HomeMy WebLinkAboutLAKE HILL ACRES #5 BLK 1 LT 1Lake Hill Acres #5
Block 1
Lot 1
#051-122-20
DT1000895
Municipality of Anchorage Page Of �-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5,w92 01 55 PID Number:
Name: TZo bei w&O
Wastewater System: ElNew X Upgrade
AddrepO$O--,e, o4z E l� ov QHS
ABSORPTION FIELD
Phone:
694-
No. of Bedrooms:
3
❑ Deep Trench ❑ Shallow Trench ❑ Bed o Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
CrJ
Total Depth from original grade:
t
3
• GPD/Sq. . Ft.
Lot:` Block: I 1 S divisioge
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
_
J?� PT�•)Y
7.5 Ft.
0'57 Ft.
Townsh-
? 15
Range:
1ZI
Section:
512
Fill added above original grade:
Gravel length:
20
l.J
1.0 Ft.
Ft.
WELL: ❑New ❑Upgrade
.
Gravel dPRrh:WiATS
Lt
Numberof lines:
Distance between lin
Ft.6
Ft.
Classification (Private, A,B,C): Total De
Ft.
Cased To:
Ft.
Total absorption area:/ OM
ZQb ms"). Ft.
Pipe material'¢ 'PVG
LtD- 9
Driller: ' ` Date Drilled:
G�
Static Water Level:
Ft.
lrj t'a�l,ler^:
1 v' \ �Ar
Datei alle�d.,.z� 199 Z
Yield:
Pump Set at:
Casing Height Above Ground:
I
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
❑ S.T.E.
❑ Septic ❑ Holding Uf
To
Septic
Absorption
Litt
Holding
Public/Private
Manufacturer: �\ �pacit in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
Well
�'
�Z,YY'7
74"Ps
NA
f%S'
Material: Number of Compartments:
35'
+I So'
-75'x"'
WA
�O'
LIFT STATION
Water
Lot
r
S
_ r
!bb
N
--
Size in gallons:
Manufacturer:
Line
0(:f
Foundation
aS
�S`
o
rvA
"Pump on" level at: " level at:
High water alarm at:
CurtainN
A
/v�
NA
%�»
N
Pump Mak del
Electrical Inspections performed by:
Drain
Remarks: ;,ryt 512-'ric <-VFT 5TPrTlb+e t�av)owo
BENCH MARK
/NSTAA_LCV fL1QL0211a oetb- P LAR A -r 85»0459)
Location and Description: 'RAOis: AtIzeb2 Lowe -=look
G/4241=- S Lfl+4 = V 5
FUILDiMGe F6Q1v1>Hn ex
iF . V �'TC e0C-LC5 U=
-m SZ*L AG;4r N3? wRTGK< 5'N5TL'm OP6Pbor
Assumed Elevation:
I00
e2 DEs1
Qrst. r.1e.
�
Or A4.,,%%
i'yY� to"Nae9i x.0667@ d�6'��
Inspections performed by: Dates: 1st (�-ZS`"�
• 9Y �'FL i®
2nd 6-19 _9Z
m. "32•E 6
Department of Heal" d Hu rvices approv I
44 � as �o .� OZ
Reviewed and approved b Dater
P11
Permit No. 5 W9Z O1gs- Page �' of ^�
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Ll 3l L^Z-ke-4y}.s -res #-5 PID No.:
EDGE ovr New eA
Zo' --
1
!=� ML
meta 1 Toy -
79 -ma n 19/Q1I unn 9s
GY\371N1�
'peMo.rvt 4" PVRIC
GeN"Lmer New 9" PPRF
-N);'RR t= "I G ov e"�
G-tjrkr' • New vlbLo
EkkSTI N 4
MbVN� �,pVL°12
LZ' - SyYRo.-.l
GY%ST1NG- 4"Pimt=
6 � SY ro Cr 'Rewelz
12nck
I IMIpa27U1D St1+.p ��
..��. n.,cA Isbs o6o(D)
�_
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J k&, 19"
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920155
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC.
OWNER NAME:CAYWOOD ROBERT L
OWNER ADDRESS:P. 0. BOX 774042
EAGLE RIVER ALASKA 99577
PARCEL ID:05112220
LEGAL DESCRIPTION: LAKE HILL ACRES #5 BLK
1
LOT SIZE: 31345 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 1
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1 LT
DATE ISSUED: 6/26/92
EXPIRATION DATE: 6/26/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
"�—
DATE:
ISSUED BY : DATE: 6 - >- � ' o '�'—
SITE PLAN—VIAS CEWATER ABSORPTION SYSTEMS UPGRADE
M I Y' rotr L0e
cV�
OND6'j DP P
. WCLL
liyCJ�u"tiiet�vb <
i
% T'C.S,r 410
p�p
NO -T&%'
see seer 3 �aR SzEPL,gCrnwT
�Ax �- {gee; es a5 rky�.0 r � G• �rrt+�x�
OF A4 '41
SITE PLAN DETAILS
Reef ,It PROPOSED WASTEWATER ABSORPTION SYSTEM UPGRRDE
Aw,t e �� LOT I LAKE HILLS ACRES SUBDIVISION, 05
e eaee PREPARED FOR: ROBERT CAYWOOD
b�p PO BOX 774042
00 P NO,lm—u EAGLE RIVER, AK, 99577
4$ SCALE: V = 100' DRAWN BY CAL
`
AL
CONSTRUCTING ENGINEERS 346-2000
9601 BUDDY WERNER DR 694-9098
ENGINEER'S SEAL ANCHO ACaEF AXs, 99516
DRAWING N 92—S1-06-1
AESORPTION SYSTEM DESIGN
9
�Y.1ST1 N(r 0V -V
LtoP,c� EN/A`6LOSC% w'fr{IN
,-W u 5 E ////_L��\o vw? Al-1o..� 141G'11• W AT6�2
atq(Ces�l57 r36 Id-�57NLL�A,
oV aS}�tj{Q, Ri"
rc� I ac.eyr,ohk SLts ae.,,
,1 `ly
Con5kvu�'jL'n
i lOieS i
Q
piPe, a-4 e'a or 1e}cl.
Qcoi
V .c.,'(-
"" Fe;-* ,I"lpo -FGb, zx1S+NN j Pevk7 j�ipe -o
¢�,3 of new
a�savr,;,�r l�ld sx'r1s�o ,.
new ell Mror 6c�wcah �+ Jll l�dey'41
JInSdalt
9" pie'
jp ve �' el,�� o�
a
lhs%ll
n.o„� lo,'
4vl-�e. hea,- �nc� otY-Fie.}c� a5�i�hw� above.
DESIGN DETAILS
Jo Alt PROPOSED WASTEWATER. ABSORPTION SYSTEM UPGRADE
A624, .2 Ilk I LOT I LAKE HILLS ACRES SUDDIVISION f #5
PREPARED FOR. ROBERT CAYWOOD
° �7 PO BOX 774042
5 R ('dcee' o
EAG I-JERIVER, AK, 99577
p'ti No. 1732-E 6p -
a ;dne ,I A ' NOT TO SCALE DRAWN BY CAL
CONSTRUCTING ENGINEERS 346®2000
9&�1 BUDDY%rE ER DR 694-9098
_ _. NGI EAt ANCHORAGE, .Ate, 99516
DRAWING # 92-S3-06-1
ABSORPTION SYSTEM DESIGN
rA
O
I
ter I wllNsv�ATIoN
77,
VOVTV3 Ay 9VOLI?rP To ��rnoa a 6radc>
Otb,f1(-�S1 L4f Tb
tc* MIWIVNvv� 4' A6ovg tom+ I-VvV"-.
'(-o�?soflL �$nr p 10P4" bF -ILL AAAvSVIAL
5Gr 5H( -(-T 53 PO(C FLITI1�'✓< te-IV�)LS
p� -moi Is.rs.c
nlajrJc sant)
16'
Nl 1I•)If vN
PAQ ExiSf co. er
i mf7ox'aea 52rri
.�..._; Sr�� � �oGk � (�'� n• u„rev„}
�1 Low Pipe j""> -r 'oma /
(a” A%ovc- PIPE Fol KYSS>olr�L
Z” �,[y� INS�I�r}*T\b'rJ AIINti;l l/t1� '
SCOPE OF PROJECT: Existing absorption field is designed and installed as two
(2) bedroom system (Per_mit 85-0459). Existing system is adequate for 2
bedrooms. Proposed project is to add additional bed area to bring system
to meet three bedroom minimum requirements.
ABSORPTION AREA CALCULATIONIS:
Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity
Existing system: 2 bedrooms (300gpd), 150 gpd required for addition
Soils rating, proposed addition, 0.8 gpd/sf
Minimum sizing: 150 gpd -- 0.8 gpd/sf = 187.5 sf absorption area (addition)
(Existing bed dimensions 12'W x 64'L) Use 12'W x 161L = 192 sf minimum for addition
IMPACT ON ADJACENT LOTS: There are no public wells within 200'- of this
absoption system. All private wells which are on adjacent lots are shown
on the site plan.The proposed absorption system has no impact upon any
adjacent lots as shown on attached site diagram.
`ENGINEER'S SEAL
DESIGN DETAILS
PROPOSED WASTEWATER ABSORPTION SYSTEM UPGRADE
LOT 1 LANE HILLS ACRES SUBDIVISIONr #5
PREPARED FOR: ROBERT CAYWOOD
PO BOX 774042
EAGLE RIVER, AK, 99577
NOT 10 SCALE
i
-CONSTRUCTING ENGINEERS 346®2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516
DRAWN BY CAI.
DRAWING N 92-S2-06-1
T(s1' Oro IL'7 4, 1
(4p
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
14s* ,
PERFORMED FOR:^-O�etnWG3G DATE PERFORMED: `}�'�
LEGAL DESCRIPTION: L1 G � I IS tY vt:54 J Township, Range, Section: SZ �• IS N P 1
DEPTH SLOPE SITE PLAN
(FEET) ®k"��flr I I I I I --r-T--�--�
1 -J
2 � GLa �j 51 L T
4
s�rvri
5
6 ko-
7
s
9
WAS GROUND WATER ('� ��'�hov�•.�},v
10 L=NCOUNTERED?=> __,
11 s
F YES, AT WHAT L
DEPTH? �j �S PO IA S9 Q-
12 E
Dglh to Waler After
13 rdanitorinD?
14
15
16
17
19
19
Reading Date
ILMI
GrossNet
Time
Time
Depth to
Water
Net
Drop
1
Z0oW+r
M1�
n r
e
st
S
I I,r
t d
ISS n
7-117"1
WAS GROUND WATER ('� ��'�hov�•.�},v
10 L=NCOUNTERED?=> __,
11 s
F YES, AT WHAT L
DEPTH? �j �S PO IA S9 Q-
12 E
Dglh to Waler After
13 rdanitorinD?
14
15
16
17
19
19
Reading Date
ILMI
GrossNet
Time
Time
Depth to
Water
Net
Drop
1
Z0oW+r
M1�
n r
l
S
I I,r
t d
ISS n
7-117"1
Get 1
rn 7,.
PERCOLATION RATE — � (minutes/inch) PERC HOLE DIAMETER _8
TEST RUN BETWEEN _._ 6 FT AND S FT
COMMENTS—SZnc-1 4a1,}e-V Wde22 ,—
PERFORMED BY: �����'"'�- '^ �' inca I _r CERTIFY THAT THIS ))TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6I"ZO (.9-Z,
o Municipality of Anchorage
DE=PARTMENT OF HEALTH 1£ HUMAN SERVICES
825 "L" Street Anchorage, Alaska 99502-0650
SOILS LOG ®- PERCOLATION TEST
OXX vuu
bag 22, Im
• X*
PERFORMED FOR: Izvbnr" Com'^ a U1�`"}G. - � 4
..— :L�----DATE PERFORNfE-ViLEGAL DESCRIPTION: DESCRIPTION:Lt E--''�=�I�jSz-Q-`�".��+' Township, Range, Section: S Z 't'1S-n1 iZ I lJ
DEPTH" SLOPE -TSITE PLAN—y —T -v
(FEET)
A -r tZiSf"�'�S' rno�rl'���1
- -- �- bCZi(dtNAL �20U1J12
�vc� o�rs:c
ch.),, Is•, 14
Pic F -Li vArTjt) J
117 _ WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT t L
J DEPTH? S 5 t7e�b� P Ft
1:_ ottSil�t ✓r2 E
1,.; Depth to Water After —
hlnnitoring7 S_5" t uJ 00e- 6�Zv"`ate
1A
16
10
1';
18
19
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
Z
Zvi
Z,-7 t
20 I I PERCOLATION RATE Zt
(minutes/inch) FERC HOLE DIAMETER
!` TEST RUN BETWEEN FT AND --PFT
COMMENTS5�., � Z?10 C,V <a"P.,1<-4z, 1 cz)tS"i
PERFORMED BY: 4`Sy�,'°�t is,�. ?,� -- CERTIFY THAT THISTEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ts.
�(L
f'
® f Municipality of Anchorage
Q DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PER17ORMED FOR:��E'N C�h wcyc! _ DATE PERF(
LEGAL DESCRIPTION: L, (,-le'-, , t t} 5 - �y"e S_ 5 Township, Range, Section`S_Z T1 �N 2.I IJ
FI DEPTH ((;� SLOPE SITE PLAN r-�
(FEET) DYJ`n-' �1 I
1
i
3
4
3
7
8
9
10
11
12
13
14
15
16
17
18
19
G lzv
F N z,a
5 P& ,V
WAS GROUND WATER /
ENCOUNTERED? `!
S
IF YES, AT WHAT L
DEPTH? L p
E
Depth to Water After N bT �1�N liz�CjJ — -
MmitorinD7 _ _ Date: —
Reading Date I Gross Net Depth to Net
Time Time Water Drop
20 PERCOLATION RATE ___ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND ,.—_ FT
COMMENTS JV ZS ffl'n-4- IR 1f`t)13 v�S`r Po1-L, - bL)(,I -R> 69515-rZ
PERFORMED BY: �?hSTr•yU�ie�� "I�Yt I ��j`C.•-- CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
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
❑NEW
5.AJ •
6'.Z97
UPGRADE
MAI LINGA S if,
C5
LEGAL DE CRIPTION
LEGAL
LOCATION
NO. OF BEDROOMS ^
WellAbsorp�n
arep
Dwelling /
PERMIT NO.
O
DISTANCE TO:
CJVy
S
Y
P: Q
Manuf3,ct�urer e�
�✓�+.
3YG}�ee O
G� T �
No. of comps rtmgnts
G
n~
Liq. ,ag@c d gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
02<
Manufacturer IFV f7Material
Liquid capacity in gallons
x—_
0
Well
Foundation
Nearest lot line
PERMIT NO.
w=
DISTANCE TO:
u- z
No. of lines
Length of each line
Tot I n Tines
Trench width
Distance between lines
_j
Z w
inches
CC
finish
Materialtheneath the
Total effective absorption area
Top of tile to grade
®
inch
Lu
Length /
6
Width
/Z
Deplth �r rr / PERMIT NO.
AAtD � 6 s'a Z�crre✓6�uc S
a
Type of criib
Crib diameter
rib depth Tota effective sorption areae7
w
6 +a
N
DISTANCE TO:
Well /�
Building undatign
Nearest lot line / '• ,
(, m �- .••• °i••°• LS
w
CI s
Depth
Driller �..�-
Distance to lot line
PERMIT N °•
J
Lu
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorpti�l are
• • °" • '
IV vr r ® ••
OTHER
b /s h r
PIPE MATERIALS
((
FE 10 •+■
SOI L TESt RAT N /
2.570 .5oYiJO =I L L /Sb
L I
f O �►
-
INSTALLER(
REMARKS
e / C .gn/dr w•4l'T tis z�c�Ea v.t,
m0"D ED 03"A
CS
O we Z
A o E Ot7
¢C 01 rl �I OP _11W4 WrKC_
06 n /�U7 tdll2�
GvA v2 G 'T
u
es6 4 A.) e 14 1 rc
dG /J fiat ISI /v` �/YN`t &AAr Me&AU d1
r /
dh
L ,O ",C4,1- w,4S A 6 e r L k ##WOo
R_ ,
-\-
I
APPROV - C r, -t-'- DATE LEGAL
ry d�(tE)
Y;L`.:.-L.. $'SIL i..,�[giL^.v(t,� •dJdf Q / �/
/i ��� IRS
a
.. �4_11 P.- X�� ��.����1����
DEPARTMENT OF HEALTH�ANDENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, Al.". 99501
264~4720
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
850459 ENGINEERED DESIGN
07/3O/85
GARY EVENSC/8 S & S.ENG/G"
SRB196X
EAGLE RIVER, AK 99577
694~2979
LEGAL DESCRIP: SUBDIVISIOW:-LAKE HILL ACRES 1*5 LOT: 1
SECTION: 2 TOWNSHIP: 15N RANGE: 1W
LOT SIZE: 25840 (SQ"FT" OR ACRES)
BLOCK: NA
Tz�
I certify that:
1" I am f'amiliar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of' Alaska.
2. I will install the system inaccordance with all MOA codes and regulations,
and in compliance with the design criteria of' this permit.
3. I will adhere to all MOA and State of Alaska requirements f'or the set back
distances from any existing well, wastewater disposal system or public
s�werage system on this or any adjacent or nearby lot.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN.ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS--BUIiTS
WILL NOT BE APPROVED WITHOUT'ANELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELE:CTRICIAN.
SIGNED DATEJL:
APPLICANT: GARY EVENS C/O S & S
'
ISSUED BY DATE:
���~___�__~
�!
� �.. ❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE
+.c DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST QJ
PERFORMED FOR: V ��%% / 'en J DATE PERFORMED: 7 V s'
LEGAL DESCRIPTION: / `^—" 14"(+cam 4C2Es 0—,S -
SLOPE SITE PLAN
DEPTH
(fEkTT)
1 <
2 • /' /,�
3 v'
4-
5-
7 5
8 `` G
t
9 �
�. vI
10 ,An
11f Gl�1iI, CQ d �i WAS GROUND WATERj /�f L
ENCOUNTERED?
O
12,l / J� IF YES, AT WHAT /� t E
13 Q ib> t1 jjX DEPTH?
`2o /P- 7 (/,r/ 7 /r ys
41516 14-
15-
16
17
18
19
20
LJ
COMMENTS f
�k,OFESS104
•ate
/Tv,p- live -
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
/L
736v
/°
Ile
xx
PERCOLATION RATE 2
c�.y
TEST RUN BETWEEN _—T
r�
—(minutes/inch)
51 FT
.� �Si �,. L:a•�i �vticn�iu•a
PERFORMED BY: - ;`' i��+� r CERTIFIED BY, / DATE:
SOILS LOG
MUNICIPALITY OF ANCHORAGE
y,f DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
1,. 825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED: ✓ v
C
LEGAL DESCRIPTION: G-- / 4 %-�-f fe— Ce s
SLOPE SITEIPLAN
10-
10 /go % %i Al Orc / yv L
WAS GROUND WATER S
11 ENCOUNTERED? C S L
O
12IF T / t/ E
13 7 s T
14-
15-
16-
17
4151617
18-
19-
20-
COMMENTS
81920
COMMENTS
DEPTH
(tECT)
VV�/+��- �G/�/ C /�_
/ G
Net
Time
Depth to
Water
Net
Drop
1
41
2-
3
` c
6Z G!/%
,
c
I
4
7
`(�•
9-
10-
10 /go % %i Al Orc / yv L
WAS GROUND WATER S
11 ENCOUNTERED? C S L
O
12IF T / t/ E
13 7 s T
14-
15-
16-
17
4151617
18-
19-
20-
COMMENTS
81920
COMMENTS
JPERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND—� FT
dfs SRO 190 S ntta•; / O �T
PERFORMED BY: CERTIFIED BY:- DATE:
,;a PH. 604.237D v
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
41
JPERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND—� FT
dfs SRO 190 S ntta•; / O �T
PERFORMED BY: CERTIFIED BY:- DATE:
,;a PH. 604.237D v
LOCATION OF WELL (Pleoss complete ;either to, Ib or Ie.)
'WJ TER YJELL RECORD
STATE OF'ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
A.D.L. No.
`Io. Borough Subdivision at Block: Ib. 1/4 qtrs. Scotian No. Townshlp N ❑ I Range EC] .Morldlag.,.,
Anch Lake Hil 1 ll—°r_cr-at- 6❑ W❑
Ic. DISTANCE AND DIRECT IO F OM ROAD 1 TERSECTIONS 3. OWNER OF WrLL:-
Acres Mr. Gar Evans
Address: SR 2: Box 6384
Street Address and Area of Well Locati n Chugiak, _ Ak.99567
2. WELL LOG
i Material Type
.Feet Below
Surface
I Top Bottom
4. WELL DEPTH: (final)
5. DATE OF CO)APLETION
Overburden 0 20
6, >MCabb tool O Rotary ❑ Driven ❑ Dug
❑ Augo-r ❑ Jelled ❑ Bared ❑ other:
Gravel 20 44
7.USE: CR Domestle ❑ Public Supply C] Industry
❑ Irrigation ❑ Recharge ElCommerical
❑ Tait Wall ❑ Other'.
i
S. CASING: C) Threaded Welded
diem._6 . In. 10- 44 11. Depth Weight 1 7 lb%./it.
diMNtrMlD^„fy C5 fflAD th Stickup fl.
YNWRWN RO7EC71OP(
Type Diameter:
SloC1.At1h6P9@: I Length:
Sol between ft. and ft.
Gravel ppek
I r
-
f
j
10. STATIC WATER LEVEL: fl.
❑ Above or ❑ Dolow land surface Dole
Equipment used:
.
1
I
(
'
11. PUMPING LEVEL below land surface and YIELD
11. after hrs, pumping g. p.m.
It. offer hrs. Dumping g. p.m.
-
12.GROUTING Well Grouted: O Yes Ej No
Mclsrla!7 ❑ Neat Cement Othort
13. PUMP: (if available) HP'
Length of Drop Pipe - ft, capacity g.p.m.
_ ❑ Subm. ❑ Jet O Csntrfllcol- ❑ Other
'
14.REMARKS: Product�on of 20 GPM
I
TION: 0❑
15. Water Temperature F C
on and this report is true to the bast of my knowledge and belief;
AA 5385
-Contract License Number
EAgle River, Ak. 99577
I
I
f
i
I
16. WATER WELL CONTRACTORS CERTIFIC
This well was drilled under my jurlsdiel
Magniiqon Drj I lin
Registered Business Noma
Address: 0. Box 770504
Signed:
Authorized
Form O2-WWR (11/81) - Cope
oat$: Aug..12,' 1985
Represenlol' a
Distribution: WHITE -State DGGS, PINK -Driller, CANARY-Cuslomcr -
lMUNICIPALITY
OP ANCHORAGE
DEUPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
U
\
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
❑ NEW
❑
UPGRADE
MAILING ADDRESS
-45_2_
LEGAL DESCRIPTION
1_01T I L��� t-���� ��>✓s
LOCATION
NO. OF BEDROOMS
Well Absorption area
Dwelling
PERMIT NO.
D
Uy
F z
Manufacturer
Mate
No. of compartments
aQ
wF
y
Liq. capacity in gallons
Inside length
Width
Liquid dept
IF HOMEMADE:
0y
J 0 z
DISTANCE TO:
Well 1
- - ®
Dwelling
PERMIT NO.
0 z Q
~110P-19
Manufacturer Material
'S
Liquid ca achy in gallons
C�-� 1
_ � 1_-.
O
Well Foundation Nearest lot line
PERMIT NO.
J =
w
LLI
J LL z
No. of lines Length of each line s Trench width
Distance between lines
H z W
nches
CCF
Top of tile to finish grade Material beneath the
effective absorption area
0
inches
Le I1Width Depth
PERMIT NO.
U)
QF
Type of crib Crib diameter Crib depth Tota e r tion
area
wa
W
Well Building foundation
Nearest lot line
DISTANCE TO:
J
Class Depth Driller
Distance to lot line
PERMIT NO.
J
W
uildin foun &ti n Sewer line
Septic tank
Absorption area (s)
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST
jo
,//RAATI)NGKA
INSTALLER
/1/o LL)
REMARKS
COE
-0ka
Zi
APPROV DATE LE L FjIjTluFo1A
MUNICIPALITY OF ANCHORAGE
Department ' Health and Environmental rotection
825 L Street, Anchorage, AK. 9y501
264-4720
11 ( # # # HANDWRITTEN PERMIT #
Permit # (13 ��`( SITE SEWER PERMIT / pfsO'7
Applicant: J G��� Mailing Address :tAj-.. •r & 46-Z 4V-44
Location4L4 ly,*j�tC/c onJe'Number
ber
Legal Description 4rr / aldflic;.1 X1,i14:24J a:
L. of Size
Type of Soil Absorption System Is: r5vsi-i
Trench: Drainfield: _ Seepage Bed: Holding Tank :
Maximum Number of Bedrooms: Soil Rating(sq.ft/br)
p� The Required Size of the Soil Absorption System Is:
H
DEPT/ LENGTH o io
_ GRAVEL DEPTH `-� WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet) . ae_ eeolda4,1
# # REQUIRED °C(HOLDING) TANK SIZE = 9000 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet',
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
# # # PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
le residence is emQde ed to include more that bedroo residence is emode
� s Issued b `
Signed: 14
y'
pplicant
Date:
�! 7 ��
Cx/t,% !u!c✓i�7i� u»e� Goe �i+ar ta�tK
SWP/024 (1/81) aSec✓'��► /f� /9,83
ins mac✓ m
A
/ U U, � 1:1 1 1 1—.- ]l 0— "T" CH P- 1 P Ja C: V- — fl Ch�
`
DEPRRTMENT OF HEHLTH HND ENVIRONMENTHL PROTECTION
825 'L' STREET/ ANCHORAGE/ RK 99501 `
' 264-4720 � 8NCHOR8GE 694-21]1 �
EAGLE RIYER
�� ��W���
PEAMIT NO. 8]1098
RPPLIC8NT� F�RNK PLUNK PHONE
RDDRESSBOX 452
HNCHORRGE/ R|( 995Q7
LEGOL HILLS 8C17,7ES #5 BLOCNH LOT: 1
LOT �IZE 0 SQFTTOWNSHIP: — RHN.ESECTION: ~
|1RXIMUM NUM8ER DF 0 SOIL RRTING 0 0 0 FT./8R)
LISTED HRE THE OPTIONS HVHIL8BLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTE�t CHOOSE THE OPTIOT4 THRT 8EST FITS YOUR SITE.
ICERTIFY 1-1 1RT�
�I HM F8MILI8R WITH THE REQUIREUENTS FOR ON—SITE SEWERS AND WELLS HS SET
FQRTH 8Y T||E MUNICIPHLITY OF RNCHORRGE HND THE STATE OF HLHSKR
2. I WILL INSTALL T||E SYSTEM IN WITH THE CODES AND HAVE RECEIVED
H COPY OF THE SUMMHRY HND DIHGRHM RTTHCHMENTS WHICH IS PHRT OF THIS
PERMIT.
], I UNDERSTRND TH8T THE ON~SITE SEWER SYSTEM MY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMDDELED TO INCLUDE MORE THHN 0 BEDROOMS.
PERMIT RPPLICHNT HRS T||[ RESPONSIBILITY TO INFORM PERSONNEL DURING
THE INSTHLLHTION INSPECTIONS OF HNY WELLY HDJHCENT TO THIS PROPERTY HND
THE NUMBER OF RESIDENCES THHT THE WELL AILL SERVE.
IF O LIFT ST8TI�N IS INSTRLLED/ HN ELECTRICHL PERMIT AND INSPECTION MUST
]E OBTHINEDRS-8UILTS CHNNOT BE 8PPROVED WITHOUT HN ELECTRICAL INSPECTION
�EPORT. THE [LECTRICHL WORK MUST BE DONE BY H LICENSED ELECTRICIFRA.
5ICNED
^..... .... ..... ..... ..... ... . .^.�����
HPPLIC8��T� �R8�J|( PLUNK
ISSUED 8YDHTE
�..... ..... ..... ..... �..... ���..... �������.������
/l ~
s_ L�
Municipality of Anchorage
On -Site Water and Wastewater Program n
(907)343-7904
Certificate of On -Site Systems Approval rr
Parcell.D. 051-122-20 Expiration Date:
1, GENERAL INFORMATION
Complete legal description Lake Hill Acres 45, Block 1, Lot 1
'Location (site address) 22349 Mirror Lake Drive Chugiak, AK 99567
Current Property owner(s) Dennis & Helen KaSZynskl Day phone
..,_..
Mailing address 22349 Mirror Lake Drive Chugiak, AK 99567
Real Estate Agent Day phone
s
2. �*Ii OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual
El
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Puhlic: Sewer
❑
Waiver/Variance request
Received by" - ,r l i i' 2 o` -1 Date:
COSA to be release(fto the engineer, unless otherwise requested by the engineer.
COSA Fee $ 6 Waiver Fee $
Date of Payment 3ti h Date of Payment
Receipt Number C) 13a� G Receipt Number
COSA# 0,5C 1: 1 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIG ATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
522-7773
Date 7/31
®—
4918
Conditional approval for bedrooms, with the following stipulations:
BY: Original Certificate Date: S /
The cip c
The /11pDevelopment 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 blue sheet ( - :. c
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Lake Hill Acres #5, Block 1, Lot 1
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 8/12/85 Sanitary seal (Y/N) Y
Total depth 44 ft. Cased to 44 ft.
FROM WELL LOG
Date of test 8/12/85
Static water level 0 ft.
Well production 20 9 -
p.m -WATER SAMPLE RESULTS: a'q
Coliform 0 colonies/100 mL Nitrate
Arsenic N/D ug/L Date of sample: 6/24/13
411111C or*
141200.
Parcel ID: 051-122-20
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
6/24/13
0 ft.
3.85
g.p.m.
Collected by: Garness Engrg.
Tank Type/Material Septic/Steel Date installed 8/16/85
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) _
Date of pumping 7/19/13 Pumper JRs Pumping
C. ABSORPTION FIELD DATA
Y
Date installed 8/85-6/92 Soil rating (g.p.d./ft2 or ft2/bdrm) '8 GPD/SF System type Raised Bed
Length 84 ft. Width 12 ft. Gravel below pipe `5 ft.
Total depth 4-5 ft. Eff. absorption area 1,008 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/8/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 460 gal. New depth 6 in.
Elapsed Time: 120 min. Final fluid depth 5 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 1184 Size in gallons 150* Manhole/Access (Y/N) Y
"Pump on" level at 18* in. "Pump off' level at 10' in. High water alarm level at 22* in.
Datum Bottom of Tank Cycles tested 3 Meets alarm & circuit requirements? Y
Lift Station Inspected, Repaired and Certified 7/26/13.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot > 100' On adjacent lots >100'
>100' On adjacent lots >100'
Absorption field on lot 1
Public sewer main N/A Public sewer manhole/cleanout NIA
Sewer/septic service line >25' Holding tank N/A
Animal containment areas >50 Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >5'
Water main > 10' Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10'
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells On adjacent lots >100'
Absorption flet
Surface water
d >5'
>100'
Water main N/A
Driveway, parking/vehicle storage >
F. COMMENTS
`From Municipal Records. Lift Station was Refurbished in February of 2011. Wiring
Certified to Meet Code at that Time. Absorption Bed Extended in 6/92 to Accomodate
Three Bedrooms.
G. ENGINEER'S CERTIFICATION
! certify that I have determined through field inspections and OF ° QCT ®�
review of Municipal records that the above systems are in P•'°°° ° .S�®®
conformance with MOA COSA guidelines in effect on this date.pp'E-
0.7
Michael E. Anderson, P.E. ® '*•�%
Engineer's Printed Name /°"' a-=-- » O
7131/2013 00 °
Date ._MICHAEL E ANDERSON :,Q�
COSA brown sheet_10-10-12.doc
r
r
Municipality of Anchorage �4
• Development Services Department o
3
Building Safety Division a >'
On -Site Water and Wastewater Program S A gy1_r
4700 Bragaw Street
P.O. Box 196650
US , Anchorage, AK 99519-6650
r� www.muni.org/onsite ,\ q
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-122-20 COSA # 0 sc- 1110
Expiration Date:
1. GENERAL INFORMATION
Complete legal description Lake Hill Acres #5 Block i, Lot z
Location (site address) 2234.9 Mirror Lake Drive
Current Property owner(s) John & Ronda Miller
Day phone
Mailing address
Lending agency
Day phone
Mailing address
Real Estate Agent Eva Loken
Day phone 68c)-6479
Mailing Address
Unless otherwise requested, COSA will be
held by DSD
for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER- DISPOSAL:
Individual Well
®
Individual On-site
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 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 base orbthe information
obtained from "the Municipality of Anchorage files and from my investigation and inspectioh,"tfle ohite mater
supply and/or wastewater disposal system is(are) in compliance with all applicable Munic)para6df tate codes,
ordinances, and regulations in effect at the time of installation. s
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 100217 Anchorage, AK ggS10
Engineer's Printed Name Steven R. Pannone, P.E. Date 2/3/2011
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 all wells and septic systems depend on the local soil condition, ground water '���� OF q�
levels that may fluctuate during the year, and the water usage of the family being served by the system. ���` ..........•••••••..; q, �
These conditions are outside the control of the evaluator of this system. All systems eventually fail and . �•.•''y
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that 2,� =• 49 rH��
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future ,•••••t ••• ... ...........:....�
performance nor give any estimate of how long the system will continue to meet the operational........... ..... 0
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed :Steven R. Pannone;• i
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �1�� No. CE 8149 AV
confer any legal right
SIGNATUREer. �� ♦ ..
Approved for -3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
;t6�V1t►F A&ar /,,
J
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
2ev 1/05)
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
Original Certificate Date:44_
% I
Municipality of Anchorage *AE
Development Services Department Building Safety Division
On -Site Water & 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 CHECKLIST
Legal Description: Lake Hill Acres #5 Block 1, Lot 1 Parcel ID: 051-122-20
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 8/121198S Sanitary seal (Y/N) Y_
Total depth &4—ft. Cased to eft.
FROM WELL LOG
Date of test 8/12/1985
Static water level o ft.
Well production 20 9.p -m.
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12 in.
AT INSPECTION
2/2/2011
o ft.
7+ 1 g.p.m.
Coliform Nea colonies/100 mL Nitrate ND mg/L Other bacteria Nea colonies/100 mL
Arsenic: M.o ug/I Date of sample: 1112/2021
Collected by: Northrim Eng
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Matsu / Steel Date installed 8/6/1985
Tank size l000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 1/12/2011 Pumper JR's Pumping
C. ABSORPTION FIELD DATA
Date installed 612911992 Soil rating (g.p.ddfiz or fe/bdrm) o.8GPD/SF System type Mound
Length 84 ft. Width 12 ft. Gravel below pipe o.5 ft.
Total depth 3 ft. Eff. absorption area loos ftz Monitoring tube Y Depression over field N
Date of adequacy test 212/2011 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test o in. Water added472 gal. New deptho in.
Elapsed Time: loo min. Final fluid depth o in. Absorption rate >= 45o+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed �/ia8 Size in gallons i5o+ Manhole/Access (Y/N) Y
"Pump on" level at 2.8 in. "Pump off' level at 1o. in. High water alarm level at 22 in.
Datum Bottom Cycles tested 3 Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 15o* On adjacent lots ,00+
Absorption field on lot 130
Public sewer main 75+
Sewer /septic service line 25+
On adjacent lots ,00+
Public sewer manhole/cleanout ,00+
Holding tank loo+
Animal containment areas 5o+ Manure/animal excrete storage areas soo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation zo+ Property line ,o+
Absorption field 5+
Water main zo+ Water service line 25+ Surface water zoo+
Wells on adjacent lots zoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ,o+ Building foundation ,o+ Water main 75+
Water Service line 25+ Surface water zoo+ Driveway, parking/vehicle storage ,o+
Curtain drain 5o+ Wells on adjacent lots zoo+
F. COMMENTS
* Lift station installed prior to sa85and is enclosed inside building foundation (from records)
G. ENGINEER'S CERTIFICATION ��OF 1144
I certify that I have determined through field inspections and J Go•'•'�.9 '
review of Municipal records that the above systems are in ff 49 rH
S
conformance with MOA COSA guidelines in effect on this date. ..... . ""' "
j'Steven
Engineer's Printed Name Steven R. Pannone, P.E. �'s, R. Pannone: No. CE 8149 .:'
Date - 2131201, � . `�.
••• .A
���*�ESS\C����
COSA Fee $-1 - any`==P�
Date of Payment _ o/�-�-7� f!
Receipt Numbery (5-%-7
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
• "'� Community Development Department
Development Services Division
SA ETY
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 11103 0
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 1 of
Lake Hill Acres #5 Subdivision. This inspection revealed an arsenic
concentration of 13.0 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/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. information on
arsenic is available from the On -Site Water and Wastewater Program
website (www.muni.or /og nsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
SOW'k.T
,
DATL
« 4 T i
GRO
rx -WW
'A�.«„a &uRrF 5tw«d
a
1"_1", V
Date: 1/31/11
MEMO
Steve Eng, PE, PH
P.O. Box 770724, Eagle River AK 99577
(907) 694-7028 tel
northrimeng@aol.com
Number of Pages: 1
To: Eva Loken, Prudential Jack White Vista Real Estate, Inc.
Subject: Lake Hill Acres #5, Block 1, Lot 1
Water & Wastewater Inspections
Water samples were collected and 2 inspections performed on the subject property during mid-
January, 2011. The purpose of the inspections was in order to obtain a COSA from the MOA.
The wastewater system does not meet the requirements of Chapter 15.65 of the MOA code. We
were unable to proceed with obtaining the COSA due to the following deficiencies:
1. The lift station was inoperative during the inspection. A thick layer of ice was formed at the
surface of the fabricated pipe -culvert lift station. The floats were frozen in this ice layer. The
MOA inspection required lift station cycle operation- the lift station will not function
properly with frozen floats. Components may also have been damaged by the ice. The lift
station does not meet requirements of arctic construction.
2. The lift station was visibly corroded. The cover was structurally deficient due to the
corrosion. It is likely that the interior is also corroded, allowing untreated sewage to enter the
water table adjacent to Mirror Lake.
3. The wiring did not meet NEMA or UL standards. Corrosion evident.
4. The system was manufactured and constructed over 25 years ago, without engineering plans.
Better technology is available in current lift stations. We recommend replacement.
5. A water sample revealed Arsenic over the maximum contaminant level (MCL). This is
currently not being enforced by the MOA. Arsenic can be removed from the water by a
"Point Of Use" (POU) technology.
Rising Son Electric, In.c.
14916 Woodland Drive
EaOle River. A.,K 99577
`v (907) -62-2-6777
� Bill To I
Prudenti-al Vista Real
Azin.- Cre.,j b0oxorn
1(i615 Cimtorfi.06, I)ri% c
Eaele Rivei, AK 99577
Invoice
Date Invoice #
IW2011 121,23
RO. Number
Terms
Due Date
Project
Due oil receipt
2,; 10!
Quantity Description
Rate
Amount
I sho\1 lip f'CL"- jncluks first 4.5 nninw,- 021;03) , 11 ( *vl i k L,,)
8�,(,Jfi
0mill
�3A 1 ( te) -Trouble slwt lit "Istaiionitid found thp! the high
2 0
level float was bad,
2 Additional tinic billed in lialf hour increments - 02/0VI 1 (Mike)
4-2 5't}
02,108/11 (Mike) - Wire lift station back tip to code. clieckwid
tested, all working. well, In order to brima tip to code we had to
remove flex, -ntid replacc it with liq, liar:.
3 Additional finic hilicd in lialf hinir increment, - 02108A 1 (Jon)
4 2.
02VIA I (Jon) - Replat d outleis vith GFCI's in liq, tit:, and
Mikc -wilt lift Station,
2 Fucl Charoc 1-1'aglc River
a.C1tl
10,(110
Materials-
112.00
112,00
1 - 2 garig in usi, cover
2 _.20 illilp C. FCA
4 - 496-3 P2"211OLE' RKJID STRI,
I - -.I*P-,296 2,?7 wp h1k c\'r
I - TP7086 1,11 xvp bx .3-1 2" hole
1,T5090 L21 I JF 9f CN
10' - 1,-'2 UIT Coil L'I"'MC
22314; N-firror 1: make Drive - Chugiak. AK 99507
Thailk yoj for till. 1,11"iness,
Total
-f -f L-- 11 . Y1 JU f ..!Y jul .L J1\J JL] 111,: 1 "UI- V1
Jr's Septic Pumping
K:,
Flintstone Enterprises
P.O Box 773415 Date: 2/9/11
Eagle, River, AK
99577-3415 Phone: 907-694-6454
Fax 907-3449821
Invoice # 11p6
Invoice to: Pannone Engineering
Prudential Real Estate
Job Locatlon:
22349 MIRROR LAKE DR
Chugiak, AK
Worked Preformed;
REPLACE GRINDER PUMP IN LIFT STATION
REPLACED FLOATS
PUMPED & CLEAN LIFT STATION
PUMP AND FLOATS
$552.00
PUMP LIFT STATION
$185.00
LABOR 2 MEN 2 HOURS EACH
$260.00
TRAVEL TIME 1 HOUR
$65.00
AMOUNT DUE
$1,062
Thank You for your Business,
Please Make Check Payable to Flintstone Enterprises
All accounts over 34 days will be subject
To interest and all collection fee's
2011-02-09 17:53 AAROW PUMP & %AfELL 18882806416» Fax P 111
AAROW Pump & WE11 SERVICE, LLC 11H�I(��)N -
P.Q. Box 110496
Anchorage, AK 89511
Office: (907) 346-9355 • Fax (907) 333.8976
Eagle River: (907) 622.9336 N2 08910,
CUSTOMER JOB SITE
7
A0
L
Thank You
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for In 80 days I agree tri allow Aarow
Pump & Well Servlca, LA,.C. the right to remove unpald for equipment and chargo for labor alrcady performed & ldt)ur to remove unpaid for equipment,)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE,
SERVICE CHARGE AT RATE OF 1,5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES M} j
Division of Environmental Services M
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # HAA # WE0 2IQ9 1 l
1. GENERAL INFORMATION
Complete legal description L 1 51 L_>_k4_> 4- Js Aons +
2.
3.
4.
Location (site address or directions) ZZ�4L-z1�S1.ny-eN
Property owner
7b'_-� Cz'-`, W L°<�
Day phone
699 - g7:7 -S$
Mailing address
Pb -06Y -D 4-b 4-z- ,
� 1C'2'1_beV 99
S �-9-
Lending agency
Day phone
Mailing address
Agent "� �zk�v Day phone 6S6 -
Address Iii 35 01 G-ler,r Sv; �- I DGS �51�- � avl I.9 95�'a
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site ><
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 fRev. 1/91) Front MOA 921
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify 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 G r� s -6v "i" Phone 346 "z6O0 4 9a9g
Address X01 AY\ -r-,-;L-
Engineer's
r-ma
Engineer's signature
6. ®HHS SIGNATURE
Approved for bedrooms.
a
Disapproved.
Date
Conditional approval for bedrooms, with the following stipulations:
/V&
Additional Comments
4l
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA u21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L"I (31 LzVp 4-o)5 #5 Parcel I.D.
A. WELL DATA
Well type TFI1 J f'_T If A, B, or C, attach ADEC letter. ADEC water system number
Log present(Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
C?N -F1 1.45
44'
Y
/ln v say �,., t I•.
— Date completed /y5 lLt t 9Ss Driller "
1s"
Cased to 44 Casing height
FROM WELL LOG
S-1 z oos
Z47
i
SEPARATION DISTANCES FROM WELL TO: p
Z
Septic/holding tank on lot 1-1 Oa ; On adjacent lots 1 no
Absorption field on lot
Public sewer main
Sewer service line -r SCS
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank +100
WATER SAMPLE RESULTS:
Coliform Nitrate d Other bacteria C
Date of sample: (- ZS -5 Collected by: CA -L,\
B. SEPTIC/HOLDING TANK DATA
Date installed �-6'�S Tank size ! OoZ> Compartments z
Lt FT P'UmP I N$Ti0rLLW)
Cleanouts (Y/N1 y Foundation cleanout (Y/N)Mbb( &6r 95 Depression (Y/N)
High water alarm (Y/N)
Date of pumping
y Alarm tested (Y/NI y
I I-Zv- 91
Pumper -?_ 1215 'L,'Ir P I N (r-
SEPARATION
r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot "14>0 On adjacent lots -F Iy6 Foundation 95'
To property line 'f lS Absorption field S, Water main/service line iv_'
Surface water/drainage -t-LUO
72-026 (Rev. 7/91)Front - - CONTINUED ON BACK PAGE
N/
Wires properly protected (Y/N)
AT INSPECTION
m
72
6 - Z9 -9Z
o z
OICP-, r*aTesI
9
g. o
r -o
.D
g.p.m.
g.p.m.
G/
rTi
rZI
Y
G)
SEPARATION DISTANCES FROM WELL TO: p
Z
Septic/holding tank on lot 1-1 Oa ; On adjacent lots 1 no
Absorption field on lot
Public sewer main
Sewer service line -r SCS
On adjacent lots
Public sewer manhole/cleanout
Petroleum tank +100
WATER SAMPLE RESULTS:
Coliform Nitrate d Other bacteria C
Date of sample: (- ZS -5 Collected by: CA -L,\
B. SEPTIC/HOLDING TANK DATA
Date installed �-6'�S Tank size ! OoZ> Compartments z
Lt FT P'UmP I N$Ti0rLLW)
Cleanouts (Y/N1 y Foundation cleanout (Y/N)Mbb( &6r 95 Depression (Y/N)
High water alarm (Y/N)
Date of pumping
y Alarm tested (Y/NI y
I I-Zv- 91
Pumper -?_ 1215 'L,'Ir P I N (r-
SEPARATION
r
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot "14>0 On adjacent lots -F Iy6 Foundation 95'
To property line 'f lS Absorption field S, Water main/service line iv_'
Surface water/drainage -t-LUO
72-026 (Rev. 7/91)Front - - CONTINUED ON BACK PAGE
C. LIFT STATION Ey-57IN G_
Date installed 7171h-1_0'316-Og (FYJ,�M A5�_ Manufacturer
Yiw G ii_ 121 1,V
Size in gallons
Vent(Y/N)
High water alarm level
Pump on" level at
Meets MOA electrical codes (Y/N)
Manhole/Access (Y/N)
Y
� 5 "Pump off" level at 18 �
Cycles tested 3
'
D. ABSORPTION FIELD DATA 1T1004t-- A f5L'P6ZA00^ CAfi c -Mi rL>C 75?Dttaar. Torp,-,� 0!gQ
-Z-40
SEPARATION DISTANCE FROM LIFT STATION TO:- L-A� S p i�Tjon) (*rvcto5 c>7 )rJ 13u) t.P)(v(7
fi-ovN'9 F}'R brJ R1�D<r Ing, P1 L)Du�/
Well on lot ^74 On adjacent lots Surface water -75'
Total absorption area
Depression over field (Y/N)
Results (pass/fail) 74
IJ
VN Y,
12 months) (Y/N)
Cleanouts present (Y/N)
Date of adequacy test
for z
Peroxide treatment (past
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
�
Well on lot l 30 On adjacent lots -t-laU Property line
GpIVav Lir p -ro 6+v q ov-
To building foundation To existing or abandoned system on lot 13 D 6K 5Y53L-"
t4rawL,,,5-r Lb75 5C'eVw1p 1g`f
On adjacent lots h1aLD1 +s ,JC> CutbankyU Water main/service line ' t00
Surface water t[� Driveway, parking/vehicle storage area Zn r
e � 3-•9z
bedrooms
f
IOr
Curtain drain
-rlvb
'
E. ENGINEER'S CERTIFICATION
l certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in
Signature
Engineer's Name
Date
effect o��the�cf�F��1
,this inspection.
,r.;• � �+ „ Kra '.fv ^' ;.
s1• �� � ��.-n CSFKi //���
VfG `tiYFCH i'ea Sag E`4.iK9riV!_• ITiT''
r., n
HAA Fee $ / ZO �Waiver Fee: $
Date of Payment ?_ 2—g Date of Payment
Receipt Number t136 �� l.� Receipt Number
HEALTH AUTHORITY
APPROVAI,S
SEwFA & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW .EST
;ITE PLANS
ROAD DESIGN
SOIL Tr,;V
nAr4)LA.TION
TES1
SfAUCTORAI, rs
NF,CNANtCAL
INS!+EC710NS
ON PITS
WASTE WATGR
OIBP69AL SYSTEM
ROBERT $RAPER, P.E.
r ROGER SHAFER, P.E.
--.....--------------- CIV!LiNG(NEER5
(907) 694.2.979
FAX 694-1211
December 20, 1991'
Robert Caywood
P. 0. Box 174032
Eagte Rivet, Atabka 99577
REFERENCE: Lot 1; b.Cock l; Lake N.itZ Acre6 #5
22349 Lake Sho%Le Drive
Dear ,tit_ Caywood,
At !uout request an adequacy test wab persotmed on .the septic sybtvn
,serving :the tesetenced propetty on Novembet 21, 1991. water was added
to the by6tern white watet tevet mea6utement6 wete -taken Srom the
mon,i totting .tube Located within .the ten.chs.ietd. r'tom thi6 -te6,t we -Sound
the b y6tem .to be currentt y b'una1t- ..on4.ng adequately. S -ince .the 6 y6tem
was .i.nstaUed to setve a 2 bedroom h.ott6e, an approvat would be t -united
.to a 2 bedroom capacity. The continued adequacy o6 the 6y6-tw .Ls not
g uata.nteed .
The Aept-ic .tank was pumped by JR's Puritp•ing Serv.ice6 on November 21,
1991.
Duk-ing .the 6eptic adequacy tv_at a (tow test was petsormed on the wort
6e4v.ing th-ib property. The stati.c watn-r teve-t within the wal wa,6
mea.6uted at 0 St. betow the .top o6 .the cr(s•ing (attes.i.an) . The totat
d-tawdown was 1.5 St. with a conA Lnue.d Stow tcate measured at 7.4 GPM.
Thio Stow rate .i6 not guatant(,.ed to temLun constant, subsequent
va)LiaV.on.s Can aceto.
tuatett 6anptes were taken on November 21, 19c) l and -te6-ted Son eo-2.!_60)W
bactet.ia 9 n4tta:te6. 7'he ate-sutts we.fl,e Latissactcmy, however, 2
eoton,ie6 0s 'Jothet bactet.ia" were Sound. Ther2sore, we temmpted on
December 2, 1991. The nesut.ts Son A(Utis sompte showed no bactet.i.a
preb ent.
Ori December 4, 1991 we examined Sour test hot.e6 which you had excavated
Sot putpo6(. os upgrading the septic- 6y4tem Son a 3 bedroom hou6e.
Theae tib adequate so.it on the property to upgrade the septic sy,5tem Sot
a 3 bedroom house., however, due to poor 6a•it.6 and high gtoundwa.tvc
there .i6 ,2ot a tocatt on Sot an altetnate 3 bedroom teachs.i.etd 6.i.te.
The de,6.ignati.on o6 thZ6 at'tetaate 6.ite woutd be required prior .to
obtaining a pe4jn4.t. to upgrade t4ce sepVc 6y6tem to 6enve a i bedroom
hGt'r1 e.
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 Datej0�/2 /&j
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivisl n, section, township, range)
z. / z /-)k�� !GreS tea%✓ �'
Location (address or directions)
(b) Applicant Name Telephone: Home Gao6✓ — Business
i
Applicant Address °fes t °peel .j?
1
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain);
i
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Te ephone
/'12
(f) TdArthe HAA to the following address: {
I
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑
Number of Bedrooms
Other
3. WATER SUPPLY
Individual Well Community ❑ 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
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
5. ENGINEERING FIRM PROVIDING ,NSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATI()t4 �
Ascertified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation of this fa,.r, r;<
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and a(1gr„tE,
forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information ot)tarrrrd
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply anwor
wasteu,aterdisposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
She date of this inspection.
H
Herne of Firm r _2.44iTelephone
v'lii�J
Address
Bate
V4EP APPROVAL �� ``
Ali; roved for LC_ bedrooms by
A; proved Disapprove
Terrisof Conditional Approval
Conditional
CAUTION
tee; ea'aa�."9
� I
RL bcrrr At. Shaiar v' `
•• [�10. 145/•[ :rbf:,
°v '�4"•.1e3
Date
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 engineers work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
MUNICIPALITY OF ANCHORAGE.
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
P C 1985
Legal Description: G �� F1If*i—
S
A. WELL DATA
Well Classification 1U4 4e If A% B B.€ C. Approved (Y N)
Well Log Presen (Y N) Date Completed X Z/mss YieldZorCPe S S
Total Depth Cased to Depth of Grouting
Static Water Level 91
Pump Set At E't' f--(
<t
Casing Height Above Ground Sanitary Seal on Casin N)
Electrical, Wiring in Condui (Y ) Depression Around Wellhead (Y No
Separation Distances from Well:
To SepticfF Tank on Lot !®�% �' ; On Adjoining Lots
l®D 74
To Nearest Edge of Absorption Field on Lot l®y ; On Adjoining Lots
To Nearest Public Sewer Line ti Dae To Nearest Public Sewer
d
Cleanout/Manhole /U'= AJ 96 To Nearest Sewer Service Line on Lot
Water Sample Collected by - S �'���hee�% ; Date
Water Sample Test Results f Ia iv SR9 o cg
Comments
B. SEPTIC/ TANK DATA
Date Installed'P eJ_ Size 1600 No. of Compartments
Standpipes/N) Air -tight Caps6/N) Foundation Cleanoutg/N) _
Depression over Tank (Y UN Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) for
/
Holding Tank High -Water Alarm (Y/N) A' A-1- Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/tTank:
To Water -Supply Well /Oa v- To Building Foundation
el 6
r �
To Property Line `O A To Disposal Field S
i
To Water Main/Service Line %®0 v4 To Stream, Pond, Lqe, or Major Drainage
Course
Comments
Page 1 of 2
v AJC _ w s 'TN !AJ 'y Q e
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata SD �j�� Type of System DesignOu
Date Installed 16 ASO ` Length of Field/6 51 r
Width of Field / 2
Depth of FieldS21-AiO Z( "S/r/6 S�uu-v.
Gravel Bed Thickness
,O
Square Feet of Absorption Area % 6 Standpipes Present(QN)
Depression over Field (4Y/0 N O Date of Last Adequacy Test AJ -e Ly
Results of Last Adequacy Test f'a
Separation Distance from Absorption Field:
To Water -Supply Well r7o' To Property Line
/O 1
To Building Foundation J u To Existing or Abandoned System on
Lot N ) &J ; On Adjoining Lots "'00 r,o-
f I '
To Water Main/Service Line /a � To Cutbank (if present) 'v D oJ -F
To Stream/Pond/Lake/or Major Drainage Course !(JOU
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
c�
Date Installed 498 /;2!1 Dimensions 36
Size in Gallons �J`�8� Co Manhole/Access(Y
4, ii
,.Pump On" Level at I8 "Pump Off' Level at
High Water Alarm Level at ___4 Ak" Oamo 07—r Vent (Y6
Tested for Xs- 5F,�, V Pumping Cycles A
Electrical Codes (Y/
Comments G S /3 NS .9-4- C $ Z2
4=-94- CtP,qr 12 Z /1 L FUi e fq tiU
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed. EIGH45EHIpG Date �/2,
SPO '19V T
Compa;y,1,a m�&;; "T,s^S;zn� 'T MOA No. 8S W 3
PH. 604-PO79
r. p,
Receipt No.
Date of Payment 9 -1?- 195
z',
Amount: $ �/} . Z, e
P, �e Nn. 1,557-G v R t'.,r'-�•
Page 2 of 2
72-026 (11/84)
D AJ
Time
APPLIC IT FILLS OUT UPPER HAII3NLY
,Properly Owner"
t -r' k_ /7 rr• r Phone C`•
Mailing Address
^,- ' if r' /% I _ - ;_�; i Zip Code l%� C� ✓�!
Buyer
7 '
Date
0ZAddress Zip Code
Lending Institution
Inspector
Phone
Address
/
J j �f Zip Code
J)6
Realty Co. &Agent
Phone
Address
Zip Code
A
- DEP T OF VI" N
TAL PkOjcGT10N
ENVIRONM"
Legal Description
f / j ) 1
/ .o -,i f 4��� •}.rr� L...�
Street LocationLTs
�.�CEi�ED
Type o�f esidence
/ `�! IN ��
Le'Single Family
4✓��^"Lf
❑ Multiple Family
No. of Bedrooms
❑ Other
1
Water S ply
ndividual -
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
O Community
Soils Rating
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Well Log Received -
r e
Sewer Disposal
I- t )
❑ Individual
Year Individual Installed:
LE)P blic Utility
201ding
When Connected to Public ility:
C Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
V OF ANCHORAGE
Field Notes:
- DEP T OF VI" N
TAL PkOjcGT10N
ENVIRONM"
�hPY 2 -
�.�CEi�ED
( ;APPROVED BEDROOMS o4l'
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDIT NA APPROVAL'
y
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received -
Septic Tank Size
-
Well to Tank
Time
APPLK'
NT FILLS OUT UPPER HAS_ ' ONLY
Propt✓rty Owner ,
Time
Date
Mailing Address
Date
Zip Code
Inspector
Buyer
Inspector
Address
Field Notes:
Zip Code
Lending Institution
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Phone
Addressr)
� 'J Zip Code
V 1<7 "
Realty Co. & Agent
DATE 40
which will establish a continuous and
Phone
Address
Zip Code
Soils Rating
Legal Description
Well To Absorption Area
Street Location
Septic Tank Size
Type o Residence
Well to Tank
Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water S. ply
ndividual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
Sewer Disposal
❑ Individual
Year Individual Installed:
�❑ Public Utility
molding Tank
When Connected to Public Utility✓
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
Itssuming that the above conditions are satisfied,
( j/) GOND1TIONA APPROVAL --f<
and that a permit can be issued, a continuous main
V 1<7 "
tenance contract must be prepared and submitted
DATE 40
which will establish a continuous and
BY.
uninterrupted maintenance schedule for the
holding tank.
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
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James Christian
4101 Wispen Circle #A
Anchorage, Alaska 99503
Dear Mr. Christian,
EXCAVATION
WORK
May 23, 1983
ti
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
Reference: Lot 1; Addition ##57 Lake Hill Acres subdivision; Plot 67-69
At your request we performed an examination of the holding tank
located on the referenced property. We found the holding tank
to have a capacity of 2000 gallons and to be located in excess of
150 feet from the lake.
At the same time we took a sample of the water from the well casing
on this property and submitted it to Chemical and Geological
Laboratories of Alaska, Inc. The results of this well sample
dated May 20, 1983 indicated that the water was satisfactory.
If we may be of further service, please do not hesitate to contact us.
E.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
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(907) 264-4111
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DEPARTIMENT OF HEALTH AND ENVIRONMENTAL PROTFCTION
July 13, 1983
PEDI - A General Partnership
Star Route A 452
Anchorage, Alaska 99507
Subject: Lot 1 Lake Hill Acres Subdivision Addtion #5
Mirror Lake
It has recently come to our attention, and has subsequently
been confirmed by a field inspection, that either during the
initial installation or a subsequent system upgrade, the on-site
facilities for wastewater disposal on the subject lot consists
of a 2,000 gallon tank purportedly utilized as a holding tank.
The existance of this 2,000 gallon tank is also confirmed in a
letter from S & S Engineering to James Christian dated May 23,
1983(copy attached). We understand that the original residence
on the subject lot was destroyed by fire in 1978 or before.
It should be clearly understood that a holding tank does not
constitute a septic system, and holding tank installations are
only permitted under certain very limited conditions.
This office is withdrawing the Health Authority approval for the
subject location until a considerable amount of additional
information is availed. It is suggested that you contact the
undersigned as soon as possible to discuss what additional
information and/or action is needed.
If there are any further questions, please call this office at
264-4720.
Since'renly,/
Robert W. Robinson
Environmental Engineering Manager
RWR/ljw
cc: Larry Head
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MUNICIPALITY OF
DEPT. OF HEALTH
825 L STREET
POUCH 6-650
ANCHORAGE, AK",
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P.E.D. I" A
STAR ROUTE
ANCHORAGE,
ANCHORAGE
& ENVIRONMENTAL PROTECTION
99501
GENERAL PARTNERSHIP
A BOX 452
AK., 99507
REQUEST FOR PERMISSION TO UTILIZE HOLDING TANK
ATTENTION ROBERT ROBINSON.
I request permission to utilize a holding tank on LOT ONE (1)
OF ADDITION FIVE (5) OF LAKE HILL ACRES SUBDIVISION, filed under
PLAT NO. 67-699 ANCHORAGE RECORDING DISTRICT.
It is my understanding that a structure was erected in 1968-
1969, and sold to a buyer in 1975~1976. The buyer lived in the
structure until it burned in 1978" In 1979 the buyer sold the
remains of the structure and a small cabin to another party. The
charred remains of the structure and the cabin were cleared from
the property in 1981-82. The buyers of 1979 sold the property in
1982 to P"E.D.I" who is requesting this permission of utilization
on the existing holding tank.
Attached is a drawing of the lot and the approximate location
of the holding tank and lines" It is my understanding that uDEH-
DECu has copies of the examination done on the holding tank by
S&S ENGINEERING. If I can answer any other questions please
call (345-2459) or write to the above address.
Respectfully,
4A,"L
FRANK PLUNK
General purpose Worksheet
le
Y-SCAL PIPE
CLEANouT o4ND
,ELL AYD EAID CAPS .
otE
i)4A'K /{FCD 1H PLAeC
WlrN G-Ar.V.4,vto.vO cAat.E
ATTACHED To CONCRETE 4NcffonS$
A..
EXCAVATION
WORK
August 14, 1983
Mr. Frank Plunk
Mr. James Christian
P.E.D.I.A General Partnership
SRA Box 452
Anchorage, Alaska 99507
ROBERT A.SHAFER
CIVIL ENGINEER
694-2979
Reference: A request for permit for holding tank, Lot 1; Addition 5;
Lakehill Acres -Subdivision (Mirror Lake)
Gentlemen:
In reference to the Municipalitjr.'s letter to you dated August 4, 1983,
we performed those tasks required by that letter. Results of
our work are as follows:
(1) The holding tank was exposed and inspected. A Municipality
on-site sewage disposal system and/or well inspection
report is attached. The original of this report has
been filed with the Municipality.
(2) The continued presence -of water in the stand pipes
was a result of a negative grade from the mid point
between the first clean-out and the holding tank.
This situation was corrected while the pipe was exposed.
The integrity of the pipe was acceptable and the slope
met minimum requirements at the time of the backfill.
(3) All stand pipes were exposed and inspected and are adequately
sealed.
(4) There is no existing line between the proposed residence
and the third stand;pzpe. It is assumed that once the
new residence is constructed that the line between the
residence and the third stand pipe will be connected
and placed at a proper slope.
(5) There is no indication or evidence that a septic tank
has ever existed on this site.
(6) Our inspection of the well indicated that the total
depth of the well to be approximately 37 feet with
a clean water level at 32 feet. The water between
page two
Mr. Frank Plunk
Mr. James Christian
32 and 37 feet appears to have an accumulation of silt.
The static water level was at ground level at the be-
ginning of our test. However, after pumping the water
level down to approximately 20 feet the casing appeared
to be smooth on the inside with no indication of perforations.
It is felt that the water accumulated in the casing is
coming in from below the 20 foot level. The original
well drilled may well have been below 40 feet, however,
silting from the bottom of the well casing upward may
well have resulted in a shallower depth at this time.
It wasnalso observed that the recovery rate in this well
is extremely slow. it may well be possible that you
will be required to have this well drilled deeper to
meet the minimum depth of 40 feet as required by the
Municipality and in order to improve the recovery rate.
The data and information provided within this letter was gathered
on August 12, 13, and 14, 1983. If we may be of further service
please --)Jo not hesi,Ae to contact us.
S
ERT A. SH ER, P.E.
/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
V1 A
POU(,r. 6-650
ANCHORAGE, ALASKA 99502-0650
(907)264-4111
iUNr f:N O WI PS.
AIA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
August 4, 1983
Messrs Frank Plunk & James Christian
P.E.D.I< A General Partnership
Star Rt A Box 452
Anchorage, AK 99507
Re: Request for Permit for Holding Tank
Lot 1 Addn 5 Lake Hill Acres Subd.
(Mirror Lake)
Gentlemen:
This will continue correspondence on the captioned subject ending
with Mr. Plunk's recent letter and attached sketch. As you are
aware, we have had one of our inspectors at the subject site on
several occasions in an attempt to determine and locate the
existing wastewater disposal system. The attached field sketch
depicts the findings and observations of our inspectors.
In view of the fact that a residence did exist on the subject lot
and said residence was served by a holding tank, this office will
re -issue a permit for the use of a holding tank under certain
terms and conditions. This office has no file or record of any
type of disposal system or well on the subject lot. Therefore,
the information listed below will be required before the permit
can be issued,
1. The holding tank must be exposed and inspected. Information
must be on file as to the size and configuration of the tank,
the manufacturer of the tank, the number/location/size of the
inlet and outlet connections, the size/location/condition of
the cleanout facility, and the general physical condition of
the tank.
2. The continued presence of water in all of the standpipes is a
serious concern to this office. This condition could indi-
cate any one of several undesirable situations which must be
addressed prior to placing the system into operation. In all
probability, there is a negative slope in the connecting line
between the holding tank and the standpipe (561/2'). This line
must be exposed and inspected for integrity and slope.
Messrs Frank Plu. & James Christian'
" August 4, 1983
P'age 2'
3. All standpipes must be exposed and inspected.
4. The connecting line from the residence site to the holding
tank is assumed to be at the third standpipe (nearest to the
lake). This line must be located, exposed, and inspected for
slope and integrity.
5. There is no indication or evidence of a septic tank being
included in the existing system. This must be clarified.
6. Our inspection of the well indicated the total depth to be
36'. According to the MOA water well standards, "wells will
be drilled and cased with unperforated pipe to a minimum
depth of 40' in unconsolidated materials such as sand and
gravel." During our inspection it was also observed that the
static water level in the well was at ground level. This is
a concern in that it creates serious doubts as to the source
of the water in the well. It is certainly possible that a
replacement well will have to be drilled. According to our
field survey (arid to the sketch attached to Mr. Plank's
letter), the setback distance from the existing well to the
nearest standpipe is 27'. This well must be pumped down to
observe the source of water entry and to attempt to determine
the casing setting depth and integrity.
7. Assuming that the above conditions are satisfied, and that a
permit can be issued, a continuous maintenance contract must
be prepared and submitted which will establish a continuous
and uninterrupted maintenance schedule for the holding tank.
The data and information herein requested must be gathered and
submitted by an approved professional engineer and recorded and
approved by this department.
Sincerely,
Robert W.'Robinson
Environmental Engineer Manager
RR2/p/D7
To
From:
Re:
MUNICIPALITY OF 'ANCHORAGE
MEMORANDUM
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Date 19
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