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HomeMy WebLinkAboutSOUTH LAKEWOOD HILLS BLK 1 LT 2SOUTH LAKEWOOD HILLS Block 1 Lot 2 #015-151-02 Address: 6250 O'Malley Rd. Anchorage, AK 99507 RE: R21-2635, Pilings for Deck Extension To Whom It May Concern, Piles were driven in the specific locations marked and staked by the owner, no obstructions were hit and there were no complications in the process. Todd Youngr`� Bushwhacke l`Piledriving 907-441-7646 �?'- 3 -Z l Date Ana -MD I G1 'ER ANCHORAGE AREA BOROI' "I ucYARTMENT OF ENVIRONMENTAL QUALI,. _3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME �'` / �/ �:./—_� �' / fG�� -ADDRESS-S" '51,4 ! _PHONE � LOCATION %%���,%"7r'- LEGAL DESCRIPTIONZL__,-f _r/J. _ - - rao SEPTIC TANK: / DISTANCE FROM WELL _ MATERIAL ��� 4.1T �yi` C NUMBER OF COMPARTMENTS LIQUID LIQUID CAPACITY_��L.__—GALLONS. INSIDE LENGTH '-L- ._INSIDE WIDTH DEPTH °-- SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS--/---- OUTSIDE DIIAMMETTERR OR WIDTH ��c' , LENGTH_, DEPTH LINING MATERIAL%E_'1 CTS-'J�_21DISTANCE FROM WELL �C'__. �.- ,BUILDING FOUNDATION �C NEAREST LOT LINE /�J3'-'ems. , TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL—.---ATION , N - LOT LINE_ _, OF LINES NUMBER OF LINES STANCE BETWEEN LINES TRENCH IDTH_ IN. TOTAL EFFECTIVE ABSORP AREA______ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE__ DEPTH OF FILTER MATERIAL BENEATH TILE—_ IN. ABOVE TILE WELL: ''�/'�'l/fJ/ / DISTANCE FROM i WATER ,rte DEPTH ,X 21 I` BUILDING FOUNDATION `=G' -_SAMPLE NEAREST NEAREST / _ SEPTIC - SEEPAGE< rr// _ OTHER LOT LINE fl /% SEWER LINEsI� f- , TANK <-� ¢- SYSTEM--`��� !e CESSPOOVT_��&� , SOURCEye�fij� DISTANCES DIAGRAM OF SYSTEM v 7 • R Q A\ 4 yUt a e J DATE' Lam/ C APPROVED__ _ ' G. .A.B. RAGE AREA GH V RE DEPARTMENT OF ENVIRONMENTAL ORENV RONMENTAL BYL1GH PERMIT NO. C, 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT �(. NAME OF APPLICANT y'lf/ / ',/!j° r` MAILING ADDRESS' f! PHONE INSTALLATION LOCAT LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED t` SEEPAGE PIT DRAIN FIELD TO BE INSTALLED BY d'.✓ / OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUZSQIL,-ZEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE" TYPE x"!'! SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS �r FOUNDATION TO SEPTIC TANK { FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL r f. SEPTIC TANK SEEPAGE PIT �-� DRAIN FIELD TO NEAREST LOT LINE. f/ WELL TO SEPTIC TANK DRAIN FIELD f SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK ��' SEEPAGE PIT 17a_\hry1�L��. SEPTIC TANK, ! .1 , SEEPAGE PIT `�{" DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB, CROSSING.GAP OF, EXCAVATION 5 FEET INTO UNDISTURBED SOIL 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT -- FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR' LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE I GREAS­--,,R ANCHORAGE AREA BOROUGH D E P AR'i T r I p, r, 116 CASE 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Virgil Clemenson Date Performed 9/13/71 Legal Description: --—L6-f —2r�l foc� §tj b'Fi�v 1 S i o n S. Lake Wood ls This Form Reports Soils - Log X— — —T�erE6T­ation-Tesf Depth Feet Soil Characteristics PAN - 3- 7— a­ 9— IG— /Gr own silty sand with fine gravel (SM) Gray sandy gravel Gray sand -silt mix (M) lp" Was Ground Water Encountered? yes If Yes, At What Depth? 10.5' - small seepage Reading Date Gross Time Not Time Dept' to H2O j Net Drop Percolation Rate minute Proposed InstaT1-a-t­ion:— Seepage Pit x Drain Field Depth Of Inlet Depth To Bottom Of Pit Ur- Trench— COMMENTS: 159 square feet of drainage area is required per bedroom with the crib set from 2' to 8' deep. Test -Per orme y R. E. Car is e --D 'at W -7-e r t i f ie d y NATIONAL TESTING SERVICES, INC.' Date: T Development Services Department On -Site Water &Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 015-151-02 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: -q— & -2-/ Complete legal description South Lakewood Hills Sub, Block 1, Lot 2 Location (site address) 6250 O'Malley Road Current property owner(s) Joe Bell Day phone (907) 350-4047 Mailing address 12570 Old Seward Hwy, Anchorage, AK 99515 Real estate agent Joe Bell 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone (907) 350-4047 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Q 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. COSA Fee $ 5 5D Waiver Fee $ Date of Payment , CD2 Date of Payment Receipt Number 0 � 0 6 1,L) Receipt Number COSA # O S C a 11 323 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/8/21 6. DSD SIGNATURE System #1 Approved for _� bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, � :49TH . .......... Benjamir iSchiller ll VIPFq• CE 12592 ;0'/ ll PROFESS),* with the following stipulations: ,,itl((((((w," oST``v'!ATER Z Jai PROGRAM �0- Vim- Original Certificate Date: & IL -,7 -z 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 Checklist blue sheet ATO I+��' T 'ilii Legal Description: South Lakewood Hills Sub, Block 1, Lot 2 Parcel ID: 015-151-02 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1970 Total depth 129* ft Cased to 86+* ft ❑o Sanitary seal is functioning correctly ®❑ Wires are properly protected Casing height (above ground) 13 in. Date of flow test for COSA 5/12/21 Well production at time of test 3.6 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.21 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by . Forge Engineering Date of Sample 5/5/21 Static water level at beginning of test 58 ft. Comments *No well log available. Data taken from camera inspection 8/4/12. B. TANK DATA Age of tank(s) 50 years Tank type/material Espinosa/Concrete Measured operating fluid level in septic tank 47 0 Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Seepage Pit Which system tested (date installed) 9/20/1971 FE -1 ALL standpipes present per record drawing Total measured depth from grade 9.0 ft (max) Measured depth to pipe invert from grade n/a ft (min) ❑ N/A — pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field © System presoaked (Required if vacant for greater than 30 days prior to date of test) 2000 Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. T STATION ❑ Require intenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/14/21 Results Q Pass For 3 bedrooms Fluid depth prior to test 55 in Water added 607 gal New depth 62 in Elapsed time 1440 min Final fluid depth 54 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft M Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' E] Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No M Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft E] Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7 Yes if No ft Surface Water > 100' ft ft ft ft ft R Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' F11 Yes if No ft Private Wells > 100' Yes if No Water Main > 10'✓❑ Yes if No ft Community Wells > 200' 0✓ Yes if No. Water Service Line > 10' [✓ 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' P/ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓� Yes if No ft Private Wells > 100' ®✓ Yes if No Water Service Line > 10' [Z] Yes if No ft Community Wells > 200' 0✓ Yes if No Surface Water > 100' F,71 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION �4 .-, � ������ 1 certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with .,;.M.... • MOA COSH guidelines in effect on this date. ... ... ~..a ....... . I! Benlann chiller G, • .. CE 12592 •c�`i�® ��lF�•.,6/8/21 •'@��.� �):kF�pROFESSO COSA Checklist yellow sheet ft ft ft ft Ln r - S 89-59'El-"..'- 1 126' NOTE: THE NORTH 25' WAS TAKEN FOR R.O.W. FOR O'MALLEY ROAD. (PLAT No. 76-197) N 89'59'W 126' C'J WOODMONT DRIVE MORTGAGE SURVEY _K_ SCALE GRID Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inC (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken0langsurvey.com OF g000� jonafhan*langsurvey.com I hereby certify that I have surveyed the following described property: 49TH**' -700, LOT 2, BLOCK 1, SOUTH LAKEWOOD HILLS (PLAT No. P-355) ............. .... . .... Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and Is subject to any inaccuracies .. .. ..... ... .. .. 0� KENNETH. G6. LA�N* that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other Improvements. LS -5202 Dated this the — — — — Day of — — — — — — — — — - I at Anchorage, Alaska �OQR0"ZSS100- If is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 SEPTIC--�,_ .0'X30.5'.' PIPES CANT 2E 62,3' rn 0 r.� 1 STORY RES11 N E X CD BSMT. Lli W/ DAYLIGHT 62.3' p. 24.5' Z U) Fn Lot 1 Qi M I-,! Lot 3 r I".) < M 10'x16.1' CARPORT WELL 17.7'x16.1' SHED L tJ 10CARPORT Lot 2 32,130 S.F. NOTE: THE NORTH 25' WAS TAKEN FOR R.O.W. FOR O'MALLEY ROAD. (PLAT No. 76-197) N 89'59'W 126' C'J WOODMONT DRIVE MORTGAGE SURVEY _K_ SCALE GRID Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inC (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken0langsurvey.com OF g000� jonafhan*langsurvey.com I hereby certify that I have surveyed the following described property: 49TH**' -700, LOT 2, BLOCK 1, SOUTH LAKEWOOD HILLS (PLAT No. P-355) ............. .... . .... Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and Is subject to any inaccuracies .. .. ..... ... .. .. 0� KENNETH. G6. LA�N* that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other Improvements. LS -5202 Dated this the — — — — Day of — — — — — — — — — - I at Anchorage, Alaska �OQR0"ZSS100- If is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963 Municipality of Anchorage G4 @V Development Services Department Building Safety Division On -Site Water and Wastewater Program a s 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-151-02 COSA # S C� a la49 Expiration Date: 1. GENERAL INFORMATION Complete legal description SOUTH LAKEWOOD HILLS BLOCK 1 LOT 2 Location (site address) 6250 O'MALLEY RD., ANCHORAGE, AK 99516 Current Property owner(s) DAVID BOCK Day phone 240-5221 Mailing address 3704 ARCTIC BLVD. #729, ANCHORAGE, AK 9903 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Spurkland Enginneering Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland 5. DSD SIGNATURE �IGApproved for bedrooms. Disapproved. Phone 279-3916 Date JULY 20 2012 .a cE OF A<,qs li, i�A,P TN %�flf 4 .•�.. ............ . E.SPURKLAND;Qz / tl�i�\�l� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �it-L Original Certificate Date: ' 1 (Rev. 11/05) Municipality of Anchorage Development Services Department 4 Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Sou}%- l NKC WooA bills 5W Lt Z ParcellD: 015- 151- 0� A. WELL DATA Well type 9MA, If A, B, or C provide PWSID # = Well Log (Y/N) Al Date completed 1970' Sanitary seal (YM) y Wires properly protected (YM) Y Total depth l22 ft. Cased to (ZZ ft. Casing height (above ground) _ LI n. FROM WELL LOG AT INSPECTION Date of test 11 7f ro ly I -Z Static water level unkna,on ft. 88 ft. Well production u0 Mown g.p.m. 217- g.p.m. WATER SAMPLE RESULTS: Coliform NE(s colonies/100 mL Nitrate 0.51110 mg/L Collected by: Anson Muwe55 Arsenic: N 0 ug/L date of sample: 6 t9 17 B. SEPTICIHOLDING TANK DATA TankType/Material E-W1/00Fl !440 Date installed SIT_ Tank size 1000 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/N) __!y High water alarm (Y/N) Af Date of pumping 29 Pumper qr comb .SEzdic.e.o C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.dAf ft2/bdrm i 12 System type Length ft. Width Iq ft. Gravel below pipe ft. Total depth ft. Eff. absorption area 33bft2 Monitoring tube i Depression over field Date of adequacy test 619 I Z Results (Pass/Fail) PAs_ For 3 bedrooms Fluid depth in absorption field before test 23 in. Water added 45 gal. New depth j4 in. Elapsed Time: Ift min. Final fluid depth 22 in. Absorption rate >= '156 g•p•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) Mme koou) if yes, give date D. LIFT STATION Date installed z Size in gallons Manhole/Access (Y/N) "Pump on" lev t _ in. "Pump off level _ in. High water alarm lev t in. Datum Cycles t d Meets alarm rcuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknM station on lot 501+ - Absorption field on lot 100 1+ Public sewer main NA Sewer /septic service line 2 51F Animal mntainment area. - 50 + On adjacent lots 100 1+ On adjacent lots 1001; Public sewer manhole/deanout /VA Holding tank Il/A Manure/animal excrete storage areas 10_ o� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54- Property line S + Absorption field 5 Water main NA Water service line 10'4 Surface water I00 Wells on adjacent lots 1001t• SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line tori- _ Building foundation tor+ Water main NA, Water Service line 101+ Surface water toor+ Driveway, paftVtvehide storage JC t+ Curtain drain 50'+ ,Q Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION O a`A\\`, ��......4q �) I certify that I have determined through field inspections and �Q • ' S',f �t review of Municipal records that the above systems are in i oj.•' conformance with MOA COSA guidelines in effect on this date. j Engineer's. Printed Name LABS 5FAMKLAND rr PURKLAND j/ Date COSA Fee $ Waiver Fee $ _ Date of Payment �!a 3 �a Date of Payment Receipt Number M3 B3 Receipt Number (Rev. 4/10) AAROW PUMP & WER SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 No. 902 Office: (907) 346-9355 • Fax (907) 333-8976 Eagle River: (907) 622-9335 / CUSTOMER /) JOB SITE 1V INVOICE DATE BELL DEPTH e SWL CHL091NATED PUPdP DEPTH SALESPFaSON QUA TITY DESCRIPTION PRICE AMOUNT �f<� _rte _�'T_ , LABOR HOURS RATE AMOUNT TOTAL MATERIAL f TOTAL LABOR WORK ORDERED BY DATE COMP. TOTAL I LABOR PAY THIS AMOUNT '- X) Thank You SIGNATURE (1 Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed &.labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.51% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. PRaPpgQ RVVQD {Leal eLv. (AeaAee) ---------------------------------- O'MALLEY ROAD NBB'SB'OOYV RB.Oa M�D .uvula - IABa.ELDT Mee waffiCT mar B1eaMe 1df SCE e0L1w18 sereAac PEM B.eaYN wnM 462,9 8 9 8 z so $ 3 8 WE0 LL MW 009' W WE a WOODMONT DRIVE M ------------------------------------ UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Ll LOT WR4 SURVEY TYPE SYMBOLS ❑ F0UNI)A70N AS -BOLT ❑ FINAL S UGMRE AS-BWLT SET REBAR r= ;w DRAINAGE 0 ASPHALT [3IL... Aa-BwLT ... Lor ... TaPOOR o FOUND REBAR 8 86 OD '..e... CONCRETE WO FENCE 11 AS -MILT LTT ... NO T 7QICA AS -BV T ... NO T RECER L 00 ASSUMED ELEV. 4t--- ® H X METAL FENCE WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION •&*"16 OF , Prepared by Robert E. Johns, Jr. & Assoc. PLOT PLAN •.••-�E •�_P;.•"•....••• 1� Professional Land Surveyors Naw^ > aleel4ar + a a Nt •sl.ws •���� �! vl , 1700 Brink DHre. a mT .n Imwrr. as a ern.Iwaw nuo e. AN „ ANCHORAGE, ALASKA 99504 „ _ Rea. Lot S.F. Rac. Plot File No. 1O"�i°' p1tl 4O°`LMehScale: •: FOUNDATION AS -BUILT AV •••, •••••• ••. ,. 1 6�' L e E .Itlwe r. IIraT "n'l root I "' a ,•'OBERT,•• •• I.....• Date $alre Surveyed: 7/11/12 Drawn by. Checkedb�MK nwwn m eu. CIL a.a rose a ew ••J �• •: H � Date Drawn: Grid: W.O. • P % a' •� ''•, —S 7/11/12 2638 12-251 FINAL STRUCTURE AS -BUILT Bare E AYn., r. Nwar uoe I @ ,.•• >oj� �. d^ ••••... Legal Description: L nwlel' wase.. m eBr M as aet a ro. `„" ..,, .•.•• ypa•1 �•f0 Lot 2 BLOCK 1 enwlw;,,. pro r...,.,.....`a� ••• /�._ each, �•• OnI I rU 1 AIICIAFrInM Lill 1 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 3/19/84 (a) Legal Description (include lot, block, subdivision, section, township, range) —Lot 2, Block .1, SOUTHLAKEWOOD HILLS SUB. ANCiIORACTs RE;COyi�T._�_D?�T,_ Location (address or directions) M��� O'Mal LAX-gg�,d. �;rnitYl�Riria, nn� n-1.nek T�..sL_.�if_Fis� (b) Applicants Applicants Name Charles & Dila Wood _ Telephone 345-5037 Applicants Addressl3200 Mt Place, Str- "A" Box 372 "Z" Anchorage 99516 (c) Applicant is (check one) lending Institution Owner./builder � s Buyer Other �_j (explain); Seller (d) Lending Institution Alaska Pacific D7tg Co Telephone 276-3110 Address 101 West Benson Blvd, P.O. Box 420, Anchorage, Ak 99510_A!� (e)I2 a1 Estate Co. &Agent CENTURY21 Jokin DiBene .CO. 201 East 56th St Address Anchorage, Ak 99502 Telephone _____L9071 563-3313 2. Type cf Residence Single -Family 5]� Multi -Family f:--} Number of BedrecxTs Three 3_)___- 3. Water Supple a Individual Well 51� Community other (cbscribe) Public Note: If cam unity c& - it system, must have written confirmation from the State DepartTent of Environmental Conservation attesting to the legality and status. Is the G11 adequate for the number of bedrooms specified in this HAA (Y/N) Y 4. Sewage Dis ,sal Or. site EizPublic F-1 Community Holding Tank Is the wastewater disposal system adequate for the number of bedroms, (YM) Y [Page 1 of 21 2--1.5-84 5. Enainee.rin,2 Firm Providing Inspections, Tbsts, Data and "nfcrmaticn I certify that I have checked, verified, or conformed to all m0A HAA Guidelines in effect on t% ' to of this T)ecticn. Date signed /'G7.Sc1 Telr hone 561-134_. Name of Firm Arctic Engineers. 11 Inc Address 3.506 West 36th Ave., Ste. 201,.��'''PPP`Y;�„a` a`a �i> i 4f•t�''Y� Signed by Thomas Regan k"ia ,.• '°°°'� Date 3-26-84 f=�a +s:.fasP. n ea em. (ENGINEER SEAL)gaQJf, ° Vim'°� G.DHEP Approval ,f Approved for X17 tedreo b � 1f�� j �'-z L� t=_��, Date d �Y Approved,DisaopLoved Conditional `� Terms of Conditional Approval The `Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the 4-astewater disposal system. This approval indicates that, as of tl ralidatior. date shown abcve, based on the data and information furnished by an engineer 'registered in the State of Alaska, the water supply and wastewater disposal system is safe and ']Unc- tional for the number of bedrooms and type of structure indicated. (D HEP SEAL) 7. Mail the MAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE (MOP.) MUNICIPALITY OF AXORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 MAR 2 H-1904 A. WELL DATA RECEIVED Well Classification Individual If A, B, or C, D.E.C. Approved(v/N) N/A Well Log Present (Y/N) N Date Completed 1971 Yield 7 qpm + Total Depth 122' Cased to 122' Depth of Grouting unknown Static Water Level 751 Pump Set At --- Casing Height Above Ground 1211+ Sanitary Seal on Casing (Y ) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N_ Separation Distances from Well: To Septic/Holding Tank on Lot -)'� 100' + On Adjoining Lots 100' + To Nearest Edge of Absorption Field on Lot 100'+ ; On Adjoining Lots 100'+ To Nearest Public Sewer Line N/A To Nearest Public Se:+pr Cleanout/Manhole N/A To Nearest Sewer Service Lire on Lot 25' +— Water Sample Collected By T. Regan ; Date 3-23`-84 -- Water Sample Test Results Satisfactory for Total Coliform —_ Comments B. SEPTIC/HOLDING TANK DATA Date Installed — 9-71 Size innn Noa of Compartments T Standpipes (Y/N) Y Air -tight Caps (Y/N) s _Foundation Cleanout (YM) N Depression over Tank (Y/N) N Date Last Pumped e 6-83 Pumping/Maintenance Contract on File (Y/N)N/A 9 for N/A Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water -Supply Well 1001 + To Building Foundation X41 To Property Line 5' + To Disposal Field 15' To Water Main/Service Line 101 + To Stream, Pond, Lake, or Major Drainage Course None noted Comments �,� � Leh e . c G.L.Ff u x rr�E�s,t (,tib v f4 t.� [Page 1 Of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 159 sq:ft./bed Type of System Design crib Date Installed 9-71 Length of Field 14' Width of Field 14' Depth of Field Gravel Bed Thickness 6' Square Feet of Absorption Area 336 Standpipes Present (YM) Y Depression over Field (YM) N Date of Last Adequacy Test 6-83 Results of Last Adequacy Test Adequate Separation Distance from Absorption Field: To Water -Supply rAbll 100' + To Property Line 35' To Building Foundation 30' + To Existing or Abandoned System on Loth/ A ; on Adjoining Lots 3a'+ To Water Main/Service Line 101+ To Cutbank(if present) none To Stream/Pond/Lake/or Major Drainage Course None noted To Driveway, Parking Area, or Vehicle Storage Area 10' + D. LIFT STATION N/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical CodLs(Y/N) Diirensions Manhole/Access (YM) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed� Date 3-26-84 Company Arctic Engineers, enc. MOA No. 5184-001 KB1/d5/s [Page 2 of 21 �2 Time APPLIC O NT FILLS OUT UPPER HAL" 0NLY Prop-;rty Owner ( Phone /4.1. ' 1. L t .� c7 Mailing Address �_.� ...'".. - ,� Zip Code `1 el <'- Buyer Date Date Address - Zip Code Lending Institution ',t�- Phone y.�360 Inspector Address ! i- 1 Zip Code - Realty Co. & Agent - Phone Address Zip Code '� e`-�� U`azvl C`7dA Y 2 3 ," Legal D criptig¢.� lI��VV -- i-.. hl �C 6..- lti..>f>(� Street Location ( ) DISAPPROVEDq���,�,�./j�t�.-�ks�.(�_..ca� C✓�'g-a-(��l ' ( CONDITIONAL APPROVAL' DATE `�' Z"7'a' J� Type of Residence C�,Single Family 3 GA,+%yx , — ❑ Multiple Family No. of Bedrooms_ ❑ Other Well Log Received Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. P- Individual EI' Community \ , � For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility--' Sewer Disposal _ 0 Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �2 Time Time Time (� (� Time ^�d L1L7rC_1L V Date Date Date Date Inspector Inspector Inspector/' Inspector rf Q Field Notes: 7 71/'�'Q MUNICIPALITY OF ANCHORAGE 6 � � PEPT. OF Hr_P.LTH ° � C-�,U It'd �".� ENVIROaNCMLN fAL PROTECTION'PROTECTIONW '� e`-�� U`azvl C`7dA Y 2 3 ," RECEIVED ( LYQPPROVED BEDROOMS 'CONDITIONS OF APPROVAL r ( ) DISAPPROVEDq���,�,�./j�t�.-�ks�.(�_..ca� C✓�'g-a-(��l ' ( CONDITIONAL APPROVAL' DATE `�' Z"7'a' J� �c�'-�>D �--�!"! /�%i� .r✓�,.pa.Jp��C't'°GJ Soils Rating Date Sewer Installed Well To Absorption Area 'kms Well Log Received Septic Tank Size cot 9—/ 1 Well to Tank 7 72023131827