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Home My WebLink AboutLAKEWOOD HILLS LT 4 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP251124 PID Number: 1531211000 Dwelling: FN Single Family (SF) F -I with ADU El Duplex (D) El Two Single Family Project: 1771 New FNI Upgrade Name George ABSORPTION FIELD A Deep Trench 171 Wide Trench El Bed F-1 Mound Site Address 7101 Omalley Rd, Anchorage, AK 99507 El Other Phone Number of Bedrooms Soil Rating depth from original grade 14 1.2 GPD/SF JTotal 10.83 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.83 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block Lot Lakewood Hills Lot 4 Fill added above original grade 0 Ft. Gravel length 40 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines NA Distance between lines NA Ft. SEPARATION DISTANCES To Septic Absorption j Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 560 FF 1 NA Ft. Well +100 1 +100 NA +25 TANK El Septic A S.T.E.P. 171 Holding El Other Manufacturer GREER Capacity 1500 Gal. 1+100 Surface Water +100 +100 +100 NA Material P01Y Number of compartments 2 Lot Line +5 +10 NA NA NA Foundation +10 +10 NA NA LIFT STATION Manufacturer Orenco Capacity 1500 Gal. Remarks Alarm location Electrical installed by House Capstone PIPE MATERIAL House totank PVC Tank to PVC drainfield Installer Zollinger Contracting — Drainfield PVC CO/MTPVC Inspector Matthew Balzarini BENCH MARK (Assumed elevation) 100 ft Inspection 15t 8/29/25 M 8/30/25 Location and description dates: 2 3rd 9/3/25 4th Top of tank manhole (inlet chamber) ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date eq 4 TH 9 Septic Syste MATTHEW P. BALZARINI CE118893 Approved Date K. ��l`��F,�F13/20��°�.:� lk�, ROFESS0 _Xe. this approval does not include well permit requir ment egg�' (Rev 05/0218) MATTHEW P. BALZARINI CE118893R E GISTEREDPROFE S S I O N A L E N GINEER 9/3/2025 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP251124 Work Type: Septic Upgrade Tax Code Number: 01531211000 Site Legal Address: LAKEWOOD HILLS LT 4 G:2539 Site Mailing Address: 7101 O'MALLEY RD, Anchorage Owner: GEORGE ALLEN F & HAZEL R Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: �11rnt r L)eparta))ent 5/2/2025 5/2/2026 27285 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The existing septic tank is to be decommissioned. Received By: 5 5 C '0 F C Date: Issued By: o Date: 4 MUNICIPALITY OF ANCHORAGE r. Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 0 15-312-11 Property owner(s) ALLEN & HAZEL GEORGE Day phone Mailing address 7101 O'MALLEY ROAD ANCHORAGE, ALASKA 99507 Site address 7101 O'MALLEY ROAD ANCHORAGE, ALASKA 99507 Legal description LAKEWOOD HILLS LOT 4 Number of Bedrooms 4 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable RN APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption Field El Initial ❑ Septic Tank Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: -z' 5- Permit No. L L 11 'z' Waiver Fees: Date of Payment: Waiver No. Distance: 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! May 1, 2025 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: LAKEWOOD HILLS LOT 4 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1500-gallon deep-burial STEP tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on April 16, 2025. No groundwater was observed at test hole excavation or monitoring. The absorption area is on a raised hill area that consists of flat slopes at the proposed upgrade location and slopes off on areas to the side per the attached design. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251124, Curtis Townsend, 05/02/25 17.6' 6. 7 ' 19.0'6. 7 ' 28.1' 26 . 3 ' 64.7' 26 . 3 ' GA S EL E C . 4BR RESIDENCE 12.3'x16.3' SHED APPROXIMATE EDGE OF ASPHALT DOG KENNEL FIRST WATER CONSULTING LAKEWOOD HILLS LOT 4 DESIGN CALCS: NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251124, Curtis Townsend, 05/02/25 12.3'x16.3' SHED APPROXIMATE EDGE OF ASPHALT DOG KENNEL FIRST WATER CONSULTING NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK OR FIELD. DESIGN DETAILS: LAKEWOOD HILLS LOT 4 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251124, Curtis Townsend, 05/02/25 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : LAKEWOOD HILLS LOT 4 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 5/1/2025 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 SM/sp 7 8 9 10 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 4/24/25 10 min 6” 3 5/16” “ 6” 3 3 /16” “ 6” 3 3 /16” “ 6” 3 1/16” “ 6” 3 2/16” “ 6” 3 1/16” PERCOLATION RATE 3 (MIN / INCH) TEST RUN BEWTWEEN 6 & 7 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 4/24/2025 TESTHOLE # 25-1 DATE PERFORMED: 4/16/2025 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: ALLEN & HAZEL GEORGE 05/01/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251124, Curtis Townsend, 05/02/25 17.6' 6.7' 19.0'6.7' 28.1' 26.3' 64.7' 26.3' GAS ELEC. RESIDENCE SHED SHED 12.3'x16.3' SHED APPROXIMATE EDGE OF ASPHALT DOG KENNEL 6"x6" POST W/ SAT. DISH LEGEND FOUND 5/8" REBAR, NO CAP EDGE OF GRAVEL DRIVEWAY DECK/BOARDWALK CHAIN-LINK FENCE EDGE OF ASPHALT RECORD DATA PER PLAT #P-342 SEPTIC PIPE WELL FOUND 5/8" REBAR, PLASTIC CAP TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.053 SCALE: 1" = 30 FEET DATE: 3/27/2025 SHEET: 1 of 1 MOA GRID: SW2539 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 7101 O'MALLEY RD, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 4LAKEWOOD HILLSPLAT #P-342 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 MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: '~,~ 74 ~Zo ~ o Well ' Absorptio~ DwellinL [00 Material, ~ IF HOMEMADE: Inside length Width~T~ Liq, ty in gallons DISTANCE TO: PHONE ('~ 0 b~'~ [~] NEW 5W- ~UPGR*~E NO. OF BEDROOMS PERMIT NO. No, of compartments Liquid daDth Well Dwelling PERMIT NO. Manufacturer I Material Liquid capacity in gallons Well .~-. DISTANCE TO: Length of eaph line No. of ,nes/ I TOp of tile to finish grade ]Nearest lot ~ .nb Trench w...-~dtb inches Total length pf iJ3,es Material beneath tile Depth Length Width PERMIT NO. _ Distance between lines Total effective¢~rSon area PERMIT NO. Type of crib ;rib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line DISTANCE TO: Building foundation Sewer line PERMIT NO, Absorpt on area(s) Septic tank OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL Permit ~ ~ Applicant Location: ~UNI~IPALITY 0F ANCHORAGE~ Department:"'f Health and Environmenta~?rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Legal Description: Type of Soil Absorption System Is: Trench: Drainfield: ~aximum Number of Bedrooms: - /OR ON-SITE SEWER PERMIT Phone Number: Seepage Bed: Holding Tank: Soil Rating (sq.ft/br) /~ The Required Size of the Soil Absorption System Is:' DEPTH // .LENGTH ~C~ _ GRAVEL DEPTH. 5 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 th~ 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~'(~ 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 r~sidences that the well will serve. * * * TWO(2) I'NSPECTIONS 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 3L 1 9 8 2 * * * I certify that: (1) I am familiar with the requ'irements 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 the re?den~i~emodeled to include more that~ bed~s~,~~ - Date: . ~-- SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST PERCOLATION TEST SLOPE SITE PLAN WASGRO,'DWA*ER [ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORIV]ED BY: '~ ~'- CERTIFIED BY: ~'-"~'~ DATE: °~'~ ~~'' ~"- iGREATER ANCHORAGE AREA BOROUGH DEPARTMENT O,F ENVII~ONMENTAL QUALITY 274.4561 The Unders{gned, Being Duly Sworn, Upon His Oath Deposes & Says'. Last ~ First ALASKA did then and thee commit t~~e: - I ~EREB~ ~GR~TH~ ABOVE MENTIONED VIOLATION WI~ ~ DAYS FROM THIS DATE, IT IS UND~ACTION WIL~ FOLLOW IF . ~. ~ ~ignature ~ ~HE UNDERSIGNED STATES ~HAT HE HA9 JUST AND REASON- ABLE GROUNDS TO BELIEV~ AND DOES B~LIEVE THAT THE PERSON NAMED ABOVE COMMITTED THE oFFENSE HEREIN 6ET~ORTH~NTRARY~O , ~ N~- 8906 EQ-002(1 3.1.¥0 BO X~Vfll$Od ~elsod snl, 'ON ON¥ £33~15 Ol IN35 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) %. ~-~a~e .of person requesting app~rovat 2. ~a~-~_ of property: owner ~/-~' Nu~,:~, be~ooms in house Watex~.Analys i s: b. Detergent "' Well data: Deptll_ ~,, ~, / . ' ~ Distance f~om well to closest existinE~f~'"~/~6p6sed: /~pO 1, Sewer line 3, Seepage Area /~ ~ 4. Cesspool' S. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses~ barn, drainage ditch, etc. 7. Sewage disposal system. Age of system Septic tank capacity in gallons ~( ~ , / 1. If "home made" show diagram on reverse side of this for Disposal field or seepage pit size and ty~e 1. Distance to property line to house foundation . e. Percolatio~ Test '~esults .. f. Percolation Test performed by ~, "~-~. Use the reverse.side of this form to show diagram, Dia[ram should include ~ ?-~he fo]]~wlng information: ppoperty lines~.well location, house locatlon~ "v-o~r~{c tank location, disposal area location~ location of percolation test, a~. direction of ground slope. 9. The ln-~ox~t~on .on this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed' ~0 BE FILLED OUT BY HEALTH DEPART~-~ENT PERSONNEL [----]'T~e above described sanitary facilities are hereby approved, subject to the ~l~owing cond~onsi ' ' " Conditions: The above described sanitary facilities are disapproved for the following reasons: Approval is valid for one year following the date of approval. CPJ: cw FHA Form .~ - Rev. July .195., FEDERAL HOUSING ADMINISTRATION Budget Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGOR OR SPONSOR MORTGAGEE , J SERIAL NO. PROPERTY ADDRESS ~{~{ {)jJj.,~{~{~ ~ BLOCK NO. LOT NO. Can attic or other area be made into additional bedrooms? (If Yes, how many.~) ~ Yes ['--1 No ~ I SYSTEM DESIGNED FOR []Individual NO* OF BDRMS. GARBAGE DISPOSAL [] Individual ,~- N Yes ~ No SUBDIVISION NAME TOTAL NUMBER: LIVING UNITS BEDROOMS BATHS WATER SUPPLY BY: -']Public system SEWAGE DISPOSAL BY: BASEMENT [] New installation ¥es VINo I-]Community system [~ Community system r-j public system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [--'] County ~ Local Department of Health that this individual v~ater-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [--] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: ~-1 Can be expected to function satisfactorily, and , [~ Cannot,he expected to function satisfactorily is not likely to create an insanitary condition DATE SIONATURE / ........ J / ~ ..~ :::7 . NOTE: The health auth0rlt/should}omplet~ }he app'ropriat~ opinion statement above and a~x date, signature and title m the spaces provided. / ,' / Use of the above grid ~br He~ t~ Department Inspector's sketch as welJ as use of the bock of this form is at the option of the 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 SIGNATURE MIrALTu AIIJI'#~DITY APPROVAL ] CHIEF ARCHITECT r~ DEPUTY FOR CHIEF ARCHITECT FHA Form 257.t STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Drilling Started: ____/____/______ Completed: ____/____/_______ Pump Install: ____/____/_______ City/Borough Subdivision Block Lot Property Owner Name & Address Well location: Latitude Longitude Meridian ____________ Township ______ Range _______ Section _______ , _____ 1/4 of _____ 1/4 of _____ 1/4 of _____ 1/4 BOREHOLE DATA: (from ground surface) Suggest T.M. Hanna’s hydrogeologic classification system* https://my.ngwa.org/NC__Product?id=a185000000BYub3AAD Depth From To Drilling method:  Air rotary,  Cable tool,  Other Well use:  Public supply,  Domestic,  Reinjection,  Hydrofracking  Commercial,  Observation/Monitoring,  Test/Exploratory,  Cooling,  Irrigation/Agriculture,  Grounding,  Recharge/Aquifer Storage,  Heating,  Geothermal Exploration,  Other Fluids used: Depth of hole: __________ ft Casing stickup: ___________ft Casing type: __________ Casing thickness: _________ inches Casing diameter: _________ inches Casing depth: __________ ft Liner type: _________ Depth: _____ ft Diameter: _____inches Note: Well intake opening type:  Open end,  Open hole, Other Screen type: _________, Screen mesh size: ____________ Screen start: ________ ft, Screen stop:________ ft, Perforated  Yes  No Perforation description: Perf from: ________ ft, Perf to: _______ft, Perf from: ________ ft, Perf to: ________ ft Gravel packed  Yes  No Gravel start: ______ ft , Gravel stop:______ ft Note: Static water (from top of casing): _______ ft on____/____/_____ Artesian well  Pumping level & yield: ______ feet after _____ hours at _____ gpm Method of testing:__________________________________________ Development method:______________ Duration: ____________ Recovery rate: _________ gpm Grout type: _________________ Volume __________________ Depth: From ___________________ft, To ___________________ft Final pump intake depth: __________ ft Model: _______________ Pump size: _____________ hp Brand name: __________________ Include description or sketch of well location (include road names, buildings, etc.): Was well disinfected upon completion?  Yes  No Method of disinfection: Was water quality tested?  Yes  No Water quality parameters tested: Well driller name: .................................................................................. Company name: ................................................................................... Mailing address: .................................................................................... City: __________________________ State: AK Zip: ___________ Phone number: (________) ________- ______ Driller’s signature: Date: ______/______/_________ Anchorage Municipal Code 15.55.060(I) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. City Permit Number: _____________________________ Date of Issue: _____/____/_________ Parcel Identification Number: ______-_______-________ *Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https://dnr.alaska.gov/welts/ OR email electronic well logs to dnr.water.reports@alaska.gov North 189 n SE SESW 8 ALLEN GEORGE 7101 OMALLEY AK, 99507 SE n Municipality of Anchorage 14 UNKNOWN -149.749283 012N n 112 4LAKEWOOD HILLS 61.1236191 n n S 4 003W 44534 n MUNICIPALITY OF ANCHORAGE Development Services Department Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Certificate of On -Site Systems Approval OSC251369 Parcel ID 015-312-11 Legal description LAKEWOOD HILLS LT 4 Site address 7101 OWALLEY RD Expiration Date: 8/11/2026 Current property owner(s) GEORGE ALLEN F & HAZEL R X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: By: Original Certificate Date: 9/4/2025 This Cert' ' ate of On -Site Systems Approval (COSA) is intended to demonstrate the subject K s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, pment Service Department (DSD) issues COSAs based upon representations provided by an ndent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I . D. 015-312-11 Complete legal description Location (site address) LAKEWOOD HILLS LT 4 7101 OMALLEY ROAD Current property owner(s) ALLEN 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: *1 Private Well serving #1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 43 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ QG Waiver Fee $ Date of Payment b12 -o12-5 Date of Payment COSA # 11 SC ZS� tic! `7 Waiver # COSA Application_Apr2025.doc COSA Checklist_May2025.docx COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D.DISPOSAL FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: Lakewood Hills Lot 4 0153121100 1 +3 7/31/69 189 NA unknown 2.72 +24 8/11/25 Matthew Balzarini 120 8/11/2025 Tank and lift station are new 2025 10.8 0 Poly Tank and lift station are new 84 0 84 Tank and field are new; replaced 8/29/2025 COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Phone Engineer’s Printed Name Date 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Northern Lights Construction and Engineering 907-854-5244 Matthew Balzarini 9/3/2025 MATTHEW P. BALZARINI CE118893R E GISTEREDPROFE S S I O N A L E N GINEER 9/3/2025 17.6' 6.7' 19.0'6.7' 28.1' 26.3' 64.7' 26.3' GAS ELEC. RESIDENCE SHED SHED 12.3'x16.3' SHED APPROXIMATE EDGE OF ASPHALT DOG KENNEL 6"x6" POST W/ SAT. DISH 2.0' CANT. LEGEND FOUND 5/8" REBAR, NO CAP EDGE OF GRAVEL DRIVEWAY DECK/BOARDWALK CHAIN-LINK FENCE EDGE OF ASPHALT RECORD DATA PER PLAT #P-342 SEPTIC PIPE WELL SEPTIC TANK LID FOUND 5/8" REBAR, PLASTIC CAP TIMBERLINE SURVEYING AND MAPPING 17035 BARONOFF AVE EAGLE RIVER, AK 99577 907-242-5320 ryan@timberlinealaska.com FILE NO.: 25.053 SCALE: 1" = 30 FEET DATE: 9/3/2025 SHEET: 1 of 1 MOA GRID: SW2539 SCALE: 1" = 30 FEET(11"x17") 30'0' 60' AS-BUILT OF: ADDRESS: 7101 O'MALLEY RD, ANCHORAGE, AK LOCATED IN: ANCHORAGE RECORDING DISTRICT LOT 4LAKEWOOD HILLSPLAT #P-342