HomeMy WebLinkAboutLAKEWOOD HILLS #2 LT 26ALokewood Hill
Lot Z6A
#015-135-20
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201089 PID Number: 015-135-20
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
James & Julie Christiansen
ABSORPTION FIELD
❑ Deep Trench X Wide Trench ❑ Bed ❑ Mound
Site Address
7401 Upper O'Malley Rd. Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(906) 458-2197
4
1.2 GPD/SF
7.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
Fill added above original grade
0.8 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Ft i
1
Ft.
Well
>100'
>1 00'
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,250 Gal.
Surface Water
>100'
>1 00'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Plastic
2
Foundation
> 10,
>1 0'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Wilco Contractors
Drainfield D3034 CO/MTD3034
Inspector J. Millette / L. Tidwell
BENCH MARK (Assumed elevation) 100 ft
Inspection 15' 5/7/20 5/8/20
da
Location and description
2nd
3rd 4t'
Top of foundation @ point A.
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
N�
Conditional Approval: Date
.•�P�'OF�Se♦e
• c�,• •••.,! e
7
••49th
'eyes
OF
0. off
E. ANDERSON ;�t�j
o •. 403 Ar
Septic System
r
A rove ®
pp Date �' D
e No. CE -4381
®ejTF,p'••.., 5/14/20
Note: this does include
•,.••''c`�G:
•
#4444 ESS\St`'♦s
approval not well permit requirements.
kRcv UJ/VL/ 10)
LAKEWOOD HILLS #2, LOT 26A
PERMIT # OSP201089 PID # 015-135-20
I 1
LOT 24A I-----
� /�CAt� _
/ S-
L I r NEW 50' ONG x 5'wi6E 14' EFF. I
/DEPTH ABSORPTION TRENCH.
:• 49th •:
MICHAEL E. ANDERSON
No. CE -4381
5/14120 •��
0�� pROFES51�A�e
0 50 100
WE ME FEET
111=50'
51
MH
76.9
57.4
2CO
78.6
59.6
DV
80.2
61.0
C01
144.1
129.6
MT1
145.9
131.8
CO2
142.2
139
MT2
143.5
139.
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEAN
DV - DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
PERMIT # OSP201089
NOR
[NGIN E[RING
PID # 015-135-20
VJ. I
2" INSULATION
73.3 FINISH GRADE 72.5 ORIGINAL GRADE
1 I 1 1
- 65.5
�® 50'
NO GROUNDWATER 5/1/20
57.5
PROFILE AS -BUILT
(NO SCALE)
65.5
n-• H
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907)343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201089
Work Type: Septic Upgrade
Tax Code Number: 01513520000
Site Legal Address: LAKEWOOD HILLS #2 LT 26A G:2540
Site Mailing Address: 7401 UPPER O'MALLEY RD, Anchorage
Owner: CHRISTIANSEN JAMES L & JULIE A
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft
Total Bedrooms:
gent S�
oI
Depai-mieiit
5/4/2020
5/4/2021
71062
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date:
Z0
4
UMUP UTY (OF ANCHORAGE
o
Community Development Department `' Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 015-135-20
Property owner(s) James & Julie Christiansen Day phone (906) 458-2197
Mailinq address 7401 Upper O'Malley Rd. Anchorage, AK 99507
Site address SAME
Legal description (Sub'd., Block & Lot) Lakewood Hills #2 L26A
Legal description (Township, Range & Section)
Lot Size 71,062 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field ❑X Initial ❑
Single Family (SF)
❑X
(w/wo ADU)
Septic Tank INUpgrade ❑X
Duplex (D)
ElHolding
Tank ❑ Renewal ❑
Multiple Dwellings
❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
a 0'j—,
(Signature of property owner or authorized agent)
14®VIb
Permit/Rush Fees: q5-2 / IN. 00 Waiver Fees:
Date of Payment: 4L301&6v16 Date of Payment:
Receipt Number: OWS11) Receipt Number:
Permit No. nS1?261614 Waiver No.
COVID-19
Permit App_: -:-::."C; DISCOUNT APPLIED
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
May 1, 2020
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Lakewood Hills #2 Lot 26A – 7401 Upper O’Malley Road
Septic System Design
Dear On-Site Services Engineer:
The four-bedroom septic system on the subject lot has failed and must be replaced. We are
submitting this design and permit application for the construction of a new septic tank and drain
field. The attached site plan identifies the location of the home and the existing well and septic
system along with the proposed system. No conflicts exist between this proposed system and any
other well or septic system on this lot or adjacent lots.
The ground surface on the lot slopes toward Hillside Drive near the back of the lot exceed 25%
but are less than 46%, and drop less than 10’ from the septic location before shallowing out to a
flatter area. It is on this slope that the proposed absorption trench is located. The flowline elevation
will be 4’ below original grade to meet the steep slope design requirements as outlined in the
Municipal Ordinance governing septic system design and construction. No slope waiver is
required. Contours are shown on the site plan showing the grade and direction of flow. Stormwater
drainage will not impact this septic system. The new trench will be constructed parallel to the slope
as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, more than 5’ away from the septic tank, and more than 14’ away from the
existing 7’ effective absorption trench.
Please refer to the attached test hole log, plan, and profile sheets for the septic design. If this design
is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
5/1/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201089, Deb Wockenfuss, 05/04/20
//
10050 0
FEET
1"=50'
4-BDRM HOME
NOTE:
SLOPES >25%, BUT <34% WITHIN 50' OF THE ABSORPTION TRENCH.
TRENCH IS DESIGNED TO MEET STEEP SLOPE REQUIREMENTS. NO
SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
DV - DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
LAKEWOOD HILLS #2, LOT 26A
5/1/20
PATIO
SHED
DECKSHED
20' U TI LITY EASEMENTHILLSIDE DRIVEUPPER O'MALLEY ROAD 10' T&E EASEMENT820825830EXISTING WELL
INSTALL NEW 1250-GAL SEPTIC
TANK w/ 20" MANWAY & DOUBLE
CLEANOUTS AT INLET & OUTLET.
INSTALL NEW 50' LONG x 5' WIDE, 4'
EFF. DEPTH ABSORPTION TRENCH.
ADD 2" INSULATION OVER PIPE
THAT RUNS UNDER DRIVING AREA.
CO
CO
MT
MT
EXISTING ABSORPTION
TRENCH TO REMAIN IN
PLACE FOR FUTURE USE.
PARKING AREA
DRIVE WAY
DECOMMISSION EXISTING
SEPTIC TANK PER MOA CODE.
ADD DIVERTER VALVE FOR
FUTURE USE OF EXISTING
ABSORPTION TRENCH.815810A
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201089, Deb Wockenfuss, 05/04/20
LAKEWOOD HILLS #2, LOT 26A
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: 1-5 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE TRENCH SYSTEM
1250-GAL SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
6"
6"
3' 0"
4'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 7.5' BELOW GRADE - MEASURED FROM LOW SIDE OF TRENCH
FLOW LINE ELEVATION: 3.5' BELOW GRADE - MEASURED FROM LOW SIDE OF TRENCH
TOP OF TRENCH: 6" ABOVE GRADE
600 GPD / 1.2 GPD/SF /5' WIDE * 0.5 RED. FACTOR = 50 LF TRENCH REQUIRED (50 LF SPECIFIED)
5/4/20
GEOTEXTILE FABRIC
EXI STI NG GROUN
D
30% GRADE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201089, Deb Wockenfuss, 05/04/20
5/4/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201089, Deb Wockenfuss, 05/04/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE 1
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
LAKEWOOD HILLS #2 L26A
4/24/20
J. MILLETTE
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?-
1.4 6
5 6
015-135-20
JAMES & JULIE CHRISTIANSEN
2:00
4/24/20
1
2
3
4
5
6
5 0
16 / 11 0
16
2:09
2:18
2:28
2:37
2:46
OB
Professional Engineers Stamp:
5/1/20
8m 3s
NO
None
5/1/20
GM (SILTY SANDY GRAVEL)
8m 30s
8m 15s
8m 33s
8m 35s
8m 40s
5 0
16 / 11 0
16
5 0
16 / 11 0
16
5 0
16 / 11 0
16
5 0
16 / 11 0
16
5 0
16 / 11 0
16
6 0
16
6 0
16
6 0
16
6 0
16
6 0
16
6 0
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201089, Deb Wockenfuss, 05/04/20
GRE,,,ER ANCHORAGE AREA BOR_ JGH
Department of Environmental Quality
3330 (2 Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL [~'.~)(~5
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITYf')'~'~l GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH__ IN. TOTAL EFFECTIVE
ABSORPTION AREA .~21,~ ~ SQ. FT. LENGTH OF EACH LINE
(f DEPTH OF FILTER ~ {
DEPTH: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE IN. ABOVE TILE IN.
WELL:
TYPE ___
BUILDING
FOUNDATION
CESSPOOL
CONSTRUCTION
NEAREST NEAREST
LOT LINE_ SEWER LINE__
OTHER SOURCES
DEPTH
SEPTIC SEEPAGE
TANK SYSTEM
APPROVED
DISAPPROVED
REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL'~'~'~ '~) /
LOT SLOPE:
REMARKS:
G.A.A.B.
F:I P t;;' L.. ]i C I::I N T
i.,.. 0 C FI T ;[ Eli"C,
L E G I.:11_
L,.EFF S]:2:E d-:Z~:}i:,:id. :!._:;6:¢...IF:II;i:E FEET
T'¢i::'E '.iF :[;'[II.... I.::IE~SOI~:BTIEd'.,t '.:~::"r'STEM .T.S: TRENC:H
I'"iF:I;:-:iII'"II...IM I'.,li_IME:ER (IF E:EDRCICIi'"IS == 4.
THIE RE(.-:¢.J ]: RE[:, S I ;;i!:E OF THE: SO l I_.' I::IE::~ ORF'T I Oi'.,I :.."5'¢:F:;'TEM t LE;:
-I"HE LENGTH t:::, ]: I'"IEt'4S ]: Ot'.,I I S TI--I.E L. ENGTH ( I N FEET ::, OF 'THE 'FRENCH O1:;: [.',Fd:l I NFI EL..D.
'T'HE [:,EF'TH OF Ih TREI'-,IE:I,-I OR F'IT IS Tt-.IE [:,I?T'RI'qE:E BETHEEN TI,-IE SUF.:FF!CE (:iF TIdE
GREMLIN[:, F:li'.,l[:, 'I.HE BOTTOM O1,:' T.HE E',=.=;C:R',,,'F:I'rION ,::IN FEE:T::,.
THEF;.:E ]::E, F,tE~ SET I,,.! :I: D']"I.-I FO[,;.: TI:;!E:t'.,ICHES.
THIE EiI~:I:::I',,,'EL~ [:,tEI,:'TI,-t I~i.:.:; TNE MINIMUM [:,EPTH £)1::' GI~'.FZI'v'EI,_ BETHEEtq THE OUTF:RI_I_. F:'ZF'E
F::It'.,I[:, THE BO"I"TEff,i OF THIE EY:CFi',,,'RT:I:ON (IN F-:'EET).
E',I.::IC:I-:::F'ILLIHEi CE:' Rl",l"r' S"r'STEM I,f]:THZ 1"1" I::IHFtt.... II".ISF'EC"I"Z':H",t I::IN[)I-II,-FF. ,HI_ THIS
DEF:'F'Ii:;I"t"MENT HILL BE %IJE',J'ECT
M I N :i: MLIM [:, I STI.:-iI'qCE BETI.,.ItEEN
:!..OO I::'tEET I::'(]F.: Ft I::'R]:VFITEZ I.,.IEL. I... OR ;.2:00 FE:ET FOI';.: F-I F:'UE~LIC: HELl_.
1.41ELI._ L..OGtE; FIRE F::ELT.!UII,;.".E]:)FtI'-,I[.', MUST BE F::ETUF:'.NED TO THE I]:,IEF'I:::II'4'.TME'i'.,IT 14:['T'HIN 2i:O I::,FIb"-.=.;
O1,:' THIE HELL COMF'LETtON.
'E,F'E C: Z F' ]: CF.-IT :( Ot'-,t:'~;
.'1: N:E;'I."FI!....L..FI'T' I ON.
t E:IEI.;:.'T ]: F'.,.' 'i"FIFI'T'
:t.: I !::tf"l i::'FtM:i:L...T.F~R I.,.IITH THE I,REQLI:[REMEN'I.'"2, F'OR ON-SZ'I"E SEI.,IIEI;:.'S FIND t.,.iEL.I....S
F:'Ot:.?.Ti-'~I E':"r' THE MUI'-,IIC:ZF'r::IL.:(T'./ EE:' FINCI-aL3F.~FIGE.
;;it: :i: I4]:L..!_ .'[i'.,t.':J~;TF:iLL Ti-.IEZ L'-'.;'-r'STEM tN F:ICE:ORDFINCE 14)1TI,--I THE C(]DE'.i~;.
::~!:: :1: ijt'-,i[:,EI.;::STI,:IN[:, TI.-II::tT THE Eif.,!-LE;]:TE SEi4EF:'. S'-r'ST['.:]"I Ml,::l"r' REL::!I...I!I';-'.E E'NI_F:II'",.':(2iEMEi"IFF IF: THE
RE:~:]; I [::,ENE:[E ]: ::5 F.".EI"IC~DEL..E[:' TO 3( iqCI...f...I[)E I'"IOI';-'.E THIqt",t 4-
CONSULTING GEOLOGIST
BOX 476-1~4, STAR ROUTE A' ~' ANC}-IORAGtE, ALASKA 99507 · PHONE:
SOILS LOG
De~pth (feet) Soil Description
-10-
-12-
-14-
-18-
-20-
· otaz ~e~h / ~ £eet i.
Was grou_ndwater encoun'bered _~ ? What depth
Depth to bedrock ~'~-OI . How de~ermined_~
Respeot±'ully submitted
ConSulting Geologis'b
?
?
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I. D. 015-135-20
1. GENERAL INFORMATION
Expiration Date: T ^ M - 2 V
Complete legal description Lakewood Hills #2, Lot 26A
Location (site address) 7401 Upper O'Malley Road Anchorage, AK
Current property owner(s) James & Julie Christiansen Day phone (906) 458-2197
Mailing address 7401 Upper O'Malley Road Anchorage, AK 99507
Real estate agent Christina Gamez Day phone (907) 952-1496
2. TYPE OF DWELLING:
❑° Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
KI
Fs
Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $
Date of Payment
Receipt Number /�
COSA # 05U61 14
Waiver Fee $ _
Date of Payment
Receipt Number
Waiver #
COVID-19
25% DISCOUNT APPLIED
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Civil Engineering Phone 907-522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 5/15/2020
_,-W)))D)wWIII
Original Certificate Date: 5-- )S,—?—C)—
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
••s�� OF
is 49th••• =•♦f
6. DSD SIGNATURE
10
i r C'�'�,
System #1 Approved for
.. .+
s.....:.... ..............................
bedrooms e � ;MICHAEL E. ANDERSON••: � s
System #2 Approved for
g♦�- • No. CE -4385 I,,-,
bedrooms ®♦s'F`•• 5/15/20 '' �e
Disapproved
.
♦� 444., i;SsSa�se:+®
Conditional approval for
bedrooms, with the following stipulations:
_,-W)))D)wWIII
Original Certificate Date: 5-- )S,—?—C)—
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Lakewood Hills #2, Lot 26A
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Pre 1977
Total depth 199* ft
Cased to 63* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) '18 in.
Date of flow test for COSA 5/8/20
Static water level at beginning of test 141 ft
Comments *Per Well Inspection in MOA file dated 5/14/12.
B. TANK DATA
Age of tank(s) <1 years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction - 5/7/20
D. ABSORPTION FIELD DATA 5' Wide Shallow Trench
Which system tested (date installed) 5/8/20
❑ ALL standpipes present per record drawing
Total measured depth from grade 7.8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 015-135-20
Structure served by this system
Well production at time of test 3.9 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 8.90 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample
4/28/20 .-
B. -
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date New Construction
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
❑ Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
M✓ Yes
if No
ft
F7, Yes
if No ft
Neighboring Tank > 100' ✓� Yes
Neighboring
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' Q Yes
if No ft
Neighboring Absorption Fields > 100'
F✓ Yes if No ft
Water Main > 10'✓1
Animal Containment > 50' p✓ Yes
if No ft
M✓ Yes
if No
ft
F71 Yes if No ft
Water Service Line > 10'
✓0
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' 0✓ Yes
if No
ft
r✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑✓
Yes
if No
ft
Surface Water > 100'
U Yes if No ft
Property Line > 5'
F/1
Yes
if No
ft
Wells on Adjacent Lots:
FV1
Absorption Field > 5'
F71
Yes
if No
ft
Private Wells > 100'
F✓ Yes if No ft
Water Main > 10'✓1
ft
Yes
if No
ft
Community Wells > 200'
F71 Yes if No ft
Water Service Line > 10'
✓0
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
U
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
F,71
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
FV1
Yes
if No
ft
Private Wells > 100' R Yes if No ft
Water Service Line > 10'
F/�
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
New Septic System constructed
5/7/2020.
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
°.., 5/18/20 �.�'•�
41,aOFE`JS��,�w
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC
Subdivision: Lakewood Hills #2, Lot: 26A
A water sample revealed a nitrate concentration of 8.90 milligrams per liter (mg/Q.
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.
Mail�ngivoo
Ad�ress P O�Box196650�'� Anchorage, Alaska 99519 6650 * wwvv muni org `��
ti
ASBUILT
el;�-11!2�-'
Chi ADn R- AQCn0TA'PV0 T AllTn 01-1-1111-
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE- Z:�
FOLLOWING DESCRIBED PROPERTY:
OF A�
AND THAT NO FNCROACHI�ENTS EXIST EXCEPT AS -TA7 aT- ........
INDICATED. IT IS THE RESPONS!BILITY OF THE TH
.... .
OWNER TO DETERMINE THE E' cjsTENCE � OF ANY GRID: .....
EASEMENTS, COVENANTS., OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
Uuana Mrik Sowa,d
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB* Is * / . 'c.1 a
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND -At
'tt
ARY LINES. DRAWN: Irk
T�
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak, us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~
I. GENE~L INFORMATION Expiration Date: ¢'- ~ ~ ~/%
Complete legal description
· Location (site address)
Current Property owner(s)
Mailing address
Lending agency
LAKEWOOD HILLS #2 LOT 26A
7401 UPPER O'MALLEY *ANCHORAGE, AK
BERT &: ELLINE WHEELER Day phone.
7401 UPPER O'MALLEY *ANCHORAGE~ AK
Day phone
225-4570
Mailing address
Real Estate Agent
RICK JARVIS W/ REMAX
Day phone 244-3590
Mailing address
Unless Otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site []
Individual Water Storage [] Individual Holding tank []
Community Class.__Well [] Community On-site '~ []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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 oM the
information obtained from the Municipafity of Anchorage files and from my investigation and inspection~ the
on-site water supply and/er wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Phone 337-6179
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Engineer's Comments:
tn conducting this evaluation, GEG, LtD. attempted to provide a ~horough,
conscientious engineering analysis of the system in accordance w/th ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of file
system uncle: the conditions encountered at the time of the test, and sensration
distances measured to readily identifiable features, The operatiocal life of aft wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during t~ffe year, and the water usage of the family being served by the system.
These conditions are outside the control of the e valuator of the systero. Satisfactory lest
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments, GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requireroents of the ADEC or MOA DSD. The content of this report is for
the sole benefit of tbs owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legsl right whatsoever.
5. DSD SIGNATURE
V'''/'' Approved for ~ bedrooms.
Disapproved.
Conditional approval for
ON-SITE
WATER AND
bedrooms, with the following stipulations: ~.'~. pROGRAM
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6660
www.ci.anchorage.ak, us
(907) 343-7904
Legal Description:
A. WELL DATA
Well type PRIVATE
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
LAKEWOOD HILLS #2 LOT 26A PamellD: 015-~,,~
*PER AAROW PUMP AND WELL SERVICES. SEE ATrACHED.
IfA, B, orC provide PWSID~ N/A NO
Date completed PRE-1977 Sanitary seal (Y/N) YES YES
Total depth '199 ft. Cased to'63+ ft.
FROM WELL LOG
Date of test NO WELL LOG
Static water level / ft.
Well production J g.p.m,
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: ND ugJL
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Foundation cleanout (Y/N) YES
Date of pumping 5/11/12
C, ABSORPTION FIELD DATA
Date installed 6/3/,77
Length ¢0 (CALC.) ft.
Nitrate 6.36 mg./L
Date of sample: 4/30/12
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
5/7/12
138 ft.
3.16 g.p.m.
12+ in.
Collected by: GEG. Ltd.
Date installed 6/3/77
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
System type DEEP TRENCH
Gravel below pipe 7 ft.
Tank size. 1250 gal. Number of Compartments 2
Depression over tank (Y/N) NO
Pumper. ANCHORAGE CESSPOOL PUMPING
[*BELOW EXISTING GRADE]
Soil rating (g.p.d./ft~orO 125
Width 5 ft.
Total depth '12,22 ft. Eft. absorption area 560 ft2 Monitoring tube YES
Date of adequacy test 5/8/12 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 47.75 in. Water added 617 gal.
Depression over fled NO
For 4 bedrooms
New depth **82 in.
Elapsed Time: 946 min. Final fluid depth53.75in. Absorption rate >= 640 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
**FULL, 4/' ABOVE INVERT. DURING THE PROCESS OF FILLING THE SYSTEM WE INADVERTENTLY
FILLED IT ABOVE THE TOP OF THE 4 INCH LATERAL SEVERAL TIMES. SEE AFDACHED LETrER,
D. LIFT STATION
D. ate ins~iled Size in gallons ~ ~
Pump on' level at ~High water alarm level at n
Datum ~ _ .
.-------- Cycles tested Meets alarm & cimuit requirements~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot I~° '~ On adjacent ots. 100'+
Absorption field on lot /od 4- On adjacent lots 100'+
Public sewer main N/A Public sewer manhole/cleanout N/A
Sewer/septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field. 5'+
Water main N/A Water service line. 10'+ Surface water. 100'+
Wells on adjacent lots 100'+
Property line 10'+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
Water main N/A
Driveway, parking/vehicle storage
O~
*PORTION OF DRAINFIELD IS UNDER THE GRAVEL DRIVEWAY THAT IS NOT SHOWN ON THE AS-BUILT SURVEY
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date ~"// ~ /I Z-
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number.
Mnnicipality of Anchorage
Community Development Department
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 # 121166
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
26A of Lakewood Hills #2 subdivision. This inspection revealed a nitrate
concentration of 6.36 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.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GE~NEI~AL CONTRACTORS ~,~ ~ ~
To Whom This May Concern:
The drainfield would not accept a 600 gallon surge, but rather the water was given an
initial 250 gallon surge followed by water being added in 45 gallon increments. The total
of 617 gallons was incrementally added over 333 minutes. Our findings indicate that the
system will absorb approximately 640 gallons per day when filled to 100% capacity.
Please contact us aestions.
Sincerely,
Aarow Pump & Well Service, LLC
P.O. Box 110496
Anchorage, AK 99511
office: (907) 346-9355 · Fax (907) 333-8976
Eagle River: (907) 622-9335
No. 9364
CUSTOMER JOB SITE
'q C
/QUA~EY : DESCRIPTION ' : PRICE AMOU~
// ,/ ~ TOTA~ LABOR
:WORK ORDERED BY DATE OOMP. TOTAL
LABOR
I..-/I / ! . /
S~,' ."A URE
(t Hereby Acknowledge th6 Satisfactory Completion of the Above Deco, .,o ¢1o, k and agree ~hat !f Cbove wo[k is not paid for in 90 days I agree to allow Aerow
Pump & Well Service, EEC, the right to remove unpaid for oou ol ,i_ ~t ~tnd charge for labor already performed & labor to remove unpaid for equipment,)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS,
R
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ASBUILT S.EWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SC'4!-E;,
FOLLOWING DESCRIBED PROPERTY: *?'
DATE. O� R �0
Ar
AND THAT NO FNCROACHMENTS EXIST EXCEPT AS p'`��
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE E:CISTENCE OF ANY GRIDS
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- Duane Mark Seward ;' A
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: t � •., LS -5918
ANY DATA HEREON BE USED FOR CONS'T'RUCTION '3 4r
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN. `�b"$ "�,�.,,�
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ASBUILT S.EWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SC'4!-E;,
FOLLOWING DESCRIBED PROPERTY: *?'
DATE. O� R �0
Ar
AND THAT NO FNCROACHMENTS EXIST EXCEPT AS p'`��
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE E:CISTENCE OF ANY GRIDS
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- Duane Mark Seward ;' A
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: t � •., LS -5918
ANY DATA HEREON BE USED FOR CONS'T'RUCTION '3 4r
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES. DRAWN. `�b"$ "�,�.,,�
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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
'°1, o l
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ¢~4>i* !~//~:~¢.'~/..~m,~ Telephone:Home ~¢&-&~9o Business
Applicant Address 7 ¢0/ L~. ¢ ¢,~'~
(c) Applicant is (check one): Lending Institutio~ ~; Owner/builder ~; Buyer ~; Other ~ (explain);
(d) Lending Institution '~/~F~, ~; I-',/A :~A ¢ t ~--':¢ C_ Telephone
Address /
(e) Real Estate Company and Agent th/0
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family,J~ M/Ct~/~r-I
Number of Bedroon~/
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written ~°n,f rmati0n from the State Department of Envi'ronmental Conservation
~ ~ ' I~ .
attesting to the legality and status. ,',~ , :
4. SEWAGE DISPOSAL , ~.,., ~ i i ....
Onsite~[~ Public [] Community [] Holding TAnk~
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. ..\.,
72-025 (11/84}
Page 1 of 2
ENGINEERING FIRM PROVIDh..., INSPECTIONS, TESTS, FILE SEARCH, D~ FA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HeaJth
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
Telephone
Approved for ~/~ bedrooms by
Approved /'~"" Disapproved
Terms of Conditional Approval
,'. CAuTioN
The Muncipality of Anchorage Department o¢ Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representabons ¢ven ih~paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP do~¢ 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 ANCHORAGF-
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-472O
Legal Description: /--
OCT
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth i q~. Cased to
Static Water Level /¢~/'///'~¢.-J-¢--~/
Casing Height Above Ground /
Electrical Wiring in Conduit (Y/N) y
Separation Distances from Welt:
To Septic/Holding Tank on Lot -- /~'~O'¢- ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ./,/'~tO/¢ ; On Adjoining Lots
If A, B, C, D.E.C. Approved (Y/N) ~////E
Date Completed I ~ 7 "J I¢ Yield
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N) F
Depression Around Wellhead (Y/N)
./~-///Z/t.~ TO Nearest Public Sewer
F///'/ To Nearest Sewer Service Line on Lot
./~, ~vl/~.~ ..,/_<~/¢' ;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~,/?,~
Standpipes(Y/N)
Depression over Tank (Y/N)
Size
Air-tight Caps (Y/N)
Pumping/Maintenance Contract on File (Y/~)~ / m//~
Hol0ing Tank High-Water Alarm (Y/N)
Separation Distances from Septic/H/olding Tank:
To Water-Supply Well /~ --
To Property Line ~.)
To Water Main/Service Line U-~(~
Course
Comments /
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped L.~/;2~/,-~ ~
; for
Temporary Holding Tank Permit/(Y/N)
/
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
!
ABSORPTION FIELD DATA / ~gfy" -- &Od TI~ /t~ d
Soils Rating in Absorption Strata
. ./
Date Installed '
/
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N).
Results of Last Adequacy Test -
Separation Distance from Absorption Field:
To Water-Supply Well /('20¢¢-
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ~ /
Depth of Field . ~l~./z~ /
Gravel Bed Thickness 7 /
Standpipes Present (Y/N)
Date o_.~f Last Adequacy Test /~)/~ /
To Proper y Line
To Existing or Abandoned System on
; On Adjoining Lots /¢"201'z
To,Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or ~nformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed '~'~_. -~.¢4z,'¢-~¢'~// Date /O, /6~' ~,~:,
!
Company MOA No.
Receipt No.
Date of Payment / ~.") '-- /.'~ ~ ~'~
Amount: $ .C~
Page 2 of 2
72-026 (11184)
Engineer's Seal
Time
Date
Insp 2~f-~'
~--. MUNICIPALITY OF ANCHORAG~-~
DEPARTML.¥ OF HEALTH AND ENVIRONMEI. ~L PROTECTION
825 L Street, Anchoraae. Alaska 99501
~m~' 264-4720
Date Received: January 6, 1978
%2: Time #3: Time
Date Date
Insp- Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska Mutual Savings Bank
Mailing Address: Post Office Box 1120 99510 Phone: 274-3561
2. Property Owner: Louis A./Elaine M. Wheeler
Mailing Address: Star Route A Box 47 99507
Phone: 276~5716
3. Legal Description: Lot 26 Lakewood Hills Subdivision #2
4:
Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
Well System: Individual well (x) Community/Public System ( )
Permit # ~. Depth of Well Well Log on File
Construction Bacterial Analysis
0
Sewage Disposal System:
Permit # U~
Septic Tank Size
Absorption Area
On-site System (x)
Installed iq~l . Installe~
~-g-} ~;, i'./,~ Manufacturer
~f3~)A£3 ' Soils Rate Material
Public Utility
( )
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
". Pa~e Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 26 Lakewood Hills Subdivision #2
Comments:
Affadavit Attached~( )
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
IViUNICIPALITY OF ANCHORAGE
DEPARTMENT OF H£ALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner: Louis A. Wheeler
Mailing Ad'dress: SPA Box 47..' Anch. AK 99507
3. Name of Buyer: N/A
Mailing Address:
4. Name of Lending Institution:
Mailing Address: P.0.
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:
Location:
VA FHA. ,CONV
and Elaine M. Wheeler
Day Phone:_~76-q7_l 6
Day Phone:
Alaska Mutual Savings Bank
Box 1120, Anch. 99510 Phone: 274-3561
n/a
L 26~.Lakewood Hills #2
Phone:
Upper O'Malley Road
Type of Facility to be Inspected:
Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility__
If ndividual, date of installation
No. Bdrms. 3
Individual . X
one.
.Individual (on-site)_ x
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received September 23, 1976
Time of Inspection 3:15 p.m.
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
9:24-76 Friday
Pratt
1. Approval requested by:
Mailing Address: 3201 C Street
2. Property Owner: Alan Woodward
Mailing Address:
Jack White Company % Toni Brown
Phone: 277-1553
Phone: 344-4836
Legal Description: Lot 26 Lakewood Hills ~2
Location: 1st House on north side of Upper O'Malley
5. Type of facility to be inspected
6. Well Data:
A. Type Individual
C. Construction
7. Sewage Disposal System:
A. Installed 1966
C. Septic Tank: 1.
D. Seepage Pit:
E. Disposal Field:
8. Distances:
A. Well to: Septic tank
Nearest lot line
B. Foundation to septic tank
Single Family No. of bedrooms 1
B. Depth
D. Bacterial Analysis
On-site system
B. Installer
Size 2. Manufacturer
1. Absorption Area 2. Material
Total length of lines
199'
, Absorption area
Other contamination
, Absorption area
, Sewer Lines
C. Absorption area to nearest lot line
E0-034 (1/7~) P~n~ I n~ fwn n~n~¢
Page'2.of two pages - Rec ~t for Approval of Individual $
Legal Description l,ot 26 T,al~ewoocl ~I±115 ~2
~r & water Facilities
Comments
Approved Date
Greater Anchorage Area Borough, Department of Environmental Quality
Approval.Valid for one year from date signed
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1/74)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchorage, Alaska 99504 276-2221
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CM RO VA
2. Property Owner: Louis A. Wheeler
o
FHA CONV
Mailing Address: 1508 Craig Drive Day Phone: contact realtor
Name o~U~. previous owner : ~Alan Woodward (,~til 1 n~m?y±~g)
Mailing Address:,
4. Name of Lending Institution:
Mailing Address:
5. Name of Realtor or Agent:
Mailing Address: 3201
,n/a Day Phone: 344-4836
sold on assumption
n/a
Toni Brown, Jack
"C" Street
,_Phone:_
White Company
Phone:. 277-1553
Legal Description: Lot 26, Lakewoor] Mill,~ #2
Location: 1st house on North side of' UpD~-
~lm~l !ey Road
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
single family
No. Bdrms.
Public Utility
XXX
Individual
If Individual, number of dwellings 0resently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility.
one
199 ft.
Individual (on-site). xxx
Iflndividual, dateofinstallation appx 66 (1966)-
PLEASE COMPLETE PRIOR TO SEPT. 30
CONTACT PREVIOUS OWNER FOR APPOINTMENT
CONTACT REALTOR WHEN TESTS COMPLETE
PLEASE DO NOT MAIL
72-003(3/76)