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HomeMy WebLinkAboutROCKHILL BLK 2 LT 24Rockhill Block 2 Lot 24 #015-063-21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 y11*0e`1. tof 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211131 PID Number: 015-063-21 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name DAVID HAAG ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address 9721 MAIN TREE DRIVE ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 907-529-6558 3 1.2 GPD/SF JTotal 9 (MAX) Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 4.06 Ft. Subdivision Block Lot ROCKHILL; BLOCK 2, LOT 24 Fill added above original grade SEE DWG. Ft. Gravel length 40 Ft. Township Range Section Gravel width 5 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 400+ F0 1 -Ft. Well 1001+ 1001+ 2, TANK W Septic ElS.T.E.P. EJ Holding El Other Manufacturer Capacity GREER TANK 1000 Gal. Surface Water" 100,+ 100'+ Material Number of compartments Lot Line 5'+ 10'+ NA HDPE 2 Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield A+ HOME SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.00 ft Inspdection Ist 8/5/21 2nd 8/6/21 Location and description Td 8/13/21 4'h - op o -t Mo_v-,V.o(e U4 " PGEG ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp oo6oOp�� o Conditional Approval: Date 0 f ....... ......� f e A. Gor _ss,, 0� p Septic System Approved Date 1.2115-1.20.2 /5 3 0�)7 51_ ` 0�44���ed c o� Note: this approval does not include well permit requirements.Aecc 44��O0000�a� �nov uaiuci 101 PERMIT NUMBER: PARCEL ID NUMBER- OSP211131 RECORD DRAWING 015-063-21 DRIVEWAY 4- A d. EXISTING HC9= V. A - . . .0 NEW 1000 GALLON HOPE GREER TANK m Ak IROCKHILL; BLOCK 3, LOT 9 1 F-A ­_r 1-3 MH1 49.5 75,0 STI 541 79.6 DBL1 55.1 80.7 DBL2 56.0 81-5 FD 56.5 81.9 COI 80.4 102.7 IMT1 1 78.3 100.6 M - C52 69.7 73.0 MT2 7 d 71.4 1 4.0 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD GARNESS ENGNINEERINGi(NROUP Y T 9 Ltd ENGINEERING < SALES CONSULTING ;'� 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507' PHONE (907) 3376179' FAX (907) 33&3246' WEBSITE:—g—sengnsenngcom PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DAVID HAAG 907-529-6558 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: ROCKHILL; BLOCK 2, LOT 24 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM RECORD DRAWINGS 9/17/2021 DRAINFIELD LICENSE #AECC884 ROCKHILL; BLOCK 2, LOT 25 111=40' PERMIT NUMBER: PARCEL ID NUMBER: OSi1211131 RECORD DRAWING 015-063-21 TH#1 TOP OF MH = 100.00 FINAL GRADE = 99.2-99.4 Mt ---J ST2 TOP INLET TANK 9352 —\ I I I I r TOP OF TANK AT OUTLET = 93.53 INVERT OF BUNG AT INLET = 92.85 NEW 1000 GALLON H.D.P.E. GREER SEPTIC TANK RATED INVERT OF BUNG AT OUTLET = 92.71 FOR 10' BURIAL MT CO FINAL GRADE = 97.7-98.0 ORIGINAL GRADE AT HIGHEST POINT = 97.15 r FILTER FABRIC RELATIVE ELEVATION AT BOTTOM OF T.H. = 82.15 T.H. DRY ON 8/5/2021 INVERT OF PIPE = 92.21 BOTTOM OF TRENCH = 88.15 GARNESS EN(ANEERIM-31 GROUP, Ltd ENGINEERING SALES, CONSULTING 3701 E. TUDOR ROAD SUITE 101 • ANCHORAGE, AK 99507' PHONE (907) 337-6179 • FAX (907) 338.3246 • WEBSITE:—.games.ng n.e N.— PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DAVID HAAG 907-529-6558 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: ROCKHILL; BLOCK 2, LOT 24 D.J.G. TYPE OF WORK: DATE: I,, SEPTIC TANK PROFILE 8/23/2021 THE SURVEY DATA AND MEASUREMENTS HEREON ARE PREPARED FOR THE ©i ER OF RECORD AS OF THE DATE OF THIS SURVEY ANY USE OF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS WRITTEN PERMISSION IS PROVIDED. THE INFORNATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOV ANY CONFLICTS BETtVEEN £XISTIN6 STRUCTURES AN.P PLATTEN LOT LINES ANP/OR EASEMENTS; ANS IS NOT TO BE USED FOR POSITIONING APPITIONAL STRUCTURES, INPROVEMENTS, OR FENCELINES EASEMENTS OF RECORD 7 OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOYN HEREON ( UNLESS INPICATEP) NOTE: F£NCEL IVES THAT MAY APPEAR ON THIS PRAYING ARE NOT TO BE USED TO PETERMNE PROPERTY LINES OR POSITION APPITIONAL IMPROVEMENTS. ANY PAVING SHOAVN HEREON MAY BE APPROXIMATE PUE TO EXCESSIVE SNOY AND/OR ICE. NOCORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 24, BLOCK 2, ROCKHIL L SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 23 RD DAY OF AUGUST , 2021 1 095, FB 212-32, 215-68 HOLT LAND SURVEYING 93e9 GROVER DRIVE ANCHORAGE, AK 99587 345-5513 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211131 Work Type: Septic Upgrade Tax Code Number: 01506321000 Site Legal Address: ROCKHILL BLK 2 LT 24 G:2438 Site Mailing Address: 9721 MAIN TREE DR, Anchorage Owner: HAAG DAVID G & C RENE Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: 21 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms 5/11/2021 5/11/2022 43099 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By:� Issued By: Date: :5 �- I )- / Date: 5- It (? 3 MUNIUPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-063-21 Property owner(s) David Haag Mailing address 9721 Main Tree Drive *Anchorage, AK Site address 9721 Main Tree Drive *Anchorage, AK Legal description (Sub'd., Block & Lot) Rockhill; Block 2, Lot 24 Legal description (Township, Range & Section) Lot Size Day phone 907-529-6558 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial ❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade Fx I (D) ❑ Holding Tank ❑ RenewalDuplex ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: $ 5 � 5 , Date of Payment: .541.202 1 Receipt Number: C6 2Z 3G Permit No. D S P 11 1 5 t Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211131, Rebecca Carroll, 05/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211131, Rebecca Carroll, 05/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211131, Rebecca Carroll, 05/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211131, Rebecca Carroll, 05/11/21 OWNER OFRECORD AS OF THE DATE ANY USE OF - IS PROHIBITED PERMISSIONWRITTEN PROVIDED. THE INFORMATION HEREON IS FOR THE USE OF LENPING INSTITUTIONS SPECIFICALLY TO SHOD ANY CONFLICTS SETYEEN EXISTING' STRUCTURES ANIS PLATTED LOT LINES ANPIOR EASEMENTS 4 ANP IS NOT TO BE USES FOR POSI TIONIN; APPI TIONAL STRUCTURES 4 I17PRO VEMENTS 1 OR FENCEL IVES - EASEMENTS OF RECORD, O THEN' THAN THOSE APPEARING ON THE RECORD PLA T 7 ARE NOT SHOYN HEREON ( UNLESS INDICA TEP) NOTE: FENCEL IVES THAT NAY APPEAR ON THIS PRA&ING ARE NOT TO BE USED TO PETERNNE PROPERTY LINES OR POSITION ADDITIONAL I17PRO VE!` ENTS . ANY PA DING SH04YN HEREON MAY BE APPROXIIIA TE PUE TO EXCESSIVE SNOld ANDIOR ICE - Sao CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED ED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 24, S`OCK2 ROC NILE SLIS ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 7T/-/ DAY OF APRIL , 2021 14-9-95, FB 212-32 HOL T LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE, AK 99507 345-5513  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME .~, PHONE I ~,N EW MAILING ADDRESS LEGAL DESCRIPTION ~ t LOCATION Iwe,,~l~ , Absorption area Dwelling PERMIT . ~. ~ Manufacturer Greet Materia,~¢~ ~ Liq. ca%a~y~llons IF HOMEMADE: Inside length Width Liquid depth ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons Q Well~l M~Z~-- NO. of linesI Loner" of each ,,noHq. T .a, ,o ¢h'of , .hq Trench width60 inches Distance between ,ines~ ~ Top of tile to finish grade Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well i Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOl L TEST RATING REMARKS I APCROVED E i ] ] ~:~"!' :[ C)F~F:ti3ECq"T L..E ]q_.,, .. LT. 24 [.:~LI-:::2 ROC:KHILLS :";/[:, __Ir"ri''.. =, ........ .~. z..*'F,= T'fF'E ~'i'l,'::" cr.;:r_. FiEE.;!3F*.:F'TtO1.-,! ?-/STE1.,!'-.-7':/: [:,RRI1..4FIELi}.~ HFtX]:FIUF! ,K, ltb.bt:. OF BEDF::CC$iS .... ]: :'4;OIL. F.:RTI?.,](') (9]:! k [, EF.. = 'T'HE i-~:E(;!Li :1: F;:EI.(';:, '/:; Z ZE OF "."HE :~i;O t L FIE '.;'~i: P.F'T I "..' 1.'~ '-2'-r%TEH I "}; ' ,::!.~Dg(~)¢ rE ';! .. FiF4:E FEET ............ 'r,= TI'-E LE'1.'!GT-i (IN FEET) OF TH, E "rF.'l::'*",t'"'~4 CIR t}F.:FI!!',!F"I:EL[:'. ~"F[:: ]f:::TF '"[:' q "'~c'i~%4 Fl:: :'fl" 're .... -E .... t'::'rFtq''''= F'ETt~]' :': '::~ OF ..... k"[~' !3RO(JND FI1..4D THE Bo-rT(;;$! OF THE ThE 3RFf,,'E ..... ::: EPTH :[ :}; "."kE 1..!! k :: ¥ ... I',I F.U(:, THE E}T"t']*' (;IF' THE EXCFI',/FtTZOh! :Iht FEET). , .~ ,: '::, 'r = .... PR ] '.~ EC (.r.r' :r t}Ii!~F'F.IF.-:'THIiD.IT i.,.f :[ LL ~': F ........ ~., .., E ..... Ti:) H I ?,I I FIt..tH D I STFINCE BET!.,E;Eh! F:I NELL Ri'.,!D RI.-.!'..,--' C)t',!--.S Z TE d..~t9 FEET FOR R F:I:i:!',/RTE i.,EL.L O.R j.[.'-.'i~Zi TO 20,9 FEET FROH Fl PUBL:[C !4EL.L UPON THE T?F'E O1=' F'LIBLZC: I.,.tELI. .... ?'!!!'.,ti?KIll [)ISTF4_kfE:E FROi"i F:I PRI',/R'TE !.,.iELL. 'T'O R PR!'vFr'FE :F;E!,,.fEF:: LINE :[:~:]; 25 FEET Ffl'.,l[) TO F! COHt"!UN:[T'f :~3Ei4EF..: L:i:i'4E :[E~; 75 FEET. i.,.!ELL LOGS RRE RE6:!LtIF.:E,r.::, FIND HLIST EiE RETURNE[)'!"O THE DEPFilt:;F??!EI',.IT HITHtN ]:i3 DFF/S OF' 'THE HELL E:OI'-!F'LETZO?,i. O'T'HEF:: F.':EQU l' REI"IEhF!"E; i"!F?'r' FtF'PL."r'. SPEC Z F ]: C:Frr' :t: (:SIS FIND CO1....t'.:.~i;TRU(:.'.'T :l: ES! D t Fi(:~RF:!i"!~; FIRE FiVR i LRBLE TO INSURE F:'I;?.OF'EF:'. :.[. HS'TF~LLF?,"Z :!.' C:ERT :[ F'.¢ THF!T !: :[ F!hl FRi','IZL.~F~R lqtTh' THE itEQ(JIREHE1.,?T'E; FOR (}F,!-:i:i;:ETE :F;Ek!ERS FiND i.,.iELi..S F;iS E;ET F'ORTH E',%.' THE ?iL!1.,.i:i: C ;[ P.¢:il... Z ]"'¢ OF i:::!?.,ICHORFI(3E. 2: t 14:£L!.... tNS"!"F~.LL THE Sh.".E;'TEi'4 Zi'.,i Fii]:C:(]F?.[)Ri'-~CE ki:E'i"H THE CODE:}:;. ]:: Z IJNDEF;:E, TI::IND T!...iR'T' 'T'HE ON..-S!'TE ¢];Ek!EF[: 5'.¢:E;TE?,! .r'iR'.r' f;i:EOUZ?.E ENLF:IRE~iE:i'IEf',FI" IF' THE RES; t DE1.,E:E t 2; RE}'tO[)ELED TO :!: hE::LUDE FK)f;:E "FH. Ri',i 3 E',E[:,ROOI'dS. ./ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMED FOR: ~Q'~/"-) _J~..~-~).,r') DATE PERFORMED: LECA'DESCR,PT,ON: £o~K /-/, /Id ~©. ~IR'. ,2 SOILS LOG PERCOLATION TEST 1 2 3 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: SLOPE SITE PLAN ENCOUNTERED? _ SL P IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN ' FT AND -- FT CERTIFIED BY~~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastswater Program 4700 South Bmgaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorege.ak.us (907) ~a~-TS04 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 015-06.3-21 ¶. GENERAL INFORMATION Explrablon Date: Complete legal description ROCKHILL SUBDMSION; LOT 24, BLOCK 2, Location (slte eddress or directions) 9721 MAINTREE: DRIVE ANCHORACE, AK 99516 Current Property owner(s) Mailing address Lending agency DAN JOBSON 9721 MAINTREE: ORATE Dayphone ANCHORAGEt AK 99516 Dayphone 546-1009 Mailing address Real Estate Agent Mailing address Un. less othetWf.~. requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 TERRIE PISA w// PRUDENTIAL JACK WH~E Day phone 3201 'C" STREI-I-I-I-I-I-I-I-I-ET ANCHORAGEt AK 99503 762-3157 3. TYPE OF WATER SUPPLY: Individual Well ~:] Individual Water Stemge Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Se~ces 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. CedJflcates of Health Authority Approval are required for the transfer of title (except between spouses) for properties sewed by a single family on-site wastewater disposal end/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 properUes 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 engines~s wonk. Note:Alaska Water and Wastewater Consultants, Inc. shall bo paid $1,110.00 at, or prlor to closing for the englnaedng services provided. . 4. STATEMEHT OF INSPECTION BY ENGINEER As ce~fied by my saal affixed hereto and as of the validatio~ date shown below, I ve~'y that my Investigatk~, based on procedures outlined in lf~ Heslth Authedty Approval Guidelines for this application, shows that the on-site water supp~, and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and Iype of structure Indicated herein. I further verify that based on tho Infonwation obtained from the Municipali~y of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance ~ all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. NameofFlrm ALASKA WATER &: WASTEWATER CONSULTANTS. INC. Phone 537-6179 Address. 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 .~/ / Engineer's Printed Name JEFFREY A. CAENESS. P.E. Date · / Engineer's Comments: = ~~~~~~n~t~ e. ........... 5. Dso s~ 4~wq.. .......~,~?~ ~ ~p~r ~ ~. ~: ON-SITE Di~ppmv~, WATER AND ~ ~ WAS~A~ER ~ndiaona~ approval ~r ~ ~ms, ~ ~e fll~ sapula~on~ ~'., PROG~M ..~. Attachments~ HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Englneefs Reo~t Other Municipality of Anchorage Development Services Department Building Safety Dlvtslon On-SKe Wst~r & Wsstewster Program 4700 South Bragaw 6L P.O. 6ox 196650 Ancf~rage, AK 99519-6650 www.cLanchorage,ak.ua (9O7) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descdption: ROCKHILL SUSDMSION; LOT 24, BLOCK 2, Parcel ID: 015-063-21 WELL DATA Welt type tqaVAI~ If A, B, or C provide PWSID~ N/A Data completed 7/20/82 Sanitary seal (Y/N) YES. Total depth 76 lt. Casedta 75 lt. FROM WELL LOG Date of tast 7/20/82 Static water level 25 Well preduction 15 g.p.m. WATER SAMPLE RESULTS: well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 2/26/01 8,3 g.p.m. 12'+ in. Coliform. 0 colonies/100 mi. Data of sample: 2/26/01 B. SEPTIC/HOLDING TANK DATA Nilrata 4.41 mg./L. Collected by: Other bacteria AWWC, INC. Tank Type/Matarial Tank size1250 gal. Foundation cleanout (Y/N) YES Data of ppmping 2/26/01 C. ABSORPTION RELD DATA STEEL Number of Compertmenta 2 Depression over tank (Y/N) NO Pumper 0 coloniss/lO0 mi. Water added 1137 gal. Data installed Claanouts (Y/N) High water alarm (Y/N) NORTHLAND PUMPING in. Absorption rata >= NONE KNOWN 6/28/82 TRENCH Systam type Gravel below pipe 4 It. Depression over field NO ._ For 3 bedrooms New depth 14 .in. 4.50+ g.p.d. ff yes, give data - ,125 D~a Installed ~ Soil rating (g.p.dJlt~o®-- Length 44 ft. Width 5 lt. Total depth a. Ts fl. Eft. absorption area 381 fl= Monitoring tut)eYES Date of adequacy test 2/26/01 Results (Pass/Fail) pASS Ruid depth in absorption field before test 1'. in. Elapsed Time: 6. min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) D. UFT STATION Size in gallons Manhole/~)------/ Data installed 'Pump on' level at ~ =~L~~~ ~ ~tar alarm level at in. Da..~~ & circuit requirements?. Cyctee tasted Meets alarm E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ On adjacent lots 100'+ 100% On adjacent lots N/A Public sewer manhole/cieenout N/A 25'+ Holding tank N/A Septic tank/lift Station on lot Absorption field on lot Public sewer main Sewer/septic service line Fe SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line Water main N,/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5% Surface water 100'4. Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS Building foundation 10'+ Surface water 100'+ Wells on adjacent lots 100'+ Water rnsln Driveway, parldng/vehide storage 50'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Englneer'sjPdn/t~, Name Date ! / ,J]-PPI~EY ~ GARNESS Da..,Pa ent D I U! 0 Receipt Number \."~ ~'~ (~e~. Waiver Fee $ Data of Payment Receipt Number. 03-01-01 16:3Z FROM-CTE ENVI~I~ENTAL .~Tr~ CTIE Environmental Service. Inc. 5615301 T-246 P.02/03 F-836 CT&£ RtI.H Client Name Project Name/~ Client Sample ID Matrix Ordered By PWSID San'q~Ie R_,marks: 1010917001 Ag. Water & Wastcwatc~ Consuhan~ ]ac. L24 B2 Rockhil19721 Main T~e L24 B2 R~ckhil19721 Main T~e Drinking Water Client PO# Printed Date//'lme 03/01/2001 12:30 Coil.ted Dote/Time 02/26/2001 9:05 Received Date/Time 02/26/2001 14:00 Technical Director Stephen C. Ede Relea,ed By ~~__~, Ib~uhs PQL Unia Method Limits D~te Date Init Wa=ers Dep&r~en= Nitrate-N 4.41 0.500 mg/L EPA 300.0 10 max 02,'26/01 SCL M£crob:I. ology Laboratory Total Coliform col/lOOmL SMI8 9222B 02/26/0 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name d,~ l,-, <;o ~'~ Applicant Address (c) Telephone: Home ,,~,~(',~ .'~z_~..~,,C~ Business -- Applicant is (check one): Lending Institution []; Owner/builder J~]; Buyer []; Other [] (explain); (d) Lending Institution Address 7 AL- I~o~ tr~.r,~) J~_.~_J('Telephone (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,' Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community welt system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public[] Community[] Holding Tank[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legatitY and status. -- , ~ 72~025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,J~¢-u--J '/~[l_,d c~ ~' Address "~ ! ~ '7 ~ ~" /~ C(J y Date '~L../'~'7 /_,~"~ ~ WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. Telephone ,."~,~.~- /-/L7 Il ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DNEP APPROVAL. (/~ ~"'"~ .. /~ Approved for '_~ -~ed roo m s by'~(%, Approved ~ Disapprovc~? Terms of Conditional Approval · NElL HAWTHORNS CE - 4369 o' CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAl PROTECTION R 2 '31986 WELL DATA Well Classification Well Log Present (Y/N) Total Depth '7 ~ / Static Water Level .2 .;~" ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot '~ $, If A, B, C, D.E.C. Approved (Y/N) ~ . Date Compl~ed 7 */~Q Yield cas~ed~l~· .~.s~,?.¢ Depth of Grouting ~, )~,-,¢'~-~, Pump Set At U~ ~ ~ ! ~ ~ Sanitary Seal on Casing (Y/N) f~' Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ^)/,,9 Cleanout/Manhole /~/,'"~ Water Sample Collected by J~" Water Sample Test Results '~'" ; On Adjoining Lots / /-'~ f:~ ; On'Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed ~ Standpipes (Y/N) y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well I ?_ ,~' To Property Line ~ To Water Main/Service Line ~ '~'~ Course Size 1 ~ _~-~2 ~,S~,¢ No.~)f Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~ Date Last Pumped ~/ 7 ; for Temporary Holding Tank Permit (Y/N) / To Building Foundation / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /,'¢.~ / ..42 To Building Foundation ~ .'~3 Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments "'~,-~ ~' ~,,0 ~,~ Type of System Design '"'~)"~-~ Length of Field Depth of Field Gravel Bed Thickness ,,,~¢- ~,~ Standpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line JO To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have.ch~clCed, vialed, or conformed to ail MOA and HAA guidelines in effect on the date of this inspection. Signed ,~,,"/ ~ Date "'~///') /,'~ C o m pa n / ~'"~"~ ~-~-Jv'~-~ ? ~- MOA No.' '' Receipt No. ~~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) APPLI~NT FILLS OUT UPPER HAY '~ ONLY .~ Phone Buyer Address Zip Code Realty Co. & Agent /~,)/~;.~[- ' - ~- ~ ' Phone Address Zip Code Legal Description ~O'~ 24 :Block :2 1~OCkI~±11 street Location Typ~e o.,,9~'Eesiden ce [] Multiple Family No. of Bedrooms [] Other Wa~t er/S'u p ply Lyf'Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 197'5. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sew_er D~posa~ / LC/individual Year Individual Installed: [] Public Utility When Connected to Public Utility: , [] Holding Tank - NOTE: THE INsPEcTIoN FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ~LINICtlP ~LI"I'Y OF ANCHORAGE r'E ~T. OF HE,",LTII Field Notes: ENVirONMeNTAL PROTECTION, NOV 8 RECEI E ( '~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE { ~' -- ~'? ~ ~'~ ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ALASKA el dlROrlmE llTAL COF1TROL SE!RuiC $, ~nclin¢¢rJn§ 6 ~nuironmcntal ~tucJics InC. November 4, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority MUNICIPALITY OF ANCHORAOE PEPT. OF ti=/,LTil E, ENVIRONMEi'~TAL PROTEC]'JON RECEIVED On November 3, 1983 our company collected a water sample from the house located on Lot 24 Block 2 Rockhill Subdivision. The property owner is Dan Jobson. The water analysis will be delivered on Monday, November 7, 1983. The well is located 140 feet from the septic tank and 140 feet from the leach field. The electrical wires are encased in conduit. All the standpipes are capped. The well casing stands 1 feet above ground and has a sanitaz~_s_eal. g~ Lero~lC. Reid, Jr