The URL can be used to link to this page

Home My WebLink AboutLAKEWOOD HILLS LT 17ALakewood Hills Lot 17A #015-122-25 -w ►.w o a - / Municipality of Anchorage •� Development Services Department •_'' __"_ Building Safety ' Division Onsite Water 8 Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ek.us (907) 343-7904 Page 1 or 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW000469 PID Number. 015-122-25 Name: SAM NEWBY Wastewater System: ■ New ❑ Upgrade Address: 10200 HILLSIDE DRIVE ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-6112 4 ■ Deep Trench a Shallow Trench Dead ClMound alxher LEGAL DESCRIPTION s 0.45 Taa Depth an ery„y grad,: erd/sg. R (8.64-9.56)/(8.0-9.54)R Lot Block Subdivision: 17A - LAKEWOOD HILLS Depth to pipe botte.n dam origkal g,ay: (2,62-3.54)-(2.01-3.55)R Gavel depth bwwath pp. 6.0/6.0 Township: — Range: — Section: _ ra aad.d stews wlgthd pude R grow wnpu. SEE DWG. R 120' TOTAL (2 ® 60')n WELL: ■ New ❑ Upgrade craw wlauc2 5 woe.. a shwa: Drlawe b.tw..n Anw: 12 Cbrrwliwr prhatw A&C : D.pN: Co.M is Tobi PRIVATE 206 206 Tote absorption area R 2 R pip. a neem: R R �' 1440 so. R ASTM D -3040/F-810 D.b DrgM Stoup Maly lewd ALPINE DRILLING 11/29/00 124 rL DERS CONSTRUCTION 11/2 /00 - 11/28/00 Tl.ld: Awnp sat At: C -Ing Height Ate.. assns: 40 UNKNOWN 2 .it an 'I'S TANK gpy n. R SEPARATION DISTANCES ■Septic 0Holding 13S.T.EP. 13 Other To prem Septic Tank Absorption field LNt Station Holding Tank /Pnwab sewer urw mrOCb"w' ANCHORAGE TANK Cep..lpr In g.U": 1250 Well 1000+ 100'+ — — 25'+ mat'dk STEEL a cw,.Porb b: 2 Surface Water 100'+ 100•+ — — — LIFT STATION Lot Line 5'+ 10'+ _ _ — 5ki in ge"e"s bwwr«anr. Foundation 5'+ 10'+ _ _ _ en lnwl °t ° a: wgh wmw eenn a, Curtain Drain dept 0-An`d k -P-5 s p rfte—wd br: NONE Remarks: BENCH MARK toeptbn dna Dwpnplba BOTTOM OF SIDING AT POINT "B" Manned a.walien: 102.82 R [NoesTE" WAL �o�op 4 o OF 0p Inspections performed by AWWC, INC. Dates: 1st 11/27/2000 2nd_ 11/27/2000 3rd 11/27/2000 4th11/28/2000 e ..A ••••• •ess: Department of Health and Human Services approval E-7953 ;'*d'`G Reviewed and approved by: � Date• �44p°a � Itw. t P oressto c ��00000� PERMIT SWONUMBER: ASID DRAWING PARCEL IDNUMBER: SW0OO469 015-122-25 UNAMED RIGHT—OF—WAY r—� I I ISI I TH/z I 1 I I I ALTERNATE SITE. \ WILL REQUIRE A — LIFT STATION AND 31.14 AN ISF OR A 13' DBL1 X 50' BED. DBL2 --% EXISTING FOUR BEDROOM HOUSE l SPLITTER (FS) GENERAL LOCATION OF EXPLORATORY TEST ROLE NO GROUNDWATER, IMPERMEABLE SOILS. OR BEDROCK TO 17 FEET. THE BOTTOM 3 TO 4 FEET OF THE HOLE WAS SANDY SOILS. 2/13/2001 --OF DRAWN 8Y: ALASKA NNATER & WASTE NVATRR C.J.G. o CONSULTANTS, INC. sem: Q e ; 4 ....... evol oreeRR Rom su.e to • ux�eRece. ex Musa. • rP°Ne ooTpe s�nv -rm ex vusea1" — 30' p ... rce — Q PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q SAM NEWBY (907) 345-6112 2 OF 3 f ey LEGAL DESCRIPTION: 40& J C 7953 LAKEWOOD HILLS SUBDIVISION; LOT 17A, •• SE OF WORK:AS—BUILT DRAWING FOR NEW WELL LOCATION AND SEPTIC SYSTEM 4�D�p'OFaestoo � 0000� w A I B C ST1 24.961 19.72 — ST2 31.14 14.46 — DBL1 37.16 14.75 — DBL2 39.07 15.86 — FCO 12.98 18.96 — FS 40.08 17.11 — 001 37.74 31.29 — MT1 35.89 27.64 — 0O2 — 38.91 136.26 MT2— 33.40 34.05 CO3 53.23 42.36 — Mi3 54.89 41.36 — 004 — 47.95 52.17 MT4 — 46.02 152.49 EXISTING FOUR BEDROOM HOUSE l SPLITTER (FS) GENERAL LOCATION OF EXPLORATORY TEST ROLE NO GROUNDWATER, IMPERMEABLE SOILS. OR BEDROCK TO 17 FEET. THE BOTTOM 3 TO 4 FEET OF THE HOLE WAS SANDY SOILS. 2/13/2001 --OF DRAWN 8Y: ALASKA NNATER & WASTE NVATRR C.J.G. o CONSULTANTS, INC. sem: Q e ; 4 ....... evol oreeRR Rom su.e to • ux�eRece. ex Musa. • rP°Ne ooTpe s�nv -rm ex vusea1" — 30' p ... rce — Q PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q SAM NEWBY (907) 345-6112 2 OF 3 f ey LEGAL DESCRIPTION: 40& J C 7953 LAKEWOOD HILLS SUBDIVISION; LOT 17A, •• SE OF WORK:AS—BUILT DRAWING FOR NEW WELL LOCATION AND SEPTIC SYSTEM 4�D�p'OFaestoo � 0000� w PERMIT SWONUMBER: A S -BUILT DRAWING P 015 ID NUMBER: SW000469 015-122-25 FaL FNH. am 'loll sn srz XFGF T" rW OF TAM Af FW- 91.9 AfOUtLEf - 91.96 Af Utf - 91.42 SOUTHW TR CH NM I M CtUON 5MIC TANK v>zra�ol,vu Af ODUf - 91.0 NORTHEAST TR H 89.52 (AV0 - 9011(AV0 DATE opdo4� y, ,_ 1/9/2001 ALASKA NNINFLR & NNASTIM'A'I'LR5�E C.J.C. CONSULTANTS, INC. 6901 OFRARR ROAD, $UTE 29 - ANCHORAGE, AK 90504 - PNONF (007)117-0170 - 1" (907)33"246 N.T,S. PREPARED FOR: PHONE NUMBER: PACE NUMBER: SAM NEWBY (907) 345-6112 3 OF 3 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION, LOT 17A, TYPE OF WORK: PROFILE AS -BUILT OF NEW SEPTIC SYSTEM 10 am 9967 c C 7953 4 Fran : ALPINE DRILL 907 345 0202 Jan.27.2001 06:40 AM Pot Hick Mystrom Mayor Municipality of Anchorage Department of Health and Human Services 825 *0 Street P.O. Box 708850 Anchorage, Alaska 99519-6650 dap:" WO.anchaaga ak.uc Permit Number: 4SW00 0469 Date orlssue: 11-6-00 Parcel Identification Number: 01 1 ,25 - Date Started: 11-28-00 Date Completed: 11-29-00 Is well located at approved permit location? ® Ya No Legal Description: Lakewood Hills Lt 17 A Property Owner Name &: Address: Sam Newby 12929 Tracy Way Anchorage Ak 99516 Borehole Data: Soil 7ype,Thickness & Water Strata stick-up Depth (ft) From To 0 2 Method of Drilling ® air rotary ❑ cabletool Caging type: steel Wall Thickness: .02.5 inches sill 2 21 Diameter: ¢ inches Depth: 206 feet silty gravel 21 65 Liner Type: sandy sill silty cobbly gravel silt cobbly gravel sill 65 81 115 143 167 81 115 143 167 183 Diameter: inches Depth: feet Caging stickup above ground: 2 feel Static water level (from ground level): 124 feet Pumping icvcl:-LO-6fcet after 2 hours pumping n gpm Recovery Rate: 40 gpm silty water sand & gravel 183 188 Method of Testing: airlift gra vellysilt 188 195 Well Intake Opening Type: water sand & gravel 195 206 ® Open land ❑ Open Hole ❑ Screened Start foot Stopped foot ❑ Perforations Start foct Stopped feet Grout Type: Renfeyqte N 8 Volume: Lbg Depth: Start0 feet Sloppod + feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller: Alpine Drilling & Enterprises P O Box 110496 Anchorage AK 99511 Attention: The well driller shall provide a well Ing to the property owner within 30 days of completion and the property M\TIY IM 0\n YMII 41,11" #hall ntn\/I/IP 0 \\•AI IAO In \h. ni t of ".1\h R• human C"\$n" u•:th:n An A.,,& of LnInnlM:nn MUNICIPALITY OF ANCHORAGE Department of Health and Human Services Onsite Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ONSITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number. SW000469 Legal Description: LAKEWOOD HILLS LT 17A Design Engineer. 0041 AK Water & Wastewater Consulta Owner Name: Sam Newby Owner Address: 12929 Tracy Way Anchorage , AK 99516 - Date Issued: Nov 06, 2000 Expiration Date: Nov 06, 2001 Parcel ID: 015-122-25 Site Address: 010200 HILLSIDE DR Lot Size: 51964 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of: ❑✓ Disposal Field ❑,/ Septic Tank ❑ Holding Tank E] Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: 11 -7 -co Issued By: �/ W. i 'ten ✓( Date: / /- 6 -0 0 ALASKA WATER & WASTEWATER CONSULTANTS, INC..,.. October 30, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 RECEIVED NOV 0 12000 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Ref: Well and Septic Design for Lakewood Bills Subdivision; Lot 17A To whom it may concern: The proposed 4 bedroom house will be served by a private well and septic system. Two test holes were excavated on the property to find an appropriate location for the septic system. The proposed septic system will be designed within the 30 foot radius of test hole #1 (south hole). We are proposing that a 1250 gallon septic tank and dual deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.45 gallons/day/f12 should be used. 2. TRENCII DESIGN: a. Percolation Rate: 43.6, 60, <l, & 69 minutes/inch b. Allowable Application Rate: 0.45 gallons/day/f12 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1,333 f12 f. Total Depth: 9 feet (max.) g. Effective Depth: 6 feet It. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 120 feet long k. Effective absorption area = 1440 ft2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the property is generally flat. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, hvo soil logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Dcbarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com ii i i I i I I I LOT 188 I I LAKEWOOD HILLS S/D I 1 ciq�ry I O~J' II 1 1 1 LOT iflA I LAKEWOOD HILLS S/D I I r----------------- I I I L r+ `-VACAHT 1 1 1 1 y\ I LOT 7 HILLSIDE PARK S/D i lt ( _UNAMED RIGHT-OF-WAY_L 1 I i I ~ I ,44 PROPOSED ' / I ALTERNATE SITE L\\ WELL i ALJ HILLSIDEOPARK S/D 1 1 I PROPOSED O BEDROOM HOUSE Ld I' Q i I I I I I I I I I I 1 I r it I HILLSIDEOPARK S/D 1 I 1 PROPOSED SEPTIC I I ' I Z 1 SYSTEM. SEE PAGE 2 1 I I p 1 OF 2 FOR DETAILS I LOT 10 I 1 I ry 11LLSIDE PARK S/D :2 0 , , Ld U I I > I I Do LOT 11 LOT B o HILLSIDE PARK S/D I LAKEWOOD HILLS S/D Ld r� I VACANT I I I J I I SIO HILLSIDE PARK S/D LOT is LAKEWOOD HILLS S/D 1 - JY DATE: 10/30/2000 DRAWN BY: ALASKA NATER 8 AVASTKAVATRR K.D.W. SCALE:y, CONSULTANTS, INC. :. 6001 DER4RR ROAD, SUTE 2R ANONOR4GE, AK 09704 - PHONE (901)317-0179 - FAX (907)358-3246 1 = 100' ............. L � 9 �� 1. PREPARED FORPHONE NUMBER: PAGE NUMBER: SAM NEWBY (907) 345-6112 1 OF 2 A G�,, fr A. arness, F. VVA 4'q -7953 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION; LOT 17A 4yVti�e4\F' TYPE OF WORK: SITE PLAN FOR DESIGN OF SEPTIC SYSTEM AND WELL LOCATION a^y^djDro UNAMED RIGHT—OF—WAY r --n I TH12 I I I I ALTERNATE SITE. �--� WILL REQUIRE A LIFT STATION AND AN ISF OR A 15' X 50' BED. PROPOSED DRAINnmm-A' EXCAVATE TWO TRENCHES THAT ARE 9 FEET DEEP. BY 2.5 FEET WIDE. BY 60 FEET LONG EACH. ADD 6 FEET OF CLEAN. WASHED SEWER DRAINROCK. PRRSED FOUR BEDROOM HOUSE l INSTALL FOUNDATION CLEANOUT - PROPOSED 1250 GALLON SEPTIC TANK INSTALL DOUBLE CLEANOUTS INSTALL FLOW SPUTTER r� 0 Li 0 ;. tea++ �tSpp0 ALASKA 117ULR & «'AS'I EN T sR CONSULTANTS, INC. 6001 DFRA ROAD. SUTF M - ANCHORAGE. AK 09564' i ORF (997)331-6119 • FAX 907)336Ji46 10/30/2000 o F opp ap N • •• ' " ••"y Q ; f ey Garness; Da •' • C 7953 pk� �0n� ' . ••' .Fd `14�^epp•••••••••'ood DRAWN BY: K.D.W. SCALE: = 30• PREPARED FOR: PHONE NUMBER: SAM NEWBY (907) 345-6112 PAGE NUMBER: 2 OF 2......••• LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION; LOT 17A TYPE OF WORK: DESIGN OF SEPTIC SYSTEM AND WELL LOCATION pp000F000'�600 ALASKA WATER & WASTEWATER CONSULTANTS, INC. I SOIL LOG - PERCOLATION TEST I LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION; LOT 17A PERFORMED FOR: PAT ADAMS DATE PERFORMED: 7/6/99 SOUTH HOLE DEPTH ____ (feet) ORGANIC TESTHOLE # 1 1 (PACE 1 OF 2) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 •. SOIL CLASSIFICATIONS DATE 1GWI ORG ink.. IIIIIIIIIML 7/15/99 SP ��Iil!11 CL GC OL IIIIIIIIIMH ' %//%CH i}111131SM • Sc ML/SM DEPTH TO GROUNDWATER DATE DRY 7/7/99 DRY 7/15/99 DRY 10/25/2000 PERC. HOLE WAS PRESOAKED 4+ j +TH12 I I i I {THJ1 i 1 I I I I I I ESTHOLE LOCATIONS I I E GENERAL 11 DATE READING CLOCK TIME NET TIME I (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/13/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 4:11 — 6 — 2 4:41 30 5 9/16' 7/16- 3 4:42 — 6' — 4 5:12 30 5 1/2- 1/2' 5 5:12 — 6' — 6 5:42 30 5 1/2' 1/2' 19 PERCOLATION RATE 60 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 40 TEST RUN BETWEEN 2.5 FT. AND 3.0 FT. COMMENTS: PERCOLATION DATA ON THIS PACE FOR UPPER BENCH PERC. HOLE ONLY. PERK TEST IN UPPER BENCH WAS PERFORMED IN LOAM MATERIAL. PERFORMED BY ALASKA WATER & WASTEWATER. I. JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RM D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: f0140 IM ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE 2B • ANCHORAGE. AK. 99504 PHONE (907) 337-6179 • FAX (907) 336-3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION; LOT 17A PERFORMED FOR: PAT ADAMS DATE PERFORMED: 7/6/99 SOUTH HOLE eet) ITESTHOLE #1 1 (PACE 2 OF 2) 7- 8— 8 z 0 9 t H 0 10 = 0 12 1i z 0 13- 14- 15- 0 314150 N 16- 17- 18- 19- 20- COMMENTS: 6 17181920COMMENTS: DATE 2 SITE PLAN - - -- I I' = 100' j +THS2 I I I TH#1 I I I I I VE GENERAL LOCATIONS I E GENERAL I I I I I I I i I I I DATE READING CLOCK TIME (MIN./INCH) SOIL CLA I ATI• NET DROP (INCHES) 7/13/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING LOWER BENCH PERC. 1GW 1 •- — 6' — 2 1GPIIIIIIIIIMIL 30 5 5/16' 11/16- 3 4:45 — 6' — 4 GMCIL 30 5 1/4' 3/4- 5 5:17 — 6' 0206--%'T 6 5:47 NNH •IIIIIIIIIMH 11/16' !$SP%//%CH ;Ills:sl • SC 7- 8— 8 z 0 9 t H 0 10 = 0 12 1i z 0 13- 14- 15- 0 314150 N 16- 17- 18- 19- 20- COMMENTS: 6 17181920COMMENTS: DATE 2 SITE PLAN - - -- I I' = 100' j +THS2 I I I TH#1 I I I I I VE GENERAL LOCATIONS I E GENERAL I I I I I I I i I I I DATE READING CLOCK TIME (MIN./INCH) I NET TIME (MINUTES) I WATER LEVEL READING NET DROP (INCHES) 7/13/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING LOWER BENCH PERC. HOLE ONLY. 1 4:14 — 6' — 2 4:44 30 5 5/16' 11/16- 3 4:45 — 6' — 4 5:15 30 5 1/4' 3/4- 5 5:17 — 6' — 6 5:47 30 5 5/16' 11/16' PERCOLATION RATE 43.6 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. PERCOLATION DATA ON THIS PAGE FOR LOWER BENCH PERC. HOLE ONLY. PERFORMED 9Y ALASKA WATER do WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFOR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: N ALASKA WATER & WASTEWATER CONSULTANTS, INC. I SOIL LOG — PERCOLATION TEST I LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION: LOT 17A PERFORMED FOR: PAT ADAMS DATE PERFORMED: 7/6/89 NORTH HOLE (feet) ORGANIC TEST HOLE #2 1 — (PAGE 1 OF 2) LOAM 11 SOIL CLASSIFICATIONS SP q::<o-'. GW r ORG SITE PLAN I' = 100' ' — GP ML GM CL 1 ♦TM#2 I 4 GC OL ML/SM °, •�•� SW MH I I 5 '• •'• SP CH I } SM OH I I 6 SC I I 4TH# 1 I I I 7 DEPTH TO GROUNDWATER DATE I I I TESTHOLE LOCATIONS I E GENERAL a DRY 7/6/99 DRY 7/15/99 1 I 9—DRY 0/25/2000 I I 10- 0 11 -4 h I f11f1 cM/sM 12- 13- 14- 15- 16 213141516 B.OR 17 19 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 7799 P��EO �0�� P�c�O 19� PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20 TEST RUN BETWEEN 2.5 FT. AND 3.0 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR UPPER BENCH PERC. HOLE ONLY. PERFORMED BY ALASKA WATER do WASTEWATER. I. JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PERFQRMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON ALASKA WATER & WASTEWATER CONSULTANTS, INC. MMC. M. OiJVt PHONE (907) J37-86 7179 FAX (907) 338-3248 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION; LOT 17A PERFORMED FOR: PAT ADAMS DATE PERFORMED: 7/6/99 NORTH HOLE (fPTti eet �� TEST HOLE #2 1 (PACE 2 OF 2) 2 6- 7— z 7 z 0 9 z Lq 0 10- 11 0 11 J2 o: 0 12 z 0 13 S 6= 14 vV)j U 15 0 N 16 0 17 18 19 20 DATE SITE PLAN _ _ -- 1' = 100' j JHJ2 1 I I •. I IIIIIIIII Imm > NET DROP (INCHES) I E GENERAL 1 PERC. HOLE WAS AM*, N/NHS • LIMIIIIIIIII RAM R!ilit�l 1�'.dB • mow. 1 4:16 DATE SITE PLAN _ _ -- 1' = 100' j JHJ2 1 I I CLOCK TIME I �THj1 I I I NET TIME (MINUTES) I I ITESTHOLE LOCATIONS NET DROP (INCHES) I E GENERAL 1 PERC. HOLE WAS I 1 I 1 1 I HOURS PRIOR TO TESTING DATE READING CLOCK TIME PERC. HOLE DIA. 6 (INCHES) I NET TIME (MINUTES) I WATER LEVEL READING NET DROP (INCHES) 7/13/99 PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING 1 4:16 — 6- — 2 4:46 30 5 5/8' 3/8' 3 4:47 — 6. — 4 5:17 30 5 1/2' 1/2' 5 5:17 — 6. — 6 5:47 30 5 9/16' 7/16' PERCOLATION RATE 68.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6.0 FT. AND 6.5 FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR LOWER BENCH PERC. HOLE ONLY. • PROBABLY STILL RECOVERING FROM PRESOAK. PERFORMED BY ALASKA WATER k WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED/ IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I. D. 015-122-25 1. GENERAL INFORMATION Expiration Date: Complete legal description Lakewood Hills, Lot 17A 7-�25--1 �L Location (site address) 10200 Hillside Drive Anchorage, AK 99507 Current Property owner(s) Ronald M. Handran Day phone Mailing address Real Estate Agent 921 S. Shelley Lake Lane Spokane Valley, WA 99037 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Date: f Received by: 1 f A ! COSA to be released?to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5;* Date of Payment 'f l a; Zjj -i Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number 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 Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 522-7773 Date 4/21/2014 p w F 4- F k f z.y=`rl 6. DSD SIGNATURE e'� 1� System #1 Approved for bedrooms System #2 Approved for bedrooms Y PP Disapproved Conditional approval for bedrooms, with the following stipulationsr zr-A'—P2 PROGRAM By: I ` Original Certificate Date: 4 Th i all, of A orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represent ons 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet r .. c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _Of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Lakewood Hills, Lot 17A A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 11/29/00 Sanitary seal (YIN) Y Total depth 206 ft. Cased to 206 ft. Date of test Static water level Well production FROM WELL LOG 11/29/00 WATER SAMPLE RESULTS 124 ft. 40 g.p.m. Coliform 0 colonies/100 mL Nitrate 6.95 mg/L Arsenic N/D ug/L Date of sample: 4/8/14 B. SEPTICIHOLDING TANK DATA Parcel ID: 015-122-25 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 4/17/14 120 ft 7.4 g.p.m. Collected by: Anderson Engrg. Tank Type/Material Septic/Steel Date installed 11/27/00 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) Date of pumping 4/8/14 Pumper A Plus Home Services C. ABSORPTION FIELD DATA Date installed 11/27/00 Soil rating.45 GPD/SF Deep Trench (g.p.d./flz or fiz/bdrm) System type Length 2 @ 60 ft. Width 2.5 ft. Gravel below pipe 6 ft. Total depth 9 ft. Eff. absorption area 1,440 if Monitoring tube Y Depression over field N Date of adequacy test 4/17/14 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 50/62 in. Water added 1,000 gal. New depth 59/71 in. Elapsed Time: 1,440 min. Final fluid depth 50/62 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off' level at Datum Cycles tested Manhole/Access (Y/N) in. High water alar level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A , Animal containment areas > Manure/animal excrete storage areas >100 SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 Water main > 10, Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Absorption field >51 Surface water >100' Water main _ N/A Driveway, parking/vehicle storage > 10' G. ENGINEER'S CERTIFICATION �As�k,0-t%% I certify that I have determined through field inspections and s�� °.. •. X80 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 0y Michael E. Anderson, P.E. 00 Engineer's Printed Name f ' 0..... . Date . 4/21/14 =�. MICHAEL E. ANDERCON d*t� ✓i ;. CE -438] COSA brown sheet -1 0-1 0-12.doc Municipality of Anchorage xL Community Development Department a Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141145 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 17A of Lakewood Hills subdivision. This inspection revealed a nitrate concentration of 6.95 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. G,S J: Municipality of Anchorage \�/l.�O• •6. Development Services Department Building Safety Division � • • - ; Onsite Water and Wastewater Program S. , L 1 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsde (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. - 015(2225 COSA# ,)t0Wgcj v Expiration Date: S 1. GENERAL INFORMATION Complete legal description LBKr wood "Is Lot 1-4 A Location (site address) totoo %AMsiAr- Drive. A& qq51(0 Current Property owners) 3� efnM KA- DOOLA A0,D Day phone Mailing address Lending agency Mailing address Day phone Real Estate Agent F049, Sarrea k Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site RQ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of OnSfte 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 Onsite 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 dale 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 Address Engineer's Printed Name 'fo66&„ one 27q•391to Date ...,'C� OF 5. DSD SIGNATURER .T ✓ Approved for bedrooms. f� Disapproved. Condifional approval for bedrooms, with the foll wing stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By ��W • Original Certificate Date: 2,— oZ - G (Rr. I IMS) Municipality of Anchorage • Development Services Department Building Safety Division Onsite wafer a wastewater Program 4700 Bregaw Street P.O. Box 196850 Anchorage, AK 99519-850 www.muni.orglonsite (9D7) 9437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LooDeaaiption: L%kewe" RAI., Ltk ISA Parcel►D: ol5-las �s A. WELL DATA wel MMI -M16- If A. B, or C provide PWSID 4 = Well Log (YM) Y Date completed IL9-Oo Sanitary seal (YIN) wires property protected (YIN) y, Total depth 1216 rt. Cased to 40 t. t. Casing height (above ground) 16 in. FROM WELL LOO AT INSPECTION Date attest 11-29-00 I1%S,j2& Static water 1" 124 fl, l25 fl. Well production -i0 O.P.M. 5 9 -P.M. WATER SAMPLE RESULTS: Cditom�col,71es/100 mL Nitrate -I& mglL Other bacteria coloniesl100 mL L Amok:0 Date of sample: 1 Sot: Collected by: dare Spt r itla„a B. SEPTICINOLDINO TANK DATA Tank Type/Meterlel er.1 Date installed o Tank size 1250 gal. Number of Compartments Cleanouts (YM) Y Foundation deanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) A/ Date of pumping r2 Pumper Arewal Ac tlotk 134y.R;cur C. ABSORPnON FIELD DATA Date i stallad J4jj[0A Soll rating (g.p dAe orferocirm)0�- .5 Systern type Drcn i'rrnt k Length 40, x 1 n. WIft 2.5 fl. travel below pipe 61.0 6.0 n. Total depth _-L—ft. Eft. absorption area liglVe Monitoring tube Y Depression over field _/ Date of adequacy test 2bLoc, Results (Pass/Faiq _11__ For -I- bedrooms Fluid depth In absorption field before teat y0 kn. water added 000 gal. New depth 3 _9(v In. Elapsed Time '� min. Final fluid depth _k� W 5 in. Absorption rate >= 600 9.p.d. Any rejuvenation treatment (past 12 mo.) (Ymi a type) AWE Kn.wn It yes. give date D. UFT STATION Date installed Size In gallons Manhole/Access (YM) 'Pump an level _ kn. 'Pump =1,,SA lo. High water alarm levo in. Datum Cycles Mesta alarm & it repuiraments9 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankNR station on lot + 100' Absorption Reid on lot +IccI On adjacent lots + tco On adjacent Iota + loo ' Public sewer main /NIA Public sewer manhole/deenout N/� A Sewer /septic service line +251 Holding tank A414A Animal Contelnment areas #100' Manura/animal excrete storage areas + too' SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO Building foundation + 5 ' Property one + lo' Absorption Reid +511 Water main 6 ,A Water service one + 2 5 ' Surface water #100 Wens on adjacent lots + loo' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property one + lo' Building focandation + IG' Water main N/JA Water Service line 4-150' Surface water 4 100 Driveway, parlrungfvehide &forage a 2 5 ' Curtain drain N.0- Wells on adjacent lots t (DO F. COMMENTS: G. ENGINEER'S CERTIFICATION I car* that I have determined tluough field kup&cV ns and review of Munk*W records Mat the above systems are in conformance wfM MOA COSA guldeNnes in effect on M18 date. Engineer's Printed Name Tebber �y.klwwd Date Zfzofo(o( II� COSA Fee S -7 r �) 'C� > 'Ota Y� Waiver Fee S _ Date of Payment ` Zf9/ QV.0 `I I G b r Date of Payment Receipt Number[, �.. �(!{Sj Receipt Number (Rev. 1low OF q�Sl ,..AP.•••.... ,*:497N* rfw Municipality of Anchorage ,�*0a00 • Development Services Department::?`'; Building Safety Division ' - ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site System Approval # 060049 During a recent Certificate of On -Site System Approval inspection and test of the potable water supply well on Block , Lot 17A of Lakewood Hills subdivision, a nitrate concentration of 5.80 milligrams per liter (mg/L) was reported for the property's water well sample. The Environmental Protection Agency (EPA) maximum contaminant level (MCL) is 10.0 mg/L. Although the subject water well sample is less than the MCL, it is suggested that periodic testing be performed to insure the wells continued suitability. More information on nitrates is available from the On -Site Water and Wastewater Program, at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site System Approval. 02-C2-06:19:42 ; SGS ReLM 1060419001 Client Name TobbcnSporklandP.E. Project Nrme/M L6kewood Hli!s L17A Qiart Sample Lakewood Hi4'x L17A Matrix Drinking Water PwslD 0 Sxmelo Ronwks: - ':907 551 5301 21 < All Daer./Timu arc Aloka Standard Time hinted DetelTlme 07/0212006 15:04 Colireted Dat%Mme 01/:5/2006 IOAS Realved Dste/Tlmc 0125/200611.16 Teehaleal D;Mttae Stephen C. File -- Allovmble Peep Awls. Perenxter Results PQL WAS MOM ConttunarlD Lunits Data Dam Init Ni:nlc•N S.SO 0.100 mill EPA M.2 D (-101 01=6 IC Mwtsls by TCD/Y.s Aewwie 5.00 U 5.00 Mlasebi01e9_v Laboestory Tow; Co1:(umt 0 uS/L EP200.8 C 012WG6 M'011% Tr e0V100ml. SM2092226 A (o-1) 01.25/d6 TV I 67-151 LAKEWOOD HILLS SUBDIVISION LOT 17A 52,031 S.F. UNNAMED RIGHT-OF-WAY b N AI A9e5nmwr 9R0.51' N o`J-J4-vU"t Lov./J DECK BUILDING DETAIL SCALE 1"-20' AS -13U I LT WELL I CRAVEL 'I Im ENCROACHMENTS EXIST EXCEPT AS INDICATED. I DRIVE 1 I 4726 WEST 88TH AVENUE 6I I 1 APPEAR ON THE RECORDED SUBDIVISION PLAT. W)I I I I 68.9' I I TING I ESTABLISHING BOUNDARY OR FENCE LINES. DINGNDETAIL) 2/1/2006 ANCHORAGE RECORDING DISTRICT, ALASKA I(SEE 70.4• I '.FENCE (APX) I x b I I x 4i SEPTIC SYSfEY I / I L:�+ I I �I I �I I �I I I N o`J-J4-vU"t Lov./J DECK BUILDING DETAIL SCALE 1"-20' AS -13U I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC R IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.LS. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 4726 WEST 88TH AVENUE COVETS OR RESTRICTIONS WHICH DO NOT ANCHORAGE. ALASKA 99502 APPEAR ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRIDDATE HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. 2539 2/1/2006 ANCHORAGE RECORDING DISTRICT, ALASKA F.B. WH JOB N0. 00-15 No' NOTE NO CORNERS SET THIS DATE K 4.1 - CAW .� Q�.''OF.... ♦ ,k 0 49ILL * ; ....................... I n ' Jaastoldl : u e �• LS -6091 .' 1AV .0. IN -0�essionol �° 50' 3 1 11=40' moo\ 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-122-25 HAA# ��} (7 1 00 O g 3 1. GENERAL INFORMATION Expiration Date: 6-114-01 Complete legal description LAKEWOOD HILLS SUBDIVISION; LOT 17A Location (site address or directions) 10200 HILLSIDE DRIVE, ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SAM NEWBY Day phone 345-6112 12929 TRACY WAY ANCHORAGE AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well IN Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. L 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 AuthorityApproval Guidelines for this application, shows that the on-site water supplyandlor 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 Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Address 6901 DEBAR ROAD, SURE 2B ' ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AM C, Inc, attempted to provide a thorough, conscientious engineering anaysls of the system in accordance with ADEC and MDA DSD Guidelines d Regulations The reported results described the performance of the system under the conditions encountered at the time of the lost and separation distances measured to readily identifiable lea tures. fie operational fife of all wells and septic systems depend on the local sails condition, groundwater lovelS that may fluctuate during the year, and the water usage of the famly being served by the system. These conditions are outside the control of the evaluator of the system. Satislactory test results do not guarantee future performance of the system, nor do they guarantee Chet there are no hidden defects or encroachments. AMWV, Inc. can therefore not provide any warranty or future estimate of how long the system wilt continue to moot Me operational requirements of the ADEC or 6fOA DSD. The content of this report Is for the sole benefit of the owner fisted above. Any reliance upon or use of this report by any other person or party is not autirorized, nor will it caiforany legal right whatsoover. 5. DSD SIGNATURE _L,-"' Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Data D Manitenance Agreements Supplemental Engineer's Reort Other ,A,. Cad•••• O ON-SITE WATER AND WASTEWATER : PROGRAM ,....... By: &"'. / Original Certificate Date: 3 )'V — O 1 (ive. ince) Municipality of Anchorage ' Development Services Department Building Safety Division Onsite water tL wastewater Program 4700 South Bragew St. P.O. Boz 198850 Anchorage, AK 99519-66M www.cim1chorage.ak.us MM 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST eel7ec: Legal Description: LAKEWOOD HILLS SUBDIVISION; LOT 17A Parcel ID: 015-122-25 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 11/29/00 Sanitary seal (Y/N) YES Totel depth 206 fL Cased to 206 ft. FROM WELL LOO Date of test 11/29/2000 Static water level 124 ft. Well production 40 9.p -m. Wen Log (YM) YES Wires properly protected (YM) YES Casing height (above ground) 24 in. AT INSPECTION NEW N/A ft, N/A 9 - p.m - WATER SAMPLE RESULTS: Coliform 0 coloniss/100 ml. Nitrate 4.40 mgA-. Other bacteria 0 colonies/100 ml. Date of sample: 3/1/2001 Collected by: AWWC, INC. B. SEPTlC/HOLDINO TANK DATA Tank TypelMaterial STEEL Date installed 11/27/00 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA Date Installed 11/27/00-11/28/00 Soil raring .p.d fe/bdrrc)0.45 System type DEEP TRENCH Length 120' (2 ® 60')ft. Width 2.5 R. Gravel below pipe 6.0 ft. Total depth 10.6+/ -ft. Efl. absorption area 1440 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) - Fluid depth In absorption field before test= In. Water added=gal. Elapsed Time: = min. Final fluid depth = in. Absorption rate >_ For 4 bedrooms New depth =1n. g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - If yes, give date - D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklUft station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 58+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100•+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10,+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 50'+ Curtain drain N/A Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i cattily, that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineers Printed N me JEFFREY A. CARNESS Date 2 !i2!01 HAA Fee $ �1 Date of Payment Receipt Number (Rev. 12M) Waiver Fee $ Date of Payment Receipt Number 03-06-01 11:05 FRW-M ENVIRCN6ENTAL CUE Environmental Services Inc. AIL. ---------------.- m CTLEReLp 1011103001 Client Name AK Water & Wastewater Consultants Inc. Prole" Name/C Lakewood Hills Client Sample ID Lakewood Hills L17A Nairh Dtiaking Rater Ordered By PNI,S1D 0 5615301 T-337 P.02/03 F-974 CBent POC Printed Datdrlme Collected Date lime Received Data'rtme Technical Director Released By +yf 03i06i2001 15:22 0101,2001 13:30 03;021001 12:30 Stephen C. Edc NEPORM-1 Sample Rrmrks. All)weLle Prey Aealvsia p1minc,cz Ratilts PQL Lego hteCaal Untie Date Date Init Water@ Department Nitrate -N 4.40 0.500 mg/L EPA 300.0 10 trax 03/02101 SCL Microbiology Laboratory To:al Coliform 0 Y aoVIODmL SM159222B 03/Dni KAP