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ROLLING HILLS VIEW ESTATES BLK 3 LT 4
Rolling Hill View Este Block 3 Lot 4 #050-322-29 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211141 PID Number: 050-322-29 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ROBERT GUISINGER ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 19348 MEADOW CANYON DRIVE, ER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot ROLLING HILLS VW. EST. 3 4 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 100'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 5'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks TANK INSULATED. 5'+ TO DECK SUPPORTS. 1996 FLOW SPLITTER REPLACED / REPAIRED. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 3034 Installer QRS drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspeectio V1 5/12/2021 5/13/21 Location and description 2nd 3`d 4'" CORNER OF DECK ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF Conditional Approval: Date G3 *: 49TH .....�:*�� �.. Curtis Huffman. • Appro edSepticstem / �� F • CE 128991 / l� Datek'p,F-• .X5/14/2021. •��C�'.w Now PROFEWQA' _ ~' Note: this approval does not include well permit requirements. tnev uoiuu 10) PID: 050-322-29 PERMIT: OSP211141 Lot A—C=19,2' B—C=15,8' A—D=19,3' B—D=21.2' A -E=22.5' B—E=30,1' /MH MAINTAINED 5'+ CO TO DECK SUPPORTS & MELD DECOMMISSIONED EXISTING S.T. & INSTALLED NEW 1000 -GAL HDPE SEPTIC TANK WITH NEW DCO. ROLLING HILLS VIEW ESTATES B3, L4 PREPARED FOR: ROBERT GUISINGER 19348 MEADOW CANYON DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 SEPTIC SECTION SCALE, NTS SUPP FirstWaterAK@gmail. c9m DATE: 5/20/2021 SURVEY. KGL DRAWNL FWCS SCALE: 1" = 30' 5/20/2021 0 Tract D Tract E W c, o �o w 0' � aECK 2.0' CANT \ \ MORTGAGE SURVEY _x_ SCALE _ 1"_= 50__ GRID NW_0255 _ Project No. Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & A S S o c i a t e S, inCm (907) 522-6476 Phone o4Qpppp� (907) 522-4625 Fax oc� OF q C p�4 Professional Land Surveyors ken0longsurvey.com ,9 jonathan®longsurvey.com ©P S QO I hereby certify that I have surveyed the following described property: LOT 4, BLOCK 3, ROLLING HILLS VIEW ESTATES SUBDIVISION (PLAT No. P-624) Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other. Improvements. Dated this the __7 ___ Day of —_— v_�`_' ____- — at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 MUNICIPALITY OF ANCHORAGE On ite Water & Wastewater Program PO S= ING54 4700 Elmore Road And--4+A4C, Aladgk* 99519-5W0 Phony' (9 343.7904 Fax: XW?) 343-7907 hWh @vw.muni.oQ %Ite On -Site Wastewater Disposal System Permit Pe rcr !t Number, OSP211141 Work Type; SeplcTank lJpgrade Tax Godc Nkimbcr; 05032220000 Effective late: Expiration Date, Sits LagaI Ad -dress: ROLLIMG HILLS VIEW ESTATES BLK 3 LT 4 G=0255 S ite M M I i n g Address, 1934;5 M EADOW CANYON DR, Eag Ie River Owner. GUISINGER ROBERT P Design Engineer: FIRST WATER CONSULTING This parmit is for the construction of; ❑ Disposal Field 0 Septic -rank 13 Holding Tank El Plvy Lot Size in Sq Ft, Total Bedrooms: rt,cnt , J. �piP,rrttrrs 512021 W1X022 37897 El Private Vvell 13 Water Storage All c-Dnstructon shall he in accordance with. 1. The attached approved design, 2. All rMuirernen#S speelfied In Anohorage PSIuniclpal Cade Chaplsrs 15.55 and 15-65 and the State of Alaska WaMewaker M5pas.al Requkalion s (I 8AAC72) and Drinking Water Requiatians (I 8AACM ) I The waatewatsr code requires inapectiona during the installation- The cnginecr 3ball notify the Development Services Department per AMC 15,66, provide notification by calling (90 7) 343-7004 (247), 4- From October 15 to April 15, a subsuriece soil absorption system ur;der oonstrucUen during freozOg Wealher sbnlI be ei%er; a. Opened and Closed on the acme -day, or �- Ceaamd, sealed, and heated to pravant freezing 5/1212021 Received By-- UGke: �— fssued Date..1 .2 f MUNIMPALITY OF o,Iik Development Services Department=" On -Site Water & Wastewater Section Parcel I.D. 050-322-29 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) ROBERT P. GUISINGER Day phone Mailing address 19348 MEADOW CANYON DRIVE, EAGLE RIVER, AK 99577 Site address 19348 MEADOW CANYON DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) ROLLING HILLS VIEW ESTATES B3, L4 Legal description (Township, Range & Section) Lot Size 37,897 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade ElDuplex (D) ElHolding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: a � 5 Waiver Fees: Date of Payment: 5111 W21 Date of Payment: Receipt Number: a 111 G 2 Receipt Number: Permit No. O S Pa 111 q I Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com May 7, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: ROLLING HILLS VIEW ESTATES BLOCK 3, LOT 4 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211141, Rebecca Carroll, 05/12/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211141, Rebecca Carroll, 05/12/21 ~ Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5[~1~O~O~ RID Number: O50-"~ u"~": ~m~ ~ Wastewater System: u New ~ Upgrade ~'~ ~ ~ 5r, &~l~A~ ~f577 ABSORPTION FIELD Phone: S~ -~5~ No. of Bedrooms:~ ~eep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION Soilaating: O,~ ~ ~,~ j Lot: ~ Block:5~'[~Subdiv~i°n:~ ~ ~ Depth to pipe bosom from original grade:~, Ft. Gravel depth beneath pi~e~t~ Ft. Township: ~ ~ Range: ~ Section: ~ Filt added above originalo "~grade:/ Ft. Gravel length: ~ Ft. WELL: ~,~;~ D New ~ Upg~ Gravel width: ~ ,~, Numberof lines: Distance between ]ines: ~. ~ ~5' ~.~ Classification~%~(Private, A,B,C): ~ ~Ft. Cased To: Ft. Total~absorption area: ~ .~'~Pipe material:~ --~/~/ Driller: ~ Date Drilled: Static Water Level:Ft. Install~.~ff~ ~N~{~¢~Ck~(~j~ Date installed:j~ J J"~/~/ ~'~GPM IPumpSetat: Ft. CasingHeightAboveGround:Ft. · TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines .~~ ~ '~ ~ j~ ~ Welkr ~i ~ i -- -- ~1~ Material: ~.~ Number of Conferments: Sudace ~ Water I~"~ I~'~ _ ~ LIFT STATION Lot Size in gallons: ~ Manufacturer: Line JOl'~ I0~ -- ~ "Pump on" level at: ~level at: High water alarm at: Foundation lO t~ iOI.~ -- __ Cu.ai.Drain ~' ~*' ' ~'~ --- -- ~1~ctri~ll~ctiOnspedOrmedb,: Remarks: BENCH MARK Location and Description: Assumed Elevation: Inspections pedormed by:, &, ,,"'"""""e Dates: 1,, tib/~ 17034 Eagle River Lo~ R~d, ~ 2nd~ ~[ ~.~ ,O~,T C. ¢~*" Eagle River, Alaska ~5~ ~ i/16~ ¢~?~,. CE-8801 Department of Heal~an~ ~u~an $e~ices ap~oval ' ', ."". ,, ."~ ,, .,, Reviewed and approved by: Date:/~-22- 77 ~'¥'"::- - ~.~-: ...... .:"'~ ' 72-013 (Rev. 9/91) MOA 25 Permit No SW960504 Page 2 of 2 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 LOT 4, BLOCK 3, ROLLING HILLS VIEW EST. Legal Description: 050-522-29 PID No.: B C 4.0' - 13.5' - 17.5' - 24.0' - 29.0' - 58.0' 66.5' 57.5' 67.0' 67.5' 66.0' 69.0' 67.0' 83.0' 83.0' 82.0' 82.5' TRE~ :HES 100' WELL RADIUS WELL oCO 90,6'- cc ~ cc ST2 1000 GAL SEPTIC ~90.4' TANK = 80.1' = 79.0' = 75.1' CO4 = 75,0' .~01 ~02 MT1 SEI:'TIC TANK FLOW (CONNECTED FLOW DIVEBER(FD) SCALE = 40' CO1 = C02 = 76.3' C03 = C04 = & NO WATER 58.6' B.O.; 72-013 A (Rev. 9/91) MOA 25 ~o I~O~ERT C. COWAN ~; 8801 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519 -6650 PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960304 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:HUFF LARRY M & OWNER ADDRESS:19348 MEADOW CANYON DR EAGLE RIVER, AK 99577 PARCEL ID:05032229 LEGAL DESCRIPTION: ROLLING HILLS VIEW ESTATES BLK 3 LT 4 DATE ISSUED: 9/18/96 EXPIRATION DATE: 9/18/97 LOT SIZE: 37865 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 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. DATE: DATE: ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. CIVIL ENGINEERS September 13, 1996 (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON S~TE WASTEWATER DISPOSALSYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 3, Roliing Hills View Estates Request you expedite issuance of a permit to upgrade the septic system serving the existing three bedroom house on the referenced property. Please expedite this permit due to surfacing effluent. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and after seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 --q SITE PLAN DESIGN \ / © .-t ://'/ / Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERPORMED POR: X//P/ X LEGAL DESCRIPTION:ZOO' 4// ~hO&/4'_~ .~&Z~vG Township, Range, Section: .~'./~'/J, ~?o'"~'"'~'~, //~/../_ .~- ~/,~"/.~ ~"Z' T'~-F'~C'~ SLOPE SITE P!~AN 6 7 8 9 10 11 12 13 14 15- 16- 17 18 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT ~) DEPTH? ./~' /~' P E Depth to Water Alter_ ~, ~/~. ~' Monitoring? P"~ ~' Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN '"~ FT AND ~ FT COMMENTS =~ ~ ~ ~ I _ -~;ERTIFY THAT TH, IS TEST WAS PERFORMED IN PERFORMED BY: 17034 .~-'-~lC ~':C~ L==p ..-'= ..... ~1 /i 7 / ~ ACCORDANCE WI~'~LeLP~NE/~I~31~L~N~7~TAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, RE. ROBERT A. SHAFER, RE. CIVIL ENGINEERS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS (907} 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL iNSPECTiON & FLOW TEST SiTE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN REFERENCE: Lot 4, Block 3, Rolling Hills View Estates September 13, 1996 GENERAL: 1. The scope of this project includes the installation of a leachfeild trench to serve the three bedroom residence located on the referenced property. The existing septic tank is to be excavated to verify integrity. If of poor inegrity than the tank is to be pumped, crushed, and abandoned in place; and a new 1000 gallon septic tank is to be installed. The existing bed is to be abandoned as such that it may be used in the future. e Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise~ the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Be Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP ' SUITE 204 . EAGLE RIVER, ALASKA 99577 Page Two Lot 4, Block 3, Rolling Hills View Estates September 13, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over 'the distribution pipe to provide a minimum of 2 inches of cover over the pipe. e A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to 'the effective depth of the gravel as noted on the design. Page Three Lot 4~ Block 3, Rolling Hills View Estates September 13, 1996 5e Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the 'trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. e The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe. Perforated Solid J Cast Iron ASTM D3034 (PVC) ASTM F810 (HDPE) ASTM D2662 (ABS) Yes Yes Yes Yes Yes No Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inl. ets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the ~200 sieve. When sand is being' used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever appiies~. Page Four Lot 4, Block 3, Rolling Hills View Estates September 13, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3e The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 4~ Block 3, Rolling Hills View Estates September 13, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequencer procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER :--v ~ MUNICIPALITY OF ANCHORAGE 'O ' 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 C,~t ~,J~ ~,~1,~ [-'~ I~' i~P-~ (~,~-~. ~O~ ~ UPGRADE MAILING ADDRESS ~}O ~ LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS ]Well IAbsorptionarea Dwelling ¢,~ PERMIT NO. ~ O ~ ~ ~¢ ~ ~ DISTANCE TO: [OO ~ ~ ~O~ ~ ~ Z Manufacturer Material No. of compartments ~ ~ Liq. capacity in gallons IF HOMEMADE: Inside length ~ Width Liquid depth ~ ~ ~ PERMIT NO. ~ ~ DISTANCE TO: Well Dw~ ~ ~'~ Manufacturer__ Material Liquid capacity in gallons Well ~ Foundation Nearest lot line PERMITNO. ~ DISTANCE TO: ~O~t ~ ~O~ ~Ot~ ~ ~ No. of lines Length of each line , Total length of line~I Trench width Distance between lines Material beneath tile Total effective ab~ptio~area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Cfi TotaJ effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class ~ ~XIG~IE~ Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING ~ ~ INSTAELER REMARKS ~ APPROVED 8"B 19~ DATE LEGAL POLI~,i~ 6 650 ANCHORAGE, ALASKA 99502--0650 (907) 26zi 4 i I 1 TONY KNOWL[ S MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840593 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 4 Block 3 Rolling Hills View Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 DEPARTMENT OF HEALTH AND ENVIRONMEN]'AL PROTECTION $25 L STREET, ANCHORAGEE~ AK 99501 264-4720 PERMIT NO: DATE ISSUED: AI-'F'L I CANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: Lei' SIZE: MAX BEDROOMS: 84059~ o7 / ;. 4 LARRY M. HUFF 12701 GALLEON CIRCLE ANCHORAGE~ AK 99515 345-6732 SUBDIVISION: ROLLING HILLS VIEW E LOT: 4 SECTION: 6 TOWNSHIP: 4t4N RANGE]: 1W .89A (SQ.FT. OR ACRES) 3 BLOCK: 3 Listed belc~w are the options available to you in designing yo~u- septic system. Choose the option that best. £its your site. DEF:'TH TO PIPE BOTTOM (FT.) 4.0 4.'0 4.0 GRAVEL. DEPTH (FT.) 5.0 0.5 3.5 ]"OTAL DEPTH (FT.) 9.0 4.5 7.5 GRAVEL WIDTH (FT.) .'-?. 5 17.0 5.0 GRAVEL. LENGTH (FT.) 58.0 54.0 41.0 -GRAVEL VOLUME (CU.YDS.) 19.3 21.4 30.3 TANK SIZE (GALS) 1.~000.0 *'* 1~000.0 ~'~ 1,000.0 SOIL RATING (SQ.FT. /BR) 1~5 125 1~5 ~. TANK MUST HAVE AT LEAST TWO COMPARTMENTS I c:erti£y that: 1. I am Familiar' with t. he requirements £or on-site sea, ers and weIlm as set £orth by the Munic:ipality o£ Anchorage (MOA) and the State o¢ Alaska. 2. I will install the system in accordance with all MOA codes and regulations~ and in compliance with the des:i, gn criteria o~ this permit. .3. I will adhere to all MOA and State o~' Alaska requirements Cot the mint bacl,: dist. ances Crom any existing well, wastewater disposal system or public sewerage system on ~.his or any adjacent or nearby lot. 4. I understand that this per'mit is valid ~op a maximum o~ 3 bedrooms and any enlargement will require an additional permit.. IF A [...IF]" STATION IS INSTAL. LED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSF'ECTION MUST BE OBTAINED; (2) AS-.BUI[:TS WILL. NOT BE AF'PR/G~O WITHOUT AN ELECTRICAL INSPECTION REPORT~ AND (3) THE LECTRICAL WOR~-~'M~f~cr BE ~)~NE BY A LICENSED ELECTRICIAN. ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST Z. 1(_,,-/'4' T _,,~"/ ~ '~ IF YES, AT WHAT DEPTH? 10 11 12 13 SLOPE [] SOILS LOG [] PERCOLATION TEST 14 15 16 17 18 19 20 PLAN Readi~r~ ~,~-~,'~'~1~ L Gross Net Depth to Net ~e~ ~. ~e. Time Water .rop '~;~2. ' ........ .,f¢~2~ l ' PERCOLATION RATE 't'~/ t'/~ minutesiineh COMMENTS PERFORMED BY: TEST RUN BETWEEN o ~ -- FT ~: 'J:'~'~! ~ ~IVE,~, A~S~<A ~ ~ CE RTl FIE ~NER OF LAND \DDRESS L£GAL DES( )~\TE - Started "ER[lIT NUMBER KiND OF F( ~ by suLLI 'AN WATER WELLS CHUGIAK AL, AS'KA99567 · TELEPHONE688-2-/59 From'~ FJ _Fi, t~rom Ft. to_ From From ___Ft. to From .... 2_Ft. k rom ...... Ft. t( ~rom__ _Ft. 1o ...... Ft ..... From ...... Ft. to .~Ft Vrom~ _~Ft. ~o From .... Ft, to .... Ft,___ From ___Ft. to Ft. MUNMPAUTY OF ANCHORAGE Development Services Department 3^ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-322-29 1. GENERAL INFORMATION Expiration Date: g-2 q - 2 % Complete legal description ROLLING HILLS VIEW ESTATES BLOCK 3, LOT 4 Location (site address) 19348 MEADOW CANYON DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) ROBERT P. GUISINGER Mailing address Real estate agent Day phone 19348 MEADOW CANYON DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 5 Date of Payment Receipt Number.�� 7 Ci 5 Receipt Number COSA # 0SG�1 1237 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/1312021 Comments: This investigation was completed in compliance with MOA guidelines: regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the 441\\\\\ system and maintenance. The operational life of all well and septic systems are subject to OF As�il these various and dynamic characteristics and are outside the control of the evaluator of the ^! well and septic system. Therefore, any estimate of how long a system will function'satisfactory s�g�Q: • • • . • �9 ��l for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & TH , , , , ,•;* �r 6. DSD SIGNATURE• :• Curtis Huffman j System #1 Approved for bedrooms ��F6,, •• CE 128991 System #2 Approved for bedrooms lliF�PROFESSCO Disapproved Conditional approval for bedrooms, with the following t1RR (kati(DGPt((,r .�`V,\- QPM\v OF,q 1� r J� ON-SITE p WATER AND m t Z o PROGRAM6�; SERV\, ,.\ Original Certificate Date: .5 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other Legal Description: ROLLING HILLS VIEW ESTATES 133 L4 Parcel ID: 050-322-29 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 9/1984 Well disinfected for coliform test? ❑ Yes ® No Total depth 84.5 ft ® Coliform bacteria is Negative Cased to 40+ ft Nitrate 9.41 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected Casing height (above ground) 24 in. Collected by Date of flow test for COSA 4/26/2021 Static water level at beginning of test 77 ft. Date of Sample 5/5/2021 Well production at time of test 3.6 gpm Comments WELLHEAD EXTENDED AND WELL SCOPED — SEE ATTACHED COLE SULLIVAN LETTER. B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 11/13/1996 ® ALL standpipes present per record drawing Total measured depth from grade 9.5 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 4/26/2021 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 3 in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7' OF THE 7.5' ED PER IR Elapsed time <15 min ® Code -required soil cover over field W/ INSUL Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons F�'� Comments/Deficiencies: TESTED UPPER 1996 TRENCH — LOWER TRENCH MOSTLY SATURATED. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ® Yes Septic Tank/Lift Station on Lot > 100' ft Surface Water > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No _ ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Community Wells > 200' ® Yes if No _ Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. TH � ..• .... ........... ' Curtis Huffman �� ?'FG, •. CE 128991.• ® VslFl1 5117/21. •���v�.� � PROFESSIONP ft ft ft ft ft ft ft ft Nitrate advisory Certificate of On -Site Systems Approval # OSC 211237 Subdivision: Rolling Hills View Estates B 3 Lot 4 A water sample revealed a nitrate concentration of 9.41 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. r x a a t Ma�lmg Address R YD Box 196650 *Anchorage, Alaka£99519 6650 *www mum org .tu: ,. !w aa. U�s,� n rte, -r zl.. R- DOC CO dba 0 io O otLE N -- ULLIVAN WATER WELLS RO. 54k 670269, Chugiak, AK 99567 688-2759 TO, (A I S ii' -L q e. TERMS: 1 1/2% interest per month on unpaid balance #0555 PHONE DATE OF ORDER ORDER TAKEN BY CUSTOMER'S ORDER NO. DAY WORK CONTRACT EXTRA JOB NAME/NUMBER JOB LOCATION JOB PHONE STA -RTI G DATE -D zcd Z - QTY DESCRIPTION OF WORK PRICE AMOUNT &A'VA JvtAltzi5 4o 2- 0 4,- 11 look-c-IC71 Cl Y4 0,4 0- boi(ovii 'j ► per/ C -D No discounts will apply if invoice is not paid within 30 day 3. If paying with credit-card please add 3.75% credit card fee, -17 Work ordered by ------- DATE COMPLETED Signature I I hereby acknowledge the satisfactory completion of the above described work. Municipality ot' Ancl orage Development Services l epdHment Building Sat'ely Division On-Site Water and Waslewaler Program 4700 South Bragaw St. P.O. Box. '196650 Anchorage, AK g951g-6650 www.cLanchorage.ek. Us (907) 3,13-7g04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-322-29 1. GENERAL INFOI~MATION Complete legal description T,r~ r 6: Location (site address or directions) Current Properly owner(s) Larry Huf£ Mailing address 17)348 Heat;tow (;~qyon D~. Lending agency Expiration Date: /~ _ c~_ o ~ Z9348 Meado~ Ca~yon Day phone Ea~le River. Day phone 742-1300 AK 99577 Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA wi//be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 3 Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site J~ Individual Holding tank Community On-site Public Sewer The Munic!pality of Anchorage Development Services Department (DSD) Issues Certil]cates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transt'er of lille (except be[ween spouses) for propedies served by a single family on-sile wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certil]cates of Heallh Authorily Approval are valid for 90 days from Ihe date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Cedil~cates may be reissued for a period at up 1o one year with valid water samples.) Cedific'~es are valid for one year for propedies served by Class A or B wells or a public water system. The Municipaiily at Anchorage Is not responsible for errors or omissions In the professional engineer's work. STATEMENT OF INSPECTION By ENGINEER As certified by my seal affixed hereto and as oi' the v';lidafion da{e shown below. I verity Ihat my Inves[tgalion, based on procedures outlined In Ihe Health Authorl~ Approval Guldetines for Ihls applicalion, shows Ihat Ihe on-site water supply and/or wastewater disposal system ts(are) safe, functional and adequate for Ihe number of bedrooms and lype of structure Indicated hereln. I fudher varig/Ihat based on tile Information obtained from the Municipality of Anchorage files and from my Invesltgalion and Inspection, tile on-site water supply and/or wastewater disposal system Is(are) In compliance Wilh all applicable Municipal and State codes, ordinances. and regulations In effect at Ihe time of Installalion. NameofFirm S & S Engineering Address 17034 N. Eagle River Loop Ea~le River AK Engineer's Printed Name Robert C. Cowan DSD SIGNATURE · ~" Approved for . ~ Disapproved. Conditional approval for Phone 694-2979 99577 Da~e, bedrooms. 'l,"~', · ...'~'~ , bedrooms, with the following stipula,ions: egr% . ...... o -s r[ Allachments: HAA Checklist Septic Sys[em Advisory Well Flow Advisory X Maintenance Agreements S~pplemental Engineer's Report Other Original Cedificate Date: ?- ,'~' - 0 2,.... Municipality of Anchorage Development Services Department BuUdiog Safety Division On-Site Water & Wastewater Program 4700 South Eregaw St. P.O. Box 196650 Anchorage. AK 99519-6650 v~-~.ci.anchorage,ak.us (~07) 343-?eO4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Lot 4; A. WELL DATA Well type SF Date completed 9/84 Total depth 84 ' Block 3; Rollin~ Hills View Es~marcollD:' IfA, B, or C provide PWSID # Sanitary seal (Y/N) ¥ Date of test Static water level Well production 5 WATER SAMPLE RESULTS: Coliform O colooies/100 Date of sample: 6 / ;)- o / 0 2 B. SEPTIC/HOLDING TANK OATA TankType/Material Se.n~ t 050-322-29 -- Wall Log (Y/N) Y w es prope protecmd (Y N) ¥ 40+ It. Casing height (above ground) 12 + in. AT INSPECTION ft. 72 fl. g.p.m. :}. 6 g.p.m. Tank size 1 000 gal. Foundation cteanout (Y/N) ¥ Date of pumping 6 / 8 / 0 2 C. ABSORPTION FIELD DATA Cased to __ FROM WELL LOG 9~84 66 Nitrate ~'-&~ mg./I. Other bacteria o colonies/100 mi. Collected by: S & S En~ineerin8 Number of Compartments 2 Depression over tank (Y/N) N Pumper JR's Septic Oatelnstelled ll/13/96Soilrating (g.p.d./fi=)0]([['~0 ; 0,6 Length 5 5 fl. Width 2.5 ff. Total depth 9.5 It. Eft. absorption area 8 2 5 fi= Monitoring tube __ Date of adequacy test 6/[3/02 Results (Pass/Fall) Pass Date installed I I / q ! cl F. Ctsanouts (Y/N) Y High water alarm (Y/N) N System type ..~ Gravel below pipe 7.5 ft. ¥ Depression over field N For :~ bedrooms New depth {~ [ in. Fluid depth in absorption field before test [8~ in. Water addedq~,~ gal. * ' * Elapsed Time: 60 min. Final fluid d"'~'~pth 6~ ~ ln. Absorption rate >= 4 5 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ,N If yes, give date -- D. LIFT STATION Date installed N / A 'Pump on" level at Datum Size in gallons in. 'Pump off" level st Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alan~ & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots 100 On adjacent lots 1.00 Public sewer manhole/cleanout Holding tank N / A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 ' + Water main N / A Wells on adjacent lots 100 ' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 ' + Properly line ~ ' + Water sen'ice line 1. 0 ' + Water Service line Absorption field 5 ' -I. Surface water 100'+ Building foundation 10 ' + Water main 10'+ Surface water 100'+ D~iveway, parking/vehicle storage Curtain drain none known WellsonedJacenticts !.00'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field JnspecSo~s end review of Municipal records that the above systems are conformance w~th MOA HAA guidelines Jn effect on this date. Engineer's Pdnted Name Date HAA Fee $ Date of Payment Receipt Number [Rev. 12/00) 375"- ~ &/~/o -'- 0~ ~o Waiver Fee $ Date of Payment Receipt Number J~-24-OZ II:IOAI/ FROM-CT&E ENVIRONI,~NTAL ,~T~.. CT&E Envlmfln,ental Service, Inc. 90?56153O1 T-358 P.OZ/02 F-225 CT&E Ref.# 1023598001 Client Name S & S ~nginecrtn§ l~roJect ~ame/~ ~ Hi~ V,ew Est Olent Sample ~ ~ot 4 Block 3 ~ls Dfl~tnc Wato O~eted ~y ~WSID 0 .~omplc Re. nfl/s: Nitrite-N 5.64 ~L 0.200 EPA 300.0 All Dater/Times are Alaska Standard Time Printed Date'Time 06/24/2002 10:3'7 Collected Date/Time 05/20/2002 J 6:40 Received Dat~Tlme 05/~,~'2002 Technical Di~ St~htn ~ Ede AHownbJg P~'~P An~ysis Limits Date Date (<1o) 06/21/02 Init Total Coliform col/lO~mL SMI8 9222B (<1) 06/21/02 BAG i I 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 r~ _ GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name .-~..-~'~-_*~T- ~-'~'~¢:¢'~ Telephone: Home [c~¢i'J¢~ci(°~-~l Business Applicant Address (~, ~:~, ~ ~;;~t~cLJ¢ '~--~-~d.~.'E~ ~¢~~,/~. Applicant is (check one): Lending Institution []; Owner/builder,~Buyer []; Other [] (explain); (d) Lending Institution ~'d~"~"-A~¢''- b-~t~'l-L_P'3~ __ Telephone Address ~ ~¢-~ ~ ~ (e) Real Estate Company and Agent ~~ - Address Telephone (f) ~thttttt~e HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other '/ / / i ' 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 Onsitel~- Public[] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ~ ..... · ~ 72~25 (11/64) 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ Date Telephone 6. DHEPAPPR~_O .L,~ ApProved Disapprove( Terms of Conditional Approval ~onditi6nal -l¢-7'5" 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 profe~sior~al '- 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 '~i analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in th~: ~ ' professional engineer's work. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~ Well Classification Well Log PresentatiON) Total Depth ~ ) Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/~ Tank on Lot To Nearest Edge of Absorption Field o¢ Lot To Nearest Public Sewer Line . Cleanout/Manhole ¢~] 1¢~ ' MUNICIPALITY OF ANCHORAGE DEPT. OF HE ENViRONMENt.. ALTH & '~" PROTECTioN RJ C EI ED If A, B, C, D.E[C. Approved (Y/N) Date Completed ~-1 / ~ LJ¢ Yield ~¢~'0/'¢¢ Depth of Grouting ~-- Pump Set At ;Z"'z~ ~ Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~) Water Sample Collected by Water Sample Test Results Comments ~ t'-~ t F ~ ; On Adjoining Lots ~, ~::~ i ~ '~On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on B. SEPTIC/I'tOI. iDIf~'TANK DATA Date Installed ?- ~' Standpipes (~N) Depressid'n over Tank Pumping/Maintenance Contract on File Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/F~ Tank: To Water-Supply Well ~ ~C::~ ~r To Property Line ~;:~ i'4- To Water ~/Service Line ~ ~ Course "~ Size j ¢~-*O No. of Compartments Air-tight Capst~'4) Foundation Cleanout ~N) Date Last Pumped i,~. ~ ' for Temporary Holding Tank Permit (Y/N) To Building Foundation ~ I~ To Disposal Field I ~ t-.t- ~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed v'/ .. ~ Width of Field ~ Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~, ~ ~ '~' /f"~/L.-," Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~;~N) Date of Last Adequacy Test To Building Foundation Lot ~/~ To Water Me,4.~/Service Line ~ ~ 1 4. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ 14' To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify,that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si-ned 8 "i~, ~ g i . ~R~ i~6~ Date Compa~;,~k~ ~'I~ER, : ~, 6~ MOA No. Receipt No. Date of Payment Amount: $ ~ ~ Page 2 of 2 72-026 (11/84)