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HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 1 LT 5Lok¢ O' The
Hills East
Block I
Lot 5
#015-333-05
MUNICIPALITY OF ANCHORAGE
DE,,_ TMENT OF HEALTH AND HUMAN SERcS
Environmental Health Division J S
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Na e P71w.� DISTANCES
�� S ��, TO SEPTIC ABSORPTION
Address a FROM TANK FIELD WELL
/7-! � eu� Wb, S 17 C 7-16
Phonels) Permit No. No. of Bed oms WELL
V�
4 �-a� 1, V ery S7o,? -7 / i
LEGAL DESCRIPTION LOT LINE
Lot Block Subdivision- 0
°T��- �• FOUNDATION
Township, Range, Section
rJ', r--+C,rsrgr..2-3;
AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
/� — driveway, water bodies, etc) -
TANKS
SEPTIC ❑ HOLDING
Manufacturer Capacity in gallons
K��0
Material ..�r�sJ� No. of Compartments
57 %v jv 4'
TYPE OF SYSTEM
❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER v ,3
Depth to pipe bottom from Total depth from original grade O
original grade
FT FT
Fill added above original grade Gravel depth beneath pipe
FT FT
Gravel length Gravel width
FT FT �
Total absorption area - Distance between lines
SQ FT FT
Number of lines Soil rating Pipe material
SQ FT e,-77,
Installer Date Installed
a 4s1J el -,ii 10 13
WELLS
o d
11 PRIVATE El OTHER (Identity)
Classification (A,B,C) Total Depth Cased to 7F I
c6719�i. A FT FT
Installer Date Installed:
REMARKS: Y a.
Si:ale: ���' ENGINEER'S SEAL
""'�` d y' T •"'rn� ��� Inspections Performed b
Date:
onj 4*0 RP/eta li . I exa*ks
I — --A �% >
cattily that this inspection was performed according to all
Municipal and State guidelines in effect
t/on^this dale:
Health Department Approval: v Date: —L fl /
72-013 (3/85)
m
MUNICIPALITY OF ANCHORAGE
Desartment o� Health & Human Services
S25 L Street, AnchoraOe, Alaska 99501 343-4720
UN~SITE SEPTIC
lANK PERMIT
Permit Number: S70271
Upgrade
Date lssued: 10/O9/87
Owner Name: NORTH AMERICAN SAVINGS & LOAN
Day Phone:
Owner Address: 3120 S" HARBOR BLVD.
7l4~549~7300
SANTA ANA,CA 92704
Parcel Id: 15~333-O5
Lot Legal: �ubd visior�� LAKE8�THE� E,
Lot:
HILLS
5 8lock: 1 �
Section: 23 Township: 12N Range:
3W /
Lot Size 25034 (s�.�t, or acres>
Max Bedroom�: This Permit: 4 Total Capacity:
4
SEPlIll- TANK: Minimum Lotal se�tic tank
capacity:
1,250 gallons. Each
se�tic
tank must have at least 2 compartments, Depth to
top
o� septic tank<s>
< 4.0
!eet requires insulation over tank(s).
I CERTIFY THAT:
1. I am [amiliar with the requirements {or on�site
sewers and wells
as set
�orth by the Municipality o� Anchora�e (MOA)
and the StaLe o� Alaska.
2. I will instal] the s�stem in accordance with
all MOA codes and regulations;
and in compliance with the design criteria o�
this permit.
3. I will adhere to aIl MOA and State o/ Alaska
req:irements for the
set �ack
distanc�s trom an� existing well, wastewater
disposal system or
Public
sewerage system on this or any adjacent or nearby
lot.
4. I understand that this permit is valid �or a
maximum o{ 4 bedr�oms.
I
also understand that the capacity o� the total
system is 4 bedrooms
and
any enlargeme:t will require an additional permit.
Signed:
DATE:
.... ..... ____,__
(Owner) NORTH AMERICAN SAVINGS & LOAN
Municipairty
of
Anchorage
October 9, 1987
P.O. Bel 196650
ANCHORAGE, ALASKA 99519-6650
(907)264-4111
TONY KNO WLES,
MAYOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
Alan Wien
Alaska Environmental Control Services
1200 W. 33rd Avenue, Suite B
Anchorage, Alaska 99503
Subject: Lot 5 Block 1 Lake 0' the Hills Subdivision
Waiver Request WR87-059
Dear Mr. Wien:
Your request for a waiver of the 100 foot separation required between the
septic system on the subject lot and the lake to the south has been granted.
The separation distance between the lake and the existing absorption field has
been waived to 89 feet. The separation between the lake and a proposed
replacement septic tank has been waived to a minimum distance of 80 feet.
These waivers are based on your assessment that site conditions on the subject
lot will mitigate the potential of lake contamination in this case. Your
soils investigation indicates that a thick layer of peat lies between the lake
and the septic system which should provide excellent filtration of the
effluent. The house foundation and the topography in the vicinity of the
septic system should direct effluent away from the lake in the event of septic
system failure or overflow.
Given the fact that the existing absorption system is less than ten percent
short of the required design absorption area for a four bedroom dwelling, and
the fact that a recent adequacy test has demonstrated that the system is
easily capable of handling the design flow from a four bedroom house at the
present time, an enlargement of the absorption system will not be required for
approval of the septic system for four bedrooms. The volume of the septic
tank will have to be upgraded to 1250 gallons, however.
This waiver is valid for the existing four bedroom, single family dwelling.
This waiver does not apply to future upgrades of the system.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
cc Gus Andress, P.E.
Manager, On-site and Water Quality Programs
AE
CALASKA ��UIROWnTAL COnTROL S6401US, InC.
kS
Q Engineering & Enuironmental Studies
October 6, 1987
Municipality of Anchorage
Department of Health & Human Services
825 L Street
Anchorage, Alaska 99501
Re: Lot 5, Block 1, Lake 0' the Hills East Subdivision
The subject lot contains a 4 bedroom house served with community water and an
on-site sewer system. The sewer system, installed 10/22/84, was originally for
3 bedrooms. On 9/2/87, an adequacy test and Health Authority inspection was
performed. We found the separation distance to be 79 feet from the lake to the
tank and 89 feet from the lake to absorption area. On 9/30/87, a soil
investigation was done to upgrade the system to move it entirely outside the 100
foot setback from the lake. 3 testholes were dug all showing inadequate soil
for an on-site system. All holes showed 8 to 10 feet of peat with impermeable
silt below. This area, which is the only upgrade area available, is downslope
from a ridge that the existing trench was installed in.
The existing tank is 1000 gallon capacity. We propose to abandon this tank and
install a new 1250 gallon tank at 100 foot from the lake, as shown in the
diagram. As for the trench, 20 feet of it is within the 100 foot setback from
the lake with the closest point being 89 feet. The asbuilt shows it to be 5
feet wide with 7 feet of sewer rock with no credit given for the extra width.
Since the extra width and area exists, we request that you now approve credit
for the width which would make the total effective absorption area equal to 771
square feet. See attached calculations. For a 4 bedroom system, 824 square
feet of area is required making this trench only 53 square feet shy on area.
Referring to the attached adequacy test data, the trench had only a few inches
of water in the bottom at the start of the test. 475 gallons was added with a
total rise of 1.27 feet. Drawdown data shows that this bottom area of the
trench is capable of absorbing in excess of 1000 gallons per day.
Surface elevations were shot on the lake level and around the sewer system. The
area over the existing tank and the portion of the trench encroaching on the
lake slopes to the north towards the road. The bottom of the trench is at the
same level as the water in the lake.
Due to the conditions listed above „we request that you grant a waiver of 89
feet for the absorption area to the lake. The excessive amount of peat
surrounding the area will also provide excellent filtering of the effluent.
Based on the adequacy test results, we also request that you approve the
existing trench for 4 bedroom capacity. The only option available to increase
the effective absorption area would be to raise the trench with an additional 6
inches of sewer rock below the pipe. This would give an additional 54 square
feet of area, however, it may require a lift station if adequate fall can not be
maintained from the foundation cleanout. To avoid the lift station and still
raise the trench, the new tank could be installed approximately 10 feet to the
north of the existing tank if a waiver of approximately 85 feet could be
1200 West 33rd Auenue. Suite 8 . Anchorage. Alaska 99503. 907) 561-5040
granted. The new tank would be water tight with the inlet, outlet and manholes
adequately sealed.
If you have any questions, please call.
Sincerely,
k---_
Alan C. Wien
Engineering Technician
49 *®a
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/ SYMBOLS
/
SURVEY TYPEDRAINAGE
f O ELEVATION �.
Q AS- BUILT - NO CORNERS SET
�_ WOOD FENCE
❑ PLOT PLAN - AS -BUILT - LOT SURVEY -TOPOGRAPHY
-�T CHAIN LINK FENCE
❑ LOT SURVEY
NOTE: Fences are shown in their approximate
❑ RECERTIFICATION AS -BUILT - NO CORNERS SET
locations only.
;t is the responsibility of the builder or owner, prior to
LEGEND hub 8 tack -found E3 set
iron riper
cc.ns'ruction, to verify proposed building grode relative
pipe -found O set O
to finished grade and utility connections andto determine
brass Cap -found -set
'oe ex�s-ence of any easements, covenants or .restrictions
wh:rr do net appear on the recorded subdivision plat.
alum. cap -found a set e
i_c;t Survey CE-ti`icaFion
Pre or d by
BENCH or
INC.
1 here7y cer2ily'hW I hive
..�••,,,,,,=.'1.;',
Professional Land Serve ors
•u•veYed the ty shown
_.-.d
_
"`.-
Drawn by-
deocrt-ad hereon, and
.- ..
it '
Scale= 1" = 40'
WAS
1':c impro.e^ier`s s't,;o*ed
-t`, seen wiin:n t`.e pr-:rertY
of and dnat overl
.. u
.
Date Surveyed- 2/25/1985
Chocked e
d byREJ
on od)acon' or^i
!'•W.O.
a -d ta31 na in: rw - C�5 an
'•
� ... p c G. LSt,tae, p
Dote Drawn-
2/26/1985
Grid
2639
M -02E.'7:
of C`ICii"y, •t':r. J/
e :r c:h cn tt!a ; r:;ts in
Legal Description.
r a1sit;I (.I;., •?�i-.t-on
-
LOT 5, BLOCK 1, LAKE 0' THE HILLS EAST SUBDIVIS
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: SF3 ,���L' - DATE PERFORMED:
LEGAL DESCRIPTION:L-!rS/ L,*-vE U, 7 ,4<<r �r Township, Range, Section: -7-Ij Al jZ3A SES Zj
DEPTH - SLOPE SITE PLAN
(FEET)
1 '�-7�
2
3
X007 u�l=
4
5
6
7
8
9
R�
10
11
Edi
'i#
12-
21314
13-
14-
15-
15
16
16-
17
17
JR.
18
o 'R.IUY C. RFID, °o
295 c�
19
WAS GROUND WATER /O
ENCOUNTERED? �(
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Date:
20-j ...... j PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS
i
PERFORMED BY: �CS A, 1 AZ -L1 J A24--- CEF
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
79-nnR [Rau d/k51 .
IFY THAT THIS TEST WAS PERFORMED IN
9 -3.4 ��
(ENGINEER'S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: SGbreJ/C, DATE PERFORMED: 7
LEGAL DESCRIPTION: LSB/ 1/1rZ,,6;' // )�tL3 township, Range, Section:/I y,f–P,3 tom) Sg"% Z-3
DEPTH SLOPE SITE PLAN
(FEET)
2
3
4-
6-
7 67
8 /L/
9
10
11
12
i
i
13
14
E,�lD
WAS GROUND WATER /
ENCOUNTERED?
PjGGC/6RFr� �+� IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring? Date:
OF A
16
T H
17 ,e °
V Y•YooeY sae°
18
p Y
A a
00000.""
!w : Y C. REID
19 �4, CE - 2251
1
Reading Date Gross Net Depth to Net
Time Time Water Drop
Y9 YYC94
•OOOY
R. e At
0
20- �BgSaa��'E COLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS 5014- !46110 73r GZ-
PERFORMED BY: ' 2F'G5 A` ZJIE CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 2 -Jo /
—ef
w
Ul€ r ��
0a /�
�i• C4i1 a z; SEAL)
0 GO
•
Municipality of Anchorage 0oe eeeeo• o
;me o es
DEPARTMENT OF HEALTH & HUMAN SERVICES d
825 "L" Street, Anchorage, Alaska 99502-0650 : R C. RI ID, JR.
- Ce -2251 e
SOILS LOG - PERCOLATION TEST ®q�;'°
PERFORMED FOR: SEtpJ/C.E,' - - - DATE PERFORMED:
LEGAL DESCRIPTION:jsgtd`! jLLS . Township, Range, Section: -Al Z3,�J iff-e: y3
DEPTH
SLOPE SITE PLAN
- - -
(FEET) - -
1
2 FILL N
3 moi/
4-
5-
6-
7 567
8 ! �.
9
10
11
12-
13-
14-
15-
16-
17-
18-
191
213141516171819
Yr
WAS GROUND WATER
ENCOUNTERED? d
S
IF YES, AT WHAT L
O
DEPTH? P
E
Depth to Water After
Monitoring? Dale:
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND - FT
COMMENTS 1tolL r�tSyr: '�G j�,e �St-SJ?e� 9�fJ��'
PERFORMED BY:%2 I _ `CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: /7 -'50 —,?-7
72-008 (Rev. 41851 - - - - -
ALASKA ENVIROK ,cNTAL eoB L S /3 1-t s 67f..r7
CONTROL SERVICES, INC. SHEET NO. OF
1200 West 33rd Avenue, Suite B cJiE�
ANCHORAGE, ALASKA 99503 CALCULATED BY DATE 16'4-87
(907) 561-5040
CHECKED BY DATE
/2ALASKA ENVIRONM�II TAL JOe�e r
CONTROL SERVICES INC. wwom«o w o zi 7o a 15, of
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503 CALCULATED BY DATE 9"Z
(907) 561-5040
CHECKED BY DATE
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ALASKA ENVIROI,,, rXNTAL JOB
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B SHEET NO. CF -
ANCHORAGE, ALASKA 99503 CALCULATED BY DATE
(907) 561-5040
CHECKED BY
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264.4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
KNEW
AI-O3 PZ I J,. I?)LzizR
x`22 -/ol jr
❑ UPGRADE
MAILING ADDRESS
1,1220 C2on1 C:iP-CLkF 4MC14 t2 6i' 4K ciqs4s
LEGAL DESCRIPTION �Q(j
1 5- ISIC-L l 49 C- OP i I+I= j4aLI-S �12 N 23 Lv ScC LZ.
LOCATION
NO. OF BEDROOMS
1'iExLt=Ps 5 i
3
DISTANCE TO:
Well
CUMI�
Absorption area
Dwelling
'7 /
PERMIT NO.
81-16-738
U Y
W Q
Manufacturer C�j2 C (� 2
Material
No. of om artments
L P
wF
Liq. capacity in gallons
/� Q D
IF HOMEMADE:
Inside length
�._
Width_
Liquid depth
OOz
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= z H
Manufacturer
Material
Liquid capacity in gallons
O
W =
DISTANCE TO:
Well i
comij
Foundation f
Nearest lot line 3U1
PERMIT N
C./ 73 0
J - z
z w
No. of lines
Length of each line
5
Total length of lines .�
Trench width
ieMes
Distance between lines
~ ¢ H
Top of the to finish gradeI
Material beneath the
Total effective absorption area
nches
/5(, (j2-
Length
Width
Depth
PE RMIT NO.
e
Lu
(7
i i--
Type of crib
Crib diameter
Crib depth
Total effective absorption area
w °L
w
y
Well
Building foundation
Nearest lot line
DISTANCE TO:
•�---
�'-
Class
Depth
Driller a
Distance to lot line
PERMIT NO.
liq
Lu
Building foundation
Sewer lines_
Septic tank
Absorption area(s)
DISTANCE TO:
L
•�-
OTHER
T�t
PIPE MATERIALS
1L
TP
_
0303L/
SOIL TEST RATING
,ZI
a0& aZl/�iZ
30
INSTALLER
Ary, I�
C` sea-X1-(05 &X OJ
REMARKS
IE NU CPEDAT -O(L OXT iv D T N71
jlJsuk.^* aou ()wFk/Mr- U-1LD2lUE- PnffiCdL
G
i-
a k;=� kEzY t3o
TWc-P6CTED �7 91t n ��i TC i
d
IfJF
C i
AA u
C-i it
APPROVED DATE LEGAL
�,t,6IUf 21 '3 L( L t F(;/u (RKI= 0 F Tlk i1- �i5 TIzA) P-
x TANK MUST HAVE AT LEAST TWO COMPARTMENTS
1: certify that.
1.. 1 aun i;[mlliar' with the I'equirernf?ntsi 'ior ori--si.to sit:.vipr's arlu we'i.I<_i
forth by the M;.miCipal.ity of Anchor,age 0-10A) nri the St<,te of AI l'a:ika.
?. I wi.l1. 7.1i 'l. ial 1.1 'L 11 f_i iays.5'!'. E'in ii aC:coi"vl:1r`}Cf Shr i'C. hl ma .L 1. MO( C�(:f iJ?is ar"tu r{t-?s4"ilc't'L..:L C)ri';g
and in C:oonpli.3nC2 With tLir, uC_sigii C:: r'` 7.' L'er'?e, Cif this I:)L::�r'tinit.
1 ('d .i.l1. c�ul-,ei,e 'L•{;,) all MOA anC:1 tStevt.f.--..' of I'�lasfka r' E n%{i..t:i.. r e lmL:n is il�r, the ._.-ft
r. '.;r i:.. t.. ..
... s,... .,y ., '1
disstanCes Lr'ocn ::•iri'y' Exii-.3ting wC^ll1 .fiJsi=;tf:?!Mater dispos;.11 _aya(.t".m of (:.}�il "ic
saw(eratge- GySt.21n an t.hi,.5 or any ,-=tu..je=cemt or` noc'.trhy lat. -
4. 1 t.inuerstdnu that •1.his3 p(ermi.t is vall.0 for a rnaxi'DUCA of !:.)E'C1r 00MIS c'.riu
any r_an l�-:r cS r_1mc�nt will. r2r�uir(=._ln <acld itit.}nl permit. .
,T.F A !__:LFT STATION IS INSTALLED 11\1
I _.F. 'Y' C3 IL-='
6:" h Pi, 1.1 iL : = 6 0_:3 F,";° C-§ E
'THEN (1.) AN
E1..L::CTRICAL. F'ERMI'T AND
DEPARTMENT OF HEALTH AND ENV I RON
IENTAi_ PROTECT I ON
WILL_ hd0'1 BE
APPROVED WITHOUT AN ELECTRICAL
1325 I_ t:S'1•F:EEI_ n ANCHORAGE, (OFtACit=;
(;I<: 4 �:,i i :l
�V
tY
LO=i; 1.ElDONE ZAI
264_.aL72 3
ELECTR l:Clt?"d.,
SIC3NED
F,, E:- "!Cry"11 :A _ 1
APPLICANT-
f-`ERMIT NO-
S4C)7; S
1SSLJED BY
DATE ISSUED,,
�o: -3/29/8/1 I-
ea-.,,-✓ /��e;��-�e/ /i.�.'�� �..v
/J �
Xao--`--
AP171L.ICAN'fs
A1 ... BtERT J BIERRIA JR. �
V
_................ __ ........ .!.., ...............J^........._... �/
ADDRES- 3'-
12EI20 CRON CIRCLE
ANCHORAGES AK ?9515
CONTACT PHONE'
522-101:5
1_.EGA-L_ DESC"RI1='
SUBDIVISION- LAKE JIF THE HIL.L_3
E. [J]T. 5 BL_i_1(,V"1'':c
I
;ECTIONo ^' 101WNSL-111P. 12N
RANGE:" 3W.
LOT SIZE-,
2 C)UC) (SQ.1"T. OR ACf:E.,OD
MAX BEDROOMS'
_
Lint. -d below
are, the options �--vailable -11.o you
in cle==_,icJning, your,;Fptic
SysBtGrn. Choose the apt ion th n.t be2sst f i.LS yot_ r,
s34.'1'. E?..
_.. _. .... ..... ..•. __ --
._ ._.. _. __ ._. _._ __ ._ __ _. ..._ ._. _. _._ __
f<M: EE °;j i
_. _. __ _. .._ ..... .__ .•.. ._.. _... .._ •..
:1.•_x x.....13 @,.4 .. Dt F:;� IF
..._ .._ - ..._
V,,11
DEPTH TO PIPE
BOTTOM (L='•T'.) LL. 0
4. o 4. 0
GRAVEL. DEPTH
(FT„ ) 7.5
0.5 35 .5
TOTAL. DEF"TH (FT.)
11.5
C,5 7. 5
GRAVEL_ WIDTH
(FT. ) 2,, 5
22. ( C}
GRAVEL LENGTH
(1' T.) -112. (:)
42.0 67. ON
GRAVEL. VOLUME
(CL.J. YDS. 7 11.2
34. `3
TANK SIZE (GAL -S) 1.yc)()C).:) ' ''r
1.�t(10() (i .x 1,i+.'iC)C}.Cy .x..r.
SOIL._ RATING (SG..F"T. /BR) 206
01 c06
x TANK MUST HAVE AT LEAST TWO COMPARTMENTS
1: certify that.
1.. 1 aun i;[mlliar' with the I'equirernf?ntsi 'ior ori--si.to sit:.vipr's arlu we'i.I<_i
forth by the M;.miCipal.ity of Anchor,age 0-10A) nri the St<,te of AI l'a:ika.
?. I wi.l1. 7.1i 'l. ial 1.1 'L 11 f_i iays.5'!'. E'in ii aC:coi"vl:1r`}Cf Shr i'C. hl ma .L 1. MO( C�(:f iJ?is ar"tu r{t-?s4"ilc't'L..:L C)ri';g
and in C:oonpli.3nC2 With tLir, uC_sigii C:: r'` 7.' L'er'?e, Cif this I:)L::�r'tinit.
1 ('d .i.l1. c�ul-,ei,e 'L•{;,) all MOA anC:1 tStevt.f.--..' of I'�lasfka r' E n%{i..t:i.. r e lmL:n is il�r, the ._.-ft
r. '.;r i:.. t.. ..
... s,... .,y ., '1
disstanCes Lr'ocn ::•iri'y' Exii-.3ting wC^ll1 .fiJsi=;tf:?!Mater dispos;.11 _aya(.t".m of (:.}�il "ic
saw(eratge- GySt.21n an t.hi,.5 or any ,-=tu..je=cemt or` noc'.trhy lat. -
4. 1 t.inuerstdnu that •1.his3 p(ermi.t is vall.0 for a rnaxi'DUCA of !:.)E'C1r 00MIS c'.riu
any r_an l�-:r cS r_1mc�nt will. r2r�uir(=._ln <acld itit.}nl permit. .
,T.F A !__:LFT STATION IS INSTALLED 11\1
AN AREA
COVERED BY MOS; DU11_.1)Ih•IG CODES�
'THEN (1.) AN
E1..L::CTRICAL. F'ERMI'T AND
INSPI-.E.
MUST BE ('.i:"f II,El.D;; (2) AS"BL{:I:L.T
WILL_ hd0'1 BE
APPROVED WITHOUT AN ELECTRICAL
111SPECTION REPORT- AND (:.') THE
tY
LO=i; 1.ElDONE ZAI
L.ICE_EwTiICA_ 1\1w3EG
ELECTR l:Clt?"d.,
SIC3NED
Gr
DATE.
APPLICANT-
ALAI tJ T9TERRIA JLt.
1SSLJED BY
i
D'ATE.�
s/._.__. ___.._._...._.._._.._..__...__...._
............. _...
_................ __ ........ .!.., ...............J^........._... �/
-� . .. MUNICIPALITY OF ANCHORAGE
. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG - PERCOLATION TEST
17
SOILS LOG
gwe-73 y
PERCOLATION
TEST
PERFORMED FOR: DATE PERFORMED: '�/—,26
r
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. Oi5::.~'~:~-O.~
1. 'GENERAL INFORMATION
Complete legal description
· Location (site address)
Expiration Date:
Current Property Owner(s) K¢i~k
Mailin'g' address
Day phone
Lending agency
Day phone
Mailing address
Re~l E~'tfite'Agent _D~o~to;, ~.
Mailing Address
Unless otherwisei r'equested~ COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
,.
TYPE OF,'.WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class. /~, Well
Public Water System
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 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 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 S~¢..~z,v~
Address 2,o3 CO, i5~k Av~,
Engineer's Printed Name
Ak,
DSD SIGNATURE
~"/' Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev, 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LegalDescription:..[_~,~e.. O' ~r~¢ ~{1/5 ~-~SJ[ [~1~,, ~ Lo - ,5 ParcellD:
A. WELL DATA
Well type .~, ~)1{(. "A"
Date completed. --
Total depth -' ft.
IfA, B, or C provide PWSlD #..¢,t ~00~ Well Log (Y/N)
Sanitary seal (Y/N) -- Wires properly protected (Y/N)
Cased to -" ft. casing height (above ground)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production ---
WATER SAMPLE RESULTS:
ft. ft.
g.p.m. ~ g.p.m.
Coliform ~ coloniesll00 mL Nitrate "' mg/L
· Arsenic: --"- ug/L 'date of sample: ---'
B, SEPTIC/HOLDING TANK DATA
..Tank Type/Material. Anc~(~¢o.e~. 'Ta~-I
J
Tank size t'~50 gal. Number of.Compartments
Foundation cleanout (WN).
'Date of pumping (ill~I
C. ABSORPTION FIELD DATA
Date installed Iol:Zz~ Soilrating (g.p.d./f¢or~~
Length 5~ ft. Width ,5
Totaldepth II ft.
Date of adequacy test
Fluid depth in absorption field before test J;~ in.
Elapsed Time: i300 min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Other bacteda " 'colonies/100 mL
Collected by: ~
Date installed
~, Cleanouts (Y/N) '7'
Depression over tank (Y/N) /V' High water alarm (Y/N) /V'
· Pumper
ft.
Eft. absorption area ~5~ ftz Monitoring tube
~//~.oto Results(Pass/Fail) P,~5
Water added [~50 gal.
__ in. Absorption rate >=
System type ~8¢-~ %r~_k,
Gravel below pipe '~' ~ ft.
~epression over field
For ~'1 bedrooms
New depth 5,.~ in.
(o00 g.p.d.
If yes, give date -
De
IglFT .STATION
Date installed
"Pump on" le~.
Datum
SEPARATION DISTANCES
Size in gallons
"Pump off" level
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Manhole/Access (Y/N) /
High water alarm level at / in.
Meets alarm & circuit requirers?
On adjacent lots
Absorption field on lot
On adjacent lots
· Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line
Holding tank
Animal containment areas
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +.~51
Water main 4- lO ~
'Wells on adjacent lots ~00j
Property line. 'f IO
Water service line
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 4- {0 J Building foundation
Water Service line -I- lOI Surface water '~
Curtain drain 4. 501 ,
M~.~ ob~rv ~ Wells on adjacent lots
COMMENTS
Water main + I0I'
Driveway, parking/vehicle storage.
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 Nam,e. L 3~¢,5 ,~p~4,,- ~,~
Date 'll~l~.O~O
COSAFee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Municipality of Anchorage
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
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. , O I ~::~. ~) ~'~?~-~--~ COSA#
· '". :-,' ,~*~.' :-_ Expiration Date:
1. G EN ERAL IN.F~)I~MA. TION
Compl'ete legal 'descri~,tion I.a ~.
Lo~atio~ (site address) l{O'{I
Current .Property oWner(s)
Mailing' ~idd~ess J ~."~
~or~'3er~ .~ru~'c¢. Day phone
Lending agency
Dayphone
Mailing address
Real Estate Agent
Mailing Address
Un/ess otherwise requested, COSA wi//be hem by DSD for pickup.
NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ,~t Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~.
Individual Holding tank [~
Community On-site
Public Sewer []
The Municipality of Anchorage Development Se~ices 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. Cedificates of On-Site Systems Approval are required for the transfer of
ti'Je (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 pedod 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 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 lype of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage flies 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
/
Engineers Pdnted Name ~
5. DSD SIGNATURE
t//'' Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
WATERAND · m-
WA51P.:vvATER: :
PROGRAM ,' ,.
· ' .q"' .-'
,'. ..... .'
By:.
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other.
Original Cedificate Date: //~)//'~ ~'/~ 7
(Rev. 11~5)
Municipality of Aochorage
Development Services Department
Building Safety Division
On-Site Water & W~t~r~°mgr~m ~
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196650
www. mudi.o~'g/onsite
(~07) 343-79o4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
A. W~LL DATA
Well ty~e ~. If A, B, or C pn~le PWSID # 213~0~ Well Log (Y/N)
Date completed ~ Sanitary seal (Y/N)" Wires properly protected (Y/N)
Totel depth -- ff. Cased to '- ft. Casing height (above ground) '- in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level
ft*
WATER SAMPLE RESULTS:
Golfform -" colonies/lO0 mL
Arsenic: -- mg/1
g.p.m.
Nitrate "- mg/L.
Date of sample:
--- ft.
g.p.m.
Other beatnri~
Collected by.
.. SEPTIC/HOLDING TANK DATA !
TankType/Material ~nC~l~l. eQ,, '~/Jcf~'/
J
Tank size ~ gal.
Foundat~o;~ (~ea~oui (Y/N) '/
Date of pumping ~__
C. ABSORPTIOH FIELD OATA
Length gq' fi.
Date installed
Number of Compartments 7. Cleanouts (Y/N)
Del~ession over tank (Y/N) ~ High water alarm (Y/N)
Pumper ~'~qc~ Pu,,~,~;~,~
Sail rating (g.p.d./fl2
Width ~ ~ ft.
Gravel below pipe ~ I
ft*
Totaldepth' II ft. Eff. absorption area '~G
Date of adequacy lest ~l//z~0'~ Results(Pass/Fail) Pe,~ For ~ bedrooms
Fluid depth in absorption field before test O in. Water added ~ Z(,~ gal. New depth 1'9 n.
Elapsed Time::0~ min. Final fluid depth H in. Ab$o~'ption rate >= /'t'~O g.p.d.
Any rejuvenation treatment (paat 12 mo.) (Y/N & type)
D. LIFT STATION
Date installed - / Size in gallons -: - ---~- - -.-Manhe.io/,a~ss (Y/N) · ~
'Pump o~ 'Pump off'~n. High wata~
Da~gm~ '7 Cyctes.~ed Mee~,,,~ & circuit requiremems?
E. SEPARATION DISTANCES
in.
SEPARATION DISTANCES FROM WELL ON LOT TO: Co,~,~'~' ~/'~ C/~_~ ~[ *
Septic tank~lff station on lot
Absorption field on lot
Public sewer main
Sewer/septic service line '-'
Animal containment areas
On adjacent lots --
On adjacent lots --
Public sewer manhole/cieenout -
Holding tank --
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation +
Water main 4.
Water sen4ce line -t-
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Pr. o.,pe~? line 'Y lO ' Building foundation ~r ~0 'f
Water Service line .~ JO Surface water ~ ~1
Curtain drain ~ Wells on adjacent lots · ~1)O'
F. COMMENTS
Abserptlon field
Surface water
Water main
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conf~mance with MOA COSA guidelines in effect on this date.
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
I O /tO /O
Waiver Fee $
Data of Payment
Receipt Number
'--'-- MOUNTAIN LAKE DR
~-._ / I /
· o. !
\ }.:'.'//
~, ...i.. i ,// /
· ~."" '"""'"~' ~e.o'- ,,' ~ / / /-.,~
, --~~ - /,,'
_,v"5,~~ . / / /
~-/\ - ~ /,. / /
/ \ /#/ / '~,,,
- 4.'?/ /
/
· ~..,, \ ,',' / ..
~Y '~"~" -~...~.~..~,_~, Robert E. Johns, ;Jr. ASSOC.·
,.~t,u~ Profeaatom~! L~nd Surveys1
· ------..---- . . ~..1.7_0'7 RS3'
· I~OT Pt.~NS · LOT sum~ra
Environmental Consulting and Design
Municipality of Anchorage
Development Services Department
Building Safety Division
On Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650
Anchorage, Alaska 995 i 9
Subject:
COSA REQUEST
Lake O' the Hills East Block 1 Lot 5
October 9, 2007
Dear Jeff Poet,
During the COSA review process it was discovered that a potion of the drain field serving the
above referenced lot lies beneath the drive way. The top of the sewer rock is 6 feet below the
driveway surface. The monitor tube is protected by steel caps, marked sewer, flush with grade.
The section of trench underneath the driveway does not appear to be in the typical travel lane (i.e.
vehicles would not typically travel over the trench to access the garage). There is no depression
over the trench. The trench has been in service since 1984 and the recent adequacy test did not
indicate any adverse effects do to the driveway.
If you have any questions, please contact me a 279-3916.
Sincerely,
203 West 15tb Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (907) 276-6013, SpurklandEng~gci.net
· unicipahty
ANCHORAGE. ALASKA 99519-6650
Anchorage
MAYOR
October 9, 1987
D£PARTId~NT OF H~Ii.YH · HUMAN SERVIC£S
Alan ~ten
Alaska ~ironmental Control Services
1200 V. 33rd Avenue, Suite B
Anchorage. Alaska 99503
Subject: Loc S Block 1 Lake O' the ~llls Subdivision
Waiver Request l~It87-0~9
Dear ~r. Vien:
Your request for a waiver of the 100 foot separation required between the
septic system on the subject lot and the lake to the south has been granted.
The separation distance be~een~he lake and the existing &bsor?~lon field has
been waived to 89 feet. The separation baleen the lake and a proposed
replacement septic tank has been waived to & minimvz distance o~ 80 feet.
These valve,s are based on ~our assessment ~hat site condl~io~ on
loc will ~[~lga~e the ~o~en~ial of la~e con~l~ion in ~his case. Your
soils /~estigation indicates tha~ a thick la,er of pea~ lies }e~een ~e la~e
and ~e septic system which should provide excellen~ filtration o~ the
ef~uen~. ~e house fo~/on and ~he ~opozraphy In
septic system should d~ec~ ef~uen2 a~ay fro~he lake in,he tven~ of septic
sys~e~ failure o~ over~ov.
Civen ~e face tha~ ~he txis~ln$ abso~lon sys~e~ is less ~n ~en percent
~ho~ o~ ~he ~equl~ed desl~ abso~lon a~ea for a four bedroom d~ellin~, and
~a fac~ tha~ a ~ecen~ adeq~cy ~es~ ~s demo~ra~ed
easily capable of handlin~ ~h~ dest~flov fro~ a four bedroom
presen~ ~lme, au enlargement off the abso~lon system will no~ be ~equired for
approval of ~he septic ays~e~ for four bedrooms. ~e vol~e o~ ~e septic
~a~vi[1 have to be ~graded to 1250 gallo~, however.
~is waiver is ~alid for ihs exis~ins four bedroom, single f~ily d~ellinz.
~[s waiver does ~oC apply =o future upzrades off the system.
Sincerely,
Scepl~en S. riot-tls
Civil Engineer
On-site Services
cc Cus Andress,
· Hanager, On-site and ~a~er (luality~zogra~s
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES y e
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# - 2)7�-('�, �)
1. GENERAL INFORMATION
HAA#
Complete legal description Lot 5• Block 1 • Lake Q'The Hills Fast -
Location (site address or directions) 11071 Mt. Lake Drive
Property owner Brent Jennison L � �C) Day phone 346-2500
Mailing address P.O. Box 92772, Anchorage, Alaska 99509
Lending agency — City Mortgage Day phone 277-0700
Mailing address 121 W. Fireweed Boulevard, #120, Anchorage Alaska 99503
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: A- �'
3. TYPE OF WATER SUPPLY:
Individual well
Community well X
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L crr S ?2t~� I L A V� r)' Parcel I.D.
1kXws E-ks-r'S>
A. WELL DATA
Well type A If A, B, or C, attach ADEC letter
Log present (Y/N) Date completed
Total depth Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump leve
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
2bv ik
Absorption field on lot
Public sewer main
Sewer service line.
WATER SAMPLE RESUL'
Coliform
of sample:
B. SEPTIC/HOLDING TANK DATA
Nitrate
ADEC water system number Z t '5t 03
Driller
Casing height
Wires properly protected
AT INSPECTION
g.p.m.
; On adjacent lots
On adjacent lots —
Publizetrol=eumtan7kdl��
Collected by:
Other bacteria
Date installed 10 -13 ' Sy Tank size Compartments 2
Cleanouts (('ay'N) Foundation cleanoutaN) Depression (Y& tJ
High water alarm (YIQ /" Alarm tested (Y/N) 4
Date of pumping i3 —`�Z Pumper-�
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 2vo On adjacent lots �IA Foundation 1z�t
To property line 10 -Absorption field t Water main/service line ID {
Surface water/drainage au25 U�enJ6� ���+� �'�'S'►
72-026 (Rev. 7/91) Front _ - CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes
— Manufacturer
Manhole/Access (Y/N) .
Pump off' level at
Cycles tested
SEPARATION-OTSTANCE FROM LIFT STATION TO:
on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Surface water
Date installed k - 22 ,34 Soil rating 1_,CL System type _D (Z-A�t�i✓t��-L�
Length S9 Width 5 Gravel thickness 7 Total depth
Total absorption area 7 7/ Cleanouts present/N)
Depression over field (Ya /J Date of adequacy test /D - 27- 9 z-
ResultsJEEgo/fail) PAss for r—OU - L-1 ) bedrooms
Peroxide treatment (past 12 months) (Y&) AeJoad If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot �::. `Je On adjacent lots "11A Property line
To building foundation 1 3 To existing or abandoned system on lot
On adjacent lots Zo ) �_ Cutbank '`/6, Watermain/service line /o ) 4-
Surface water 9 % ufAto� y7 e.v.1 Driveway, parking/vehicle storage area—
Curtain
rea Curtain drain ''flit -
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect e�g date of this inspection.
�3F:n oCOr. as A
Et`JGINEtiRINCa
17034 r-agle River Loop Road No. 204
Signature;774
6 agie River, Alag :a 99
11! I 040GLO0
Engineer's Name
�� ®Gt 0e4
��3 p—��! 4� it illi, J. ->i`iA ia Gee -syr
Date 1( s<�
�e Gi Cli. i;21 i o'
HAA Fee $/ Z A0 Waiver Fee: $
Date of Payment Date of Payment
Receipt Number ���/�� Receipt Number
72-026 (Rev. 3/91) Back MOA 21
sy e OF e aSNo
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
October 28, 1992
Mr. Ray Shafer
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, Alaska 99577
SUBJECT: Lake O' The Hills East Subdivision
Class "A" Public Water System, PWSID 213603
Dear Mr. Shafer:
WALTER J. HICKEL, GOVERNOR
(907) 349-7755
I have completed a review of this office's files concerning the monitoring status of the -
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on September 21, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on June 12, 1991. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on July 23, 1992. This does meet the provisions of 18 AAC
80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were
submitted to this Department on July 7, 1992. This does meet the
provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
r
ichae
Environmental Eng. Asst. If
panted on recycled paper b r 0
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVALg�—
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
4~ D ryle /%ILLS ��� -7'1-7--.Al 03PJ S6C- Tij
Location (address or directions)
i,, AtWMJ Jrh" s � &,4f
(b) � Applicant Name § Telephone: Home Business
Applicant Address. 3/za
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent XAek u''W172r CO'
Address ju) L 17:
Telephone S(o3-SSa
(f)
1,
2. TYPE OF RESIDENCE
Single-FamilyyX Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well ❑ Communityv Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
OnsiteX Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
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pau~elqo uo!~e~JOiUi eq~ uo peseq leql Xjpe~ Jequni I 'u!eJeq peleo!pu~ eJn~nJ~s jo edXl pue smooJpaq Io Jeqmnu eql
e~en~pe pu~ leUO!~Ounj 'ejes si mais~s i~sodslp Je~e~a~se~ Jo/pue Xlddns Jale~ eus-uo eq~ leq~ s~oqs le~oJddv
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NO~V~O~NI aNY ~VO 'H3~S ~ll~ 'S~S~ 'SNO~O3dSNI ~NIOIAOBd ~1~ ONI~)NION)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
MUNICIPALITY OF ANCHORAGE CHECKLIST - FEBRUARY 1984
ENVIRONMENTAL SERVICES DIVISION
264-4744
Legal Description: 44-r� �'�K �� 7
OCT 2 01987 11r1_' -s 4�77 - rIXAI 031J
A. WELL DATA RECEIVED
Well Classification eef-#f If A, B, C, D.E.C. Approved©/ J) � � � Z'1300.3
Well L resent (Y/N)
Total Depth
Static Water Level
Casing Height Above Grou
Cased to
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Date Completed
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N) —
Depression Around Wellhead (Y/N)
; On Adjoining Lots
djoining Lots
To Nearest Pub i ewer
To Nearest Sewer Services e on Lot
; Date
Date Installed O 43'rl Size /Z$�O No. of Compartmentsy
Standpipes) Air -tight CapsY/ ) Foundation Cleanout)9l)
Depression over Tank (Y% Date Last Pumped A
Pumping/Maintenance Contract on File (Y/N) ; for /JJ 4
Holding Tank High -Water Alarm (Y/N) /z" Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply We Il eey4 f . To Building Foundation
To Property Line '©•� To Disposal Field 7
To Water Main/Service Line -' !o To Stream, Pond, Lake, or Major Drainage
Course ' d SES G✓/H�iL .
Comments
Page 1 of 2
72-026 (Rev. 8/86) Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area . ~ ~'
Depression over Field *(Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Type of System Design
Length of Field
Depth of Field ,//
Gravel Bed Thickness
Standpipes Present'N)
Date of Last Adequacy Test
To Property Line
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~$a"¢' ~ ~/,¢-aVAf... o
To Existing or Abandoned System on
; On Adjoining Lots ~'~'
To Cutbank (if present)
D. LIFT STATION
Size in Gallons __
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump cfr' Level at
-- Vent (Y/N)
g Adequacy Test. Meets MOA
'° Check P~rmitted Bedroom Rating Against HAA Request **
I certify that I h a~e,,~hec,~r d. ver~'ied, or conformed to all M CA and HAA guidelines in effect on th(
Signed ~-----/-~'~/d~,~'-"' Date
Company /~"~ '~ ' ' MOA No.
Receipt No. r/"~ ~ ~
Date of Payment /"~'~.~ C~ ~. "
Amount: $ ,./~)~/~ ~"'"'~'~--~
Page 2 of 2
his inspection.
pp AA OF
STEVE COWPER, GOVERNOR
b U U
DEPT. OF ENVIRONMENTAL CONSERVATION/
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 "C" STREET, SUITE 1334
ANCHORAGE. ALASKA 99503
DATE: �v �-7
------/-_-^----------
PWSID #: _ ------
To Whom It May Concern:
According to the records on file in this office. the
- --= ✓yr3�o7a_ Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Sincerely__
Ronald S. Klein
Environmental Field Officer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date (113h 7
1, GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, s township, range)
t _.[-e• /2 1', L f i nLle X 44.1 r'rr 1(3 �-- T T/'R�1 to- aw
Location (address or directions)
po
(b) Applicant Name Telephone: Home Business -22 moors _
Applicant Address t 2 gt2 D C-2 e,y� (1-0 ?(�
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Z; Buyer ❑ ; Other ® (explain);
�i
(d) LendingVnstitution o7 �� T eph ne
Address
(e) Real Estate Company and Agent
(f)
Address
Telephone
Mail the HAA to the following address:
®til
2. TYPE OF RESIDENCE ,.
Single -Family [b Multi Family ® ' Other g
Number of gedrodnis'
n
3. WATER SUPPLY
Individual Well ❑ Communitylp Public El
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation }
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite P; Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11/84)
Page 1 of 2
A 0
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION'
As certified by my seal affixed hereto and as of the validation date shown below, I verifythat my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address
Date r
an
(D S d ss
a4-e-Y6_�
sir-s-0�krj
"A cK ra �/ l _-i p 9
® Ag`���_
6. DHEP APPROVAL„ --
Approved for j. bedrooms by t � Date
e�
0
Approved ,Z Disapproved Conditional
Terms of Conditional Approval
V����
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
• Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264 4720
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
ItPR 51985
Legal Description: / 12A " 3L
A. WELL DATA
Well Classification (10z If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) � Date Completed � Yield
Total Depth ��� Cased to N I A� Depth of Grouting N4
Static Water Level Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N) w/4
rat De ression Around Wellhead Y/N w
Electrical Wiring in Conduit (Y/N) P ( )
Separation Distances from Well:
To Septic/Holding Tank on Lot c2r7,o ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot �20()� ; On Adjoining Lots
To Nearest Public Sewer Line "(It— To Nearest Public Sewer
Cleanout/Manhole (A- To Nearest Sewer Service Line on Lot 0)/
i"
K//7(
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
A)
; Date
Date Installed /0&(4 Size IOUO No. of Compartments
Standpipes ON) Air -tight Caps 6Y Foundation Cleanout ON)
Depression over Tank (Y& Date Last Pumped L/.,A-
Pumping/Maintenance Contract on File (Y/N) nJ(,4� ; for °�(
Holding Tank High -Water Alarm (Y/N) N i A—Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well c20OJ
To Property Line
To Water Main/Service Line
i
To Building Foundation
7�
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Course -
MUNICIPALITY OF ANCHORAGE
CommentsBERT OF HEALTH &
ENVIRONMENTAL PROTECTION
Page 1 of 2
72-026(11/84)
NOV 2 6X985
C. ABSORPTION FIELD DATA
FA -6_V_ G+6I t t/1 \
- �s•r
Soils Rating in Absorption Strata Type of System Design Tei:�
Date Installed lo��� Length of Field
Width of Field Depth of Field %� y
Gravel Bed Thickness 7
Square Feet of Absorption Area `%� Af Standpipes Present (Y/N) 0
Depression over Field (Y
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well 1)
To Building Foundation
Lot N
To Water Main/Service Line
Date of Last Adequacy Test
NIA <I4.
To Property Line 3U /
To Existing or Abandoned System on
On Adjoining Lots
i
t To Cutbank (if present) A -
To Stream/Pond/Lake/or Major Drainage Course �o o r
�F
To Driveway, Parking Area, or Vehicle Storage Area • Ld,1 � zzs acti "P,
i r
C
D. LIFT STATION
Date Installed 't-tk Dimensions /L)/A-
Size in Gallons 1 k Manhole/Access (Y/N) {
�J--
"Pump On" Level at lu14 "Pump Off' Level at K)I/fl
High Water Alarm Level at I� Vent (Y/N) Aj/q
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
" Check Permitted Bedroom Rating Against HAA Request "`
I certify that I have che,cke , verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 3/ 5
Company r! C (/ MOA No. k5 -D2<i 'Z O %
�•e soo e e oe �•�_Ry ji
Receipt No. '��� �l4''7 G�06';9 °�°➢p� `�
Date of Payment •.e e. ee ®°�enee 6.3
Amount: $
oY C. Reid, J9, j
No. aa.5t•I: v
t•
Page 2 of 2 d <'t
72-026 (ivea)
EF 0"F VA S 98 81IL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION ;T Telephone: (907)
Address:
t'
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
DATE
T
PWS I.D.# C Z &66
To Whom it May Concern:
According to records on file in this office the
Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
J, 4t dmlll�