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Home My WebLink AboutSOUTH LAKEWOOD HILLS #1 BLK 6 LT 3South Lokewood Hills Lot 3 I lock 6 #015-151-28 Municipality of Anchorage .er '.... Development Services Department - Budding ,Safety Division On-Site Water and Wastewater Program, 4700 S. I~agaw SL P.O. Box 196650 Anct~ge, AK 99519-6650 Page / of ON-~ITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECT]ON REPORT Permit Number. .S CC/O¥ O ~.~='~' PID Number:. OI 5' - 15'1 -~ mm,: ~ m ~"~,,~ J~ oO ~'~ r cZ' e ~ Wastewater System: [] New [] Upgrade LEGAL DESCRIPTION n.I n. TANK SEPARATION DISTANCES gsep~c E]H~4c~g OS.T.E.P. DOUser. Tank Field Station Tank Sev, ef Une C~. V ' Development Se~ices Depa~ment Approcal , PERMIT NO: SW040288 PAGE 2 OF 2 ~ ~ ,' DBL C.O. "D" 20, 29' ,, ~ ~ ~SOILABS. TRENCH .. · , , RI~ , D~INFIELD ~ULL RUN~ DBL~ ~~ P~N VIEW SCALE: 1" = 30' , , ~FILTER FABRIC ,, .:.~;~ 57~T LONG SOIL ABS. TRENCH . ,, w. 9.6' EFFECT~E G~VEL , , '~'~.. ~i' BOT. TRENCH LOT 3, BLK. 6, ~OUTH ~K~OOD HILLS ' ' ~ ~= J:':"- ~EL~. ~.6' SEPTIC SYSTEM UPG~DE " .,= ~:~:~ , AS-BUILT INSPECTION REPORT ', ', BOTOM T.H. ~1 SCALE: AS NOTED ; ~ ELEV. 62.6' CROSS-SECTION ~4~30 ECHO STE~ET D~WN aY TFU : VM.T. DRYe/16~ NOT TO SCALE ANC.O~O~A~S~ I AUGUST, 2~ MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 23, 2004 Expiration Date: Jul 23, 2005 Permit Number: SW040288 Parcel ID: 015-151-28 Legal Description: I~OUTH [.AKEWOOD HILLS/fl BLK -. 6 LT.~.3 Design Engineer: 0019 Flattop Technical Services Site Address: 011051 WILDWOOD DR Owner Name: THOMAS VAN HOOMISSEN Lot Size: 30400 SQ. FT. Owner Address: 11051 WILDWOOD DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516- This permit Is for the construction of: [] Disposal Field [] 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 DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 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 dosed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. If the existing 1,350-gallon concrete septic tank requires replacement, the replacement septic tank must meet current specifications and setback requirements. Received By: ,J~".-.~ ~ .ssued ..... ,,, (:)., Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~q~O Acres/Sq.Ft. Property owner(s) Mailing address (1) Mailing address (2) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Permit Number SW Day phone "~ 'z 3 - t ~, ~ Zip Code Number of Bedrooms ~'~ [] Well Only [] [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev. 12/00) 7 /z.t 55-5 1 J,l,n Waiver Fees: Date of Payment: Receipt Number: CIVIL & ENYIRONMENTAL ENG£NEERD~G · ENERGY CONSERVATION & ANALYSIS TIIEODORE F. MOORE. P.E. PII: (907) 345.1355 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 July 21, 2004 14530 ECIIO ST. ANCIIORAGE, ALAS KA 99516 Dear Sirs: The purpose of this letter is 1o provide the required design nm'ative in support of our application for a permit to upgrade the wastewater disposal facilities on Lot 3, Block 6, South Lakewood Hills S/D #1. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity oftest hole # 1 As can be seen from the soil log, the native material between 5 and 20 feet below ground level is a silty, gravelly sand with a measured peru rate of 10 minutes per inch. Using a somewhat conservative soil application rate of 0.6 gpd/sq, fl., this 4-bedroom residence requires a total absorption area of (4 x ! 50)/0.6 = 1000 square feet. The proposed 56-foot long trench design with 9 feet of effective gravel depth has a total absorption area of 1008 square feet. The topography of the lot in the area of proposed construction slopes down towards the north and west at 5-I 0%. Although the existing concrete septic tank is only 68feet from the well, that separation distance war legal at the time of installation in 1972, and we propose to retain this tank in service, if an inspection reveals that it is still in good condition. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. MICHIGAN BOULEVA'RD, ',, I I ~-~ ~. ~1 .~ I~ ~ ' W~ ....... ~ ~, ~, , , MICHIGAN '.~ J ......... "~'~'~"k ......... =-~ ............ ;''. J ,~ { .................. 10 -~ ...................... ~2~ ............. T.H. C.O.~ - ..' ', ', '.. ~ { ~1~ ~ "' ' ' '. ', I ' CONSTRUCT N~ ', ', ',, ,, { M.T.~ ~ ~56-F~T LONG " -~ .......... , ~ ~ ,' SOILABS. TRENCH ..:-' ' ', '' '- ' ~ ~ co~ X / ~.~.0.~.o~w~ ...-: : ~ ~ ~ ,oo V' ..' .... .' .' ~ , I~ ; ~ R~ , , HOUSE~ ~ ' ~ ' '~~' ' INSTALL ~,"'__ " ' '~ ~ ~ o ,' m~ o ~ ,=~ ..... ~~_ ~3~', , , , ," I ~ .. : ~WELL ,, ~ISTINO~ 135~ALLON ~~ ~ ' ' ~ '" I - ~~==[ ~AR, ' ' ~ · D~INF ELD .... CONCRETE ................. ~ , ............... "==~ = SEPTi~ ~,~='~ ..... ~ , , .. ........ I ................ c .... ~_ , - .' ~T 'lC ~' ' ' ~ ~ ~ I SE~ Oz ~ ~ I ~ LOT 3, BLOCK 6, SO~H ~K~OOD HILLS ~1 o; ~ WELL~ SEPTIC SYSTEM UPG~DE "~ ~ ~ , ~0o. s~ ,~N O ~ I I ~~ ~ F~OPTECIINICALSERVICES J 1 INCH = 50 FEET I ', ~ouse ~o ~c.o ST.~T : O~WNSYTFU ', ~ ~NC.O~.A~S~ i JULY, 20~ I J ',, NOTE: THIS IS NOT A SUR~YED P~T. ' ' ALL LOCATIONS SHOWN ARE APPROXIMATE. C.O. C.O. \ "A" ~ ~FROM DIV. ~ \ VALVE ~ 4' DIA. F-810 PERF. PiPE $6-FOOT LONG \ SOIL ABS. TRENCH ~ w, 9.0' EFF. GRAVEL PLAN VIEW SCALE: 1" = 10' -- MONITOR TUBE -- CLEANOUT 14 3UND DI~ F-810 PERF. PIPE SEWER GRAVEL CROSS~ECTION "A - A" SCALE: 1" = 5' LOT 3, BLOCK 6, SOUTH LAKEWOOD HILLS SEPTIC SYSTEM UPGRADE PLAN AND CROSS-SECTION FLATI'OP TECIINICAL SERVICES I 14530 ECIIO STREET I ANCIIORAGE, AK, 99516 I SCALE: AS SI IOWN DRAWN BY: TFM JULY, 2004 TEST HOLE FLATI'OP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: __ Lot 3, Block 6,.South Lakewood Hirls S/D_ahe ! DATE PERFORMED: ___July _12, 2004 PERFORMED FOR: Tom ~/anhoomissen DEPT. (feet) 3 4 12 - 14-' 15-' SM Reddish sandy loam GP/GM Sandy Gravel SLOPE ML Gravelly silt Cohesive SM/GM Siltygravellysand Becomes somewhat cleaner w. depth Depth to Groundwater _-.N~-~m~([~va~e r Monito~:tube f~ry . Date I Reading 5% 50% 0% :'//~ 2 ::] 12" Presoak - -- _-'.~.Add water & start- ' '~-+' -A~J-d~at e r "'"~-T, - #2 17 -~::::::: ~ ---r~._A~:ld~ater I SITE PLAN 116 Date 7/12/04 ____~ 25% ~,, 0%__..~. 71_1.9104 SLOPE COMMENTS: Clod< Net Tune Tune (minutes) 11~.'12 11~2 30 __ __:11:43 . 12:13 . __.30 .. "--12:14 '--12:44 ___ ----30 - ' Percometer J Net Drop , Reading ,l (inches) , .... 19 '15/1'6", '--i~-§/16 _~, ---23 1/2' -"---- , -201/6 ':--3 3/8 { 23 9/16 ~ PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 8.0 FI'AND__8.5 __ FT PERFORMED BY FLATTOP TECHNICAL SERVICES. I _~',4~/' ~___ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: "7 / 2../ /~ 0'~,~ q:fattop ~c[inica£$e~ices 14550 ~.ef~o Street, .~ncf~orage, ~ 99516 · Oo0 Lot 3, Block 6, South Lakewood ltills S/D #1 11051 Wildwood Drive Wastewater disposal system installation Specifications 1.0 General: I.I The scope of the project consists of inspection of the condition of an existing concrete septic tank, replacement if necessary, and construction of a 56-foot long soil absorption trench containing a total of 9.5 feet of sewer gravel. i.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All c. onstruction procedures and material specifications shall conform to Municipal and State reqmrements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. i .5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing single-compartment concrete septic tank may be retained in service, only if it,s structural integrity has been verified by the inspecting engineer, and if it has functional cleanout pipes with airtight caps, allowing pumping access to each compartment. Any existing septic tank or seepage pit which is not retained in service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. The inspection wiil involve exposing the outlet of the tanl and digging sufficiently far down alongside the tank to determine if there is any indication of lealage along seams. The inspection shall also verify the presence of a functional outlet baffle and the presence or installation ofa foundatlon eleanout. 2.2 lfthe existing septic tank is no longer sound, it shall be replaced with a new 1250-gallon, 2 compartment Municipally approved septic tank set level on undisturbed soil outside the 100-foot radius around the well. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. Ifthe tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproofmechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of I/8" per foot. A cleanout shall be installed 1 - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream ofthe septic tank. A "Bull Run" diversion valve shall be installed in the approximate location shown on the site plan allowing future reconnection to the original dminfield as desired by the property owner. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 56-foot long trench to a depth of 14 feet below ground level in the approximate location shown. The long axis ofthe excavation shall parallel an existing contour 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 9.5 feet ofapproved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 9.0 feet above the bottom ofthe sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion ofthe monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 3 feet of soil cover is to be placed over the filter fabric. 3.6 The top surface ofthe cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement ofadequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of 4 engineering inspections will be required during the course of the project: (I) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. A septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing ofthe inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. GREA"" R ANCHORAGE AREA BORf= Department of Environment Quality~ ,GH 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM /'£I¢/dG,~N' MAILING ADDRESS,-.-~rRrA '~.~' 1.5-"~7 ~'~,~,,~ PHONE..~.q~..35-2~! LEGAL DESCRIPTION f0T SEPTIC TANK: DISTANCE FROM WELL ~/~C~, INSIDE LENGTH NUMBER OF MANUFACTURER ~-Ef;A.V'd.q MATERIAL C~0~ COMPARTMENTS I ~ INSIDE WIDTH ~ LIQUID DEPTH ~ LIQUID CAPACITY/,3'~'O GALLON~J TILE DRAIN FIELD: DISTANCE FROM WELL/3F-~/'3. NUMBER OF LINES ~ ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE ~ TOTAL LENGTH FOUNDATION ~"~' NEAREST LOT LINE /0 I'f- OF LINES DISTANCE BETWEEN LINES '2(~ TRENCH WIDTH ~ · IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE .~., .~3 ~ DEPTH OF FILTER MATERIAL BENEATH TILE ~-~ IN. ABOVE TILE ~ IN_ WELL: BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION DEPTH NEAREST NEAREST SEPTIC SEEPAGE LOT LINE__ SEWER LINE__0 TANK . SYSTEM OTHER SOURCES DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: ~1~' SEWER LINE DEPTH: PIPE MATERIAL: ~ LOT SLOPE= REMARKS: ~ ~T Form PW-027 DIAGRAM OF SYSTEM G.A.A.B. GREAiER ANCHORAGE AREA BOR~ .'JgH mEPARTMENT OF =NVIRONMENTAL GUAL~Y ,soo TUDOR ROAD ~OUC" e.e,o SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION Or: SEPtiC TANK ~ SEEPAGE Pit ~ ~', ORAl" FIELD ~. L:,~ .A,L,. ADDRESS ~ /~'¢~ '~ ~t~/~ R"O"E ~'~ NOT~t T~IS PERMIT IS HOT VALID WITHOUT 5OIL FINAL INSPECTION= 24 HOUR ROTICE REQUIRED. BACKFILLING OF ANY BYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD DRAIN FIELD GRAVEL BACKFILL CONFORM TO BOR HEALTH AUTHORITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-6S AND THAT THE ABOVE · ''" GREATER ANCHORAGE AREA BOROUGH .~ DEPAR~"ENT OF ENVIRONMENTAL QUALI"~ CASE 3500 TUDOR ROAD 'ANCHORAGE; ALASKA 99502 Performed For Bill Erickson Date Performed 6/1/72 Legal Description: Lot 3 Block e Subdivision Lakewood " This Form Reports Sotls-L~g Percolation Test Depth Feet 1 3~ 4~ 5- 6" 7 8-- 9~ 10- Soil CharacteriSttc~ Brown Clayey Sand with Scattered Gravel (CC) Gray and Tan Sandy Silt (ML) with Clayey Silt Seams with occassional Fine Gravel, Was Ground Water Encountered?. If Yes, At What Depth?. r Reading Date Gross Time _Net Tim Depth to HDO Net Oro N Proposed Insta]lation: / Seepage Pit Drain Field Depth Of Inlet Oep~h To Bottom Of Pit b'r Tr nth__ COMMENTS: This material exceeds the 250 s uare* feet per-b~room criteria and ~as a and depth. - .... o .... r .... uu~=u uu uuab Aocat~o~ Date:' Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF oN-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-151-28 Expiration Date: GENERAL INFORMATION Complete legal description Lot 3, Block 6, South Lakewood Hills Subdivision No. 1 Location (site address) 11051 Wildwood Drive Anchorage, AK 99516 Current Property owner(s) Thomas and Debra Van Hoomissen Mailing address 11051 Wildwood Ddve Anchorage, AK 99516 Day phone 223-1278 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four 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 sample results. (Certificates may be reissued for a period of up to one year with valid water sampleS.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~/ Approved for Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date ~/ ~eee . · A bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O, Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 3, Block 6, South Lakewood Hills Subdivision No. 1 A. WELL DATA Well type Private Date completed 1972 Total depth 138+ ft. IfA, B, or C provide PWSID # ... Sanitary seal (Y/N)... Y Cased to 138. ff. FROM VVELL LOG Date of test Unknown Static water level Unknown Well production Unknown WATER SAMPLE RESULTS: g.p.m. Coliform 0 .colonies/100 mL Arsenic: N/D ug/I B. SEPTIC/HOLDING TANK DATA Nitrate .638 mg/L Date of sample: 7/26/10 Parcel ID; 015-151-28 Well Log (Y/N) N Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 8/5/2010 117.9 ft, 7.8 g.p.m. Other bacteria 0. Collected by: M. Anderson Date installed 8/28/72 Cleanouts (Y/N) High water alarm (Y/N) Y >12 in. Tank Type/Material Septic/Concrete Tank size ,1~35o gal. Number of Compartments, 1 Foundation Cie~h0ut:(Y/N)'' Y Depression over tank (Y/N) N Date of pumping Denai Se?erE& Drain Pumper 8/6/2010 AsSO.P O. FIELD =ATA . colonies/100 mL N Y Date insta,C=~:l' 8/17/04 ;Soil rating (g.p.d./ft2 or ~/bdrm) .6 GPD/SF System type Deep Trench Length 57 ff~ Width 2.5 ft. Grovel below pipe 9 ft. ~ ? ft. ' Eft. absorption area 1,094 .ft2 Monitoring tube Y Depression over field N . Any rejuvenation treatment (past 12 mo.) (Y/N & type) Total depth, Date of adequacy test 8/5/10 Results (Pass/Fail) Pass For. 4 bedrooms Fluid depth in absorption field before test 12 .in. Water added 1,009 gal. New depth <l- Elapsed Time: 6o min. Final fluid depth 0 in. Absorption rate >= 600 N If yes, give date in. g.p.d. D. LIFT STATION Date installed "Pump on" level at~ Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at~ Cycles tested in. Manhole/Access (Y/N) · High water alarm level at Meets a arm & circuit requirements? in. , SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 68~*** Absorption field on lot >100' Public sewer main N/A Sewer/Septic service line >25' Animal containment areas >50' On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A >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 >1o' Building foundation >1o' Water main N/A Water Service line Mo' Surface water >1oo' Driveway, parking/vehicle storage, Curtain drain. None Noted Wells on adjacent lots >1oo' COMMENTS: SepUc Tank was Installed in 1972. The Separation Distance from the Well at that time was 50'. >25' 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 Michael E. Anderson, P.E. Date 8/6/2010 COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of PaYment Receipt Number SGS Ref.# 1103637001 Client Name Anderson Engineering Printed Date/Time 07/29/2010 8:55 Project Name/# Water Samples Collected Date/Time 07/26/2010 13:00 Client Sample ID L3,B6 South Lakewood Hills #1 Received Date/Time 07/26/2010 13:48 Matrix Drinking Water Technical Director Stel~hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/27/10 07/28/10 KDC Waters Department Total Nitrate/Nitrite-N 0.638 0.100 mg/L SM20 4500NO3-F B (<10) 07/27/10 LCE Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 07/26/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 07/26/10 DLC Bill To Tom Vaahoomissen 11051 Wildwood Dr Anchorage, AK 99516 Denali Sewer & Drain Service PO Box 141811 Anchorage, AK 99514-1811 Bus.(907) 333-5794 Fax (907) 333-9776 denalisewerdrain~gmail.eom www. denalis eweranddrain- eom Invoice Date Invoice # 8/6/2010 01704 P.O. No. Terms Rep Project Service Date Credit Card Isaac 8/6/2010 Item Description Qty Rate Amount Vac Truck 1 pump septic 1 155.00 155.00 ***Pumped I000 gallons septage Please Pay From This Invoice, Thaak You For Your Business! Total $~55.00 Payments/Credits $o.oo Plebe no~ ou~ mail~ ad~s h~ ~ Balance Due s155.oo changed. Please update your records. Mnnicipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St, P,O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description L~/- ,3'., Location (site address or directions) Expiration Date: I - t/.-I .- ,~c--3 Current Property owner(s). Mailing address ,I Lending agency Day phone Day phone Mailing address Real Estate Agent Mailing Address Day phone Unlessotherwiserequested, HAAwillbeheldbyDSDforpickup. Ple~e cc~ll c.,~,~t~.~ ~ ~5/~, NUMBER OF BEDROOMS: ~./ ~z-.,~At/~ /'~/f '~ re~c~//~ ~ 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 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. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are .valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the informaUon 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. NameofFirm F/~t/op 7'~¢4~;c,,/' ~er'u~.ee~ Phone Address I y~'~¢A~ ~.) ~t~r~) ~ Engineer's Printed Name ~eo~O~ ~. ~oo~ Date. 5. DSD SIGNATURE ._~ Approved for q Disapproved. Conditional approval for __ .+" ~ /' -,, ~ :1;'.~.= ,~ ~ ., bedrooms. ,, bedrooms, with the following sbpulabons: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01102) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type ~v/ . Date completed Total depth ~,1 $8 Date of test Static water level Well production WATER SAMPLE RESULTS: Col~orm Q colonies/100 mi. Arsenic: ~ rog. Il. B. SEPTIC/HOLDING TANK DATA If A, B, or C provide PWSID # Well Log (Y/N) Sanitary seal (Y/N) Y Wires properly protected (Y/N) Cased to ~_..L3..~ff. Casing height (above ground) 11~ in. FROM WELL LOG AT INSPECTION g.p.m. '7, ~ + g.p.m. Nitrate ~'. ~'~ mg./I. Date of sample: .~.Z_2,V/o,y' Tank Type/Material 5',?~c / ~'~.,, c,-~,~' Tank s~ ( 7~G gal. Numar of ~m~en~ 1 Founda~on d~no~ (Y~) ~ Dep~sion over ~nk (Y/N) ~ Da~ of pumping ~//· / of Pum~r ~ ~ C. ~SOR~IoN FI~D DATA Da~ ins~ll~ ~/~/o~ ~il rating (g.p.d.~ or ~) ~ Le~ ~ ff. W~ ~ ~ ff. Total de~h I Y fl. Eft. abso~on ama IO~ Mon~fing ~ Da~ of ed~ua~ ~t ~,A, ~ N~) Resu~ (Pas~Fail) P~ Fluid dep~ in abso~on fle~ ~ ~st ~ in. Wamr add~ ~ E~ Time: ~ min. Fi~l fluid dep~ O in. Any mjuve~n ~a~ent (~st 12 mo.) (WN & ~) ~ Other bacteria (;:) colonies/100 mi. Collected by: Date installed ~/z&/t~'~ Cleanoute (Y/N) ~* High water alarm (Y/N) ~/, 4 _ gal. Absorption rate >= System type Gravel below pipe ,9 ft. Depression over field For Y bedrooms New depth O in. K oO g.p.d. If yes, givedate ~/.~ D. LIFT STATION /~/. ,~'. Date installed "Pump on" level at __ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main ~/. ,4. Sewer/septic sewice line Manhole/Access (Y/N) High water alarm level at Mee~ alarm & circuit requirements? On adjacent lots ~ IO~ · On adjacent lots ~. f oO ' Public sewer manhole/cleanout Holding tank /~/..,'~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Pmberty line ~' ~' Water service line "~ ~ ' Absorption field 9,.~ ' Surface water '.> /c,c~ / Building foundation t ~.' Water main ,~. 4. Wells on adjacent lots ~> Jo~o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 73' s Surface water ~, Wails on adjacent lots '~>/~;~ ' Water main /~. 4. D~mway. pa~VJng/vehicie storage ~ 3'0 / Property line I '7 ~ Water Service line ';> t o' Cu~lain drain /~p/~ 5¢,/~ 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 w/th MOA HAA guidelines/n effect on this date. Engineer's Printed Name '-/'~o,~'~,,q~ ~. /-~-o ~ Date ~,~¢~,~,¢~- /~ '2.o0¥ Waiver Fee $ Date of Payment Receipt Number in. HAA Fee $ Date of Payment t~,/ Receipt Number (Rev. 12/01) SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 10454010O1 Flattop Technical Sty. L3, Bk 6, So Lakewood tlills #1 L3, Bk 6, So Lakewood tlills # I Drinking Water Sample Remarks: All Dates/Times are Alaslm Standard Time Printed Date/Time 08/27/2004 6:42 Collected Date/Time 08/24/2004 13:00 Received Date/Time 08/'24/2004 14:00 TechnicaIDirector j Stephe~. Ede Allowable Prep Analysis Parameter Results PQL Units Mc~hod Container ID Limil~ Dale Date Init Waters Department Nilrale-N 0.265 0.100 m~L EPA 300.0 B (<=10) 08/24104 JJB Microbiology Laboratory ToUl Coliform 0 col/100mL SM20 9222B A (<=1) 08/24104 DKC SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ IN~IRUCTION80g RL~E 81DE BEFORE CO~ECTING ~ MUST BE COMPLI' I~-D BY WATER SUPPUER SAMPLE COLLECTION: TO BE COMPLETED BY LABORATORY Date: '~ ' 'rime: GE:> SAMPLE TYPE: O ~R~ 200W. F~Ji IcR DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax: ~07-561-5301 1 045401 · !~ Routine [] Repeat Sample (refer to lab no. Special Purpose [] Tmat~l Water [] Untreated Water . .! Phone F~x~. RUSH SAMPLE [~ Satisfactory []. Unsatisfactory Fo~ ii FW- 0053 12/17/03 ~ I : ~ ' ~" ...... ' I , ~ .. · I · · .'' . . . ~ ~ ~ ' . . .. . . , . ?.~ , ~ ............... .,. . .~~ ~;., -. ~ ............ . .- ' .' ...i- ~' ,,,,,~ ~ . i - -, ::. '~;~.:..._ ~. ~ ./~ 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent N¢;,,, ~- Address Day phone 3 ¥~'- ~ Day phone ~ -~ ~ e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC atte..s, ting'.t~ the legality and status of system. Se Engineer's signature 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. Name of Firm Address I ¥..C'~J DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone ~' ¥,{'- I.F,.~..~ Date, bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~ ~)"~ 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,oT 3, BLk' (% .~ou'~;~ L~'~'~,oo~, H~u.S Parcel I.D. O · ~--- / ,~"~ ~--~ A. Well Data Well type Log present (Y/N) H Total depth ~, I,~.~ Sanitary seal (Y/N) y If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ 1¢~"12 Driller Cased to '~. ¥~ ' Casing height Wires properly protected (Y/N) FROM WELL LOG g.p.m. Date of test Static water level Well flow Pump levelf SEPARATION DISTANCES FROM WELL TO: ~SepticJholding tank on lot 'Tq~ 7o C.o. Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ~./~o ~ ; On adjacent lots ~-/oo ~ Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~:~ ¢ol /~'o~ m~ Date of sample: '7/~o/~/~ Nitrate Collected by: ~'Z B. SEPTIC/HOLDING TANK DATA Date Installed ~/"/~ Cleanouts (Y/N) High water ala~'m (Y/N) Date of pumping ~,/* Tanksize 13~o CA~- .Compartments I Foundation cleanout (Y/N) ~ Depression (Y/N) t,{/.~ Alarm tested (Y/N) k Pumper ~^c/~o~'~'~' ~'~.c~',/,~oo/' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: '~'Well(s)onlot .7,4' F,~,:,,~ C.O. Onadjacentlots To property line ~- Io' Absorption field Surface water/drainage >. t0{3 Foundation Water main/service line CONTINUED ON BACK PAGE C. UFT STATION Date installed Manufacturer Size in gallons, Vent (Y/N) 'Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) 'Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water. D. ABSORPTION FIELD DATA Date installed ~ ["/:z Soil rating (GPD/FF) J.o System type Length Ico' '*;;.-.- '~ Width (~ f Gravel thickness o.5' ' Total depth Total absorption area ~,oO F{'~' Cleanoat present (Y/N) ¥ Depression over field (Y/N) Date of adequa-c~-test '~ [~J/~ ~, Results (pass/fail) ~o ~ for Water level in absorption field before test O After test Peroxide treatment (past 12 months) (YiN). No~: k:~v~q If yes, give date 1~.4, Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J I '5' Feo~ ~.T. On adjacent lots % f ~o ' Property line To building foundation ~,o' F,% ~ i~ ,T, To existing or abandoned system on lot On adjacent lots · so ' -. Cutbank N,~. .Water main/service line Surface water >.too ' Driveway, parking/vehicle storage ama 2 ~ f Curtain drain E. ENGINEER'S CERT1FICA'I3ON I cerb*fy that I have checked, vedfied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ Date of Payment Receipt Number 72*026 (3/93)* Back Waiver Fee$, , Date of Payment Receipt Number. .I COMMERCI~ TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY ~ 5633 B Alaska 99518, Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER PUBUC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM FcATr~ Te co 6o'c$ ldo. I)ey Ye~' SAMPLE TYPE: ~Routlne 0 Check 5ample (for routine ~ample with leb ref. no. [:] Special Purpoee 0 Treated Water ,'~/Untreated Water SAMPLE No. LOCATION 41 I SI I Time Co;bct,KI Collected By 3 ;a ~. · C/4,('15 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ~'atisfact ory [] Unsatisfactory [] Sample too long In transit; sample should not be over 30 hours old at examination to indicate rermbte results. Please send new sample via special delivery ma~. Dete Received Time Received Analytical Method: Membrane FIIte~ NOt of colonies/lO0 mi. Lab Ref. No. Result' I I-1-1 I ~ I I m READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:, Direct Count Verlflcallon: LSB Fee, el CoIffon~ Confln~ltlon Final Membrane Fillet Reeult8 BACTERIOLOGICAL WATER ANALYSIS RECORD Colltorm/100 mi BGB TNTC = Too Numerous To Count OB = Other Bacteria Member of the $G$ Gr, Coliform/lO0 mi PART ONE OF TWO REPIAINDER TO FOLLOW COMMERCIALTESTING & I NGINEERING CO. &Il ENVIRONMENTAL LABORATORY SERVICES ' "'¢"~ REPORT of ANALYSIS Chemlab Ref.l :93.3772-1 Client Sample ID':L3 B6 8. [~ZOOD HILLS FRONT HOSE BIB ~latrix 5~33 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name Ordered By : Project Name : Project# : PWSID :UA :F[AT~P 7~CHNICAL 8RV WOP~ Order :68935 Report Completed :08/03/93 Collected :07/30/93 @ 15:00 hrs. Received :07/30/93 @ 16:00 hrs. Technical Director:S~SPH~ G< EDE ReleasEd By : /'""~/ ..~.-------. Sample Remarks: ROUTINE SA~iPLE c0r]'.r"CTED BY: CHRIS. OC Allowable Ext. Anal Parameter ' Result~ Qual Units ~ethod A Limits Date,,Date Init Nitrate-N ! 0.21 mg/L EPA 353.2/300.0 10 08/02 LLH * See Special Instructions Above UA = Unavailable ** See Sample Remarks ;~bove NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND. WEST VIRGINIA. NEW JERSEY, SOUTH CAROLINA MUNICIPALI'FY'OFANCHORA(~E Department o! Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) (b) Locat'ion iaddress o; di~'ect, i6ns) Property oWner 6~'/~ "~'~--~/"/~ Mailing Addre;~ ~771~-." 4~j ~ ~ ~, (c) Lending Institution ' Telephone Telephone: (home) E'4,,'3 o?~-5~Buslness. Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here~,, If hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family'~ Number of bedrooms 3. WATER SUPPLY Individual Well'~ Community r'l Public n Note: If community well system, must have written, c~nfirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public r'i Community n Holding Tank CI Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed he reto 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 end 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 ~C..5 Telephone ~.7 ~...5"5"5'.,~ Address / ~//" Date 6. DHHS APPROVAL Approved for ,/Y/ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 o r analyze data befo re a certificate is issued. The Municipality of Anchorage is not responsible for e rror~ or omissions in the professional engineer's work. Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) .~UNiCII,N. rrf OF(~II,~ON Health Authority Approval {"AA) ENVI~'ON~NTAL$£~ ' CHECKLIST FEBRUARY 1984 . - 343-4744 FEB 2 ~, .989 Legal Description: Well Classification ~D,E/'I/~-?"~' If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y~) Date Completed ~,d,,<,,J~/~J .... Yield 7, 7 ~P,// Total Depth >/$/' Cased to ~ Depth of Grouting Pump Set At ~/~ Sanitary Seal on Casing~N) Depression Around Wellhead (Y~ Static Water Level //~' Casing Height Above Ground Electrical Wiring in Conduit ~I~N) /¢r~ -f ; On AdjoiniHg Lo{~s' To Nearest Public Sewer Cleanout/Manhole ; Date ~ o,~-~-o~ '"' SEPARATION DISTANCES FROM_~..W. EL4.: . To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~//,'~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~"~ Water Sample Test Results Comments /.JE'zz. ~//.~J SEPTIC/HOLDING TANK DATA Date Installed E'--~.-~'-?~- Size /~ ~-No. of Compartments Standpipes ~)~N) Air-tight Caps Depression over Tank (Y~..~ Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,~/~ / · Foundation Cleanout (Y~) Date Last Pumped ;for ,d/,~ Temporary Holding Tank Permit (Y/N) ~/,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: . To Water-Supply Weli -. ~.~t , ~'t,,~ £i ~" ' /'~ ' ~" To Property ne To Water Main/s~n'ice'Line ' ': ' ' '; '/ To Stream, Pond, Lake or Major Dra~rmge Course Co m m e n t s'~/',~"~.*~ 1"'~ , ~ ',~f ~;~,l,~z,~ ,/'~'~'~'~'~'~'~'~ To Building Foundation To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'° ?-"~"" 7 Width of Field ~'; ~ Square Feet of Absortion Area ~'~ '"'"' Depression over Field (Y{~) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: Type of System ~e~ign Length of Field /,~o ...- Depth of Field Gravel Bed Thickness Statndpipes Presentl~lN), Date of Last Adequacy Test To Water-Supply Well To Building Foundation ' Lot ,,J/~* To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'· ~/'~,~//7~,~ '7~'~'~ To Property Line /d ·'f' ' *" To Existing or Abandoned System on ; On Adjoining Lots /0 '7~ To Cutback (if present) ,~J/~ D. LIFT STATION Sizein Gallons ~ ' "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~'~'~ Vent (Y/N) '.' -'"'""~ ~........~Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines.in effect on the date of this inspection. -- -' ~;.' A '..~ ~ Company ~ ~;~ ' ~ "'~- ~ _, .. . , ~W~ ~ ~ '~ , Date of Payment ~/~Y/~ 7 Waiver Fee: $ ~,~.t~)e.c~ Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES 0 .TELEPHONE (907) 562-2343 5633 B St~ · ' ~' Anchorage, Ale,, Drinking Water Analysis Report for Total Collf¢ TO BE COMPLETED BY WATER SUPPLIER I-I PUBLIC WATER SYSTEM I.D.# ~{1 PRIVATE WATER SYSTEM " Mailing Address ~ ALASKA, INC. a 99518 m Bacteria~ TO ', COMPLETED BY LABORATORY A~ ,is shows this Water SAMPLE to be: ~tisfacto~ [-I 'Unsatisfactory [] Sample too long In translt; sample should not be over 30 hours old at examination to.Indicate reliable results. Please send new sample via special delivery mail. Date Received ~ ' ~-0~ ~ ~ ' Time Received Analytical Method: Membrane Filter Phone No. City State Mo. Day Year zip Code SAMPLE TYPE: .1~ Routine Check Sample (for routine sample with lab ref. no. I-I Special Purpose ) C3 Treated Water ~ Untreated Water SAMPLE ,~ Time Collected NO. LOCATION Collected By .. I (-. '6(.. e READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too Numberous OB = Other Bacteria * No.lof coloniesll00 mi. Lab Ref. No. Result* BACTERIOLOGICAL WATER · Membrane Filter:. Direct Count Analyst Coliform/100mi ,Verification: LTB ' BGB Final Membrane Filter Results ~ tte To Count ~' ' I~ Collform/100ml CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 Date ~epozt tztnted: fEB 22 89 ! 17:02 Client Sample ID:ti. 86 $. tA~OOD HILTS Collected lIB 20 $~ ! 15:35 h~e. P~ese~ved vtth :COOL Client Har~ : A Client Acct : [eq I O~desed By : Analyeis Completed :!lB 12 09 ScM Hepoxte to: Special Instzuct: Cho~l&b lei l: 4BDB Lab H~pl ID: I #atstz: WATBI Allo~able Pasametel Tested ~eeult/Onite ~ethod LtMte ~H~ITI-H O.lt ~/1 HI 353.2 10 ~ample IOUTI~ Hemasks: 3A)OLI COtL[CTSD D! I Testa tezfo[aod ' See Special Inatzuctione Above UA-Unavailable Itl)- ~ona Detected .*' See Sample Hema:ks Above HA- Hot Analyzed LT-lese Than, CT-CEeater Than IME [ECEIVED NCHORAGE ,~D~,. UNIC PALITY OF A DEPARTMENMT OF HEALTH & ENVIRONMENTAL PROTEC~{O~ 825 LSt,.t. Ancho,~,At~ka~l FEB 1 7 991 ENVIRONMENTAL SANITATION DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES )1RECTIONS: Complete ail parts o. page I. Incomplete r~quest~ will not be processed. Please altow ten (10) days for p¢ocessln§. ~ NG ADDRESS lNG ADDRESS )R/AGENT 5. LEGAL DESCRIPTION · /. · STREET LO ~- t -- ' ' 6. TYPE OF RESID r"l One ~ Four t'-I Other _ C~'~SlNGLE FAMILY i-'l Two r-I Five [-I MULTIPLE FAMILY r"l Three i'-1 Six ~ WATER SUPPLY ;~ INDIVIDUAL· r'-'l COMMUNITY [] PUBLIC UTILITY · ATTACH WELL LOG. A well log is required for all wells drilled ' since June 1975. For wells drilled pr[or to that date, give well depth (attach log if available.) ~ 8."~"EWAGE DISPOSAL SYSTEM [~* INDIVIDUAL/ON-SITE·* I--i PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) · ~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY I'"] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM i-'IINDIVIDUAL/ON -SITE ~'IPUBLIC UTI LITY Connection Verified i'-ISeptic Tank or J'-'iHolding Tank Size: I'~ T° IfTank ishomemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA ~] ONE [] TWO PERMIT NUMBER DEPTH OF WELL 'DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL 4. DISTANCES WELL TO: to nearest Lot Line NUMBER OF BEDROOM~ THREE [] FIVE I-'1 OTHER FOUR I--I SIX 5. COMMENTS {~APPROVED FOR __ ~ BEDROOMS CONDITIONAL APPROVAL (Fetter must accompany certificate) DISAPPROVED 72-010(Rev. 6/79) TELEPHONE (907).279-4014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: Water System Name ~. / ~ / Mailing Address ~ u City State I.D. NO. Zip Code SAMPLE TYPE: 1:3 Routine [] Check Sample (for routine sample with lab ref. no. t I=1 Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION ., ~, +..I.. ~- ,~ [,..,,--,~. It,,. ~ I I , I I 5 I I Time Co~le~ted Collecte~ By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send .new sample. Date Received Time Received Analytical Method: [] Fermentation Tube J:::] Membrane Filter Lab Ref. No. Result' Analyst I I-n I fiT'1 I1-1-1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 0~.1220 Rev, 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Directions for Collecting Samples of Water for Total Coliform Bacteria Examination This wa~er analysis deals with materials present in very minute quantities. Carelessness in collecting and handling may lead to misleading results. Water samples will have to reach the laboratory as quickly as possible within 48 hours after collection. After 48 hours, the significance of the bacteriological analysis is impaired and resampling will be nec- essary. Send to Laboratory fastest way: (i.e. special delivery mail.) In collecting samples from TAPS or PUMPS proceed as follows: a) Remove any aerators or screens attached to the outlet. b) Thoroughly flush tap or pump by allowing water to run freely with a fully opened outlet for three Or four ~inutes. c! e) Reduce fk~w so that small stream flows. Remove bottle from mailing tub~. Hold bottle in one hand while removing cap with the other. Avoid touching the neck of the bottle and the inside of the cap. ' ' Fill the bottle to its shoulder while attempting to avoid splashing. Immediately replace cap, being sure that it is tight, but not so tight as to split the cap. f) - Complete the portion of thelab fo~m ~vhich is indicated "TO BE COMPLETED BY SUPPLIER;°' Fill in all appropriate blanks carefully, including your public water system identification number (ID No.). Contact the Alaska Department of Environmental Conservation if you do not know your ID number..(Public water suppliers only) g) Pack bottle carefully in mailing tube with lab form. ': The requirements for analysis of .public water systems for total coliform bacteria are defined in the Drinking Water regulations administered by the Depart[~[ent of Environmental Conse~vatlon. W.~ling Erickson P.0.Box 10-1921 South Station Anchorage, Alakak~, 99511 Tobben Spur land P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 AtUNICIP^[I~y OF ANCHO~GE 0~b CF9,' *.198d ENVI~oNMLN LtL; :' OT~CTION FEB 9 198l RECEIVED SEWER ADEQUACY TEST Legal: Location: Residence: Water System: Sewer System; Date of Test: Test Procedure: Lot 3, Block 6, South Lakewood Hills Corner Michican and Wildwood W.Erling Erickson Tw~ Storey, Four Bedrooms, Built in 1972 On Site Well From Municipal Records: Tank 1350 Espinoza Concrete Absorption System Drainfield 100 feet long, 6 feet wide 12 inches of gravel Totsl effective absorption Area. 600 f~.sq. Soil Rating 150 Feb. 5, 1981 System was inspected on Feb. 3, 1981. No vents on drainfield. Tank was installed approximately 15 feet higher in elevation than the field. ~O feet of cast iron pipe connects the field and the tank. 0n Feb. 5 water at a stedy state of 9 gal per min. was introduced to the tank. The following readings of the water level in the tank weze observed. Time (Min) Water Volume (gal.) Depth ( X~ches ) o o 61~ lo 9o 6~ 15 135 6~ ~o ~8o 6~ ~ 27o 6~ 60 ~ 60' 75 675 60 · There was a 2~ inch layer of scmn floating on the liquid in the tank. This Layer was waahed away by the inflowing water. # Tobben Spur~land P.E. W. ErlfnE E~ickson two Test Result 675 g~l. of w,~ter w~s introduced into th system. This is more than ~0~ of the voids in the gravel when installed. If the c[reinfield ih faili~'-it can be ex"pected that more than ~)~ of the voids, would be filled with wqter. Since the voild are still ther the system must be operatin~ properly. Ther was no sign of surface flow fro~ the drainfield. MARVIN BEYER 1750 DIMOND BLVD. ANCHOPJ. GE, ALASKA Mr. ~illiam E. Erikson Box 1547 SRA Anchorage, Alaska 99502 Subject, soil Test Lot $ Blk.6 South L~k~Ood Hills Sulk. C ~tl gn~n I On August 5, 1972 a soil test pit wac excavated on the ~tbJect property in tbs location of tbs proposec~ seepage pit. This pit was excavated to a depth of 12'-6" axed the coils logged. Ail mea~araments are from ground surface. 0"-8" Organic ~"-$6"d Sandy.Silt, ~ 2k~'~ ~6'-50" Cr~velly ~and ,SP '~ ~.~..$' 50"-60" Sandy Silt, MJ~ % v % · '- ~ ' --60"-67" Cravelly ~and, SP ~¢ -- 5 : -,y' 67"-150' Gravelly Stir, ML~,F No percolation tests were made. The this layer of gravelly sand fA'om ~6~ to 50" and from 60"to 67" appear to be good for percolation zo toh seepage pit should be in this zone. Pl~se contact me if there are any question. V~y Yours,/~ Marvin Be~, P.E. ~_lasP~ Reg. #14~5E