HomeMy WebLinkAboutLAKEWOOD HILLS #3 LT 30
Municipality of Anchorage Page
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: ~'c~J ~ZOO~ PIDNumber: Ol~'~O~'
Uam~eoe,?¢,h ~y ~ ~j;~ Wastewater System:
Address:
Phone: .~' IOO'~ ~ NO. oFB~drooms:
.~ ~Deep Trench O Shallow Trench O Bed O Mound D Other
LEGAL D ESCRIPTI O N soil Rating:o, ~5 GPD/Sq. Ft, Total Depth from original g~de~
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
Township:.~I~ Range: ~ ~ Section: J/~ ~ Fill added above original grade:~ Ft. Gravel length: ~ Ft.
WELL: N/A Q New ~ Upgrade Gravelwidth: ~ Ft. Number of lines:/ Dislance between lines:_ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled: Static Water Level: Installer: Date installed:
Yield: GPM Pump Sel at: Ft. Casing Height Above Ground:Ft. TAN K
SEPARATION DISTANCES ~Septic ~ Holding U S.T.E.P.
To Septic Absorplion Lift Holding Public/PrivateManufacturer: Capacity in gallons:
From Tank Field Station Tank S .... Lines
~ Material: , - Number of Compartments:
SurfaCewater i 3 &' 12 ~ ' ~/~ N/~ loc ~ LIFT STATION fi/A,
Lot f ¢ Manufacturer:
Line t~ 7,5 N /A ~/A iOO~ Size in gallons:
i 50 / ~/t~ ~/~ 1OO ~ "Pump on" level at: I "Pump off" level at: High water alarm at:
Foundation
5
3
CurtainDrain ~/~ ~ ~ ~/~ ~ ~ ~/~ Pump Make & Model Electrical Inspections performed by:
Remarks: BENCH MARK
Location and Description:
~ ENG~~L
Department of Health and Human Services apprqval
Reviewed and approved by:~~__ Date:
72-013 (Rev. 9/91) MOA 25
Permit No. SWgaO018
Po9e 1 of 1
Hunicipati±¥ oF Anchorcge
DEPARTMENT BF HEALTH AN]] HUHAN SERVICES
ENVIR[}NHENTAL SERVICES ]}IVISION
P,O, Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-4744
On-Site Wcstewcten Disposc~ System cnd/or WeE[ Inspection Repopt
Description LAKEWBOD HILLS ~3 LT 30
PID No~ 01513409
NOTE
1: NEW 1000 GAL. SEPTIC TANK WAS INSTALLEB DUE TI] THE POOR CONDITTION I]F EXISTING CENENT TANK.
2~ OLD TANK WAS CRUSHED IN PLACE AND BACKFILLED.
3~ PERC PIPE WAS LEVEL AS SHOWN BY TOE ELEVATIONS AT CLEANOUTS.
4, CENENT SLAB AT DDBR USED AS TBH FOR ELEVATIONS OF ])RAIN FIELD. ASSUMED 100 FEET
5. ELEVATION OF THE GROUND IS 97.1' ABOVE THE FIELD.
6, ALL EXISTING CLEANDUTS HAVE BEEN RENDVED,
oWELL
SCALE 1~=30'
])BOR SLAB
100'
75'
C.D,#
ELEV, COMMENTS
C,D,~3 - TANK PUMPDUT COMPARTMENT
C,O,ff4 - TANK PUMPOUT COMPARTMENT
g.D,If7 90,8'
C.0,#8 90,8'
M,T,~I 84.8' NO WATER ]NCOUNTERED
M.T.il2 84,8' NO WATER INCOUNTERED
INLET 92,4' TANK INLET (TOP OF PIPE)
OUTLET 92,1.' TANK OUTLET(TOP OF PIPE)
ENGINEERS · ARCHITECTS · SCIENTISTS · SURVEYORS
March 20, 1992
Mrs. Susan Oswald
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
RECEIVED
MAR 2 3 7992
Municipality of Anch
Dept. Health ,, ~,.. [orage
., ~x nun)an 8ervice8
Re: as-built approval
Lakewood Hill #3 Lot 30
Dear Mrs. Susan Oswald
This letter is to present our conclusions regarding the reasons for allowing the new absorption
field on the above referenced field. Normal conditions would require that the new field be 16
feet form the old one (2 times the 8 foot gravel depth of the old field).
The need for separation between the active and abandoned fields is based on the assumption that
an abandoned field may have failed due to clogging of the soil immediately adjacent to it. The
percolation rates at this site suggest that the soil are tight. If this abandoned field failed because
of soil clogging, the area affected would be relatively close to the abandoned field(within a few
feet). We believe that a high groundwater table probably contributed more to the failure of the
field than soil clogging. At this site, we believe a 10 foot separation would be adequate to
assure that the performance of the new system is not affected by the impacts that the abandoned
system may have on the soil surrounding it.
In addition, the bottom of the new field is at 6.5 feet below existing ground and the top of the
abandoned field is 5 to 5.5 feet below existing ground. Most of the new field is above the soil
which may have been impacted by the abandoned system. Also, the separation distance
requirement is not meet only at single point along the 70 foot length of new field.
Please approve the installation of the new field as shown on the submitted as-built.
Very truly yours,
Carey. S. ey. er,;~.E,
S~.ar?ivSi~n~gmeer
CSM:KMA: 1110-0026
301 ARCTIC SLOPE AVENUE, SUITE 200 · ANCHORAGE, ALASKA 99518-3035
19071 349-5148 · FAX 19071 349-4913
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:SW920018
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:SEVENTH DAY ADVENTIST
OWNER ADDRESS:1480 UPPER OMALLEY RD
ANCHORAGE, ALASKA 99516
DATE ISSUED: 2/03/92
EXPIRATION DATE: 2/03/93
PARCEL ID:01513409
LEGAL DESCRIPTION: LAKEWOOD HILLS #3 LT 30
LOT SIZE: 15682 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS
ISSUED BY:
Tom Fink,
Mayor
Municipality Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
February 25, 1992
Carey Meyer, P. E.
Arctic Slope Consulting Group, Inc.
201 Danner Avenue
Suite 200
Anchorage, Alaska 99518-3035
Subject: Waiver Request for Lot 20 Lakewood Hills Subdivision
Waiver Request ~WR920003, PID #015-134-09
Dear Mr. Meyer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved.
waived distance is 5 feet.
The
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur:
On-site Services
#3
tjw~7
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
Re: Upgrade Septic System Approval
Lot//30, Block #, Lakewood Hills Subdv.
Dear Mr. Roth:
Attach is the permit application for upgrading a septic system on the above referenced lot.
Below is a narrative of probable impacts to adjacent properties.
1. Adjacent Wells - There are no existing wells within 100 feet of the proposed new septic
system. All adjacent wells have sanitary seals in place and have positive drainage away from
the well head.
2. Adjacent Wastewater System - The proposed deep trench absorption system will replace
the existing trench system. Testing of the existing system indicated it no longer accepted the
amount of the water it was designed to. The tank that is existing is adequate for the three
bedrooms at the residence.
3. Reserved Space - The proposed system is the third system to be placed on the lot. The
only remaining area that could be used for an absorption system would require a well radius
waiver.
4. Drainage - The lot is moderately flat (0-5 %). Positive drainage away from the field will
be maintained. No concentrated surface water will be directed toward the field and no existing
streams or lakes are within 100 feet of the proposed field.
The installation of this on-site system will have no probable impacts to adjacent well or septic
systems. The proposed system's separation distance radius will include parts of adjacent lots,
but will not interfere with the on-site systems on these lots.
Ve~~our8,
Carey S.
Sr. Civil E~ginexW
FO'
~O
301 Danner Avenue, Suite 200 o Anchorage, AK 99518-3035 o (907) 349-5148 FAX (907) 349-4213
A subsidiary of Arctic Slope Regional Cor, ooration
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
Re: Upgrade Septic System Approval
Lot #B0, Block//, Lakewood Hills Subdv.
Dear Mr. Roth:
CO
The proposed system for the above referenced lot the system will fall within the lot line
separation distance on the northwest corner of the lot. Due to the location of the existing well
and the failed absorption system on the lot, the only location that a system can be place outside
the well radius and meet lake seperation requirements is at the northwest corner ( see the
attached proposed system plan). Tile system will be parallel to and approximately five feet from
tile Upper O'Maliey right-of-way. The system will also fall within the required ten foot
separation distance between the new field and the lot to the west lot line. The lot to the west
of the existing lot is empty at this time. The lot has several areas where septic system can be
placed that are not effected by the proposed system.
The soil on the lot is a silty soil which percs at an average rate of 31 min./inch. The
existing ground slopes to the north, away from the existing system and the on site well. The lot
is large but the useable area (due to the lake at the south lot line) is very limited. The proposed
system will not effect the roadway in any way.
Very truly yours,
Carey ey P.E.
Sr. Civil Engineer
301 Danner Avenue, Suite 200 o Anchorage, Al( 99518-3035 o (907) 349-5148 o FAX (907) 349-4213
A subs/diary of Arclio Slope Regional Corporalion
Permit No.
Page .of
. Municipality of Anchorage
DEPARTMENT'OF'HEALTH AND HUMAN sERVICES
ENVIRONMENTAL SERVICES-DWISION
P.O..Box 196650 · Anchorage, Alaska 99519-6650. Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: _ .b,~b~.¢¢,,~ ~;JJ.~ ~- ,3_ L¢~ ¢30
No.:
Lo~- ~
'1
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site WaStewater Disposal System and/or Well Inspection Report
Legal Description: ~,;;,'~'~:F~ ~.Ci~:0 /C1~¢5 ;:.¢,~-/.¢2r ~,3¢ f31¢&- PID No'
~JoT Ak~ A~ u~.r
DA'CE: , .Z/2--/[~'~ SHT.:
PREPARED BY: (KAl. I,: ~z,'-/~ ~ ,'
SUBJECT.' ~-~.l(~,~,~ ~'-/;ll~ ~ /~(- ~o
OF__
PROJECT:
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers · Architects · Scientists " Surveyors
-0
F/£/-z3 i/-s ~,,5
301 Danner Avenue * Anchorage, AK 99518-3035 · PHONE (907) 349-5148 * FAX (907) 349-4213
A subsidiary o fA rctic Slope Regional Corporation
oT,c LOpE ooNs.= o o oup, ,;.o. RECEIVED
£nglneers . Archi~ect. s oScienUstso Su~eyors FEB 1 4 199~
~,~: (~) ~-~ ~0,: (~o~) ~*~-~ I~lU~:Cq~ahty~ of Anchorage -
Oept, Health & Human Services
SO~ ~OG - ~ACO~A~O~ ~
P~O~{ED FOR: 7~5 T ~ ~ ~ / DATE
DEPTH
WAS GROUND WATER
ENCOUNTE. KED?
L~ YES, AT W~dAT DEPTH?
Depth Io Water After
hfon. itor~ng?
Township, Rane¢, Section:
SLOPE
S
/do L
~ O
P
Date I/Z~/~. E
SITE PLAN
Reading , Date Time Time Water Drop
~ " 5,~° 8°~;~ J q ~/,~ I
I
PERCOLATION RATE ~ ~. (minutes/inch) PERC HOLE DIA},IETER /~
TEST RUN Bm'W~EN ~ 7z ' FT ,~ND ~ ZZ ' VT
EZFORMEDBY: ~.~r~ AC~c~Z'/',i,.'~',, I ~"/ m~",./~'rt.- CERTFFY THAT THIS TEST WAS PERFORJMED IN
CCORD.:'d'!CE V~qTH Ai.L STATE ,AND ,",IUNICLP.a.L GUIDELINES IN EFFECT ON THIS DATE. DATE: / / ~ J/~[~"
RECEIVED
FEB 1 4 1992
ARCTIC SLOPE CONSULTING-GROUP,
SOILS LOG ~ PERCOLATION TEST
PEP. FORMEDFOR: T~",~F fl/OAE ~
LEGALDF--SCP-Jk~'TION: Z-o/- 30 ~-~k~: ~o.~c2~[ /i/,,'{{-~3 To',vnshlp:Rzn~¢:S¢cdon:
DEPTH
WAS GROUND WAT~R.
ENCO UNTF~R-ED ?
~ YES, AT WHAT DEPTH?
Depth to Water After
Monltodng? ~J ~ t, ,~.
SLOPE
t l'
SITE PLAIN
PERCOLATION RATE. ...q 4.J, .,~ (minutes/inch) PERC HOLE DDG\.IETER _ ~, ' /
TEST RUN BETWEEN ~ . ~ FT AND ?.O FT
~?~,=OP~VIEDBY: ~'~r~ Ac/<Nz'~',-i~,,1 ~l ~-'~/ g}/}ek~~'~ CERTIFY THAT THIS TEST ",VAS PERFORNIED IN
'ZCORD.'LNCE X,VITH ALL STATE AND MUNICIPAL GU1DELINES IN EFFECT ON T}HS DATE. DATE:
P.O. BOX 6650
ANCHORAGE, ALASKA 99502-0650
(907) 264-4111
TOI,t¥ KNOWLES.
DEPARTMENT OF HEALTH & HUMAN SERVICES
January 10, 1986
TO: Permit Applicant
Subject: Permit # 850583
Lot 30 ~Lakewood Hills Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as-built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. 0swalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
DEF::'AF~(T'h'IE:.NT' [:IF::' FIIEAI....TI*'i AND ENVIRONMEI'JTAL.. F'I:~.:O]]EC]~]:(]N
82.5 L.. STREET, ANCH[]RAGE~ AK 9950:L
2.64'-4720
PERM I T NC:)',',
DA]'E ISSUED:
ALASKA ~:X]NF. OF::' SDA ' S
6J.O() O'MAL.LIEY RD
ANCHOF::AGE, AK 995 16
346-. 1004
SiI.JBD I V I S l ON: LAI-:::Et,dOOD t'-I ILLS
SECTION: 14 T'OWNSHIP: 12N
:L9904. (SQ.F:'T,, OR ACRES)
3
L.OT~ 3() ~:: 3
RANGE: 3W ~ ~
Lis'Led below ape 'Lhe c)p'Lions available 'La you :Ln des:Lgnil"ig yC)up septic:
system,,' Choose t. he:, optior~ that. best ¢J.'Ls your' s.it.E~.
~IF F.~: I]iEE .,rpql El: I]--.~ :ED~ tiE..:::: Z:], ip,,,~ =, :E:',~, F',: ~.'.::.~
DEF::'"f'H TO F::'iPE BOl'T'OM (F::T'.) 6.0 6.5 6,, 0
]~RAVEL. DEPTH (F'T,,) 5.5 O. 5 2?. 0
i'OTAI_ DIEF']']'"I (I:::"T ,, ) i 1 ,, 5 7 ,, 0 8 ,, 0
:]';i;:~:AVEL W l DTH (F::"I".) 2.5 24.0 5 ,, C)
:;'ff:;:AVE:L.LJENG]"H (F:'T.) 75.0 46.0 116,, 0 '~"~
.;)F;'.hVEL VOL..UME (CU. YDS. ) 4 1 .,'7 40.9 53.8
i'hNK S!ZE (GALS) 1~000~0 '~-'~s 1~000.() ~"~' ' :i.~OOC),,O '~-~'
SOIL. RAT]:NG (SQ,,F::'T'. /BR) 2'75 242 ~'~'Z'5
· x..~.~. GRAVIEL I_IENGTI"I > '75 F'T,, RE(:;!UIFiES MUL, TIF:d_E RL,HqS (NO'T' EXCIEEDING 75 F:'"I'. EACH)
'~--~'~ 't"ANK MUS'T' HAVE Al" L..EAS'f' 'T'WO C:OMF:'AFCI"MENT'S
t: cer'tiry t, hat.:
i. I am Fam:Ll:Lar. w:L'l:.h 't'.he r'ec!uiPements For' on.-s:i.'Le ~[~eWel"S ancl wells as se'L
Fc, r'th by t, he Munic:ipality oF Anchcmage (MOA) arid the Stat. e) oF Alaska.
2. I wi].! :Lnst. all t. he:, syst. em in ac:cop(::tar'ice wJ.t. ln a:!.:L MCIA c:odes and r~egulat.:Lc)ns,
al]cJ iri c:omp].J, arlc:e:. J,~it.h the c:lE, sigf'i (::Pit. ePia c)~' th:i.~ per~m:i.t'..
3. i will acthepe t.c] all MOA anti St.a'Le o{ Alaska i~equii~emen'l:.s for t. he set bac:k
clJ. s'Laric:es Fpc)m any exist:Lng ~A~ell, wasCewa'Lep d:i, sposal syste:,m c)P public
servel*age syst, em On t. his of any adjac:e)rlt, of r'leaPby ].ot..
4,, I ur~der'stand that t, his per-mit. :i.s va].id ¢of a rnax:LmL~m c:~I:' 3 bedr'oc)ms arid
any er'~].aPgemerrL ~,.~i].l r'eqt.iipe an addit.:i,c)na], per. mit..
EF::' A I_IF::'T' STATIOI',t ]:!3 INS'TALLED IN AN 'AREA COVERED BY MOA BLJILDING CODES,
I'HEtq (I) AN EL.IEC"FRICAL I::'EERMiT AND IIqSF'ECTION MLES"F BE OBTA]:NED~ (2) AS...,,BUII...TS
~]ILI._ NOT BE AF'F'ROVED WITHC)tJ"I:' AN EL.ECTRICAL. ZNSPECTtON REPORT; AND C];) ]"HIE
~:I...IECYFRiCAI.,. WC)RI< MUST BE: DONE BY A L...ICIENSED EL. ECTRiCIAN.
i~ ! GNED DATti]i: :,
~F:'F:'L.I CANT: A]...ASKh CONF:'. 01':' SDA ' S
DEF:'AFCI"FIEIq'f' OF: HE~L]"H AND ENVIROIqMENTAI_ PROTECTIDtq
825 L STREET, AI',ICHORAGE, ~J'::: o~='('.l
APF'L I C;AN'I":
ADDRESS:
CONTACT F:'FIONE:
I_I;ii:GAL. DESCRII::':
1....0'1" S I Z E:
MAX BEDI:~O[]I¥tS ~
09? 11/E,,.~
ALASI<A CONF,, Of:- SDA ' S
6:1.00 0' MAL. t_EY RD
Ai'qCHORAGE, AK. 99516
346- 1
SUBDIVISION: LAKEWEIOD HII-I-S
SECTION: !4 T'OWNSHIP:
J, 99()4. (S6~,, F"I", OR At]RES)
3
5 LOT: 30 ~
:L2N RANGE: 3W
I...ist.(~:)ct I:)eic)w ape:, t. he c)ptior~:.4 available t.o you in clesigr'ti~-~g your sept. it
:::v:,~¢ . [;hoc. se the opt. ion that best fits you~' site.
GRAVEL DEPTH (I::'T,) ~- ,
GRAVEI.~. L.EIqGTH (FT,
GRAVEL VOI_UME (CU. ¢DS~
'TAIqlc: SIZE (GALS)
.~.s.;~. TANI< IdUST HAVE AT LEAST TWO COMPAR]"MEN]%
]: cer't.i¢y that.
I,, I am ~'amilian wit. h the ]'equirements f'oP on-.site, sewer's and' wells as set
['oPt. h by t. he Idun:[cipa].:i.'[.y o¢ Anchor'age (MOA) arid the Stat. e c:)~' Alaska,
2, I ~,,,~J.].l insta].l t. he system in ac:cordance wit. h all MOA c:odes and Pegulat. ions,
and :i.n compliance with the design cr'itepia c)¢ this per'mit.;
::5. I w:i. ll aclhei-e 't.o ali. MOA and S-Lat. e~ o¢ Alasl.::a pequiPemerr~s CoP t. he set. bac:k
distances f'rom any exis'Ling ~;el],, wastewat, ep disposal, system of public
se~-,~er'age system on Chis or any acljacent of neam'by lcd:.,,
4,, I undei"stand that. this per'mit, is raj. id ~'of a max:i.r~um o¢ 3 beclr'.ooms arid
any (~nlar'gement. ~,,~i
:t:1:::' ALit::']''"":,:~lA~" '"' IL]l,!' IS INS]"ALLED. IN AN AREA COVERE':D BY MOA BUILDI'NG
- ~ .... ~' '1' (2)
'T'HEN ~1) AN 1:.1....,:.., Ri~.,AL PERMIT AND INSI::'ECT]'ON MUST' .::~::. OBTAINEr)~ AS.....BUIL..TS
WILt... NOT BE AI~IR~) WITHOU]" AN ELECTRICAL INSI::'IECTI[)N RIEF:'ORT'~ AIq~5 (3) 'T'HE
'~ ............................ : ............................... ~._~ ........... ~~ ........... Z./,_ L.L..,,/..~..Z ..............
All LICANT'~ ¢.-~t...~,..,,'::Pu CO ,1 , . .0¢~ .~ ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~ SOILS LOG
PERCOLATION
TEST
7
8
9
10
11
12
13
14
15
filL
SLOPE
DATE PERFORMED:
SITE PL~AN
WAS GROUND WATER ~'~"~_ S
L
o~" ~¢~:~COUNTERED? O
P
IF YES, AT WHAT
E
DEPTH?
16
17
18
19-
20-
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
ff ~'~I [o:~ I0 0.~3 0,07
~>o 5 G-~t ~o:~. lo:~ (o o.~o ~.?¢ o.~
PERCOLATION RATE ~ 7. ~:) (minutes/inch)
]['ESTR~N BETWEEN ~o0 . FTAND -~';~.~-~ ET
~NA-~5- O~ ¢ CERTIFIED BY: DATE:
72-008 (6/79)
· 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
MAILING ADDRESS
LOCATION NO. OF BEDROOMS
Wall Absorption araa D~elllnfl ~ffBMIT ~0.
~ ~ Manufacturer~' ~ Material ~ N°' of compartments
O Z ~ Manufacturer Material Liquid capacity in gallons
O Wall Foundation O~ Nearest lot line PERMIT NO.
~ m No. of lines [ Length of each lineup Total length of I,n~ Trench width Distance between lines
Total
~ To, of tile to fin,,h ~rade ~, ~' Material beneath tilo ~[ ~[~ inchesinchas effective absor~,~ ~ea.
ken,th ~idth Depth P~IT ~0.
~ Type of crib
~ ~ ~ ~ia~ Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ ?~ ~ Depth ~~ ~1~ Distance to lot line PERMITNO.
~ DISTANCE TO: Building foundation Sewer Dine Septic tank Absorption area(s)
OTHER
SOl L TEST RATING ~'
INSTALLER
REMARKS ~.. ~. m
ED DATE LEGAL
MI--I~I I. C I t. r;lI I T%-' ~]F I-]~'-~C:H~_,.RFII]E
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 ~l~ STREET, ~NCHORAGE., ~K, ~9501
264-4~20
C~ ~-~-- S I]'E SEI~ER LIPGRB[)E P E E~ ~'1
RPF'LICRNT SEVENTH DRY ADVENTIST-A ?I8 BARROW
LOCATION UPPER O"MALLEY RD
LEGAL L~O~ LRKENOOD HILLS
TYPE OF SOIL 8BSORBTION S~STEM IS: TREN_.H
LOT SIZE
MRXIMUM NUMBER OF BEDROOMS
~OOO0 SQ.iARE FEET
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[)EF'T'H= ::L__~-: LEr~iGTH= 4~-]i i_~RR%~EL [:,EPTH= 8
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
RND THE BOTTOM OF THE EXCAVATION (IN FEET).
F'ERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEF'RRTblENT DURING THE
INSTRLLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T[qCI ¢-.._o ) I I'~$PE C: T I Or-IS FIRE RE _F-~LI
BACKFILLING OF' ANY SYSTEM WITHOUT FINRL INSPECTION AND RF'PRO',/AL BY This
DEPARTMENT WILL BE SUBJECT TO PROSECLTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SENRGE DISPOSAL SYSTEM IS
· 00 FEET FOR ~ PRIVHTE WELL; OR
±50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
O]'HER REQUIREMENTS M8Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F'E~:~"l I t E:~P I IF:ES [:,EL-'-EMBEIF: ' i-~--'l.. ~L_'~- 7:-B
I CERTIFY THAT
t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
I~PL~CFINT SEVENTH DAY ADVENTIST-AK MISSI
September 13, 1978 R&MNo. 851121
Mr. Eugene Star
718 Barrow Street
Anchorage, Alaska
99501
Subject: Soil Investigation for Sanitary Sewer System, Lot 30, B~,
Lakewood Hills Subdivisio~Anchorage, Alaska
Dear Mr. Star:
This letter is prepared as a supplement to the R&M Soils Report of May
26, 1978 for the subject property.
To assure that the test results would not be adversely effected by the
nearness of the existing malfunctioning drainfield, an additional test
hole was drilled on September 11, 1978 and a second percolation test was
performed.
The additional test hole was drilled to a depth of 10 feet and soil
conditions were the same as noted in the earlier report. The test hole
was located at the west end of the marked area for the proposed new
trench, a distance of 29 feet from the standpipe at the end of the
existing absorption field.
Results of the percolation test performed within the bore hole are shown
in the attached Table t. Ail depths were measured from the top of
hole. The data in Table 1 show average infiltration from the depths
indicated to the bottom of the hole. The measured percolation rate was
18.8 minutes per inch.
Please contact us if you have any questions concerning this letter or if
we can be of additional service.
Very truly yours,
R&M CONSULTANTS, INC.
~ary A. Smith
Senior Geologist
GAS/djb/12-U
Time
Elapsed
Time
PERCOLATION TEST
Table 1
Sdp~. 13, 1978
R & M No. 851121
Inches
Drop In Inches
1:23
1:25
1:27
1:28
1:33
1:43
1:53
2:03
2:13
2:23
0
2
4
5
10
20
30
40
50
60
58.6
59.2
59.8
60.0
60.5
61.8
62.6
63.6
64.0
64.2
1.6 inches in 30 min.
18.8 minutes per inch
0.6
0.6
0.2
0.5
1.3
0.8
1.0
0.4
0.2
I~EI~ORANDUM
TO
Mr. Eugene Star
7th Day Adventist Church
Gary Sm
SUBJECT
Soil Investigation for Sanitary SewerrSystem
Lot 30, Block 3, Lakewood Hills Subdivision,
AnchQr_a~e~ Alaska
DATE PROJECT NO.
October 2, 1978 851121
In accordance with our conversat±on th±s morning and based on my discussions
concerning the s,ubject project with Mr. Hank Alters of the Department of
Health and Environmental Protection, I am submitting below the verification
of subsurface conditions-that Mr. Allers requested.
On September 11, 1978, we drilled a 10 foot deep test hole for the
purpose of running a perc~lat±on test at the site of the proposed
absorption trench.~'The ground water level ~t the site of this test hole
is considered to be the same (171feetl as in the f~rst test hole
located 20 feet away.
May 26, 1978 R&M No. 851121
Mr. Eugen~ Star
718 Barrow Street
Anchorage, Alaska 99501
Subject: Soil Investigation for Sanitary Sewer System,
Lakewood Hills Subdivision, Anchorage, Alaska
Lot 30, Block 3,
Dear Mr. Star:
At your request of May 22, 1978, we conducted a subsurface soils investi-
gation at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the
Municipality of Anchorage Department of Health and Environmental Protection.
This investigation, which was accomplished on May 25, 1978, consisted of a
test hole drilled to a depth of 20 feet below the existing ground surface.
The test hole was sited according to your instructions and its location is
shown in attached Drawing A-O1. Drilling was accomplished with a rotary
drill rig using continuous flight solid-stem auger with an outside diameter
of 6 inches. A sample was taken at the depths shown on the soils log in
Drawing A-01. The sample will be held in storage at our lab for approxi-
mately six months. In addition, all material brought to the surface by the
augers was continuously monitored by an experienced engineering geologist.
The topography at the drilling site is generally horizontal. At the time of
the investigation the site had grass cover. The top of the test hole was
located at original ground surface.
The soils encountered in the bore hole are shown in the test hole log in
Drawing A-01. This log displays specific conditions encountered at the test
location. However, subsurface conditions may vary in other parts of the lot
without any apparent surficial evidence of the change. Groundwater was
encountered in the test hole at a depth of 17 feet. Bedrock was not encoun-
tered. At the time t~e hole was drilled seasonal frost was not present.
Permafrost was not encountered.
A percolation test was performed within the bore hole at the depth shown in
the attached Table 1. Ail depths were measured from the top of the hole.
The data in Table 1 show average infiltration from the depths indicated to
the bottom of the hole. The measured percolation rate was 50 minutes per
inch.
May 26, 1978
Mr. Eugene Star
Page -2-
We appreciated this opportunity to be of service to you. Please contact us
if you have any questions concerning this letter or if we can be of addi-
tional service.
Very truly yours,
R&M CONSULTANTS, INC.
Lynne Kosikowski
Staff Geologist
JMB:LK/kah
PERCOLATION TEST
7th Day Adventist
R & M NO. 851121
TIME
ELAPSED
TIME
INCHES
DROP IN INCHES
9:20
9:21
9;22
9:23
9:24
9:25
9:26
9:27
9:28
9:29
9:30
9:35
9:40
9:45
9:50
10:00
10:10
10:20
0
1
2
3
4
5
6
7
8
9
10
15
20
25
3O
4O
5O
60
42
42
42
42
42
42.6
42.6
42.6
42.6
42.6
42.6
42.6
43.2
43.2
43.2
43.2
43.2
43.2
0
0
0
0
0
0.6
0
0
0
0
0
0
0.6
0
0
0
0
0
1.2 Inches Total Drop
50 Mintues Per Inches
BORING NUMBER 1 Date Completed: 5-26-78
SOIL DESCRIPTION
PEAT
Dark Brown, Soft, Slightly Moist
-- 2.0'
SILT W/TRACE GRAVEL (ML)
Brown, Medium Dense,
Slightly Moist to Very Moist
· WD
Water Table Encountered @
17' While Drilling
20'T.D.
LOCATION
SKETCH
No Scale
LOT 30
%TPPF, R ~l MAT,T.~.V
NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE
NOT BEEN MEASURED BY SURVEYING METHODS.
EXPLANATION
ORGANIC MATERIAL
Little Visible Ice O:10' Vx
A.B. '--/cE Z~£SCR/Pr/OH
SS,72,SZ I% 85.gpcf
I ~DRFOE~SlTY
I I ~wAr~R coNr~r
~ ~ BLOWS/FOOT
BEDROCK
Y~ B -WHILE DRILLING
TYPICAL SOILS LOG A.a-AFTER BORING
Ss /4 "SPLIT SPOON WITH 140 LB HAMMER
Sz 1.4" SPLIT SPOON WITH 340 LB. HAMMER
Sh ~5" SPLIT SPOON WITH 340 LB. HAMM£B
~p 2.5" SP~IT SPOON, PCSH~D
A AUGFB SAMPLE
Ts SHELBY TU3E
Tm MODIFIED SHELBY TUBE
~ BULK SAMPLE
G~VEL
~ ~ COBBLFS*
C& A Y 80UADF~S
~ SILT ~ BEDROCK
SOIL SYMBOLS
_J NSULTANTI~, INC. LOT 30, BLOCK 3 GRID.
ATE. ~_o~_7~1 II"N"'N~"~ ~.o._o~,s.. .~.N..s ~.v~¥o.s LAF~EWOOD HILLS SUBDIVISION I' /PROJ. NO.
RedifLorm® 4S 471
SIGNED
SEND PARTS ! AND 3 WITH CARBON INTACT -
PART 3 WILL BE RETURNED WITH REPLY.
DATE
Parcel I.D. #
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
035-].34-09 HAA #
1. GENERAL INFORMATION
Complete legal description
Lot 30, Lakewood Hills #3
Location (site address or directions)
7480 Upper O'Malley
Property owner Sam Cora;os
Mailing address
Day phone 346-1518/258-7722
Lending agency
Mailing address
Day phone
Agent
Address
Day phone
e
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water
If community well system, provide written confirmation from State A DEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Community on-Site
NOTE:
xxx
PubliC sewer
If community wastewater system; provide written confirmation from State ADEC
attesting to the legality and status of System. '
7~43251Rev. 1/91) Front MOAII21
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 further verifythat 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.
S & S ENGINEERING
Nameof Firm ~Tn~4~C~,,~hm_.,L?~pR_~=.2.Mc. 204 Phone ~' 0/?'- ~-~ '7 ~
Eagle River, Alaska 99577
Address
Engineer's signature . . . Date. /~//,',/e ~
Approved for--'-~,~- '~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Note: The well for this property meets e×ist±n§ State and Municipal Codes,
The'r'e ar~ nitrates present. It Js su_~_~ested that par~d~c ~a~t~ng be
performed to insure the wells continued suitability. Current nitrate
~c~'-~tr~.tion is 5.52 mg,/1. EPA ~a×im,am concentration is !0.0 mg/1.
More information on nitrates is available from the On-site Services Program,
Additional Comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given 'n paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a cour[esy to purchasers of homes
andtheir lending institutions in order to 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, I/91} Back MOAi¢21
Municipality of Anchorage DEC
DEPARTMENT OF HEALTH & HUMAN SERVICE~uN[cIPALI~Y OF
Environmental Services Division F-NVIP'ONMFN~¥~LSERVICES~
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
Legal Description: L ~ 7 .~0 L~,<,~,,~¢~,~ i-t/~.~. ,~ # -~ Parcel I.D.: O/
A. WELL DATA
Well type
Log present (Y~,~) iV 0
Total depth
Sanitary seal (~/N)
Date completed
Cased to ~'0
IfA, B, or C, attach ADEC letter. ADEC water.system number
Casing height (above ground)
Wires properly protected (~/N)
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform
Date of sample:
FROM WELL LOG AT INSPECTION
.~ g.p.m. $~. t
Nitrate
B. SEPTIC/HOLDING TANK DATA
Collected by:
Other bacteria
S & S ENGINEERING
17(;.~4 ~,~|~ R;wr L,~up
Eagle River, Alaska 9~577
g.p.m.
Date installed ..~/2-~'(' o/2_ Tanksize 1o~ o Number of Compartments .
Foundation cleanout (Y,~ ,~ ~- z'¢"~ Depression (Y/I~
Date of Pumping I:~//o/~ ¢ Pumper ~,¢-
C. ABSORPTION FIELD DATA
Date installed ~-/:~ ?/t ~ Z_
Length /~ '~ Width
Effective absorption area ) 0 o 0
Date of adequacy test ~ ~/~/c1 ~
Fluid depth in absorption field before test (in.);
Fluid depth ~ 3. /;~ (ins) Minutes later:
Soil rating ~or ft2/bdrm)
0-¥--~- Systemtype 'T,¢.~-.,' c/~
Gravel thickness below pipe r~ Total depth / o
Monitoring Tube present (~/N) ¥*$ Depression over field (YI~'~ ~'~' ~
Results~____~ail) /~'J' For '~ bedrooms
Immediately afterc/~''/'/ gal. water added (in.):
Absorption rate = ~5-0 -/ .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~¢'"¢ ~ '~¢~' ~' If yes, give date --
72-026 (Rev. 3/96)*
D. LIFT STATION
[:)ate installed Size in gallon~a..-/~-~----
Manhole/Access (Y/N) "Pum~ "Pump off" level at*
High water alarm level at* ~ *Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ]/ 0
Absorption field on lot / O ~
Public sewer main ~ //')-
Sewer'/septic service line '~. &- 4-
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation ~" 3 Property line I '¢' Absorption field
Water main/service line /0 ~ Surface water/drainage ?oo 'f'- Wells on adjacent lots
/oo -/..
SEPAIRATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '7 '/~. Building foundation / o 4- Water main/service line
Surface water / o O "f' Driveway. parking/vehicle storage area
Curtain drain p 0 ,, ,'c- ~: ,,,o ~¢' Wells on adjacent lots I
ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal rec~a'~Cfe'~t~ vc~lems are
in conformance wit~ M~A ~uidelines ip effect on this date.
Signature
[Engineer's Name _/(~/~ ~ Co,~'~
Date / ~/t~ / ~ ~ ~... ~ 8.01 .,..~¥~
,t~ 'c,},' ............
HAA Fee 8. ~C)
Date of Payment
Receipt Number L~ '.~. '~.'~/ (
72-026 ([lev.
Waiver Fee $
Date of Payment
Receipt Number
DEC-15dB OB:51 FRO~FCTE E!~VIRONBENTAI 5G1~30i T-O)O POD/OF ~-Ig3
CT&E
Client Name
Project Name/~'
Client Sample ID
Matrix
Ordered By
PWSID
987115001
S & S l~ng~neeriag
Lot 30 Lakewood Hill #3
Lo!: 30 Lakcwoofl Hills #3
Drinking Wa~er
0
Sample Remarks:
Clie.t POg
Primed Date/Time 12/15/98 00:55
Collected Date/Ti,ne 12/08198 15:45
Received lYatelTime 12/08/98 16:lZ0
Tecl, nical Director: S~ephen C. Ede
Released B y~_~L~~~
o
O.lOO mg/L EPA 300.0
10 max
I~/oB/gB KAP
1~y09/98 12/1119§ SCL
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~)~.~ -- \ ~\~ (~)o~ HAA #
1. GENERAL INFORMATION
Complete legal description £~,~<,-.cu,,or~ t~ ;~ ~'$
Location (site address or directions)
A,,cl-~¢,~ ~, ../* I,,_~ L~ q ¢,5
Property owner
Mailing address
Lending agency
Day phone
Mailing address
Agent
Day phone
Address
Unless otherwise reqUested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
NOTE:
Individual well
Community well
Public water
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 (Rev. 1/91) Front MOA#21
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 further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm ,A,5.(L. G.
Address
Engineer's signature
Phone
5'9.5' l~ -
~ PROFESS~
DHHS SIGNATURE
Approved for 7'~4-/~,~z~-~ ¢ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By:
AdditionalComments Note: The well for this property meets existing
State and Municipal Codes. There are nitrates present. It is
suggested that a periodic testinq be performed to insure th~ wells
continued suitability. Nitrate concentration is 6.7 mg/1. EPA
- maximum concentration is !O.0. mg,/!.
~_~_ ~'~6'-4.~-.* Date_
72-025 (Rev. 1/91) Back MeAlY21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: J-~l~,~uoocl ~;[15 ~ ~o'~' c3 (~
Parcel I.D.
A. WELL DATA
Well type
Log present (Y~) /'~o
Total depth u,t
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number --
Date completed ~J~,~o~,-~ Driller u,~ ~.~,-~
Casedto''~-~~'[(' Casing height I,$
/
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG AT INSPECTI~)~IICIPALITY OF ANCHORAGE
;z J;~ $ /~7~ ENVIRONMENTAL SERVICES DIVISION
g.p.m.
2.7
R ¢.IHVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
I
0
Absorption field on lot 1 o
Public sewer main ( oo
Sewer service line / do
; On adjacent lots i0o ~'
; On adjacent lots IOO f
Public sewer manhole/cleanout leo {'
Petroleum tank JOe'{
WATER SAMPLE RESULTS:
Coliform 5~.~ ~r,c [-o~- ~
Date of sample: ~/2~ ['~Z-
Nitrate 0-~,
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (~.~N)
High water alarm (Y~ //DO
Date of pumping
Tank size 1ooo ?q.I Compartments ~
Foundation cleanout (~N) ~5 Depression (Y~) .'Cid
Alarm tested (Y/N) ~
Pumper ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot lie ' On adjacent lots
To property line /'8, / Absorption field
Surface water/drainage l o o ~
f
Foundation 51
Watermain/serviceline /ook
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
D. ABSOFIPTION FIELD DATA
Date installed ~
Length_ 5~ ~ Width -~'
Total absorption area
Depression over field (Y,~.)
Results (pass/fail) /U
Peroxh'le treatment (past 12 months) (Y/(~
Soil rating o,4.5 ~ Pt0/5'¢; System type
Gravel thickness G,5 Total depth ~',
Cleanouts present ~N) ~¢&
Date of adequacy test -
for '~
If yes, give date
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I¢?~ '
To building foundation .~O ~
On adjacent lots /co +
Surface water ~ co ~
Curtain drain [0o6-
On adjacent lots ~oo ~ Property line
To existing or abandoned system on lot
Cutbank ~oo~' Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Date
Engineer's Nam,e
HAA Fee $ __/~
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
From : ALPINE DRILL 907 345 0202 Mar. 23.1992 0S:01 PM
Alpine Drilling & Enterprises
P.O, Box 110496
Anchorage, AK 99511-O496
3-~3-9z
To, Susan Os~alt ?ax- 3h3-67~0
Anchor&ge DRHS
The ~elt loc&ted on Lot 30 [~kewood Hills #3 does h~ve casing extending
beyond %he lO0' depth, There is no water enterin8 the Hell from &boys
the depth of $0'.
D~vid L. Harper ~
Alpine D~illing & Enterprises
REr.F. IVED
MAR 2 3 1992
IV'~u:: ,.: .. - ~ A~chorage
Dept. Heaith ~ Human Services
Ancho~aqe ~K 99S18
Our Lab $: i Al16358
Location/Pro~·ec~t -
Your S~mPleiZ~: Lakewood ~ills
Method · Parameter · , Un£=s
i Nltrate-N
N£crebioZocjy Supervi~o= '
~epo='c. Date: 03/03~92
Da~e ~,~ved: 02/28/92'
Date Sampled= 02/28/92
Time Sa~pZed=. 1430
Collected BF~ K~A
MDL = Method
L~mit
Flag'Defl~£~ion~
H = ~ove ~e~Ia~ory
Date
aesul= Flag
6.7' ~.~ 0~/~e/~