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HomeMy WebLinkAboutROLLING HILLS ESTATES BLK D LT 2Rolling Hills Estates Block D Lot 2 #011-072-43 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000316 PID Number: 011-072-43 Name' HERMAN RAMIREZ Wastewater System: ❑ New ■ Upgrade Address: 7415 SAND LAKE ST. ANCHORAGE, AK 99502 NORTH/SOUTH] [NORTH/SOUTH] [ ABSORPTION FIELD Phone: (907) 243-0728 No. of Bedrooms: 4 ❑Deep Trench ■Shallow Trench CJ Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: 0.8 111.from i 21 e *0 /09-11.0 GPD/Sq. Ft Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 2 D ROLLING HILLS ESTATES 7.0-7.2/10.9-11.0 Ft 4.05 Ft. Township: — Range: — Section: — Fill added above original grade: Gravel length: 39/41 0.8 — 1.1 Ft Ft. Gravel width: Number of lines: Distance between Iln.e: 15'+ WELL: El New El Upgrade 5 Ft 2 Claselft.tion (Private, A.B.C): Total De Gaud To:Total absorpilcn area: Pipe matedoi: Ft Ft. 800 SQ. Ft D 3034/ F-810 Driller. Date Drilled: Static Water level: Installer. A+ HOME SERVICES Dote installed: 9/12/2000 Et. Yeld: Pump Set At: Casing Height Above Ground: �/ TANK GPM Ft. Ft SEPARATION DISTANCES ■Septic 11 Holding DS.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer. ANCHORAGE TANK Capacity in gallons: 1250 From Tank Field Station Tank Sewer lines Well 100'+ 100'+ — — 25'+ Material: STEEL Number of compartments: 2 Surface 100'+ 100'+ - - - LIFT STATION Water LotSize 5'+ 10' — — — in gallon.: Manufacturer. Line 'Pump on' loyal at: Pump off at High water alarm at: Foundation 5'+ 10'+ — — — Make el: Electrical Inspections performed by: DrainPump Drain NONE KNOWN BENCH MARK Remarks: EXISTING SEPTIC TANK COMPLETELY ABANDONED. Locotian and Description: *BOTTOM OF TH "SHOT" ® 6' BELOW BOTTOM OF TRENCHES. BOTTOM OF SIDING — NE CORNER OF HOUSE. Assumed Elevation: 100.00 Ft ENGINEER'S SEAL o p06��0 I 4 o •,. Inspections performed by: AWWC, INC. Dates: 1st 9/12/2000 2nd 9/12/2000 3rd 9/23/2000 •• d�00 re A. Garness. r s° -7ss3 ap .•` e o Department of Health and Human Servi es approval '' Sao Reviewed by: Date: d �� OP1 4 • ��4"°'Professloilo, and approved oODO�`�DOO 72-013 (Rev. 9/91) MOA 25el PERMIT NUMBER: SW000316 I ( I AS -BUILT DRAWING /FLOW SPLfifER� I S / DBL / ` FCO / EXISTING FOUR BEDROOM HOUSE A I 0 100' WELL RADIUS I I I NEW IDRAINFIELDS PARCEL ID NUMBER: 011-072-43 C04 MT2 A ' ST1 67.8 48.8 ST2 74.1 _THjj1 C05 76.2 48.9 DBL2 76.9 49.5 FD 77.4 JC03 FS 87.7 CO2 C01 F 69.1 'T2 FLOW DNERTER w w CO2 88.5 (FD) MT2 115.1 ri 01 CO3 I 94.3 C04 101.6 60.8 C05 L NEW 12510 96.8 SUMP 117.7 GALLON SEPTIC TANK EXISTING — DRAINFIELD TO BE USED AS A RESERVE SITE 10' UTILITY EASEMENT ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 213 • ANCHORAGE, AK 99504 • PHONE (907)337-6179 • FAX (907)538324 PREPARED FOR: PHONE NUMBER: HERMAN RAMIREZ (907) 243-0728 LEGAL DESCRIPTION: ROLLING HILLS ESTATES; LOT 2, BLOCK D TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE (-�S PTIC ARE�D 9/27/2000 DRAWN BY: K.D.W. 1" = 30' 2OF3 wiffYliffigivmn. L+7953 ' .... eoA A B ST1 67.8 48.8 ST2 74.1 48.0 DBL1 76.2 48.9 DBL2 76.9 49.5 FD 77.4 50.1 FS 87.7 54.1 C01 85.3 69.1 MT1 103.6 73.6 CO2 88.5 55.3 MT2 115.1 77.8 CO3 119.7 94.3 C04 101.6 60.8 C05 129.3 96.8 SUMP 117.7 117.6 wiffYliffigivmn. L+7953 ' .... eoA j PERMIT NUMBER: AS -BUILT DRAWING POCEL ID NUMBER: - SW000316 011-072-43 TOF OF TANK - AT INI.FT - 91.96 INwu of ftNG- Af IWFf - 90.99 NORTH TRENCH FINAL GK'A7F - 98.9 5il 5f2 n II NSW 1250 GALLON 5FPTIC fAW — f0F OF TANK AT01.Wf-91.91 %wVRr a P" AT OUf1.Ff - 90.66 GpAV7F - 98.11 I'll w `FINN. Qv Aa - 99.8 ORIGINAL 97,22 O96BB 97.0 I / 99.0 -97.22 - 96.88 - 99.03 I I/ INVFRFor FIFF - 90.05 60(TOMofTRFNCNJ `lmkrCrFIFF 60(TOM of aKu BOTTOM OF TH = 60.0 -90.06 - 66.0 ( AVG.) - 86.0 ( AVG.) DATE: 9/27/20( A'llk DRAWN BY: ALASKA AVATER & WASTEWATER K.D.W. =• - - -_ CONSULTANTS, INC.SCALE: N.T.S. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: HERMAN RAMIREZ (907) 243-0726 1 3 OF 3 LEGAL DESCRIPTION: ROLLING HILLS ESTATES SUBDIVISION; LOT 2, BLOCK D TYPE OF WORK: AS -BUILT PROFILE OF SEPTIC SYSTEM UPGRADE reA. ess;' C 7953 pyo f es sio�°oo �OO�Do�o 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-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 22, 2000 Expiration Date: Aug 22, 2001 Permit Number: SW000316 Parcel ID: 011-072-43 Legal Description: ROLLING HILLS ESTATES BLK D LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: 007415 SAND LAKE RD Owner Name: Herman Ramirez Lot Size: 27500 SQ. FT. Owner Address: 7415 Sand Lake Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99502 - This permit is for the construction of: Z Disposal Field C Septic Tank Holding Tank ❑ Privy Private Well 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 day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: 9 — 2 2 —QQ ALASKA WATER F& WASTEWATER CONSULTANTS, INC. - :' August 4, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well and Septic Design for Lot 2, Block D, Rolling Hills Subdivision To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The current septic system is in a state of failure and needs to be replaced. A test hole was excavated on the property. The proposed septic system will be designed around the 30 foot radii of test hole #1. We are proposing that a 1250 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached are logs which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a SM/GM hardpan material to a depth of 7 feet in TH#1 followed by an SP -SM material to a depth of 17 feet (bottom of test holes). No groundwater was encountered during the excavation of the test holes. A percolation test for TH#1 was performed between the depth of 7.5 feet and 8.0 feet which had a percolation rate of 7.9 minute/inch. It is our opinion that due to the overall appearance of the soils, a application rate of 0.8 gallons/day/ft should be used. 2. TRENCH DESIGN: a. Percolation Rate: 7.9 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 750 ft2 f. Total Depth: 11.0 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.5 i. Minimum Length: 76 feet long (2 x 38 ft) j Effective absorption area = 760 ft2 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwa.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The subject lot is generally flat. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. d .E., M.S. NOTE: Attached is a site plan drawing a design drawing„ 2 soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debar Road, Suite 2B * Anchorage, AK 99504 Ph: (907)337-6179 * Fax: (907)338-3246 * Website: akwwc.com EVENSON SUB. LOT 3, BLOCK 1 h EVENSON SUB. LOT 2B, BLOCK 1 I I I NSON SUB. 2A, BLOCK 1 0 LOT 1. BLOCK 1 IN I I I I I I I I I J ROLLING HILLS ESTATES LOT 4, BLOCK A W-73 AVE. _____ — / -� ROLLING HILLS ESTATES / I LOT 1�1 BLOCK 0 I PROPOSED SEPTIC SYSTEM --1 ROLLING HILLS ESTATES LOT 5, BLOCK A i / 100' WELL RADIUS 1 ROLLING HILLS ESTATES LOT 3, BLOCK D , SEEPTTIIC ` ----J L----------------. ---- F---------------- C ARS SEPTIC SYSTEM.-- 'ROLLING HILLS ESTATES LOT 78, BLOCK G I j ROLOT G17. HILBLOCKLS EST I7,IIBLOCKT OSS \7 loo, WELL RADIUS 7 I %'I � \ �o/r? '`�•,� I 177 % I 1t�A� DRAWN BY: 1]t y ! 0, N ALASKA WATER & WASTEWATER 1.w.M. SCALE: CONSULTANTS, INC. 6901 DE9ARR ROAD SUITE 29 •ANCHORAGE AK 99604 •PHONE (9073337-60 • FAX 907 93246 1 " = 100, PREPARED FOR PHONE NUMBER: PAGE NUMBER: HERMAN RAMIREZ 243-0728 1 OF 2 y, J f y A. ESE: LEGAL DESCRIPTION: E-7953 ROLLING HILLS ESTATES SUBDIVISION; LOT 2, BLOCK D NPE OF WORK: `Jkj�aed Pr°fesaiGn -� SITE PLAN ��,�1t».,: I � PROPOSED NEW DRAINFIELDS. --- - _ EXCIVATE TWO (2) TRENCHES THAT ARE 11.0 FEET DEEP (MAXIMUM), -,,BY 5 FEET WIDE, BY 30 FEET LONG EACH. \ ADD 4 FEET OF CLEAN MASHED / I SEWER 0100' DRAINROCK. WELL RADIOS \ / / I INSTALL DOUBLE CLEAd1O PROPOSED NEW 1250 � GALLON SEPTIC TANK. Wu EXISTING 4 BEDROOM HOUSE i- INSTALL FLOW SPLITTER � I \ / \ EXISTINGSATRENCH TO BE RESERVE USED SITE. A XISTING COMPLEfEL BESEPTIC ABANDONED. — INSTALL FLOW DIVERTER ---------------� 1DD' WELLM lL PTIC ARE i I I I I I I _J I � I ALASKA WATER &WASTEWATER CONSULTANTS, INC -� Ran, n9 R 9Oeu. SIRIE 19 • MCHOI E M 89504 • PHONE (807)557-81]8 FA% (80])3]8-3115 BY: J.W.M. V, = 40' 'PREPARED FOR: PHONE NUMBER: rnu¢ rvumocn: HERMAN RAMIREZ (907) 243-0728 2 OF 2 LEGAL DESCRIPTION: I ROLLING HILLS ESTATES SUBDIVISION; LOT 2, BLOCK D DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE I I I I 7 ..... ....... e fr A. ess•- —7953 ALASKA WATER & WASTEWATER CONSULTANTS, INC. I SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: ROLLING HILLS SUBDIVISION; LOT 2, BLOCK D PERFORMED FOR: HERMAN RAMIREZ DATE PERFORMED: 7/28/2000 DEPTH ORGANICS (feet) TEST HOLE #1 1 (PAGE 1 OF 2) 7 9 10 11 12 13 14 15 16 17 18 19 COMMENTS: SP—SM DEPTH TO DATE GROUNDWATER DRY 7/28/00 mm DATE READING CLOCK TIME NET TIME (MINUTES) SOIL CLASSIFICATIONS 7/31/00 2 HOLE WAS PRESOAKED FOR 4 HOURS PRIOR TO TEST. 1 7:29 6" — 2 7:59 GW 1 7/8" 4 1/8" ORG 3 8:00 6" — 4 8:30 30 MIN. 2 1/8" 3 7/8" 5 8:31 DENSELY PACKED 6" GM 6 CL 4 2 3/16" 3 13/16" SM/GM HARDPAN GC OL SW MH 5 °a 8°®a SP CH SM .' OH 6 Sc 7 9 10 11 12 13 14 15 16 17 18 19 COMMENTS: SP—SM DEPTH TO DATE GROUNDWATER DRY 7/28/00 mm DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/31/00 PERK HOLE WAS PRESOAKED FOR 4 HOURS PRIOR TO TEST. 1 7:29 6" — 2 7:59 30 MIN. 1 7/8" 4 1/8" 3 8:00 6" — 4 8:30 30 MIN. 2 1/8" 3 7/8" 5 8:31 6" — 6 9:01 30 MIN. 2 3/16" 3 13/16" PERCOLATION RATE 7.9 TEST RUN BETWEEN 7.5 PERFORMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORM I ACCORDANCE WITH ALL DATE. DATE: 6D PERC. HOLE DIA. 6" (INCHES) I 8.0 FT. , CERTIFY THAT I GUIDELINES IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. fi90PHONEA(90 )RR 0337 S61 9 UITE 26 FAX (907) 39 32469504 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: ROLLING HILLS SUBDIVISION; LOT 2, BLOCK D PERFORMED FOR: HERMAN RAMIREZ DATE PERFORMED: 7/28/2000 DEPT�NI TEST HOLE #1 1 (feet (PAGE 2 OF 2) 2 3 4 5- 6- 7- 8- 9— s7 89 Ld Q 10 a LJ 11 Lil 12- 13- 14- 15- 16- 17- 18- 19 213141516171819 20 COMMENTS: SOIL CLASSIFICATIONS DATE I SEE PAGE 1 OF 2 1 SEE PAGE 1 OF 2 FOR TEST HOLE LOCATION. DATE READING CLOCK TIME I NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/31/00 PERK HOLE WAS PRESOAKED FOR 4 HOURS PRIOR TO TEST. 1 7:29 6" — 2 7:59 30 MIN. 6" 0" 3 B:00 6" — 4 8:30 30 MIN. 6" 0" 5 B:31 6" — 6 9:01 30 MIN. 6" 0" PERCOLATION RATE <120 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN 3.5 FT. AND 1_FT. PERFORMED BY ALASKA WATER & WASTEWATER I, THIS WAS PERFORMEQ Iq ACCORDANCE WITH ALL DATE. DATE: 18 ba IDa CERTIFY THAT IN EFFECT ON THIS 0, GREM (ER ANCHORAGE AREA BOWUGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMEYEe 1��/cC� [� ��e�M/)AILING ADDRESS / /�`� (�'C�� PHONE �77- LOCATION ��«nJ f7� LEGAL DESCRIPTION L4�t � "t IK f�oi I H SEPTIC TANK: DISTANCE %�/) 7: ;_. NUMBER OF FROM WELL L LSL_ MANUFACTURER / MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH / LIQUID DEPTH LIQUID CAPACITY/25�QALLONS. TILE DRAIN FIELD: TOTAL 7O (NEAREST LOT LINE -5-0/ OF LINES NGTH�S I DISTANCE FROM WELL [_FOUNDATION NUMBER OF LINES___L_ — DISTANCE BETWEEN LINES& TRENCjH' WIDTH 3L N. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_IN. ABOVE TILE IN. WELL: TYPE- CONSTRUCTION l DEPTH h DISTANCE FROM: BUILFOUNDSEPTICNE 4 REST NEAREST DATION�oING/, LOT LINE L— SEWER LINE 0)/ , TANK/ / 0, SYSTEMS CESSPOOL _L�—, OTHER SOURCES APPROVED DISAPPROVED REMARKS - R DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: / DATEVAI(77APPROVED AIV ' ^ 0 -1KJ P -J "1 ` DEPHRTMENT HEHLTH $107ECTION 825 STREET HNCHORHGE/ HK Ts,� / �27951j ������ ��� ���_��I �� ����� ����� � � ,��/� PERNTT NO. ApPLICHNT 1570 1/2 MEDFRH 2�7�ld�� | LOCHTION SHND LHKE ROAD LEGAL L2 BD ROLLING HILLS EST LOT SIZE` 27500 SQUHRE FEET + { TYPE OF SOIL HBSORBTION SYSTEM IS- TRENCH MHXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SQ FT/BR)=: 195 � THE REQUIRED SIZE OF THE SOIL HBS�RPTION SYSTEM IS� --- = .4 ��F-­o %P E:7 L_ ������ � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF TH� GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE (IN FEET). HINTENHNCE I - :IC E r, I F- :N'r' HRGE THE SOIL EM HND/OR YOU MHY BE SUBJECT TO PROSETIr�[ON ^' '' '~'E'' ^~ ~~E~ TI 1E ..EP`8"Fl 1 1 ~~. ~ FEE�� ^'F '. ~ ..S~ ^^ ~Y -+E.. ^~~~E~ +11 E i.. `_+11 ~S 4-.~ F__ T. ' BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPHRTl��NT WlLL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL. HND HNY ON�SITE SEWFGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WELL QR 200 FEET FOR H PUBLIC WELL WELL LOGS HRE REQUIRED AND MUST BE RETURNED TO THE DEpHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. SPECIFICHTIONS AND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TQ INSURE PROPER INSTA LLHTION ��1 "T" Fz� L_ I C-- ��V-'e C­*fi rA F �� If— F- 9-0 k H I F'. I CERTIFY Tl HT 1� I HM FHMlLIHR WITH THE RE0iIREMENTS FOR ON-SITE SEWERS HND WELLS AS SET FORTH BY THE OF ANCHORAGE. 2 I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THAT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN 4 BEDROOMS SIGN�D� �~_����~ . ~ � Hf -PI ICHNT HERMHN RHMIREZ ~���� _ 6,- t 9 _ 10 0 v (�1 rCA� S- SJ - 000 - - - -- 11 SatiV14 W 14 - l.`j. Was ground water encountered? A` If vcs , . dt wiia t der)U12 Reading Date Gross lime Net Time- Dep, ment of Health and EnOronmenta �rotect4on Cos �,� ► �" / Anchorage, Alaska 99507 r: self's 1,o(; I'f:iu)),A P10N TEIST_ Performed for 14C-1eM1+A) 2fiM tr?e Z Mtn Perform 1 �f-30-77 Le1J,rl Uc-;cription t -o4 2.�:..3Lot:K_ _t2cYL�iN.�Zt}(c This form reports. Soils ____ Percolation test ✓_ _._� .^_ log ? _ - --- Depth Feet 6,- t 9 _ 10 0 v (�1 rCA� S- SJ - 000 - - - -- 11 SatiV14 W 14 - l.`j. Was ground water encountered? A` If vcs , . dt wiia t der)U12 Reading Date Gross lime Net Time- Uepti) to water Nut drop !' i h ► b w\ P rr6-!-ltlon rate P ,7 16 4117111inute, Proposed iris LaIIat 6' Secnage Pit Urairn f icld Ilci)th of Inlet Ucpth. to bottom cil' i)i t or trench Ferfortned By: ��n5 �dl�{%`s - Certified By: !`!_-4�`t .�.w— JaLe. po e x (2� c::)�(Z Municipality of Anchorage • Development Services Department ��'�'�°_ Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-66501 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING n Parcel I.D. 011-072-43 COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description ROLLING HILLS ESTATES S/D; BLOCK D, LOT 2 ❑ Individual Holding tank ❑ Location (site address) 7415 SAND LAKE ROAD * ANCHORAGE, AK * 99502 Current Property owner(s) Mailing address Lending agency Mailing address KEITH BEAUGEZ Day phone 7415 SAND LAKE ROAD * ANCHORAGE, AK * 99502 Day phone 947-0507 Real Estate Agent DAR WALDEN W/ KELLER WILLIAMS Day phone 865-6404 Mailing address 101 W. BENSON BLVD #503 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 4 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners, Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners, Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t 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. t 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. in conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for --t— bedrooms. Disapproved. Phone 337-6179 Date 3a 117. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other OF ON-SITE WATER AND WASTEWATER PROGRAM By: Q'e f°l' Original Certificate Date: f , (Rev. 11105) Municipality of Anchorage a • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ROLLING HILLS ESTATES S/D; BLOCK D, LOT 2 Parcel ID: 011-072-43 A. WELL DATA Well type PRIVATE *PER GEG INSPECTION. **PER AAROW PUMP AND WELL INSPECTION. SEE ATTACHED. If A, B, or C provide PWSID# N A Date completed PRE 12/29/77 Sanitary seal (Y/N) YES Total depth *89+ ft. Cased to **40+ ft. FROM WELL LOG Date of test Static water level pJ ft. Well production g.p•m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate N fl mg./L. Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION Arsenic: g' 55ug./L. Date of sample: 7/13/2012 B. SEPTIC/HOLDING TANK DATA 7/13/2012 3.96+ — 9 -p.m - Collected by: GEG, Ltd. Tank Type/Material SEPTIC/STEEL Date installed 9/12/2000 Tank size 1250 gal. Number of Compartments E Cleanouts (YIN) YES Foundation cleanout (Y/N) KYLES Depression over tank (Y/N)ND High water alarm (Y/N) N/A Date of pumping f �' Pumper AA c, YO L)n c, d W, v2 1 "L C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 9/12/2000 Soil rating .p.d./ r ft2/bdrm) 0_8 System type DUAL TRENCH 139' 8 41') 5 ft. Gravel below I 4.05 ft. Length aO TOTAL ft. Width pipe Total depth *11.5/11.7 ft. Eff. absorption area840 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **7/13/2012 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test E in. Water added 1760 gal. New depth 39 in. Elapsed Time: 615 min. Final fluid depth 27 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — NOTE: 1980 TRENCH CONNECTED AS RESERVE SITE. AT INSPECTION, 1980 TRENCH WAS NOT IN USE AND DRY. SEE MOA DOCUMENTATION FOR 1980 TRENCH INFO. **TESTED SOUTH TRENCH ONLY. NORTH TRENCH HAD 28" OF LIQUID IN IT UPON INSPECTION. D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' level High water alarm level at in. Datum 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 N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date :7 130)12. COSA Fee $ q`f o . w Waiver Fee $ _ Date of Payment / / //;Z Date of Payment Receipt Number ��L< Receipt Number (Rev. 11/05) AAROW PUMP & WEU SERVICE, LLC P.O. Box 110496 L� Anchorage, AK 99511 Office: (907) 346-9355 - Fax (907) 333-8976 Eagle River: (907) 622-9335 CUSTOMER MWHUE Ob L-L,r r No. 9481 NIL,�S X31, V L.2 JOB SITE J L J INVOICE DATE WELL DEPT (�J• -WL CHLORINATED PUMP DEPT] SALESPERSON UANP Y- ..: DESCRIPTIONS - - PRICE AMOUNT ✓e % ccs 3e,2 e!: f;4 cj� �'2 /7 l � c yo �- LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDERED BY DATE COMP. TOTAL LABOR r PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. _ - © §! !!; --------------------------------------------------------------- ----------------------------------- �aw \ \ \\j 2� �/! , zZ§.! �)\((§, � }\( !: y /§/ ! >,:z !,: . \, /( Of =�,K !;! E//=! !E; — � � � ----------------- — — — — � , 6, ..:e-.; §rrlri)E ; §§//;§,0 ! --—f—=----- z� f I � Y a GVOH 3AIV7 OW Municipality of Anchorage • Development Services Department Building Safety Division �. On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 t Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Q Parcell.D. DlI' f7"!dCOSA# D8o3�� 1. GENERAL INFORMATION Expiration Date: Z Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROLLING HILLS ESTATES' BLOCK D LOT 2 7415 SAND LAKE ROAD 'ANCHORAGE AK RICHARD & SHELLEY EBENAL Day phone 458-6465 7415 SAND LAKE ROAD 'ANCHORAGE AK Day phone BELINDA DAMS W/ PRUDENTIAL Day phone 727-0431 3801 CENTERPOINT DRNE 11200 *ANCHORAGE AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ 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 Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 watersupply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verily that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site watersupply 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 C Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date q'9 / De Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily identifiable features. The operational #to of aff wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system w711 continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the ownerlisted above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for q bedrooms. Disapproved. ttt��;i.ur•,. Conditional approval for bedrooms, with the fllo\y1�i�Aofi?yl� ���• AQP bo •: ON-SITE •: m%RPATrD Akin. WASTEWATER Attachments: Fi 4TSE`n t�1111 COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Reort Nitrate Advisory Other By: WXZZ Original Certificate Date: lilw. 11M1 \ Municipality of Anchorage (• �\ Development Services Department Building Safety Division 4; On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ROLLING HILLS; BLOCK D, LOT 2 Parcel 0:611-072--40; A. WELL DATA *BASED UPON NEIGHBORING WELLS QFe a-r':rc"W %A. -LL- wG! Well type PRNATE If A. B, or C provide PWSID# N/A Well Log (Y/N) NO PRIOR TO Date completed 12/29/77 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 88+ ft. Cased to •40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test G 8/21 /08 LO Static water level 0 11E�� ft. 86 ft. N Well production 9.p-m. 5.07 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate NO mg./L. Other bacteria colonies/100 ml. Arsenic:=_7ug./L Date of sample: 8/21/08 Collected by: GEC Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/ STEEL Date Installed 9/12/2000 Tank size 1250 gal Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 8/20/08 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA 'BELOW ExisTING GRADE OMT'S ON THE YEAR 2000 SYSTEM 4/2/1980 150 TRENCH Date installed 9/12/2000 Soil rating (g.p.d./ft'o /bd 0_8 System type DUAL TRENCH 60 2.5 5 Length 39/41 ft. Width 5 ft. Gravel below pipe 4.05 ft, ST/NT 600 Total depth'11.87-11.91ft. Eff. absorption area 800 f? Monitoring tube YES Depression over field NO Date of adequacy test "8/22/08 Results (Pass/Fail) PASS I I IFor 4 bedrooms ST/NT ST/NT ;; ST/NT Fluid depth in absorption field before test L in. Water added ±!2L _,Cgal. New depth 7 27 in. ST/NT Elapsed Time: 120 min. Final fluid depthl5 24 in. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **TESTED THE 2000 TRENCHES BOTH OF THE 2000 TRENCHES WERE PRE—SOAKED WITH A COMBINED 1000 GALLONS OF WATER ON 8/21/08 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" IeveHigh water alarm level at in. Cycles tested Meets alarm & circuit requirements) SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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 COSA guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date qb/oo COSA Fee S bb Date of Payment g d b Receipt Number. 444-Q1O0 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage .. .° • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080312 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block D, Lot 2 of Rolling Hills Estates Subdivision. This inspection revealed an arsenic concentration of 7.87 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ret# 1084434001 Client Name Garness Engineering Group, Ltd. Project Name/# Rolling I fills Estates BlkD,L2 Client Sample ID Rolling I [ills Estates DIkD,L2 Afatri= Drinking Water PH'SID 0 Printed Date/Time 09/052008 14:29 Collected Datelrime 08212008 13:45 Received Datelrime 08212008 15:10 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Malysis Parameter Results PQL Units Method Container ID Limits Date Date ]nit Metals by ICY/MS Arsenic 7.87 5.00 Waters Department Total NitraictNitritc-N ND 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 ug/L EP200.8 C (<10) 0827/08 0828/08 hill mg/L SM204500NO3-F D (<10) 09/03/08 JDZ col/100mL SM209222B A (<200) COVl0pmL SM209222D A (<I) coVl00mL SN1209222B A (<I) 0821/08 KAR 0821/08 KAR 0821/08 KAR SAND LAKE ROAD u 0 NORM 125.CO' N P I K Efl v 8r� N - _ 40' 8=. SEWM UNE_ _ - - - - o i e n A �s v. �, Pe QnA�Pr rA o Pysosos 5058P n� a - — 4_------ SOUTH Municipality of Anchorage Development Services Department .. Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw SL' P.O. Box 196650 Anchorage, AK 99519.6650 www.d.anchorage.akus (907)343-7904 CERTIFICATE OF HEALTH :AUTHORITY APPROVAL FOR A`SINGLE FAMILY DWELLING_isS✓� Parcel I.D. 011-072-43 HAA# HA000495 " 1. GENERAL INFORMATION' Expiration Date: 8 - Xq - D 1 Complete legal description ROLLING HILLS ESTATES: LOT 2, BLOCK D Location (site address or directions) 7415 SANDLAKE ROAD Current Property owner(s) HERMAN RAMIREZ Day phone (907) 243-0728 Mailing address 7415 SANDLAKE ROAD ANCHORAGE, AK. 99502 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for plckup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site In Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $250.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As cortided by my seal affixed hereto and as of the validation data shown below, l verify that my lnvestigatlon, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the MunldpalityofAnchorage riles and from mylnvestigadon and Inspection, the on-site water supply and/or wastewater disposal system ls(ars) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA VIATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily klontifiable features. 7779 operatlonat fife of all wells and septic systems depend on the local soils condition, groundwater lowls that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfadwy lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Ina can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not aulhorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE l -*f Approved for 4 bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Manitenance Agreements Supplemental Engineers Reort Other � 'y ,Garness': , 7953 V�•.• , O • ' ON-SITE • •' WATER AND .; WASTEWATER PROGRAM By: /z�� Original Certificate Date: �' 9 - O trsw.122ot Municipality of Anchorage o (' Development Services Department Building Safety Division ' Onsite Water & Wastewater Program 4700 South Bragew SL P.O. Box 196650 Anchorage, AK 99519 -MO www.cl.anchorage.akus (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ROLLING HILLS ESTATES: LOT 2, BLOCK D Parcel ID: 011-072-43 A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (YM) NO Date completed EM2 ro +2L2907Sanitary seal (YM) YES Wires properly protected (YM) YES Total depth 86+ fL Cased to 40+ fL Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 9/22/00 Static water level ft. 86 fL Well production g.p.m. 5.4 9— p.m-WATER SAMPL RESULTS: Califonn colonies/100 ml. Nitrate • !i:mgJL Other bacteria-4Loolonies/100 mi. Date of sample: 5/23/01 ColWed by: AWWC, INC. B. SEPTIC/HOLDING TANK DATA TankType/Material STEEL Date Installed 9/12/00 Tank size '1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA ee ow FINAL cRAOE Date installed 9/12/00 Soil rating 0.p.d r fe/bdnn) 0_8 System type DUAL TRENCH Length 39/41 fL Width 5 R Gravel below pipe 4.05 fL Total depth •t2•r >>•s fL Eff. absorption area 800 fe Monitoring tube YES Depression over field NO LElapsed quacy test NEW Results (Pass/Fail) Fo ed ora n absorption field before test_ in. Water _gal.' New depth _in. e: _min. as epth _ in. Absorptiontate >_g.p.d. iaUon treatment (past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at n. E. SEPARATION DISTANCES High water alar level at fn. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot 1000+ Absorption field on lot 1000+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehlcle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ 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 JEFFREY A. GARNESS Date HAA Fee $ Date of Payment Receipt Number (Rev.12M) Waiver Fee $ Date of Payment Receipt Number_ 141Y-25-01 13:27 FROW CT&E Environmental Services Inc. CP&E ReLN 1012840001 Client Name AK Water & Wastewater Consultants Inc. Project NameX 7415 Sand Lake Client Sample 1D 7415 Sand Lake Matrix Drinking Water Ordered By PWSID 0 Sande Remarks: T-089 P.02/03 F-540 Client POa Printed Datealme Collected DateMme Received Date/Pime Technical Director Released By✓yy 05/25/2001 12:27 05/23/2001 15:15 05/23/2001 16:04 Stephen C.Ede /� 15/L/ . Allowable Ptep Analysis Panmeter Results PQL Units Metbod Limits Date Date !nit Waters Department Nitrato•N 0.500 U 0.500 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 0 col/100mL SMIS92220 (<10) 0523/01 SCL 0523/01 KAP \4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D.# 011-072-43 HAA# �16(_-Y�C't- G15 1. GENERAL INFORMATION Complete legal description ROLUNG HILLS ESTATES7 LOT 2 BLOCK D Location (site address or directions) 7415 ROLLING HILLS ESTATES ANCHORAGE AK 99502 Property owner. Mailing address Lending agency Mailing address Agent— Address— Unless gentAddress Day phone (907) 243-0728 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MCA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,500.00 at, or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal Ind State codes, ordinances, and regulations in effect on the date of this inspection. A , -,r, Name of Firm Phone _L907 337-6179_ Engineer's Signaturery i" Date o 7/00 _ In conducting this evaluation, AWWC, Inc. ai r, QEncountered d to'p6 ' a thorough, conscientious engineering analysis of the system in accordance with ADE C and M A HGuidelines &Regulations. The reported results described the performance of the system under the conditions at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend ' on the local soils condition, ground water levels that may fluctuate during the year, and the water Qoopp , usage of the family being served by the system. These conditions are outside the control of o �4 the evaluator of the system. Satisfactory test results do not guarantee future performance o `� �� • _,r",�,1 of the system, nor do they guarantee that there are no hidden defects or encroachments. op,. .7 AWWC, Inc, can therefore not provide any warranty for future estimate of how long the p,'C j : ;Q _T.H -Y system will continue to meet the operational requirements of the ADEC or MCA DHHS. The content of this report is for the sole benefit of the owner listed above. Any Q reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. O _P/* .Jeffrey A. Garness:• 6. DHHS SIGNATURE O 9 7953 Approved ,•' c` Approved for 1' bedrooms�ooe u � ��_�ofes sion o Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments A Date / O —/ 0 -0 2 R The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1191) Back MOA #21 Computer Version Municipality of Anchorage OCT 0 5 2000 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division LIN OF AN HO 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) VNTAL SERVICES Health Authority Approval Checklist Legal Description: ROLLING HILLS ESTATES; LOT 2, BLOCK D Parcell.D.: 011-072-43 A. WELL DATA Well Type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) NO Date completed PRIOR TO 12/29/77 Total depth 86'+ Cased to 40'+ Casing height (above ground) / Sanitary seal (Y/N) YES Wires properly protected (Y/N) Date of test Static water level Well production FROM WELL LOG AT INSPECTION 9/22/2000 WATER SAMPLE RESULTS: Coliform w Nitrate M' a N -v Other bacteria Date of sample: 9/26/2000 Collected by: A.W.W.C., INC. B. SEPTIC/HOLDING TANK DATA Date installed 9/12/2000 Tank size 1250 Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) Date of Pumping NEW Pumper *BELOW FINAL GRADE C. ABSORPTION FIELD DATA Date installed 9/12/2000 Soil rating (g.p.d./f:2 or ft2/bdrm) 0.8 System type DUAL TRENCH Length 39'/41' Width 5 Gravel thickness below pipe 4.05' Total depth *12.1/11.8 Effective absorption area 800 SO FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail) Foredrooi Fluid depth in absorption field before test (in.); Imme ii r gal. water added (in.): Fluid depth (past 12 months) (Y/N) 72-026 (Rev. 3/96)` Computer Version Absorption rate = If yes, give date D, LIFT STATION Date installed Manhole/Access High water alarm level at* "Pump off' level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+___ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 10'+ Water main/service line_ Surface water 100'+ Driveway, parking/vehicle storage area _10'+ ___ Curtain drain NOkE KNOWN Wells on adjacent lots 100', F. ENGINEER'S I certify that I I of Municipal r' with MOA H1 Signature_ Engineer's HAA Fee S U' " Inspections and review ams are in conformance +s date. A. GARNESS g Date of Payment Receipt Number 72-026 (Rev. 3/96)' Computer Version Waiver Fee Date of Payment Receipt Number WKV� MJF E-7953 ,•',c°O 10-02-00 18:43 FROM -CTE ENVIRONMENTAL 5615301 T-891 P.02/03 F-581 ME Environmental Services Inc. AZIAL. Laboratory Division rrr®rJrrrrrrr®rrr®®rr�rry®®r�rrrr®rrr�rrrr.�rrrr Laboratory Analysis Report CT&E Rel:# 1005773001 Client PO# Client Name AK Water & Wastewater Consultants Inc. Printed Date/Time 10/02/2000 Project Namem Rolling Hills Lot 2 Blk D 17:51 Collected Date/Time 09/25/2000 20:00 Client Sample ID Rolling Hills Lot 2 Blk D Received Date/Time 09/26/2000 8:50 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By YWS1D 0 Released B Sample Remarks: Parameter Results PQL UnitsMethod Allowable 'r pte Analysis Limits DaDate Init Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 10 max 09/26/00 SCL Microbiology Laboratory Total Coliform 0 col/lOOmL SM18 9222B 09/26/00 IDT 200 W. Potter Drive, Anchorage, AK 99518.1605 —Tel: 1907) 562-2343 Fax: (907) 561-5301 3180 Pager Road, Fairbanks,AK 99709.5471 —Tel: (907) 474.8656 Fax: (907) 474.9685