HomeMy WebLinkAboutLAKEWOOD HILLS #2 LT 23 Onsite File
Lakewood Hills
# 2
Lot 23
#015 - 134 - 17
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181007 PID Number: 015-134-17 ❑ New ❑✓ Upgrade
Name:
Kraig & Kathryn Holdren ABSORPTION FIELD
Address ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
10501 Hillside Drive ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 1GPD/SF 10.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 3.5 Ft 6 5Ft.
Lakewood Hills#2 23 Fill added above original grade Gravel length
Township Range Section 0.5 Ft. 47 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 5.OFt. N/A N/A Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line 611 Ft2 1 N/A Ft.
Well 77.2 92.2 N/A N/A 25+ TANK El Septic ❑S.T.E.P. ❑Holding LI Other
Manufacturer Capacity
Surface Water 100+ 100+ N/A N/A Greer Tank 1250Ga1.
Material Number of compartments
Lot Line 32.1 20.3 N/A N/A STEEL 2
NA
Foundation 48.2 57.5 N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ 50+ N/A N/A Gal.
Remarks Pump on level at Pump off level at High water alarm at
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to
Installer drainfield 3034
Guaranteed Services Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft
Inspection 151 2/8/18 o Location and description
dates: 2 2/9/18
3rd 4th Top of deck pile
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date ,�. ALgo,1h�
e •,pie r
I ••t eveCn E IFannor
aei
814
..,
�Approv ki.., rc_P Date Z -2I-L ofiv
1%`. p oo4�4
\ \\t6�
Inspection
Report_1-1-12.doc
IDESIGN PARAMETERS I i I\-\----
/ f / / / I /
UPGRADE SEPTIC SYSTEM I \_ / I\
NO. BEDROOM: 4 (600 gpd)
I TANK SIZE: 1,250g I I \ / / \
PERC RATE: <1MPI
SOIL RATING: 1 GPD/SF I I \ M
AREA RQD: 600 SF \ �MM_ �,
SYS. TYPE: DEEP TRENCH: 6.5'ED `� • ��
MIN LENGTH: 46.2 LF 1--/ / \ `'LI \
II/ < i ..?,
USED: INSTALLED 1250g SEPTIC TANK/� ffti-
47LFx2.5'Wx6.5' E.D., 10.0' TD INSTALLED DCO AFTER - - z
_,TOTAL 611 SF h ay �� ,.
/ .0., \
20.3 /1- WELL E A_ _ji
I I I I INSTALLED DRAINII FIELD M1 D 92 ( - r
J I 47LF x 2.5'W x 6.5'ED x 10.0'TD IT 2 1 TH-1 96- 3
I INSTALLED CO AT EACH END AND MT ^I I -N ---V / \
III , / 1 l 1 / I I 1 77.2 J
c
I I 1 I. sa _ : 3e`�,S
I I 1 • -----t
o/ I I I CRIB (E) \ys �A _ : -
N I REUSED AS RESERVE \N..
/
I I BASED ON CAT III \� DC 1 / /
1
III I � �>tz' \ 7 < /DESIGN IPARAMETERS oW \ DECOMMISSIONED SEPTIC TANK 8PRN
RESERVE SEPTIC SYSTEM w cwn PPE�R CODE ``IA N -
NO. BEDROOM: 4 (600 gpd) .�L`' - ���� �tVt \ A B
TANK SIZE: 1500g ADVANTEX _J -\ _ \ -
W/ AX20 POD I = \ N \ \
DC1 10.2 27.5
PERC RATE: <1MPI I • ,, N - \ _ Ti 69.3 50.2 -
-
SOIL RATING: 6 GPD/SF I a \I \ T2 77.0 56.3
AREA RQD: 100 SF `~ \ DC2 77.7 56.9
f
SYS. TYPE: CRIB: 6.0'ED I ( / ' Cl 96.3 75.3
MIN SIDEWALL LENGTH: 16.7 LF _ _
t / - = , C2 711.0 59.0
REUSED EXISTING AS RESERVE:
1 �
8LFx6'Wx6.0' E.D. ` ) • •/TI " . �- _• -•
TOTAL AREA: 192 SF I ` I I ! 1 • I - - - ,
r 1- r r- m
W O O O W O RIGID INSULATION D 1-
-1 z Z -1 Z 0 FILTER FABRIC m 0
C°w 4 w m w w 4"0 DRAIN PIPE Z z
9 U v v o v V
DRAIN ROCK 6'
100.8 100.2- ABOVE PIPE INV _/-100.2
TH-1
99.7' 99.7 9 a=u=n 8-1
` RIGID INSI AT10N7 .1[..E1741 .5=7111111= 0.5 -DR-
��
97.2 NEW 1250g `97.0 96.2 ••r•..�r•.r 4 is_ • •4 4.�_ •• rr:i-
• 96.2
SEPTIC TANK :_6:.:wav:!N-i:li r:r:r i;r�:i r:r.V.ii
..II;I t r :1:i.iii=i.i.. Ij.d ij:•4:••:
i:i:i:i i.i<i i:t i i i 4 4d.W:i fa.i:
ci i:i:i:i:III.J;i:.:i is i:i�Vi:iji i ViNi:
: .:,...: :..:..=.... .::i:
PROFILE . .
GP/
i'i i40::" i:r3isi:i:gi..*:.:i:.:i j_�.�.!.o_89.7SW
SCALE 1'=10' 89.7 .,.........
-16.083.7(DRY)
NO GROUNDWATER
01/16/18
NOTES: LLC �..��\ Dote
RECORD DRAWING PANNONE ENG SVC, LLC ` ���
P.O. BOX 100217 ANCHORAGE, AK 99510 r ��•
OF A�gsli, 2/13/2018
PHONE (907) 272-8218 FAX (907) 272-8211 /�g0P �4 '�y f. Scale
* 4 •. /`•.• •.I/, -P.I.D. NO
LAKEWOOD HILLS #2, LOT 23 ' -
KRAIG & KATHRYN HOLDREN /
Steven R. Pannone t PERMIT NO.
10501 HILLSIDE DRIVE
I,��cs REv 2/2020 8r�/ 0SP181007
PLAN ANCHORAGE, AK 99507 ll'4:b • ••�F� Sheet
l PROFESSIO .�
1\\\'k���`` 2 OF 2
RIGID INSULATION
FILTER FABRIC
4"0 DRAIN PIPE
DRAIN ROCK 6"ABOVE PIPE INV
w
m
w0 0 O w0 j j
JZ Z Z JZ 0 IX 0
2 I- Z
Ow w n mw a 0
oU O O C3O z
J 0 J
- — 100.8— _ - 100.2 U TH-1
RIGID INSULATION? 99'7 99.7 -0.5 -OR-
97.2 NEW 12509 97.0 96.2/ 96.2
SEPTIC TANK
GP/
SW
89.7- -89.7
PROFILE
-16.0 83.7(DRY)
LEGEND
DESIGN PARAMETERS W WATER LINE/
WELL RADIUS
DESIGN PARAMETERS RESERVE SEPTIC SYSTEM
UPGRADE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) SS NEW SEPTIC
NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1500g ADVANTEX
TANK SIZE: 1,250g W/ AX20 POD
PERC RATE: <1MPI PERC RATE: <1MPI ABBREVIATIONS
SOIL RATING: 1 GPD/SF SOIL RATING: 6 GPD/SF TH TEST HOLE
AREA ROD: 600 SF AREA RQD: 100 SF (P) PROPOSED
SYS. TYPE: DEEP TRENCH: 6.5'ED SYS. TYPE: CRIB: 6.0'ED (E) EXISTING
MIN LENGTH: 46.2 LF MIN SIDEWALL LENGTH: 16.7 LF CO CLEAN OUT NO.
MT MONITOR TUBE NO.
USED: REUSE EXISTING:
47LFx2.5'Wx6.5' E.D., 10.0' TD 8LFx6'Wx6.0' E.D. TYP TYPICAL
TOTAL AREA: 611 SF TOTAL AREA: 192 SF R.I. RIGID INSULATION
NOTES: LLC ����\ Dote
RECORD DRAWING PANNONE ENG SVC, I \,T
P.O. BOX 100217 ANCHORAGE, AK 99510 �.G OF A�4(5 k 2/13/2018
PHONE (907) 272-8218 FAX (907) 272-8211 , 4. ��i'•--y�� Scale
_ %*: 49 TM ,d� .,*�' NTS
P.I.D. NO
LAKEWOOD HILLS #2, LOT 23 ..4...,_ ) -134-17
KRAIG & KATHRYN HOLDREN , Steven . annone e PERMIT NO.
10501 HILLSIDE DRIVE I�,�'cc�. CE 8149 . - OSP181007
PROFILE ANCHORAGE, AK 99507 1keoA?QFESS40NP� sheet 3
~r ~aul N~lson
E~ld of o,maJ, ie¥ Head
19g fsst of 6" ~el], ~ 10,00 peF foo$
Rog of ~ll for Nelson
5 to lb ~{ooky top soil
15 to 46 rocks ~ gravel
46 to 46,6" Gravel seepage
46'6'~ 65 Oement gravel
65 to 165 Fine sand and gravel
L65 to 18% ~oarse sand
/81 to /.86 %;earle sand a seepage
186 %0 lggOoarse sand & gravel ~ood ~ater.
,~a'~er ale ared .p quickly and pumped at the rate of
s~v~n gallons per mim~t~ ~tatic ~ater 1~ve1~62 foot
well cased ~lth 6" heavy steel plpe~
Joe Guthrb~
GREATER ANCHORAGE HEALTH DISTRICT
217 E STREET · P. O. BOX 968
ANCHORAGE, ALASKA
5,43 Gh~ge of Dire~i~a ~ 'Gle~n~at~ ~hatl b~ !n~t~lled ~g each ~hamg~
cleanout would b~ necessary. T~m installation of ~his cl~uOu~ 0u~side
building ~m~l~ also be difficult.
Inclosed please find y~r ~iginml copy of ~b~ w~ll log. When ~he
is hooI~dup ~o ~he ho~se line~ please no~ify me~d t will t~e a
Wager s~ple. The installation ~1i al~o n~e~ a 42 gallon (mini~ size)
If ~ ea~ be of any f~eth~ heip. ~!a~iS~ e~ll on me.
~ ~,[,~-~i! ' ' DEPARTMEN', ~/6J~ALq,'H AND, Ek ~RONMENTA "~aOTECTION
t ~T~ to/k/ 264-4720
~-~ ~ Date Received: September 28, 1977
~1: Time ~~] ~2: Time #3: Time
Da~e /~ ~ ~7~ Date Date
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Lomas and Nettleton Company
Mailing Address:
Property Owner:
4449 Business Park Boulevard
Malcolm E. Duncan
Star Route A Box 47A 99507
Mai[_ing Address:
Phone: 274-7661
Phone: 349-1943
3. Legal Description: Lot 23 Lakewood Hills Subdivision #2
4:
o
Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Three
Number of Bedrooms:
Well System: Individual well (x) Con, unity/Public System ( )
Permit
Depth of Well
Well Log on File ( )
Construction ~.~_e~,?~ /~~$?)Bacterial Analysis
Sewage Disposal System: On-site System (x) Public Utility ( )
Permit tt
Septic Tank Size
Absorption Area
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
P,age
~ Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water FacilitJ~es
Legal Description: Lot 23 Lakewood Hills Subdivision
Colv3~ent s:
Affadavit Attached: ( )
Disapproved:
Letter Attached: ( )
Date:
Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE !:,,.,
-DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Ma iii n g Ad d ress.._~-~
3. Name of Buyer:
VA X" FHA __CONV
Mailing Address: Day Phone:
4. Name of Lending Institution: "'~L~ [~,_J~ ,S ~ ~1~-~--~'~
Mailing Address: ~q.L~fl ~]~;.~J~ ~Q~- ~'~(L~hone:
5. Name of Realtor or Agent:_ ~ ~
Mailing Address: Phone:_
Legal Description: kC)_%L ,~ 'Z~ ~Jt._ '~ k.~%--C)-C~ ;'~ I~(/~ '-~-
Location:. ~ ~'~ ,~.'~ ~(' ql '7 ~
7. Type of Facility to be Inspected:
8. Water Supply
Type of Supply:
Public Utility Individual__
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
Public Utility
.Individual (on-site)
If Individual, date of installation
72-003(3/76)
Ancho~age~ Alaska
1/% Section 1% T12~,
On the basis of a tisch Tea~ fo~ alkyl.bease~e-sulfona~a (co~anly ~fe~red ~o a~
~edfcal'Pi~c~o~
CPJ~c~
5 August 196J,
Hr. Paul Go Nilsen
c/o Anchora~,~e Westward Hotel
3I,d & E Streets
Anchorage, Alaska
Pdt: Lot 23,
4ake~-~ood i!ills Subdivision
D~a~' Mro Nilsen:
The G~ater Anchorage Health District gives its approval to the sewage .disposal
syste~.~ located on the property owned by Mr. Paul C, ~ilsen, legally described as
Lot 23, Lakewood Hills Subdivision on the basis of prior app?oval foP~FH.Ao
A Hach Test performed by this office on the water supply indicated an absence of
alkyl-benzene-sulfonate (co~m~only referred to as deterg,,ent)o A bacterial analysis
also ' "' ~ ~
~nalcated negative results.
Sincerely,
DAVID Ro Lo DU~£,A~, MoD~
Medical Directo~TM
Clifford P. Judkins
CPJ: cw
FHA Fo*tm 2573 · FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8
Rev. J~ly ,~sB
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART I.--TO BE COMPLETED BY FHA
SERIAL NO.
INSURING OFFICE
Federal Housing Administration
MORTGAGOR OR SPONSOR
Paul G. Nilsen
SUBDIVISION NAME
L~kewood Hills Subdivision
MORTGAGEE
National Bank of Alaska
Box 600, Anchorage, Alaska
TOTAL NUMBER:
BATHS
PROPERTY ADDRESS
BASEMENT
New installation
I [--~ Yes [~No
WATER SUPPLY BY:
[] Public system [] Community system
SEWAGE DISPOSAL BY:
---1 Public system [] Community system
PART II,--TO BE COMPLETED BY HEALTH DEPARTMENT
60-008931
BLOCK NO. LOT NO.
23
Can attic or other area bo made into
additional bedrooms?
(if Yes, how rnony~)
NO. SYSTEM DESIGNED FOR
[] Individual
[] Individual 3 [~ Yes [] No
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State r'] County r-J~ocal Department of Health that this individual water-supply system
[] is [] is not satisfactory as a domestic water supply for the subject property.
It'~s-the opinion of the r-] State [] County [~\Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
]Can be expected to function satisfactorily, and
{xis not likely to create an insanitary condition
]Cannot be expected to function satisfactorily
I TITLE
JDATE]
SIGNATURE
Qp[eTp~ovi~e2. ~ /~ ro riateo ini, statement ab ..... d a~x~ate, slgnature.-' tlt e n the
7NOT~ The heal~ould ,omplete the upp . .
health authority.
PART III.~FOR USE OF FHA OFFICE
TO THE CHIEF UNDERWRITER:
I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the
Individual water-supply system be considered [--] Acceptable [] Not Acceptable
/ Sewage disposal be considered [] Acceptable [-~ Not Acceptable.
DATE
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
SIGNATURE
UKAl?ld AII'I'UIIDITY APPROVAL FHA
,t-e '~"¢': ?~ ~ / . ~ c:~ ~: - ~.: / 'Xq p~odsuI .
. , . ~' , '~[Joqmv qll~OH l~Ol ~ ',hunoD ~ '0linS ~ :tq ~p~m uop~dsuI
'Au* j~ 'sl~q~qxa paao.~ddu ql[~ Xldmo3 o~2p~ saop ~ uopqlmSUI
'oN ~ 's*A ~ :~m*~e~ ~udunom dtu~ 'o~ ~ 's~A ~ :p*mu~ XFodoJd mooJdm~
.} .' ..; :, , . . .
: '.:;: : : '~d dm~ ~ 'puno2~ a~oq~ asnotldmnd ~ 'mamas~q~o moo~dmnd ~ '~uatuas~6 ~ :u~ pa~
'o N ~ 'so~ ~' :~q~p~a~ zo~oo Ip~ U~ s~u}uod0 'lma~ ~' 'pooAk ~ 'a~aa~u~ ~ :~aao~ lla~
'll~o~q ~u~pzo ~' 'Aq> palpp~ ~ '~noz~
'~aaj~jo tpdap m ~q3pJa~ pal~a8
'alnuN~ Jad suo u~'pp~X alum~xoJddv 'laaJ~'lla~ u} aa~,~ jo [o~aI gu}dmnd m qldap m~}xoaddv
· ,aaj~'gu!s~2 jo q~da~ / :~ ,~' ' 'guise2 jo adX~ '~aaj [7}' /[ /tt~dap lmO~ 'saqou, :~5" "za2atuu}~
mOll~n~lsuo~ I1~
· ~aaj ....... 'uopnllod alq~ssod jo sao~nos ~atpo '.~aaj ~ . .. '[oodssa2 '.~aaj ~ ) ~., '~d a~daas
:~aaj ~- 'pla9 lesodsJp :~aaj .'5 r: 5 '~um 2udas :laaj
'llata paJo~ ~ 'lla~ 7n~ ~ 'lla~ uaapG ~ 'llaa~ paluJ~ ~ :mo.g Xlddns Ja~ua lunHaipui
· laa) ~;// 'audi ~JadoJd luoJj moJj ~2uq las gm[la/a
'stualsXs lusodup-oge~as ptm alddns-Jalu~ lunp[~[pu} ~loq ~1[~ padolaaap ~upq lou aJU ~ aau ~ p~qmqq~u' u] sapsadoad
--zal~a jo ,{lddns a~unbape qs!uJnJ m X~!up!^ ale!patutu} u} Sllata jo aJnl!uJ jo pJo>a~ 1uaoaJ lsotu
'pooqaoqqgpu u! AJgtumsn:J lou aau [] aJu U~"SllaaX Nnp!A!pui
'sat[ou! ..... 'u!gtu jo az!S 'laaj .... 'u!utu Jal}~ta o!lqnd ~saJeau m a3ul~ls!CI
WtlSAS Alddn$-~FIIVAA 1VrlalAIGNI~NOI&:)tdSNI :lO ~UOdtlt
'soq3u!
'loaj aaunbs
saq~o
'2a~j
lgpm~m gu}u}'I 'SUOllUg ',i~pude> p!nbFi '~aaj' 'tpdaG '~aaj
'J~aJ [] 'apes [] 'luoJj [] 1u ou![ loI lsa~au :1aaj 'uo!lupunoj :laaj
'SUOll,~'
?
'~aaj
'q~dap p!nbFI '~aaj
"~uatm~dtuo3 ~alU! X~p~duD ,SUOl[~
sluatmJgdmo> jo ~aqtunN~.~w ~ 1 / ::~ .,: ! c,~
.;, ':'//, !.?.' 7 'i t -
W:tlSAS IVSOdSla'tOVMIS IVIllJIAIONI--NOII:)]dSNI ~O 1~1Od311
' (4M)
~ INDIVIDUAL WATER SUPPLY
": ; '/'/ ::' /~ / ALASKA D~PARTM~NT OF I-~ALTH
f
Sect/on ot Sanitation and Eflg/nee~in~
ACTI°N ON REQUEST FOR
Your recent request for an analysis of a sample
from the Individual Private Water Supply
Lab. No, 234.59
Southcentral Regional
BACTERIOLOGICAL WATER ANALYSIS
"~Satisfactory
Questionable
examination has been completed.
Records in this office indicate this Individual Private Water Supply to be of .
sanitary status.
Analysis shows this SAMPLE to be x/ Satisfactory
Questionable . Unsatisfactory
Unsatisfactory.
If an "Unsatisfactory" or "Questionable" status is indicated above, you should take immediate action as recommended below.
1. Boil or chemically treat your water supply to protect your family from water-borne diseases as outlined in eh-
dosed leaflet, "Drink It Pure."
2. Improve your spring--See bulletin HSE-6-2
3. Improve your cistern--See bulletin HSE-6-3
4. Improve your dug well--See bulletin HSE-6-4
5. Improve your driven well--See bulletin HSE-6-5
6. Improve your drilled well--See bulletin HSE-8-6
7. Relocate your well to a safe location in,relationship to your sewage disposal system--See bulletin HSE-15
8. Bottle broken in transit, please send new sample.
9. Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results.
Please send new sample.
10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation office for
bulletins, consultation, and assistance.
I1. This is a surface water source and subject to pollution by man and animals. An approved water supply source
should be developed,
sAN TAPdAN'S M3.aKS
A~)i{~HSE~-FI (e)
Out Completely.
INDIV!DUd WATER SUPPLY
ALASIL~ DEPART1VIF2~ OF ~Ip:<t[
Section of Sanitation and ~-gineering
Request for Bacteriological Analysis
Please Look on Reverse of[
Sheet for S~mple Collection
1. ~ructions.
Lab. No ...........................................
(Name of person collecting sample) (Ditto) (Time)
Water sample collected from [~'~itchen tap; [] Bathroom tap; [] Basement tap;
[] Other (list) ........................................................ ~ ...... : ............... ~'"'7'; ........ ~ .......... ,. ....... ~ .................
Address premise where source ~s loe~u ........ ~..e.,.......~.....,.~.: ................................................. ~-----/,+~,,-*~.-'- .......... , .................. : .....
(Mr.)
~Ivir~) /....&L~;.~.?L....../.~.!~:~::~::~->.'.~' ' .dCq2..-/~:/ ' ' z'-~
Mail repor~ to (.Miss) .... .......................... .:?.L~ Cd .............. ./'.z/.~J::~f~:9.::~.:q.:'./.,::=,
(Name) (Box No. or street address) (City)
Please place an ',X" in the box before items which best describe your water supply:
SOURCE: Well -- [] Dug, [] Driven, [~--D~lled, [] Bored
[] Spring, [] Cistern, [] Other (list) .......................................................................................... : ....................
[] CreeR, [] River, [] Lake, [] Pond ................................................................................ ~ ............... : .................
DUG WELL
OR CISTERN CONSTRUCTION: Wails- [] Wood~ [] Concrete, [] Metal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concrete, [] Metal, [] Open Top
LOCATION: [] In basement, [] Basement offset, [] Under house, ~'l~n yard
Other ................................................ : ........................... -:.:::::-: ...... ~ ......................................................................................
DISTANCE TO: Buildlng sewer or other drainage pipe.: .~.:2.....feet, Septic tank .~.%.?....feet, Tile field ..'.2~.:Z ....
feet, Seepage pit .~::~(:.)."£eet, Cesspool ;:.:..~=....,. feet, Privy.....~LL:... feet. Other possible sources
of contamination (list) ....... .'.::.:...:: ...........................................................................................................................
MATERIAL: Building sewer -- [Fl/Cast iron, []. Wood, [] Tile, [] Fibre pipe, [] Asbestos cement
Joint material -- Type ....... .(-.~.~:!~.~>.~.:~ ..............................................................................................................................
GENERAL INFORMATION: Does water become muddy or discolored? [] yes, When? .......................................................................................................................................................
Diameter of well ............... ~..i~./. .............................. depth ............~....~..~ ................................. feet
Well casing material ........ ~'.~;".Z'.z~..'::./. ....... diameter.....(,2:f.~ ...... depth.....~...?.:..~ ................
~:tgetrh t:p tdt~ °fPr oPmt P; ct t om. ~.: ,?!i: .~..(.9....~. ................................................................................... feet
Pump location: I-q'Ih~ well, [] Offse~ in basement, [] In basement
[] In utility room, [] On top of well
t f], ., . l/ ~o" '] ~.
[] Other (t~t) ...... .~..c..~.~.'.:.~:..%Z:~.£~..~.:>k:.':r. ..........................................................
PURPOSE OF EXAMINATION: Illness suspected? [] yes, ~J'ho New so~rce of supply? [~-yOs} [] no
Repairs ~o existing system? [] yes,
/..--oz.-L-./;
Remarks: ....................................... : ....... , .......... : ...................... J.L.~ ...........................................................................................................
PLEASE DRAW A SKETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WATER
SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LINES OR OTHER SOURCES OF POLLUTION AND DISTANCES
BETWEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILITIES.
SAMPLES MUST BE S~3BMITTED IN CONTAINERS PROVIDED BY T~E ALASKA DEPARTMENT OF HEALTH
,
;:7
INDIVIDUAL WATER SUPPLY
ALASKA DEPARTMR. NT OF I-IBALTH
Section ot Sanitation and ]tnglneering
Soathcentra! Regional
ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS
Your recent request for an analysis of a sample
from the Individual Private Water Supply
serving. Ptilll l'{il~en .was
receivefl 12-1q~61 snd
examination has been completed.
Records in this office indicate this Individual Private Water Supply to be of
sanitary status. ~
Analysis shows this SAMPLE to be Satisfactory ;(
If an "Unsatisfactory"
1.
.tfro Paul Nil~en ' (?"
P.O. ~ox 520
tnehorag% Alaaka
i ,qatisfactory "/>;.: Questionable
Questionable Unsatisfactory.
Unsatisfactory
or "Questionable" status is indicated above, you should take immediate action as recommended below.
Boil or chemically treat your water supply to protect your family from water-borne diseases as outlined in en-
closed leaflet, "Drink It Pure."
2. Improve your spring See bulletin LISE-6-2
3. Improve your cistern--See bulletin HSE-6-3
4. Improve your dug well--See bulletin HSE-6-4
5. Improve your driven well--See bulletin HSE-6-5
6. Improve your drilled well-- See bulletin HSE-6-6
7. Relocate your well to a safe location in relationship to your sewage disposal system See 'bulletin HSE-15
8. Bottle broken in transit, please send new sample.
SANITA1LIAN'S REMARKS
9. Sample too long in transit; ,sample should not be over 48 hours old at examination to indicate reliabIe results.
Please send new sample.
10. Contact your nearest [] Local Health Department or [] Alaska Health Department, Sanitation office for
bulletins, consultation, and assistance.
11. This is a surface water source and subject to pollution by man and animals. An approved water supply source
should be developed.
Signatme . ~ ~'
Out Completely.
l¥lo~¢dtg', ~ff ~¢c. sda)., I'Vednesday
INDIVIDUAL WATER SUPPLY
AI, AsEA DEPARTMENT OF I~E&L~H
Section of Sanitation and i~.n_~meering
Request for Bacteriological Analysis. X~b. No ...........................................
, ,.,, v, . ...., ..........
Water sample collected by ........ /:../-~:& ........................................................................
(Name of person collecting sample) (Date) (Time)
Water sample collected from ~:Kitchen tap; [] Bathroom tap; [] Basement tap; [] Other (list) .....................................................................................................................................
Address premise where source is located .................................................................................................................................................
(~r.) , .,
:"!' / :" 1,
Marl report to (Miss) . t {/'~ ~'£~":(Name)"/'"['L'i':~'t'::~':!:"kJ ........................ '"('~'~'~'
Please place an "X" in the box before ire.ms'which bast describe your water supply:
SOURCE: Well -- [] Dug, [] Driven, [~:Drilled, [] Bored
[] Spring, [] Cistern, [] Other (list) .................................................................. : .......................
[] Creek, [] River, [] Lake, [] Pond ................................................................................ ~ ............... : .................
DUG WELL
O1~ CISTERN CONSTRUCTION: Walls- [] Wood, [] Concrete, ~tal, [] Tile, [] Brick or Concrete Block Top -- [] Wood, [] Concretef~etal, []~Open Top
LOCATION: [] In basement, [] Basement offset, [] Under house, [~Zn~yyard
Other .............................................................................................. ~ ........................................................... . ..........................
DISTANCE TO: Building sewer or other drainage pipeA ....... :....feet, Septic tank .............. feet, Tile field ..............
feet, Seepage Pit .Z....[[i..[[feet, Cesspool .............. feet, Privy ..............feet. Other PosSible sources
of contamination (list) ....................................................................................................................
MATERIAL: Building sewer -- [] Cast iron, [] Wood, [] Tile, [] Fibre pipe, [] Asbestos cement
Joint material -- Type ............................................................................................................................................. : .........
GENERAL INFORMATION: Does water become muddY or discolored? [] yes, [] no
When ? ............................................ .[.:~
; /, ' ................................./f,/~ ..... '2 ..........................................
Well eas~ng material .......... ::..? ........................ diameter .................... .................
Length of drop pipe ........... 6,~,.1.~...~)~} ..............................................................................................
Water depth from bottom .......... ~.~'/.). ....................................................................................... feet
Pump location: [~/In welI~[] Offset~ in basement, [] In basement
[] In utility room, [] On top of well
[] Other (list) ........................................................................................................
PURPOSE OF EXAMINATION: Illness suspected? [] yes, ~no New source of supply? [] yes, [] no
Repairs to existing system? [] yes, ,~: no
Remarks: ...... .~..~L.', ....... I:JD[*..L- ............. /:.:f.J:;!*£::~:E:[?.¢....,.J.~-.z.'.'..*.:.....,.';[:t,:":~2: ..............................................................................
PLEASE DRAW A 8KETCH IN THE SPACE BELOW. THIS SKETCH SHOULD SHOW LOCATION OF HOUSE, WAT~-~
SUPPLY SOURCE, SEPTIC TANK, SEWER, DRAIN LIliES OR OTHER SOURCES OF POLLUTION AND DISTANCES
BETWEEN WATER SUPPLY SOURCE AND ANY OF ABOVE FACILITIES.
SAMPLES MUST BE SUBMITTED IN CONTAIN~t~ PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH
0
•
•_,t 1._ Municipality of Anchorage - 8 ,,
On-Site Water and Wastewater Program ^ j•C.? . ,z,r .
(907) 343-7904
a '
&td 15 all .a
• Certificate of On-Site Systems Approva 4Nimw,
� ti
Parcel I.D. 015-134-17 Expiration Date: ` +� •
1. GENERAL INFORMATION
Complete legal description Lakewood Hills #2 Lot 23
Location (site address) 10501 Hillside Drive
Current Property owner(s) Kraig & Kathryn Holdren Day phone
Mailing address 10501 Hillside Drive Anchorage, AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
/ ��
I
Received by. ;` itbib Date: 2_12'/1 B
COSA to be released to the engineer,unless otherwise requested by the ineer.
COSA Fee $21.Qg-SDIWaiver Fee $
Date of Payment aEl i s) 18 Date of Payment
Receipt Number O2 ttI f-- -.f-- -. G Receipt Number
,
COSA# 0501210 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 wastewfatdt. s Ssal,system is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installati n* .11
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation .'s - .es, easured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,g ;k k-' 14-s that may fluctuate 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 2/14/2018
...co.-oitesy, �I� :VITA
/*: 49Th, /\
6. DSD SIGNATURE . g-..- •• ••R0•'•{�0
1C System #1 Approved for L( bedrooms :S�everi.k. `annone: fr
r -0.• CE-8149.
Disapproved � !�q pNA �
i
System#2 Approved for bedrooms 0••• •O
t 0,. .�
,
Conditional approval for bedrooms, with the following stipulations:
__�V
J UN-SITE G) ;
WATER AND
•
WASTEWATER oz
cc‘ PROGRAM co
"fir,4PRV\C1
�Y• /!� — / Original Certificate Date: 02."Zl —(g
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: •
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet r '- , c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system i
Certificate of On-Site Systems Approval Checklist
Legal Description: Lakewood Hills #2 Lot 23 Parcel ID:015-134-17
A. WELL DATA
Well type Private If ', B, .r C provide PWSID# Well Log (Y/N) Y
1_ OV •....' �� I Y
Date complete. Sanitary seal (Y/N) Y Wires properly protected (Y/N)
Total depth 192 ft. Cased to 192 ft. Casing height(above ground) 12+ in.
FRO�M� �WELL LOG AT INSPECTION
Date of test � It.f /t961' cilkisq 2/8/2018
Static water level 62 ft. 65 ft
Well production 7 g.p.m. 6+ g.p.m.
WATER SAMPLE RESULTS:
' , ��3 0
Coliform Ne8 colonies/100 mL Nitrate "a_ mg/L
Arsenic N V ug/L Date of sample: 2/8/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 2/8/2018
Tank size 1250 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/A
Date of pumping NEW Pumper •
N/A
C. ABSORPTION FIELD DATA
Date installed 2/8/2018 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 GPD/SF System type Deep Trench
Length 47 ft. Width 5.0 ft. Gravel below pipe 6.5 ft.
Total depth 10.0 ft. Eff. absorption area 611 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results(Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 77.2 4- On adjacent lots 100+
Absorption field on lot 92.2 On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
* Sa UX,ivQL DSV \YAcol •
G. ENGINEER'S CERTIFICATION .:- OF AL,Qk;k
I certifythat I have determined through field inspections and ofzet. �e
9 p Al •
Oj•' � ••9 #�
review of Municipal records that the above systems are in 0*: ' /\ •.* tt�
conformance with MOA COSA guidelines in effect on this date.
Steven Pannone — • �'���• per
Engineer's Printed Name i• Sleveri 1Z. 'annone•
Date
2/14/2018 h-0:-.,• CE-8149• i,,
1t 0�OFES•si .c
COSA canary sheet_2-6-15.doc
Municipality of Anchorage �.•
i • Development Services Department
Building Safety Division n alb a
$n i E!Y
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite •
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 181051
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
23 of Lakewood Hills #2 subdivision. This inspection revealed a nitrate
concentration of 8.30 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
8147G
Lot 22
I50 N89°56'00"E 280.00
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REVISED 2-13-18,Adde Cle �;1,
nowt /,
RECERTIFIED 2-12-18/, ,
```��� 1 AS-BUILT NO CORNERS SET THIS DATE
�� OF . A k '1 I hereby certify that I have performed a Mortgagee's inspection
Q • .9S of the following described property: LOT 23,
• •,� 1 LAKEWOOD HILS SUBD.,ADDITION No. 2
i �• 49th %\ '� ,
*• • • •' Anchorage Recording Precinct,Alaska,and that the
7...
, —/�T %�• • improvements situated thereon are within the property Tines
" y Ow and do not overlap or encroach on the property lying
>/ ^ •.Fred Walotka,o / adjacent thereto,that no improvements on the property lying
•• • A, ow adjacent thereto encroach on the premises in question and
i ,z,•. 3255 - S ,•��� — that there are no roadways,transmission lines or other
„_ Fp • . • . , • p .V visible easements on said property except as indicated
SCALE: 1"= 50' 1' oF• • • •+• •0,N 41
hereon.
1 �� Dated at Anchorage,Alaska
EASEMENTS OF RECORD,OTHER THAN \�X N�•
this 12th day of July 1994.
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON. FB 18-1, pg 29 Engineers and Surveyors
UNLESS OTHERWISE NOTED FB 94-1, pg 43-44 BE 907-248-1666