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HomeMy WebLinkAboutLAKEWOOD HILLS #4 BLK 1 LT 2t,a K008 woo a ,�a�5 13q- 3a Municipality of Anchorage • �..r Development Services Department Building Safety Division On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW030027 PID Number. 015-134-30 Name: CCOLONY BUILDERS Wastewater System: ■ New ❑ Upgrade Address: 2340 LOREN ROAD * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-0371 4 O Deep Trench ■ Shollow Trench OW O Alound O other LEGAL DESCRIPTION Soo RaUnT 1.2 Total Depth from orWml grade: 5.52-9.72 cn/s,. ►t. R Block: lot: Subdivision: Depth to pipe bottom hem ce4nia grade: Gravel depth beneath pipe: 1 2 LAKEWOOD HILLS #4 SEE DWG ►t 4 rt Township: Range: Section: Fli added above "Ind erode: Grove lonath: — — — SEE DWG R 60 Tt WELL: ■ New ❑ Upgrade Grovel waft: 5 Number of lines: 1 Distance between Ince: 1 — R Ht cioeeekown Private. "c): Told Depth: Cooed To: Total obsorptton ono: Pipe rat.rld: D 3034/ F-810 PRIVATE 367 n. 104 R 600 so. pt. Griller. Dote Drilled: Stado Water ,uve: kwwkr: CATS EYE Dole 4%2%2003-5/5/2003 ALPINE DRILLING 4/15-17/03 94 R Tleld: Pump Set At, 1 Caekq Height Above Ground: TANK 3 GPN UNKNOWN R 2 n. SEPARATION DISTANCES ■Septic OHolding OS.T.E.P. ODther To Septic Tank Absorption Fu Lift Station Holding Tank bllo/Private S -or Lin"" Nonufactunr. ANCHORAGE TANK capacity N gallon' 1250 Well r 100'+ 100'+ — — 25'+ Material; STEEL Number of comportrnenb: 2 Surfacewater 100'+ 100'+ — — — LIFT STATION 5'+ 1 D'+ — — — =`e N galkmw Monutaetwer Foundation 5'+ 10'+ — — — amp an eve at mp al: Nth water alarm at Curtain Drain NONE KNOW Vurrq Motu 0 -WA l loans Performed br Remarks: BENCH MARK Location and D«orlpaara TOP OF WELL HEAD A «med Elw.otiwc 2.63 R ENGINEER'S 0 Inspections performed by. AKWWC , INC. Dates: 1st 4/2/2003 ....:...... ...........:....OD 2nd 4/3/2003 3rd 5/5/2003 '. f e A. a ess. . Q� �' Development Services Departant Approval 0 —7953f �4p�ea'P"" Reviewed and approved by: Date: - _p a�EoA� d rofessior` o �D0000��o (Rev. 12/01) PERMIT NUMBER AS—BUILT DRAWING PARCEL NUMBER: SW030027015-11 34-30 4 �1 i IB( "• ^ •' s' TERNATE SITE � 'r'.. 5.'•� Vii•. 'N ♦ • 1 'f, TH/1 ♦♦♦♦ •� � ' UPPER OMALLEY ROAD NEW OTA�O SEPTIC IK\\ A B ♦♦` FCO 7.79 39.24 THlz ST1 9.55 35.93 ST2 15.42 34.62 DBL1 18.28 38.40 DBL2 21.70 42.51 C01 31.75 73.23 NEW DR MT1 29.96 71.16 CO2 50.52 44.17 MT2 50.061 47.01 4 �1 ALASKA NATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE ?B • ANCHORAGE. AK 99501. • PHONE (907)337-0179 - FAX (907)338-32L PREPARED FOR: PHONE NUMBER: COLONY BUILDERS (907) 345-0371 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #4; LOT 2, BLOCK 1 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 5/8/2003 1 0::;l OF " Q AWN BY: OP•``•...... Sapp Z.T.G. 1" 0 40• ...... ... . 'oE NUMBER: O 2 OF 3 O f GO ss: .1 e dp'g;P ' •'•,�o i IB( "• ^ •' s' TERNATE SITE � 'r'.. 5.'•� Vii•. 'N ♦ • 1 'f, TH/1 ♦♦♦♦ •� � ' UPPER OMALLEY ROAD ALASKA NATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD. SUITE ?B • ANCHORAGE. AK 99501. • PHONE (907)337-0179 - FAX (907)338-32L PREPARED FOR: PHONE NUMBER: COLONY BUILDERS (907) 345-0371 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #4; LOT 2, BLOCK 1 TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 5/8/2003 1 0::;l OF " Q AWN BY: OP•``•...... Sapp Z.T.G. 1" 0 40• ...... ... . 'oE NUMBER: O 2 OF 3 O f GO ss: .1 e dp'g;P ' •'•,�o f PERMrrNUMBER: AS -BUILT DRAWING PARCEL INUMBER: SWO - SWO3OO27 015-11 34-30 TOP OF TANK A INLET - 96.30 r -FINAL GRADE 100.30+ / .T0P OF TANK AT OUTLET - 96.29 NEW 1250 GALLON INVERT OF BUNG11 SEPTIC TANK AT INLET - 95.81 INVERT OUTLET BUNG AT T - 93.66 FILTER TH#1 & TH#2 FINAL GRADE - 98.66-101.19 ORIGINAL GRADE - 96.6-101.00 .. ......... . i%i% � •%iii%i%i%i%i%i%i%% aEvow 4oO DRAWN BY: Z.T.G. tl ��.• ALASKA IVA1'LR R WASTENVATLR SCALE: W��-•�-�-•-•••••�••�CONSULTANTS, INC. 6901 DE84RR R04D, SUITE 28 • ANCHORAGE. 4N 9950E • PHONE (907)337-6179 • FAX (907)338.521.6 N.T.S. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: COLONY BUILDERS (907) 345-0371 3 OF 3 � • •• ' Q .G 00 ( ffr Hess E 953 .•'• o� LEGAL DESCRIPTION: LAKEWODD HILLS SUBDIVISION #4; LOT 2, BLOCK 1 QQ� o �Opp00000� TYPE OF WORK:ap�ofessio�o� PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM U MAY -08-2003 15:36 3456934 P.01 Municipality of Anchor ge Department of Health and Human Servi . es 825`V Street RO. Box 196650 Anchorage, Alaska 99519.6650 Rick Mystrom � httaJlrwvw.a.nnchorsge.ek vz Mayor ' I Permit Numb I r. #$W 030027 Date of Issue: Parcel Iden#itication Number: 015-134-30 Date Started. 15-0 ]late Completed: 4-17-03 is well located at approveii permit location? ® Yes No Legal Deseription: I Lakewood Hills # 4 Blk 1 t 2 Property Own�r Na'Me tit Address: Colony Bu#ders ' 2340 Loren Circle Anchorage, Alaska 99516 Borehole Dant: Depth (ft) Soil Type, Thickness &Vater Strata From To stick-up 0 2 sandy siltygravel 2 35 sandy srlt 35 47 sandy gravel ; 47 58 sandy s#t 58 62 ' sandy gravel? 62 _ 101 bedrock 101 367 ijlg/o 3 Method of Drilling w air rotary ❑ cable tool I Casing type: steel Wall Thickness: .250 inches Diameter. ¢ inches j Depth: 104 feet Liner Type: Diameter. in8hes Depth: feet Casing stickup ab a ground: 2 feet Static water level (from ground level): 94 feet Pumping level: ?65 feet after 2 hours pu=mping 3 prn Recovery Rate: 31 pm Method of Testing; iM Well Intake Openi°g Type: ❑ Open End El Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: hentonire granules Volume: 1 br Depth: j Start 0 feet Stopped feet Pump: intake Depth feet Pump size h� Brand Name Well Disinfected Ipon Completion? ® Yes ❑ No Method of Disinfe tion: Chlorin tablets Comments: ! Well Driller. Alplie Drilling & Enterprises PO Pox 110496 ; Ancftorage Alaska 99511 I I i t I ! I Attention: Ine well driller shall provide a well log to the property owner within 30 days of completion and the property .. fit. tL. .. ,l11 ..I.L fT.. .. I.. I1... .. I.L 1. iH J... .0.. ..1.••... ..0.�I TOTAL P.01 Y' l MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030027 (L'egai.Description:*LAKEWOOD HILLS #4 BLK; 1 LT; 2 Design Engineer: 0041 AK Water & Wastewater Consultarr Owner Name: Colony Builders Owner Address: 2340 Loren Circle ANCHORAGE . AK 99516-0000 Date Issued: Feb 24, 2003 Expiration Date: Feb 24, 2004 Parcel ID: 015-134-30 Site Address: 007701 UPPER OMALLEY RD Lot Size: 47045 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [j Disposal Field 0✓ Septic Tank Holding Tank Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 02��� 0,3 Date: 2 z ¢ 03 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMI:Y DWELLING Parcel I.D. 015-134-30 Permit Number 51.V030O27 Property owner(s) COLONY BUILDERS Day phone 345-0371 Mailing address (1) 2340 LOREN CIRCLE t ANCHORAGE. _AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 1: LAKEWOOD HILLS SUBDIVISION #4 Legal description (Section, Township & Range) N/A Lot Size 910 y15� Acre Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well 0 Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS INC. Permit Fees: $550 +c' Date of Payment: a I ( L4 103/ Receipt Number: Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER F& WASTEWATER �mu�uacarwmwaw:mwenmm�uv®armti CONSULTANTS, INC. �m�srmn:a+�aw�r a:mmia���ira+rwomnu February 12, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Well and Septic System for Lot 2, Block 1; Lakewood IIills Subdivision #4 To whom it may concern: The proposed 4 bedroom house will be served by a private well and septic system. Two test holes were excavated on the south portion of the property. The drainfield will be designed around the 30 foot radii of these test holes. We are proposing that a 1250 gallon septic tank and a 5 -wide type drainfield be installed. The well is to be drilled in the area shown on the site plan and design drawing. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: a. Percolation Rate: 4.7 & 2.42 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 600 ft2 f. Total Depth: 9 feet (max.) g. Effective Depth: 4 h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 60 feet long each k Effective absorption area = 600 ft2 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed design. 4. TOPOGRAPHY: The area for the proposed septic system is a 10%-15% slope running approximately northeast to southwest; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your M.S. NOTE: A site plan drawing, a design drawing, a topography drawing, two soils logs, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com HAMPTON HILLS S/D LOT 3, BLOCK I co 7 c / j LAKEWOOD HILLS XD 14; / LOT 5. BLOCK t 1 \ I ` I I I LAKEWOOD HILLS S/D j4; LOT 4, BLOCK 1, 1 `3 / mac EEn / PROPOSED 4 BEDROOM HOUSE % ! ARMC e' / ! / / LAKEWOOD HILLS S/D %4; ! A\ LAT 2, BLOCK 1. ! HIDAWAY LAKE S/D; LAT 1, BLACK 1, FA 1 I rtN jyW Y V� 1 (SEE DESIGN 6W ---- UPPER OMALLEY ROAD TE srrE �------- I LAKEWOOD HILLS S/D %4; LOT 5. BLOCK 1, 1 DATE _ 2/13/2003 t rt1 ALASKA AVATER & WASTEWATER: Z.T.G. CONSULTANTS, INC. SCALE 1" 100 6901 DEBARR ROAD. SUITE 28 • ANCHORAGE. AK 99504 • PHONE (907)337-6179 • FAX (907)338.3246 COLONY BUILDERS 345-0371 1 OF 2 1L DESCRIPnON: LAKEWOOD HILLS SUBDIVISION #4; LOT 2, BLOCK 11 OF WORK. SITE PLAN FOR PROPOSED WELL AND SEPTIC SYSTEM 11 07953 JC �J ' •......•••'\�o �e�frofesslo!? / l II o \ INSTALL FOUND A ON CLEANOUT 1 + PROPOSED 1250 GALL& / I SEPTIC TANK / I INSTALL DOUBLE nrktjnl c,� j . 4PRoposFO ho&gom NOTE: THE CONTRACTOR SHALL HAVE THE NEIGHBORING 100 FEET WELL RADIUS TO THE WEST BE FLAGGED B) A REGISTERED LAND SURVEYOR PRIOF TO CONSTRUCTION. WELL TH/I / ZROPOSEDRAINFIELD. EXCAVATE A TRENCH THAT IS 9 FEET DEEP MAXIMUM BY 60 FEET LONG BY 5 FEET WIDE. ADD 4 FEET OF CLEAN, WASHED SEWER DRAINROCK. -9 -76,, ALASKA ANIATER & `VASTENVATER CONSULTANTS. INC. 901 OEBARR ROAD. SUITE 2B • ANCHORAGE. AK 99504 • PHONE (907)337.6179 • FAX (907),538.5266 EPARED FOR: PHONE NUMBER: SITE UPPER OMALLEY ROAD 2/13/2003oQv o F Z.T.G. 1" = 40' COLONY BUILDERS 345-0371 2 OF 2 LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION #4; LOT 2. BLOCK 1 TYPE OF WORK: DESIGN OF PROPOSED WELL LOCATION AND SEPTCI SYSTEM ............ ............ ffr y arnes In E 79 e� ro f e s slo�°o�� t 4� O d4 ALASKA VVATKR & WASTEWATER �'`• �a00 CONSULTANTS, INC. --+ 4 6901 OEBMR RQAC. 3FITE 2B • 90304 • PHONE. (907)MI-6179 • FAX (907)3M-,3246 • WUMM' ckwc.wm SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION - LAKEWOOD HILLS SUBOMSION J4; LOT 2, BLOCK 1 OD or S: PERFORMED FOR: COLONY BUILDERS DATE: 2/6/2003 QQ�,�r •. CE 9534p DEPTH ���oapro f es 610T% o" (feet) �-, J TEST HOLE 1 �D�0000a`� ORGANICS SOIL CLASSIFICATIONS 2,`o GW- ORG3 GP 1111 [ILI ML GM CL 4 GCFFTIT OL °• • ° o SW MH 5 •• •'• : SP CH BBC M OH ! I 6 ! it t � i 7— DEPTH TO DATE �� n18z GROUNDWATER -�TH/1 8 DRY 2/6/2003 DRY 2/7/2003 f J 9 GM DRY 2/13/2003 SITE PLAN 10 11 12 13 14 15 16 17 B.O.11. 18 19 PERCOLATION RATE 4.7 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.5 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: MATT FISHER PERCOLATION TEST PERFORMED BY: MATT FISHER COMMENTS: PERFORMED BY AKWWC. INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W ERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 0 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 2/7/2003 1 10:56 — 6" — 2 11:06 10 3 7 8" 2 1/6" 3 11:06 — 6" — 4 11:16 10 3 7 8" 2 1 8" 5 11:16 — 6" — 6 11:26 10 4" 2" 7 11:26 6" 8 11:36 10 4" 2" 9 11:36 — 6" — 10 11:46 10 3 7 8" 2 1 8" 11 11:46 — 6" — 12 11:56 10 3 7 8" 2 1 8" PF' Sd4 F ALASKA WATER & WASTEWATER •�--�•-•---CONSULTANTS, INC. 5t QD 6901 DEAm Aw.SURE 20 1 ANCRFMX AK 99504 • PHONL (907)337-6179 • A%: (907)JM-3246 •WEBSITE: ok.ratom ......... ............... SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: LAKEWOOD HILLS SUBDIVISION J4; LOT 2, BLOCK 1I O � •, eff a A. or ss! PERFORMED FOR: COLONY BUILDERS DATE: 2/6/2003 hQ�°tv C 7953 l��Q DEPTH 4400eaI'rofesslo�°t,�o (feet) TEST HOLE #21�04000vo� ORGANICS SOIL CLASSIFICATIONS I--- 2 - - - , GW ORG ! 3 GP ML GM CL I 4 GC OL ! / °.°• o SW MH f } '.:•. t SP CH 5 SM ; OH ;l 6 SC ! ' I / i 7 DEPTH TO DATE GROUNDWATER !' ! �� THg2 8 ^ J + TH/1 11 � / 9 GM SITE PLAN 1"-100' 10 11 12 13 14 15 16 17 B.0.11. 18 19 PERCOLATION RATE 2.42 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.5 FT. AND 6.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES El NO SOILS LOGGED BY: MATT FISHER PERCOLATION TEST PERFORMED BY: MATT FISHER COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W S P RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DATE READING DRY 2/6/2003 DRY 2/7/2003 DRY 2/13/2003 10:58 - DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 2/7/2003 1 10:58 - 6" - 2 11:08 10 1 2" 5 1 2" 3 11:08 - 6" - 4 11:18 10 3 4" 5 1 4" 5 11:18 - 6" - 6 11:28 10 1 1 2" 4 1 2" 7 11:28 - 6` - 8 11:38 10 1 3 4" 4 1 4" 9 11:38 - 6" - 10 11:48 10 1 7 8` 4 1/8" 11 11:48 - 6` - 12 11:58 10 1 7 8" 4 1 8" MUNICIPALITY OF ANCHORAGE Development Services Department 1 p p �, / Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel 1. D. 015-134-30 1. GENERAL INFORMATION Expiration Date: --3" 1 —7 - 2 0z 0 Complete legal description Lakewood Hills #4, Block 1, Lot 2 Location (site address) 7701 Upper O'Malley Road Anchorage, AK Current property owner(s) Justin McMullin Day phone Mailing address Real estate agent P.O. Box 3983, Palmer, AK 99645: Jamie Harvey 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 227-1059 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ n Waiver Fee $ Date of Payment gal �/� l Date of Payment Receipt Number Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/4/19 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: .L�L���� 1Iy OF�rrro 'r Original Certificate Date: 12^ 1 < —19 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 C Other COSA Checklist blue sheet Legal Description: Lakewood Hills #4, Block 1, Lot 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4/17/03 Total depth 367 ft Cased to 104 ft FOR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '18 in. Date of flow test for COSA 11/27/19 Static water level at beginning of test 125 ft. Comments B. TANK DATA Age of tank(s) 16 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 5 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 11/25/19 - A Plus Home Services D. ABSORPTION FIELD DATA 5' Wide Shallow Trench Which system tested (date installed) 5/5/03 IN ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4.0 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: septic is adequate for a bedrooms. COSA Checklist yellow sheet Parcel ID: 015-134-30 Structure served by this system Well production at time of test 0.42 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 11/22/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 11/27/19 Results E✓ Pass For w bedrooms Fluid depth prior to test 12.5 in Water added 662 gal New depth 12.5 in Elapsed time 0 min Final fluid depth 12.5 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) No If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' M✓ Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft r7✓ Yes if No ft Neighboring Tank > 100' P/ Yes if No ft Private Sewer/Septic Line > 25' ✓0 Yes if No ft Absorption Field on Lot > 100' Fv Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Fv� Yes if No ft Water Main > 10' Animal Containment > 50' P/ Yes if No ft F� Yes if No ft Q Yes if No ft Water Service Line > 10' 0✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' E✓ Yes if No ft ✓❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' P Yes if No ft Private Wells > 100' Fv� Yes if No ft Water Main > 10' ✓0 Yes if No ft Community Wells > 200' Q 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' P/1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' El Yes if No ft Community Wells > 200' R Yes if No ft Surface Water > 100'✓® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l 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.49th _ •' L4ICHAEL E. ANDERSON ^ r 4>.•'�..: 12/13/19 F� COSA Checklist yellow sheet Well Water Advisory Certificate of On -Site Systems Approval # OSC191580 Subdivision: Lakewood #4, Block: 1, Lot: 2 This well's productivity was determined to be .42 gallons per minute. The minimum well productivity required under (AMC. 15.55) for a 4 -bedroom residence is .41 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Municipality of Anchorage ' Development Services Department ° Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING —�h �J Parcel I.D. 015-134-30 HAA# 1.) q 1.. GENERAL INFORMATION Expiration Date: /'9_ — 2 Complete legal description LAKEWOOD HILLS SUBDMSION #4; LOT 2, BLOCK 1 Location (site address or directions) 7701 UPPER OWALLEY ROAD * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address COLONY BUILDERS Day phone 345-0371 2340 LOREN ROAD * ANCHORAGE. AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3, TYPE OF WATER SUPPLY: 0 Individual Holding tank ❑ Individual Well ❑ Individual'Water Storage ❑ Community Class Well ❑ "Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of alt wells and septic systems depend on the local soils condition, groundwater levels that may Auctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for + bedrooms. Disapproved. Phone 337-6179 Date I e 03 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist ✓ Septic System Advisory Well Flow Advisory J : UN -51 I t WATER AND WASTEWAIM PROGRAM J�J q��•, •_• • •�• ,• •• 1 Manitenance Agreements JJJ����'"tMS��" Supplemental Engineer's Reort li Other By: Original Certificate Date: 0 3 , (Rev. 12/01) .. . Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.enchorage.ak us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LAKEWOOD HILLS SUBDIVISION 14; LOT 2. BLOCK 1 Parcel ID: 015-134-30 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 4/17/03 Sanitary seal (YM) YES Total depth 367 ft. Cased to 104 ft. FROM WELL LOG Date of test 4/17/2003 Static water level 94 ft. Weli,production 3 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. AT INSPECTION ft. — g -p.m - Coliform 0 colonies/100 ml. Nitrate 2.98 mg./L. Other bacteria 2 colonies/100 ml. Arsenic: N A mgJL. Date of sample: 9411/200 Collected by: AKWWC, INC. B. SEPTIC/HOLDINO TANK DATA Tank Type/Material STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) —YES Depression over tank (Y/N) NO Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed4L2/oaL5./5/2oo3Soll rating 0230br ftlbdrm) 11.22 Length . 60 ft. Width 5 R. Date installed 4/2/2003-5/512003 Cleanouts (Y/N) YES High water alarm (WN) N/A System type SHALLOW TRENCH Gravel below pipe 4 ft. Total depth 7.4 - o•9ft. Eff. absorption area 600 ft= Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) - For 4 bedrooms Fluid depth in absorption field before test - in. Water added =gal. New depth =in. Elapsed Time: T.- min. Final fluid depth - in. Absorption rate }= - g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NEW If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" in. E. SEPARATION DISTANCES High water alarm level at in. Cycles tested Meets alarm & circuit requirements?. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1000+ Absorption field on lot 1000+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 5'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION v �I 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in " '"".. conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS v�Sy'-v FE -7953 al/r jO Date 3 D . f 41 • • ± • 4 e^od�ofasslo0±� HAA Fee $ S ! 5 - Waiver Fee $ qq�� Date of Payment _1 _L Date of Payment Receipt Number Receipt Number (Rev. 12/01) 9-17-03; 9:41AM; ;907 5615301 # F- 2 I -SG$ CS Ref.# 1035881001 :tient Name AK Water & Wastewater Consultants Inc. Iroject Name/# Lakewood Hills S/D #4 :tient Sample ID #4 Lot 2, BIk 1 Iatrix Drinking Water All Datesj7Imes are Alaska Standard Time Printed Date/Time 09/162003 7:38 Collected Date/Time 09/112003 15:55 Received Date/Time 09/122003 13:40 Technical Director Ste hl a C. Ede Released./,' ample Remarks: Allowable Prep Analysis iometer Qualifiers Results PQL Units Method Container ID Limits Date Date Init 'aters Department Nitrate -N 2.98 0.100 mg/L EPA 300.0 B (<=10) 09/12/03 IS ticrobiology Laboratory Total Coliform 2OB, NoColi coU100mL SM189222B A (<-1) 09/12/03 KC 9-17-03; 9:41AM: :907 5615301 P F— 3 SILCT&E Environmental Services Inc. ' S Laboratory Division rv�r�m®%omm�•ssisr�iomveP®oeeesoosr�oare�i►s►,�®ei•►im®r,�a. 200 W. Potter Drive eking Water Analysis Report for Total Coliform Bacteria T ichors ee, AK 99518-1606 READ INSTRUCTIONS ONREYERSESIDE BEFORECOLLECTLNGSAIKPLE Fax: 1907) 561 -S301 - MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY D PUBLIC WATER SYSTEM I.D. # gk PRIVATE WATER SYSTEM D• Senditesules O Sendinvoice' ro r� onau a.a. ALASKA WATERS WASTEWATER .rh°". °'" r 3701 E. Tudor Road, Suite 101"= Mwfog Ad* orage, Aluka 99507 ay ur p o sendXesutts 3701-1. Tudor Road, Suite 101 m Anchorage, Ala&a 99507. ty SAMPLE DATE: L=L` f Month SAMPLE TYPE: t3 Routine o Repeat Sample (for routine sample with lab ref. no: ) o Specint Purpose SAMPLE LOCATION L.gkc%�� 6 /D Y, Comments: m ` C® Day Year t] Treated Water Untreated Water Analysis shows this Water SAMPLE to. be: Satisfactory , O Unsatisfactory O Sample over 30 hours old, results may be unreliable 13 Sample too long in transit; sample should notbe over3;Vhours old At examination to indicate reliable results. Please send new sample via special delivery mail. Date Rece{ved 7 - �2'0 Time Received Analysis Began Analytical Method:. �k Mernbranc Filter O: MMO-MUG ''10 m], Result* Analyst 1035881 *-/A 11111111111011 tray h�CA, Sent to A.D.&C. Anch Fbks Jun ❑ Faxed Time Collected Collected By wf • rkau Pilot ..'Date: Time• Clientinotified of unsatisfactory results: Phoned Spoke with Faxed Date: Time: BACTERIOLQGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform F� Cot! ' -� r Membrane Filter. Dlrect.Cobnt c7�O 9 A -O C -n-1 t Coloniest100 ml. Veriflcatioo: LTB rGB COLIFIRM Fecal Collform Confirmation Final Membrane Filter Results sTC1, Coliform/100 ml Reported By V zx��2 ' Date D3 Time1,,E-6V hn A.e1 SGS Member of the SGS Group (Socidt� Gdnrirale de Surveillance) ?NTC- Tao Nuaasaus 70 Count oB -otbn Bactark 68-134 LAKEWOOD HILLS SUED., NO. 4 LOT 2b6 BLOCK 1 1. 0 h _ROgp FINAL. STRUCTURE AS -BUILT AS—BUILT I HEREBY CERTIFY THAT I HAVE suRvEyEr THE PROPERTY DEPICTED ABOVE AND THAT NC +�,t�6j CASTALDI LAND SURVEYII ENCROACHMENTS EXIST EXCEPT AS INDI D. �* Of ALq, JEFF A. CASTALDI, R.L TT IS THE RESPONSIBILITY OF THE OWNER TO *'s,,,......., 4728 WEST 88TH AVEN RETERMINE THE EXISTENCE OF ANY EAS . ENIYwyr� ANCHORAGE. ALASKA 99 OR RESTRICTIONS WHICH DO 0� * - 49 m PHONE 248-5454 APPEAR ON THE RECORDED SUBDIVISION P .............•••• UNDER NO CIRCUMSTANCES SHOULD ANY •. Ge�D DTC HEREON BE USED FOR CONSTRUCTION 0 ' Jmffwy A. Cc 2W 9/1e/20" ESTABLISHING BOUNDARY OR FENCE LIN 1� ti •,, Ls -6091 ANCHORAGE RECORDING DISTRICT, ALAS 1� •'......"' Fa. 03-17 doe NO. V6421 NOTE: NO CORNERS SET THIS DATE. �a6�sarl pf =30' 1GREa �R ANCHORAGE AREA BOR`IGH Department of Environmental Quality 1'Io 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME IMMIM�. MAILING ADDRESS 3%17 ewzLK[i-f Aly PHONE LOCATION /YIALL��/ �LEGAL DESCRIPTION z6 -1-z SEPTIC TANK: DISTANCE//�� NUMBER OF FROM WELL PROP- MANUFACTURER�Sta� 5l"� / a MATERIALZ« A -I !S3Z% COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 13'07 GALLONS. SEEPAGE PIT: r '/ / NUMBER OF PITS DIAMETER OR WIDTH 2a,�3 r LENGTHZ�._T2 DEPTH LINING MATERIAL % fttiY'M6 &R+B SIZE: DIAMETER DEPTH 3 f DISTANCE FROM: WELL TOTAL EFFECTIVE 4/ BUILDING FOUNDATION nom, NEAREST LOT LINE Q -I" ABSORPTION AREA (WALL AREA) �S� 7 SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE 10"619, CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES DEPTH NEAREST SEPTIC SEWER LINE TANK_ APPROVED DISAPPROVED REMAR DISTANCES: INSTALLED BY: John /_Oetcel PIPE MATERIAL: (wr Lllu)v LOT SLOPE: REMARKS: 'Sole G�FtCC+�C/ ta2�>C�i �L Form PW -026 DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM _ DATE _CW • Q APPROVFD G.A.A.B. Seerxv)e, P;"r I r v. h rt �o, l" i x P�'oP wet t, ZI V, fiPplelk r\ IUrI Fact 2" Nuus�y� 1uT L J Ale DATE _CW • Q APPROVFD G.A.A.B. GREATL:.R ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 9500 Tl!D0R ROAD "OUCH 6"15150 A!4CHOF`AGE. ALASKA 99502 ru.['rr.orvf 279.0686 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT NAME OF APPLICANT _L--IL`—�IJ_/.Ij—`---- MAILING ADDRESS �I / /��._/---.�!1 t�HONE IA7y INSTALLATION LOCATION LEGAL DESCRIPTION 1r / INSTALLATION OF: SEPTIC TANK SEEPAGE PIT __�^ DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED eC� �–� �'�P�Oy ZZ TO BE INSTALLED BY== - SOIL TEST RESULTS �NOTE. THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATEDn�s _ � PFRMiT VA11O flNE YFAR FINAL INSPECTION, 84 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HrALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE/6' D TYPESt a DT COP1C P P.SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS 5 ft, FOUNDATION TO SEPTIC TANK FOUNDATION 7'0 SEEPAGE PIT 20 ft, DRAIN FIELD 1.0 ft" SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK—5 fto . SEEPAGE PIT 20 ft, DRAIN FIELD 0� TO NEAREST LOT LINE. s6 WELL TO SEPTIC TANK S SEEPAGE PIT' DRAIN FIELD 41,1 r).�---• ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 fto SEEPAGE PIT 10 ft. DRAIN FIELD 10 fta--, SEPTIC TANK. 25 ft*, SEEPAGE PIT 100 fto , DRAIN FIELD 50 ft, DIAGRAM OF SYSTEM 4" CAST IR0N SIPHON R[PTI[ PIPE KITH AIRTIGHT CRIB IANK CAPS CAST'1 Rl': level � GAIT IRON INTO UtIDl6TPI:DED SOIL IIIN11lUP C I required ul:cnever line crosses under driv.lxay. 7'O RIVER, LAKE. STREAM. P. n.l can un.l. ?ISI CAST IRON IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. nI I I'T- ' PIT- 1T- 100 1. 0 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT 1:'I:! PIIOI.IC FITTED WITH AIRTIGHT REMOVABLE CAPS. to rncff- r.o" T^ I'I f- 120' Nps :[R LIN;- nn BACKFILL f,n'.i.n' GRAVEL CAS; 1:!011ji SCIER SC I Ir.E CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I:IIM IC 10 gin. r:e- 200' In I•Ir - 200' 109'-2^.0' 0': Ly `.A`!SE'1. l lcE Pjli l EALTH AUTHORITY Ae!'Irti lOu OR LICENSED DESIGNER RAVEL RAGGKFII.L�s A8naso CRIB. ' (CRIB )d' I11NIt4UH AOOr'E' NATER 4 10CII S^KER CC NSI k!R ,TR[P. HELLS. SCCPAGE PIT E1CMATION BASED ON 'vCLL'ao SOIL TEST. F- Grade; P r fu 'co or de; p r fon: except 10' precruding HOUSE tank 6 tha. should I not exceed P%. i 6' per 100 on flat terrains. DST Ifni, .7 SEPTIC PI?L I TAMC 0 / IlfiU.`.• —_r A INCH DISTPC OCn —) CAST IR0N SIPHON PIPE SOIL ;\ .� �SEEPAGE PIT - `.J CRIB }.. ifJ<–�___� GRAVEL BACKFILL P 20' Nih'111UN - NEAP[ST LOT LIME 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.80 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN �{Ay�CCORDANCE WITH SAID CODE, DATE _/0 ,�—� APPLICANT'S SIGNATURE r C, A S IC 4y 3 5 0: 0 T U D 0 P 12 A C H 0 R A GE , ALASKA 99502 Performed For Performed /© Lecia I Oes c ri n ti on Lor moi35/XSuhdi vision This Form Renorts Soils Loo Percolation Test Oenth Feet Soil Characteristics I — 2 3 A 5 — 7 in Was Ground Water Encountered? If Yes At what Donth?- -F---­------ --------------- Reading Date Gr n ss Time , Not Time I Donth to 1120 ............ Percolation Rate P r o r os e d I Ti s t a i I tier) D nth -P T ' i t - Net Dron,; e. 0 n I e o T t,rl!'i t 01, Trench C ()MVENTS 6a e r fi Test Performed 1. F, C-0 cvv&, C e�� wd °u�y ` Gvq TTC'A04Aff Ly,' 1 n�� GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 0`14n=L0,,,,,ov°°° k 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received May 13, 1976 Time of Inspection 9:30 a.m. 1� 6Date of Inspection 5-17-76 REQUEST FOR APPROVAL OF Les INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Mailing Address: Alaska Mutual State Bank 2. Property Owner: Thomas & Darlene Smith Mailing Address: Box 37A Star Route A Box 99507 3. Legal Description: Phone: Phone: 344-4669 Lot 2 Lakewood Hills Subdivision 4. Location: O'Malley Road, see map 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: Individual A. Type DgIlle-p B. Depth 211' C. Construction apayuea D. Bacterial Analysis Lr rha 7. Sewage Disposal System: On-site system OIX117� A. Installed B. Ir,taller C. Septic Tank: 1. Size It2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: Monday A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages MUNICIPAI I1? l:F ;°00 01)oiq,Gf 1)I:1'1 Of FiS4LT� f Iii�Vl°°':1fVi14[I�:TS',I_ Ft,�:;f_C(IQh! MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF'a INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: `y/ Mailing Address: �o� �yf ��� �� Day Phone: 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: '!� Phone: 5. Name of Realtor or Agent: Mailing Address: G Phone: 6. Legal Description: e, ��,1�T/ Gl a2 Location; 7. Type of Facility to be Inspected. " e No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) �— If Individual, date of installation !h " I 72-003(3/76) Page 2 of two pages - Re st for Approval of Individual er & Water Facilities Legal Description Comments A Lot 2 Lakewood Hills Subdivision Disapproved Date^`% Approuva Valid for one year from date signed Greater Anchorag A `a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I 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 EQ -034 (1/74) Date