-' K.1 F' 101 F4 CT @ _w F;*.', S==B ff'_3 �_ L 3 '0 0 DEP'ART'MENT ._.,- HEALTH AND ENVIRONMENTAL PROTECTION 825 JL STREET, ANCHORAGE, PIF::. 9950.1. 264-4720 14 EE: E._.. L.._ fol tl 4 Ell C3 1`4 _.. :t: _T'FE <5 F=_. 14 E7 ONE F ^ E__ F=_ rQ1 I tl_ PERMIT NO. 4 8101.2:1.KAA_Lc�fr�. p L7fF L rif='PI_ICFltdT DENNIS HEE;EF:T' SRA E,ilX 17"2:I. 99507 ;::.1�- r-,•,�;, LOCATION PETRIFIED FOREST C7.i^:CLE — L..EGt"II_. L 6 E 3 ROC::f::HILL. SID LOT SIC=E 54000 SQUARE FEET TYPE: OF SOIL ABSORPTION SYSTEM I.`::,: 'T'Ft'FtdCH tut"K") I'IPI;<,1hiLIh1 tdUt9EEk: CIFT EIE:CFa..iOf1y; 5 SOIL f2F1'fIYdG ;c,G! f='7"r'f F:?= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �o?� a I CJI P.'�:d ff== 9=�"' T" p--6 _::: �_. „=? �._.. E=: V"•.9 e�::a _ Y._ B -•I �_� �a u�a Y"-. t=i °•r' @W �_ IC co C:� 6-'"• �Y _ a -•H :�:= x�=� r � ��,�) THE: LENGTH DIMENSION IS THE. LENGTH CIN FEET) OF THE TRENCH OR DRAINF'IELD. THE: DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE. OF THE: GRCII,fY•D F'iND THE BOTTOM OF THE EXCAVATION ON FEET). THERE 15 NO SET WIDTH FOR TRENCHES;. THE GRAVEL_ DEPTH 15 THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL._ PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). E 4, F.:.. ¢_ g 1.9 1: low En K> 13 EE--1F"I— I 111-- p... B 1 l' -O 1-C. c::X: 1E EE :70EEO CEM Y 3 9'-1 N_.... L... 13 r-4 *HS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFOF:M THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT 'I'C'I THIS PROPERTY AND THE NUMBER OF RESIDENCE'S THAT THE WELL WILL SERVE. _... - Y- 114 C fl 1 N .8 9 Cr: :: g- 3: e.3 t" 4!:; F=X FA: IE = Q E G--_ d-_9 :Y: Rte:* 1EE IC:::« _ .. BACKFILLING OF ANY SYSTEM WITHOUT FINAL_ INSPE:C:TICiN AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WEL..L. AND ANY ON-SITE SEWAGE DI::;POSAL.. SYSTEM IS 110 F=EET FOR A PRI'•iATE. WELL OR 150 TO 200 FEET FROM A PUBLIC: WELL DEPENDING UPON THE. TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE: WELL TO A PRIVATE SEWER LINE: IS 25 FEET AND TO A I_:OMMUNIIY SEWER LINE IS 75 FEET. WELL L_til:5`_ ARE: REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS, OF THE WE:L-L.. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. 1.1 E: EZ F' : a._ _• A.- °=v _71._ I CERTIFY THAT 1: 1 FIM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS: AND WEL..L_'_, AS SE'T. FORTH BY THE: MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INS:;TAL.L. THE SYSTEM IN ACCORDANCE WITH THE CODES. : 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE: RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. :_;IGNED:..___.___.____.._.....__.._.__--...._.._._..__......_..._._.__..._.._.__...._._—____. /1 APPLICANT DENNIS HEBE:R.T �( P nL 1 J�cL�sn� f ISSUED ki','.............................. DATE ---- �MA------- s,,.a, 0 MUNICIPALITY OF ANCHORAGE Department i Health and Environmental Protection 825 L Street, Anchorage, AK. 99501 264-4720 # HANDWRITTEN PERMIT # # WELL AND/gW ON-SITE SEWER PERMIT �7 1 7,2/ Applicant: � �Y�/s �� ,x'77 Mailing Address: Sk19 goo Location: P&7_PC/fP 6)4CST �i/EG 6 Phone Number: _ 3 f,4( -S ff2? _ Legal Description: _.10T_ i�" &�k j Poet"_ Lot Size:—.SV4000 +- Type of Soil Absorption System Is: Trench: ->(' Drainfield: ` y Seepage Bed; Holding Tank: Maximum Number of Bedrooms: _15-_ Soil Rating(sq.ft/br) /,7 The Required Size of the Soil Absorption System Is: DEPTH � LENGTH _GRAVEL DEPTH / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). # REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS �" # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the numbe,: of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer .line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 3 1 # # I certify that: (1) I am familiar with the requirements for on --site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if i e residence is I to include more that bedrooms. � Signed: ��// 1� Issued by:n4l 'Z Applicant l n'I°J°�icAAi%`" DES/PES S ODkvi A/9?W6 Date: SWP/024(1/81) MUNICIPALITY OF ANCHORAGE fe DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: Q I S L.♦ a 54 K 1 DATE. PERFORM LEGAL DESCRIPTION: 13 > 14 ILL SUlo, DEPTH � J ` SLOPE SITE (FEET) I cvvv 11L 2 3 4 Z �� 5 54uD�/ d L 5 - 6L F), 7 12S 8 9 10- 11 WAS GROUND WATER �/ a ENCOUNTERED? 0 12 - - P IF YES, AT WHAT E 13 Z. " nnt YDEPTH? �( 1 r'L 1a Sit 7 G,�aut-I 15 or 44 a9 15 ��� ••aaeaaa°y� ��� , 8 Y es' � 0 saaOOeo 18- a Basso •aoaon°.aoaea•oa�a e• $g NO. 1732-E 19 June 22, 1968 fig °0a 20 L° a° eaaaa V 1`gAL. �,®^av PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN -- FT AND FT COMMENTS Ct9tiS e e"! 'r G PERFORMED BY: 7 CERTIFIED BY: W S01 LS LOG ❑ PERCOLATION TEST Reading Date Gross Time Not Time Depth to Water Not - Drop 72-008 (6/79) Municipality of Anchorage • Development Services Department Building Safety Division ° On -Site Water and Wastewater Program 4700 South Bragaw St. E T 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 l.D. _ 0/5-04,_-3.4 _ HAA Expiration Date: j — %, _01f L GENERAL INFORMATION Complete legal description Le i h 3 is73> Q-Oc�IG w it_ L. S/o Location (site address or directions) _ (s 201 ��� ri "eoP itA e e C i. -e -le %507 Current Property owner(s) Mailing address to Day phone.. 5y10- 2723 Lending agency Day phone Mailing address nn Real Estate Agent 3,_t�,r i; llP-1c Day phone Mailing Address 2G 0.0 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 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 vallid supplysystem. 90 days fromathe date of sso issues sue for properties served by a private Certificates Class Cfwell and may be reissued Approval with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and state codes, ordinances, and regulations in effect at the time of installation. Name of Firm oby S Ae ? Phone X74-3cr%� Address Io21Sa iri 17 H Za-5 4--te,AIS Engineer's Printed Name. i e l6 be K Date 5. DSD SIGNATURE Approved for ' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.32 mg/l. EPA maximum concentration is 10.0 mg/l. More information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: jb �� Original Certificate Date: (Rev. 01/02) untel ahty of Anchorage DevelopmetIt Services De artment eell o p < Building Safety Division � mr ti.x , On -Site Water& 1%�a'sfawate� P`ro�rant ' s . w ,= y., ox 96 0 .ci anchorage:ak.us ` EALTH AUTHORITYAPPROVAL CHECKLIST' Strip ion :. c �: l gk 3 LT % Parcel ID: 015 06, -3 oL( If A B, or C protii&e PW§ Well Log (Y/N) o N" pleted + 0-$` Sanitary seal (Y/N) --- Wires properly protected (Y/N) _. , th �_ft ,_ Cased fo " q�- ft. Casing height (above grountl) ___��___in, est- to 8! iter' evel iuctiori g p.m. SU colonies/100 iil. Nitrate 5 �a °.1-mg./I. Other bacTe"'na I�k�J colonies/100 ml. Dafe'ofsam'pIa. _N Collected by. J ..5�+vrLc iakoQ sw .w Mate n �g yy�C Date installed - N29/ 13 �% 9al Number of Compartments ��� Cleahotats cleanout,(YIN) ,Depression over tank (Y/N) Al-_ High water alarm (Y/N) eV/,A M Y B Soil rating (g.p.d./ft2 or ft2/bdrm) System type TrenCA . ft Width �;M !PN ft.' Gravelbel0wpipe � ft. ft Effabsorption area �S6 -ft Monitoring tube Depression over field Efw1 quacy test J Z �y Results (Pass/Fail) For —n bedrooms_ n absorption field before test ��� in. Water added],�Q gal, New de fh /o ie: �L min. Final ;fluid deptB � in. Absor tion rate >= ' 7�' Q afion treatment (past 12 mo.) (YIN &type 0 mIf ves.''aive date / Size in gallXe in. "Pump off' in. High water alarm le I at in. aN. Cycles test Meets alarm & cir uit requirements? o£ ' IOS a on adjacent lots fDO+ On adjacent lots 10(7 k m %V Public sewer manhole/cleanout Y4 A N w jpp k Holding Yank A �,...„..�.. ES FR6M SEPTYC%HOLDING,7AT1'I< ON'LOT TO OT-19-Od 01:/35PM FJRON-CTdE ` ESI, SCS ENV SERVICES 9075615301 T -tat o noma SGS' SGS Ref.# 1044042001 Client Name Tobben Spurkland P.E. Project Name/# Rockhill Bllk 3 Lt 6 Client Sample ID Rockhill Blk 3 Lt 6 Matrix Drinking Water All DoleslTimes are Alaska standard Time Printed Date/Time P7/15/2004 16:22 Collected Date rime P7/12l2004 14:00 Received Date/Time p7/12/2004 15:15 Tecknical Director _ StephoWe. Ede Sample Remarks: i PMame[tt Results ns Allow IC A%Iyosia Lim is Jnll Haters Department .. . Nin -ate -14 5.32 0.100 mg/l. EPA 300.0 B (<=1 p) 07/12/04 JJ6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 995196650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILL/Y DWELLING4 / 2 Parcel I.D. # 015-063-04 HAA # ��i�bGCa / _ 1. GENERAL INFORMATION Complete legal description ROCKHILL SUBDIVISIOM LOT 6. BLOCK 3 Location (site address or directions) 6701 PETRIEIED TREE CIRCLE Properly owner ROBERT & MICHELLE SWIFT Day phone Mailing address c/o BOB BAER ® TOTEM REALTY Lending agency Mailing address Day phone Agent BOB BAER Day phone (907) 272-0571 Address TOTEM SEAiTv 724 r= 15th AVE ANCHORAGE AK 99501 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 5 XX 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 XX Holding Tani( Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72025 (Rev. 1191) Front MOA #21 Computer Version Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at, or prior to, closing for the engineering services provided. 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 MunicipaJ�and State codes, ordinances, and regulations in effect on the date of this inspection. /I Name of Finn Phone (907) 337-6179 Engineer's Signature v _ Date 6.112A0 In conducting this evaluation, AWWC, In a e ted to provide a timorough, conscientious engineering ana&vIs of the system in accordance with ADEC and M A DHHS Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water p0�0p04 usage of the family being served by the system. Thaw conditions are outside the control of o OFA p the evaluator of the system. Satisfactory fest results do not guarantee future performance o p4 of time system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will confine to meet the operational requirements of the ADEC or MOA DHHS. ......... ... ........... The content of this report is for the sole benefit of the owner listed above. Any 0 reliance upon or use of this report by any other person or parry is not authorized, • • • • . • • • nor will it confer any legal right whatsoever. �O P '.J fr A. Go ess; ` 6. DHHS SIGNATURE 0o 9T ' ! —7953 c G Approved for bedrooms 444ed efaaste^�� p o Uhl.._ —cam Disapproved Conditional approval for bedrooms, with the following stipulations: Additional 0 Date 6-/-5'o D The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the pmfessional engineers work. 72-025 (Rev. 1191) Back MOA 021 Computer Vemlon Municipality of Anchorage KLICEIM DEPARTMENT OF HEALTH & HUMAN SERVICES JUN 14 Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343.4Zj%1CINA1AY Of A vIRnNMENTAL URVIC Health Authority Approval Checklist Legal Description: --ROCK HILL S/); LOT 6, BLOCK 3 Parcel I.D.: 015-063--04 _ A. WELL DATA Well Type__PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number__ Log present (Y/N) Y _—_ Date completed _ 6/10/81 Total depth _ X92' Cased to 40'+ Casing height (above ground)— 20'" Sanitary seal (Y/N)_ Wires properly protected (Y/N)_ YES FROM WELL LOG AT INSPECTION Date of test _ 6/10/81 - 6/8/2000 _— Static water level Wall production 11-m a WATER SAMPLE RESULTS: Coliform - "e' —Nitrate �o --Other bacteria.— Date of sample: _ (T zd © _Collected by: __— A.W.W.C.. INC. B. SEPTICMOI_DING TANK DATA Data installed _ 7/7/9-3 _Tank size 1500 Number of Compartments— 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression (Y/N)_ NO High water alar (Y/N)NA Date of Pumping 6/8/2000 _ Pumper_ ROTOROOTE R _ C. ABSORPTION FIELD DATA Date Installed 5/81—_Solt rating (g.p.dJfl2 or ft2lbdnn) 125 System type TRENCH — Length 63' Width 4' Gravel thickness below pipe 6' Total depth _ 10' — Effective absorption area _?56 Monitoring Tube present (YIN) YES Depression over field (Y/N) NO Date of adequacy te6t_-6 8 2000 Results (Pass/Fall)—EASEL—For. 5 --Bedrooms Fluid depth in absorption field before test (in.); 0" Immediately after %2-2. gal. water added (In.): _10" Fluid depth 0"—(Ins) Minutes later: 20 Absorption rete =1 600+ GPD — Peroxide treatment (past 12 months) (Y/N) NONE KNOWN _ If yaa, give date ----- -- 72-M (Rev. 31 r Computer Version D. LIFT STATION Date installed Manhola/Aocess (Y/N) High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: at` 'Pump oir level at` Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line Absorption field 5'+ Water maln/servios line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Driveway, paridng/vehlcle storage area 10'+ Curtain drain F. ENGINEER'S I certify that 1 of Municipal With MOA H"� Engineer's Date I, i HAA Fee $ 7ro NONE KNOWN field Inspections and review i systems are in conformance on this date. A. GARNESS Data of Payment � ` 1q_00 Recelpt Number b 6�)(n J g I(q 72-026019v 9/96)• Computer Verelon Wells on a Waiver Fee Data of Payment R"Ipt Number 06-13-00 16:20 FROM -CTE ENVIRONMENTAL 5615301 ALCUE Environmental Services Inc. �iir.�riirr •/riiwrwors ME Ref.# 1002788001 Client Name AK Water Ar Wastewater Consultants Inc. Project Name/ft Rockhill SID Lot 6 Blk 3 Client Sample ID Rockhill SID Lot 6 Blk 3 Matrix Drinkmg Water Ordered By PWSID 0 Sample Remarks: T-095 P.02/03 F-058 Client PON Printed Date/Time 06/13/2000 13-51 Collected Date/Time 06/08/2000 13:00 Received Date/Time 06108/2000 13:50 Technical Director Stephen C. Ede Released B �� Al LouaDle Prep Analysis Parameter Results PUL units Meta6(1 Liali is pate Dace Inix waters Department Nitrate•x 4.96 0.500 m0/L EPA 300.0 10 max 06/08/00 SCL Micronioloyy Laboratory Total Coliform 0 col/100m4 Shia 92228 06/00/00 KAP MUNICIPALITY OF ANCHORAGE fi • !� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519..6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. it �� c-nl—�- —� << - HAA# 1. GENERAL INFORMATION 11/LL 5/lam Complete legal description 40-r �Q� �K 3 � - Location (site addressor oodirections) —Z 6 ( 'L IF) s 01AkoL u I Lso 'j Day phone 3 �i(v-zy�a Property owner Mailing address �zb l �� r211 'er�z"Q M -a C12 1— Day phone --- Lending agency Mailing address Day phone Agent Address — Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well — community well Public water — NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site -�--- Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov. 1191) Front MOA 1121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my 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 FirmpA u j Phone g Address C�)Ci s-iw-?ozS Engineer'ssignatur Date y-28-916 e.. f CI: -8149 '<v 6. DHHS SIGNATURE 1� Approved for bedrooms. Disapproved. M Conditional approval for bedrooms, with the following stipulations: Additional Comments 1UTlr The Municipality of, Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rav1/91) Back MOAN21 Municipality of Anchorage DEPARTMENT Of: HEALTH & HUMAN SERVICE L Environmental Services Division L oe* £325"L" Street, Room 502 O Anchorage, Alaska 99501 • (907) 343-4744 it Mumc,pality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description:1/we�ol� (41L -e Parcel I.D.: ©/ 5`- 64,g -e) T A. WELL DATA Well type --�I"Rt VA i d If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) _� Date completed (n -/o-- ('5 1 Total depth Cl Z Cased to q 2 Casing height (above ground) _ l� Sanitary seal (Y/N) FROM WELL LOG Date of test /I o % F31 _ Static water level 6� - Well production //0 WATER SAMPLE RESULTS: Coliform — d Nitrate Wires properly protected (Y/N) AT INSPECTION / - 2--7 -4 6 g•p.m. 0_ g.p.n1. Other bacteria ' (�:) Date of sample: _ / --Zg —g A __ Collected by: S -R Q P,AL.Nr9nl e--- B. s B. SEPTIC/11OLDING TANK DATA Date installed , Q Tank size / 1300 Number of Compartments Z Cleanouts (YIN)—Y--- Foundation cleanout (Y/N) Depression (Y/N) J . High water alarm (Y/N) '/A Date of Pumping I -Z 7- 46 Pumper '(I azq-d. LA.vn C. ABSORPTION FIELD DATA Date installed 5 -let Soil rating (g.p.d./ft'- or ft'-/bdrm) 1'2,S- _ System type Length _ (3 '_Width _ �d Gravel thickness below pipe 6. 6 t Total depth /0 Effective absorption arca 7S 6 Monitoring Tube present(Y/N) ` peDepression over field (Y/N) Aq—_ Date of adequacy test I - -,?/Q Results (Pass/Fail) C}� A�� C For S- bedrooms Fluid depth in absorption field before test (in.); Sir Immediately alteR-50 gal. water added (in.): Z? -Y Fluid depth EJ1vl (ins.) Minutes later: -- o Absorption rate = -b / 1,.r2 D g,p,d, Peroxide treatment (past 12 months) (YM) /I1 0 If yes, give date `^ D. LIFT STATION A i Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons on" level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / Cb On adjacent lots O d Absorption field on lot / f o 0 ; On adjacent lots O O Public sewer main �` Public sewer manhole/cleanout t'V A Sewer /septic service line / O0 Lift station M %Ili SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation $- 1 Property line �;- Absorption field / O t S-0 .t., l r>`t- Water main/service line '> Surface water/drainage Wells on adjacent lots l 00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / b 'tom Water main/service line Surface water / Op Driveway, parking/vehicle storage area K O Curtain drain Wells on adjacent lots /00+ Property line df F. ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal records that-the.q�oue systems are in conformance with A110A HAA guidelines in effect on this date. Ct Signature.... �.. Engineer's Name STZ�1 eiV 12•PfAan�orv�,C1> e3' t1" i ie rmpeHere F` Date t — 2 8 — (off ; ^•,.,: gbo r 2 > 8 ------- HAA Fee $ Waiver Fee $ Date of Payment �- S-`�� Date of Payment Receipt Number o i io3.3Receipt Number Rev. 8/95 OSS: haa.wk.doc Steven R. Pannone, P.E. P.O. Box 142025 Consulting Engineer Anchorage, Alaska 99514 (907)272-8218 SEPTIC SYSTEM ADEQUACY TEST Legal: Lot 6 Block 3 Rockhill S/D RECEIVED Location: 6201 Petrified Tree Circle Owner: Carol Faulkerson Municipality of Anchorage Dept. Health & Human Services Septic System: From Municipal Records: Tank: 1500 Absorption System: Trench Absorption Area: 756 s.f. (631 x 4'W x 6' Total Depth = 101) Soil Rating: 125 Installation Date: 5/4/81 Date of Pumping: 1-27-96 - Northland Pumping Date of Test: 1-27-96 Test Procedure: System was inspected and measured. Tank was found with 4 Feet of cover. Liquid depth was measured in the monitor tube, and found to be dry. Water was added to the system at a constant rate of 8 G.P.M. The water levels in the tank and monitor tube was monitored. A total of 750 Gallons of water was added. During the test the level rose zero Inches in the field. No rise was noted in the tank. The infiltration rate was monitored for 95 Minutes. During this period a total of 750 Gallons were absorbed By extending the observed infiltration rate a total absorption rate 11,520 Gallons per day was arrived at, TESTS RESULTS: This system meets the code requirements of the Municipality of Anchorage. The operational life of all 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. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. "m C:E:-3112 c�4 4r �60 X1!31/96 16:21 CT&E ESI ANCHORAGE 4 907 272 8218 ME Environmental Services Inc. �I CT&E Ref.# 96.0291-1 Matrix WATER Client Sample ID L6 BLiK3 ROCKHILL Client Name PANNONE EN© SRV. Ordered By STEVE Project Name Project# PWSID T.TA Sample Remarks: SAMPLE COLLECTED BY: S.R.P. NO.238 902 WORK Order 20879 Printed Date 01/31/90 9D 14:46 hrc. Collected Date 01/28/96 0 14:00 hrs. Received Date 01/29/96 eO 10:15 hrs. Technical Director STEPHEN C. FDR Released QC r•-- Allowable Ext. Anal Parameter Results Qual ----- -- ----------------------------------------------- Units Method Limits Date Date Init Nitrate-N 5.0 D 11 ----------------------- mg/L EPA 353.2 I-------------------------- 10. -------- 01/29/96 EMB --- -•••••.•...T.c==va.rWrr---. * Sac Special Instructions Above ** aee Sample Rmmarke Above ;;:U = Undetected, Reported value is theractical p quatYCilication limit. D = Secondary dilut.l.oll. UA = Unavailable NA - Not Analyzed LT a Less Than GT = Greater Thar 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.# 0/5 0(05 0y' HAA# '0Q_ '-)CnLll 1. GENERAL INFORMATION Complete legal description L0- l `J V_ -� -Qoe_ L' V Location (site address or directions) Property owner Mailing address Lending agency II'' IIa. D.e.vlvtiS Day phone 5 6P 2 — Z2 3� a Day phone Mailing address n Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I \; 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 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 // PJ��e" t �Pur� �atao� �� Phone%q- 39l b Address Engineer's signature � -��� Date / Gl 22G g3 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. bedrooms, with the following stipulations: By. ) r Dated `y MITI(: 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: "I'sa ' ,' wa Parcel I.D. 015 D to -S O L/ A. WELL DATA Well type If A, B, or C, attach ADEC letteCr. ADEC water system number 'W y/0 j a a-1 SUE Log present (Y/N) Date completedDriller LTA. Total depth- -1� Casedto �fZ Casing height Sanitary seal (Y/N) y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date test 6/10181 t 11W'/q3 i � z of Static water level rri -7 �17 I, Well flow 9 -p.m. / g,p.me'oto p z Pump level �o Nowt i ii r" w SEPARATION DISTANCES FROM WELL TO: .Septic/holding tank on lot n-' ; On adjacent lots > y Absorption, fleld on lot On adjacent lots 3� Public sewer main NPublic sewer manhole/cleanout NSA Sewer service line I rrep Petroleum tank N10 WATER SAMPLE RESULTS: 7 /7 Coliform — Ty Nitrate Other bacteria Date of sample: � a ��q3 Collected by: 51 SEPTIC/HOLDING TANK DATA Date installed��if I q ( Tank size /t5'0-0 Compartments �, I Cleanouts (Y/N) y Foundation cleanout (Y/N) Depression (Y/N) ' V High water alarm (Y/N) /WAR Alarm tested (Y/N)I NSA Date of pumping 4��.! qY / Pumper .g 01-0(le- S __ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s) on lot 106' On adjacent lots 7 / 3-0 Foundation 3 To property line % yO Absorption field I D Water main/service line > n Surface water/drainage 72-026 (Rev. 7101) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) N� High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installed -61y/81 Soil rating IA5 System type J r -H CA Length Width Gravel thickness / r Total depth / D Total absorption area 754�- � Depression over field (Y/N) 1V Results (pass/fail) Peroxide treatment (Past 12 months) (Y/N) _ Cleanouts present (Y/N) Date of adequacy test I,2A 93 for -5 bedrooms I i4 i 4 i 3 4 q' Y ap u7 L O.0� If yes, give date talk x 5"_ 6<4G CeA. s y s SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Z /OJr On adjacent lots % / $D Property line 1>,X0 To building foundation To existing or abandoned system on lot N On adjacent lots i!V-D Cutbank Nnvte. Water main/service line 76O Surface water O Driveway, parking/vehicle storage area 1 ui� Curtain drain �I IV E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Trott4 a I O Cuf Dyy' kLau.� Date 6 �L/ T t `t q 3 HAA Fee $ / ZD ry Waiver Fee: $ Date of Payment A Date of Payment Receipt Number �W32rck,D4Q Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Chemiab Ref.# :93.0349-1 REPORT of ANALYSIS Client Sample ID :6/3 ROCS HILL Matrix : WATER Client Name :TOBBEN SPURELAND, P.E. Ordered By :TOBBEN SPURELAND Project Name Project# PWSID :UA Sample ROUTINE SAMPLE COLLECTED BY: STUART. TAG MARRED SAMPLED AT 1333 HRS, Remarks: WE RECEIVED SAMPLE AT 1330 HRS. QC Parameter Results Qual. Units Method NITRATE -N 4.17 mg/l EPA 353.2/300.0 Collected :01/26/93 @ hrs. Received :01/26/93 @ 13:30 hrs. WORE Order :62647 Report Completed :01/27/93 Technical DirectorEP EN C. EDE Released By Allowable Extract Analysis Limits Date Date ------------------------------------ 10 01/27/93 01/27/93 ' See Special Instructions Above UA - Unavailable See Sample Remarks Above NA - Not Analyzed U - Undetected, Reported value is the practical quantification limit. LT - Less Than D - Secondary dilution. GT - Greater Than �2�S�±GS Member of the SGS Group (Societe Generale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Rou< /11/-Z, sofa 12 -Al 3U.) lel Location (address or directions) � 01_P_&rAIFiE.O 0?6P_ � (b) Applicant Name Telephone: Home Business az " 2 Applicant Address—�Z111 RIf -/,c 1�� - r1p �-r c V (c) Applicant is (check one): Lending Institution ❑ Owner/builder �4"; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address _— (e) Real Estate Company and Agent Address —. Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family (4 Multi -Family ❑ Other Number of Bedrooms _41 3. WATER SUPPLY Individual Well X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 1Y Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ]2-025(11/94) 33 L6 80CK lqk/ : 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and Slate codes, ordinances, and regulations in effect on the date of this inspection. Name Addre Date 's -4)l -'s-0 YU EM6vE CU/VJ)i T[,omnG 7-0 G 0C/4 i G ANrj F.YrEnrD Cl --A oor To 2 can�PfJRTaY/E�j 'N TRIVK AIND CLEAN our nFTE� Tnn/K (('-( SQRrNG.. I 5f'ECTE/O 61. 301e6 -OV U EFF K -AI r cHUck' lens (jyCr ®oc�s, a n Mq aG 4 . .. ov 4,3122 n°n °,..n•nn R Y C. REID, 11.. SC51-2251 ,AF �r,1lPessicfi��� 6. DHEP APPROVAL(_j� Approved foryu.P bedrooms b — - 2-.- Approved—_ Disappro e _ Conditional Terms of Conditional Approval C CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/04) MUNICIPALITY OF ANCHORAGE �� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECLPT. OF HEALTH & NMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVA1rl N 07 OF ON-SITE SEWER AND WATER FACILITY 264-4720 R E EG� D Application Date {{{000 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) -I Location (address or directions) Applicant Name I CAIA1/S 0er Telephone: Home — Business Applicant Address 6p'm® Ameelth ��� �i�' �✓ 99s7� Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); Lending Institution Address Real Estate Company and Agent Address Telephone ' (f) I 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms —__- Telephone 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) Lfi 5. ENGINEERING FIRM PROVIDINL .aJSPECTIONS, TESTS, FILE SEARCH, DA7,% AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Awl ,� Telephone �'/-se �B Al -- 7g9- "6W A0 d-Y%t1h et"Weu7— is ZW &�%OWMMW7— Og_ 5:077le R' AAlb DHEP APPROVAL �l�) Approved for rn u" bedrooms by Approved Terms of Conditional Approva Lo 04� Engi OF '4`4p14% >006®66®co °`d�k 6e 4 ,7 06 d' 90 Oy C. Reid, Jr. No, 2253.,x-. \ R: , ° oa�� or; n6•.0600° ROFES�S�. CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 1 11/841 MUNICIIEpALITY OF ANCHORAGE (MOA) MUNICIPALITY OF Aty�RLAfH AUTHORITY APPROVAL (HAA) DEPT. OF HEAL ENVIRONMENTAL PROTECTVMiCKLIST- F 72RUARY 1984 IAN 07 19* Legal Description: B/_fele leaCi�'hzL A. WELL DATA RECEIVE® �%�A/ �j� '5&e Well Classification ��.Fid�l'7�' If A, B, C, D.E.C. Approved (Y/N) ___a4 Well Log Present (Y/N))— _ Date Completed RAIOI oz'�� Yield � �- j�* u� i AJ Total Depth � Cased to _—/�— Depth of Grouting - //�{...��� r Static Water Level • 7 s� Pump Set At Casing Height Above Ground—�^ 7 Sanitary Seal on Casin (Y N) Electrical Wiring in Conduit (Y ) Depression Around Wellhead— Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots - To Nearest Edge of Absorption Field on Lot / ; On Adjoining Lots /e -y To Nearest Public Sewer Line— To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected byA- e S ' AVAII ; Date --L: —Sid, Water Sample Test Results _ IlAn— — Commentso PJ A"d 7Z-57 B. SEPTIC/HOLDING TANK DATA Date Installed Size d % No. of Compartments -Z� Standpipes(Y ) - �— Air -tight Cap (Y ) Foundation Cleanout N) Depression over Tank ()V Date Last Pumped 9 iY 3 Pumping/Maintenance Contract on File (Y/N)� for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line To Building Foundation CO ^ To Disposal Field To Stream, Pond, Lake, or Major Drainage Course— comments ' tG4 �afT ,j 7,11 77 ,&—W7- 0,4c i/K &7- A7- Jaf//ICIy. Cw,,b Page 1 of 2 72-026(11/84) L 6 83 A'44+41 - C. ABSORPTION FIELD DATA Soils Rating in Absorption Strat Date Installed Width of Field a 11 TiZ Type of System Design �lCl Length of Field Depth of Field ravel Bed Thickness Square Feet of Absorption Area �{° Standpipes Presen A N) Depression over Field (Y9NE Date of Last �AAd""e/�q}' Adequacy Test �`. (o Results of Last AdequacyTest Separation Distance from Absorption Field: To Water -Supply Well /OX• ��� / To Property Line /0 ~9r" / To Building Foundation �� To Existing or Abandoned System on Lot AV4 ; On Adjoining Lots '5-6 / -/- To Water Main/Service Line 41-A To Cutbank (if present) .✓�.� To Stream/Pond/Lake/or Major Drainage Course ArI4 To Driveway, Parking Area, or Vehicle Storage Area Comments L[A*✓Mr /ice%X' 147'7G 7lJx//( e4' tlrPi7tCr Co 1LI� c%%�lL('r r, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments - Dimensions Manhole/Access (Y/N) — 'Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I have eckerf, verifi d, or conformed to all MOA andHAAguidelines in effect on the date of this inspection. Signed lel (/< A �� Date � � 6 Company CS MOA No. OF ®dee A Receipt No.��,`Qa.......•..ga��Y4S�D .p • 8 Date of Payment Amount: $ �Sy.��. �� i Mar" Page 2 of 2 72-026 (11/84) eY C. Reid, Jr No. 2251.E eY; � �'e•uee.e*�.��. ALASKA RUIR01 STAL COnTROL REIM, InC. Engineerinq 6 environmental Studies 01/06/86 DENNIS HEBERT SELLER—DENNIS HEBERT DENNIS HEBERT 6201 PETRIFIED TREE. CIRCLE 6201 PETRIFIED TREE CIRCLE ANCHORAGE ALASKA 99516 ANCHORAGE, ALASKA 99516 50844 LEGAL:ROCKHILL SUBDIVISION BLOCK 3 LOT 6 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -01/03/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 756 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 901 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 9/19/85 . FLOW TEST ON WELL WELL FLOW DATE -01/03/86 A FLOW TEST WAS PERFORMED ON THE WELL. 901 GALLONS OF WATER WAS PUMPED AT A RATE OF 6.4 GPM OVER A DURATION OF 2.4 HOURS. THE DRAWDOWN WAS 3.2 ' WITH A RECOVERY TIME OF 1 MINUTES AND THE STATIC WATER LEVEL WAS 67.7 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. 1200 UJest 33rd Avenue, Suite B o Anchoroge, Alaska 99503 • (907) 561-5040 ALASKA ENVIRO("v--7NTAL CONTROL SERVII._j, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 rami aai.r%nan dos— SHEET N0. OF CALCULATED BY �� ,' DATE CHECKED BY DATE PROOV 2W 1� I.., GM , Mas 01471, APPLI( ANT FILLS OUT UPPER HAL ;ONLY Property Owner � IVAJ15 Time Phone Mailing Address,% („1( .( Zip Code Buyer Date Address k& Zip Code Lending Institution a,..r,F•l-1'j _ Phone Address Zip Code c� 1. ('0/ Y Realty Co. & Agent AIC Phone Address Zip Code Legal Description:"; Street Location G( Type of Residence Single Family ( DISAPPROVED ❑ Multiple Family No. of Bedrooms ( ) CONDITIONAL APPROVA ' ❑ Other DATE Water Supply X Individual BY: ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community Date Sewer Installed For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Septic Tank Size I ?,j Sew r Disposal Well to Tank 7 Individual Year Individual Installed: ❑ Public Utility. When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION. FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: M:;*,I)-�In^1.ITY OF ANCHORAGE ,nL,vr, OF HEALTH & PROTECTION ENVi"1-NM'1VTAL MAR 2 11 63 RECEIVED ( Y,') APPROVED BEDROOMS � /_) 'CONDITIONS OF APPROVAL ( DISAPPROVED ( ) CONDITIONAL APPROVA ' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size I ?,j Well to Tank - C '.?,RECEIVED INSPECTIOnv APPOINTMENTS TrME TIME TIME NUMBER OF BEDROOMS C�t.A _ 0 DATE DATE DATE ❑ Three ❑ Six 7. WATER SUPPLY INSPECTOR INSPECTOR INSPECTO since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) MUNICIPALITY ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. Of HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTERRAbNMENTAL PROTECTION /825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL SANITATION DIVISION AUG J 1981 Telephone 264-4720 RR rr ���� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Pleaseallowten (10) days for processing. DIRECTIONS: 1. PROPERTY OWNER � PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAI LING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILINGADDRESS 5. LEGAL DESCRIPTION t. STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS El One ❑ Four ED Other Ltl/9INGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY [t, ,+NDIVIDUAL* * 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 UU- IIINDIVIDUAL/ON-SITE** atl 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) in I n /] 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 INSTALLER Tankor❑ Holding Tank ❑Septic C�,A _ b If Tank is homemade Size:�,2 give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS (J' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE (�% BY STATE OF ALASKA DEPART'.-fEN'T OF NATURAI. RESOURCE'S DIVISION OF LAND AND WATER MANAGEM11NT OFFICE L'Sc ONLY LAS APPLICATION FOR WATER RIGHT You will need (1) a map showing the location of you: source of water and the area of use, (-) a co;y of your property ownership document, i.e. deed, patent, lease agreement or an eaten., ;t a;r:cme:lt if you do not own the PO,-:.')' involved, (3) a Copy of your driller's well lo;, if applicatian is for an existing well, (4) Statement of Beneficial Use Of Water (Form 10-1003A) ifthis is an water use, and (5) App!ica:icn for Pcr^:t to Corst:,'.:t or Modify Dam (Form 10.1015) if you will Se ccr.structLno a dam over 10 fou: high or over 50 aur: feel of storc;e ?!case type or print Ln ink_ I. Full Ictal name of Applicants) cl 2. M32''ing Address °1 C �c h Cn r /4 6kti Horne Phone —222- 346 - Business Phone ----- 3. SOL': -e of Water Supply: (a) Well �iDr'!ed C Hand Driven D_; Otlt:: If e.x:sdny wc!1, ]f;:i!: ccnr!r.0 i well . 1f;x::Ln� •.roil. end :o I:' Tot -1 '--;(h Cj2 / Int_ c Depth _JC4 S;_... !,vel (`=) C1 Scr:`ce % .::C. Sr:_enCU4 Yc:_ No '-'-Unknown 1-2 St:e--, n Ris c rI L_Ke n 5r rn Give n_-ne (if un:1,.- state s0)