HomeMy WebLinkAboutROCKHILL BLK 1 LT 7Rock Hill
lock 1
Lot 7
#01§-362-1§
Municipality of Anchorage Page ~__ ol *_.~___
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: ,D ~ 00~ J'~ ~' PID Number: ~ ~ '~ '~'~-- [~
Phone: J No. ol Bedrooms:.~ ~ Deep Trench ~Shallow Trench g Bed ~ Mound ~ Other
LEGAL DESCRIPTION so,.~..g: j.~SPb/Sq.F,. TolalDeplhfromodginaJg,ade:
Township: J Range: Seclion: Fill added above original grade' Gravel length: ~ ~ Ft,
Yield: J~.m~Se,~*: J C~¢,~eig,d Abo~e Grou,d:
SEPARATION DISTANCES ~Septic U Holding E] S.T.E P.
Remarks: R~O~s,~,~ ~ ~.~ BENCHMARK
J Assumed Elewtion: I 0 ~ =
17034 Esgle River L~p Road~ ~ ~ ~ ~ /~9th ~'~ ~' '
.nspechonsperformedby:[.ebm..r. Al..k.,,~g Dates'lst ~-~-00 .:~YZ ~
Department of Health and Human Servic~ s approval ~, %-.. ,.-~ -,
72-013 (Rev. 9191) MOA 25
PERMIT NO. %W000156 PACE 2 OF 5
iVlunicip, ati% oF Anchop~Qe
DEPARTMENT OF HEA~THAND HUBAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O Box 196650 OAnchorage, Alaska 99519-66500Telephone: 343 4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
LEGAL LOT 7, BLOCK 1, ROCKHILL S/D
P.I.O. NO. 015--362--15
10' ELEC~'RIC EASEMENT,
UG TELECOM & ELECTRIC EASEMENT
& DBL2
DV (DIVE VALVE)--I
C01
NEW
1500 GALLON
SEPTIC TANK
CO
TH
1" 40'
ROBERT C. COWAN
CE-8801
PERMIT NO S_WO00136 PAGE 3 OF 3
Municip. cdit~ oF anchoco, qe
DEPARTMENT OF HEA~THAND HUP~AN SERVICES
ENVIRONMENTAL SERVICES DIVISION
PO. Box 196650 OAnchonc9e, A(eska 99519 66500Tetephone: 343-4744
ON-SITE WASTEWATER DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT
[,gOAL LOT 7, BLOCK 1, ROCKHILL S/D P.I.D. NO.
015-362-15
MT2
NEW ~
1500 GAL ~
SEPTIC 92.0'
TANK
A B C
~CO 7.5' - 53.0'
_ST1 11.0' - 53.5'
ST2 21.0' - 55.0'
DBL1 21.0' - 60.5'
_DBL2 20.5' - 61.0'
_DY 25,5' - 57.0'
301 24.0' - 56.0'
vlT1 41.5' 19.8'
2,02 56.0' 86ff¢- 110.0'
vlT2 51.5' 82.0' 105.5'
303 45.0' 17,0' -
30 25.5' - 55.5'
A
WATER FOUND @
81.1' B.O.H.
80,1 '
ROBERT C. COWAN
¢:E - 8801
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: I~.. t¢~[ (~
LEGAL DESCRIPTION:j''~ ~' -7
"~. U ~ ~g~/ DATE PERFORMED:
/~ ~(: .< / /k''~(,~ ~ Township, Range, Section:
4-
5
6
7
8
9
10
11
12
13
14-
15-
16-
19-
2O
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER /v~ 0
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Oepth to Water Afier _ _
MonitorinD? . Oate:
Gross Net Depth to Net
Reading Date Time Time Water Drop
,_
90 ~ '/~"
PERCOLATION RATE "~' ~ tminutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN "~ __ FT AND ~ FT
17034 Eagle River Loop Roaa No, 204
ACCORDANCE WI~[d~[~I~T~E~'~.,~AL GUIDELINES IN EFFECT ON THLS DATE. DATE:
72-008 {Rev. 4/85)
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON.,.~ITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: May 31,2000
Expiration Date: May 31,2001
Permit Number: SW000'136
Legal Description: ROCKHILL BLK 1 LT 7
Design Engineer: 0003 S & S Engineering
Owner Name: Eric & Karla Zuspan
Owner Address: 6301 Barry Ave.
Anchorage, AK 99516-6516
Parcel ID: 015-362-15
Site Address: 006301 BARRY AVE
Lot Size: 40650 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
~ Disposal Field [] Septic'rank ~ Holding Tank [] Privy
[] Private Well E~ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same clay.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
ROBERT C, COWAN, P.E.
ENGINEERINGSTUDIES
,q. NDREPORIS
SOIL TEST
May -2~:, 2000
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 7, Block i, Rockhill S/D
It is requested that you issue a permit to install an upgraded septic system to serve the
existing five bedroom dwelling on the referenced property.
A test hole was excavated and a percolation test was performed. The approximate location
of the test hole is located on the attached site plan. At the time of excavation 5/20/00 water
was not found. ,0~r~ ', o,}vJ o~ ,.,o,~,-~a,,.c t 7-~ ,~,o,~,~-,,~.,.,-~ ~-o,~,l
Vie do not anticipate any adverse effects on neighborin~ wells, septic systems, reserve
areas or drainage patterns by the installation of the proposed septic system. Thc
construction of this system will not prevent any future development on any of the adjacent
properties.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan, P.E.
RCC/jhm
Enclosure
17034 NORTH EAGLE RIVER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 99577
1" = 60' -- SITE PLAN UPGRADE
/I I I
/ I I I X
// ,'/
/k /~~
/~ /
/21,
, ~~
PERFORMED FOR:
LEGAL DESCRIPTION:
Municipality of Anchorage.
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
, ~N'.,,.- A '"'.~I,
~h "'N '~""~"'"~ """"'"'~
~ ROBERt C. COWAN /~
'i
DATE PERFORMED ~ ~, ,~ ~l,~~ ~
~00~l*L Township, Range, 8eotion:
1
2
3
4
5
6
7
8
9
10
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
JhL.
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT '- O
DEPTH? p
Depth to Waler After j G ' .~--'J,)?/o ~,
MenJtering? Bale:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
Io - _
o V dj I0"
" ~0 '/~" 7 o / ~ %" 3 '/~"
" "J ~ t" H o / ~j v~" 3 %"
PERCOLATION BATE 3, ~__ (mlcluJe$/lllCh) PEBC HOLE DIAMETER
TEST RUN BETWEEN 7 F'r AND ~ FT
72-008 (Rev. 4/85)
WELL INSPECTION
& FLOW TEST
ROAD DESIGN
ROBERT C. COWAN, P.E.
CIVIL ENGINEEP.,S
(907) 694-2979
FAX (907) 694-1211
ON-srrE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
REFERENCE: Lot 7, Block 1, Rockhill S/D
May 22, 2000
GENERAL:
The scope of this project includes the verification of the existing 1500
gallon septic tank or installation of a new 1500 gallon tank if necessary, m~d
installation of:¢-new trenchsto serve the existing five bedroom residence
located on the referenced property.
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 necessaW
underground utility locates.
Unless specifically agreed otherwise, the property owner shall be
responsible for final grading areas subsequently depressed from soil
settling.
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 fi'om 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.
7034 NORTH EAGLE RIVER LOOP · SUITE 204 * EAGLE RIVER, ALASKA 99577
Page 2
I.ot 7~ Block 1~ Rockh]ll 8/D
May 22, 2000
2. 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.
4. 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 fi'om
the septic tank.
ABSORPTION TRENCIt/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.
A silt barrier nmst be installed between the final gravel layer and the native soil
backfill. Ensure the silt ban'ier 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 tlu'ough 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 3
Lot 7, Black '1, Rockhlll S/B
May 22, 2000
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:
1. Any septic tank proposed for installation must be constructed by a Municipal approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic system installations in the
Municipality of Anchorage:
~vp.e of Pipe Perforate~
Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) 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 inlets 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.
All 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 requirement applies.
Page 4
Lot 7, Block I, Reckhlll $/D
MaS' 22, 2000
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 mnst 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.
3. The final inspection is to occur upon final grading of the property.
Often there will be mom 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
pm-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.
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,
sequence, procedures or the safety precautions incident to this project.
CONTRACTOR/INSTALLER
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 9950'1 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~AILING ADDRESS
[] UPGRADE
Weft ]Absorption area Dwellin9
DISTANCE TO: //~) ~ ¢' 'Ma
Manufacturer ~t'- ~ ¢_ ¢~ [ Wi~
Liq. IF HOMEMADE: Inside length
/
Dwefling
NO. OF BEDROOMS
DISTANCE TO: ~/~.~ ~'
/ '7 ~'~
PE T NO.
No. of compartments
Liquid depth
Well PERMIT NO.
Liquid capacity in gallons
Foundation
Material ~
Nearest lot Ii m/
/Trench width.~
Top of tile to finisi~ grade
Total length of lines
Material beneath tile
PE IT NO.
Distance between lines
effective bsorption area
Length
Width
Depth
PERMIT NO.
Type of crib rib diameter Crib depth Total effective absorption area
Wel~ Building foundation Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line PERMIT NO.
8uiiding foundation Sewer line Septic tank Absorption area(si
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE LEGAL
¢ / L 7 d / ,
72-013 (Rev. 3/78)
o ~~ 21232e
..... ....
.... b'~:L' 5F ff::~:~'F ~ .................
Depth of well ..... ~.~ ~ ~
'S~ze o~ cas~¢ ..... ~¢ .....
Distance to water ~0 ~e..
Dist~ce to water while pure in
P g ................ :.--~---: ............................... at rate
of ~ ·
.......... ~ ................................... gallons per hour.
Formation
from to
~o
5~
7J.-
6~
Driller
DELTA DRILLING COMPANY
SRA SOX 394 B
ANCHORAGE. ALASKA 99507
~Y'/v?¢^/~'/ 4r-¢ ,z/ -'r,-,,, .o._, ..,__
HFIXIMUM NLIHE:E:R OF BIEDR. OOi'dS = 5
E:O I L RI:IT I NG < E;Q FT/'BR ) = 85
TNE REQUIRED SIZE OF THE SIDIL RBSORPTION SYSTEM IS:
E> IE F" -'IF" f-Il =~
THE LENGTH DIHENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRIi'.,IFIELI}.
THE DEF'TFI OF R TRENCFI OR PIT ]:S THE DISTRNC:E BETI.qEEI'.,I THE SURFRCE OF THE
GR. OI.JN[:, FIN[) Tt4E E~O]"T'OH OF- THE EXE:FIMATION (IN FEET."-'.
THEF:E IS NO :SET HI[:,TH FOR TRENCHES.
THE [iRI:IVEL DEPTFI IS TFIE I'/ININIJI'd DEPTH OF' GRFIVEL BETNEEN TNE OUTFFILL F'IPE
RND THE E:OTTOH OF THE EXCFI',/RTION (IN FEET).
PERMIT RPF::'LIIZ:F~NT FIRS TNE RESPONSIBILITY TO INF'ORM THIS
INE;TF~LI_FYrION INSF'EC:TION~ OF' RNY HELLS FtDJFICENT Ti3 TFIZS
NUi"IBER OF R. ES:[E:,ENCES THFtT 'THE: HEL. I. HILL SERVE.
DEPRRTMENT DURING
F'ROF'ERT'¢ FIND THE
E:RCKFILL. ING OF RNY SYSTEM I.JI'T'HOt.rF FINRL INSF'ECTION RND RPF'RCm'¢RL DY THIS
DEPFIRTP1ENT I4IL,,L DE :5UB,.TECT TO F'ROSECLITION,
I"IINIP'IUM DISTRNCE BE'FI4EEN I.a HEI_L FIND ANY ON-SITE SEHRGE DISF'OSFIL SYSTEM IS
:1.00 FEET FOR FI PRI',,,'FITE !.4ELI. OR :'LSE) TO 200 FEE]" FROM FI F'UBLIC HELL. DEPENDING
UPON ]"FIE TYPE OF PUBLIC HEI_t ....
HINIMUH [:,ISTRr.,ICE FROH FI PRI',,,'R]"E HELL TO la PRIVRTE SEHER LINE I!5 ;7...:5 FEET RND
TO R coHrIUNITY SEHER LINE IS 75 FEET.
HELL LCiGS RRE REQUIRED FIND MUST E:E RE'I"IJRNE[:, TO "f'HE DEF'RRTMENT HITHIN .".$0 DFIYS
OF THE HELL CONPLETION.
OTHER REC::!LIIREMENTS MRY FIPPLY. E;F'ECIFICR'I"IONS RND CONSTRLICI'ION DIFIGRFIMS FIRE
FIVRILRBLE "fO INSURE PROPER Ii'4STRI_.I_RTION.
I CER'FIFY 'I'HFIT
:L: I AH FRi','IILIFIR HITH THE REQL.IIF.:EHENTS [:OR ON-.SITE SEI4ERS I:'IND HELLS FIS SET
FORTH E:Y TFIE MUNICIPFILITY OF FINCI-IORFIGE.
2: I HILL INSTFILL 'f'HE SYSTEM :[i'.,I RCC:ORDRNCE HITH ]'HE CODES.
':" I UN[.)ER_,'[PN[ THWr TFIE 31~-....,~TE :,EHER JIRE ENI_FtRISEHENT~IF TI-IE
RESIE:,ENCE I=, REf'IODELED TO INC:LtJDE MORE THFIN 5 E,E[:,F~ ]FIM.5. \ ~ ,
FIPPLI R:[CFIF]RD J, BI_LIME~
~: MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
S25 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PFRCOLATION TEST
MOLLS LOG
D PERCOLATION
TEST
PERFORMED FOR:
LEGAL OESCR PT QN
3
5
16-
17-
18-
19-
coMMENTS
SLOPE
GATE PEREORMED:__4 'X4 / c/~.1
SITE PLAN
WHAT
PERFORMED
72~008 (6/7g)
Reading Date Gross Net Depth to Net :
'rime ' Time Water Drop
PERCOLATION RATE (mlnute$/inch)
TEST RUN BETWEEN FT AND FT
/
ALASKA ENVIRONMENTAL
CONTROL SEI:IVIC" . INC.
1200 West 33rd Avenu=, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
jos__~l /.-? ROcKI*/I~.~.5
SHEET NO,
CHECKED BY.
SOAL~ I t~=20'
DATE
6i8910 ..
u �� O
7.E��_ Municipality of Anchora;� : p
On-Site Water and Wastewater Program °- 1.
JUL 2 4 2017— (907) 343-7904 ti S`A E-Y e
C'
Certificate of On-Site Systems Approva °` 6 8 -
Parcel I.D. 015-362-15 Expiration Date: I O ~JC,) / 7
1. GENERAL INFORMATION:
Complete legal description Rockhill; Block 1, Lot 7
Location (site address) 6301 Barry Avenue`Anchorage,AK 99507
Current Property owner(s) Kristine&Shawn Safford Day phone (202)654-2260
Mailing address 6301 Barry Avenue`Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
oismilmi
Received by:— Date: -7/41 `7
COSA to be released to the engi ear,unless otherwise requested by the engineer.
COSA Fee $ Z(, - Waiver Fee $
Date of Payment 7121-1111 Date of Payment
Receipt Number 04512. G. Receipt Number
COSA# 05C.111 \2_ Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
-V.i`' 34,
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.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: .49I /
44Qb��Q
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o QF 4
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �� ,••..•..• .•..'.7
industry practices. The reported results describe the condition of the system/s on the date/s of the O 1ns
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or U
encroachments may exist that were not identified during the evaluation. The operational life of all wells /�: 'i 9 H ?� •.7tvo
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ........ '' .it
groundwater levels (that may fluctuate during the year), quality of construction (materials and V
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and /..
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 0 ,J� A\Garr, ss:
system/s: therefore, GEG makes no warranty (express or implied) regarding the future performance of Oro E_795'
the well or septic system. GEG makes no representation whether an alternative well or septic system V 9 °' / 7 c�Q
can be installed on the property in the event either of the current systems fail to perform adequately in Q4r, '• 1T°o
the future. The content of this report is for the sole benefit of the person/party that retained GEG to kit\ p ofess of'c' -
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
i •
System #1 Approved for 3 bedrooms ��� "✓
System #2 Approved for bedrooms •
Disapproved T WATER
AND m
VrgSTL'-v, �-
vA
Conditional approval for bedrooms, with the following sti • r �
By: f Original Certificate Date: 7 3 ) - ) 7
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Rockhill; Block 1, Lot 7 Parcel ID: 015-362-15
A. WELL DATA *Assumed to be 40'+
Well type Private If A. B. or C provide PWSID# N/A Well Log (YIN) Yes
Date completed 7/7/1981 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 71 ft. Cased to*Unknown ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 7/7/1981 7/12/2017
Static water level 30 ft. 37.8 ft.
Well production 12 g.p.m. 5+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 8.91 mg./L. Collected by: GEG, Ltd.
Arsenic: ND<5 ug./L. Date of sample: 7/12/2017
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/3/2000
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) Yes Depression over tank (YIN) No High water alarm (Y/N) N/A
Date of pumping 11/21/2016 Pumper McDonald's Pumping Service
C. ABSORPTION FIELD DATA *Below Existing Grade East MT/West MT
Date installed 6/3/2000 Soil rating or ft2/bdrm) 1.2 System type Trench
Length 82 ft. Width 5 ft. Gravel below pipe 2-5 ft.
Total depth*14+/*12.8+ft. Eff_ absorption area 640 ft` Monitoring tube Yes Depression over field No
Date of adequacy test 7/12/2017 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 0 in. Water added1,093 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN &type) None Known If yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at '• wa er alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100 + On adjacent lots 100 +
Public sewer main
75'+ Public sewer manhole/cleanout 100'+
Sewer /septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 104
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain None Known Wells on adjacent lots 100'+
F. COMMENTS
Septic tank is located under paved area that has potential for a vehicle to park/position over
the tank. A parking curb (4" x 4" timber) was "pinned' to asphalt to restrict vehicle access
over tank. (see attached photo)
4Q6�4
G. ENGINEER'S CERTIFICATION OF..- . .. \\A,
TIk4
1 certify that I have determined through field inspections and I __�Q
review of Municipal records that the above systems are in �' 0
conformance with MOA COSA guidelines in effect on this / _______'-.74
Q
date.
Engineer's Printed Name JEFFREY A. GARNESS Q�9, .• E7779 e.. OOH
Date '11 2,t!' /? c1(4,0, '-1-I. .'lf ...'. ..;_41
�,�o
/ �4�d PrOfe5si0 0`
�00000 .
#AECC884
(Rev. 11/05)
un
•
Micipality of Anchorage
♦ uL
Development Services Department
s.1 Yd dR a
Building Safety Division s
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 171312
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 7 of
Rock Hill subdivision. This inspection revealed a nitrate concentration of
8.97 milligrams per liter (mg/L) was reported for the property's well water
sample. 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.
Nitrate Fact Sheet
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.
Ecklund, Timothy J
From: Jeff Garness <Jeff@garnessengineering.com>
Sent: Monday, July 31, 2017 8:25 AM
To: Ecklund, Timothy J
Subject: Rockhill Subdivision, Block 1, Lot 7 - 6301 Barry Avenue
Hello Tim. See the following email summary (from Dave Harper with Arrow Well & Pump Service) of the well camera
inspection at the subject property. It is cased to 40+,
Best Regards jeff
Jeffrey A Garness, P.E., MS.
President
Garness Engineering Group, Ltd
3701 East Tudor Road, Suite 101
Anchorage, Alaska 99507
Ph: (907) 337-6179
Cell: (907) 244-9612
Fax: (907) 338-3246
Website: www.garnessengineering.com
From: David Harper [mailto:dlharper2@gmail.com]
Sent: Sunday, July 30, 2017 7:30 PM
To:Jeff Garness <Jeff@garnessengineering.com>
Subject: 6301 Barry Avenue
Jeff, the well located at the above address has been has been checked for leaks, cracks and or incoming water to
a depth below 40 feet with a down hole camera. None of the above was found. Thanks,
David L. Harper
Aarow Pump & Well Service, LLC
1
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.a k.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY AP.P. ROVAL
FOR A SINGLE FAMILY DWELLIN..G, :'
Parcel I.D. ~ ~C'5'- ~ ('' ~' - I ~"
1. GENERAL INFORMATION
Complete legal description ,. ~ ~
Loca~on (site addi:e~s o-r directions)
HAA . fl40103
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
Day phone
Day phone
Mailing address
Real I~st~te'Agent
Mailing Ad. dress
Onlessothe~lse~q~ested, H~wi#beheidbyDSDforpickup.--
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single fam~y on-site wastewater disposal and/or water
supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
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 verity 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 verity that based on the information obtained fi.om the
Municipality of Anchorage flies and fi.om 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.
S & $ ENGINEERING
Name of Firm '17n~ ~,,._~., D;.,.,- ~ ~ o.,.~ ,,=...__~ Phone
Address Eagle Rive~, Alaska 99577
Engineer's Pdnted Name k~,.,~,~....-f ' ~. ~/.z')(~, '.., Date '7/3/0/
· ' ..... , .... ,~ ~.~.*' '* .'0,~- ,,~'-, ...'~_NG NEEP/~,~" ,;-z .'¢.~
...... : · .=. ....... .~ -..- .,--~. 'WATt, AriD ~...m~//~-,(,~/~_.
5. DSDSIGNATURE ....... ... : · nn~,',^,, · ~-'~,~
:c ........ · .... ~ ' :q.'..' '"" '~,~ ·" · '~ ~ ~'% ..",~;
/// Approved for - - ~ bedrooms: % ~£..~ ...'~.~ t) ~,.,, %.. ..... ~,~
.................. .~_. .............. :. , .....:,/~."~.... .... · _c.~'.~.~'~· ~l.
... · ..... . . . .]" ~ .;';'.".'... "/JJJjj))))})))))'
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Note: The well.for this property meets existiug State and Muuicipal Codes. '['here are nitrates
Current nitrate concentration is 6.92 mg/l. EPA maximum concentration is 10.0 mg/1. More
information on nitrates as available lrom the On-Site Services Program, at 343-7904.
Attachments:
HAA Checklist
Septic S~,stem Advisory
Well Flow Advisory
X
Maintenance Agreements
· .~;upplemental Engineer's Report
Other
Odginal Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewatar Program
4700 South Bragaw St.
P.O. Box 196650 Arx:fmmge, AK 99519-6650
www.ct.anchorage.ak.us
(~07) 343-7~04
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescripiton: LO7' '7 Rt.~clc I ReCK
A. WELL DATA
Well type ~A~v4~'
Data completed
Total depth "/I
Data of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform O colontas/100 mi.
Date of sample: ~,/~.1 / o I
B. SEPTIC/HOLDING TANK DATA
ff A, B, or C provide PWSID #
sanitary sea ~) ¥~ .J
Cased to ¥~ 4 ft.
FROM WELL LOG
-71
%O fL
J 3- , g.p.m.
Well Lng (~1) Y'~ -/'
Wirespmpedyprotected~'/N) ¥4 .r
Casing height (above ground) ~ ¥ 4* in.
Nitrate 6,q3. mgJI.
Collected by:
AT INSPECTION
Tank.Type/Matadal ~,~7,C / $7*£4 /.-
Tank size !.Ce 0 gal.' ' Number of Compartments
Foundation cieermutt~tN) y,t f Depression over tank (Y~
Other bacteria O colonies/100 mi.
$ & $ ENGINEERING
;~'~ ~,agie ~iver Loop ROId NO~ ~
E~gle Rlvtr, ~Jalkl
Data ~s~ ~/~/O o
ci~u~ ~) Y~ ~
High ~ter ~a~ ~ ~ ~
Date of pumping ~,/A -/,,e ,., Pumper
C. ABSOR~ON FIELD DATA
Da~ins~ll~ G/3/eO ~,ra~g~er~) /.
length. ~ ~ fL ~ ~ fL Gravel bel~ pipe ~ '/~ fL
To~ldep~ / ~ fL Eff.~so~ionar~ ~0
Date ~ ad.uaw ~t ~/~ - ~ ~ ~ R~ul~ (P~Fall) ~' For ~ bedr~ms
Fluid d~th in abso~aon field ~fom ga. N~ depth in.
Elaps, T~o: ~ fl:i:::: .... '. ~,,fion rate >= g.p.d.
~y rejuvanaflo~ ~st 12 ~.) ~ & ~) If y~, give date
O. UR' STATION
Date installed Size in gallons ~ ....
'Pump on" level at in. 'Pump o~..~t--""--In. High water alarm level at
Datum Cycles tested Meets alarm & circuit requirements?
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /o o ('/-
Absorption field on lot ,/0 0 ~
Public sewer main ~/~
Sewer/septic service line ~- 5- .~L
On adjacent lots
On adjacent lots
Public sewer rnanhole/deenout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation "7 Property line ~/~f / Absorption field -(" '~'
Watermain ~J /,R Water service line /O '3/` Surface water / {31) '-/.
Wells on adjacent lots ,/0 0
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~"f~ / ~
Building foundation / ~' Water main ~/~
Water Service line ) 0 --}- Surface water / 0 0 -t-- Driveway, parking/vehicle storage '~ ~ ' '')'
Curtain drain ~¢~.~ /,~,v~,~.- Wells on adjacent lots
F. COMMENTS
O. ENGINEER'S CERTIFICATION
IcertifythetlhavedeterminedthroughfieldinspecSonsand
review of Municipal records that the above systems are in
Engineer's Printed Name /~O/~,~T' ~" ~'0~./~,~-~
_ · . / _ / .
·
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
JUN-28-O$ 08:22 FROM-CT&E ENVIRONI~NTAL SRV
ECT&E Environmental Se~ices, Inc.
9075615~01
T-140 P.O~/05 F-~42
CT&K RefJf 1013582002
Client Eame S & S _l:nLZineedn~
~t Sample ~ ~t 7 Block I R~bi11 S~
~ D~n~-~ Water
O~e~ By
~ 0
P~L
Client PO~
Printed Date/Time 06/27/2001 15:52
Collected Date/'l'lrn~ 06/21/2001 17:00
Received Dale/'l'ln~ 06/22/2001 12:03
Albwablc Pr~p A~naly~is
l. imi~s D~m Dste Init
Niu'ate-N
6.92
0.500 ~ EPA 300.0 (<10) 06/22/01
SCL
Microbiology l. nbor~A:ory
To~al Coliform
0 coPlOOmL SM189222B
0~22/01 SKW
Municipality of Anchorage
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 "L" Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-4744
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ,O1¢- 3b~- 15
1. GENERAL INFORMATION
Complete legal description
Expiration Date:
Lot 7, Block 1, Rock Hill S/D
Location (site address or directions) 6301 Barry Avenue
Current Propertyowner(s) Eric & Karla Zuspan Day phone 346-1187
Mailing address 6301 Barry Avenue, Anchorage, AK 99516
Lending agency
Mailing address
Day phone
Real Estate Agent Dynamic/Brian Roit
Day phone 261-7652
Mailing Address 311]. C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: "-~
-'~'/,~/o ,~
NUMBER OF BEDROOMS: 5
TYPE OF WATEFI SUPPLY:
Individual Well
Individual Water Storage
Community Class
Public Water System
Well
TYPE OF WAS'TEWATER DISPOSAL:
[] Individual On-site
r-] Individual Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Department of Health and Ftuman Services (DHHS) issues Certificates of
Health Authority Approval (RAA) based only upon the representations given in paragraph 5 by an independent
professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are
required for the transfer of title (except between spouses) on properties served by a single family on-site
wastewater disposal and/or wa~er supply system. DHHS also issues HAAs upon request to home owners.
Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by
a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates
are valid for one year for properties served by ClassA 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.
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 the Health Authority Approval
application show that the on-site water supply and/or wastewater disposal system is safe, functional and
adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-
site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
S & S ENGINEERING
Name of Firm 17034 Eagle River Loop Road No. 204 Phone 6' c~ ~ _ ~.~ ? c.~
h..agle River, Alaska '~9577
Address
Engineer's Printed Name
DHHS SIGNATURE
Approved for
Disapproved.
Date
bedrooms.
Conditional approval for bedrooms, with the following stipulations.
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 6.12 mg/1. EPA maximum concentration is 10.0 mg/1.
~ore informanion on ninranes ~s available from nhe On-sine Services Program,
DHHS~ 343-4744.
Attach ments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Expiration Date:
Original Certificate Date:
Reissue Date:
Municipality of Anchorage
Department of Health and Human Services
Division of Env~ronmentel Services
On-Site Services Section 825 %" Street Room 502
~.O. Box 196650 Anchorage, AK 99519-6650
www, ci.anchorage.aK.us
(907) 343-4744
,ECEIVE
JUN 07 ~000 ~
MUNICIPALITY OF ANCHORAGi.~
'VIRC)NMEN'rALSEI~VICE8 DIVI$I '
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Descriotion: Lo T- '1
A. WELL DATA
Parcel I.D.:
el ,5- ~ ] 6~). -~ 5'-
Well type
Date completed ?[~
Total de[3th -7 I ft
FROM WELL LOG
Date o' test
Static water leve .3 o
Well oroduction
WATER SAMPLE RESULTS:
Coliform ~ colonies/100 rr
Date of sample:_
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
f A, B, or C provide PWSID # __
Sanitary seal ~/,~ .f
Cased to .~0 +_ ft
fl
g.p.m
Nitrate /~,1~.
Collected by:
Casing height (above ground) __
AT INSPECTION
5-/ ~/oo
3 ~; ft
'7~ 1½ ~- _ g.p.m
Well Log ¥ ¢ $
Wires properly protected
,-'q"/¢- in.
mg/I Other bacteria 0 .colonies/lO0 mi
· ~i & S ENGINEE~J~I~
'17034 Eagle River Loop Road No, 2~4
Ea~lle RJyer~ Alal~Jfa
Date installed G / a. ,Jo o
CJeanouts 'Yf~ Foundation cleanoul
Date of pumping )v/,9 - ~' ~ ~,
Tank size ) .,c ¢ o ga~ Number of Compartments 2.
Y/~- ~' Depresmon over tank /v o High water alarm
Pumper
C. ABSORPTION FIELr) DATA
//
Date instarled ~ /~/o o Soil rating ~_~_.2~-~10r ft2/bdrm) ), ~ System type_?,,~,~,.,c/¢
Length ~' '~ ft Width ,.C- ft Gravel below pipe ~ '/~- ft
Total depth./.~ _ft Effective absorption area (~do ft2 Monitoring tube Y~- J, Depression over field ~ o
Date of adequacy test/v/,9 - ~,~ Results (Pass/Fail) For 6"" bedrooms
Fluid depm n absorption field before test ~-----~ter added__ gal. New depth _ in.
Elapsed Time: ~ Final fluid depth in Absorption rate >= . g.p.d.
Any reJuveni~'T't?~'~tment (past 1 2 mo.) (Y/N & type) If yes, give date
72-026 (Rev, 01/00~*
D. LIFT STATION
Date installed . Size in gallons ~~'-
"Pump on"levelat_ ~ .H. ighwa.teral~rm, levelat__ in
Datum ~---~elg es tested. Meets alarm & circuit requirements
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ]Oo ~
Absorption field on 1et
Public sewer main
Sewer/septic service line
On adjacent lots /ao 4,
On adjacent lots / o o '
Public sewer manhole/cleanout.
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation "7 / Property line /-/~
Water main /v/4 Water service line /o .-/
Drainage ~, /',~ Wells on adjacent lots ¢' o o ~¢
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ ~ Building foundation ) "/ Water main
£
Absorption field ,.,c
Surface water ,~ o ,, .-.,t
Water Service line
Curtain drain
Surface water I o o
Wells on adjacent lots
Driveway, parking/vehicle storage
F. 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 HAA guidelines in effect on this date.
Engineer's Printed Name
/_
Date ¢0 /7/0 o
HAA Fee $
Date of Payment
Reoe pt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 01/00)*
06-01-00 2~:36 FRO~-¢TE ENVIRONMENTAL §616~01 %660 P06/06 ~-427
CT&I:- Environmental Services Inc,
Laboratory Diviaion ii~ll~w~~drdrdrdardmP'~Mr~'~J'd~;J
200 W, Potter Drive
Anchorage, AK g9518-1605
Drinking Water Analysis REport for Total Coliform Bacteria ~., ~o7~ 56~.~a~a
--_ i~Sr~UCT~ONS ON ~vE~E SIDE 8EFOR~ COLLEC'TING S~ Fax ~ ~61 -~301
~a~ ~u~~~~~~ To ~ CO~T~ ~Y ~O~TO~Y
-'~ S,~nd Red,am
Send l~voJeS
Month
SAMPLE TYPE:
;~ Routine
c] RepeaT Sample (for rnutinesample
with lab ret', no, __ __~)
gl Special Purpose
SAMPLE LOCATION
Day Year
[~ Trea~ed WaTer
311 UnTreaTet WaTer
,~yS~S shows this Water SAMPLE to be
Satisfactory
0 Unsatisfactory
Sample over 30 hourS old. results may
be unreliable
Q Sal'nple too long tn ~ns~t: sample should
no~ be ov~ 48 hou~ old st examinanon
m indlea~ rehable results. Ple~ send
new sample v~a spectal dehveD m~il.
DaTe Received _~ b. D~
Time Reeel,ed / ~[ ~-
An~lc~ Melh~: ~embme Fil~ n ~MUG
· Namer ofcolome~lQ0 mL
Lab Ref. No. R~uI~ Analy*~
c
Sen~ o'A.D,}'-. · AnC~ Fb~ Jun
Time CollecTed
Collected By
BACTE~OLOGIC~ WATER ~YSIS ~CO~
Client notified of unsatisfactory resultS:
PlloMefl "' Spog~ with Faxca
E. Coil ~
c:OLIFIRM__~ ~
MMO-MUG II~mlB To'ad Collfom .
Membrane FIITe~ DlrC~T
Verification: LTB __. BGB
Fecal Coliform Canfl, ruction
Final Membrane Filter P,~ulta ....
Repo~eQ By . . ,.
C~lifnrrWlO0 mi
~ ~ MotnT~f af ~rm SG~J Group (SOc~Ma Ganofalo da SurvedianCei ~
ENVIRONMENTAL FACILITIES IN At. ASIOL CAt. IFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI, NE~V JERSEY, OHIO. wEST VlflGiNIA
08-01-00 23:36 FROM'CTE ENVIRON)ENTAL 5615301 T-BBO P.03/0§ F-42~
,a~ CT&E Enviro~lmeflla[ Services Inc.
CT&£ Ref,# 1002565002
Client Name S & S Engineering
Project Name/~ MIA
Clieni Sample ID 1.o~ 7 Block 1 Roc~ill
Matrix DrYing water
Ordered By
PWSID O
Sampl= Remargs:
Ni%ra~e.H
6,12
POt.
Client PO#
Printed Date/Time 06/01/2000 [4:09
Collecte~l Dart,/Time 0513012000 11:30
Received Date/Time 05130/2000 12:15
Teehnlcal Director Stephen C. Ede
0.500 ~J/g EPA 300.0
max 05/30/0D sCk
HlCRt) LABORATORY
Totat Cotiform 0 cot/lOOmL SHI~ 92228 85130/00 O,P
MUNICIPALITY OF ANCHORAGE . -
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# .~~_~n~)- \,~
1, GENERAL INFORMATION
Complete legal description
Lot 7~ Block 1 f Roc]~hill Subdivision
. :J~°ca!io~ (siteaddress or directions)
6301 Barry Ave.
i. Property owner Val and Donna Peyton
~ i' Mailihg'-'ad~ress 6301 Barry Ave., Anchorage, AK
.. :;;,.~p~(~i~,g agency
Day phone 346--2'~02 '
99516 ·
Day phone
..... : : ~ U~I~Ss ~}h~,~e ~'t~,'H~ ~ill be held fo~ P,ck~p
3, ?TPE OFWA1ER SUPPLY:
Individual well x
........ Community well
.... - ..... ' ::': Pubhcwater ' . ~ ~,:¢,-:
': ¢: 4'~'N~i~??'/f ~m~ ~t~'~eii ~stem/ provide wri~en confirmati~
. lng to the legality and status of system.
4, TYPE OF WASTEWATER DISPOSAL:
;: Individual on-site
": "~; ~' H0iding tank * :
- NOTE: Ifcommunity'Wastewatersystem, provide wri~en confirmation from
a~esting to the legality and status of system.
72~O25(Rev. 1/91) Front MOA~I
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 systern 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 wastawater 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 _ Environmental. Manaqement, Inc.
Address 206 E. Firewe~,~./ St~01~orage, AK
Phone 272-9336
99503
Date _q -/~'
6... , :.-_ .-:_
: t : ' bedrooms, -' .. - '
.-:- ~'/' ~ :' ""~ ' Oonditional' approval for ' bodroomo,' with the following 'Stipulations:
: ",'"AddifionalC~mments Note: The well for this property meets existinq
· ,J~ Stat.,.e.and.'~,unicipal Codes. There are nitrates present. ~It is
.~L- ~ub~es~'~bha~-~ a n~r~a~c %~s~n~ be oerformed to [nsu~e ~he w~lls
-' :: ~ ;- Oo~t~,~s~ab~.ii~ N~trate concentration is.5.77 mg/l~ f.EPA' ' ~ '.
The Municipali~ of Anchorage DePa~ment of Health and Human Sewices (DHH8) l~Ues Health Authori~
Approval Ce~ificete~ based only upon the representations given in paragraph 5 above by 'an independent
professional engin~r registered in the State of Alaska. The DHH8 does this as a cou~esy to purcha~m of hom~s ·
and theirlending institutions in order to ~tis~ ce~ain f~eral and state requirements. Employ~ of DHHs d° not ,
conduct inspections or anal~e,data before a ce~ificate is i~ued. The Municipali~ of Anchorage ~s not
r~ponsible for effom or oral,ions in the p~ofe~ional engin~ffs work.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~Ot 7, Block I, Rockhill Subdiv,Paroel I.D.
A. Well Data
Well type Private
Log present (Y/N)
Total depth 71 ft.
Sanitary seal (Y/N) yes
If A, B, or C, attach ADEC letter. ADEC water system number
yes Date completed 7/7/81 Driller Delta Drilling Company
Cased to 71 ft. Casing height 2 fit.
FROM WELL LOG
Date of test 7/7/81
Static water level 30 ft.
Well flow 12
Pump level1 t]nkno~cn
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 135 +ft.
Wires properly protected (Y/N) yes
AT INSPECTION 'i~
4/7/95 ~j,,:~ "J
37 ft 3 ~n (~ _, ~'<
g.p.m. 6 g.p.m, r'r~l ~.~, ~ ~
unkno~ ~=~ ~
~ C
0
; On adjacent lots 100 +
Absorption field on lot 110 + ft.
Public sewer main N/A
Sewer service line N/A
WATER SAMPLE RESULTS:
Coliform 0
Date of sample:_ 04/06/95
; On adjacent lots lg0 + fl-.
Public sewer manhole/cleanout N./A
Petroleum tank None
Nitrate 5.77 mq/1 .- · Other bacteria
,Collected by: Larry Helqeson
B. SEPTIC/HOLDING TANK DATA
Date installed 9/18/81
Cleanouts (Y/N) yes
High water alarm (Y/N)
Date of pumping
Tank size 1,500 qallons Compartments 2
Foundation cleanout (Y/N) yen Depression (Y/N)
None Alarm tested (Y/N)
9/19/94 // Pumper Rotc Rooter ',
None
SIEpARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 135 + ft. On adjacent lots
To property line 20 ft. Absorption field
Surface wateddrainage 100 + ft.
100 + ft. _Foundation 8 ft.
60 ft. / Water main/service line N/A ,- '
72-026 (3/93)' Front CONTINU ED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" Level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO: N/A
Well on lot
On adjacent lots
Surface water
D, ABSORPTION FIELD DATA
Date installed 9/18/81
Length 75 ft.
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) 85 System type Trench
Width 3 ft. "' Gravel thickness 3 ft. / Total depth
450 sq.ft. Cleanout present (Y/N) yes Depression over field (Y/N)
4/6/95 Results (pass/fail) Pass for 5
3" /' After test 7.5" ~"-
No If yes, give date
11
No
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 110+ ft
To building foundation 20 ft.
On adjacent lots 30+ ft.
Surface water 100+ ft.
Curtain drain None observed
E. ENGINEER'S CERTIFICATION
E~..gin'e~rs Name John Simpson
/'/Dctc¢ April 13, 1993
On adjacent lots 30+ ft. Property line
To existing or abandoned system on lot N/A
Cutbank N/A Water main/service line N/A ~'
Driveway, parking/vehicle storage area 25
*25 ft. from driveway (under edge of asphalt~
play area)
o. of this inspection.
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
Ad lq 9% t'5:2¢_: ,.]0HHEE:,]IF4L TE'STIIIG -' '9072724159 110.2:[0 D~2
CT&E Environmental Services Inc.
Laboratory Division r`~`~`~`~`~`~`~`~`~jj~J~j~JfJfJJ~~~
,~;. n~,,-~ Laboratory Analysis Report
WATER
Sample F, eraarks; Sh2qPLg COLLECTED
200 W. Poller D, ive, Anchorage, AK 995181605 -- Tel: (90'?} 562-2343 Fax; (907} 561-5301
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 DWFLLING
Parcel I.D. # _~-~_\~/-~
GENERAL INFORMATION
Complete legal description
Location !site address or directions)
Property owner
Mailing a.ddress ~;:30 ]
Lendi'ng ~gency /"//4
Mailing a~lgress
Agent .... /"~'/~
Address
Day phone 34
Day phone
Day phone
2. NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF: WASTEWAT'ER DISPOSAL:
NOTE:
Individual on-site 2<
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify Th .t m~,
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 Environmental Management, Inc.
Address 907 E. Dowlin~d,. ~uite ~ Anchorage,
DHHS SIGNATURE
Approved for ~'
Disapproved.
Conditional approval for
_ Phone (907)562-2580
AK 99518
Date April 13, 1993
/
bedrooms.
bedrooms, with the following stipulations:
By:
Additional Comments Note: ~he well for this property meets existinq
State and Municipal Codes. There are nitrates present. It is
continued suitability. Nitrate concentration is 5.21 mg/1. EPA
m~am c~ccr~-r~-t~l~-s 10.0. mg/1.
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.
72~325 (Rev. 1/9t) Back MOAli21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL, CHECKLIST
Legal Description: L-d~-t~ ~-O¢/~/~ ~ ~OC~;// ~ Parcel I.D.
A. WELL DATA
Well type ~r; ¢.F~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter.
"¢¢-~ Date completed
7' I ~&. Cased to.
FROM WELL LOG
J~' g.p.m.
ADEC water system number¢.
":'¢ / "¢/~ / Driller "~'~JJk
:~ / ~' Casing heig~lC~¢h~q~
Wires properly protected (Y/N)
.??. 21 1995
AT INSPECTION
g.p..m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot J / O
PubLic sewer main
Sewer service line
; On adjacent lots
____; On adjacent lots
PubLic sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform O (¢Ji'~¥~'~./trO ,,,L Nitrate
/
Date of sample:
Collected by: ,~/~T'~-j~ ~ ~e,¢~;
B. SEPTIC/HOLDING TANK DATA
Date installed ,' ~"//$' /f~/ _Tanksize
Cleanouts (Y/N) "/¢----< ' Foundation cleanout (Y/N)
Compartments o)./
Depression (Y/N) ~0)~¢
High water alarm (Y/N) : /~/01~ C-
Date of p~.mp!ng _ ~/ '2-2,/ ~,,'~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot' '.. . On adjacent lots
To property line o~ 0 .[/", Absorption field
Surface water/drainage /0~) -t~ ~/' .
Alarm tested (Y/N)
/O~)'d' ~(~, Foundu. ,~n ~
~0-~' Water main/servic ' line N~ //~
/
72.026 (Rev 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Vent (Y/N)
"Pump on" level at
Manhole/Access (Y/N)
"Pump (~ff". level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date inst,alled ', C'//iCC
Length ":~ ~"?f¢' ' Width
Total absorption area ~ 5-0
Depression over field (Y/N)
Results (pass/fail) iO rx 55
Peroxide treatment (past 12 months) (Y/N)
Soil rating
Gravel thickness ~ ,~¢ ' Total depth
Cleanouts present (Y/N)
Date of adequacy test
for -~'
If yes, give date
System type
I/
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //O~L )¢~L, On adjacent lots Z:~ O~' L-~¢¢', Property line
To building foundation ~0 ~.,~, TO existing or abandoned system on lot
On adjacent lots ,~ 0'qh(~'~' Cutbank /~//}' Water main/service line
/
Surface water
Curtain drain
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection,
Signatur~
HAA Fee $
Date of Payment ~'~'~/- ~-'5
Receipt Number ~ ¢'¢~' ';~'~' ~Z~'/~ ~
72-O28 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL, TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE. ALASKA 69518 TELEPHONE (907) 562-2343
.oahb Ref.! :93.1209-2
;liont Sample ID :EATt[~OOM L7 El R(ERHILLS
Matrix : #A~ER
REPORT of ANALYSIS
FAX: (907) 561-5301
Client Name :ENVIRONMK)~AL MO~ I0C (EMI)
Ordered By :D~UEA I~OGI
ProJeot Na~o :
ProJeotl :
PWSID :gA
Collected :03/24/93 0 h~s.
ReoHvod :03/24/93 e 16:50 bra.
#ORR O~der :64330
Repozt Co~leted :03/29/93
Teohnioal Director .:~E~t~C.E~.: .
Sample
Remarks:
RO~I~ SAMPLE COLLECTED BY: U.A.N., WZT~SSED
~C Allowable Extract Analylle
Parameter Reeuhe Oual. Units Method Limite Date Date Init
DITRATE-U 5.21 I~/1 EPA 353.2/300.0 10 03/26/93 lLfl
* See Special Irmtructions Above UA - Unavailable
" See Sample Remzks Above NA - Mot knalFzed
U - Undetected, Reported value is the practical quantification lim/t. IT - Less Than
D - Secondary dilution. GT - Greater Than
~r~{~ Member of the SGS Group (Soci~t~ G~nGrale de Su~eillance)
MUNICIPALITy OF ANCHORAGE
DEPAR'rMENT OF HEALTH AN[;) ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
^pp,,cat,on Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
~,,¢ ~ ~ .~. ,,,,.., '
Applicant Address _{~->f¥~/ PHS, I~ Y hf-(/l~ ~VC'/?/ t~ [/. ,. ,.
c~ ACplicant Is {6heck on&J: L~ding Institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) C~&~n¢4e~titg,t~b¢~ Telephone
(e) Real Estate Company and Agent
Address
Telephone __
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Sing[a-Familyj~ Multi-Family []
Number of. Bedrooms. , ~
Other
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.
Page 1 of 2
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.
ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA ~ A 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 adequale
for the ~umber of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of A~chorage fi~es a~d from my investigatio~ and inspection, the on-site water supply and/or
wastewater disposal system is iR compliance with all Municipal and State codes, ordinances, and regulations
the date of this inspection.
Name of Firm _. ~ ~, / ~" Telephone
Date
Approved_ ,~ Disapproved _ Conditiona/g./
Terms of Conditioner Approval
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 Ancl~orage is not responsible for errors or omissions in the
professional engineer's work,
Page 2 of 2
72-025 {11/84)
MUNICIPALITY OF ANCHORAGE (MO~.,
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHOP, AGJ~.
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION;
A. WELL DATA
Well Classification [NOJJ//DU/~./- If A, B, C, D.E.C~ Approved (Y/N)
Well Log Present (¢N) Date Comp~ted '7/'7/~ / Yield
TotalDepth . 71/ Depth of Grouting _
Stat ~ water Leve ~, ~ ~' Pump Set At
Casing Height Above Ground
Electrical Wiring in Conduit (/~)
Separation Distances frorn Well:
To Septic/Holding -rank on Lot
_347
Sanitary Seal on Casing("(~N)
Depression Around Wellhead (Y¢I~
; On Adjoining Lots l j~)/,?L.
To Nearest Edge of Absorption Field on Lot'J~/~¥ ~lO ~"; On Adjoining Lots I 00
To Nearest Public Sewer Line /~/+ To Nearest Public "'
oewer
Cleanout/Manhole ~/~ To Nearest Sewer Service Line on Lot
Water Sample Collected by ~4, ~J~¢//[J~;'~ ; Date __
Water Sample.Test Results .%~ (,% ~'~O'T0~ ¢
: ' ' ' ~ .... ¢ C "' ~ ' ~r ....
¢ O~ILCE~5 IJE;RIF:/~TfOA/ O~ ~(.~
SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes I~/N) . Air-tight Caps (~/N)
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High.Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well J ?~..~
To ProPerty Line
To Water, Main/Servi... ce Line J~/
· gommcms- ' '.. *. i
P~ge'lof2 ~* ¢,~,~ ~
..>
. Size /~'~d_ff~ NO. of Compartments
Foundation Clea~out ~?)N)
Date Last Pumped
JV/J2l ,for /V//'~
Temporary Holding Tank Permit (Y/N) _ n////'~
To Building Foundation
To Disposal Field _ '-~
To Strearn, Pond, Lake, or Major Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed .
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
To Building Foundation 2~ /
Lot
TO Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments '~ ~/~'J(.,/E f.,¢'//~-¢
Type of System Design
Length of Field -,,)¢G'
Depth of Field //
Gravel Bed Thickness ~'~ /
Standpipes Present
Date of Last Adequacy Test
TI$¢ CTORT
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots -?~C)" '']'-
To Cutbank (if present) ~,///~
i 0C9 '
D. LIFT STATION
Date Installed Dimensions
Size in Gallons Manhole/Access (Y/N) //
"Pump On" Level at "Pump Off" Level at
HighWaterAlarmLevelat j /{~ ~
Tested for k~/ ~'--I~ / Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N) I ~/~
Comments .-- ,.~.~,~¢-
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I hav6 c~9~lf, ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed O,,/~,~zP'~ Date
Receipt No. ~ ~
Date of Payment (~'
Amount: $ ~ ~ ~
Page 2 of 2
72-026 (11/84)
ALASKA , iUIROiqmE F1TAL COFITROL SE! dlCC$, IrlC.
~n§inee,'inq & ~nuironment~l $1utlie$
RICHARD BLUMER
6303 BARRY AVENUE
ANCHORAGE ALASKA
99516
SELLER-SAME
JUNE 6 1986
RICHARD BLUMER
6301 BARRY AVENUE
ANCHORAGE ALASKA
99516
60256
LEGAL:ROCKHiLLS BLOCK 1 LOT 7
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY 'rEST DATE-JUNE 3 1986
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 450 SQFT.
TRE SYSTEM IS CAPABLE OF ACCEPTING 750 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 1189 GALLONS.
BASED UPON THE TEST DATA TIlE SYSTEM IS ACCEPTABLE FOR A
5 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR
THIS 5 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JUNE 4 1986
THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER
SUPPLY OR WASTEWATER SYSTEM.
FLOW TEST ON WELL
WELL FLOW DATE-JUNE 3 1986
A FI,GW TEST WAS PERFORMED ON THE WELL. 1189 GALLONS OF WATER WAS
PUMPED AT A RATE OF 8.49 GPM OVER A DURATION OF 3 }{OURS.
THE DRAWDOWN WAS 7 ' WITB A RECOVERY TIME OF 10 MINUTES
AND THE STATIC WATER LEVEL WAS 36.9 FEET.
THE WELL IS ADEQUATE FOR THIS 5 BEDROOM HOME.
, APPL -.--,NT FiLLS OUT UPPER
Pr~erty Ow~e~r~/~.,/~ /~/[}g/'~ ~/~ ~~ ~ Phone
Mail~"gAddre~ ~ ~ /~ ~ ZipC°de~~
Buyer ~, ~ ~
Address ~ ~Y"~ ~ Zip Code
Lending Institution //// ~ ~ / -- Phone
Address ~~ /~ ,:~C Zip Code
Realty Co. & A~nt Phone
Address /~ Zip Code
Legal Description ~ ~
Type of Resi~nce
~ngle Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
~'dividual A~ACH WELL LOG. A w~l log is required for aH wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~ndividual Year Individual Installed:
~ Public Utiiity When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE iNITIATED.
Time Time Time Time
Date Date Date
Inspector Inspector Inspector Inspector
Field Notes:
(~'"APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
June 21, 1982
Dick and Donnie Blu~er
SRA Box 1570W
Anchorage, AK 99507
Subject: Lot 7 Block 1 Rockhill Subdivision
Approval. for the individual sewer and water facilities cannot
be granted until the following items have been completed:
" A well log submitte~ to this office for our files an~
review.
The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 ~ Street, for our review.
Please notify this Department for a reinspection when the
note~ discrepancies have been corrected. If there ~re any
further questions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt
Associate Envirom~ental Specialist