HomeMy WebLinkAboutLAKEWOOD HILLS LT 19MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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: -~tV-/cJ2-'~)..~ ~ PID Number: ~ ~- I~-O
Name: ~T~t ~ ~ E¢~ Wastewater System: D New ~pgrade
Address:
l O o ~ ~ ! ~-L~t D ~ ~ ~ ABSORPTION FIELD
Phone: ~-- ~ 7~ Nc. of Bedrooms:~ ~ep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other
LEGAL DESCRIPTION so, Rating: Total Depth from original grade:
Lot: Block; Subdivision: 3epth to pipe bottom fram original grade: Gravel depth beneath pipe
Township[ ~ Range: ~ ~ Section: [ ~ Fill added above original grade: Gravel length:
Number of lines: Distance between lines:
WELL: O New ~ Upgrade Gravel ~ ~¢~ ~ Ft. J ' Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: ~ Pipe material:
~. ~. ~ s~.~. F ~
Driller: Date Drilled: Static Water Level:Ft. Installer:~~ Date instalJed:lo/~
Yield: GPMI~ Pump Set at: Ft. Casing Height Above G~ound:Ft. ~ TANK
SEPARATION DISTANCES ~pti~ ~ Ho~di.g u S.T.E.P.
TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~NC~ ,~ I~
Material: Number of Co~rtments:
Sudac~ -- ~~ LIFT STATION
Water
Lot Size in gallons: Manufacturer:
Line ~
Foundation ~ ~ "Pump on' level at: "Pump off" level at: High water alarm at:
Cu~ainDrain ~ ~ Pump Make & Model Electrical Inspections pe~ormed by:
Remarks: BENCH MARK
~~ , : Assu~ed Elevation:
,.: .. ENGINEER'S SEAL
Inspections performed by: ~ Dates: 1st
Department of Health and Numan Ser¢ces approval .:, : ,,~.
Reviewed and approved by: ..... Date /~ .
72-013 (1/91)MOA 25
r3M
_ _ ? ~LrV_ ~o, oo _ _
c'5 0 £5 50 75 I0~ 1~$
£~ALE: 1' -- 50
/
TBB'BEN SPURKLAND P.E,
2'03 W 15TH. AVENUE
ANCH, AK, 99501.
LOt 19 LAKE~/00D HILLS S/D
SEC 14, FISN
lO000 HILLSI~E
SEPTIC SYSTEM .AS]BUILT
DAT~, £CT, ~0 ]99z~
SHEET, 2/$ GRID, £529
SPURK/AN]] P.E', LOT ]g LAKEP/00fl HILLS S/~g SEPTZC SYSTI[H~A$~JZLT
a03 Vl. Sth Ave SECT!ON 14 I'12N R3V ~T£, OCT, 20 19~2
Anchor'~Oe Al< 99501 lOflflO HILLSI.D£ .DRIVE SHEET, 3/3 6RX~ 2539
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE
1 OF
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920348
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:STRANIK GERALD M &
OWNER ADDRESS:10000 HILLSIDE DR
ANCHORAGE, AL 99516
DATE ISSUED:10/14/92
EXPIRATION DATE:10/14/93
PARCEL ID:01512202
LEGAL DESCRIPTION: LAKEWOOD HILLS LT 19
LOT SIZE: 84000 (SQ. FT.)
NUMBER OF BEDROOMS: 5 THIS PERMIT: 5
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 (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THIS UPGRADE MUST BE INSTALLED AS SHOWN ON THE APPROVED
ENGINEER'S DESIGN DATED 10/7/02.
RECEIVED BY: '~--- .~-~---~
LOT
(907} 279-57i6
SEPTIC SYSTEH DESIGN
JERRY STRAN!K
STANDARD TRENCH
TOTAL LENGTH
TOTAL. WIDTH
TOTAL DEPTH
ROCK DEPTH
COVER
- FT.
£
2 FT.
il FT.
6 FT.
5 FT.
16 FEET SEPARATION FROM
TRENCH
SEPTIC TANK i500 GAL.
iNTEGRiTY OF TANK.
NECESSARY.
EXISTING
VERIFY
REPLACE IF
INSTALL SPLITTER BOX TO EXISTING
SYSTEM.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION: L~:~-~
3
4
7
8
10
12
13-
14-
18
20-
': "" '.
DATE PERPORMED:
L~,~/'¢oJ ~I I~ Township, Range, Section:
SLOPE
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT (~
DEPTH? p
E
SITE PLAN
Deplh t° Water Aft~.~v~ ~/~,/~ ~
hlonitoring? §ate:
!
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE '/ ~
(minutes/inch) PERG HOLE DIAMETER
N~TTL~TI~N
LOT 18~
I I
, I
.50 I0~ 150
SCALE; 1" = 100 FT,
~50 300
TUBBEN SPURKLANB P,E.
203 W 15TN. AVENUE
ANCH, AK, 99501
LOT 19 LAKEh/00II HILLS S/ll
SEC 14, TI2N R3~/
lOO00 HILLSIDE DRIVE
SEPTIC SYSTEH I~ESIGN
13ATE, DCI;, 7 199£
SHEET, l/S GRIg, ,2539
INSTALL NEW TRENCH
] O0
\
EXSIT. TRENCH
INSTALL DIVERTIDN VALVE-
T3M
E BLPE£F FENSE P£ST
V. i00,00
94
PS .~0 7~ 100
SCALE: 1' = 50 FT.
/,
TBBBEN SPURKLAND P,E,
EO3 ~ I~TH, ~VENUE
ANCH, AK, 99501
LOT 19 LbKEWB019 HILLS S/19
SEC I4, TI£N RBW
10000 HILLSIDE DRIVE
SEPTIC SYSTEM DESIGN
DATE, 00~ 7 199p
SHEET, P/3 GRID, £~$9
16
SCALE
$' ~/ide
b2' L
li' l~eep
6' Se~/er rock
5' Cover
M/ro£! 140
6 £t o£ Sep~;ic Rock
I!00 gal S!~c tank
Sp#$$er 3ox
4-Ft Man,ay Riser
ND SCALE
Exlsf, Oround
4' Mm Cover
~'~-~nk
150~ ~al, sep'~lc '~onk
FBM r~TP DF FENSE P£ST
ASSUMED ELE~ I00,00
TDB3EN SPURKLAN3 P,E,
803 W15%h Ave
Anchor~De Ak 99501
LDr 19 LAK£ /DDD HILLS 3/9
SECTION i4 712N R3~/
~0000 HILLSIDE D~IVE
SEPTIC SYSTEM DESIGN
DATE, ~TCT, 7 !992
S~EET, 3/3 O~;D, £~39
~NICIPALITY OF ANCHORAGE
Heal~ 'land Environmental Protect
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPORT ONLSI'fE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM ,WELL_ I(~(''}
INSIDE LENGTH__
MANUFACTURER
INSIDE WIDTH_
NUMBER OF
COMPARTMENTS
LIQUID DEPTH
· LIQUID CAPACITYt~~O~ GALLONS.
TILE DRAIN FIELD:TM
DISTANCE ~ROM WE'L ~0¢ % FOUNDATION 5-O4
I
'# of Lines __ DISTANCE BETWEEN LINES
ABSORPTION AREA '"--/ C~ SQ. FT. LENGTH OF EACH LINE
· DEPTH OF FILTER
DEPTIt: TOP OF TILE TO FIf'.IISH GRADE ~_~,~'- MATERIAL BENEATH TILE__ .(¢::' IN. ABOVE TILE
' TOTAL LENGTH
NEAREST LOT LINE__ ~-O OF LINE
SEEPAGE PIT:
Log Crib. Rings__
BUILDING FOUNDATION
DIAMETER -- OR WIDTH. LENGTH ., DEPTH
Crib Si~e:i DIAMETER___DEPTH.--DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE___ ABSORPTION AREA (WALL AREA)
SQ. FT.
Well ~--~
Class:-gt'~2 '' Depth:
Well Distance To: Lot Line~o¢
Bldg: 'LJO~ Sewer Line: ._~___[
Pipe Materials: ~ ~q. '
# of Bedrooms:
Installer: .\~ ~ 9..~<~ '
Remarks: ~ \~?/~'
APPROVED_ ~..~r~"'"7
/ :_-2:25 '" L'" STREET, ANCHORFIGE, AK. '_=,.~0± ~ ~,'/¢"~1 -'~ '
F'ERbl!..", ,' '~"~',' ,' b-"'--"¢:; ..... :' /Z}:I'ZZDrKLUL.J
- '", , -'- " P. 0. BCI,:.:: 4-~.8~F.18
HFFL. I _.HN] JOHN C:RL]MBIE
L OCA T I ON H ~~'E
L. EGRL. LOT .1..~ LAKEWOOD HI. LLS SUBD LOT :SZZE 2L08~00 SQUARE FEET
TYF'E OF S]IL FIBSORBTION SYC';TEM I:=,. TF. EN_.H
-' · '-- '= = SOIL RATING '::SQ Ff,-'GR':,= .1.~
MFIXIMUM NI_IMBER OF E,E[.,F. .... M_, 5 .... · ....
THE REQUIRED SIZE OF THE S]IL ABSORPTIDN SYSTEM IS:
F_:, E F' ]- H = i 2 L E i~-.~ IS "F H = 4 ~"-_'~ ~3 F-: R %; E ~ .... [:, E F' "T' H = :'7.-S:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET::' OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF Ft TRENCH OR PIT IS THE [:,ISTFINCE BETWEEN THE SIJRFAI]:E OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFiVEL DEPTH IS ]'HE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFFILL PIPE
RND THE BOTTOM OF THE E',:..',CFiVFITION (IN FEET).
~.~T=: E 6--.~ L.~ ~ ~:~: E [:" '--; E F' l I C: T R ~-1 ~'=:: S ~] Z b: ~ :]L 5
P'i--IE:I-:::R~SE F'I_Flt'-.IT C,F'T I C,~'-.~
R PACKAGE PLANT MAY BE: INSTALL.ED AT THE PERM ITTEE'"S OPTION SUBJECT TO THE
FOLLOWING CONDITIONS:
· :L. EITHER R CLASS I OR II NSF APPROVED PLFINT MAY BE INSTFiLLE[:,.
2. A CONTINUOUS MAINTENANCE AGREEMENT IS REC..!UIRE[:,. IF R MRIN"rENANCE
FIGREEMEN-r IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL
ABSORPTION SYSTEM AND,.-"OR YOU MAY BE SUBJECT TO PROSECUTION.
Tt..l t_-II < 2 ) I i'4SF'I:--ZC:T I I_-~t'-~S R ~:,i:E; REIE;!i_i ][ RE[:,,
BACKFILLING OF FIN'-," SYSTEM WITHOUT FINAL INSPEC:TION FIND RPPRO',,,'AL BY THIS
DEPFIRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL FIND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
:l. 00 FEET FOR FI PRI'¢FITE WELt.. OR :~."00 FEET FOR Fi PUBLIC WEt_[_.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN .S':0 [:,FTYS
OF' THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRIJCTION DIFIGRFIMS FIRE
R',,,'AILABLE TO INSURE PROPER INSTFILLRTION.
t CERTIFY THFiT
:~.: I rim FFiMILIFiR WITH THE: REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MIJNICIPFiLITY OF FiNCHORAGE.
2: I WILL INSTFII_L ]'HE SYSTEM IN ACCORDANCE WITH THE CODES.
7.-..':: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENC:E IS REMODELE[:' TO INCLUDE MORE THAN 5 BEDROOMS.
......................
Ii~ll'~, ~_.1
4040 "B" STREET,
ANCHORAGE, ALASKA 09503
PHONE: 907-270-2581
July 25, 1977
W.O. #D10290
CCC/HO
801W. Fireweed Lane
Anchorage, AK 99503
Attention:
Subject:
Mr. Lou Cassetta
Subsurface Investigation for Suitability of
On-Site Sewer, Frank Reed, Jr. Residence,
Lot 19, Lakewood Hills Subdivision
Gentlemen:
Transmitted herein in accordance with your instructions are
the results of the above referenced investigation as performed
by us on July 18, and 19, 18, 1977. The scope of this
project is investigation for suitability of an on-site
sewerage system.
In..l~aed in this t~cansmittal are:
Test Hole Location Sketch Figure 1
Test Hole Log Table A
Explanatory Information Sheets ~-3
The exploration was conducted with a Nodwell mounted Mobi~.e
B-50 drill rig using a continuous flight solid stem auger~
The rig is owned and operated by Denali Drilling~ Inc.
Drilling was supervised,, the test holes logged and percola'-
tion test performed by Mr. Mike Hewitt, Technician with
Alaska Testiab.
The log of the test hole is included as Table A of this
report. Zn interpreting the log it would be helpful to
utilize the explanatory information contained in Sheets 1
to 3 of this report.
When drilling was completed a 3/4" slotted PVC pipe was
inserted in the hole to aid in determining the free water
level. For the percolatioh test, the test hole was filled
with water and left overnight ~to saturate. On returning the
next day, the hole was refilled with water and the drop in
the water level carefully monitored over the next 60 minutes°
This procedure is not a standardized perco].ation test,
however~ we understand thi~t the Municipality of Anchorage,
Department of Pub].ic Hea.Lth and. Environmental Pzotec~..~ n
Lot 19
Lakewood Hills Subdivision
Date: 7-18-77
Logged By: M. Hewitt
W.O. #D10290
Depth in Feet
From To
0.0' - 3.0'
3.0' - 7.0'
7.0' - 15.0'
15.0' - 19.0'
Soil Description
F-4, Sand~ Silt with organics, ML.
F-2, fine Silty Sand, SM.
NFS to F-2, medium Sand with S~lty Sand lenses,
SP-SM.
NFS to F-2, slightly Silty Gravell~ Sand,
SP-SM.
Bottom of Test Hole:
Frost Line:
Free Water Level:
19.0'
None Observed
None Observed
Sample Depth Blows/6" M%
I 5.0'
2 10.0'
3 15.0'
4 19.0'
Type of
Sample unified
G SM
G SP-SM
G SP-SM
G SP-SM
Remarks:
1. Type of Sample, G=Grab, SP = Standard Penetration,
U = Undisturbed.
2. Dry Strength, N=None, L=Low, M=Medium, H=High.
3. Group refers tQ similar material, this study only.
4. General Information, see Sheet 1.
5. Frost and Textural Classification, see Sheet 2.
6. Unified Classification, see Sheet 3.
cCC/HOK
July 25, 1977
Page 2
prefers tests performed in this manner to evaluate a site
for a proposed on-site sewerage system.
Using the above test, the observed minimum percolation rate
was 2.1 minutes per inch. Since the effective absorptive
capacity of sandy soils such as these often decreases with
time, we recommend a percolation rate of 5.0 minutes per
inch be used for design purposes.
No water table was observed during drilling. It should be
noted though, that the free water level normally fluctuates
seasonally and with precipitation.
We hope this report meets your present needs. If we can be
of further service, please feel free to contact us.
Sincerely,
ALASKA TESTLAB
R. Mark Hansen
RMH:rb
Enclosures
cc: Ken Walch, DOWL
Test HOle Log - Description Guide
The soil descriptions showu on the logs are the best estimate of the soil's
characteristics at the time of field examination and as such do not achieve the
precision of a laboratory testing procedure, If the log includes soils samples,
those samples receive an independent textural classification in the laboratory
to verify the field examination,
The logs often include the following items:
Depth Interval -- usually shown to 0.1 foot, within that zone no
significant change in soil type was observed through drill action, direct
observation or sampling.
Frost Classification - NFS, Fl, F2, F3, F4, see "Soil Classification
Chart"
Texture of Soil -- An engineering classification of the soils by particle
size and proportion, see "Soil Classification Chart", note the
proportions are approximate and modifications to the soil group due to
stratification, inclusions and changes in properties are included.
Moisture Content - this is a qualitative measure;
dry, no or little apparent surface moisture,
damp, moisture forms portion of color, less than plastic limit,
wet, no free water, often soft, if cohesive soil,
saturated, free water may be squeezed out, ifa free draining soil;
dilatent at natural moisture content, if a non-plastic silt or fine
sand. (The moisture content is further deflnedby reference to PI,
LW, NP, M%or dilatency.)
Density - refers to more-or-less non-cohesive goils, such as sand gravel
mixtures with or without a fine fraction, derived from drilling action
and/or sample data; usually described as: very loose, loose, medium
dense, very dense. General intent is to portray earthwork
characteristics.
Stiffness - refers to more-or-less cohesive soils and fine grained silts of
t-']~-clay-silt groups. Derived from drill action and/or sample data. Very
soft, soft, stiff, very stiff and hard are commonly used terms.
Particle size - The largest particle recovered by the split spoon is
1-3/8", Shelby tube 3", auger flights (minute-man) 2", Auger flights
(B-50 hollow stem) 6"-8". Larger particles are described indirectly by
action of the drilling and are referred to as cobbles, Y' to 8", or
boulders 8"+. Therefore when reviewing the gradation sheets, if any,
the description on the hole log must be considered for an indication of
larger particles.
Unified Soil Classification - This is a two letter code. See Unified
Classification sheet for further definition. In some cases AASHO and/or
FAA soil classifications may be shown as well as the unified.
Atterberg Limits - useful for fine grained and other plastic soils.
P._~l; natural moisture content believed to be less than plastic limit
PI+; natural moisture content believed to be between plastic and liquid
][-mits
L_._~; natural moisture content believed to be greater than liquid limit
N~P; non-plastic, useful as a modifying description of some silty
mad:rials.
Dilatency - is the ability of water to migrate to the surface of a
sattttated or nearly saturated soil sample when vibrated or jolted - used
as an aid to determine if a fine grained soil is a slightly or non-plastic
silt or a volcanic ash,
Rock flour - finely ground soil that is not plastic but otherwise appears
similar to a clayey silt.
Organic Content - usually described as Peat, PT, sometimes includes
discrete particles such as wood, coal, etc. as a modifier to an inorganic
soil. Quantity described as; trace, or an estimate of volume, or, in case
of all organic, - as Peat. This may include tundra, muskeg and bog
material.
Muck - a modifier used to describe very soft, semi-organic deposits
usually occuring below a peat deposit.
Amorphus peat - organic particles nearly or fully disintegrated.
Fibrous Peat - organic particles more-or-less intact.
Bottom of Testhole - includes last sample interval.
Frost Line - seasonal frost depth as described by drilling action and/or
samples at the time of drilling.
Frozen Ground - other than frost line, described by samples, usually
includes description of ice content, often will include modified Unified
Classification for frozen soils - this is a special case related to
permafrost studies.
Free Water Level -- The free water level noted during drilling. This is
not necessarily the static water table at the time of drilling or at other
seasons. Static water table determination in other than very permeable
soils requires observation wells or piezometer installations, used only in
special cases.
Blow/6" - The number of blows bfa 140 weight free falling 30" to
advance a 2" split spoon 6"; the number of blows for a 12" advance is,
by definition, the standard penetration.
,,4% - natural moisture content of the soil sample, usually not
performed on clean sands or gravels below the water table.
Type of Sample -
S__P, refers to 2" split spoon driven into the soil by 140 pound
weight, a disturbed sample,
S, thin wall tube, "Shelby" used to obtain undisturbed samples
of fine grained soil,
G, "grab" disturbed sample from auger flights or wall of trench.
C, cut sample, undisturbed sample from wall of trench.
Dry' Strength - a useful indicator of a soil's clayey fraction, N=None,
L=Low, M=Medium, H=High
Group - The samples are placed into apparently similar groups based
on color and texture and are arbitrarily assigned a group letter. Further
disturbed tests including Atterberg Limits, grain size, moisture-density
relationship, etc. may be performed on the group and are assumed to
reflect the general distrubed characteristics of the soils assigned to the
group. This is an important phase of the soil analysis and is used to
standardize the various qualitative determinations and to reduce the
number of quantitative tests necessary to describe the soil mass.
SOIL CLASSIFICATION CHART
30% GRAVEL
CLAY
CLAYEY
CLAYEY CLAYEY
OR ~ CLAYEY
OR
SILTY SILTY
SILTY ~ SILTY
SAND GRAVEL
GRAVELLY SAND SANDY GRAVEL
SAND GRAVELLY SAND GRAVEL GRAVEL
0 10 20 30 40 50 60 70 80 90 100
GRAVEL (+#4 SCREEN) % BY WEIGHT
NONFROST SUSCEPTIBLE SOILS ARE INORGANIC SOILS CONTAINING LESS THAN 3% FINER THAN 0.02 mm.
GROUPS OF FROST-SUSCEPTIBLE SOILS:
F1 GRAVELLY SOILS CONTAINING BETWEEN 3 AND 20% FINER THAN 0.02 mm.
F2 SANDY SOILS CONTAINING BETWEEN 3 AND 15% FINER THAN 0.02 mm.
F3 a. GRAVELLY SOILS CONTAINING MORE THAN 20% FINER THAN 0.02 mm. AND SANDY SOILS
(EXCEPT FINE SILTY, SANDS) CONTAINING MORE THAN 15% FINER THAN 0.02 mm.
b. CLAYS WITH PLASTICITY INDEXES OF MORE THAN 12. EXCEPT VARVED CLAYS.
F4 a. ALLSILTS INCLUDING SANDY SILTS.
b. FINE SILTY SANDS CONTAINING MORE THAN 15% FINER THAN 0.02 mm.
c. LEAN CLAYS WITH PLASTICITY INDEXES OF LESS THAN 12.
d. VARVED CLAYS.
Fine-grained $o~s Coarse-grained soils
More than half of material is smaller Mo~e than half of material is
than No. 200 sieve size larger than No. 20O sieve sizeb
(Tile No. 2O0 sieve size is about the smallest particle visible to naked eycJ
U~e grain size curve in identifying the fractions as given under field identification
P]astieity index Less than 5% G\¥, GP, S\¥, SP
~ ~llllll~,llllllllllll~[~ ~. :~. ~ ~$Z~ ~. ~. ~ Z]~
~': ~,~,,,,,,,,,,,,,~,~~ ~ ~ ~ ~
IIIlllllltlllllllllllt lllll
~lllllllllllltlllllllllllll~l
DRILLING, INC.f
DRILLING LOG
Well Owner_
.Use of Well
Location (address of: Township, Range, Section, if known; or distance mmn road
Size of casing ~" _.Depth of Hole
Static water level ! :: ~.1 ft. (~h6va)
Screen ( ); Perforated (
.... feet Cased to ' ' · feet
(below) land surface. Finish of well (check one) open end (
).
Describe screen or perforation
Well pumping test at gallons per
of drawdown from static level.
Date of completion
(minute) for hours with
ft.
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
.TO
_TO.
.TO
_TO.
.TO.
_TO
_TO
_TO
.TO.
NYVYVA Certified Contractor
Certificate No's. 814 & 973
2 -- STATE
MUNUPAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-122-02
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Lakewood Hills Lot 19
10000 Hillside Drive
Current property owner(s)
Mailing address
Real estate agent
Sylvia & Benjamin Ha
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Expiration Date: l 2—S
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
$550
COSA Fee $ Waiver Fee $ _
Date of Payment 2 (;�_' 2 Date of Payment
Receipt Number 67160 ! i Receipt Number
COSA # OSC211134 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures
outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or
wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated
herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State
codes, ordinances, and regulations in effect at the time of installation.
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 distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly
recommends buyers hire their own engineer to evaluate this report.
Name of Firm Pannone Engineering Services
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E.
6. DSD SIGNATURE
System #1 Approved for �� bedrooms
System #2 Approved for bedrooms
Disapproved
Phone (907) 745-8200
Date 09
Conditional approval for bedrooms with the following stipulations:
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ON-SITE
WATER AND
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to Date:�f c/
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory �—
Arsenic Advisory
Other-�AM��1ic� (�^�
Legal Description: Lakewood Hills L19
If more than 1 septic system on lot: COSA Checklist # 1
A. WELL DATA
n Well log is filed with Onsite (or attached)
Date drilled 3/24177
Total depth 235 ft
Cased to 229 ft
no Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 15 in.
Date of flow test for COSA 3/812021
Static water level at beginning of test 197.5 ft.
Comments
B. TANK DATA
Age of tank(s) 199P -years
Tank type/material
Measured operating fluid level in septic tank
0 Standpipes/foundation cleanout per record drawing
Date of pumping I a
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 10/10/05
0 ALL standpipes present per record drawing
Total measured depth from grade 13.25 ft (max)
Measured depth to pipe invert from grade 4.25 ft (min)
❑ N/A — pressurized field
❑® Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
OR System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-122-02
Of 1 Structure served by this system 1
Well production at time of test 4.35 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑ Yes ❑✓ No
0 Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L N Arsenic less than MRL (ND)
Collected by Pannone Engineering
Date of Sample 3/10/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 3/8/2021
Results ❑ Pass For 5 bedrooms
Fluid depth prior to test 0 in
Water added 750 gal
New depth 45 in
Elapsed time 1440 min
Final fluid depth 0 in
Absorption rate '750 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
11
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0✓
Yes
Community Sewer Manhole/Cleanout > 100'
✓[] Yes
if No
ft
❑✓ Yes
if No
Neighboring Tank > 100' ✓M Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No
Absorption Field on Lot > 100' r✓ Yes
if No
ft
Holding Tank > 100' ✓� Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
'Animal Containment > 50' ✓0 Yes
if No
✓� Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' F/� Yes
if No
ft
Q✓ Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
❑✓ Yes if No ft
Property Line > 5'
0✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
F✓
Yes
if No
ft
Private Wells > 100' Fv Yes if No.
Water Main > 10'
✓0
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No .
Water Service Line > 10'
0
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 21 Yes if No ft if absorption field is under driveway comment below
Property Line > 10'
✓M
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓0
Yes
if No
ft
Private Wells > 100' Q✓ Yes if No
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. -2 1O 213
COSA Checklist yellow sheet
of AL,
`� TH
V - ....
Steven
R. Ponno�ie �
CE 0149 w
/-_ZFESSO`t`
ft
ft
ft
ft
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 211134
Subdivision: Lakewood Hills Lot 19
A water sample revealed a nitrate concentration of 8.99 milligrams per liter (mg/Q.
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.
Mailing Address PCO Box 196650* Anchorage, Alaska 99519 6650 www muni OC91PR
_ ��
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.
Mailing �iddress P O Box 196650 *Anchorage, Alaska 99519 6650 * uvww muni org , �I
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC 211134
Subdivision: Lakewood Hills Lot 19
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 29 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Mailing Address P O Box 196650' Anchorage, Alaska 99519 6650 *www muni org
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Municipality of Anchorage "
On-Site Water and Wastewater Program • ]l
(907) 343-7904 s A . E T t
Certificate of On-Site Systems Approval
Parcel I.D. 015-122-02 Expiration Date: - -�O
1. GENERAL INFORMATION
Complete legal description LAKEWOOD HILLS LOT 19
Location (site address) 10000 HILLSIDE DRIVE
Current Property owner(s) SYLVIA & BENJAMIN HA Day phone
Mailing address 10000 HILLSIDE DRIVE
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: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received .y: 5 � � 1, I•�� � / Date: 7//q 19)
I
COSA to be released to the engineer,unless otherwise requested by th�eer.
COSA Fee $ � — Waiver Fee $
Date of Payment L,-2- l7 Date of Payment
Receipt Number 632Z2-r5\ Receipt Number
COSA# 05C V$ 12AD Waiver#
iii
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are)in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
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 distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels 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 6/21/2018
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6. DSD SIGNATURE 44::: :,W2--
System #1 Approved for , bedrooms Sieven R. Pannone. /
CE-8149 ,�
System#2 Approved for bedrooms r�!$9s'• • '��
Disapproved Mkt R?OFESSio*.�
b.
Conditional approval for bedrooms, with the following stipulations:
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By: �� ` Original Certificate Date: l� 7
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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 1
Certificate of On-Site Systems Approval Checklist
Legal Description: LAKEWOOD HILLS LOT 19 Parcel ID: 015-122-02
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 3/24/77 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 235 ft. Cased to 229 ft. Casing height(above ground) 9 in.
FROM WELL LOG AT INSPECTION
Date of test 3/24/77 6/1/2018
Static water level 190 ft. 196.9 ft
Well production 5 g.p.m. 4 4 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEC' colonies/100 mL Nitrate 7.20 mg/L
Arsenic ND ug/L Date of sample: 6/1/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
ANC-S z-tANK/ STEEL 10/19/92
YP Date installed
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over PLtank(Y//N)y�N� �� High water alarm (Y/N) N
Date of pumping 24' ('U Pumper t f LJ. 1)Q.A,v1 et 3
C. ABSORPTION FIELD DATA
Date installed 1 0/1 0/05 Soil rating2 2 0.6 DEEP TRENCH
(g.p.d./ft or ft /bdrm) System type
Length 70 ft. Width 2 ft. Gravel below pipe 9 ft.
C�3'' .)
Total depth 12.5 ft. Eff. absorption area 1 260 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/1/18 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test DRY in. Water addeal. New depth DRY in.
-f-
Elapsed Time: 7 min. Final fluid depth DRY in. Absorption rate >= 750 g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) 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 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+
Public sewer manhole/cleanout 100+
100+
Sewer/septic service line 25+ Holding tank
50+ Manure/animal excrete stora a areas 100+
Animal containment areas 9
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
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+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
SURVEY ON FILE
G. ENGINEER'S CERTIFICATION � of AL,Q�%
I certify that I have determined through field inspections and ,�g�P -..,,,—..1-"P#1,
review of Municipal records that the above systems are in a*; TH \ * �
conformance with MOA COSA guidelines in effect on this date. F•.• 0
Steven Pannone :S}e1,�, �, onnorie:"
Engineer's Printed Name r�•1;• CE-8149
Date 6/21/2018 �,lgs• ^�'
1kx1 ,FROFEss0•:
COSA canary sheet_2-6-15.doc
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. # C) I ~"-
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
J.o'[- Iq LA~_I/__--~. L~DOO~ l~tl.-Lc'
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Day phone 7t,(
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
NOTE:
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
lng to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
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
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 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.
NameofFirm -"'~ ~i~-~.~,-I ¢',~O¢-_~I.~A-h, IL.~ ~:~}.~, Phone
Address ¢~O ~ ~ /~-,~.~ ~¢~_¢.~ ~
Engineer's signature ~ ~
DHHS SIGNATURE
~ Approved for ~/'¢¢ ~-~'~ bedrooms.
Disapproved.
Conditional approval for
Date
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in 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 (Re'.', 1/91) Back MOA#21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
· ega. Descri¢on: l't LoJ. .-oo.Cl4,'Lls Parce, .D.
A. WELL DATA
Well type ~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
If A, B, or C, attach ADEC letter. ADEC water system number
y Date completed ~'~"v/'~'7 Driller
~--5~~' Casedto ~?/. ~( Casing height 10 't --
7 '~ Wires properly protected (Y/N)
FROM WELL LOG
i' o
g.p.m.
AT INSPECTION
I
Oil '~ / ~/1" MUNICIPAL TY OF ANCHORAGE
~.- ENVIRONMENTAL SERVICES DIVISION
ocl' 2 1 1992
gcc/' RECEIVED
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
N it rate
Collected by:
Other bacteria ~' P
B. SEPTIC/HOLDING TANK DATA
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
'--- Tank size J ,~-- u--~ Compartments
Foundation cleanout (Y/N) Y Depression (Y/N)
1~/~.~ Alarm tested (Y/N) ~'~'//',X-
i '1'"/'//'/,'..~ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot J~'O On adjacent lots ~,
To property line ~:) ~ ~)
Foundation
Surface water/drainage
Absorption field
Water main/service line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
/
C. LIF'Y STATION ~//~.~
Date installed
Size in gallons
Vent (Y/N/
High water alarm level
Meets MOA electrical codes (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump'off" level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
Surface water
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
D. ABSORPTION FIELD DATA
Date installed J 'L.
Length ,~,~, Width _3
Soil rating L ~
Gravel thickness
Cleanouts present (Y/N)
Date of adequacy test
for ~
System type "~'~
-- Total depth
bedrooms
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot I ~-~rO On adjacent lots ~ / ~ Property line
To building foundation 7C~ To existing or abandoned system on lot
On adjacent lots ~ 1~
Surface water ~, ¢ vi ~
Curtain drain jk,,~ ¢ ~ ~
/'~/ ~.¢ If yes, give date
Cutban k ,I"///_~. 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.
Engineer's Name i ~P~'-
HAA Fee $ / '~¢
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
)
CHEMICAL & GEOLOGICAL LABORATORY
->"'x 5033 B STREET ANCHORAGE, A~SKA 9~51~ TELEPHONE (907) 5~2-2343 FAX: (907) 581-$301
~N~'~I~ R~T~ f~r I~OIC~ ~ 59587
Chemlab g~t,[ 92 5699 Sample ~ i ~atrix: W~T~
Clllnt ~¢mpls
~reierved w/th
UA C~l,~t A¢¢t -TOBBEE$
OCT 13 92 ~ [t:O0 hrs. g?O~ : PO~ ;NONE RECEIVED
OCT I~ 92 ~ i5:45 hzs R,q! :
AM ~QUI~D Oxder.d By :TOBBEN
trmlysls ¢ompl,tod : OCT 14 92
[aborat:ory Supervisor : 8TtPH~N ¢. ~DE
t
~and ~po~ts to:
gPA 353,2/3[)0
Sampla BOlI?lffi ;~.B~ COLLECTED ~: STUABT
NA- Not Analyzed ~I-~s Than, GT-Gr~at*r Than
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
D,ws,oN oF ENV, RONME.TAL SERV,CES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date ,~F'r
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Prope~y Owner ~ E~ Telephone: Home ~7~- Ag/~ Business
Mailing Address
(c) Lending Institution ~'. ~/~ ,~P---
Mailing Address
Telephone
(d)
Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the followino address: or; Check here ~/if hold for pick up.
List contact person and day phone number below. ,/~
TYPE OF RESIDENCE
Single-Family~l~
Number of Bedrooms
3. WATER SUPPLY
Individual Well~ Community [] Public[]
/-
Note: If comm flnity well system, must have written confirmation from the State Departme?t of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community []
Holding Tank
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page I of 2 72-025 fRev 8/86~ Front
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· ,^~,Gg ,MUNICIPALITY OF ANCHORAGE (MOA)
~\.~,( Ot ''~ \Ct% 0~'~'~ HEALTH AUTHORITY APPROVAL (HAA)
~ ,,~,~,,.. CHECKLIST - FEBRUARY 1984
,q\~O~,t~ O,i~1 264-4720
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth ~ ~--~
Static Water Level
7'
Cased to
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) ~'
Separation Distances from Well:
To Septic/Holding Tank on Lot ,~0
IfA, B, C, D.E.C. Approved (Y/N)
Date Completed ~/~, ~/77 Yield
-~ ~ ~ Depth of Grouting 1~ ~ il/
Pump Set At ~ T'~
/"'"~' Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
! "~ O ~/' ; On Adjoining Lots
l'~O ~',~ J;:~ To Nearest Public Sewer
Comments
To Nearest Sewer Service Line on Lot
'"~- ~. ;Date ~/'///~/"~ ~ ~
0
B. SEPTIC/HOLDING TANK DATA
Date Installed t 0 l ~'-]/
Standpipes (Y/N) T
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ~' 0 ~I~
To Property Line -~,d~
To Water Main/Service Line ~ /LO
Size J ..~d~) No. of Compartments TI,,~ 0
Air-tight Caps (Y/N) Y Foundation Cleanout, (Y/N)
~ Date Last Pumped ~'Z/~A'/
[h¢/,,~r ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Course
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~)¢-~'~/o-- / ¢ 77
Width of Field ~ C)
Square Feet of Absorption Area 7C~ Y
Depression over Field (Y/N) jk,¢
Results of Last Adequacy Test r ~.¢~.
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation '~ V
Lot ~',~. t~/~ ~
To Water Main/Service Line .':> ! ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
~ ¢/~'~) Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~
To Existing or Abandoned System on
; On Adjoining Lots ~
To Cutbank (if present)
Comments
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ./)'~ ~ ~-'- - -~,,¢-..¢~~ Date ¢/'~'/~:27 ~
/
Company MOA No.
Receipt No. ,/'00/~02-..
Date of Payment ~1~'//~'/
Amount: $
Page 2 of 2
72-026 (11/84}
'?'° ' " ';?' '~' Engineer's Seal
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
RESIDENTIAL
WELL
INSPECTION
LEGAL:
LOCATION:
OWNER:
TYPE OF WELL:
WELL LOG AVAILABLE:
LOT 19, LAKEWOOD HILLS
10000 HILLSIDE DRIVE
FRANK REED
SINGLE FAMILY
YES
INSTALLATION REQUIREMENTS MET: YES
WELL YIELD FROM WELL LOG:
-~ ..,, · h~'o. 2225 -E /'.,?.~ ~
~.. ',.L"..~,' %
5 GALLONS PER MINUTE
PUMP YIELD:
5 + GALLONS PER MINUTE
DATE OF INSPECTION:
APRIL 9, 1987
TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 5
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. THE WELL
WAS PUMPED TILL THE DRAWDOWN STABILIZED. AT THE BEGINNING OF THE
TEST WATERLEVEL WAS FOUND AT 198 FEET BELOW TOP OF CASING. AFTER
20 MINUTES OF PUMPING THE WATER LEVEL WAS AT 220 FEET AND AFTER
50 MINUTES 221 FEET.
ON APRIL 15TH. THE WELL WAS PUMPED CONTINUOUSLY FOR THREE HOURS.
A TOTAL OF 830 GALLONS WERE DELIVERED.
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA
APRIL 14, 1987. 1985. TEST WAS NEGATIVE.
ON
TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
The Municipal requirement for well flow is 150 gallons of water
per bedroom per 24 hours.This well surpasses this requirement.
The assessment of the condition of this well applies only to the
conditions as of this date. The flow rate of the well may change
due to subsurface conditions that may not be observed from the
surface, and changes in land use and other factors that may
impact the conditions of the aquifer feeding the well.
CONSULTING ENGINEER
203 W. 15tl~ AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL:
LOT 19, LAKEWOOD HILLS
LOCATION:
10000 HILLSIDE DRIVE
OWNER: FRANK REED
RESIDENCE:
SINGLE FAMILY, FIVE BEDROOMS
WELL:
PRIVATE, ON SITE
SEPTIC sYSTEM:
FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1500 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 704 SQ. FT.
SOIL RATING: 125
INSTALLATION DATE: OCTOBER 1977
DATE OF PUMPING: APRIL 9, 1987. ISAACS PUMPING SERVICE
DATE OF TEST:
APRIL 15, 1987.
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED ON APRIL 8.
T~ANK ~A~Q~D WITH HEAVY DEPOSITS___QF
AND SLUDGE. ~N__~P~IT, 3-~--~Tti~__TAN_K~A~--EX_P-O_S~E2/ AND THOROUGHLY
T~C~S ~~ A~q CLEANED. ON APRIL 14TH.
LONS OF CLEAN WATER WAS ADDED TO THE TRENCH. THIS WATER
WAS ABSORBED WITHIN 19 HOUR~. ON APRIL 15TH. 820 GALLONS WERE
ADDED. IN ~6 HOUR$~~LLO~ WERE ABSORBED PLUS
WASTEWATER ~ GENERATED ~ THE RESIDENCE. /D~ ~/~/~
TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels 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 septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
MUNICIPAl. Iff OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE D[PT, OF H~ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONENVI,~CNM~.NTAL PROTECTION
~/~ 825 L Street Alaska 99501
Anchorage,
{ ENVIRONMENTAL ENGINEERING DIVISION '8E~2 9 1978
Telephone 264-4720 R~L~i, LV~ .~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
J PHONE
1. PROPERTY OWNER
PRQPERTY RESIDENT (If different from above) PHONE
2, BUYER ~~~ PHONE
MAILING ADDRESS
v
3, LENDING INSTITUTION PHONE
I
MA~LING ADDRESS
5. LEGAL DESCRIPTION
! 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
/~ [] One []' Four
SINGLE FAMILY [] Two ~ Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available,)
8. SEWAGE DISPOSAL SYSTEM
individua,/on-s te, g ve nsta,lation date
INDIVIDUAL/ON-SITE**
If system is over two (2) years old an adequacy test is required
[] PUBLIC UTILITY by this Department. '/~-~c7- ,~c,~'~. g~-~ '~<~'
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME ' TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DI R EC;~IONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
E~]' SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SlX
PERMIT NUMBER
2, WATER SUPPLY
E~] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRI L LE'-D
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
E~]Septic Tank or [~Holding Tankc-.~ O ~-- ]z
Size:./.~%~ If Tank is homemade SOILS RATING
give dimensions: [ ~,.,~,-""
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DI~'TANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
[~"%~PPROVED FOR~'"'~BEDROOMS
E~] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE ~ ~///~
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
O'MALL~_Y R~AD
(BASIS OF BEARtNGS)
50
I
LEGEND _.
4~ MONUMENT FOUND
0 IRON PIPE SET
DTI000912
LOTS 12A & I4A LAKEWOOD HILLS SUBD,
FRED WALATKA S ASSOCIATES