The URL can be used to link to this page

Home My WebLink AboutBUBBLING BROOK LT 4 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181163 PID Number:015-492-16 Dwelling: ❑■ Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ■❑ Upgrade Name: Hans Hager ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 6350 Rockridge Dr. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Bubbling Brook 4 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ TANK II Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100'+ Anchorage Tank 1000 Gal. Material Number of compartments Lot Line 5'+ Steel ` , 2 Foundation 6.2' NA -LIFT �N- Pow. V twf1 4- Manufacturer Capacity Curtain Drain Orenco Equipment 80* Gal. Remarks * Pump on level at Pump off level at High water alarm at volume at high water alarm elevation 12 in. 36 in. 42 in. Pump make and model Electrical Inspections performed by Orenco PF 200511 ,44 OA PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield Northern Excavation Drainfield Co/MTD3034 Inspector Crewdson Engineering BENCH MARK (Assumed elevation) 100 ft Inspection s, Location and description dates: 1 7-31-18 2^°8-3-18 3rd 49' Bottom of siding at location "A" on record drawing COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp EOFAL ‘1 Conditional Approval: Date "Ay..• • IA/ //I�� .me. Cdson11527 �j -- — — ' � � Approved — Date g(d « N,g PRO . .`�sg 4� =v Inspection Report_9-1-12.doc A CL.( 1 161 d 7 Pt pons el Q . LOT 4 4 `� well y0 ABANDONED BED �__� PLAN1-..,___. _ : . i v a . SCALE: 1"-30' tiq, IC I v.. a' SHED i = + 700, I R , \ j C/1i SWING TIES tv • ++ Opp Of FC:A 5.6',B 39.0' • F oti , FT S1:A 8.2',B 40.0' ::' ' \ S2:A 13.5',8 42.2' .......•11.1::::" yo / DC:A 15.2',8 42.9' 3 BR SFH 2 110: PV:A 18.1',B 44.2' • PV• °S2 . FC S1 A BENCH MARK) • t PTIG TANK. 700 • . 700 GRAVEL. ` \�!! *- 111k,,.., (E)DRAINFIELD— DRIVEWAY . . X90/ 1'ROCK /us \ \�S RETAINING WALL /(TYP) REENHOUS\ ) II \ / MT CO /// :L,7> • — — — --7: — = . UTILITY EASEMENT — — — — 7 N 89°59'55"E 265.00 BENCH MARK NOTE ASSUMED ELEV 100' THE SEPTIC TANK IS OUTSIDE BOTTOM OF SIDING AT"A" THE FOUNDATION STRUCTURAL ELEV SOIL PRISM EG 99.3' ELEV FG 99.6' EG 99.2' FC FG 99.5' - - S1 S2 ELEV EG 99.0' FG 99.3' -- 5.6' -- DC LEGEND FG-finish grade 1 (E) existing INV-invert 1 \SEPTIC TANK PUMP VAULT BR-BEDROOM MT-monitor tube STEEL AT-1000 2' DIA. CPEP CO-cleanout PV-pump vault ELEV INSULATED DC-double cleanout S#-septic tank cleanout EG-existing ground SFH-single family home TOT 90.94' PROFILE ELEV-elevation TOT-top of tank INLET INV 90.36' OUTLET INV 90.19' SCALE: 1"=10' Crewdson Engineering, LLC Bubbling Brook, Lot 4 P •of -• Septic Tank Upgrade 4.4. ..ty • '�� Record Drawing ..1'• 114'1 • •aures A.Crewdson • Plan & Profile Views ' 11• C11527 p+••.,- Civil&Environmental Engineering Jl •p' (9 4 P' Prepared for: Hans Hager Date: 8-10-18 .4,•17•F•• .,pN'c�� PO Box 671389 Chugiak AK 99567 • cellc.l@outlook.com Permit: OSP181163T4 ON THIS DOCUMENT IS THE PROPER,OF _ Page: 2 of 2 Cell/Text:907-280-9493 • Fax:907-688-2295 Al I.INFENGINEE IN R CONSTRUCTION PURPOS ES WITHOUT WRITTEN PERMISSION FROM'CREWOSON ENGINEERING LLC�OF� ALLC #112279 to Att!, MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program ��- "- S PO Box 196650 4700 Elmore Road ` �. ,a� '�` ; Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 3 `" httpa/www.muni.org/onsite , f I)upa rtin 'nI 4rycNURPG' On-Site Wastewater Disposal System Permit Permit Number: OSP181163 Effective Date: 7/10/2018 Work Type: SepticTank Upgrade Expiration Date: 7/10/2019 Tax Code Number: 01549216000 Site Legal Address: BUBBLING BROOK LT 4 G:2638 Site Mailing Address: 6350 ROCKRIDGE DR, Anchorage Owner: HAGER HANS L & Lot Size in Sq Ft: 52558 Design Engineer: CREWDSON ENGINEERING, LLC Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field El Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: 411 Date: � /.;2—/ W Issued By: /1 ,, / ,/jar t Date: ��®�� MUNICIPALITY OF ANCHORAGE (4:17;-) Development Services Department \ Phone: 907-343-7904 On-Site Water & Wastewater Section Fa • •I -343-7997 k‘.46789 /07 7 ON-SITE SEPTIC/WELL PERMIT APPLICATION 1 JUN Z u 1018 1- Parcel I.D. 015-492-16 041.068 hc. Hans Hager �s 8I, `1 ' Property owner(s) g Day phone Mailing address 6350 Rockridge Dr, Anchorage, AK 99516 Site address same Legal description (Sub'd., Block & Lot) Bubbling Brook, Lot 4 Legal description (Township, Range & Section) Lot Size 52,558 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field I I Initial Single Family (SF) [x I (w/wo ADU) Septic Tank 0 Upgrade H Duplex (D) Holding Tank ❑ Renewal Multiple Dwellings Li 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 ' unicipal Codes. 7"---- (Sign-//le o property owner or authorized agent) Permit/Rush Fees: 4,,.. II Waiver Fees: Date of Payment: �p /0//2� Date of Payment: Receipt Number: 1-2 Receipt Number: Permit No. O3P 0 1/63 Waiver No. _ G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc crevids.tatianwing,CE uC •General Contactor James"Jay" Crewdson, P.E. Email:CELLC.1@outlook.com Cell/Text: (907) 280-9493 Fax: (907)688-2295 `0ao.a, Civil&Environmental Engineering July 9,2018 Plan Reviewer On-site Water&Wastewater Program Municipality of Anchorage 4700 Elmore Road Anchorage,AK 99519-6650 Reference: Bubbling Brook, Lot 4 Septic Tank Upgrade Crewdson Engineering LLC is requesting a septic tank upgrade permit be issued for the three-bedroom home. The scope of work for the project is: 1. Decommission the existing septic in accordance with the code. 2. Remove any existing stand pipes from the previously abandoned Bed drainfield. 3. Install a new 1000-gallon deep burial steel septic tank with new foundation cleanout and post tank double-cleanouts. Please feel fre to contact me if you have any questions. Thanks, / /16 411 O q \‘ James" 'Crewdson, P.E. 6! .0 • ••�!F9�� *:49J �� •;*v* J- ,es A.Crewdson / /li • C11527 ••• j '‘VIZ°‘Exk •.4 PO Box 671389 • 18368 Amonson Road • Chugiak,Alaska 99567 I \ GAZEBO ii) / BRIDGE/ ov Lot 3 PLAN / / SCALE: 1".30' Q4oy / pond J ,..s7. o LOT 4 well r40 r .. .. ABANDONED 1 • -� BED 1 ' �� it• 1��■ JAE rim „s 4' . ... 0 , oy "_ 1Oo. \ .^ ,SHED. o 'e/1- 3 BR SFk \ O syrO, (E)SEPT C TANK 4 S1 F /ECK (P)SEPTIC TANK S*_J.VI 1000-GALLON STEEL D ; : • \ DEEP BURIAL SEE NOTES .. 700. • - GRAVEL-.• Rll'6- (E)DRAINFIELD---- DRIVEWAY V ROCK \ \ PRETAINING WALL qOj1 s \ ( ) GREENHOUSE\ `SMT CO -----2. • / . .. 10'UTILITY EASEMENT \ N 89°5965” 265.00 NOTES LEGEND 1. THE EXISTING SEPTIC TANK SHALL BE DECOMMISSIONED IN ACCORDANCE WITH THE CODE (E) existing 2. REMOVE ANY REMAINING SEPTIC STANDPIPES FROM ABANDONED BED (P) proposed BR-bedroom 3. THE PROPOSED SEPTIC TANK SHALL BE CO-cleanout 3.1. OUTSIDE THE FOUNDATION SOIL BEARING PRISM OR 10 FEET MIN FROM THE FOUNDATION DC-double CO FC-foundation CO 3.2. 100 FEET MIN FROM ALL WELLS AND SURFACE WATER MT-monitor tube 3.3. 5 FEET MIN FROM THE EXISTING DRAINFIELD 4. INSTALL NEW FC AND DC SFH-single family home 5. ABANDON THE DRIVEWAY AS NEEDED TO PROVIDE 2 FEET MIN S#-Septic Tank CO SEPARATION TO THE PROPOSED SEPTIC TANK C ►1I9,.. lc Bubbling Brook, Lot 4 .��Nvx\\ Septic Tank Upgrade %* �� ••79kk �i DESIGN i / fames A.Crewdson :Q Al/i tea, .. Prepared for: III .0.•. C11527 kW Civil&Environmental Engineering Hans Hager Date: 7-9-18 i Fq .-c1-/V:-4,� = Page: 1 of 1 <<� o�ss�`�� PO Box 671389 Chugiak AK 99567 . Gello.1ioutlook.com Permit: OSP 1 8 \�x.�� Cell/Text:907-280.9493 . Fax:907-688-2295 ALLINFORMANONSHOWNONTHISDOCUMENTISTHEPROPERTYOfCREWOSONENGIEERING.LLCMDSHALLNOTREUSEDFOR ALLC#112279 ENGINEERING OR CONSTRUCTION PURPOSES WITHOUT WRITTEN PERMISSION FROM CREWDSON ENGINEERING,LLC Municipality of Anchorage Page I of ~-- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _~ t~) ~. ! 0 II ~ PID Number: Ol'~,~ q,~., I Name: ~ ),~,r,.~O~ t) I~ Wastewater System: ~ New ~ Upgrade Address: ABSORPTION FIELD ~hono: ~o. of ~odrooms: __~ - /~ W~ ~ ~ Deep Trench n Shallow Trench nBed ~Mound UOther LEGAL DESCRIPTION so, Rating: Total Depth from original grade: O' q ~ GPD/S% Ft. ~ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: ~ Range: ~ Secti°n:~ Fill added above original grade: Gravel length: WELL: ~ New ~ Upgrade Grave~ depth: Number of lines: Distance between lines: I ~ .t. I ~ .t. Classification (Priv~ A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: ~ " I Date Drilled: Static Water Level: Date installed: Yield: GPM [ Pump Set at: Ft. IC"sing Heigh~ AbOve GrOu"d:Ft. TANK SEPARATION DISTANCES ~Septic : .oUi~ ~ TO Soptic ~bsorption Lift ~oldin~ ~ublic/~riva~o Manufacturer: Capacity in ~allons: From Tank Field Station Tank SewerLines ~Yl ~T~M~ t ~00 Material: Number of Compartments: Well Water !oo~ I~ t ~ ~ ~/~ I~ * LIFT STATION Lot ~ t I~ Size in gallons: Uanuf~r: t / at: Foundation ~ ~ g ~/~ ~ 8 Remarks: ~" ,~o/~P,¢~ ,~d BENCH MARK Location and Description: I ~ I Assume~ Elevalion: I Ft ENGINEER'S SEAL -uepartment of Healt~d Hum~rvices~ approval ~ ................... Reviewed and approved by' /~ Date' ~/~~ 72-013 (1/91) MOA 25 Permit No...~V,J ~ I 0 I ) ~'- Page -~- of ~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report PIDNo.: (Dl_~--~, q?-LII:, C_.O_ £_o2. MT £.o % . zfl.~ 4 b.q 72-013 A (2/91) MOA 25 co PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910115 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:ULRICH VERNON B & OWNER ADDRESS:6350 ROCKRIDGE DR ANCH AK. 99516 DATE ISSUED: 5/23/91 EXPIRATION DATE: 5/23/92 PARCEL ID:01549216 LEGAL DESCRIPTION: BUBBLING BROOK LT 4 LOT SIZE: 52558 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: IN VIEW OF THE TRENCH LENGTH OF 100', IT IS RECOMMENDED THAT THE POINT OF ENTRY INTO THE TRENCH BE AT MIDPOINT. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER May 15, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519~6650 REFERENCE: Lot 4; Bubbling Brook Subdivision; RECEIVED MAY 1 6 1991 Mu,~!cipaiity of A~chorag. e Dept. Health & Human 8erwces Request you issue the attached conditional H~ Certificate and grant a permit to upgrade the septic system in accordance with the at~ached design. The existing l~achfield ~s tested on April $0, 1991 and found to have an absorption capacity of approximately 100 GPD. Although this is inadequate for an approval on the existing system there is no sewage surfacing and the curren~ occupants reportedly have not experienced any problems. There ms approximately $ ft. of frost encountered while excavating the test holes. Since the proposed system will be across and along the driveway where frost depths are anticipated to be gr~at, we ask that the actual upgrade be performed later in the s~mmer. Due to lot topography we feel this to be the best location for an upgrade. The proposed system is to be insulated and a filter cloth is to be used as special construction for installing a leachfield under the drive. Since the existing septic tank is approximately 7.5 ft. deep the proposed seepage trench is 13 ft. deep with only 5 ft. of sewer rock. This excessive cover depth will also prevent freezing under the driveway. We do not anticipate any drainage pattern changes or adverse effects on neighborirug~operties by the installation of the proposed upgrade. Sincerely' / 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 SCALE PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: _L..-,~''' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth Io Waler A~fler. , Monitoring? - .L,-'¥~ Date: SITE PLAN L O P E PERCOLATION RATE "~"~" (minutes/inch) PERC HOLE DIAMETER ~ TEST RUN BETWEEN ~T AND7 FT COMMENTS / / PERFORMED BY: ~,,; ......... .;:,= ~.;[,;~; L~(~ J{o~_ .~..~ ..~ ./r.,D~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH AT,.L STATE AND MUNICIPAL GUIDELIN~F~IECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Gross Net Depth to Net Reading Date Time Time Water Drop PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCR,PT,ON: L A- 1 2 3 4 5 6 7 8 lo 12 13 14 15 16 ~7 2O WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE S L IF YES, AT WHAT O DEPTH? p Depth to MO nitor in g ? '"'~. ~""~-""? Dale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWE~N//.,,"~ FTAND COMMENTS PERFORMED BY:) 70'g-'~Ea~e ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~ECT ON THIS DATE. 72-008 (Rev. 4/85) ~('~ (minutes/inch) PERC HOLE DIAMETER ~ FI CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: MUNICIPALITY OF ANCHORAGE D£ RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 %" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name ~co~r' iV~Orr,'$ Address Phor/eis)~ jl ~ JPermlt~ 0 ~ ~ ~N°' INo olBedrooms~ LEGAL DESCRIPTION Lot J Subd~ws~on Township Range, SecUon DISTANCES WELL SEPTIC TANK LOT LINE 6 0 FOUNDATION ABSORPTION FIELD /3 WELL AS-BUILT DIAGRAM ~Show local,on el welD, septic system, property hrles, loundatlorl, driveway water bodies, etc.} TANKS SEPTIC [] HOLDING Ar~ckc, r-~c~e, no. I0o0 TYPE OF SYSTEM TRENCH ~ BED [~ W. DRAIN [] OTHER Depth to p~pe bottom horn Ii lotal depth from original grade Fill added above orlg hal grade ] Gravel depth beneath p~pe ~ [~FT Vz F1 Gr~veJ iehg~h ~r~wg 3~ J~ ET ~ SO ET ~ ET WELLS PRIVATE [] OTHER ¢ldentifvi C~assdK}atlop, (AB,Q) ]oral Depth I Cased to REMARKS: Scale: Inspections Performed by Date I 7 ' cedily that this inspection was peflormed according to all Municipal and Slate guio~eT'~nes in effect on this date: -- 72 013 (3,'85) ENGINEERS SEAL SCO'! ]' M{)ia;F;: ]1S 51.3:1. El,, ?STH AVE,, P,,NCH!i)F,h':.~.i.%}!E, Al< 99:".51i. ~::, :!!;.q-,ii:,-'" iL :[ 9 e SUBD I V I .::, 1 [..44. BUBBL_ I h.iG BROOK "'"'"' ' I F:': '.!!:;I:}.'7 E: ') .[ OH :: 2 .if!; i t.. ¢,,..~.:, !-! I. q 0000 '-'l S{i;! ,, F: "I". 0t:::; .e E: l::;'. !ii; S ) ?:~,;,'.~t~.:.::,n'~,. t;.t-.,c,.:::s~.:.;, the er:~t.:i~:n that best I:i.t..;~; ye, ur'. site. ":d:'F'T'Fi '""' F' '"~" ,, ........ ~,.J Ib~:. 80'f"I'OH (F"'I",) 3 0 ~'~' () ,, 5 1. 9 ,, 0 3.4:.. 0 ,=:. ,.J..q. t, C:' (ii C,. 0 '~-'~.- 1. 5 0 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (ENGIN%R'S SEAL) LEGAL DESCRIPTION: oL. 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 ~.l~bt¢,~5~r¢o~_ L~I ~ ¢.¢ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? 3y'$ ~'~- 'IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? J4t Date: s L O P E Gross Net Depth to Net Reading Date Time Time Water Drop PERGOLATION RATE __ tminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FTAND FT COMMENTS ~-~e ~)~,a¢,,,fO,- ~;1t~ 77~e b~'~ ~1%a~¥ ,'~ThO 'TVae 5,>-~ 0'~ PERFORMED BY: /~-~'~'5 I "'"""'-~-'-,~ ..... ~ .... _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFEC~L,,.ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: (E DATE PERFORMED: LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 20 c/Co, .~ Township, Range, Section: ~-~3 ~/~ ~fz-3~"c' tit I SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p ~ Depth to Water Alter ~o(e ~fo,~/e,ff ~'o Monitoring? ~v/z.~ f Date:m~,~ ~IZ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND I FT COMMENTS --~'~' / '7~ .Z -~ ~-- ,'J t/,J - ~/(y ~/ ~ ,/~0 ~' /~. ~ Se,~,,~ /,'~ ~ PERFORMED BY: ~ ~('~ ~~' ~-CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFE NTHISDATE. DATE: ~ Y Jc~1~__/__?_ 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: (E L) LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 Township, Range, Section: ~ SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E SITE PLAN Ca 5-~s ' ~ -IN -111 13 14 15 16 17 18 19 2O Depth Io Waler After Moniloring? Dale: Reading Date Gross Net Depth to Net Time Time Water Drop 7/zs- I 3't + I ~ ,f ~1 - &" ~' Cminutes/inch) PERC HOLE DIAMETER iD" __ FT AND __ FT DATE: ~ d"/7 1~' COMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4t85) PERCOLATION RATE __ TEST RUN BETWEEN ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB ,/~ ¢~/,~e SHEET NO. CALCULATED CHECKED BY SCALE DATE / / / / / ALASKA ENVIRONMENTAL CONTROL SERVV ;, INC. 12OO West 33rd Aven~*~, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 $~T ~0~ ~A~T~D ~¥ ~£~D ~¥ OF DATE M JMUP , U Y OF AMC HORAGE Development Services Department 'i'Q Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-492-16 1. GENERAL INFORMATION Complete legal description Bubbling Brook, Lot 4 Location (site address) 6350 ROckridge Dr. Current property owner(s) Mailing address Real estate agent Expiration Date: -z�- 2692C) Marc Todino Day phone 830-563-0397 6350 Rockridge Dr., Anchorage, AK 99516 Debbie Higbee -Warburton 2. TYPE OF DWELLING: Fx] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 907-748-7375 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Fx� Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � � 6 Waiver Fee $ Date of Payment 04IV -' Date of Payment Receipt Number drVP Ndle"t' Receipt Number COSA # (5 6C '�Lo 11'7-& Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as .of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval. Guidelines for this. application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated .herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Crewdson Engineering, LLC Phone 9077280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 6-2-2020 A� i �aW�°�.� o a ��, 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms . Disapproved '!/ ame C1'152ewason:� Conditional approval for bedrooms, with the following sti S10NP= Original Certificate Date:2z 20 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 Septic System Advisory Well Flow Advisory COSA Cheddlst blue sheet . . X Nitrate Advisory Arsenic Advisory Other r y '!/ ame C1'152ewason:� Conditional approval for bedrooms, with the following sti S10NP= Original Certificate Date:2z 20 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 Septic System Advisory Well Flow Advisory COSA Cheddlst blue sheet . . X Nitrate Advisory Arsenic Advisory Other Legal Description: Bubbling Brook, Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10-1986 Total depth 194 ft Cased to 194 ft ❑ Sanitary seal is functioning correctly ON Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6-7-18 Parcel ID: 015-492-16 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No 0 Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L F_*1 Arsenic less than MRL (ND) Collected by Crewdson Engineering LLC Date of Sample 6-3-20 Static water level at beginning of test 136 ft. Comments * Arsenic results not available due to lab equipment breakdown, 6-7-2018 Arsenic was Non -Detect. B. TANK DATA Age of tank(s) 2 years Tank type/material septic/steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6-1-2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 6-20-91 ❑ ALL standpipes present per record drawing Total measured depth from grade 15.2 ft (max) Measured depth to pipe invert from grade 10.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ® Required maintenance completed Age of lift station 2 years Lift station material plastic Comments: Adequacy test date 6-7-18 Results Q Pass For 3 bedrooms Fluid depth prior to test 44 in Water added 460 gal New depth 61.5 in Elapsed time 480 min Final fluid depth 44 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) No If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' El Yes if No 5.6* Community Sewer Manhole/Cleanout > 100' ry Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' ✓M Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' 21 Yes Animal Containment > 50' Yes if No ft []✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' L✓,i Yes if No ft✓Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No 5.6* ft Surface Water > 100' Q Yes if No ft Property Line > 5' ✓l1 Yes if No ft Wells on Adjacent Lots: if No Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' FV -1 Yes if No ft Water Main > 10' Fl Yes if No ft Community Wells > 200' E] Yes if No ft Water Service Line > 10' 21 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F� Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS *Per the records: the septic tank is outside the foundation soil bearing prism *'Per the records: the absorption field is partly under and/or near the driveway and is insulated. No known freezing issues. G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet •�'� F ALX%Jt i_ ....... X09 ,James A. Crewdson 01152�� OFESSO A 'C td�� ft ft Owner Marc Todino Lift Station/Pump Vault Street Address 6350 Rockridge Septic Tank: -Sludge level 2 inches Pumping: required yes no -Pumping completed es no Lift station: -Pump basket cleaned yes o Effluent filter cleaned yes no -Control floats cleaned ygs no Proper float settings confirmed es no -Operation satisfactory es no Alarm System: -Dedicated electrical alarm circuites no ®Audible and visual alarm inside dwelling es no -Alarm system operation satisfactor not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations yes no -Weep hole functionales no -Manhole lid: Functional es no Insulated es no Properly Securedes no Other -All manufacturer required inspections and maintenance completed es no Comments: The lift station is approximately 2 years old and is in excellent condition. Septic tank and lift station pumped by McDonald's Pumping on 6-1-2020 Qualified Maintenance Provider: Technician James Crewdson Company Crewdson Engineering LLC/Denali Env Signature Date of maintenan ental Supply 4_ Ci Date 6-1-2020 MUNICIPALITY OF ANCHORAGE 1. :" Development Services Department y� Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 015-492-16 Expiration Date: I /— 1 (9.1 1. GENERAL INFORMATION BubblingBrook, Lot 4 Complete legal description Locatio }on (site address)^-6350 Rockridge Dr. a Cur.rent property owner(s) Hans Hager Day phone w Mailing address. ' •. ,' 350 Rockridge Dr. Judy Lamb Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: I , M1f41t bur Date: 0-15- zJ IIP COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ S z 6 Waiver Fee $ Date of Payment gt?-1/43 Date of Payment Receipt Number d33O (C1 Receipt Number COSA# 05(.1W/3615 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate-of On-Site-Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Crewdson Engineering, LLC Phone 907-280-9493 Address PO Box 671389, Chugiak, AK 99567 Engineer's Printed Name James Crewdson Date 8-6-2018 q� OFA4�1k • 6. DSD SIGNATURE ,' 49T. r i .,/ System #1 Approved for - bedrooms gj W,'. Jai, es A. rewdson ; System #2 Approved for bedrooms 70G%l11527 •'�`�i Disapproved it �' . �pROFESSIONP� Conditional approval for bedrooms, with the following stipulatiot/I`N‘%%:%.� -SITE wAT �.� WASTEAND pROCR RAM By: 1 . - � Original Certificate Date: �-(0 - ( g The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Bubbling Brook, Lot 4 Parcel ID: 015-492-16 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑® Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled 10-1986 Water storage tank volume 0 gallons Total depth 194 ftWell.disinfected.for,ctest? El Yes 0 No Cased to 194 ft ❑® Coliform bacteria is Negative IJ Sanitary seal is functioning correctly Nitrate mg/L 0 Nitrate less than MRL (ND) ❑® Wires are properly protected Arsenic ug/L 0 Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by Crewdson Engineering Date of flow test for COSA 6-7-18 Date of Sample 6-7-18 Static water level at beginning of test 136 ft Comments . B. TANK DATA C. LIFT STATION Age of tank(s) 0 years ❑ Required maintenance completed Tank type/material 5a I/s Age of lift station 0 years • Standpipes/foundation cleanout per record drawing Lift station material Plastic Date of pumping new tank Comments: new installation: no required maintenance 24" diameter pump vault with Orenco pump equipment • D. ABSORPTION FIELD DATA Which system tested (date installed) 6-20-91 Adequacy test date 6-7-18 El ALL standpipes present per record drawing Results n Pass For 3 bedrooms Total measured depth from grade 15.2 ft (max) Fluid depth prior to test 44 in Measured depth to pipe invert from grade 10.1 ft(min) Water added 460 gal ❑ N/A—pressurized field 61.5 New depth in . ❑® Monitor tubes go to bottom of drainfield. If not, state Elapsed time 480 min depth into effective 0 Code-required soil cover over field • Final fluid depth 44 in �� Absorption rate 450+ gpd ❑ System preso'a'kid°,;•,'='V,..:•. (Required,it uaoalYf;for`gdreaterrtfaan 30 days prior to - Any rejuvenation treatment(past 12 months) No date of te�s't `' •' ' GalloxtsgntrodGc�c�" .' Va(lons If yes, enter date. • Comments/Deficiencies. ' z COSA Checklist yelliii,A11eett;'' E. SEPARATION DISTANCES — From Private Well on Lot to: (Please enter distances if less than required or if community well) - Septic Tank/Lift Station on.Lot> 100' Community Sewer Manhole/Cleanout> 100' Z Yes if No ft Ea Yes if No ft Neighboring Tank > 100' 4 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot> 100' pRYes if No ft Holding Tank > 100' X Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' (� Yes if No ft Yes if No ft • Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft i Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ❑ Yes if No, , ft_ Surface Water> 100' [-Yes if No ft Property Line > 5' 0,Yes if No ft Driveway/Parking > 0' Yes if No, comment Absorption Field > 5' Yes if No ft Wells on Adjacent Lots: Water Main>10' [N Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' [SI Yes if No ft Community Wells >200' ' Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' p.Yes if No • ft Driveway/Parking > 0' ❑ Yes if No, comment Property Line > 10' [ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' !S.Yes if No ft Water Service Line > 10' Yes if No ft Community Wells >200' ®,Yes if No ft Surface Water> 100' E Yes if No ft F. ENGINEER'S COMMENTS • Per the records: the septic tank is outside the foundation soil bearing prism. y _\fr Per the records:The absorption field is partly under and/or near the driveway and is insulated.The owner states"there have been no freezing issues'. G. ENGINEER'S CERTIFICATION _F:c O F A< xl ,:Ay:.•' qd';i+ I certify that I have determined through field inspections and review �9 I, of Municipal records that the above systems are in conformance with #14* : r.� N / MOA COSA guidelines in effect on this date. / Ehnly t.• 1'r• *. / tn' ,a,mes",4.Crewdson : / V4... C11527 •. i i 1'104ESSIO i ". COSA Checklist yellow sheet d‘\l.�-N" A LLc Hda9- l • I 8369E 1 Z��`�So ROCKRIDGE DR \ ...,,> 'oo • 2 Lots c \N , • —— ' li *0(2)CS yard �'i ��10'utility easement n) lights II i. Ir. , \\ if. I'1 ; I LOT4 ! h 25'creek i I 1 maintenance I easement centered I 1 on stream thread \\ j \ yard light N \ \ \ \\ \\ .ccgazebo , W I '.- \\ \\ 0 culvert' I.; g bridged \ \ \\ o Lot3 \\\ \ \ \ f I, o \ \� I Z \ \;1 \ sandbox lb cti well—o`, \ _r ,/— ^�� yard light � / \• \` 9 2.0 O 4/ 2.0 OH, gam- sun room • - \ \ yard light ANL deck ,\ I A sE-.1 e 49.0 ' 2 Storyr‘i" �-`y2.0 OH \ \ �O septic oFrame 9.0 =- 96.1 I -q stream vents- 4 House I 30.0 ithq deck f) • septic tank—' , _. 28.0 2.0 OH 11 N .yard light frock -� gravel retaining_, I septic wall(typ) greenhouse co /- I N.O \ / 1 N 89°59'55" E 265.00 Revised 8-04-18 100"' RECERTIFIED :- 1: Revised 6-27-18 AS-BUILT NO CORNERS SET THIS DATE .N.`"`\li �.- { ' I hereby certify that I have performed a Mortgagee's inspection K. OF • •A 4-q t of the following described property:Lot 4, Bubbling i...."P.• `' •sf_ #, Brook Subdivision 49th i� •1 - r• - •* I Anchorage Recording District,Alaska,and that the •••',/Ate' ••:•/ •f- Improvements situated thereon are within the property lines and do not overlap or encroach on the property lying , "�abeth L. Walatka,•15 / adjacent thereto,that no improvements on the property lying / `•°,,.‘ •• • ' i adjacent thereto encroach on the premises in question and i,�F��•••8036 - LS •.•yJ2- — that there are no roadways,transmission lines or other � o X40. •, , , . •0,g3 Air visible easements on said property except as indicated I �SsioNA- '� hereon. SCALE: 1"= 50' IX NAN.N• Dated at Anchorage,Alaska EASEMENTS OF RECORD, OTHER THAN b - / • — LS this 6th day of June ,2018. THOSE SHOWN ON THE RECORDED l� FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors 907-248-1666 UNLESS OTHERWISE NOTED. FB 18-2, pg 70-71 &74-76 MB 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. # (~/-~- L-t°l ~- \L~ 1. GENERAL INFORMATION Complete legal description Lot 4; Bubbling Brook Subdivision; Location (site address or directions) 6350 RocEridge Drive Property owner Mailing address Lending agency Mailing address Agent Judy Lamb Address V~tnon Ulrich 6350 Rock~idge Drive, Anchora.qe, Day phone 346-1076 Ak. 99516 Day phone Day phone 345-3600 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: XX 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 WASTEWATER DISPOSAL: NOTE: Individual on-site 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. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & S ENGINEERING Name of Firm 17o:~4 ~1~ ~,,~ L,~p ~,~ ~ ~ Phone ~ ~/~ 2. fi' "~ ~ Eagle River, Alaska 99577 Address Engineer's signature THE CONDITIONS OF THE HEALTH AUTHORITY APPROVAL DATED 5-30-91 HAVE BEEN COMPLETED. bedrooms, with the following stipulations: DHHS SIGNATURE ~ Approved for ~-~ bedrooms. Disapproved. Conditional approval for Additional Comments Date 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. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,~'~ Parcel I.D. A. WELL DATA Well type ~-~_ Log present (Y/N) Total depth Sanitary seal (Y/N) _~.A,~;J~ If A, B, or C, attach ADEC letter. Date completed Cased to I ~ 4- Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /'~'0 ' Absorption field on lot I Public sewer main Public sewer service line FROM WELL LOG Io-~b water system number ,~/~/ ADEC /O - _~{,'2 Driller ~c~--_. ~/~/A~u..3_~'~ Casing height I .~- "'~ Wires properly protected (Y/N) ~ AT INSPECTION ~ --~ 4 - t I~O ~= ~ ~ ~.p.m. ~. ~ ~ ~.p.m.~ >~ ~ ; On adjacent lots / ~0 ~ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform --_~_~ .~, ~ .~C~-~ ~' ~ Nitrate I Date of sample: /_~ _ ! '-~ _ c// ~'~.-~L.~c'''~/'~, ~t0~,/ Other bacteria Collected by: ~-~J~')L~o ~ T-~c. ~. B. SEPTIC/HOLDING TANK DATA Date installed ./0 - / 0 - ~:~2 Cleanouts (Y/N) ~ High water alarm (Y/N) Date of pumping /'-I/' - Tank size / OC:¥g ?~ / Foundation cleanout (Y/N) c~ Compartments Depression (Y/N) Alarm tested (Y/N) /~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /~C) On adjacent lots ( Oo 'Jr' To property line I ~ Absorption field Surface water/drainage I ID~ Foundation Water main/service line io7- 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level ' . ,,,~el at MOA electrical codes (Y/N) Meets Sje~Ao~iON DISTANCE FROM LlF~';~ATIONdjacent iot~T~ Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Lc) - ./' ~ - Length ,/('~ ( Width Total absorption area I ,~ Depression over field (Y/N) Results (pass/fail) f~ / Peroxide treatment (past 12 months) ~T~ ~ ~/~,.-~F"/S y s t e m type Gravel thickness ~ Total depth Cleanouts present (Y/N) / Date of adequacy test for Soil rating bedrooms ~/~ If yes, give date AJ/IA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain I On adjacent lots ! ~o '/- Property line '/- To existing or abandoned system on lot Cutbank ~-0 -h Water main/service line Driveway, parking/vehicle storage area O E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in"~'fect Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 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 Parcel I.D. # t~ [~Z-~ _ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ ~ - \ ~ HAA # GENERAL INFORMATION Complete legal description Lot 4; Bubbling Brook Subdivision; Location (site address or directions) 6350 Roch,t~dg6 Drive_ Property owner Mailing address Lending agency Mailing address Agent Judy Lamb Address 6350 Rockridge Drive. Anchorage, Day phone 346-1076 Ak. 9956 Day phone Day phone 345-3600 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well XX 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 WASTEWATER DISPOSAL: NOTE: Individual on-site 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. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER * As certified by mYseal affixed hereto and as of the validation date Shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect On the date of this inspection. Name of Firm ~ i 2'334 Eagle River' Loop Road No. 2_0~. Address ~.~,_ Engineer's signature Date ~//~/~/~'/' 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. _{N~X_ Conditional approval for ~0~ bedrooms, with the following stipulations: Additional Comments ~Z ,~¢~,,~'/"~-,~: ~ ':~: /~~¢~ By: /~~~ ' Date ¢*~/ 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 courtes~ 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. 1/91) Back MOA ~21 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type ~-~.~/~q~'. -~ If A, B, or C, attach ADEC letter. Log present {3~1) Total depth Sanitary seal ~3~7N) ~ Date completed Cased to \~ ADEC water system number ~:~_ ~ Driller"~ ~ ~L,~~~ Casing height [, Wires properly protectedd~/N) V FROM WELL LOG Date of test Static water level ~::~ ~ -.,. Well flow Pump level AT INSPECTION MAY 1 6 199[ g'P' ECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots { ~lJr- Public sewer manhole/cleanout t'-I c:~'J~----, Petroleum tank WATER SAMPLE RESULTS: Coliform ~;~c~/~ ~ Nitrate Date of sample: z~ ~ ~"7 ~ '~ ~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~ c~- ~ c~-~ Cleanouts ~TN) ~ High water alarm (Y/N) Date of pumping Tank size / ~ Compartments Foundation cleanou~N) '7' Depression (YZS~ r ~ //~ Alarm tested (Y/N) '""- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ,~f'c:> On adjacent lots To property line ~ ~ Absorption field Surface water/drainage \ Foundation ~ I Water main/service line ! c:~t ''~ 72-026 (Rev, 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Size in gallons'"'"'"'"'""~. Vent (Y/N) "Pum~ High water alarm level ~..,y.~es tested Manufacturer Manhole/Access (Y/N) "Pump off" level at Surface water D. ABSORPTION FIELD DATA Date installed t I Length ~ ~> Width Total absorption area Depression over field (Y,~ Results (pas~ ~, c~-~ Peroxide treatment (past 12 months) (Y~) Soil rating Gravel thickness Date of adequacy test for System type Total depth ~ I''JZ present~/N) If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: I Well on lot \ ~-c~ To building foundation On adjacent lots .~t+ Surface water ~ ~ Curtain drain I On adjacent lots \ c:>~:> ~ Property line ~, '-~ To existing or abandoned system on lot Cutbank J~,=. I'~ Water main/service line 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. Signature ; :~:;3,; ~.~,~ R;w;- L~,~p R~a~ No, 204 Engineer's Na~~le R;ver, Alaska ~9577 Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NOTE: This bid doe,.,, not ~m" ':',u~e~ ap.¢ .',..-,., - ' -'" .qS.,~.'.n !jpq~'.,%fi:,. ~,,,,.. ~[Jrl %. ....... ' -'"' ..... J,;]pa) ;fy or arty' oLher, ~.,-r:,:.,;: ,:,r ,~.!)-~i..~l...' · .,,::~¢Jrt nS. Pr'ea-e..':t,:.d i'::_v 5 h S Fn.gir.,ceving T}IJS hid '.{;o,';s t'10~, iHC~ ' $1~000, .,O wijr bo added to Lb'i= bi,.: 'if' eng'1 nee r, . . RECONM~NI)ATiON: ice ~'eco,,memi t:hat this wor'k not cummencc ar, tiT arrow, ' " to'frost cond i t'fon s "~n d,- '~,c,",,-'-'y.- ' "' - .... i-91 due :::;OOB':STARTi~C DATE June INI.SN. DA'r[ ,,~,,~ 13, 199! weather ~er,r,'Cti~,q ]: .... ~OJ,.~,{}]~,,,~50-O0}.. Lg..~e paid upon acceptance Of [hi~ bid and thu balance, ~'-. : ,.,:.'.' ...,.::.:'..::.:::.: .'.',,'. ' ......................' ~ . , ~,~,,t.~-,t ,}t: t'*,lCrl 1l ~lt> ,' -- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name --~/[/~ (~A/Ti~rCT~&i~ Telephone: Home ~tf~//~ Business Applicant Address -~/~ ~ ~ ~~ ~/~ ~/ ~ ~ ~/~ (c) Applicant is (check one): Lending Institution D · Owner/builder~; Buyer D · Other ~ (explain); Telephone (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: / . / TYPE OF RESIDENCE Single-Family[] Multi-Family [] Number of Bedrooms ,-~ 3. Other WATER SUPPLY Individual Well ~ Communityl-I Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/~4) Page 1 of 2 ENGINEERING FIRM PROVIDI.._. INSPECTIONS, TESTS, FILE SEARCH, D._ 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 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 4~C--~ {/~ Telephone Address /~'~ ~ ~~ ~/~ ~ ~~' , , , , , , , , o v, .,. . Approved for ,-.,.---~.--('~-~ bedrooms by ..... Approved~ Disapproved Conditional Date . _ / . Terms of Conditional 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 Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) . KRC'6o~ WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present f~N). ! Total Depth / Cased to Static Water Level ~;20 / Casing Height Above Ground Electrical Wiring in Conduit CN) Separation Distances from Well: To Septic/Holding Tank on Lot P/~ / ~,'//~ ~'~ If A, B, C, D,E.C. Approved (Y/N) //~///~ ' Date Completed / ~¢ Yield ~0 ~ Depth of Grouting Pump Set At ~ ~~¢ 2. ¢ ~ ~ Sanitary Seal on Casing ~N) Depression Around Wellhead (Y~ · On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results )~O / ' On Adjoining Lots /V/A To Nearest Public Sewer , /t//~ To Nearest Sewer Service Line on LOt J. {ff ~r/'~7-'/' ~ L'/(/ ; d ate Comments B. SEPTIC/HOLDING TANK DATA Date Installed -I / Standpipes CN) Air-tight Caps C/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 / ~//0 / To Property Line ~'t~ To Water Main/Service Line Course /~_,~ /-7/- Size / 000 No. of Compartments Foundation Cleanout ~,N) Date Last Pumped /Ch N~/i~r ;for ,~.//~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 7 To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) Co ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ( (2/i Width of Field Square Feet of Absorption Area Depression over Field (Y~ To Water-Supply Well To Building Foundation Lot Results of Last Adequacy Test Separation Distance from Absorption Field: To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~,/'N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on · On Adjoining Lots --~ To Cutbank (if present) /o0 Comments To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at / ,, "Pump Off" Level High Water Alarm Level at / V~~_~,~~m Tested for pin Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) jt Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h av~c.c~c~k~ed,_~ified,.;~or conformed to all MOA a,nd HAA guidelines in effect on the date of this inspection. Signed d~~~¢'¢'~t-~' Date /'~-/~-¢/~' ~ I · /' ,~_~'-.-~ ///~/'~". MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)